Posts Tagged ‘evidence-based practice’

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Study Clarifies How Staff Nurses Use Research in Practice

September 5, 2014

By Sylvia Foley, AJN senior editor

Most health care professionals agree that it’s important to apply research findings to real-life practice. Indeed, several studies have shown that nurses place a high value on doing just that. Yet numerous barriers continue to prevent or hamper the implementation of evidence-based practice (EBP).

Table 4. ‘Of the tools available to you at work and/or home, which tools do you use?’

Table 4. ‘Of the tools available to you at work and/or home, which tools do you use?’

To learn more, Linda Yoder and colleagues surveyed nearly 800 staff nurses in an acute care multihospital system. They sought to determine the extent to which these RNs used research findings in their practice; what types of knowledge they used; and what personal, professional, and organizational factors enhanced or hindered their use of research. In one of this month’s two CE features, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” Yoder and colleagues report on their findings. Here’s a short summary.

Methods: A cross-sectional, descriptive, online survey design was used. The survey, which asked about use of research findings in practice and EBP participation, was placed on the hospital system intranet.
Results: The forms of knowledge that staff nurses reported relying on most were their personal experience with patients, conferences, hospital policies and procedures, physician colleagues, and nursing peers. Although a variety of resources were available for help in locating research and implementing EBP, respondents reported many of the same barriers that have been reported in other studies: lack of time, lack of resources, and lack of knowledge. Although their attitudes about research utilization and EBP were positive overall, respondents expected unit-based educators and clinical nurse specialists to collect and synthesize the research for them.
Conclusions: These findings are similar to those of other recent studies in this area. A great deal of work remains to be done if we are to inform, educate, and assist staff nurses in using research and implementing EBP. It may be unrealistic to expect bedside nurses to add these activities to their duties unless they are compensated for the time and have the support of master’s- or doctorally prepared nurses to serve as EBP coaches and champions.

The bigger picture. In closing, Yoder and colleagues call for a kind of climate change, stating, “We believe, as do others, that nurse leaders, managers, and educators have a responsibility to create a culture that supports EBP and research utilization.”

For more details, read the article, which is free online. And please weigh in and share your own experiences!


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AJN’s September Issue: Anaphylaxis at School, Central Line Care, EBP, More

August 29, 2014

SeptemberAJN’s September issue is now available on our Web site. Here’s a selection of what not to miss.

It’s back-to-school time, and on our cover this month is a photo of Head Start nursing supervisor Travia Williams weighing a student in the program’s classroom at Cocoa High School in Brevard County, Florida. The program provides enrolled children with screening, physicals, and other health care services.

According to the National Association of School Nurses, a third of all school districts in the United States have reduced nursing staff and a quarter don’t have any nurses at all. Yet there is the potential for more emergencies in school now than ever, with school nurses treating increasingly complex medical conditions and chronic illnesses. For more on the important role school nurses play in handling these health emergencies, see the In Our Community article, “Emergency Anaphylaxis at School.” And don’t miss a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Applying EBP to Practice. Despite the recognized importance of evidence-based practice (EBP), there continues to be a gap between the emergence of research findings and their application to practice. In this month’s original research article, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” the authors used an online survey to determine to what extent RNs in an acute care multihospital system used research findings in their practice. Several barriers to such use were revealed, including lack of time and resources. This CE feature offers 3 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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How a Busy Hospital Reduced Its Rate of Hospital-Acquired Pressure Ulcers to Zero

August 8, 2014

By Sylvia Foley, AJN senior editor

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

In 2009, when one of the world’s largest cardiac care hospitals experienced a spike in the number of surgeries performed and a corresponding rise in hospital-acquired pressure ulcers, many people were concerned. The hospital—Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India—soon initiated a program to address the problem, and nursing superintendent Rohini Paul was tasked with designing and implementing effective preventive strategies. In this month’s CE feature, “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment,” Paul and colleagues describe what happened next. Here’s a brief overview.

Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers.
By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program’s success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U.S. acute care environments.

The authors emphasize the importance of “absolute transparency and personal accountability” in ensuring the program’s sustained success. As one senior nurse said, “It was the personal responsibility that started making a difference. Now everybody’s aware, everybody’s cooperative and on their toes, and we have no skin ulcers.”

For more details, read the article, which is free online. And please share your experiences and insights with us below.

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AJN’s March Issue: New Series on Systematic Reviews, HIV Update, C. Diff on the Rise, Sexual Assault, More

February 28, 2014

AJN0314.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Advances in HIV testing and treatment. The photo on our cover, showing members of  Sexy With A Goal (SWAG), a program provided for lesbian, gay, bisexual, and transgender individuals affected by HIV and AIDS by the AIDS Service Center of New York City’s Lower East Side Peer Outreach Center, reflects the changing face of the AIDs epidemic. Thirty years ago, a diagnosis of HIV was tantamount to a death sentence. But the young men on our cover prove that this is no longer the case. With advances in treatment and patient advocacy, education, and support, HIV is now a chronic, manageable disease. A CE feature, “Nursing in the Fourth Decade of the HIV Epidemic,” discusses HIV epidemiology and policy in the United States, the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic.

If you’re reading AJN on your iPad, you can watch a video describing one author’s early experience with an HIV-infected patient by tapping on the podcast icon on the first page. The video is also available on our Web site. A

New option for victims of sexual assault. Until recently, survivors of sexual assault were not entitled to a free medical forensic examination unless they reported the assault to law enforcement. The authors of “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option,” March’s original research CE, studied the implementation of the new nonreport option, exploring its impact on survivors, the criminal justice system, and sexual assault nurse examiners. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New series on systematic reviews. Since the advent of evidence-based practice in health care, nurses and other clinicians have been expected to rely on research evidence to inform their decisions. But how does one uncover all the evidence relevant to a question? “Systematic Reviews, Step by Step: The Systematic Review: An Overview,” the first article in a new series from the Joanna Briggs Institute, provides a synopsis of the systematic review as a scientific exercise, and introduces nurses to the steps involved in conducting one. Read the rest of this entry ?

