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Using CINAhl and pubmed to find nursing research articlesPlease turn on speakers for audio. Slides will advance automatically. Right click to pause or end.

A Presentation for Saint Louis University School of Nursing StudentsBy Mary Krieger, MLIS, RNMedical Center LibraryJune 9, 2011This powerpoint will show you how to develop a search and how to use online databases at SLU to find journal articles for your research papers and assignments.

1Difference between Google and a databaseGoogle (search engine)Searches billions of web pages not necessarily journal articlesNo quality control of contentDatabases at SLU (CINAHL, PubMed)Cover specialized health sciences subject areasSelective in journals that are included More effective and time saving for students

As you know, some students and health care professionals use Google or Medscape to find information for research projects because they are easy to use and familiar.

Google and other internet search engines are searching billions of web pages and the hits returned are not the peer-reviewed journal articles that your instructors require you to use for assignments. There is no quality control of the content with most internet search engines.

It is much more effective to use the CINAHL or PubMed databases which are available through the Medical Center Library at SLU. These databases are selective in the journals that they cover and you can link directly to the full text of the journal articles that you need. 2Which database to choose--CINAHL?Cumulative Index to Nursing and Allied Health Literature (CINAHL)Subscription only--not freeCovers English and non-English language journalsDates of most articles from 1981 to present

There are two key databases for nursing research. The acronym CINAHL stands for the Cumulative Index to Nursing and Allied Health Literature and this database covers nursing journals extensively.

CINAHL is not a free databasethe Medical Center Library pays an annual fee for students to use it.

CINAHL covers both English language and non-English journals so be sure to use the Limit for English.

The date range for most of the articles in CINAHL is from 1981 to the present. New articles are added continuously as they are published.

3Which database to choose--CINAHL?Contains nursing-related subject headingsCan limit a search to Research Articles and Peer Reviewed Journals Includes books, nursing dissertations, ANA and NLN publications, standards of practice, book chapters, and others

One of the biggest benefits of using CINAHL is that it contains a vast array of nursing-related subject terms that target the topics that nursing students are researching.

CINAHL has a simple, efficient way to limit your articles to research studies and to peer-reviewed journals which many instructors require for assignments.

In addition to journal articles, the CINAHL database has records for nursing dissertations, book chapters, ANA publications, and other types of literature.4

This slide shows the details included in the full record for a journal article in CINAHL. The article title is shown at the top. The affiliation field shows that these authors from the University of Virginia. The CINAHL record describes the publication type for an item: this is a journal article and it is a research article.

Each record in the CINAHL database also includes Subject Headings which are a standardized list of search terms which can be used to make searching more consistent and precise. Also, you will find that not all articles in databases have an abstract. If no abstract is present, the subject headings are a snapshot of the topics that are covered in the article and can help you decide if the article is relevant to your research. 5

CINAHL records also provide information on the peer review status of the journal in which the article is published. This article is published in a journal that is peer reviewed.6

For each record in the CINAHL database, you will also see the FIND IT@SLU icon which allows you to directly access the full text of the article if the library has this journal online. If the library does not carry this journal, the FIND IT@SLU icon will allow you to quickly request the article through our document delivery service. This service is free to students and you will receive an email when the article is available for you to download. Your articles will usually arrive within 24-48 hours of making the request.7

CINAHL link on MCL home pagehttp://www.slu.edu/libraries/hsc

You can access the CINAHL database from the Quick Links section of the Medical Center Library home page or from the Databases link which lists all of the health sciences databases which the library provides.8Which database to choose--PubMed/MEDLINE?Produced by the National Library of Medicine5,200 worldwide journals in 37 languages Includes over 20 million citations from 1940s to presentMainly peer reviewed biomedical journal articlesCan limit to nursing subset

The second database that is essential for nursing research is the PubMed/MEDLINE database.

This is the premier biomedical database produced by the National Library of Medicine. PubMed/MEDLINE is a much larger database than CINAHL and it has a broader coverage of medicine and science research. Most of the journals covered by PubMed are peer reviewed but PubMed does not have the limits that CINAHL has for Research and Peer Reviewed articles.

PubMed does has a limit for a Nursing Journal subset which can be useful if your instructor has specified that your articles must come from nursing journals.9What is the difference between PubMed and MEDLINE?PubMed is the free version of MEDLINELibrary also subscribes to Ovid MEDLINESearch interface looks different and searches differentlyDatabase is the same/citations sameYour preference--choose one and become familiar

Students often ask if there is a difference between PubMed and other versions of MEDLINE that they may have used in the past.

PubMed is the free version of MEDLINE and it is available to all health care professionals worldwide. PubMed could also be considered the authoritative version of MEDLINE since it comes directly from the National Library of Medicine. The library also subscribes to the Ovid version of MEDLINE which you may wish to use if you are more familiar with that interface.

