In July 2004 our 436-bed suburban-Chicago hospital, Adventist Hinsdale Hospital, set out to encourage discussion among staff nurses on how to better integrate the findings of nursing research into daily practice. The effort was a part of a hospital-wide quality-improvement initiative designed to earn Magnet certification, an award bestowed by the American Nurses Credentialing Center, given to "health care organizations that provide the very best in nursing care." (See http://www.nursingworld.org/ancc/magnet/index.html.)
We cochaired a nursing research committee that was established to support nurses in evidence-based practice. In our first meeting, we realized that we didn't have enough information about staff nurses' familiarity with research. How many of our bedside nurses, for example, knew how to search databases such as PubMed? And what did the phrase evidence-based practice mean to them? We decided our first step would be to survey the RNs on staff. In doing so we hoped to convey the value of adhering to standards of practice, to generate enthusiasm for finding the evidence supporting those standards, and to foster an environment in which staff helped to develop policies and procedures.
Survey method. The committee designed its own one-page survey (after a fruitless literature search for questionnaires). We included both open-ended questions and closed-ended questions. We used a one-day "snapshot" survey method, distributing and collecting the questionnaire from all three shifts of RNs throughout the hospital in a single day. We chose a day in the middle of the week when the numbers of patients and staff were high.
On the day of the survey 260 RNs were on duty. We gave questionnaires to 200 of them, in both inpatient and outpatient areas, believing this to be a representative sample. At the end of the day, 162 completed surveys were returned; the return rate was 81%, representing 62% of the RNs working that day. Response rates varied among units: the highest responses were seen in medical-surgical units, with 24% (n = 38); critical care units, with 19% (n = 30); and the maternal-child unit, with 14% (n = 22). We also surveyed nurses in the ED, the pain management center, the gastrointestinal laboratory, the operating room, the nursing pool, and the family medicine clinic, as well as in the pediatric, postanesthesia, psychiatry, acute rehabilitation, nursing education, oncology, radiology, ambulatory care, same-day surgery, and preadmission testing units. Inpatient units produced a greater response than outpatient units.
Our survey solicited basic demographic information. For example, regarding educational background we found: 49% had a bachelor of science in nursing (BSN) degree, 29% had an associate's degree, 14% had a nursing diploma, and 8% had a master of science in nursing (MSN) degree. These percentages reflected those of the hospital over all.
Our survey also found significant variation in staff nurses' familiarity with research methods and nursing research publications. Among these findings are the following:
* Only 58% of respondents-primarily medical-surgical and critical care RNs-said they received or subscribed to nursing journals.
* Fewer than half (45%) of respondents had completed a nursing research course; most of these had a BSN or MSN degree.
* More than half of respondents reported reading nursing journals at least monthly, including those they subscribed to and those they received for free. Forty percent (n = 65) reported reading journals at least weekly and 34% (n = 55) said they did so at least monthly. More nurses responded to "reading journals" than "receiving journals" (154 versus 104, respectively). Among the peer-reviewed journals, respondents said they subscribed to were AJN, RN, and Nursing, and the specialty journals American Journal of Critical Care, Journal of PeriAnesthesia Nursing, Journal of Pediatric Nursing, Clinical Journal of Oncology Nursing, Journal of Neuroscience Nursing, Journal of Emergency Nursing, and Journal of Obstetric, Gynecologic and Neonatal Nursing. The complimentary journals cited were Nursing Spectrum and Advance for Nurses.
* Nearly a third (31%; n = 51) said they had participated in a research project, most of them (76%) as data collectors. Nine nurses reported experience as research investigators or coinvestigators.
* Attitudes toward nursing research were positive, over all, with 71% (n = 115) of respondents agreeing with the statement, "We need to do more." Forty percent (n = 65) said that they'd made a change in their practice based on new research or information from a journal. Although, 10% said nursing research had no value or did not affect their practice, and 8% said it was boring.
What we learned and did. The survey results gave us information we could use to measure progress toward meeting our goal of establishing standards for evidence-based practice and earning Magnet recognition. We learned that our nurses were mostly supportive of nursing research but needed guidance and institutional support to incorporate evidence into daily practice.
In response, the committee worked with hospital administrators to launch projects on every nursing unit in support of evidence-based practice. We organized classes, taught by the hospital librarian, on how to use research databases and find specific studies. The classes provided nurses continuing education credit.
We also worked with administrators and nurses on each unit who were responsible for quality improvement to identify research pertinent to their projects. We developed a template for handouts that emphasized the research findings supporting policies, protocols, care guides, order sets, and clinical standards. The hospital's nursing clinical practice committee adopted this template for use in all departments. We created a handbook designed to help nurses to find the research appropriate to specific practices and to undertake original research projects. Every nursing unit and all senior nursing administrators received a copy.
To encourage nurses' confidence and involvement, we helped units to set up journal clubs for staff interested in discussing research and its applicability to practice. The research committee also added a section to the hospital's monthly nursing newsletter called "Nursing Research Corner," featuring staff-written review articles.
At first glance, the Magnet standards for evidence-based practice seem daunting-for example, creating links between nursing and the institutional review board, involving nurses in multidisciplinary research projects, and initiating evidence-based clinical improvement projects. But our experience shows that taking the process step by step, and involving nursing staff, can advance the Magnet application process.
Using the Hospital Library to Teach Staff
A nursing research committee and hospital library can educate staff on the facility's resources to find answers to clinical questions. The curriculum should
* list nursing journals available through the hospital library.
* identify at least three databases that can be used through the library's Internet subscriptions, including review services such as the Cochrane Library (http://www.cochrane.org/reviews/clibintro.htm) and databases such as PubMed (http://www.ncbi.nlm.nih.gov/entrez).
* demonstrate an online search using author, title, and subject prompts, as well as how to limit search features and other refining tools.
* provide nurses opportunities to practice searching so that they will be more likely to do it on their own.
Journal Clubs
Discussion groups are an informal and potentially enjoyable way for busy professionals to remain current with the literature. Ideally, the clubs consist of staff from one or two units with comparable populations, clinical issues, and technology. They meet monthly for up to 45 minutes. Members take turns selecting a topic and leading discussion.
Presenter guidelines:
* Choose a pertinent topic.
* Post and distribute copies of research articles well in advance of the meeting.
* Present highlights of the articles for the first 10 to 15 minutes of the meeting, then act as moderator for group discussion.
* Prepare and distribute a one-page summary of the research findings for participants.
Resources
The following resources may be helpful in starting a similar project in your institution:
Burns N, Grove K. Using research in nursing practice with a goal of evidence-based practice. In: Understanding nursing research. 3rd ed. Philadelphia: Saunders; 2003. p. 436-72.
Nursing Executive Center. Toward evidence-based nursing: reforming culture, enhancing practice. In: Nursing executive center practice brief. Washington DC: The Advisory Board Company; 2003. p. 1-41.