Seeking out new knowledge or theories on a topic, or finding literature that supports protocols in practice is exciting; lifelong learning and proving you are providing gold standard patient care is essential and extremely rewarding for any veterinary nurse (VN). The purposes of literature searching and reviewing will be different for each individual VN. A VN may want to find and review literature to:
The necessity for, and benefits associated with, evidence-based practice cannot be over emphasized, and all VNs should be inspired and motivated to improve their knowledge and skills when they are surrounded by tutors at College or University, their peers in practice and all of the journals and information sources that arrive in practice on a weekly basis. There are some negative aspects of literature searching unfortunately, but with practise and experience of sourcing quality information the negatives are surmountable. Literature searching can take a long time and some VNs might not have access to a wide variety of sources, whereas other VNs may have access to an abundance of literature due to their circumstances or studies. Another key consideration is whether the VN possesses literature reviewing and critical reading skills. These skills are useful for analyzing the literature, deciding whether it is a reliable piece of information and thus realizing how actionable that information is to them in practice or how the findings can contribute to their academic work. To be able to review literature well, however, it has to be found in the first place, so this shall be considered in the first part of the article.
Literature searching
In reality, literature searching can be tedious and an inexperienced VN or researcher can often spend hours searching for useful information to no avail; this can happen to experienced researchers too as discussed by LoBiondo-Wood and Haber (2002). This is at best frustrating and at worst extremely disheartening, and can completely disengage people with the concept of evidence-based practice and gold-standard veterinary nursing care; this ultimately can negatively influence patient care and stifle the progress of the profession. It is hoped however that this article will help the VN to overcome some of these problems and begin to enjoy engaging in literature searching, because the results can be extremely rewarding and ultimately help improve patient health and welfare.
Different types of information veterinary nurses might use
There are many different types of literature available for a VN to read and review, and many sources of literature that they can access, as depicted in Figure 1.
The type of literature sourced from these different locations will vary dramatically in quality, style of presentation, reliability, validity and ultimately usefulness or how actionable it is (Harvard, 2007). The differences between the categories of literature are detailed in Table 1. The ways to differentiate between a ‘good’ and a ‘bad’ piece of literature will be addressed later in the literature reviewing section of this article.
| Category | Details |
|---|---|
| Primary | Considered an original source of evidence on a topic. |
| Secondary | These sources of information cite, comment on or build on primary sources of literature. |
| Tertiary | These sources of literature are derived from primary and secondary sources, primarily secondary sources. |
| Gray literature | These sources of information are very useful to people with regards to policy and agendas, and they also tend to be readily available online. |
Searching via journal — hard copy and electronic
Aveyard (2010) explained that once a person has decided on a research subject or topic of interest, they must then consider the types of literature that might be most useful to inform them. If a VN is searching for literature on a particular topic out of general interest and in an effort to update their knowledge, reading the weekly veterinary newspapers is a good place to start, such as the Veterinary Times and the Veterinary Nursing Times. They will probably also receive a range of veterinary journals in practice depending on their subscriptions such as The Vet Record, In Practice, The Veterinary Nursing Journal and The Veterinary Nurse. They can hand search through these hard copies of the journals, which does take quite a lot of time and means there has to be a well organized, spacious area or library for storing the back copies. Alternatively, many of these periodicals are now available electronically, which enables the VN to specifically search through the archives of the publications in relation to their particular topic using key words and phrases, or they can search for articles by particular authors. Examples of some journals available electronically include In Practice, The Vet Record and The Veterinary Nurse, all of which require the VN to pay a subscription to access full-text articles. The International Veterinary Information Service (IVIS) at http:// www.ivis.org/home.asp is another very useful electronic resource for VNs to utilize, which facilitates access to a wide variety of congress proceedings from around the world; this simply requires the VN to register with them to become a member.
If the VN types in the name of a journal into any inter-net search engine they will typically be able to search the archives of the journal without any form of subscription and read abstracts. However, to read the full-text articles usually requires a subscription or the VN will be given the option to pay for them; the price of articles does vary considerable between publications, and having paid for a few articles of interest it would probably have been more financially beneficial to have paid the subscription. VNs should be encouraged to review abstracts of all articles carefully (especially those reporting the findings of research studies) before deciding to purchase the full-text versions, as the abstract should give the reader a clear idea as to whether the full article will be useful to them or not. It must also be remembered that an abstract can make an article sound better than it actually is in reality, so the VN must exercise caution when reading them. With regards to research studies, abstracts tend to summarize the entire project in a very small amount of words, and their findings, conclusions and recommendations will typically highlight or suggest that their study has unearthed interesting new knowledge or has added to an existing body of knowledge. In some cases it is only when the full text is read and the study critically reviewed that it becomes clear that there were flaws, be they inappropriate methodology and methods or very small sample sizes, which in fact may invalidate the whole study including the conclusions they have drawn.
