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P R O F E S S I O N A L N O T E B O O K

The stereotype: The hospital library is a dusty bookmuseum used mainly by students. It may have theanswer you need, but who knows where? Those

shelves and shelves of journals and books are jealouslyguarded by a stern librarian, her hair in a bun, who glaresat you as you approach the reference desk. She does notreally want anyone to actually use the library; “her” booksand journals might be put back in the wrong place on theshelves. You decide to find your answer some other way.

Reality: A question on clinical practice has arisen inyour emergency department, and there is a difference ofopinion among the staff. You call the library and ask if theyhave any information on the topic. The librarian may askyou several questions about the topic so he or she can tailorthe information to your specific need. The librarian tellsyou he or she thinks a literature search in the Medline data-base will provide the answer to your question. Within a day,you receive a list of citations and abstracts for journal arti-cles from the Medline database about your topic. The li-brarian asks you to select articles from the literature searchyou would like to see in full text and tells you he or she willeither get them for you from the library’s collection or re-quest them via interlibrary loan from other libraries. Yousay you would like 2 articles in particular for a meeting to-morrow morning, and you would like the remainder of thearticles by the end of the week. One of them is from a jour-nal that is not in your library’s collection, so the librarianarranges for it to be faxed from the medical school acrosstown. Armed with the articles from your literature search,you go into your meeting the next day prepared with thelatest evidence-based information on your topic.

Just as new information technologies are changing theways medicine is practiced, sometimes at a dizzying pace,

The Health Sciences Library and Professional

Librarians: Important Resources for Busy ED Nurses

and Nurse Managers

Author: Kristyn Gonnerman, MLS, Fontana, Calif

Kristyn Gonnerman is Assistant Librarian, Kaiser Permanente MedicalCenter, Fontana, Calif.

Reprints not available from the author.

J Emerg Nurs 2003;29:183-6.

Copyright © 2003 by the Emergency Nurses Association.

0099-1767/2003 $30.00 + 0

doi:10.1067/men.2003.24

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so have those new technologies changed the way health sci-ences libraries access and deliver information to their cus-tomers. The laborious process of searching through manypaper volumes of Index Medicus for citations to journal ar-ticles was replaced by ordering computerized literaturesearches from the National Library of Medicine (NLM).That process in turn was replaced in the early 1970s by li-brarians dialing into NLM’s computers via modem andperforming the literature search in the MEDLINE databasethemselves for a fee. In 1997 NLM debuted PubMed, itsWorld Wide Web interface to MEDLINE and several otherscientific databases. This development allowed anyone withInternet access to search the world’s premiere clinical litera-ture database at no cost. Likewise, routine library tasks suchas interlibrary loan are now performed using fax machines,E-mail, and electronic transmission of scanned articles be-tween libraries with use of specialized software.

As technology and the Internet have made informationmore accessible than ever before, however, a new problemhas arisen for busy clinical professionals: too much material.The challenge now is quickly selecting just what they need,when they need it, from the overwhelming number ofsources, databases, and Web sites accessible via the Internet.Also, copyright ownership issues exist. Few health sciencepublishers offer free access to their Internet or online data-bases without expecting payment.

So, what is the best way to cut down on time spentlooking for that needle in the Internet haystack and have freeaccess? Contact the library at your institution, or the nearestacademic institution with a health sciences focus, and dis-cuss your information needs with the librarians on staff.

The librarian arranges for it to befaxed from the medical school acrosstown. Armed with the articles fromyour literature search, you go into yourmeeting the next day prepared with thelatest evidence-based information onyour topic.

Most librarians working in the health sciences have amaster’s degree in library and information science; manyhave other advanced degrees as well. As part of their gradu-ate coursework and work experience, medical librarianslearn how computerized databases work, search many differ-ent types of clinical and scientific databases, become familiarwith the standard reference books in the health sciences lit-erature, and attend continuing education courses and con-ferences to stay current. Librarians use a technique called thereference interview to “triage” their customers’ requests andselect the right resource to answer each question. At some in-stitutions, librarians even attend rounds and perform data-base searches “on the fly” during case presentations; othersare members of their facility’s institutional review board andperform extensive literature review searches in preparationfor clinical trials. Librarians frequently offer formal and in-formal training for clinical professionals in efficient databasesearching techniques and resource evaluation.

CINAHL

CINAHL, which began in 1982 as a printed index to thenursing literature, currently indexes more than 1600 jour-nals, nearly 500 of which are nursing journals.3 In addi-tion to the nursing literature, it now also indexes titles infirst-response services, occupational, physical, and respira-tory therapy, speech-language pathology, biomedicine,alternative and complementary medicine, consumerhealth, and health sciences librarianship. CINAHL’s listof titles indexed by subject shows 32 titles that focus onsome aspect of emergency services.4 In addition to printjournals, CINAHL also indexes books, dissertations, soft-ware, audiovisuals, and online nursing journals. It con-tains full-text documents and articles from sources suchas selected state nursing journals, nurse practice acts,patient education materials, and research instruments.

CINAHL is a subscription-only database that may beaccessed from its own CINAHLdirect online service viawww.cinahl.com, and there is a charge to order the fulltext of the articles. Some professional nursing associationsalso offer access to CINAHL as a membership benefit.There is another way to access CINAHL as well: manyhealth sciences libraries choose to pay for an institution-wide subscription to this database, which allows staff tosearch it in the library or from their own personal com-puters at no cost. For the nurse manager, this arrange-ment may also allow for retrieval of journal articles at nocost from their libraries’ own collections, or atno/reduced cost from other libraries via interlibrary loan.

