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Getting Magnetized: Service Strategies for Nursing Excellence

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1 Getting Magnetized: Service Strategies for Nursing Excellence
Joy Kennedy, MLS Northwest Community Hospital Health Resource Library Based on contents created by Margaret (Peg) Allen, MLS-AHIP

2 Introductions Margaret (Peg) Allen, Library Consultant, Author and CE Presenter Joy Kennedy, Northwest Community Hospital, Health Resource Library Peg developed this course originally at my urging for a regional conference. I have since taken over presenting the course in person and substantially revised the course with the latest revision of Magnet requirements. Peg and I were awarded scholarships to the 2008 MLA-NN/NLM Continuing Education Institute. We revised the original course and adapted it to an online environment and now offer it (and other courses) online via the MLA Moodle server. NCH is a Magnet certified hospital preparing for renewal of certification this fall. I have been head of the library for almost 18 years, on various Magnet Committees & on hospital’s Patient Education Committee, Continuing Medical Education & Research Committees. I now report to our head of research. I’m past chair of CAPHIS and cochair of the Standards Committee for NAHRS.

3 Northwest Community Hospital http://www.nch.org
Our new 9 story wing new patient rooms, expanded neonatal unit, expanded ER designed to handle 80,000 patients a year, etc. We’re a non-profit suburban Chicago hospital with no academic or religious affiliation. We have various Top 100 hospital designations and the second busiest ER in Illinois after Cook County Hospital.

4 Learner settings—show of hands
Librarian and/or nurse? Hospital/health system? Involved in ANCC Magnet Program? Magnet status – achieved, preparing, site visit? Academic – ADN, BSN, Graduate programs Nursing school faculty/library liaison Combined – hospital/nursing school setting Academic medical center – multiple programs Academic medical center, no nursing school Professional nursing society Public health Other Let’s learn a little bit about each other. How about a show of hands.

5 Course Objectives Participants will be able to:
Describe the ANCC Magnet initiative and its significance to hospitals and nurses. Describe the knowledge-based information needs of nurses Identify collaborative education and service strategies to improve knowledge-based information services for nurses Identify opportunities for librarians and their library to partner with nurses to improve patient care and safety These are my objectives for the day – reflect on how they relate to individual goals

6 Learning plan ANCC Magnet Program
History of Magnet Program & its Importance to Nurses, Hospitals “Forces of Magnetism”—was 14, now consolidated into 5 “Model Components” For each: library opportunities Information Needs of Nurses & Evidence-Based Nursing Practice Evaluation: final questions; forms

7 ANCC Magnet Program Why ANCC Magnet Certification?
Magnet: the Standard Produced by ANCC Why would your hospital be interested in getting the Magnet Nursing Certification? We can see why nurse administrators would want it—it would be national recognition of the quality of the nursing program they have helped build Let’s take a look at this short video produced by ANCC and clearly aimed at hospital administration

8 “Magnet: the power to attract and retain”
Latest Magnet Film “Magnet: the power to attract and retain” Here’s the most recent film which has replaced the earlier film on the Magnet website. Note the different audience and the different arguments used in this film. Its pretty easy to see the differences between these films.

9 Magnet Certification ANCC Magnet Recognition Program®—Recognizing excellence in nursing services Developed by the American Nurses Credentialing Center, part of ANA, to recognize health care organizations that provide the very best in nursing care. “Seal of approval” for quality nursing care Aids in nurse recruitment and retention Rapid growth – 7 in 2000; 300+ now

10 Historical Background
In 1983, the American Academy of Nursing commissioned a Taskforce to research why some hospitals attracted and kept nurses in a time of severe nursing shortage. McClure, MM, Poulin, M., Sovie, M. & Wandelt, M. (1983). Magnet hospitals: Attraction and retention of professional nurses. American Academy of Nursing Task Force on Nursing Practice in Hospitals. Kansas City, MO: American Nurses Association. As a reaction to the growing recognition that the supply of nurses in practice was not keeping up with demand much less with the future demands of an aging population— AAN commissioned a research study of why some hospitals seemed to have success attracting & retaining their nurses The research identified and described variables that created an environment that attracted and kept well-qualified nurses. These institutions were called “Magnets” because they attracted good nurses. These variables were called “forces of magnetism,” and formed the basis of the original Magnet recognition program and the underpinnings of the current requirements. So, note that Magnet developed out of research findings.

11 Research Findings: Characteristics of Magnet Hospitals
Participatory Management (Shared Governance) Nursing Autonomy & A Supportive Nursing Leadership Career Development Opportunities for Nurses Recognition of Importance of the Quality of Patient Care What did the AAN study find?

12 Further Research on Magnet Hospitals
Magnet Hospital nurses were more satisfied with their jobs Nurses at Magnet hospital are more likely to be certified in specialty areas, maintain continuing education & participate in community programs Strong relationship between the degree of nursing autonomy & quality of care patients received More studies of Magnet hospitals were done—Ah, the importance of research, a continuing theme A body of research about Magnet hospital grew and they proved More satisfaction with the jobs in Magnet hospitals More use of certified nurses in Magnet, higher levels of CE and greater participation by nurses in community programs, outreach to community Research has shown links between nursing quality , nurses freedom to practice nursing at the highest standards and patient outcomes. This research is significant in that it proved some things that nurses had believed, it shed light on the way health care was practiced in Magnet hospital—collaboration, professionalism, etc.—could lead to better outcomes. I tell people that even if your hospital does not get Magnet the lessons learned from this research—interdisciplinary care planning, for example—are the ways that medicine will be practiced in the 21st century if a hospital is to survive.

13 More Resources on Magnet
Nursing Center Articles: Costs unless Nursing Center member $4-$8 each ANCC page on Medscape: You can read some of these resources on Magnet on your own

14 Nursing Shortage Resources
American Association of Colleges of Nursing The Nursing Shortage: Is this cycle different? OJIN 2001 Discover Nursing Here are some resources for you to look at later. The Am Assoc of College of Nursing: if you look under Publications you’ll find position statements and white papers that deal with the education of nursing and some on the nursing shortage. The Online Journal of Issues in Nursing in 2001 had an issue that discussed the nursing shortage. Even 10 years ago there was recognition that a shortage was coming and something needed to be done. Note that the Sept issue of OJIN again had an dealing with “pathways to nursing”. The debate goes on. Finally, I’ve included a link to a site paid for by Johnson & Johnson which is designed to recruit people to become nurses. There are free recruitment materials here—brochures, posters, pins, videos, etc. All designed to encourage people to become nurses. In the Why section it shows a chart and says that by 2020 there is expected to be a shortage of 800,000 nurses.

15 Organizational Structure
I show this slide so you can see who actually is behind the Magnet Recognition program. It might help you understand the emphasis, perhaps bias, in the Magnet requirements toward advanced education for nurses.

16 Appraisal Review Process: Phases
Preparation: Self-Assessment Phase One: Application Phase Two: Written Documentation Phase Three: Site Visit by Surveyors Phase Four: Commission Vote CELEBRATE! Hospital does a self assessment and determines if they are ready—Magnet journey creates the CULTURE of nursing excellence & can take 1 – 7 years. Next the application is prepared—pay fee of between $13,750 for 100 or less beds to $60,000+ for 950+ bed hospital . The facility has up to two years to submit Written Docs. Originally there was a one year Lag time to reduce the rush factor, now that is no longer necessary. Written documentation: Some facilities have groups put together the info, some have one coordinator; Many have an outside consultant evaluate at some part of the process. Usually have one who authored the application write up/edit so the Written Documentation is consistent. Very often there is a mock survey and an outside consultant used. Site visit: Different than any other “visit” —very motivating. The appraisers are there to verify, amplify and clarify the written documentation. They will ask questions, may ask to look at additional documentation and listen to your story from all the nurses, at all levels. The appraisers do not make the final decision but recommendations to the Commission on Magnet Recognition. Magnet is the ONLY certification that focuses solely on the nurses. Different from others. Three days. The COM reviews all the documents and the appraisers report to come to a final decision. Hospitals are notified soon after by the Chair. We got a phone call that was broadcast to our nurses. Celebrate—celebrate even if you don’t get Magnet because you’ve put in an amazing effort and grown as an organization as a result.

