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• To learn how participating in a journal club can enhance healthcare staff’s understanding of evidence-based practice
• To understand the practical steps required to establish and sustain a journal club in a healthcare setting
• To recognise how discussing research articles can actively contribute to staff members’ professional development
With the rise in the number of older people in the population and new developments in older people’s services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep up to date with the latest research. This article describes the process of establishing a multidisciplinary journal club in a residential care setting and recognising the potential of such clubs to develop staff members’ critical thinking, presentation and communication skills. The authors emphasise the importance of fostering a culture of learning in older people’s services and describe how a journal club can support healthcare professionals to maintain their knowledge and improve care.
Nursing Older People. doi: 10.7748/nop.2023.e1448
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Duffy A, Lawler F, Dalton C et al (2023) Setting up a journal club for healthcare professionals in an older people’s residential care setting. Nursing Older People. doi: 10.7748/nop.2023.e1448
Published online: 18 October 2023
Globally, older people are living longer due to advances in older people’s care, with healthcare professionals continually seeking ways to enhance their knowledge and practical skills to meet the needs of this population (Pagnucci et al 2023). Older people are not a homogenous group (Makita et al 2021); each person is an individual with their own specific needs and preferences, which often vary across the age spectrum. Healthcare professionals should be able to recognise and address the unique care needs of each individual, whatever their culture, background, religion and medical condition (Kogan et al 2016, Heid et al 2020). Valuing the voices of older people and their families when providing care is crucial (Middleton 2019).
Residential care facilities offer long-term care services to adults who require assistance and can no longer live in their own homes (Health Information and Quality Authority (HIQA) 2016). In such settings, the concept of person-centred or resident-centred care is commonly cited as an overarching philosophy (Pakkonen et al 2023), with the quality of this care frequently used as a measure to indicate clinical competence (Park and Choi 2020). Therefore, any healthcare professional providing care to older people must ensure they incorporate evidence-based practice into their daily care routines (Mueller et al 2023).
Relying on research evidence and maintaining a culture of ongoing learning are crucial elements for healthcare professionals who are striving to achieve standards of clinical excellence (HIQA 2016). Therefore, healthcare professionals working with older people must continuously seek ways to enhance their knowledge and practical skills to provide high-quality care for this population group. Academic journal clubs can provide a structured environment for healthcare professionals to discuss and critically appraise research related to their practice without spending significant amounts of time away from clinical areas (Leonard et al 2022).
This article outlines the benefits of journal clubs and describes the process the authors used to establish a multidisciplinary journal club in a residential care setting.
Keeping up to date with evidence-based knowledge when caring for older people requires healthcare professionals to be informed about age-related issues and conditions such as frailty, dementia, elder abuse or falls management (Nursing and Midwifery Board of Ireland (NMBI) 2015). Kerr and Rainey (2021) asserted that healthcare professionals should be able to make informed decisions based on the most up-to-date evidence, leading to improved healthcare outcomes for older people. However, Rahman et al (2012) identified several issues that can hinder the implementation of evidence-based practice in residential care settings, such as a lack of appropriate knowledge among staff, high staff turnover rates and inadequate staffing levels, inconsistent regulatory practices, absenteeism, and ineffective management.
As the number of older people in the population increases, the demand for specialised care for older people such as respite care services, memory clinics and social prescribing is rapidly evolving (Prajankett and Markaki 2021). At the same time, the evidence underpinning healthcare practice is constantly being updated (Bakula et al 2019). By ensuring that their care is evidence-based, healthcare professionals can provide patients, their families and carers with treatments that reflect clinical guidelines rather than relying on outdated or ineffective practice. In addition, by staying up to date with the latest research, healthcare professionals will be able to consolidate theory into clinical practice, thereby emphasising areas for further research and quality improvement (Ryder et al 2018).
There are many opportunities for healthcare professionals to keep up to date with advances in their field and extend their practice skills (Grainger 2022). Undertaking a postgraduate educational programme is one method of accessing specialist practice; however, such programmes can be expensive and time-consuming. Continuing professional development (CPD) programmes in specialist areas, such as care of the older person, may be provided by a healthcare professional’s local hospital. These programmes are frequently delivered using blended learning, which reflects a recent transition from traditional classroom-based learning towards increased use of digital approaches including webinars, video-streaming, podcasts and e-learning platforms (Huang 2021). The use of blended learning means that learners do not need to commit to spending significant time away from clinical practice (Ryder et al 2018, Connolly et al 2020). Such CPD programmes are designed to upskill healthcare professionals and provide specialised knowledge to develop their clinical competencies (Ryder et al 2018). Kerr and Rainey (2021) also recommended that healthcare professionals have protected time away from direct patient care to reflect and study.
