- Email: [email protected]
Geriatric Journal Club for Nursing: A Forum to Enhance Evidence-Based Nursing Care in Long-Term Settings
CLINICAL EXPERIENCE
Geriatric Journal Club for Nursing: A Forum to Enhance Evidence-Based Nursing Care in Long-Term Settings Susan K. Kartes, RN, MSN, GNP, and Hosam K. Kamel, MD, FACP, AGSF
Unlike medical research that is often conducted to find causes and cures for disease, the main goal of nursing research is to help find ways to achieve excellence in nursing care. Examples for areas often covered by nursing research include the development of scientific body of nursing knowledge, practice evaluation, professional growth, development and revision of standards of care including policies and procedures, development of efficient nursing care delivery systems and cost effectiveness of nursing interventions.1–3 Incorporating findings from nursing research into nursing practice can greatly enhance nursing care and patient outcomes. While there are many forums to acquaint physicians with medical research (eg, morning reports, daily rounds, noon conference, grand rounds, journal clubs, scientific conferences), most of these forums are not available or practical for the majority of nursing staff practicing in long-term settings. The reasons for this are multiple and include time away from patient care, financial constraints, and lack of resources to cover for a nurse while he or she attends a conference. A nurse-led journal club can be a useful and practical way to introduce nursing staff in long-term setting to nursing research. Here, we describe our experience of introducing a monthly geriatric journal club for nursing staff of the nursing home unit at the Zablocki VA Medical Center in Milwaukee, Wisconsin. The authors also suggest strategies to develop and conduct a successful journal club for nurses practicing in a long-term care setting. NURSING JOURNAL CLUB Journal clubs for nursing have been thriving in various settings as the importance of incorporating evidence-based
Geriatric nurse practitioner, Division of Extended Care, Zablocki VAMC, (S.K.K.); assistant professor of medicine, Division of Geriatrics and Gerontology, Medical College of Wisconsin, and director, Geriatric Evaluation and Management Unit and Subacute Care Unit, Zablocki VAMC, Milwaukee, Wisconsin (H.K.K.) Address correspondence to Hosam K. Kamel, MD, Zablocki VAMC, W. National Ave. (CC-G), Milwaukee, WI 53295. E-mail: [email protected] mail.
Copyright ©2003 American Medical Directors Association DOI: 10.1097/01.JAM.0000083381.66504.7C 264 Kartes and Kamel
practices in nursing care is becoming increasingly recognized. This forum is not costly, allows nursing staff to remain close to patient care areas if the need arises, and stimulates discussion among peers. The incorporation of clinical nursing research, which examines interventions to improve nursing practice, into daily nursing practice is likely to improve nursing care and patients’ outcomes. Nursing journal clubs may help bridge the theory-practice gap that is often noted among nurses practicing in long-term settings.1 The club provides a forum where nurses not only learn about what is in the literature but are also stimulated to critique their own practice. CHALLENGES TO CONDUCTING A JOURNAL CLUB FOR NURSES IN LONG-TERM SETTINGS A major challenge to introducing a journal club that discusses nursing research to nursing home staff is to get them enthused and make them feel that this exercise is worthwhile and likely to improve nursing care and patient outcomes in the nursing home. Unlike the situation in acute care settings, nursing staff in long-term care settings is rather heterogeneous. Most of the care in long-term care settings is provided by certified nursing assistants (CNAs) with licensed practical nurses (LPNs) often passing medications and providing treatment and RNs performing patient assessments and directing patient care through assignments. A successful journal club in the nursing home should address the needs of all staff members. The journal club presenter should select articles that can be understood by all levels of staff. Clinical studies and review articles that describe interventions aimed at improving patient care are particularly suitable for this forum. Tables 1 and 2 list some of the topics and journals, respectively, that may be particularly useful in this regard. It is important that all the staff members attending the journal club feel welcomed whether they are RNs, LPNs, or CNAs. The atmosphere should encourage members to feel comfortable to engage in the discussion and comment on the information presented. It is important to keep members excited about the journal club experience and encouraged to attend future journal clubs. In our experience, we noticed that oftentimes nursing assistants felt they could not understand or relate to research. Adopting an open forum of discussion greatly helped change this perception. Distributing journal JAMDA – September/October 2003
Table 1. Suggested Topics for Nurses’ Journal Club in Long-Term Care Settings ● Falls: Assessing fall risk, fall prevention, post-fall assessment ● Pressure ulcers ● Urinary incontinence ● Importance of physical activity ● Disease processes ● Osteoporosis ● Macular degeneration ● Diabetes ● Patient care issues ● Bowel function ● Foot care ● Medications ● Pain assessment
club articles a few days in advance is important to give members the opportunity to be prepared to discuss the article and to stimulate information exchange at the journal club meeting. At the end of each journal club, it is useful to ask attendees if the information presented in the journal club would make them change their practice patterns and how. In our facility, journal club discussions increased staff knowledge of the topics discussed by 27% (⫾22%) as assessed by pre-test and post-test scores. The knowledge gains were greatest among LPNs (40%), followed by RNs (33%), and least among CNAs (17%). Finding an appropriate time and place to hold the journal club can be a challenge. It is helpful if the place chosen is in proximity to patient care areas. This is important in the event staff are needed to attend to an emergency. Scheduling journal club on days were staffing is optimal is likely to improve attendance. Administrative support is crucial to the success of nursing journal club in long-term settings. Pointing out that attending journal clubs is likely to increase staff proficiency and enhance patient care may greatly help optimize administrative support. Extending invitations to the nursing home administrator and the director of nursing to attend the journal club is likely to have a positive impact on staff participation. Keeping the administration updated on the impact of the journal club experience on staff practices and patient care is important in order to maintain administrative support. WHO SHOULD LEAD THE DISCUSSION AT THE JOURNAL CLUB? The person leading the journal club needs to be familiar with how to conduct a literature search, how to critique an
article, and be familiar with policies and procedures in the facility. Familiarity with policies and procedures should help the journal club leader recommend and implement changes in staff practices based on the literature reviewed. An advance practice nurse, such as clinical nurse specialist or a geriatric nurse practitioner (GNP), may be best suited for this role. HOW TO MAKE THE JOURNAL CLUB A PLEASANT EXPERIENCE FOR THE NURSING STAFF The journal club should incorporate strategies that have been shown to motivate learners. Examples of such strategies include (1) an enthusiastic teaching style, (2) role modeling, (3) application of the research that is presented to the participants’ interests, and (4) self-critiquing by participants’ of their own practice patterns in view of knowledge presented.4,5 Journal club members should feel comfortable providing comments and input into the discussion. The journal club atmosphere should be nonjudgmental. The expectation is that members are prepared to discuss the article. This requires that the articles be distributed to the members a few days in advance to give participants the opportunity to review the material and prepare for the discussion. THE CLEMENT ZABLOCKI VA MEDICAL CENTER EXPERIENCE The Clement J. Zablocki VA Medical Center houses a 64-bed nursing home unit staffed with 36 staff members (9 RNs, 11 LPNs, and 18 CNAs). Our nursing journal club was started in the fall of 2001.6 The journal club is led by a GNP who is also involved in providing patient care on the unit. The main goals of the journal club were to (1) increase staff knowledge, (2) improve patient care through implementation of research interventions, (3) improve nursing assessment skills, (4) motivate staff to think about what they do and why they do it, and, finally, to improve reporting of changes in patient status. The journal club members met monthly. The meetings were usually held on the 3rd Wednesday of the month. Wednesdays were chosen because of presence of adequate staffing on that day of the week. The journal club was held at the same time each month so staff members can plan for it in advance and mark their calendars. Meeting times were preposted 1 to 2 weeks in advance as a reminder for staff. The GNP often selected the articles to be discussed from various nursing and long-term care journals (Table 2). Topics were often related to practical aspects of nursing patient care (Table 1). Journal club members were also invited to provide articles or studies for review. The nursing home unit secretary