17 Magnet and Hospitals: How has the research translated into the Magnet program requirements?

18 Magnet Recognition Program Goals (“Core Values”)
Promoting quality in a setting that supports professional practice; Identifying excellence in the delivery of nursing services to patients/residents; and Disseminating “best practices” in nursing services. The Magnet recognition programs goals grew out of this research

19 Magnet Recognition Program Requirements
Focus On: Leadership of the Chief Nurse Executive Work environment Adherence to standards Interdisciplinary collaboration Cultural and ethnic diversity of patients and care providers is recognized by the hospital Best nursing practices - evidence-based practice, quality improvement, research – are demonstrated Benchmarking against quality standards in certain areas

20 Original 14 Forces of Magnetism
Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality of Care Quality Improvement Consultation and Resources Autonomy Community and the Hospital Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development These are the original 14 elements identified in the 1983 research study of 163 hospitals as characteristics of hospitals that were best able to recruit and retain nurses during the nursing shortages of the 1970s and 1980s. These characteristics seem to pull nurses like a magnet to these hospitals and to keep them when other hospitals nearby were losing nurses. These characteristics became the ANCC Forces of Magnetism used in the original Application Manual & that provide the conceptual framework for the Magnet appraisal process. In the original application process hospital would have to take each Force and detail how they qualified in that area. They presented organizational charts, statistics, surveys of their nurses, etc. Our application filled a shelf in the library and had an index. In Oct ANCC released a new manual for the application process that focuses on the Five Model Components of Magnetism. Magnet Hospitals: Attraction and Retention of Professional Nurses. American Academy of Nursing. Kansas City. : Taskforce on Nursing Practice in Hospitals PMID:

21 Five “Model Components” of Magnetism
Transformational Leadership (TL) Quality of Nursing Leadership (Force #1) Management Style (Force #3) Structural Empowerment (SE) Organizational Structure (Force #2) Personnel Policies and Programs (Force #4) Community and the Healthcare Organization (Force #10) Image of Nursing (Force #12) Professional Development (Force #14) Exemplary Professional Practice (EP) Professional Models of Care (Force #5) Consultation and Resources (Force #8) Autonomy (Force #9) Nurses as Teachers (Force #11) Interdisciplinary Relationships (Force #13) New Knowledge, Innovation, & Improvements (NK) Quality Improvement (Force #7) Empirical Outcomes (EO)  Quality of Care (Force #6) (http://www.nursecredentialing.org/Magnet/NewMagnetModel.aspx) In effort to simplify the application process, they have restructured but retained the 14 components. They emphasize this to maintain continuity and the evidence base on which Magnet is founded. This is the mapping they provide from the old Forces of Magnetism and the new Model Components. Note that each component is followed by a two letter designation. Various requirements in the Manual are referred to by these letter and then numbered. After some you’ll see EO and a number with a specific empirical outcome stated. There isnt much in the Manual under Empirical Outcomes as they are included the required ones under each component—evidence of so many programs, so many policies, so many research projects.

22 Magnet Model Components
Here is the current graph used to explain and illustrate Magnet

23 The Application Each component of the new Magnet Model requires two kinds of submissions: Evidence Documents: particular pieces of documentation such as annual reports, organizational charts, policies & procedures, tables of committees, statistics, data, etc. Evidence Narratives: narrative statements to support the evidence with descriptions of programs, processes or services that provide examples of how each is “operationalized” The actual application and its renewal is quite involved and complicated. The surveyors when the visit have studied the document which is quite a feat. Next we’ll explore each of the Magnet components and discuss its implications for library services.

24 Magnet Components Explained
Let’s take each of the 5 model components and discuss possible services for each after lunch.

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26 Transformational Leadership(TL)
Quality of Nursing Leadership “Knowledgeable, strong, risk-taking nurse leaders follow a well-articulated, strategic and visionary philosophy in the day-to-day operations of the nursing services. Nursing Leaders, at all levels of the organization, convey a strong sense of advocacy and support for the staff and for the patient. (The results of quality leadership are evident in nursing practice at the patient’s side.)” Management Style “Healthcare organizations and nursing leaders create an environment supporting participation. Feedback is encouraged and valued and is incorporated from the staff at all levels of the organization. Nurses serving in leadership positions are visible, accessible, and committed to communicating effectively with staff.” Transformational Leadership: These quotes describe the kind of organization that Magnet is looking for.

27 Required Examples of “Sources of Evidence” for Transformational Leadership
Evidence of strategic planning by nurse-leaders Evidence of advocacy and influence—show organizational wide changes, recognition and reward of innovation by nurses Give examples, from several different nursing units, of advocacy by the CNO on behalf of the staff, such as requests for additional FTEs, systems, equipment, personnel support and so forth. Evidence of visibility, accessibility and communication—show that the CNO is visible and accessible to direct-care nurses, that nurse leaders use input from direct-care nurses, and changes in the work environment and patient care based on input for direct-care nurses. Then the applying organization is asked to furnished “sources of evidence” that the comply. They expect specific examples and, if they don’t exactly see what they expect, they’ll ask for clarification. One way to support the CNO and other nurse leaders is pretty obvious:

28 Library Collection Resources:
AONE: The American Association of Nurse Executives--http://www.aone.org & books & Nurse Leader Top Nursing Journals: Zone 1 1. J Nurs Adm 2. Nurs Manage 3. Nurs Econ 4. Nurs Adm Q 5. Hosp Health Netw 6. Nurs Res 7. JAMA 8. Am J Nurs 9. N Engl J Med Zone 2 (Top 10) 1. J Nurs Scholarsh 2. Med Care 3. J Adv Nurs 4. J Nurs Care Qual 5. Harv Bus Rev 6. Nurs Outlook 7. Mod Healthc 8. J Healthc Manage 9. Health Care Manage Rev 10. Nurs Educ Perspect (2002–) I’ll start you out with an obvious one. Library Resources 1. AONE is the leading organization for nursing leaders; the official journal is Nurse Leader. You might want to look at the AONE website, their books and its journal Nurse Leader. Look at the table of contents and you can discover the interests of nurse leaders 2. The NAHRS mapping studies can help with collection development for the disciplines they serve. Carol Galganski conducted one on the literature of nursing administration. She found that the types of resources used in nursing administration (formats) showed a different pattern than the clinical disciplines (More books? ) Check article in JMLA 3. The Mapping studies have tried to answer the question, What are the core journals, in this case in Nursing Administration? How this is done is to look at what journals are being cited in the literature, in the bibliographies of articles being published. For all 18 studies, 3 years of data, over 102,000 journal citations were mapped, the average pattern of dispersion. On average 2% of titles were in Zone 1, had the most citations, middle zone average 11%, zone 3, most dispersed,averaged 87% of the rest of the literature. You should have most of these first nine journals or easy access to them and you’ll all recognize them as journals that are cited again and again in the literature of nursing administration. Zone 2 journals are important but specialized and you should have at least a few of them if you can So for collection development purposes look for the mapping studies when they appear. They are “hard evidence” that you can use. The protocols for mapping the literature are developed and available so if you know someone who’s looking for a sure fire project they might consider updating one of the mapping studies. Galganski, Carol. (2006) Mapping the literature of nursing administration. J Med Libr Assoc 94(2) Suppl, E

29 Services for Transformational Leadership
Brainstorm– more ideas? New services or changes, additions or improvements to existing services? Table of contents services especially electronic TOC & RSS feeds to save leaders time Collections of nursing certification books Business databases such as EBSCO’s Health Business fulltext & straight business databases like ABI Inform SDIs to Administration of articles on topics such as leadership Library as continuing education center—positioning and emphasizing a role Special book collections on innovation, leadership, shared governance, mentoring, teambuilding, budgeting, writing management documents Place on the library website hot topics Provide bibliography and packets of articles for mandatory manangement/leadership classes Meet with nurse leaders and ask their imput into library services, collection additions, and how to save them time Searches, article collections on the Magnet journey, support for announcing the effort to get magnet Workshops and 1on1 teaching for leaders on searching management topics, Provide statistics to managers by unit on searches done, ills and other library use Work with nurse managers to support budget proposals and share costs of new resources for nursing Set up a blog for nurse managers

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31 Structural Empowerment (SE)
Organizational Structure Personnel Policies and Programs Community and the Healthcare Organization Image of Nursing Professional Development Description: Magnet hospital environments are “flat, flexible and decentralized.” “Nurses throughout the organization are involved in self-governance and decision-making structures and processes that establish standards of practice and address issues of concern.” Describe how the CNO has enabled decentralized decision-making through education, facilitation, and support. Describe how decision-making is operationalized to involve all levels of nurses. This is where Shared Governance comes in. This is an important concept in nursing and I urge you to do a search under that term and read some of the articles that describe it more fully.

