Nursing is a dynamic profession in which treatment protocols, technologies, and research stay in constant flux (Barnard, Nash, & O’Brien, 2005; Sherwill-Navarro, 2004). Nurses need to know how to access professional research to keep abreast of these changes while providing the best patient care possible (Cheek, Gillham, & Ballantyne, 2005; Morgan, Fogel, Hicks, Wright, & Tyler, 2007). Nurses must also provide information alternatives as more consumers use the Internet to find health information (Fox, 2006). However, access to online information of questionable quality can deceive even the most astute health care professionals (Dee & Stanley, 2005).
Librarians are trained professionals who find and assess information, and the libraries where they work often hold valuable resources. Although an institution’s library provides excellent resources for finding information, the exponential growth in distance education makes visiting a home campus difficult (Gandhi, 2003). Nurse educators and librarians can work together to educate nurses, no matter their location, on finding credible health information. Mutual respect, open communication, and flexibility are primary requirements in a collaboration of this nature (Sherwill-Navarro, 2004). This article offers an example of collaboration between nurse educators and librarians to better equip graduate, RN-to-BSN, and BSN students to evaluate and use health information.
Evidence-based practice is critical to effective nursing (Brookman, Lovell, Henwood, & Lehmann, 2006; Flemming, 2007; Kronenfeld et al., 2007). Nurses must integrate the best available evidence with their professional experience (Flemming, 2007). However, finding the best clinical evidence (e.g., systematic reviews) using multiple Web sites, research databases, and publications can prove challenging and time consuming (Tod, Bond, Leonard, Gilsenan, & Palfreyman, 2007). In addition, individuals may have trouble evaluating information credibility (McKnight, 2006; Morgan et al., 2007).
By forming partnerships with library and health information professionals, nurses are able to better navigate through evidence-based practice guidelines and relevant clinical research while working in hospitals, private practices, and many other environments outside of the academic arena (Brookman et al., 2006; Guessferd, 2006; Schwing & Coldsmith, 2005). Working with library and health information professionals also enhances the efforts of nursing instructors who teach students to evaluate information and use current treatment practices throughout their careers (Barnard, Nash, & O’Brien, 2005; Butell, O’Donovan, & Taylor, 2004; Cheek et al., 2005; Dee & Stanley, 2005).
In addition, academic nursing departments find close relationships with their libraries useful during accreditation and reaccreditation processes (Burke, 2003). Although general-focus librarians often provide exemplary service in these situations, partnering proves easier if libraries have liaison programs (Macaluso & Petruzzelli, 2005). Liaison librarians generally have professional or educational experience in a specific subject matter so they can better understand the needs of the individuals they serve. For example, a nursing liaison may have practiced as an RN in a previous career or a business liaison may hold a master of business administration (MBA) degree in addition to their master of library science (MLS). Liaisons act as conduits between their library and specific departments or programs within their institution to effect closer relationships between the library and the department or program (Glynn & Wu, 2003; Stoddart, Bryant, Baker, Lee, & Spencer, 2006; Yang, 2000).
With the rapid growth in opportunities for distance nursing education (Nelson, 2007), campus-based library services no longer meet all learners’ needs (Gandhi, 2003). Nelson highlighted the importance of library service to online nursing students:
A quality online education program requires a well designed and well-delivered curriculum, as well as a wide range of student support services. Examples of key student support services include…library services
The number of students furthering their nursing education online should only grow as online education attempts to address nursing shortages (Mancuso-Murphy, 2007), increasing the need for library support.
Despite this need, many library services for distance learners are limited to the virtual realm via online tutorials and self-guided presentations (Green, Wu, & Nollan, 2006; Shaw Morrison & Krishnamurthy, 2008). As evidenced in responses received by Shaw Morrison and Krishnamurthy in their evaluation of an online instruction module, students primarily served through online means desire some in-person research guidance. Searches of the library literature have yielded few examples of librarians providing extensive face-to-face as well as virtual service to distance students (Block, 2007; Richard, 2006).
The Distance Issue
Nursing faculty and librarians at a university in the rural southeastern United States found success by melding traditional face-to-face instruction with methods afforded by telecommunications technologies. By embracing old and new paths of teaching, nursing students at varying education stages can choose methods that work best with their learning styles.
