Quality in Primary Care Open Access

Introduction

The internet is an increasingly important source of information for healthcare professionals. More and more resources are becoming available online that assist both clinicians and administrators to base new procedures on reliable evidence. But unfortunately not all staff members are making equal use of these new information sources; research shows that ‘nurses clearly lag behind other groups in workplace use of the internet’.[1] It seems that nurses, like the rest of the population, are developing increasing proficiency with the technology, but that ‘they are not using their newfound skills to search out nursing information’.

Some of the reasons suggested for this are that nurses have fewer opportunities at work; that nursing is perceived as a practical, hands-on profession; or that there is no time during their day to receive appropriate training on how to find good quality information on the net. It may also be due to a belief that there are few good quality nursing websites, but this belief is unfounded. The following resources have been selected because of their emphasis on embedding quality in nursing practice, and because they provide access to a much larger body of work supporting a whole range of nursing specialities. The worldwide web can be an immensely valuable tool for supporting continuing professional development, understanding clinical governance, and sharing knowledge through professional networks. And for those who are concerned about their internet searching skills, an online teaching resource is discussed below that has been written especially for nursing staff.

Royal College of Nursing www.rcn.org.uk

The mission of the Royal College ofNursing (RCN) is to represent nurses, to promote excellence in practice, and to shape health policies. Consequently, their site is a treasure trove of resources that support nurses wishing to develop their understanding of evidence-based practice and clinical governance. Joining the RCN will give you access to the full text of a range of web-basedmedical journals, but even without access to the ‘members only’ area you are likely to discover something of interest.

Under the resources menu, you should pay particular attention to ‘Improving care’. This subsection of the site holds a collection of nurse-led clinical guidelines developed by the RCN or in partnership with other organisations. Topics covered include the recognition and assessment of acute pain in children, and pressure ulcer risk assessment and prevention. Although this section is small at the time of writing, it looks set to increase rapidly as the RCN continues to produce new guidelines.

Also found within this section are details of the quality improvement programme that provides information support for all aspects of clinical governance and clinical audit. Of particular interest is Clinical Governance: an RCN resource guide (www.rcn.org.uk/ publications/pdf/ClinicalGovernance2003.pdf), which summarises the key themes of clinical governance and explains how the term can be applied in a nursing context. Real-life case studies are used to show clinical governance in action.

Finally, if you get tired of pointing and clicking, and feel the need to cast your eye over some good, old-fashioned ink and paper, the RCN provides the Nursing Libraries service (www.nursing-libraries.org). This offers you the chance to find a nearby library based within your own geographical location, one that will offer services tailored to nurses.Amap of theUKis provided, which allows you to zoom in on a required area, until you find a suitable library in your vicinity. This makes it particularly easy to see what route you will need to take in order to get there. In addition, contact details and individual peculiarities are listed, to help you determine how helpful each library will be.

Nursing and Midwifery Council www.nmc-uk.org/nmc/main/ home.html

The Nursing and Midwifery Council (NMC) was set up by the government to ensure that nurses, midwives, and health visitors provide high standards of care to their patients. Its aims encompass setting standards for education, practice and conduct, and providing advice to nursing staff. Its clearly laid out website is a useful resource as it makes all of their publications available in PDF. Select the ‘Publications’ section of the site to see the Code of Professional Conduct; a variety of guidelines for professional practice (for example for the administration of medicines); documents supporting nursing education like the PREP Handbook; and numerous research reports.

If you have time to browse, check out the ‘Advice’ area of the site, which contains a large collection of succinct topic summaries ranging across the whole spectrum of nursing practice. These summaries can be searched by keyword, or located alphabetically by title, and are an invaluable means of rapidly getting to grips with key phrases and buzz-words. If, having read the advice, you remain in the dark, the site also offers an electronic help-desk for you to contact via email.

Foundation of Nursing Studies www.fons.org/

The Foundation of Nursing Studies (FONS) is an independent charity that works in partnership with nurses to develop, promote, and improve patient care. It helps nurses to bring together knowledge and practice by encouraging the use of the most up-todate methods. This is the essence of evidence-based nursing. FONS funds projects, both large and small, aimed at developing nursing practice, and their website gives details of these projects (as well as the opportunity to apply for a grant yourself). Of particular interest is the report called Taking Action: evidence based nursing (www.fons.org/projects/longterm.htm), which is the culmination of a long-term series of workshops and evaluations examining the impact that clinical governance has had on nursing practice. This can be found in the ‘Projects’ area of the site, along with many other useful project evaluations.

Forming professional links, networks of contacts, and communities of interest is becoming an increasingly valuable and valued aspect of professional development. To be effective, clinical governance and evidence-based nursing rely on the sharing of knowledge between colleagues. In order to support this, FONS provides a list of nursing networks that you can join, based on your particular speciality. Initiatives such as theConsultantNurseNetwork and the Developing Practice Network provide a forum for the exchange of ideas, mutual challenges and mutual support.

Gateways to other nursing resources

Each of the resources discussed so far provides a page with selected links that will connect you to other websites of interest to nurses. However, if you wish to cast your net a little wider in your search for nursing information there are a number of useful resource gateways. On the internet, the term ‘gateway’ refers to a large collection of links based around a particular subject area that have been hand-picked by a team of specialists. These can be searched, and although you will be presented with fewer links than from a traditional search engine (such as Yahoo), the resources you find will be of a higher quality.

