EP14 Resources, such as professional literature, are readily available to support decision-making in autonomous nursing practice.
Provide two examples, with supporting evidence, of how resources are used to support evidence-based clinical decision-making in autonomous nursing practice.
Example 1
NAME OF INITIATIVE
Medical Library E-Resources
BACKGROUND AND PURPOSE
Homestead Hospital and Baptist Health South Florida (BHSF) consider employees as their most valuable asset and as such invest a multitude of resources for the education, professional development and clinical support of their employees. The Medical Library is part of the services provided by the Center for Research and Grants, which is the research hub for BHSF. This corporate department provides research leadership, support, and education for physicians, nurses, research coordinators, administrators and students.
The Medical Library is a corporate function and had been in existence since 1961. Medical Library Services Director Devica Samsundar, MLIS, AHIP is the head. Her staff consists of 2 medical librarians, John Reynolds, MLIS and Carrie Figueredo, MLIS, 4 library coordinators and 2 part time library service assistants. The Medical Library has always been ahead of the curve and had a vision of bringing to the staff timely the latest evidence in a rapidly changing healthcare environment. To fulfill this vision, they developed very early on their vast array of online resources in 1995 to complement the traditional brick-and-mortar locations.
Type of Resources Readily Available to Nurses
The medical library supports all BHSF employees, including nurses and medical staff, through its robust online resources called “E-Resources” and physical locations in various campuses. (EP14 01 Medical Library E-Resources website screenshot) Its services include:
- computerized literature searches on MEDLINE, CINAHL, Mosby’s Nursing Consult and other evidence-based health and business databases,
- document delivery to users electronically by e-mail, fax, photocopy or mail (for articles from their journals or other libraries in hospitals and medical schools in the United States, including the National Library of Medicine),
- access to core reference and journal collection,
- circulation and interlibrary loan of books and DVDs for ongoing learning,
- electronic access to OVID MEDLINE and other databases, e-textbooks and e-journals (from offices and home, after library hours, using the ATHENS portal), and
- educating library users regarding effective searching for evidence based resources, relative to the provision of excellent health care to patients. (EP14 02 “The Deep Dive: Searching the Databases” flyer and attendance roster)
Fully embracing patient-and family-centered care, the physical library sites welcome patients, families and their visitors to come in during office hours to access reliable supplemental patient education materials or to use the internet to connect with family and friends. (EP14 03 BSHF-1300.04 Access to Library Services policy)
How Resources are used for Evidence-Based Clinical Decision-Making in Autonomous Nursing Practice
Clinical Decision-Making and Clinical Autonomy
Clinical autonomy refers to the authority and freedom of nurses to make nursing care decisions (within the full scope of their practice) in the clinical care of patients within interprofessional practice environments (Weston, 2008). The Medical Library invests a huge proportion of its budget subscribing to reliable medical databases, e-books and e-journals which are peer reviewed and regularly updated. (EP14 04 Medical Library budget for E-Resources) This ensures staff has access to the latest evidence to guide them with clinical decision-making and clinical autonomy. The plethora of E-Resources is available to all staff 24/7 through the intranet or internet. When the employees are within the hospital campus, these online resources can be accessed through any desktop computer, laptop and work stations on wheels (WOWs) providing on demand support at their fingertips. When employees are outside the hospital, they are still able to access the
E-Resources remotely by requesting a personal log-in to ATHENS.
The Mosby Suite, a nurse-specific reference, consisting of the Mosby Nursing Consult, Mosby’s Nursing Skills and Mosby’s Index is a more recent addition to the database. The initial subscription to this invaluable nursing resource in 2011 was realized through a grant from the corporate Centers for Excellence in Nursing (CEN). Nurses utilize the Mosby’s Nursing Consult as a one-stop shop for latest drug information, patient education, professional journals, reference books, current nursing news, clinical practice guidelines and standards, evidence-based content, and care planning tools. Mosby’s Nursing Skills provide nurses access to a vast listing of nursing procedure. It has allowed streamlining of the policy and procedure manual and ease in locating clinical procedures at the point-of-care through its searchable feature. Mosby’s Index offers a very robust journal abstracts and indexing database to nurses which are helpful with literature searches. Furthermore, Micromedex is the go-to place for nurses when they need detailed monographs for drugs, disease, alternative medicine, toxicological management, and patient education documents (available in English and Spanish). Staff can also suggest purchase of reference materials which are helpful to their practice to the Medical Library Services Director.
