Teaching and Learning in Nursing 12 (2017) 53–58

Contents lists available at ScienceDirect

Teaching and Learning in Nursing

journal homepage: www.jtln.org

Using a Virtual Journal Club for Sharing Evidence-Based Practice

Recommendations in Critical Care Registered Nurses
Ruth Ann LaMar, DNP, MSN, RN ⁎
School of Nursing, Ball State University, Muncie, IN

a r t i c l e i n f o a b s t r a c t

Keywords: Objective: Registered nurses must remain current with evidence-based practice knowledge to meet job de-
Virtual journal club mands in an evolving health care climate. This pilot study's purpose was to investigate a virtual journal
Evidence-based practice club's effect on satisfaction, knowledge, and practice.
Registered nurse
Background: On-line learning is used to convey information while meeting diverse learner needs, and jour-
nal clubs are used to disseminate and discuss evidence-based practice knowledge. Combining the 2 con-
cepts into a virtual journal club creates an opportunity to meet learner needs while discussing
information that promotes evidence-based practice knowledge and implementation.
Setting/Population: Sixteen critical care nurses from one midwestern teaching hospital's intensive care unit.
Methodology: Researchers used the Kirkpatrick Learning Evaluation Model in a 4-week-long, mixed
methods pilot study. Researchers presented 1 article about sepsis in an on-line discussion forum. Nurses
took a pretest before participation and a Likert-type satisfaction survey and posttest after participation.
Two weeks following journal club participation, researchers sent participants e-mails asking if/how nurses
applied knowledge to practice. Researchers analyzed pre−/posttest results using McNemar's Test.
Results: Sixteen nurses actively participated. Ten nurses took satisfaction surveys, choosing mostly 4 s (agree)
and 5 s (strongly agree), reflecting statistically significant satisfaction. Sixteen nurses took pre- and posttests
and demonstrated improvement in knowledge; however, only answers to 2 questions demonstrated statisti-
cally significant improvement. Eight nurses responded to the evaluation surveys with comments surrounding
increased confidence in caring for septic patients and increased awareness of symptomology, testing, and
treatments. Two nurses noted that their practice was not impacted by participation.
Practice Implications: Choose relevant articles and make hard copies of the article available for easy access. The virtual
journal club discussion forum should promote ease of use and be moderated by someone well positioned to participate
frequently and knowledgably. In addition, consider offering continuing education credits to encourage participation.
© 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.

Introduction and Background 2012). On-line learning is one strategy that is meeting this need with
its asynchronous, self-paced, and self-directed format (Dovi, 2014;
Registered nurses (RNs) must be integral in applying current re- Morente, Morales-Asencio, & Veredas, 2014). On-line learning may
search to practice with constantly evolving health care knowledge affect- meet the needs of learners who receive and assimilate information in di-
ing treatments, patient satisfaction, and patient outcomes; thus, verse ways (Cottrell & Donaldson, 2013; Morente et al., 2014), can reach
innovative professional development strategies are needed that are flex- more health care workers at one time without limitations of time/place
ible with health care workers' schedules and that facilitate nurses' learn- restrictions (Morente et al., 2014), and offers interaction experiences
ing and implementation of new evidence (Bilodeau, Pepin, & St-Louis, that might not be available otherwise (Carter, Rukholm, & Kelloway,
2009). In addition, some health care organizations may view on-line pro-
fessional development as a more cost-effective approach for presenting
Research Project Completed in Partial Fulfillment of Doctorate of Nursing Practice information to a large number of people (Sortedahl, 2012). Therefore,
Degree, Indiana University School of Nursing, 1111 Middle Drive, Indianapolis, Indiana, on-line education is being used in health care as an effective method of
United States of America 46202. conveying knowledge and overcoming time, class attendance, diverse
Research Project completed at Indiana University Health Ball Memorial Hospital,
2401 West University Avenue, Muncie, Indiana, United States of America 47303.
learner, communication, and financial barriers. (See Tables 1 and 2.)
⁎ Corresponding author. Tel.: +1 765 489 5599. Journal clubs have been used within health care for many years as a
E-mail address: rasorrell@bsu.edu. way to share and discuss evidence-based practice (EBP) knowledge

