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  • Thank you very much. As the program and the title on the slide indicates, I am going to talk to you today about some of the strategies we have used at The Ottawa Hospital to increase usage of library resources by nurses. Several of these strategies have been developed in response to research published about Nursing Knowledge Translation and my participation on the Nursing Knowledge Translation Working Group at the hospital.
  • The Ottawa Hospital Library Services at The Ottawa Hospital Nursing Knowledge Translation Working Group / Survey results Strategies that work / Strategies that don’t work Your strategies
  • To start with, I would like to give you some context about The Ottawa Hospital. The Ottawa Hospital is a large teaching hospital specializing in tertiary and quaternary levels of care. In the Champlain LHIN, we are the big hospital with approximately 12,000 staff and over 2,000 physicians and residents. We have around 1150 beds and we are spread all over the city of Ottawa. There are three main campuses, the Civic and General campuses which also include the Rehabilitation Centre and the Cancer Centre and the Riverside campus which is an outpatient site. In addition we have a second Cancer Centre site co-located with the Queensway Carleton Hospital and a variety of smaller sites sprinkled throughout the region.
  • Of those 12,000 employees, we have around 4.400 nurses. Our nurses range from recent graduates to seasoned old-timers who are days away from retirement. They also play a number of different roles throughout the hospital. As the largest single employment group within the hospital, it is critical to understand their information needs, their information seeking behaviours and their well established processes in order to serve them better.
  • At The Ottawa Hospital, we have a growing number of RNs with a baccalaureate or higher. Last year we hired 240 new graduates and 133 experienced nurses. So all of the new grads have BScNursing and about 1/3 of the experienced nurses have a baccalaureate. In the next few years we are looking at hiring 350 – 400 new nurses per year, of which I suspect 75% will be degreed nurses. The retiring nurses tend to be RNs without a baccalaureate. In addition, we have many nurses enrolled in courses outside of TOH with at least 120 asking for tuition assistance in the past year.
  • 10.2 FTE – 3.8 FTE Librarians with master’s degrees 5.4 FTE library technicians 1.0 FTE management Key services include literature searching, information literacy training, document delivery, weekly table of contents service, web-based catalogue, access management. Provide services for other organizations – 9 Regional hospitals, Ottawa Public Health Historically the medical libraries were for physicians, residents…many other clinicians did not fee welcome.
  • Climate for change in Nursing Need for evidence-based practice; Increase in acuity, workload ; Global Shortage of Nurses; Explosion of information 17 year lag between new science and adoption into clinical practice (Salmand, ) Nursing Knowledge translation working group - 15 members including Library Representation Director of Library Services at TOH and Librarian Nursing Representation Educators, APN, Managers, Clinical Nurses, NPPD , Chief Nurse Executive Tasks Assess current state of KT practices at TOH Conduct KT survey to determine current practices in nursing Analyze survey findings and literature Suggest strategies to promote KT at TOH Disseminate results Promote education regarding KT Promote awareness of current KT resources among TOH nurses
  • Final Survey distributed to 3 groups of nurses: Total: 359 of 754 surveys returned= 47% return Research Utilization Questionaire Random Convenience Clinical Nurses (random sample n=193 of 588) 33% return CNCPC nurses (n~42) 100% return Nursing Retreat (n~124) 100% return
  • 6 Intranet(Infonet)67(34.7%) 8Electronic Databases64(33.2) 9Manager61(31.6) 10Textbook39(20.2) 11www.uptodate.com31(16.1) 12Shift Coordinator29(15.0) 13TOH Library Website28(14.5) 14Other36(18.7)15APN18(9.3) 16Personal Visit to TOH Library11(5.7) 17Nursing Professional Practice Department11(5.7) 18Clinical Expert10(5.2) The most frequent sources of information listed under other were journals (9/36 – (25%) and physicians (7/36 – 19.4%)
  • Type of information sought in the average month The most frequent information sought listed under other was Drug Information (9/16 – (56%). Significant differences A greater proportion of nurses with less than one year of experience (57%) than nurses with more experience (13%) preferred to consult a clinical nurse for information (ρ = .043). A smaller proportion of nurses with less one year of experience (29%) than nurses with more experience (59%) preferred to use the intranet for information (ρ = .027)
  • Nurses with five or less years experience are more likely than nurses with more experience to use an indexed data base 9% external librarian 10% other? Centre 4%
  • Nurses with five or less years experience are more likely than nurses with more experience to use an indexed data base (ρ = .000).
