Influences of evidence-based nursing intervention on pressure ulcers in intensive care units: A meta-analysis

A meta-analysis was conducted comprehensively to investigate the impact of evidence-based nursing (EBN) interventions on pressure injury (PI) in the intensive care unit (ICU) patients. Computer searches were performed, from databases inception to November 2023, in Wanfang, PubMed, China National Knowledge Infrastructure, Google Scholar, Embase, and Cochrane Library for randomized controlled trials (RCTs) on the application of EBN interventions in ICU patients. Two independent researchers conducted screenings of the literature, extracted data, and carried out quality evaluations. Stata 17.0 software was employed for data analysis. Overall, 25 RCTs, involving 2494 ICU patients, were included. It was found that compared to conventional care methods, the implementation of EBN interventions in ICU patients markedly decreased the occurrence of PI (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.17-0.30, p < 0.001), delayed the onset time of pressure ulcers (standardized mean difference [SMD]: -1.61, 95% CI: -2.00 to -1.22, p < 0.001), and also improved nursing satisfaction (OR: 1.18, 95% CI: 1.14-1.23, p < 0.001). Our findings suggest the implementation of EBN interventions in the care of PI in ICU patients is highly valuable, can reduce the occurrence of PI, can delay the time of appearance, and is associated with relatively higher nursing satisfaction, making it worthy of promotion.

Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey

BACKGROUND

Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing.

AIMS

The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland.

METHODS

Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test.

RESULTS

Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings.

LINKING EVIDENCE TO ACTION

There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Military Nursing Evidence-Based Practice Summit: A Descriptive Analysis of EBP Barriers and Solutions Within the Military Healthcare System

BACKGROUND

Evidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit.

METHODS

A qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team.

RESULTS

The study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes.

CONCLUSIONS

The results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.

Evaluating the performance of an integrated evidence-based nursing knowledge management (I-EBNKM) platform in real-world clinical environments

BACKGROUND

For evidence-based knowledge to be applicable in clinical practice, providing support for and the management of knowledge is required to ensure the effective sharing of appropriate expertise across healthcare organizations. Knowledge management platforms can provide a wide range of benefits related to the activation and establishment of evidence-based practice (EBP) in clinical environments.

OBJECTIVES

In this study, we developed an integrated evidence-based nursing knowledge management (I-EBNKM) platform and applied it in real-world clinical environments to evaluate its effectiveness.

METHODS

We designed an I-EBNKM platform with three main functions: (1) clinical questioning and knowledge linkage, (2) systematic knowledge management, and (3) knowledge communication. After a two-month long application of the I-EBNKM platform in real-world clinical environments, we evaluated the changes in the levels of knowledge in EBP, attitude, practice, confidence in clinical questioning, individual innovative behavior, innovative organizational culture, and organizational knowledge management. The experimental and control groups consisted of 198 nurses, who participated in the study.

RESULTS

After applying the I-EBNKM platform, the levels of EBP knowledge and skills (t = 7.16; p <.001), attitude (t = 6.30; p <.001), practice (t = 7.63; p <.001), confidence in clinical questioning (t = 4.57; p <.001), individual innovative behavior (t = 8.72; p <.001), and organizational knowledge management (t = 7.43; p <.001) differed significantly between the experimental group and the control group.

CONCLUSION

The results of this study clearly indicate that the I-EBNKM platform we developed has the potential to enhance nurses' involvement in ensuring effective knowledge management in real-world clinical environments. Therefore, the provision of an innovative digital approach ensuring systematic and timely organizational support among nurses is of critical importance.

Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial

INTRODUCTION

Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID.

METHODS AND ANALYSIS

Using an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites.

ETHICS AND DISSEMINATION

Ethics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman's Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, 'business as usual' ED training schedules and university curricula.

TRIAL REGISTRATION NUMBER

ACTRN12621001456842.

Seeking to Understand: Qualitative Research on Sustainability of Evidence-Based Practice in Acute Care

OBJECTIVE

The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting.

BACKGROUND

There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes.

METHODS

A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT).

RESULTS

Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care.

CONCLUSIONS

Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.

Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study

Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.

