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International Journal of Nursing Education Scholarship

Volume 6, Issue 1 2009 Article 12

Using an Interactive Journal Club to Enhance Nursing Research Knowledge Acquisition, Appraisal, and Application
Audrey Steenbeek Adele LeBlanc Nancy Edgecombe Rosemary Anderson Joel Durling Ruth Bainbridge

Dalhousie University, a.steenbeek@dal.ca Dalhousie University, nancy.edgecombe@dal.ca Dalhousie University, joel.durling@dal.ca Dalhousie University, aleblanc@swndha.nshealth.ca Nunavut Arctic College, randerson@nac.nu.ca Nunavut Arctic College, rbainbridge@nac.nu.ca

Copyright c 2009 The Berkeley Electronic Press. All rights reserved.

Using an Interactive Journal Club to Enhance Nursing Research Knowledge Acquisition, Appraisal, and Application
Audrey Steenbeek, Nancy Edgecombe, Joel Durling, Adele LeBlanc, Rosemary Anderson, and Ruth Bainbridge

Abstract
Nursing practice is intricate and multifaceted. It requires the application of current, healthrelated research. Nurses are expected to employ evidence-informed practice in making decisions about the clinical care of their clients. A journal club is one method that can help promote an increased awareness of research, educating students to critique and use research ndings. In this descriptive pilot study, the use of a journal club was evaluated. University undergraduate nursing students (N=35) across three sites in eastern Canada participated. Although the results are limited, participants found the journal club sessions enjoyable and benecial for helping them interpret research ndings and apply research to clinical practice. More research directed at helping nursing students critique and apply research to nursing practice is warranted. KEYWORDS: research critique, journal club, active learning

Steenbeek et al.: Journal Club

The practice of nursing is complex and requires the understanding and application of current, health-related literature. New graduates must be multifaceted and prepared to work in a variety of settings as well as employ evidence-informed practice in making decisions about the clinical care of their clients. Over the years, journal clubs have been successfully implemented in many medical school education programs (Khan & Gee, 1999). While there are some reports of journal club use in the nursing literature (Kleinpell, 2002), only a few nursing schools have adopted the journal club as a means for engaging student dialogue, active learning, continued education, research critique, and evidence-informed practice. Internet based journal clubs, such as those provided through Web-CT, provide a means of keeping abreast of new knowledge and research evidence. Through a guided discovery approach, journal clubs can enhance literature appraisal skills and facilitate the learning process within the context of clinical problem solving. Although the benefits of journal clubs are numerous, several frequently cited advantages include defining clinical problems, searching, evaluating, and applying current nursing research, and encouraging interaction and dialogue with other nursing students and instructors (Kleinpell, 2002; Swift, 2004). Critical review of research is an essential component of evidenceinformed practice (Kleinpell, 2002). Journal clubs can facilitate evidenceinformed practice by promoting an increased awareness of current research, educating nursing students to critique and appraise research literature, and subsequently, encourage research utilization (Glazer, 2000; Kirchhoff & Beck, 1995; Kleinpell, 2002; Shearer, 1995). More importantly, journal clubs can enhance the learning experience for nursing students through dialogue, interaction, and active learning. Developments in computer technology have revolutionized how educators can transfer knowledge. The efficacy of using WebCT, with new pedagogical ideas like journal clubs, in meeting students needs for an efficient and interactive learning experience, has been demonstrated in several studies (Bosco & Ward, 2005; Mash, et al., 2005). Incorporating Web-CT in journal-based forums reflects a more flexible approach to learning as it is dynamic, portable, self-paced, and a more convenient way to access information such as journal articles, the journal club schedule, and other resources for adult learners, especially those in rural and remote areas. In this study, examined was the feasibility of implementing a multi-site, Web-CTenhanced journal club with undergraduate nursing students attending three different program sites of Dalhousie University, in eastern Canada. Using the