NeLH Nurse Portal www.nelh.nhs.uk/nurse/

The National electronic Library for Health (NeLH) programme is working to develop a digital library for NHS staff. The NeLH does not produce content itself, but supplies links to various sources of knowledge that have been quality assured. The Nurse Portal is one of a number of portals that aim to offer information services to specific professional groups, particularly those that have previously been under-served by traditional library services. It is constructed specially to enable rapid access to electronic resources by timepoor nurses with lower-than-average ICT skills.

The NeLH is a good place to visit for information that supports the whole healthcare profession. For instance, the ‘Frameworks and guidelines’ area includes links to the National Institute for Clinical Excellence (NICE) and the Healthcare Commission, and ‘Search for the evidence’ provides a menu of electronic databases helping you to find systematic reviews on different health topics.

But in truth, the range of nurse-specific resources available fromthis page is small, and many of the links that are provided turn out to be dead, or contain very little information content. Worth a look though is the ‘Internet discussion’ section on the bottom right, which gives you the opportunity to connect to various discussion groups. These are run by the Joint Information Systems Committee, and allow you to receive and contribute to mailing lists populated by other nurses and nursing researchers throughout the UK. They are free to join and cover specialities including paediatric nursing, health visitors, and others. Discussion groups are an effortless way to stay current on the issues that are being discussed by your colleagues around the country.

NMAP www.nmap.ac.uk/

For large numbers of nurse-specific resources, and in particular for resources supporting nursing specialities such as geriatric nursing or maternity clinics, the Nursing, Midwifery and Allied Health Professionals’ (NMAP’s) site is the one to visit. Created by a core team of information specialists and subject experts, and working in partnership with the RCN, NMAP provides links to over 3500 internet resources. Each resource has been carefully selected and evaluated, and a description is provided beside each link that will help you to judge its applicability to your practice or research.

NMAP provides the facility to search for a particular subject, and to narrow your results by resource type (e.g. electronic book, patient information leaflet, news service, etc) or geographical location (UK or international). You may also browse through different topics arranged alphabetically (choosing between Medical Subject Headings (MeSH), RCN headings and National Library of Medicine subject headings). These topics are sufficiently specific to allow you to quickly retrieve a few highly relevant resources. As an example, the first few (RCN) entries are: ‘abdomen’; ‘accident and emergency nursing’; ‘accidents in home’; ‘acoustic injuries’; and ‘acquired immune deficiency syndrome’.

Internet for Nursing, Midwifery and Health Visiting www.vts.rdn.ac.uk/tutorial/nurse/

All of the resources discussed so far provide access to, and are themselves, quality assured sites. But what is a quality site? And how can you learn the skills needed to find and critically appraise online information for yourself? The Internet for Nursing, Midwifery and Health Visiting is an online tutorial from the Virtual Training Suite that lets you develop and practice your internet information skills. Although this site has been written primarily for students and researchers, it is equally useful for anyone currently working as a nurse and wishing to further their professional education.

The tutorial begins with a tour through the most important nursing resources on the web, and enables you to better distinguish the different types of resource available. The discover section is next, which will teach you about the sites that can help you seek information on the net, and how to make the best use of them. Learning how to evaluate your results, determine the best quality sites, and avoid the pitfalls of using the web is the focus of the review section. The tutorial finishes by asking you to reflect on what you’ve learnt and ensure that you can make practical use of the internet in your work.

This site is filled with hints, tips, and quizzes to help you remember what you’ve learnt, and should take around an hour to go through frombeginning to end. This resource has been carefully and cleverly designed, and if you can spare the time to work through it you are likely to be rewarded with slightly less frustration the next time you go to find information online.

Journal articles

In order to find the most rigorous, research-based information to support excellence in nursing care you must go to peer-reviewed journal articles. For access to the widest range of quality periodical publications the key resource is still your local nursing library, which is likely to have, or be able to obtain, a copy of almost any article on nursing practice that you might need. However, where location or time factors make visiting your library unfeasible, you will find that many journals are now available online in an electronic format.

By going through the resources that have already been listed in this article youwill be able to find links to a large number of electronic journals. A few of these online publications are freely available to everyone, others are free to all employees of the NHS, and some are free to NHS members in England. If you have trouble accessing an electronic journal, or are asked for an ATHENS password, get in touch with your local nursing library for clarification.

Of particular interest is the British Nursing Index, which can be used to search for references to nursing articles that support evidence-based practice and other aspects of clinical governance. This resource is available to members of the RCN, or via nursing libraries around the country. The journal, Evidence- Based Nursing, is also a key resource, which can be browsed at https://ebn.bmjjournals.com/. Articles that are more than a year old are freely available in full text. Finally, it is worth referring to Internurse (www. internurse.com), which is a unique online resource containing over 8000 peer-reviewed full-text nursing articles. This collection can be accessed for free by employees of the NHS using your ATHENS password.

Conclusion

Nurses are on the front line of healthcare practice, and are very often the staff members whose job it is to inform and instruct patients about their own health. For this reason, the time taken by nurses to find information online should not be considered ‘nonproductive’, but should be seen as a key aspect of their job. Nurses themselves, their administrators, and their colleagues must be encouraged to consider nursing as an intellectual as well as a practical vocation. This article has shown that a considerable amount of nursespecific knowledge is waiting online to be used by staff, including nursing guidelines, journal articles on evidence- based nursing, training resources to improve information literacy, andmuch more. Data shows that nurses will make use of this electronic information; all that is required is for them to be pointed in the right direction.[2]

References

1. Estabrooks CA, O’Leary KA, Ricker KL and Humphrey CK. The internet and access to evidence: how are nurses positioned? Journal of Advanced Nursing 2003;42(1):73– 81.
2. Wozar JA and Worona PC. The use of online information resources by nurses. Journal of the Medical Library Association 2003;91(2):216–21.