Journal Clubs have long been used with great success in medical education. They were instituted in the early 1800s in England where a group of students met regularly in a room over a baker's shop to read journals or play cards. In Montreal in 1875, Osler, considered one of the fathers of modern medicine who established the medical residency program, developed a Journal Club for medical residents to share articles, because the journals were too expensive for individual purchase. They met at dinner to review and discuss the latest medical research. By 1900, Journal Clubs were a routine part of medical education.
According to Patel et al. (2011), who reviewed nursing literature on Journal Clubs, the earliest nursing articles were published in 2001, but little has been written in nursing literature and even less nursing research conducted on the topic. I found three columns and five relevant articles published in nursing journals in the past 10 years that focused on the effectiveness of Journal Clubs as a teaching strategy, rather than on "how to" develop a Journal Club. It seems that it is time to resurrect this old and successful educational technique as part of our nursing professional development (NPD) strategy. This is especially true because more than 60% of nurses consult with each other on practice issues, and the responses are more likely to be tradition based than evidence based (Krugman, 2009).
In 2007, I developed a resource for our organization, "Ten Steps to Developing a Successful Journal Club." A few "free-standing" clubs were implemented in our facilities, but I only know of one that continues to be held successfully. Staff even came in on their days off to attend, and no one would miss it. If you don't already have one or more Journal Clubs, I would encourage you to start one in your facility. However, what I am suggesting is that we begin to incorporate the Journal Club format into some of our existing face-to-face educational programs.
WHAT IS A JOURNAL CLUB?
"A journal club has been defined as an educational meeting in which a group of individuals discuss current articles, providing a forum for a collective effort to keep up with the literature" (Kleinpell, 2002 p. 412). The purpose of a Journal Club is to review current nursing literature, discuss the information and evidence provided, and determine potential practice changes with the ultimate goal of improved patient outcomes. In fact, the Journal Club is an early example of the flipped classroom concept. Students read the articles and then come together with a facilitator or mentor to discuss the content and its application. In addition, if you listen to nurses talk around the lunch or dinner table, you are more than likely to hear them discussing patient care issues in an informal way. The Journal Club lends formality and structure to these important patient care conversations, supported by literature and guided discussion. Journal Clubs provide an open forum for discussing nursing issues in a friendly environment. They also offer new nurses an opportunity to talk with more seasoned nurses about patient care issues. Journal Clubs bring evidence to the nurses rather than expecting the nurses to seek out new evidence.
There are several types of Journal Clubs. They vary by location and method: in-person meetings on or off site, virtual meetings or blogs, videotaped conferences or telephone conferences, and traveling Journal Clubs. Some include repeated sessions in any of these formats to ensure more staff are able to attend. Game format, debate format, or Journal Club fair/poster presentations may be incorporated. A Journal Club might also be combined with patient rounds. Journal Clubs also vary by objectives: evaluation of research, change in nursing practice, learning medical statistics, improving clinical decision making, piquing interest in conducting staff-driven research, learning research design, discovering new evidence in a specific specialty, developing critical appraisal skills, teambuilding, and professional development.
BENEFITS OF THE JOURNAL CLUB FORMAT
* Keep nurses up-to-date with current research and clinical knowledge
* Promote professional reading
* Skill development in reading and critically appraising research
* Shorten the knowledge-to-practice gap
* Incorporate evidence into professional practices and patient care
* Promote interaction and dialogue among nurses, creating a community of practice
* Provide a structured social venue to learn from each other, stay current, and debate the evidence
* Promote team building and interdisciplinary collaboration (interdisciplinary Journal Clubs)
* Improve patient care organization-wide though policy and procedure changes
* Improve presentation, writing, and communication skills
* Support Magnet designation-"Nurses incorporate evidence-based findings and standards into the delivery of patient care" (American Nurses Credentialing Center, 2013, p. 43)
CHALLENGES
* Staffing, time, and attendance issues (These challenges would be eliminated by incorporating this strategy into current classes rather than instituting a formal Journal Club.)
* Lack of expertise in research and interpreting medical statistics
* Lack of interest; we are doing fine as we are
* Lack of motivation, lack of perceived benefit, WIIFM (what's in it for me?)
* Selecting articles that will interest the staff and be relevant to the content of the class
* Too much material
* Unfamiliarity (This approach does not seem to be used in many nursing programs, and it should be incorporated into nursing curriculum.)
* Nurses may feel vulnerable if they share their views
* Lack of administrative support for the Journal Club and practice changes
* Staff ill prepared for the meeting; can be perceived as demanding
* NPD practitioner's or facilitator's lack of skill and/or confidence
STEPS FOR INCORPORATING JOURNAL CLUB FORMAT INTO EXISTING EDUCATION
1. Select the NPD practitioner(s) who will add this strategy into appropriate classes.
2. Prepare the NPD practitioner through providing information on this technique.
3. Identify course objectives and the goals of including this format in the curriculum.
4. Select an article(s) based on the course content. You might use an article on wound care, medication administration, central venous access, enteral feeding, SBAR (situation, background, assessment, recommendation) communication, or tracheostomy care-topics you might include in orientation or continuing education classes.
5. Develop or select forms and format-a guided form to complete, small group discussion, general group discussion, poster display.
6. Get the word out-let the staff know that they are expected to read a specific article before attending the class. (Some will and some won't, but you can deal with that.)
7. Hold the session and create an action plan to incorporate evidence into practice if appropriate or discuss how the information has been incorporated into current policies and procedures. The NPD practitioner can present the article, lead the discussion with predetermined questions, and guide the staff through analyzing the article.
8. Evaluate the session.
9. Adopt, alter, or abandon changes for future sessions.
Key questions that can be discussed and forms that can be used are included in journal articles devoted to how to conduct a Journal Club and are listed below under "How to Guides." However, the general format includes discussion of the following:
* Study description: the problem or question
* Evaluation of literature
* Conceptual framework
* Sample: Who were the subjects and are they representative?
* Methods and study design: how was data collected, reliability and validity of instruments
* Data analysis and results
* Clinical significance: How would you apply the findings, and is the evidence strong enough to warrant a practice change?
This strategy incorporates adult learning principles, active participation/learning, and learning from peers; uses flipped classroom concept; provides opportunity for formalized "lunch time" discussions, learning to read and review nursing literature; allows nurses to participate in potential or recent practice changes; and encourages development of "free-standing" Journal Clubs. The NPD practitioner can play a key role in implementing this strategy and helping nurses learn to read, analyze, and apply nursing research.
I want to end with two quotes about the impact of evidence-based practice and the Journal Club format.
Evidence-based practice leads to improved patient outcomes, continuity of care, increased engagement among professionals, and is a key component to achieving Magnet designation. EBP also leads to decreased medical errors and mortality rates, and decreased healthcare costs for both the patient and the institution. (Patel et al., 2011, pp. 227-228)
Journal clubs are a favorable teaching method among health care professionals, and this novel practice for nurses should be more widely considered among educational leaders as a worthwhile investment. (Lachance, 2014, p. 564)
HOW-TO GUIDES
Davies, M. (2014). Nursing Journal Club facilitator's workbook. Yale New-Haven Hospital. Retrieved from http://r.search.yahoo.com/_ylt=AwrT6V3U2DxWuvUAqYknnIlQ;_ylu=X3oDMTByb2lvbXVuBGN
Oncology Nursing Society Journal Club. (2010). A how-to guide designing & creating a Journal Club for oncology nurses. Retrieved from https://www.ons.org/sites/default/files/Journal%20Club%20Toolkit.pdf
References