Transcript Nursing Information Access: Library Services for the

Getting Magnetized: Service Strategies
for Nursing Excellence
Joy Kennedy, MLS
Northwest Community Hospital
Health Resource Library
Based on contents created by Margaret (Peg) Allen, MLS-AHIP
Introductions
• Margaret (Peg) Allen, Library Consultant,
Author and CE Presenter
• Joy Kennedy, Northwest Community
Hospital, Health Resource Library
2
Northwest Community Hospital
http://www.nch.org
Learner settings—show of hands
• Librarian and/or nurse?
• Hospital/health system?
– Involved in ANCC Magnet Program?
– Magnet status – achieved, preparing, site visit?
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Academic – ADN, BSN, Graduate programs
Nursing school faculty/library liaison
Combined – hospital/nursing school setting
Academic medical center – multiple programs
Academic medical center, no nursing school
Professional nursing society
Public health
Other
4
Course Objectives
Participants will be able to:
• Describe the ANCC Magnet initiative and its
significance to hospitals and nurses.
• Describe the knowledge-based information needs
of nurses
• Identify collaborative education and service
strategies to improve knowledge-based
information services for nurses
• Identify opportunities for librarians and their
library to partner with nurses to improve patient
care and safety
5
Learning plan
• ANCC Magnet Program
– History of Magnet Program & its Importance to Nurses,
Hospitals
• “Forces of Magnetism”—was 14, now consolidated into
5 “Model Components”
– For each: library opportunities
• Information Needs of Nurses & Evidence-Based
Nursing Practice
• Evaluation: final questions; forms
6
ANCC Magnet Program
Why ANCC Magnet Certification?
Magnet: the Standard
http://198.65.134.123/Magnet/ResourceCenters/Faculty/MagnetFilm
.aspx
Produced by ANCC
7
Latest Magnet Film
“Magnet: the power to attract and retain”
http://nursingworld.org/media/play.asp?f=6&q=m&t=
v
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Magnet Certification
ANCC Magnet Recognition Program®—
Recognizing excellence in nursing services
– Developed by the American Nurses Credentialing
Center, part of ANA, to recognize health care
organizations that provide the very best in
nursing care.
– “Seal of approval” for quality nursing care
– Aids in nurse recruitment and retention
– Rapid growth – 7 in 2000; 300+ now
http://www.nursecredentialing.org/Magnet/ProgramOverview
/GrowthoftheProgram.aspx
9
Historical Background
• In 1983, the American Academy of
Nursing commissioned a Taskforce to
research why some hospitals attracted and
kept nurses in a time of severe nursing
shortage.
– McClure, MM, Poulin, M., Sovie, M. & Wandelt,
M. (1983). Magnet hospitals: Attraction and
retention of professional nurses. American
Academy of Nursing Task Force on Nursing
Practice in Hospitals. Kansas City, MO:
American Nurses Association.
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Research Findings: Characteristics
of Magnet Hospitals
• Participatory Management (Shared
Governance)
• Nursing Autonomy & A Supportive Nursing
Leadership
• Career Development Opportunities for
Nurses
• Recognition of Importance of the Quality of
Patient Care
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Further Research on Magnet
Hospitals
• Magnet Hospital nurses were more satisfied
with their jobs
• Nurses at Magnet hospital are more likely to
be certified in specialty areas, maintain
continuing education & participate in
community programs
• Strong relationship between the degree of
nursing autonomy & quality of care patients
received
12
More Resources on Magnet
• Nursing Center Articles:
http://www.nursingcenter.com/CareerCenter/magnet.asp
– Costs unless Nursing Center member $4-$8 each
• ANCC page on Medscape:
http://www.medscape.com/partners/ancc/public/ancc
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Nursing Shortage Resources
• American Association of Colleges of Nursing
http://www.aacn.nche.edu/Media/shortageresource.htm
#about
The Nursing Shortage: Is this cycle different? OJIN
2001
http://tinyurl.com/2md5lc
• Discover Nursing
http://www.discovernursing.com/
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Organizational Structure
American
Nurses
Association
American Nurses
Credentialing
Center
American
Academy of Nursing
Accreditation
Certification
Magnet
Recognition
Program
American Nurses
Foundation
Institute for
Credentialing
Innovation
Measurement
Services
Research
Institute
Commission on
Magnet
Recognition
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Appraisal Review Process:
Phases
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•
•
•
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Preparation:
Self-Assessment
Phase One:
Application
Phase Two:
Written Documentation
Phase Three: Site Visit by Surveyors
Phase Four:
Commission Vote
CELEBRATE!
16
Magnet and Hospitals:
How has the research
translated into the
Magnet program
requirements?
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Magnet Recognition Program
Goals (“Core Values”)
• Promoting quality in a setting that
supports professional practice;
• Identifying excellence in the delivery of
nursing services to patients/residents;
and
• Disseminating “best practices” in nursing
services.
18
Magnet Recognition Program
Requirements
Focus On:
•
•
•
•
•
Leadership of the Chief Nurse Executive
Work environment
Adherence to standards
Interdisciplinary collaboration
Cultural and ethnic diversity of patients and care
providers is recognized by the hospital
• Best nursing practices - evidence-based practice,
quality improvement, research – are demonstrated
• Benchmarking against quality standards in certain
areas
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Original 14 Forces of Magnetism
1.
2.
3.
4.
5.
6.
7.
