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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
    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
    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)
    12Shift Coordinator29(15.0)
    13TOH Library Website28(14.5)
    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
    Sources of individual patient information
    Personal experience in nursing
    Least used
    Nursing Journals
    ways nurses have always done it
    research journals
    medical journals
    Nurses use a variety of sources
    RankSources of Informationn(%)
    1Colleague (peer)166(86.0)
    2Internet Search Engines161(83.4)
    4Unit Manuals152(78.8)
    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.
  • Presentation Slides

    1. 1. Increasing Library Usage by Nurses Strategies based on Nursing Knowledge Translation Research
    2. 2. Outline The Ottawa Hospital Nursing Knowledge Translation Working Group Strategies we have tried Strategies you have tried
    3. 3. Introduction
    4. 4. The Ottawa Hospital Clinical Nurses 3517 FTE Advanced Practice Nurses 31 Clinical Managers 70 Nursing Professional Practice 15 Nurse Educators 56
    5. 5. 5 The Ottawa Hospital Educational Level of Nurses Registered Practical Nurse RN no Bacc. RN - Bacc or higher
    6. 6. 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
    7. 7. Library Services @ The Ottawa Hospital Electronic access transformation Client service transformation Increased emphasis on healthcare professionals (nursing, allied health)
    8. 8. Nursing Knowledge Translation Working Group Climate 1. ↑ need for evidence-based practice 2. ↑ in workload and acuity 3. Shortage of nurses 4. Explosion of information
    9. 9. Mandate • Provide direction for the – Access – Integration and – Utilization of Nursing knowledge resources to support the clinical, educational, research and managerial endeavors at TOH
    10. 10. • 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
    11. 11. Years of Experience in Nursing <1 1-5 6-10 11-15 19-20 21-25 >26 17% 30% 15% 8% 16% 4% 10%
    12. 12. Distribution of Times New Knowledge Sought by Years of Practice 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Years of Practice Percent 0 times 1-5 times 6-10 times > 10 times 0 times 6% 1-5 times 14% 40% 40% 75% 57% 38% 44% 6-10 times 10% 23% 13% 29% 25% 31% > 10 times 86% 50% 37% 13% 14% 31% 25% <1 Year 1-5 Years 6-10 years 11-15 years 16-20 years 21-25 years 26 + years
    13. 13. What sources of information do you use when seeking new knowledge? 83% 81% 79% 51% 86% 0% 20% 40% 60% 80% 100% Colleague (peer) Internet Search Engines Educator Unit Manuals Centre for Nursing Excellence
    14. 14. Type of Information Sought 76% 51% 51% 31% 22% 8% 76% 0% 20% 40% 60% 80% 100% Nursing Policies and Procedures Patient Diagnoses and Treatments Patient Education Specialty information Clinical Practice Guidelines Professional information (CNA, RNAO, CNO) Other
    15. 15. 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
    16. 16. Use of Indexed Databases to Carry Out Literature Searches by Years of Experience 86% 45% 17% 6% 14% 25% 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% <1 Year 1-5 years 6-10 years 11-15years 16-20 years 21-25 years 26 or more years Years of Experience
    17. 17. Barriers Rank Barriers % (n) 1 Workload/Not enough time 76 (147) 2 Limited research skills 32 (61) 3 Not aware of what resources are available 31 (60) 4 Limited computer skills 30 (58) 5 Limited computer access 22 (43) 6 Difficulty determining if information obtained is valid /current /applicable to clinical situation 21 (41) 7 Other 6 (12)
    18. 18. Changes that would assist you in Accessing Information? Rank Changes Required % (n) 1 Remote off campus access to electronic resources (e.g. from my home computer) 58 (111) 2 More Information on TOH InfoNet 41 (79) 3 More computer workstations 38 (74) 4 More electronic journals 32 (62) 5 Automatic e-mail updates 29 (56) 6 More electronic books 22 (42) 7 Other 16 (31) 8 Access to Knowledge synthesis programs 12 (24) 9 Access to Knowledge broker 8 (16)
    19. 19. 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)
    20. 20. 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.
    21. 21. Survey results What does that mean for libraries?
    22. 22. 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
    23. 23. Inservice sessions 10 minute sessions done on the wards Focus on tools they can use from their workstation Relationship building session
    24. 24. 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
    25. 25. Pathfinders Tool for educators to offer to clinical nurses who want to change areas
    26. 26. Nursing Librarian Mixed blessing • Builds tremendous relationships • Creates more work than you can imagine • Problem keeping up in a timely way
    27. 27. Accessibility • 24 hour access to library • Remote access via Athens • PDA compatible resources • Training in the evening shift
    28. 28. 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 **
    29. 29. 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
    30. 30. 30 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
    31. 31. 31 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
    32. 32. Your strategies – what works / what doesn’t