Nursing Research: Show me the evidence!

Danielle's Picks from the Literature - January 2012

2012-01-25T09:36:00.000-08:00

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, patient preferences and patient-centred care.
Hopp, Lisa;
International Journal of Evidence-Based Healthcare, 2011 Dec; 9 (4): 335-6

2. Evidence-Based Nursing. Taking care of business with TCAB.
O'Neill, Jennifer A.; Holecek, Nancy; DeLima, Mary;
Nursing Management, 2011 Dec; 42 (12): 19-22

3. Evidence-based practice and research: the challenge for transplant nursing.
White-Williams, Connie;
Progress in Transplantation, 2011 Dec; 21 (4): 299-305
Abstract: Despite the initiative for nurses to engage in evidence-based practice and research, little is known about transplant nurses and the role they play in research and evidence-based practice in nursing care. The definition of evidence-based practice and research and how it relates to the role of the transplant nurse, the facilitators and barriers to research and evidence-based practice, and the implications for the future of research and evidence-based practice in transplant nursing are addressed.

4. Developing Guidelines for Clinical Protocol Development.
Levin, Rona F.; Lewis-Holman, Seon;
Research & Theory for Nursing Practice, 2011; 25 (4): 233-7

5. Promoting the Implementation of Evidence-Based Practice: A Literature Review Focusing on the Role of Nursing Leadership.
Sandström, Boel; Borglin, Gunilla; Nilsson, Roland; Willman, Ania;
Worldviews on Evidence-Based Nursing, 2011 4th Quarter; 8 (4): 212-23
Abstract: Objectives: Despite a growing interest in evidence-based practice (EBP), the implementation into clinical practice of knowledge derived from research has proved to be a cumbersome process. Additionally, the literature seems to present a fragmented picture with research mainly focusing on a few factors of possible importance, among which leadership appears to be one of the more important. Thus, this study aimed to systematically review the literature regarding leadership and its possible influence on the process of implementing EBP. Approach: A literature review was conducted. Electronic database searches were conducted to identify studies on leadership, administrators, managers, implementation, evidence-based and nursing. The search identified 43 potentially relevant papers, of which 36 were excluded after an appraisal was performed by two independent reviewers. Results were extracted and synthesised into a narrative text. Findings: Seven papers were included in the literature review. The findings can be divided into three major areas: (1) characteristics of the leader, (2) characteristics of the organisation and (3) characteristics of the culture. Our findings indicate that leadership is vital for the process of implementing EBP in nursing and also highlights the possible importance of the organisation and the culture in which the leader operates. These factors together with their characteristics were interpreted to be intrinsic in the creation of a nursing milieu that is open and responsive to the implementation of EBP. Conclusions: Although there seems to be scholarly agreement that leadership is a vital part of the process of implementing EBP, more rigorous research is needed concerning the possible role of the leader. Our findings also indicate that leadership cannot be studied in isolation or without being clearly defined.

6. An Exploration of the Roles of Nurse Managers in Evidence-Based Practice Implementation.
Wilkinson, Joyce E.; Nutley, Sandra M.; Davies, Huw T.O.;
Worldviews on Evidence-Based Nursing, 2011 4th Quarter; 8 (4): 236-46
Abstract: Background: Internationally, nurses face ongoing difficulties in making a reality of evidence-based practice. Existing studies suggest that nurse managers (NMs) should play a key role in leading and facilitating evidence-based practice, but the nature of this role has not yet been fully explored or articulated. This is one of the first studies to investigate the roles of NMs in evidence-based practice implementation. Methodology and Methods: Using a case study approach the study explores five propositions in relation to the NMs' potential evidence-based practice role and the extent to which their attitudes, knowledge, and skills support such a role. In doing so, it draws on interviews (n = 51), documentary analysis and observational data. Findings: Data analysis reveals that the role of NMs in facilitating evidence-based practice is underarticulated, largely passive and currently limited by competing demands. Progress in implementing evidence-based practice in the case study sites is largely explained by factors other than the role played by NMs. As such, the findings expose significant discrepancies between NMs' actual roles and those espoused in the literature as being necessary. Contextual factors are important and it is clear that the role of the contemporary NM places considerable emphasis on management and administration to the detriment of clinical practice concerns. Conclusions: The study reveals that NMs are only involved in evidence-based practice implementation in a passive role, not the full engagement described in the literature as being necessary. This study adds previously lacking detail of the roles of NMs. It elucidates why exhortations to NMs to become more involved in evidence-based practice implementation are ineffectivewithout action to address the problems identified.

7. A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing.
Nairn, Stuart;
Nursing Inquiry, 2012 Mar; 19 (1): 6-17
Abstract: A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing This paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter-related. On one side, there is the view that all healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge.

8. Determining factors in evidence-based clinical practice among hospital and primary care nursing staff.
De Pedro-Gómez, Joan; Morales-Asencio, José Miguel; Bennasar-Veny, Miquel; Artigues-Vives, Guillem; Perelló-Campaner, Catalina; Gómez-Picard, Patricia;
Journal of Advanced Nursing, 2012 Feb; 68 (2): 452-9
Abstract: Determining factors in evidence-based clinical practice among hospital and primary care nursing staff. Journal of Advanced Nursing 68(2), 452-459. Abstract Aim. The general aim of this study is to identify key factors perceived by nurses to influence evidence-based clinical practice at different centres. Background. During the last decade, there has been an increased interest in the identification of factors that facilitate the transfer of knowledge into clinical practice, among health care professionals. Previous research states that a suitable organisational framework and practice environment seems to have influence on a greater use of scientific evidence by nurses, which can be directly observed in patient outcomes. In consequence, several authors suggest that strategies should be encouraged from managers and nurse executives to guarantee the existence of environments that avoid emotional exhaustion and improve satisfaction of nurses with their work, and at the same time, ensure the use of research-guided nursing decisions. Methods. Following the Spanish validation of the Practice Environment Scale-Nursing Work Index and Evidence Based Practice Questionnaire, a descriptive observational cross-sectional study has been conceived, from 2010 to 2011, in order to identify determining factors in evidence-based clinical practice at different centres. In a second phase, a qualitative study has been designed, using focus groups, to identify practice factors that can lead to a successful implementation of evidence-based clinical practice. Discussion. Organisational and attitudinal interventions are needed in order to implement evidence-based clinical practice that improves the quality of patient care.

9. Whither Nursing Models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care.
McCrae, Niall;
Journal of Advanced Nursing, 2012 Jan; 68 (1): 222-9
Abstract: Whither Nursing Models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care. Journal of Advanced Nursing 68(1), 222-229. Abstract Aim. This paper presents a discussion of the role of nursing models and theory in the modern clinical environment. Background. Models of nursing have had limited success in bridging the gap between theory and practice. Data sources. Literature on nursing models and theory since the 1950s, from health and social care databases. Discussion. Arguments against nursing theory are challenged. In the current context of multidisciplinary services and the doctrine of evidence-based practice, a unique theoretical standpoint comprising the art and science of nursing is more relevant than ever. Implications for nursing. A theoretical framework should reflect the eclectic, pragmatic practice of nursing. Conclusion. Nurse educators and practitioners should embrace theory-based practice as well as evidence-based practice.

10. Hourly rounding: challenges with implementation of an evidence-based process.
Deitrick LM; Baker K; Paxton H; Flores M; Swavely D;
Journal of Nursing Care Quality, 2012 Jan-Mar; 27 (1): 13-9
Abstract: Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting. This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and evaluation are required for successful implementation of a nursing practice change.

11. Practice Makes Perfect—Research Makes Perfect Practice.
Christian, Becky J.;
Journal of Pediatric Nursing, 2012 Feb; 27 (1): 90-1

12. Statistical process control in nursing research.
Polit DF; Chaboyer W;
Research in Nursing & Health, 2012 Feb; 35 (1): 82-93
Abstract: In intervention studies in which randomization to groups is not possible, researchers typically use quasi-experimental designs. Time series designs are strong quasi-experimental designs but are seldom used, perhaps because of technical and analytic hurdles. Statistical process control (SPC) is an alternative analytic approach to testing hypotheses about intervention effects using data collected over time. SPC, like traditional statistical methods, is a tool for understanding variation and involves the construction of control charts that distinguish between normal, random fluctuations (common cause variation), and statistically significant special cause variation that can result from an innovation. The purpose of this article is to provide an overview of SPC and to illustrate its use in a study of a nursing practice improvement intervention.

13. Towards improved organisational support for nurses working in research roles in the clinical setting: A mixed method investigation.
Rickard, Claire M.; Williams, Ged; Ray-Barruel, Gillian; Armit, Lyn; Perry, Chris John; Luke, Haida; Duffy, Paula; Wallis, Marianne;
Collegian, 2011; 18 (4): 165-76
Abstract: Background The clinical research workforce within nursing is growing including those employed to lead studies, coordinate research and many hybrid roles. Several studies have reported high job satisfaction among research nurses. However, there have also been reports of limited options for career development and professional integration, likely reflecting typical informal, departmentally based management models. Institution-wide studies of issues related to research nurses are lacking, thus hampering the design and implementation of effective organisational frameworks to support and develop these positions. Aims To explore experiences of nurses employed in research positions regarding organisational structures and support for research career pathways, and determine what reforms would strengthen an effective research specialisation pathway. Methods A mixed-methods, cross-sectional approach, using a 104-item survey and semi-structured interviews of 11 staff in research roles at an acute care hospital in Queensland, Australia. Results Research nurses lack organisational support in many job aspects that they deem important. A management model for the coordination of research nurses within a health district could maximise development of this field. Academic liaison and mentoring for nurses in research, and recognition for effort, are key areas for a management model to target. Conclusion Nurses in research roles need individual mentorship, collective support, and the professional recognition and status that researchers in other settings are afforded. A comprehensive research management model would provide structured organisational support for nurses in research, improve professional development opportunities, ensure efficient use of human resources, synergistic working partnerships, and further contribute to a culture of evidence-based healthcare.

14. Advancing Nursing Administration Through Research.
Hill, Karen S.;
Journal of Nursing Administration, 2011 Dec; 41 (12): 558-64

More tips for getting published in the nursing literature!

2012-01-18T10:30:00.000-08:00

Last year the British Journal of Nursing published a compilation of articles for nurses on publishing in the professional literature. Tips include recommendations on getting started, writing structure, and how to choose the right journal. The entire series is available to St. Joseph Hospital, Orange and CHOC staff through the Burlew Medical Library's CINAHL database.

Writing for professional publication. Part 1: Motivation.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2010 Sep 9; 19(16): 1062.

Writing for professional publication. Part 2: Subject matter.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2010 Sep 23; 19(17): 1121.

Writing for professional publication. Part 3: Following journal guidelines.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2010 Oct 28; 19(19): 1260.

Writing for professional publication. Part 4: Supporting your statements.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2010 Nov 25; 19(21): 1374.

Writing for professional publication. Part 5: Creating interest.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2011 Jan 13; 20(1): 49.

Writing for professional publication. Part 6: Writing the abstract.
Fowler J
British Journal of Nursing (BJN) (BR J NURS), 2011 Jan 27; 20(2): 120.

Writing for professional publication. Part 7: Structure and presentation.
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Feb 10; 20(3): 190.

Writing for professional publication. Part 8: Targeting the right journal
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Feb 23; 20(4): 254.

Writing for professional publication. Part 9: Using client case studies.
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Mar 10; 20(5): 330.

Writing for professional publication. Part 10: Publishing a project report.
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Apr 14; 20(6): 371.

Writing for professional publication. Part 11: Writing conference.
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Apr 21; 20(7): 451.

Writing for professional publication. Part 12: Summary of the series.
Fowler, J
British Journal of Nursing (BJN) (BR J NURS), 2011 Apr 28; 20(8): 509.

