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Empowering change with traditional or virtual journal clubs By Gina Dovi, MSN, RN, CPHON

“IS THE CARE I PROVIDE to my patients based on current evidence? Do my colleagues provide care in the same way? How can I make a change that will improve my patients’ outcomes?” Nurses may ask themselves these questions to assess their own use of evidence-based practice (EBP). Using EBP can empower nurses, improve patient outcomes, and increase patient safety.1 This article describes the impact a journal club can have on promoting EBP and positive change, as well as best practices for successful journal clubs. Take a closer look A journal club is a gathering of colleagues to discuss relevant professional articles about a clinical practice topic.2 One of its purposes is to increase healthcare professionals’ knowledge of practice changes, leading to improved patient outcomes. Reviewing and critiquing research in journal clubs isn’t a new idea; this teaching method has long been employed by medical schools to share current knowledge and translate it into EBP.3 Journal clubs have gained popularity within the nursing field as one way to bridge gaps in nurses’ knowledge of EBP.4 Journal clubs can also contribute evidence for components of the Magnet® program, including new knowledge, innovation and improvement, exemplary professional practice, and structural empowerment.3,5 For nurses, reading, critiquing, and discussing journal articles helps to fulfill a commitment to lifelong learning and meet a recommendation set forth by the Institute of Medicine.6 www.Nursing2014.com

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Journal club participation helps nurses develop a positive attitude toward research and improves their ability to interpret and critically appraise articles.2,7 These clubs provide an avenue for active learning experiences in which nurses interact, discuss, and evaluate current practices and new innovative EBP.3 Professional development also occurs as nurses question traditional practice and seek research-based solutions to clinical problems.8 Promoting evaluation of research and awareness of practice through journal clubs can lead to nurse-driven practice assessments and changes that may contribute to improved patient outcomes. My Magnet-designated facility, Hackensack University Medical Center, is a nonprofit, teaching, and research hospital with over 700 beds. Its allergy center conducts bimonthly journal clubs to discuss current literature relevant to its patients. In these journal club meetings, clinical nurses can seek ways to integrate a new idea, process, or treatment to improve patient outcomes. For example, after reading an article from the New England Journal of Medicine, the nurses learned that omalizumab not only treats asthma, but it can also diminish clinical signs and symptoms of chronic idiopathic urticaria. This new knowledge helped nurses collaborate with physicians to improve patient care and outcomes.

Turning on the power Nurse empowerment is having the clout to improve care for patients in an environment that fosters professional practice.9 To most effectively create change and promote research use, journal clubs should be connected to structured systems for practice change, such as nursing practice councils.4 The nursing council structure at my facility includes unit-based councils and an institution-wide professional practice council that reviews all policies and develops new policies based on EBP. One pilot study of journal clubs and EBP concluded that participation in a journal club was an effective catalyst to EBP initiatives.1 In another survey, journal clubs were found to make a difference in attitudes and reduce perceived barriers to research usage in nursing practice.7 Other nurses have reported that journal club participation caused them to question their standards of practice and explore best practices.10 Forming traditional journal clubs Preliminary steps to take when planning a traditional journal club meeting include developing a purpose for the club, deciding on a time and place to meet, advertising the meeting, selecting a relevant topic, and choosing a leader to guide the group.11,12

How participants can prepare for a meeting Providing questions and guidelines to consider while reading the article can help to facilitate active discussion and participation. Here are some examples: • What’s the question to be answered or purpose of the article? • Is the literature comprehensive, and does it provide a rationale for the article? • What’s the study’s design? • What are the main findings? The participants can be asked to think about the article’s relevance to their practice and policies. The discussion may empower nurses to seek further education on the topic, implement quality improvement projects, or conduct their own research.13 Questions include: • What does the article recommend for the future? • What did you like about the article? • How does the article relate to your current practice? • How can you change your current practice or unit policies to reflect the findings of this article?

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Although some institutions have formed journal clubs to meet criteria for Magnet status, the journal club may be more successful if it’s formed because of the interest of those involved.12 To engage nursing staff who may be unfamiliar with critiquing research and using EBP, a first meeting of a journal club may include a discussion of the basic principles of EBP as well as the process of initiating practice changes at the institution.3 Articles chosen to review may discuss research, EBP, clinical care, or quality improvement.12,13 (See How participants can prepare for a meeting.) Journal club leaders can make sure that the club’s goals and objectives are met. Leaders may choose articles, create guidelines for reading, encourage reading the articles before the meeting, and plan incentives, such as continuing nursing education credits or food. Creating an agenda for the meeting is one way to make certain the group’s goals and objectives are achieved.11 Leaders may develop PowerPoint presentations to provide a visual approach to learning and discussion. These presentations may include information about the clinical issue, current practice, prior studies, suggestions for practice changes, and impact on patient care.3 To encourage full participation, a different person can be chosen to lead the club each time. Tapping nurses with advanced education in research and experience in critiquing strategies can also help.4 However, nurses at all levels should be included in journal clubs and mentored for professional development.7 Overcoming barriers For a journal club to be successful, nurses must find ways to overcome barriers.12 For instance, nurses may not know how to lead a journal club discussion. To address this at my facility, the clinical level IV nursing committee conducted a literature review and created a template for journal club leaders to use www.Nursing2014.com

