Is “Nurse” Necessary? Questioning Redundancies in Breastfeeding Research Searches

Observation

A systematic review titled “The Relationship between Partner Support and Breastfeeding Self-efficacy: A Global Systematic Review” was recently conducted. This parent systematic review was registered in PROSPERO (CRD42025615339) and conducted in line with MECCIR standards. It aimed to examine the evidence on partner support and its impact on breastfeeding self-efficacy. Seven databases (MEDLINE Complete, Embase, CINAHL, Web of Science, Scopus, The Lens, and the Maternal and Child Health Library) were searched from inception to mid-January 2025, with no language restriction, using controlled vocabulary and keywords related to breastfeeding, self-efficacy, and partner support. Two reviewers independently conducted title/abstract and full-text screening using predefined eligibility criteria based on the Population, Concept/s, Context (PCC) framework. A total of 21,214 records were retrieved, out of which 10,122 were eligible to be title and abstract screened after the removal of duplicates. Only 14 citations met inclusion criteria in the parent systematic review.

Critiques of Current Practice

During the screening phase, an overwhelming number of articles that discuss nursing as a profession or nursing care rather than breastfeeding were found—most likely due to the use of “nurse” and “nursing” in the search strategy.

Methods

Two search strategies were conducted at the end of May 2025 on Medline Complete (EBSCOhost) and Embase, one with the keyword “nurs*” and another one eliminating “nurs*” as a keyword from titles, abstracts, and keywords.

Results

Records retrieved from Medline Complete and Embase decreased substantially when “nurs*” was excluded, from 856,394 and 1,061,716 to 301,671 and 395,330, respectively (Table 1).

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Table 1.

Difference in Retrieved Records With and Without the Use of “Nurse/Nursing” Keywords on Medline Complete and Embase Databases.

	Medline Complete		Embase
	Search Strategy	Records Retrieved	Search Strategy	Records Retrieved
With “nurs*” Keyword	(MW “Breast Feeding”) OR (MW “Bottle Feeding”) OR (MW “Milk, Human”) OR (MW “Breast Milk Expression”) OR TI (breastfeed* or breast-feed* or breastfed or breast-fed or “human milk” or breastmilk or breast-milk or lactat* or ((infant* or child* or boy* or girl* or neonat* or toddler* or baby or babies) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*)) OR AB (“breast feed*” or breastfeed* or breast-feed* or breastfed or “breast fed” or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or nurs* or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*)) OR KW (“breast feed*” or breastfeed* or breast-feed* or breastfed or “breast fed” or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or nurs* or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*))	856,394	breast feeding/ or breastfeeding transmission/ or breast milk/ or breast pump/ or lactation/ or (breastfeed* or breast-feed* or breastfed or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or nurs* or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) adj3 (fed OR feed*)) or (IYCF or (formula adj3 milk)) or ((breast or milk) adj3 pump*)).ti,ab,kw.	1,061,716
Without “nurs*” Keyword	(MW “Breast Feeding”) OR (MW “Bottle Feeding”) OR (MW “Milk, Human”) OR (MW “Breast Milk Expression”) OR TI (breastfeed* or breast-feed* or breastfed or breast-fed or “human milk” or breastmilk or breast-milk or lactat* or ((infant* or child* or boy* or girl* or neonat* or toddler* or baby or babies) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*)) OR AB (“breast feed*” or breastfeed* or breast-feed* or breastfed or “breast fed” or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*)) OR KW (“breast feed*” or breastfeed* or breast-feed* or breastfed or “breast fed” or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) N3 (fed OR feed*)) or IYCF or (formula N3 milk) or ((breast or milk) N3 pump*))	301,671	breast feeding/ or breastfeeding transmission/ or breast milk/ or breast pump/ or lactation/ or (breastfeed* or breast-feed* or breastfed or breast-fed or “human milk” or “breast milk” or breastmilk or breast-milk or lactat* or ((infant* or child* or boy or boys or girl or girls or neonat* or toddler* or baby or babies or newborn* or new-born* or offspring* or off-spring*) adj3 (fed OR feed*)) or (IYCF or (formula adj3 milk)) or ((breast or milk) adj3 pump*)).ti,ab,kw.	395,330
Percentage Reduction With and Without “nurs*” Keyword	65%		63%

To assess whether this reduction affected comprehensiveness, we compared the studies included in the final review across both search strategies, based on predefined inclusion criteria. All included studies were captured by the reduced search, suggesting that no relevant evidence was lost.

Limitations

This analysis was based on two databases and one review topic, which may limit generalizability of findings. Search terms and indexing can differ across databases, and in some situations, including “nurs*” may still be necessary to find relevant studies. These results should therefore be interpreted cautiously and viewed as context-specific rather than universal.

Implications for Research and Policy

Including the terms “nurse” or “nursing” in search strategies for breastfeeding research can introduce significant inefficiencies and compromise the quality of evidence. These terms are vague since they commonly refer to nursing as a profession or nursing care settings, rather than infant feeding, especially breastfeeding. Thus, searches yield a high volume of irrelevant literature that requires screening for identifying relevant articles and filtering unrelated results; this is a consumption of both time and effort. Moreover, this increases the risk of overlooking key studies that use more precise terms like “breastfeeding” or “lactation.” Incomplete or skewed evidence bases weaken the validity of systematic reviews that inform public health policies and clinical guidelines. Policies derived from flawed evidence risk inadequate support for lactating parents and create inconsistency in clinical practice. Clear and precise terminology in search strategies is therefore essential, not optional, for producing rigorous research and policy grounded in reliable evidence. Nevertheless, the inclusion of the truncated keyword of nurse and nursing, that is, “nurs*” remains important in reviews focusing on breastfeeding in nursing practices or healthcare delivery.