Posts Tagged ‘Nursing research’


Noise in the ICU: Terminology, Health Effects, Reduction Strategies, and What We Don’t Know

May 16, 2014

By Jacob Molyneux, AJN senior editor

Noise isolation headphones to use in loud environments

via Wikimedia Commons

I woke up this morning, as I do every morning now, to the sound of pile driving at a large construction site a block and half away on the Gowanus Canal. It shakes the earth and reminds me of the forges of evil Sauron in one of the Lord of the Rings movies. I once had a dog lose a good bit of hair when there was a pile driver for several months in the lot behind another apartment in Brooklyn.

The negative physical and emotional effects of excessive noise get an occasional mention lately in health reporting, but in New York City or along the remotest forest lane, the forces of quiet can seem to be in rapid retreat before an army of leaf blowers, all-terrain vehicles, diabolically amped-up motorcycles, huge TV sets, garbage trucks, helicopters, and the like.

Lest I sound like a total crank (I do have useful noise-cancelling headphones plus an Android app that offers such choices as white noise, brown noise, burbling creek, steady rain, crickets, and soothing wave sounds), there’s a reason for the preamble. Florence Nightingale herself called unnecessary noise “the most cruel absence of care which can be inflicted either on sick or well,” as is pointed out by the University of Washington researchers who wrote the latest installment of our column Critical Analysis, Critical Care.

“Noise in the ICU” looks at current research about the health effects of noise in the ICU, provides useful definitions of the terminology used when talking about sound levels, and considers strategies for reducing noise, as well as what still needs more study. The article will be free for a month (until June 15), so give it a look and see if it gets you thinking. After all, to quote the article again, “Studies have found that sound levels in the ICU continue to exceed WHO recommendations.”

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Need Help Writing Systematic Reviews?

March 10, 2014

By Shawn Kennedy, AJN editor-in-chief

CaptureAs I explain in this month’s editorial, we’ve seen an increase in submissions, especially literature reviews, many from students in doctoral programs and from clinicians in organizations pursuing Magnet status. Many purport to be systematic reviews but lack many of the defining features, such as detail about search strategies or real synthesis of the results. This lack of knowledge around writing scholarly works reflects poorly on us as a profession.

We are very pleased to be collaborating with the Joanna Briggs Institute, the Australia-based group (they are at the University of Adelaide) with an expertise in appraising and synthesizing research and facilitating its dissemination and use. We launch a new series, Systematic Reviews, Step By Step, in the March issue. As our Evidence-Based Practice, Step-By-Step series does for applying evidence-based practice, this series presents a clear, progressive plan for writing a systematic review in several monthly installments. Read the rest of this entry ?


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 ?


AJN 2013 Book of the Year Awards: Winners in 19 Categories

January 8, 2014

AJN 2013 Book of the Year Awards 

BOTYSince 1969, AJN has been announcing its annual list of the best in nursing publishing. The most valuable texts of each year are chosen by AJN’s panel of judges. Only books published between August of the prior year and August of the award year are eligible. To quote AJN‘s editor-in-chief Shawn Kennedy, our Book of the Year awards, announced each year in our January issue, “are sought after by authors and publishers . . . the awards give us the opportunity to acknowledge high-quality publications.”

Below you can find the 2013 first-place winner for each of the 19 categories. To see a listing of all winners (there are 2nd and 3rd place winners for each category as well), please click this link. Read the rest of this entry ?


‘My Professor Said to Submit My Paper’ (We Hope They Also Told You This)

February 22, 2013

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

When we get a manuscript submission, I always read the cover letter first to learn about the author and why the article was written. Often, the first sentence goes something like this: “I am a student and I’m submitting my capstone paper as required by my professor.” Or the letter may say, “My professor encouraged me to submit this paper, my capstone work.”

The paper is usually the very paper the student wrote and submitted to the professor. And that almost always means it’s not suitable for a professional journal.

The problem is not that we won’t consider manuscripts written by students—we sometimes welcome them, especially papers written by nurses who are experienced clinicians and working toward a graduate degree. The problem with the submissions I’m talking about here is inherent in the purpose of the papers themselves. Student papers are written primarily to demonstrate what the student knows about a subject; these papers tend to be expansive, cover the topic in a superficial way, and include a long list of references of books, articles, and Web sites (or, conversely, they may only have a few references, mostly Web sites, plus perhaps one much-cited textbook—thankfully, few are citing Wikipedia).

Student papers that describe themselves as “literature reviews” often have no information about the search strategy—and little synthesis. Instead, they contain a long list of various studies related to the topic, with no real discussion of key findings or filtering of the information for relevance. Student  papers tend to cover what most nurses in practice already know. Writing them may help a student get a good overview of what’s known about a specific clinical topic or issue, but this doesn’t mean the papers should necessarily be published.