Effect assessment of the application value of evidence-based nursing intervention in operating room nursing: A protocol for a systematic review and meta-analysis

BACKGROUND

The advantages of evidence-based nursing (EBN) intervention in health care settings have been widely disseminated to nurses throughout the world. More researches are reporting the effectiveness of EBN intervention in operating room nursing. However, the results are inconsistent. This study focuses on conducting a meta-analysis and systematic evaluation aimed at determining the usefulness of EBN intervention in operating room nursing.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols criteria were used to write this paper. We will look for relevant studies from 2 Chinese databases (China National Knowledge Infrastructure and Wanfang database and also from 3 English databases such as Web of Science, Cochrane Library, PubMed, and EMBASE), to locate all relevant randomized controlled trials and observational studies assessing the application value of EBN intervention in operating room nursing from their commencement to June 2021. Separately, 2 authors will choose the studies, do the data extract and conduct the assessment probing into the likelihood of bias. If there is a disagreement, it will be resolved by the third author. RevMan 5.3 software and Stata 15.0 software will be used to conduct the meta-analysis.

RESULTS

The usefulness of EBN intervention in operating room nursing will be assessed in this study.

CONCLUSION

The purpose of this research is to conclude the value of EBN intervention in operating room nursing and the quality of current data.

ETHICS AND DISSEMINATION

Since there is no requirement for data on the individual patient, hence there will be no need for ethical approval.

OSF NUMBER

DOI 10.17605/OSF.IO/MSXNF.

Eliminating Hospital-Acquired Pressure Injuries Caused by Graduated Compression Stockings

PURPOSE

The purpose of this evidence-based practice project was to reduce the incidence of pressure injuries (PIs) from the use of graduated compression stockings in patients on a gastrointestinal (GI) sarcoma surgery unit. Before this project, the standard of care for preventing deep vein thrombosis (DVT) included the use of graduated compression stockings, anticoagulation therapy, and intermittent pneumatic compression devices. We sought to examine the impact on PI and DVT risk of using only anticoagulation therapy and intermittent pneumatic compression devices.

METHODS

The pilot phase of the project began in June 2017 when nurses on the GI sarcoma surgery unit initiated a practice change in which graduated compression stockings were removed during the 7 AM shift change and put back on the patient before bedtime. Data on the incidence of DVTs and PIs were already being collected in our institution's electronic health record and safety intelligence reporting system. The project team monitored the incidence of PIs and DVTs throughout the project. After the pilot project concluded in August 2017, the GI sarcoma surgery unit staff continued the practice of taking off graduated compression stockings during the day, until on June 2018 the use of graduated compression stockings was formally discontinued for all surgical patients, both during the day and night.

RESULTS

Data collected during the pilot phase revealed that no PIs or DVTs occurred among the 497 study patients on the GI sarcoma surgery unit. From June to October 2017, the unit cared for a total of 856 patients and PI and DVT rates remained at zero. From the start of the pilot project in June 2017 to October 2018 (five months after the discontinuation of graduated compression stockings on all surgical units) the unit cared for 3,141 patients-an average of 174 patients per month-and had a zero rate of PIs and DVTs.

CONCLUSIONS

We found that the use of graduated compression stockings confers more risks than benefits for patients. Our findings prompted the discontinuation of graduated compression stockings use in postoperative patients throughout our institution. In the 17 months after the pilot project was initiated, no PIs occurred among patients in the GI sarcoma surgery unit, which also maintained a zero rate of DVTs.

Flipping the Graduate Nursing Classroom: An Integrative Review

BACKGROUND

This integrative review examined whether academic performance and student satisfaction increased in graduate nursing students when using a flipped classroom (FC) modality compared with traditional classroom methods. The FC model is an instructional design in which students perform traditional learning activities at home via an online platform in preparation for performing higher order in-class activities. This model has been proven efficacious in many disciplines but has been studied only recently in graduate nursing education.

METHOD

A literature search identified five articles. Articles were evaluated, and themes were identified.

RESULTS

Articles were analyzed for rigor using standards outlined by Shavelson and Towne. No one operational definition of an FC was identified in graduate nursing education. Most studies reported positive trends in student performance; however, student and faculty satisfaction varied.

