JOURNAL CLUBS & THE CNScacns.org/wp-content/uploads/2018/09/CACNS-JournalClubs.pdf · JOURNAL CLUBS & THE CNS Cheryl Westlake, PhD,RN, ACNS-BC, FHFSA, FAHA, FAAN. Professor, Doctoral

JOURNAL CLUBS & THE CNS

Cheryl Westlake, PhD, RN, ACNS-BC, FHFSA, FAHA, FAANProfessor, Doctoral Programs

School of Nursing, Azusa Pacific [email protected]

mailto:[email protected]

Objectives

1. Describe clinical nurse specialist’s (CNSs) role in journal club development & implementation

2. Review tools for critiquing clinical & research articles

3. Address barriers to journal club implementation

4. Consider journal club evaluation

Cheryl Westlake, PhD, RN, ACNS-BC, PN, FHFSA, FAHA 3

What is a journal club?(Steenbeek, et al., 2009; Westlake, et al., 2015; Winterbottom, 2011)

•Cost-effective strategy for enhancing practitioner capability & satisfaction

•Educational tool that • Bridges research & practice• Facilitates application of research to clinical setting & • Raises awareness of new solutions to promote

value-based nursing


Why conduct journal clubs?(Bazarian, et al., 1999; Gloeckner & Robinson, 2010; Linzer, Frazier, DeLong, Siegel, 1988; Ploeg, et al., 2007; Luby, Riley, & Towne,

2006; Sciarra, 2011; Steenbeek, et al., 2009; Zarghi, Mazlom, & Rahban, 2012)

Enhances• Nursing care skills essential to translating research

to practice • Interprofessional credibility

• Reading habits • > # of articles read/month)• > time in daily literature reading (930 min/day)

especially pat care articles in nurses’ specialty• Utilizing current research in practice better patient

outcomesCheryl Westlake, PhD, RN, ACNS-BC, PN, FHFSA, FAHA 5

• Clinical thinking • Critical-thinking skills

Journal club benefits(Burstein, Hollander, Barlas, 1996; Elnicki DM, Halperin, Shockcor,& Aronoff SC. 1999; Linzer et al., 1988; Macrae, Regehr, & McKenzie, 2004; Moharari et al., 2009; Spillane & Crowe, 1998; Steenbeek, et al., 2009 Zarghi, Mazlom, & Rahban, 2012)

• Fosters scientific literature review germane to clinical practice

• Through critical analysis, helps develop knowledge & assess state of science

• d understanding of (Rice, et al., 2011)

• Research methods • Critical appraisal knowledge & skills • Critical reading ability of original research articles

• Qualitative paper review among those w/ • least prior qualitative methods experience & • more developed learners


• Statistical analysis

Journal club benefits• If created in concert w/ academic partners, may

• help boundaries b/t researchers & clinicians • provide routine place & time for networking,

coaching, & academic-practice collaborations (Moharari et al., 2009)

• Only 1 study reviewed, researchers found no significant change following journal club implementation (Langkamp, Pascoe, & Nelson, 1992)


Who benefits(Ploeg, et al., 2007; Luby, Riley, & Towne, 2006; Sciarra, 2011)

• Nursing staff

• Organization - Fosters nursing practice changes (Luby, Riley, & Towne, 2006; Ploeg J et al., 2007; Sciarra E. 2011)

• Student nurses - learning promoted (Thompson, 2006)

• Journal club members (Burstein, Hollander, Barlas, 1996; Letterie & Morgenstern, 2000; Mukherjee, Owen, Hollins. 2006; Spillane & Crowe, 1998)

• Patients? Cheryl Westlake, PhD, RN, ACNS-BC, PN, FHFSA, FAHA 8

• CE • Educator prof dev

• Found social gathering enjoyable• Overall satisfaction w/ program • d confidence• Interest to continue

http://www.nacns.org/wp-content/uploads/2017/01/CNSCoreCompetenciesBroch.pdf

CNS Preparation & leadership • Determine

• Member #s • Meeting times/places

• Have clear aims, objectives & short- & long-term goals• Provide invitations w/ journal article• Consider inclusion of article-related challenging clinical

situation & question• Need clearly stated focus, e.g. - critical appraisal skills &

enhance EBP; assist in adherence to & achievement of goals • Disseminate articles prior to meeting - allow time to

• Read articles in advance & • Prepare for discussion

• Facilitate discussion• Document• Evaluate


CNS Preparation & leadership • Ideal member #s unknown

• Smaller group will promote meaningful discussion among members in the time allotted (Billingsley, et al., 2013; Kean, 2013; Silvey, 2013);

•Frequency• Weekly (O’Nan, 2011; Sciarra, 2011)

• Monthly meeting (Burstein, Hollander, Barlas, 1996; Mukherjee, Owen, Hollins. 2006; Nesbitt & Barton, 2014 2014 Silvey, 2013)