32 Required examples of “Sources of Evidence” for Structural Empowerment
Professional Engagement - show that the structure and processes of the hospital enable nurses from all setting and roles to participate in organizational decision-making groups such as committees, councils, and task forces. Commitment to Professional Development- show how the organization sets expectations and supports nurses at all levels who seek formal education (BSN, master’s, doctoral degrees.) Continued on Next Slide

33 Sources of Evidence For Structural Empowerment (continued)
Teaching & role development-show how it promotes the teaching role of nurses, how nurses support community education activities, how nurses support academic practicum, adjunct faculty, mentorships, etc. Commitment to community involvement – show structure and processes to allocate resources to affiliations with nursing schools, consortiums and community outreach

34 Shared Governance: key concept
Shared Governance is a management model proposed & described in the nursing literature over 30 years ago. It has a specific meaning, almost an emotional context, to nurses. Shared Governance spreads the authority and responsibility for nursing practice down to the unit level and involves nurses directly in practice decisions. A key concept to the quality of nursing leadership, the management style of the organization and nursing empowerment is Shared Governance. Shared governance facilitates joint decision making by nurse leaders and staff nurses about matters of practice, education, etc. Collaboration is the key to this management model and makes staff nurses empowered to assume authority and responsibility and accountibility for the care that they provide. Recognized by hospitals as an important element in the delivery of consistently high quality care.

35 Shared Governance Includes
Autonomy of Practice, Control of Practice Environment, Effective Nurse-Physician Relationships Encompasses concepts such as empowerment, autonomous decision making, accountability, collaboration, mentoring, high-quality patient care, and evidence-based, excellent professional nursing practice. (McClure M, Hinshaw A. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses. Kansas City, Mo: American Nurses Publishing; 2002.) We’ve had shared governance in my hospital for almost 20 years, very successfully. where councils or committees have various charges and scopes of responsibility to plan and engage and communicate. Nursing Practice council, Nursing Research council, Nursing education council, Outcomes Measurement, etc. etc. etc. have broad authority to make decisions. Staff nurses are on these councils. I strongly urge you to read one or two of the articles on the bibliography about shared governance and become familiar with the concept as it is an important one to nurses. Note that though they mention evidence-based nursing practice it is emphasized later when we discuss New Knowledge.

36 Ideas for Library Services for Structural Empowerment?
Remember that SE is composed of these “Forces of Magnetism” Organizational Structure—flat structure, participatory Personnel Policies and Programs—nurse involvement Community and the Healthcare Organization Image of Nursing—positive and professional Professional Development—encouraged Facilitate Policies and Procedures on intranet If you have nursing students doing a practicum be part of their orientation, Consumer health services/partnerships with public libraries Support partnerships with community-based organizations and advocacy groups Help nurses and other health professionals in the community, including public health EBP competency instruction (with CE credits) & other jointly produced courses Journal clubs CEU articles in nursing journals or web Respect – treat equal to physicians Displays Support celebrations—Nurses Week Support for updates of nursing policies & procedures through searches, ILL, etc. Development of intranet site of Library resources; availability of Library resources inside electronic medical record Forums, wikis & SharePoint on hospital Intranet for nurses to collaborate & share Building relationships with local nursing students & act as resource for public library & junior college Work with Nursing Staff Development to jointly create professional development courses for nurses Act as consultant/searcher to nurses with new ideas for change Supporting nurses continuing education with the collection, instruction, encouragement Teaching nurses to search, about evidence-based practice principles, how to use databases Open houses, trivia contests and raffles promoting library – let them know that library is for all staff Promote Nurses Week as well as National Medical Librarians month Serve as a mentor in learning the research process Support and attend research day poster sessions – see what happened with those searches! Workshop on creating posters for research days and conferences Become part of new nurse orientation – last stop on tour (with treats?) so they can browse and see what’s available “Extra” services – notary, test proctoring Post/share articles written by nurses and other staff; maintain bibliography Demonstrate that “knowledge is power” Support for journal clubs – try online, as Moodle forum Column in nursing newsletter

37 What Library Services? Brainstorming?
Facilitate Policies and Procedures on intranet If you have nursing students doing a practicum be part of their orientation, Consumer health services/partnerships with public libraries Support partnerships with community-based organizations and advocacy groups Help nurses and other health professionals in the community, including public health EBP competency instruction (with CE credits) & other jointly produced courses Journal clubs CEU articles in nursing journals or web Respect – treat equal to physicians Displays Support celebrations—Nurses Week Support for updates of nursing policies & procedures through searches, ILL, etc. Development of intranet site of Library resources; availability of Library resources inside electronic medical record Forums, wikis & SharePoint on hospital Intranet for nurses to collaborate & share Building relationships with local nursing students & act as resource for public library & junior college Work with Nursing Staff Development to jointly create professional development courses for nurses Act as consultant/searcher to nurses with new ideas for change Supporting nurses continuing education with the collection, instruction, encouragement Teaching nurses to search, about evidence-based practice principles, how to use databases Open houses, trivia contests and raffles promoting library – let them know that library is for all staff Promote Nurses Week as well as National Medical Librarians month Serve as a mentor in learning the research process Support and attend research day poster sessions – see what happened with those searches! Workshop on creating posters for research days and conferences Become part of new nurse orientation – last stop on tour (with treats?) so they can browse and see what’s available “Extra” services – notary, test proctoring Post/share articles written by nurses and other staff; maintain bibliography Demonstrate that “knowledge is power” Support for journal clubs – try online, as Moodle forum Column in nursing newsletter

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39 Exemplary Professional Practice (EP): Sources of Evidence
“Describe and demonstrate” in 9 areas: Professional Practice Model Care Delivery System(s) Staffing, Scheduling, and Budgeting Processes Interdisciplinary Care Accountability, Competence and Autonomy Ethics, Privacy, Security, and Confidentiality Diversity and Workplace Advocacy Culture of Safety Quality Care Monitoring and Improvement Elements of the original Forces of Magnetism have been incorporated into Exemplary Professional Practice and reconfigured into these 9 Sources of Evidence. In one of our online classes we asked the librarians whether their hospital had designated a “professional Practice model” and if so, what? Very interesting. One person inquired of the CNO, explained why and was immediately included in Magnet efforts. Considering PPM generally has nurses looking into various nursing theories about patient care and either adopting one or, as is common, writing their own based on one or more nursing theories. Once this is done it is important to collection development that you know what this model is as it can guide you to develop various areas of the nursing collection in response. How much complementary and alternative medicine? How much multicultural/multilingual material? How much self help and self care information? My nurses refer to their PPM when they craft budget requests, evaluate existing or new services, etc. Nursing theories really count in Magnet hospitals. 39 39

