It takes an average 17 years — nearly 2 decades — for evidence gleaned from randomized controlled trials to make its way into health care practice, according to the Institute of Medicine’s Crossing the Quality Chasm report. This suggests that many of the methods and procedures used in patient care are likely outdated and in need of an upgrade.
At the Veterans Affair Medical Center in San Francisco, nurse specialists in gastroenterology and hepatology formed a nursing journal club to investigate and discuss evidence-based innovations in their field. What began with a few minor bumps ended up significantly improving the patient experience for men and women in their care.
Staff nurse Joyce Hughes, MSN, BS, RN, CGRN, wrote about the experience in Gastroenterology Nursing.
The obstacles nurses initially faced in forming their specialty journal club are undoubtedly familiar to nurses everywhere: a perceived lack of time to attend meetings and insecurity about evaluating research articles. The staff, however, largely embraces a “Let’s try it!” mindset, Hughes said, and worked through the issues to progress the club project.
Specifically, nurse unit leaders made sure to arrange the first journal club meeting for a time when procedures and patient needs tended to be low. The club leader used that initial meeting to introduce a procedure for evaluating research articles and then guided nurses on how to use it. Journal club members decided to meet for an hour each month throughout the next year, and nurse participants each signed up for a specific topic to investigate. At least a week before each meeting, the nurse whose topic was scheduled to be discussed distributed an article to every member of the club to review in advance.
“Some of the articles reviewed reinforced our practices, but several encouraged change,” wrote Hughes. She went on to describe 4 patient procedures that were improved through evidence gathered from the club.
“Nursing journal clubs are a good way to keep the staff aware of recent developments in professional practice and facilitate evidence-based change,” Hughes concluded. “I highly recommend journal clubs as a way to get all nurses involved and excited about finding ways to improve patient care.”
Other nurses report similar experiences with journal clubs.
“It keeps nurses up to date about the latest evidence that supports clinical nursing practice,” said Roque Garvida Jr., RN-BC, MSN, an informatics practice specialist at Kaiser Permanente Panorama City Medical Center in Working Nurse, a publication for California RNs.
“It clarifies many burning clinical questions, like what is the most effective way of shift-to-shift reporting. We found out from the evidence that the best way is incoming and off-going nurses giving report at the bedside using a standardized tool, involving the patient in the conversation and getting their input into the nursing plan.”
Even in environments where nurses are less enthusiastic toward change, journal clubs can broaden views and pave the way toward evidence-based updates.
“Journal clubs can be particularly useful in keeping up-to-date on practice, improving reading habits and critical appraisal skills, facilitating learning and openness to evidence-based practice principles, and promoting multidisciplinary cooperation,” wrote Stephen McKeever, PhD, RN, senior lecturer in children’s nursing at London South Bank University in a bmj blog. “It is proposed that developing these skills can be effective in overcoming some of the often cited barriers to implementing of evidence-based nursing practice.”
If journal clubs can get busy nurses reading and talking about research advances, an appreciation for adopting evidence-base practice will naturally follow.