The Journal Club An Occasion for Mentoring : Critiquing Research for Evidence-Based Practice Dianna Hutto Douglas, DNS RN CNS Susan Rick, DNS RN CNS

Evidence-Based Practice Research utilization/innovation diffusion process begins with a new idea or empirically based innovation that is scrutinized for adoption in the practice setting. Evidence based practice by contrast begins with a search for information about how best to solve specific practice problems. The emphasis is on identifying the best available research evidence and integrating it with clinical expertise, patient input, and existing resources. (Polit & Beck, 2003)

Evidence-Based Nursing Practice Evidence base nursing practice is the conscientious, explicit and judicious use of theory derived research based information in making decisions about care delivery to individuals or groups of patients in consideration of individual needs or preferences (Ingersoll, 2000)

Evidence-Based Practice Models Originated outside the United States First publication of Evidence Based Nursing was launched in1998 Definitions crafted by nurses have varied with evidence derived from research expressed as a common theme (Jennings & Loan, 2001) Levels of evidence - especially in the United States literature reference the Agency for Healthcare Research and Policy schema of evidence (including qualitative studies as well as quality improvement and program evaluation data)

Types of Evidence Research based Opinion based Discussions Fact based Expert based Patient view based Professional expertise and experience Quality improvement data Evaluation data

Hierarchy of Evidence Meta-analysis of controlled studies Individual experimental studies Quasi experimental studies Non-experimental studies Program evaluations, research utilization studies, quality improvement projects and case reports Opinions of respected authorities and expert committees (Stetler et al, 1998)

An Occasion for Mentoring Mentoring is a fundamental form of human development where one person invests time energy and personal; knowledge to assist another person in their growth and development (McKinley, 2004) Mentoring is a special way to transfer knowledge and it can occur in all setting in which scientific inquiry is being deliberately pursued (Byrne & Keefe, 2002)

Attributes Mentoring Relationships Stewart & Krueger (1996) extracted six essential attributes of mentoring from 82 research abstracts and journal articles: Teaching/Learning process Reciprocal Role Career development relationship Knowledge differential between participants Duration of several years Resonance

The Development of Nursing Science Foundation for the growth of the nursing discipline and profession Knowledge development takes place in the various setting where nursing is learned and practiced Programs of scientific inquiry are established in both the university and clinic setting and often flourish where the two are merged

Research Mentoring in Nursing Research mentoring activities are appropriate in various settings: Academia Formal programs of research Clinical practice Research partnerships between academics and clinicians (Byrne & Keefe, 2002)

Barriers to the Integration of Evidence-Based Research into Practice Limited education in and expertise to judge the scientific merit of a research study Limited exposure to research journals Intimidated by research jargon and statistical symbols Infrequent use of research in practice (Goodfellow, 2004) Many nurses feel they have no authority to change nursing practice in spite of research to support a change in practice (Retsas, 2000)

Benefits of a Journal Club as a A Means to Incorporate Evidence-Based Practice Cost effective Allows nursing staff to remain close to patient care areas Stimulates discussion among peers in regard to clinically relevant problems Allows exploration of most current literature Stimulates nurses to Critique their own practice (Kartes & Kamel, 2003)

Benefits of a Journal Club as a Means to Incorporate Evidence-Based Practice Encourages nurses to read and critically review research Allows nurses to discriminate and evaluate information logically Provides a basis for making decisions that effect patient outcomes Promotes professionalism and positive attitudes Promotes evidence-based nursing practice and bridges the gap between research and practice (Goodfellow, 2004)

Criteria for Selecting Research Articles Focus on a Problem of Clinical Relevance Is the research article relevant to: Patient population Nurses clinical experience Nurses level of understanding Nurses interest in current research topics The most current research findings that might have influence practice (Goodfellow, 2004)

Criteria for Selecting Research Articles Scientific Merit Does the research article: Critically review the literature Clearly describe ethical and methodological issues Provide easily understood statistical analysis Accurately interpret the research findings Generalize findings to other populations and situations Is the research article well written and insightful

Criteria for Selecting Research Articles Implementation Potential Are the research findings clinically significant Information is transferable to the clinical setting Does the nursing staff have the power to implement change based on these research findings Does the research have the potential to improve patient outcomes Implementation with no physical or psychological harm to patients Implementation with minimal or justifiable cost to the hospital or patient (Goodfellow, 2004)

Guidelines for Critiquing Research for EBP Does the introduction State the problem State the significance to nursing Is the review of literature current, thorough, and reflective of critical analysis Are research questions, purposes, and/or hypothesis clearly written Are independent and dependant variables identified Is the methodological design defined and appropriate to study (Goodfellow,2004)

Guidelines for Critiquing Research for EBP What setting was used to collect data What is the population Is the population clearly described What is the sample size Is sample size sufficient Is protection of human subjects clearly addressed What instruments were used to measure the variables Are the instrument reliable and valid How were the data analyzed Are the statistical test appropriate (Goodfellow,2004)

Guidelines for Critiquing Research for EBP What are the results of the study What are the strengths What are the limitations of the study Is there congruence between the results and the discussion of the research What are the implications for nursing practice What are the implications for nursing research How may the results of this study be applied to your nursing practice and patient care (Goodfellow, 2004)

The Tale of Two Journal Clubs Selection of clinical sites: (Two magnet hospitals) Oncology unit Psychiatric Unit Leadership style and selection of leader Selection of Journal Articles Mutual collaboration Strategies to make journal club a valuable experience Enthusiastic teaching style Role modeling Critique of relevant self-selected research articles Application of research and promotion of evidence-based practice

Journal Club: An Occasion for Mentoring: A Win/Win Collaboration Benefits to individual members Professional development Acquisition of new knowledge Continuing education credit Improved competence and confidence in delivering EB Care Benefits to hospital Maintaining magnet status Improved patient care Promote the utilization of EBP Stimulate desire to conduct research on unit Benefits to faculty Community service Mutual professional development Building collaborative relationships Improves potential for more collaborative research

References Byrne, M. W. & Keefe, M. R. (2002). Building research competence through mentoring. Journal of Nursing Scholarship, 34 (4), Goodfellow, L. M. (2004). Can a journal club bridge the gap between research and practice. Nurse Educator, 29 (3), Ingersoll, G. L. (2000). Evidence-based nursing: what it is and what isn’t. Nursing Outlook, 48 (4), Jennings, B.M. & Loan, L. (2001. Misconceptions among nurses about evidence-based practice. Journal of Nursing Scholarship, 33 (2), Kartes, S. K. & Kamel, H. K. (2003). Geriatric journal club for nursing: A forum to enhance evidence-based nursing care in long- term settings. Journal of American Medical Directors Association, 5,

References McKinley, M. G. (2004). Mentoring matters: creating, connecting, and empowering. AACN Clinical Issues, 15 (2), Polit, D. & Beck, C. T. (2003). Nursing research principles and practice. (7 th ed.). Philadelphia: Lippincott Retsas, A. (2000). Barriers to using research evidence in practice. Journal of Advanced Nursing, 31, Stetler,C. B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitsgerald, J., Giuliano, K., Havener, P., & Sheridan, E. A. (1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11 (4), Stewart, B. M. & Krueger, L. E. (1996). An evolutionary concept analysis of mentors in nursing, Journal of Professional Nursing, 12 (5),