Posts Tagged ‘evidence-based practice’

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AJN Collections of Note: From Women’s Health Issues to Assessment Tools for Older Adults

May 18, 2015

By Jacob Molyneux, senior editor

'Nuff Said by ElektraCute / Elektra Noelani Fisher, via Flickr.

Elektra Noelani Fisher/ Flickr

It’s easy to miss, but there’s a tab at the top of the AJN home page that will take you to our collections page. There you can delve more deeply into a wide range of topics—and find many options for obtaining continuing education credits in the process.

For example, you’ll find a collection of recent continuing education (CE) feature articles devoted to women’s health issues, such as menopausal hormone therapy, cardiovascular disease prevention for women, and issues faced by young women who are BRCA positive.

The patient population in the U.S. continues to age. To gain confidence in meeting the needs of these patients, nurses can consult our practical collection of articles and videos devoted to the use of evidence-based geriatric assessment tools and best practices.

For the more creative side of nursing, we have a collection of 20 visual works and poems from our Art of Nursing column.

For those concerned with potential legal issues, it’s a good idea to have a look at the three CE articles from our Legal Clinic column on protecting your nursing license.

For would-be authors and those interested in applying knowledge to practice more effectively, there are step-by-step series on conducting a systematic review and on how nurses can implement evidence-based practice at their institutions. Read the rest of this entry ?

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Cochrane Reviews: An Oft-Overlooked Evidence Source for Nurses at the Bedside

May 1, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

“Research holding the torch of knowledge” (1896) by Olin Levi Warner. Library of Congress, Thomas Jefferson Building, Washington, D.C./Photo by Carol Highsmith, via Wikipedia

Long ago, in an ICU far away, I picked up the habit of saying, during rounds, “Well, you know, research suggests the practice…” I have trouble remembering who taught me this tactic, but it has always been a highly effective way of advocating for my patients.

The eyes of doctors, never ones to be silenced by a nurse who reads research, usually light up at the challenge.

I’ll admit that, for a while, many of my conversational citations came from ‘clinical pearls’ or tidbits I read from certifying organizations via social media. While my knowledge was based on credible sources, my analysis was topical, at best.

Then I started graduate school. Although my program isn’t a clinical one, the need to seek out evidence for class assignments intensified my practice of trying to apply research evidence at the bedside.

It’s tricky to find and discuss credible research as a bedside nurse. Services like Lexicomp and UpToDate, which most hospitals hold subscriptions to, compile current research for clinician use and provide comprehensive information that’s far more credible than Wikipedia. But they’re exhaustive and often require a pretty hefty chunk of time to really analyze and understand. Printing out a 37-page document to hand to an attending on rounds isn’t a practice I’d recommend.

So how do we get reliable, evidence-based information efficiently when it’s needed? It wasn’t until deep into grad school that I started to realize that Cochrane Reviews were sometimes the best bedside research translator out there. The Cochrane Collaboration is an international, nonprofit organization that performs systematic reviews on peer-reviewed journal articles. The reviews are considered, by my professors at least, often the best form of evidence. Short summaries and abstracts are free to all users and are easy to find via PubMed and print. (Full access is subscription based, at least in the U.S.)

‘Sedation vacations': yes, no, maybe? A topic I’ve always loved to use my research line on is the practice of ‘sedation vacations.’ When patients are deathly ill and ventilated, their lives depend on the use of sedatives. However, studies have linked lengthy use of sedative agents to serious complications—drug bioaccumulation, postextubation delirium, decreased quality of life, and adverse events, to name a few. Hence, the daily sedation vacation was born.

Most ICUs these days require a daily sedation vacation for intubated, sedated patients. There’s little doubt that patients are often oversedated, and the practice of pausing the sedation to see if they wake up and then readjusting their sedation according to policy can cut excess use. Some units allow nurses to perform the practice without input from an attending physician. Others rely on a case-by-case method. I’ve worked in both, and in both have said the words, “You know, research calls for daily sedation vacations, and this patient meets the criteria. Should I move forward?”

In most such instances, a sedation vacation was authorized for the patient, and sometimes a discussion of current practices was stimulated by my reference to research. I’d always thought that sedation vacations were a validated, proven, evidence-based practice, and had always advocated for them when my patients met clinical criteria. Read the rest of this entry ?

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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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