The university’s school of nursing had offered degrees at the bachelor of science in nursing (BSN) level for four decades. The RN-to-BSN completion track began more than two decades ago, and a master’s level family nurse practitioner (FNP) program started at the end of the 1990s. Graduate level programs in nursing education, anesthesia, and administration have since been added.
As the number of programs, and subsequently enrollment, grew, the school of nursing found that not enough clinical sites were available to meet student needs in the rural, mountainous location of the university. Therefore, splitting campuses proved crucial. The school of nursing established a secondary “hub/distance/satellite” presence (referred to as a satellite campus in this description) 50 miles from the university and closer to large urban medical centers. Only junior-year prelicensure students remained at the main university campus.
Coinciding with this split of nursing campuses, the RN-to-BSN completion track began a move to online instruction. Within 5 years, enrollment increased from more than 25 students to more than 100 students in the program annually. Next, the master of science in nursing (MSN) program adopted online instruction. The FNP and certified registered nurse anesthetist (CRNA) track students also took the first year of core masters courses online, adding classroom, laboratory, and clinical courses during the remaining years, whereas the nurse educator track existed completely online. In 2007, total MSN enrollment was more than 85 students annually. Because all MSN students, regardless of their course method, completed a research project or thesis, substantial library resources were needed.
To increase parity of library services between the main and satellite nursing campuses, the liaison librarian assigned to the school of nursing approached leadership within the library and the school of nursing with the idea of regular, onsite reference help at the satellite campus. Both parties agreed. The librarian reapportioned tasks to free 1 day every other week and began onsite services in 2005.
The satellite campus offered an interesting challenge in providing library services. Although students and instructors were not based at the university’s main campus, they did not meet the standard profile of distance students and educators. Although students and faculty at the satellite campus were physically distant from the main campus and its library, these students and instructors were not distant from one another. Many students regularly attended classes at the satellite campus. Unlike satellite campuses to which instructors broadcast lectures via actual satellites, professors at the campus taught at that location, in most cases had offices there, and often lived closer to the satellite campus than to the university’s main campus. The face-to-face structure of the program called for a face-to-face component in library service in addition to existing Web-based help guides and tutorials.
The liaison librarian promoted services by visiting students, faculty, and staff at the satellite campus; sending out e-mails; making posters; and distributing flyers. Instructors at the satellite campus soon began calling on the librarian for help gathering information for courses, conference presentations, and program changes. The librarian helped faculty expand research topics, perform literature reviews, and find avenues for professional publication.
Faculty invited the librarian to class orientations; those initial invitations turned into requests for classroom instruction. The librarian provided one-visit or two-visit sessions on request. Each session covered specific course assignments, such as papers or presentations, and included hands-on instruction whenever computer laboratories could be scheduled. For Web-based courses, instructors often designated the librarian a teaching assistant or class member via course management software. When e-mail and online communication did not fully answer questions, the librarian consulted with students by telephone and in person. Whether conducting independent research or reviewing the literature, students sought assistance in locating study models, pretested questionnaires, and relevant publications.
Client Satisfaction Survey
To assess the effectiveness of specific services to the satellite nursing campus, the librarian surveyed faculty and staff there. Students were not included in this assessment but will likely be the focus of a future survey. Also, the librarian wished to first obtain an accurate picture of the quality of the relationship between program instructors and the university library as this relationship appeared to be directly proportional to student engagement.
The librarian chose a client survey tool (Tennant, Cataldo, Sherwill-Navarro, & Jesano, 2006) that addresses medical faculty perceptions of a library liaison program. After receiving permission from the survey author, the librarian adapted the survey to gather information specific to the satellite campus. The librarian submitted the survey tool and an explanation of methodology to the university’s Institutional Review Board; the research was deemed exempt from further review. The school of nursing’s head also approved the research study. Using the university-supported tool Ultimate Survey, invitations to participate in the online assessment were e-mailed to instructors and program staff at the satellite campus. The first page of the survey functioned as the consent form; participants were required to provide consent to advance.
