LIBRARY AND INFORMATION LITERACY

Author: Roxanne M. Arndt, MSN, San Antonio, TXSection Editor: Nancy McGowan, RN, PhD, CEN

Society has demanded of health care providers thatthey provide safe and effective care. Nurses and otherhealth care professionals must develop the skills neces-

sary to incorporate evidence-based care into practice. To ac-complish this, health care professionals must be informationliterate to access, appreciate, and apply this information.1

The definition of information literacy is derived fromthe American Library Association: “To be information lit-erate, a person must be able to recognize when informationis needed and have the ability to locate, evaluate, and useeffectively the needed information.”2

Health professionals need to have access to informa-tion to make patient care decisions and to answer questionsthat may arise. Lack of time, lack of access, and lack of skillsto retrieve the information can be seen as barriers in locatingthis information.3

Developing information literacy programs is documentedfrequently in nursing and library science literature.4 Layton andHahn5 indicated that there was a need to integrate informationliteracy programs through nursing curriculum as a replace-ment for the brief orientation to the library that most studentsreceive today.Use of technology can be integrated into the cur-riculum and can serve a dual purpose: learning necessary com-puter skills and conducting proper searching techniques thatyield reliable information necessary to produce scholarly work.

There is a common assumption held by students andteachers that everyone knows how to conduct a literaturesearch.6 Most students who enter college are children ofthe Information Age and know about the World WideWeb. The Web gained popularity in the 1990s when thesestudents were only a few years old. Because of this, mostfaculty make the assumption that librarians are not neededto teach information-searching skills to these students.Librarians are aware of the differences that exist betweensurfing the Web and searching a database.7

In a study that examined information literacy andlibrary attitudes of 87 occupational therapy (OT) students,it was discovered that librarians ranked third in the students’choice for seeking information.7 The majority of studentspreferred to ask their classmates (36%). This was found tobe consistent with how other health professionals such asnurses and physicians seek information.

Without the development of information literacy skills,nurses will spend unnecessary time looking for information.In the survey that was conducted in the OT students, 36 of87 students said that they spent 30 minutes looking for in-formation before they decided to ask for help.7 Eight stu-dents worked for 1 to 2 hours before seeking assistance,and fifteen students never asked for help. Collaborationbetween OT faculty and librarians could help improve thecomfort level between OT students and librarians when itcomes to asking for help. In this vein it is quite easy to imag-ine nurses, particularly emergency nurses, feeling the needto find information themselves and consequently spendinguntold numbers of hours searching for information thatmay be readily available with the help of a medical librarian.It is important to have all health care professionals recognizethe vast amount of knowledge and help that the medicallibrarian brings in helping initiate searches.

A curriculum-integrated program was designed to as-sist nursing students to develop an awareness of nursingliterature, focusing on the ability to locate, retrieve, and eval-uate this information.8 This program was implemented in abachelor of nursing course at the University of Wollongong(Gwynneville, New South Wales, Australia). It was a col-laborative effort with the faculty librarian, who has theknowledge and expertise for this kind of program content.The program consisted of several lectures and tutorial ses-sions presented by the faculty librarian and other membersof the faculty. The students were given 3 library-basedlearning activities and learning assessments that had beentied directly to the content area they were learning at thetime. This integrated-curriculum approach must be taught inincremental steps, must be applicable to the students’ aca-demic and professional lives, must be structured so that suc-cess will be attained, must have direct rewards, and must berelevant to the information being studied.8

Nurses must be able to collect information indepen-dently that is appropriate for the area in which they areworking. The learning process needs to be interactive ratherthan passive. Nurses will be ready to address the challenges

Roxanne M. Arndt is Doctoral Student, College of Nursing, Texas Woman’sUniversity, Houston, TX.

For correspondence, write: Roxanne M. Arndt, MSN, 15147 Spring Mist,San Antonio, TX 78247; E-mail: rarndt@yahoo.com.

J Emerg Nurs 2009;35:360-2.

Available online 28 May 2009.

0099-1767/$36.00

Copyright © 2009 published by Elsevier Inc on behalf of the EmergencyNurses Association.

doi: 10.1016/j.jen.2009.03.011

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of an ever-changing profession if they learn how to gather,analyze, and effectively apply knowledge.9

As the nursing profession evolves, it depends heavilyon an evidence-based practice approach, as well as theability of nurses to access and adequately evaluate the pro-fessional literature. An information literacy program wasdeveloped and implemented into a foundations-in-nursingcourse in an associate degree nursing program in Ohio.4 Aquestionnaire containing 22 items was administered beforethe course and at the end of the course. The objective ofthis program was to education nursing students to developthe skills necessary for applying current outcomes of nurs-ing research to nursing practice. The results of this study in-dicated that nursing students had negative attitudes towardthe need to stay current in nursing literature.4 It is importantthat nurses working in emergency departments recognizethe need for staying current in their field and make everyeffort to develop the necessary skills to conduct searchesthat produce relevant and practical information.

Joint Commission on Accreditation of HealthcareOrganizations standards have dictated that there mustbe information resources available to staff. This informa-tion must be current and accurate. There are many re-sources that fit this description. Textbooks, journals, anddatabases are just some of the sources of information thatare available to health care professionals. The problem stillremains, however, if these professionals cannot access thisinformation because they do not possess information lit-eracy skills.