http://dx.doi.org/10.1016/j.teln.2016.08.006
1557-3087/© 2017 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
54 R.A. LaMar / Teaching and Learning in Nursing 12 (2017) 53–58

with the added benefit of a greater understanding of research method- Table 2

ologies (Steenbeek et al., 2009). Combining on-line learning and jour- Knowledge (N = 16)

nal clubs opens the door for interactive learning experiences through Question Pretest correct Posttest correct Difference P
a virtual journal club (VJC) wherein knowledge is shared and discus- responses (#,%) responses (#,%) (+/−)
sion is encouraged so that learning takes place and evidence can be 1 6 (37.5%) 13 (81.25%) +43.75% 0.0196
put into practice (Lehna, Berger, Truman, Goldman, & Topp, 2010). 2 9 (56.25%) 16 (100.0%) +43.75% *
3 12 (75.0%) 12 (75.0%) 0.0% 1
4 9 (56.25%) 10 (62.5%) +6.25% 0.7055
Literature Review 5 8 (50.0%) 10 (62.5%) +12.5% 0.5271

The author searched several databases from October 3 to 7, 2014 to

organization. A viable alternative is required whereby nursing staff
obtain research articles: CINAHL through EBSCO, Cochrane Library,
is held accountable for learning, new knowledge can be gained and
ProQuest, Medline through Ovid, Web of Science, Medline through
learning can be evaluated, new skills and knowledge can be effective-
EBSCO (using different search terms than CINAHL/EBSCO search), and
ly implemented, and patient outcomes can benefit as a result, with-
PubMed. A variety of search terms and combinations were used: virtual
out the extra cost for and time spent in face-to-face training.
journal club, journal club, on-line education, web-based learning, e-learning,
knowledge, understanding, comprehension, practice, skills, application, im-
Intended Improvement
pact, affect, influence, registered nurses, nurses, and RNs. After obtaining
relevant articles, the author combed through reference lists and forward
With the establishment of a VJC through an on-line collaboration por-
searched in an effort to capture all applicable research.
tal in our study, nurses independently can access and read a current re-
The literature search resulted in 37 studies. Excluded studies were
search article and interact with other members in an on-line forum,
more general with a focus on on-line, Web-based, and/or e-learning.
overcoming classroom attendance barriers (Lizarondo, Kumar, &
Also excluded were the systematic reviews that included the nine articles
Grimmer-Somers, 2010). The VJC's facilitators are the hospital's nurse re-
that made the final cut for critical appraisal. Study outcomes revealed
searcher and the author of this article. The research article choice was
that, while no researcher has actually observed practice change or im-
based upon a current area of interest in the intensive care unit (ICU)
proved patient outcomes as a result of journal clubs, nurses, nursing stu-
and upon recommendations from the unit leaders and unit-based
dents, and medical doctors reported satisfaction with journal clubs and
council. For the purpose of this small pilot study, only one article was
an increase in practice and research knowledge. Some studies went a lit-
used for VJC evaluation. To incentivize RNs to participate, we gave $5
tle further. McLeod, MacRae, McKenzie, and Brasel (2009) compared
Subway gift cards to participants and one massage gift certificate to
moderated face-to-face journal clubs and on-line journal clubs and
the participant chosen in a drawing. Another incentive was that VJC
found that participants scored better on critical appraisal tests in the
participation could be included in yearly evaluations.
face-to-face clubs as opposed to the Internet journal club, demonstrating
that informative comments and free give-and-take interaction in-person
Study Question
may be valuable to increasing knowledge and need to be considered
when using the on-line format for learning. Kawar, Garcia-Savan,
In ICU RNs, what is the effect of VJCs on satisfaction, knowledge,
Baker-Genaw, Drake, and Kaatz (2012) presented evidence that enthusi-
and practice?
asm about and involvement with the new club may wear off after the
first few months, so members may require incentives to participate
Ethical Issues
(Sciarra, 2011). Kean (2013) offered valuable information about using
an embedded librarian in a VJC, especially for nurses who may not be
This small pilot study was deemed a performance improvement
aware of the resources medical librarians have to offer. Lastly, several au-
project and, therefore, did not need institution review board approv-
thors reported that study participants experienced an increase in under-
al. Because of the nature of the project, the identities of participants
standing interpretation of research methodologies.
were known. However, the responses to evaluation tools were confi-
dential to the researcher who collected the data because names were
Local Problem removed. The nurses were informed in unit meetings prior to the
study that participation was not required and that no form of punish-
Currently, the hospital under scrutiny continues to provide some ment would be given to those who did not participate.
EBP education to nursing staff through in-class instruction, requiring
nurses to come in on days off and receive an hourly wage during the Setting
training (Youngblut & Brooten, 2001). This method of education in-
curs substantial cost to the institution and requires nursing staff to The pilot study took place within the ICU of a teaching hospital in
come in on unscheduled work days, creating problems with atten- Midwestern Indiana. The ICU was chosen through recommendations
dance. While face-to-face education maintains staff accountability from the ICU manager, clinical nurse specialist (CNS), and nurse re-
and is ideal for evaluating learning outcomes, it is not the most effi- searcher who believed that ICU staff would benefit the most because
cient use of time and resources for both employees and the they are a relatively young team in terms of years of experience and
have, traditionally, been open to learning opportunities. To participate
Table 1 in the VJC/study, nurses had to work in the ICU as a unit or float staff
Satisfaction (N = 10) nurse on a supplemental, part-time, or full-time basis.
Question Mean scores
Methods
1 4.3
2 4.3
3 3.9 For the author's project of developing interventions to implement a
4 4.3 VJC, intervention mapping (IM) was a helpful tool to ensure that all
5 4.2 necessary components of the process were included. Step Zero of IM
6 4.2
is conducting a needs assessment. Rationale for the project was that
 R.A. LaMar / Teaching and Learning in Nursing 12 (2017) 53–58 55