Articles written for professional journals have a different purpose. These articles, properly done, should be written with the reader in mind, presenting new information the reader needs to know or that provokes the reader to think about something in a different way. The reader should come away with new knowledge or a new perspective.

There are many good reasons that faculty should encourage students to write. For one, we need nurses at all levels to write about their work, and not enough of them do so. And the responsibility for nursing’s scholarly work cannot rest solely with academics and researchers; clinicians have the firsthand knowledge about care processes and outcomes, and they need to document their work. They need to communicate to the public about what it is that they do so that nurses’ work becomes more visible; they need to communicate to colleagues about what works and what doesn’t so that we can replicate successful quality improvement initiatives.

But in encouraging students to write, faculty members need to give the correct messages.

Here’s what faculty might tell students:

  1. Go to the journal’s Web site and review several articles similar to what you want to write. Note the tone, level of detail, sourcing. Search the journal to see if it recently published articles on a topic similar to what you want to write. Send a query letter to determine whether your topic is of interest.
  2. Review the submission guidelines. Pay special attention to the instructions for authors and to how to format the paper and the references. This isn’t just an academic exercise, but is necessary so that references appear correctly and are verifiable in online databases. Also keep in mind that many journals run software to detect plagiarism, and the results can be inaccurate if the software reads the references as part of the body of the manuscript because they are improperly formatted.
  3. Write the manuscript using the information you learned when preparing your capstone paper or thesis as a starting point. All information is not equal. Be selective. Perhaps include a case study, and focus on what’s new or important for nurses to know. In addition, write to the audience that makes up the readership of the journal. Use active voice; avoid jargon. If there’s a word limit, honor it.
  4. Be sure to use primary sources when providing citations to support facts. Ask the librarian to help you find the correct sources.
  5. Spell-check your article before you send it. Read it aloud. Ask a colleague to read it.

We often suggest that new authors invite a colleague or faculty member who has published in a peer-reviewed journal to be a coauthor. And perhaps faculty should rethink requiring all students to submit papers and instead only encourage those students whose papers go beyond competence and add to our knowledge or understanding of a topic. We want students to want to write, and their first experience with publishing shouldn’t be one in which they have little chance of success.

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Nursing Research: Alive and Well

September 17, 2012

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

Last week I spent two-and-a-half days in Washington, DC, where there are LOTS of campaign collectibles. My favorite: coffee mugs proclaiming “Friends Don’t Let Friends Vote [insert Democratic or Republican).” Also noteworthy: “Hot for Mitt” and “Hot for Barack” hot sauce (see photos). I was there attending the meeting of the Council for the Advancement of Nursing Science (CANS), where close to 1,000 nursing researchers met to share their work. It wasn’t too long ago that one would have been hard-pressed to find that many nurses doing research. The National Institute of Nursing Research (NINR) only celebrated its 25th anniversary in 2010 (see our 2010 article about their many accomplishments).

Creativity and innovation. Kathi Mooney, PhD, RN, FAAN, from the University of Utah College of Nursing, gave the keynote—and it was perfectly suited to this group, many of whose members are immersed in analytical thought and scientific methodology. Mooney talked about the importance of creativity and innovation in moving research forward—yes, applying scientific rigor to identifying knowledge gaps and building on known research is critical, but she urged attendees to step back occasionally and be open to other ways of thinking.

To do that, she said, one must create time for reflection and thinking. She also encouraged deans and faculty to foster environments that support creativity, where there’s freedom to explore non-mainstream thinking, risk taking is encouraged, and there’s time for social interaction and informal encounters.

Posters and symposiums and podium presentations filled the rest of the schedule. The presentations were akin to speed dating—researchers had less than 15 minutes to present the highlights of their work. I’m sure for those presenting and those involved in the particular area of research, it might have been frustrating, but for someone like me seeking what’s new and compelling across many areas, it was an ideal format. As one presenter said, “It’s like being a detective on Dragnet, that old TV show, where the lead detective would say, ‘Just give me the facts, please.’”

Some takeaways for me:

Creative thinking involves reframing problems and tasks (one example from Mooney: does the stone cutter see his job as cutting large chunks of stone, or as being part of a team that’s building a cathedral).

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Legacy of the Living Legends: Slackers Need Not Apply

October 27, 2011

By Shawn Kennedy, editor-in-chief

Earlier this month, I attended the American Academy of Nursing 38th Annual Meeting and Conference. With e-mails flooding my inbox and a full meeting agenda over the next few days, I was thinking of skipping the 2011 Living Legends event that took place on the first evening. Thankfully, an old friend, nurse historian Sandy Lewinson, talked me into going—it was one of the more memorable nursing events I’ve attended.

