Navigating the evidence-based practice maze

Strategies to promote practice nurse capacity to deliver evidence-based care

Purpose

– Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice.

Design/methodology/approach

– A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare – namely, a clinical aide and online training.

Findings

– The perceived impact of both resources was determined by views on relevance and design – particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues.

Research limitations/implications

– This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare.

Practical implications

– Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited.

Originality/value

– Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial

BACKGROUND

On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses' responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses' knowledge.

METHODS/DESIGN

A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial's completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis.

RESULTS

Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses' knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2).

CONCLUSIONS

A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses' knowledge, but not nurses' responses to patients who triggered the MEWS reporting algorithm.

TRIAL REGISTRATION

This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545 ) on 9 September 2013.

Supporting the use of evidence in community nursing: a national strategic approach

While there is an acceptance across all stakeholders that nursing practice should be informed by evidence, there is a substantial literature on the challenges this creates for nurses in the delivery of services. These challenges are accentuated for nurses in community settings, where accessible, up-to-date research evidence is more problematic because of the decentralised organisation and delivery of these services. Recognising this gap, and the consequent needs of its members, the Institute of Community Health Nursing (ICHN) in Ireland has commenced a national strategic development in this area. The purpose of the strategy is to actively support and facilitate public health and community nurses to provide services to individuals, families and communities that are based on the best available research evidence. This article provides a brief overview of the development and key components of the ICHN strategy.

Monitoring vital signs using early warning scoring systems: a review of the literature

AIM

To evaluate the need for, and the development and utility of, pen-and-paper (Modified) Early Warning Scoring (MEWS/EWS) systems for adult inpatients outside critical care and emergency departments, by reviewing published literature.

BACKGROUND

Serious adverse events can be prevented by recognizing and responding to early signs of clinical and physiological deterioration.

EVALUATION

Of 534 papers reporting MEWS/EWS systems for adult inpatients identified, 14 contained useable data on development and utility of MEWS/EWS systems. Systems without aggregate weighted scores were excluded.

KEY ISSUES

MEWS/EWS systems facilitate recognition of abnormal physiological parameters in deteriorating patients, but have limitations. There is no single validated scoring tool across diagnoses. Evidence of prospective validation of MEWS/EWS systems is limited; neither is implementation based on clinical trials. There is no evidence that implementation of Westernized MEWS/EWS systems is appropriate in resource-poor locations.

CONCLUSIONS

Better monitoring implies better care, but there is a paucity of data on the validation, implementation, evaluation and clinical testing of vital signs' monitoring systems in general wards.

IMPLICATIONS FOR NURSING MANAGEMENT

Recording vital signs is not enough. Patient safety continues to depend on nurses' clinical judgment of deterioration. Resources are needed to validate and evaluate MEWS/EWS systems in context.

The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis

BACKGROUND

Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice.

OBJECTIVES

The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000-2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored.

DESIGN

Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000-2006.

METHODS

The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn.

RESULTS

The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy.

CONCLUSIONS

Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant.