BARRIERS TO SUCCESSFUL JOURNAL CLUB Outcomes
Journal clubs are a critical way to help clinical nurses make the connection between their practice and how to use evidence in practice. Colleagues often express frustration when journal clubs are not successful. This column focuses on methods to overcome some common barriers to starting and sustaining journal clubs so this activity can be integrated into your staff development practice.
Journal clubs represent a long-standing tradition of supporting professionals in the scientific and healthcare fields to meet together to critically evaluate current literature. The first citations reporting medical journal club activity were in the 1800s (Linzer, 1987). The nursing profession has been slow to adapt journal clubs, but the momentum is growing as the volume and relevance of nursing research studies increases and evidence-based practice becomes more widely accepted. I suspect that many readers of this column do not realize that Journal for Nurses in Staff Development published an article on journal clubs in 1988, during the early years of this journal!
If journal clubs have such a long tradition of success and nursing articles about how to manage journal clubs have been published for more than 20 years, why is it so difficult to initiate and/or sustain this important activity in many healthcare institutions? Some of the barriers can be quickly identified, whereas others are more complex. A primary reason is that many nurses have no experience leading journal clubs or analyzing the literature, even those who are master's prepared. This activity has not been a part of either undergraduate or graduate nursing education until recently, and in many nursing programs, it is still not highlighted nor are actual journal clubs held as a part of the curriculum to improve skill acquisition. Lack of confidence means that journal club activities may fall to the bottom of the list when professional development specialists are planning learning activities for clinical nurses.
A second recognized barrier for journal club success may be the lack of interest by clinical nurses. Journal clubs often "die on the vine" because of poor attendance or nurses arriving for journal club sessions ill prepared for the discussion. When a group of clinical nurses attend without having read or analyzed the article, even the most motivated nurse educator can become discouraged! Not only are nurse leaders often uncomfortable leading journal clubs, but clinical nurses feel inadequate attending because they also lack confidence and experience. A third and often unrecognized barrier for journal club success is comfort by both professional development specialists and clinical nurses with current nursing practice. A "group-think"-type atmosphere can settle in, with a perception that patients are doing satisfactorily so "why is change necessary?" Environmental factors may reinforce this norm, such as physicians providing positive praise for nurses and families satisfied with care. Note that physicians are generally pleased when nurses carry out orders without question, and families are usually grateful, lacking knowledge about best practices. Change is difficult, and journal clubs represent potential change.
The challenge of journal clubs is to create an environment where all nurses feel comfortable learning how to read a journal article, analyze data, and discuss the strength of the evidence to determine if it is sufficient to make practice changes. Nurses learn complex technology easily so they can definitely achieve journal club skills. Support is needed to gain mastery of the techniques.
Three main factors have been identified as barriers for successful journal club activity: lack of skill and confidence, facing the challenges of low clinical nurse motivation, and a strong aversion to change because of a high level of comfort with current practice. Strategies to overcome these barriers are identified in Table 1.
As you reflect on your role as a professional development specialist, remember the survey results of Pravikoff, Tanner, and Pierce (2005) that more than 60% of nurses consult one another with practice questions. Journal clubs are a crucial alternative to relying on peers who may not know the evidence. Journal clubs reinforce the importance of using data to influence practice. Journal clubs develop critical thinking, promote peer learning, build team relations, and improve outcomes. Journal clubs help nurses stay current and strengthen collegial relations in rapidly changing clinical environments. Be persistent with journal clubs. Over time, you will find the clinical nurses taking the lead, and you will assume the role of coach rather than leader. This is the ultimate goal, that clinical nurses own their practice and feel proud it is evidence based!
REFERENCES