Quality of Nursing Leadership
Organizational Structure
Management Style
Personnel Policies and
Programs
Professional Models of Care
Quality of Care
Quality Improvement
8.
9.
10.
11.
12.
13.
Consultation and Resources
Autonomy
Community and the Hospital
Nurses as Teachers
Image of Nursing
Interdisciplinary
Relationships
14. Professional Development
Magnet Hospitals: Attraction and Retention of Professional Nurses. American
Academy of Nursing. Kansas City. : Taskforce on Nursing Practice in Hospitals.
1983. PMID: 6551146
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Five “Model Components” of Magnetism
1.
Transformational Leadership (TL)
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2.
Structural Empowerment (SE)
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3.
Professional Models of Care (Force #5)
Consultation and Resources (Force #8)
Autonomy (Force #9)
Nurses as Teachers (Force #11)
Interdisciplinary Relationships (Force #13)
New Knowledge, Innovation, & Improvements (NK)

5.
Organizational Structure (Force #2)
Personnel Policies and Programs (Force #4)
Community and the Healthcare Organization (Force #10)
Image of Nursing (Force #12)
Professional Development (Force #14)
Exemplary Professional Practice (EP)
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4.
Quality of Nursing Leadership (Force #1)
Management Style (Force #3)
Quality Improvement (Force #7)
Empirical Outcomes (EO)

Quality of Care (Force #6)
(http://www.nursecredentialing.org/Magnet/NewMagnetModel.aspx)
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Magnet Model Components
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The Application
Each component of the new Magnet Model
requires two kinds of submissions:
– Evidence Documents: particular pieces of
documentation such as annual reports,
organizational charts, policies & procedures,
tables of committees, statistics, data, etc.
– Evidence Narratives: narrative statements to
support the evidence with descriptions of
programs, processes or services that provide
examples of how each is “operationalized”
Magnet Components
Explained
Transformational Leadership(TL)
• Quality of Nursing Leadership
– “Knowledgeable, strong, risk-taking nurse leaders follow a
well-articulated, strategic and visionary philosophy in the
day-to-day operations of the nursing services. Nursing
Leaders, at all levels of the organization, convey a strong
sense of advocacy and support for the staff and for the
patient. (The results of quality leadership are evident in
nursing practice at the patient’s side.)”
• Management Style
– “Healthcare organizations and nursing leaders create an
environment supporting participation. Feedback is
encouraged and valued and is incorporated from the staff
at all levels of the organization. Nurses serving in
leadership positions are visible, accessible, and committed
to communicating effectively with staff.”
26
Required Examples of “Sources of Evidence”
for Transformational Leadership
• Evidence of strategic planning by nurse-leaders
• Evidence of advocacy and influence—show organizational wide
changes, recognition and reward of innovation by nurses
• Give examples, from several different nursing units, of advocacy
by the CNO on behalf of the staff, such as requests for additional
FTEs, systems, equipment, personnel support and so forth.
• Evidence of visibility, accessibility and communication—show
that the CNO is visible and accessible to direct-care nurses, that
nurse leaders use input from direct-care nurses, and changes in
the work environment and patient care based on input for
direct-care nurses.
Library Collection Resources:
•AONE: The American Association of Nurse Executives-http://www.aone.org & books & Nurse Leader
•Top Nursing Journals:
Zone 1
1. J Nurs Adm
2. Nurs Manage
3. Nurs Econ
4. Nurs Adm Q
5. Hosp Health Netw
6. Nurs Res
7. JAMA
8. Am J Nurs
9. N Engl J Med
Zone 2 (Top 10)
1. J Nurs Scholarsh
2. Med Care
3. J Adv Nurs
4. J Nurs Care Qual
5. Harv Bus Rev
6. Nurs Outlook
7. Mod Healthc
8. J Healthc Manage
9. Health Care Manage Rev
10. Nurs Educ Perspect (2002–)
Galganski, Carol. (2006) Mapping the literature of nursing
administration. J Med Libr Assoc 94(2) Suppl, E-87-91.
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Services for Transformational
Leadership
• Brainstorm– more ideas? New services or
changes, additions or improvements to
existing services?
Structural Empowerment (SE)
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Organizational Structure
Personnel Policies and Programs
Community and the Healthcare Organization
Image of Nursing
Professional Development
Description: Magnet hospital environments are “flat,
flexible and decentralized.” “Nurses throughout the
organization are involved in self-governance and
decision-making structures and processes that establish
standards of practice and address issues of concern.”
Required examples of “Sources of
Evidence” for Structural Empowerment
• Professional Engagement - show that the
structure and processes of the hospital enable
nurses from all setting and roles to participate
in organizational decision-making groups such
as committees, councils, and task forces.
• Commitment to Professional Developmentshow how the organization sets expectations
and supports nurses at all levels who seek
formal education (BSN, master’s, doctoral
degrees.)
Continued on Next Slide
Sources of Evidence For Structural
Empowerment (continued)
• Teaching & role development-show how it
promotes the teaching role of nurses, how
nurses support community education activities,
how nurses support academic practicum,
adjunct faculty, mentorships, etc.
• Commitment to community involvement –
show structure and processes to allocate
resources to affiliations with nursing schools,
consortiums and community outreach
Shared Governance: key concept
• Shared Governance is a management model
proposed & described in the nursing literature
over 30 years ago. It has a specific meaning,
almost an emotional context, to nurses.