Interview

2012-01-10T15:41:00.000-08:00

Welcome to Vickie’s Research Corner.
Over the past several years here we have had so many interesting research studies. I would like to introduce you to Irma Patrick; she is currently the manager of Cardiac/Renal. She has worked at St. Joseph’s Hospital since 1997. She just finished her Masters in Nursing with a focus in Leadership at California State University Fullerton this past year. As part of her Master’s project, Irma decided to try her hand at research. Her study was called “Use of Healing touch Self-Care Technique to Reduce Stress in Bedside Nurses: A Pilot Study.
When asked how she became interested in her study she stated that “I decided to research Healing Touch. I developed interest in energy work after attending a meditation seminar in Hawaii. I then decided to take a Healing Touch class. Once I started my Masters program I realized I have an avenue to perform research in this area and wanted to get away from just studying clinical practice.”
Healing Touch Program (2009) explains that human energy system is made up of an energy field (aura), energy centers (chakras), and energy tracts (meridians) and that they work interdependently and influence physical, emotional, mental and spiritual life. Desired outcomes of HT are achieved when there is an unimpeded flow of energy and balancing of the energy field.
According to her literature review nurses who perceive themselves as healers often feel unsupported in their work environments. Often many nurses do not have a good work balance and do not practice self-care. Alternative therapies allowing nurses to self heal may help to decrease stress and avoid burnout. Several studies identified that healing touch reduced stress.
Irma worked with her chair who happened to be our own Dana Rutledge. They developed the pilot study. The study questioned if performing healing touch self-care technique for 15 minutes during a work shift reduce levels of stress during the shift. This study was a randomized clinical controlled trial. Eight nurses from each shift from the Cardiac Renal Unit were invited and they must have attended a Watson’s Caritas Summit and volunteered for the study. Nurses were randomized into two groups- intervention of Healing Touch and the control group who just took a break for 20 minutes and could do whatever they wanted on their break.
The results of the study were very positive! The tool used measured positive and negative feelings of the intervention pre and post intervention. The results demonstrated that both groups experiences increased positive feelings and decreased negative feelings (p<0.001). There was a significant time effect with decreasing negative feelings (p=0.038) with nurses in the Healing Touch group having a greater decrease in negative feeling than those in the control group. Overall Irma was very happy with her study especially since she has never done a study before. She would eventually like to do a larger study and continues to work on her Healing Touch study with a goal of certification through ANCC.- Irma and 8 other volunteers offered brief Healing Touch sessions to attendees of the Cultivating Optimal Healing Environments Conference held at St Joes on May 3, 2011. She will be taking the Level 4 Healing Touchclass in February at The Sisters of St. Joseph of Orange Center for Spiritual Development.

Danielle's Picks from the Literature - December 2011

2011-12-19T15:55:00.000-08:00

LAST PICKS for 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.

Evidence-Based Nursing. Safe patient handling: Is your facility ready for a culture change?
Cadmus, Edna; Brigley, Patricia; Pearson, Madelyn;
Nursing Management, 2011 Nov; 42 (11): 12-5

Development of a Radiation Skin Care Protocol and Algorithm Using the Iowa Model of Evidence-Based Practice.
Bergstrom, Kelli;
Clinical Journal of Oncology Nursing, 2011 Dec; 15 (6): 593-5
Abstract: Limited evidence-based standards of care exist in the management of irradiated skin; therefore, the development of a skin care protocol is necessary to improve patient outcomes. This article describes the use of the Iowa Model of Evidence-Based Practice to Promote Quality Care as a framework to identify and validate current evidence. The resulting radiation therapy algorithm provided a succinct guideline for nurses to direct the prevention and management of skin damage secondary to radiation therapy, thus improving quality care.

Putting Evidence Into Practice.
Von Ah, Diane; Jansen, Catherine; Allen, Deborah Hutchinson; Schiavone, Rosalina M.; Wulff, Jennifer;
Clinical Journal of Oncology Nursing, 2011 Dec; 15 (6): 607-15
Abstract: Cognitive impairment is a clinically complex symptom commonly experienced by cancer survivors. Although research in this area has grown, many questions remain regarding underlying mechanisms, trajectory, and specific interventions nurses can offer patients to prevent, treat, and manage cognitive impairment effectively. As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for cognitive impairment in cancer survivors. The studies were categorized into nonpharmacologic interventions, including complementary and alternative therapies and cognitive training, and pharmacologic interventions, including psychostimulants and erythropoietin-stimulating agents. Using the ONS PEP Weight of Evidence Classification Schema, the levels of evidence for these interventions were consistent with the categories of effectiveness not established or not recommended for practice. Additional research is needed to identify effective preventive and treatment strategies for cognitive impairment in cancer survivors.

A discussion of approaches to transforming care: contemporary strategies to improve patient safety.
Burston, Sarah; Chaboyer, Wendy; Wallis, Marianne; Stanfield, Jane;
Journal of Advanced Nursing, 2011 Nov; 67 (11): 2488-95
Abstract: A discussion of approaches to transforming care: contemporary strategies to improve patient safety. Journal of Advanced Nursing 67(11), 2488-2495. Abstract Aim. This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group^®. Background. International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Data sources. Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. Discussion. A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. Implications for nursing. These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. Conclusion. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes.

A Practical Communication Strategy to Improve Implementation of Evidence-Based Practice.
Diedrick, Lee A.; Schaffer, Marjorie A.; Sandau, Kristin E.;
Journal of Nursing Administration, 2011 Nov; 41 (11): 459-65

Putting Evidence Into Practice.
Feight, Deborah; Baney, Tara; Bruce, Susan; McQuestion, Maurene;
Clinical Journal of Oncology Nursing, 2011 Oct; 15 (5): 481-92
Abstract: Radiation dermatitis, or radiodermatitis, is a significant symptom caused by radiation therapy for the treatment of cancerous and noncancerous conditions. Radiodermatitis can negatively affect patients' physical functioning and quality of life. The Oncology Nursing Society coordinated a Putting Evidence Into Practice (PEP) project team to develop a PEP resource summarizing current evidence for the management of patients with radiodermatitis. Oncology nurses play an important role in educating, assessing, and monitoring patients for this symptom. Many common nursing interventions for radiodermatitis are based on tradition or opinion and have not been researched thoroughly. In addition, evidence to support some current interventions in practice is lacking. This article presents information concerning radiodermatitis, summarizes the evidence-based review for its prevention and management, and identifies gaps in the literature, as well as opportunities for research, education, and practice.

Factors affecting evidence translation for general practice nurses.
Mills, Jane; Field, John; Cant, Robyn;
International Journal of Nursing Practice, 2011 Oct; 17 (5): 455-63
Abstract: Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.

Spotlight on Outcomes. Data-Driven Decision Making: A Nursing Research and Evidence-Based Practice Dashboard.
Mick, JoAnn;
Journal of Nursing Administration, 2011 Oct; 41 (10): 391-3 (

Engaging and Developing Research Leaders in Practice: Creating a Foundation for a Culture of Clinical Inquiry.
Stanley, Terry; Sitterding, Mary; Broome, Marion E.; McCaskey, Marjorie;
Journal of Pediatric Nursing, 2011 Oct; 26 (5): 480-8
Abstract: This article describes the first formative year experience of a research council in a children''s hospital within a Magnet-designated hospital system. The vision, transformational leadership structure, and implementation strategies used during the first year of formation of a Nursing Research and Evidence-Based Practice Council (NREBPC) are delineated and reflect Magnet components and sources of evidence (American Nurses Credentialing Center [ANCC], 2008). The use of the nursing excellence framework (ANCC, 2008) coupled with principles of adult learning to expand the knowledge and skills of nurses on the NREBPC are described and examples provided. Initial outcomes in terms of nurses'' leadership for research studies and planned documentation of additional metrics that have the potential to improve care through the development of a culture of inquiry are proposed.

Engaging with children in research: Theoretical and practical implications of negotiating informed consent/assent.
Lambert, Veronica; Glacken, Michele;
Nursing Ethics, 2011 Nov; 18 (6): 781-

Impacting Practice Through Evidence-Based Education.
Sciarra, Erica;
Dimensions of Critical Care Nursing, 2011 Sep-Oct; 30 (5): 269-75
Abstract: Evidence-based practice has been demonstrated to positively impact patient outcomes, yet nurses are having difficulty incorporating it into their practice. The purpose of this study was to determine the educational needs of intensive care unit nurses regarding evidence-based practice and to implement a strategy to meet those needs. Evidence-based practice education in this pilot study was shown as an effective catalyst to nurses beginning and participating in evidence-based practice that could potentially improve patient outcomes.

The experience of critiquing published research: Learning from the student and researcher perspective.
Knowles, Judie M; Gray, Morag A;
Nurse Education in Practice, 2011 Nov; 11 (6): 390-4
Abstract: This paper commences with affirmation of the importance of research critique within academic programmes of study, and the context of this skill within the nursing profession. Judie (student) shares an experience from a Professional Doctorate in Education (EdD) assignment that involved selecting and critiquing a piece of published research. "The qualities of an effective mentor" (Gray and Smith, 2000) was critiqued using the Critical Appraisal Skills Programme (CASP, 2006) framework. Morag was the researcher and co-author (Gray and Smith, 2000) and was subsequently contacted by Judie for the purposes of validating her critique assignment. On the tenth anniversary since publication of her PhD research findings Morag reflects on the original article in the light of Judie's critique and shares evaluative comments. Some of the assignment critique is validated by Morag, whilst some of the evaluation demonstrates unreliability of critique shown by Judie. Discussion surrounding sufficiency of research critique through systematic examination of a published article, versus an original research report such as a thesis ensues. The student and researcher/author reveal their learning from this collaborative experience and conclude with recommendations for; setting critique assignments; authors publishing their research findings; and students undertaking critique assignments.

Tips for Getting Published in the Nursing Literature

2011-11-18T09:36:00.000-08:00

The editorial team at Research in Nursing and Health (RINAH) have created these helpful videos with tips on writing for publication & getting an article published.

Part I - Getting Started
http://youtu.be/E3_uExz8m9g

Part II - How to Succeed in Publication
http://youtu.be/-Iahw0QD8-w

Part III - Submission Process for a Research Journal
http://youtu.be/E3_uExz8m9g

Also, check out their free Virtual Issue - Helpful Editorial Hints for Getting Published.

Danielle's Picks from the Literature - November 2011

2011-11-15T11:23:00.000-08:00

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. What is a randomised controlled trial?
Nelson, Andrea;
Evidence Based Nursing, 2011 Oct; 14 (4): 97-8

2. Evidence-Based Nursing. 10 ways to practice evidence-based staffing and scheduling.
Reese, Susan M.;
Nursing Management, 2011 Oct; 42 (10): 20-4

3. Implementing evidence-based practice: real-life success stories.
Reflections on Nursing Leadership, 2011 3rd Quarter; 37 (3). (2p)

4. Searching for Evidence Regarding Using Preoperative Disinfection Showers to Prevent Surgical Site Infections: A Systematic Review.
Jakobsson, Jenny; Perlkvist, Agnetha; Wann-Hansson, Christine;
Worldviews on Evidence-Based Nursing, 2011 3rd Quarter; 8 (3): 143-52
Abstract: Background: Postoperative surgical site infections (SSI) are the third most common health care associated infection. Even though several studies have pointed out the benefits of disinfection showers prior to surgery in order to reduce SSI, it remains unclear how to optimize this disinfection procedure. Aim: To find evidence for how many times preoperative disinfection showers should be performed in order to reduce bacterial colonies and minimize the risk of SSI. Method: A comprehensive literature search of multiple databases published during 1986S2008, supplemented by a manual search of the references in all relevant articles. Protocols were used in quality assessment and the data synthesis is descriptive in a narrative form. Results: The 10 studies included had different designs, interventions, and samples, which makes it difficult to compare them. Moreover, the quality of the reviewed studies varied and only four had a high level of evidence. Therefore, the results failed to give an unambiguous answer about the optimal number of preoperative showers, so only assumptions can be made. It is quite obvious, however, that preoperative disinfection showers with chlorhexidine gluconate (CHG) are effective from a microbiological point of view since eight of the reviewed studies showed a sharply reduced skin flora after using CHG. Conclusions: Currently, clear evidence for how many times preoperative disinfection showers should be performed to minimize the risk of SSI is missing. This highlights the need for further research that focuses on the number of preoperative disinfection showers in relation to SSI, in order to obtain optimal effect. Until then, it would be wise to follow previouslymade recommendation of three to five preoperative showers. Moreover, in order to have the intended effect of preoperative disinfection, it is important that health care professionals have the knowledge to guide patients with information and clear instructions about disinfection shower procedures.

5. Teaching and Learning about the Impact of Evidence-Based Practice Implementation.
Wilkinson, Joyce E.; Kent, Bridie; Hutchinson, Alison; Harrison, Margaret B.; Worldviews on Evidence-Based Nursing, 2011 3rd Quarter; 8 (3): 187-88

6. Factors affecting evidence translation for general practice nurses.
Mills, Jane; Field, John; Cant, Robyn;
International Journal of Nursing Practice, 2011 Oct; 17 (5): 455-63
Abstract: Mills J, Field J, Cant R. International Journal of Nursing Practice 2011; 17: 455-463 Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.

