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Information Literacy and Computerized Information Resources

Diane S. Pravikoff / June Levy

INTRODUCTION

This chapter presents information about electronic resources that are easily available and accessible and can assist nurses in maintaining and enhancing their professional practices. These resources aid in keeping current with the published literature, in developing a list of sources for practice, research, and/or education, and in collaborating with colleagues.

As is evidenced in earlier chapters, nurses use computers for many purposes. Recently, most of the focus has been on computerized patient records, acuity systems, and physician ordering systems. One of the major purposes for which computers can be used, however, is searching for information. Many resources are available on computer, and the information retrieved can be used to accomplish different ends. Computers also are available in various sizes, improving portability and availability wherever a nurse is practicing. Many of the resources described in the following sections will be available via mobile devices.

To maintain professional credibility, nursing professionals must

1.   Keep current with the published literature

2.   Develop and maintain a list of bibliographic and other sources on specific topics of interest for practice, research, and/or education

3.   Collaborate and network with colleagues regarding specifics of professional practice

Electronic resources are available to meet each of these needs. This chapter addresses each of these requirements for professional credibility and discusses both essential and supportive computerized resources available to meet them. Essential computerized resources are defined as those resources that are vital and necessary to the practitioner to accomplish the specific goal. In the case of maintaining currency, for example, these resources include bibliographic retrieval systems such as MEDLINE or the CINAHL database, current awareness services, review services, or point-of-care tools and may be accessible on the World Wide Web. Supportive computerized resources are those that are helpful and interesting and supply good information but are not necessarily essential for professional practice. In meeting the requirement of maintaining currency, supportive computerized resources include document delivery services, electronic publishers, and various sites on the World Wide Web. There are many resources available to meet each of the above requirements for professional credibility. For the purposes of this chapter, selective resources are identified and discussed as examples of the types of information available. Web site URLs of the various resources are included as well. It is important that the nursing professional determine her or his exact requirements before beginning the search. Planning the search will be stressed throughout this chapter.

INFORMATION-SEEKING BEHAVIOR OF REGISTERED NURSES

Multiple practice standards organizations (Institute of Medicine [IOM], Agency for Healthcare Research and Quality [AHRQ], American Nurse Credentialing Center [ANCC]’s Magnet Recognition Program, American Association of Colleges of Nursing [AACN], National League for Nursing [NLN], The Joint Commission [TJC]) insist that nursing care be based on information derived from best practice evidence. To identify best evidence and apply it in the care of the patient, the nurse must apply the information literacy process as defined by the American Library Association (American Library Association, 2018):

1.   Recognize the need for evidence.

2.   Know how to search and find relevant information.

3.   Access, utilize, and evaluate such information within the practice environment.

These components are identified as competencies for the basic nurse (American Nurses Association, 2015). In 1989, the American Library Association (ALA) described the “information literate” person as one who can “recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information” (American Library Association, 1989). The ALA continues to identify it as a basic competency for higher education (American Library Association, 2018).

While the importance of maintaining currency with published literature is stressed, research has indicated that nurses often do not access the tools needed to do so. Neither do they have the ability to utilize these tools, if available, within their work setting. A national study of 3000 nurses licensed to practice in the United States was conducted in 2004 to better understand the readiness of nurses to utilize evidence-based nursing practice, based on their information literacy knowledge and competency (Pravikoff, Pierce, & Tanner, 2005). This landmark study demonstrated that many nurses were not aware that they needed information; once they recognized a need, online resources available for them to use were inadequate and respondents had not been taught how to use online databases to search for the information they needed. In addition, they did not value research as a basis on which to formulate and implement patient care.