• Shared Governance spreads the authority and
responsibility for nursing practice down to the
unit level and involves nurses directly in
practice decisions.
Shared Governance Includes
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•
•
•
Autonomy of Practice,
Control of Practice Environment,
Effective Nurse-Physician Relationships
Encompasses concepts such as
empowerment, autonomous decision making,
accountability, collaboration, mentoring,
high-quality patient care, and evidence-based,
excellent professional nursing practice.
(McClure M, Hinshaw A. Magnet Hospitals Revisited: Attraction and Retention of
Professional Nurses. Kansas City, Mo: American Nurses Publishing; 2002.)
Ideas for Library Services for
Structural Empowerment?
Remember that SE is composed of these “Forces of Magnetism”
Organizational Structure—flat structure,
participatory
Personnel Policies and Programs—nurse
involvement
Community and the Healthcare Organization
Image of Nursing—positive and professional
Professional Development—encouraged
What Library Services?
• Brainstorming?
37
Exemplary Professional Practice (EP):
Sources of Evidence
“Describe and demonstrate” in 9 areas:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Professional Practice Model
Care Delivery System(s)
Staffing, Scheduling, and Budgeting Processes
Interdisciplinary Care
Accountability, Competence and Autonomy
Ethics, Privacy, Security, and Confidentiality
Diversity and Workplace Advocacy
Culture of Safety
Quality Care Monitoring and Improvement
Elements of the original Forces of Magnetism have been
incorporated into Exemplary Professional Practice and
reconfigured into these 9 Sources of Evidence.
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Exemplary Professional Practice:
EP
• The achievement of exemplary professional
practice involves both philosophy and practice,
patient/family centered care, interdisciplinary
collaboration, ethical & safety considerations, and
use of data and national benchmarks to improve
performance and patient care.
• It is hard for me to imagine that the exemplary
practice by nurses can take place in isolation from
knowledge-based resources and the assistance of
librarians to locate these.
• What services can you suggest or changes to
current services?
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Nurses as Teachers :Resources
• Journals
–
–
–
–
–
J Contin Ed Nurs
J Nursing Ed
Nurs Educator
Nursing Ed Perspectives
Intl J Nurs Ed Sch(IJNES)
• Nursing Organizations
– NLN
– AACN
• Listservs
–
–
–
–
–
–
BIRTHED
NURSED-L
NURSENET
NURSEGRAD
NRSINGED
NURSENET
• Blogs
– The Teachers corner
– Nursing school blog
– Mediblogopathy
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Interdisciplinary Relationships:
Resources
• Institute of Medicine Studies
http://www.iom.edu/
• COGME – NACNEP report
Council on Graduate Medical Education and the
National Advisory Council on Nurse Education
and Practice
http://www.cogme.gov/jointmtg.pdf
42
Library services for Exemplary
Professional Practice
• Brainstorming?
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New Knowledge, Innovation, &
Improvements (NK)
• “Magnet organizations conscientiously integrate
evidence-based practice and research into clinical and
operational processes.”
• “Magnet organizations have an ethical and
professional responsibility to contribute to patient
care, the organization, and the profession in terms of
new knowledge, innovations and improvements.”
• “This component includes new models of care,
application of existing evidence, new evidence, and
visible contributions to the science of nursing.”
45
Library Services for NK?
• Evidence based practice—discovering new
knowledge
• If no new knowledge on a practice question,
conduct your own study
• Share your research results
• Obvious Magnet opportunities for library
Ideas?
Empirical Outcomes (EO)
• The application manual states that “the
empirical measurement of quality outcomes
related to nursing leadership and clinical
practice in Magnet organizations is
imperative.”
• The component does not state any particular
requirements itself but that outcome sources,
indicated by EO, are requested throughout the
sources of evidence.
Suggestions for Empirical Outcomes:
If you have any outcomes to report under any of the Magnet
components, you should try to include:
• Purpose
• Background
• Who was involved—
CNO, staff RNs, APRNs,
pharmacists,
physicians, etc.
• How the work was
done, i.e. methods &
approach; RN involved
in planning
• Describe the
measurement used to
evaluate outcomes &
the impact (results &
significance)
Tips for Data Gathering
• Document planning meetings, including who is
present and if they are an RN
• Have a sign-in sheet for meetings, programs,
presentations, etc. and ask about RN status
• Capture as much data as possible about use of
resources, statistics by status (RN, physician,
staff) such as interlibrary loan, circulation, etc.
• Consider regular monitoring of quality of
information services by a feedback sheet or
questionnaire and capture RN status if possible.
What do librarians need to know
about nurses, EBNP & nurses
information Needs?
The Philosophy & Research
51
Evidence-based Nursing Practice
(EBNP), Nursing Research &
the Magnet Journey
Margaret (Peg) Allen, [email protected] &
Joy Kennedy, [email protected]
52
Evidence Based Nursing Process
1. Define the
question
5. Evaluate the
process
2. Collect
evidence
4. Integrate evidence
into practice situation
3. Critically appraise
the evidence
--graphic developed by Dr. Susan
Pierce from the Pravikoff, Pierce &
Tanner
53
Data Use in Clinical Decisions
Expert
Personal
Knowledge
Patient
Specific
Data
Published
Knowledge-based
Information
Clinical Decision
(based on Graves JR, Corcoran S. The study of nursing
informatics. Image. 1989;21:(4):227–31.)
The practice of evidence based care seeks to make
published knowledge-based information more central to
the clinical decision process.
54
Relationship of Information
Literacy, EBNP & Nursing
Information
Research
EBP
Competency
Based
Teaching
55
Evidence Based Practice
Competencies
“National Consensus of Essential Competencies for
Evidence Based Practice of Nursing”
Developed in 2005 by the Academic Center for
Evidence-Based Practice (ACE), University of
Texas Health Science Center at San Antonio,
available for purchase
(http://www.acestar.uthscsa.edu/Competencies.htm)
Information Literacy
Competencies which follow reference these
competencies
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Information Literacy Competencies for EBNP
• In 2006, Peg Allen was asked to present
“Teaching Clinicians to Fish” for the annual ACE
Star Summer Institute on Evidence Based
Practice
(http://www.acestar.uthscsa.edu/past_institutes.htm)
– Link above includes abstracts to past Institutes
• Using the ACE EBP Competencies, Peg drafted:
– Information literacy competencies for all
– Nursing/clinician & researcher competencies
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Basic Health Information Literacy
Competencies—everyone in healthcare
• Uses quality health information portals, such as
Medline Plus and libraries
• Searches for information in appropriate formats
• Evaluates health information resources regardless of
format – Accuracy, Balance, Completeness
• Understands use of Boolean AND, OR and other search
techniques for Internet search portals and layperson
databases
• Observes intellectual property rights – does not
plagiarize
• Cites sources using a standard bibliographic format
58
Clinician Competencies
• Recognize ratings of strength of evidence when
reading literature, including web resources
– Evaluate and use resources for quick reference,
including PDA tools
• Searches core bibliographic databases for
chosen health profession
– Develop a searchable question
– Search CINAHL & NLM/AHRQ databases using subject
headings, EBP filters and limits
– Evaluate citations for potential relevance
“Clinicians” refers to doctors, nurses,
technicians, etc.
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Clinician Database Competencies
• Can develop a searchable question
– “The question is just as important as the answer. The answer you get
out is only as good as the question you put in.”*
• Search CINAHL & NLM/AHRQ databases using
subject headings, EBP filters and limits
– “It's not your father's literature search… Unless I know the clinician
wants to see everything, or is doing research rather than addressing
an actual patient issue, I filter.”*
• Can evaluate citations for potential relevance
– Expense of retrieval, including copying or ILL, is not insignificant.
*Email comments from Marcy Brown, MLS, West Penn Hospital - Forbes
Campus, Monroeville PA, May 1, 2006
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Clinician Competencies – Point of Care
Databases
• Recognize ratings of strength of evidence
when reading literature, including web
resources (Undergraduate, Star Point 1, #4)
• Evaluate and use resources for quick
reference, including PDA tools
•
•
•
•
Evidence-base – references?
Relevance to clinical needs
Ease of use
Currency
• Goal: Synthesis of credible evidence
61
Nurses as Knowledge Workers
How do Nurses Use
Information? How does their
Information Needs Differ from
Others?
62
Nurses as Knowledge Workers:
Similarity of Nursing Process Steps with
Knowledge Worker Roles
Nursing Process Steps
• Assessment
• Diagnosis
• Planning
• Intervention
• Evaluation - outcomes
Knowledge Worker Roles
• Data-gatherer
• Information User
• Knowledge User
• Knowledge Builder
Needs of the Practice Environment
Source: Sydney-Halpern R, Corcoran-Perry S, Narayan S. Developing
clinical practice environments supporting the knowledge work of nurses.
Computers in Nursing 2001 (Jan-Feb); 19(1):17-23.
63
Medical vs. Nursing Concerns in
Evidence-based Practice
Same patient with broken hip, different EBP concerns.
Nursing care is focused on the patient, not the disease process.
Nursing Concerns
Medical Concerns
–
–
–
–
–
Hip replacement
Hip pinning
Watchful waiting
Surgical risks
Correct prosthesis
Same Patient,
Different Concerns,
Different Info Needs
–
–
–
–
–
–
Pain
Incontinence
Immobility
Confusion
Skin breakdown
Inadequate sleep
Source: Lang NM. Discipline-based approaches to evidence-based practice: a
view from nursing. Joint Commission Journal on Quality Improvement 1999
(Oct); 25(10):539-44.
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Patient knowledge
also influences
shared decisions & is
part of “the
evidence”.
Diagram courtesy of:
Lisa K. Traditi, MLS, AHIP
Head of Education and Learning Resources Center
Denison Memorial Library
University of Colorado at Denver and Health Sciences Center
65
Continuum of Information
Needs in Evidence-based
Healthcare
Patient-focused clinical questions –medical
plus nursing/allied health implications
Interdisciplinary guidelines – evidencebased “best practices”
Based on clinical research
Management and education issues – many
related to Magnet components and forces
All of these factors, all of these information needs are
involved in EBP.
66
When is Research Utilized?:
When do nurses look for
research?
Let’s look at Nursing’s Research
Utilization Models to better
understand Evidence Based
Nursing Practice (EBNP)
67
Research Utilization Models: What
Causes Research to be Used?
• Ottawa Model of Research Use
• Stetler Model of Research Utilization
• Practitioner orientation
• Two levels: individual and organization
• Focus on research competencies
• Iowa Model (Titler et al.) of Research in Practice
• Knowledge focused triggers: new practice standards,
philosophies of care, research and meta-analysis
• Problem-focused triggers: clinical questions, quality
improvement projects, journal clubs
(Polit & Beck (2006), Using research in evidence-based practice in Essentials of
Nursing Research, pgs. 457-494.)