CONCLUSION

Current evidence on FC in graduate-level nursing education demonstrates an overall lack of rigor. The FC model has been inconsistently operationalized in graduate-level nursing, prohibiting comparison among studies. This limits the ability of evidence-based experts to reproduce studies. [J Nurs Educ. 2020;59(6):305-310.].

Selection of the Study Participants

Editor's note: This is the second article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.

The Nominal Group Technique: Generating Consensus in Nursing Research

The purpose of this article is to describe the Nominal Group Technique and its application as a consensus-generating approach in nursing research. The approach incorporates face-to-face meetings to explore opinions, generate ideas, and determine priorities. The nominal group technique process, which is based on a study designed to develop a nursing student clinical placement (clinical practicum) evaluation tool, is described. Advantages of the approach include creative face-to-face discussions with minimal resource demands. The nominal group technique is beneficial and can be used to achieve consensus in nursing research, but a lack of anonymity may preclude the process in some investigations. [J Nurs Educ. 2020;59(2):65-67.].

From Education to Practice: Incorporating Quality Improvement Projects Into a Baccalaureate Nursing Curriculum

The accelerated pace of change in health care and the call for a radical transformation in prelicensure nursing education will require changes in baccalaureate nursing programs to ensure nurses are adequately prepared for practice. At one Midwestern university, academic nurse educators developed an innovative multilevel interprofessional and intradisciplinary education opportunity using a Lean Healthcare quality improvement (QI) process to improve systems, strengthen academic-practice partnerships, and bridge the education-to-practice gap. During one 16-week semester, one group of sophomore and junior clinical nursing students worked collaboratively with personnel at a local health care organization on a QI project on sequential compression devices. The students identified practice barriers related to sequential compression device compliance when medication prophylaxis was contraindicated. Using a Lean QI framework, the students developed and implemented a comprehensive, evidence-based venous thromboembolism prophylaxis policy, including tools and strategies for educating employees and patients.

Knowledge translation: A concept analysis

AIM

The aim of this article is to clarify the concept of knowledge translation (KT) to close the gap that exists between research knowledge and actionable nursing practice.

BACKGROUND

KT addresses the research to practice gap that exists in healthcare. KT is often confused with other terms and needs to be defined further as a concept for clarification and application in nursing practice.

DESIGN

Concept analysis using the Walker and Avant method.

DATA SOURCES

Databases searched were OVID, CINAHL, ProQuest, Mendeley, Western Libraries, and Google Scholar. Keywords used were "knowledge translation", "knowledge", "translation", "evidence-based practice", "research dissemination". Abstracts were reviewed for relevance, and 27 articles available in full-text and in English from 2000 to 2018 were retained. Online dictionaries included Merriam-Webster. The ancestry method was also used to retrieve relevant articles.

RESULTS

KT is one of many terms used to describe the concept of moving research to actionable practice in healthcare. Six attributes of KT were identified: collaboration, action, receptivity, process, translation, and improved healthcare outcomes.

CONCLUSIONS

Nurses are responsible to provide the best care to their patients, and effectively using KT in nursing practice can ensure better outcomes for patients.

Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer

To investigate the effect of evidence-based nursing (EBN) intervention on upper limb function in postoperative breast cancer patients undergoing radiotherapy.A total of 126 breast cancer patients who had received postoperative radiotherapy in the Union Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology from September 2017 to September 2018 were randomly divided into 2 groups, namely, experimental and control groups, with 63 cases in each group. Both the control and experimental groups received routine postoperative radiotherapy followed by traditional and EBN interventions, respectively. All patients were followed up for 6 months and differences in the upper limb function after nursing intervention were compared between the 2 groups.The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), and short form-36 survey (SF-36) in the 2 groups had no statistical significance before intervention. After the EBN intervention, the SAS and self-rating depression scale scores of patients in the experimental group were lower than that of those in the control group. In the experimental group, 90.67% of the patients had an excellent score for the University of California, Los Angeles shoulder score, which was higher than that of the control group (73.92%). The Mayo Elbow Performance Score of the experimental group (95.01) was higher than that of the control group (91.33). The total length of the sum of arm circumference in the experimental group was (128.39 cm) lower than that of the control group (143.66 cm). The scores of SF-36 in the overall health, physical pain, mental health, and physiological functions of the patients in the experimental group were higher than those of the control group. All of these parameters' differences between the 2 groups were of statistical significance (P < .05).EBN can positively influence the negative emotional state of breast cancer patients after radiotherapy. At the same time, it is helpful in reducing the degree of lymph node edema on the affected side of the upper limb, thereby improving the function of the shoulder joint, which has a positive effect on the upper limb function.