The academy honors “Living Legends” in recognition of the multiple contributions these nurses have made to the profession and the impact these contributions have made on health care in the United States and abroad. This year’s honorees are shown in the photo, from left: May L. Wykle, Meridean L. Maas, Ada Sue Hinshaw, Suzanne Lee Feetham, and Patricia E. Benner.

Credited with such achievements as creating a nursing taxonomy on nursing error, building the science of pediatric nursing in the context of the family, conducting ground-breaking nursing research, developing and implementing professional nurse governance in employing organizations, promoting policy change, and addressing the nursing shortage, these nurses join 77 other nursing notables who’ve been so honored since the first class was named in 1994. Read the rest of this entry ?


Toward a Less Painful Death: ICD Deactivation at End of Life

October 14, 2011

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

Lightning by snowpeak, via Flickr

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So it’s essential for providers and patients to talk about the possibility of deactivation, well in advance of such crises.

Russo, the coordinator of the pacemaker clinic at the Department of Veterans Affairs Medical Center in New York City, wanted to better understand why providers and patients weren’t discussing this possibility and to find ways to promote more timely discussions. Read the rest of this entry ?


Killing Traditional Nursing Duties #3 – NPO after Midnight

October 11, 2011
fasting Buddha/ via Wikipedia Commons

By Shawn Kennedy, editor-in-chief

In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post called “Killing Traditional Nursing Duties #1.” We did another post on the answers to our second question, “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)?” This also got many comments in response.

Our last question was this:Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Here’s some of the comments we received on the blog:

My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before?

…most of the younger anesthesiologists/CRNA’s allowed BLACK COFFEE to be drunk right up until time  of surgery. No dairy or sugar in it, obviously.

The facility that I work for does routinely follow ‘nothing by mouth’ after midnight guidelines. If the patient  is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable and will change the orders, writing NPO after midnight with the exception of clear liquids.

Responses on Facebook, however, showed a stricter adherence to the traditional no eating or drinking after midnight before surgery; it was fairly unanimous that institutions still follow this ancient practice (though one person did ask, “What’s npo?”!).

Well, it’s clear that this month’s CE article by Jeannette Crenshaw is sorely needed. “Preoperative Fasting: Will the Evidence Ever Be Put into Practice?” addresses the fact that despite 25 years of evidence and standards showing that NPO after midnight is not good practice, it is still used in most hospitals and preoperative practices. The evidence support clear liquids up to a few hours before surgery, and many groups have endorsed carbohydrate-rich beverages along with clear liquids up to a few hours before surgery.

So read Crenshaw’s article and disseminate it to your colleagues and clinical practice committees—practice changes should be based on evidence, and for this, the evidence is clear.

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So What? An Invitation to Nurses To Tell Us How They’re Translating Research into Practice

June 17, 2011

By Inge B. Corless, PhD, RN, FAAN, professor at the MGH Institute of Health Professions, Boston, and Brian Goodroad, DNP, RN, AACRN, nurse practitioner and associate professor at Metropolitan State University in Minneapolis–St. Paul, Minnesota

by centralasian/via Flickr

Crossing the Quality Chasm, an Institute of Medicine report from 2001, bemoans the chasm between our current research knowledge and the current state of care. Back in 2003, Don Berwick, now the Administrator of the Centers for Medicare and Medicaid Services, provided the following pithy codification of the problem in a JAMA article called “Disseminating Innovations in Health Care” (subscription required; click here for the abstract): “Failing to use available science is costly and harmful; it leads to overuse of unhelpful care, underuse of effective care, and errors in execution.” Berwick pondered the slow pace of innovation adoption and attributed it to three factors:

  • the characteristics of the innovation
  • the characteristics of the potential adopters
  • contextual factors

Berwick also made this observation about innovations that do get adopted: “Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all.”

Given these obstacles, what can be done to facilitate the integration of research findings into practice? What can be done to change this situation, and what would this entail?

One step is to share our knowledge and our successes in making changes, along with the obstacles to doing so. We invite nurses to identify research that has changed or somehow influenced their practice and to share their experiences with us for potential publication on this blog. We’re not asking for formal academic work here; what’s we’d like is simple, brief (one to five paragraphs) summary description in your own voice. Briefly describe the study and its findings, as you understand them—and then describe how the findings were integrated into practice and any outcomes (whether they were formally measured or anecdotally reported). Read the rest of this entry ?


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