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Journal Of Pediatric Medicine

Our critical care medicine journal clubs meet in an area somewhat remote from the critical care units. Led by the critical care medicine faculty, the sessions take place at a specified date and time during the day, and are not repeated. High acuity and an intense pace contributed to the challenges for staff in arranging to leave the bedside for an hour block of time. The review articles are available in an administrative area usually not frequented by the nursing staff.

Because the nature of the articles may be intimidating to some staff nurses, they may be reluctant to contribute to the discussion. Results of studies conducted by physicians are shared with nurses in an inconsistent manner, which means the nurses may not appreciate the relevance to their daily practice. On a few occasions, advanced practice nurses (APNs) have led the journal clubs, but the participation of nurses in the review and discussion of current research literature has been sparse overall.

Nursing Journal Clubs

To address some of these issues, our pediatric intensive care unit (PICU) APN started nursing journal clubs for the critical care nurses. The goals were to bring nursing research to the staff, to enhance staff nurse participation in journal clubs, to make nursing research more palatable, to advance the concept of evidence-based practice and to ease staff into the research process.

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The APN collaborated with the PICU nursing leadership to select a consistent meeting day and time that would best accommodate the nurses' schedules. Because the census usually is low, Sunday was chosen.

To allow for the participation of nurses on the night shift, who are usually organized and under way with their care by early evening, leadership recommended meeting at 10:30 PM. This would sandwich the journal club between change of shifts and lunch hours, while fulfilling the APN's night staff requirement.

Practical Considerations

The discussion format used is consistent with the American Journal of Critical Care Journal Club Article Discussion Points that can be found online at www.ajcconline.org. The components included are description of the study, literature evaluation, methods and design, results and clinical significance.

However, because of time constraints, not all these points are covered each time. Instead, the APN highlights 1 or 2 components that are most interesting, most relevant to practice or most unique in terms of other studies on the same topic.

Flexibility is essential to the success of the arrangement. The APN must be willing to repeat journal clubs several times during the same night, and to stop and start while nurses leave to tend to their patients' needs. Because of the way the unit is configured, journal clubs usually meet at the central nursing stations with front- and backroom locations. An isolation hallway also poses coverage issues for staff to relieve one another.

Occasionally, journal clubs are repeated for the intermediate and cardiac ICU staffs. There is no minimum attendance requirement. In fact, journal clubs have been repeated for a single nurse whose patient assignment load precluded attending at the time scheduled. These repeat offerings make the time commitment for the APN significant. Of course, staff nurses who lead journal clubs do not have the degree of flexibility, so their sessions are not as likely to be repeated.

Finding Success

Some of the ways the journal club has been approached are unique. For example, an undergraduate nursing student doing her practicum at our organization asked if she could do a critical care project. The APN worked with the faculty member to arrange that a journal club be presented by the student for the PICU staff. She aligned her topic with an evidence-based project that was launching at our organization. The result was that the needs of both the student and the staff were met. Another approach that was used by 2 nurses was copresenting. They had similar interests and found that sharing the work of preparation was more fun than working alone. Staff nurse presenters have the freedom to choose a topic, as long as the topic is consistent with current debate in the literature.

Journal club meetings are announced through several channels including electronic mail, consistently formatted flyers placed in "high traffic" areas and overhead announcements within the unit one half hour before and immediately prior to the journal club beginning. There are also postings on a research-devoted bulletin board outside the nursing lounge. Charge nurses are called and reminded at the start of the shift during which the journal club will occur.

With increasing popularity, there is now a monthly sign-up schedule, and club sessions are announced in advance in our Critical Care Newsletter.

Looking to the Future

In the future, we hope to expand journal club participation to the neonatal ICU and to involve Transport Team nurses and respiratory therapists. We also want to have staff nurses summarize their presentations in the Critical Care Newsletter, because writing fits professionally with presenting and research. In addition, the APN has collaborated with the nurse who coordinates continuing education in trauma for the organization. The credit is applied to journal club attendance, and nurses may use it toward their trauma requirement. Collaboration is beginning to take place between staff nurses and the critical care education specialists on article selection and new product information. If topics pertaining to quality are being considered, the APN and staff nurses will verify with the nurse manager that they are aligned with unit goals.

Targeting staff when they are in their first or second year of employment may be a valuable retention measure. In this early stage of employment, nurses are often ready to forge ahead professionally, and expand their level of participation and commitment to the unit on which they work. Involvement in research via journal clubs may be one method to accomplish career satisfaction. In fact, nurses have even given their peers a quiet ovation when they complete an article review!

Tracy Pasek, RN, MSN, CCRN, and Jessica Zack, RN, BSN, CCRN

Pasek is the advanced practice RN and Zack is the professional staff RN in the PICU at Children's Hospital of Pittsburgh. For more information about the journal club, contact Pasek at (412) 692-5897; e-mail. Tracy.Pasek@chp.edu, or Zack at (412) 692-5160; e-mail. Jessica.Zack@chp.edu.

"In Our Unit" highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming "In Our Unit", send it to CRITICAL CARE NURSE, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049: e-mail, ccn@aacn.org.

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