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AVirtualNursingJournalClub_BridgingtheGapBetweenResearchEvidenceandClinicalPractice.pdf

Author Affiliations: Clinical Nurse Specialist (Ms Rosen) and Nurse Scientist (Dr Ryan), Professional Development, Practice & ResearchDepartment, SouthNassau Communities Hospital, Oceanside, New York.

The authors declare no conflicts of interest. Correspondence:MsRosen, SouthNassau Communities Hospital,

One HealthyWay, Oceanside, New York 11572 ([email protected]). DOI: 10.1097/NNA.0000000000000824

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T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N

A Virtual Nursing Journal Club

Bridging the Gap Between Research Evidence and Clinical Practice

Jacquelyn Rosen, MS, RN, PMHCNS-BC Marybeth Ryan, PhD, RN, ANP

Creating a nursing journal club is an initiative to pro- mote nurses' use of best evidence in practice. A virtual nursing journal club (VNJC) was implemented in a Magnet®-designated, midsize community hospital. The VNJC fostered nurses' reading nursing research studies and subsequent interaction with other nurses. The VNJC's formation, implementation, and evalua- tion are described. Quantitative and qualitative re- search critique items and an evaluation form are included that are essential to the site's ongoing processes.

In the early 1990s, research utilization evolved into a new and more rigorous, systematic process, that is, evidence-based practice (EBP), which has become the criterion standard for nursing practice. Evidence-based practice is defined “as a lifelong problem-solving approach to clinical practice.”1(p3) It involves use of the most current and best research, one's clinical ex- pertise, and the patient's values and preferences; all are essential to answering clinical nursing problems, providing safe and quality care, and yielding positive patient outcomes.1

The Institute of Medicine's2 report advocating the use of strong research evidence in practice asserted that it is time to begin developing an effective infra- structure in order to apply knowledge to health- care delivery. Building on this, the American Nurses Credentialing Center's Magnet®-designated organi- zations require nurses to apply research evidence in their practice.3,4 Yet, despite the now global support

for EBP, a gap remains between the continued emer- gence of research evidence and translation into clini- cal nursing practice.5 As 1 way to bridge this gap, the nursing profession is using traditional and online journal clubs; the latter are known also as virtual journal clubs. The purpose of this article is to describe the development, implementation, and evaluation of a virtual nursing journal club (VNJC) by the Nursing Research/Evidence-Based Practice Council (NREBPC) in a Magnet-designated, midsize community hospital. Council members sought to improve nurses' research literacy andmove research evidence into clinical practice.

Literature Review

Background The literature is replete with studies that explore the barriers preventing nurses from applying evidence in patient care. Pravikoff et al6 examined the readiness of 760 US nurses for EBP. The subjects represented nurses working in clinical settings whowere a subgroup of a larger sample. In this descriptive, exploratory study, nurses responded to a 93-item questionnaire seeking to determine their perceptions of how available informa- tion resources were and how skilled they were in using them.Nurses ranked 10 individual barriers to using re- search in practice. Ranking 5th and 10th, respectively, were “difficulty understanding research articles” and “lack of skills to critique… the literature.”6(p48)

Following this research, other studies have ex- plored barriers to nurses' use of EBP practice7-9 and their perceived EBP knowledge and skills.3,10 Studies also examined specific interventions designed to pro- mote EBP. Straka et al11 reported the use of a web page that included an online journal club as one of several interventions to create a culture of EBP and nursing research in a pediatric hospital. It is evident

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from these studies that while progress has been made, challenges remain to nurses' implementing and sus- taining EBP within organizational settings12 and ful- filling the IOM's2 previously mentioned mandate.

Purposes and Types of Nursing Journal Clubs The primary purposes of a journal club are to educate nurses how to develop scholarly reading habits and critically appraise research studies, promote the appli- cability of research findings to clinical practice, and improve patient outcomes.13-16 Through a journal club, nurses can gain insight into their practice and find research-based solutions for their clinical nursing prob- lems.13 Cooper and Brown17 found that nurses who participated in a journal club continued their profes- sional development through postgraduate education and used journal club–acquired skills in their studies.

Journal clubs vary by location and can be tradi- tional or online. In traditional journal clubs, nursesmeet face-to-face with other nurses to discuss a clinical practice topic or research study. Increasingly, online technology is being used for journal clubs.15 Wilson et al,18 however, reported a pilot study in which 36 RNs participated in a hybrid method that included online and in-personmeetings. Options for conducting a journal club are synchronous or asynchronous. A synchronous journal club refers to a live meeting that happens at a specific date, time, and place. An asyn- chronous journal club allows for more flexibility because individuals participate in an activity and dis- cussion at various dates and times independent of others.19

