Nurse Practitioners: Do they value library resources like MDs or like RNs? Bridget Faricy-Beredo, RN, MLIS University of Toledo October 12, 2014

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1 Nurse Practitioners: Do they value library resources like MDs or like RNs? Bridget Faricy-Beredo, RN, MLIS University of Toledo October 12, 2014

2 Background: The Value Study (VS) An effort to replicate the notable Rochester study (Marshall, 1992) linking library use to clinical decisionmaking Like the original, results are a descriptive synthesis of qualitative data MUCH LARGER - 56 library sites serving 118 hospitals, 16,122 respondents vs. 208 Commitment to open access and open data, encouragement Sponsored by NL/LM, MidAtlantic region with funding from NLM, NIH, DHHS (Marshall, et al., 2013)

3 My interest: Nurse Practitioners Nurse practitioners (NPs) are an emerging group of providers, 171,000 nationally in 2013 (AANP, 2014) Duality of NP practice (serving both selected nursing and physician roles) Paucity of library research with NPs creates challenge in designing services The Value Study collected data from 598 NPs, ~3% of all NPs nationally NPs represented in the data but not discussed in the main survey results

4 Value Study Measures Measuring Value 1. Value themes: Quality of information Cognitive value Contribution to patient care Time saved 2. Related positive events 3. Negative events avoided 4. Ranked importance of information sources

5 Value Themes: Quality of information Cognitive value Contribution to patient care Time Saved Each of the first 3 categories were measured by 3 subquestions (9 total measures) NPs led the positive responses in 6 out of 9 measures* 7 out of 9 measures showed little variation (± 1%) 2 measures showed larger variation (+ 3-4%) o Information contributed to a better informed clinical decision* o Information provided new knowledge* o NPs led in both Resident Physician Time Saved in Hours Nurse NP Stand. Dev. ± hours Minutes saved showed little variation minutes. NPs did not lead.

6 Related Positive Events Meta/Categorical question: Did you handle the situation differently?* Did the following change in a positive way? 1. Change diagnosis 2. Change choice of test* 3. Change choice of drugs 4. Change other treatments* 5. Change length of stay (reduce) 6. Change post-hospital treatment 7. Change advice given* NPs led affirmative responses in the meta question and 3 of 7 categories * In general, little variation: <2% Two categories had greater variation o Choice of test*, 2-3% o Advice given*, 2-6% o NPs led in both NPs did not lead for change of diagnosis, drugs, LOS, posthospital treatment.

7 Negative Events Avoided 1. Hospital admission* 2. Hospital readmission* 3. Patient mortality* 4. Language/cultural misunderstanding* 5. Patient misunderstanding of disease* 6. Hospital acquired infection* 7. Surgery 8. Regulatory non-compliance 9. Additional tests or procedures* 10. Medication error* 11. Misdiagnosis NPs led with affirmative responses in 8 of 11 categories * In general, little variation: <2% One category had greater variation: o Avoided Patient Misunderstanding of Disease* 3-4% variation Did not lead in Surgery, Regulatory non-compliance, and Misdiagnosis Recent work found the strongest predictor for all nurses of avoiding an adverse event was being an NP (Marshall, et al., 2014)

8 Importance of the information received from the information resources ~3% ~46% Nurse NP Resident Physician 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

9 Conclusion Healthcare providers in general did not show great variation. However, when NPs acted distinctly, they do not act like RNs or MDs. They acted like themselves! o Though slight, there is a consistent trend of NPs leading positive responses across the board that did not track with another profession 19 of the 30 measures investigated (63%) Limitations: this descriptive comparison of qualitative data. Statistical significance was not investigated What does that mean for us? This is a group who appear to uniquely value the information and services we provide