Academic journal clubs were first established for doctors in the late 19th century by William Osler, a physician at McGill University in Montreal, Canada (Duncan et al 2018, Epstein 2018). Journal clubs specifically aimed at nurses were first documented in the late 1990s and designed as planned educational interventions where nurses could review published research and discuss how evidence could be used in practice (Leonard et al 2022).
Journal clubs are recognised as a collaborative approach to learning that can motivate healthcare professionals to read and critically appraise the latest evidence (Aronson 2017). The purpose of a journal club is for members to keep up to date with the latest research in a particular field, to encourage the development of critical thinking and presentation skills, and to promote scholarly discussions, lifelong learning and collaboration between members (Taywade et al 2022).
Journal clubs meet to discuss one or more research articles and can be held weekly, every two weeks, monthly or quarterly depending on the availability of members, with monthly being the preferred frequency identified in the literature (Rosen and Ryan 2019, Leonard et al 2022, Valizadeh et al 2022). Attendance is voluntary and the duration of each journal club meeting ranges between 30 minutes and one hour. There is no recommended number of members (Häggman-Laitila et al 2016). The journal club discussed in this article included two facilitators with specialised knowledge in older people’s services, however, there is no set number of facilitators.
• Academic journal clubs can provide a structured environment for healthcare professionals to discuss and critically appraise research related to their practice
• Journal clubs are a collaborative approach to learning that can motivate healthcare professionals to read and critically appraise the latest evidence
• Benefits of journal clubs may include: keeping up to date with evidence-based knowledge and practice; developing critical thinking skills; facilitating collaboration; developing presentation skills; and promoting critical discussion
• When setting up a journal club it is important to determine the frequency and duration of club meetings, set objectives, assign roles, establish ground rules, choose relevant articles and evaluate the meetings
The style of presentation in a journal club may range from a didactic classroom-type approach used to share information about a chosen article, to an informal discussion group where staff members are encouraged to choose articles they would like to explore. As well as formal academic journal clubs where research articles from high-impact peer-reviewed journals are critiqued, some journal clubs function as informal workshops, which are less structured so that clinical staff do not feel daunted when discussing research. To ensure the discussions are productive and respectful, ground rules for communication, attendance and confidentiality are usually established by the facilitator and the group members at the beginning of each meeting (Gardner et al 2016).
Participating in a journal club can have several benefits for healthcare professionals. For example, journal clubs provide an opportunity for members to learn from each other and gain insights into various approaches to clinical issues. An additional benefit is that members are supported to gain confidence in skills such as public speaking, using technology such as Microsoft PowerPoint and answering questions from an audience (Fylking and Opheim 2020). The clubs also provide a forum for networking and the dissemination of research knowledge (Häggman-Laitila et al 2016). Consequently, healthcare professionals are encouraged to critically reflect on the theory-practice gap and bridge the divide between research and clinical practice (Fitzgibbons et al 2017).
Table 1 details the benefits of journal clubs.
The impetus for the introduction of a journal club in the authors’ residential care setting emerged from a quality improvement initiative aimed at engaging clinical staff with academic literature. The journal club was considered to be an informal platform for staff working with older people to discuss the emerging and sometimes contentious issues they experienced daily in a safe environment with support from the advanced nurse practitioner (CD), nurse tutor (AD) and librarian (FL). The authors also felt that journal clubs offered an avenue for education that did not require the extensive time commitment typically associated with completing education programmes or modules.
For the authors of this article, setting up a journal club for a multidisciplinary team in an older person’s service involved several steps:
1. Establishing an education team to facilitate the setting up of the journal club.
2. Determining the frequency and duration of the club’s meetings.
3. Setting objectives.
4. Assigning roles to the team members.
5. Establishing the ground rules.
6. Choosing relevant articles to discuss.
7. Evaluating the journal club meetings.
In April 2022, the first step was taken to identify a team of project facilitators who would manage the setting up of the journal club. This education team included the nurse tutor, librarian and advanced nurse practitioner at Our Lady’s Hospice & Care Services in Dublin, Republic of Ireland. Since one of the objectives of the project was to facilitate a journal club that would be of interest to all members of the multidisciplinary team, healthcare professionals from all disciplines were invited to join the club. The aim was to provide staff members with an opportunity to present an article and lead a journal club meeting if they so wished. It was crucial to consider the availability of staff to attend the meetings; for example, it was decided that an appropriate time might be when afternoon shift handovers were completed and staff might have some time for educational initiatives (Epstein 2018).
