Paving the way: stepping stones to evidence-based nursing

Research nurse or nurse researcher: How much value is placed on research undertaken by nurses?

The argument for evidence-based nursing practice informed by research has placed nursing research capacity-building firmly on the agenda. Despite the recognition of the need for sustainable sources of funding, the emphasis has remained on NHS R&D undertaken by doctor, supported by other professions such as nurses. Indeed, it is common for nurses to be employed in the role of research assistant or data collector, under the supervision of a doctor. The titles ‘Research Nurse’ and ‘Nurse Researcher’ are used interchangeably and this paper highlights the distinction between the two, the requirements of their posts, reasons why nurses may become involved in research and the difficulties that this may entail. We draw attention to the expectations of the research training that first-level nurses receive, the assumption that it results in them being research competent, and the implications for the status of nursing research. Investment in research capacity-building needs to be reflected in the organisation and infrastructure of academic departments and NHS trusts. Joint, long-term educator/practitioner/researcher appointees are required to facilitate the nurseorientated research necessary to inform the increasing demands on practice. If the practice of nursing, midwifery and health visiting is to be underpinned by a scientific evidence-base specific to its own needs, it is necessary to foster an environment conducive to reflection on practice and cultivation of ideas.

Web resource appraisal process (WRAP): A framework to establish critically appraised nursing knowledge-an active web based learning exercise

There have been dramatic advances in Internet technology in the past 10 years. However, for the Internet to reach its full potential for nursing practice and education, improvements in the quality and accessibility of health care information on the Internet are needed. This paper describes the development of a Web Resource Appraisal Process (WRAP). The WRAP consists of a template and series of online tutorials designed to facilitate the development of online resources for nursing. The WRAP can be described as a content focused authoring tool. The WRAP directs users through a range of high quality international health websites and databases in order to collect information related to specific practice areas. The WRAP then provides an ordered structure for the presentation of this information in an online format. The WRAP is a website with three main functions. Firstly, it is a teaching and learning resource promoting interactive learning using online resources. Secondly, the WRAP promotes the application of research evidence to practice by providing a standardised framework for the critical review of information resources. Thirdly, the WRAP provides a mechanism for the collaborative documentation of nursing knowledge. This paper concludes by discussing implications of the WRAP for the development, documentation and dissemination of knowledge across the health professions.

Implementing skin-to-skin contact at birth using the Iowa model: applying evidence to practice

Prolonged skin-to-skin contact (SSC) between mothers and newborns in the hour after birth is associated with physiologic and psychological benefits for both mothers and infants, yet this is not a standard practice at all birthing facilities. The purpose of the project described in this article was to implement SSC immediately aft er birth for healthy term newborns as a routine, evidence-based practice in a labor and delivery unit at a Midwestern U.S. academic medical center. When incorporated into routine newborn care, SSC promotes key maternal-infant health outcomes of importance to quality nursing care.

Developing postoperative pain management: utilising the promoting action on research implementation in health services (PARIHS) framework

BACKGROUND

The development of acute pain services (APS), education programmes, and protocols assumed an expectation that health care professionals would integrate evidence into everyday practice. However, research evidence into pain management would suggest that this is not the case.

APPROACH

Through a review of the literature, the authors aim to (1) explore the factors that have a significant influence on getting evidence into practice (using the PARIHS model as a guide) and (2) examine the relevance of these factors to postoperative pain practices.

FINDINGS

The need to assist clinicians with developing a greater awareness of the competing and complex influences that surround pain management practices is outlined.

RECOMMENDATIONS

There is a necessity to adopt a systematic, rigorous, and multidimensional approach to pain management issues, utilising the PARIHS framework as a guide, to improve pain practices.

Working in partnership to develop evidence-based practice within the massage profession

In view of changing policy and recommendation for complementary medicine, the moves towards regulatory mechanisms and an evidence base for practice, there is a need to establish the extent to which this is happening within professions and identify away forward that will benefit the individuals and organisations involved. This paper outlines the views and opinions of professional masseurs at the Northern Institute of Massage in the North of England and discusses how such a professional organisation for massage can work in partnership with Higher Education to develop a stronger evidence base for practice. The study concludes that a significant number of practitioners of the Northern Institute are aware of the need for an evidence base for practice but need to be supported in finding, reading and applying research findings to their practice. A partnership between professional organisations for massage and higher education can benefit both parties and help to facilitate change for the future.

