The Journal Club
An Occasion for Mentoring :
Critiquing Research for
Evidence-Based Practice
Dianna Hutto Douglas, DNS RN CNS
Susan Rick, DNS RN CNS
Evidence-Based Practice
Research utilization/innovation diffusion process
begins with a new idea or empirically based
innovation that is scrutinized for adoption in the
practice setting.
Evidence based practice by contrast begins with a
search for information about how best to solve
specific practice problems. The emphasis is on
identifying the best available research evidence and
integrating it with clinical expertise, patient input,
and existing resources.
(Polit & Beck, 2003)
Evidence-Based Nursing Practice
Evidence base nursing practice is the
conscientious, explicit and judicious
use of theory derived research based
information in making decisions about
care delivery to individuals or groups
of patients in consideration of
individual needs or preferences
(Ingersoll, 2000)
Evidence-Based Practice Models
Originated outside the United States
First publication of Evidence Based Nursing was
launched in1998
Definitions crafted by nurses have varied with
evidence derived from research expressed as a
common theme (Jennings & Loan, 2001)
Levels of evidence - especially in the United
States literature reference the Agency for
Healthcare Research and Policy schema of
evidence (including qualitative studies as well
as quality improvement and program evaluation
data)
Types of Evidence
Research based
Opinion based
Discussions
Fact based
Expert based
Patient view based
Professional expertise and experience
Quality improvement data
Evaluation data
Hierarchy of Evidence
Meta-analysis of controlled studies
Individual experimental studies
Quasi experimental studies
Non-experimental studies
Program evaluations, research utilization
studies, quality improvement projects and case
reports
Opinions of respected authorities and expert
committees
(Stetler et al, 1998)
An Occasion for Mentoring
Mentoring is a fundamental form of
human development where one person
invests time energy and personal;
knowledge to assist another person in
their growth and development (McKinley, 2004)
Mentoring is a special way to transfer
knowledge and it can occur in all setting
in which scientific inquiry is being
deliberately pursued (Byrne & Keefe, 2002)
Attributes Mentoring Relationships
Stewart & Krueger (1996) extracted six
essential attributes of mentoring from
82 research abstracts and journal
articles:
Teaching/Learning process
Reciprocal Role
Career development relationship
Knowledge differential between participants
Duration of several years
Resonance
The Development of Nursing Science
Foundation for the growth of the
nursing discipline and profession
Knowledge development takes place in
the various setting where nursing is
learned and practiced
Programs of scientific inquiry are
established in both the university and
clinic setting and often flourish where
the two are merged
Research Mentoring in Nursing
Research mentoring activities are
appropriate in various settings:
Academia
Formal programs of research
Clinical practice
Research partnerships between
academics and clinicians
(Byrne & Keefe, 2002)
Barriers to the Integration of
Evidence-Based Research into Practice
Limited education in and expertise to judge the
scientific merit of a research study
Limited exposure to research journals
Intimidated by research jargon and statistical
symbols
Infrequent use of research in practice (Goodfellow, 2004)
Many nurses feel they have no authority to
change nursing practice in spite of research to
support a change in practice (Retsas, 2000)
Benefits of a Journal Club as a A Means to
Incorporate Evidence-Based Practice
Cost effective
Allows nursing staff to remain close to patient
care areas
Stimulates discussion among peers in regard to
clinically relevant problems
Allows exploration of most current literature
Stimulates nurses to Critique their own practice
(Kartes & Kamel, 2003)
Benefits of a Journal Club as a Means to
Incorporate Evidence-Based Practice
Encourages nurses to read and critically review
research
Allows nurses to discriminate and evaluate information
logically
Provides a basis for making decisions that effect patient
outcomes
Promotes professionalism and positive attitudes
Promotes evidence-based nursing practice and bridges
the gap between research and practice (Goodfellow, 2004)
Criteria for Selecting Research Articles
Focus on a Problem of Clinical Relevance
Is the research article relevant to:
• Patient population
• Nurses clinical experience
• Nurses level of understanding
• Nurses interest in current research topics