The next step was for the education team members to determine the frequency and duration of the meetings. Following discussions with ward managers it was decided to hold the journal club on the first Thursday of each month in the afternoon for a period of 45 minutes. Once the frequency and duration of the journal club meetings was agreed, the initiative was communicated to local staff via email. Posters announcing the journal clubs were also placed on ward notice boards, and staff were informed and reminded about the journal club at clinical team meetings.
In total, 46 staff members were emailed each month reminding them of the upcoming meetings and nurse managers were also asked to share this information with their ward staff. The number of attendees ranged from 11 to 29 staff members, with 18 attending the first meeting. The meeting with the highest attendance was one focusing on the management of motor neurone disease.
The education team members discussed the objectives of the journal club, agreeing that its function should be to provide an educational intervention that promoted a culture of learning in the residential care setting. The journal club also had to consider the varying education needs of multidisciplinary staff ranging from healthcare assistants to nurses who had undergraduate degrees or postgraduate qualifications. The final objectives of the journal club, as agreed by the members of the education team, were to:
• Promote multidisciplinary working by promoting the sharing of knowledge between staff members and reducing the disparity between education and practice.
• Enhance staff members’ knowledge of older people’s services.
• Learn from each other and develop a community of healthcare professionals with a shared interest in older people’s care.
• Support members of the journal club to develop critical thinking and reflective and presentation skills.
• Develop optimal clinical practice and to assist staff members to keep up to date with developments in older people’s care.
The next step involved assigning specific roles for the education team members in facilitating the upcoming journal club meetings. The nurse tutor and advanced nurse practitioner had overall responsibility for managing the journal club and obtaining accreditation from the NMBI before commencing the clubs. Accreditation ensured that the journal club met the quality standards of the NMBI, with nurses being awarded two continuing education units for preparing and attending the meetings.
The librarian assisted those staff members who were interested in presenting at the journal club to find relevant articles from sources such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database.
One week before each journal club meeting, the nurse tutor circulated the link to the relevant article chosen by the presenter to all 46 staff members in the email group reminding them of the upcoming journal club and recommending that they read the article before attending. Any student learners undertaking placements in the residential care setting were also invited and encouraged to attend (Aronson 2017).
It was important to establish ground rules for the journal club meetings. At the start of each meeting the facilitators advised the attendees about confidentiality and the importance of respecting residents’ privacy and dignity.
The importance of time management was recognised because staff members were given protected time away from patient care to attend the journal clubs; therefore, the facilitators emphasised that the meetings would begin and end on time. It was also important that attendees were given an opportunity to share their views and experiences in a safe space, so they were informed that respectful communication was expected.
Once the meetings began, the members of the education team provided constructive feedback on the presentations and supported open discussion to encourage critical thinking. For example, the education team members were often able to clarify complex concepts brought up by the chosen articles, such as how to respond to suspicions of elder abuse.
The next step involved choosing the articles that would be discussed at each meeting. The education team members regarded it as essential to select articles in the specialist area of older people’s care, which would be a topic of shared interest for the attending multidisciplinary staff members. The articles usually discussed in journal club meetings comprise peer-reviewed articles from academic journals (Valizadeh et al 2022).
The first two journal clubs were led by the education team and the topic suggestions – urinary tract infection management and antimicrobial resistance and pain management in dementia care (Table 2) – were provided by the advanced nurse practitioner following discussions with staff members.
Following the first two journal clubs, some staff members volunteered to present a journal club themselves. Some staff members worked with the librarian to identify relevant articles that they could present at the journal club, while others shared the article that they had chosen to present with the nurse tutor to ensure the subject was suitable. No articles were excluded from discussion in the journal club.
Table 2 identifies the peer-reviewed articles discussed in the 11 journal clubs that had been held at the time of writing and since the process began in April 2022.
