Searching the Literature: A Guide for Nurses

The following steps will serve as a guide while you search the literature. REMEMBER: The research process is iterative and you will likely need to revisit certain steps throughout the search process.

Determine the type of information you need.

The investigation process begins with determining the type of information needed in order to answer your research question or topic. The questions that arise are typically divided into Background or Foreground questions.

Background questions

Ask for general knowledge of disease processes or clinical contexts; they ask "who, what, when, why, where or how" about a single disease, drug, intervention or concept. Secondary sources such as textbooks, nursing reference sources and review articles can provide relevant and reliable answers quickly.

Examples:

What are COX-2 inhibitors?

What causes depression?

When do complications of appendicitis usually occur?

What is temporal arteritis?

How is Type II Diabetes managed?

**The best resources to answer them are: Books & textbooks, clinical practice guidelines, clinical EBM resources

Foreground questions

Ask for specific knowledge one can apply to a specific patient or problem. They often compare two things: two drugs or treatments, the prognosis of two groups, two diagnostic tests, or the harms or benefits of two approaches. They require primary sources that synthesize a wide range of knowledge, and usually call for evidence-based answers.

Examples:

What are the effects of prolonged bed rest on patients with severe scoliosis after lumbar surgery?

Are mobile devices an effective tool to manage workflow in an emergency department?

What are the determinants of transitions to palliative care in acute care patients under the age of 35?

**The best resources to answer them are: Databases

Foreground questions will require you to comprehensively search the literature. To do so, you will need to develop a search strategy using the PICOT model. See Step 2.

 

At UTC, DNP students formulate research questions based upon the PICOT format. This method is used to aid you in identifying concept areas on which to focus during your search.

What is PICOT?

PICOT is a tool for distilling the essential components of a research topic into concepts. Finding relevant medical information is often easier if you break down your research topic by developing a PICOT question. PICOT is an acronym for:

Patient / Population / Problem

How would you describe this group of patients similar to yours? What are the most important characteristics of the patient(s)? What sorts of participants, from where, with what features?

Issue / Intervention

Which is the main prognostic factor, intervention, treatment, or exposure you are considering? What do you want to do for the patient? What other factors can influence the prognosis?

Comparison

What is the main alternative to compare with the intervention? At times your question may not have a comparison!

Outcome

What are you aiming to accomplish, measure, improve, make an impact on? Are you trying to eliminate or relieve symptoms? Reduce the number or severity of adverse effects? Improve functions?

Time

What is the duration or timeframe that you are looking to examine?

EXAMPLE PICOT:

Does hand washing (I), compared to not washing hands (C), among healthcare workers (P) reduce hospital acquired infections (O) over the course of a summer (T)?

Overview

It's likely that you will have to use synonyms to ensure that you have thoroughly explored the research on your question. At this stage, you will brainstorm synonyms, but the databases also give you good suggestions for alternate terms to use.

Natural Language vs. Database Language

Oftentimes, we employ commonly used words in our searches. Below is a chart representing just a few common medical terms and their corresponding "technical" terms. Look for those technical terms when searching databases & employ them in your Google searches too!

TIP:

You can locate the "database language" in PubMed by searching your term in MeSH (it's a dropdown selection on the PubMed search bar) or by searching the CINAHL Headings in CINAHL (available on the blue bar at the top of each page.)

Natural Language vs. Database Language
Natural Language Database Language
Heart attack Myocardial infarction
Swelling Edema
Bruise Contusion
ACL Anterior Cruciate Ligament
Shingles Herpes zoster

Similar concepts (terms with similar meaning)

  • Hypertension
  • High blood pressure

Alternate spellings or acronyms:

  • ACL or anterior cruciate ligament
  • Leukemia or Leukaemia
  • Handwashing or Hand washing

Umbrella terms & specific names:

  • Sexually transmitted diseases
  • Syphilis, gonorrhea, herpes, chlamydia, etc.

Tips for finding synonyms

  1. The Internet: Is your search term or concept called anything else? Look it up in an encyclopedia to find out. For example, in the Wikipedia entry for "hypertension", the synonym high blood pressure is quickly identified in the opening sentence. This is true for most Wikipedia entries for scientific and medical terminology. It is Wikipedia, so exercise caution when using this as a background reading source.
  2. Other background sources: You can also easily find synonyms in other background sources, including your lecture notes, as well as textbooks and print encyclopedias (yes! they still exist!) which you can find via the library catalog.
    1. Background sources can also help you find umbrella terms and specific terms, as well as provide you with the kind of contextual information on a topic that always comes in handy when you're searching!
  3. Use database subject headings: CINAHL is great for finding subject headings. If you run a search and find a good article, look at the subject terms listed by the database. Use those terms in subsequent searches.