40 Exemplary Professional Practice: EP
The achievement of exemplary professional practice involves both philosophy and practice, patient/family centered care, interdisciplinary collaboration, ethical & safety considerations, and use of data and national benchmarks to improve performance and patient care. It is hard for me to imagine that the exemplary practice by nurses can take place in isolation from knowledge-based resources and the assistance of librarians to locate these. What services can you suggest or changes to current services? Assist with local guideline/standards development, have copies of national & state guidelines, practice acts, etc. Bibliographic management software support for work groups Assist with development of databases/content management systems supporting transparent access to local as well as national standards and guidelines Serve as an inside consultant to interdisciplinary committees to find evidence to base their decisions on Teaching? Resources on teaching, Support development of teaching materials such as graphic & multimedia,Audiovisual resources, Orientation center for classes Interdisciplinary relationships: Magnet program sees librarians as example of interdisciplinary activity; Committee participation—Research, IRB, Patient Safety, Patient Education

41 Nurses as Teachers :Resources
Journals J Contin Ed Nurs J Nursing Ed Nurs Educator Nursing Ed Perspectives Intl J Nurs Ed Sch(IJNES) Nursing Organizations NLN AACN Listservs BIRTHED NURSED-L NURSENET NURSEGRAD NRSINGED Blogs The Teachers corner Nursing school blog Mediblogopathy

42 Interdisciplinary Relationships: Resources
Institute of Medicine Studies COGME – NACNEP report Council on Graduate Medical Education and the National Advisory Council on Nurse Education and Practice

43 Library services for Exemplary Professional Practice
Brainstorming? Assist with local guideline/standards development, have copies of national & state guidelines, practice acts, etc. Bibliographic management software support for work groups Assist with development of databases/content management systems supporting transparent access to local as well as national standards and guidelines Serve as an inside consultant to interdisciplinary committees to find evidence to base their decisions on Teaching? Resources on teaching, Support development of teaching materials such as graphic & multimedia,Audiovisual resources, Orientation center for classes Interdisciplinary relationships: Magnet program sees librarians as example of interdisciplinary activity; Committee participation—Research, IRB, Patient Safety, Patient Education

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45 New Knowledge, Innovation, & Improvements (NK)
“Magnet organizations conscientiously integrate evidence-based practice and research into clinical and operational processes.” “Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations and improvements.” “This component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing.” Duh! Library roles here are very obvious. {read} Librarians are the Gatekeepers for new knowledge through our databases, search services, etc. AND by our very presence on and contributions to efforts in this area we re-enforce the interdisciplinary aspect of services in this area—WIN WIN

46 Library Services for NK?
Evidence based practice—discovering new knowledge If no new knowledge on a practice question, conduct your own study Share your research results Obvious Magnet opportunities for library Ideas? Provide information on how to find EBP articles, several EB nursing pages including PICO samples, and a link to the EB pyramid Provide literature searches, provide Linkout from PubMed, additional electronic resources Teach evaluating the literature; Help them really understand EBP Put policies in APA format, teach APA Collaborating with nurses to provide online EBP course, training classes on PICO clinical questions Provide point-of-care information products RSS feed to AHRQ Healthcare Innovations Exchange & OJIN Overhaul the nursing journal collection Provide “tips” under signature re new web resource, search tip, etc. Add CINAHL (or another nursing database) Add more full text – Joanna Briggs, Cochrane Library, nursing research and specialty journals Involve nurses in decisions on new library resources Diversity collection – links Facilitate new information product demonstrations Support for new technologies, including handheld devices Rounding with nurses on different units Use nursing staff to help with training on library resources

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48 Empirical Outcomes (EO)
The application manual states that “the empirical measurement of quality outcomes related to nursing leadership and clinical practice in Magnet organizations is imperative.” The component does not state any particular requirements itself but that outcome sources, indicated by EO, are requested throughout the sources of evidence.

49 Suggestions for Empirical Outcomes: If you have any outcomes to report under any of the Magnet components, you should try to include: How the work was done, i.e. methods & approach; RN involved in planning Describe the measurement used to evaluate outcomes & the impact (results & significance) Purpose Background Who was involved—CNO, staff RNs, APRNs, pharmacists, physicians, etc. CNO: Chief Nursing Officer APRN: Advanced Practice Registered Nurse, e.g. Clinical Nurse Specialists (CNS), Nurse PractitionersNP), Certified Nurse Midwives (CNM), Nurse Anesthetist, plus any other titles 49

50 Tips for Data Gathering
Document planning meetings, including who is present and if they are an RN Have a sign-in sheet for meetings, programs, presentations, etc. and ask about RN status Capture as much data as possible about use of resources, statistics by status (RN, physician, staff) such as interlibrary loan, circulation, etc. Consider regular monitoring of quality of information services by a feedback sheet or questionnaire and capture RN status if possible. *If you’re planning an activity that includes CEUs, RN MUST be part of the planning process. Very helpful for setting objectives  50

51 The Philosophy & Research
What do librarians need to know about nurses, EBNP & nurses information Needs? The Philosophy & Research

52 Evidence-based Nursing Practice (EBNP), Nursing Research & the Magnet Journey
Margaret (Peg) Allen, & Joy Kennedy, 52 52 52

53 Evidence Based Nursing Process
1. Define the question 5. Evaluate the process 2. Collect evidence 4. Integrate evidence into practice situation This slide explains the basic process of EBN – graphic developed by Dr. Susan Pierce from the Pravikoff, Pierce & Tanner ICIRN research and included in her presentation at the 2003 MLA Evidence Based Nursing symposium – slides linked as a Supplementary reading. Note that it is more than just Finding the evidence It involves critically appraising the evidence. I’ve found nurses to be somewhat uncomfortable doing this. Often this isn’t fully explained in their coursework or integrated into their knowledge. This is also a failing of physicians and other healthcare professionals who haven’t had training in this. All research evidence is NOT equal and shouldn’t be treated as such. Which leads to the next stage of integrating evidence into the practice situation. This process is also complicated as I’ll explain later. Finally, evaluate the process, this is an important step that is often skipped and shouldn’t be. Note the close match to the steps of the nursing process, from assessment to planning, implementation, and evaluation. 3. Critically appraise the evidence --graphic developed by Dr. Susan Pierce from the Pravikoff, Pierce & Tanner 53 53 53

54 Data Use in Clinical Decisions
This schematic is another way of looking at the inputs into a clinical decision – into what to provide for an individual patient. Studies looking at the knowledge actually used by most nurses show the same pattern as with physicians: expert personal knowledge is used more than published information. This may be what the nurse learned in school and (hopefully) continuing education or going to another expert, such as a clinical nurse specialist. The practice of evidence based care seeks to make published knowledge-based information more central to the clinical decision process. (based on Graves JR, Corcoran S. The study of nursing informatics. Image. 1989;21:(4):227–31.) The practice of evidence based care seeks to make published knowledge-based information more central to the clinical decision process. 54 54 54

55 Relationship of Information Literacy, EBNP & Nursing
EBP Research, information, competency based teaching – all of these are key concepts to EBNP. We’re going to quickly summarize some of the research into these concepts. We feel that if you are going to devise new services they should be based on nursing research and values. Our Nursing and Allied Health Research Section (NAHRS) surveys are part of the evidence – you may want to view the presentations and summary reports on the NAHRS Research page on the MLA site So lets examine the nursing research and what we know from it about information literacy, evidence-based practice and nursing. 55 55 55

56 Evidence Based Practice Competencies
“National Consensus of Essential Competencies for Evidence Based Practice of Nursing” Developed in 2005 by the Academic Center for Evidence-Based Practice (ACE), University of Texas Health Science Center at San Antonio, available for purchase (http://www.acestar.uthscsa.edu/Competencies.htm) Information Literacy Competencies which follow reference these competencies 56 56 56

57 Information Literacy Competencies for EBNP
In 2006, Peg Allen was asked to present “Teaching Clinicians to Fish” for the annual ACE Star Summer Institute on Evidence Based Practice (http://www.acestar.uthscsa.edu/past_institutes.htm) Link above includes abstracts to past Institutes Using the ACE EBP Competencies, Peg drafted: Information literacy competencies for all Nursing/clinician & researcher competencies 57 57 57