To further support nurses in clinical decision-making and clinical autonomy, the corporate office spearheaded a Policy Administration Management (PAM) system. PAM’s goal is to be the resource center for all corporate end entity policies and attachments. PAM has allowed the migration of most policies and procedures and standing order forms online; provided a mechanism for regularly reviewing policies and procedures (P&P); and quicker turnaround time with posting of newly approved or reviewed P&P.
Exhibit EP14a: Policy Administration Management intranet page
Organizational Autonomy
Organizational autonomy refers to the authority and freedom of a nurse to be involved in broader unit, service line, organization, or system decision-making processes pertaining to patient care, polices and procedures, and work environment (Weston, 2008). Through an active and well-developed Shared Governance structure, Homestead Hospital nurses are engaged in organizational and system-wide decision-making processes. These activities include policy development, product selection, committee work, performance improvement (PI) projects, adoption of evidence-based practice, (EBP) and conduct of research. When nurses need a review of literature to help them in the aforementioned activities, they can either access directly the E-Resources (CINAHL, Medline, and Mosby’s Index) or request the help of the Medical Library with a database search or article reprints by sending an e-mail or approaching the library coordinators at the physical locations. Additionally, staff can request a one-on-one consult with dedicated Nurse Scientist Maria Ojeda, ARNP or the PI department. Employees can seek the assistance of these experts at any step in the process but are highly encouraged to consult them early on during the conceptual stages so that a well-thought out plan and outcomes measurement for the project can be laid out.
Summary
BHSF and Homestead Hospital invest considerable resources, both information management and human, for the nurses to support them with evidence-based clinical decision-making in autonomous nursing practice.
Summary of Attachments/Hyperlinks/Evidences:
EP14 01 Medical Library E-Resources website screenshot
EP14 02 “The Deep Dive: Searching the Databases” flyer and attendance roster
EP14 03 BSHF-1300.04 Access to Library Services policy
EP14 04 Medical Library budget for E-Resources
Exhibit EP14a: Policy Administration Management intranet page
Example 2
NAME OF INITIATIVE
Transformation of an Office Space into a Physical Library
BACKGROUND AND PURPOSE
Homestead Hospital did not have a physical library in its campus due to spatial limitations. As described above, employees utilized the E-Resources and corresponded with the Medical Library staff via email and phone when they needed assistance with database search or article reprints. At times, staff visited the physical sites located in the other two campuses to consult with library coordinators or medical librarian when they happened to be at these locations.
In late 2011, a space utilized as a doctor’s office in a centralized section of the hospital was vacated by the practice. While empty, the area was used as conference room for various council or committee meetings. In January 2012, a fortuitous conversation transpired between Medical Library Services Director Devica Samsundar and Homestead Hospital Magnet Project Director Julie David, ARNP. Samsundar expressed that she has an approved 1 full-time equivalent (FTE) for a library coordinator slated for a sister hospital but they did not have the space to allocate for a library. David related to Samsundar the availability of an office space and its potential of becoming an ideal site for a physical library due to its size and location. Samsundar agreed to reallocate the open FTE to Homestead Hospital if the space can be secured and reconfigured into a library. Coincidentally during this time, Homestead Hospital Anesthesia Chief Samir Kulkarni, MD, became a benefactor and donated monies through the Foundation earmarked for the development of an employee and medical staff resource center. It was also around this time that the Patient-and Family-Centered Care Council completed their gap analysis. They identified as the number one priority the lack of a patient and family resource center accessible to patients, families, and staff.
David developed a proposal to reconfigure the existing office space, using the earmarked Foundation funds, into an onsite medical library that would be staffed by a library coordinator. Additionally, she proposed that the front part of the space be designated as a patient and family resource center where patients and families could access supplemental, reliable medical literature and the internet. She pitched the idea to Chief Nursing Officer Gail Gordon, RN. Gordon wholeheartedly endorsed it to the senior executives who then approved it unanimously.
