Thursday, January 27, 2011

Danielle's Picks from the Literature - January 2011

Here are my picks from the nursing literature published over the last few months. Staff at St. Joseph Hospital or Children's Hospital of Orange County may be able to access some of the full text articles through the Burlew Medical Library.

1. Implementation of evidence-based nursing practice: nurses' personal and professional factors?
Eizenberg MM
Journal of Advanced Nursing, 2011 Jan; 67 (1): 33-42
Abstract: Aims. This paper is a report of a study conducted to explore the relationship between nurses' personal and professional factors and evidence-based nursing practice. Background. Like most health-related professions, nursing is shifting from the traditional intuition-based paradigm to evidence-based nursing practice. Methods. A cross-sectional survey was conducted in 2007 with a convenience sample of 243 nurses from northern Israel, who worked in hospitals or in the community. Associations between background variables and evidence-based nursing practice were examined. For the purpose of finding factors that predicted behaviour, a logistic regression analysis was conducted. Results. The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. Moreover, evidence-based nursing practice was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace. The variables emerging as predicting evidence-based nursing practice were: education, skills in locating various research sources, support of the organization for searching and reading professional literature, knowledge sources based on colleagues and system procedures (inhibiting variable), knowledge sources based on reading professional literature, and knowledge sources based on experience or intuition. Conclusion. The findings point to the need for research-based information, exposure to professional journals and, in particular, organizational support for evidence-based nursing practice.

2. The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.
Ploeg J; Skelly J; Rowan M; Edwards N; Davies B; Grinspun D; Bajnok I; Downey A
Worldviews on Evidence-Based Nursing, 2010 4th QUARTER; 7 (4): 238-51
Abstract: Background: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. Aim: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. Methods: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N = 191) and administrators (N = 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. Results: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. Conclusions and Implications: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidencebased practices to advance positive patient, organizational, and system outcomes.

3. Evidence-based nursing practice in the perioperative setting: a Magnet journey to eliminate sacred cows.
Mellinger E; McCanless L
AORN Journal, 2010 Nov; 92 (5): 572-8

4. Critical care: does profusion of evidence lead to confusion in practice?
McKenna H
Nursing in Critical Care, 2010 Nov-Dec; 15 (6): 285-90
Abstract: There have been a plethora of articles on evidence-based practice or its many derivative terms (evidence-based nursing, evidence-based medicine, evidence-based health care, etc.). However, the word 'based' implies an almost unquestioning belief in evidence. I will argue that the term 'Evidence Informed Practice' is probably more accurate. This argument will be underpinned by Archie Cochrane's 'road to Damascus' questioning of the value of soft over hard interventions and challenge what is held up as gold-standard evidence. The differences in definitions of evidence-based practice will also be discussed. Carper's identification of ethical, aesthetic and personal knowing will be used to debunk the myth that empirical evidence is always the gold standard for care and treatment. It will be argued that empirical evidence can be ignored when it clashes with other types of evidence. Finally, the tension between certainty and agreement with evidence will be explored.

5. Recognizing the evidence and changing practice on injection sites.
Cocoman A; Murray J
British Journal of Nursing (BJN), 2010 Oct 14; 19 (18): 1170-4
Abstract: Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.

6. Exploring the effect of conducting sensitive research.
McGarry J
Nurse Researcher, 2010; 18 (1): 8-14

Abstract: The term 'sensitive research' has become recognised in health and social care research literature generally. It has been used to describe a wide range of topics, undertaken across a variety of disciplines and settings, using a range of methods. Drawing on evidence from other disciplines, this article examines the particular issues and effects that arise for nurses in carrying out sensitive research as the field continues to evolve.

7. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.
Schindler CA; Mikhailov TA; Kuhn EM; Christopher J; Conway P; Ridling D; Scott AM; Simpson VS
American Journal of Critical Care, 2011 Jan; 20 (1): 26-35
Abstract: Background: The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. Objectives: To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Methods: Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. Results: The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable underpads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. Conclusions: The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.

8. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.
Harris J; Kearley K; Heneghan C; Meats E; Roberts N; Perera R; Kearley-Shiers K
Medical Teacher, 2011 Jan; 33 (1): 9-23
Abstract: Background: Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established. Objective: This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making. Methods: We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings. Results: Eighteen studies were included. Studies reported improvements in reading behaviour ( N = 5/11), confidence in critical appraisal ( N = 7/7), critical appraisal test scores ( N = 5/7) and ability to use findings ( N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities. Conclusion: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

9. A 15-step model for writing a research proposal.
Martin CJH; Fleming V
British Journal of Midwifery, 2010 Dec; 18 (12): 791-8
Abstract: On occasion midwives may be required to construct a research proposal. In the current climate of evidence-based practice. Such activity is considered an elemental skill for career progression in both education and service. Examples of where writing a research proposal may be required include: writing an assessment for under and post graduate research modules or designing a dissertation, MPhil, Prof Doc or PhD. Within clinical practice there are also audit and evaluation of practice responsibilities. With these factors at the forefront, this article provides a template specifically designed to direct midwives through the procedures of constructing a research proposal. The purpose of a research proposal is to produce a template of common understanding from which tasks are allocated, divided and discussed by researchers, clinical staff and in some cases participants. The finished product is then used to communicate intent to the ethics committees and grant funding bodies before authorization and money are awarded.

10. Clinical librarians as facilitators of nurses' evidence-based practice.
Määttä S; Wallmyr G
Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3427-34

Abstract: The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice.

11. Teaching Research and Evidence-Based Practice Using a Service-Learning Approach.
Balakas K; Sparks L
Journal of Nursing Education, 2010 Dec; 49 (12): 691-5
Abstract: Because nurses are expected to engage in evidence-based practice (EBP), nursing students must learn to critically evaluate and apply research findings to prepare for professional practice. To connect research and EBP, the focus of a baccalaureate research course was changed from a traditional format to one of evidence appraisal and synthesis. Using an approach that incorporated service-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world. Working with a community partner, students were able to develop PICO (Population, Intervention, Comparison, and Outcome) questions and critically appraise the literature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experience because course assignments had a direct impact on current practice. Research courses taught from an EBP perspective can provide motivation for students to incorporate research into their practice as professional nurses.

12. Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm.
Mallory GA
Nursing Outlook, 2010 Nov; 58 (6): 279-86
Abstract: The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

13. Interdisciplinary evidence-based practice: Moving from silos to synergy.
Newhouse RP; Spring B
Nursing Outlook, 2010 Nov; 58 (6): 309-17
Abstract: Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform.

Wednesday, January 19, 2011

St. Joseph Hospital Nurses & Staff Publish Two New Articles!

Congratulations to the following St. Joseph Hospital nurses and staff for their recent contributions to the literature:

Pamela Matten, RN, BSN, OCN; Victoria Morrison, RN, MSN, FNP; Dana Rutledge, RN, PhD; Timothy Chen, PharmD; Eunice Chung, PharmD; Siu-Fun Wong, PharmD, FASHP, FCSHP; Jane Johnson, RN, BSN, CWOCN; Darcie Peterson, RN, BSN, CWOCN; Betty Campbell, RN, BSN, CWOCN; Regina Richardson, RN, BSN.

See the details of their two publications below. Articles are available in full text online to all SJH & CHOC employees. Please visit the Burlew Medical Library website for more information.

Evaluation of Tobacco Cessation Classes Aimed at Hospital Staff Nurses.
Oncology Nursing Forum
Volume 38(1), January 2011
Pages 67-73

Pamela Matten, RN, BNS, OCN, Victoria Morrison, RN, MSN, FNP, Dana N. Rutledge, RN, PhD, Timothy Chen, PharmD, Eunice Chung, PharmD, Siu-Fun Wong, PharmD, FASHP, FCSHP


To evaluate a three-hour smoking cessation program and its effect on nurse knowledge, counseling behaviors, and confidence in counseling behaviors.

Hospital-Acquired Pressure Ulcer Prevalence-Evaluating Low-Air-Loss Beds.
Journal of Wound, Ostomy & Continence Nursing
38(1), January/February 2011
Pages 55-60

Johnson, Jane; Peterson, Darcie; Campbell, Betty; Richardson, Regina; Rutledge, Dana


Higher-category pressure redistribution mattresses are considered a critical component of a pressure ulcer prevention program, but few studies have quantified the impact of specific preventive measures on the incidence or prevalence of hospital-acquired pressure ulcers (HAPUs). Therefore, this study was undertaken to determine the impact of low-air-loss beds on HAPU prevalence. METHODS: This prospective, comparative cohort study monitored the prevalence of HAPU at our hospital and compared rates of matched medical-surgical units with and without low-air-loss beds. Units without low-air-loss beds used a variety of alternative pressure redistribution devices for patients deemed at risk for pressure ulceration. The prevalence of HAPU was operationally defined as the number of patients with HAPUs divided by numbers of patients observed. RESULTS: The prevalence of HAPU over 3 quarters in 2008 ranged from 1.0% to 3.3% (overall rate 2.4%). Eighty-three percent of patients with HAPUs were cared for on low-air-loss beds. Of 12 patients with 16 HAPUs during this time, 75% were aged 70 years or older and 25% were managed in critical care units. Over half of patients who developed HAPUs had been hospitalized for 20 days or more. Half of the patients with HAPUs were scored as no-low risk on the Braden Scale. On the paired medical-surgical units, no statistically significant differences were found when patients with low-air-loss beds were compared to standard hospital mattresses supplemented by a variety of pressure redistribution devices. Seven of 11 HAPUs (63%) occurred in patients placed on low-air-loss beds. CONCLUSIONS: The prevalence of HAPU in patients placed on low-air-loss beds was no different from patients placed on standard hospital mattresses supplemented by a variety of pressure redistribution devices. Further research is needed to determine the impact of specific strategies on prevention of HAPU.