58 Basic Health Information Literacy Competencies—everyone in healthcare
Uses quality health information portals, such as Medline Plus and libraries Searches for information in appropriate formats Evaluates health information resources regardless of format – Accuracy, Balance, Completeness Understands use of Boolean AND, OR and other search techniques for Internet search portals and layperson databases Observes intellectual property rights – does not plagiarize Cites sources using a standard bibliographic format All people who work in healthcare, including health organization staff & volunteers, should have basic health information literacy competencies. 58 58 58

59 Clinician Competencies
Recognize ratings of strength of evidence when reading literature, including web resources Evaluate and use resources for quick reference, including PDA tools Searches core bibliographic databases for chosen health profession Develop a searchable question Search CINAHL & NLM/AHRQ databases using subject headings, EBP filters and limits Evaluate citations for potential relevance “Clinicians” refers to doctors, nurses, technicians, etc. Clinicians competencies, by clinicians we include nurses, doctors, technicians. 59 59 59

60 Clinician Database Competencies
Can develop a searchable question “The question is just as important as the answer. The answer you get out is only as good as the question you put in.”* Search CINAHL & NLM/AHRQ databases using subject headings, EBP filters and limits “It's not your father's literature search… Unless I know the clinician wants to see everything, or is doing research rather than addressing an actual patient issue, I filter.”* Can evaluate citations for potential relevance Expense of retrieval, including copying or ILL, is not insignificant. * comments from Marcy Brown, MLS, West Penn Hospital - Forbes Campus, Monroeville PA, May 1, 2006 Summarized here are the clinician’s database competencies, with comments from Marcy Brown Searchable question—this is the hardest thing to teach nurses in my years of experience. The holistic way that nurses are trained to think makes the hierarchical tree structure of databases difficult for them. PICO was developed as a guide to help them think of ways to break their question down into concepts– chunks—that are searchable AHRQ and government and quality websites are often forgotten with the emphasis on CINAHL & NLM databases No we cannot give them all 125 citations—they need to be able to evaluate what is relevant, understand the parts of a citation like number of pages, type of article so that they can evaluate whether or not it might be useful 60 60 60

61 Clinician Competencies – Point of Care Databases
Recognize ratings of strength of evidence when reading literature, including web resources (Undergraduate, Star Point 1, #4) Evaluate and use resources for quick reference, including PDA tools Evidence-base – references? Relevance to clinical needs Ease of use Currency Goal: Synthesis of credible evidence Clinicians competencies, by clinicians we include nurses, doctors, technicians. 61 61 61

62 Nurses as Knowledge Workers How do Nurses Use Information
Nurses as Knowledge Workers How do Nurses Use Information? How does their Information Needs Differ from Others? 62

63 Needs of the Practice Environment
Nurses as Knowledge Workers: Similarity of Nursing Process Steps with Knowledge Worker Roles Nursing Process Steps Knowledge Worker Roles Assessment Diagnosis Planning Intervention Evaluation - outcomes Data-gatherer Information User Knowledge User Knowledge Builder The source article by Sydney-Halpern and others points out the similarities between steps in the Nursing Process and Knowledge Worker roles and what is needed in the clinical practice environment to support the nursing process. 20th century information systems supported the first two Knowledge worker roles--data gathering and information user roles of nurses, the latter when a nurse gathers data and makes her assessments. In 21st century information systems, knowledge-based information is needed for the third role—the Knowledge User step—such as is found in various point-of-care information products. The last step in the Knowledge worker process—the Knowledge builder role– refers to the last step in the Nursing Process—evaluation and outcomes and is an excellent match to the Empirical Outcomes at the center of the Magnet model. Knowledge building requires the ability to aggregate data for research studies to build knowledge. For nursing, this means standard labels for the nursing interventions. Hence, the need for a standard nursing terminology, especially nursing diagnoses and interventions, in the practice environment and in information systems. Nursing interventions need to be built into hospital information systems, but not always case. Nursing needs a voice to make this happen – perhaps this is an example of place for technological innovations in the Magnet environment. Needs of the Practice Environment Source: Sydney-Halpern R, Corcoran-Perry S, Narayan S. Developing clinical practice environments supporting the knowledge work of nurses. Computers in Nursing 2001 (Jan-Feb); 19(1):17-23. 63 63 63

64 Medical vs. Nursing Concerns in Evidence-based Practice
Same patient with broken hip, different EBP concerns. Nursing care is focused on the patient, not the disease process. Nursing Concerns Pain Incontinence Immobility Confusion Skin breakdown Inadequate sleep Medical Concerns Hip replacement Hip pinning Watchful waiting Surgical risks Correct prosthesis Same Patient, Different Concerns, Different Info Needs The physician and the nurse have different concerns in EBP based on their differing roles. When evaluating a patient with a hip fracture, the physician is concerned about the medical management of the broken part. The nurse takes the broader view, required by nursing’s more holistic view of care. Nursing care is focused on the patient, not the disease process. Source: Lang NM. Discipline-based approaches to evidence-based practice: a view from nursing. Joint Commission Journal on Quality Improvement 1999 (Oct); 25(10): 64 64 64

65 Patient knowledge also influences shared decisions & is part of “the evidence”.
We’ve looked at the clinician and at the nurse in the information process. Let’s not forget one other key player in evidence-based practice—the patient-- and where knowledge falls in evidence based practice. Lisa Traditi has this diagram to explain that what the clinician (doctor or nurse) knows and what is in the literature is ALSO influenced by what the patient (and family) wants, based on their health beliefs, culture and other individual factors. Diagram courtesy of: Lisa K. Traditi, MLS, AHIP Head of Education and Learning Resources Center Denison Memorial Library University of Colorado at Denver and Health Sciences Center 65 65 65

66 Continuum of Information Needs in Evidence-based Healthcare
Patient-focused clinical questions –medical plus nursing/allied health implications Interdisciplinary guidelines – evidence-based “best practices” Based on clinical research Management and education issues – many related to Magnet components and forces All of these factors, all of these information needs are involved in EBP. All of these factors, all of these information needs are involved in evidence based practice. 66 66 66

67 When is Research Utilized?: When do nurses look for research?
Let’s look at Nursing’s Research Utilization Models to better understand Evidence Based Nursing Practice (EBNP) Research utilization was a major topic in the nursing literature in the years leading up to evidence based nursing practice (EBNP). It is important that we understand the thought and philosophy that developed in nursing literature to explain why research was being utilized. Let’s look at this now. 67 67 67

68 Research Utilization Models: What Causes Research to be Used?
Ottawa Model of Research Use Stetler Model of Research Utilization Practitioner orientation Two levels: individual and organization Focus on research competencies Iowa Model (Titler et al.) of Research in Practice Knowledge focused triggers: new practice standards, philosophies of care, research and meta-analysis Problem-focused triggers: clinical questions, quality improvement projects, journal clubs I urge you to add Polit and Beck text to your library if don’t already have it. It is an excellent basic guide to nursing research. Chapter 18 discusses models of research utilization—the Ottawa model, the Stetler model, and the Iowa model, etc. All are very viable models for research utilization for evidence-based practice. There’s not time to go into their subtle differences but lets focus on the Iowa model cause it seems to resonant with our experiences as hospital librarians—or at least, my decades of experience as a hospital librarian. The Iowa model acknowledges that a formal research utilization/ EBP project is typically begins with a trigger. This is either the emerging awareness of innovative research findings or a problem based trigger that has its roots in a clinical or organizational problem. This is how we’ve been approached in our hospitals when nurses seek research information. BUT if this is what STARTS the use of research, what are some barriers to research utilization and evidence-based practice you might find in a hospital. (Polit & Beck (2006), Using research in evidence-based practice in Essentials of Nursing Research, pgs ) 68 68 68