7. Creating a Unit-Based Resource Nurse Program.
Quinn-O'Neil, Beth; Kilgallen, Mary Ellen; Terlizzi, Janice A.;
American Journal of Nursing, 2011 Sep; 111 (9): 46-51

8. Bridging the Theory-Practice Gap.
Tart, Rebecca Creech; Kautz, Donald D.; Rudisill, Kimberly D.; Beard, Edward L.; Nurse Educator, 2011 Sep-Oct; 36 (5): 219-23

9. The experience of critiquing published research: Learning from the student and researcher perspective.
Knowles, Judie M; Gray, Morag A;
Nurse Education in Practice, 2011 Nov; 11 (6): 390-4
Abstract: This paper commences with affirmation of the importance of research critique within academic programmes of study, and the context of this skill within the nursing profession. Judie (student) shares an experience from a Professional Doctorate in Education (EdD) assignment that involved selecting and critiquing a piece of published research. "The qualities of an effective mentor" (Gray and Smith, 2000) was critiqued using the Critical Appraisal Skills Programme (CASP, 2006) framework. Morag was the researcher and co-author (Gray and Smith, 2000) and was subsequently contacted by Judie for the purposes of validating her critique assignment. On the tenth anniversary since publication of her PhD research findings Morag reflects on the original article in the light of Judie's critique and shares evaluative comments. Some of the assignment critique is validated by Morag, whilst some of the evaluation demonstrates unreliability of critique shown by Judie. Discussion surrounding sufficiency of research critique through systematic examination of a published article, versus an original research report such as a thesis ensues. The student and researcher/author reveal their learning from this collaborative experience and conclude with recommendations for; setting critique assignments; authors publishing their research findings; and students undertaking critique assignments.

10. Translating Caring Theory Into Practice.
Tonges, Mary; Ray, Joel;
Journal of Nursing Administration, 2011 Sep; 41 (9): 374-81

11. Measuring Caring--The Next Frontier In Understanding Workforce Performance and Patient Outcomes.
Nelson, John W.;
Nursing Economic$, 2011 Jul-Aug; 29 (4): 215-9

Danielle's Picks from the Literature - October 2011

2011-10-11T11:59:00.000-07:00

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.

Evidence-Based Nursing Practice: Is It Really Necessary?
Elliott, Rowena W.;
Nephrology Nursing Journal, 2011 Jul-Aug; 38 (4): 309-36

Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing.
Currey, Judy; Considine, Julie; Khaw, Damien;
Journal of Advanced Nursing, 2011 Oct; 67 (10): 2275-83
Abstract: Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing. Journal of Advanced Nursing 67(9), 2275-2283. Abstract Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion. The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses.
Gerrish, Kate; McDonnell, Ann; Nolan, Mike; Guillaume, Louise; Kirshbaum, Marilyn; Tod, Angela;
Journal of Advanced Nursing, 2011 Sep; 67 (9): 2004-14
Abstract: The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing 67(9), 2004-2014. Abstract Aim. To identify approaches used by advanced practice nurses to promote evidence-based practice among clinical nurses. Background. Barriers encountered at individual and organizational levels hinder clinical nurses in their ability to deliver evidence-based practice. Advanced practice nurses are well placed to promote evidence-based practice through interactions with clinical nurses. However, little is understood about how advanced practice nurses might realize this potential. Method. A multiple instrumental case study of 23 advanced practice nurses from hospital and primary care settings across seven Strategic Health Authorities in England was undertaken in 2006. Data collection comprised interviews and observation of advanced practice nurses and interviews with clinical nurses and other healthcare professionals. Data were analysed using the Framework approach. Findings. Advanced practice nurses acted as knowledge brokers in promoting evidence-based practice among clinical nurses. Knowledge management and promoting the uptake of knowledge were key components of knowledge brokering. Knowledge management involved generating different types of evidence, accumulating evidence to act as a repository for clinical nurses, synthesizing different forms of evidence, translating evidence by evaluating, interpreting and distilling it for different audiences and disseminating evidence by formal and informal means. Advanced practice nurses promoted the uptake of evidence by developing the knowledge and skills of clinical nurses through role modelling, teaching, clinical problem-solving and facilitating change. Conclusion. The role of advanced practice nurses in knowledge brokering is complex and multi-faceted. It extends beyond the knowledge management, linkage and capacity building identified in the literature to include active processes of problem-solving and facilitating change.

The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: Pre-test post-test comparative study.
Aitken, Leanne M.; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn;
International Journal of Nursing Studies, 2011 Aug; 48 (8): 918-25
Abstract: Abstract: Background: Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. Objectives: To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses’ perceptions of the practice environment and work satisfaction. Design: Pre-test post-test 2 group comparative design. Settings: Two intensive care units in tertiary teaching hospitals in Australia. Participants: A convenience sample of registered nurses (n =244) working full time or part time in the participating intensive care units. Methods: Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Results: Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological – individual, psychological – family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre – 4.85±0.93; post – 5.36±0.89, p =0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p <0.05). Conclusions: Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability.

Maintaining a Full House for Research Involvement Among Float Pool Nurses.
Egbert, April; Lincicome, Amber; Elam, Ashley; Shinkle, Mary; Long, Lisa English;
Journal of Pediatric Nursing, 2011 Aug; 26 (4): e24-5

Advancing Nursing Research Through a Mentorship Program for Staff Nurses.
Gawlinski, Anna; Miller, Pamela S.;
AACN Advanced Critical Care, 2011 Jul-Sep; 22 (3): 190-200

Nurse Champions: A Key Role in Bridging the Gap Between Research and Practice.
White, Carole L.;
JEN: Journal of Emergency Nursing, 2011 Jul; 37 (4): 386-7

Research using blogs for data: Public documents or private musings?
Eastham, Linda A;
Research in Nursing & Health, 2011 Aug; 34 (4): 353-61
Abstract: Nursing and other health sciences researchers increasingly find blogs to be valuable sources of information for investigating illness and other human health experiences. When researchers use blogs as their exclusive data source, they must discern the public/private aspects inherent in the nature of blogs in order to plan for appropriate protection of the bloggers' identities. Approaches to the protection of human subjects are poorly addressed when the human subject is a blogger and the blog is used as an exclusive source of data. Researchers may be assisted to protect human subjects via a decisional framework for assessing a blog author's intended position on the public/private continuum. © 2011 Wiley Periodicals, Inc. Res Nurs Health 34:353-361, 2011.

Four rights for focusing clinical nurse specialist research: right focus, right projects, right level, and right resources.
Albert, Nancy M; Fulton, Janet S;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Jul-Aug; 25 (4): 165-8

Engaging and Developing Research Leaders in Practice: Creating a Foundation for a Culture of Clinical Inquiry.
Stanley, Terry; Sitterding, Mary; Broome, Marion E.; McCaskey, Marjorie;
Journal of Pediatric Nursing, 2011 Oct; 26 (5): 480-8
Abstract: This article describes the first formative year experience of a research council in a children''s hospital within a Magnet-designated hospital system. The vision, transformational leadership structure, and implementation strategies used during the first year of formation of a Nursing Research and Evidence-Based Practice Council (NREBPC) are delineated and reflect Magnet components and sources of evidence (American Nurses Credentialing Center [ANCC], 2008). The use of the nursing excellence framework (ANCC, 2008) coupled with principles of adult learning to expand the knowledge and skills of nurses on the NREBPC are described and examples provided. Initial outcomes in terms of nurses'' leadership for research studies and planned documentation of additional metrics that have the potential to improve care through the development of a culture of inquiry are proposed.

Can You Hear Me? Facilitating the Voice of Frontline Nurses Through Nursing Research.
Vogelsmeier, Amy;
Western Journal of Nursing Research, 2011 Oct; 33 (6): 743-4

Social Networking & the Nurse

2011-10-11T11:08:00.000-07:00

The American Nurses Association has just published a new guideline, Principles for Social Networking and the Nurse. The guideline is intended to cover the benefits and risks of social networking and include the following six principles:

Nurses must not transmit or place online individually identifiable patient information.

Nurses must observe ethically prescribed professional patient-nurse boundaries.

Nurses should understand that patients, colleagues, institutions and employers may view postings.

Nurses should take advantage of privacy settings and seek to separate personal and professional information online.

Nurses should bring content that could harm a patient’s privacy, rights or welfare to the attention of appropriate authorities.

Nurses should participate in developing institutional policies governing online contact.

A free electronic version of the complete guideline is available to all ANA members.

Mosby's Nursing Consult - ANA Edition

2011-09-14T15:46:00.001-07:00

The ANA provides Mosby's Nursing Consult - ANA Edition free of charge to it's members. This resource provides:

Evidence based monographs, reviews the current evidence on a clinical problem and provides recommendations for nursing care

Practice guidelines from over 150 professional organizations

Clinical updates, best practice articles written by nurses for nurses

Members can log-in with their ANA username/password to take advantage of this useful resource.

New Nursing Research Toolkit available from the ANA

2011-08-30T16:42:00.000-07:00

The American Nurses Association has a new Research Toolkit available free of charge. The Toolkit was developed to help nurses provide evidence-based care and promotes quality health outcomes. It includes a section on introduction to research and evidence-based practice. Access to resources that help the nurse translate evidence into practice and to support nurse researchers are available. While the Tool is free, ANA members only can log in with their username and password to gain access to a research repository containing reviews of research articles. Richard Barry, the librarian at ANA says, "this toolkit will change over time and add new resources to meet your needs." Check out this great new resource to add to your Evidence Based Practice tool belt!

Danielle's Picks from the Literature - August 2011

2011-08-25T10:33:00.001-07:00

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. Children's nursing research: toward development, drudgery or demise?
Long, Tony;
British Journal of Nursing (BJN), 2011 Sep 8; 20 (14): 873-7
Abstract: This paper, based on a presentation to the UK Association of Chief Children's Nurses, is the author's personal reflection on the nature and future of children's nursing research. Key constitutive elements of this concept are considered to arrive at the conclusion that children's nursing research is research undertaken by children's nurses into questions of relevance to children's nursing practice and services, or wider issues in which children's nursing has a vital role. Three possible futures are presented, of which only the last is positive and desirable: development in line with the reality of practice and population needs. An integrated approach is necessary, with responsibilities both for those in positions of authority in the service and for researchers themselves. In particular, this partnership is essential for children's nursing to evidence the impact of research and for children and young people to reap the greatest benefit from evidence-based practice.

2. Grading recommendations in clinical practice guidelines: randomised experimental evaluation of four different systems.
García CA; Alvarado KP; Gaxiola GP;
Archives of Disease in Childhood, 2011 Aug; 96 (8): 723-8
Abstract: Objective To evaluate the effect of presenting a recommendation in a clinical practice guideline using different grading systems to determine to what extent the system used changes the clinician's eventual response to a particular clinical question. Design Randomised experimental study. Setting Clinician offices and academic settings. Participants Paediatricians and paediatric residents in private and public practice in Mexico. Intervention Case notes of a child with diarrhoea and a question about clinician preference for using racecadotril. The same evidence was provided in a clinical recommendation but with different presentations according to the following grading systems: NICE (National Institute for Health and Clinical Excellence), SIGN (Scottish Intercollegiate Guideline Network), GRADE (Grading of Recommendations Assessment, Development and Evaluation) and CEBM (Centre for Evidence-Based Medicine, Oxford). Main outcome measure Mean change in direction from baseline response (measured on a 10 cm visual scale and a Likert scale) and among groups. Results 216 subjects agreed to participate. Most participants changed their decision after reading the clinical recommendations (mean difference 0.7 cm, 95% CI 0.29 to 1.0; p<0.001). By groups, mean change (95% CI) from baseline was 0.04 (-0.68 to 0.77) for NICE, 0.31 (-0.41 to 1.05) for SIGN, 2.18 (1.48 to 2.88) for GRADE and 0.08 (-0.52 to 0.69) for CEBM (p=0.007 between groups). In a final survey, a small difference was noted regarding the clarity of the results presented with the GRADE system. Conclusion The clinician's decision to use a therapy was influenced most by the GRADE system. Trial registration number NCT00940290.

