Ten Steps to Developing a Successful Journal Club

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Ten Steps to Developing a Successful Journal Club
Joyce Johnson, Ph.D., RN, C SCPMG Regional
Director of Education and Research
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And here are the 10 steps which we will review in
this module to help you develop your own Journal
Club
Revise if needed
Evaluate
Hold journal club
Invite participants
Develop/select forms
Select article(s)
Set time and place
Identify target audience
Identify goals
Identify a leader
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What is a journal club?

• a group of individuals who
  meet regularly to critically
  evaluate recent articles in scientific
  literature
• Usually organized around a defined subject in
  basic or applied research
• Participants can voice their views on such topics
  as the appropriateness of the research design,
  statistics employed, the methods that were used,
  etc.
• The group might synthesize the results of several
  articles and discuss the usefulness of the
  results and potential application

http//en.wikipedia.org/wiki/Journal_club
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The First Journal Clubs

• St. Bartholomew's Hospital in London in the
  mid-1800s as a kind of club...a small room over
  a bakers shop near the Hospital-gate where we
  could sit and read the journals. (from the
  Memoirs and Letters of Sir James Paget, a British
  Surgeon)

http//en.wikipedia.org/wiki/Journal_Club
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First formal journal club

• Sir William Osler established the first
  formalized journal club at McGill University in
  Montreal in 1875. The original purpose was for
  the purchase and distribution of periodicals to
  which he could ill afford to subscribe.
• The fact that journal clubs are still in
  existence today suggests that they are seen as
  having an important role.

http//en.wikipedia.org/wiki/Journal_Club
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Why develop a journal club?

• Keep current with new knowledge
• Promote better understanding of the research
  process
• Learn to evaluate the strength of evidence
  improve ability to critically appraise research
• Promote implementation of new knowledge in
  practice
• Improve patient outcomes
• Especially helpful if you are implementing
  evidence-based practice and/or are working toward
  Magnet Status

Russell 2006
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Are Journal Clubs really effective?

• There appears to be no well-designed study which
  has investigated the impact of journal clubs on
  patient outcomes.
• There is some evidence that sessions
  incorporating principles of adult learning are
  more likely to have an impact not only on
  knowledge but also on skills and behavior.

• Principles of adult learning
• Relate task to personal goals or immediate
  environment
• Present learning objectives as clinical problems
• Use problem-solving techniques
• Vary teaching approaches to suit different
  learning styles
• Use active learner participation
• Provide frequent constructive feedback

Swift 2004
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Lets work through the 10 steps one at a
time
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Step 1Identify a Leader to organize the Journal
Club Project

• It is important to have one person who takes
  responsibility for the club
• It should be someone who is interested, committed
  to the concept and willing to organize it
• You could consider a clinical educator, clinical
  nurse specialist, nurse practitioner, nurse
  manager or senior staff member

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Identify a Leader (cont.)

• Consider Journal club members taking turns after
  the first meeting to facilitate subsequent
  sessions but be sure there is one person with
  overall responsibility for the project.

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Step 2Identify Goals

• If the group is inexperienced in critiquing
  research, then a goal might be for the group to
  critique the same article and incorporate sharing
  and discussion about how to critique an article
• If the group is more experienced, the goal might
  be to identify a clinical problem and critique
  several articles relating to that problem
• If the group is mixed, the goal might be to teach
  and mentor the inexperienced members
• An application to practice goal is generally
  included

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Possible Goals

• Prepare staff to critique research articles
• Evaluate the best evidence of a practice
• Contribute to the application of research in a
  specific area

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Step 3Identify target audience

• Based on your goals, identify your audience
• All nurses in a particular specialty
• A cross section of staff
• Interested staff
• Staff in bachelors and masters programs
• All staff on a specific unit
• Open to all

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Step 4Set a time and place

• Select a convenient meeting time and place such
  as a monthly lunch on campus or an early dinner
  in a local restaurant with ample free parking
• The environment needs to be comfortable and suit
  the group
• Food is often an important element and supports
  attendance as well as discussion

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Step 5Select article(s)

• Select the article or articles based on your
  goals
• A specific process such as change of shift report
• Care of a specific population
• A topic of general interest to the audience
• Use your librarian to help locate appropriate
  articles
• Use web sites
• http//cl.kp.org
• www.ncbi.nlm,nih.gov/
• www.Medscape.com

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Step 6Develop/select forms

• Consider using two forms
• One to summarize each article read and discussed
• One to summarize all the articles discussed by
  the group
• Examples of such forms are on the following pages
  but developing a form that fits the needs of the
  group is also a
  option.

