When EBSCO Publishing acquired CINAHL Information Systems in 2003, they promised to keep CINAHL intact as well as to develop enhancements that would further the usability of this primary nursing and allied health database.
It seems EBSCO has kept its word with the introduction of CINAHL Plus, an expanded version of the original Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition to the original content, CINAHL Plus includes over 300 additional journals; new materials such as Evidence-Based Care Sheets, Quick Lessons, and Search Strategies; expanded searchable cited records; and indexing for important journals in nursing and allied health dating back to 1937.
For users familiar with the EBSCOhost design layout, the CINAHL Plus search screen is similar. EBSCOhost CINAHL users have always had the option to search or browse using a variety of methods. CINAHL Plus adds two more: Evidence-Based Care Sheets and Quick Lessons. The search results screen has added tools as well. While CINAHL simply displays all results by date, options are available in CINAHL Plus to filter and sort results by Periodicals, Books, Continuing Education Units (CEUs), Evidence-Based Care Sheets, Quick Lessons, Research Instruments, and Search Strategies.
Evidence-Based Care Sheets and Quick Lessons
Evidence-Based Care Sheets provide two page portable document format (PDF) summaries of treatment care for many conditions and include a list of references. They are intended to be general informational overviews of the subjects for health care professionals. Users may browse for a term or select a topic from an extensive list. While these care sheets are certainly useful for nurses at point-of-care, one must consider the caveat of authority. Care sheets are written by CINAHL Information Systems. Reviewers and their affiliation (generally members of a Clinical Research Council) are duly noted at the end of the material. To further aid users in evaluating the effectiveness of recommendations, a “coding matrix”' classifies references at the end of the care sheet, listing everything from “M” for meta-analysis to “GI” for general or background information, texts, or reports. The sheets also include a disclaimer that assumes no liability on the part of CINAHL Information Systems for included information.
Quick Lessons are similar to the Evidence-Based Care Sheets, again providing two-page summaries in PDF for many diseases and conditions, with references. Quick Lessons include etiology, clinical presentation, assessment, treatment goals, and other information tidbits, such as “Red Flags” to consider during treatment and advice for the patient's family. Like Evidence-Based Care Sheets, users can either browse for a term or select a topic from an extensive list. Quick Lessons also index CEUs and exam questions, which can be divided into their own list using the CEU or Quick Lesson sort buttons. However, the content of the two did not have much difference.
While Evidence-Based Care Sheets and Quick Lessons are useful additions to CINAHL, the search/browse process leaves much to be desired. Within the topic lists, users have the option to search for terms, however, if there are no results for a topic, the page reloads in the alphabetical location where the topic would appear. This can be confusing, as there is no message indicating “no results found.” In addition, subject coverage is limited: as of March 2006, only 92 Evidence-Based Care Sheets and 148 Quick Lessons were available.
Search Strategies
Search Strategies are an interesting addition to CINAHL Plus. Presented again in two-page PDF format, Search Strategies begin with a case study and then offer strategies on planning a search related to the topic. Search concepts are compared and mapped to CINAHL terms in a simple table, while flowcharts illustrate limit options like Explode and Focus. Illustrated graphics of Boolean operators are included to demonstrate the use of “AND” and “OR” in searching. Finally, a selected bibliography is attached that includes both CINAHL Accession numbers and PubMed identification numbers (PMIDs) in the citations.
Search Strategies are published by CINAHL Information Systems and are written by a small but talented group of authors. Several contributors were authors of Information RN: Searching the Literature for Lifelong Learning in Nursing (1988). In addition, notable librarian Margaret (Peg) Allen, AHIP, is credited for several entries. While some may look upon Search Strategies as a subtle threat, this tool could be useful to librarians as a handout during education sessions or as a hint sheet for a patron. For students, Search Strategies present a way to learn how to use a database without having to ask. This may make some librarians uncomfortable, but, with remote access and off-campus learning becoming more prevalent, it would be a boon for more databases to provide this type of content.
Cited References
Another added benefit to CINAHL Plus is an increased number of searchable cited references as well as a Cited References search screen, which is available from the Basic and Advanced Search. On the Cited References search screen, users enter terms in the author, title, source, year, or all fields. The results of a cited reference search are displayed below in the Cited References sub-tab. The search fields remain available so users can edit search terms or run a new search. Users can mark records and retrieve a list of Citing Articles from the results of the Cited Reference search.
Cited References also appear on the Search Results screen, where each citation indicates the number of cited references, when available. Although CINAHL Plus includes searchable cited references for more than 1,160 journals, not all cited references have abstracts or detailed records. In addition, references are listed randomly on the Cited Reference results page. For example, when comparing an original bibliography from an article to the CINAHL Plus Cited Reference list, references were not listed alphabetically (as they appeared in the full text), by date, or in the order they were cited in the text. In addition, no information was provided regarding the algorithm or order used in displaying CINAHL Plus cited references.
In the Cited Reference page, users may also be confused by the Related Records feature. To view records related to the original article, users are advised “to mark checkboxes and click Related Records.” This leads users to a list of related records that seem to be the bibliographies of the articles listed as the original record's cited references. The Related Records feature is an excellent way for users to mine out related articles they may have missed, but confusion may reign in the process.
Coverage
While CINAHL Plus touts indexing dating back to 1937, a closer look reveals only a small selection of journals offer this type of coverage. RN and the American Journal of Nursing are the only two journals dating back to 1937 in the CINAHL Plus database coverage list. The next closest journal is Geriatrics, with coverage beginning in 1946.
Conclusion
CINAHL Plus adds a variety of new features to the original CINAHL database. While the functionality of some of the new search mechanisms leaves something to be desired, the usefulness of the available content cannot be denied. Users would be wise to consider the authority of information presented, especially when using the Evidence-Based Care Sheets. Simply including “evidence-based” in an article title does not make the material good information. Users should examine the type of materials used to back up an evidence-based recommendation, as many care sheets cite evidence of only marginal strength. Nursing students should also note that care sheets and Quick Lessons, while useful for an overview, are not primary journal articles and should not be substituted as such when writing a paper. Overall, CINAHL Plus does a good job in providing new and useful content. The challenge, as always, is providing users with simple tools and methods to mine out the information.