68
What are the Barriers to Research Utilization?
• Individual constraints
– Lack of time
– Little experience/low
comfort level with library
and search techniques
– Limited ability to
understand/interpret
research reports
– Limited exposure to to
research-use strategies
during educational
preparation
– Negative staff attitudes
toward research
• Organizational constraints
– Lack of availability of
pertinent research findings
– Limited access to journals
– Lack of administrative
support
– Cost constraints
– Concerns about reallocation
of staff time
(As summarized by Simpson B in Canadian Nurse, 1996 Nov; 92 (10): 22-5. )
What can librarians do to help overcome these barriers?69
From Research Utilization (RU)
to Evidence-Based Practice
Research Utilization
• Component of EBP
Evidence-Based Practice
• Broader concept
• Only research accepted as
evidence
• Evidence other than
research part of EBP
• Critical appraisal of
research reports
• Critical appraisal of all
evidence
Based on Levin, Rona F. & Harriet R Feldman, Teaching Evidence-Based
Practice in Nursing: A Guide for academic and clinical settings. New York:
Springer, p. 11.
70
National Council of State Boards of Nursing,
National Survey on Elements of Nursing
Education, 2006
“The graduates were more likely to feel adequately
prepared when nursing programs:
1. taught use of information technology and evidencebased practice,
2. integrated pathophysiology and critical thinking
throughout of curriculum…”
(https://www.ncsbn.org/RB24_06ElementsofNursing.pdf)
– p. 37
71
Interagency Council on Information
Resources for Nurses (ICIRN) Research:
Six Common Questions
• Are nurses aware of the need for research-based
information?
• Do nurses identify information needed for
research-based practice?
• Do nurses have the ability and availability to
electronically search for information?
• Do nurses actually apply electronic informationseeking processes?
• What information do nurses use?
• For what purposes do nurses use information
retrieved?
72
--Pravikoff, Tanner, Pierce
ICIRN Research Results
• Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005).
Readiness of U.S. Nurses for Evidence-Based Practice?
American Journal of Nursing, 105(9), 40-51.
http://tinyurl.com/35clnb
• Dee, C., & Stanley, E. (2005). Information-seeking
behavior of nursing students and clinical nurses:
implications for health sciences librarians. Journal of
the Medical Library Association, 93(2), 213–222.
http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&blob
type=pdf&artid=1082938
• For more information and color slides, see MLA
2003 Symposium: Evidence-Based Nursing Practice:
Needs, Tools, Solutions
http://nahrs.mlanet.org/resource/symposium/index.html
73
ICIRN – similar conclusions in UK &
Canadian Studies
• The Information Needs of Nurses, Health Care Assistants,
Midwives and Health Visitors. Summary report of RNC survey
(2005, April 20, 2005).
http://www.rcn.org.uk/__data/assets/pdf_file/0010/78670/002780.pdf
• Canadian Nurses Association position statement “Nursing
Information and Knowledge Management” (November, 2006)
http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS87-Nursing-infoknowledge-e.pdf
Conclusion: "Having good access to information – via the
Internet and via a physical library and via information
skills – appears to have a direct effect on putting evidence
into practice. Those with the best access to information
were also more likely to both search for evidence and to
change their nursing practice as a result of research.“ (RNC
74
survey)
Nursing Values and Research
In presentations on the Pravikoff study, the
authors stress the need for nurses to value
nursing research.
FYI: Article on values free from Nursing Ethics collection,
http://www.nursingcenter.com/home/NursingCenterEthics.asp
Other than ICIRN what other important nursing educational
initiatives should librarians be aware of?
75
T.I.G.E.R.—
Technology Informatics Guiding Educational
Reform
• http://www.tigersummit.com/About_Us.html
• Summit of major nursing organizations & 20 nursing
informatics societies (& NAHRS reps)
• Goal was to identify information/knowledge management
best practices & effective technological capabilities of nurses
• Action plan for transforming nursing practice and education
to better prepare nurses to practice in an increasingly
automated, informatics-rich, and consumer-driven health
care environment
76
Librarians’ Role
• Can librarians help address barriers to
EBNP?
• Can librarians help with T.I.G.E.R. initiatives?
• What does research show us about the
Librarian’s role ?
77
MLA & NAHRS Research Efforts
• As Peg Allen, Pam Sherwill-Navarro and
Susan Jacobs worked with ICIRN, the
T.I.G.E.R. Summit, and students in MLA CE
classes, the need evolved for learning about
librarian roles in EBNP & the Magnet
program.
• Learning has occurred via surveys, teaching,
and MLA programs at the national and local
levels
78
NAHRS 2007 Magnet Coordinator survey
Goal: To assess library resources and services at ANCC (American Nurses
Credentialing Center) certified Magnet facilities.