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Step 7Invite participants
Getting the Word Out

• Design a flyer to announce the journal club with
  title, place, time and plans. Include RSVP so
  you have an accurate count for food
• Send flyer electronically or post
• Consider inviting an expert to help in the first
  few sessions especially with an inexperienced
  group
• 2-3 weeks prior to the meeting, make enough
  packets to distribute to the participants.
  Include the flyer and the article(s) that will be
  discussed.
• Distribute the packets or select a place where
  they can be picked up.

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Step 8Hold the journal club

• Begin and end on time
• Open the meeting with an overview of what will be
  discussed
• If critiquing the article(s) as a group, work
  through the article(s)
• If articles were reviewed prior to the meeting
  then each presenter should give a brief overview
  of their article and facilitate a discussion
• Encourage active participation by using
  pre-planned discussion questions

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Agenda Examples

• Your agenda needs to reflect your goals and the
  needs of your participants. Following are two
  examples of journal club agendas where the
  reading and study is done prior to the meeting
  and the discussion centers around application.

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Journal Club FormatReview - General

1. Briefly Why was the article chosen for review?
   2 min
2. What is the general content area discussed in the
   article? 10 min
3. Discuss two practice-items in the article that
   are most meaningful for the group. 15 min
4. How will implementing these practice items change
   or augment our practice? 20 min
5. How can we disseminate this information to our
   colleagues? 10 min
6. Plan for dissemination of information. 3 min

Sinai Hospital
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Journal Club Format - Research

• Briefly Why was the study chosen for review? 2
  min
• Clearly state the scientific background to the
  study. 5 min
• Summarize research findings. 20 min
• Critique the research identify both the
  positive and negative components. 10 min
• Briefly How might the findings relate to our
  work? 10 min
• Leave time for discussion 5-10 min, after or if
  appropriate during the talk. You can stimulate
  discussion, for example by asking about issues,
  that are unresolved in your mind or by suggesting
  studies related to the work.
• In some cases a more general review may be
  appropriate, but usually it is best to discuss
  just one or two studies, as the time is limited.
  This does not mean that you need not do a
  substantial amount of background reading to
  ensure that you really understand the problem
  that is being addressed. Additional reading can
  be presented as a printed list.

Sinai Hospital
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Questions you can use to evaluate the articles

• Were the results valid?
• What are the results?
• How can I apply the results?
• There are many sub questions under each major
  category depending of the type of research
  articles being evaluated see next pages.

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Randomized Controlled Trial Research Literature
Questions

• Were the results Valid?
• Were patients randomized?
• Was randomization concealed?
• Were patients analyzed in the groups to which
  they were randomized?
• Were groups shown to be similar in all know
  determinants of outcomes or were analyses
  adjusted for differences/
• Were patients aware of group allocation?
• Were clinicians award of group allocation?
• Were outcome assessors aware of group allocation?
• Was follow-up complete
• What are the results?
• How large was the intervention effect?
• How precise was the estimate of the intervention
  effect?
• How can I apply the results?
• Were the study patients similar to the patients
  in my clinical setting?
• Were all important outcomes considered?
• Are the likely intervention benefits worth the
  potential harm and costs?

Malloch Porter-O-Grady, 2006
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Non-Interventional Study Questions

• Were the results Valid?
• How were the subjects selected and are they
  similar to the patient population you care for?
• Are the procedures for recruiting subjects and
  collecting data well described? Do these
  procedures appear to be consistent?
• Did the researcher give attention to using valid
  and reliable tools to capture the study data?
• What are the results?
• Was the researcher looking for relationships
  between variables or comparing differences
  between groups on the variables of interest?
• Are there significant relationships or
  differences?
• How can I apply the results?
• What is the implication of the findings for a)
  nursing practice/ b) research needs? C)
  educational use?

