Nurse Prescriber, 1(10), Page 1 of 6, e32

© 2006 Cambridge University Press

ISSN 1467-1158
doi:10.1017/S1467115804001889
Archive January 2004

Focus On

Electronic database searching skills for nurse

prescribers

Peter Stokes BA Hons, BSc, MCLIP

Homerton School of Health Studies, Education Centre, Peterborough District Hospital, Thorpe Road,
Peterborough, PE3 6DA, UK

Summary The increased emphasis on evidence-based practice within healthcare has compelled nurses to
obtain up to date research information to assist them in clinical decision-making. Electronic databases are a
crucial resource for finding this information, but a successful search strategy is vital if relevant information is
not to be missed. This article highlights the key steps in the searching process with examples from three data-
bases on the OVID and Dialog Datastar platforms.

Keywords Computerized literature searching; Electronic databases; Information Retrieval; Nurse Prescribing;
Searching skills

Introduction
The need for research information in nurse education has changed with the introduction of Project 2000. Nursing
became a diploma/degree discipline with continuing education of trained nurses expected. This has meant that
nurses are now required to access research information for courses. This has implications for nurse lecturers
who must focus on their own development, as Kirk et al. note [1] ‘clearly research is now within the remit of all
nurse teachers.’
Within health care, the advent of clinical effectiveness is significant. Hamer and Collinson [2] state that: ‘the purpose
of the clinical effectiveness initiative is to ensure that decisions about clinical services and care are increasingly
driven by evidence of clinical and cost effectiveness, coupled with systematic review of the evidence on health
outcomes.’
This evidence is obtained through the identification and retrieval of research information, and its use defined
as evidence-based health care. As Muir Gray [3] states ‘clinical decision-making is now based on information
derived from research to a much greater degree than it was.’

Vehicles of medical information

Print media according to Mulhall and Le May [4] ‘remain the major source of information for most professional
groups’ and journals, which have regular publication dates, are the preferred tool used for publication of med-
ical research.
Electronic media can include primary research – the Internet through electronic journals and other sources – or
be used to facilitate the retrieval of print media, using filters available on the Internet or through electronic

NPR/FO
Page 2 of 6 Focus On

databases. Electronic databases have traditionally been available via CD-ROM, but more and more are becoming
available through online vendors.

Types of database and providers

Before embarking on any search it is important to ascertain what is required in order to formulate a search strategy.
The first port of call for nurses searching for the best evidence is to try the Cochrane Library and Clinical Evidence
databases. These databases contain systematic reviews and evaluated evidence on a range of topics of interest.
However, they only have limited resources in that systematic reviews have not been conducted on everything
and also the searcher may be looking for something other than an intervention which will not be found on these
databases.
The next option is to search bibliographic databases, such as CINAHL, MEDLINE, British Nursing Index (BNI),
ASSIA and EMBASE. These databases cover a range of health-related topics and contain references to thou-
sands of nursing journals. These databases are supplied through various vendors and although the content of
the database remains the same regardless of which vendor is used, the way the database is searched can be
different. This article will show various search examples on the ovid and dialog datastar platforms and give
ideas on how best to build a search (advanced search techniques are not within the scope of this article):

Avoid typing in whole phrases – searches for ‘nurse

prescribing in the community’ or ‘nurse prescribing
on the ward’ will not work!

Stage 1: Subject of keyword?

An understanding of the difference between a subject search and a keyword search is an important first step in
the development of database searching skills. Keyword searching will look for the exact words specified –
anywhere in the database, whereas subject searching will look exclusively within subjects assigned by a human
indexer corresponding to the topic of an article.

But why have the option for both?

The first point to remember is that not all databases have a subject search option and some databases only
have a limited range of subjects. In these cases keyword searching is an advantage. Those databases with
extensive thesauri and indexes (such as CINAHL and MEDLINE) sometimes default to a subject search unless
otherwise instructed; in these cases start with a subject search.
There are pros and cons for both types of searches.

Subject
The main advantage for subject searching is that records will be retrieved even if the initial keyword used is not
found in the record. This is particularly pertinent if a record has no abstract available and the title is ambiguous.
In these cases an indexer would assign subjects to records that would enable the searcher to locate these items.
A second advantage is that terms with different spellings (i.e. Americanization) will be found within a single subject.
Another advantage is that many subjects can be assigned to articles so that topics other than the main subject
or title words can be indexed. This can include statistical methods and assessment tools that may otherwise
be difficult to locate.
The disadvantage of subject searches is that the searcher is relying on the competency of the indexer not to
miss any potentially useful records and also that some topics may not fit readily into any assigned subjects or
may not be recognized and the search fails.