• Couple times/year (Billingsley, et al., 2013; Lehna, et al., 2010; Sortedahl, 2012)

•50 minutes to 2 hours (Kean, 2013; Mukherjee, Owen, Hollins. 2006; Silvey, 2013)

•Attendance voluntary (Bazarian JJ, Davis CO, 1999; Burstein, Hollander, Barlas, 1996)

• Convenient meeting times per member schedules (Berger, Hardin K, Topp., 2011)

• W/in normal working hours (Silvey, 2013)

• Repeated meeting may be necessary to meet needs of alternate shift workers (Kean, 2013)


CNS Preparation & leadership Article selection• Nurses/students (O’Nan, 2011)

• Participants & researcher (Nesbitt, 2013)

• Researcher & or author of journal club article (Lehna, et al., 2010; Sciarra, 2011; Sortedahl, 2012)

Original research • Universal appeal • Relate to:

• Clinicians’ questions• Patient population of interest• Important or interesting diagnoses• Common clinical problems

• Meta-analyses, guideline recommendations, & cost-effectiveness analyses not recommended - more difficult to appraise critically


CNS Preparation & leadership Approach

• 2 articles on same topic, but w/ contrasting conclusions -facilitate lively discussions

• Multiple articles on 1 topic w/ high & low strength & evidence quality

Journal club facilitator• Researcher (Lehna, et al., 2010)

• Researcher, CNS, or MSN-prepared clinical nurse or nurse (Billingsley, et al., 2013; Nesbitt, 2013 ; Sciarra, 2011; Sortedahl, 2012)

Meeting preparation• Articles distributed in advance (Lehna, et al., 2010; Nesbitt, 2013 ; O’Nan, 2011;

Sciarra, 2011; Sortedahl, 2012)


Article Selection•Resources

•American College of Physicians (ACP) Journal Club

• http://annals.org/aim/journal-club• Summarizes best new evidence for internal medicine from

over 120 clinical journals. • Monthly feature of Annals of Internal Medicine• Research staff & clinical editors rigorously assess scientific

merit of medical lit as published • Worldwide panel of > 5,000 physicians assesses clinical

relevance & newsworthiness of rigorous studies•TRIP database


http://annals.org/aim/journal-club

Article Selection•Resources - TRIP database

https://www.tripdatabase.com/about#pico

• Clinical search database to support their practice &/or care• Research evidence• Images• Videos• Patient information leaflets• Educational courses • News


https://www.tripdatabase.com/about#pico

Appraisal Tool• Use established tool or reading guide• Encourage systematic approach to appraising evidence• Assessing research methods & results for threats to

internal or external validity and other biases• Article review questions may differ for research versus

non-research (clinical review) articles• Grading of Recommendations, Assessment,

Development and Evaluation (GRADE) system • Taxonomy that creates evidence quality tiers based on

multiple criteria • Uses standardized definitions (http://www.gradeworking group.org)


Research Appraisal Tool


Clinical Appraisal Tool


Evidence Quality

GRADE system High Further research very unlikely to change

confidence in estimate of effectModerate Further research likely to have important impact

on confidence in estimate of effect & may change estimate

Low Further research is very likely to have important impact on confidence in estimate of effect & is likely to change estimate

Very low Any estimate of effect is very uncertain


Documentation & TOE•Assist clinicians to create TOE to organize & document• Article’s evidence before adjourning• Group’s summation & description of f/u action• Potential practice /practice change

recommendation

•TOE may be used to • Facilitate discussions about evidence synthesis• Promote conclusions based on strongest evidence


Journal Club Implementation Barriers

•Relevance•Attendance•Participation•Confidence •Limited research & evidence searching expertise


Relevance

• Journal article agreed on by membership• Nursing governance committees may be accountable

for content & updates• Meeting - question driven• Ideally, questions come from journal club members, • Non-nursing personnel may provide unique

perspectives & broaden participants’ perceived value of article

Cheryl Westlake, PhD, RN, ACNS-BC, PN, FHFSA, FAHA21

Attendance/Participation –Consider/experiment w/ formats

• Face to face (Fowler, Gottschlich, Kagan, 2013)

• Virtual at single or multiple sites (Berger, Hardin, & Topp, 2011; Sortedahl, 2012)

• WordPress.com – blogging; discussion boards (Kean, 2013; Lehna, et al., 2010)

• Second Life - Multiuser virtual environment - social media (Billingsley, et al., 2013)

• Twitter - @twitjournalclub, bimonthly w/ 3400 followers (Silvey, 2013; Zoonotica, 2013)

• Web conferencing program - Elluminate Live!

