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Research Guide for Masters and Doctoral Nursing Students

Resources, search strategies and research assistance for Nursing students enrolled in Masters and Doctoral programs.

Nursing literature reviews

In Nursing, literature reviews are conducted to investigate what has been published regarding an evidence-based research question that will help inform best practice for healthcare decisions, with the goal of improving patient care.

This page will help walk you through stages for getting started when developing an answerable evidence-based practice question and planning out what to search for and where to search when reviewing the literature to answer that question. You will be able to:

  1. Develop an evidence-based research question that addresses a clinical problem using PICO
  2. Build a search strategy for 2-3 concepts using Boolean operators (OR, AND, NOT)
  3. Find sources of evidence by selecting 2-3 databases that fit your research question and considering other sources of information, such as from professional nursing organizations 

These steps are fluid and acknowledge that as you become more familiar with the evidence on your topic of interest, you may revisit, revise and refine your research question, search strategy, and sources of evidence.

Adapted from the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals Question Development Tool - Appendix B. ©The Johns Hopkins Hospital/The Johns Hopkins University

Using the Johns Hopkins Nursing Question Development Tool Appendix B

The Johns Hopkins EBP Appendix B Question Development tool provides guidance with steps for developing an answerable and searchable research question. This page is designed to pair with the Appendix B so that you become comfortable with developing a Nursing literature search. Download the Appendix B and follow its steps as you work through the boxes on this page.

1) Develop your evidence-based research question

When developing an evidence-based research question, there are some key considerations to make. These considerations can be answered based on clinical practice observations you've made and preliminary literature searching. 

  1. What is the problem I am trying to solve?
  2. What are data and sources of information that validate that problem? What practice observations and safety/risk management concerns have I encountered? What do we not know?
  3. Why is my problem important and relevant? What consequences would there be if it were not addressed?

 

Once you've identified a clinical problem, determine whether you are trying to solve a background or foreground question. This will help determine the goal of your literature review and structure your research question.

Background: Establish the state of evidence of your topic (no comparison group); broad

  • Ex: What are common risk factors for developing hypertension?

Foreground: Compare specific interventions; narrow

  • Ex: In adults with hypertension, how does a low-sodium diet compared to standard care reduce blood pressure over six months?

In Nursing literature reviews, the PICO framework is used to formulate research questions and guide the search for evidence. 

P (population, problem) Characteristics of a population (age, gender, ethnicity, etc) within a specific condition (disease) or set of circumstances
I (intervention) Treatment, medication, education, diagnostic test, or care practice 
C (comparison) Alternate intervention or control group, if applicable 
O (outcome) indicators of successful intervention implementation (reduced rates, increased performance, etc.)

Once these elements are identified, we can build our research question. Note that background questions will not have a Comparison, whereas foreground questions will include both an Intervention and Comparison.

Background question example: What are the most common causes of pressure ulcers in immobile patients?

  • P: immobile patients
  • O: development of pressure ulcers

Foreground question example: For patients with chronic pain, does acupuncture compared to standard pain medication improve pain relief?

  • P: patients with chronic pain
  • I: acupuncture
  • C: standard pain medication
  • O: pain relief

2) Build a search strategy

Once you've identified your PICO question, identify 2-3 PICO elements to include in your literature search. 

  • Searching for background questions will generally include Population and Intervention.
  • Searching for foreground questions will generally include Population, Intervention and Comparison.
  • Because the Outcome (O) can often overly limit your results, it's best to evaluate your search results for the Outcome rather than include it in your search strategy unless you are wanting to limit studies to a specific outcome of interest. 
  • Searching for 4 or more concepts (P, I, C, O) might bog your search results down too much.

Next, brainstorm multiple keywords to use in a literature search for your concepts, as many researchers use various terminologies to describe the same concept (ex: critical care or intensive care). Consider:

Different phrasings nurse-led or nursing-led
Synonyms intensive care or critical care
Word plurals model or models
Acronyms clinical nurse specialist or CNS
Common vs. specific names high income countries or United States or Western Europe

Here is an example keyword log for the question: In post-operative patients (P), does early ambulation (I) decrease the incidence of post-operative complications (O)?