Implementation Science Training and Resources for Nurses and Nurse Scientists

PURPOSE

The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science.

ORGANIZING CONSTRUCT

There is a push for providing safe, effective, patient-centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence-based practices to improve quality of care.

METHODS

We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice.

FINDINGS

Implementation-trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings.

CONCLUSIONS

Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science.

CLINICAL RELEVANCE

Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science-trained nurses are in a position to be excellent improvers for meaningful change in practice.

Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture

BACKGROUND

This study aimed to identify clinical nurses' evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt's Advancing Research & Clinical Practice through Close Collaboration model as the first step.

METHODS

A descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.

RESULTS

Our findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.

CONCLUSIONS

Based on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.

Midwives' use of best available evidence in practice: An integrative review

AIMS AND OBJECTIVES

To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care.

BACKGROUND

Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice.

DESIGN

A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review.

METHODS

The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question.

RESULTS

The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach.

CONCLUSION

Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice.

RELEVANCE TO CLINICAL PRACTICE

Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.

Current Resources for Evidence-Based Practice, November 2019

A review of new resources to support the provision of evidence-based care for women and infants.

Improving Transition to Practice: Integration of Advanced Cardiac Life Support Into a Baccalaureate Nursing Program

BACKGROUND

Nursing students often lack the skills and confidence to intervene in the care of a deteriorating patient as they transition into clinical practice. Exposure to these situations is limited during their academic career. Our team sought to address this by embedding American Heart Association (AHA) advanced cardiac life support (ACLS) content into the curriculum and offering certification to senior-level students.

METHOD

The senior skills course was redesigned to include education on current AHA ACLS guidelines and skills. ACLS algorithms were introduced and reinforced by mock code labs utilizing rapid cycle deliberate practice and interprofessional simulation. After completion of the semester, students were given the option to be ACLS certified.

RESULTS

Students and stakeholders reported positively on the ability to certify in ACLS at our institution prior to graduation and reported increased confidence in their ability to manage patients with cardiopulmonary arrest.

CONCLUSION

Providing simulated experiences for these clinical situations can reportedly increase confidence and improve preparedness in senior-level BSN students. [J Nurs Educ. 2019;58(3):182-184.].

Using Standardized Actors to Promote Family-centered Care

PURPOSE

The purpose of this study was to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation. This study was considered an innovative approach within our undergraduate program because the use of standardized actors (SAs) was new to the program and had only previously been used in our graduate program.

METHOD

This study used a mixed method design of descriptive comparative data and content analysis to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation.

RESULTS

There were 146 students who participated in this study. Thematic analysis indicated that empathy needs to extend beyond the patient to the family. A comparison of the standardize actors' and peer assessment of student empathy was significant.

CONCLUSIONS

Nurse educators can use standardized actors as caregivers in simulation as an effective teaching strategy to connect theory and the philosophy of family-centered care to its application in pediatric nursing practice.

PRACTICE IMPLICATIONS

Family-centered care is a key philosophy in pediatric nursing. Students report that there is a significant gap between family-centered care theory and its application to practice. Few baccalaureate nursing students receive experience in family interactions during their clinical time. Therefore, this research supports the need for incorporating family-centered care simulation practices in nursing education to increase student nurses' readiness to practice in specialty settings such as pediatrics.

Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis

OBJECTIVE

The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes.

DESIGN

A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

DATA SOURCES

PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.

STUDY SELECTION

To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.

REVIEW METHOD

Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.

SYNTHESIS METHOD

For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI.

RESULTS

Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.

CONCLUSIONS

Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.

The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study

Background

Evidence-based nursing (EBN) has been an important training mechanism for improving the quality of clinical care. At present, the pedagogy focuses on the application of e-learning and team-based learning to enhance learners’ engagement and learning effectiveness.