the VJC was a means of promoting nurse reading and application of that 1 month would be given. Based on the adult learning theory prin-
EBP. The author and nurse researcher met with other groups within ciple that adults are internally motivated and self-directed, the author
the same hospital network that had completed similar projects to in- and nurse researcher decided to leave the application of evidence to
vestigate what worked and what did not work within their VJCs. The practice up to the nurses' judgment, although any application to practice
author and nurse researcher met with the EBP committee, unit-based had to be consistent with the hospital's existing policies and procedures.
council, ICU manager, and CNS to investigate what they believed was The discussion forum took place within an eLearning Module System
needed for the project, as well. Four needs were identified: determin- typically administrated by two staff development members with special
ing key stakeholders and building relationships with them, finding or training, so they were made aware of VJC dates and were involved in the
building an appropriate forum for discussion that was easy to locate entire process because they were responsible for initiating and termi-
and use, developing a strategy for selecting and obtaining appropriate nating ICU nurse access to the journal article and for helping with any
articles, and developing strategies for encouraging participation. software issues specifically involving eLearning Module System.
Step One in IM is reviewing behavioral outcomes and specifying Step 5 in the IM process is the development of an evaluation plan. In
learning objectives by creating a matrix of performance objectives and the process and effect evaluations, it is necessary to determine if the in-
determinants for each behavior (Tortolero et al., 2005). A matrix of be- tervention was or was not successful (effect evaluation) and why the
havioral outcomes with associated determinants, learning objectives, intervention was or was not successful (process evaluation; Tortolero
and relevant theory principles is found in Appendix A, and the matrix et al., 2005). The evaluation plan used for this pilot study was based
for VJC performance objectives and determinants is found in Appendix B. on Kirkpatrick's Four-Level Evaluation Model and measured whether
Step Two in IM is the selection of theory-based, practical methods performance objectives were met using mixed methods (both quanti-
and strategies (Tortolero et al., 2005). A conceptual theory guides iden- tative and qualitative). Kirkpatrick's four levels are designed as a se-
tification of appropriate intervention strategies and is a supporting quence of ways to evaluate educational programs, and as one
technique that influences change in the determinants identified in proceeds through each of the levels, the evaluation becomes more dif-
Step One. Because the learners in the VJC are adults and exhibit adult ficult and requires more time. In practice, then, it is common for
learning behaviors, the author chose Malcolm Knowles' Adult Learning trainers to evaluate Levels 1 and 2 and never proceed to Levels 3 and
Theory. Knowles identified six principles of adult learning: adults are 4, where the most useful data exist (Kirkpatrick & Kirkpatrick, 2007).
internally motivated and self-directed, adults are goal oriented, adults The four levels of Kirkpatrick's evaluation model are as follows: reac-
bring life experiences and knowledge to learning experiences, adults tion – what participants thought and felt about the training (satisfaction
are relevancy oriented, adults appreciate respect, and adults are practi- level); learning – the resulting increase in knowledge and/or skills
cal. The learning objectives in Step One are supported by principles of (evaluated using a knowledge demonstration or test); behavior – trans-
the adult learning theory (Mitchell & Courtney, 2005). fer of knowledge, skills, and/or attitudes from classroom to practice
Step Three in IM was designing and developing the VJC in such a way (evaluated observation or surveys/questionnaires); and results – the
that participants are most likely to meet learning objectives. The nurse final results that occurred because of participation in a training program
researcher met with the chief nursing officer and ICU manager in the be- (performance based and may involve change in customer outcomes).