•Hybrid - both face-to-face & virtual component• Travelling poster board (Campbell-Fleming, Catania,& Courtney, 2009)

• Author in the Room - author invited to participate in meeting & address questions and issues (Bradley, et al., 2004)Cheryl Westlake, PhD, RN, ACNS-BC, PN, FHFSA, FAHA 22

Bradley, Schlesinger, Webster, Baker, Inouye, 2004; Campbell-Fleming, Catania, 2009; Evans, 2003; Howic, Chalmers, Glasziou, et al., 2011; Radhakrishnan & Jacelon, 2012; Silvey, 2013

Second lifehttps://secondlife.com/


Attendance - Consider members • Consultants - promote multidisciplinary attendance

• Multidisciplinary teams/consultants - clinical librarians, statisticians, pharmacists, MSWs, RDs, PTs or OTs, online discussion monitor, library resource person, & technical support person• Conduct orientation sessions • Generate journal club leadership discussions questions• Create Web sites and posts for article storage and access• Address technical issues• Assist w/ methodological & statistical discussions • Have each member present portion of critique or statistical

analysis at each meeting


Attendance • Planned marketing strategy?

• Collaborate w/ education, communication, & marketing to develop marketing plan

• Journal club re-named Smarticles (Krugman, 2009)

• Promotional campaign used Smarties participation & + feedback

• Incentive = core characteristic (Berger, Hardin K, Topp., 2011)

• Article-specific, pre-/post-test learning achievement assessment, CEUs, Career/clinical ladder points (Billingsley, et al., 2013; Kean, 2013)

• Door prizes (i.e., book, gift certificate, free lunch)• Food - availability may (Silvey, 2013)

• Improve attendance & • Create environment conducive to participation


Participation • Original research of universal appeal • Approach - 2 articles on same topic, w/ contrasting

conclusions• Food - may create environment conducive to

participation• When confident that learning, participation (Silvey, 2013)

• End meeting by asking for clinical ‘‘bottom line’’• Document

• Learning logbook (online, if possible) (Dobrzanska & Cromack, 2005)

• Completed critical appraisals- tangible report & reference to reread, when appropriate

• Group decisions about needed follow-up• Implementation of evidence and outcome monitoring


Confidence• Journal club membership d confidence• Articles selected - Multiple articles on 1 topic w/ high & low

strength & evidence quality• Use active learning principles (Barnes, 1989)

• Purposive: task relevant to learners' concerns• Reflective: learners reflection on meaning of what is learned• Negotiated: negotiation of goals & methods of learning b/t learners & CNS• Critical: students appreciate different ways & means of learning content• Complex: learners compare learning tasks w/real life complexities & reflect• Situation-driven: situation need considered to establish learning tasks• Engaged: learning activities reflect real life tasks

• Select right multidisciplinary members • Statistician or nurse w/ strong statistical background to answer method, analysis,

& results-related • Librarian for resources

• Answering individuals’ questions central to learning & motivation (Silvey, 2013)


Limited research & evidence searching expertise?

• Virtual journal club may bridge limited CNS research expertise (Billingsley, et al., 2013)

• Mentored, virtual, journal club w/ 4-session plan: (Silvey, 2013)

• Orientation session• 2 sessions - critiquing research literature using structured tool kit• Debriefing & planning session w clinical experts w/ literature critique

competency• Specialty group journal club participants

• competencies in determining design• interpreting statistics

• Pilot, online, school-nurse journal club using Elluminate Live! d (Howick, et al., 2011)


• competencies in determining design• interpreting statistics

• linking conclusions/findings • Identifying limitations

• knowledge of link b/t evidence & practice

• understanding of evidence in articles

• connectedness to nurse colleagues

• intent to use evidence in practice

Evaluation Use structure, process, outcome model (Phillips & Glasziou, 2004)

(Donabedian, 1988)

Meeting’s structure (Duffy, et al., 2011)

• Format• Scheduling• Meeting frequency and duration • Actual participant #s


Process Evaluation • Participants’ perceptions re: ideal participant

#/session • CNS’s ability to promote participation & discussion• Participation satisfaction, comfort, & or confidence• Intent to attend future meetings (Garcia, Judkins-Cohn, &Samsundar, 2013)

• Participant #s over year • Articles reviewed/meeting & or /year • Individual #s posting online • Connectedness to nurse colleagues• Intent to use evidence in practice• Discussion & postings/article


Outcome Evaluation • Learning goals and objectives achieved• Knowledge improvement

• Articles’ content• Research process

• Applicability of enhanced content knowledge to practice• Clinical, quality, & cost impact of practice changes • Evaluation tools

• Created from articles reviewed • Other available tools

• CNSs publications about journal club structure, process, & outcome evaluation - lack of evidence on journal clubs’ impact on evidence-based nursing implementation


• Participants’ perception • Objective assessment

Questions?

Documents

JOURNAL CLUBS & THE CNScacns.org/wp-content/uploads/2018/09/CACNS-JournalClubs.pdf · JOURNAL CLUBS & THE CNS Cheryl Westlake, PhD,RN, ACNS-BC, FHFSA, FAHA, FAAN. Professor, Doctoral