  • Barriers to accessing information Significant difference Nurses with 16 or more years of are more likely than nurses with less experience to identify a lack of research skills (ρ = .006) and a lack of computer skills (ρ = .011) as barriers to accessing information.
  • What else cold be done to help you access information and new knowledge relevant to your nursing practice?
  • We asked years of practice but not education level Only RN participated Estabrooks 2002 Med surg nurses 230 nurses in 5 adult 2 paediatric 2002 study Canadian nurses 4 teaching hospitals of Ontario and Alberta Administered x2 6 month Estabrooks 1996 600 out of 1500 Bessler 1994 212 our of 572 medical surg areas in North Eastern US Estabrooke Sources of individual patient information Personal experience in nursing Least used Nursing Journals ways nurses have always done it research journals medical journals media Nurses use a variety of sources RankSources of Informationn(%) 1Colleague (peer)166(86.0) 2Internet Search Engines161(83.4) 3Educator157(81.3) 4Unit Manuals152(78.8) Inservices Under use of journals
  • Previous surveys grouped internet use with choices about information obtained from media popular magazines, Television, Internet Previous survey results and our survey results ranted media as the very low as a basis for Knowledge used in clinical practice (Question 9 p) Limited discussions in the literature about search engines as a preferred source of information to guide clinical practice. Clinical nurse sought information about patient treatment and diagnosis Specialty information Patient Education Increased Use of search engines Estabrooks The internet and access to evidence How are nurses positioned Nursing and Health Care Management Issues Surveys from 1996 and 1998 reported that internet use by nurses was low compared to other groups despite similar access Nurses value inerpersonal contact and prefer to use personal experience and communication with colleagues and patients rather than online and traditional sources of practice knowledge Limited information about internet Context of sources of information to guide practice Not evaluated within the context of sources of information to guide practice Previous studies 96 and 98 Later surveys included internet with media popular magazines, television, internet Low rankings as a form of knowledge used in practice Our observations were that the use of internet search engines by the nurses at our institution was increasign We included this as component of our survey We also wanted information about what search engines were used? Where Electronic Data base used? Were the nurses able to access Did they consider the validity of source of their information
  • Time is usually of the essence – they want to know now, they will go to the closest source – speed of service becomes important Relationships mean a lot to nursing – they need to know that you exist to even come to you, they need to feel comfortable coming to you Internet search engines are playing an increasing role Look at 3 levels of knowledge as outlined in Lost in Knowlegde Translation: time for a Map by Graham, Logan and Harrison, (2006) 1. Inquiry – original research articles 2. Synthesis – systematic reviews, meta-analysis, 3. Tools – guidelines, best practices, instruments to measure, - most clinical nurses are not looking for original research articles or synthesis…they want guidelines, policies and procedures, best practices and drug information - APNs, Nurse educators are more likely to look for original research and sythesized materials.
  • Training sessions developed for the intranet although relatively easy to create and available to any one on any shift, not easily measured and do not know who you are reaching Similar issue with electronic resource usage Libraries may need to rethink and redesign services to meet the needs of different segments of the nursing population. We also need to reassess how we measure success…it is no longer relevant to measure based on whether people are coming into the library, or are registered users.
  • Despite the issues and barriers that we face, we have been able to increase the number of nurses registered over the past 3 years. We have also increased the # of literature search requests by 35%...whether that is a result of a number of initiatives to create guidelines and clinical pathways or because we have done such a great job marketing, I don’t know.