Benefits and Barriers Traditional nursing journal clubs have been shown to be useful in implementing and maintaining EBP and developing and supporting research skills, such as read- ing and critical appraisal, while increasing confidence in these areas and facilitating lifelong learning.20-22 Partic- ipation in these clubs, however, continues to be chal- lenging. This can be related to lack of time and/or consensus about meeting times, the increasing demands of the bedside nurse in the ever-changing healthcare environment, lack of motivation or interest in reading articles, and a lack of confidence in reading and ana- lyzing the nursing research itself.14,21,23-25

In a study of 29 pediatric nurses who attended a monthly journal club, the majority of the respondents agreed that attending the journal club was useful to promote EBP in the workplace, although only 41% had attended meetings 3 or more times.22 Lachance21

reported that nurses developed skills in their abilities to read and critically appraise research when attending journal clubs, but consistent attendance was found to be a common issue. There is a need for self-motivation,

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mostly because the sessions are considered extracur- ricular. Interestingly, the author asserted that there is a misconception that journal clubs could expose a nurse's research knowledge, potentially creating a sense of vulnerability and discouraging participation. Other barriers included technical issues, such as find- ing sufficient articles to form an opinion and feeling that there was not enough time allotted for discussion at the meetings.21

In contrast, online journal clubs have been found to be convenient, flexible, and useful. Berger et al13

asserted that establishing a virtual journal club was 1 way to remove the traditional journal club barrier of accessibility. Online journal clubs solve the issues of place and time, allowing nurses to read research ar- ticles where and when it is convenient for them.26

Billingsley et al14 asserted that virtual journal clubs are cost-effective venues for nurses that reduce the challenges of face-to-face journal clubs. Nurses also can interact with other nurses through a blog format as they respond to the article's content.13 “The virtual journal club offers a nonthreatening environment for nurses to learn to read and interpret clinical research at their ownpace. They can take advantage of the critiques written and/or reviewed by an experienced researcher and learn the process of critical appraisal.”13(p118)

Conceptual Framework The hospital's Professional Practice Model served as the underpinning for the VNJC. Among essential com- ponents of the model that foster the delivery of quality patient care are the following concepts: EBP, research, professional development, and Benner's Novice to Ex- pert Model.27 It is the authors' belief that each of these concepts/perspectives interfaces with and is exempli- fied by nurses' participation in the VNJC. Nurses can move from a novice-to-expert nurse researcher, over time, as they develop a strong research skill set that is fostered by the VNJC.

Developing the VNJC The NREBPC members formed a work group to de- velop a nursing journal club. The council chair and cochair, the designated leaders for the initiative, dis- tributed relevant articles to members for their review and to promote discussion about a process to be followed. The literature review was invaluable in the early stages of development. In addition to the review, practical tips and steps for starting a journal club that could be incorporated into a virtual formatwere iden- tified.28,29 Based on the literature and discussion, council members chose an online format for the jour- nal club.

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The information technology (IT) department mem- bers were present during an NREBPC meeting and became involved in the journal club's development. The importance of collaborating with IT representa- tives has been advocated.15,16 Others discussed the use of WordPress.com, an asynchronous, easy-to-use discussion platform, when developing their online jour- nal clubs.30-32 Moonan et al31 outlined the strengths of Word Press.com. It “a) is user friendly; b) is free; c) is mobile application accessible; and d) allows for the cre- ation of a private, password-protected blog.”31(p547)

Thus, this user-friendly, blogging platform was chosen for the journal club. The chair and cochair continued to collaborate with IT to install the VNJC site on the hospital's existing intranet.

Figure 1. Quantitative critique—sample page.

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Creating goals, objectives, and the VNJC process followed. The purpose of the VNJCwas reinforced by the literature cited above. The goal was to provide an interactive mechanism for nursing staff that would assist them to critically evaluate nursing research stud- ies, keep abreast of current research findings, promote an EBP environment by translating new research knowl- edge into practice, and strengthen collegial relation- ships within the institution. Objectives developed stated that nurses using the VNJC will enhance their professional development as they: 1) search current nursing research studies related to a clinical topic; 2) use critiquing guidelines to critically appraise nursing research studies; 3) increase critical thinking and clini- cal problem-solving skills; 4) share research-related

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information with nursing colleagues; 5) motivate nurs- ing colleagues to participate in the VNJC process; and 6) apply current best research knowledge to evidence- based patient care.

Constructing a user-friendly critique form to ac- company each posted nursing research article was an- other task. Using the literature and a critique previously developed by the hospital's nurse scientist (NS), mem- bers created a quantitative critique form (Figure 1) and later a qualitative critique form (Figure 2). Nurses can use the forms as a guide before, after, or while reading an article, thus developing or refining understanding and critiquing skills.

Council members agreed that the hospital's RNs were the target audience for the initiative. A nursing research study article would be posted quarterly via the hospital intranet and archived on the site after 3 months. The article selection process has evolved since the VNJC's inception. Initially, only council mem- bers selected and critiqued an article; now, they can volunteer to select and critique a research article with

Figure 2. Qualitative critique—sample page.