Keyword
This type of search is sometimes referred to as a text word search.
 Focus On Page 3 of 6

Keyword searches can retrieve more records than subject searches depending on the word or phrase searched
for. This is because this type of search looks in the whole record for the relevant word and can therefore pick
up records that have the word within fields such as the journal title. In some cases, however, the records may not
in fact be relevant as no subject has been assigned to it. Also, only those references with the exact word or phrase
that is typed in will be found, i.e. a search for heart attack will not find an article that has the term myocardial
infarction instead. The keyword option can be useful if subject searches fail when the term is not recognized
(Table 1).
Table 1. Advantages and disadvantages of subject vs. keyword searching

Subject search Keyword search

Advantages Records found that do not contain the keyword
Covers different spellings
Useful if subject searches fail
Links to additional terms
Disadvantages At the whim of the indexer (?)
Search can fail if term is not recognised
Can retrieve more records than a subject search
Useful of subject searches fail
Can find ‘obscure’ topics
May pick up irrelevant records
Caution with different spellings, plurals and synonyms

Ovid example
A search for nurse prescribing on CINAHL, BNI and MEDLINE illustrates the point (Table 2).
When this phrase is searched for on CINAHL, the database maps it to prescriptive authority. This is the only
subject listed which shows that according to the database this is the same thing. (Bear in mind the database
has an American bias so some terms used in the UK will not be used in the US.) In the same way a search for
cancer would be mapped to the subject neoplasms. This search for prescriptive authority yields 1551 hits. A
keyword search can be performed for nurse prescribing on CINAHL which locates only 412 hits.

Table 2. Results for nurse prescribing searches on ovid (please note these results were correct
at the time of writing)

Phrase CINAHL BNI MEDLINE

Prescriptive authority (subject) 1551 0 0

Nurse prescribing (subject) 0 31 0
Nurse prescribing (keyword) 412 352 185

On BNI a subject search for prescriptive authority not surprisingly locates nothing. However, nurse prescribing
is listed and 31 hits will be retrieved. This is much less than the result on CINAHL, so back it up with a keyword
search. In this case the keyword search locates 352 hits, which will include fields such as journal titles.
Subject searching for either prescriptive authority or nurse prescribing will not find anything on MEDLINE, but the
keyword nurse prescribing will find 185 hits. This is because MEDLINE generally concentrates on medical topics.

Dialog datastar example

When nurse prescribing is searched for on CINAHL, the database performs a keyword search, but can also
map it to prescriptive authority if the Thesaurus Mapping option is selected. The nurse prescribing keyword
search locates 661 hits and the subject prescriptive authority yields 1542 hits. The extra hits on dialog com-
pared to ovid for the keyword search are due to extra fields provided in the record of each article and differ-
ences in indexing practices.
On BNI a subject search for prescriptive authority not surprisingly again locates nothing and nurse prescribing
is also not found. So the only option is a keyword search which locates 315 hits. There is, however, the subject
prescribing that could be used.
Subject searching for either prescriptive authority or nurse prescribing will not find anything on MEDLINE, but
the keyword nurse prescribing will find 199 hits (Table 3).
Keep it simple – more words generally mean fewer hits.
Page 4 of 6 Focus On

Table 3. Results for nurse prescribing searches on dialog datastar (search results
correct at time of writing)

Phrase CINAHL BNI MEDLINE

Prescriptive authority (subject) 1542 0 0

Nurse prescribing (subject) 0 0 0
Nurse prescribing (keyword) 661 315 199

Stage 2: Wildcard and truncation

If keywords are part of the search, it is very important to be aware of wildcards and truncation. Both of these
searching techniques allow many different words to be searched at one time.

Wildcards
Wildcards are used to replace letters that are different in similar words, and are particularly useful with American
spellings. Generally, the letters that are different are replaced with a certain character (sometimes a question mark
or a hash mark) which denotes any letter. In this way immuni?ation will include immunization or immunisation.

Truncation
Keyword searches for diabetes will not find diabetic or diabetics. Truncation (sometimes called stemming) is a
useful way of searching for words that have the same start of the word (stem), but end differently and can get
round this problem without the searcher typing in each word. The stem of the word is used with the letters that
are different replaced with a certain character (sometimes an asterisk or a dollar sign) which denotes any let-
ters past this point. In this way diabet$ will include diabetes, diabetic or diabetics.
If this technique is applied to the nurse prescribing keyword search, different results are obtained (Table 4 and
Table 5).
Remember subject searches do not require wildcards or truncation techniques as the term is mapped to a
subject heading.

