AML: CINAHL - Advanced Searching

Open CINAHL Searching in another browser window to work through this tutorial side by side.


CINAHL is the most comprehensive source for nursing and allied health information.

This guide should be used simultaneously with the live website (on the right).

The guide will:

  • Provide an overview of using subjects, subheadings, and refining tools
  • Explain other features such as the Tree View and refining results
  • Suggest sample searches using these features

Use the arrows at the bottom to navigate the guide page by page.


Navigating the Guide

Using Guide on the Side (GotS):

  • The menu button (top right of guide) Menu Button can be used to skip to any section of the guide.
  • Links to additional information appear throughout the guide.

This tutorial has been approved for CEU credits

This continuing nursing education activity has been approved by the Montana Nurses Association for 1 contact hour. Montana Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

For more information regarding contact hours, please call Kathy Murray, 907-786-1611.

To receive a completion certificate, learners must answer all the questions posed throughout the tutorial.

Let's begin with a brief review.

What is CINAHL?

CINAHL is the largest and most in-depth nursing research database. This licensed online source for high quality nursing and allied health article citations includes some full text articles links.

The abbreviation stands for the Cumulative Index to Nursing & Allied Health Literature.

CINAHL Plus with Full Text provides:

  • full text for 734 journals
  • indexing for 5,000 journals in the fields of nursing and allied health
  • 4,300,000 records
  • 1930's-present
  • 55% of the citations are not in PubMed/MEDLINE.

Why use CINAHL?

This tool provides citations for:

  • nursing dissertations
  • full text CEUs
  • selected conference proceedings
  • standards of practice
  • educational software
  • audiovisuals, books
  • book chapters

CINAHL provides full text for:

  • evidence-based care sheets
  • quick lessons
  • clinical innovations
  • critical paths
  • drug records
  • research instruments
  • clinical trials. 

It also includes reviews and protocols from the Cochrane Database of Systematic Reviews and publications from the National League for Nursing and the American Nurses' Association.

Library online article tools provide greater flexibility in refining search results.  The tool is already focused on the topic of nursing, so fewer unrelated articles will appear in the results of a search.

How Do I Access CINAHL

From the Library homepage:

1. Choose Databases, then enter CINAHL  

Overview of the Searching Process

The following slides will move you through the searching process. You will:

1. Determine the research question.

2. Enter one subject/topic/concept at a time.

3. Explode the subject if this option exists.

4. Add relevant subheadings.

5. Search for the next subject headings; repeat steps 1-3 until all subjects have been entered.

6. Combine subjects using OR, AND.

7. Focus using the Edit search feature to limit to peer review, age groups, etc.

8. View the results.

9. Try different combinations or additional subject terms if not satisfied with the results.

Chapter: Determine the Research Question

Step 1: What is the research question?

  • Often the hardest step is determining the research question. 
  • Write the question down as one simple sentence.
  • For example: Do air beds help prevent pressure ulcers?


Subject Searching

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Subject headings are standardized terms that describe a concept. They help you find articles about topics that can be expressed in many ways.

For Example: Cancer can be described in various ways, including malignancy, carcinoma, melanoma, breast cancer, etc.

With all these possible terms to choose from, how do you know which to search on?

In CINAHL, the subject heading for cancer is Neoplasms. By searching on Neoplasms, you'll find articles about this topic regardless of how an author may have referred to it.

Tip: Read the Scope note to learn how this subject is used in CINAHL. Scope notes are found in the third column to the right of each subject heading.

Subject Searching

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To begin searching for articles on a topic, make sure that the Suggest Subject Terms box is checked. This allows the computer to help you choose a more exact subject heading.

Snippet of entry page

More About Subject Headings

Subject Searching

3 of 4Step 2: Enter each concept one at a time and use the subject heading suggested by the computer.

Enter decubitus ulcers in CINAHL. 

Instead of decubitus ulcers, CINAHL tells us to use?