PICO Element Possible Search Terms
P post-operative patients post-operative or post-surgery or post-surgical
I early ambulation early ambulation or early mobilization or early walking or early movement
C N/A
O decreased incidence of post-operative complications N/A (evaluate the search results to see if/how complications are reduced)

 

Once you have determined keywords for 2-3 PICO concepts, we will use Boolean operators (OR, AND) to create search strings. 

  • OR connects synonyms and broadens our search: post-operative OR post-surgery OR post-surgical
  • AND connects different concepts and narrows our search: post-operative AND early ambulation

When you use both OR & AND, use parentheses () to group like concepts together within the parentheses using OR and separate the main concepts using AND. This works like order of operations in math and helps ensure the database reads your search string correctly.

(post-operative OR post-surgery OR post-surgical) AND (early ambulation or early mobilization or early walking or early movement)

Alternatively, you can use the Advanced Search in a database to input search strings for each concept in separate boxes. Here is a screenshot from CINAHL:

 

 

There are two additional search strategies we can use to refine our keywords:

Term How it's used What it does
Truncation * nurs* nurse, nursing, nurses,  . . . 
Phrase searching "_" "critical care" finds "critical care" as an exact phrase

Below is an example search strategy that uses truncation * and phrase searching "":

(post-operat* OR post-surg*) AND ("early ambulat*" OR "early mobilizat*" OR "early walk*" OR "early movement*")

A Subject Heading--also known as an Index Term, Subject Term, or a Controlled Vocabulary--is a descriptive word or phrase assigned to an article that allows other articles with similar focus to be classified accordingly and enables them to be found together, which is why they are particularly useful in Systematic Literature Searching.

While most articles have subject headings assigned to them, it is still important to mix searching with subject headings with freely generated keywords to get the best Search Recall.

Database Subject Heading(s) Field Tag(s) Explosion
PubMed MeSH [Mesh] (after) Automatic unless [MeSH:NoExp] is used
CINAHL (Ebsco) MeSH, CINAHL Subject Headings DE (before) + after broader term includes all specific terms
PsycINFO (Ebsco) APA Thesaurus of Psychological Index Terms MM (before) adds the specific terms individually with OR
SPORTDiscus (Ebsco) SPORTDiscus topical Thesaurus DE (before) adds the specific terms individually with OR
ERIC (Ebsco) ERIC Thesaurus DE (before) adds the specific terms individually with OR
Sociological Abstracts / Social Services Abstracts / GenderWatch (ProQuest) Thesaurus MAINSUBJECT(subject term) MAINSUBJECT.EXACT.EXPLODE(subject term)

 

Before searching the literature, establish inclusion and exclusion criteria to provide boundaries for your search.

For example, you may want to include student nurses but do not want to include post-licensure nurses.

Below are common factors to consider when determining what evidence to include or ignore:

  • Publication date (it's common to search between the past 5-15 years depending on your topic)
  • Population characteristics (age, race, etc.)
  • Setting (country, language, etc.)
  • Study type (randomized controlled trials, systematic reviews, etc.)

3) Find sources of evidence

For academic databases relevant to your research question, a good rule of thumb is to select at least two scientific databases, namely CINAHL and PubMed (or MEDLINE). If your research question intersects with other disciplines, also include a subject database from that discipline into your literature search. If you are conducting a more rigorous review type like a systematic review, explore three or more databases to ensure your search is comprehensive.

Best Bets:

If you're researching a mental health condition, also search:

If you're researching an education-related intervention, also search:

Use the library's Databases by Subject to find additional databases that may intersect with your research question.

For interdisciplinary research and citation metrics:

For systematic reviews and randomized control trials:

For sociology and social services research:

For kinesiology and fitness-related research:

In addition to peer-reviewed articles from scholarly databases, consider what other types of evidence should be reviewed for your research question. We call this grey literature, research and materials outside of peer-reviewed journal articles.

  • Standards (regulatory, professional, community)
  • Clinical Practice Guidelines
  • Organizational data (e.g., quality improvement or financial data, local clinical expertise, patient/family preferences)
  • Evidence-based professional organization position statements
  • Consensus studies (e.g., commissioned reports from the National Academy of Medicine, professional organizations, philanthropic foundations)