Search Operators (AND, OR, & NOT)

These operators can be used in Library databases, but also work really well in Google!

Operator Purpose Example Search Visualization
OR

Expands the search.

Used to string synonyms together.

Results include all articles with any of the terms used.

Hand washing

OR

Hand Hygiene

(all results including the words "hand washing" as well as all results including the words "hand hygiene")

venn diagram - union of two sets with search terms 'hand washing' and 'hand hygiene'
AND

Narrows the search.

All retrieved results must include all terms connected with AND.

AND usually combines different concepts together in one search.

Hospital infection

AND

Antibiotic

(only results that include both the terms "hospital infection" and "antibiotic")

venn diagram - intersection of two sets with search terms 'hospital infection' and 'antibiotic'
NOT

Excludes results with a specific term.

Really handy to eliminate unwanted search results.

Antibiotic

NOT

Penicillin

(all results with the term "antibiotic", but excluding those with the term "penicillin")

venn diagram - relative compliment of terms 'antibiotic' not 'penicillin'

Wildcards

A wildcard is a character that can be substituted for one or more characters in a search term. These work in most databases & also in Google.

Common wildcards include:

Asterisk—can be used for any number of characters, but is most often used with a root word.

Example: Using the term microb* will search for all possible endings of that word, including microbe, microbial, microbiotic, microbiology, etc.

Question Mark—can be used to represent a character that is missing. It is most often used to retrieve all word variants.

Example: Searching for colo?r will return results with color and colour.

Phrase Searching

Use quotation marks to search for phrases. Phrase searching is excellent when the desired result is specificity.

Example: Searching for "nosocomial infections" will retrieve results where both terms are used together in the specified order.

CAUTION! Do NOT use phrase searching in PubMed! It turns off Automatic Term Mapping. Just don't do it!

Google Site Searching

Google site searching can help search across various government websites or can help you better search poorly indexed websites. Site searches should be typed into the browser search bar (where the web address is located). Some browsers will

Site Searching by URL

  • site:URL plus search terms

Example: site:cdc.gov influenza will retrieve results from only the CDC's website that are related to influenza.

Site Searching by Domain

Example: site:.gov influenza will retrieve results from all websites ending in .gov with the term influenza.

Mining Reference Lists

When you find a great article, look at its list of references (bibliography) for more relevant articles. If the article you found is perfect for your research, it is likely that it cited many other articles that will also be important to your research.

When you find an article in a reference list that you would like to locate, just copy the title and paste it into the Library's search box. If you cannot locate the article this way, try pasting it into Google Scholar. (REMEMBER: Only use Google Scholar through the Library's website. Click on "Databases" on the search box to locate Google Scholar.)

Research is like building a house: you are going to need more than 1 tool to do the job right. In addition to the usual health sciences databases, consider other disciplines that might be interested in your area of research and survey them as well. For instance, many of your PICOT questions will have elements of interest to the field of Psychology. Be sure to check Psychology databases too.

Health Science Databases

CINAHL

Comprehensive database for nursing and allied health professionals. Includes more than 50 nursing specialties such as speech language pathology, nutrition, and general health and medicine.

PubMed

National Library of Medicine index of medical, healthcare, and biotechnology sources. (See Step 7 for tutorials to help you with learning to use PubMed.)

PubMed tip sheet from DNP Orientation (pdf)

Cochrane Library

A very small, but powerful database of evidence-based reviews.

UpToDate

Access answers to clinical questions and recommendations for diagnosis and treatment.

OVID Journals

Over 90 journals in nursing and allied health.

Clinical Trials

Database of publicly and privately supported clinical studies of human participants worldwide.

Health Reference Center Academic

Nursing and allied health journals, magazines, newsletters, select consumer health sources, and video demonstrations.

SPORTDiscus

Covers biomechanics, exercise, kinesiology, movement science, nutrition, occupational health and therapy, physical fitness, physical therapy, rehabilitation, sports and exercise psychology, coaching and education, and sports medicine.

Multidisciplinary Databases

Web of Science

Includes Science, Social Science, and Arts and Humanities Citation Indexes from 1988-present. NOTE: Web of Science also indexes Medline, the primary component of PubMed! So if you are struggling with PubMed, give Web of Science a try as it is much easier to search and navigate.

PLOS (Open Access)

Open access journals in biology, medicine, and more.

General Science Full Text

Covers astronomy, biology, botany, chemistry, conservation, environment, genetics, physics, physiology, zoology, and more. Definitely not your best bet, but does include some microbiology and medical research.

Nature Publishing Group

Over 60 science and medical journals including Nature (1869-current) and Scientific American (1845-current).

Google Scholar

Search for scholarly books and articles. Be sure to always go through the Library's website to get to Google Scholar. By doing so, you will be connected to the articles that we subscribe to.