 Secondary goal: enhance Magnet coordinator awareness of what
librarians can contribute to the Magnet journey
Process



Developed by NAHRS Task Force to Create Standards for Nursing
Information Resources and Services in Health Care Settings and
Research Committee, using Survey Monkey
Approved by MLA Board, with additional questions on role and value
of librarian
Sent to Magnet coordinators via ANCC list with cover message
encouraging Magnet coordinators to get librarian help with completing
survey
Richard Barry, ANA Librarian (ANCC is unit of American Nurses
Association) facilitated use of Magnet coordinator list
2. Follow-up mailing to Magnet coordinator list
3. DOCUSER database used to identify librarians at Magnet hospitals with
no response, sending them the final request
NAHRS Research page:
http://nahrs.mlanet.org/activity/mapping/research/index.html
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1.
Librarian’s Role in Magnet Journey?
• 156 (81.7%) reported librarian involvement,
including four hospitals where Magnet coordinator
said Yes and librarian said No
• Types of involvement
– Typical library services, including teaching & searches
– Magnet committee – often only non-nurse
– Input on Magnet application
• Proof reading
–
–
–
–
–
Bibliographic citation management
EBP support for guidelines development
Nursing research committee & IRB
Nursing education committee
Web pages; one Evidence Based Nursing Blog
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Added Value of Medical Librarian
12. If your facility or institution has a medical librarian or access
to one, do you perceive that this provides added value for the
institution and employees?
–
–
–
96.3% of (184 of 191 hospitals) said yes.
Comments added by 89 hospitals for yes responses, and 2
No/no response (see separate comments list)
Librarians sometimes unaware of what was valued by those in
Magnet coordinator role
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Magnet Coordinator Comments
• “Our librarians are easily accessible and very willing to assist students,
staff, and visitors with any questions or concerns. They have really done
a nice job of welcoming research issues and expanding resources to meet
our needs.”
• “We partnered with the librarians to help us set up a file management
system for cataloging evidence.”
• “As employees are focusing on more evidenced-based practice and
hospital-based research, medical librarian became a valuable resource to
staff.”
From one without:
• “We don't have access, but are recognizing the value; I have consulted a
university librarian and have brought this information to my CNO – that
is why we will have this service available in 2008.”
More comments available with report on NAHRS website,
http://nahrs.mlanet.org/activity/mapping/research/index.html
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Librarian comments – value & role
• Value of resources and services
• Involvement of a health sciences librarian on Magnet team
• Librarian involvement on committees
–
–
–
–
Education: Staff; Nursing; Patient/Family
IRB (Institutional Review Board)
Nursing Research
Patient Safety
Example: “Librarian is a member of multidisciplinary teams, provides inservices, is closely aligned with Medical Education, Human Resource
development, CME, and clinical research activities; supports information needs
for patient care; manages centralized knowledge-based resource and media
services for entire system of 6 hospitals and 10,000+ employees.”
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“The Magnet Journey: Opportunities
for Librarians to Partner with Nurses.”
• Title of article for JMLA Vital Pathways
symposium issue October,2009
• Vital Pathways for Hospital Librarians (VP)
task force: official MLA response to threats
faced by hospital librarians
• Like Magnet, Vital Pathways focus was on
outcomes
• Efforts continuing by HLS & NAHRS
sections now that VP taskforce ended
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After the Class is Over: Magnet Challenge
Action Plans
• Analyze your organization, your nurses and nursing
leadership
• Think about the concepts we’ve discussed
• Read some of the literature we’ve provided – search
for more addressing your idea
• Analyze your library’s resources and viable
alternatives
• Convey your willingness and eagerness to be part of
the Magnet process—and your enthusiasm
• Be aware that additional resources for library may
not be forthcoming
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How to Fund: Business plan or Grant
proposal?
• A grant proposal is like proposing a new
service, except that you are going to an
external funding source
• In business plan, think of administrators as
an “external” source with little or no
knowledge of what we do – write so that
they understand your request
• No library jargon!
• KISS principle: Keep it simple, stupid
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Peg’s thoughts on grants:
http://www.healthknowledgeconsultants/grants.h
tm
• Strategic Planning Model
– Strengths – why you can be trusted with their
money
– Weaknesses – why you need funding
– Opportunities – funding organization priorities
(Magnet expectations)
– Threats – what will happen without funding
• Find funding organizations interested in
supporting your needs
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Strategic Planning: SWOT Model
Strengths
Weaknesses
Effective Programs
Opportunities
Threats
Analysis of each component is foundation for success
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Program Planning Model
Strengths or Weaknesses?
Knowledge sources
Nurses’ needs
Can you turn weaknesses into opportunities for improvement?
Effective Programs
Information portals
Lack of librarian time
Opportunities or Threats?
89
Thoughts continued…
Needs assessment is vital for either grant or new
service plan
• Proposal Development Bibliography – a beginning
DeSilets, L. (2007, May). Needs assessments: an array of possibilities. Journal of Continuing
Education in Nursing, 38(3), 107-114. Retrieved June 22, 2009, from CINAHL with Full
Text database.
Overview of different methods – use not limited to continuing education.
Dickerson, P. (2008, October). Addressing barriers to enhance outcomes. Journal of
Continuing Education in Nursing, 39(10), 437-438. Retrieved June 22, 2009, from CINAHL
with Full Text database.
Barriers in context of continuing education – need to get input from the learners.
Caldwell, L., Luke, G., & Tenofsky, L. (2007, Jan-Feb). Creating value-added linkages through
creative programming: a partnership for nursing education. Journal of Continuing
Education in Nursing, 38(1), 31-36. Retrieved June 22, 2009, from CINAHL with Full Text
database.
Focus on collaboration and partnerships. Hospital library is mentioned as part of what
the hospital supplied to on-site BSN program. Notes value of champions from each
organization.