Management of acute radiotherapy induced skin reactions: a literature review

Up to 60% of patients with cancer will receive radiotherapy treatment at some stage during their illness. One of the main side effects of this treatment is an acute skin reaction, which may range in severity from a mild erythema to moist sloughing off of the epidermis. The management of these skin reactions varies between cancer centres and is often based on personal preference and historical practices rather than clinical evidence. This paper presents a literature review that was conducted to discover the most commonly recommended treatments and the research evidence to support them. The review was conducted in two parts and looked at both clinical papers and research studies. A multitude of treatments were recommended in the clinical papers, but few were supported by high quality research. As a result of combining the evidence from both sources, preliminary guidelines for acute skin reaction management can be produced, but these should be implemented in clinical practice and their clinical performance evaluated. There is a need for further research to review treatments that have produced promising results in the reviewed research studies and to evaluate other commonly recommended topical treatments.

Intuition: an important tool in the practice of nursing

AIM

The aim of the study reported here was to evaluate the role of intuition, to examine nurses' understanding of intuition and their perceptions of their use of intuition, and to assess the impact of intuition on nursing practice.

BACKGROUND

When we read the dictionary definition of intuition, we have a sense of the meaning but there is also a sense of something still not quite defined. Yet we instinctively know what intuition is. That is, of course, an example of intuition in itself: an understanding of the concept based on our feelings, knowledge and experience. Intuition is a concept neither clearly articulated nor adequately theorized in nursing. There is evidence to suggest that practising nurses use intuition and that its use can change outcomes for patients. Because of its influence on patient well being, it needs to be recognized as an important tool in the practice of nursing. The very nature of intuition determines that there will be little agreement on a precise definition and little empirical evidence to support its existence or worth. Neither of these issues detracts from the fact that intuition is an important part of nursing.

METHODS

Grounded theory was used as the overarching theoretical and methodological framework for this study. Using focus group interviews and the Delphi survey technique, data were collected from 262 Registered Nurses who volunteered to take part in the study.

FINDINGS

The theory that emerged from this study provides nurses with a way of articulating their understanding of intuition and their perceptions of its use in nursing practice.

CONCLUSIONS

Intuition is not some mystical power that appears from nowhere, with no rational explanation or basis. The findings from this study show that it is a product of the synergy that occurs as a result of the interaction of a number of factors.

Developing information literacy: a key to evidence-based nursing

This report describes the evaluation of a curriculum-integrated programme designed to help students develop an awareness of the nursing literature, the skills to locate and retrieve it, and skills required in its evaluation; in other words'information literacy'. Positive changes in student performance on objective measures of information-literacy skills were revealed as well as a significant increase in the levels of confidence of the student in performing those skills. Students who had undertaken the information-literacy programme ('programme' students) performed better on a range of objective measures of information literacy, as well as reporting higher levels of confidence in these skills, than students who had not participated in the programme ('non-programme' students). Evaluation of this programme provides evidence of the potential usefulness of a curriculum-integrated approach for the development of information-literacy skills within nursing education. With these underlying skills, students will be better equipped to consolidate and extend their key information-literacy skills to include research appreciation and application. These are vital for effective lifelong learning and a prerequisite to evidence-based practice.

Clinical effectiveness on an acute in-patient psychiatric unit

The paper outlines a model for addressing clinical effectiveness, and an illustration of how this is practically implemented through team working in a multidisciplinary in-patient environment. This is particularly relevant given the number of recent reports that highlight the need to develop and invest in the in-patient services. The difficulty in implementing evidence-based practice for mental health interventions is also addressed and initiatives being developed to enable a realistic approach in such an environment are described. The paper describes a structure and a process, using examples from audit, research and other initiatives particular to the unit, in providing accessible evidence based interventions for ward based staff, and improved clinical effectiveness generally.

Utilization of the Iowa Model in establishing evidence-based nursing practice

Clinical practice based on tradition or established rituals appears to be widespread amongst a variety of nurses and practice settings. However, tradition-based practice may not necessarily be based on sound scientific evidence and could potentially be harmful to patients or result in inappropriate utilization of resources. Conversely, evidence-based practice is the utilization of the best available empirical evidence in the practice setting, to facilitate sound clinical decision-making. Suctioning ventilated patients is a necessary and important aspect of patient care. However, normal saline instillation prior to suctioning, in order to loosen secretions, remains a common nursing procedure despite research suggesting that there is no clear benefit and in some instances may be harmful. Several models have been developed over the past few years to facilitate nursing practice that is based on research or the best available evidence. The Iowa Model, developed at the University of Iowa Hospitals and Clinics, serves as a framework to improve patient outcomes, enhance nursing practice and monitor health care costs. Moreover, it facilitates the application of empirical evidence to clinical practice. This paper will discuss the utilization of the Iowa Model to promote evidence-based nursing practice, with regard to normal saline instillation prior to suctioning, in the critical care unit of a 100-bed hospital in Hong Kong. Patient, staff and fiscal outcomes will also be reported.