The Online Journal of Clinical Innovations

Special Section: Online Journal Publication

This article is one of a group of articles written in response to a call to online journal editors for manuscripts describing the evolution of their online journal.

Introduction

A critical issue for the discipline of nursing is how to apply information gained from research in practice. This issue is so important, in fact, that some link the survival of the profession with the ability to "establish the clinical significance of our research and consequently our practice" (Estabrooks & Hodgins, 1996). The transfer of knowledge has always been crucial, but in today‘s managed care environment, with its emphasis on containing cost while maintaining quality, nurses must have access to knowledge and practice innovations, not only to improve costs and quality, but also to improve outcomes(Donaldson & Rutledge, 1998). Knowledge innovations may emerge not only from research, but also from quality improvement initiatives, published clinical anecdotes, conference presentations and proceedings, continuing education, and collegial exchanges.

Over the past two decades, numerous efforts have been undertaken to develop methods of transferring knowledge into practice (Crane, 1985; Haller, Reynolds, & Horsley, 1979; King, Barnard, & Hoehn, 1981; Rutledge & Donaldson, 1995). Common barriers to research utilization, such as lack of time to read and inability to access research reports, prevent nurses from integrating new research findings and applying them to their practice (Bostrom & Wise, 1994; Brett, 1987; Champion & Leach, 1989; Coyle & Sokop, 1990; Funk, Champagne, Tornquist, & Wiese, 1995; Funk, Tornquist, & Champagne, 1995).

The Online Journal of Clinical Innovations (OJCI) (www.cinahl.com/cexpress/ojcionline3/index.html) and the corresponding CINAHL Clinical Innovations Database were developed to reduce time/access barriers by providing accessible, systematic, integrative reviews of practice-related knowledge. The focus of the OJCI is on harvesting new knowledge for transfer into practice to drive clinical innovations - new solutions or practices that solve problems - and make them accessible to nurses in varied roles and diverse settings.

History of the OJCI to Target Audience

Two sets of circumstances in the nursing community converged to stimulate the development of the OJCIin 1998. The first was nursing administrators and clinical leaders voicing the need for full-text content related to specific clinical problems, such as fall risk assessment and prevention. The librarian staff of Cinahl Information Systems confirmed that they were repeatedly performing literature searches in response to staff and patron requests for content related to specific clinical problems. Abstracts of articles found in bibliographic database searches did not contain enough helpful information to guide practice. Thus, additional time and effort were required to access print journals and obtain full articles. The results of these frequently requested searches were not disseminated widely in any useful format. Secondly, two nurse researchers completed a research utilization project that demonstrated the need for a clinical innovations bibliography and practice implications database to expedite the harvest and transfer of new knowledge to practice (Rutledge & Donaldson, 1995).

Initially, our focus was to develop the CINAHL® Clinical Innovations Database (CCID) and create a file of extensive abstracts that would be part of the CINAHL® database. We hoped that these documents would be helpful to clinical nursing staff in translating new research-based knowledge into practice. A universal issue in health care - fall prevention - was selected and the process of reviewing the literature was begun. Soon after we began summarizing the vast amount of literature and exploring other information resources, published and unpublished, we realized that the amount of information was far too extensive even for an expanded abstract. The only solution seemed to be a Web-based journal that could accommodate the large manuscripts.

But a journal alone would not meet the need for solutions to clinically focused problems in a more easily accessible and readily usable format. So we decided to use both Web and database technology. The OJCI articles could provide extensive systematic reviews of literature of manageable size on the Web, while shorter summaries of the reviews would become part of the CINAHL database labeled "Clinical Innovations." The summaries would be searchable and retrievable like any other citation in the database but would contain background information from the OJCI articles as well as key implications for practice. Although they would be shorter in length, perhaps 4-7 pages long, they would still be substantive enough to be helpful.

Thus, a searcher with a practice question (e.g., what is a particular patient‘s risk of falling?) could search the CINAHL database and find not only citations of the literature available, but also a CCID record that would provide important information from the OJCI article. When time permitted, the searcher could access and read the full article from the OJCI that might be more than 30 pages long.

The manuscripts, which include tabular presentations of the literature highlighting the strength of the evidence and alerting the clinician to key implications for practice, are quite lengthy - often 30-40 pages or more. A unique feature of the OJCI is the corresponding link to the summary in the CINAHL database that includes enough useful information to assist in planning care.

The target audience for OJCI articles and CCID includes clinicians and researchers. Clinicians may find useful answers to immediate practice-related questions in the CCID, with more in-depth information available if needed from the OJCI. Researchers can use the OJCI systematic reviews as state of the science or, more appropriately, state of the knowledge or state of the evidence papers, because they cover a wide range of resources - material published in both traditional and nontraditional sources.

OJCI Staff

Cinahl Information Systems, which publishes the Cumulative Index to Nursing & Allied Health Literature® print index and the CINAHL database, also publishes the OJCI. Diane Pravikoff, RN, PhD, Cinahl‘s director of research, serves as the OJCI‘s Managing Editor, editing all articles and writing many of the summaries for the database. By recommendation of the editorial staff, Nancy Donaldson, RN, DNSc, and Dana Rutledge, RN, PhD, are co-editors of the OJCI. During the formative years, they were principal authors of the manuscripts, refining the knowledge syntheses methods, format and content for future authors. The editorial board consists of nine members selected for their both academic and clinical expertise, and is committed to the goal of advancing research and knowledge utilization.