Twenty-one individuals at the satellite campus were invited to participate in the survey. Fourteen individuals (67%) entered the survey, and 13 (93%) completed it (1 left the survey after answering the first question). Survey questions covered instructor and location status, length of instructor’s service at the distance nursing campus, knowledge of and contact with the library liaison, changes in relationship with the university library, service usage, scheduling, and quality of service.
All respondents (N = 13) knew the librarian assigned to work with them and had contact with her. Regarding the use of onsite librarian services, 7 (54%) respondents stated that they used the services of the librarian often (six or more times per semester) at the satellite campus, whereas 5 (38%) stated that they used the services of the librarian occasionally (three to five times per semester), and just 1 (8%) used the librarian rarely (two or fewer times per semester). When queried about their use of services while the librarian was at the main university campus, 3 (23%) stated they used services often, 7 (54%) occasionally, and 3 (23%) rarely, indicating that use of services carried over between face-to-face and off-site communication. Eighty-five percent of respondents stated the librarian’s visit schedule met their needs. All respondents (N = 13) stated support for continuing onsite services to the satellite campus, and all respondents rated the librarian’s service level as excellent (1 = poor and 5 = excellent).
Lack of retrospective and detailed record keeping presents a barrier to more formal program evaluation. Traditionally, libraries have gathered usage statistics by gate count (i.e., number of individuals entering the library building), circulation of materials (i.e., number of books checked out), print journal usage, instruction sessions offered, and questions asked at the physical reference desk. Although many libraries record numbers of Web page visits, database log-ins, e-mail and instant messages received, and other types of “new” information service, standards for keeping this type of data vary. The library reference staff at the institution in this study have only recently included “off-reference desk” activities in their statistics. E-mail, consultation, and phone statistics have been compiled by the library liaison during the third year of this service to the satellite campus, but without separation by academic program or campus. The recent start of detailed record keeping will provide a baseline to assess program growth.
Costs have remained stable during the 3 years of the program. Monetary expenditures (outside of the librarian’s salary, which remains the same regardless of location) are limited to the rate for use of a state vehicle for commuting between the main campus and the satellite campus. Indirect costs include increased workload on the librarian’s coworkers while she is away and increased workload on the librarian (e.g., making up shifts on the reference desk) when she returns to the main campus. Library administration continues to enthusiastically support the program and considers the program at an acceptable level of cost versus benefit.
Anecdotally, the liaison librarian has seen an increase in the number of face-to-face consultations at the satellite campus after sending reminders of impending visits through the course management software. An increase in student and instructor communications as each semester progresses as individuals gain familiarity with program services has also been noted. More detailed statistics should provide a clearer picture of what interventions work best in advertising the librarian’s services.
As Shaw Morrison and Krishnamurthy (2008) reported, many online students prefer some form of in-person guidance. The addition of a face-to-face component to online library services fits well with the philosophy of most online programs in the school of nursing.
Long-distance education, with students and instructors spread nationally or internationally, is discouraged in the school’s RN-to-BSN track. RN-to-BSN faculty members have found that face-to-face orientations are essential to successful communication. The library liaison usually begins her contact with RN-to-BSN students when she provides instruction on information finding at these orientations.
In addition, nursing faculty and their library support foster close relationships with staff at students’ clinical sites. Faculty members establish professional relationships with clinical coordinators and preceptors while the librarian offers research help to clinical educators. Students benefit from these established relationships that merge their classroom and real-world experiences together.
Relationship building is also vital in the librarian’s work with faculty and graduate students. These individuals often comprise the bulk of the librarian’s face-to-face consultations at the satellite campus. Their research and publication needs can be complex and poorly defined, especially at the start of project planning. An appointment with the liaison librarian provides help in narrowing the scope of a project, finding relevant literature, and locating appropriate professional venues for the publication of results.
Differing professional practices, expectations, and cultures sometimes make nurse educators and librarians feel as though they do not speak the same language. That chasm expands when educators and their students are no longer physically close to the library building. To bridge the gaps in information literacy and lifelong learning, nurse educators, their students, and their librarians must work together and use as many communication formats as needed to accomplish their goals.
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