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Keywords: Evidence/Learning/ Professional Development/Reflection/ Revalidation ●This article has been double-blind peer reviewed

Author Lyndsey Anton is nursing practice educator, nurse education team; Nia Morris is clinical librarian, Wrexham Medical Institute; Susan Ira Mahony is former clinical librarian, Glan Clwyd Hospital; all at Betsi Cadwaladr University Health Board.Abstract Anton L et al (2016) Improving nurses’ access to healthcare evidence. Nursing Times; 112: 10, 17-19.This article describes how the education team and library services at Betsi Cadwaladr University Health Board found a way to help nurses keep updated, and support them with the introduction of nurse revalidation in April 2016. The education team bridged the gap between nurses and library resources by delivering “5 a Month”, a small selection of current literature on chosen monthly topics from the library, to nurses at their place of work.

Nurses are responsible for the care they deliver to patients and need to be able to justify what they have done (McSherry et al,

2002). To do this, they are expected to reflect on high-quality healthcare evidence, ensure their clinical practice is evidence-based and consider how that evidence can be used to improve the care they offer patients. Nurses also need to use effective search strategies to locate appropriate evidence and resources (Robb et al, 2014).

Recognition of the importance of evidence-based practice has grown over recent years; it is now accepted as a neces-sary component of high-quality patient care and is no longer an obscure concept (Grant et al, 2012). The goal of evidence-based practice is to provide an interven-tion that has the greatest likelihood of suc-cess, thereby achieving the best patient

5 key points 1 Evidence-based

practice is vital to the delivery of high-quality healthcare

2Reflection on practice is a

crucial aspect of nurse revalidation, and encourages nurses to use experiences in their work to improve their future practice

3Nurses will be required to

produce evidence to demonstrate they have met their revalidation responsibilities

4Nurses often lack the skills

and/or confidence to find and evaluate evidence

5Providing nurses with a

regular selection of relevant articles makes it easier for them to access appropriate evidence

outcomes at the lowest costs (Melnyk and-Fineout-Overholt, 2015). The procedures used should be justifiable and nurses should be able to reference authoritative evidence (McSherry, et al 2002) but many encounter barriers in seeking to use cur-rent evidence in practice including: » Staffing challenges, such as numbers

and skill mix;» Demanding time commitments;» Identification and location of the evi-

dence, especially if they have limited experience of this (Grant et al, 2012).The requirement for all nurses and mid-

wives to revalidate with the Nursing and Midwifery Council when they renew their registration every three years from April 2016 has intensified their need to use appropriate evidence to shape their prac-tice. However, good professional practice also requires them to use the best available evidence. The NMC Code states that nurses and midwives must: “maintain the knowl-edge and skills you need for safe and effec-tive practice” (NMC, 2015).

McSherry et al (2002) stated that evi-dence-based practice provides nurses with a sound and rational basis for decisions taken about the care being provided to patients. However, more recently Melnyk and Fineout-Overholt (2015) defined it more broadly as a lifelong problem-solving approach to clinical practice.

Continuing professional development is similarly integral to the role of nurses. Maintaining up-to-date skills and know-ledge and providing evidence-based care is paramount to ensuring standards are maintained and the Code is upheld. All nurses and midwives must act in line with the Code, whether providing direct care to individuals or groups, or bringing

In this article... The importance of evidence-based practice How revalidation supports evidence-based practice A service regularly distributing relevant articles to nurses

Many nurses find it difficult to access evidence on which to base their practice. A health board addressed this by regularly emailing them a selection of appropriate articles

Improving nurses’ access to healthcare evidence

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18 Nursing Times 09.03.16 / Vol 112 No 10 / www.nursingtimes.net

Many staff members found that being sent monthly articles by email was useful

Making the most of library servicesLibrarians have the skills needed to locate evidence-based information, but can pro-vide more relevant evidence when working in collaboration with clinical staff. The ideas for 5 a Month enabled the clinical librarians to work closely with the educa-tion team to develop a system that built on the strengths of both teams.

In a survey of physicians and residents in 118 hospitals in the US, respondents were asked if they had used library resources to search for information relating to a specific clinical case; 75% stated that they definitely or probably han-dled patient care differently using infor-mation obtained through the library (Gard Marshall et al, 2014). This highlights the positive effect library services can have on care delivery.

