Posts Tagged ‘nursing research’
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 ?
Posted in nurses, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged American Academy of Nursing, Living Legends, nurse, nursing research | 2 Comments »
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 ?
Posted in audio interviews, continuing education, ethical issues, nurses, nursing research, pain control, palliative care, patient perspective | Tagged end of life care, ICD deactivation, implantable cardioverter-debrillator, nursing research, pain management, systematic review | Leave a Comment »
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.
Posted in nursing perspective, nursing research, Shawn Kennedy, AJN editor-in-chief | Tagged Evidence-based medicine, NPO after midnight, nursing research, obsolete nursing practices | Leave a Comment »
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 ?
Posted in nursing innovations, nursing perspective, nursing research | Tagged Amelia Peabody, Crossing the Quality Chasm, Donald Berwick, evidence-based practice, Institute of Medicine, nursing research, quality improvement | 2 Comments »
June 7, 2011
By Sylvia Foley, AJN senior editor
In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.
Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?
Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged hepatitis C outbreak, infection control, Nevada whistleblower protection law, nursing research, patient safety, public health, Texas whistleblowers | 2 Comments »
May 25, 2011
By Sylvia Foley, AJN senior editor
There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)
But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.
The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:
- Nearly three-quarters of the respondents had participated in a MET call.
- The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
- But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?
Posted in continuing education, nurses, nursing perspective, nursing research, patient safety | Tagged evidence-based practice, medical emergency teams, MET, nursing research, patient safety, rapid response teams | 1 Comment »
April 1, 2011
By Sylvia Foley, AJN senior editor
The fork and the spoon, by Jordan Fischer via Flickr
Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:
People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.
In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. Read the rest of this entry ?
Posted in continuing education, nurses, nursing research, palliative care, practice tips | Tagged dementia, feeding difficulties, malnutrition, nursing research | 1 Comment »
October 4, 2010
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.
Posted in nursing innovations, nursing perspective, nursing research, professional identity, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged AJN, evidence-based practice, National Institute of Nursing Research, NINR, nursing research | 1 Comment »
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 AHQR, evidence-based practice, nursing research, virtual learning | Leave a Comment »
June 7, 2010
By Shawn Kennedy, AJN interim editor-in-chief
Pasig River, Manila, Philippines, by ibarra_svd / Bar Fabella, via Flickr
A significant number of foreign-educated nurses (FENs) come to the United States each year to work; although the exact number is unknown, consider that in 2009 alone, more than 14,000 FENs passed the NCLEX exam for licensure to practice here. Many come because they’ve been actively recruited by firms acting as agents for hospitals and nursing homes; others come on their own. Some are recruited from developing countries that, because of severe internal nursing shortages, can ill afford to send qualified nurses abroad. And some FENs learn that what they expected—or were led to expect—doesn’t match what they actually find when they arrive.
In the June issue of AJN, you’ll find a comprehensive study examining the international nurse recruitment business, an industry that’s gone through rapid growth in the last decade. Supported by a grant from the John D. and Catherine T. MacArthur Foundation, Patricia M. Pittman and colleagues conducted interviews with industry executives and focus groups with FENs. Read the rest of this entry ?
Posted in advocacy/political action, ethical issues, international nursing, nursing perspective, nursing research, nursing shortage, nursing students, Shawn Kennedy, AJN editor-in-chief | Tagged international nurse recruitment, nurses, nursing research, recruitment industry, voluntary code of ethics, WHO | 4 Comments »