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More thoughts on proposals…
• Realistic plan & budget – but double time
you think you need
– Keep objectives simple – don't tie to specific
methods
• Follow their writing instructions!!!
• Meet deadlines
– Build in enough time in proposal development
process for last minute snafus
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Summing up:
• Collaborate with nursing
to choose resources and
strategies!
• Map projects to Magnet
model components!
• Evaluate efforts, gather&
analyze data – translate
to outcomes!
• Publish your data and
share your ideas with
librarians & with nurses
elsewhere!
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80
70
60
50
40
30
20
10
0
East
West
North
1st 2nd 3rd 4th
Qtr Qtr Qtr Qtr
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Summary: From ideas to action
Librarians & the Magnet Program
By Joy Kennedy & Peg Allen
Librarian roles in
the Magnet journey
Magnet components
94
Transformational Leadership
Suggested Ideas from our Classes
• Table of Contents Service,
especially electronic TOC &
RSS feeds
• Collection of Nursing
Certification Books
• Business databases such as
EBSCO’s Health Business
Fulltext & databases
available from local public
libraries
• SDIs to Administration of
articles on topics such as
Leadership
• Library as “Learning
Center” or “Continuing Ed.
• Special collections
developed on Innovation
& Leadership, Shared
Governance, Evidencebased Practice, Mentoring,
Teambuilding, Budgeting
• “Hot Topic” searches on
Library website
• Using SharePoint to share
ideas, searches among
leaders
• Providing databases of all
kinds & training
• Bibliography of resources
in packets for mandatory
management/leadership
classes
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Transformational Leadership
More ideas
• Start by meetings with
nursing leaders to discuss
how library can help them,
especially time saving
services
• Searches for nursing
leaders on magnet
components & other topics
as they lead the Magnet
journey
• Workshops and 1-to-1
teaching for leaders on
searching for management
topics
• Statistics on searches by
department and unit,
showing that nurses at all
levels use services
• Work with nurse
administrator to support
budget or share costs for
new resources for nursing
• Nursing Research: Show
Me the Evidence Blog from
the library at St. Joseph
Hospital (Orange,
California)
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Comments on Transformation
Leadership
• “The library is away from their unit and provides them a quiet place to
contemplate and explore new ideas. “
• “Since I am included in many Manager meetings - I do get a chance to hear
some of the concerns in the organization - and many times I come back, run a
search - and email the person who would most likely be interested in what the
literature has to offer them. This has really impressed several individuals.”
• “I partnered with our Practice & Education Councils to visit EACH unit on day
shift to promote remote access to resources and Nursing Consult in particular.
We dropped off snacks to each unit's break room and did on-the-spot "speedy
reviews" of what this product has to offer. We also left behind vendor-provided
promotional items, reference cards, my business cards, and remote access
applications with each unit's manager. Since that time, I have seen an upswing
in Nursing Consult usage, and we received over 100 new Athens access
applications.”
• Time saving for Administrators: “Whenever I work with a nursing administration
employee on a CINAHL search, I always show them how to create an account in
EBSCO; they love the fact that they can save their searches, including articles
stored in their folder. “
Structural Empowerment
--Suggested Ideas from our Classes
• Open houses, trivia contests
and raffles promoting library
– let them know that library is
for all staff
• Promote Nurses Week as well
as National Medical Librarians
month
• Serve as a mentor in learning
the research process
• Support and attend research
day poster sessions – see
what happened with those
searches!
• Workshop on creating posters
for research days and
• Become part of new nurse
orientation – last stop on tour
(with treats?) so they can
browse and see what’s
available
• “Extra” services – notary, test
proctoring
• Post/share articles written
by nurses and other staff;
maintain bibliography
• Demonstrate that
“knowledge is power”
• Support for journal clubs –
try online, as Moodle forum
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• Column in nursing newsletter
Structural Empowerment
More ideas
• Support for updates of
nursing policies & procedures
through searches, ILL, etc.
• Development of intranet site
of Library resources;
availability of Library
resources inside electronic
medical record
• Forums, wikis & SharePoint
on hospital Intranet for
nurses to collaborate & share
• Building relationships with
local nursing students & act as
resource for public library &
junior college
• Work with Nursing Staff
Development to jointly create
professional development
courses for nurses
• Act as consultant/searcher to
nurses with new ideas for
change
• Supporting nurses continuing
education with the collection,
instruction, encouragement
• Teaching nurses to search,
about evidence-based
practice principles, how to
use databases
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•
•
•
•
•
Comments on Structural
Empowerment
“Employees are empowered where they have access to information, support,
resources and opportunities to learn & grow in their work setting.”
“just getting the word out to the nurses that we are here to support their journey
and what we have to offer.”
“Of course, there is more to structural empowerment than internet connectivity, but
we all know information is power, right? If they are empowered to make clinical
decisions based on evidence, they need access to the evidence, even beyond a
packaged resource on the intranet.”
“The library will search for funding opportunities for specific research projects,
specifically community nursing projects that support the hospital's community
involvement.”