ginning to obtain approval and support for the project, which was neces- Level 4, effect on patient outcomes, was the only level not evalu-
sary to ensure that staff nurses had the education and time they needed ated for this pilot study because of too many other factors affecting
to be able to adequately participate in the program. Keeping the learning outcomes. For instance, the article participants read was on the sub-
objectives in mind, the author, nurse researcher, and two nurses from ject of sepsis, and coinciding with the sepsis article was the planning
staff education worked together to make the VJC as user friendly as pos- of a brand new sepsis bundle implementation. Therefore, it would be
sible, knowing that adult learners are practical and appreciate respect for very difficult to attribute improved patient outcomes solely to the
themselves and their time. The resulting VJC was easily accessed through reading and discussion of sepsis in the VJC.
the hospital's intranet system with which the nurses were familiar and
utilized an easy-to-use discussion forum format. Analysis
Step Four of IM is adoption and implementation. The purpose of the
VJC was to create a forum whereby nurses could independently access Level 1 evaluation in Kirkpatrick's model (evaluating satisfaction
the journal club, read the assigned article, and interact with other mem- with the educational offering) was accomplished using a 6-item survey
bers asynchronously in order to learn new EBP information. Performance with Likert-type responses given after VJC participation. The possible re-
objectives and determinants were reviewed to ensure that the implemen- sponses were 1 (strongly disagree), 2 (disagree), 3 (neutral), 4 (agree),
tation of the VJC would promote performance objective attainment. The and 5 (strongly agree). Ten of the nurses (62.5% response rate) complet-
four performance objectives were (a) inform and invite nurses to join, ed the satisfaction survey. Seventy percent of respondents gave the first
(b) participate in VJC, (c) actively discuss/employ strategies to apply statement, “I will be able to use what I learned from reading this article,”
new knowledge to practice, and (d) demonstrate application to practice a 4 (agree). Statement 2 was, “I am able to learn in an on-line, asynchro-
(Appendix B). Keeping the personal and external determinants in mind, nous format like this journal club.” Again, 70% of respondents gave this
the author and nurse researcher planned implementation in such a way statement a 4 (agree). For statement 3, “Discussion with colleagues was
as to overcome most, if not all, determinants that can present obstacles. helpful to further understand the content of this article,” 90% of respon-
The author and nurse researcher used a 4-month planning period to dents chose 4 (agree). Statement 4 was, “The VJC was easy to use.” Forty
design the intervention with the last 2 weeks focusing on communica- percent of respondents chose 5 (strongly agree), and 50% chose 4
tion of VJC information and instructions. Communication occurred at (agree). Statement 5 was, “I will participate in the VJC again when of-
unit meetings, through informational e-mails and flyers and through fered.” Forty percent of respondents chose 4 (agree), and 40% chose 5
face-to-face contact with staff nurses known to have been important (strongly agree). Last, Statement 6 was, “Participating in this journal
champions in the past. The nurses were informed that participation in club was a good use of my time.” Forty percent of respondents chose
the discussion forum was encouraged but not required because later at- 4 (agree), and 40% chose 5 (strongly agree). Therefore, respondents
tendees might find that their comments had already been stated. The were overwhelmingly positive about the VJC and agreed that they
nurses were given contact information in case of software errors or would participate again when it is offered in the future.
other questions so that time would not be wasted. The author and Level 2 evaluation in Kirkpatrick's model was accomplished using
nurse researcher believed that, in order to meet learning objectives, suf- pre- and posttests in order to measure knowledge increase. The pre-
ficient time should be allotted for VJC involvement, so it was decided and posttests were exactly the same with five questions offering
56 R.A. LaMar / Teaching and Learning in Nursing 12 (2017) 53–58

