Resource guide for nursing students.




This guide provides you with an introduction to the UNF Library's services; it also acts as a point of reference for: UNF Library's nursing databases, PICO(T), search strategies, the systematic review, suggested tools for evaluating the systematic review process, the Prisma Flow Diagram, and RefWorks.   


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Your Library Account: See a list of materials you have checked out, renew materials, view any fines you might owe, and more.

Off-Campus Remote Access: Access UNF Library online resources when you are not on campus. Click on Library --> Select Remote Login from under My Accounts --> Enter your N# and Password.

Borrowing Library Materials: Faculty, students and staff automatically have borrowing privileges. Show your Osprey1 Card to borrow materials from the UNF Library.

Interlibrary Loan: Can't find what you need at the UNF Library? Interlibrary loan (ILL) can obtain books and articles for you from other libraries. 

Research Consultations: Need help? Book a research consultation for a one hour session. Librarians can meet with you in person at the library, via phone, or through a Blue Jeans video chat.

Nurses working   

For more information on Clinical Practice Guidelines and where to find them, please review this article.

PICOT diagram


Formulating a PICOT question is the first step in the process of carrying out a focused literature review and analysis of evidence.

PICOT is an acronym for the elements of the clinical question: a way of asking a clinical question that will help guide the search for evidence.



   Image Reused with permission of Hawaii Pacific University

P = Patient population of interest: Identify patients by age, gender, ethnicity, disease or health problem

I = Intervention of interest (can also be issue of interest that has no comparison): Which intervention is worthwhile to use in practice? Which issue is studied (e.g. a treatment, diagnostic test, prognostic factor)?

C = Comparison of interest (you do not always have a comparison): What is the usual standard of care or current intervention used now in practice?

O = Outcome: What results do you wish to achieve or observe as a result of an intervention (e.g. change in patient behavior, physical findings, patient perception)?

T = Time (you do not always have a time frame): What amount of time is needed for an intervention to achieve an outcome (e.g. the amount of time needed to change quality of life or patient behavior)?


Example of a PICO(T) Question

1. PICOT Question:

Population: Bariatric adolescents considering or undergoing gastric bypass surgery.

Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.

Comparison: The nurse's role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.

Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.

Time: perioperative including the 6 weeks post recovery.

PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?


PICO(T) Worksheets

Watch: Finding the Evidence 2 Turning Search Terms into Search Strategies

Credit: Bodleian Libraries

University of Oxford




Search Strategy: A search strategy is an organized structure of key terms used to search a database. PICO(T) is part of your search strategy. The search strategy combines the key concepts of your search questions in order to retrieve accurate results. NYU LibGuide provides students with a thorough overview of the Search Strategy. This includes Boolean worksheets.

Researchers use Boolean Logic to combine search terms. 

Most databases allow the use of AND, OR and NOT to broaden or narrow and search. 

  • AND will narrow the search to include only records with both terms. 
  • OR with broaden the search to include records with either term.
  • NOT will narrow the search to exclude records with one of the terms.

Truncation:  You can use an * at the end of a word stem to broaden your search to include related terms.  For example, to search for child, children or childhood use the search term child*

Putting quotes "" around words allows you to search for a phrase.  For example, searching language development, without quotes, finds records with both the word 'language' and 'development' somewhere in the record.  Searching "language development", with quotes, only find records with the phrase "language development".


Boolean Logic Search

Limiters: Use limiters to hone in on topics. Health/Nursing databases provide many limiters. CINAHL's limiters enables you to limit by peer-reviewed, geography, age, sex, human study, evidence based practice, etc.

Screencast of CINAHL's limiters


The PICO(T) question is the catalyst to your research:

1. PICOT Question:

Population: Bariatric adolescents considering or undergoing gastric bypass surgery.

Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.

Comparison: The nurse's role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.

Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.

Time: perioperative including the 6 weeks post recovery.

PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?


PICO(T) Search Strategy example


Subject Searching

Subject searching is a more precise way to search, particularly when your search term can have more than one meaning. Every item in a database is assigned specific subject headings using a controlled vocabulary, which can vary by database. Most medical databases use MeSH (Medical Subject Headings), which is continually updated by the National Library of Medicine. MeSH uses a hierarchical system that allows for easy broadening or narrowing of topics. CINAHL uses subject headings unique to the database that use the same structure. 

MESH Subject Headings

MeSH is the National Library of Medicine's controlled vocabulary thesaurus. It consists of sets of terms naming descriptors in a hierarchical  structure that permits searching at various levels of specificity.

MeSH descriptors are arranged in both an alphabetic and a hierarchical structure. At the most general level of the hierarchical structure are very broad headings such as "Anatomy" or "Mental Disorders." More specific headings are found at more narrow levels of the thirteen-level hierarchy, such as "Ankle" and "Conduct Disorder." There are over 28,000 descriptors in MeSH with over 90,000 entry terms that assist in finding the most appropriate MeSH Heading, for example, "Vitamin C" is an entry term to "Ascorbic Acid." In addition to these headings, there are more than 240,000 Supplementary Concept Records (SCRs) within a separate file. Generally SCR records contain specific examples of chemicals, diseases, and drug protocols. They are updated more frequently than descriptors. Each SCR is assigned to a related descriptor via the Heading Map (HM) field. The HM is used to rapidly identify the most specific descriptor class and include it in the citation.