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another member(s) and invite a staff nurse towork on a critique, or a staff nurse can volunteer to select and critique a study. Nursing leadership can make recom- mendations to the NREBPC for a topic, as well as en- courage their staff on a unit-based council to choose an article. A selected article is sent to the council chair to determine its research rigor and application to practice. She also critiques the article and collaborates with the individual(s) involved to finalize the critique. The article and critique are then sent for posting to the site administrator, a clinical nurse specialist who is the NREBPC cochair. To guide staff nurses, the NS created a document titled, Process for Selecting and Critiquing a Nursing Research VNJC Article; this is available on the council's free intranet site.

Two council members volunteered to select the 1st nursing research article to be posted. The hospital's medical librarian, an active council member, assisted with the literature search. The quantitative study cho- sen pertained to shared governance, an area on which the hospital was focusing. To create an educational

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experience for council members and develop or hone their critiquing skills, they used the new critique form and came to ameeting prepared to review the selected article together. Four article-related questions were developed and included on the site to stimulate readers' thoughts and encourage them to interact with other nurses by replying on the comment board. Each quar- ter, the cochair informs nurses via email when a new article and critique are posted and embeds a link to the article to promote access to it.

Prior to launching the VNJC, flyers, emails, and the hospital's newsletter were used to advertise the endeavor. Initially, interest in the VNJCwasminimal.

Figure 3. Virtual nursing journal club evaluation form.

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The NREBPC continued to discuss ideas to facilitate participation. Active marketing through research events and unit-based council encouragement were initiated, resulting in the number of site visits increasing. Nurses' comments about the article, however, were minimal. Rodriguez and colleagues'25 study of nurses' percep- tions of an online journal club revealed that finding ways to acknowledge their participation in the club was a potentially strong motivator. Initially, contact hours were awarded, and a moderate increase in com- ments ensued. When nurses were offered the incentive of points toward the hospital's clinical advancement program (CAP), participation grew rapidly.

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Outcomes In a systematic review of nursing journal club studies by Häggman-Laitila et al,33 the following 5 subcate- gories of journal club outcomes were identified from the studies reviewed: “improved skills for becoming familiar with research, becoming enthusiastic about nursing development, professional and personal growth, learning in nursing, and implementation of research evidence in clinical practice.”33(p169) Since its inception, there have beenmore than 2600 site visits.Nurses' com- ments have increased to an average of 65 per article. They post feedback and ideas about the study, as well as reply to each other. The comments often include in- sightful comparisons of patient care across units or shifts; this is a benefit of the virtual journal club.

As a requirement for receiving CAP points, par- ticipants complete an evaluation (Figure 3). Nurses' responses focus predominantly on improving research attitudes, knowledge, and confidence, as well as apply- ing current best research knowledge to evidence-based patient care. In replying to the evaluation questions, a VNJC participant stated, “it is likely that I will use what I learned in this article to be more self-aware… I will also use it to make other nurses aware and to in- form management if any transitions can be done in a simpler way.” Another participant stated, “this activity enhances my knowledge, not only of nursing research but nursing care,” and another, “I like to keep up-to- date with the latest research, and reading up on studies helps me improve my nursing practice.”The outcomes realized from the VNJC reflect the categories identified by Häggman-Laitila et al,33 support the Institute of Medicine's2 mandate, and provide evidence of contin- ued movement toward attaining the VNJC's goals.

Implications for Nurse Leaders Nurse leaders need to create a culture that promotes EBP within the organization. The resulting climate of inquiry leads to nurses approaching research activities

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from an engaged posture; this includes participating in and benefitting from the VNJC. Providing resources such as the VNJC assists nurses to develop their re- search literacy skills and use them to interact with other nurses in the setting. Additional research-related resources need to be provided, for example, availabil- ity of a medical librarian, nurse researchmentors, and ongoing collaboration with other departments, among them IT. A visionary nurse leader will recognize the cost-effective benefits of implementing a VNJC. Nurses who become confident in their research skills through the opportunity to read and critique research studies on the VNJCmay develop a desire to conduct a nurs- ing research study. Changes in practice through nurs- ing research study results can produce more efficient, quality patient care, and cost-effective outcomes.

Future Plans Several future goals have been identified for the VNJC. These include encouraging more nurses to select re- search articles and write questions to accompany them34,35; using the VNJC evaluations and annual nursing learning needs assessments to identify future quarterly articles33; including other disciplines36; de- veloping measures, for example, an online survey using a Likert-type instrument, to further evaluate theVNJC's impact on nurses' practice and patient outcomes; and conducting a study to determine if nursing research studies resulted from VNJC participation. An addi- tional nursing research study that explores nurses' comments may capture themes to further develop this self-directed, self-paced electronic approach to trans- lating research evidence into clinical practice.

Acknowledgments The authors thankClaire Joseph,MS,MA, AHIP, Di- rector Medical Library; John Malzone, Information Services; the Nursing Research/EBP Council mem- bers; and nurses who participated in the VNJC.

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