10 References American Association of Nurse Practitioners. (2014). NP Fact Sheet. Retrieved August 27, 2014, from Dunn, K., Brewer, K., Marshall, J. G., & Sollenberger, J. (2009). Measuring the value and impact of health sciences libraries: planning an update and replication of the Rochester Study. Journal Of The Medical Library Association: JMLA, 97(4), doi: / Marshall, J. G. (1992). The impact of the hospital library on clinical decision making: the Rochester study. Bulletin of the Medical Library Association, 80(2), Marshall, J. G., Morgan, J. C., Klem, M. L., Thompson, C. A., & Wells, A. L. (2014). The Value of Library and Information Services in Nursing and Patient Care. Online Journal of Issues in Nursing, 19(3), 1-1. doi: /OJIN.Vol198No03PPT02 Marshall, J. G., Sollenberger, J., Easterby-Gannett, S., Morgan, L. K., Klem, M. L., Cavanaugh, S. K.,... Hunter, S. (2013). The value of library and information services in patient care: results of a multisite study. Journal Of The Medical Library Association: JMLA, 101(1), doi: /

11 Suggested Reading: NPs & Libraries Adams, A., Adams, R., Thorogood, M., & Buckingham, C. (2007). Barriers to the use of e-health technology in nurse practitioner-patient consultations. Informatics in Primary Care, 15(2), Al-Ghabeesh, S. H., Abu-Moghli, F., Salsali, M., & Saleh, M. (2013). Exploring sources of knowledge utilized in practice among Jordanian registered nurses. J Eval Clin Pract, 19(5), doi: /j x Andrews, J. E., Pearce, K. A., Ireson, C., & Love, M. M. (2005). Information-seeking behaviors of practitioners in a primary care practice-based research network (PBRN). Journal of the Medical Library Association, 93(2), Bartlett, J. C., & Marshall, J. G. (2013). The Value of Library and Information Services in Patient Care: Canadian Results From an International Multisite Study. Journal of the Canadian Health Libraries Association (JCHLA), 34(3), doi: /c Cogdill, K. W. (2003). Information needs and information seeking in primary care: a study of nurse practitioners. Journal of the Medical Library Association, 91(2), 203. Garrett, B., & Klein, G. (2008). Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses. Journal of Clinical Nursing, 17(16), doi: /j x Gorman, P. N., Yao, P., & Seshadri, V. (2004). Finding the answers in primary care: information seeking by rural and nonrural clinicians. Studies In Health Technology And Informatics, 107(Pt 2), Gschwandtner, T., Kaiser, K., & Miksch, S. (2011). Information requisition is the core of guideline-based medical care: which information is needed for whom? J Eval Clin Pract, 17(4), doi: /j x Hersh, W. R., Crabtree, M. K., Hickam, D. H., Sacherek, L., Rose, L., & Friedman, C. P. (2000). Factors associated with successful answering of clinical questions using an information retrieval system. Bulletin of the Medical Library Association, 88(4), Hunt, S., Cimino, J. J., & Koziol, D. E. (2013). A comparison of clinicians' access to online knowledge resources using two types of information retrieval applications in an academic hospital setting. Journal Of The Medical Library Association: JMLA, 101(1), doi: / Johnson, H. L., Fontelo, P., Olsen, C. H., Jones, M. A. J. K. D., & Gimbel, R. W. (2013). Family nurse practitioner student perception of journal abstract usefulness in clinical decision making: A randomized controlled trial. Journal of the American Association of Nurse Practitioners, 25(11), doi: / Kannampallil, T. G., Jones, L. K., Patel, V. L., Buchman, T. G., & Franklin, A. (2014). Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings. Journal Of The American Medical Informatics Association: JAMIA. Murphy, A. L., Fleming, M., Martin-Misener, R., Sketris, I. S., MacCara, M., & Gass, D. (2006). Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature. BMC Nursing, 5, Shams, M.-L. A. (2006). Mapping the literature of nurse practitioners. Journal of the Medical Library Association, 94, E-114-E-121. Tanner, A. B. (2000). Readiness for evidence-based practice: information literacy needs of nurses in a southern United States state. (Ed.D.), Northwestern State University of Louisiana. Westbrook, J. I., Coiera, E. W., & Gosling, A. S. (2005). Do online information retrieval systems help experienced clinicians answer clinical questions? Journal Of The American Medical Informatics Association: JAMIA, 12(3),

12 Acknowledgements Thanks to my UT colleagues Jodi Jameson, Wade Lee, Jolene Miller and Gerald Natal for their inspiration, encouragement and assistance. Thank you to JoAnne Gard Marshall, Jennifer Craft Morgan and colleagues for their commitment to open access and legacy of scholarship. Thank you to my mom, Karen Faricy a nurse s nurse who is now an NP s NP.