CINAHL Subject Headings-

The CINAHL subject headings are based on the MeSH headings, with additional specific nursing and allied health headings added as appropriate. Each year, the headings are updated and revised relative to terminology needed in these fields. In addition, new terms from MeSH may be added as well.



Watch: Use MeSH to Build a Better PubMed Query


Credits: National Center for Biotechnology Information (NCBI)


Watch: How to Save and Print Searches in PubMed and Cinahl (Memorial University Library)

Your instructor will often request that you track your search terms.  Many databases offer a "Search History" option.  This brief tutorial will show you how to save and print your search history in PubMed and Cinahl. 


Note: Additionally, you can save your searches within Cinahl and PubMed. In Cinahl, you have the option to create a My EBSCOhost folder; In PubMed you can save your searches within a NCBI account.  Other nursing databases offer similar options. 

Systematic Review Chart   

  Credits: Cornell & Brown Universities

             Systematic Review Visualized

Designed by Jessica Kaufman, Cochrane Consumers & Communication Review Group, Centre for Health Communication & Participation, La Trobe University, 2011. CC-BY-SA License

Additional Information

Open Textbooks

Literature Reviews for Education and Nursing Graduate Students by Linda Frederiksen and Sue F. Phelps

Cover of book


This open textbook is designed for students in graduate-level nursing and education programs. From developing a research question to locating and evaluating sources to writing a sample literature review using appropriate publication guidelines, readers will be guided through the process.  



By CFCF (Own work) [CC BY-SA 4.0 (], via Wikimedia Commons:

Evidenced Based Medicine Diagram


Journal Articles



Watch: Systematic Approaches to Searching the Health Science Literature

Credits: Yale University Medical Library

Chart of Other types of literature reviews

Credits: Cornell and Brown Universities

Other LibGuides

There are several tools that help organize the systematic review process.  While many researchers use a spreadsheet to do this, others prefer a specialized instrument.  Some require a paid subscription, others are free of charge.  Each product has its own strengths, and as every research project is different, we do not recommend one over the other.   All are web-based. 

Covidence:  "A web-based software platform that streamlines the production of systematic reviews, including Cochrane Reviews. Citation screening, Full text review, Risk of Bias assessment, Extraction of study characteristics and other study data, Export of data into RevMan. Nonprofit organization, open source software." (first SR free for 2 reviewers, then fee-based)




Distiller"DistillerSR is the the world’s most used systematic review software. It was designed from the ground up to give you a better review experience, faster project completion and transparent, audit-ready results." (fee-based) 

JBI SUMARI: "The System for the Unified Management, Assessment and Review of Information (SUMARI) is the Joanna Briggs Institute's premier software for the systematic review of literature. It is designed to assist researchers and practitioners in fields such as health, social sciences and humanities to conduct systematic reviews. SUMARI supports 10 review types, including reviews of effectiveness, qualitative research, economic evaluations, prevalence/incidence, aetiology/risk, mixed methods, umbrella/overviews, text/opinion, diagnostic test accuracy and scoping reviews. It facilitates the entire review process, from protocol development, team management, study selection, critical appraisal, data extraction, data synthesis and writing your systematic review report. Essentially, it is a word processor, reference management program, statistical and qualitative data analysis program all in one easy to use web application." (fee-based)



Rayyan"Rayyan is a web application to help systematic review authors perform their job in a quick, easy and enjoyable fashion. Authors create systematic reviews, collaborate on them, maintain them over time and get suggestions for article inclusion." (free; new)


Additional Resources:

AMSTAR- AMSTAR is a tool to evaluate the quality of an existing systematic review. AMSTAR stands for A Measurement Tool to Assess Systematic Reviews. It is an excellent indication of how other researchers will evaluate your systematic review.

Brown School of Public Health provides a list of additional resources for systematic reviews and meta-analysis.

What is Prisma?

PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.


Prisma Flow Diagram


Prisma Flow Diagram Worksheet

Prisma Homepage

An Evidence-Based Approach to Scoping Reviews (Khalil et al., 2016)


Step 1: Preparation To complete the the PRISMA diagram print out a copy of the diagram to use alongside your searches. It can be downloaded from the PRISMA website. You will need to print a copy for your totals, but you may want to print out a copy for each database you search as well. If you are using this system for a more advanced assignment, ask your supervisor whether they would like you to follow this system, or to specify totals for each individual database in your final PRISMA diagram.


