• How-To: Referencing – Modified Harvard System

    by Alan Batt. Last modified: 26/01/14

    In this post we will deal with referencing, an area that presents difficulty for many people.

    A reference is any piece of material (published or unpublished, electronic or audio-visual), to which you the writer of the article/essay refers. It is important to cite all these sources correctly. These references provide evidence of the point you are making, and allow the reader to consult further information on the topic if they so wish. It is also a method of acknowledging other writer’s work.

    Though there is no “correct” or “incorrect” way of referencing, the most commonly used method for prehospital research and writing is the Modified Harvard System. Using this method, the names of the authors and year of publication are provided in the text, and then the full list of references is given at the very end, after the text.

    Using references isn’t difficult – it’s just a matter of getting used to using them! Just remember to be consistent, and always have somebody else check your work before submitting it.

    Take a deep breath, and let’s go…

    Using the Modified Harvard System

    Referencing within the text

    Referencing within the text itself is done by reference to the author and year of publication. This can be done in many ways. For examples see below:

    Single Reference

    Chronic venous insufficiency accounts for approximately 75% of all leg ulcers (Smeltzer and Bare, 2004).


    According to Smeltzer and Bare (2004) chronic venous insufficiency accounts for approximately 75% of all leg ulcers.


    If you use a direct quote you must include the page number from which the quote is taken. e.g. “75% of all leg ulcers are caused by chronic venous insufficiency” (Smeltzer and Bare, 2004, p24)

    Multiple References

    If you make reference to a number of texts published by the same author on the same year you may use (a, b, c,) with the reference to distinguish the book or article to which the reference refers e.g. if referring to two documents produced by the World Health Organisation in 2012, use (World Health Organisation 2012a) for one and (World Health Organisation 2012b) for the other.

    These letters should also be used in the reference list so that the reader can distinguish which publication you are referring to each time that you use the reference. In the reference list this should appear as:

    World Health Organisation (2012a). World Health Statistics. France: World Health Organisation.

    World Health Organisation (2012b). World Malaria Report 2012. France: World Health Organisation.

    Edited Books

    Some books are published under the name of an editor with individual chapters written by different authors. In these situations you should ensure that you reference the individual author rather than the editor of the book e.g. (Tucker 1997). The following would then appear in the reference list at the end of the text:

    Tucker V. (1997). “From Biomedicine to Holistic Health: Towards a New Health Model” In: Cleary A. & Treacy M. (1997). The Sociology of Health and Illness in Ireland. Dublin: University College Dublin Press.

    Corporate bodies

    Where you wish to refer to a publication by a government department, public body or organisation the authorship is not always clear.  Authorship generally resides with the publishers e.g. (Department of Health, 2002), (American Heart Association, 1999) etc.

    Secondary sources

    You should always try to ensure that your references are primary sources, as opposed to quoted in someone else’s work.  There are occasions that this will not be possible. In this situation you may use a reference that has been cited by another author. It must be clear that the reference you are using is from a secondary source.

    Freud’s theory of the Oedipus Complex states between the ages of three and five, children developed an attraction for the parent of the opposite sex, and a hatred of the parent of the same sex. (James, 1964)

    or you could also reference it as Freud, cited in James, as in the example below:

    The Oedipus Complex states between the ages of three and five, children developed an attraction for the parent of the opposite sex, and a hatred of the parent of the same sex. (Freud 1899, cited in James 1964)

    In the reference list at the end of your text it is only necessary to reference James.

    James E. (1964). The life and works of Sigmund Freud. Middlesex: Penguin Books.


    Reference list

    At the end of the work, all references used in the text are listed alphabetically under the author’s name.  This list should allow your reader to find all the references that you used in your text. See the examples below.

    Where there is more than one author, all authors must be cited in the same order that they appear in the book or journal.   If you use material from different years for the same author then the latest work (most recent date) is listed first in the reference list followed by the entry for publications for earlier years.

    Single author:

    Twycross R. (1999). Introducing Palliative Care. Oxford: Radcliffe Medical Press

    More than one author:

    Saunders C. and Baines M. (1982). Living with Dying. Oxford: OxfordUniversity Press

    If the author and the publisher are the same, the name is repeated:

    World Health Organisation (2012a). World Health Statistics. France: World Health Organisation.

    When the work is part of a series, the title of the series should be given:

    Department of Health and Children (1999). Childhood Accidents (Reports on Public Health and Medical Subjects, No. 210) Dublin: Department of Health and Children.

