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Journal Clubs & EBP

A closer look at the how these clubs can help bridge the gap between research and practice.

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In nursing, the evidence-based practice (EBP) process consists of developing a practice inquiry, retrieving and critiquing current evidence, and bringing this evidence into practice. The process follows with an adept synthesis of clinical expertise combined with patient and family needs and values.1-3

The appropriate use of EBP by nurses is vital to providing cost-effective, safe and up-to-date patient care, as well as facilitating the scientific growth of the nursing profession as a whole.4-6

However, nurses' lack of knowledge and skills are barriers to EBP, contributing to a disparity between current research and nursing practice at the bedside.4,7-9 

Conducting the Study
In researching information for our study, the literature identified professional journal clubs as a cost-effective and well accepted approach to bridging the research and practice gap, as nurses learn to retrieve and share evidence significant to practice inquiries.10, 11

For our study, the authors wanted to assess the relationship between EBP outcomes and a professional journal club for the bedside nurse. The proposed problem statement was, "What are selected nurse attitudes, knowledge, and utilization of EBP before and after participation in a professional journal club?"

We asked bedside nurses from our level 2 emergency and trauma center if they would take part in the research. Participation was anonymous and voluntary. Thirty-one nurses signed up. Their mean age was 41.5; mean years in practice 17; 25 were RNs and 4 were APRNs. Twenty-nine of them completed the pre-intervention questionnaire and 30 completed the post questionnaire.

We used a commercially available measurement tool, the Clinical Effectiveness and Evidence-Based Practice Questionnaire (EBPQ). Developed by British researchers Dominic Upton and Penney Upton, this 24-item, self-report instrument is designed to evaluate nurses' practice or attitude, knowledge, and utilization of EBP.

For the purpose of this study, the journal club consisted of three sessions over a 9-week time period. Prior to the first session, nurses were given the opportunity to participate in the study by anonymously completing the pre-intervention EBPQ. The first session, an orientation, provided the journal club participants with education regarding EBP, developing a sound practice inquiry, finding resources, and how to critique those resources. The second and third sessions consisted of journal club activities including development of practice inquiries, finding and critiquing a resource, and sharing the resource with club participants. At the conclusion of the third session, the nurses were given the opportunity to anonymously complete the post-intervention EBPQ.

Data Treatment Protocol
Descriptive statistics were utilized for the evaluation of the measures of this pre-intervention and post-intervention study. The paired t-test and Pearson r correlations were calculated to compare the pre-intervention and post-intervention data. The Cronbach's alpha coefficient was considered to determine the reliability and internal consistency of the EBPQ measurement tool, both pre- and post-intervention.12 

Results & Data Analysis
Pre- and Post Intervention Findings

The EBPQ utilized four items to determine participant's perceived attitude regarding EBP. Each participant selected one of seven boxes on a continuum, with the lower number representing less perceived importance of EBP. Below are the pre- and post- intervention mean findings.

In Figure 1 the EBPQ utilized 14 items to determine participant's perceived knowledge regarding EBP. Each participant selected one of seven boxes representing the degree to which they perceived their knowledge regarding the item (1=Poor, 7=Best).

Figure 2 illustrates the pre- and post-intervention mean findings. The EBPQ utilized six items to determine the participant's perceived frequency of utilization over the past year. Seven boxes represented a continuum between never (1) and frequently (7) utilized.

Figure 3 illustrates the pre- and post-intervention mean findings. The paired t tests and Pearson's r values demonstrated significant findings in most of the items. Cronbach's alpha was utilized to assess the reliability of the instrument's items based on internal consistency for these participants. The pre-intervention Cronbach's alpha of 0.96 and a post-intervention Cronbach's alpha of 0.94 both represented significant reliability.

Implications for Nursing Practice
This study found statistically significant improvements in aspects of EBP after involvement in the journal club. The cost-effective and well accepted nature of the journal club to foster EBP among nurses will contribute to the sustainability of this initiative. Further study would be beneficial in establishing practice and policy changes resulting from established journal clubs. Further study should also expand beyond the limitations of this study, including the small, single setting.

The appropriate utilization of EBP by nurses is vital to providing cost-effective, safe, and up-to-date patient care, as well as facilitating the scientific growth of the nursing profession as a whole. As a cost-effective and well accepted approach, the professional journal club may serve to foster the EBP process and facilitate bridging the research and practice gap.

Stacey Pfenning practices in the St. Alexius Emergency and Trauma Center, Bismarck, ND. Pfenning is also an associate professor for the graduate nursing division at the University of Mary, Bismarck.

 References
1.  Craig, J. & Smyth, R. (2007). The Evidence-Based Practice Manual for Nurses (2nd ed.).  Churchill: Elsevier.

2. Malloch, K. & Porter-O'Grady (2006). Introduction to evidence-based practice in nursing and health care. Sudbury: Jones and Bartlett.

3.  Straus, S. E., Haynes, R.B., Richardson, W. S., Gasziou, P., & Richardson, S. (2005). Evidence-based medicine: How to practice and teach EBM (3rd ed.) Churchill: Elsevier Health Sciences.

4. Fink, R., Thompson, C., & Bonnes, D. (2005). Overcoming barriers and promoting the use of research in practice. The Journal of Nursing Administration, 35, 121-129.

5.  Newhouse, R., Dearholt, S., Poe, S., Pugh, L., & White, K. (2005). Evidence-based practice: A practical approach to implementation. The Journal of Nursing Administration, 35, 35-40.

6.  Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-51.

7. Brady, N. & Lewin, L. (2007). Evidence-based practice in nursing: Bridging the gap between research and practice. Journal of Pediatric Health Care, 21, 53-56.

8. Hutchinson, A., & Johnston, L. (2006). Beyond the barriers scale: Commonly reported barriers to research use. The Journal of Nursing Administration, 36, 189-199.

9.  Udod, S., & Care, W. (2004). Setting the climate for evidence-based nursing practice: What is the leader's role? Nursing Leadership, 17(4), 64-75.

10.  Dwyer, J. (2007). Nursing journal clubs: How to develop and achieve success with your efforts. American Academy of Ambulatory Care Nursing 29(3), 1, 14-15.

11. Goodfellow, L. (2004). Can a journal club bridge the gap between research and practice? Nurse Educator, 29, 107-110.

12.  Polit, D. & Beck, C. (2006). Essentials of nursing research: Methods, appraisal, and utilization (6th ed.). Philadelphia: Lippincott Williams & Wilkins[DS1] .


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