Supporting Evidence-Based Nursing

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Demand of evidence-based nursing has been taken seriously both in the University of Kuopio (UKU) and in the Kuopio University Hospital (KUH). Role of information professionals in the process is expanding. Survey in May 2007 in order to develop information retrieval training in KUH, in order to find out the nursing staff’s educational needs in information retrieval, knowledge about EBN, attitudes towards EBN.

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Supporting Evidence-Based Nursing

  1. 1. Supporting Evidence-Based Nursing Tuulevi Ovaska Kuopio University Hospital Medical Library Kuopio University Library EAHIL Workshop, Cracow, Poland, September 2007
  2. 2. 14 September, 2007 2 Introduction  Growing demand for evidence-based nursing (EBN)  Challenge for information professionals in hospitals  Teaching information literacy (IL) skills for nurses  Promoting research utilisation in nursing  Supporting nurses’ continuing education and life long learning
  3. 3. 14 September, 2007 3 Key concepts – EBN  Evidence-based nursing is the process by which nurses make clinical decision using the best available research evidence, their clinical expertise, and patient preferences
  4. 4. 14 September, 2007 4 Key concepts – EBN  EBN steps 1. Formulation of an answerable question to address a specific patient problem or situation 2. Systematic searching for the research evidence that could be used to answer the question 3. Appraisal of the validity, relevance, and applicability of the research evidence 4. Decision making regarding the change in practice 5. Implementation of the evidence based practice decision 6. Evaluation of the decision outcome
  5. 5. 14 September, 2007 5 Key concepts – EBN  Information technology is an essential tool for each step of the EBN process  EBN does not stop at information retrieval  EBN is the connection of internal evidence (patient-related understanding) and external evidence (or knowledge from studies)  Information literacy helps in making the connection
  6. 6. 14 September, 2007 6 Key concepts – IL  Information literacy is the ability  To recognize that information is needed  To find it  To evaluate it  To use it in practice  Part of the process of evidence-based practice  Foundation for critical thinking also in EBN
  7. 7. 14 September, 2007 7 Key concepts – IL  Computer literacy does not mean the same as information literacy but computer skills are needed in information retrieval from electronic resources  Not only the competencies of nurses, but also the availability and usability of databases have to be taken into account
  8. 8. 14 September, 2007 8 EBN in UKU and KUH  Demand of evidence-based nursing has been taken seriously both in the University of Kuopio (UKU) and in the Kuopio University Hospital (KUH)  Role of information professionals in the process is expanding
  9. 9. 14 September, 2007 9 EBN in UKU and KUH  The Department of Nursing Science in the University of Kuopio is profiled nationally as a preventive nursing science research and education unit  University of Kuopio was the first university in Finland to start with a degree program in Health Administration with nursing science as a major in 1979
  10. 10. 14 September, 2007 10 Evidence-based nursing in UKU  Evidence based nursing  First year students  Basic concepts in evidence-based nursing, retrieval of evidence-based research from databases, critical evaluation of research evidence, products of evidence-based nursing, theories of research spreading and factors influencing on it  Information professionals teach information retrieval
  11. 11. 14 September, 2007 11 Evidence-based nursing in UKU  Development of Evidence Based Nursing  Third year students  Development of scientific knowledge, its nature and usefulness, nursing outcomes, and effectiveness in health care  Majority of the students have at this point completed the Information Retrieval and Library Skills course compulsory for all undergraduate students  Many students make appointments with information specialists
  12. 12. 14 September, 2007 12 Evidence-based nursing in KUH  Kuopio University Hospital has the longest nursing research tradition in Finnish hospitals  Nursing research systematically developed  Stretches from practical development activities of the nursing units to academic dissertations
  13. 13. 14 September, 2007 13 Requirements of EBN  Nursing workforce able to access and effectively use information-retrieval systems is necessary for efficient and effective information use  Libraries have a crucial role  EBN requires  Clinical information and decision support system available at the point of use  Quick access to available evidence-based information  Computerized clinical information system
  14. 14. 14 September, 2007 14 Survey results in Kuopio University Hospital  Survey in May 2007  In order to develop information retrieval training in KUH  In order to find out the nursing staff’s  Educational needs in information retrieval  Knowledge about EBN  Attitudes towards EBN  Link to the electronic survey was put on the hospital intranet and send to several in-house mailing lists of the nursing staff  162 answers