Table 2. Examples of Journals that May Be Used as a Resource for Nursing Journal Club in Long-Term Settings ● Advance for Nurse Practitioner ● American Journal of Nursing ● Annals of Long Term Care ● Geriatric Nursing ● GRECC (Geriatric Research and Education and Clinical Center) newsletter ● Journal of the American Medical Directors Association ● Nursing Spectrum
CLINICAL EXPERIENCE
Kartes and Kamel 265
Table 3. Steps for Using a Metered Dose Inhaler (MDI)* Use of an MDI with a spacer (10 steps)
Rational
1
Insert the canister into the actuator (holder) and then into the spacer
1
Insert the MDI canister into the actuator (holder)
2
Inspect the spacer for foreign objects; if there’s a valve, make sure it’s intact Test-spray (prime) the MDI into the air one or two times. At a minimum, this should be done on first use of a new canister Shake the MDI and spacer unit vigorously
Secures the connection, allowing an accurate dose to be delivered when activated Prevents foreign objects from being aspirated; ensures that the valve is working properly Ensures the patency of the canister opening and that the metal canister is properly inserted into the actuator Mixes the propellant and medication together before inhalation Empties the lungs and prepares them to take in medication
2
Test-spray (prime) the MDI into the air one or two times. At a minimum, this should be done on first use of a new canister Shake the MDI vigorously
5
3
4
Use of an MDI without spacer (8 steps)
5
Exhale comfortably (as a normal full breath) before closing your mouth around the mouthpiece of the spacer
6
Push down only once on the MDI canister, to administer one puff at a time
Provides adequate time for medication to reach the lungs
7
Inhale deeply and slowly through your mouth for 3–5 seconds without triggering spacer’s warning signal that breath is not adequate Hold your breath for 10 seconds
Maximizes penetration of medication into lungs
8 9 10
Remove the MDI and spacer unit from your mouth before exhaling Wait 20–30 seconds between inhalations or follow the package insert recommendations
3 4
Exhale comfortably (as in a normal full breath) before closing your mouth around the inhaler mouthpiece or holding the device 2–4 cm from your mouth. (An experienced patient can follow his preference. If he/she is new to inhaler use, a respiratory therapist can be consulted.) Push down only once on the MDI canister, to administer one puff at a time. Inhale deeply and slowly for 3–5 seconds while holding firmly onto the canister
Allows the medication to reach target sites in the lung tissue Allows for normal exhalation
6
Hold your breath for 10 seconds
7
Remove the MDI from your mouth before exhaling
Allows maximum absorption of medication in the lungs
8
Wait 20–30 seconds between inhalations or follow the package insert recommendations
SOURCES National Heart, Lung and Blood Institute. Guidelines for the diagnosis and management of asthma: expert panel report Bethesda (MD): Department of Health and Human Services 1997 Jul. NIH Pub. No. 97-4051; Brenner PS, et al Nurse’s knowledge and ability to use metered dose inhalation (MDI) devices with / without spacers. Poster session presented at the 24th annual meeting of the Midwest Nursing Research Society; 2000 Apr; Dearborn (MI) *A laminated card for nursing staff demonstrating steps for using a Metered Dose Inhaler (MDI)
helped photocopy articles and post meeting announcements throughout the nursing home. Journal club articles were often distributed to members at least a week in advance so that club members had adequate time to review the material and prepare for the discussion. The GNP often led the discussion at journal club meetings. The discussion was often informal in order to encourage and welcome comments from all attendees. Pre-tests and post-tests were used to assess knowledge gained from the journal club discussion. Many of the articles discussed included continuing medical education tests. These questions were often used for 266 Kartes and Kamel
the pre-tests and post-tests. The questions were answered in a group format, which often helped emphasize key points from the article discussed. Attendees received continuing education credit through the VA education department for time spent. Before adjourning, the group often discussed if the new knowledge presented would influence their practice patterns and how. If the consensus was that it would, the GNP often asked for volunteers to help implement the changes. This approach led to the implementation of several changes in nursing care delivery, nursing home environment, and policy JAMDA – September/October 2003
