Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics

OBJECTIVE

This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics.

BACKGROUND

Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience.

METHODS

University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program.

RESULTS

The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction.

CONCLUSIONS

Interventions targeting frontline leaders positively impact CN performance.

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.

Assessing Evidence-Based Practice Knowledge: An Innovative Approach by a Nursing Research Council

OBJECTIVE

The aim of this study was to describe the structure and processes implemented by nursing research councils to conduct a nurse-led research study at an urban community teaching hospital.

BACKGROUND

We assessed nurses' knowledge, skills, and attitudes toward evidence-based practice (EBP) to inform development plans.

METHODS

This is an institutional review board-approved single-site cross-sectional anonymous online survey (Evidence-Based Practice Questionnaire [EBPQ]) emailed to 850 participants. Data were analyzed using SPSS v25 (Armonk, New York).

RESULTS

Initial response rate was 11%. Deployment of new strategies achieved an overall response rate of 57.5%. EBPQ subscale scores were highest for "attitude," followed by "knowledge/skills," and "practice." Lowest-scoring items included critical appraisal of literature, converting information needs into a question, time for new evidence, information technology, and research skills.

CONCLUSIONS

Our EBPQ scores were consistent with prior findings. Our strategies provide a framework for other institutions in similar stages of implementing EBP and nurse-led research initiatives.

Depression treatment research in people with cancer does not reflect cancer prevalence: findings from a systematic review

BACKGROUND

One in six people with cancer will develop depression at some point in their care. Untreated depression affects quality of life, cancer care satisfaction and healthcare expenditure. Treatments for this vulnerable heterogenous population should be evidence based and specific. A common sentiment is that psychiatric research does not reflect the prevalence of patients with cancer and comorbid depression and is biased towards certain cancers, but this has not been empirically shown.

STUDY SELECTION AND ANALYSIS

A systematic review of studies on psychological and pharmacological treatments for depression in people with cancer was conducted. Of 4621 papers identified from a search of PubMed and PsycINFO up to 27 June 2020, 84 met inclusion criteria (eg, adults with cancer; depression diagnosis; treatment study) and comprised 6048 participants with depression with cancer.

FINDINGS

Cancer types are not proportionally represented in depression research in accordance with their incidence. Breast cancer is over-represented (relative frequency in research 49.3%, but 11.7% of global cancer). Cancers of the head and neck and bone and soft tissue were close to parity. All other cancers are under-represented. Representativeness varied 40-fold across different cancers.

CONCLUSIONS

The evidence base for depression treatments is dominated by a single cancer. Given heterogeneity in cancer populations (eg, stage of illness; psychological impact; cancer treatments), it is possible that depression treatments may not have the same benefits and harms across all cancers, impeding the ability to offer people with different cancers the best depression treatment. While the dominant opinion within this research field is that a cancer bias exists, this is the first study to demonstrate as such.

Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: A cross-sectional study in Poland

BACKGROUND

Achieving high quality care through full use of potential stemming from the use of the principles of evidence based practice (EBP) requires adequate shaping of student attitudes toward EBP already at an early stage of education, as well as teaching in the scope of knowledge and skills essential to apply EBP in future professional work. Therefore, nursing educators need a tool to assess competency in EBP. This study aims to present the adaptation of the psychometric test and setting norms to the Polish version of the Evidence Based Practice Competence Questionnaire (EBP-COQ_P).

METHODS

Poland-wide multicentre study, cross-sectional validation design, a representative sample of 1636 nursing students. The EBP-COQ_P was validated in terms of content validity through an expert review. The EBP-COQ_P was administered to evaluate test reliability and validity. Settings norms for the Polish nurse population were also done.

RESULTS

Confirmatory factor analysis demonstrated that 25 items are grouped into three categories which define competences related to EBP: attitude, knowledge, and skills. Cronbach's alpha was 0.856 for the entire questionnaire. EBP-COQ_P had good parameters of absolute stability. EBP-COQ_P was also characterized with external construct validity. Measurement with the use of EBP-COQ_P allowed for a good differentiation of the respondents in terms of their expertise in EBP (known-groups validity).

CONCLUSIONS

In terms of reliability and validity, EBP-COQ_P is compared with its original version. EBP-COQ_P may be used in educational practice (graduate and postgraduate education). Polish norms set for a representative group of nursing students may serve as a benchmark for the results obtained from individual and group measurements.

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.

Perceptions of Rural Magnet Nurses' Comfort and Confidence With Evidence-Based Practice

BACKGROUND

Evidence-based practice (EBP) is essential for improving outcomes for patients and is an expected competency of nurses. However, current practice finds varying levels of comfort and confidence among nurses regarding EBP implementation.

METHOD

A descriptive study using an online survey was conducted to assess the perceptions of nurses at a rural midwestern Magnet^® hospital on their comfort and confidence regarding EBP and compare the results to the nurses' level of education and years of experience.

RESULTS

Although nurses agreed that EBP is important for patient care, nurses with a baccalaureate degree or higher reported increased comfort and confidence with EBP implementation. However, nurses with more years of experience, regardless of education level, reported increased comfort and confidence with EBP, although that finding did not reach significance levels.

CONCLUSION

Creating a culture of EBP is the responsibility of every organization. Administrators and educators must continue to assess the comfort and confidence levels of nurses who work directly at the bedside and provide continuing education and hands-on opportunities to increase nurses' comfort and confidence with implementing EBP. [J Contin Educ Nurs. 2019;50(11):495-500.].

Enacting evidence-based practice: pathways for community nurses

Community nurses are expected to deliver evidence-based practice, which is challenging given the diversity and breadth of the evidence base from which they can draw. This study aimed to explore community nurses' experiences of implementing change in their practice. Qualitative semi-structured interviews (n=9) and focus groups (n=2) with community nurses (n=17) were conducted. Three pathways to introduce change in practice were identified by participants: bottom-up, top-down and collaborative pathways. These are based on the nature of the proposed change, the available evidence, 'buy in' from colleagues and issues around implementation. The findings identify approaches to implementing change in community nursing practice. Practitioners would benefit from support to navigate the complex process of change through managerial support, ongoing education, accessible online resources and support through a practice development role.

The Value of Evidence

We strive to put evidence into action to promote optimal nursing care, regardless of whether those care practices are brand new or decades old.

Randomised controlled trials as part of clinical care: A seven-step routinisation framework proposal

Evidence translation in wound care relies on the need for evidence generation. Clinical practice may generate evidence only if evidence-generating research projects, such as randomised controlled trials (RCTs), became routinised in clinical settings. The aim of this study was to identify optimal trial-related practices to routinise trial-related activities in Melbourne-located wound clinics as reported by clinicians and researchers. We conducted a secondary analysis of the available data on how to routinise RCTs in clinical care, with a focus on enablers and suggestions provided by the participants during face-to-face and telephone interviews. Data were obtained from a qualitative observational study nested within a randomised, double-blinded, placebo-controlled trial on clinical effectiveness of aspirin as an adjunct to compression therapy in healing chronic venous leg ulcers (ASPiVLU). We developed a seven-step Routinisation of Trials in Clinical Care Framework. These steps include: (1) pre-trial clinical site assessment, (2) optimising pre-recruitment arrangements, (3) developing and updating trial-related skills, (4) embedding RCT recruitment as part of routine clinical care, (5) promoting teamwork and trial-related collaboration, (6) addressing trial-related financial issues, and (7) communicating trial results to clinicians.

Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings

The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e-learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital-acquired pressure injuries and the percentages of each stage of pressure of injury 1-4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure-relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice.

Does Changing Newborn Bath Procedure Alter Newborn Temperatures and Exclusive Breastfeeding?

PURPOSE

This evidence-based practice project evaluated effects of changing timing/character of initial newborn baths on infant temperatures and breastfeeding status.

BACKGROUND

The hospital protocol for initial bathing procedures was updated: immersion baths; 12 hours postpartum; family included.

METHODS

Staff nurse champions provided staff training. The evaluation included three seven-week periods (2016-2017) and three measures: adherence, temperature stabilization, and exclusive breastfeeding.

RESULTS

Of 1,205 38-week healthy newborns, 322 were born preimplementation (Pre), 486 after (Post), and 397 during maintenance (M). Adherence to bath timing increased and was maintained: 28 percent Pre; 83 percent Post; 85 percent M. Almost 100 percent of newborns had stable temperatures. Breastfeeding exclusivity rates did not change (ps greater than or equal to .05): baths less than 12 hours: 79 percent Pre, 74 percent Post, and 68 percent M; baths 12 hours: 68 percent Pre, 71 percent Post, and 73 percent M.

IMPLICATIONS

Changing bath time/character for healthy newborns maintained thermoregulation and exclusive breastfeeding rates. Nurses changed practice quickly, maintaining adherence over time.

Assessing the value of practice-based leg ulcer education to inform recommendations for change in practice

The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts.

Identifying Critical Factors in Determining Discharge Readiness from Skilled Home Health: An Interprofessional Perspective

A lack of readiness for discharge from skilled home health can result in adverse events among older adults. The purpose of the current study was to explore interprofessional home health clinician perceptions of the factors they consider important to determine readiness for discharge among skilled home health recipients. A qualitative descriptive study was conducted using four focus groups among 32 interprofessional clinicians from one large skilled home health agency and two telephone interviews with home visiting physicians. A semi-structured interview guide was followed. Qualitative content analysis was used for manifest coding and then thematic analysis. Five themes emerged: (a) patient safety, (b) long-term plan is in place, (c) reached maximum self-care potential, (d) presence of a willing and able caregiver, and (e) patient attributes. The goal of this line of inquiry is to develop an evidence-based home health discharge decision support tool to provide a standardized approach in determining readiness for discharge from skilled home health services. [Res Gerontol Nurs. 2016; 9(6):269-277.].

Is it time for a review of the way that NICE guidelines are developed, presented and used to inform policy and practice?