3. Implementing evidence-based nutrition guidelines: the critical care experience.
Cahill, Naomi E;
Clinical Nutrition Insight, 2011 Aug; 37 (8): 1-5

4. Immunological Methods for Nursing Research: From Cells to Systems.
Morrison, Helena W.; Downs, Charles A.;
Biological Research for Nursing, 2011 Jul; 13 (3): 227-34

5. Spit: Saliva in Nursing Research, Uses and Methodological Considerations in Older Adults.
Woods, Diana Lynn; Mentes, Janet C.;
Biological Research for Nursing, 2011 Jul; 13 (3): 320-7

6. Why and when should we conduct collaborative international oncology nursing research?
Hinds, Pamela S;
Cancer Nursing, 2011 Jul-Aug; 34 (4): 253-4

7. Innovation in engaging hospital staff and university faculty in research.
Zinn, Jennifer; Reinert, Jean; Bigelow, Andrea; Ellis, Waqiah; French, Amanda F; Milner, Frostenia; Letvak, Susan;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Jul-Aug; 25 (4): 193-7
Abstract: PURPOSE: : The purpose of this article was to describe an innovative faculty-staff engagement dinner that was conducted to enhance collaboration between university faculty and hospital staff. Specific steps used to develop the dinner, as well as outcomes gained, are discussed. BACKGROUND/RATIONALE: : Collaborative relationships between academic and clinical nurses may promote nursing research and strengthen mutual interest. Unique stressors and demands of clinical and academic nursing often lead to isolated practice roles. Nursing may require new ways of facilitating collaboration between groups. DESCRIPTION OF THE PROJECT:: A dinner supported by a health system was planned for nursing staff interested in conducting research. Faculty at 2 local universities interested in collaborating with nursing staff were invited. Forty participants attended, including 8 faculty from 2 universities, 17 staff nurses, and 16 nurse leaders. Seven collaborative research projects were initiated following the dinner meeting. INTERPRETATION/CONCLUSION: : Faculty and nursing staff partnerships were established and led to research projects that focused on themes of improving quality. Faculty and nursing staff expressed enthusiasm for the opportunity to connect over shared research ideas. IMPLICATIONS: : Mechanisms for enhancing staff nurse and nurse faculty collaborative relationships are needed to promote nursing research that ensures evidence-based bedside practices. A dinner event was an innovative method to partner nurses at the bedside with faculty with expertise in research methods.

8. Facebook: A Tool for Nursing Education Research.
Amerson, Roxanne;
Journal of Nursing Education, 2011 Jul; 50 (7): 414-6
Abstract: Facebook is an online social networking Web site that allows users to connect with other users. Nurse educators can use this technology to advance nursing research. Social networks provide new opportunities for locating potential research participants and maintaining contact during the research process. The purpose of this article is to explain how the researcher used Facebook to locate previous nursing students to ask them to participate in a qualitative study. Between 2006 and 2008, 22 nursing students had participated in international trips over a 3-year period. Because the students had graduated and moved to other geographical areas, the researcher had little or no contact information to use to follow-up with them. The researcher used Facebook to locate 18 of the 22 nursing graduates and invite them to participate in a qualitative research study. A discussion of the process and the potential ethical issues are provided.

9. Demystifying nursing research terminology. Part 1.
Welford, Claire; Murphy, Kathy; Casey, Dympna;
Nurse Researcher, 2011; 18 (4): 38-43
Abstract: Aim This article aims to provide clear explanations of the research approaches available for nursing research. Background There are numerous research approaches available to the nurse researcher. There is also some ambiguity in the literature in relation to research terminology and this often leads to confusion about which approach to adopt. Data sources A review of the available and most up-to-date literature. Discussion The most commonly adopted approaches in nursing research are described and discussed. Conclusion This article explains the research paradigms and the rationales for choosing particular paradigms while part two will provide an explanation of the methodological options available to the researcher. A table is included that summarises the key information related to each paradigm. Implications for practice/research These articles will be particularly useful for the novice researcher or for the doctoral student.

10. Obstacles and Drawbacks to Avoid in Qualitative Nursing Research.
Windle, Pamela;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 173-5

11. Magnet status-does it promote holistic health care?
Jackson, Christina;
Holistic Nursing Practice, 2011 Jul-Aug; 25 (4): 175-83

12. Introducing evidence into nursing practice: using the IOWA model.
Doody, Catriona M.; Doody, Owen;
British Journal of Nursing (BJN), 2011 Jul 14; 20 (11): 661-4
Abstract: Evidence-based practice has gained increasing popularity in all healthcare settings. Nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform decisions, actions and interactions with patients, to deliver the best possible care. Within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based. In order for nurses to operate from an evidence-based perspective, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.

13. What is a systematic review?
Clarke, Jane;
Evidence Based Nursing, 2011 Jul; 14 (3): 64

14. Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Majid, Shaheen; Foo, Schubert; Luyt, Brendan; Xue Zhang; Yin-Leng Theng; Yun-Ke Chang; Mokhtar, Intan A.;
Journal of the Medical Library Association, 2011 Jul; 99 (3): 229-36
Abstract: Objective: Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated. Method: A total of 2,100 copies of the questionnaire were distributed to registered nurses in 2 public hospitals in Singapore, and 1,486 completed forms were returned, resulting in a response rate of 70.8%. Results: More than 64% of the nurses expressed a positive attitude toward EBP. However, they pointed out that due to heavy workload, they cannot keep up to date with new evidence. Regarding self-efficacy of EBP-related abilities, the nurses perceived themselves to possess moderate levels of skills. The nurses also felt that EBP training, time availability, and mentoring by nurses with EBP experience would encourage them to implement EBP. The top three barriers to adopting EBP were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles. For literature searching, nurses were using basic search features and less than one-quarter of them were familiar with Boolean and proximity operators. Conclusion: Although nurses showed a positive attitude toward EBP, certain barriers were hindering their smooth adoption. It is, therefore, desirable that hospital management in Southeast Asia, particularly in Singapore, develop a comprehensive strategy for building EBP competencies through proper training. Moreover, hospital libraries should also play an active role in developing adequate information literacy skills among the nurses.

15. Nurturing the Novice Nurse Researcher: Strategies for Librarians.
Nursing & Allied Health Resources Section (NAHRS) Newsletter, 2011 Jul; 31 (3): 8-10

16. Spirituality in nursing: a systematic review of the literature from 2006-10. Pike, Joanne;
British Journal of Nursing (BJN), 2011 Jun 24; 20 (12): 743-9
Abstract: Spirituality in nursing care has been discussed for many years in the nursing press. There has been no literature review that explores only UK literature, and this article updates a literature review carried out in 2006 (Ross, 2006). Aim: The review was designed to investigate the current nursing evidence underpinning the concept of spirituality and its application. Method: A systematic review of the literature was undertaken and a thematic analysis performed following a search for literature using defined dates, databases and search terms. Results: Four major themes emerged from the literature: concept clarification; spiritual care-giving; religion and spirituality; and nurse education. Conclusion: Definitions of spiritual care vary, and the concept of spirituality in nursing is still under development. However, until a common language of spirituality is developed, models of spiritual care developed through research involving mainly nursing staff will be difficult for nurses to apply.

17. Nursing work environment and nurse caring: relationship among motivational factors.
Burtson PL; Stichler JF;
Journal of Advanced Nursing, 2010 Aug; 66 (8): 1819-31
Abstract: Aim. This paper is a report of a study of the relationships among compassion satisfaction, nurse job satisfaction, stress, burnout and compassion fatigue to nurse caring. Background. Nurse caring is the most influential dimension of patient advocation and is predictive of patient satisfaction. Qualitative studies have indicated that nurse caring is a key motivational factor impacting recruitment and retention. Methods. A correlational study of nurses ( N = 126) was conducted in 2008 at a single, academic medical center. The six variables of interest were operationalized using four valid and reliable research instruments: (1) the Mueller McCloskey Satisfaction Scale, (2) the Professional Quality of Life Scale, (3) the Stress in General Scale and (4) the Caring Behaviors Inventory. Results. Pearson Product-moment correlations showed statistically significant relationships between nurse caring and compassion satisfaction ( r = 0DT51, P < 0DT001), nurse job satisfaction subscales ( r = 0DT16-0DT28, P < 0DT05), stress ( r = -0DT21, P < 0DT05), and burnout ( r = -0DT22, P < 0DT01). A statistically significant relationship was found between the nurse caring subscale of knowledge and skill and compassion fatigue ( r = -0DT22, P < 0DT01). Hierarchical multiple regression analysis demonstrated that compassion satisfaction ( R² = 0DT287, [beta] = 0DT536, P = 0DT000) and nurse satisfaction with social interaction opportunities related to work ([beta] = 0DT223, P = 0DT032) explained variability in nurse caring. Conclusion. Fostering compassion satisfaction and social interaction opportunities among nurses may improve nurse caring, potentially sustaining long-term improvements in patient.

18. Quality caring in nursing: applying theory to clinical practice, education, and leadership.
Gottesfeld IB;
Nursing Education Perspectives, 2010 Jul-Aug; 31 (4): 260

Danielle's Picks from the Literature - July 2011

2011-07-13T11:17:00.001-07:00

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. An Evidence-Based Review of a Lentinula edodes Mushroom Extract as Complementary Therapy in the Surgical Oncology Patient.
Shah SK; Walker PA; Moore-Olufemi SD; Sundaresan A; Kulkarni AD; Andrassy RJ;
JPEN Journal of Parenteral & Enteral Nutrition, 2011 Jul-Aug; 35 (4): 449-58
Abstract: The purpose of this review is to present the currently published evidence regarding the use, efficacy, potential mechanisms of action, and results of published clinical trials regarding the use of a Lentinula edodes mushroom-derived extract (active hexose correlated compound) as complementary therapy in patients with cancer. The authors explore the current preclinical and clinical evidence as it relates to this topic and its potential use in the surgical oncology patient. There has been a growing interest in stimulation of the immune system in trauma, cancer, and surgical patients in general. Little, however, has been written about some-of the supplements in widely used in Japan and China, but relatively unheard of in the United States.

2. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.
Fonarow GC; Yancy CW; Hernandez AF; Peterson ED; Spertus JA; Heidenreich PA;
American Heart Journal, 2011 Jun; 161 (6): 1024-1030.e3

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

4. Evidence-Based Nursing. Getting "research rich" at a community hospital.
Staffileno, Beth A.; McKinney, Cally;
Nursing Management, 2011 Jun; 42 (6): 10-4

5. The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: A Framework for Transformation.
Goode, Colleen J.; Fink, Regina M.; Krugman, Mary; Oman, Kathleen S.; Traditi, Lisa K.
Worldviews on Evidence-Based Nursing, 2011 2nd Quarter; 8 (2): 96-105
Abstract: Background: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. Aim: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. Approach: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.

6. Obstacles and Drawbacks to Avoid in Qualitative Nursing Research.
Windle, Pamela;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 173-5

7. Nursing Journal Club: Bridging the Gap Between Practice and Research.
McClurkin, Sylva L.; Bailey, Lillian; Kwan, Meggie;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 192

8. Who uses nursing theory? A univariate descriptive analysis of five years' research articles.
Bond, A. Elaine; Eshah, Nidal Farid; Bani-Khaled, Mohammed; Hamad, Atef Omar; Habashneh, Samira; Kataua', Hussein; al-Jarrah, Imad; Kamal, Andaleeb Abu; Hamdan, Falastine Rafic; Maabreh, Roqia;
Scandinavian Journal of Caring Sciences, 2011 Jun; 25 (2): 404-9
Abstract: Since the early 1950s, nursing leaders have worked diligently to build the Scientific Discipline of Nursing, integrating Theory, Research and Practice. Recently, the role of theory has again come into question, with some scientists claiming nurses are not using theory to guide their research, with which to improve practice. The purposes of this descriptive study were to determine: (i) Were nursing scientists' research articles in leading nursing journals based on theory? (ii) If so, were the theories nursing theories or borrowed theories? (iii) Were the theories integrated into the studies, or were they used as organizing frameworks? Research articles from seven top ISI journals were analysed, excluding regularly featured columns, meta-analyses, secondary analysis, case studies and literature reviews. The authors used King's dynamic Interacting system and Goal Attainment Theory as an organizing framework. They developed consensus on how to identify the integration of theory, searching the Title, Abstract, Aims, Methods, Discussion and Conclusion sections of each research article, whether quantitative or qualitative. Of 2857 articles published in the seven journals from 2002 to, and including, 2006, 2184 (76%) were research articles. Of the 837 (38%) authors who used theories, 460 (55%) used nursing theories, 377 (45%) used other theories: 776 (93%) of those who used theory integrated it into their studies, including qualitative studies, while 51 (7%) reported they used theory as an organizing framework for their studies. Closer analysis revealed theory principles were implicitly implied, even in research reports that did not explicitly report theory usage. Increasing numbers of nursing research articles (though not percentagewise) continue to be guided by theory, and not always by nursing theory. Newer nursing research methods may not explicitly state the use of nursing theory, though it is implicitly implied.

9. Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital.
Jamerson, Patricia A.; Fish, Anne F.; Frandsen, Geralyn;
Applied Nursing Research, 2011 May; 24 (2): 110-3
Abstract: For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.