and procedures in the nursing home unit at the Zablocki VA Medical Center. For example, guidelines for administering the metered dose inhaler (MDI) were developed on our nursing home unit, and a laminated card was provided to each staff member to use when teaching residents about MDI use (Table 3).7 In addition, a humor bulletin board was started on the nursing home unit. This board provided comics and jokes for the residents, visitors and staff and was updated regularly by a staff member. The policy for foot care on the unit was also updated so that all residents with diabetes, peripheral vascular disease, or sensation loss would have foot care daily.8 An article on physical activity helped support and enrich the nursing home restorative program.9 In addition, an article on macular degeneration improved the staff’s knowledge of this condition. All patients with macular degeneration now have that noted on their problem list as well as an order of Amsler grid and a procedure and schedule for its use.10 CONCLUSION Nurse-led journal clubs can be a useful and practical way to introduce nursing staff in long-term setting to nursing research. In this article, we offered tips for making this process
CLINICAL EXPERIENCE
work in long-term care. The impact of nursing journal clubs on patients’ satisfaction, patients’ care, and staff’ satisfaction deserves further study. REFERENCES 1. Pollard A, Taylor T. A nurses’ journal club: Creating a positive learning environment. Contemp Nurse 1997;6:157. 2. Smith EM, Michael DH. Faculty development: Using nursing journals as teaching tools. Dean’s notes, a communications service to nursing school deans, administrators and faculty 2001;22:3. 3. McCauley D, Nolf B. NT Practice Solutions. Nurs Times 2001;97:37. 4. Owen S, Wheway J, Martin A. The use of a journal club and clinical seminars on a 4-year undergraduate, pre-registration, mental-health nursing degree. Nurse Educ Today 2001;21:297–301. 5. Burrows D, Baillie L. A strategy for teaching research to adult branch diploma students. Nurse Educ Today 1997;17:39 – 45. 6. Kartes SK, Poster presentation, the 24th annual meeting of the Midwest Nursing Research Society, 2000; Dearborn, MI. 7. Togger D, Brenner P. Metered dose inhalers. Am J Nurs 2001;101:26 – 32. 8. Fielo S. Focus on the Feet. Nurs Spectrum 2001;14:20 –23. 9. Sebastian L. Exercise for Health and Fitness. Nurs Spectrum 2001;14: 24 –27. 10. O’Reilly E. Age-related macular degeneration. Nurs Spectrum 14:22–25, 2001.
Kartes and Kamel 267
Geriatric Journal Club for Nursing: A Forum to Enhance Evidence-Based Nursing Care in Long-Term Settings Susan K. Kartes, RN, MSN, GNP, and Hosam K. Kamel, MD, FACP, AGSF
Unlike medical research that is often conducted to find causes and cures for disease, the main goal of nursing research is to help find ways to achieve excellence in nursing care. Examples for areas often covered by nursing research include the development of scientific body of nursing knowledge, practice evaluation, professional growth, development and revision of standards of care including policies and procedures, development of efficient nursing care delivery systems and cost effectiveness of nursing interventions.1–3 Incorporating findings from nursing research into nursing practice can greatly enhance nursing care and patient outcomes. While there are many forums to acquaint physicians with medical research (eg, morning reports, daily rounds, noon conference, grand rounds, journal clubs, scientific conferences), most of these forums are not available or practical for the majority of nursing staff practicing in long-term settings. The reasons for this are multiple and include time away from patient care, financial constraints, and lack of resources to cover for a nurse while he or she attends a conference. A nurse-led journal club can be a useful and practical way to introduce nursing staff in long-term setting to nursing research. Here, we describe our experience of introducing a monthly geriatric journal club for nursing staff of the nursing home unit at the Zablocki VA Medical Center in Milwaukee, Wisconsin. The authors also suggest strategies to develop and conduct a successful journal club for nurses practicing in a long-term care setting. NURSING JOURNAL CLUB Journal clubs for nursing have been thriving in various settings as the importance of incorporating evidence-based
Geriatric nurse practitioner, Division of Extended Care, Zablocki VAMC, (S.K.K.); assistant professor of medicine, Division of Geriatrics and Gerontology, Medical College of Wisconsin, and director, Geriatric Evaluation and Management Unit and Subacute Care Unit, Zablocki VAMC, Milwaukee, Wisconsin (H.K.K.) Address correspondence to Hosam K. Kamel, MD, Zablocki VAMC, W. National Ave. (CC-G), Milwaukee, WI 53295. E-mail: [email protected] mail.
