Danielle's Picks from the Literature - September 2012

Here are my picks of the literature for June. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.

1. Evidence-based nursing. Got accountability? Increasing data transparency.
Meltsch, Tami J.;
Nursing Management, 2012 Jun; 43 (6): 13-5

2. Nurse-directed interventions to reduce catheter-associated urinary tract infections.
Oman, Kathleen S.; Makic, Mary Beth Flynn; Fink, Regina; Schraeder, Nicolle; Hulett, Teresa; Keech, Tarah; Wald, Heidi;
American Journal of Infection Control, 2012 Aug; 40 (6): 548-53
Abstract: Background: Catheter-associated urinary tract infections (CAUTIs) are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections. Evidence-based guidelines exist for indwelling urinary catheter management but are not consistently followed. Methods: A pre/post intervention design was used in this quality improvement project to test the impact of nurse-driven interventions based on current evidence to reduce CAUTIs in hospitalized patients on 2 medical/surgical units. Interventions consisted of hospital-wide strategies including policy and product improvements and unit-specific strategies that focused on a review of current evidence to guide practice. Results: The number of catheter days decreased from 3.01 to 2.2 (P = .018) on the surgery unit and from 3.53 to 2.7 (P = .076) on the medical unit. CAUTI rates were too low to achieve significant reduction. Product cost savings were estimated at $52,000/year. Conclusion: Guidelines derived from research and other sources of evidence can successfully improve patient outcomes. Nurse-driven interventions, combined with system-wide product changes, and patient and family involvement may be effective strategies that reduce CAUTI.

3. INSPIRING CHANGE. Plan for a successful research day!
Mikos-Schild, Sophia; Avelino, Aida; Calvario, Marilou; Mata, Annette;
Nursing, 2012 Aug; 42 (8): 11-2

4. Facilitators and Barriers to Clinical Practice Guideline Use Among Nurses.
Abrahamson, Kathleen A.; Fox, Rebekah L.; Doebbeling, Bradley N.;
American Journal of Nursing, 2012 Jul; 112 (7): 26-36

5. Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes.
Richardson, Jeannette; Tjoelker, Rita;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2012 Jul-Aug; 26 (4): 205-11
Abstract: PURPOSE: : The purpose of this project was to demonstrate the value of clinical nurse specialist (CNS)-led efforts to optimize patient outcomes through continued monitoring and management of a previously implemented evidence-based practice project. BACKGROUND: : Central line-associated bloodstream infections (CLABSIs) significantly impact patient morbidity/mortality and cost of care. In 2006, the critical care unit (CCU) of the Portland VA Medical Center implemented national recommendations for the prevention of CLABSIs through use of the Institute of Healthcare Improvement Central Line Bundle. This practice change was led by the CCU and infection control CNSs, and compliance in the completion of bundle items has remained consistently high (>90%). Although the CCU has maintained CLABSI rates below the national benchmark, it experienced a 4-month period of increased incidence in late 2008. DESCRIPTION: : Clinical nurse specialists in CCU and infection control organized a "Hot Team" of nurses from multiple departments throughout the hospital to evaluate processes/data related to the recent increase in infections. Using national guidelines, the team focused on interdisciplinary implementation of strategies beyond the Central Line Bundle components. Consideration of cost and workflow patterns was critical to decision making. OUTCOME: : Infection rates in CCU decreased from a high of 1.5 per 1000 line days down to 0 in June 2011, with the last CLABSI occurring in May 2010. CONCLUSION: : The formation and efforts of a CNS-led team of nurses has been successful in decreasing infection rates through implementation of multiple innovative strategies. IMPLICATIONS: : Clinical nurse specialist surveillance, management, and leadership following project implementation are valuable strategies for continued optimal patient outcomes.

6. Employing a clinical governance framework to engage nurses in research.
Kinney, Sharon; Lima, Sally; McKeever, Stephen; Twomey, Bernadette; Newall, Fiona; Journal of Nursing Care Quality, 2012 Jul-Sep; 27 (3): 226-31
Abstract: The theoretical benefits of engaging in quality and research activities are readily apparent; however, engagement of clinical nurses in these pursuits remains challenging. In addition, the separation of quality improvement and research as distinct endeavors can impair desired improvements in patient outcomes. We propose that employing a clinical governance framework to inform nursing research in the clinical setting enhances the engagement of nurses in the generation and utilization of evidence to improve the quality of care.

7.  Research study or quality improvement project?
Arndt, Jane V; Netsch, Debra S;
Journal of Wound, Ostomy & Continence Nursing, 2012 Jul-Aug; 39 (4): 371-5

8. The Evidence-Based Practice Course as an Opportunity for Writing.
Dewar, Susan R.;
Nurse Educator, 2012 Jul-Aug; 37 (4): 143-4

9. QI, EBP and Research: How Do They Differ?
AACN Bold Voices, 2012 Jun; 4 (6): 18

10. Practice-Based Evidence and Qualitative Inquiry.
Leeman, Jennifer; Sandelowski, Margarete;
Journal of Nursing Scholarship, 2012; 44 (2): 2nd Quarter: 171-9
Abstract: Purpose: Nurses and other healthcare providers continue to underuse interventions demonstrated to be effective at improving health outcomes. We propose in this article that if more evidence-based practice is wanted, greater use must be made of qualitative inquiry to obtain practice-based evidence derived from the experiences and practices of healthcare providers and the contexts of healthcare provision. Approach: We present a framework for the use of qualitative methods to contribute to the following categories of practice-based evidence: (a) practice-based interventions and implementation strategies, (b) causal mechanisms, (c) approaches to adaptation, (d) how-to guidance, (e) unanticipated effects, and (f) relevant contextual factors. Conclusions: Qualitative inquiry has an essential role to play in incorporating more practice-based evidence into the evidence base for nursing practice. Clinical Relevance: This framework can be used by clinicians to plan for the implementation of interventions in practice, by researchers to discuss the practice implications of their findings, and by researchers to launch qualitative studies explicitly designed to capture practice-based evidence.

11. Evidence Into Practice: Publishing an Evidence-Based Practice Project.
Adams, Susan; Farrington, Michele; Cullen, Laura;
Journal of PeriAnesthesia Nursing, 2012 Jun; 27 (3): 193-202

12. The role of the advanced practice registered nurse in ensuring evidence-based practice.
Moseley, Marthe J;
Nursing Clinics of North America, 2012 Jun; 47 (2): 269-81
Abstract: The advanced practice registered nurse (APRN) is vital in role-modeling and ensuring evidence-based practice (EBP) engagement and application at the point of care. This article describes the formulation of national competencies for EBP, specific to the APRN level. The application of selected competencies is delineated and the creation of an APRN action plan to identify necessary EBP competencies is discussed. If EBP skills are lacking, the action plan is used for development of skills in the required areas.

13. Implementing Skin-To-Skin Contact at Birth Using the Iowa Model.
Haxton, Dawn; Doering, Jennifer; Gingras, Linda; Kelly, Lucy;
Nursing for Women's Health, 2012 Jun-Jul; 16 (3): 220-30

14. Clinical research nursing: A critical resource in the national research enterprise.
Hastings, Clare E.; Fisher, Cheryl A.; McCabe, Margaret A.;
Nursing Outlook, 2012 May; 60 (3): 149-156.e3
Abstract: Translational clinical research has emerged as an important priority for the national research enterprise, with a clearly stated mandate to more quickly deliver prevention strategies, treatments and cures based on scientific innovations to the public. Within this national effort, a lack of consensus persists concerning the need for clinical nurses with expertise and specialized training in study implementation and the delivery of care to research participants. This paper reviews efforts to define and document the role of practicing nurses in implementing studies and coordinating clinical research in a variety of clinical settings, and differentiates this clinical role from the role of nurses as scientists and principal investigators. We propose an agenda for building evidence that having nurses provide and coordinate study treatments and procedures can potentially improve research efficiency, participant safety, and the quality of research data. We also provide recommendations for the development of the emerging specialty of clinical research nursing.

15. Quality improvement, evidence-based practice, and nursing research . . . Oh my!.
Raines, Deborah A;
Neonatal Network, 2012 Jul-Aug; 31 (4): 262-4
Abstract: Research is a word that evokes feeling of fear and dread in many nurses. Maybe its memories of the research course required in their nursing education program, hours spent in the library, or deciphering the statistics section in a research article. Most nurses want to focus on nursing skills and are unaware of the relationship between research and nursing care skills, such as administering medications, protecting skin integrity, or educating an anxious parent. Many nurses see research as distinct from patient care and nursing practice, but nothing is further from the truth. Quality nursing care is based on questioning the things nurses do and looking at the relationship between nursing care and patient outcomes. For a long time, nursing practices were based on tradition. Even the emergence of the neonatal intensive care unit (NICU) was grounded in the tradition of the adult intensive care unit. Equipment and practices were downsized without evidence that what worked with an adult patient could be effectively miniaturized and used with neonatal patients. If the goal of nursing practice is excellent care and quality outcomes for patients, then questioning practices, examining outcomes, using evidence, and sharing discoveries are essential components of the nurses' role.

16. Challenges that may arise when conducting real-life nursing research.
White, Edward;
Nurse Researcher, 2012 Jul; 19 (4): 15-20
Abstract: Aim To reveal some of the unexpected occurrences that can arise during real-life investigations to upset the conventional research process. Background As novice investigators develop their careers, they are increasingly likely to encounter aspects of research that are rarely mentioned in nursing textbooks. This paper sets out several such occurrences that may challenge the researcher and the practical consequences for an unsuspecting investigator. Data sources The author's experience in research over the past 30 years. Discussion In seeking to find satisfactory solutions to problems during research, researchers will also face dilemmas that offer at least two possibilities, neither of which may be acceptable. Experienced researchers will recognise this situation and acknowledge the range of trade-offs that characterise social research. Implications for practice/research Novice researchers should be forewarned of some of the challenges they could face when carrying out future research.