Further discussions between the library and education team staff also raised prac-tical considerations. Copyright law rightly restricts the copying of some information to protect authors. It was decided therefore that only open-access articles from PubMed and Biomed Central should be used in 5 a Month so they could then be viewed instantly from an email, simpli-fying access. However, accessibility of information neither ensures it is the best-quality evidence nor that it provides the only available perspective. To encourage wider reflection, we therefore made use of the clause in the NHS Wales copyright licence that allows storage of licensed or owned content for access by authorised users for up to 30 days.

The education team set up the 5 a Month page on the nursing and midwifery information zone of the health board intranet where, for 30 days, a further five selected articles on the topic of the month, from journals paid for by NHS Wales, could be accessed. These would be auto-matically deleted at the end of the 30-day period and there would be a hyperlink directly to the intranet page from the 5 a Month email.

For the librarians, 5 a Month not only encourages dissemination of recent research or editorial opinion, but has also given them a unique opportunity to reach out to non-library users to make them aware of its services and resources without intruding on valuable staff time. The initi-ative has also helped to promote a closer working relationship between the library and education teams. By encouraging a better understanding of issues, such as copyright, the library has been able to offer guidance on the legality of accessing licensed works, while its role has been

Overcoming barriers to accessing evidencePape (2003) advised that the use of evidence-based practice needs to be nurtured, and creativity is required to engage nurses to use new ways of collating their evidence. To enhance the use of further evidence for reflection on topics of current interest to nurses, and to overcome some of the bar-riers nurses face when trying to do this, the education team reflected on strategies that would ensure nurses were regularly exposed to articles of interest and relevance that could support practice and revalidation.

An initial meeting was arranged between the education team and the library service to investigate whether pro-viding five articles a month on a selected topic might encourage nurses to further access, read and reflect on some up-to-date literature each month. The literature would be sourced by the education team and cascaded to nurses by email.

The knowledge and skills base of nursing is diverse; it encompasses an extensive range of interventions and activi-ties (Smith et al, 2004), so the articles selected would have to meet the wide range of needs of nurses working in any area. Such a wide remit meant the service, which became known as “5 a Month”, could only provide a taster of the literature on a selected topic each month.

The aim would be to make it easy for staff to access further information for pro-fessional reflection, rather than give con-clusive summary evidence on a topic. The purpose would be to encourage profes-sional thought, reflection and interest rather than to synthesise or critically eval-uate the evidence. Many nurses are not con-fident about using library databases (Robb et al, 2014) so we hoped that highlighting library services in this collaborative way would also encourage them to seek library support in accessing further evidence.

their professional knowledge to bear on current practice in other roles, such as education or research (NMC, 2015). The principles and values identified in it are not negotiable and can be applied to many settings.

How revalidation supports evidence-based practiceThe new revalidation system replaces post-registration education and practice (PREP); from April 2016 all nurses and midwives will need to be ready to revalidate the next time their registration is due for renewal. This involves completing a range of revali-dation activities and being able to demon-strate this to the person responsible for confirming this to the NMC (in most cases confirmers will be line managers).

The major differences between PREP and revalidation activities are that, in addition to undertaking 35 hours of con-tinuous professional development and 450 practice hours (900 for those with dual registration), registrants will be required to provide their confirmer with evidence of these and of:» Five reflective accounts, detailing

reflections on practice or professional development, and linking their learning from these reflections to aspects of the Code;

» Five pieces of practice-related feedback;» A reflective discussion with another

registrant (this can be combined with the confirmation discussion).The Code advises that nurses’ and

midwives’ commitment to maintaining standards should be fundamental and a reinforcement of their professionalism. Revalidation will provide the means of demonstrating this commitment in a thorough, richer way. The Code “will become central in the revalidation process as a focus for professional reflection” (NMC, 2015).Al

amy

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team and library service, it has developed and expanded and is ultimately bridging the gap between knowledge and action.

Revalidation is set to change the regula-tion of the nursing profession and, while nurses need to embrace the change, they must also be given the support to facilitate the transition to a new way of regulation. We hope 5 a Month has become a small step in this process for our nurses. NT

ReferencesGard Marshall J et al (2014) Library and information services: impact on patient care quality. International Journal of Health Care Quality Assurance; 27: 8, 672-683.Grant M et al (2012) Evidence-based practice for staff nurses. The Journal of Continuing Education in Nursing; 43: 3, 117-124.McSherry R et al (2002) Evidence-informed Nursing: A Guide for Clinical Nurses. London: Routledge.Melnyk BM, Fineout-Overholt E (2015) Evidenced-based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia, PA: Wolters Kluwer.Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives. Bit.ly/CodeNMCPape TM (2003) Evidence-based nursing practice: to infinity and beyond. Journal of Continuing Education in Nursing; 34: 4, 154-161.Robb M et al (2014) Strategies for searching and managing evidence-based practice resources. The Journal of Continuing Education in Nursing; 45: 10, 461-466.Smith P et al (2004) Shaping the Facts: Evidence-based Nursing and Health Care. Edinburgh: Churchill Livingstone.Straus S et al (2009) Knowledge Translation in Health Care: Moving from Evidence to Practice. Chichester: Wiley-Blackwell.

midwifery information zone of the health board intranet are also encouraging (Box 3).