10. Models to enhance research capacity and capability in clinical nurses: a narrative review.
O'Byrne, Louise; Smith, Sheree;
Journal of Clinical Nursing, 2011 May; 20 (9/10): 1365-71
Abstract: To identify models used as local initiatives to build capability and capacity in clinical nurses. The National Health Service, Nursing and Midwifery Council and the United Kingdom Clinical Research Collaboration all support the development of the building of research capability and capacity in clinical nurses in the UK. Narrative review. A literature search of databases (including Medline and Pubmed) using the search terms nursing research, research capacity and research capability combined with building, development, model and collaboration. Publications which included a description or methodological study of a structured initiative to tackle research capacity and capability development in clinical nurses were selected. Three models were found to be dominant in the literature. These comprised evidence-based practice, facilitative and experiential learning models. Strong leadership, organisational need and support management were elements found in all three models. Methodological issues were evident and pertain to small sample sizes, inconsistent and poorly defined outcomes along with a lack of data. Whilst the vision of a research ready and active National Health Service is to be applauded to date, there appears to be limited research on the best approach to support local initiatives for nurses that build research capability and capacity. Future studies will need to focus on well-defined objectives and outcomes to enable robust evidence to support local initiatives. To build research capability and capacity in clinical nurses, there is a need to evaluate models and determine the best approach that will provide clinical nurses with research opportunities.

11. Evidence-based practice implementation strategy: the central role of the clinical nurse specialist.
Muller, Anne; McCauley, Kathleen; Harrington, Paul; Jablonski, Julie; Strauss, Robyn; Nursing Administration Quarterly, 2011 Apr-Jun; 35 (2): 140-51
Abstract: The Hospital of the University of Pennsylvania Model of Excellence in Nursing Professional Practice serves to fully integrate therole of the clinical nurse specialist (CNS) in the implementation of evidence-based care and the role of organizational change agent. Inthis role, the CNS is responsible for the identification and remedy of system-wide challenges to optimal quality care, mentorship ofclinical nurses both as clinicians and as leaders, and enhancement of interdisciplinary partnerships. Integrating the CNS role as thenursing department knowledge keepers, knowledge seekers and knowledge disseminators able to proactively develop and enhanceinterdisciplinary partnerships required systematic educational sessions and use of outcome measurement tools. Resources have included roledevelopment seminars, individual mentoring and standardization of role expression, across service lines. Development and implementation ofan outcome measurement tool has served to further quantify the contribution of the CNS and standardized role implementation across servicedivisions. This dedication of resources has resulted in a significant number of unit-based and system-wide CNSs, serving as a significantsupport to the clinical nurse's practice and leadership development. This article will describe some of the processes used to enhancethe role of the CNS implementing change and practice improvement at the Hospital of the University of Pennsylvania.

12. Negotiating Journal Authorship: Strategies and Hazards.
Sommers, Marilyn S.;
Clinical Nursing Research, 2011 May; 20 (2): 115-9

13. From Practice to Print: Creating a Thriving Culture of Writing.
Saver, Cynthia;
Nurse Leader, 2011 Jun; 9 (3): 23-5

14. Nurses' and patients' perceptions of caring behaviours: quantitative systematic review of comparative studies.
Papastavrou, Evridiki; Efstathiou, Georgios; Charalambous, Andreas;
Journal of Advanced Nursing, 2011 Jun; 67 (6): 1191-205
Abstract: Aim. This paper is a report of a systematic review conducted to test the hypothesis that nurses and patients perceive the concept of caring in nursing differently. Background. Caring is viewed as the central focus of nursing. However, despite its fundamental place in clinical practice, researchers and scholars have failed in reaching a common definition. This failure has led to eliciting for nebulous interpretations of the concept often leading to perplexity and opposing views between patients and nurses. Data sources. Extensive search was conducted using MEDLINE, CINAHL and EMBASE between March and May 2009 with no publishing time limit and the keywords 'care', 'caring', 'nurse', 'nursing', 'behavio(u)rs', 'patient', 'perception', 'quantitative' and 'comparative'. Review methods. This quantitative systematic review of comparative studies followed the guidance of the Centre for Reviews and Dissemination. A seven-item 'yes' or 'no' checklist was developed and used for appraising the quality status of the selected literature. Narrative summary technique was used to report outcomes. Results. Evidence of incongruence of perceptions between patients and nurses is mainly supported by the literature. Few studies, however, report aspects of congruence. Conclusion. There is considerable evidence of the assertion that there is no congruence of perceptions between patients and nurses as regards to which behaviours are considered caring and intended caring is not always perceived as such by the patient. Further research is needed, however, to generate more knowledge on the relationship between caring behaviours, patient outcomes and health or nursing costs.

15. Self-Care Strategies to Enhance Caring.
Shiparski, Laurie; Richards, Kim; Nelson, John;
Nurse Leader, 2011 Jun; 9 (3): 26-30

16. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey.
Gerrish, Kate; Guillaume, Louise; Kirshbaum, Marilyn; McDonnell, Ann; Tod, Angela; Nolan, Mike;
Journal of Advanced Nursing, 2011 May; 67 (5): 1079-90
Abstract: Aim. This paper is a report of a study to identify factors influencing advanced practice nurses' contribution to promoting evidence-based practice among front-line nurses. Background. Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care given by front-line nurses. Method. A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with frontline nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with Masters qualifications and those with lower qualifications. Findings. Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses' practice. Advanced practice nurses' skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with Masters qualifications perceived themselves to be more skilled in all aspects of evidence-based practice than those with lower qualifications. Conclusion. Advanced practice nurses are well placed as clinical leaders to promote evidence-based practice by frontline nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require Master's preparation.

Danielle's Picks from the Literature - June 2011

2011-06-17T15:38:00.000-07:00

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

EBP Resource Update: Cochrane Reviews

2011-06-07T08:18:00.000-07:00

The folks at The Cochrane Collaboration have been busy in 2011! This year alone they have written over 200 new Systematic Reviews of the medical and nursing literature, intended to guide Evidence Based Practice. Topics are taken from a wide range of disciplines and include such issues as:

Baby-led versus scheduled breastfeeding for healthy newborns

Foam dressings for healing diabetic foot ulcers

Folic acid supplementation for the prevention of anaemia in preterm neonates

General health checks for reducing morbidity & mortality from disease

Intensive glucose control versus conventional glucose control for type I diabetes mellitus

Not familiar with Cochrane Reviews yet? Basically, "a Cochrane Review is a systematic, up-to-date summary of reliable evidence of the benefits and risks of health care. Cochrane Reviews are intended to help people make practical decisions." Learn more about Cochrane Reviews and how they can help guide Evidence Based Practice at their website.

Click here for a complete list of Cochrane Reviews. The full text of Cochrane Reviews are available to all SJO & CHOC physicians & staff through the Burlew Medical Library.

Institute of Medicine calls for a "Gold Standard" in the evidence process

2011-05-16T09:00:00.001-07:00

Much of my time as a medical librarian involves searching the literature to find guidelines and systematic reviews to inform evidence based clinical practice. This year the Institute of Medicine has put out a call to professional organizations that produce guidelines and conduct systematic reviews to adhere to a "gold standard" for the processes. The IOM's "Standards for Developing Trustworthy Clinical Practice Guidelines" cover 8 key components including: maintaining transparency, rating practice recommendations based on the strength of the evidence, & using systematic reviews that have been conducted based on IOM's standard. Find the full text of both reports here http://www.iom.edu/Reports.aspx.

Danielle's Picks from the Literature - April 2011

2011-04-19T13:55:00.000-07:00

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.

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

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

Professional Issues. Scholarship in Nursing: Not an Isolated Concept.
Robert, Ruth R.; Pape, Theresa M.;
MEDSURG Nursing, 2011 Jan-Feb; 20 (1): 41-4

Evidence-based nursing. Does journal club membership empower practice?
Sciarra, Erica;
Nursing Management, 2011 Jan; 42 (1): 17-8

Evidence-based nursing. Enhancing nursing's presence.
D'Alessio, Eileen; Magsalin, Maria; Neville, Kathleen L.; Patten, Constance;
Nursing Management, 2010 Dec; 41 (12): 16-8

Ebp: evidence to practice implementation.
Adams S; Cullen L;
Journal of PeriAnesthesia Nursing, 2011 Feb; 26 (1): 35-7

Following the evidence: planning for sustainable changed: the ebp team makes plans to implement an rrt in their hospital.
Finout-Overholt E; Williamson K; Gallagher-Ford L; Melnyk BM; Stillwell SB; American Journal of Nursing, 2011 Jan; 111 (1): 54-60

Barriers and perceived needs for understanding and using research among emergency nurses.
Chan GK; Barnason S; Dakin CL; Gillespie G; Kamienski MC; Stapleton S; Williams J; Juarez A; Li S;
JEN: Journal of Emergency Nursing, 2011 Jan; 37 (1): 24-31

Evidence-based practice mentors: taking information literacy to the units in a teaching hospital.
Arguelles C;
Journal of Hospital Librarianship, 2011 Jan-Mar; 11 (1): 8-22

A regional evidence-based practice fellowship: collaborating competitors.
Weeks SM; Moore P; Allender M;
Journal of Nursing Administration, 2011 Jan; 41 (1): 10-4

Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model.
Levin, Rona F; Fineout-Overholt, Ellen; Melnyk, Bernadette Mazurek; Barnes, Michael; Vetter, Mary Jo;
Nursing Administration Quarterly, 2011 Jan-Mar; 35 (1): 21-33

The systematic review of literature: Synthesizing evidence for practice.
Rew L;
Journal for Specialists in Pediatric Nursing, 2011 Jan; 16 (1): 64-9

Clinical nurse specialist driving exemplary practice and clinical innovation in a magnet organization.
Gunn, Sharon; Flanders, Sonya; Leeper, Bobbi;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Mar-Apr; 25 (2): 94

Barriers to translating evidence-based breastfeeding information into practice.
Brodribb W;
Acta Paediatrica, 2011 Apr; 100 (4): 486-90

Implementing an Evidence-Based Practice Change.
Gallagher-Ford, Lynn; Fineout-Overholt, Ellen; Melnyk, Bernadette Mazurek; Stillwell, Susan B.;
American Journal of Nursing, 2011 Mar; 111 (3): 54-60

Clinical nurse specialist multidisciplinary rounds as a strategy to translate evidence-based practice to the bedside.
Johnson, Melissa; Amber, Rhonda; Cahill, Donna; Nolan, Scot; Azuma, Nancy; Davidson, Judy; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Mar-Apr; 25 (2): 80

WJNR Special Issue: Evidence-Based Practice

2011-03-17T10:45:00.000-07:00

Check out the April 2011 issue of Western Journal of Nursing Research dedicated to Evidence-Based Practice. Articles focus on the following three topics: approaches and programs to foster EBP, leadership support needed to promote EBP, and case studies of nurses applying evidence to address clinical issues.

Access to the full text is available to all St. Joseph Hospital of Orange and CHOC employees through the Burlew Medical Library website.

New resource about statistical tests

2011-03-09T16:02:00.000-08:00

The Journal for Wound Ostomy & Continence Nursing has begun a 6-part series on statistical tests with its January issue. Eberly & Telke have written an easy-to-read essay on comparing means between two samples.

Research Abstract and Commentary:Patient Perspectives on Falls

2011-03-09T15:56:00.000-08:00

Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention

Patient falls and falls with injury are the largest category of reportable incidents and a significant problem in hospitals. Patients are an important part of fall prevention; therefore, we asked patients who have fallen about reason for fall and how falls could be prevented. There were two categories for falls: the need to toilet coupled with loss of balance and unexpected weakness. Patients asked to be included in fall risk communication and asked to be part of the team to prevent them from falling. Nurses need to share a consistent and clear message that they are there for patient safety.

Carroll, D. L., Dykes, P. C., & Hurley, A. C. (2010). Applied Nursing Research, 23, 238-241.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

Given the fact that patients continue to fall, these researchers sought to understand the unique views of patients who had fallen within 48 hrs of their fall while an inpatient in an acute care hospital. They interviewed 9 cognitively intact men and women with ages from 24 to 78 years. Six of the participants had fallen in the past.

Results were fascinating, with cogent excerpts from patient statements. Patients’ reasons given for falling made sense: losing one’s balance while in a hurry to get to the bathroom, being involved in a normal activity while weakened from the condition leading to hospitalization, and not having items within reach. Patients were able to come up with ideas to prevent their own falling in the future: thinking ahead and NOT getting up quickly or without help; asking for help when it is needed, and overcoming the natural instinct to “not bother” the nursing staff; and using appropriate assistive devices (e.g., walkers, slip resistant socks).

The study pointed clear messages to nurses:
• Give anticipatory guidance for patients at risk of falling.
• Help patients feel comfortable asking for help.
• When a patient requests help, respond quickly and positively.
• Think ahead to patients’ needs to prevent their needing to go beyond their capabilities.