69 What are the Barriers to Research Utilization?
Individual constraints Lack of time Little experience/low comfort level with library and search techniques Limited ability to understand/interpret research reports Limited exposure to to research-use strategies during educational preparation Negative staff attitudes toward research Organizational constraints Lack of availability of pertinent research findings Limited access to journals Lack of administrative support Cost constraints Concerns about reallocation of staff time There has been quite a bit of research over the years and the findings are pretty consistent. As we look at these barriers, we want you to keep them in mind as you plan services to nurses. Some we can do nothing about –the lack of quality research in nursing and lack of administrative support for research utilization are typically beyond our control as librarians BUT SOME WE CAN HELP WITH Note that Lack of time is one of the main constraints to individuals—this is definitely an area where our expertise can cut the time they might spend seeking and validating research. We CAN seek to provide wide access to journals as difficult as working thru IT can be AND we can help with last of research by urge nurses to do research and help with that process. We CAN provide studies to administration about the value of research utilization to the bottom line to gain support. AND as librarians we should try to overcome “limited access to journals” in organizational constraints with electronic access to journals on the nursing units. This wasn’t an option for many hospitals when this article was published in 1996. (As summarized by Simpson B in Canadian Nurse, 1996 Nov; 92 (10): ) What can librarians do to help overcome these barriers? 69 69 69

70 From Research Utilization (RU) to Evidence-Based Practice
Component of EBP Only research accepted as evidence Critical appraisal of research reports Broader concept Evidence other than research part of EBP Critical appraisal of all evidence Since concern about research utilization in nursing pre-dated the evidence-based practice movement, this chart (columns reversed from the source) is helpful in explaining the difference. It would be very helpful when teaching the naysayers in nursing, who are concerned that overreliance on research evidence will take away from knowledge or wisdom possessed by seasoned nurses, as well as the patient centered philosophy of nursing. As for “evidence other than research”, Nurses don’t like to rank quantitative studies above qualitative, but consider both useful, with relative value depending on the nature of the question. The Levin & Feldman book is very helpful for teaching EBP and values librarians’ contributions. Based on Levin, Rona F. & Harriet R Feldman, Teaching Evidence-Based Practice in Nursing: A Guide for academic and clinical settings. New York: Springer, p. 11. 70 70 70

71 National Council of State Boards of Nursing,
National Survey on Elements of Nursing Education, 2006 “The graduates were more likely to feel adequately prepared when nursing programs: taught use of information technology and evidence-based practice, integrated pathophysiology and critical thinking throughout of curriculum…” (https://www.ncsbn.org/RB24_06ElementsofNursing.pdf) – p. 37 We urge you all to review this report. It has some key findings about nursing graduates and their readiness to be nurses. What do they need to know to be effective nurses. More and more there is a recognition that evidence-based practice is key to the preparation of new nurses… as is information technology. (We feel that the nurses writing the survey often confuse database searching with information technology, but that’s another story.) If the concept of “critical thinking” (which we don’t have time to cover but is a specific concept in nursing education) is taught and applied throughout the curriculum, it results in graduate nurses that feel more prepared to be nurses. Information technology/information literacy and EBP skills need to be integrated, taught with, the pathophysiology (disease concepts) and with the critical thinking concepts to it work well for nursing practice. The next slide is an example of curriculum integration, that could be modified when teaching staff nurses. Think about how point-of-care electronic resources might supplant printed sources. 71 71 71

72 Interagency Council on Information Resources for Nurses (ICIRN) Research: Six Common Questions
Are nurses aware of the need for research-based information? Do nurses identify information needed for research-based practice? Do nurses have the ability and availability to electronically search for information? Do nurses actually apply electronic information-seeking processes? What information do nurses use? For what purposes do nurses use information retrieved? This study by Pravikoff, Tanner and Pierce for ICIRN (Interagency Council on Information Resources for Nurses) asked these core questions about nurses’ information literacy. The second question looks at whether nurse continue to question after graduation, or whether they are complacent. No one doubts the value nurses place on knowing the patient and the knowledge of “expert” nurses, seasoned or clinical nurse specialists. However, there is continuing concern that nurses don’t look for research evidence in the literature when they should. Note the highlight on the third concept. Do nurses possess these key skills? If yes, does their work environment support electronic access? The ICIRN research has been replicated in hospitals assessing readiness for EBP as part of the Magnet planning work. Some examples are included in book “Real stories of nursing research” and Diane Pravikoff is willing to share the research instrument. 72 72 --Pravikoff, Tanner, Pierce 72

73 ICIRN Research Results
Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. Nurses for Evidence-Based Practice? American Journal of Nursing, 105(9), Dee, C., & Stanley, E. (2005). Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians. Journal of the Medical Library Association, 93(2), 213–222. For more information and color slides, see MLA 2003 Symposium: Evidence-Based Nursing Practice: Needs, Tools, Solutions You can read the results yourself but my personal experience is that there is great variability among nurses—not by age, but by how technologically adept they are. Some nurses don’t even know how to open their accounts, open an attached pdf document, how to reply to an . Others are extremely knowledgeable. But as you work with nurses be prepared for either extreme. Again I urge you to read the ICIRN results in that first citation on the slide, and to read Dee and Stanley’s study of the information seeking behavior of nurses. The third citation is to a symposium given at MLA 2003 on evidence-based nursing practice. The slides posted on the NAHRS site are extremely helpful and expands the information we’re giving you briefly in this presentation. Susan Pierce and Diane Pravikoff presented the Louisiana and New York studies leading up to the ICIRN research. Updates to the searching workshop are included in the next PowerPoint program for this module of Getting Magnetized. p 73 73

74 ICIRN – similar conclusions in UK & Canadian Studies
The Information Needs of Nurses, Health Care Assistants, Midwives and Health Visitors. Summary report of RNC survey (2005, April 20, 2005). Canadian Nurses Association position statement “Nursing Information and Knowledge Management” (November, 2006) Conclusion: "Having good access to information – via the Internet and via a physical library and via information skills – appears to have a direct effect on putting evidence into practice. Those with the best access to information were also more likely to both search for evidence and to change their nursing practice as a result of research.“ (RNC survey) The ICIRN conclusions were seen in UK and Canadian. Notice that the RNC summary (cited first) puts together the need for Internet access, library/librarian access, and information literacy skills in the quote at the bottom of the slide. 74 74 74

75 Nursing Values and Research
In presentations on the Pravikoff study, the authors stress the need for nurses to value nursing research. FYI: Article on values free from Nursing Ethics collection, Other than ICIRN what other important nursing educational initiatives should librarians be aware of? 75 75 75

76 T.I.G.E.R.— Technology Informatics Guiding Educational Reform
Summit of major nursing organizations & 20 nursing informatics societies (& NAHRS reps) Goal was to identify information/knowledge management best practices & effective technological capabilities of nurses Action plan for transforming nursing practice and education to better prepare nurses to practice in an increasingly automated, informatics-rich, and consumer-driven health care environment

77 Librarians’ Role Can librarians help address barriers to EBNP?
Can librarians help with T.I.G.E.R. initiatives? What does research show us about the Librarian’s role ?