Published by The Berkeley Electronic Press, 2009

International Journal of Nursing Education Scholarship, Vol. 6 [2009], Iss. 1, Art. 12

principles of problem-based learning, researchers examined the effectiveness and appropriateness of implementing a journal club as an educational tool, using teleconferencing: to promote current nursing knowledge, increase research critiquing skills and student dialogue, and apply research findings to address clinical problems. No studies of this kind were found in the literature. METHODOLOGY This descriptive pilot study was conducted over a four month period between September and December 2006. Funding was obtained from a Teaching and Learning with Technology Development grant from Dalhousie University. Ethics approval was obtained through the Dalhousie University Research Ethics committee and a research license was obtained from the Nunavut Research Institute. Written consent was obtained from each participant prior to the first session. All were assured that participation was voluntary and that they were able to withdraw from the study at any point without any consequences. Undergraduate nursing students in all four years of the program attending any of the three University sites (Halifax, Yarmouth & Iqaluit) were eligible. Participants were informed about the study through e-mails via the undergraduate list-server, posters, in-class presentations, and word of mouth. Each participant was also given password access to the Web-CT program hosted from Site 1 and maintained by the research assistant. Web-CT was used to obtain information about the study and the investigators, a schedule of journal club sessions, selected research articles, article critique work sheets. It also hosted a shared blackboard for posting questions. Quantitative articles pre-selected by investigators from peer reviewed Canadian journals, focused on topics such as infectious diseases, public health, and education that would appeal to BScN students. Prior to each journal club session, participants were asked to read the assigned article and critique it to the best of their ability with no other resources other than the article critique work sheet (Appendix 1) provided. Initial Journal Club Session During the first journal club session, all participants were assigned a 3digit identification number and completed a confidential baseline questionnaire to collect information about demographics, previous Web-CT/ journal club experiences, critiquing skills, and research utilization. Participants from the three study sites then engaged in a one hour journal club session led by the principle investigator in Halifax. The session was simultaneously hosted at the two other sites using tele-conferencing. The article was discussed after which each

http://www.bepress.com/ijnes/vol6/iss1/art12 DOI: 10.2202/1548-923X.1673

Steenbeek et al.: Journal Club

participant completed the worksheet. These were collected at the end of the session by the research assistant and co-investigators at their respective sites. Web-CT was not used during this session. Subsequent Journal Club Sessions After the first session participants were encouraged to attend three additional journal club sessions scheduled over the next three months. Similar to the first session, all participants were expected to read the assigned article selected and answer the questions on the research critique work sheet. Each of these sessions were one hour in length and hosted from Halifax. After the final session, participants completed a questionnaire in which they evaluated their experiences of reading the assigned articles, using the critique worksheets, participating in the journal clubs by tele-conference, and accessing the Web-CT program. Data Coding and Analysis All the worksheets and questionnaires were coded, scored, and analyzed by the research assistant and principle investigator. Exploratory analysis and descriptive statistics were completed using SPSS and SPLUS version 2000. Worksheets from each of the four sessions were based on the correct answer for each question and scored out of 30 as a means of evaluating the participants research critiquing ability. Researchers expected scores to increase with each subsequent journal club session. RESULTS Thirty-five students participated in the pilot study. Approximately 37% rated their overall computer skills as good and, with the exception of participants from Iqaluit, 77% reported previous Web-CT use (see Table 1). The most common barriers to research utilization identified by participants were the inability to locate articles in general (74.3%) and difficulty understanding the research articles (40%) (See Table 2). For participants in Halifax and Yarmouth, there were no documented problems with accessing the Web-CT program; however, there was minimal student discussion noted and the primary use of the program was for accessing the journal club schedule, articles, and worksheet. Although disappointing, similar problems have been cited in the literature especially with journal clubs primarily hosted through Web-CT (Mash, et al., 2005). Participants from Iqaluit had trouble accessing the Web-CT program.