Studies like this one which offer patient perspectives are so important for nurses to read and reflect on… please let us know in the Office of Nursing Research (714-771-8120; 12698) if you need help in this.

Danielle's Picks from the Literature - March 2011

2011-03-01T11:43:00.000-08:00

Creative partnerships for funding nursing research.

McCann JJ; Hills EB; Zauszniewski JA; Smith CE; Farran CJ; Wilkie DJ;

Western Journal of Nursing Research, 2011 Feb 01; 33 (1): 79-105

Implementation of evidence-based nursing practice: nurses' personal and professional factors.

Eizenberg MM;

Journal of Advanced Nursing, 2011 Jan; 67 (1): 33-42

Lower extremity ulcer management: best practice algorithm.

Simms KW; Ennen K;

Journal of Clinical Nursing, 2011 Jan; 20 (1/2): 86-93

Linking economics and quality: developing an evidence-based nurse staffing tool.

Anderson, E Faye; Frith, Karen H; Caspers, Barbara;

Nursing Administration Quarterly, 2011 Jan-Mar; 35 (1): 53-60

Painful breast lumps in nursing mothers: identifying and treating plugged ducts, mastitis, and abscess.

Balkam JJ;

American Journal of Nursing, 2010 Dec; 110 (12): 65-7

Clinical librarians as facilitators of nurses' evidence-based practice.

Määttä S; Wallmyr G;

Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3427-34

Dissemination of research into clinical nursing literature.

Oermann MH; Shaw-Kokot J; Knafl GJ; Dowell J;

Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3435-42

Virtual journal club connects evidence to practice: an analysis of participant responses.

Lehna C; Berger J; Truman A; Goldman M; Topp R;
Journal of Nursing Administration, 2010 Dec; 40 (12): 522-8

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

Towards Evidence-based Management: Creating an Informative Database of Nursing-Sensitive Indicators.

Patrician PA; Loan L; McCarthy M; Brosch LR; Davey KS;

Journal of Nursing Scholarship, 2010; 42 (4): 4th Quarter: 358-66

Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: bridging the theory practice gap.

Ferrara, Lucille R.;

Research & Theory for NursingPractice, 2010; 24 (4): 213-6

Pilot study to test the use of a mobile device in the clinical setting to access evidence-based practice resources.

Morris J; Maynard V;

Worldviews on Evidence-Based Nursing, 2010 4th QUARTER; 7 (4): 205-13

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-BasedNursing, 2010 4th QUARTER; 7 (4): 238-51

Danielle's Picks from the Literature - January 2011

2011-01-27T13:02:00.000-08:00

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.

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

2011-01-19T14:30:00.001-08:00

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

Abstract

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

Abstract

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.

Danielle's Picks from the Literature - December 2010

2010-12-22T09:47:00.000-08:00

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. Translating Infant Safe Sleep Evidence Into Nursing Practice.
Shaefer SJM; Herman SE; Frank SJ; Adkins M; Terhaar M;
JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 2010 Nov-Dec; 39 (6): 618-26 CINAHL AN: 2010847501

2. Improving diabetes patient outcomes: Framing research into the chronic care model.
Dancer S; Courtney M;
Journal of the American Academy of Nurse Practitioners, 2010 Nov; 22 (11): 580-5 CINAHL AN: 2010851492

3. Conceptual models of evidence-based practice: part II of a four-part series on evidence-based practice.
Bondmass M; Nevada RNformation, 2010 Nov; 19 (4): 6, 22 CINAHL AN: 2010855071

4. 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 CINAHL AN: 2010831580

5. Evidence and the Executive. Instruments to Assess Organizational Readiness for Evidence-Based Practice.
Newhouse RP;
Journal of Nursing Administration, 2010 Oct; 40 (10): 404-7 CINAHL AN: 2010851305

6. Culturally competent psychiatric nursing care.
Wilson DW;
Journal of Psychiatric & Mental Health Nursing, 2010 Oct; 17 (8): 715-24 CINAHL AN: 2010777605

7. Good practice in management of patients with urethral catheters.
Pratt R; Pellowe C;
Nursing Older People, 2010 Oct; 22 (8): 25-9 CINAHL AN: 2010826639

8. Evidence-based practice, step by step. Critical appraisal of the evidence: Part II: Digging deeper--examining the "keeper" studies... sixth article in a series.
Fineout-Overholt E; Melnyk BM; Stillwell SB; Williamson KM;
American Journal of Nursing, 2010 Sep; 110 (9): 41-8 CINAHL AN: 2010829193

9. Preoperative fasting doesn't mean nothing after midnight: staff nurses can encourage the adoption of evidence-based practices.
Sendelbach S;
American Journal of Nursing, 2010 Sep; 110 (9): 64-5 CINAHL AN: 2010829198

10. Sustaining excellence: clinical nurse specialist practice and magnet designation.
Muller AC; Hujcs M; Dubendorf P; Harrington PT; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2010 Sep-Oct; 24 (5): 252-9 CINAHL AN: 2010771289

11. Health facility design. Evaluating the evidence in evidence-based design.
Stichler JF;
Journal of Nursing Administration, 2010 Sep; 40 (9): 348-51 CINAHL AN: 2010802322

12. WOCN update on evidence-based guideline for pressure ulcers.
Ratliff CR; Tomaselli N;
Journal of Wound, Ostomy & Continence Nursing, 2010 Sep-Oct; 37 (5): 459-60 CINAHL AN: 2010802053

13. Journal clubs on the night shift: a staff nurse initiative.
Stewart C; Snyder K; Sullivan SC; MEDSURG Nursing, 2010 Sep-Oct; 19 (5): 305-6 CINAHL AN: 2010804977

Danielle's picks from the literature November 2010

2010-11-18T10:16:00.000-08:00

1. Translating Infant Safe Sleep Evidence Into Nursing Practice. Shaefer SJM; Herman SE; Frank SJ; Adkins M; Terhaar M; JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 2010 Nov-Dec; 39 (6): 618-26
Abstract: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals. An approach was developed for creating sustainable change in nursing practice by implementing nursing practice policies that could be monitored through quality improvement processes already established within the hospital organization. Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.

2. 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.

3. Marketing evidence-based practice: what a CROC™!. Boyington AR; Ferrall SM; Sylvanus T; Clinical Journal of Oncology Nursing, 2010 Oct; 14 (5): 653-5
Abstract: Nurses should be engaged in evidence-based practice (EBP) to ensure that nursing care is efficient and effective. This article describes one cancer center's use of the Marketing Mix framework to educate staff nurses with the CROC™: Clinging Rigidly to Outdated Care campaign. As a result of the campaign, five EBP projects have been initiated in the cancer center.

4. Evidence-based practice guidelines: a survey of subcutaneous dexamethasone administration. Walker J; Lane P; McKenzie C; International Journal of Palliative Nursing, 2010 Oct; 16 (10): 494-8
Abstract: Searching for good evidence to develop clinical practice guidelines can be challenging, as research may not be published or available. A simple question set the authors on a journey to find evidence related to the nursing administration of subcutaneous dexamethasone in the palliative setting. This article outlines the search for evidence and discusses the survey results to gather expert opinion about the nursing administration of dexamethasone. Survey results indicated that only 39% of community services gave dexamethasone via a bolus injection and 88% gave it via a continuous infusion, mainly for site preservation. The diluents used were water for injection or normal saline. Many procedural aspects were supported by current guidelines, with several services using the New Zealand Waitemata District Health Board's (2008) clinical guidelines. Developing and implementing procedural recommendations for nurses to administer this subcutaneous medication will form the next stage of the project.

5. Evidence supporting technology-based interventions for people with early-stage alzheimer's disease. Buettner LL; Yu F; Burgener SC; Journal of Gerontological Nursing, 2010 Oct; 36 (10): 15-9
Abstract: Innovative uses of technology offer many exciting possibilities for better care and improved quality of life for people with Alzheimer's disease and their families. This article provides empirical evidence through a systematic review of 10 studies involving technological advances. Although the studies reported have a small number of participants, the early results are positive. We believe the use of technology has the potential to save health care costs, ease caregiver stress, and help people with dementia live better, safer, and more fulfilling lives.

6. Rating the level, quality, and strength of the research evidence. Jones KR; Journal of Nursing Care Quality, 2010 Oct-Dec; 25 (4): 304-12
Abstract: Improving patient safety and quality requires more consistent application of best practices based on the strongest scientific evidence available. Although evidence-based practice initiatives are increasingly being implemented in healthcare settings, clinicians may not have had the necessary preparation to accurately determine the overall strength of evidence supporting specific practice change recommendations. A particular issue is lack of clarity in use of the terms level of evidence, quality of evidence, and strength of evidence. This article clarifies the important differences among these terms.

7. Implementing Evidence-Based Practices: Considerations for the Hospice Setting.
Sanders S; Mackin ML; Reyes J; Herr K; Titler M; Fine P; Forcucci C; American Journal of Hospice & Palliative Medicine, 2010 Sep; 27 (6): 369-76

8. Cultivating quality: an evidence-based approach to taking charge. Flynn JP; Prufeta PA; Minghillo-Lipari L; American Journal of Nursing, 2010 Sep; 110 (9): 58-63

9. Evidence-based practice and the magnet journey. Krugman M; Journal for Nurses in Staff Development, 2010 Sep-Oct; 26 (5): 239-

10. Cannabis use in palliative care – an examination of the evidence and the implications for nurses. Green AJ; De-Vries K; Journal of Clinical Nursing, 2010 Sep; 19 (17/18): 2454-62
Abstract: Aim and objective. Examine the pharmaceutical qualities of cannabis including a historical overview of cannabis use. Discuss the use of cannabis as a clinical intervention for people experiencing palliative care, including those with life-threatening chronic illness such as multiple sclerosis and motor neurone disease [amyotrophic lateral sclerosis] in the UK. Background. The non-medicinal use of cannabis has been well documented in the media. There is a growing scientific literature on the benefits of cannabis in symptom management in cancer care. Service users, nurses and carers need to be aware of the implications for care and treatment if cannabis is being used medicinally. Design. A comprehensive literature review. Method. Literature searches were made of databases from 1996 using the term cannabis and the combination terms of cannabis and palliative care; symptom management; cancer; oncology; chronic illness; motor neurone disease/amyotrophic lateral sclerosis; and multiple sclerosis. Internet material provided for service users searching for information about the medicinal use of cannabis was also examined. Results. The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care. Relevance to clinical practice. Questions and dilemmas are raised concerning the role of the nurse when caring and supporting a person making therapeutic use of cannabis.

11. Evidence-based practice. Fluconazole to prevent systemic fungal infections in infants: reviewing the evidence. Wilkerson J; McPherson C; Donze A; Neonatal Network, 2010 Sep-Oct; 29 (5): 323-33
Abstract: IN NEONATOLOGY, EVIDENCE-BASED practice (EBP) relies on well-designed, adequately powered trials to guide practitioners. Several large randomized controlled trials (RCTs) have been conducted to explore the use of fluconazole for fungal prophylaxis in premature infants. Despite the findings of these studies, practice varies among units. In a recent survey of members of the American Academy of Pediatrics (AAP), 34 percent of clinicians indicated that they have used antifungal prophylaxis and only 11 percent of clinicians indicated that a written protocol was in place in their NICU. Intravenous (IV) fluconazole (66 percent), oral nystatin (59 percent), and IV amphotericin (21 percent) were the three most commonly used agents among the respondents.

12. Describing the problem for an evidence-based practice improvement project: a missing ingredient. Burke RE; Levin RF; Research & Theory for Nursing Practice, 2010; 24 (3): 155-8

Clinical Experts Update

2010-11-09T11:42:00.000-08:00

View my guestbook
Welcome to Vickie’s Research Corner. Over the past several years the Office of Nursing Research at St. Joseph Hospital has been holding annual classes for Clinical III/IVs called the Clinical Nurse Experts in Evidence-Based Practice (EBP). This class is designed for the Clinical Nurse III or IV who have an interest in learning more about EBP. Currently we have had twenty-five RNs who have graduated in the past 3 years.
I would like to introduce you to Larisa (Kozuki) Taraborrelli a graduate from our Summer 2009 class. Larisa is currently a Clinical Nurse III who has worked in the Emergency Department (ED) for the past 5 years. This year she will be applying for her Clinical Nurse IV. When asked why she wanted to become a Clinical Expert, Larisa responded that she was going to be involved in the Pediatric Blood culture Study in the ED and wanted to understand EBP and research better.
Larisa currently sits on the Policy & Procedure Committee (P&P) and feels as a result of the class she has a much better understanding of why incorporating evidence into policies and procedures is important for practice- Evidence-Based Practice is best practice! Currently the P&P Committee has been working on incorporating current evidence into new and renewing policies and she is now an integral part of making those changes as a committee member.
Over the past several months Larisa has been working on updating the Burn Policy for the ED and is looking for current research related to burn treatments. She also stated that since taking the class she has a much better comprehension of how EBP impacts her own practice. She is now able to look up information and answer the question why!
EBP is so important for our practice as nurses and as you can see our Clinical Experts are becoming quite the specialist in the world of EBP. If you are a St. Joseph RN and interested in becoming a Clinical Expert of EBP and you are a Clinical Nurse III/IV look for the next opportunity in May 2011 to apply! If you are a Clinical Nurse II then find out who is that expert on your unit, if you don’t have one may be one day it will be you!