Copyright ©2003 American Medical Directors Association DOI: 10.1097/01.JAM.0000083381.66504.7C 264 Kartes and Kamel
practices in nursing care is becoming increasingly recognized. This forum is not costly, allows nursing staff to remain close to patient care areas if the need arises, and stimulates discussion among peers. The incorporation of clinical nursing research, which examines interventions to improve nursing practice, into daily nursing practice is likely to improve nursing care and patients’ outcomes. Nursing journal clubs may help bridge the theory-practice gap that is often noted among nurses practicing in long-term settings.1 The club provides a forum where nurses not only learn about what is in the literature but are also stimulated to critique their own practice. CHALLENGES TO CONDUCTING A JOURNAL CLUB FOR NURSES IN LONG-TERM SETTINGS A major challenge to introducing a journal club that discusses nursing research to nursing home staff is to get them enthused and make them feel that this exercise is worthwhile and likely to improve nursing care and patient outcomes in the nursing home. Unlike the situation in acute care settings, nursing staff in long-term care settings is rather heterogeneous. Most of the care in long-term care settings is provided by certified nursing assistants (CNAs) with licensed practical nurses (LPNs) often passing medications and providing treatment and RNs performing patient assessments and directing patient care through assignments. A successful journal club in the nursing home should address the needs of all staff members. The journal club presenter should select articles that can be understood by all levels of staff. Clinical studies and review articles that describe interventions aimed at improving patient care are particularly suitable for this forum. Tables 1 and 2 list some of the topics and journals, respectively, that may be particularly useful in this regard. It is important that all the staff members attending the journal club feel welcomed whether they are RNs, LPNs, or CNAs. The atmosphere should encourage members to feel comfortable to engage in the discussion and comment on the information presented. It is important to keep members excited about the journal club experience and encouraged to attend future journal clubs. In our experience, we noticed that oftentimes nursing assistants felt they could not understand or relate to research. Adopting an open forum of discussion greatly helped change this perception. Distributing journal JAMDA – September/October 2003
Table 1. Suggested Topics for Nurses’ Journal Club in Long-Term Care Settings ● Falls: Assessing fall risk, fall prevention, post-fall assessment ● Pressure ulcers ● Urinary incontinence ● Importance of physical activity ● Disease processes ● Osteoporosis ● Macular degeneration ● Diabetes ● Patient care issues ● Bowel function ● Foot care ● Medications ● Pain assessment
club articles a few days in advance is important to give members the opportunity to be prepared to discuss the article and to stimulate information exchange at the journal club meeting. At the end of each journal club, it is useful to ask attendees if the information presented in the journal club would make them change their practice patterns and how. In our facility, journal club discussions increased staff knowledge of the topics discussed by 27% (⫾22%) as assessed by pre-test and post-test scores. The knowledge gains were greatest among LPNs (40%), followed by RNs (33%), and least among CNAs (17%). Finding an appropriate time and place to hold the journal club can be a challenge. It is helpful if the place chosen is in proximity to patient care areas. This is important in the event staff are needed to attend to an emergency. Scheduling journal club on days were staffing is optimal is likely to improve attendance. Administrative support is crucial to the success of nursing journal club in long-term settings. Pointing out that attending journal clubs is likely to increase staff proficiency and enhance patient care may greatly help optimize administrative support. Extending invitations to the nursing home administrator and the director of nursing to attend the journal club is likely to have a positive impact on staff participation. Keeping the administration updated on the impact of the journal club experience on staff practices and patient care is important in order to maintain administrative support. WHO SHOULD LEAD THE DISCUSSION AT THE JOURNAL CLUB? The person leading the journal club needs to be familiar with how to conduct a literature search, how to critique an