The final step was to evaluate the journal club periodically to ensure achievement of the objectives and to consider how to improve future meetings. The education team decided to evaluate the fourth (cognitive stimulation therapy) and ninth (transition to nursing home care) journal clubs. Attendees were asked to anonymously complete an evaluation form that involved them listing three elements they liked about the journal clubs and three elements they would consider changing. This encouraged attendees to provide constructive feedback on positive aspects and areas for improvement without taking up too much of their time.
After each of the two evaluated meetings, the feedback was highly positive. Overall, the attendees agreed that the topics being discussed were relevant to their practice and that the journal club represented a safe forum because the facilitators were knowledgeable and encouraged group dialogue without fear of judgement or repercussions. One of the suggestions for improvement made by attendees was to extend the sessions from 45 minutes to an hour to enable more time for discussion.
The facilitators were cognisant that feedback was only received from those who attended the journal club on a specific day, and the long-term effect on the attendees’ practice was unknown (Häggman-Laitila et al 2016).
The authors’ experiences of developing a journal club for healthcare professionals working in a residential care setting was similar to that of Davis et al (2014), who reported that healthcare professionals often had limited exposure to academic articles, resulting in a lack of understanding of how to incorporate research evidence into practice.
Healthcare professionals working in clinical practice can sometimes find that reading academic articles is challenging. Some of the issues include the use of complex academic language, lack of understanding of scholarly writing styles, the use of unfamiliar research terms, and content that clinical staff might find challenging to apply in practice (Leonard et al 2022). A lack of knowledge about research methodologies can also present a barrier to healthcare professionals’ ability to critique the literature. However, Nesbitt (2013) asserted that journal clubs were not designed to improve nurses’ competence in critiquing and appraising research; rather, they should be an opportunity for nurses to read articles, discuss the evidence as a community and reflect on the implications for their practice.
Another major challenge for healthcare professionals regarding academic reading is time constraints. Managing patient care responsibilities and administrative tasks and keeping up to date with mandatory training requirements may leave little time for in-depth reading, analysis and reflection on journal articles. Accessing the literature can also be a daunting task for many healthcare professionals, with the volume of published literature adding to the challenge of identifying relevant articles. Despite these issues, developing skills in reading and interpreting academic articles is crucial for healthcare professionals’ evidence-based practice, as is remaining up to date with the latest research advancements in healthcare. Through attending and presenting at journal clubs, healthcare professionals can be supported by skilled facilitators to overcome these barriers (Nesbitt 2013, Valizadeh et al 2022).
To overcome some of the potential barriers to healthcare professionals’ accessing academic articles, the authors of this article agreed to include research that was relevant to the staff’s clinical practice as part of their journal club meetings. The education team also sought to recommend content that aligned with the knowledge and expertise of the various multidisciplinary journal club attendees. The focus of the journal club project was on sharing accessible and readable articles that were relevant to the attendees’ clinical practice.
Implementing a journal club into healthcare practice can be a transformative process, encouraging attendees to develop new insights, attitudes and ways of thinking (Leonard et al 2022). However, in common with most healthcare practice development initiatives, it is important to recognise the challenges involved. For example, embedding a journal club into a residential care setting took a considerable amount of time for several reasons, including high staff turnover. This is supported by research suggesting that the implementation of new practice initiatives in healthcare settings can take anywhere up to 17 years to become fully integrated into routine care due to the complexity of healthcare systems, staff resistance to change, resource limitations and the need to accumulate evidence that demonstrates a project’s effectiveness (Morris et al 2011).
To successfully introduce a journal club in a healthcare setting, it is important to recognise that the process demands meticulous planning, active involvement of stakeholders such as clinical staff, training for facilitators, and continuous support from a librarian or education team. These measures will assist project leaders to overcome barriers to the implementation of a journal club and ensure they become regular practice within a healthcare organisation (Epstein 2018).
Academic journal clubs can offer various benefits to healthcare staff. The authors of this article established a journal club for multidisciplinary healthcare team members working with older people in a residential care setting. Throughout the process, the authors learned the importance of: ensuring that the chosen academic content was of interest to staff; considering staff members’ availability to attend journal club meetings; and ensuring that the focus was on sharing articles that were relevant to clinical practice. The benefits of setting up a journal club included enhancing healthcare professionals’ knowledge; developing their critical thinking, presentation and communication skills; and fostering a culture of CPD.
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