Objectives

This study applied the flipped classroom approach to conduct evidence-based nursing (EBN) teaching. The aim of this study is to elevate the learning effectiveness of the flipped classroom group to the traditional teaching group in terms of knowledge and self-efficacy in practice.

Design

A pretest-posttest nonequivalent control group with a quasi-experimental quantitative design.

Methods

The study recruited 151 nurses, of whom 75 were in the control group and 76 were in the experimental group. During the EBN course, the control group received training via traditional pedagogy while the experimental group engaged the flipped classroom approach. The learning effectiveness of EBN knowledge and self-efficacy in practice were evaluated across the three time points: pre-course, post-course, and one month after the course.

Results

In both group the scores of the EBN knowledge and self-efficacy in practice improved after training. The scores of the experimental group increased significantly than in the control group. However, the scores declined in both groups one month after the course. Even so, the experimental group’s score of self-efficacy in practice was still higher than that of the control group.

Conclusion

The implementation of the flipped classroom approach and team-based learning effectively enhanced the learners EBN knowledge accumulation and self-efficacy in practice. The research results can be used as an important reference for improving clinical nursing teaching quality.

Development of a complex intervention for early integration of palliative home care into standard care for end-stage COPD patients: A Phase 0-I study

Background

Research suggests that palliative home care should be integrated early into standard care for end-stage COPD patients. Patients also express the wish to be cared for and to die at home. However, a practice model for early integration of palliative home care (PHC) into standard care for end-stage COPD has not been fully developed.

Aim

To develop an intervention for early integration of PHC into standard care for end-stage COPD patients.

Methods

We conducted a Phase 0–I study according to the Medical Research Council Framework for the development of complex interventions. Phase 0 aimed to identify the inclusion criteria and key components of the intervention by way of an explorative literature search of interventions, expert consultations, and seven focus groups with general practitioners and community nurses on perceived barriers to and facilitators of early integrated PHC for COPD. In Phase 1, the intervention, its inclusion criteria and its components were developed and further refined by an expert panel and two expert opinions.

Results

Phase 0 resulted in identification of inclusion criteria and components from existing interventions, and barriers to and facilitators of early integration of PHC for end-stage COPD. Based on these findings, a nurse-led intervention was developed in Phase I consisting of training for PHC nurses in symptom recognition and physical therapy exercises for end-stage COPD, regular visits by PHC nurses at the patients’ homes, two information leaflets on self-management, a semi-structured protocol and follow-up plan to record the outcomes of the home visits, and integration of care by enabling collaboration and communication between home and hospital-based professional caregivers.

Conclusion

This Phase 0-I trial succeeded in developing a complex intervention for early integration of PHC for end-stage COPD. The use of three methods in Phase 0 gave reliable data on which to base inclusion criteria and components of the intervention. The preliminary effectiveness, feasibility and acceptability of the intervention will be subsequently tested in a Phase II study.

Rethinking pain education

EBN engages readers through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

Communication technology and healthcare

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes.

How to Engage Your Team to Implement Delayed Cord Clamping

This article describes how a health care team changed practice by implementing delayed cord clamping as standard practice. After administration of a survey to assess clinicians' knowledge and to discover barriers to this proposed practice change, members of a multidisciplinary committee used the results to create a guideline for delayed cord clamping and a plan for successful implementation. Integral to embedding and sustaining changes in practice was development of the Delivery Room Brief and Debrief Tool and inclusion of the process into nursing guidelines and the electronic health record. Through the use of these tools and teamwork, delayed cord clamping was implemented as standardized practice across six hospitals within this health care system.

Interpreting measures of risk: Translating evidence into practice

Advanced practice registered nurses must have a working knowledge of statistical principles in order to provide high-quality, evidence-based care. This article presents basic concepts of risk indexes and case study examples illustrating how these measures can inform practice.