    Edited texts (Collections of works by numerous authors):

    References to works consisting of chapters written by different authors are made under the editor’s name(s):

    Cleary A. and Treacy M. (eds) (1997). The Sociology of Health and Illness in Ireland. Dublin: University College Dublin Press.

    Where referring directly to a chapter published in an edited work:

    Reference is made to the author of the particular chapter. The word “In” should follow details of the chapter:

    Tucker V. (1997). “From Biomedicine to Holistic Health: Towards a New Health Model” In: Cleary A. and Treacy M. (1997). The Sociology of Health and Illness in Ireland. Dublin: University College Dublin Press.


    Journal Articles

    The author’s name and page number of the article are always included. The title of the article follows the year, and can be included in inverted commas. The journal name then follows this, and this can be underlined. Then the Volume number follows this, followed by the issue number in brackets. Finally the page numbers of the article should be included. See examples below

    Single author:

    Weingart S.D. (2011) Preoxygenation, Reoxygenation, and Delayed Sequence Intubation in the Emergency Department. The Journal of Emergency Medicine. 40(6): p. 661-667.

    More than one author:

    Weingart S.D. and R.M. Levitan (2012) Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Ann Emerg Med 59(3): p. 165-175.e1.



    Quaile A. (2013). “The importance of awarding excellence”. Journal of Paramedic Practice. 5 (7): p369

    Sometimes the author of an editorial is not included with the text.  If not the references can be listed under the name of the journal.

    Nursing Times (1999). Editorial Nursing Times 69 (50):  p1671.


    Conference Papers

    Papers from conferences should be referenced as for chapters in a book. See examples below:

    O’Leary G. (2005). “Patient Support and Quality of Life – Organ Conserving Surgery.” In: Head and Neck Study Day, UCD. 3rd March 2005. Unpublished.

    Kaasa S. (2004). “Dying Patients – What should be the standard of care?” In: MASCC/ISOO 16th International Symposium on Supportive Care in Cancer. June 24-27 2004, Florida: MASCC/ISOO



    Corporate Authors

    Any report which is not the responsibility of any one individual should be listed under the name of the body/bodies responsible for its publication.  Reports should not be listed under the name of the Chairperson of a committee in spite of the fact that they may be commonly referred to in this manner.

    Multiple Sclerosis Society of Ireland (1996). Multiple Sclerosis: Multiple Challenges. Cork: Multiple Sclerosis Society of Ireland.



    Secondary references

    As stated earlier, always try to use primary/original sources.  When this is not possible, then use the reference for the work in which it is quoted.

    James E. (1964). The life and works of Sigmund Freud. Middlesex: Penguin Books.



    Electronic references

    It is important to reference literature from electronic sources such as databases, the internet and email clearly.  An approved format for the referencing of such items does not exist as of yet, so the Modified Harvard System can be adapted for use in such situations. The following information should be included where possible:

    • Author/s name and initials
    • Year of publication
    • Title of the document being referenced (with an edition or version number if later than the first) (e.g. the title of a web page, PDF document etc.)
    • Location – URL, ftp address, etc – wherever the user has to go to in order to locate the document in question (e.g. http://www.cancer.ie/pdfs/Breast.pdf)
    • The date you accessed the resource.  This is essential if a document is likely to change or move.
    • You need to check the reliability and authenticity of the information from any website. The authorship of websites can often reside with voluntary organisations, NGOs, community organisations etc.

    All website and email addresses should be recorded exactly as displayed within the source. All symbols etc must be included, as well as the use of capital letters. No symbols or punctuation should be added.



    Author’s name, full title of the document in quotation marks, full title of the CD/DVD, publisher, the date of publication.

    e.g. Schnell F.M. (2003). “Overview of Emesis and efficacy of agents for CINV”. Controlling Chemotherapy-induced nausea and vomiting. Advancmed: 2003.


    Internet document/PDF document

    Be sure that you include the full, correct address for the document you are referencing. See examples:

    National Multiple Sclerosis Society (2004). “Multiple Sclerosis Information Sourcebook” http://www.nationalmssociety.org/sourcebook.asp (Accessed 15th April 2012)

    Irish Cancer Society (2002). “Understanding Breast Cancer”  http://www.cancer.ie/pdfs/Breast.pdf  (Accessed 15th September 2012).


    Phew…that’s it!

    There is quite a lot there to referencing correctly, but it is a skill that you will develop over time, and it is not that difficult. The important part is to write down your references accurately as you go, this will prevent you having to look for references in a panic, and ultimately will help you to avoid making mistakes while referencing.

    Using a citation manager such as EndNote or Mendeley can make your referncing life much easier, check out the resources page for more information.


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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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