“Librarians who have some familiarity with public health information resources can
be valuable members of a team tasked with developing a hospital's community
engagement program - identifying the major health challenges in a given community,
mapping strengths and weaknesses... “
Exemplary Professional Practice
--Suggested ideas from our Classes
• Support community outreach
– help with health fairs and
health career events
• Teach health literacy classes at
public library, working with
nurses from various
specialties
• Provide handouts and
resources for community
events, including Medline Plus
bookmarks and pens
• Resources and workshops on
finding patient education
resources, including those for
• Library services for
patients as TV menu
choice – hand delivering
packets
• Support “information
prescription” program
• Proactive sharing of
articles on “hot topics” –
example of article on
bullying that addresses
horizontal violence issues
• Support for nurses
returning to school
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Exemplary Professional Practice
More ideas-• Books, bibliographies or Internet Portals on nursing
theory and/or conceptual framework of nursing
• Teach nurses about searching for info on EBP, how to use
quality measures
• Keep ANA guidelines in collection
• Nursing ethics resources
• Serve on Interdisciplinary Research committee
• Provide citation management software & support it to
effect collaboration
• Find out about Professional Practice Models, how to search
for information about them in support of organization’s
choice
• Be internal expert and resource for planning
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Comments on Exemplary
Professional Practice
• “I approached our Nursing Director this morning who is also the
person handling Magnet. She was extremely pleased that I am
taking the initiative to find out what I can do as a librarian to
support the Magnet process. She advised me that both the PPM
and the Nursing Care Model are being developed. She suggested
we meet this week and discuss. I am excited about developing
better ties with the Nurses.”
• “I've talked to the nurse in charge of our "Journey to Magnet" and
she says we don't have a Professional Practice Model yet, but that
would be part of the strategic plan developed at the all-day Magnet
retreat that I will be attending on Nov 23rd. She asked if I would
talk for 5-10 minutes about this online Magnet course and how the
library can help in the pursuit of Magnet. With all the information
I've learned so far, that won't be a problem.”
• “through a literature search, [library can] provide reviews and
updates, standards, trends, and changes as they relate to nursing
practice issues”
Typical comment:
• “We often say that it seems as though all the nurses
here at the hospital are going to school! We do
support them in every sense since we feel that we
are their "home" library and that they are here more
than they are at school, especially for those who are
taking online courses. One of the most recent things
we did was to create a Resources for Local Nursing
Programs link
(http://www4.umdnj.edu/camlbweb/nursingschool
s.html) from the Academic Resources -- Nursing
Education section of our library page. We tell the
nurses that we will even try to help them
troubleshoot using the resources from their nursing
schools. Also, since we have these links from the
library page, the sites are not arbitrarily blocked by
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New Knowledge, Innovations, and
Improvement
--Suggested Ideas from our Classes
• Add CINAHL (or another
nursing database)
• Add more full text – Joanna
Briggs, Cochrane Library,
nursing research and
specialty journals
• Involve nurses in decisions
on new library resources
• Diversity collection – links
• Facilitate new product
demonstrations
• Support for new
technologies, including
handheld devices
• Rounding with nurses on
different units
• Use nursing staff to help
with training
105
New Knowledge, Innovations, and
Improvement —More ideas
• Provide information on how
to find EBP articles, several
EB nursing pages including
PICO samples, and a link to
the EB pyramid
• Provide literature searches,
provide Linkout from
PubMed, additional
electronic resources
• Teach evaluating the
literature
• Help them really understand
EBP
• Put policies in APA format
• Collaborating with nurses
to provide online EBP
course, training classes on
PICO clinical questions
• Provide point-of-care
information products
• RSS feed to AHRQ
Healthcare Innovations
Exchange & OJIN
• Overhaul the nursing
journal collection
• Provide “tips” under email
signature re new web
resource, search tip, etc.
106
Comments on New Knowledge,
Innovations, Improvement
• “help the nurses ensure their practices are evidence-based by
participating in the Nursing Policy & Procedure Committee; I encourage
them to find updated references when reviewing/revising p&ps, and I
conduct literature searches, ideally with them but often on my own, to
find the highest level evidence possible”
• “providing a sample research problem and giving nurses a PICO
worksheet or something to work through to really "get" how PICOs are
developed.”
• “I prepared over 40 clinical disease PowerPoint presentations along
with EB/full-text articles for academic medicine. It is now the goal of
the library to provide these clinical modules to the nurses as
supplemental resources for self-directed learning. The bibliographies
will be expanded to include nursing literature and, where necessary,
the PowerPoint Presentations will be edited to reflect nursing's unique
approach to disease treatment and management.”
Empirical Outcomes
--Suggested Ideas from our Classes
• “We keep track of the nursing searches and one on ones
that we do and what type of nurse the patron is (admin,
staff, educator, etc) and provide those numbers to the
leadership. …This is a concrete way the library can show
that nurses are learning more about searching and using
the literature in clinical practice.”
• Using Google docs for quizzes, evaluations & feedback on
searches – shorter surveys are best
• Capture stories of how services, especially searches,
made a difference in patient care
• Capture statistics on use of electronic resources,
including title specific data for nursing journals
• Publications list kept by library is part of the evidence
for Magnet
108
Empirical Outcomes
--More ideas
• Tying library services to outcomes both
quantitative and qualitative
• Provide evidence that library education
& efforts are effective as well as use
statistics by type of user
• Provide searches and information in
support of National Patient Safety Goals
• Benchmarking data for QI department
• Provide guidelines (guidelines.gov) and
statistics
109
Questions?
Evaluation--Complete MLA form
• Certificates returned for forms
Thank you!
Joy Kennedy, MLS
[email protected]
110