Two incidents are weighing heavily on my mind as I worry about the future of the nursing profession in this world of information technology and evidencebased practice. The first occurred several months ago at a student nursing conference. Two soon-to-graduate baccalaureate students told me they had yet to spend any time in the school library searching for information for research papers or care plans. They got information, they said, from the World Wide Web, their textbooks, or the two journals to which they subscribed. They didn't feel it was necessary to search CINAHL® or MEDLINE®. They were convinced they had everything they needed. Will they always practice nursing based only on what they know now?
The second incident was a poster presentation by two doctoral candidates from Louisiana at the Sigma Theta Tau biennial convention in San Diego in November 1999 (Pierce, 1999; Tanner, 1999). Their research examined electronic information-seeking by practicing nurses (including advanced practice RNs), faculty, and baccalaureate and graduate nursing students. They found that only a small percentage of their sample, including faculty, had Internet access at home or work, most did not use either CINAHL or MEDLINE successfully, and although the subjects agreed that nurses should use research in their practice, most did not regularly read research articles. In fact, 16% of the nursing faculty stated they never read a research study.
Why do I find these events so troubling? First, the students in the first incident did not realize what they were missing. In their complacency, they were unaware of- and unconcerned by- the vast amount of information that should be part of their clinical decision-making and resulting nursing practice. If they are not searching the literature, how can they know what they are not reading? The ability to think critically is essential for evidence-based nursing practice. I agree with Verhey, who in this Journal recently stated that "accessing bibliographic databases and obtaining current information is the first step in the development of critical thinking and problem solving skills" (Verhey, 1999). If students are not educated to use these tools, where does that put their critical thinking?
Second, these tools are also going unused by many practicing nurses and faculty members, perhaps because they are either intimidated by them, unfamiliar with them, or overwhelmed by what they consider to be the tremendous task of learning how to use them. As long as this continues, there is little hope that those students or their peers in the first incident will be educated to use the tools by their mentors and faculty. If this is the case, when will the cycle end? Faculty members are, on average, in their 40s or older, were not "raised" with the electronic tools such as bibliographic databases, have had the benefit of librarians to do their searches for them, and have not always had easy access to or understanding of computers. To stress the importance of information- seeking and information literacy to their students along with the professional obligation of career-long literature searching, faculty has to believe it and live it themselves. If they are themselves inadequately trained, how will this happen? And what does this say about our future? This is a serious threat to our profession in a time when information is abundant and the ability to filter and evaluate it are vital.
Which brings me to my third area of concern- how do we as database or information providers ensure that faculty are aware of new changes and features so that they can be comfortable enough to educate their students? Everyone knows how quickly things change in the electronic world. Just as publishing hundreds of new nursing journals accomplishes nothing if they aren't read, adding new features or information to a database is useless if no one knows about it. When I was an undergraduate nursing student the only way to search the nursing literature was through the Cumulative Index to Nursing Literature (the "Red Books" we called them) or through the International Nursing Index- looking up one heading at a time and manually eliminating duplicates. When the "Red Books" became the CINAHL database, searching became easier and more exciting in the combining of terms, searching of various fields in the bibliographic citation, or limiting to certain years of publication.
Every year, along with adding more types of materials to index such as doctoral dissertations, software, audiovisuals, nurse practice acts, research instruments, standards of practice, and codes of ethics (many of which are available in full text), we at Cinahl add more subject headings with which to index and more fields to provide access. For example, the cited reference field contains the references listed at the end of the article (when permission is given by the publisher to include this material). The grant information field includes the verbatim description of the granting source as presented in the article. Imagine being able to search for a particular grant number in the grant information field and then following the progress of the research resulting from that grant by searching for the original authors as a reference cited in subsequent research by others. And that subsequent research cited by others who follow. We will easily see the development and progress of nursing knowledge.
Information about the CINAHL database, as well as a "demo" database, is available on the CENAHL website at http://www.cinahl.com. Medical librarians are also wonderful resources who can assist in answering questions about search techniques or strategies. But the only way to really know how these systems work is to use them, to practice with them, to be persistent, to ask for help. For the good of the nursing profession, educators must master these tools and demand mastery from their students.
- Pierce, S.T. (1999). Information needs identified, information resources utilized, and electronic information-seeking processes applied by nursing faculty and students in identifying and retrieving nursing information Poster presentation, Sigma The ta Tau Biennial Convention.
- Tanner, A. (1999). Clinical information needs identified, information resources utilized, and electronic information seeking processes applied by registered nurses. Poster presentation, Sigma Thêta Tau Biennial Convention.
- Verhey, M.P. (1999). Information literacy in an undergraduate nursing curriculum: Development, implementation, and evaluation. Journal of Nursing Education . 38(6), 252-259.