METHODS AND APPROACH
Once approval was obtained, Samsundar and David immediately dove into project planning. A meeting took place in April 2012 with Samsundar, David, Support Services Vice President Corey Gold and Interior Designer Maria Saenz. They discussed the design, lay-out, furniture and equipment needs and set timelines for project completion. Concurrently, Samsundar also worked on hiring and on boarding a library coordinator. Staying true to the spirit of shared governance, David put together an ad-hoc team from nursing, ancillary department and medical staff, represented by Kulkarni, to obtain input into the layout and review the plans. (EP14 05 Medical Library Plan) Devica met with the group, showed them the plan and solicited their suggestions. Thereafter, David completed the furniture purchase order. (EP14 06 Medical Library furniture purchase order) The project moved at a fast pace and a soft opening transpired in July 2012 followed by an official ribbon cutting ceremony in August 24, 2012. Due to austerity measures that were put into place in the middle of the year, the filling of the library coordinator position was placed on hold. Despite of this, Samsundar was still able to reallocate existing staff and provide a library coordinator Monday-Friday from 10 am to 2 pm. She also engaged the Volunteer Services department to help out with the staffing.
Type of Resources Readily Available to Nurses
The opening of an onsite library has been very well received by the nurses and the rest of the staff. In addition to the E-resources, they had experts on site whom they could ask and query and dialogue with about their areas of interest. Additionally, nurses now had access to circulation materials such as CPR, ACLS books, general reference books, DVDs and certification review guides. For example, in 2012 the Medical Library added 45 nursing certification study guide books to its collection in the areas of Critical Care, Progressive Care, Emergency and Pediatric Emergency Nursing, NICU, Wound Care, Gastroenterology, Infusion Nursing, Perianesthesia Nursing, Neuroscience Nursing, Med-Surg Nursing, and Surgery Nursing. Selections were based on input from nurses and clinicians at all facilities. These books have been circulated 37 times through library and interlibrary loans.
How Resources are used for Evidence-Based Clinical Decision-Making in Autonomous Nursing Practice
Clinical Decision-Making and Clinical Autonomy
Having a library coordinator or medical librarian onsite is particularly convenient when nurses are looking for articles pertaining to a clinical problem or issue in practice that needs to be addressed. (EP14 07 Thank You Email from a Nurse Library Client) Nurses who pursue the Professional Nursing Advancement Program (PNAP) find this additional support helpful in putting together their portfolio, particularly, in fulfilling the evidence-based research project requirement. Additionally, employees now have an area for quiet time and reading. With a 24/7 badge swipe access, this dedicated space has been a tremendous benefit for nurses who are going back to school for studying, doing research or online postings.
Organizational Autonomy
Nurse members of the Policy Workgroup are very enthused with having a physical library. They utilize its services when looking for policy references and often conduct their pre-meeting research in the library. The additional benefit brought about by the onsite library is the enhanced collaboration between its staff and the shared governance councils. The Evidence-Based Practice and Research Council (EBPRC) partnered with the Medical Library in establishing a hospital-wide online journal club in September 2012.The club is called the “Tree of Knowledge”, coined by Clinical Nurse, Debra Zorns, RN in reference to the nursing Professional Practice Model which has the shape of a tree. This online forum is open to all RNs and some ancillary departments. Unit Practice Councils (UPC) rotate on a monthly basis in selecting articles in their areas of interest and initiating the discussion. Nurses who participate in the discussion are eligible to earn 1 continuing education (CE) credit by answering specific questions. (EP14 08 Online Journal Club SharePoint site)
PARTICIPANTS
The team members who worked on the library project included:
Name/Credentials |
Years RN/ Years Specialty Experience |
Title |
Department |
Role in the Team |
Julie David, MSN, ARNP, ANP-BC |
21 years / |
Magnet Project Director |
Magnet Designation |
Co-Project Lead |
Gail Gordon, MSN, RN, NEA-BC |
45 years / |
Chief Nursing Officer (CNO) and Vice President |
Nursing Administration |
Executive Sponsor |
Devica Samsundar, MLIS, AHIP |
23 years |
Medical Library Services Director |
Medical Library |
Co-Project Lead |
Corey Gold, MS, CRTT |
35 years / |
Support Services Vice President |
Administration |
Facilitated Construction |
Samir Kulkarni, MD |
24 years |
Medical Director |
Anesthesia |
Benefactor |
OUTCOMES
A year after its opening, 274 staff and visitors used the computers and 104 books/DVDs were borrowed.
Exhibit EP14b: Homestead Hospital Medical Library Usage
Analysis: demonstrates the considerable increase of article reprints, searches, and user requests among employees a year after the opening of the onsite medical library.
Summary of Attachments/Hyperlinks/Evidences:
EP14 05 Medical Library Plan
EP14 06 Medical Library furniture purchase order
EP14 07 Thank You Email from a Nurse Library Client
EP14 08 Online Journal Club SharePoint site
Exhibit EP14b: Homestead Hospital Medical Library Usage