article, and be familiar with policies and procedures in the facility. Familiarity with policies and procedures should help the journal club leader recommend and implement changes in staff practices based on the literature reviewed. An advance practice nurse, such as clinical nurse specialist or a geriatric nurse practitioner (GNP), may be best suited for this role. HOW TO MAKE THE JOURNAL CLUB A PLEASANT EXPERIENCE FOR THE NURSING STAFF The journal club should incorporate strategies that have been shown to motivate learners. Examples of such strategies include (1) an enthusiastic teaching style, (2) role modeling, (3) application of the research that is presented to the participants’ interests, and (4) self-critiquing by participants’ of their own practice patterns in view of knowledge presented.4,5 Journal club members should feel comfortable providing comments and input into the discussion. The journal club atmosphere should be nonjudgmental. The expectation is that members are prepared to discuss the article. This requires that the articles be distributed to the members a few days in advance to give participants the opportunity to review the material and prepare for the discussion. THE CLEMENT ZABLOCKI VA MEDICAL CENTER EXPERIENCE The Clement J. Zablocki VA Medical Center houses a 64-bed nursing home unit staffed with 36 staff members (9 RNs, 11 LPNs, and 18 CNAs). Our nursing journal club was started in the fall of 2001.6 The journal club is led by a GNP who is also involved in providing patient care on the unit. The main goals of the journal club were to (1) increase staff knowledge, (2) improve patient care through implementation of research interventions, (3) improve nursing assessment skills, (4) motivate staff to think about what they do and why they do it, and, finally, to improve reporting of changes in patient status. The journal club members met monthly. The meetings were usually held on the 3rd Wednesday of the month. Wednesdays were chosen because of presence of adequate staffing on that day of the week. The journal club was held at the same time each month so staff members can plan for it in advance and mark their calendars. Meeting times were preposted 1 to 2 weeks in advance as a reminder for staff. The GNP often selected the articles to be discussed from various nursing and long-term care journals (Table 2). Topics were often related to practical aspects of nursing patient care (Table 1). Journal club members were also invited to provide articles or studies for review. The nursing home unit secretary
Table 2. Examples of Journals that May Be Used as a Resource for Nursing Journal Club in Long-Term Settings ● Advance for Nurse Practitioner ● American Journal of Nursing ● Annals of Long Term Care ● Geriatric Nursing ● GRECC (Geriatric Research and Education and Clinical Center) newsletter ● Journal of the American Medical Directors Association ● Nursing Spectrum
CLINICAL EXPERIENCE
Kartes and Kamel 265
Table 3. Steps for Using a Metered Dose Inhaler (MDI)* Use of an MDI with a spacer (10 steps)
Rational
1
Insert the canister into the actuator (holder) and then into the spacer
1
Insert the MDI canister into the actuator (holder)
2
Inspect the spacer for foreign objects; if there’s a valve, make sure it’s intact Test-spray (prime) the MDI into the air one or two times. At a minimum, this should be done on first use of a new canister Shake the MDI and spacer unit vigorously
Secures the connection, allowing an accurate dose to be delivered when activated Prevents foreign objects from being aspirated; ensures that the valve is working properly Ensures the patency of the canister opening and that the metal canister is properly inserted into the actuator Mixes the propellant and medication together before inhalation Empties the lungs and prepares them to take in medication
2
Test-spray (prime) the MDI into the air one or two times. At a minimum, this should be done on first use of a new canister Shake the MDI vigorously
5
3
4
Use of an MDI without spacer (8 steps)
5
Exhale comfortably (as a normal full breath) before closing your mouth around the mouthpiece of the spacer
6
Push down only once on the MDI canister, to administer one puff at a time
Provides adequate time for medication to reach the lungs
7
Inhale deeply and slowly through your mouth for 3–5 seconds without triggering spacer’s warning signal that breath is not adequate Hold your breath for 10 seconds
Maximizes penetration of medication into lungs
8 9 10
Remove the MDI and spacer unit from your mouth before exhaling Wait 20–30 seconds between inhalations or follow the package insert recommendations
3 4
Exhale comfortably (as in a normal full breath) before closing your mouth around the inhaler mouthpiece or holding the device 2–4 cm from your mouth. (An experienced patient can follow his preference. If he/she is new to inhaler use, a respiratory therapist can be consulted.) Push down only once on the MDI canister, to administer one puff at a time. Inhale deeply and slowly for 3–5 seconds while holding firmly onto the canister