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Nurse managers confer with many other health profes-sionals in the course of their work; adding the institution’slibrarian to that group saves time and effort and ensuresthat decisions affecting patient care and strategic and capi-tal planning, which nurse managers must make every day,are made with the best data available.

When nurse managers need to navigate the Internetand the clinical literature on their own, most will make thebest use of their time by going directly to databases thatfocus on the medical literature. The two most important arethe Cumulative Index to Nursing and Allied Health Litera-ture (CINAHL) and MEDLINE, the clinical literaturedatabase sponsored by the NLM (see sidebars).

The PubMed home page at www.pubmed.gov offers anonline tutorial, and many health sciences libraries offerclasses or informal instruction in searching both MED-LINE and CINAHL. These classes allow busy health careprofessionals to learn how to get the most out of these 2comprehensive, sophisticated information resources in themost efficient way possible.

Some questions which come up in the course of a nursemanager’s day may also be answered via the Internet itself,without turning to a formal search of a literature database.Many government and educational institutions offer infor-mation free of charge via the Internet, but finding that nee-dle in the haystack may require more work than turning toa known, authoritative resource.

Librarians use a technique called thereference interview to “triage” theircustomers’ requests and select the rightresource to answer each question.

No one is in charge of content on the Internet. Nursingprofessionals familiar with conventions within their own dis-cipline with regard to publication are sometimes surprised tolearn there is no quality control, no application process, andno peer review on the Internet. Anyone with Internet accessand some inexpensive software can create a Web site and putit on the Internet. It is up to the individual user to separatethe wheat from the chaff. The Medical Library Associationhas developed a set of guidelines on evaluating Web sites,which include such recommendations as the following:

• Look for an easily identifiable sponsor of the Website, or lists of board members or consultants. This in-formation may help you establish the site’s credibility.

• Check the Web site’s address for information onwhether the site is commercial (.com), educational/nonprofit (.org), or government sponsored (.gov).This information may provide more informationabout the site’s intent.

• Currency: Is it clear how often is the site updated? Isthe last revision date posted?

• Factual information should be verified from a pri-mary source via a bibliography, abstract, or links toother pages. Opinions should be clearly stated assuch, and a source should be identified.1

Quantity is another problem facing Internet users.One source estimates that nearly 40 million Web sites existon the Internet.2 Some techniques librarians use to increasethe chance of retrieving relevant results when searching theInternet include the following:

• Using the search engine’s special features, such asdrop-down menus to combine terms or limit resultsby language, for example.

MEDLINE

MEDLINE is the biomedical literature database spon-sored by the National Library of Medicine. It containsnearly 11 million citations and abstracts from more than4500 journals, and includes references to the literaturedating back to 1966. A quick search reveals 486 journalsin MEDLINE that contain some variation on the term“nurse” in their titles. It has a broader scope thanCINAHL and encompasses the preclinical sciences,behavioral science, administration, public health, veteri-nary, and other disciplines.5 It is searched via the PubMedsearch interface, which is available at no charge via theInternet at www.pubmed.gov. Unlike CINAHL, it indexesmainly scholarly journals and does not include books,audiovisuals, or dissertations. MEDLINE also has no full-text content, although it does provide links to full-textsources for some citations. Very few of these are free; thelinks are to the publishers’ Web sites, and from thereproof of subscription to the paper version of the journalor a credit card number must be provided to access theactual article. There is no other source for medical topicscomparable to MEDLINE in scope, and every clinicalprofessional should become familiar with it.

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• Choosing unique or specific terms to use in thesearch; for example, not just “catheterization,” but“urinary catheterization” or “cardiac catheterization.”

• Using phrase searching by surrounding a phrase indouble quotations. This technique tells the searchengine that the words within the quotes must appearnext to each other, and in the same order, in the re-sults it retrieves.

The Internet has had a profound impact on healthcare. Nurse managers who want to use it to their best ad-vantage should consider enlisting the services of a profes-sional health sciences librarian the next time they need fastaccess to authoritative information.

REFERENCES1. Medical Library Association. A user’s guide to finding and eval-

uating health information on the Web [online] [cited 2002 Nov 11]. Available from: URL: http://www.mlanet.org/resources/userguide.html

2. Zakon RH. Hobbes’ Internet timeline [online] [cited 2002 Nov11]. Available from: URL: http://www.zakon.org/robert/internet/timeline/#Growth

3. CINAHL information systems. Products and services. [online][cited 2002 Nov 11]. Available from: URL: http://www.cinahl.com/prodsvcs/prodsvcs.htm

4. CINAHL information systems. The library. [online] [cited 2002Nov 11]. Available from: URL: http://www.cinahl.com/library/library.htm

5. National Library of Medicine. What’s the difference betweenMEDLINE and PubMed? [online] [cited 2002 Nov 11]. Avail-able from: URL: http://www.nlm.nih.gov/pubs/factsheets/dif_med_pub.html

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Gail Pisarcik Lenehan, RN, EdD, FAANc/o Managing Editor, PO Box 489, Downers Grove, IL 60515

800 900-9659, ext 4044 • karen.halm@attbi.com