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NURS 313R: Nursing Care of the Adult-Medical Surgical Patient: NURS 313R

Nursing Care of the Adult Medical-Surgical Patient

Ms. Goodman's Responses for NURS313R

Ms. Goodman’s responses for NURS313R

1)I still don’t understand advanced search parameters? Advanced search can be complicated. I suggest that you make an appointment  with a librarian to help you firm up your skills with advanced searching. Or you can take advantage of the advanced searching database tutorials. In EBSCOhost there is an explanation of advanced search located here:  Advanced Search

2)Some articles I reviewed did not have an abstract is this unusual? No, it is not unusual. Some articles might have an abstract that is visible in the PDF version of the article, but not in the entry located in CINAHL.

3)How do I narrow down searches? There are lots of ways to narrow searches. In CINAHL you can narrow your searches by using limiters, such as: date or language. More advanced limiters are: Any Author is Nurse or First Author is Nurse.  I suggest taking a close look at the database you’re using to see what limits are available and practice with those limits.

4)How do I determine what keywords to use in searching to find what I am actually looking for? Searching is an iterative process, you will enter keywords and not necessarily get the best results you need. What researchers do when their search results are not precise is to try the search again. Try also to keep track of any search terms used to determine which terms work best. There are other ways databases can help you. For example in CINAHL there is Subjects bolded category. This Subjects category will show the terms indexed in the database. Try these tips and don’t forget you can always schedule an appointment with a librarian for more assistance.

5)Which database should I use for a particular subject? I have curated a list of database resources related to databases that you can use from the NURS313R Subject Guide. The University Libraries also has a list of All Library Databases if you navigate to this page, and select All Subjects, you can view curated lists for various subjects here. Select the All Subjects drop down menu to find databases relevant to subjects of interest.

6)How do I tell the type of article I’m looking at? Read the abstract carefully there might be clues there. You can also check the subject links in your retrieval list to see if the type of article is noted there as well.

7)I’m still unsure of how to navigate the UNLV Library website and how to find the articles I need without extra information that I don’t need. Navigating the library website takes practice. Remember you can always start with the general nursing subject guide found here. You can also search using the All Library Databases link to locate databases that might help. Lastly, please make a one-on-one appointment with a librarian for tutoring on how to use library resources.

8)It is a little unclear to me how to differentiate between CINAHL and EMBASE. The University Libraries subscribes to a number of paid databases. CINAHL is a database that is part of the EBSCOhost family of databases, it is a nursing database, and you can find details about it here. Embase is also an article database from a different provider. Embase has unique features not found in CINAHL such as the ability to do a PICO search. You can learn more about Embase here.

9)Why does it take several days for the library to send an interlibrary loan article?  Is it automated or does a person approve an article when you request it? The University Library has staff who send an article request to other libraries. These other libraries have to respond saying they have the requested article and they are willing to lend the article to our library. The response from the lending library takes time, this is why it takes time to receive an interlibrary loan article.

10)What’s the difference between a meta-analysis and a systematic review? A meta-analysis is an article that reviews a number of studies and applies a statistical method to the articles to determine the size of an effect. Here is another definition for meta-analysis, “A meta-analysis is a statistical analysis that combines the results of multiple scientific studies.”  A systematic review is a research methodology applied to all of the existing evidence on a particular topic.

11)How do I access the entire article? Click the UNLV Find Text link to access the full-text of the article.

12)How do I cite articles we intend to use? Ask your instructor for guidance about how to cite the articles you will use in your assignments.

13)What is the exact difference and defining characteristics of the different types of EBP articles? Please check your NURS313R Subject Guide for details about the different types of EBP articles.

14)What are the conditions that make an article inappropriate to use? In general in your nursing courses you will want to use peer-reviewed articles, not popular articles, letters, or other non-peer-reviewed articles.

15)How do we tell apart systematic reviews vs. critically-appraised topic articles? Is it just because it’s on a specific database? You will learn how to tell the differences between articles once you become more familiar with evidence-based literature. Where you find an article does not determine always the article type. For example CINAHL database will have a range of articles from systematic reviews to cohort studies.

16)Why won’t the interlibrary loan system let me register for an account? If you’re having problems with interlibrary loan please contact their office at: 702-895-2152.

17)What is Cochrane Library? “Collection of databases containing independent evidence to inform healthcare decision making. Includes full-text PDF versions of the Cochrane Database of Systematic Reviews for both complete reviews and protocols.”

18)What do I do if an article is unavailable in full-text even after using the Find-Text link? You can request the article using interlibrary loan. To learn more see this link.

19)PICO-T is still unclear to me. PICO-T is a way to create a clinical question. To learn more about PICO-T please use the following tutorial or this one.

20)What is the best site for nursing interventions? I don’t recommend one best all inclusive site for nursing interventions. Here are a few good sites you can rely upon: CINAHL, Joanna Briggs EBP, or PubMed

21)I would like to learn more about Joanna Briggs EBP. You can read more here

22)How do I identify the type of article I am looking at? To identify the type of article you're looking at try reading the abstract or introduction of the article this will give you clues about the study type, study design, and other details about the article type. Check the author supplied keywords listed in an article too, this might give you article type information. Also, check the database supplied subject headings in your search results often times the type of article is listed among the subjects assigned to an article. 