Danielle's picks from the literature October 2010

2010-10-14T12:27:00.000-07:00

1. An evidence-based practice primer for infusion nurses. Bays CL; Hermann CP; Journal of Infusion Nursing, 2010 Jul-Aug; 33 (4): 220-5. Abstract: Evidence-based practice (EBP) is the process of using current, best evidence to guide nursing care and improve patient outcomes. This article discusses the differences between research and EBP, reviews the process of EBP, and applies EBP guidelines to central catheter infections, a clinical problem relevant to infusion nursing.

2. Involving students in the real world of evidence-based practice. Putnam JM; Journal of Nursing Education, 2010 Jul; 49 (7): 423-4.

3. Promoting evidence-based practice and translational research. Barnsteiner JH; Reeder VC; Palma WH; Preston AM; Walton MK; Nursing Administration Quarterly, 2010 Jul-Sep; 34 (3): 217-25. Abstract: Evidence-based practice (EBP) is an evolutionary step in the nursing model of excellence in professional practice at the Hospital of the University of Pennsylvania. A healthcare culture focused on excellence and world-class patient care requires that nursing research and EBP are integrated into the professional practice model and nursing care delivery. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research. This article describes the systems and structures in place to provide staff with resources in order to translate research and deliver EBP and the multiple initiatives in disseminating evidence to the point of care.

4. Engaged nurses lead way to improved outcomes via technology. Simpson RL; Nursing Administration Quarterly, 2010 Jul-Sep; 34 (3): 268-73. Abstract: Coupling evidence-based practice with technology enables nursing leaders and their staffs to engage with new vigor and passion as they integrate better practices from the nursing literature into what happens at the patient bedside. The degree to which nurses and their leaders engage positively, or negatively, affects organization's health-from the unit to the boardroom. Nurse executives now have available to them the tools needed to measure, improve, and sustain a culture of engagement in their organizations.

5. Meeting Magnet® Research and Evidence-Based Practice Expectations Through Hospital-Based Research Centers. Ingersoll GL; Witzel PA; Berry C; Qualls B; Nursing Economic$, 2010 Jul-Aug; 28 (4): 226-36.

6. Responding to agitation in people with dementia. Dewing J; Nursing Older People, 2010 Jul; 22 (6): 18-25. Abstract: Although medication and physical restraint have traditionally been used to treat agitated behaviours, there is growing evidence that holistic approaches can be beneficial, says Jan Dewing.

7. The limitations of evidenced-based practice.Baumann SL; Nursing Science Quarterly, 2010 Jul; 23 (3): 226-30.

8. Building research capacity in the nursing workforce: the design and evaluation of the nurse researcher role. Chan R; Gardner G; Webster J; Geary A; Australian Journal of Advanced Nursing, 2010 Jun-Aug; 27 (4): 62-9. Abstract: Objectives The Nurse Researcher Project (NRP) was initiated to support development of a nursing research and evidence based practice culture in Cancer Care Services (CCS) in a large tertiary hospital in Australia. The position was established and evaluated to inform future directions in the organisation. Background The demand for quality cancer care has been expanding over the past decades. Nurses are well placed to make an impact on improving health outcomes of people affected by cancer. At the same time, there is a robust body of literature documenting the barriers to undertaking and utilising research by and for nurses and nursing. A number of strategies have been implemented to address these barriers including a range of staff researcher positions but there is scant attention to evaluating the outcomes of these strategies. The role of nurse researcher has been documented in the literature with the aim to provide support to nurses in the clinical setting. There is, to date, little information in relation to the design, implementation and evaluation of this role. Design The Donabedian's model of program evaluation was used to implement and evaluate this initiative. Methods The 'NRP' outlined the steps needed to implement the nurse researcher role in a clinical setting. The steps involved the design of the role, planning for the support system for the role, and evaluation of outcomes of the role over two years. Discussion This paper proposes an innovative and feasible model to support clinical nursing research which would be relevant to a range of service areas. Conclusion Nurse researchers are able to play a crucial role in advancing nursing knowledge and facilitating evidence based practice, especially when placed to support a specialised team of nurses at a service level. This role can be implemented through appropriate planning of the position, building a support system and incorporating an evaluation plan. Database:

9. Critical appraisal of the evidence: Part II digging deeper--examining the "keeper" studies. Fineout-Overholt E; Melnyk BM; Stillwell SB; Williamson KM; American Journal of Nursing, 2010 Sep; 110 (9): 41-8.

10. An Evidence-based Clinical Guideline for Initial Management of Behavioral Emergencies. White A; JEN: Journal of Emergency Nursing, 2010 Sep; 36 (5): 450-4.

11. New evidence-based clinical practice guidelines for neonatal pain. Advances in Neonatal Care, 2010 Aug; 10 (4): 171.

12. Hypothyroidism: an evidence-based approach to a complex disorder. Kapustin JF; Nurse Practitioner, 2010 Aug; 35 (8): 44-53 Abstract: Approximately 11 million people are affected with hypothyroidism every year in the United States. Because signs and symptoms of hypothyroidism often mimic other comorbid conditions, making an accurate diagnosis can be difficult.

The Nurse Angels of St. Joseph Hospital

2010-10-01T09:42:00.000-07:00

Another St. Joseph Hospital nurse is recognized in the press for a job well done! Critical Care Manager Gemma Seidl, MSN, MPH, RN, PHN is featured in the latest issue of Advance for Nurses, discussing her innovative ICU Angel program to recognize staff nurses who go above and beyond the call of duty.

“The ICU Angel recognizes ICU team members who receive positive written feedback from patients and their families,” says Seidl, “[we] get the sickest of the sick, just hearing ‘thank you’ makes a difference. Morale is definitely up here.” Read more about Gemma Seidl and the ICU nurses at St. Joseph Hospital here.

For Nurses: Conducting an Advanced Literature Search

2010-09-28T16:03:00.000-07:00

The latest issue of AORN Journal includes a really great article for nurses on advanced literature searching in PubMed. The author details the advantages of using PubMed’s advanced search features such as Medical Subject Headings (MeSH), search fields, and limits. The article also includes techniques for building an effective search by combining terms with AND, OR, & NOT.

Effectively conducting an advanced literature search.
Brusco JM.

AORN J. 2010 Sep;92(3):264-71.

Access to this article is available online or by request to all St. Joseph Hospital and CHOC employees through the Burlew Library Website.

Improving literature search skills is a good strategy for all nurses, but the process can be daunting. Staff at the Burlew Medical Library are available to help – whether you need training or prefer we provide you with a professional mediated literature search. St. Joseph Hospital and CHOC employees can contact us through the Burlew Library Website for more information.

New article published by Bogert, Ferrell, & Rutledge: St. Joseph Hospital, Orange

2010-09-03T13:21:00.000-07:00

Congratulations to St. Joseph Hospital authors Soudi Bogert, Carmen Ferrell & Dana Rutledge for their new article published in the July/August 2010 edition of MEDSURG Nursing!

Experience with Family Activation of Rapid Response Teams
Soudi Bogert, Carmen Ferrell, and Dana N. Rutledge
MEDSURG Nursing: The Journal of Adult Health, 2010 July/August; 19 (4): 215-22.

Condition H allows family activation of a rapid response team in a hospital setting. Systematic implementation of Condition H at a 500-bed Magnet® community hospital led to varied types of calls, all of which met the policy criteria. Many communication issues were discovered through this process.

This article is so new it is yet to hit the pages of PubMed or CINAHL, but staff at St. Joseph Hospital, Orange & CHOC may access the full text of this article by making a request through the Burlew Medical Library.

Abstract and Commentary - Heart Failure and Cognition

2010-08-24T14:29:00.000-07:00

Research Abstract and Commentary
Cognitive Deficits in Chronic Heart Failure (authors’ abstract)

BACKGROUND: Patients with heart failure (HF) have been found to have cognitive deficits, but it remains unclear whether these deficits are associated with HF or with aging or comorbid conditions common in HF.
OBJECTIVES: The purpose of this study was (a) to determine the types, the frequency, and the severity of cognitive deficits among patients with chronic HF compared with age- and education-matched healthy participants and participants with major medical conditions other than HF, and (b) to evaluate the relationships between HF severity, age, and comorbidities and cognitive deficits.
METHODS: A sample of 414 participants completed the study (249 HF patients, 63 healthy and 102 medical participants). The HF patients completed measures of HF severity, comorbidity (multiple comorbidity, depressive symptoms), and neuropsychological functioning. Blood pressure and oxygen saturation were assessed at interview; clinical variables were abstracted from records. Participants in the comparison groups completed the same measures as the HF patients except those specific to HF.
RESULTS: Compared with the healthy and medical participants, HF patients had poorer memory, psychomotor speed, and executive function. Significantly more HF patients (24%) had deficits in three or more domains. Higher (worse) HF severity was associated with more cognitive deficits; HF severity interacted with age to explain deficits in executive function. Surprisingly, men with HF had poorer memory, psychomotor speed, and visuospatial recall ability than women. Multiple comorbidity, hypertension, depressive symptoms, and medications were not associated with cognitive deficits in this sample.
DISCUSSION: HF results in losses in memory, psychomotor speed, and executive function in almost one fourth of patients. Patients with more severe HF are at risk for cognitive deficits. Older patients with more severe HF may have more problems in executive function, and men with HF may be at increased risk for cognitive deficits. Studies are urgently needed to identify the mechanisms for the cognitive deficits in HF and to test innovative interventions to prevent cognitive loss and decline.

Pressler, S. J., Subramanian, U., Kareken, D., Perkins, S. M., Gradus-Pizlo, I., Sauvé, M. J., … Shaw, R. M. (2010). Cognitive deficits in chronic heart failure. Nursing Research, 59, 127-39.

Commentary by Dana Rutledge

In this carefully done comparative study, HF patients were compared with healthy (although a bit younger) and medical (current diagnosis of a major chronic disorder other than HF) patients on a battery of cognitive performance measures. HF diagnosis was documented by a test such as echocardiography, nuclear imaging, or cardiac catheterization within a 2-year window; patients had a left ventricular ejection fraction of 40% or less. HF patients came from seven sites in one Midwestern city; healthy and medical participants came from one medical practice, family members of HF participants, and volunteers. Measures selected were valid (measured what they are supposed to measure) and reliable in the populations of interest (accurate, sensitive, replicable). Procedures for testing were carefully laid out.

Study findings support previous work showing that HF patients have poorer performance compared with healthy/medical patients in memory, psychomotor speed, and executive functioning. Deficits found in HF patients show that the systematic damage from HF includes cerebral damage, and lead to cerebral hypoperfusion. Memory deficits were the most common problems identified in HF patients, followed by psychomotor slowing, and decreased executive function (thinking). These deficits are more severe in persons with greater HF severity and executive function was especially problematic in older patients with more severe HF. A unique finding was that deficits were worse in men.

What do these results say to nurses caring for patients with HF? Cognitive deficits occurred in almost 25% of patients!! Can these persons handle new information? When you try to teach them something, can they learn? Can they care for themselves? These are important considerations. All nurses should be evaluating the potential learning capacity or incapacity of these patients to determine what home care needs they have, and what deficits need to be addressed, and potentially managed by others. Home care may be necessary for many of these persons.