Subject Searching

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Click on the underlined CINAHL Heading, Pressure Ulcer.

You are now in the Tree View for this term.

The Tree View shows broader and narrower terms for Pressure Ulcer.

Heel Ulcer, which is indented under Pressure Ulcer, is a narrower term of this subject heading.


1 of 2Step 3: Explode subject heading(s) for a more comprehensive search.

CINAHL Subject Headings are arranged in a hierarchy.
The Explode feature lets you select the term, plus any terms indented underneath it.

If a term has a "+" next to it, then it also has a set of "children" term indented under the "parent" or broader term.  These will also be included in the results of an exploded search.

Check the Explode box for pressure ulcer - it is the first column to the right of the subjects.  This will search for all indented/narrower subjects:


Rule of Thumb: ALWAYS EXPLODE!!

Can pressure ulcer be exploded?


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If pressure ulcer is exploded, two narrower terms will also be searched: heel ulcer AND deep tissue injury.



Step 4. Add relevant subheadings.

Subheadings are qualifiers used in conjunction with subject headings. There are 68 topical subheadings that can be linked to CINAHL subject headings. Examples of subheadings are: adverse effects, diagnosis, or prevention and control. 

Click the yellow "call out" image to see a definition of how this term is used.


Not all subheadings can be used with all subject headings; for example, the subheading /etiology is meaningless linked to the subject heading NURSING PROTOCOLS.

Our question implies we are looking for ways to prevent pressure ulcers. 

What subheading would you attach to pressure ulcers?

Choose the correct subheading and link it to pressure ulcers.  Click on Search Database.

Explanation of Major Concept

Chapter: Continue to Add Subject Headings, One at a Time

Step 5: Add the next subject headings; repeat until all subjects have been found.

Enter air bed.  Resulting list gives two possible subject headings.  If you are uncertain as to the most relevant subject, consider searching both using OR.

Combining Results

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Step 6. Combine subjects using AND, OR.

After all the subjects have been searched, the next step is to combine the results using AND, OR.

Boolean Operators Explained

Let's say that we ran a search for pressure ulcer OR decubitus ulcer and got 2,140 results.  What would happen if we changed this search to pressure ulcer AND decubitus ulcer?

Combine your two concepts: pressure ulcer; air bed.  To combine subjects, use the boxes to the left of each result.  Then click Search with AND.

How many articles did you find?

Combining Results

2 of 3What if we changed our question to the impact of staffing levels on pressure ulcers?  Enter staffing levels.

Personnel Staffing and Scheduling looks like a good heading!

Click on the underlined heading to see the Tree View for this term.

Which of the following are narrower terms of the CINAHL subject heading, Personnel Staffing and Scheduling?

Check the Explode box in the first column - to the right of Personnel Staffing and Scheduling.  And then click Search Database.

Combining Results

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Next, combine Personnel Staffing and Scheduling with pressure ulcers.  Check the box to the left of each entry and then choose Search with AND.

Combine using AND

How many articles did you find?

Refine Results

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Step 7. Focus your results


Use the Edit search feature to refine your results to peer review, research articles, English articles, evidence-based articles, age groups, gender, etc.

Limit your results to English, peer review articles.

How many articles remain?

Another way to focus search results is found on the left hand column called Refine Results.

To see all the limits, click on the Show More link:

Refine Results

You are now on the Search Options page.

Refine Results

2 of 2Let's go back to the original question - combine the air bed result with preventing pressure ulcers. Click on the appropriate View Results link.

Review the titles and maybe the abstracts - do the articles seem relevant?

Open the PDF of the following article in your search results:

"Bed care for patients in palliative settings: considering risks to caregivers and bed surfaces"


How many figures (images / charts / tables) are in this article?


View Your Results

Step 8: Do you like the results?

Each record will include the citation information for the individual source and a link to full text if it is available

The citation includes information about the:

  • title
  • author
  • name of the journal or publication
  • date.

