1. Search question and identifying key concepts:
Start by developing a well-defined search question (Watson, 2020). This helps narrow your focus and ensures your search is purposeful (Paré and Kitsiou, 2017).
To structure your question effectively and identify key concepts, consider using established models such as PICO (population, intervention, comparison, outcome), SPIDER (sample, phenomenon of interest, design, evaluation, research type) or SPICE (setting, perspective, intervention, comparison) (Ellis, 2016; Watson, 2020). These frameworks guide you in formulating a searchable question and help ensure that the literature you find is both relevant and methodologically sound.
For example, using PICO your research question might be: Does pelvic floor muscle training improve symptoms of urinary incontinence?
P-Population=women with incontinence
I-Intervention =pelvic floor muscle training
C-Comparison= compared to no intervention
O-Outcome =improvement in episodes of incontinence
If you are not using studies comparing types of treatment or intervention then PEO (population, exposure, outcome) framework can be helpful (Royal College of Nursing, 2025)
2. Identify some keywords or synonyms
There may be terms or phrases that have a similar meaning to the key concept you have identified so you may want to look for articles using different search terms (Royal College of Nursing, 2025). For example, if your topic is skin damage resulting from incontinence, you may also use the terms:
Moisture lesions, Incontinence associated dermatitis, Moisture associated skin damage from incontinence.
3. Use appropriate search engines and databases
A
database is an online collection of journal articles and citations (Royal College of Nursing, 2025). Some databases give access to full-text articles, while others may only provide summaries (Royal College of Nursing, 2025). There are many different databases available, so it's important to explore which ones your local university or hospital library offers (Ellis, 2016). If you're not familiar with how to use databases, asking a librarian for help is a great idea—they are usually very knowledgeable and willing to assist.
Some commonly used databases include:
CINAHL (Cumulative Index to Nursing and Allied Health Literature)
MEDLINE (Medical Literature Analysis and Retrieval System Online)
4. Try different combinations for your search
Using
Boolean operators (such as
AND, OR, and
NOT) can make your searches more effective by helping you find more relevant articles (Royal College of Nursing, 2025)
- AND helps narrow the search by combining different terms. e.g. Urinary incontinence AND pelvic floor training
- OR expands the search by including related terms or synonyms. e.g. Pelvic floor training OR Kegel exercise
- NOT excludes specific terms to limit unwanted results. e.g. Faecal incontinence
(Watson, 2020)
5. Filter your results
As there may be potentially large amounts of literature sources, you can consider applying some filters to help manage and make the search more relevant (Royal College of Nursing, 2025). These may include:
- Age group of participants
- Peer reviewed articles where possible to increase credibility
- By date (limit to the last 5–10 years unless older studies are important)
- Full text articles
- English language only
6. Run your search and adapt the search strategy if needed
Once you have run your search strategy you will need to review the results (Watson, 2020). You can start by reading article abstracts and assessing their relevance. If you have too many articles it may be necessary to adapt your search strategy. This may be for example by expanding or limiting the geographical area covered by studies, expanding or limiting the date range, or removing or adding a search term (Royal College of Nursing, 2025). You could also try using a different database to see if it produces more relevant material.
7. Save your results and search strategy
When conducting any academic project or assignment, it is essential to clearly document the strategy that you used to do your literature search (Bramer et al, 2018). This includes specifying the search terms used, the databases consulted, the number of publications retrieved, and the criteria for excluding certain publications (Bramer et al, 2018). You should also report how many sources were excluded and provide justifications for their exclusion. If you revised your search strategy at any point, detail what changes were made and why they were necessary (Bramer et al, 2018).
You are now ready to appraise the literature that you have found.
How to appraise nursing research
Research quality can differ significantly, and not every study will be applicable to your needs or the specific clinical context (Critical Appraisal Skills Programme (CASP), 2025). Appraising research therefore helps determine whether a study is trustworthy, meaningful, and applicable to your clinical context (Greenhalgh, 2019; CASP, 2025). The appraisal process can be broken into three main areas:
- Assess the credibility of the research
Ask:
Is this a reliable and trustworthy study?
- Peer review: Was the study published in a peer-reviewed journal?
- Ethical approval: Did the study receive approval from an ethics board?
- Conflicts of interest: Are there any potential biases or funding sources that could influence the study?
- Introduction of bias: Is there the potential for the results to be affected by aspects such as how people were recruited? If it was an intervention study were the participants in both groups equal in terms of characteristics (such as age, comorbidities, gender, ethnicity)
- Evaluate the methodology
Ask:
Is the study design appropriate and rigorous?
- Research design: Was it quantitative, qualitative, or mixed methods? Was it appropriate for the research question?
- Sample: Was the sample size adequate? Was it representative of the population? Sample size matters less in some qualitative-style studies which are focused on quality of information rather than quantity, such as interviews, but is crucial in randomised controlled trials assessing, for example, drug safety and efficacy to establish cause and effect (Sardana et al, 2023).
- Data collection: Were valid and reliable tools or procedures used?
- Analysis: Were the methods used to analyse the data appropriate? Are results clearly presented with statistics or themes?
- Consider relevance and applicability
Ask:
Can I apply this to my clinical practice?
- Population: Does the study population reflect your patient group?
- Setting: Was the study done in a similar healthcare context?
- Intervention or topic: Is the focus relevant to your clinical question?
- Outcomes: What is the research telling us? Are the results meaningful and transferable to your setting?
- Limitations: What are the study’s weaknesses, and how might they affect its usefulness?
(Adapted from Greenhalgh, 2019; CASP, 2025)
Which appraisal tools should I use and when?
It is completely normal to feel overwhelmed at first when you are planning to appraise some literature—but don’t worry. Once you’ve identified the relevant literature, there are many validated tools available to help you evaluate it in a structured and systematic way. As discussed previously, the hierarchy of evidence highlights that different types of studies require different methods of appraisal. Table 1 highlights some examples of appraisal tools available and what type of study they are relevant for. This is why it is essential to understand the research methodology used in each study, as it will guide how you critically assess its quality and relevance.
Table 1. Examples of appraisal tools available (Adapted from: SQuIRE (2015), Ogrinc et al (2016), CASP (2023), Prasad (2024), Hopewell et al (2025))
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