The citations or records in either version of the database are the same even though the search interface looks different. Some students find PubMed easier to use, but it is a matter of personal preference and generally it is best to become familiar with one interface and use that one consistently. 10PubMed link on MCL home page

http://www.slu.edu/libraries/hsc

There is a link to PubMed under the Quick Links on the Medical Center Library home page and it can also be found using the Databases list.

Be sure to use the PubMed link through the library and not the general publics link on the National Library of Medicine (NLM) web pages. The library link will display the FIND IT@SLU icon on articles in PubMed and the public view from NLM does not. 11

PubMed contains many articles from non-English language journals so be sure to limit your search to English language articles as shown on the limits page. The check box for nursing journals is also shown in this slide.

Like CINAHL, PubMed does allow you to limit your results to certain types of articles, e.g. clinical trials, randomized controlled trials, and many others. PubMed and CINAHL both have age group limits for different populations and for dates of publication.12Setting up your search

This next section will provide some suggestions for developing a good search strategy and selecting terms to use in a search.13Write out your questionIn patients with central venous catheters, are gauze dressings or transparent dressings more effective in preventing infection?Identify the important conceptsCentral venous cathetersGauze dressingsTransparent dressingsPrevent infection (use only if result set too large)

The first tip is to write out your question and underline the concepts that you think are most important. The most effective way to search databases is to choose a few key concepts and enter those as search terms, rather than typing in long sentences or phrases. Using unnecessary words in a search is usually the reason that searchers find very few or no articles on their topic.

In the example shown we are searching for articles that discuss gauze dressings versus transparent dressings for preventing infection at central venous catheter insertion sites. The key concepts for this search would be: central venous catheters, gauze dressings, transparent dressings, and we could add in the concept of infection if the retrieval turned out to be large. And to further increase our chances of finding relevant articles, we can leave out the word dressings because this is implied with the terms gauze and transparent. Generally, the more words you type into a search, the smaller the results will get. We also dont need the words preventing, effective, or patients because these are implied by the question. 14Connecting search concepts in databases3 search concepts: central venous catheters, gauze, transparentUse the Boolean operators (connectors) AND--will retrieve database records that contain all concepts in the samerecord. OR--will retrieve database records that contain any of the terms; use to connect synonymsNOT--will exclude database records with a specific term; use cautiously

We now have three important concepts: central venous catheters, gauze, and transparent. The next step is to combine them with the Boolean operators or connectors that the CINAHL and PubMed databases will recognize.

Connecting terms/concepts with ANDConnecting terms/concepts with ORConnecting terms/concepts with NOT

The reason that the operators AND, OR, NOT are capitalized in this slide is because Boolean operators must be capitalized when using PubMed. When you connect search terms with the Boolean operator AND, it does not matter which order in which the terms are entered. They are processed equally in the database.

15Entering the search in PubMed

This slide shows how the terms could be entered in PubMed connected by AND. The arrow indicates the link used to limit the results to English language articles. Sixteen articles were found in PubMed that contain all three search terms.

Please be aware that in PubMed and CINAHL, the order of the search results is not relevancy ranked as results are in Google. In other words, the most relevant articles are not necessarily displayed at the top. Database search results are displayed in reverse chronological order by publication date, with the most recently published articles appearing at the top. So just because you dont find a good article on the first page of results, it does not necessarily mean that you need to change your search. Look through several pages of results before giving up--your perfect article could be on the second or third page. 16

This slide shows the full record for this article in PubMed. Your search terms are highlighted in red in the record.Notice that the FIND IT@SLU icon appears on every citation in PubMed and can be used to get the full article.One additional thing to know about PubMed and CINAHL--with these databases you are not searching the full text of the article. You are searching the record in the database which consists of the fields you see in the slide, primarily the article title, abstract, subject headings (called MeSH terms in PubMed), and includes a few other fields like the affiliation. One final tip, PubMed records contain a Related Citations list and this feature works really well to display additional articles that you might find relevant for your research. So be sure to check this out and this list IS relevancy ranked. 17

This slide shows the same search for central venous catheter dressings performed in the CINAHL database. Notice that CINAHL has individual search boxes where terms can be entered and the default Boolean operator is AND unless you change it using the drop down menu. Additional search boxes can be added if needed by using the Add Row link.

In this search, I have checked the limits for English language, Research Article, and Peer Reviewed, but that is optional depending upon your assignment. A date range can also be specified. 18Selecting search termsKeyword vs. Subject Headings

These next slides will briefly discuss two different types of term searching in PubMed and CINAHL.19Two ways to search PubMed/CINAHLKeyword search--also called natural language

Subject Heading search

In both databases, you can search for articles by keyword searching (also called natural language searching) which is what you use in a Google search and you can search by subject headings.20Keyword searchingSearches for an exact character string

Need to use synonyms for a conceptSide rails, bed railsOlder adults, elderly, aged, geriatric

Consider singular and plural forms of words Child, children

In keyword searching, the database searches for the exact character string that is entered in the search box. The database searches for that character string in the title, abstract, and subject heading positions in the records. The examples in the previous slides of PubMed and CINAHL searches for central venous catheter dressings were keyword searches we simply entered in the terms and they were searched in the title, abstract, and subject heading fields.