Click on the title of the result to see more information, such as an author provided abstract, and a list of Major and Minor Subjects for this article.

Tip: If you click on one of these subjects, a new search will be conducted just for that topic.

You may want to start a list of these subjects so you can keep track of the words you are using for searching.

Tip: Use the Delete Searches button to remove searches from your search history.

Save, Print and Export Articles

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The tool view differs depending if folders are used or if only one article is listed.

For one PDF, look on the right-hand side of your screen.  You can print it out, save it, email it to someone, cite it or export it to citation software in APA format.

The cite option can be particularly useful because it will create citations for the source in all major formats including APA style. You can copy and paste this text into the bibliography for your research paper.

Save, Print and Export Articles

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 Return to the results list.

Image showing Return to Results List location

Click the folder (to the right of the article title) for 3 or 4 articles.

Open the folder using either the folder icon in the blue bar at the top of the screen or the Folder View in the Folder has items link in the right column.

Image of the Folder has items

Click Folder View.  Select all or choose one results at a time.  Tools in the right column include:

  • Print
  • Email
  • Save to File
  • Export

If you choose to email your results, consider using the option to include your search history.  This will give you a record of what you've discovered in the CINAHL database.

Try a Subject Search

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Now that you have been guided through searching CINAHL using subjects, subheadings, and refining your results, try using the database to answer the following three questions.

Question: Is the shingles vaccine effective in preventing or reducing the severity of shingles in adults?

Open CINAHL.   

Keep Suggest Subject Terms checked.

Enter your first subject: shingles

What subject is suggested by the computer?

Try a Subject Search

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Click on the subject heading.  This brings up the Tree View which shows the arrangement of subjects from broad terms at the top of the page to narrower terms indented under the broader topics.

How many narrower items are found indented under herpes zoster?

Try a Subject Search

3 of 9Search for all types of herpes zoster - by clicking the Explode box - the first column to the right of the subject terms.

Since we want to try and prevent patients from suffering from shingles, what subheading would you choose? 

Subheading choices:

Try a Subject Search

4 of 9Now click Search Database.

How many articles were found?

Search for the next subject: vaccines.

Is there a specific subject for herpes zoster vaccine?


 Choose the best subject for herpes zoster vaccines. 

Can this subject be exploded?

Click the Search database button.


Try a Subject Search

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Select the boxes next to the disease and the vaccine.  Combine using AND.

How many articles did you find?

Use the Edit feature and refine your results to the age group: middle aged.  Then one more group of options: peer reviewed, English, research articles.

How many articles remain?

Try a Subject Search

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Question 2: Using OR as well as AND

Medication errors are a continuing problem.  Nursing workloads and attitudes may contribute to this issue.  How many evidence-based articles can you find on preventing medication errors linked to these two nursing issues?  Refine your results to peer reviewed articles in English. Use other limits that seem appropriate.

Which of these two options would give the most comprehensive results?

Try this search in CINAHL.

Try a Subject Search

7 of 9Click on the image to see one way of doing this search.

Search Result 1

Try a Subject Search

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Question 3: Combining Subjects to Describe a Concept

Your patient is an adolescent just diagnosed with type 2 diabetes.  He needs to learn more about dietary changes, the role of exercise and how to give himself injections.  As always, peer reviewed articles are preferred.

NB:  Subjects that are qualified by [Iowa NOC] or [Saba CCC ] are not articles on the subject, but rather articles about this particular nursing classification scheme.  Avoid these red herrings!

Use or to combine the subjects for diet, exercise, and injections. 

Try this search in CINAHL.

Try a Subject Search

9 of 9Click on the image to see one way of doing this search.

Search Result 2


You have successfully completed the CINAHL-Advanced Searching tutorial!

If you have questions or need help searching CINAHL, please contact your librarian for more help.  Consider using the Ask a Librarian feature (top blue bar) as a way to share your search history, with the librarian.

To get credit for this tutorial:

  • Students, include your name and email to
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