Published by The Berkeley Electronic Press, 2009

International Journal of Nursing Education Scholarship, Vol. 6 [2009], Iss. 1, Art. 12

Participants performance in correctly completing a standard research critiquing work sheet was also evaluated for each of the four sessions. Total mean knowledge and critiquing scores increased from sessions 1 to 3 for all three sites; for session 4 however, the total mean score for Yarmouth and Iqaluit decreased (See Figure). Table 1 Demographic Characteristics of Study Participants Characteristics Halifax Yarmouth
Gender Age Ethnicity Male Female Mean (SD) Median Aboriginal Caucasian Other 1 2 3 4 Poor Fair Good Very Good Excellent No Yes No Yes NA No Yes 3 14 24.63 (7.97) 21.50 0 16 1 2 6 9 0 1 3 6 5 2 0 17 15 1 1 12 5 0 11 28.55 (5.76) 30.00 0 10 1 4 0 5 2 0 3 5 2 1 1 10 7 3 1 8 3

Iqaluit
1 6 31.29 (6.26) 30.00 1 6 0 0 3 2 2 0 1 2 4 0 7 0 0 0 7 4 1

Total (N)
4 31 27.26 (7.31) 27.00 1 32 2 6 9 16 4 1 (2.8%) 7 (20%) 13 (37.1%) 11 (31.4%) 3 (8.6%) 8 (22.9) 27 (77.1) 21 (60%) 4 (11.4%) 9 (25.7%) 24 (68.6%) 9 (25.7%)

Year in nursing program Computer Skill Self Rating

Previous use of Web-CT Difficulties using WebCT Previous research course

http://www.bepress.com/ijnes/vol6/iss1/art12 DOI: 10.2202/1548-923X.1673

Steenbeek et al.: Journal Club

Table 2 Common Barriers to Research Utilization


Barriers Halifax Yarmouth Iqaluit Total (%)

Difficulty understanding research Familiar with peer reviewed journals Able to locate/retrieve articles in general Interested in research

No Yes
NA

No

Yes
NA No Yes
NA

8 8 1 5 12 0 12 5 0 1 16 0

5 5 1 3 8 0 9 2 0 4 5 2

6 1 0 1 6 0 5 1 1 5 1 1

19 (54.3) 14 (40) 2 (5.7) 9 (25.7) 26 (74.3) 0 26 (74.3) 8 (22.9) 1(2.9) 10 (28.6) 22 (62.9) 3 (8.6)

No Yes NA

55 50 45 40 35 30 Scores 25 20 15 10 5 0 1 2 3 4

Iqaluit Yarmouth Iqaluit

Sites

Figure. Total Mean Scores for Sessions 1-4 Journal club sessions were evaluated (See Table 3). Nearly 60% of participants found the journal club enjoyable, while 51% found their involvement as a valuable tool for enhancing their future education. Others found the journal club experience as a means to increase future employment opportunities particularly around research or advanced nursing practice (51%) and others, found the journal club as a good source of overall personal advancement (60%).

Published by The Berkeley Electronic Press, 2009

International Journal of Nursing Education Scholarship, Vol. 6 [2009], Iss. 1, Art. 12

Table 3 Participant Evaluations of Journal Club Sessions


Characteristics Halifax Yarmouth Iqaluit Total (%)

Journal clubs will help No me with my future Yes employment NA Journal clubs will help me with my future education Journal clubs will help me with my personal development No Yes NA No Yes NA

0 11 6 2 10 5 0 13 4 0 13 4 0 11 6

1 2 8 1 3 7 0 5 6 1 3 7 0 3 8

0 5 2 0 5 2 0 5 2 0 5 2 0 5 2

1 (2.9) 18 (51.4) 16 (45.7) 3 (8.6) 18 (51.4) 14 (40) 0 23 (65.7) 12(34.3) 1 (2.9) 21 (60.0) 13 (37.0) 0 19 (54.3) 16 (45.7)

Personally satisfied with No the journal club Yes NA Journal club helped me No Yes gain a better understanding of NA critiquing research

DISCUSSION In this pilot study, the feasibility and efficacy of coordinating a journal club to enhance undergraduate students understanding of nursing research were evaluated. Participants included 35 students representing three undergraduate nursing program sites at Dalhousie University. It was anticipated that these study results would help support the future use and incorporation of journal clubs in the nursing curriculum. Knowledge and research critiquing scores among the participants in Halifax increased over the four sessions, indicating an improvement in research critiquing skills, better understanding of research articles, and an increased ability to apply the research evidence to own nursing contexts. For participants in Yarmouth and Iqaluit, the total mean score for session 4 was lower than for previous sessions. This drop may have been attributed to the fact that fewer students participated in the fourth session, thereby lowering the overall mean score for these two sites; some participants were unable to attend the final session due to course assignment and final examination pressures. Even under the best of