[Nursing care perspectives and foresights]

As a continuation of its work and of the seminar on nursing sciences education in 2014, the “Association de recherche en soins infirmiers” (Arsi) organized a seminar on the 3rd and-4th of June 2016 in Nantes entitled : “nursing : perspectives and foresights”. More than fifty participants from the francophone area representing various sectors of practice : clinical, teaching, management and students gathered to debate and produce benchmarks to support the development of nursing sciences in France and to draw future directions for clinical practice and training. The successive sessions made it possible to reflect, to confront opinions, to make proposals and to identify the terms of the problematic of care and nursing knowledge today and the methodological elements relating to foresight. At the end of this very creative seminar, new avenues of reflection emerged shifting our usual look at the nurse profession. Orientations for training and practice have been defined with different stakes depending on the level of training and professional commitment. The strong links between professional, scientific and academic discipline have also been clarified, highlighting the importance to hold a high theoretical and scientific requirement, rigorous clinical practice, strong professional commitment and effective leadership.

Validation study of the Polish version of the Evidence-Based Practice Profile Questionnaire

BACKGROUND

Decisions about patient care in clinical practice should be made based on proven scientific evidence of efficacy and safety (i.e., evidence-based practice [EBP]). Currently, there are no available tools in Poland for assessing the knowledge and attitudes of specialists in health sciences towards EBP. Therefore, by validating the Polish version of the original English Evidence-Based Practice Profile Questionnaire (EBP²Q), we may provide an appropriate instrument for assessing EBP.

METHODS

The validation group consisted of 1,362 people, including nurses and midwives taking the specialization exam, second-degree students in nursing/midwifery, and staff of selected municipal and clinical hospitals in Warsaw, Pruszkow, and Chelm. The study was conducted from March to June 2014. The following psychometric properties of the EBP²Q were assessed: reliability (Cronbach's alpha coefficient, and test-retest), validity (exploratory factor analysis, Spearman's r correlation coefficient, and assessment of inter-group differences), as well as unidimensionality of domains (principal component analysis).

RESULTS

All domains of the EBP²Q were characterized by high reliability (Cronbach's alpha ranging from 0.800 to 0.972). The Polish version showed a strong similarity of factor structure with the original English EBP²Q, indicating that the condition for theoretical validity is fulfilled. Maintenance of the theoretical and discriminative validity and unidimensionality of five domains of the EBP²Q was confirmed.

CONCLUSIONS

The Polish version of the EBP²Q is comparable in terms of psychometry to the original English version. This questionnaire can be used to assess knowledge, attitudes, and skills concerning EBP among students and practicing professional nurses and midwives. The future validation of the EBP²Q in other groups of specialists in health sciences may increase the scope of applicability of this tool.

Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation

We conducted an evidence-based practice project to determine if skin-to-skin contact immediately after cesarean birth influenced the rate of transfer of newborns to the NICU for observation. We analyzed data for 5 years (2011 through 2015) and compared the rates for the period before implementation of skin-to-skin contact with rates for the period after. The proportion of newborns transferred to the NICU for observation was significantly different and lower after implementing skin-to-skin contact immediately after cesarean birth (Pearson's χ² = 32.004, df = 1, p < .001). These results add to the growing body of literature supporting immediate, uninterrupted skin-to-skin contact for all mother-newborn pairs, regardless of birth mode.

Facilitating the development of higher-order thinking skills (HOTS) of novice nursing postgraduates in Africa

BACKGROUND

International research in nursing education has shown to be deficient regarding both the quality of research produced and the building of disciplinary capacity. The CHENMA (Collaboration for Higher Education of Nurses and Midwives in Africa) project aimed to strengthen nursing and midwifery expertise in Africa. Sixteen French-speaking students of the Democratic Republic of the Congo (DRC) enrolled for a master's degree in nursing midwifery at a South African university in 2008. Ten of the initial 16 students graduated with a master's degree in 2012. One student withdrew and five students completed a postgraduate diploma in midwifery.

OBJECTIVES

The objective of this paper is to explore the quality of the output of those master's degree students, namely their dissertation (with specific reference to the demonstration of HOTS).

METHODS

An exploratory, evaluative, single, descriptive case study was utilised. Realist, purposeful sampling was used. Six of the 10 completed final dissertations were evaluated as well as three reflective reports from the supervisor, translator and critical reader.