Allows the medication to reach target sites in the lung tissue Allows for normal exhalation
6
Hold your breath for 10 seconds
7
Remove the MDI from your mouth before exhaling
Allows maximum absorption of medication in the lungs
8
Wait 20–30 seconds between inhalations or follow the package insert recommendations
SOURCES National Heart, Lung and Blood Institute. Guidelines for the diagnosis and management of asthma: expert panel report Bethesda (MD): Department of Health and Human Services 1997 Jul. NIH Pub. No. 97-4051; Brenner PS, et al Nurse’s knowledge and ability to use metered dose inhalation (MDI) devices with / without spacers. Poster session presented at the 24th annual meeting of the Midwest Nursing Research Society; 2000 Apr; Dearborn (MI) *A laminated card for nursing staff demonstrating steps for using a Metered Dose Inhaler (MDI)
helped photocopy articles and post meeting announcements throughout the nursing home. Journal club articles were often distributed to members at least a week in advance so that club members had adequate time to review the material and prepare for the discussion. The GNP often led the discussion at journal club meetings. The discussion was often informal in order to encourage and welcome comments from all attendees. Pre-tests and post-tests were used to assess knowledge gained from the journal club discussion. Many of the articles discussed included continuing medical education tests. These questions were often used for 266 Kartes and Kamel
the pre-tests and post-tests. The questions were answered in a group format, which often helped emphasize key points from the article discussed. Attendees received continuing education credit through the VA education department for time spent. Before adjourning, the group often discussed if the new knowledge presented would influence their practice patterns and how. If the consensus was that it would, the GNP often asked for volunteers to help implement the changes. This approach led to the implementation of several changes in nursing care delivery, nursing home environment, and policy JAMDA – September/October 2003
and procedures in the nursing home unit at the Zablocki VA Medical Center. For example, guidelines for administering the metered dose inhaler (MDI) were developed on our nursing home unit, and a laminated card was provided to each staff member to use when teaching residents about MDI use (Table 3).7 In addition, a humor bulletin board was started on the nursing home unit. This board provided comics and jokes for the residents, visitors and staff and was updated regularly by a staff member. The policy for foot care on the unit was also updated so that all residents with diabetes, peripheral vascular disease, or sensation loss would have foot care daily.8 An article on physical activity helped support and enrich the nursing home restorative program.9 In addition, an article on macular degeneration improved the staff’s knowledge of this condition. All patients with macular degeneration now have that noted on their problem list as well as an order of Amsler grid and a procedure and schedule for its use.10 CONCLUSION Nurse-led journal clubs can be a useful and practical way to introduce nursing staff in long-term setting to nursing research. In this article, we offered tips for making this process
CLINICAL EXPERIENCE
work in long-term care. The impact of nursing journal clubs on patients’ satisfaction, patients’ care, and staff’ satisfaction deserves further study. REFERENCES 1. Pollard A, Taylor T. A nurses’ journal club: Creating a positive learning environment. Contemp Nurse 1997;6:157. 2. Smith EM, Michael DH. Faculty development: Using nursing journals as teaching tools. Dean’s notes, a communications service to nursing school deans, administrators and faculty 2001;22:3. 3. McCauley D, Nolf B. NT Practice Solutions. Nurs Times 2001;97:37. 4. Owen S, Wheway J, Martin A. The use of a journal club and clinical seminars on a 4-year undergraduate, pre-registration, mental-health nursing degree. Nurse Educ Today 2001;21:297–301. 5. Burrows D, Baillie L. A strategy for teaching research to adult branch diploma students. Nurse Educ Today 1997;17:39 – 45. 6. Kartes SK, Poster presentation, the 24th annual meeting of the Midwest Nursing Research Society, 2000; Dearborn, MI. 7. Togger D, Brenner P. Metered dose inhalers. Am J Nurs 2001;101:26 – 32. 8. Fielo S. Focus on the Feet. Nurs Spectrum 2001;14:20 –23. 9. Sebastian L. Exercise for Health and Fitness. Nurs Spectrum 2001;14: 24 –27. 10. O’Reilly E. Age-related macular degeneration. Nurs Spectrum 14:22–25, 2001.
Kartes and Kamel 267