Health care institutions have made attempts to developinformation literacy programs to meet the Joint Commis-sion on Accreditation of Healthcare Organizations require-ments and to fill in the gaps for the lack of informationliteracy skills not acquired during the formal education pro-cess. A pilot program developed by Rosenfeld et al10 wasimplemented with a group of critical care RNs. The medi-cal librarian in coordination with the critical care instructordeveloped unit-based training sessions using lecture anddemonstration modes of instruction. The goal of the proj-ect was to develop skills of the nurses to be able to searchand evaluate electronic information to use for clinical deci-sion making. This study took place over a 60-month periodwith 40 participants.

Data from an entire month were lost because of thenetwork crashing.10 With the data the researchers had,the outcomes of the study indicated that the number ofsearches done per month increased, as did the quality ofthe searches. The competency level only improved slightly.The majority of subjects (n = 21) remained at the “no com-petency” level. Several other problems were identified withthe research. There was a small sample size, the tool that

was used had not been tested for reliability and validity,and the loss of data during June remained a problem.

Despite the limitations, the researchers discovered thatit was very difficult to teach nurses new technologic skills.10

In addition, given the heavy workload of the nursing careunit, the environment was not conducive to training, nordid it allow the nurse time to conduct the literature searchesas they were instructed. In an effort to educate nurses in theclinical setting, the challenge is to find the right mix of unit-based and off-site training opportunities to enable effectivelearning.10 It is important to have a strong collaborative rela-tionship between the librarians, nurses, and management tofacilitate the effectiveness of nurses conducting searches rele-vant to their practice. It is vital that nurses recognize theimportance of obtaining up-to-date information to enhancetheir care.

Knowledge-based information resources were mea-sured in a rural community hospital using resources froman academic health science center library.11 The objectivewas to demonstrate the information-seeking practices beforeand after access to a library electronic database was available.

The pre- and post-implementation survey showed thatnurses used colleagues for information 47% of the timebefore implementation and 65% of the time after imple-mentation. Access to the Internet for electronic informa-tion increased from 1.2% by use of online databases to6.2% after implementation. The use of electronic resourcesvia nurses’ computers on the unit increased from 7.5% to13.8%. There was also an overall increase in using printresources on the unit and the pocket handbooks that wereavailable. Overall the nurses using computers increased, asdid their use of the Web for professional tasks.11

Challenges have been identified for nursing leadership,administrators, and librarians. The clinical environment mustbe one that encourages evidence-based practice. It has beensuggested that there remains an underutilization of nursingliterature by nurses in the workforce.1 There is an abun-dance of information available, but access to the informa-tion may be difficult to obtain. Hospitals must provide theopportunities for access to the best information possible forpatient care and must allow the nursing staff to developskills to identify and apply that information.11

Time and resources are major factors when it comesto hospitals attempting to teach or improve informationliteracy skills. Professionals in health care cannot affordto be kept in the dark when it comes to acquiring informa-tion relevant to patient care. Who should be responsiblefor teaching research skills? Librarians and faculty in schoolsof nursing can assume those responsibilities. Whether theskills are taught in a curriculum or in a hospital setting, itwill take a collaborative effort. “The investment made by

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nurse educators, librarians, and administrators in teachingliteracy skills will pay off in acts of recognition and comple-tion for the nursing profession.”12

It remains the responsibility of the emergency nurseto remain as current as possible on new therapies, medica-tions, and procedures that their patients will be facing. Oneof the best possible ways to stay current is to develop skillsthat will enhance the ability to search, find, and incor-porate information into daily practice. Acquiring skills forfinding relevant information will provide a skill that is vitalfor the care of any patient.

REFERENCES1. Verhey M. Information literacy in an undergraduate-nursing

curriculum: development, implementation and evaluation. J NursEduc 1999;38:252-61.

2. American Library Association. Presidential Committee on In-formation Literacy. Available at: http://www.ala.org/ala/mgrps/divs/acrl/publications/whitepapers/whitepapersreports.cfm. AccessedMay 18, 2009.

3. Tannery NH, Wessel CB, Epstein BA, Gadd CS. Hospitalnurses’ use of knowledge-based information resources. NursOutlook 2007;55:15-9.

4. Courey T, Benson-Soros J, Deemer K, Zeller RA. The missinglink: information literacy and evidenced-based practice as a newchallenge for nurse educators. Nurs Educ Perspect 2006;27:320-3.

5. Layton B, Hahn L. The librarian as a partner in nursing educa-tion. Bull Med Libr Assoc 1995;83:320-3.

6. Oblinger DG, Oblinger JL. Educating the Net generation. Avail-able at: http://www.educause.edu/educatingthenetgen. AccessedJuly 5, 2008.

7. Kipnis DG, Frisby AJ. Information literacy and library atti-tudes of occupational therapy students. Med Ref Serv Q 2006;25:11-9.

8. Shorten A, Wallace MC, Crookes PA. Developing information:a key to evidence-based nursing. Int Nurs Rev 2001;48:86-92.

9. Fox LM, White N. Pathways to information literacy. J Nurs Educ1989;28:422-5.

10. Rosenfeld P, Salazar-Riera N, Vierira D. Piloting an informationliteracy program for staff nurses: lessons learned. Comput InformNurs 2002;20:236-41.

11. Tannery NH, Wessel CB, Epstein BA, Gadd CS. Hospitalnurses’ use of knowledge-based information resources. NursOutlook 2007;55:15-9.

12. Weaver SM. Information literacy educating for life-long learn-ing. Nurse Educ 1993;18:30-2.

Submissions to this column are encouraged and may be sent toNancy McGowan, RN, PhD, CENMcgowann@uthscsa.edu

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