RESULTS

The findings indicated that most dissertations fell below the expected standard, with a paucity of higher-order thinking and application skills. Language, and possibly cultural dynamics, seemed to be the largest barrier to learning and communication. The dissertations lacked conceptual skills, scientific writing skills, logical order of thought and congruency. Analysis of the dissertations revealed a limited ability of novice scholars to explore the nature of information and to interpret and manipulate the data in a novel way.

Enhancing neonatal wellness with home visitation

We planned and implemented an evidence-based program to screen for jaundice and to try to increase the proportion of women breastfeeding for 6 months. The program involved home visitation by a registered nurse to provide education on and support of breastfeeding, and to perform physical assessment of both mothers and newborns, including screening for neonatal jaundice. Quantitative data showed increased breastfeeding rates at 6 months. In addition, readmission rates for jaundice were higher when compared to regional benchmarks. However, the average length of stay for treatment of jaundice was shorter than regional benchmarks. Qualitative data indicated that the program was effective at achieving its goals and was valued by participants.

Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis

AIMS

To gather, assess and synthesise the currently available evidence of educational interventions on evidence-based nursing (EBN).

BACKGROUND

Previous systematic reviews have focused on the items used in reporting educational interventions for facilitating evidence-based practices in medicine and health care or teaching research literacy in nursing as well as on the outcomes of these interventions.

DESIGN

A systematic review based on a procedure of the Centre for Reviews and Disseminations for conducting a systematic review of health interventions.

DATA SOURCES AND METHODS

Texts from 2008 to 2015 were sought from the Cochrane, CINAHL and PubMed Medline databases. Eight studies were selected for the final data and reviewed for quality. Data were analysed with narrative synthesis including qualitative content analysis.

RESULTS

Four main categories and sixteen subcategories were identified. The learning contents included principles of EBN and research, the process of EBN, and planning a change in practice. The most popular teaching/learning methods were lectures/didactic presentations and group work. The interventions encouraged learners to critically examine and evaluate their practice. The interventions also improved participants' capacity to identify the need for research evidence in clinical practice.

CONCLUSION

The educational interventions were fairly similar and had promising results. However, as the level of evidence was modest in the studies, there are several development needs for interventions and further research challenges. Interventions should provide participants with sufficient competences for implementing every step of EBN, with special focus on the implementation of evidence in patient care. The assessment of the outcomes of interventions should cover all learning categories of EBN with focus on medium to long-term effectiveness. The influence of different teaching/learning methods and learning contexts and settings should be investigated further.

Mindfulness as an Intervention for Breast Cancer Survivors

Breast cancer survivors often turn to complementary health approaches (CHAs) to address the effects of treatment. Mindfulness-based stress reduction (MBSR) is a type of CHA that uses attentional and meditative exercises to minimize stress and increase awareness of the present. This article aims to determine whether adequate evidence-based research with uniform methodologies and outcomes to support MBSR as an intervention for breast cancer survivors exists.

Improving Management of Behavioral and Psychological Symptoms of Dementia in Acute Care: Evidence and Lessons Learned From Across the Care Spectrum

As the prevalence of Alzheimer disease and related dementias increases, dementia-related behavioral symptoms present growing threats to care quality and safety of older adults across care settings. Behavioral and psychological symptoms of dementia (BPSD) such as agitation, aggression, and resistance to care occur in nearly all individuals over the course of their illness. In inpatient care settings, if not appropriately treated, BPSD can result in care complications, increased length of stay, dissatisfaction with care, and caregiver stress and injury. Although evidence-based, nonpharmacological approaches to treating BPSD exist, their implementation into acute care has been thwarted by limited nursing staff expertise in behavioral health, and a lack of consistent approaches to integrate behavioral health expertise into medically focused inpatient care settings. This article describes the core components of one evidence-based approach to integrating behavioral health expertise into dementia care. This approach, called STAR-VA, was implemented in Veterans' Health Administration community living centers (nursing homes). It has demonstrated effectiveness in reducing the severity and frequency of BPSD, while improving staff knowledge and skills in caring for people with dementia. The potential for adapting this approach in acute care settings is discussed, along with key lessons learned regarding opportunities for nursing leadership to ensure consistent implementation and sustainability.