ConclusionInitial results suggest “5 a Month” has had three benefits. It has: » Improved access to educational articles

on a variety of topics, providing evi-dence in a timely manner and conven-ient form, enabling nurses to reflect on their practice and support their own evi-dence in planning for nurse revalidation;

» Increased visibility of library services with nursing staff in a more targeted way and encourage them to seek sup-port from library services by encour-aging a culture of support through col-laborative working;

» Provided a measure for impact: not only measuring the effect of the initiative, but acting as a proxy measure for the role evidence is playing in nurses’ pro-fessional development and, ultimately, their patient care.Grant et al (2012) pointed out that nurses’

involvement in evidence-based practice is crucial but must be balanced against bar-riers such as time constraints and interest. This requires focusing on small, achievable projects that offer follow-up support and have management recognition. Straus et al (2009) also described strategies that bridge the gap between knowledge and action. Although 5 a Month began as a small col-laborative project between the education

enhanced through working in partnership with the education team in defining nurses’ information needs and deciding how these are met.

How 5 a Month worksEach month the education team chooses a topic of current relevance to nurses and forwards it to the library service to undertake a search. Box 1 gives examples of topics already covered. The librarians then send a selection of relevant articles via open access and through NHS Wales licence-owned content. The education team chooses five articles from each sec-tion, trying to cover as broad a range as possible to meet the needs of nurses in as many care settings and specialties as pos-sible, from newly qualifieds to advanced practice nurses.

Once the articles are selected, the librar-ians format the content into two posters that are then forwarded back to the educa-tion team to cascade by email; the library also emails all nurse Athens account holders. The first lists the open-access arti-cles, while the second lists those paid for via NHS Wales for the intranet, which are uploaded onto the health board intranet for 30 days. Copyright declara-tions about use of the material are made clear in emails and on the intranet page, emphasising that the selected articles reflect only the authors’ views as a stimu-lant for reflection and are not given as guidelines for practice.

Feedback from staff is positive, as illus-trated by the examples in Box 2. Early on in the initiative, recipients were given the opportunity to vote on whether they wanted the initiative to continue – 95% voted “yes”. Data from the nursing and

For more on this topic go online... Using reflection on reading for revalidation

Bit.ly/NTReflectOnReading

BOX 3. VIEWS OF THE 5 A MONTH PAGEJuly 2015 – 71 views. An article on revalidation was the document that was viewed mostAugust 2015 – 77 views. An article on hand hygiene and infection prevention was the third most viewed documentSeptember 2015 – 83 views. One of the articles on nutrition and wound healing was the third most viewed documentOctober 2015 – 48 views (The 5 a Month topic was reflection for nurses, but October was busy with the Fundamentals of Care Audit, revalidation, Healthcare Standards Audit, and mentor information with a high number of views)November 2015 – 149 viewsDecember 2015 – 103 viewsJanuary 2016 – 111 views

BOX 2. COMMENTS FROM STAFF“Fabulous idea!” (District nurse team manager, March 2015)“What a great idea! I will read these articles.” (Advanced nurse practitioner, March 2015)“Can I just say what a great idea this is, and extremely useful.” (Matron, April 2015)“I just wanted to thank you for your time and effort regarding the 5 a Month and enjoy reading the up-to-date articles. Your effort is worthwhile.” (Ward sister, May 2015)“Happy to support such a worthwhile initiative and thank you for your continued interest and support.” (Matron, August 2015)“This is excellent.” (Executive director, September 2015)“This is a great initiative.” (Assistant director, September 2015)“Great idea.” (Clinical nurse manager, September 2015)

BOX 1. 5 A MONTH TOPICS● C difficile● Nursing documentation/record keeping● Patient-centred care● Duty of candour and patient safety● Revalidation for nurses● Hand hygiene and infection prevention● Nutrition and wound healing● Reflection on nursing● Continuing professional development for nurses● Reducing the incidence of pressure ulcers● Barriers to continence assessment and how to overcome them● Medicines management

For information on nurse revalidation, go to nursingtimes.net/revalidation