Table 4. Search results for truncation on ovid (search results correct at time of writing)

Phrase CINAHL BNI MEDLINE

Nurse prescribing (keyword) 412 352 185

Nurse prescrib$ (truncated) 566 679 211
Difference ⫹154 ⫹327 ⫹26

Table 5. Search results for truncation on dialog datastar (search results

correct at time of writing)

Phrase CINAHL BNI MEDLINE

Nurse prescribing (keyword) 661 315 199

Nurse prescrib$ (truncated) 1096 613 242
Difference ⫹435 ⫹298 ⫹43

Stage 3: Combining searches

Boolean operators
Sociologist, George Boole, developed these functions that now bear his name in the early 1900s.
Database searches, either by keyword or subject, will often produce such a large number of results that the
search has to be further refined. This will particularly be the case with keyword searches, which retrieve all occur-
rences of a particular word, and further words may have to be added, or as in the nurse prescribing search, dif-
ferent results are obtained from different types of search. It is then appropriate to join searches together using
Boolean operators.
 Focus On Page 5 of 6

The way these functions work is often shown via Venn diagrams and they are used to broaden or narrow
searches as follows:

‘AND’ (as well as)

When used to combine sets X and Y, ‘AND’ produces a list where both terms appear in the item records, thus
narrowing the search. For example: ‘Hospice care AND AIDS’ (Figure 1).

Figure 1. Boolean operator ‘AND’

‘OR’ (either)
When used to combine sets X and Y, ‘OR’ produces a list where either term X or term Y appear in the item
records, thus broadening the search, e.g. ‘Palliative care OR terminal care’ (Figure 2).

‘NOT’ (without)
When used to combine sets X and Y, ‘NOT’ excludes all items in set Y from set X, thus narrowing the search,
e.g. ‘Hospice care NOT AIDS’ (Figure 3: Boolean operator ‘NOT’).

Figure 2. Boolean operator ‘OR’

Figure 3. Boolean operator ‘NOT’

Page 6 of 6 Focus On

Table 6. Search results using the Boolean operator ‘OR’

Phrase CINAHL (ovid) CINAHL (ovid)

Prescriptive authority (subject) OR

nurse prescrib$ (truncated keyword) 1682 2076
Extra hits compared to
‘prescriptive authority’ (subject) search ⫹131 ⫹534

Specific disorders or drugs could be added to the nurse prescribing search to narrow the results.
Applying the principle of ‘either’ to the nurse prescribing search (Table 6).
Perform searches for each topic separately – it is easier to spot mistakes.

Stage 4: Limits
Limits are generally used if the search results are too large to realistically search through for articles of rele-
vance. The main limits that appear on virtually all databases are publication year and language, both useful but
not necessarily needed for every search. Other options may include restricting a search to certain age groups,
types of journal or publication types. It depends on the search topic as to which (if any) limits would be relevant.

Conclusion
The importance to nurses of searching bibliographic databases as a means of evidence-based practice can-
not be overstated. By using suitable search terms and appropriate search techniques nurses should be able to
locate the information they seek. This brief introduction to basic searching is a first step to providing the nec-
essary skills to do this.

Key readings
● Haig A, Dozier M. BEME Guide No 3: Systematic searching for evidence in medical education – Part 1:
Sources of information. Medical Teacher 2003; 25(4): 352–363.
● Haig A, Dozier M. BEME Guide No 3: Systematic searching for evidence in medical education – Part 2:
Constructing searches. Medical Teacher 2003; 25(5): 463–484.
● Morrisey LJ, DeBourgh GA. Finding evidence: refining literature searching skills for the advanced practice
nurse. AACN Clin Issue 2001 Nov; 12(4): 560–77.
● Shojania KG, Olmsted RN. Searching the healthcare literature efficiently: from clinical decision-making to
continuing education. Am J Infect Contr 2002 May; 30: 187–95.
● Thompson C. Searching for the evidence. NT Learn Curve 1999 May; 3(3): 12–3.

References
[1] Kirk S, Carlisle C, Luker KA. The implications of Project 2000 and the formation of links with higher education
for the professional and academic needs of nurse teachers in the United Kingdom. J Adv Nurs 1997;
26:1036–44.
[2] Hamer S, Collinson G. Achieving evidence-based practice: a handbook for practitioners. Edinburgh:
Bailliere Tindall; 1999.
[3] Muir Gray JA. Evidence-based healthcare: how to make health policy and management decisions. 2nd
Edition. Edinburgh: Churchill Livingstone; 2001.
[4] Mulhall A, Le May A (eds). Nursing research: dissemination and implementation. Edinburgh: Churchill
Livingstone; 1999.