Other Useful Databases

PsychINFO

APA psychology journals and other related sources. It is highly likely that you will need to use PsychINFO and it runs on the same platform at CINAHL so you will already be familiar with the interface!

ABI/INFORM

Business information, including accounting, management, and marketing. This database can come in handy when looking at hospital and practice administration.

In steps 1-5, you learned how to identify searchable components within a question, brainstorm synonyms, how to use a variety of search tips, and which databases are available and best for health science research.

It is now time to construct your search strategy. You may choose to organize your thoughts into a chart, as shown below using a modified version of our question from Step 2 as an example:

Does hand washing (I) among healthcare workers (P) reduce hospital acquired infections (O)? (No handwashing is the (C) and there is no (T) for this question, but you get the idea.)

Synonyms for Concept #1 (I) Hand washing OR Handwashing OR Hand hygiene OR Hand disinfection
AND
Synonyms for Concept #2 (O) Hospital acquired infections OR Cross infection OR Nosocomial infections OR Healthcare associated infections
AND
Synonyms for Concept #3 (P) Healthcare workers OR Health personnel OR Healthcare provider OR Health professional

 

The idea here is to combine synonyms and concepts in different ways for multiple searches. Example search strategies:

  • (Hand washing OR Handwashing OR hand hygiene) AND (nosocomial infections OR cross infection) AND (Health personnel OR Healthcare workers)
  • (Hand washing OR Handwashing) AND (nosocomial infections OR cross infection)
  • Pretty much any way you can think of to combine your terms is a good idea!

TIPS

  • If you find that you are not getting many results with a complex strategy, eliminate terms.
  • Also, it is often a good idea to search concepts individually, paired, and with multiples. For instance, there may be important, relevant information about hand hygiene and nosocomial infections that does not include healthcare workers. Conversely, there may be information about how healthcare workers perform hand hygiene that does not include discussion of nosocomial infections.
  • You can write your search strategy into a single search box or just use the tools provided. For instance, in CINAHL you can place search terms within boxes and choose which operators you want to use (see screenshot below).CINAHL advanced search with operators
  • It's also a good idea to keep a chart of the search strategies you have used, where you used them, and the results. (This is often called a matrix.)
  • Refer back to Step 4 for other ways to modify your search when necessary.

Choose your databases, employ your many awesome search strategies, and keep a matrix of your searches! The following tutorials can be helpful if you need a refresher on any of our databases or catalog or how to find full text in the databases:

Library Website Quick Guide

Watch this for a super quick introduction to using the Library's website/search box

CINAHL

PubMed

PubMed is one of the more challenging databases that we own, in terms of searching. I highly recommended that you peruse some of the suggested materials below.

PubMed Quick Start Guide

http://www.ncbi.nlm.nih.gov/books/NBK3827/#pubmedhelp.PubMed_Quick_Start

I recommend that you start with "How do I search PubMed?" video at the top of this section. If you are interested in others in the list, fine, but the tutorial listed below will probably answer more of your questions.

PubMed Tutorial

http://www.nlm.nih.gov/bsd/disted/pubmedtutorial/cover.htmlThis tutorial is LONG. I recommend the "Overview", "Building the Search" and "Managing the Results" sections. These really will help you improve your searching in this database, but don't burn out too fast!

Chapel's Top 5 PubMed Tips (pdf)

  1. Use the Advanced search to build a better search.
  2. Use the "Article Types" feature to get the best levels of evidence.
  3. Sort results list by "Relevance" to help weed out those pesky false hits.
  4. Narrow publication dates for most health-related research
  5. Repeat after me: Thou shalt not use quotation marks in thy PubMed searches!
  6. And a Bonus! Create an NCBI account to save a record of your searches, save your filters, create a bibliography and more!

Web of Science

PsychINFO

This database covers the field of Psychology. It should prove useful to both Education & Nursing majors.

Google Scholar Search Tips

https://scholar.google.com/intl/en-US/scholar/help.html

Be sure to visit Google Scholar only through the Library's website while you are a student here (choose "Databases" on the search box and then "Google Scholar"). This will give you access to the things we subscribe to and a way to order things we don't have through InterLibrary Loan. Remember, you should never have to pay for an article while at UTC. When you are no longer at UTC however, Google Scholar will prove a useful tool for you to gather research—some of which is freely available.

Finding Full Text

http://www.utc.edu/library/help/tutorials/reseach-basics.php#collapseSix

After landing on this page, select "Finding the article" under "Research Basics"

The Library doesn't always have direct access to an item. You will often use our Get It@UTC button to locate full text for an article. This brief tutorial shows you how!

Special thanks to the University of Toronto Libraries for sharing content used in this guide.