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  • Increasing Library Usage by Nurses Strategies based on Nursing Knowledge Translation Research
  • Outline
    • The Ottawa Hospital
    • Nursing Knowledge Translation Working Group
    • Strategies we have tried
    • Strategies you have tried
  • Introduction View slide
  • The Ottawa Hospital Clinical Nurses 3517 FTE Advanced Practice Nurses 31 Clinical Managers 70 Nursing Professional Practice 15 Nurse Educators 56 View slide
  • The Ottawa Hospital
  • Library Services @ TOH
    • 10.2 FTE
    • $1.1 million
    • 2 medical libraries and 3 patient libraries
    • Provide services to regional hospitals and Ottawa Public Health on a contractual basis
  • Library Services @ The Ottawa Hospital
    • Electronic access transformation
    • Client service transformation
    • Increased emphasis on healthcare professionals (nursing, allied health)
  • Nursing Knowledge Translation Working Group
    • Climate
    • ↑ need for evidence-based practice
    • ↑ in workload and acuity
    • Shortage of nurses
    • Explosion of information
  • Mandate
    • Provide direction for the
      • Access
      • Integration and
      • Utilization
      • of Nursing knowledge resources to support the
      • clinical, educational, research and managerial
      • endeavors at TOH
    • Administered to
      • Clinical Nurses (random sample) 33% return
      • Clinical Practice Committee 100% return
      • TOH Nursing Leadership Retreat 100% return
    • Research Utilization Survey
      • Used with permission of Drs. Estabrooks and Wolf
      • Validated Likert Scale
    Nursing Knowledge Translation Working Group - Survey
  • Years of Experience in Nursing 17% 30% 15% 8% 16% 4% 10%
  • Distribution of Times New Knowledge Sought by Years of Practice
  • What sources of information do you use when seeking new knowledge?
  • Type of Information Sought
  • When, how did you carry out your last literature Search?
    • 65% had carried out a lit. search within the past 6 months.
    • 64% Internet Search engines
    • (e.g. Google, Yahoo, MSN)
    • 20% Indexed Database
    • (e.g OVID, CINAHL, Medline)
    • 19% TOH Reference Librarian
    • 14% Never did a literature search
  • Use of Indexed Databases to Carry Out Literature Searches by Years of Experience
  • Barriers
  • Changes that would assist you in Accessing Information?
  • What did we find that is consistent with previous studies
    • Preference to obtain knowledge through personal experiences and interactions
      • Experience of caring for patients over time
      • Peers/Nurse Educator
      • In-services
      • (Spenceley et al, 2008; Estabrooke 2005; Estabrooke 1998; Baessler 1994)
    • Nurses use a variety of strategies
    • Colleague, Search Engines, Educators, Unit Manuals
    • Least Used
    • Journals including Medical and Nursing Research
    • Popular Media (magazines, Television and Internet)
  • What is new about what we found
    • Increased use of search engines as a source and a preferred source of information
      • Our survey specifically asked about internet search engines as a (preferred) source of new knowledge, and was ranked within the top 2.
  • Survey results
    • What does that mean for libraries?
  • Failed strategies
    • Open houses
      • Do not have time to go to these
    • Scheduled training session
      • Usually doesn’t fit their schedules
    • In library displays, flyers, etc.
      • They don’t come in, so they don’t see
  • Inservice sessions 10 minute sessions done on the wards Focus on tools they can use from their workstation Relationship building session
  • Support Nurse educators
    • Quarterly book lists sent to the educators
    • Table of contents service
    • Show them cool internet tools such as delicious, wikis that they can implement with their nurses
    • Participate in their committees
    • Believe in the trickle down effect
  • Pathfinders Tool for educators to offer to clinical nurses who want to change areas
  • Nursing Librarian
    • Mixed blessing
    • Builds tremendous relationships
    • Creates more work than you can imagine
    • Problem keeping up in a timely way
  • Accessibility
    • 24 hour access to library
    • Remote access via Athens
    • PDA compatible resources
    • Training in the evening shift
  • Strategies: other Raising more awareness by writing articles for the nursing newsletter Focussing on the new grads who are aware of the benefits of database searching **
  • Measuring Success
    • Who are you reaching and who is using the resources?
    • Do not underestimate the trickle down effect of information sharing
    • No longer relevant to only measure who is coming to your library or if certain books are taken out
    • Need to talk to the nurse educators to get more accurate measurements
  • Measure of Success Occupational Title (self-identified) # nurses registered as users in 2007 # nurses registered as users in 2010 Nurse 498 703 Nurse Educator 30 50 Clinical Manager 25 29 Senior Management 5 8
  • Segmentation of your population Nurses play different roles with different information needs Maybe we need to target different segments with different tools and resources to meet those needs
  • Your strategies – what works / what doesn’t