multiple choice responses and were given directly before and after VJC Sixteen nurses took the pre- and posttests evaluating learning for a
participation. Two of the questions had more than one correct answer. 100% response rate. All posttest results demonstrated improvement in
Paired t tests were used to analyze each item, and P values were obtain- knowledge. However, only Questions 1 and 2 demonstrated statistically
ed to find out if each item yielded statistical significance. significant improvement. Reading the article thoroughly was necessary
Sixteen of the VJC participants completed the pre- and posttests. The for answering the questions correctly. A couple of possible reasons for
first question required only one answer and yielded statistically signifi- not reaching statistical significance exist: the nurses were very busy with
cant improvement in knowledge (P = 0.0196). *The second question high acuity patients at the time and were not able to give full attention
had more than one correct answer, and all 16 participants answered to the article and/or the article content was misinterpreted or conflicted
correctly in the posttest, making it impossible to obtain a P value. How- with current practice, causing confusion. However, even without reaching
ever, this result is certainly statistically significant. In question 3, 12 re- statistical significance, all questions on the posttest demonstrated im-
spondents answered correctly in the pretest and in the posttest, provement in knowledge, which is promising for future VJC endeavors.
creating a P value of 1, which is not statistically significant. Question 4 The qualitative survey evaluating application to practice was distrib-
had several correct answers, and only one more participant answered uted to all VJC participants by e-mail exactly 2 weeks after the close of the
correctly in the posttest than in the pretest, yielding a P value of VJC, and only eight nurses responded (50% response rate). Not all nurses
0.7055, which is not statistically significant. Finally, Question 5 had check e-mail promptly, which may have impacted response rate. Four of
only one possible correct answer. Only two more respondents answered the respondents stated that the VJC did have an impact on their practice,
correctly in the posttest as opposed to the pretest. This yielded a P value and four nurses noted an increase in confidence in caring for patients
of 0.5271, which is not statistically significant. Therefore, only Questions with sepsis or in awareness of symptomology and treatments. It is diffi-
1 and 2 yielded statistically significant results, and Questions 3–5 did cult to quantify or describe how increased confidence and awareness
not. Nevertheless, no decrease in correct answers was noted from pre- may affect a patient, but it could be argued that these feelings may im-
test to posttest, and mild improvement was noted in Questions 4 and 5. prove nurses' prioritization and/or might prompt them to take action
Level 3 evaluation in Kirkpatrick's model was accomplished using a more quickly. Three comments focused directly on how the nurse con-
qualitative survey given 2 weeks after the close of the VJC and was used sidered different blood tests and treatment options, and one comment
to investigate application of knowledge to practice. Six VJC participants focused on how a nurse took action more quickly and had the patient
answered the two questions. The questions were as follows: 1. Fill in transferred from a medical floor to a critical care bed on presentation
the blank with a number to indicate how many, “Since participating of sepsis symptomology. Another comment noted that an actual practice
in the journal club, I have provided care directly or indirectly change involving ventilated patients on fentanyl infusions had occurred
for ___________patients with sepsis?” 2. How did what you learn in on the floor following the VJC pilot. Two comments were made by nurses
the VJC influence your care or decisions for patients with sepsis or for who noted no change in his or her practice in caring for patients with
patients whom you suspected had sepsis? sepsis. Therefore, of the eight categories of themes derived from the
An average of 2.8 patients with known sepsis were cared for by the eight qualitative responses, only two comments related to care decisions
nurses responding to the survey (N = 8), and qualitative responses not being impacted by VJC participation. The rest of the comments were
demonstrate how nurses felt the VJC impacted practice. The most com- positive about the VJC impacting care decisions, and some respondents
mon comments were associated with considering laboratories or other provided specific examples of how care decisions were changed.
treatment options for the patient. Further, four comments were made
by nurses who noted increased confidence in his or her care of sepsis Limitations
patients and in awareness of sepsis symptomology. Two comments
were associated with actual action being taken, and two comments A limitation to this small pilot study was that a small sample size
were from nurses who reported that the VJC participation did not pro- was used in a specialized setting. To generalize this study's findings, fu-
mote change in their care of sepsis patients. ture research should focus on a larger sample size across practice set-
tings. In addition, study instruments were developed for this study
Results and need further testing for validity. Lastly, researchers did not evalu-
ate patient outcomes as a result of nurse participation in the VJC.
The VJC started on February 16, 2015 at 8 am and ended on March 16,
2015 at 8 am. The author was on the unit on the first day of the VJC pilot Discussion
to answer questions and encourage participation and then visited four
more times throughout the VJC pilot on day, night, weekend day, and Implementing the VJC in an ICU where the leadership and nurses wel-
weekend night shifts to answer questions and encourage participation. come learning opportunities was a practical choice for introducing the VJC
During these visits, several nurses and the nurse manager noted more and may have promoted participation (Duffy, Thompson, Hobbs,
patients with higher acuity than normal during the VJC pilot. In the last Niemeyer-Hackett, & Elpers, 2011). Nurses reported high satisfaction
week of the VJC pilot, the nurse manager added information about the with VJC participation and demonstrated that a VJC impacts knowledge.
VJC to the shift huddles in case anyone had missed it. At the end of the Being able to obtain qualitative information about how the nurses were
pilot, 16 participants had actively taken part in discussion, although able to apply the new knowledge was of particular interest and demon-
more nurses reported reading the forum and choosing to not post any- strated that application to practice was, indeed, possible, even without
thing because comments had already been stated. Discussion was rich changing policies and procedures to fit article recommendations. The re-
and centered around new information available in the article about rec- sults of this study corroborated studies' findings in the literature review,
ommended treatments and blood tests for patients with sepsis. although none of those studies evaluated application to practice.
Ten nurses took the VJC satisfaction surveys and were overwhelming- Recommendations for future VJCs include offering CEUs to increase
ly positive about the VJC, the article discussed, and about future plans to participation and using staff-chosen relevant articles, if possible. In addi-
participate in the VJC again. The most common scores of 4 (agree) and 5 tion, future VJC facilitators should consider distributing hard copies of
(strongly agree) reflected comments made to the author of this article dur- the article to be discussed (or allow the article to be printed) so that
ing unit rounds. It is unknown why only 10 nurses completed the satisfac- nurses do not feel pressured to read article content too quickly and po-
tion survey when the VJC had 16 participants, but because the pop-up tentially miss important information. Last, the chosen discussion mod-
reminder about the satisfaction survey only appeared following article ac- erator should be knowledgeable about article content and available to
cess, it is assumed that the nurses simply did not see it. engage in on-line discussion. The person most well positioned for this
 R.A. LaMar / Teaching and Learning in Nursing 12 (2017) 53–58 57