78 MLA & NAHRS Research Efforts
As Peg Allen, Pam Sherwill-Navarro and Susan Jacobs worked with ICIRN, the T.I.G.E.R. Summit, and students in MLA CE classes, the need evolved for learning about librarian roles in EBNP & the Magnet program. Learning has occurred via surveys, teaching, and MLA programs at the national and local levels As Peg, Pam Sherwill Navarro and Susan Jacobs worked with ICIRN, the T.I.G.E.R. Summit , and students in MLA CE classes, the need evolved to learn about librarian roles in EBNP & the Magnet program. The 2007 NAHRS Magnet coordinator survey was conducted & results were presented at MLA in 2007, and the 2008 NAHRS Survey of Librarian Roles in EBNP was presented at the fall 2008 Southern Chapter (SCMLA) meeting. How would your Magnet coordinator or you respond to the Magnet coordinator survey? 78 78 78

79 NAHRS 2007 Magnet Coordinator survey
Goal: To assess library resources and services at ANCC (American Nurses Credentialing Center) certified Magnet facilities. Secondary goal: enhance Magnet coordinator awareness of what librarians can contribute to the Magnet journey Process Developed by NAHRS Task Force to Create Standards for Nursing Information Resources and Services in Health Care Settings and Research Committee, using Survey Monkey Approved by MLA Board, with additional questions on role and value of librarian Sent to Magnet coordinators via ANCC list with cover message encouraging Magnet coordinators to get librarian help with completing survey Richard Barry, ANA Librarian (ANCC is unit of American Nurses Association) facilitated use of Magnet coordinator list Follow-up mailing to Magnet coordinator list DOCUSER database used to identify librarians at Magnet hospitals with no response, sending them the final request NAHRS Research page: The next few slides describe a few of the results and recommendations from the Nursing and Allied Health Resources Section (NAHRS) survey research in July and spring of We encourage you to read the results online – both posted on the NAHRS Research page noted here. 79 79 79

80 Librarian’s Role in Magnet Journey?
156 (81.7%) reported librarian involvement, including four hospitals where Magnet coordinator said Yes and librarian said No Types of involvement Typical library services, including teaching & searches Magnet committee – often only non-nurse Input on Magnet application Proof reading Bibliographic citation management EBP support for guidelines development Nursing research committee & IRB Nursing education committee Web pages; one Evidence Based Nursing Blog Comments from Magnet coordinators where librarian said no role: Meetings to come up with ways to make resources more available to nurses. Librarian started a roving cart with books and a laptop to do searches and check out books. Helpful with literature searches and gathering resources to assist with basing policies on EBP Key member of the Evidence-Based Practice/Research Committee Partner, educator 80 80 80

81 Added Value of Medical Librarian
12. If your facility or institution has a medical librarian or access to one, do you perceive that this provides added value for the institution and employees? 96.3% of (184 of 191 hospitals) said yes. Comments added by 89 hospitals for yes responses, and 2 No/no response (see separate comments list) Librarians sometimes unaware of what was valued by those in Magnet coordinator role 81 81 81

82 Magnet Coordinator Comments
“Our librarians are easily accessible and very willing to assist students, staff, and visitors with any questions or concerns. They have really done a nice job of welcoming research issues and expanding resources to meet our needs.” “We partnered with the librarians to help us set up a file management system for cataloging evidence.” “As employees are focusing on more evidenced-based practice and hospital-based research, medical librarian became a valuable resource to staff.” From one without: “We don't have access, but are recognizing the value; I have consulted a university librarian and have brought this information to my CNO – that is why we will have this service available in 2008.” More comments available with report on NAHRS website, 82 82

83 Librarian comments – value & role
Value of resources and services Involvement of a health sciences librarian on Magnet team Librarian involvement on committees Education: Staff; Nursing; Patient/Family IRB (Institutional Review Board) Nursing Research Patient Safety Example: “Librarian is a member of multidisciplinary teams, provides in-services, is closely aligned with Medical Education, Human Resource development, CME, and clinical research activities; supports information needs for patient care; manages centralized knowledge-based resource and media services for entire system of 6 hospitals and 10,000+ employees.” 83 83 83

84 “The Magnet Journey: Opportunities for Librarians to Partner with Nurses.”
Title of article for JMLA Vital Pathways symposium issue October,2009 Vital Pathways for Hospital Librarians (VP) task force: official MLA response to threats faced by hospital librarians Like Magnet, Vital Pathways focus was on outcomes Efforts continuing by HLS & NAHRS sections now that VP taskforce ended Review documents on the Vital Pathways site – note link to Magnet coordinator survey. 84 84

85 After the Class is Over: Magnet Challenge Action Plans
Analyze your organization, your nurses and nursing leadership Think about the concepts we’ve discussed Read some of the literature we’ve provided – search for more addressing your idea Analyze your library’s resources and viable alternatives Convey your willingness and eagerness to be part of the Magnet process—and your enthusiasm Be aware that additional resources for library may not be forthcoming This is your “final test” – no grade 85 85

86 How to Fund: Business plan or Grant proposal?
A grant proposal is like proposing a new service, except that you are going to an external funding source In business plan, think of administrators as an “external” source with little or no knowledge of what we do – write so that they understand your request No library jargon! KISS principle: Keep it simple, stupid 86

87 Peg’s thoughts on grants: http://www.healthknowledgeconsultants/grants.htm
Strategic Planning Model Strengths – why you can be trusted with their money Weaknesses – why you need funding Opportunities – funding organization priorities (Magnet expectations) Threats – what will happen without funding Find funding organizations interested in supporting your needs 87

88 Strategic Planning: SWOT Model
Strengths Weaknesses Opportunities Threats Effective Programs The SWOT model is often used in publications and courses on strategic planning and proposal development. It is fundamental to the needs assessment. Peg uses it in grant proposal development, working with partners to do the SWOT analysis. Group processes for planning are chosen based on the scope of the project. Analysis of each component is foundation for success 88

89 Program Planning Model
Strengths or Weaknesses? Knowledge sources Nurses’ needs Can you turn weaknesses into opportunities for improvement? Effective Programs Information portals Lack of librarian time Opportunities or Threats? 89

90 Thoughts continued… Needs assessment is vital for either grant or new service plan Proposal Development Bibliography – a beginning DeSilets, L. (2007, May). Needs assessments: an array of possibilities. Journal of Continuing Education in Nursing, 38(3), Retrieved June 22, 2009, from CINAHL with Full Text database. Overview of different methods – use not limited to continuing education. Dickerson, P. (2008, October). Addressing barriers to enhance outcomes. Journal of Continuing Education in Nursing, 39(10), Retrieved June 22, 2009, from CINAHL with Full Text database. Barriers in context of continuing education – need to get input from the learners.  Caldwell, L., Luke, G., & Tenofsky, L. (2007, Jan-Feb). Creating value-added linkages through creative programming: a partnership for nursing education. Journal of Continuing Education in Nursing, 38(1), Retrieved June 22, 2009, from CINAHL with Full Text database. Focus on collaboration and partnerships. Hospital library is mentioned as part of what the hospital supplied to on-site BSN program. Notes value of champions from each organization. This is not just what you want to do, but a proposal to meet a need identified by working with nursing 90 90

91 More thoughts on proposals…
Realistic plan & budget – but double time you think you need Keep objectives simple – don't tie to specific methods Follow their writing instructions!!! Meet deadlines Build in enough time in proposal development process for last minute snafus 91

92 Summing up: Collaborate with nursing to choose resources and strategies! Map projects to Magnet model components! Evaluate efforts, gather& analyze data – translate to outcomes! Publish your data and share your ideas with librarians & with nurses elsewhere! 92 92

93 Summary: From ideas to action
Librarians & the Magnet Program By Joy Kennedy & Peg Allen 93

94 Librarian roles in the Magnet journey
Magnet components 94 94

95 Transformational Leadership Suggested Ideas from our Classes
Table of Contents Service, especially electronic TOC & RSS feeds Collection of Nursing Certification Books Business databases such as EBSCO’s Health Business Fulltext & databases available from local public libraries SDIs to Administration of articles on topics such as Leadership Library as “Learning Center” or “Continuing Ed. Center” Special collections developed on Innovation & Leadership, Shared Governance, Evidence-based Practice, Mentoring, Teambuilding, Budgeting “Hot Topic” searches on Library website Using SharePoint to share ideas, searches among leaders Providing databases of all kinds & training Bibliography of resources in packets for mandatory management/leadership classes 95

96 Transformational Leadership More ideas
Start by meetings with nursing leaders to discuss how library can help them, especially time saving services Searches for nursing leaders on magnet components & other topics as they lead the Magnet journey Workshops and 1-to-1 teaching for leaders on searching for management topics Statistics on searches by department and unit, showing that nurses at all levels use services Work with nurse administrator to support budget or share costs for new resources for nursing Nursing Research: Show Me the Evidence Blog from the library at St. Joseph Hospital (Orange, California) 96