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AJN’s Top 15 Most Viewed Articles in 2013

January 24, 2014
by rosmary/via Flickr

by rosmary/via Flickr

We thought readers might be interested in seeing which articles and topics got the most page views in 2013. Many of these articles are open access, including a number of CE articles as well as the articles from our Evidence-Based Practice: Step by Step series. Some articles require an AJN subscription or individual article purchase. Several of the articles in this list were from recent years other than 2013; a couple were much older, but are evidently still relevant, since not every idea in nursing is ephemeral or subject to improvement by the next generation.—Jacob Molyneux, senior editor

1. “Asking the Clinical Question: A Key Step in Evidence-Based Practice” – (March, 2010) – part of AJN‘s EBP series

2. “Improving Communication Among Nurses, Patients, and Physicians” – (November, 2009)

3. “The Seven Steps of Evidence-Based Practice” – (January, 2010) – part of our EBP series

4. “Nurses and the Affordable Care Act” – (September, 2010)

5. “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” – (December, 1984; not HTML version; readers must click through to PDF version)

6. “COPD Exacerbations” – (CE article; February, 2013)

7. “Therapeutic Hypothermia After Cardiac Arrest” – (CE; July, 2012)

8. “From Novice to Expert” – (March, 1982; article looks at stages to mastery; no html version, so click the PDF link on the landing page)

9. “Men in Nursing” – (CE; January, 2013)

10. “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections” – (June, 2013) – part of EBP series Read the rest of this entry ?

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Tightly Scripted: One NP’s Experience with Retail Clinics

November 1, 2013

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Retail health clinics (walk-in clinics that are in a retail setting such as a drugstore or discount department store)KarenRoush have become an effective mode of providing increased access to care for many people and a growing source of employment for nurse practitioners (NPs). Their place in the health care arena may take on even more significance as the Affordable Care Act (ACA) increases access to care for previously uninsured people.

I worked as an NP in a retail clinic for about six months while working on my PhD. I left because of concerns I had about the model of practice. It didn’t have to do with the fact that I had to mop the floor at closing time or collect the fees and cash out the “drawer” every night. Nor because I spent eight hours alone in a small windowless room tucked away in the back of a drugstore. Those aspects were not great, but they weren’t deal breakers.

What was a deal breaker was the rigid programming of my practice. The computer was in control. From the moment the patient checked in at the kiosk outside my door, every action was determined by the computer.

The organization I worked for prided itself on following evidence-based practice, but someone forgot to tell them that the patient’s history, presentation, and personal experience, as well as a clinician’s expert knowledge, are also part of the evidence. And as much as they insisted the programming was guided by evidence, it was clearly also guided by what would result in the highest level billing code.

From the moment I entered the chief complaint in the computer, it directed me on what to include in the history and what to do for the exam. The problem was that unless I filled out all the information, I couldn’t go on to the next screen. Say I have a feverish four-year-old with tonsillitis, screaming in her mother’s arms, and the computer insists I take her blood pressure. Why? Because there is strong evidence that strep throat is associated with pediatric cardiovascular disease? Nope. It’s because the more systems you include in your exam, the higher the billing code. As a result, I find myself struggling to take an unnecessary blood pressure, causing unnecessary distress for a sick toddler. But unless I put a value in the box asking for the blood pressure, I can’t proceed with the exam. Read the rest of this entry ?

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The 10 Most Popular Articles on AJN Right Now

October 11, 2013
From boliston, via Flickr

From boliston, via Flickr

The 10 current “most viewed” AJN articles are below. Sometimes we’re surprised by the ones that go to the top of this list. At other times, the high interest in the article makes perfect sense. Most of these articles are currently free, either because they are CE articles or because they are shorter opinion pieces or the like. We hope you’ll have a look.—Jacob Molyneux, senior editor

“The Care of Pregnant Women in the Criminal Justice System” 

CE article. Overview: Current practices in the treatment and transfer of pregnant inmates in this country may negatively affect maternal and fetal health or well-being. Some violate federal or state laws; others conflict with standards of obstetric care and are widely considered unethical or inhumane. This article discusses these practices; their legal status; and implications for nursing practice, policy, and research.

“Developing a Vital Sign Alert System”

CE. Overview: This article describes the implementation of a nurse-designed, automated system for enhancing patient monitoring on medical–surgical and step-down nursing units. The system . . . was found to substantially reduce out-of-unit codes without increasing nurses’ workload.

“Mouth Care to Reduce Ventilator-Associated Pneumonia”

CE. Overview: Despite the well-established association between good oral hygiene and the prevention of VAP, the importance of mouth care in infection control is seldom recognized. The authors discuss the pathophysiology of VAP and why oral care is crucial to its prevention. They also provide an evidence-based, step-by-step guide to providing optimal oral care for intubated patients.

“Decreasing Patient Agitation Using Individualized Therapeutic Activities”

CE. Overview: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated “sitters.” These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. . . .

“Loneliness and Quality of Life in Chronically Ill Rural Older Adults” 

Original Research CE. Overview: Background: Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality. Objectives: A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. . . .

“Evidence-Based Practice: Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice”

Free. Part of AJN‘s evidence-based practice (EBP) series. Excerpt: “A spirit of inquiry is the foundation of EBP, and once nurses possess it, it’s easier to take the next step—to ask the clinical question. Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes.” Read the rest of this entry ?

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