If the VN is searching for more scholarly literature in the form or original pieces of research, or systematic reviews they are probably, and have historically been student VNs either on an undergraduate or postgraduate course. However, every VN in practice wanting to improve their knowledge, skills and practice should be encouraged and motivated to source these types of literature too because they are typically primary sources of literature, which will facilitate evidence-based practice by influencing and improving their clinical decision-making skills. Engaging with these types of literature is stimulating, challenging and beneficial to the readers, and clinical VNs can ensure they remain up-to-date with the latest research and current thinking on a plethora of topics. This type of literature sourcing activity and critical reading will inspire practicing VNs to maintain and improve their knowledge base, which in turn will aid the delivery of gold-standard veterinary nursing care and inform and influence practice protocols. For a VN during their studies, this type of literature will also help to improve their knowledge base and learning, it will influence their vocational training and will also support and justify their academic work.
It should also be noted here that textbooks and reference books, which are secondary and tertiary categories of literature are informed by existing knowledge at the time of their writing and publication. A number of years can pass before a textbook is updated and the next edition is published, so all VNs should be encouraged to source and read research papers and articles in between times, as these pieces of information will be more up-to-date than some information in the books; this new knowledge is being generated all of the time and is what the next edition of a book will be updated with.
Searching via databases
Undergraduate and graduate higher education VN students will typically have an institutional username and password from their University that they can use to access a plethora of online research. The students will typically be taught how to search for literature using their institutional details however, from experience, it is a skill which needs to be repeatedly taught and reinforced to ensure they benefit maximally from the evidence-base available. As well as the online resources, there is also always the opportunity for them to visit their institution's library to find relevant literature for review.
Course providers should ideally teach their student VNs how to effectively search for literature using the tools available to them, and from experience demonstrations with student participation is often an invaluable way to teach these skills. Having taught the students how to access the online databases, they should be advised about how to systematically perform a literature search. These students will then be equipped with the skills and knowledge to be able to advise and guide VNs in their practices, thus improving the use of literature throughout the profession. In addition to accessing the electronic resources mentioned previously in the article, the types of databases HE student VNs will be able to access include Academic Search Complete, BioMed, British Medical Journal, CINAHL, Cochrane Library, EBSCO Host, OVID, Science Direct and Web of Knowledge, to name but a few. These databases cover a very wide range of subjects including research into biological sciences, animal sciences, medical sciences and general information for health professionals too.
Strategies for literature searching
As outlined by Punch (2009) and later reinforced by Aveyard (2010), a literature search needs to be a systematic strategy employed by the VN because this will facilitate the sourcing of a wide range of published materials in relation to a topic in as comprehensive a manner as possible. An example of a systematic literature search, including hints and tips is detailed in Table 2
| Step | Comments |
|---|---|
| Focus on a question | What is the topic being focused on? Is there a question that needs to be answered on a topic? |
| Decide on appropriate sources | What type of source needs to be searched? Academic research journals…veterinary/animal related? Topic related? |
| Divide the topic into concepts | What are the different concepts associated with the topic for research, for example if you are exploring student experiences of assessment, what different things or concepts contribute to a student's experience of being assessed? |
| Think of alternatives for the concepts | How else might the concepts you have outlined be considered? |
| Search concepts separately | Do not think you will find everything that is available about student assessments by searching using ‘student assessments’ as your key words/phrase. To perform an exhaustive search you must search each of those concepts you have identified individually |
| Combine concepts (Boolean logic) | If you perform advanced searches you can combine your searches, for example searching for ‘student experience’ in relation to ‘exams’ and ‘OSCEs’ all in combination. Boolean logic shall be outlined later in the article. |
| Limit the search | As well as trying to perform an exhaustive yet focused and effective search, you need to not get carried away. Finding one good research paper and reading their reference list can help you find other useful pieces of literature that you can then search for, but if you are not careful this can get out of control and you may lose your focus. |
| Revise the search | If you find your search is getting a little out of control or is not revealing the most useful or appropriate literature you will need to stop and review your technique. |
| Replicate the search in other sources | If you have found a very successful combination of search terms that has uncovered lots of useful literature for you in one search engine or database, replicate this search in a different database to add to your body of literature. |
Personal experience has highlighted that there are a few other considerations associated with performing a thorough academic literature search, which many student VNs will have encountered and potentially had problems with. One consideration is the vocabulary and spelling used during a search; some sources of literature will use English and some will use American English so it is always worth searching alternative spellings, such as oesophagus (English) and esophagus (American). It is also worth remembering that quite frequently the way people write some words will differ, such as ‘prenatal’, ‘pre natal’ and ‘pre-natal’, and that a search should use all different formats to unearth as much literature as possible.
