Marti Buffum, DNSc, RN, PMHCNS-BC Associate Chief Nurse for Research Deborah Burgoon, MS, RN, AOCN Clinical Nurse Specialist, Oncology VA San Francisco Kaiser Permanente Nursing Research Council March 8, 2011

Objectives Explore purposes and types of nursing journal clubs Identify methods for beginning and sustaining journal clubs Describe evaluation methods

Types of Journal Clubs Topic-based Updating Informative Team building Evidence-based problem solving Finding solutions Journal-based Specific specialty journal (AACN, JPN, GN)

Reasons for Journal Clubs Intellectual stimulation Appreciating others’ expertise Learning resources among each other Developing professionalism Remote: e-journal club, phone New projects can emerge Demystification of research Developing skills

How to Start: 6 steps! Post and distribute article Include discussion questions Plan time and location and ANNOUNCE! Identify facilitator Conduct the journal club Evaluate Schedule next meeting Kleinpell, R. (2002). Rediscovering the value of the journal club. American Journal of Critical Care. 11(5),

Customize to Your Area Nurse manager guidance and support Utilize experts as needed Engage staff, find enthusiastic champions Take turns presenting Encourage discussion Openness and flexibility required Use incentives (food?); provide CEUs Create “take home message” and post Keep continuous schedule Include staff from other units when ready!

Remote Locations Virtual journal club distribution of everything Time delay Live meeting Conference calls

APN Journal Club: Learnings Some of the things I have gained from participating in our journal club (not necessarily in order of importance): An increased sense of collegiality with other facility NPs with different areas of expertise. Expanding one’s knowledge base both from the review article as well as from NPs with different areas of expertise. Ensuring that our clinical practice is evidence based and is up to date. Improving collegiality with physician colleagues by being able to intelligently discuss recently published studies.

APN Learnings (cont’d) Opportunity for collaboration and future consultation Reading outside of my specialty that I would not normally do Reading new materials that relate to all of us and our practice (e.g., effectiveness of different diets, patient education strategies) Becoming less fearful about research critique imperfections!

Unit Based Journal Club How do staff feel about their new Journal Club? All staff feel “good, great” about Journal Club. What do staff like about Journal Club? Learning a lot Increased knowledge Being involved in discussion Change opinion/view Widen understanding New information Informative and educational Leaning something in depth Increase interest about what we’re doing Keep up with current changes/education/new knowledge

Why volunteer to do an article review? Increase self-confidence in public talking and discussion Increase knowledge of the unit as a whole Advance career activities, help unit, want to contribute Share info with staff Do it for research Way overdue, we should have done this before Nurse Manager’s encouragement I can learn something I’ll wait until I become more comfortable talking in front of staff

Should other units have Journal Clubs? All staff said “yes, other units should do it too.” What advice would you give? Time might be a problem Tight work load might stress staff Try at lunch time Maybe administrative time should be given

How to evaluate Everyone is at a different pace/level Consider journal club as an innovation Rogers’ model of diffusion Appreciation to Keri Nelson (2006) for assisting with evaluation

Who is Rogers and what is Diffusion of Innovation? Stages of Adoption: Knowledge Persuasion Decision Implementation Confirmation/Adoption

Keys to Success Understanding the stages of development can improve patience with adopting changes

Knowledge What is journal club? How do you get a journal club started on your unit? What is evidence-based practice and how can journal club be used as a vehicle to adopt changes?

Persuasion How do you get leaders and managers to buy-in to the importance of starting journal clubs? How do you promote journal club participation among staff on each unit?

Decision How do you decide if journal club is worth implementing? Is journal club relevant to the nursing practice on each unit? How is the staff going to respond to the implementation of journal club?

Implementation After journal club is initiated, how do you motivate and encourage participation among staff? How do you empower (provide resources, support and time) staff to participate? What aspects of journal club impacts nursing practice?

Adoption/Confirmation Journal club has been successfully integrated into the nursing culture on the unit. The staff values participating in journal club and volunteer to present articles with meaningful discussion. The articles/journals provide strong evidence for practice application.

Decisions for Journal Club What type of article? Research? Are findings ready for practice? What more is needed? What more would you like to know? Usefulness of discussing in a group? How to evaluate (see handout, poster)