Clinical medical librarian services for nurses

1. Clinical Medical Librarian
Services for Nurses
Clista Clanton, MSLS, AHIP
Ellen Sayed, MSLS, AHIP
University of South Alabama
Biomedical Library

2. “As nursing became involved in this movement,
the quest to define best practices began, often
resulting in complex challenges that have no
easy solutions. What is clear is the responsibility
of nurses to deliver care based on evidence, for
nurses to be able to access, evaluate, integrate
and use the best available evidence in order to
improve practice and patient outcomes (Rycroft-
Malone, Bucknall, Melnyk, 2004). The imperative
is to reduce the gap between knowledge
development and knowledge use to improve the
health of people.”1

3. • Sigma Theta Tau International: conducted survey among non-
member nurses about their familiarity and use of evidence-based
practice (EBP) within the workplace.
– Most nurses consistently need to find, access and provide care based on
evidence. Nearly two in three (64%) indicate this need arises at least
weekly and nine in ten (90%) say it happens at least occasionally.
– Just over 40% of the nurses surveyed indicated a high level of comfort about their
knowledge and experience of the EBP process. About half indicated a moderate comfort
level and just one in ten indicated a lower level of confidence.
– When asked to list the prevailing challenges to finding and accessing the
available information, lack of time (66%) and findings that are difficult to
appraise and analyze (45%) were clearly the prominent answers.1
– While three in ten (31%) nurses indicated a high level of familiarity with
EBP, almost one in four (24%) rated their familiarity low. Advanced
practice nurses were more likely to indicate a higher level of familiarity.

4. Most clinical medical librarian (CML)
programs have been targeted at
physicians. In a literature review, only six
articles were located that specifically
discussed CML services for nurses, with
four of them being published between the
years of 1983-1985.

5. Librarian collaboration with Dr.
Linda Roussel, a College of Nursing
faculty member, on teaching
evidence based practice to students
in both regular and online courses
led to participation on a hospital
committee charged with revising a
protocol on deep vein thrombosis.

6. Upon the suggestion of integrating
clinical librarians into other hospital
committees, the Medical Center’s
Clinical Practice committee requested
a CME on clinical librarianship.
Response was very enthusiastic and a
6-month pilot project for a CML was
adopted. Eight committees between
the two university hospitals were
identified for CML participation.

7. • Critical Care Committee
• Medication Use
Committee
• Multi-disciplinary Patient
Care Committee
• Pressure Ulcer
Prevention Committee
• Performance
Improvement Council
• Clinical Practice
Committee
• Medical Center Hospital
Policy and Procedure
Committee
• Children & Women’s
Hospital Policy and
Procedure Committee

8. Clinical Medical Librarian Pilot Project
• 6 month CML pilot project, start date Aug. 1
• 2 librarians at 8 hrs/week each
– Clista Clanton: Experience as a clinical librarian working with multidisciplinary healthcare
teams developing clinical protocols/pathways.
– Ellen Sayed: Experience with clinical librarianship rounding with multidisciplinary teams on
the Internal Medicine and Pediatric wards.
• Formal evaluation at end of 6 months

9. Sculpture garden at the Children’s & Women’s Hospital,
Mobile, AL

10. Committee or Person Requesting Search
# of Questions
Received from August
2006 – April 11, 2007
Children & Women’s Hospital Policy and
Procedure Committee
11
Medical Center Policy and Procedure
Committee
1
Pressure Ulcer Committee 4
Medication Use Committee/Pharmacy 9
Critical Care Committee 2
Children & Women’s PICU/Attending
Physician
3
Performance Improvement Council 3
Clinical Practice Committee 2
Patient Care Committee 2
Total Questions: 37

11. The majority of questions were received from nurses.
However, since the committees are multidisciplinary,
questions were also received from physicians,
pharmacists, and the hospital administrator for the
Medical Center.
RN, 22
Physician, 3
PharmD, 9
Administrator, 3

12. The majority of questions were received during committee
meetings. However, now that a clinical librarian has been
identified as a resource, questions are received by phone and
email as well.
In Person, 25
Email, 6
Phone, 6

13. Observations:
In observing dialogue between clinical staff during meetings,
questions that could be answered by literature searches are
discussed but probably would not be referred to the library if a
librarian was not present at the meeting.
Furthermore, some questions are raised in meetings that would
benefit from a literature search but are not posed to the librarian
present. Asking “would you like me to research this” is usually
meet with an enthusiastic “yes”. Clinicians do not always
accurately identify information needs that could be addressed by a
librarian.
Taking this active role further integrates the librarian into the
committee and enhances their role as a team member as
opposed to a guest.
Regular attendance of the meetings by the librarian is important
and leads to further opportunities for collaboration with clinical
staff that would be otherwise missed.

14. Conclusions:
The CML pilot program was evaluated by the Clinical Practice
committee after 4 months with the decision to continue the service
indefinitely.
The time spent by the librarians on the CML program has thus far
been well within the 8 hours/week allocated by each librarian.
Searches pertaining to hospital policy and protocol development,
as opposed to individual patient care questions, are predominant.
Integration into the committees has been smooth and librarian
involvement welcomed.
Nurses are integral in developing hospital policy, procedures, and
protocols. They recognize both their time and expertise limitations
in searching the literature and are appreciative of CML services.
Librarian involvement in hospital committees has helped to better
inform the library’s educational programs for medical, nursing, and
allied health students.

15. 1. Sigma Theta Tau International’s Position Statement on Evidence-Based
Nursing. Available at http://www.nursingsociety.org/research/main.html#ebp.
Accessed 6/17/06.