http://www.bepress.com/ijnes/vol6/iss1/art12 DOI: 10.2202/1548-923X.1673

Steenbeek et al.: Journal Club

circumstances, it is often very difficult to recruit students to participate in learning initiatives outside the mandatory requirements. Glazer (2000) and Kleinpell (2002) found that a lack of interest in reading research based articles, employment commitments, and student workload were common barriers to establishing a journal club. Their finding further supports the suggestion to incorporate journal clubs into required undergraduate nursing courses such as introductory research. Other strategies to improve enrolment might include making participation a mandatory or marked component, rewarding participants with bonus marks that can be applied toward final course grades, or having participation acknowledged on academic transcripts. Despite best efforts to recruit from the three sites, having a small sample size limited statistical analysis and generalizability of results. A similar study incorporating multiple universities would be beneficial. Having a journal club extend for at least an academic year might also be worthwhile. Participants from Iqaluit were unable to access the Web-CT program due to poor or interrupted internet provision or computer-related problems. Subsequently, they were unable to obtain information about the study, the articles/work sheets or post questions to other participants or investigators. This is a common problem for students studying in rural and remote regions were internet access may be sporadic and/or unreliable. Furthermore, most participants from Iqaluit did not have their own computer and had to rely on school computers. These same participants also, did not have prior experience with using Web-CT. Therefore, they were given hard copies of questionnaires, worksheets, articles, and any other pertinent study materials by co-investigators from that site and had no problems participating in the journal club sessions by tele-conferencing. Although Web-CT is becoming a very popular means of enhancing education for both undergraduate and graduate university students, its utility in journal clubs through live chats or blackboard contributions warrants more exploration especially for students living in rural or remote locations were time differences and internet access can be challenging. Internet access can also be problematic for rural and northern students with regard to accessing electronic journals. For instance, participants from Yarmouth and Iqaluit reported problems retrieving electronic copies of articles when hard copies were not available from their libraries or came with a cost. Most of the participants found the journal club experience very positive despite having a relatively small sample size and limited results. They developed greater appreciation for critiquing research articles, and have a better

Published by The Berkeley Electronic Press, 2009

International Journal of Nursing Education Scholarship, Vol. 6 [2009], Iss. 1, Art. 12

understanding of the benefits of evidence-informed nursing practice. Research critiquing and application are essential skills for students who wish to pursue graduate studies and will help promote professional growth and ongoing education upon graduation. Based on these encouraging findings, the investigators will promote the journal club process at Dalhousie University School of Nursing and integrate it into one of the undergraduate research courses. It is anticipated that the journal club will become a permanent feature of the undergraduate nursing program. Other nursing education programs are encouraged to establish their own journal club program and evaluate its utility in facilitating evidence-informed practice over time. REFERENCES Bosco, A.M. & Ward, C. (2005). Welcome to the techno highway: development of a health assessment CD-ROM and website. Contemporary Nurse 20(1), 21-7. Glazer, F.S. (2000). Journal Clubs- A Successful Vehicle to Science Literacy. Journal of College Science Teaching 29, 320-324. Khan, K.S. & Gee, H. (1999). A new approach to teaching and learning in journal club. Medical Teacher 21, 289-293. Kirchhoff, K.T. & Beck, S.L. (1995). Using the journal club as a component of the research utilization process 24, 246-250. Kleinpell, R.M. (2002). Rediscovering the Value of the Journal Club. American Journal of Critical Care 11, 412-414. Mash, R.J., Marais, D., Van Der Walt, S., Van Deventer, I., Steyn, M., & Labadarios, D. (2005). Assessment of the quality of interaction in distance learning programmes utilising the Internet (WebCT) or interactive television (ITV). Medical Education 39, 1093-1100. Shearer, J. (1995). The Nursing Research Journal Club: an ongoing program to promote nursing research in a community hospital. Journal of Nursing Staff Development 11, 104-105. Swift, G. (2004). How to make journal clubs interesting. Advances in Psychiatric Treatment 10, 67-72.

http://www.bepress.com/ijnes/vol6/iss1/art12 DOI: 10.2202/1548-923X.1673

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