Since these findings were published, many subsequent studies have been conducted in various specialty areas and countries with similar results (Ross, 2010; Majid, Foo, & Luyt, 2011; O’Leary & Mhaolrunaigh, 2011; Yadav & Fealy, 2012). Melnyk, Fineout-Overholt, Gallagher-Ford, and Kaplan surveyed randomly selected members of the American Nurses Association and found that over 70% of respondents either needed or strongly needed:

1.   Tools to implement evidence-based practice

2.   Online education and skills-building modules in evidence-based practice

3.   An “online resource center where best EBPs for patients are housed and experts are available for consultation” (Melnyk, Fineout-Overholt, & Gallagher-Ford, 2012, p. 412)

They—and others (Miglus & Froman, 2016)—determined that nurses valued and were ready to practice nursing based on evidence but need several things to be able to do so: more time, knowledge, skills, access, and a supportive organizational culture. These barriers continue to inhibit the development of evidence-based practice (EBP) competencies (Melnyk, Gallagher-Ford, & Thomas, 2016; Sadoughi, Azadi, & Azadi, 2017).

The rate of expansion in health information technology (e.g., electronic health records) is phenomenal; in addition, clinical knowledge is multiplying exponentially and dissemination methods are changing to include scholarly databases and social networking. Despite the demands for EBP, nurses continue to have difficulty finding information they need for practice and prefer colleagues as their primary source (Marshall, West, & Aitken, 2011). Alving, Christensen, and Thrysøe identified Google and colleagues or peers as the preferred sources of information in a review of studies conducted from 2010 to 2015 (Alving, Christensen, & Thrysøe, 2018). Poor search skills and time pressures were a possible explanation. Researchers in a Canadian study found nursing students used “mobile information mainly to support patient care-related tasks but did not access research-based journal articles to support evidence-based practice” (Doyle, Furlong, & Secco, 2016, p. 300).

Nurses—students, clinicians, educators, and managers— must develop efficient and effective search strategies that embrace information literacy as a framework to search the myriad of information resources available for evidence. According to recent efforts, education is embracing the change by embedding well-designed courses that offer opportunities to develop these skills throughout program curricula (Moreton, 2013; Powell & Ginier, 2013; Stombaugh, Sperstad, & Van Wormer, 2013). Results indicate that such courses are indeed effective in improving the nurse’s skills and confidence in searching for evidence (Boden, Neilson, & Seaton, 2013; Clapp, Johnson, & Schwieder, 2013; Friesen, Brady, & Milligan, 2017; Sleutel, Bullion, & Sullivan, 2018). Change in practice culture is needed to infuse information literacy throughout the workplace.

The resources and search strategy introduced in this chapter provide the reader with tools that will become the basis of life-long learning for the nurse—tools for EBP.

MAINTAINING CURRENCY WITH THE PUBLISHED LITERATURE

It is obvious that one of the most important obligations a nurse must meet is to maintain currency in her or his field of practice. With the extreme demands in the clinical environment—both in time and amount of work—nurses need easily accessible resources to answer practice-related questions and ensure that they are practicing with the latest and most evidence-based information. Information is needed about current treatments, trends, medications, safety issues, business practices, and new health issues, among other topics.

The purpose of the information retrieved from the sources listed below is to enable nurses to keep abreast of the latest and most evidence-based information in their selected field. Both quantity and quality must be considered. When using a resource, check that:

1.   The resource covers the required specialty/field.

2.   The primary journals and peripheral material in the field are included.

3.   The resource is updated regularly and is current.

4.   The resource covers the appropriate period.

5.   The resource covers material published in different countries and languages.

6.   There is some form of peer review, reference checking, or other means of evaluation.

Essential Computerized Resources

Essential computerized resources for maintaining currency include bibliographic retrieval systems for the journal literature, current awareness services, review services of the journal literature, point-of-care tools, and currently published books. All of these assist the nurse in gathering the most current and reliable information.

Bibliographic Retrieval Systems

One of the most useful resources for accessing information about current practice is the journal literature. Although there may be a delay between the writing and publishing of an article, this time period is seldom more than a few months. The best way to peruse this literature is through a bibliographic retrieval system, since there is far too much literature published to read it all. Bibliographic retrieval systems also allow filtering and sorting of this vast amount of published material.