role is the CNS because of his or her clinical knowledge and expertise, (continued)
awareness of current practice policies and procedures, familiarity with Behavioral outcomes Determinants – Personal Learning objectives – cre-
staff and environment, and access to current EBP recommendations. and external factors that ated by crossing perfor-
Future research should evaluate journal club's impact on practice influence a desired mance objectives for each
and patient outcomes because the majority of journal club studies outcome. behavior by determinants
for that behavior.
merely evaluate satisfaction. According to the literature and this
At the end of the VJC pilot,
small pilot study, journal clubs impact satisfaction, knowledge, and the nurse will have per-
practice and, therefore, have potential to impact patient outcomes. formed the following
activities:
Contributions information might (Personal) practice.
be used on the Adults bring life
I would like to thank Sue London, librarian for Indiana University School unit experiences and
knowledge to learning
of Medicine, for reviewing my search process and offering additional help
experiences (adult
with choosing articles for critical appraisal. In addition, I would like to learning theory)
thank my mentor, Dr. Renee Twibell, and my adviser, Dr. Mary Beth 6. Nurse will report Time to trial new Reported at least one
Riner, for providing insight into all aspects of my project and offering in- on attempts to put practice. (Personal) attempt to apply the EBP.
EBP in place on Adult learners like to be
struction and support as needed. Last, I appreciate Jingwei Wu's contribu-
unit. respected (adult learning
tions during the statistical analysis portion of this study. The entire project theory)
would have been impossible without the help of these valued professionals.

