Developing an evidence-based procedure: maintenance of central venous catheters

Challenging Precedent: Critical Care Nursing and Medical Product Innovation

In this presentation, I will share my unconventional journey, starting from my first job as a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, where I hold a joint position with the Institute for Applied Life Sciences and the College of Nursing. Throughout this journey, I have had many opportunities to participate in interdisciplinary clinical outcomes research and medical product development as a staff nurse, clinical nurse specialist, and project lead from the clinical, industry, and academic perspectives. While passionate about my central clinical research interests in technology innovation and its responsible use in critical and acute care, the foundation of my approach is dedicated to the values and lessons of my earliest experiences in critical care bedside nursing: supporting and preserving the dignity and humanity of person-centered patient care. Early in my career as a critical care nurse, I realized how vitally important a critical care nursing perspective could be in the design of technology for meeting the critical care needs of patients, nurses, and other professionals who provide this care. As the nation's largest group of health care professionals, nurses use more products than any other health care professional, and thus nurses have a uniquely practical and care-sensitive perspective on the development and design of medical products. Nurses, especially critical care nurses, are in a unique position to identify and address everyday health care issues, challenge assumptions and the status quo, address unrecognized and unarticulated needs, and ensure that clinical outcomes research serves as the foundation for validating the effectiveness of medical product innovation. My goal is to share lessons learned and to help participants to see the many different ways that critical care nursing knowledge can be used to improve patient care.

Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach

BACKGROUND AND PURPOSE

Making evidence-based practice (EBP) a sustained reality is a difficult endeavor. This relates, among other factors, to lack of sufficient research upon which to base implementation efforts. Alternative sources of evidence therefore need to be considered, particularly where organizational level EBP is the goal. In this article a brief evaluation of a service-based initiative with the aim of obtaining insights regarding multiple types and levels of EBP-related outcomes is described.

METHODS

A structured, retrospective improvement evaluation was conducted. Semi-structured interviews and available documents were chosen to obtain information regarding outcomes, perceived spread of reported individual changes, and factors related to the degree of progress. Underlying the method is an evaluation model that shows a progressive set of EBP outcomes at both individual and group levels.

FINDINGS

Evaluative results, although limited by several factors, provided credible and sufficient internal evidence for this organization's leadership team to build upon past efforts and refine their approach to integrating research utilization (RU) throughout the department of nursing. For example, the evaluation indicated a set of RU outcomes at the individual nurse level not previously considered and also indicated limitations and challenges to full achievement of initial project-related goals.

DISCUSSION AND IMPLICATIONS

The evaluation provided suggestive internal evidence regarding potential benefits of one component of a long-term, valued EBP initiative. However, the evaluation also raised questions regarding structural aspects of this initiative; identified barriers to progress; provided information for dialogue and planning; and highlighted future needs for a proactive, systematic evaluation and a documented trail of data related to all EBP program goals. For those in settings with similar characteristics and aims that have not built in such a prospective evaluation for EBP initiatives, this evaluative project can be assessed for its applicability.

Effectiveness of a New Flushing and Maintenance Policy Using Peripherally Inserted Central Catheters for Adults

The authors of this article sought to assess the incidence of peripherally inserted central catheter replacements, establish a best practice model, and test the impact of a new flushing and maintenance policy for peripherally inserted central catheters. This quasi-experimental study used historical data and a pre- and post-interventional research design. A new policy was instituted with a new physician order set. After an educational program was introduced and implemented, the peripherally inserted central catheter replacement rate was compared to the preintervention replacement rates. The peripherally inserted central catheter replacement rate declined by 2% immediately after the educational intervention.

The Ottawa Model of Research Use: a guide to clinical innovation in the NICU

PURPOSE/OBJECTIVES

To improve performance of a neonatal transport team by implementing a research-based family assessment instrument. Objectives included providing a structure for evaluating families and fostering the healthcare relationship.

BACKGROUND/RATIONALE

Neonatal transports are associated with family crises. Transport teams require a comprehensive framework to accurately assess family responses to adversity and tools to guide their practice toward parental mastery of the event. Currently, there are no assessment tools that merge family nursing expertise with neonatal transport.

DESCRIPTION OF THE PROJECT

A family assessment tool grounded in contemporary family nursing theory and research was developed by a clinical nurse specialist. The Ottawa Model of Research Use guided the process of piloting the innovation with members of a transport team. Focus groups, interviews, and surveys were conducted to create profiles of barriers and facilitators to research use by team members. Tailored research transfer strategies were enacted based on the profile results.

OUTCOME

Formative evaluations demonstrated improvements in team members' perceptions of their knowledge, family centeredness, and ability to assess and intervene with families. The family assessment tool is currently being incorporated into Clinical Practice Guidelines for Transport and thus will be considered standard care.

CONCLUSION

Use of a family assessment tool is an effective way of appraising families and addressing suffering. The Ottawa Model of Research Use provided a framework for implementing the clinical innovation.

IMPLICATIONS FOR NURSING PRACTICE

A key role of the clinical nurse specialist is to influence nursing practice by fostering research use by practitioners. When developing and implementing a clinical innovation, input from end users and consumers is pivotal. Incorporating the innovation into a practice guideline provides a structure to imbed research evidence into practice.

Applying Evidence-based Practice

This article describes the importance of using evidence-based practice. It suggests ways to identify practices that should be evidence based and establishes a framework for implementing this practice.

Updating the Stetler Model of research utilization to facilitate evidence-based practice

The evidence-based practice movement raises questions about the continuing viability of research utilization models. This manuscript describes the updated, practitioner-oriented Stetler Model. First developed in 1976 with Marram, it was refined in 1994 with conceptual underpinnings and a set of assumptions. The model has been further refined on the basis of a related utilization-focused integrative review methodology, targeted evidence concepts, and continuing experience through use of the model with clinical nurse specialists. The revised model continues to focus on a series of judgmental activities about the appropriateness, desirability, feasibility, and manner of using research findings in an individual's or group's practice.