Catherine Lowenhoff emphasises the need to share the uncertainties inherent in the National Institute for Health and Care Excellence guidelines with policy makers, commissioners, regulators, managers and clinicians to facilitate the paradigm shift from evidence-based practice to evidence-informed practice.

Blood Transfusion Vital Sign Frequency: What Does the Evidence Say?

Blood transfusion vital sign protocols do not have sufficient evi- dence to mandate surveillance frequency. The purpose of this study was to examine the relationship of vital sign changes to reaction times in an effort to determine best practice for monitoring patients receiving blood products.

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.

Clinical guidelines development process in Poland

Clinical practice guidelines are set of recommendations for cliniciansa bout the care of patients. The aim of clinical practice guidelines is to support clinical decision-making, rationalize diagnostic and therapeutic procedures and provide high-quality healthcare. Development of clinical practice guidelines should be a systematic process based on evidence based medicine (EBM). However, as practice shows, they are not always reliable and are not developed according to the recommended world-wide methodology. The purpose of this article is to provide an outline of the clinical guidelines development process and to present international instruments for guidance development, evaluation and adaptation

[The GRADE system]

The Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE Working Group) has developed a system for grading the quality of evidence. Over 20 organizations including the World Health Organization (WHO) have adopted it. The quality of a body of evidence involves consideration of within-study risk of bias (methodological quality), directness of evidence, heterogeneity, precision of effect estimates and risk of publication bias, and the system considers the assessment of the quality of a body of evidence for each individual outcome. The GRADE approach specifies four levels of quality. Randomized trials, usually the highest grade of evidence, can be downgraded depending on the presence of the methodological problems. A brief overview of the grade system is presented.

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.

Student life - How to practise effectively

Referring to the Nursing and Midwifery Council Code's second theme - practise effectively; think what effective nursing care means to you and how this has an impact on the essence of quality care.

Early Identification of Acute Hemolytic Transfusion Reactions: Realistic Implications for Best Practice in Patient Monitoring

Acute hemolytic transfusion reactions can result in severe complications and death. Through early identification and prompt intervention, nurses can reduce the risks associated with these serious reactions. Realistic evidence-based patient monitoring protocols can help guide identification of acute hemolytic transfusion reactions and facilitate lifesaving interventions to avert critical patient situations.

Antithyroid Drugs for Hyperthyroidism

Hyperthyroidism is a treatable endocrine disorder. Having a working knowledge of the current evidence-based guidelines for treating hyperthyroidism aids in improved patient care.

Implementation of an Evidence-Based Patient Safety Team to Prevent Falls in Inpatient Medical Units

Falls are a patient safety priority among hospital inpatients. The creation of a Patient Safety Team engaged frontline staff in patient safety and falls prevention. This intervention decreased the fall rate from 1.90 to 0.69 falls per 1,000 occupied bed days.

Developing Evidence-Based Care Standards and a Decision-Making Support System for Pain Management

Pain is a crucial sign and symptom in hospitalised patients. This paper describes how a medical centre created a knowledge-based, computerised pain management decision-making process to support nurses in personalising preventive interventions based on patient requirements.

Development of an Open Source Educational Resource: "Clinical Procedures for Safer Patient Care"

An Open Education Resource (OER) has been developed by two nurse educators to address inconsistencies in how clinical health care skills are taught and practiced in the clinical setting, and to ensure best practice and quality care based on the latest evidence. A checklist approach aims to provide clear steps and rationale for procedures, standardized processes for clinical skills and to assist nursing schools and clinical practice partners in teaching clinical skills, and keeping procedural practice current. The format is logical, organized and focused on patient safety, and will provide information retrieval opportunities at the point of care to support decisions and plan patient care. This poster discusses the development of this resource, the framework used, and the process from conception to distribution.

Postnatal Depression: Don't reinvent the wheel

Poor mental health accounts for 23% of all ill health in the UK, with the cost of treating it expected to double in the next 20 years. In addition, postnatal depression (PND) in both mothers and fathers can have a detrimental long-term impact on a child's cognitive, social and behavioural development. This paper discusses the development process of an innovative evidence-based resource which involved professional expertise and parent involvement. This unique resource helps to recognise PND in both mothers and fathers and will support health visitors in making a real impact in improving outcomes for children and families.

Aging population

Our aging population is rapidly growing and accounts for 46% of critical care patients and 60% of medical-surgical patients in the hospital. These acutely ill patients are challenging to frontline nurses because they frequently have multiple chronic conditions. This article provides a tool kit of resources and clinical skills to develop safe, quality, and accountable care plans for positive patient outcomes; it presents several resources to assist in individualized care, the complexity of care, and the issues of transitions of care. This article empowers frontline nurses to develop gerontological skills and meet the unique needs of our aging population.

Preventing Progression of Post-Thrombotic Syndrome for Patients Post-Deep Vein Thrombosis

Post-thrombotic syndrome is a chronic condition that develops in up to 50% of patients with acute deep vein thrombosis. Its burden includes increased costs, decreased quality of life, and decreased personal productivity.