The Journal ClubAn Occasion for Mentoring :

Critiquing Research for Evidence-Based Practice

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

Evidence-Based PracticeResearch 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 ModelsOriginated outside the United StatesFirst publication of Evidence Based Nursing was launched in1998Definitions 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 EvidenceResearch basedOpinion basedDiscussionsFact based Expert basedPatient view basedProfessional expertise and experienceQuality improvement dataEvaluation data

Hierarchy of EvidenceMeta-analysis of controlled studiesIndividual experimental studiesQuasi experimental studiesNon-experimental studiesProgram evaluations, research utilization studies, quality improvement projects and case reportsOpinions 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 processReciprocal Role Career development relationshipKnowledge differential between participantsDuration of several yearsResonance

The Development of Nursing ScienceFoundation for the growth of the nursing discipline and professionKnowledge 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 NursingResearch mentoring activities are appropriate in various settings:

AcademiaFormal programs of researchClinical 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 studyLimited exposure to research journalsIntimidated by research jargon and statistical symbolsInfrequent 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 PracticeCost effectiveAllows nursing staff to remain close to patient care areasStimulates discussion among peers in regard to clinically relevant problemsAllows exploration of most current literatureStimulates 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 researchAllows nurses to discriminate and evaluate information logicallyProvides a basis for making decisions that effect patient outcomesPromotes professionalism and positive attitudesPromotes evidence-based nursing practice and bridges the gap between research and practice (Goodfellow, 2004)

Criteria for Selecting Research ArticlesFocus 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 MeritDoes 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 ArticlesImplementation Potential

Are the research findings clinically significantInformation is transferable to the clinical settingDoes the nursing staff have the power to implement change based on these research findingsDoes the research have the potential to improve patient outcomes Implementation with no physical or psychological harm to patientsImplementation with minimal or justifiable cost to the hospital or patient (Goodfellow, 2004)

Guidelines for Critiquing Research for EBP

Does the introductionState 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 writtenAre 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 dataWhat is the population

Is the population clearly described

What is the sample size Is sample size sufficient

Is protection of human subjects clearly addressedWhat instruments were used to measure the variablesAre the instrument reliable and validHow were the data analyzed Are the statistical test appropriate (Goodfellow,2004)

Guidelines for Critiquing Research for EBP

What are the results of the studyWhat are the strengths What are the limitations of the studyIs there congruence between the results and the discussion of the researchWhat are the implications for nursing practiceWhat are the implications for nursing researchHow may the results of this study be applied to your nursing practice and patient care (Goodfellow, 2004)

The Tale of Two Journal ClubsSelection of clinical sites: (Two magnet hospitals)

Oncology unitPsychiatric Unit

Leadership style and selection of leader

Selection of Journal ArticlesMutual collaboration

Strategies to make journal club a valuable experience

Enthusiastic teaching styleRole modelingCritique of relevant self-selected research articlesApplication of research and promotion of evidence-based practice

Journal Club: An Occasion for Mentoring: A Win/Win Collaboration

Benefits to individual membersProfessional developmentAcquisition of new knowledgeContinuing education creditImproved competence and confidence in delivering EB Care

Benefits to hospitalMaintaining magnet statusImproved patient carePromote the utilization of EBPStimulate desire to conduct research on unit

Benefits to facultyCommunity serviceMutual professional developmentBuilding collaborative relationshipsImproves potential for more collaborative research

ReferencesByrne, 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 isn’t. 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.

ReferencesMcKinley, 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.