1. McGrath, Jacqueline M. PhD, RN, FNAP, FAAN
  2. Brandon, Debra PhD, RN, CCNS, FAAN

Article Content

The amount of literature one must sift through to be well informed is overwhelming to even the most seasoned of writers. However, to really understand the issues surrounding care in the high-risk environment of the neonatal intensive care unit (NICU), one must have a sense of the scope and quality of the information available for our decision making. "How does one keep abreast of literature and research that we should use to guide our practice when we are all so busy providing the care?" This is a common struggle we hear all the time. Most everyone complains that there is no time to search the literature, let alone read it all. As evidence-based practice becomes more routinely integrated into care, systematically searching the literature is essential to making informed clinical decisions even if one does not intend to write a manuscript for publication. To uncover the evidence and get the most unbiased sense of what is already known about a particular caregiving intervention or strategy requires a defined literature searching method. Why we choose to provide the care we deliver is important. Therefore, we should not make caregiving decisions based on what we have "always done" but rather on what is the best strategy that will lead to the best outcomes.


When there is now so much literature to search and so many databases to search in, "where should I start?" and "how do I get a quick answer?" are questions we hear often. Searching the literature today is definitely not for the faint of heart, but it can be simplified with a few targeted strategies. In 2012, McGrath et al1 published an article about best searching practices. We will quickly outline several steps here but also ask you to refer to that article for more details about the process (see Table).

TABLE. Five Systemat... - Click to enlarge in new windowTABLE. Five Systematic Steps to Refine the Search Process

Searching the literature begins with asking a discrete question. Searching also takes time but with a little forethought and planning it does get easier. If your search question is too broad or vague, the search will not yield the answers you are looking to find. The "PICOT" question has been used to guide much of evidence-based practice.2 PICOT is an acronym that outlines a strategy for designing the question to guide your search with P = population of interest; I = intervention or caregiving practice of concern; C = the comparison caregiving practice (eg, receiving surfactant vs not receiving surfactant); O = desired outcome, and T = time (eg, in the newborn period). Using this formula for designing your question before you search will make the searching process more streamlined.


Once you have your question, you need to consider which library databases to use for your search. The choice will depend on the search question but for most clinically related search questions it will be essential to include PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) and a few others. Sometimes beginning with a "keyword" search in PubMed will help you uncover the best "keywords" and MESH terms to use but you cannot stop there-"keyword" searches are very limited.3 If individuals use a different word or term to denote the same concept, an individual "keyword" search will not retrieve the same articles because keyword searches only hunt for exact matches of the words you type into the search window. MESH terms are root terms used in PubMed and CINHAL (subject headings) to link similar concepts together so that better searching occurs.3-5 MESH terms are more comprehensive because the root terms will connect all the different terms together within the database. Using MESH terms and subject headings will provide you the best way to define and refine your search strategy.4-6


As you complete your search, it is important to evaluate your results along the way. Constant appraisal of your literature search will allow you to understand whether you need to increase or broaden the focus of your question. Evaluate and refine your search until you are able to answer your question. Your literature search could yield very little evidence; however, before you make clinical decisions4-6 on limited evidence, consult a medical librarian. We include librarians in our work on a regular basis, because they understand how databases work and are more skilled at how best to complete a comprehensive search.1,4-6 As the number of published articles and journals continues to grow, it is more important to know how and when to work with a librarian. Your time with the librarian will be most informative if you go with a well-formulated question and a potential list of search terms. More detailed tips about working with a librarian are provided in the article by McGrath et al.1 Some librarians now have created forms to help you prepare for your search and to think systematically about the searching process.1


We will end by briefly discussing reference management software. For those who write on a regular basis about or around the same topic, using referencing software can be very beneficial. Referencing software creates a database of the references you retrieve from the library that you can then use to write your manuscript. An advantage of using the software is that the references can easily be added in your manuscript text and the reference list can be created through the software at the end of the manuscript. However, there are also some disadvantages. Not all journals use the same formula for developing the reference to be downloaded into your software, so you may still need to make corrections in your reference list or add missing data to your database. Thus, even with referencing software, you will need to spend some time cleaning up the references, and it is best to do this in within the reference entries so you will preserve the changes for later use. For example, you may need to make sure that the titles of the journals are abbreviated appropriately or typed out in full, depending on the manuscript style of the journal where you are planning to publish the article. For Advances in Neonatal Care, we use the American Medical Association (AMA) manuscript style, which means the journal titles will all be abbreviated. However, many nursing schools and other journals use American Psychological Association (APA) manuscript style in which the journal titles are fully spelled out. To manage referencing issues, many medical libraries now have the RefWorks software (RefWorks, Bethesda, Maryland) available to users for free.7RefWorks has improved significantly over the past few years and is great for writers who are developing a single manuscript. The software is usually available through the library and easily articulates with the databases.7 One disadvantage of this software is that the database is not a file you can save yourself on your computer for later use in another referencing management system. You can save your database of references within the RefWorks online system through the library, but you cannot personally own the software. As such, your reference files are only stored within their online system so the work you do putting your files together is not easily transferrable.


For those authors who are planning to write and publish on a regular basis, we suggest using either EndNote or Reference Manager.8,9 These 2 reference managing software systems are fairly comparable and thus, we will not recommend one over the other (interestingly, both are associated with the Thompson Corporation). Individuals who write with some frequency become comfortable with one of these managing software systems and over time build their personal reference databases in one of these 2 systems. Each software package can read the other's files so if you decide to switch software you can move your reference lists into the other software system at a later time. The reference files stored within this software become a database or repository of references. References can easily be downloaded directly from the library databases. Files can also be attached within the database, such as the PDF of the article or a table or picture. The ability to sort, search, and continue to refine the references stored is an advantage of these systems. As researchers who publish regularly, we cannot imagine functioning without these databases because for us they simplify the writing process. However, there is a time and cost (unless your institution provides for free) investment involved in the use of these systems; therefore, we would not recommend quickly making the investment. Try RefWorks first; it is typically free in medical libraries to registered users. See how the software works for you and as you become a more prolific writer or researcher invest in a reference managing system. You may also want to consider the software system your writing team is already using so you are all working together in the same environment.


Searching is not for the faint of heart and does take time but the time investment will make the work you do more meaningful. No search is easy; therefore, we end with an old adage, "Garbage in Garbage out." Investing your time in searching just makes sense for good decision-making in the clinical setting.




1. McGrath JM, Brown RE, (Abou) Samra H. Before you search the literature: how to prepare and get the most out of citation databases. Newborn Infant Nurs Rev. 2012;12(3):162-170. [Context Link]


2. Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. [Context Link]


3. National Library of Medicine. Medical Subject Headings (MESH) Fact Sheet. Accessed May 18, 2014. [Context Link]


4. Thomas BH, Ciliska D, Dobbins M, Micucci S. A process of systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs. 2004;3:176-184. [Context Link]


5. Doig GS, Simpson F. Efficient literature searching: a core skill for the practice of evidence-based medicine. Intens Care Med. 2003;29:2119-2127. [Context Link]


6. McCabe TF. How to conduct an effective literature search. Nurs Stand. 2005;20(11):41-47. [Context Link]


7. RefWorks. Published 2009. Accessed May 18, 2014. [Context Link]


8. EndNote. Thomson Reuters. Published 2014. Accessed May 18, 2014. [Context Link]


9. Reference Manager. Thomson Corporation. Published 2014. Accessed May 18, 2014. [Context Link]