A bibliographic retrieval system database allows the nurse to retrieve a list of citations containing bibliographic details of the material indexed, subject headings, and author abstracts. The nurse can search these systems using specific subject headings or key words. Most bibliographic retrieval systems have a controlled vocabulary, also known as a thesaurus or subject heading list, to make electronic subject searching much easier. For this reason, the vocabulary is geared toward the specific content of the database. These controlled vocabularies are made available online as part of the database. Key word searching is necessary when there are no subject headings to cover the concepts being searched. The nurse can also search by specific fields including author, author affiliation, journal title, journal serial number (ISSN), grant name or number, or publication type. In bibliographic retrieval systems, most fields in the records are word-indexed and can be searched individually to retrieve specific information.

Previously available as print indexes, these systems are now available electronically through online services, or via the World Wide Web. To access them, a computer with a modem and/or Internet access is required.

Since each of these bibliographic retrieval systems has its own specific content, a nurse may have to search several systems to retrieve a comprehensive list of citations on a particular topic. Directories of descriptions of bibliographic retrieval systems can be found at many sites on the World Wide Web, e.g., universities (University of California, San Francisco [www.library.ucsf.edu]), medical centers (University of Kansas Medical Center A. R. Dykes Library [https://guides.library.kumc.edu/az.php]), and government agencies (National Library of Medicine [https://eresources.nlm.nih.gov/nlm_eresources/]).

The main bibliographic retrieval systems that should first be considered are MEDLINE/PubMed and the CINAHL database, but there are several others to consider as well. These are discussed below.

MEDLINE/PubMed. The NLM provides free access to many online resources (social media tools in the connected age). (1) One of these, MEDLINE, covers 5200 journals in 40 languages (60 languages for older journals) with over 25 million references from 1946 (includes OLDMEDLINE data) to the present in the fields of medicine, nursing, preclinical sciences, healthcare systems, veterinary medicine, and dentistry. The nursing subset in MEDLINE covers 112 nursing journals. The database is updated weekly on the World Wide Web (https://www.nlm.nih.gov/bsd/medline.html—Fact Sheet MEDLINE®: Description of the Database 12/27/18 U.S. National Library of Medicine, 2013). The NLM’s databases use a controlled vocabulary (thesaurus) called MeSH (Medical Subject Headings) (MeSH: https://www.ncbi.nlm.nih.gov/mesh). These index terms facilitate subject searching within the databases.

MEDLINE and the nursing subset are available free over the World Wide Web through the NLM’s home page at https://www.nlm.nih.gov. The database is also available through the commercial vendors mentioned below (e.g., ProQuest, Ovid, EBSCO). These options allow the nurse to search by subject, key word, author, title, or a combination of these. An example of different searches with a display using the EBSCOhost interface is shown in Figs. 50.1 and 50.2.

Loansome Doc allows the nurse to place an order for a copy of an article from a medical library through PubMed (https://docline.gov/loansome/login.cfm). The full text of articles for some journals is available via a link to the publisher’s Web site from the PubMed abstract or record display. Some of the full text is available free of charge. The links indicate free full-text display on the Loansome Doc order page prior to order placement and on the Loansome Doc Order Sent page immediately after the order is finalized. NLM has a fact sheet for Loansome doc users covering the registration process, how to place an order, order confirmation, check order status, and updating account information (https://www.nlm.nih.gov/loansomedoc/loansome_home.html).

CINAHL. The CINAHL database, produced by Cinahl Information Systems, a division of EBSCO Information Services (EBSCO), provides comprehensive coverage of the literature in nursing and allied health from 1937 to the present. CINAHL has expanded to offer five databases including three full-text versions. The database covers nursing and 17 allied health disciplines, as well as chiropractic, podiatry, health promotion and education, health services administration, biomedicine, optometry, women’s health, consumer health, and alternative therapy. The most comprehensive version, CINAHL Complete, provides indexing to nearly 5500 journals from all over the world. It has full text dating back to 1937 and more than 6 million records. The nurse can earn ceus (contact hours) with CINAHL Complete and the CINAHL Plus versions.