Format of the OJCI

The first issue of the OJCI appeared in June 1998. The publishing schedule is "irregular", with issues appearing as the manuscripts are completed. The goal is to publish a minimum of four articles annually. Articles can be published as soon as the editorial and review processes have been completed. Each article is given a number, similar to an issue number in print journals, so that it is retrievable. For example, the articles and editorials in the 1998 volume, which was Volume I, were numbered 1 through 9 (6 articles and 3 editorials). The Cinahl Information Systems webmaster is key to the process of publishing and this position requires knowledge of the latest technology to improve the OJCI‘s features.

OJCI articles are published as Portable Document Format (PDF) files to ensure stability of the content. PDF files require Adobe Acrobat Reader, a web browser enhancement software, to view, read, or print the articles. The software is available for downloading free of charge at the Adobe Acrobat website (www.adobe.com).

Individual articles can be purchased as either a result of a search of the CINAHL database or perusal of the OJCI itself. Articles can be requested via e-mail through the CINAHLexpressSM document delivery service on the CINAHL website (www.cinahl.com) or through DOCLINE®, the automated interlibrary loan request routing and referral system operated by the National Library of Medicine. Subscriptions are available for individual as well as institutional (single or multiuser) purchase.

Copyright Issues

As with most print journals, the copyright for all articles and summaries for the OJCI is held by the publisher, Cinahl Information Systems. Permission to include any materials within the manuscripts in which others hold copyright is carefully obtained.

Archiving

All issues of the OJCI are currently maintained on the CINAHL website, and subscribers have access to all previously published articles along with those published subsequent to their subscription. Technical support is available through Cinahl Information Systems.

Editorial/Publishing Issues/Peer Review

In the early strategic development of the OJCI, several focus groups met to determine the feasibility of the overall concept of the OJCI. These focus groups, consisting of librarians, advanced practice nurses, staff nurses, nursing administrators, and faculty members, decided that the OJCI would be topic-driven. A list of topics was created and prioritized by indexers and librarians (based on what was reflected in current literature) and clinicians and healthcare professionals (based on their needs) and served as the basis for the subsequent development of manuscripts. A formal infrastructure and format for each manuscript and for each summary was developed to ensure consistency in manuscript development and publication.

Expert authors have been solicited to submit manuscripts using OJCI‘s approved format. The editorial board and the foremost subject matter experts review each manuscript. The manuscripts are then revised based on reviewers‘ comments, suggestions, or issues of concern. If additional reviewers are needed, they are sought and contacted. The manuscripts published on pain assessment and disease management, for example, originally began as single documents. However, in each case, after initial review, the documents were expanded into several different related manuscripts each with a more specific focus. Therefore, expert peer reviewers were sought who were knowledgeable in the more specific area. Topics in manuscripts published to date include: Readability of print materials for patient education; pain assessment and documentation for various groups (overview of adults, special populations of adults, and pediatrics); fall risk assessment and prevention; principles of effective adult-focused patient education; patient education in disease and symptom management in asthma; arthritis and diabetes; and caring for families of patients in acute and chronic health care settings. Upcoming topics include developmental care of the neonate, protection of skin integrity and end-of-life issues.

Reader Responses

The OJCI has received very positive anecdotal feedback from readers, including clinicians, researchers, and faculty members. Additional topics, expansion of existing topics, and other possible uses for the manuscripts have been suggested by these readers. The fall risk assessment article, for example, has been used as part of a fall risk assessment and outcomes measurement initiative developed by the American Nurses Association/California (ANA/C) and the California Nursing Outcomes Coalition (CalNOC) with copies distributed to over 50 California hospitals. While there is no way to determine the number of searchers who have accessed or read the CCID summaries because of their presence within the CINAHL database, the number of individuals requesting or downloading copies of the full articles has slowly but steadily increased.

Summary

The Online Journal of Clinical Innovations is a unique approach to both dissemination of information as the basis for evidence-based practice and "packaging" the information to optimize its utilization and diffusion in clinical practice. The need for dissemination of knowledge regarding nursing practice and the new computer technology with World Wide Web access have led to the development of the Online Journal of Clinical Innovations and the CINAHL Clinical Innovations Database. This pairing of bibliographic database and electronic journal provides easy access to systematic reviews of the literature that examine both qualitative and quantitative data as well as other types of evidence concerning issues of critical importance to the profession of nursing. Making information of this type easier to access should assist in dissemination and utilization of new knowledge for practice.

Authors

Diane S. Pravikoff, RN, PhD
Email: Dpravikoff@cinahl.com

Diane Pravikoff received her BSN and MSN from California State University, Los Angeles, and a PhD in Nursing from the University of California, San Francisco. She is currently Director of Research for Cinahl Information Systems in Glendale, California, the publisher of the CINAHL Database and the Online Journal of Clinical Innovations. She became particularly interested in informatics, information access, and information literacy while involved in her doctoral research and has made these the focus of her professional life.

Nancy E. Donaldson, RN, DNSc
Email: Nancy.Donaldson@nursing.ucsf.edu

Nancy Donaldson is Director, UCSF Stanford Center for Research & Innovation in Patient Care and Associate Dean for Practice, UCSF School of Nursing. She received her BSN and MSN from California State University, Los Angeles, and her DNSc from the University of California, San Francisco. Since 1996, Donaldson has served as founding Co-Editor of Cinahl‘s Online Journal Clinical Innovation. A professional activist, Donaldson is currently ANA\California Project Director and Co-Principal Investigator for the California Nursing Outcomes Coalition Project (CalNOC), an unprecedented collaborative effort to establish a statewide nursing quality outcomes research and public policy repository. CalNOC is the largest ongoing nursing quality measurement database project in the nation.