Posts Tagged ‘evidence-based practice’

« Newer Entries
h1

Entering the Mainstream? Nursing Research at 25 Years

October 4, 2010
Logo of the United States National Institute o...

Image via Wikipedia

By Shawn Kennedy, AJN interim editor-in-chief

Last Thursday the National Institute of Nursing Research (NINR) held its kick-off event to celebrate its 25th anniversary—and what could be more appropriate than holding a research symposium at the National Institutes of Health (NIH)? Scientists and researchers (nurses as well as others) whose work is supported by the NINR presented highlights of their research. (See here for synopses.)

Why it matters to all nurses. All nurses, researchers or not, should celebrate the growth and accomplishments of the NINR—its establishment provided tangible recognition of the value of the substantial body of research conducted by and/or about the nursing profession. As practitioners, where would we be without research to provide the evidence underlying care interventions or the processes of delivering that care? With the October issue, AJN highlights the NINR’s silver anniversary: on the cover, with a guest editorial by NINR director Patricia Grady, and with a timeline highlighting key milestones and landmark research supported by the NINR (click through to the PDF version to read this article). To give you an idea why nursing research matters, here’s just one entry on the timeline, from 1998:

Nancy Bergstrom, PhD, RN, FAAN, in a multisite study, tests the Braden Scale for Predicting Pressure Sore Risk and finds its predictive capability accurate. The scale is now widely used in nursing homes and hospitals.

AJN’s role in dissemination. What’s critical, though is that the outcomes of research get disseminated to those at the point of care. Researchers tend to publish in research journals, but how many nurses in clinical practice read those journals? As a general nursing journal with a wide readership, AJN covers the “broad view” of what’s important for most nurses regardless of practice setting or role. It’s our mission “to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research . . . .”

So on this 25th anniversary of the NINR, my hope for the next decade (we can’t wait another 25 years) is that nursing research will move more and more into mainstream clinical journals.

Bookmark and Share

Posted in nursing innovations, nursing perspective, nursing research, professional identity, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 1 Comment »

h1

After the Angels: In Search of A ‘Knowledge-Based’ Professional Identity

September 14, 2010

If you’re looking for angels, you’ve come to the wrong place. So says GuitarGirlRN in her latest blog post.

One stereotype of nursing (and it’s perpetuated by nurses as well as by those not in the medical or nursing fields) that bothers me is that of nurses as “angels of mercy.”

We’re expected to smile while up to our elbows in bloody shit and vomit, be pleasant to rude and sometimes violent people, put up with crap from doctors, managers, patients, their families, nurse techs, and janitors yet keep our cool, never cry, never sweat, never lose our tempers with each other, always be prepared and be right there when we are needed.

by shioshvili/via Flickr

Her point is that nurses are human; they do the best they can with scant resources, but they aren’t superhuman. They aren’t saints, they have lives of their own, and they can’t always be all things to all people. Back in 2005, noted author Suzanne Gordon wrote, with Sioban Nelson, an article for us called “An End to Angels.” In it, they presented the idea that nursing is a profession with a serious image problem, one that undercuts recruitment efforts and ill prepares new nurses for the reality of their work. The arguments in the article are subtle and thought provoking, and impossible to summarize. Here, anyway, is the introduction:

Nurses often disagree on the causes of and possible solutions to the current nursing shortage. Mandatory staffing ratios versus Magnet hospitals? Sign-on bonuses for nurses versus more unionization of RNs? The aging of the nursing workforce versus working conditions? Still, most nurses agree that the profession needs a contemporary image to attract new recruits and reinforce the idea that nursing is a profession grounded in science, technology, and knowledge. To present a modern image and solve the crisis, dozens of different groups have produced advertising campaigns and promotional messages to attract new recruits to the profession.

A close analysis of the words and images used in these campaigns reveals that, instead of creating a modern, accurate version of today’s nurse, many simply repackage nursing’s traditional stereotype of women born to be good, kind, and self-sacrificing-not educated to provide care based on science and practical skill. Although many studies-conducted by nursing, medical, and public health researchers-have documented the links between nursing care and lower rates of nosocomial infections, falls, pressure ulcers, deep-vein thrombosis, pulmonary embolism, and death, most promotional campaigns are conspicuous for their failure to promote these data. Even when ads feature a mix of men, women, and minorities, what is often communicated is a sexist, archaic message: nursing is virtuous work.

The subtitle of Gordon and Nelson’s article is “moving away from the ‘virtue script’ toward a knowledge-based identity for nurses.” So, five years on, how is the nursing profession doing with this? Do you feel you have a “knowledge-based” professional identity? Is that how patients, physicians, nursing instructors, administrators, your friends and family, and the general public see you?—JM, senior editor

Bookmark and Share

Posted in healing/holistic, media depictions of nursing, nursing perspective, nursing shortage, patient perspective, professional identity | Tagged , , | 4 Comments »

h1

An Evidence-Based Look at the ‘Unvoiced Symptom’: Fecal Incontinence

September 7, 2010

Public toilet by Looking Glass / Fernando de Sousa, via Flickr

First, a confession: initially the subject of this month’s CE, fecal incontinence, seemed so daunting that we considered lighter titles (“Don’t Pooh-Pooh Fecal Incontinence,” for one). But we decided against going that route, because we didn’t want to minimize the condition’s importance or its life-altering effects. Indeed, fecal incontinence has been called the “unvoiced symptom,” one so embarrassing that sufferers often fail to tell their health care providers about it—and one that many providers never ask about.

