So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas

Exploring nurses' use of the WHO safety checklist in the perioperative setting

AIM

To explore nurses' use of the World Health Organization safety checklist in the perioperative setting.

BACKGROUND

Promoting quality and safety in health care has received worldwide attention. The World Health Organization surgical safety checklist (2009) is promoted for reducing postoperative morbidity and mortality. The checklist has been introduced in Irish perioperative settings.

METHOD(S)

A descriptive, qualitative approach was utilised. A purposeful sample of ten nurses participated in individual, semi-structured interviews.

RESULTS

Participants were committed to promoting safety in navigating challenges in introducing, complying and accepting the value of the World Health Organization surgical safety checklist in concordance with best practice. Participants moved from task completion to embracing the checklist as an effective surgical safety checking tool. Challenges were identified around roles and responsibilities in overseeing the completion of the checklist.

CONCLUSION(S)

The management of processes is critical when implementing any safety initiative. This paper highlights the complexity and challenges in implementing the World Health Organization surgical safety checklist, contributing to global discussions around translating policy into practice.

IMPLICATIONS FOR NURSING MANAGEMENT

The effective implementation of a checklist requires a coordinated management approach in collaboration with team members. These approaches will support learning experiences contributing to a shared understanding of the change being implemented by all team members.

Development and initial testing of the stroke rapid-treatment readiness tool

No instruments are currently available to help health systems identify target areas for reducing door-to-needle times for the administration of intravenous tissue plasminogen activator to eligible patients with ischemic stroke. A 67-item Likert-scale survey was administered by telephone to stroke personnel at 252 U.S. hospitals participating in the “Get With The Guidelines-Stroke” quality improvement program. Factor analysis was used to refine the instrument to a four-factor 29-item instrument that can be used by hospitals to assess their readiness to administer intravenous tissue plasminogen activator within 60 minutes of patient hospital arrival.

Reflections of Evidence-Based Practice in Nurse Educators' Teaching Philosophy Statements

AIM

This article focuses on the nature and importance of evidence-based practice (EBP) as described in the teaching philosophy statements of academic nurse educators (ANEs).

BACKGROUND

EBP is a core competency identified by the Institute of Medicine. Its incorporation into teaching philosophies expresses ANEs' ideas, values, and practices.

METHOD

A mixed-method design using an online survey was used to collect and analyze demographic data and teaching philosophy statements from 375 ANEs. Coding was done via direct correct analysis. Themes were identified to capture the essence of the coded statements.

RESULTS

EBP and its components were mentioned 275 times collectively; 44 ANEs specifically mentioned EBP in their teaching philosophies. other components were mentioned more frequently. three themes emerged: keeping up-to-date, setting up student success with EBP, and EBP as a teaching approach.

CONCLUSION

The incorporation of EBP and its components was not widely acknowledged by ANEs.

A retrospective review of leg wound complications after coronary artery bypass surgery

Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes.