Evidence Based Nursing Training for School and Public Health Nurses
A collaboration of nursing school faculty from the Sinclair School of Nursing, University and health sciences librarians from the J. Otto Lottes Health Science Library proposed that school nurses and public health nurses needed knowledge on finding and evaluating health information in order to improve their practices. The group aimed to establish a core of trained nurses to promote trainings to other nurses, and serve as on-site trainers to other nurses in their own workplaces. The grant project took place over a three year span in various locations throughout Missouri.
Two workshops were developed by the nursing faculty and the health sciences librarians at the University of Missouri. 1. Consumer databases that are judged to be reliable and credible web sites for health information including the Medical Librarians' Association Guide to Finding and Evaluating Health Information on the Web and Top Ten Mose Useful Consumer Health Websites, MedlinePlus and additional websites including those related to prescription drugs, disease management, child health, and various others, according to audience needs. In this first workshop, participants were seated at individual computer terminals, accessing and exploring websites during the demonstration/presentation. 2. Concepts of evidence-based practice as articulated by Haynes et al, MacMaster University (2002), were presented as an overview and anchored the content related to searching professional databases. Within the context of existing guidelines familiar to participants, PubMed and CINAHL search strategies were presented by the health sciences librarians. Core content of the librarians’ presentation including using keywords and MesH subject headings, identifying literature relevant to example guidelines, using the limit functions, and finding full text. A follow-up on appraising the literature, using the hierarchy schema of research studies, and discussion of the connection of evidence to practice was presented to the groups as a summary to the second workshop.
A total of 44 workshops were held over the three year grant period (Session One - Consumer Databases n = 22 Session Two - Professional Databases n = 22 Additional informational sessions were held at regional professional meetings and local consumer health fairs. A total of 614 participants completed workshops (Session One n = 204; Session Two n = 407). Of the total participants, 157 were public health nurses from local and state agencies and 377 were school nurses from local Missouri school districts. An additional 80 participants included local librarians, social workers, specialty nurses, public health administrators and program managers.
Immediately following the training workshops, faculty/course evaluations were completed by 182 of 204 participants (89%) Session One attendees and 134 (of 152 distributed) Session Two attendees (88%). Workshop objectives were rated on a scale of (poor to excellent). All objectives were rated as excellent or good. Objectives included ‘searching the web for client/consumer information and for professional resources’; ‘evaluating websites for reliability’; ‘knowing where to find information to help consumers find information’; and ‘searching using PubMed and CINAHL’.
A pre-assessment was completed by registered workshop participants regarding access and use of on-line databases. Of the 178 responses from all years, Google was most frequently used as a first search strategy (69%) followed by Yahoo (20%). Common health information sites most frequently used were CDC (42%), WebMD (25%), PubMed (12%), and MEDLINE Plus (12%). Workshops were evaluated at least one month following the workshops. Post-workshop evaluations were completed on-line (via Survey Monkey®) by public health and school nurses only. Attendees other than nurses were not surveyed. Surveys collected data regarding participants’ use and value of workshop information. For all workshops, 119 Session One evaluations and 229 Session Two follow up evaluations were completed. Results indicate the following: • Websites public health and school nurses use most frequently for their own nursing practice include MEDLINE and MEDLINEPlus, PubMed, CDC, and Mayo Clinic. Slightly more than 50% of survey respondents (117/229; 51%) rated the training sessions as having significant or moderate impact on their work. • Websites most often recommended to clients by nurses who completed Session One workshops include MEDLINEPlus, CDC, Mayo Clinic, and KidsHealth. The majority of survey respondents (73%; 166/228) recommended sites to clients at least once, and up to ten times or more per month. • After completing Session Two workshops, 48% (95/197) of survey respondents reported they use PubMed in their work to search for journal articles at least once a month. An additional 29% (46/197) searched PubMed a minimum of 4 times up to 8 or more times per month for journal articles relevant to their practice. • Barriers identified by participants to finding information and using new skills included lack of time perform searches at work, limited or no computer/Internet access, firewalls in place preventing searching, and more practice time needed to improve search skills.
These results demonstrate the majority of public health and school nurses are accessing quality information from websites and integrating new skills into their daily practice.
 Objective 2:
Establish a core workforce of public health and school nurses who are competent in a) teaching and training in information access and use to peers and b) serving as a resource to other nurses in accessing and utilizing information for practice.
Program participants were often recruited and referred by other public health or school nurses who participated in the workshops. This was particularly true after year 1 workshops, in which the majority of new workshops in years 2, 3, and 4 could be directly attributed to past workshop participants.
• Results from evaluations indicated that nurses pass information to their colleagues in the immediate work environments. • Web sites most often recommended to other public health staff by nursing staff include PubMed and MEDLINE, MEDLINE Plus, and Mayo Clinic; after training, the majority of nurses communicated with nurse colleagues about credible websites. Slightly more than one-half of nurses (119/229; 52%) recommended at least one site to colleagues each month. An additional 32% (74/229) recommended sites to other staff four or more times per month. • Selected comments from participants include the following: o "I loved both of the workshops. I have shared all in the information with at least 40 different nurses.” o “I did learn a lot in class but the handouts are priceless. I am not very good on the computer yet so I plan to find the time to practice and this will be an educational experience for me. I constantly want to educate myself with knowledge and then educate the staff I work with." o “Shared the library site list[websites] with other nurses (twice) to look up things for clients." o “Shortly after the first class I visited 4 or 5 day care facilities in Cooper County and told them about the class and the list of websites we had been given, especially the one on kids’ health. I copied the info and mailed it out to them. I intend on adding that sheet to my other documents that I take to each of the 49 day cares in Pettis County and Morgan County too." • As a result of Session Two workshops and follow up coaching, participants developed evidence-based practice projects around topics of childhood obesity and nutrition, physical activity, vision screening, skin care prevention, palliative care, and fall prevention. In addition, participants regularly contacted the health sciences librarians for coaching and/or assistance with literature searches on topics such as vision screening, reliable drug sources, childhood obesity, head lice treatment, among others. Participants now better recognize contributions librarians make to their nursing practice through improved access to reliable information sources and encouraging appropriate use of information retrieved.
During the second year of the grant, a need was identified to reinforce learning, encourage continued use of quality information sources, and learn new evidence-based practice appraisal skills. To provide a frontline, “just in time" update, we developed electronic newsletters, titled Need to Know, distributed every six weeks via participants’ emails. A total of 11 newsletters were produced. Voice-over Powerpoints using Camtasia software were developed to provide additional coaching on evidence-based practice skills, such as developing measurable nursing outcomes, library search techniques, and steps in appraising research articles. An example using treatment and school policies related to head lice provided a face-to-face demonstration of using evidence from the literature to guide best practices. A handout of the most reliable, credible websites recommended by the health sciences librarians and the Medical Librarians’ Association for participants to post in their offices and work areas was determined to be an effective strategy to assure information is readily available and accessible.