23)If I find an article on Google Scholar and the full-text is unavailable, how do I request a loan? You can request an interlibrary loan using our ILLiad system here. To request an interlibrary loan you will need the article title, journal, author, year, volume, issue and page numbers if available, and the digital object identifier (DOI). This bibliographic information will help our ILL staff with requesting an article from another library. 

24)How do I cite EBP articles in APA format? Here is a link to citing using APA from the OWL @ Purdue, please use this resource to help you with citing articles. 

25)What is the difference between using AND & OR in a search? AND, OR and NOT are boolean operators, short connecting words you use to search for topics in different ways. Use AND for words you want to retrieve ex., elderly AND pain management; use OR to retrieve similar terms and to expand your search, ex., elderly OR aged AND pain management; use NOT to exclude words you do not want to see ex., pain management NOT opioid. If you need further assistance with searching please make an appointment with your librarian. 

26)I don't understand the difference between different types of articles. There is much to understand about article types you will learn more about article types in your nursing program. 

27)Is there a way to access these resources after graduation, without ACE credentials? Once you graduate you can access select databases on campus using a community user account. After graduation you're no longer able to remotely access CINAHL or other databases. PubMed is freely available globally, however, there is limited full-text linked through PubMed. 

28)I don't know who to make sure a citation is correct. To check your citation take a look at the APA Guide from OWL Purdue for examples to help you with writing a correction citation. 

29)Why do some searches come up with nothing? If you execute a query and retrieve no relevant results you need to refine your search terms in order to retrieve results. You may retrieve no results when you are searching for a topic and there has not been a lot of research on that topic. 

30)How do I use PubMed? Please watch these tutorials to learn more about PubMed and make an appointment with your librarian. 



Pyramid of Evidence

Three images of Evidence Based Pyramids

Murad, M.H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid.  BMJ Evidence-Based Medicine, 21(4), 125-127.

Definitions of Evidence Based Literature Types

Case Report

  •  Calls attention to an unusual association, adverse event, or a unique case
  •  Case reports may focus on a single patient or a group of patients exhibiting an adverse event, unusual association, or a unique case of disease state.

Cohort Studies

  • Cohort studies observe groups of individuals before they develop a disease or a particular outcome.
  • Cohort studies have the power to detect many different outcomes of an exposure and allow researchers to calculate a relative risk of developing a disease based on different exposures.
  • It may take many years to detect changes in the groups.
  • Because of the time involved and number of participants needed, cohort studies may be very costly.

Case-Control Studies

  • Case-Control studies begin with the outcomes and do not follow people over time.
  • Researchers choose people with a particular result (the cases) and interview the groups or check their records to ascertain what different experiences they had. They compare the odds of having an experience with the outcome to the odds of having an experience without the outcome.

Randomized Clinical Trials (RCTs)

  • RCTs follow two groups of people over time to see who achieves a particular result. In this case, the researchers assign or randomize the people to their groups.
  • Each person has an equal chance of being assigned to either group
  • Each group receives a different intervention. When the study period ends, the researchers evaluate their different outcomes and calculate the risk of one group developing the result compared to another.
  • Advantages include the advantage in assessing causality, and the intervention caused the results is clearly demonstrated.
  • Disadvantages include expense and time-consumption, and bias to the results if participants are not properly blinded.

Systematic Review

  • Focuses on a clinical topic, conducts a thorough review of the literature, validates quality of the studies and summarizes the data
  • Research review that compiles and summarizes evidence from research studies related to s specific clinical question
  • Employs comprehensive research strategies and rigorous appraisal methods
  • Contains an evaluation of strengths and limitations of studies under review


  • Quantitatively synthesizes and analyzes results of multiple primary studies addressing a similar research question
  • Statistically pools results from independent but combinable studies
  • Summary statistic (effect size) is expressed in terms of direction (positive, negative, or zero) and magnitude (high, medium, small)

  Clinical Practice Guideline

  • Clinical practice guidelines are “systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances.”
  • Guidelines can be used to reduce inappropriate variations in practice and to promote the delivery of high quality, evidence-based health care.
  • They may also provide a mechanism by which healthcare professionals can be made accountable for clinical activities.
  • Although most of the development and evaluation of clinical guidelines has occurred in the field of medicine, nurses are becoming more interested in the use of guidelines as one means of facilitating evidence-based practice.


National Library of Medicine.  Introduction to health services research.

Nursing Evidence-Based  Nursing Practice Toolkit:Practice, Evidence and Translation process (PET).  Adapted by Stroud, S., & Gansauer, L.

Thomas, L. (1999). Clinical practice guidelines. Evidence-based nursing. 2, 38-39.  http:// doi:10.1136/ebn.2.2.38

Critical Appraisal Tools

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