Step 2: Doing the database search For each database enter each key search term individually. This should include ALL your search terms, including MeSH or CINAHL headings, truncation (like hemipleg*) and wildcard (like sul?ur) search terms. Combine all the search terms in the different combinations using boolean operators like AND or OR as appropriate. Apply all your limits (such as years of search, English language only, and so on). Once all search terms have been combined and you have applied all relevant limits, you should have a number of records or articles. Enter this in the top left box of the PRISMA flow chart for each database. If you have searched databases individually, add all the 'records identified' up and fill this total number in the PRISMA flow diagram which you will use for your coursework. Remember this process of adding up the number of records in individual database searches to a total  will need to be repeated at each step if you search databases separately.

PRISMA additional sources


Step 3: Additional sources If you have identified articles through other sources than databases (like manual searches through reference lists of articles you have found or Search engines like Google Scholar), enter the total number of records in the box on the top right of the flow diagram.

PRISMA diagram showing duplicates removed box


Step 4: Remove all duplicates To avoid reviewing duplicate articles, you need to remove any articles that appear more than once. You will need to go through all the records or articles you have found in the database and manually remove any duplicates. This is not easy to do if you have a large number of articles at this point. In this case you may want to export the entire list of articles to RefWorks (including citation and abstract) and remove the duplicates there. Enter the number of records left after you have removed the duplicate in the second box from the top.

PRISMA records screened


Step 5: Screening articles The next step is to add in the number of articles that you have screened. This is the same number as you have entered in the duplicates removed box.

PRISMA records excluded box


Step 6: Screening - Excluded articles You will now need to screen the titles and abstracts for articles which are relevant to your research question. Any articles that appear to help you provide an answer to your research question should be included. Record the number of articles excluded based on this screening process in the appropriate box (next to the total number of screened records) with a short reason for excluding these articles.

PRISMA eligability box


Step 7: Eligibility Subtract the number of excluded articles following the screening phase (step 6) from the total number of records screened (step 5) and enter this number in the box titled "Full-text articles assessed for eligibility". Get the full text for these articles to review for eligibility. 

PRISMA full text articles excluded


Step 8: Eligibility - Records excluded Review all full-text articles for eligibility to be included in the final review. Remember you should be left with 6-8 papers at this point. Take a note of the number of articles that you exclude at this point and enter this number in the correct box titled: Full text articles excluded and write in a short reason for excluding the articles (this may be the same reason used for the screening phase).

PRISMA articles excluded


Step 9: Included The final step is to subtract the number of excluded articles or records during the eligibility review of full-texts (step 8) from the total number of articles reviewed for eligibility (step 7). Enter this number in the final box. You have now completed your PRISMA flow diagram which you can now include in the results section of your assignment.

PRISMA final articles

Credits: UNC Health Library  


RefWorks is a citation manager that can help you throughout the screening process. UNF students have access to this powerful tool.  

RefWorks diagram


Refworks icon

RefWorks is an online citation management tool that allows you to collect, manage and organize research papers and documents.

With RefWorks, you can:

  • Collect & Import: Save an unlimited number of references by importing from online databases, catalogs, websites, and your computer
  • Manage your Research: Organize, retrieve, read and annotate documents and references
  • Share & Collaborate: Share folders and work with others simultaneously
  • Write & Cite: Generate bibliographies and citations in thousands of citation styles, including MLA, APA and Turabian

Creating an Account

  1. From the UNF Library homepage, select My Accounts. Select RefWorks. 
  2. Click on "Create Accounts."Enter your institutional ( or email address.
  3. Since UNF subscribes to RefWorks, you’ll receive a “success” message and you will be asked to create a password.  Your institutional email becomes your login name.
  4. An activation email will be sent and you’ll need to validate your account to continue.
  5. When you click on the link in the activation email, you will be directed back to RefWorks to enter your name, role and department affiliation.  You’ll also be asked if you’d like to install the “Save to RefWorks” browser bookmarklet (a great way to capture data from web pages!) and if you’d like to install one of the paper writing helpers (Write-N-Cite for Word or RefWorks Add-on for Google Docs).  
  6. You’ll be brought directly into your new account and are ready to begin adding your research. Exporting materials into RefWorks enables one to stay organized and create a rough draft bibliography/works-cited page. 


Watch: Adding References Using Direct Export

Visit the RefWorks LibGuide for more information. 

Cochrane Library: Exporting to RefWorks

  1. Click on the checkbox to the left of each record to import.
  2. Click on the Export Selected link at the top of the results list.  (Note: if you want to export all results from a search, select Export All instead.)
  3. Choose your file type according to the computer you're using (PC, Mac, or UNIX/LINUX).
  4. For Export Type select Citation or Citation and Abstract. 
  5. Click on Export Citation.
  6. When prompted, save the resulting text file where you'll be able to find it later.
  7. Log in to RefWorks.
  8. Click the plus button in the toolbar and select Import references from the dropdown menu.
  9. Drag and drop your text file to the indicated space OR click Select a file from your computer, select the text file you saved, and click Open.
  10. RefWorks will ask what format the file is.  Enter Cochrane Library, then select the database you were searching in from the dropdown menu.
  11. Click Import.
  12. Your records will be downloaded automatically and should appear in your Last Imported folder.
Subjects: Biomedical Sciences, Nursing
Tags: health, medicine, nursing

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