The Journal Club An Occasion for Mentoring : Critiquing Research for Evidence-Based Practice

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The Journal ClubAn Occasion for Mentoring
Critiquing Research for Evidence-Based Practice

• Dianna Hutto Douglas, DNS RN CNS
• Susan Rick, DNS RN CNS

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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)

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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)

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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)

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Types of Evidence

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

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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)

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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)

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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

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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

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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)

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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)

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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)

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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)

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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)

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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

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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)

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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)

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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)

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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)

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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

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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

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References

• Byrne, M. W. Keefe, M. R. (2002). Building
  research competence through mentoring. Journal of
  Nursing Scholarship, 34 (4), 391-396.
• Goodfellow, L. M. (2004). Can a journal club
  bridge the gap between research and practice.
  Nurse Educator, 29 (3), 104-110.
• Ingersoll, G. L. (2000). Evidence-based nursing
  what it is and what isnt. Nursing Outlook, 48
  (4), 151-152.
• Jennings, B.M. Loan, L. (2001. Misconceptions
  among nurses about evidence-based practice.
  Journal of Nursing Scholarship, 33 (2), 121-127.
• 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, 264-267.

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References

• McKinley, M. G. (2004). Mentoring matters
  creating, connecting, and empowering. AACN
  Clinical Issues, 15 (2), 205-214.
• Polit, D. Beck, C. T. (2003). Nursing
  research principles and practice. (7th ed.).
  Philadelphia Lippincott. 671-705.
• Retsas, A. (2000). Barriers to using research
  evidence in practice. Journal of Advanced
  Nursing, 31, 599-606.
• 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), 195-206.
• Stewart, B. M. Krueger, L. E. (1996). An
  evolutionary concept analysis of mentors in
  nursing, Journal of Professional Nursing, 12
  (5), 311-321.