NursiNg aNd Midwifery research 4e
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‘comparison’ in this case; the ‘outcome’ is
symptom relief; and there is no ‘timeframe’. The
general keywords in the question would be
‘cancer’, ‘massage therapy’ and ‘symptom relief’.
Using these keywords, depending on the
database/s you use, will lead you to a range of
relevant studies such as Wilkinson et al.’s (2008)
review.
Medicine and are used particularly in Medline
and PubMed, and other important repositories
such as the Cochrane databases
• CINAHL uses nursing-specific terms that may
differ from those used in Medline or other
databases that use MeSH indicators.
Finding the right keywords (or variables/
concepts/terms) to include in a search is
therefore an important element. The keyword
functions of a database have ‘explode’ or ‘focus’
features for terms, where user-entered terms are
mapped to the nearest keyword (e.g. ‘mental
health nursing’ maps to ‘psychiatric nursing’ in
CINAHL). The use of truncation is another
useful tool. Truncation retrieves all variations of
a root word in a single search by using a special
symbol to replace the word endings. This
broadens the search and is useful where limited
information is available. The truncation symbol
is often a question mark ? or an asterisk *. So,
for instance, gyna* would reveal all literature title
variants, such as gynaecology (European) or
gynecology (Americanism), gynaecological etc.
Caution is advised though. A term like cerv* (for
cervix or cervical) would also reveal literature
related to the cervical spine.
Using PICO/T to develop keywords
PICO/T is an acronym that describes the
elements of a well-formed clinical question
(Moyer 2008). Chapter 4 describes this process
related to clinical question-setting in more detail
The acronym stands for:
P — for the ‘patient’ or ‘problem’
I — for the ‘intervention’ of interest
C — for ‘comparison’
O — for ‘outcome’
T — for ‘timeframe’ (not always used)
PICO/T’s primary purpose is to create clinical
questions for research studies but, in literature
searches, it can be used in a reverse manner.
Essentially, it can be used to break down
research questions into the specific keywords
that were used to construct them. For example,
you might want to know the effects of massage
therapy on patients with cancer. The clinical
question in PICO/T format would be something
like: ‘What are the effects of massage therapy
for symptom relief on patients who have
cancer?’ The ‘patients’ are cancer sufferers; the
‘intervention’ is massage therapy; there is no
Search filters
In addition to keywords, other important steps
can narrow the focus of a search strategy.
Numerous filters (database limits) are available as
‘check boxes’ to include only publications most
relevant to your keyword search, especially if
there are unmanageable amounts of research
literature on a particular topic. Commonly used
filters include:
• selecting a range of publication years (e.g.
2006–2012)
• English-language publications only
• human-research studies only
• available as full-text papers (the entire paper is
available for reading), or just the abstract.
Searches can be conducted for author, keyword,
title, and journal, using a range of search filters
to refine a search. Individual databases have
different search filter features. The use of filters
will of course exclude papers, some of which
may be useful to you. It is, therefore, advisable
to take a step-wise approach, where the focus
becomes progressively narrower as more filters
are added. Box 3.3 provides an example of
such a process. It’s not uncommon to see
extensive strategies employed in certain
Tutorial Trigger
You have noticed an increased
incidence of cannula infection rates
on your ward and decide to search
the literature for the latest information on
prevention and treatment. Identify at least
three keywords/phrases that you could use to
begin the search. Use an appropriate literature
database and identify: 1. How much literature
is there? and 2. What type of literature is it
(i.e. nursing/midwifery or medical or both;
primary or secondary or both)?
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