Declarations of Interest

I am not financially involved with any entity associated with this re-
search study. No funding was needed or obtained for this study. Study
participation incentives were paid for by the author of this article.

Differences Between Protocol and Review Appendix B

Initially, the author started out with more studies for the literature Performance Personal Personal Personal External
review, but most articles were not directly related to journal clubs or objective determinant determinant determinant determinant
(participants Knowledge Skill Attitude Organizational
VJCs, focusing on more general terms, such as online learning. The must do) practice/
resulting literature review of nine articles pertain only to journal policy/support
clubs as an intervention within health care disciplines, which relates
Inform and Familiarity Demonstrates Agree to join Hospital is
directly to the intervention and population. invite with VJC and interpersonal VJC supportive
nurses to study being communication and provides
join VJC conducted that promotes time to inform
Appendix A VJC enthusiasm and recruit
nurses
Participate Familiarity Demonstrate Demonstrate Hospital is
Behavioral outcomes Determinants – Personal Learning objectives – cre- in VJC (at with how to ability to use acceptance/ willing to
and external factors that ated by crossing perfor- least read use the VJC computers and accepting allow nurses
influence a desired mance objectives for each article and article and hospital's attitude of to stay over or
outcome. behavior by determinants access dis- discussion fo- intranet VJC come in early
for that behavior. cussion rum and re- if needed to
At the end of the VJC pilot, forum) wards of use complete VJC
the nurse will have per- requirements
formed the following Actively Provide Demonstrate View Hospital is
activities: discuss/ examples of effective willingness willing to
1. Nurse will agree to Past experience with Accessed program during employ how nurses communication to negotiate support
participate in VJC. journal clubs. (Personal) one shift strategies may apply with multi- how procedure/
Familiarity with VJC soft- Adults are internally to apply knowledge in disciplinary knowledge policy change
ware and navigation skill motivated and self- new practice team members may be with regards
directed (ADULT knowl- to discuss ways applied to to evidence
LEARNING THEORY) edge to to apply new practice application in
2. Nurses will read Access to computer with Read the article practice knowledge to within team practice
article for VJC. virtual club material Adults are goal oriented practice as useful
during shift. (External) (adult learning theory) method of
Time to read (external) achieving
3. Nurse will share Time to reflect on article Posted in discussion forum results and as
what he or she during shift. (external) on what he or she learned respecting
learned from the from the article. one another
article. Demonstrate Familiarity Demonstrate Be willing to Hospital is
Adults are practical (adult applica- with how strategies that change willing to
learning theory) tion to application to promote practice to support
4. Nurse will discuss Time to discuss Discussed the article practice practice may application of reflect procedure/
EBP with Willingness to discuss Adults are relevancy affect patient knowledge to evidence policy change
colleagues oriented (adult learning and change practice with regards
theory) outcome to evidence
5. Nurse will share Reflection on how to take Shared with others about application in
how article action – praxis. application of evidence to practice
58 R.A. LaMar / Teaching and Learning in Nursing 12 (2017) 53–58

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