Fecal incontinence has been defined as the “involuntary loss of liquid or solid stool that is a social or hygienic problem.” As authors Donna Zimmaro Bliss and Christine Norton report, possible causes include cognitive or physical disability, impaired sensory or motor function, poor coordination of defecation processes, and loose stool consistency; in some cases the cause may be multifactorial or idiopathic. Although studies of nursing home residents have found prevalence rates of more than 40%, the condition is by no means limited to elderly or disabled people.

Quality-of-life issues. Bliss and Norton provide an overview of fecal incontinence and describe what the research thus far has revealed about its impact on patients’ quality of life. Read the rest of this entry ?

Posted in continuing education, home care nursing, practice tips | Tagged , , , | Leave a Comment »

h1

Searching for the Evidence? AJN Series Demystifies EBP

July 21, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Trying to get evidence-based practice (EBP) implemented in your hospital or nursing home? Running into problems or just not quite sure how to proceed? Well, AJN has the answer.


EBP should be the basis for any clinical practice. Since last November, AJN has published a series of articles by the faculty at Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Articles are published every other month and are designed to take the reader, step-by-step, towards implementing EBP. The current article describes the beginning steps to appraising the evidence; or go here to read the first article and follow in sequence.

Listen to a podcast with series leaders Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, and Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, the authors of Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. And we’ll have a second “Ask the Authors” call in November (check our home page for details after November 1).

If you’ve had problems or hit snags on your journey to EBP, e-mail me (shawn.kennedy@wolterskluwer.com) so we can address these issues on our next call.

Bookmark and Share

Posted in Uncategorized | Tagged , , | Leave a Comment »

h1

Tech, EBP Buzzwords Among Nurse Researchers

July 19, 2010

By Shawn Kennedy, AJN interim editor-in-chief

As a lover of history, especially nursing history, I’ve been following Sue Hassmiller’s posts retracing the steps of Florence Nightingale with great interest and a bit of envy.

Well I went on a trip, too—to Sigma Theta Tau International’s 21st International Nursing Research Congress in Orlando. I was astounded by the truly international aspect of the meeting—many meetings say they are international if there’s a few hardy travelers from abroad, but there were many presenters, poster presenters and attendees from outside the United States.

What AHRQ does. Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), was the good choice for keynote. She shared some interesting data—like the fact that AHRQ is the leading funder of patient safety research in hospital and ambulatory care, or that the U.S leads the world in rates of hysterectomy. (While our rates are comparable with other countries for hysterectomy for endometrial cancer, they are “all over the map” for hysterectomy for noncancer diagnoses.) She also spoke about the agency’s research priorities—patient safety and quality of care, comparative effectiveness research, and reducing disparities in access to care for minorities and women (she acknowledged that “lack of health insurance is the biggest barrier”).

If there was a catchphrase from this conference, it was “evidence-based practice”—how to do it, teach it, evaluate it, and use it to transform practice, education, leadership style, and workplaces.

Using technology—virtual technology, simulation, social media, and Web technology—was another major theme, and presenters focused on how to integrate technology into current practice and educational settings. Sessions focusing on these topics seemed to be the best attended. Read the rest of this entry ?

Posted in international nursing, nursing perspective, nursing research, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | Leave a Comment »

h1

Déjà Vu All Over Again: Internal Uterine Contraction Monitoring Another Case of Practice Without Evidence

February 4, 2010

by mahalie, via Flickr

By Shawn Kennedy, MA, RN, interim editor-in-chief

Last week, the New England Journal of Medicine (NEJM) reported (abstract available here) on a Dutch multi-center randomized trial comparing internal versus external monitoring of uterine contractions during induced labor on rate of cesarean or instrument delivery. Among secondary outcomes they examined were use of analgesia, oxytocin and antibiotics, adverse neonatal effects, and complications from the intrauterine catheter (hemorrhage, sepsis, among others).

What caught my eye was the first sentence of the paper, which read, “The monitoring of uterine contractions by means of internal tocodynamometry during induction or augmentation of labor is advocated by professional societies in obstetrics and gynecology.” Yet, as this study points out, there has been little data to support the societies’ recommendation for internal monitoring. And, lo and behold, the results of this trial “do not support the routine use of internal tocodynamometry for monitoring  contractions in women with induced or augmented labor.”

This reminds me very much of electronic fetal monitoring. Read the rest of this entry ?

Posted in children's health, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 1 Comment »

h1

If You Think ‘Evidence-Based Practice’ Is Just Another Buzzword, Think Again

November 24, 2009

Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients’ sleep, which is important for restorative healing, to document blood pressure and pulse rate because it’s hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications.

So begins an article in the November issue of AJN, the first in a new series we are running to highlight the way’s evidence-based practice (EBP) changes what nurses do at the bedside—and saves lives. The authors point out that every day nurses perform dozens of actions and procedures without ever really asking whether the way they are doing them is the best way, or whether or not they are even helping patients by performing these actions.

While it’s true that no one will ever get anything done if it’s not possible to take certain basics of patient care on faith, it’s also true that much of what gets done is simply not supported by the available research. EBP is not just another buzzword useful for administrators who want to sound up-to-date and want to harass you with in-service training; EBP is quickly being acknowledged as the force that will drive meaningful health care reform, simultaneously improving patient care as it lowers costs. The authors have this to say:

The Institute of Medicine has set a goal that by 2020, 90% of all health care decisions in the United States will be evidence based, but the majority of nurses are still not consistently implementing EBP [evidence-based practie] in their clinical settings.

You can read the article here. But tell us: what practices, minor or major, are you unsure about when it comes to their cost or their true efficacy? And is your hospital applying EBP to change any of these practices? Are you?

Bookmark and Share

Posted in health care reform, nursing innovations, nursing perspective, nursing research, practice tips | Tagged , , , , | Leave a Comment »

« Newer Entries
Follow

Get every new post delivered to your Inbox.

Join 291 other followers