Medicines optimisation

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article outlined the priorities and challenges of medicines optimisation, which is a person-centred approach to safe and effective medicines use. The aim is for the patient to achieve the best possible outcomes from their medicines.

Chronic wounds dressing

Essential facts A chronic wound is usually defined as any wound that has not healed for six weeks or more. In the UK, about 200,000 people are experiencing a chronic wound at any one time, with an estimated annual cost to the NHS of around £4 billion. According to the National Institute for Health and Care Excellence (NICE) the selection of dressings is hindered by the relative lack of clinical evidence, while the prescription of advanced dressing, such as hydrocolloids, alginates, hydrofibre and antimicrobial dressings, for chronic wounds account for about £110 million a year in primary care in England.

Use of instruments to measure quality of life among healthy and ill adults in community settings

International interest in quality of life (QoL) has been affected by patients' prolonged survival, the increasingly aging population, the increase in chronic conditions and the increasing costs of health care. This has also led to the development of QoL instruments that meet the psychometric criteria necessary for reliable and valid outcome measures in research, health policy decision-making and, increasingly, in clinical practice. Despite the proliferation of QoL instruments available to inform best practice, clinicians seldom routinely apply them. One of the barriers to using QoL instruments is the unfamiliarity nurses have with existing instruments. In order to increase community health nurses' familiarity with existing QoL assessments, the aim of this paper is to describe five instruments and modules that have been developed by the World Health Organization's Quality of Life Assessment Group for the assessment of QoL among healthy and ill adults and to describe how their applicability could enhance evidence-based practice in community nursing.

Why nursing research matters

To coincide with the RCN international nursing research conference in Edinburgh we take a look at the state of nursing research. It has come a long way in a short time, but a key challenge is ensuring the aim is firmly on studies that benefit frontline practice.

Barriers and Facilitators of Utilizing Research Among Nurses in Nepal

BACKGROUND

This study determined the perceived barriers to and facilitators of Nepalese nurses in utilizing research in the workplace. Evidence-based nursing practice provides the synergy for high-quality patient care, but it does not seem to be the case in underdeveloped countries, such as Nepal.

METHOD

A descriptive, cross-sectional study involving 97 nurses from Nepal was conducted. Data were collected using the BARRIERS Scale and a facilitator questionnaire.

RESULTS

The top three barriers to research utilization in Nepalese nurses are (a) research reports and articles are not readily available (80.5%), (b) inadequate facilities for implementation (75.3%), and (c) research reports and articles are not published fast enough (71.6%). The top three facilitators perceived to encourage Nepalese nurses to utilize or participate in research are (a) initiation of nursing research projects (27.4%), (b) educational update on research methods (16.7%), and (c) provision of funding for research (15.5%).

CONCLUSION

Findings from this study mirror the barriers to research utilization experienced by nurses in other countries. Macro- and micro-level support are needed to foster a culture of evidence-based practice among Nepalese nurses to empower them in making informed decisions based on research in providing quality patient care.

Dissemination of Evidence-Based Practice to Directors of Nursing by an Outreach Campaign in Taiwan

BACKGROUND

Directors of nursing (DONs) have an important influence in the dissemination of evidence-based practice (EBP) in hospital settings. The current study examined how the knowledge, skills, and behaviors of DONs changed when EBP was implemented during a 5-year, nationwide promotional campaign providing EBP-related information resources and promotional activities in regional hospitals in Taiwan.

METHOD

Cross-sectional questionnaire surveys for a nationwide representative sample of DONs were conducted in 2007, 2009, and 2011 to examine views related to EBP, including changes in beliefs, attitudes, knowledge, skills, behaviors, and barriers.

RESULTS

This study enrolled 267 DONs in 2007, 257 in 2009, and 287 in 2011. During the study period, DONs' EBP knowledge and skills increased, but their beliefs and attitudes did not significantly change. Furthermore, the use of Internet-based resources, including web portals, electronic textbooks, electronic journals, and evidence-based online databases, increased. Most barriers significantly declined after the intervention.

CONCLUSION

DONs' knowledge, skills, and behaviors regarding EBP increased after the multifaceted intervention. The data suggest this outreach program is useful in disseminating EBP implementation to DONs.