[The local adaptation of clinical practice guidelines]

The ADAPTE process is a systematic approach to adapting guidelines produced in one setting for use in a different cultural and organizational context. It ensures that the guideline addresses specific health questions relevant to the context, accounting for the needs, priorities, legislation, policies, and resources in the targeted setting. The ADAPTE process was developed to meet the needs of different user groups, including guideline developers, health care providers, and policy makers at the local, national, and international level. The process is flexible; the transparent and explicit reporting enhances the quality and validity of the adapted guideline. The ADAPTE process is briefly described.

Postoperative Ileus

Postoperative ileus (POI) is a possible complication after abdominal surgery. The exact pathophysiology is unknown. Nurses should be aware of associated symptoms and evidence-based treatments to prevent or reduce the time of POI.

NASN's first evidence-based clinical guidelines: asthma

Evidence-based clinical guidelines assist health care providers to ensure best practices. The National Association of School Nurses (NASN) has developed the organization's first evidence-based clinical guidelines to assist school nurses to practice at their highest level and in response to a direct request by members. This guideline focuses on asthma; more guidelines will follow. This article provides an overview identifying why clinical guidelines are important, how the guidelines were developed, and guidance to school nurses on how to interpret and use the guidelines.

Improving the adoption of evidence-based practice through RN-to-BSN education

BACKGROUND

Although enrollment in RN-to-BSN degree completion programs has grown profoundly, a dearth of literature exists regarding the impact of RN-to-BSN education and the adoption of evidence-based practice (EBP). This study examined the elements of RN-to-BSN education that improve the awareness and adoption for EBP.

METHOD

A mixed methods meta-synthesis was conducted using qualitative, textual-narrative, and descriptive research studies. Data from six articles were analyzed, using standardized critical appraisal instruments.

RESULTS

Two findings were identified. First, EBP skills for RN-to-BSN students are influenced by exposure to educational partnerships, contextual teaching and learning, and practice experiences. Second, barriers to adoption exist for RN-to-BSN students, which limit advances in nursing practice.

CONCLUSION

A variety of contextual teaching and learning strategies can provide empowerment for RN-to-BSN students to adopt EBP in their practice. Forming partnerships in creating EBP experiences may set the stage for RN-to-BSN leadership opportunities in today's health care system.

Peripheral intravenous catheter protection: are we using best practice?

Evidence-based practice guidelines support the use of peripheral intravenous catheter-stabilizing technologies to improve clinical outcomes and decrease overall cost. Unscheduled catheter restarts can cause complications, delay therapies, and increase risk to health care providers, while prolonging hospitalizations. This article highlights examples of the latest innovative solutions that can improve peripheral intravenous catheter protection and stabilization.

Best practices for creating social presence and caring behaviors online

AIM

To identify best practices and evidence-based strategies for creating an online learning environment that encompasses caring behaviors and promotes social presence.

BACKGROUND

Faculty who teach online classes are challenged to create a sense of social presence and caring behaviors in a virtual world in which students feel connected and part of the learning environment.

METHOD

To extrapolate evidence to support best practices, a review of literature was conducted focused on social presence and caring online.

RESULTS

Faculty messages that are respectful, positive, encouraging, timely, and frequent foster social presence and caring behaviors while also allowing for caring interactions, mutual respect, and finding meaning in relationships.

CONCLUSION

A variety of measures to emulate caring online intertwine with social presence to promote a sense of caring and belonging. More research is needed to support the evidence for these strategies.

Are community nurses prepared for wound debridement?

Debridement is an essential component of wound care. However, autolysis remains a frequently used method of debridement, despite recent recommendations from the European Wound Management Association and the National Institute for Health and Care Excellence. Community nurses are recognised as front-line clinicians participating in debridement interventions. It is essential that community nurses are able to deliver the most appropriate debridement method regardless of their current skill set. This will require community nurses to revisit the evidence base for debridement, reflect on their current methods of debridement and expand their skill set when required. Guidance exists to ensure community nurses are able to offer appropriate and safe debridement to clients with non-viable tissue which is delaying the wound healing process.

Factors influencing critical care nurses' adoption of the AACN practice alert on verification of feeding tube placement

BACKGROUND

Clinical practice guidelines are intended to bridge the research-practice gap, yet little is known about how critical care nurses adopt guidelines. Feeding tube verification practices remain variable and have led to patient harm and death.

OBJECTIVES

To examine factors influencing critical care nurses' adoption of the American Association of Critical-Care Nurses (AACN) practice alert on verification of feeding tube placement and its 4 recommended clinical practices.

METHODS

Critical care nurses were invited to participate in a national, online questionnaire, guided by Rogers' diffusion of innovation framework. Descriptive statistics and logistic regression were used for data analysis. Alpha level was set at 0.05.

RESULTS

Fifty-five percent of the 370 participating nurses were aware of the practice alert, and 45% had adopted it in practice. Only 29% of the adopters had also implemented all 4 clinical practices. Significant predictors of adoption included BSN or higher nursing education and guideline characteristics of observability and trialability. Predictors of implementation of the clinical practices included staff nurse/charge nurse role, academic medical center, research/web-based information sources, and perception of a policy. Policy was the only significant predictor of implementation of all 4 practices. Adoption of the practice alert was also a predictor for 2 of 4 clinical practices.

CONCLUSIONS

Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.

Gaps in nurse staffng and nursing home resident needs

Trends in nurse staffing levels in nursing homes from 1997 to 2011 varied across the category of nurse and the type of nursing home. The gaps found in this study are important to consider because nurses may become overworked and this may negatively affect the quality of services and jeopardize resident safety. Nursing home administrators should consider improving staffing strategically. Staffing should be based not only on the number of resident days, but also allocated according to particular resident needs. As the demand for nursing home care grows, bridging the gap between nurse staffing and resident nursing care needs will be especially important in light of the evidence linking nurse staffing to the quality of nursing home care. Until more efficient nursing care delivery exits, there may be no other way to safeguard quality except to increase nurse staffing in nursing homes.

The impact of evidence-based practice in nursing and the next big ideas

The impact of evidence-based practice (EBP) has echoed across nursing practice, education, and science. The call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient. In line with multiple direction-setting recommendations from national experts, nurses have responded to launch initiatives that maximize the valuable contributions that nurses have made, can make, and will make, to fully deliver on the promise of EBP. Such initiatives include practice adoption; education and curricular realignment; model and theory development; scientific engagement in the new fields of research; and development of a national research network to study improvement. This article briefly describes the EBP movement and considers some of the impact of EBP on nursing practice, models and frameworks, education, and research. The article concludes with discussion of the next big ideas in EBP, based on two federal initiatives, and considers opportunities and challenges as EBP continues to support other exciting new thinking in healthcare.