There are a few things to remember when you perform a keyword search.

21Keyword searchingFormatting of words, e.g. needle stick (190 hits in CINAHL), needlestick (2,800 hits in CINAHL)

Variant spelling, e.g. behavior, behaviour

Two meanings for a word, e.g. walkers, AIDS

Keyword searching is fine if you remember these caveats

Keyword technique--Truncation or StemmingRetrieves a word with various endings:Asterisk symbol * in most databasesIn PubMed--hospital*In CINAHL--hospital*Retrieves articles with any of these words: hospital, hospitals, hospitalized, hospitalization

There are a few techniques you can use with keyword searches in most databases.

Truncation is a way to expand the results you get in a search without typing in every single term. The truncation symbol for the CINAHL and PubMed databases is the asterisk.23Keyword technique--Phrase SearchingMany web sites and databases allow quotation marks for exact phrase searching, e.g. white coat hypertension

If you are searching for an exact phrase such as white coat hypertension and only want to get articles that contain that exact phrase, you can use double quotes around the phrase. This technique applies to most databases and internet search engines.24Subject heading searchPubMed & CINAHL have a master list of terms called subject headings (MeSH in PubMed)

One subject heading is chosen to represent a concept

Example: Decubitus ulcer, pressure sore, bedsorePressure ulcer--subject heading in PubMed and CINAHL

Subject heading searchSearches only the subject heading field, not title and abstract

Pulls all records with the same subject heading--spend less time thinking of synonyms

Subject headings in PubMed and CINAHL vary slightly--CINAHL has more nursing-focused terms

Each record in the database is assigned subject headings and when you use this search mode, you will only be searching the Subject Heading field of the record, not words in the title and abstract.

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In the record for this article, notice that the author used the term pressure sore in the title and abstract. The indexers for the database entered the CINAHL subject heading Pressure Ulcer to the record. If you did a keyword search and entered the term decubitus ulcer you would miss this article.

But if you used the Subject Heading search mode and entered Pressure Ulcer, or if you searched for pressure ulcer as a keyword, you would find this article. 27

If you want to find the preferred term or subject heading in CINAHL, you can click on the CINAHL Headings link at the top of the page. In this slide, I typed in: pressure sore.Notice that this screen shows that for Pressure Sore, the preferred subject heading is Pressure Ulcer. It also shows that for Decubitus Ulcer, the preferred subject heading is Pressure Ulcer.To perform a search using the subject heading Pressure Ulcer, you can check the box and then click on the Search Database button. Now instead of a keyword search, you would be searching the subject heading field ONLY using the heading Pressure Ulcer. The Subject Heading search mode is an effective way to search for concepts that have many different names or it can be used if a keyword search comes up with a large number of results that arent related to your intended meaning.28

To find medical subject headings (MeSH) in the PubMed database, click on the MeSH Database link on the opening PubMed page.29

In this example, I typed pressure sore into the MeSH Database search box, and it displayed the subject heading Pressure Ulcer. To search PubMed using this heading, click on the Add to search builder button and then the Search PubMed button.

In both PubMed and CINAHL, you could also choose Subheadings which focus the search on specific aspects related to the subject heading. To find articles about nursing care or prevention and control of pressure ulcers, one or more of these boxes can be selected. Adding subheadings will cause you to retrieve FEWER articles that you would if you did not use the individual subheadings.30Summary of keyword vs. subject headingKeyword Search--will retrieverecords with an exact matchinthe title, abstract,or subject heading fields.Pros: Retrieves more results, easy to use (like Google searching)Cons: Less precise, more irrelevant hits, you must think of synonyms

So to summarize31Summary of keyword vs. subject headingSubject Heading Search--willretrieve all articles indexed in the database with that subject headingPros: More precise, less irrelevant hits, you don't need to use synonymsCons: Must use themaster list to find subject headings, subject heading may not exist, indexing is imperfect

Selecting articles for your research paper

Pitfalls to avoidLetters, commentaries, news items, and poster abstracts are usually NOT acceptable as sources for your papersAvoid articles in consumer health journals and trade publicationsTry to find research that is conducted in a country and with a population similar to your practice area

EXCELLENT!!Is Cameroon similar to U.S. population?

Non-EnglishPoster abstract--note one page length

Consumer health journal--probably not acceptable

None of these would be acceptable sources

Additional ResourcesNursing Research Guide http://libguides.slu.edu/nursingA web guide on how to use SLUs online journals, books and databases for your research SLU School of Nursing Library Online (Tutorials) http://nursing.slu.edu/online/library1.htmlMedical Center Library home page http://www.slu.edu/libraries/hsc/

Additional ResourcesYou may always contact the Nursing Liaison Librarian for assistance with difficult search topics:Mary Krieger, MLIS, RNOffice: 314.977.8810 Email: kriegerm@slu.edu

Permission has been granted by EBSCO Publishing to use screen shots from the EBSCOhost database for educational purposes only.