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Nursing: 6S/Foreground Info

Explore library resources for the Nursing program at McMaster.

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Foreground Information and the 6S Pyramid

Foreground questions are best answered by evidence found at different levels of the 6S Pyramid.

6 S pyramid of the hierarchy of evidence

The different levels of the pyramid are outlined and colour-coded to the right.

Use the concepts identified in your PICO Question to come up with approriate search terms, remembering that:

  • A piece of evidence's ability to guide clinical action increases as you move up the pyramid.
  • Topics become more specific as you move down the pyramid.

HSL's Database Fundamentals Tutorial will explain the process of building an effective and efficient search.

Off-Campus Access

The small lock icon office campus lock icon beside a link indicates this is an online library resource.  When you click on the resource link from off-campus you'll be redirected to a login page. Login using your MacID and password to access the content.


Meta-Searches search for evidence across multiple resources.  These tools return information from all levels of the pyramid:

Citing Sources


Integrating information from the lower levels of the hiearchy with individual patient records, systems represent the ideal source of evidence for clinical decision-making. 


Summaries are regularly updated clinical guidelines or textbooks that integrate evidence-based information about specific clinical problems.

Clinical Practice Guidelines

Please note, some guidelines are also published in journals. To find these, you can build your search in a journal database and apply publication type limits for practice guidelines. You may also try adding practice guideline, clinical practice guideline, to your search terms. The TRIP database, located under the Meta-Searches category, is another good resource for locating clinical practice guidelines.

Evidence-Based Texts

Synopses of Syntheses

Synopses of syntheses, summarize the information found in systematic reviews.  By drawing conclusions from evidence at lower levels of the pyramid, these synopses often provide sufficient information to support clinical action.

Evidence-Based Abstract Journals


Commonly referred to as a systematic review, a synthesis is a comprehensive summary of all the evidence surrounding a specific research question.    

Journal Databases - Systematic Reviews and other forms of knowledge synthesis can be found using the limits by publication type and by adding terms into your search e.g. "systematic review".

Synopses of Single Studies

Synopses of single studies summarize evidence from high-quality studies.   The following evidence-based abstract journals are the best place to find this type of information:

Single Studies

Studies represent unique research conducted to answer specific clincial questions.

Article Databases

Clinical Queries

The CINAHL, OVID (Medline, EMBASE, PsycINFO, and more), and Pubmed databases can be searched using the Clinical Queries filter, limiting your results to specific clinical research areas: Therapy, Prognosis, Review, Qualitative, and Causation (Etiology)

For further information and tips on using the Clinical Queries filter, please visit the following links: