Danielle's Picks from the Literature - June 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

1. Evidence-Based Nursing. Changing practice, one clinical question at a time.
Graner, Terry; Sendelbach, Sue; Boland, Lori L.; Koehn, Katheren;
Nursing Management, 2011 May; 42 (5): 14-7

2. Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture.
Makic, Mary Beth Flynn; VonRueden, Kathryn T.; Rauen, Carol A.; Chadwick, Jessica;
Critical Care Nurse, 2011 Apr; 31 (2): 38-62
Abstract: For excellence in practice to be the standard for care, critical care nurses must embrace evidence-based practice as the norm. Nurses cannot knowingly continue a clinical practice despite research showing that the practice is not helpful and may even be harmful to patients. This article is based on 2 presentations on evidence-based practice from the American Association for Critical-Care Nurses' 2009 and 2010 National Teaching Institute and addresses 7 practice issues that were selected for 2 reasons. First, they are within the realm of nursing, and a change in practice could improve patient care immediately. Second, these are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics to be addressed are (1) Trendelenburg positioning for hypotension, (2) use of rectal tubes to manage fecal incontinence, (3) gastric residual volume and aspiration risk, (4) restricted visiting policies, (5) nursing interventions to reduce urinary catheter-associated infections, (6) use of cell phones in critical care areas, and (7) accuracy of assessment of body temperature. The related beliefs, current evidence, and recommendations for practice related to each topic are outlined.

3. Evidence-Based Practice: Perceptions, Skills, and Activities of Pediatric Health Care Professionals.
Bartelt, Tera C.; Ziebert, Carolyn; Sawin, Kathleen J.; Malin, Shelly; Nugent, Melodee; Simpson, Pippa;
Journal of Pediatric Nursing, 2011 Apr; 26 (2): 114-21
Abstract: The purposes of this descriptive study were to evaluate pediatric professional staffs' perceptions of evidence-based practice (EBP), to identify individual and organizational barriers experienced when applying EBP into practice, and to determine differences in perceptions by those attending and not attending an EBP education series. A total of 486 pediatric health care professionals, 56 of whom attended all of the sessions, completed an anonymous online survey. Professional staff participated in and valued EBP activities but identified barriers to full implementation. Participants in the EBP series were significantly different in several positive ways. Implications for further education and research are delineated based on survey results.

4. Implementing and Sustaining Evidence-Based Nursing Practice to Reduce Pediatric Cardiopulmonary Arrest.
Randhawa, Simmy; Roberts-Turner, Renee'; Woronick, Karen; DuVal, Jennifer;
Western Journal of Nursing Research, 2011 Apr; 33 (3): 443-56

5. Launching evidence-based nursing practice.
Whitmer, Kyra; Auer, Christine; Beerman, Linda; Weishaupt, Lynn;
Journal for Nurses in Staff Development, 2011 Mar-Apr; 27 (2): E5-7
Abstract: In one institution's effort to develop nursing staff to use evidence in practice, formation of the Evidence-Based Practice Council was instrumental. This Evidence-Based Practice Council developed its members to support the development of others. Programming strategies included keynote speakers during Nurses Day followed by breakout sessions and programs throughout the year. Traditional means to communicate information as well as the development of an internal Web site were used.

6. Evidence-Based Nursing. Nursing research: Get started!.
Anderson, Tamika L.; Dixon, Kelly H.; Lewallen, Lynne Porter; Jarrett-Pulliam, Cindy;
Nursing Management, 2011 Mar; 42 (3): 20-3

7. Using evidence to improve safety and the quality of health care.
Bucknall, Tracy;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 1-3

8. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.
Bosch, Marije; Halfens, Ruud J. G.; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 4-14
Abstract: Background: Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. Aims: To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. Methods: In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1,274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ? 18) and preventive quality management at ward level. Results: No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. ß 0.32; p < 0.001). Conclusions and Implications: Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way.

9. Translating venous thromboembolism (VTE) prevention evidence into practice: a multidisciplinary evidence implementation project.
Duff, Jed; Walker, Kim; Omari, Abdullah;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 30-9
Abstract: Background: Venous thromboembolism (VTE) is an important patient safety issue resulting in significant mortality, morbidity, and health care resource expenditure. Despite the widespread availability of best practice guidelines on VTE prevention, we found that only 49% of our patients were receiving appropriate prophylaxis. Aim: To improve health care professionals' compliance with evidence-based guidelines for VTE prevention in hospitalised patients. Design: A practice improvement methodology was employed to identify, diagnosis, and overcome practice problems. Pre- and post-intervention audits were used to evaluate performance measures. Setting: The study was conducted from September 2008 until August 2009 and took place in a 250-bed acute-care private hospital in metropolitan Sydney, Australia. Intervention: A change plan was developed that attempted to match organisational barriers to VTE guideline uptake with evidence-based implementation strategies. The strategies used included audit and feedback, documentation aids, staff education initiatives, collaboratively developed hospital VTE prevention policy, alert stickers, and other reminders. Results: The proportion of patients receiving appropriate VTE prophylaxis increased by 19% from 49% to 68% (p = 0.02). Surgical patient prophylaxis increased by 21% from 61% to 82% (p = 0.02) while medical patient prophylaxis increased by 26% from 19% to 45% (p = 0.05). The proportion of patients with a documented VTE risk assessment increased from 0% to 35% (p < 0.001). Conclusions: The intervention resulted in a 19% overall improvement in prophylaxis rates, which is a significant achievement for any behavioural change intervention. There is, however, still a significant discrepancy between surgical and medical patient prophylaxis rates, which clearly warrants further attention.

10. Evidence-Based Nursing. How do you support your staff? Promote EBP.
Shivnan, Jane C.;
Nursing Management, 2011 Feb; 42 (2): 12-4

11. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation.
Rosewilliam, Sheeba; Roskell, Carolyn Anne; Pandyan, Ad;
Clinical Rehabilitation, 2011 Jun; 25 (6): 501-14

12. How to Read a Paper: The Basics of Evidence-Based Medicine.
Critical Care Nurse, 2011 Jun; 31 (3): 93

13. Innovativeness of nurse leaders.
Clement-O'brien, Karen; Polit, Denise F.; Fitzpatrick, Joyce
Journal of Nursing Management, 2011 May; 19 (4): 431-8
Abstract: The purpose of the present study was to describe the innovativeness and the rate of adoption of change among chief nursing officers (CNOs) of acute care hospitals, and explore the difference in the innovativeness of CNOs of Magnet hospitals vs. non-Magnet hospitals. There is little evidence to guide the description of innovativeness for nurse leaders, crucial to the implementation of evidence-based practice standards. CNOs of acute care hospitals of New York State participated in a mailed survey which incorporated the Scale for the Measurement of Innovativeness. The response rate was 41% (106/261). The majority of the sample was prepared at the master's level with 5-10 years of experience in the CNO role. A significant relationship was found between the innovativeness scale scores and the innovativeness diversity index. The CNOs who completed more leadership courses had implemented significantly more types of innovations and had higher innovativeness scale scores. Graduate level education, years of CNO experience and leadership course completion were identified as significantly influencing innovativeness of CNOs. The characteristics of innovativeness for nurse leaders presented in the present study may assist organizations, CNOs and the Magnet recognition programme to describe innovativeness that supports organizations to continuously improve the quality of patient care.

14. Evaluating Shared Governance: Measuring Functionality of Unit Practice Councils at the Point of Care.
Creative Nursing, 2011; 17 (2): 87-95

15. Securing Pediatric Peripheral IV Catheters—Application of an Evidence-Based Practice Model.
Hetzler, Robin; Wilson, Marian; Hill, Elizabeth K.; Hollenback, Cheri;
Journal of Pediatric Nursing, 2011 Apr; 26 (2): 143-8
Abstract: Peripheral intravenous catheter (PIV) insertion is a traumatic experience for children and should not be repeated more frequently than necessary. Proper securement of pediatric IVs can preserve catheter life; however, little evidence is available to describe optimal methods. Pediatric nurses at a 246-bed, community-owned district hospital observed they were frequently attempting to rescue or restart PIVs prematurely. In the context of exemplary professional practice, an exploratory evidence-based practice project was designed to increase knowledge about the best practices in maintaining and preserving pediatric PIVs. Data collection and analysis determined that practices were inconsistent and more research is needed to determine the optimal securement practices.

16. Transformational Leadership Required to Design and Sustain Evidence-Based Practice: A System Exemplar.
Everett, Linda Q.; Sitterding, Mary Cathryn;
Western Journal of Nursing Research, 2011 Apr; 33 (3): 398-426