There are some other more complex facilities available when using search engines, and a VN using these sources will become more familiar with the power of these tools the more they use them. Having developed and refined their skills, VNs should hopefully be able to access the most appropriate literature and speed up the process of them locating it in the first instance through these search engines. The key useful advanced feature of these search engines is the ‘Boolean search’, and this logic should be exploited by all researching VNs to refine their literature searches and maximize their available research time. Boolean searching involves using the words ‘OR’, ‘AND’ and ‘NOT’ when considering key words and phrases. An option to search for each concept within the title, abstract, key words or whole article etc is often available too. For example, if a VN was interested in the effects of induction agents in cats in relation to recovery times they may choose to search for the first combination of terms initially (Table 3). The VN can expand this search to encompass more potential facets of the topic by adding rows to increase the number of search terms as depicted by the second and third combinations in Table 3.
| They might use this first combination: | ||
| Search for | cats | In title/abstract/key words |
| AND | propofol | In title/abstract/key words |
| AND | recovery times | In title/abstract/key words |
| Or they might use this second combination: | ||
| Search for | cats | In title/abstract/key words |
| AND | propofol | In title/abstract/key words |
| OR | alfaxolone | In title/abstract/key words |
| AND | recovery times | In title/abstract/key words |
| Or they might use this third combination: | ||
| Search for | cats | In title/abstract/key words |
| NOT | dogs | In title/abstract/key words |
| AND | propofol | In title/abstract/key words |
| OR | alfaxolone | In title/abstract/key words |
| AND | recovery times | In title/abstract/key words |
The Venn diagrams (Figure 2) show exactly how the ‘OR’, ‘AND’ and ‘NOT’ options refine the searching process in relation to cats and propofol:
The final Venn diagram in Figure 3 shows what would happen if the first combination in the topic from Table 3 was performed. The star represents all of the information that would be gathered that concerns cats AND propofol AND recovery times.
Literature reviewing
Having found the most useful literature available on a particular topic the VN needs to be able to critically read it to establish whether it is a reliable source of information, and whether it contains any actionable information or advice that can be used to improve practice. Thus the main aim of reviewing literature is to discover what knowledge and ideas have been established on a given topic, and what are the strengths and weaknesses of this knowledge, as considered by Aveyard (2010).
Many articles in veterinary newspapers and journals are focused on a particular topic and aim to inform the reader about that topic and update their knowledge. These articles may be an account of the most up-to-date published works of scholars and researchers, disseminate current thinking and advice to veterinary practitioners and are largely peer-reviewed, which instils confidence that the work is robust and reliable information. For the VN reading literature out of general interest or to inform clinical practice, peer-reviewed articles are more likely to be fit-for-purpose.
If a VN is reviewing literature critically as part of their academic studies, they really need to break the piece of work down to examine certain aspects and decide if it is reliable (Crombie, 1996). This is particularly important when the VN is reviewing literature in order to answer a question they have formulated, or to identify a gap in current thinking to justify a proposed research study. These pieces of literature are likely to be peer-reviewed journal articles, but should also include a large number of original research papers; primary research sources. It is also important to remember that VNs in clinical practice must be encouraged to analyze literature in this way too. The decisions they reach about a particular piece of literature, and the actions they take based on the information they have read and evaluated will have a direct impact on the health and welfare of veterinary patients.
In order to fully critique a piece of literature such as an original piece of research, and thus review it appropriately, a VN should ask the following types of question (Crombie, 1996; LoBiondo-Wood and Haber, 2002; Bryman, 2008; Aveyard, 2010):
If the majority of these questions are asked about a piece of literature, the reader should be able to reach a logical, sound overall conclusion about the quality and reliability of it, which will ultimately decide whether they use the literature to inform their academic work and nursing practice, or whether they discount the literature and continue their search.
VNs must be reminded at this point that literature published in peer-reviewed journals, such as The Veterinary Nurse are likely to be reliable pieces of literature to inform their studies and clinical practice, negating the need for such an in-depth critique. The process of peer reviewing should ensure that articles or research that fall below a certain academic quality will not be published in the first place. However, it is always prudent to carefully and critically read and appraise all literature that is read because there may be quality pieces of work published in non-peer reviewed journals, and likewise there are occasional sub-standard pieces of work published in more rigorous journals. Additionally, critical reading and reviewing of literature is always a skill that all VNs can improve and develop, which will eventually mean a VN is able to very quickly identify a good quality piece of literature from a poor one.
Conclusion
As discussed by LoBiondo-Wood and Haber (2002), searching for literature and then critiquing and reviewing it are skills that need to be mastered, which does take time and effort; it tends not to come naturally. To become good at reviewing literature one must read lots of research, practise critiquing it according to a published framework, consult colleagues and academics during the process to exploit their experiences and ultimately learn how different types of literature they read can influence the implementation of research and evidence-based nursing practice.