  15. 15. 14 September, 2007 15 Figure 1: Knowledge about EBN Not at all Heard about it 2% 16 % Well 47 % Somehow 35 %
  16. 16. 14 September, 2007 16 Figure 2: EBN training Many times 31 % Never 47 % Once Almost 19 % 3%
  17. 17. 14 September, 2007 17 Figure 3: No EBN training, would attend No 6% Yes, certainly 33 % Maybe 30 % Yes, probably 31 %
  18. 18. 14 September, 2007 18 Figure 4: Would attend EBN training again No Maybe 4% 14 % Yes, certainly 53 % Yes, probably 29 %
  19. 19. 14 September, 2007 19 Figure 5: Information retrieval training Many times 14 % Never 49 % Once 35 % Almost 2%
  20. 20. 14 September, 2007 20 Figure 6: No IR training, would attend No 5% Maybe Yes, certainly 25 % 41 % Yes, probably 29 %
  21. 21. 14 September, 2007 21 Figure 7: Would attend IR training again No Maybe 3% 16 % Yes, certainly 49 % Yes, probably 32 %
  22. 22. 14 September, 2007 22 Figure 8: Searching in general Never Weekly 7% 14 % Rarely Monthly 46 % 33 %
  23. 23. 14 September, 2007 23 Figure 9: Searching Internet Never 5% Weekly 28 % Rarely 36 % Monthly 31 %
  24. 24. 14 September, 2007 24 Figure 10: Searching OPACs Weekly 7% Never 30 % Monthly 16 % Rarely 47 %
  25. 25. 14 September, 2007 25 Figure 11: Searching Finnish databases Weekly Never 6% 28 % Monthly 21 % Rarely 45 %
  26. 26. 14 September, 2007 26 Figure 12: Searching international databases Weekly 5% Monthly Never 12 % 40 % Rarely 43 %
  27. 27. 14 September, 2007 27 Figure 13: Somewhere else Books 11 % Cochrane Library Google 5% 5% Libraries 5% Journals Terveysportti 48 % (Finnish portal for health professionals) 21 % Lectures 5%
  28. 28. 14 September, 2007 28 Figure 14: Why never search No skills 21 % No time 58 % No need 21 %
  29. 29. 14 September, 2007 29 Figure 15: Why not IR training? No need 23 % No information 54 % No time 23 %
  30. 30. 14 September, 2007 30 Discussion 1  Incorporating EBP requires complete administrative support, openness, and encouragement of learning new skills  If the management is not encouraging the nursing staff, there is small chance that the efforts of the library will be of much value
  31. 31. 14 September, 2007 31 Discussion 2  The process of incorporating good quality research findings into nursing practice is not straightforward  Nurses have difficulty in accessing and appraising published research, either because they do not have access to journals and libraries, or because they have not been taught how to find and appraise research
  32. 32. 14 September, 2007 32 Discussion 3  Relying on intuition, tradition, and authority of policies and procedures is understandable due to  Lack of time  Limited access to computers  Inadequate computer skills  Insufficient language proficiency  Lack of superior support  Changes in organizational cultures do not happen overnight
  33. 33. 14 September, 2007 33 Discussion 4  Yet, my small survey indicates that  Half of present-day nurses already practice evidence-based nursing  Almost all are eager to practice evidence-based nursing
  34. 34. 14 September, 2007 34 Discussion 5  Inadequate information retrieval skills discourage nurses from seeking research studies and reports  Negative attitudes about research due to lack of familiarity with terminology, statistics, and information technology  Lowering the library threshold  Taking the library services to the customers  Training the nurses
  35. 35. 14 September, 2007 35 Discussion 6  Removing information barriers  Organizational commitment  Clinical cultures  Information infrastructure
  36. 36. 14 September, 2007 36 Conclusions 1  Nurses must be able to  Access information  Develop skills required for information retrieval  Use the information appropriately in order to answer clinical questions
  37. 37. 14 September, 2007 37 Conclusions 2  Three kinds of training for the nursing staff in KUH  First, short and open-to-all introductions  Telling about the services  Introducing the resources the library has to offer  Once a month  Different days of the week and different hours of the day
  38. 38. 14 September, 2007 38 Conclusions 3  Second, hands-on-training sessions in PC class-rooms  Getting familiar with the databases  Practicing information retrieval  Getting assistance
  39. 39. 14 September, 2007 39 Conclusions 4  Third, continue  Visiting the departments  Attending nurses’ meetings  Sitting in study groups  In addition  Being active and visible in presenting our services to the nursing staff
  40. 40. 14 September, 2007 40 Conclusions 5  Both the literature on the subject and the results of my little survey encourage us librarians to rise to the challenge of supporting nurses in evidence-based practice by providing not only access to information but also assistance and training in information retrieval  It is part of our role as information professionals to promote research utilisation in nursing and to support nurses’ information literacy and life long learning

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