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during meetings. To help select an article, the leader can survey staff for topics of interest or choose a topic from a journal specific to their area of practice. Nurses, especially those with advanced degrees who know how to use library databases, can help search for articles. Dedicating time to attend meetings is another common barrier. Repeating sessions at various times may help to boost participation.12 Another idea is integrating the journal club meeting into the unitbased council meeting. The heart failure unit at my facility conducts its journal club during monthly unitbased council meetings. The discussion is then summarized in the unit’s monthly newsletter, which is shared throughout the unit and the entire institution. This summary makes all nurses aware of research, new treatment modalities, and EBP discussed during the meeting. The clinical education department conducts its journal club meeting after its department meeting. The meeting’s goals are twofold: to earn continuing nursing education credits toward the department’s specialty certification in nursing professional development and to discuss how the article can be integrated into practice. As the journal club evolved, they transitioned from continuing education articles to focus on research articles. Virtual approaches Increasing journal club participation by using online technology such as blogs, discussion postings, wikis, and e-mails can help to overcome workday time barriers and incorporate nurses who work on all shifts.13 (A wiki is a web-based program in which many people can add content, allowing for collaboration among a group.) These asynchronous methods let participants independently access the journal club, meet its objectives, and interact as they wish.13 Virtual journal clubs allow nurses to access the club at their convenience, www.Nursing2014.com

reducing time spent away from patient care.8,14 These clubs are similar to face-toface journal clubs in that they bring current articles to nurses to review, critique, and discuss.5 The format provides a nonthreatening learning environment, the chance to engage with nurses from other units or shifts, and a format for nurses who prefer to blog.8 Online social media programs such as Twitter can also be used to facilitate colleagues’ discussion about journal articles. Some nursing journals host regular Twitter journal clubs about current articles and invite nurses to discuss and analyze practice articles. To prevent a serious confidentiality breach, avoid referring to any identifiable patient when using social media. Online options for virtual journal clubs can provide just as many benefits as face-to-face clubs. Take these steps to develop an online club. • Develop a clear objective and purpose for the club. • Decide on the journal club’s participants. Will the club involve nurses on one unit or throughout an institution? • Choose a journal club facilitator. Facilitators may change with each journal club virtual meeting. • Meet with representatives from the information technology department to determine the online format that will work best. For example, will specific software, if required, be accessible to all nurses interested in participating? Or can discussion boards be linked to the institution’s intranet? • Choose an article that meets the audience’s educational needs. Develop and provide guidelines for reading the article. • Advertise the journal club, including its purpose, how nurses can participate, and the topic that will be discussed. • Develop a timeframe for nurses to participate in the online discussion. • Measure outcomes based on the purpose of the club.

Deeper understanding Journal clubs can provide the motivation needed to empower changes that lead to improved patient outcomes. Nurses like you who are reading Nursing2014 demonstrate your motivation to keep abreast of current nursing knowledge. The time for you to be the change agent at your institution is now. Start a faceto-face or online journal club, or both! Let this article empower you to incorporate lifelong learning and positive change through journal clubs at your institution. ■ REFERENCES 1. Sciarra E. Does journal club membership empower practice? Nurs Manage. 2011;42(1):17-18. 2. Nesbitt J. Journal clubs: a two-site case study of nurses’ continuing professional development. Nurse Educ Today. 2013;33(8):896-900. 3. Patel PC, Panzera A, DeNigris J, Dunn R, Chabot J, Conners S. Evidence-based practice and a nursing journal club: an equation for positive patient outcomes and nursing empowerment. J Nurses Staff Dev. 2011;27(5):227-230. 4. Glasofer A. The role of journal clubs in bridging the research-practice gap. Nursing2013 Critical Care. 2013;8(4):41-45. 5. Lehna C, Berger J, Truman A, Goldman M, Topp R. Virtual journal club connects evidence to practice: an analysis of participant responses. J Nurs Adm. 2010;40(12):522-528. 6. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. 7. O’Nan CL. The effect of a journal club on perceived barriers to the utilization of nursing research in a practice setting. J Nurses Staff Dev. 2011;27(4):160-164. 8. Berger J, Hardin HK, Topp R. Implementing a virtual journal club in a clinical nursing setting. J Nurses Staff Dev. 2011;27(3):116-120. 9. Spence Laschinger HK, Gilbert S, Smith LM, Leslie K. Towards a comprehensive theory of nurse/patient empowerment: applying Kanter’s empowerment theory to patient care. J Nurs Manag. 2010;18(1):4-13. 10. Mikos-Schild S, Endara P, Calvario M. Journal clubs enlighten nurses, improve practice. Nursing. 2010;40(10):41-43. 11. Ravin CR. Implementation of a journal club on adult learning and nursing professional development. J Contin Educ Nurs. 2012;43(10): 451-455. 12. Steele-Moses SK. Developing a journal club at your institution. Clin J Oncol Nurs. 2009;13(1): 109-112. 13. Baker JD. Journal club as a resource for practice. AORN J. 2013;98(2):102-106. 14. Kean EB. Creating an online journal club using wordpress.com. Am J Nurs. 2013;113(3):61-65. Gina Dovi is a clinical level III staff nurse at Hackensack University Medical Center in Hackensack, N.J. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000453727.94778.00

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Empowering change with traditional or virtual journal clubs.

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