Medline Plus. MedlinePlus is the National Institutes of Health’s Web site for patients and their families providing information about diseases, conditions, and wellness issues in language you can understand. It provides information about the latest treatments, drugs or supplements, meanings of words, and access to medical videos or illustrations. You can also get links to the latest medical research on your topic or find out about clinical trials on a disease or condition. MedlinePlus is updated daily and can be bookmarked at the URL: https://medlineplus.gov/. There is no advertising on this site, nor does MedlinePlus endorse any company or product.

MedlinePlus Connect helps healthcare providers and patients access consumer health information at the point of need in a health IT system. Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect to provide health information for patients, families, and healthcare providers using standard clinical vocabularies for diagnoses (problem codes), medications, and laboratory tests. MedlinePlus Connect is a free service of the National Library of Medicine (NLM), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).

OVID EmCare. Ovid EmCare, a partnership with Elsevier, is a nursing and allied health database of over 5 million records across 3500 journals. It uses the ENTRÉE thesaurus, expanded with nursing and allied health terms (www.ovid.com/site/catalog/databases/14007:jsp).

ProQuest Nursing and Allied Health Database. ProQuest provides access to nursing and allied health literature, videos, reference materials, and evidence-based resources, including dissertations and systematic reviews.

ProQuest British Nursing Index. ProQuest’s Nursing Index is a full-text database supporting nurses and midwives in the United Kingdom.

• FIGURE 50.1. MEDLINE Search. (Reproduced with permission from EBSCO Information Services.)

• FIGURE 50.2. MEDLINE Search Result. (Reproduced with permission from EBSCO Information Services.)

ProQuest Health & Medical Collection. This collection is a comprehensive medical resource providing full-text journal content, eBooks, and evidence-based information, including dissertations and systematic reviews. It includes MEDLINE®, which contains journal citations and abstracts for biomedical literature from around the world.

Elsevier’s ScienceDirect. ScienceDirect contains over 3800 journals & serials, and 37,000 books. The digital archives go back as far as 1823. There are over 600 peer-reviewed open-access journals.

ERIC. The ERIC (Educational Resources Information Center) database is sponsored by the Institute of Education Sciences (IES) of the U.S. Department of Education and contains more than 1,600,000 citations covering education-related literature (Educational Resources Information Center, 2018). It covers virtually all types of print materials, published and unpublished, from 1966 to the present day. Currently more than 1000 journal titles are indexed in ERIC. It is updated monthly. This database gives the nurse a more comprehensive coverage of education than any other bibliographic retrieval system. The Thesaurus of Eric Descriptors, a controlled vocabulary, assists with computer searches of this database on the Internet through the World Wide Web (Educational Resources Information Center, 2018). As with the other two bibliographic databases mentioned, nurses are able to access all of the data in each record on ERIC by searching, using subject headings or key words or by searching for a word(s) in a specific field.

PsycINFO. The PsycINFO database, produced by the American Psychological Association, provides access to psychologically relevant literature from more than 2500 journals, dissertations, reports, scholarly documents, books, and book chapters with more than 3 million references from the 1880s to the present. Updated weekly, most of the records have abstracts or content summaries from material published in over 50 countries. Using the Thesaurus of Psychological Index Terms of more than 8400 controlled terms and cross references, the nurse can search for specific concepts effectively. Key word and specific field searching are also available (American Psychological Association: PsychInfo, 2018).

Social Sciences Citation Index. Social Sciences Citation Index (SSCI) can be accessed via Web of Science™ Core Collection for a fee. Web of Science, part of Clarivate Analytics, offers citations from over 20,000 journals carefully selected and evaluated and indexed to deliver influential scientific information Clarivate Analytics: Social Sciences Citation Index, 2018). SSCI contains over 6 million records in various social science fields and covers nearly 3000 journals in the social, behavioral, and related sciences. The Century of Social Sciences™ is a comprehensive backfile covering 1900 to 1955. Nurses can search back and forth in time to track research trends and findings.

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