• The most current research findings that
might have influence practice
(Goodfellow, 2004)
Criteria for Selecting Research Articles
Scientific Merit
Does the research article:
• Critically review the literature
• Clearly describe ethical and methodological issues
• Provide easily understood statistical analysis
• Accurately interpret the research findings
• Generalize findings to other populations and
situations
Is the research article well written and
insightful
Criteria for Selecting Research Articles
Implementation Potential
Are the research findings clinically significant
Information is transferable to the clinical setting
Does the nursing staff have the power to implement
change based on these research findings
Does the research have the potential to improve
patient outcomes
Implementation with no physical or psychological
harm to patients
Implementation with minimal or justifiable cost to
the hospital or patient (Goodfellow, 2004)
Guidelines for Critiquing
Research for EBP
Does the introduction
State the problem
State the significance to nursing
Is the review of literature current, thorough,
and reflective of critical analysis
Are research questions, purposes, and/or
hypothesis clearly written
Are independent and dependant variables
identified
Is the methodological design defined and
appropriate to study (Goodfellow,2004)
Guidelines for Critiquing
Research for EBP
What setting was used to collect data
What is the population
Is the population clearly described
What is the sample size
Is sample size sufficient
Is protection of human subjects clearly addressed
What instruments were used to measure the variables
Are the instrument reliable and valid
How were the data analyzed
Are the statistical test appropriate (Goodfellow,2004)
Guidelines for Critiquing
Research for EBP
What are the results of the study
What are the strengths
What are the limitations of the study
Is there congruence between the results and
the discussion of the research
What are the implications for nursing practice
What are the implications for nursing research
How may the results of this study be applied
to your nursing practice and patient care
(Goodfellow, 2004)
The Tale of Two Journal Clubs
Selection of clinical sites: (Two magnet hospitals)
Oncology unit
Psychiatric Unit
Leadership style and selection of leader
Selection of Journal Articles
Mutual collaboration
Strategies to make journal club a valuable experience
Enthusiastic teaching style
Role modeling
Critique of relevant self-selected research articles
Application of research and promotion of evidence-based
practice
Journal Club: An Occasion for
Mentoring: A Win/Win Collaboration
Benefits to individual members
Professional development
Acquisition of new knowledge
Continuing education credit
Improved competence and confidence in delivering EB Care
Benefits to hospital
Maintaining magnet status
Improved patient care
Promote the utilization of EBP
Stimulate desire to conduct research on unit
Benefits to faculty
Community service
Mutual professional development
Building collaborative relationships
Improves potential for more collaborative research
References
Byrne, M. W. & Keefe, M. R. (2002). Building research
competence through mentoring. Journal of Nursing
Scholarship, 34 (4), 391-396.
Goodfellow, L. M. (2004). Can a journal club bridge the
gap between research and practice. Nurse Educator, 29
(3), 104-110.
Ingersoll, G. L. (2000). Evidence-based nursing: what it
is and what isn’t. Nursing Outlook, 48 (4), 151-152.
Jennings, B.M. & Loan, L. (2001. Misconceptions among
nurses about evidence-based practice. Journal of
Nursing Scholarship, 33 (2), 121-127.
Kartes, S. K. & Kamel, H. K. (2003). Geriatric journal
club for nursing: A forum to enhance evidence-based
nursing care in long- term settings. Journal of American
Medical Directors Association, 5, 264-267.
References
McKinley, M. G. (2004). Mentoring matters: creating,
connecting, and empowering. AACN Clinical Issues, 15
(2), 205-214.
Polit, D. & Beck, C. T. (2003). Nursing research
principles and practice. (7th ed.). Philadelphia:
Lippincott. 671-705.
Retsas, A. (2000). Barriers to using research evidence in
practice. Journal of Advanced Nursing, 31, 599-606.
Stetler,C. B., Morsi, D., Rucki, S., Broughton, S.,
Corrigan, B., Fitsgerald, J., Giuliano, K., Havener, P., &
Sheridan, E. A. (1998). Utilization-focused integrative
reviews in a nursing service. Applied Nursing Research,
11 (4), 195-206.
Stewart, B. M. & Krueger, L. E. (1996). An evolutionary
concept analysis of mentors in nursing, Journal of
Professional Nursing, 12 (5), 311-321.