97 Comments on Transformation Leadership
“The library is away from their unit and provides them a quiet place to contemplate and explore new ideas. “ “Since I am included in many Manager meetings - I do get a chance to hear some of the concerns in the organization - and many times I come back, run a search - and the person who would most likely be interested in what the literature has to offer them. This has really impressed several individuals.” “I partnered with our Practice & Education Councils to visit EACH unit on day shift to promote remote access to resources and Nursing Consult in particular. We dropped off snacks to each unit's break room and did on-the-spot "speedy reviews" of what this product has to offer. We also left behind vendor-provided promotional items, reference cards, my business cards, and remote access applications with each unit's manager. Since that time, I have seen an upswing in Nursing Consult usage, and we received over 100 new Athens access applications.” Time saving for Administrators: “Whenever I work with a nursing administration employee on a CINAHL search, I always show them how to create an account in EBSCO; they love the fact that they can save their searches, including articles stored in their folder. “

98 Structural Empowerment --Suggested Ideas from our Classes
Open houses, trivia contests and raffles promoting library – let them know that library is for all staff Promote Nurses Week as well as National Medical Librarians month Serve as a mentor in learning the research process Support and attend research day poster sessions – see what happened with those searches! Workshop on creating posters for research days and conferences Become part of new nurse orientation – last stop on tour (with treats?) so they can browse and see what’s available “Extra” services – notary, test proctoring Post/share articles written by nurses and other staff; maintain bibliography Demonstrate that “knowledge is power” Support for journal clubs – try online, as Moodle forum Column in nursing newsletter While suggested by another, Joy can speak to mentoring nurses in her hospital’s research fellowship program, from idea through the research process to publication 98 98

99 Structural Empowerment More ideas
Support for updates of nursing policies & procedures through searches, ILL, etc. Development of intranet site of Library resources; availability of Library resources inside electronic medical record Forums, wikis & SharePoint on hospital Intranet for nurses to collaborate & share Building relationships with local nursing students & act as resource for public library & junior college Work with Nursing Staff Development to jointly create professional development courses for nurses Act as consultant/searcher to nurses with new ideas for change Supporting nurses continuing education with the collection, instruction, encouragement Teaching nurses to search, about evidence-based practice principles, how to use databases 99

100 Comments on Structural Empowerment
“Employees are empowered where they have access to information, support, resources and opportunities to learn & grow in their work setting.” “just getting the word out to the nurses that we are here to support their journey and what we have to offer.” “Of course, there is more to structural empowerment than internet connectivity, but we all know information is power, right? If they are empowered to make clinical decisions based on evidence, they need access to the evidence, even beyond a packaged resource on the intranet.” “The library will search for funding opportunities for specific research projects, specifically community nursing projects that support the hospital's community involvement.” “Librarians who have some familiarity with public health information resources can be valuable members of a team tasked with developing a hospital's community engagement program - identifying the major health challenges in a given community, mapping strengths and weaknesses... “

101 Exemplary Professional Practice --Suggested ideas from our Classes
Support community outreach – help with health fairs and health career events Teach health literacy classes at public library, working with nurses from various specialties Provide handouts and resources for community events, including Medline Plus bookmarks and pens Resources and workshops on finding patient education resources, including those for diverse populations Library services for patients as TV menu choice – hand delivering packets Support “information prescription” program Proactive sharing of articles on “hot topics” – example of article on bullying that addresses horizontal violence issues Support for nurses returning to school 101

102 Exemplary Professional Practice More ideas--
Books, bibliographies or Internet Portals on nursing theory and/or conceptual framework of nursing Teach nurses about searching for info on EBP, how to use quality measures Keep ANA guidelines in collection Nursing ethics resources Serve on Interdisciplinary Research committee Provide citation management software & support it to effect collaboration Find out about Professional Practice Models, how to search for information about them in support of organization’s choice Be internal expert and resource for planning 102

103 Comments on Exemplary Professional Practice
“I approached our Nursing Director this morning who is also the person handling Magnet.  She was extremely pleased that I am taking the initiative to find out what I can do as a librarian to support the Magnet process. She advised me that both the PPM and the Nursing Care Model are being developed.  She suggested we meet this week and discuss.  I am excited about developing better ties with the Nurses.” “I've talked to the nurse in charge of our "Journey to Magnet" and she says we don't have a Professional Practice Model yet, but that would be part of the strategic plan developed at the all-day Magnet retreat that I will be attending on Nov 23rd.  She asked if I would talk for 5-10 minutes about this online Magnet course and how the library can help in the pursuit of Magnet.  With all the information I've learned so far, that won't be a problem.”  “through a literature search, [library can] provide reviews and updates, standards, trends, and changes as they relate to nursing practice issues”

104 Typical comment: “We often say that it seems as though all the nurses here at the hospital are going to school! We do support them in every sense since we feel that we are their "home" library and that they are here more than they are at school, especially for those who are taking online courses. One of the most recent things we did was to create a Resources for Local Nursing Programs link (http://www4.umdnj.edu/camlbweb/nursingschools.html) from the Academic Resources -- Nursing Education section of our library page. We tell the nurses that we will even try to help them troubleshoot using the resources from their nursing schools. Also, since we have these links from the library page, the sites are not arbitrarily blocked by our firewall as has happened in the past. “ 104

105 New Knowledge, Innovations, and Improvement --Suggested Ideas from our Classes
Add CINAHL (or another nursing database) Add more full text – Joanna Briggs, Cochrane Library, nursing research and specialty journals Involve nurses in decisions on new library resources Diversity collection – links Facilitate new product demonstrations Support for new technologies, including handheld devices Rounding with nurses on different units Use nursing staff to help with training 105 105

106 New Knowledge, Innovations, and Improvement —More ideas
Provide information on how to find EBP articles, several EB nursing pages including PICO samples, and a link to the EB pyramid Provide literature searches, provide Linkout from PubMed, additional electronic resources Teach evaluating the literature Help them really understand EBP Put policies in APA format Collaborating with nurses to provide online EBP course, training classes on PICO clinical questions Provide point-of-care information products RSS feed to AHRQ Healthcare Innovations Exchange & OJIN Overhaul the nursing journal collection Provide “tips” under signature re new web resource, search tip, etc. 106

107 Comments on New Knowledge, Innovations, Improvement
“help the nurses ensure their practices are evidence-based by participating in the Nursing Policy & Procedure Committee; I encourage them to find updated references when reviewing/revising p&ps, and I conduct literature searches, ideally with them but often on my own, to find the highest level evidence possible” “providing a sample research problem and giving nurses a PICO worksheet or something to work through to really "get" how PICOs are developed.” “I prepared over 40 clinical disease PowerPoint presentations along with EB/full-text articles for academic medicine. It is now the goal of the library to provide these clinical modules to the nurses as supplemental resources for self-directed learning. The bibliographies will be expanded to include nursing literature and, where necessary, the PowerPoint Presentations will be edited to reflect nursing's unique approach to disease treatment and management.”

108 Empirical Outcomes --Suggested Ideas from our Classes
“We keep track of the nursing searches and one on ones that we do and what type of nurse the patron is (admin, staff, educator, etc) and provide those numbers to the leadership. …This is a concrete way the library can show that nurses are learning more about searching and using the literature in clinical practice.” Using Google docs for quizzes, evaluations & feedback on searches – shorter surveys are best Capture stories of how services, especially searches, made a difference in patient care Capture statistics on use of electronic resources, including title specific data for nursing journals Publications list kept by library is part of the evidence for Magnet 108 108

109 Empirical Outcomes --More ideas
Tying library services to outcomes both quantitative and qualitative Provide evidence that library education & efforts are effective as well as use statistics by type of user Provide searches and information in support of National Patient Safety Goals Benchmarking data for QI department Provide guidelines (guidelines.gov) and statistics 109

110 Questions? Evaluation--Complete MLA form
Certificates returned for forms Thank you! Joy Kennedy, MLS 110 110


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