Malloch Porter-O-Grady, 2006
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Guidelines for Research Critique The purpose of
a research critique is to evaluate the merits of
a study and to identify application to clinical
practice. A critique goes beyond a review or a
summary of a study and appraises the studys
strengths and limitations. The critique should
reflect an objective assessment of a studys
validity and significance. Questions used to
guide a critique can include the
following Description of the study What was the
purpose of the study? Does the problem have
significance to nursing? Why is the problem
significant/important to nursing? What is/are the
research question(s)/objectives/hypothesis? Litera
ture Evaluation Does the literature review seem
thorough? Does the review include recent
literature? Does the content of the review relate
directly to the research problem? Evaluate the
research cited in the literature and the defense
developed to support the need for the
study. Conceptual/Theoretical Framework Does the
research report use a theoretical or conceptual
model for the study? Does the model guide the
research and seem appropriate? How did it
contribute to the design and execution of the
study? Are the findings linked back to the model
or framework? Sample Who were the subjects? What
were the inclusion/exclusion criteria for
participation in the study? How were the subjects
recruited? Are the size and key characteristics
of the sample described? How representative is
the sample? Methods and Design Describe the study
methods. How was the data collected? Are the data
collection instruments clearly described? Were
the instruments appropriate measures of the
variables under study? Describe and evaluate the
reliability of instruments (reliability is the
consistency of the measures). Will the same
results be found with subsequent
testing? Describe and evaluate the validity of
the instruments z(validity is the ability of the
instrument to measure what it proposes to
measure). Analysis How was the data analyzed? Do
the selected statistical tests appear
appropriate? Is rationale provided for the use of
selected statistical tests? Were the results
significant? Results What were the findings of
the research? Are the results presented in a
clear and understandable method? Discuss the
interpretations of the study by the
authors/investigators.
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Are the interpretations consistent with the
results? Were the conclusions accurate and
relevant to the problem the authors
identified? Were the authors recommendations
appropriate? Are the study limitations
addressed? Clinical significance How does the
study contribute to the body of
knowledge? Discuss implications related to the
practice, education and/or research. What
additional questions does the study
raise? References Brink P.J., Wood,
M.J.(1998). Advanced Design in Nursing Research.
Thousand Oaks, California Sage Publications.
Frank-Stromborg, M., Olsen S.J. (1997).
Instruments for Clinical Health-Care Research.
Boston, Mass Jones and Bartlett
Publishers. Polit, D.F., Hungler, B.P. (1999).
Nursing Research, Principles and
Methods. Philadelphia, PA Lippincott. Polit,
D.F., Beck, C.T. (2006). Essentials of Nursing
Research, Methods, Appraisal, and Utilization.
Lippincott. Whitely, B.E. (2002). Principles of
Research in Behavioral Science. Boston, Mass
McGraw. Mini Glossary Cronbachs alpha (?)
widely used reliability index that estimates the
internal consistency or homogeneity of a measure
composed of several subparts also referred to as
coefficient alpha. Data analysis the systematic
organization and synthesis of research data, and
the testing of research hypotheses using those
data. Heterogeneity the degree to which objects
are dissimilar with respect to some
attribute Homogeneity (1) in terms of the
reliability of an instrument, the degree to which
the subparts are measuring the same critical
attribute. (2) More generally, the degree to
which objects are similar (characterized by low
variability). Hypothesis A statement of
predicted relationships between variables. P
value in statistical testing, the probability
that the obtained results are due to chance
alone. Significance level the probability that
an observed relationship could be caused by
chance (sampling error) significance at the .05
level indicates the probability that a
relationship would be found by chance only 5
times out of 100. Statistical significance a
term indicating that the results obtained in an
analysis of sample data are unlikely to have been
caused by chanced, at some specificed level of
probability (often .01) Variable (independent)
variable that is believed to cause or influence
the dependent variable (the treatment
variable). Variable (dependent) the outcome
variable of interest variable that is
hypothesized to depend on or be caused by another
variable (the independent variable).
Jackson, Kathy
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Step 9Evaluate the journal club session

• What went well?
• What could have been better?
• More attendance
• Different time or place
• Type of articles
• Use of form
• Provide training
• Different format
• Post article critiques
• Tape record
• session for those
• unable to attend
• - Etc.

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Step 10Adopt, alter or abandon changes

• Review the evaluation comments and make the
  necessary changes for the next meeting
• Adopt new ideas
• Alter current ideas
• Abandon what didnt work at all

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Making it more interesting

• Start with a patient story
• Occasionally do something fun like the
  psychodynamic interpretations of Goldilocks and
  the Three Bears and recognizing and interpreting
  body language
• Use media, videos, story-telling and book reviews
• This type of journal club takes more thought and
  preparation but can have more impact than the
  traditional format and is better remembered.

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Check this out for funResearch fables to aid
understanding of areas of research

• http//www.son.rochester.edu/son/research/research
  -fables

I started writing the fables in 1996, when I took
over teaching the undergraduate research course.
At first, they were "buried treasures" hidden in
the on-line course materials (it was a hybrid
course, and we were trying to get the students to
develop internet surfing skills) for students to
find. Then, as there were more of them, I started
explicitly assigning them for student reading. As
I've had time, I've written fables for areas
where students seem to get "stuck" on basic
concepts in research. For the first couple of
years, they were open access on the web, and
several other instructors in nursing and social
sciences found them and linked to them. Two years
ago, we decided to offer these fables on a trial
basis by putting them behind a password and
charging a minimal fee. The process was
cumbersome and the content was not easily
accessible. The decision to "FREE" the fables
became evident when we decided to use them as
publicity for the school and tools for the
students. Two of the fables have "readers'
theater" versions that I use in class for
traditional students. Casting the parts is always
fun. Enjoy!
Jeanne Grace, PhD, RN, C
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Dont forget to check out our Nursing
Pathways-Research Web Site

• http//nursingpathways.kp.org/scal/research/index.
  html
• is another resource for you as you set up your
  journal club.

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Journal Club Example

• I started a Journal Club for my 38-bed
  Cardiovascular unit about a year ago. It started
  and continues as a way for me to infuse the unit
  with current evidence. My topics have always
  been related to some aspect of nursing related to
  the patients we serve. While I originally
  started with a focus on 'critiquing" the current
  research, it soon became apparent that the
  average (and even above average) staff nurse is
  not going to spend his/her time on evaluating
  research design and methods of current studies to
  know that they are valid and worth paying
  attention to. And thus, my focus has evolved and
  now I aim to present the current evidence, of
  whatever topic I have chosen, in a form that is
  much more relevant for their practice. Of late,
  I present several articles related to the topic,
  reviewing current findings, clinical guidelines
  and the implications of such for their own
  nursing practice. I tend to choose topics that
  are relevant to what is currently happening on
  our unit. For instance, we recently revised our
  telemetry monitoring guidelines which created
  educational needs for monitor technicians,
  patient care technicians and RNs. My plan is to
  incorporate this into my next Journal Club
  meeting with articles to include the standard of
  care for electrocardiographic monitoring in
  hospital settings (AHA), patient and nursing
  implications of remote cardiac telemetry
  monitoring, the necessity of telemetry monitoring
  in low risk suspected acute chest pain syndromes,
  and the issues involved for RNs in directing
  unlicensed assistive personnel related to
  telemetry monitoring.
• I hold meetings once a month for anyone who wants
  to come. I post it through the Clinical
  Education department with title, and offer a CEU.
  On the unit and around the hospital, I post
  title, objectives, references 2 weeks prior to
  the meeting, which I have held around lunchtime
  to get the "passive" crowd who are grabbing a
  bite. My attendance has been pretty good from
  what I hear, at 7 individuals per session. I am
  currently trying to find ways to increase my
  attendance and have gotten several suggestions
  (shorter than 1 hour, not at lunch but rather the
  "lull" in work requirement that happens around 2
  pm, two 30-minute sessions divided to catch day
  and night shifts, etc.)
• The Journal Club is a fun endeavor. It gives you
  insight into the thinkers on the unit and is a
  good venue for opening the dialogue regarding
  practice issues and therefore expose the current
  evidence. Good luck.
• Kelly Wise, MSN, RN
• Cardiovascular Services
• Mayo Clinic Jacksonville/St. Luke's Hospital
• Jacksonville, FL
• wise.kelly_at_mayo.edu

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Bibliography

• Kleinpell, Ruth, Rediscovering the value of the
  journal club Guest Editorial,
  http//findarticles.com/p/articles/mi_m0NUB/is_5_1
  1/ai_91473102/print
• Russell, Cynthia et al, How to Develop a
  Successful Journal Club, International Transplant
  Nurses Society,
• Swift, Geraldine, How to make journal clubs
  interesting Advances in Psychiatric Treatment
  (2004) vol. 10, 67-72
• Journal Club, http//en.wikipedia.org/wiki/Journal
  _Club
• Developing A Chapter Journal Club,
  http//www.itns.org/chapters/developing-a-chapter-
  journal-club
• Journal Club Article Summary created by C.
  Crawford
• http//www.son.rochester.edu/son/research/research
  -fables
• wise.kelly_at_mayo.edu
• Kathy Jackson MSN, CNS, CRRN Clinical Nurse
  Specialist Columbus Regional Hospital 2400 E.
  17th St. Columbus, IN 472011-812-375-3996