Danielle's picks from the literature August 2010

2010-08-12T08:43:00.000-07:00

As it is such a popular feature, I will be continuing the tradition of sharing the latest nursing research/EBN articles. 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. Autonomy, evidence and intuition: nurses and decision-making. Traynor M; Boland M; Buus N; Journal of Advanced Nursing, 2010 Jul; 66 (7): 1584-91 CINAHL AN: 2010682934
Database: CINAHL Plus with Full Text

2. The Connected Learning Model for disseminating evidence-based care practices in clinical settings. Lekan D; Hendrix CC; McConnell ES; White H; Nurse Education in Practice, 2010 Jul; 10 (4): 243-8 CINAHL AN: 2010677329
Database: CINAHL Plus with Full Text

3. Central line-associated bloodstream infections: evidence for practice. DePalma JA; Home Health Care Management & Practice, 2010 Jun; 22 (4): 294-6 CINAHL AN: 2010660479
Database: CINAHL Plus with Full Text

4. General pain assessment among patients with cancer in an acute care setting: a best practice implementation project. Ang E; Chow YL; International Journal of Evidence-Based Healthcare, 2010; 8 (2): 90-6 CINAHL AN: 2010671536
Database: CINAHL Plus with Full Text

5. What do nurses need to know about the quality enterprise? Farquhar M; Kurtzman ET; Thomas KA; Journal of Continuing Education in Nursing, 2010 Jun; 41 (6): 256-8 CINAHL AN: 2010690925
Database: CINAHL Plus with Full Text

6. Translating evidence from systematic reviews for policy makers. Nannini A; Houde SC; Journal of Gerontological Nursing, 2010 Jun; 36 (6): 22-6 CINAHL AN: 2010688735
Database: CINAHL Plus with Full Text

7. What is evidence-based practice? Cullen L; Adams S; Journal of PeriAnesthesia Nursing, 2010 Jun; 25 (3): 171-3 CINAHL AN: 2010690732
Database: CINAHL Plus with Full Text

8. Development of an Evidence-Based Pressure Ulcer Program at the National Naval Medical Center: Nurses' Role in Risk Factor Assessment, Prevention, and Intervention Among Young Service Members Returning from OIF/OEF. Crumbley DR; Kane MA; Nursing Clinics of North America, 2010 Jun; 45 (2): 153-68 CINAHL AN: 2010674841
Database: CINAHL Plus with Full Text

9. Engage nurses in EBP with the nursing clinical question process. Pangarakis S; Graner T; Nursing Management, 2010 Jun; 41 (6): 15-7 CINAHL AN: 2010684003
Database: CINAHL Plus with Full Text

10. Evidence-based practice: pushback from a holistic perspective. Jackson C; Holistic Nursing Practice, 2010 May-Jun; 24 (3): 120-4 CINAHL AN: 2010655126
Database: CINAHL Plus with Full Text

11. Outcomes and evidence-based practice: moving forward. Stumbo NJ; Pegg S; Annual in Therapeutic Recreation, 2010; 18: 12-23 CINAHL AN: 2010459609
Database: CINAHL Plus with Full Text

12. "Inside looking in" or "inside looking out"? How leaders shape cultures equipped for evidence-based practice. Halm MA; American Journal of Critical Care, 2010 Jul; 19 (4): 375-8 CINAHL AN: 2010708170
Database: CINAHL Plus with Full Text

13. Evidence-based nursing. Using incident reports as a teaching tool. Besmer M; Bressler T; Barrell C; Nursing Management, 2010 Jul; 41 (7): 16-8 CINAHL AN: 2010713313
Database: CINAHL Plus with Full Text

14. Merging silos: collaborating for information literacy. Miller LC; Jones BB; Graves RS; Sievert MC; Journal of Continuing Education in Nursing, 2010 Jun; 41 (6): 267-72 CINAHL AN: 2010692418
Database: CINAHL Plus with Full Text

15. Using theory and frameworks to facilitate the implementation of evidence into practice. Worldviews on Evidence-Based Nursing, 2010 2nd Quarter; 7 (2): 57-8 CINAHL AN: 2010691792
Database: CINAHL Plus with Full Text

16. Translating an evidence-based protocol for nurse-to-nurse shift handoffs. Dufault M; Duquette CE; Ehmann J; Hehl R; Lavin M; Martin V; Moore MA; Sargent S; Stout P; Willey C; Worldviews on Evidence-Based Nursing, 2010 2nd Quarter; 7 (2): 59-75 CINAHL AN: 2010691793
Database: CINAHL Plus with Full Text

SJO nurses present ANCC 2010 Magnet Conference "virtual posters"

2010-07-27T14:57:00.000-07:00

We are proud to announce St. Joseph Hospital of Orange nurses presenting two of the 25 "virtual posters" accepted at the 2010 ANCC Magnet Conference.

Transformational Leadership: Building Leadership Competency with Blended Learning by Vivian Norman, RN, MSN, CCRN and Factors Associated with Nurses' Discussions of Hospice by Denise Boyd, RN, BSN, OCN; Kristen Merkh, RN, BSN, OCN; Dana N. Rutledge, RN, PhD; and Victoria Randall, RN.

Their posters are now available for viewing at the ANCC 2010 National Magnet Conference Virtual Poster Session via Virtual World and will remain on view until the end of the October conference.

To access Virtual World please follow the steps below (note, the software required for entry into the Virtual World is not compatible with Mac).

View this training video with step by step instructions (Windows Media Player 9 or later & speakers/headphones are required), or view the written instructions.
Register and DOWNLOAD the Virtual World software which must be installed on your computer.
You may need to work with your Information Systems department in order to be able to download the software at your desktop computer (if accessing Virtual World from work).
Technical support for actual technical difficulties is available, call 1-800-679-3646 from 9 a.m. to 5 p.m. Eastern Time and ask for “virtual technical support.” You may also email virtual technical support at support@virtualbeginnings.com. Please, carefully review the instructions above before asking for technical support.

Blog Leadership change: Introducing Danielle Linden, new Library Manager

2010-07-20T09:54:00.000-07:00

I would like to share that it has been a tremendous privilege and joy for me to have been involved in beginning the world's first blog devoted to nursing research and evidenced based nursing some 3+ years ago.
An enormous thank you to our entire blog team for their dedication to the continued improvement in the quality of our blog is in order. Nursing Research: Show me the Evidence! is truly a team effort . I will miss our entire team and wish everyone in the wider world of nursing research the best of everything. I will be retiring on August 6 after 31 years in my position as Library Manager of Burlew Medical Library, St. Joseph Hospital in Orange, California. My husband and I will be pursuing our twin loves of travel and all things "ballroom dancing". We, of course, also relish the thought of spending more time with our families, our garden, our cameras and our BOOKS!! We will also serve as volunteer couriers for the National Bone Marrow Association and I hope to involve myself in literacy training.

Please allow me to introduce Danielle Linden, MLS, AHIP as both our new Library Manager and the new administrator for our nursing research blog. Danielle received her BA in Anthropology from UCLA and her Master of Library and Information Science Degree from San Jose State University. Professionally certified by the Medical Library Association’s Academy of Health Information Professionals (AHIP) at the senior member level, Danielle has been actively involved in both the Medical Library Group of Southern California and Arizona as well as the Medical Library Association. Danielle’s experience includes working as a medical librarian in both academic and hospital environments. She is an experienced searcher and instructor in a wide variety of databases. She has a special interest in library services and resources for nurses and notably has presented a poster entitled “Incorporating Library Resources into an Undergraduate Nursing Program Wiki.” Danielle runs marathons for fun and has an outgoing, engaging personality.

Magnet Maggie at St. Joseph Hospital in Orange featured in Advance for Nurses

2010-06-30T10:40:00.000-07:00

A June 2010 issue of Advance for Nurses features a great article on Magnet Maggie and her adventures at St. Joseph Hospital in Orange, California. Not only can you follow Magnet Maggie as she tours throughout the hospital but you can also see how much fun she has had accompanying nurses to conferences and even graduations. Thank you to feature writer Candy Goulette!!

Julie's picks from the literature May 2010

2010-06-29T09:57:00.000-07:00

Here are my picks from the nursing literature for May dealing with nursing research articles or articles about nursing research/EBN. 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 library website

1. Nursing students' and clinical instructors' perceptions on the
    implementation of a best practice guideline.(includes abstract);
    Ritchie L; Evans MK; Matthews J; Journal of Nursing Education, 2010
    Apr; 49 (4): 223-7 (journal article - research) ISSN: 0148-4834 PMID:
    20055324 CINAHL AN: 2010617920

2. Partnering with your library to strengthen nursing research.(includes
    abstract); Hallyburton A; St John B; Journal of Nursing Education,
    2010 Mar; 49 (3): 164-7 (journal article - research) ISSN: 0148-4834
    PMID: 19954132 CINAHL AN: 2010602293
3. Integration of spirituality in nursing practice: a literature
    review.(includes abstract); Tiew LH; Creedy DK; Singapore Nursing
    Journal, 2010 Jan-Mar; 37 (1): 15-20, 22 (journal article - research,
    systematic review) ISSN: 0218-0995 CINAHL AN: 2010621331
4. Evidence-based nursing. 6 steps for transforming organizational EBP
    culture.Ogiehor-Enoma G; Taqueban L; Anosike A; Nursing Management,
    2010 May; 41 (5): 14-7 (journal article) ISSN: 0744-6314 PMID: 20418746
    CINAHL AN: 2010647956
5. Rapid response team - a proactive strategy in managing
    haemodynamically unstable adult patients in the acute care hospitals
    [corrected] [published erratum appears in SINGAPORE NURS J 2010
    Jan-Mar;37(1):4].Choo CL; Heng D; Ching AC; Kang J; Wentao Z;
    Singapore Nursing Journal, 2009 Oct-Dec; 36 (4): 17-22, 24-8 (journal
    article - tables/charts) ISSN: 0218-0995 CINAHL AN: 2010489902
6. Information literacy for evidence-based practice in perianesthesia
    nurses: readiness for evidence-based practice.Ross J; Journal of
    PeriAnesthesia Nursing, 2010 Apr; 25 (2): 64-70 (journal article -
    research, tables/charts) ISSN: 1089-9472 PMID: 20359640 CINAHL AN:
    2010635535
7. A meta-study of the essentials of quality nursing
    documentation.(includes abstract); Jefferies D; Johnson M; Griffiths R;
    International Journal of NursingPractice, 2010 Apr; 16 (2): 112-24
    (journal article - research, systematic review, tables/charts) ISSN:
    1322-7114 PMID: 20487056 CINAHL AN: 2010605897
8. Perceived facilitators and inhibitors for the use of personal
    digital assistants by nurses: a systematic review.Gyi AA; Journal of
    Advanced Nursing, 2010 May; 66 (5): 964-6 (journal article - abstract)
    ISSN: 0309-2402 PMID: 20423356 CINAHL AN: 2010647106
9. Rounding for outcomes: an evidence-based tool to improve nurse
    retention, patient safety, and quality of care.Baker SJ; McGowan N;
    JEN: Journal of Emergency Nursing, 2010 Mar; 36 (2): 162-4 (journal
    article - pictorial) ISSN: 0099-1767 PMID: 20211412 CINAHL AN:
    2010621739
10. Team-based care interventions involving nurses and primary care or
    community pharmacists improve hypertension control.Khan EU;
    Evidence-Based Nursing, 2010 Apr; 13 (2): 47-8 (journal article) ISSN:
    1367-6539 PMID: 20436147 CINAHL AN: 2010668595
11. Nurse-led postpartum discharge education programme including
    information on postnatal depression reduces risk of high depression
    scores at 3-month follow-up.Morrell CJ; Evidence-Based Nursing, 2010
    Apr; 13 (2): 48-9 (journal article) ISSN: 1367-6539 PMID: 20436148
    CINAHL AN: 2010668596

12. Evidence-based practice improvement: merging 2 paradigms.(includes
    abstract); Levin RF; Keefer JM; Marren J; Vetter M; Lauder B;
    Sobolewski S; Journal of Nursing Care Quality, 2010 Apr-Jun; 25 (2):
    117-26 (journal article - tables/charts) ISSN: 1057-3631 PMID: 19680149
    CINAHL AN: 2010617873
13. Accreditation and certification for evidence-based design.(includes
    abstract); Stichler JF; Journal of Nursing Administration, 2010 Apr;
    40 (4): 158-61 (journal article) ISSN: 0002-0443 PMID: 20305460 CINAHL
    AN: 2010629098
14. Knowledge translation: summarizing and synthesizing the evidence for
    WOC best practices.Kelechi TJ; Naccarato MK; Journal of Wound, Ostomy
    & Continence Nursing, 2010 Mar-Apr; 37 (2): 132-6 (journal article -
    tables/charts) ISSN: 1071-5754 PMID: 20228652 CINAHL AN: 2010604492
15.     Discover a better way to care: exploring uncharted territory,
    researchers are blazing a path to better nursing practice.Brown G;
    Johns Hopkins Nursing, 2010 Spring; 8 (1): 28-33 (journal article -
    pictorial) CINAHL AN: 2010631192
16. Telephone behavioural intervention delivered by nurses combined with
    home blood pressure monitoring improves long-term hypertensive
    management compared with usual care.Hill MN; Evidence-BasedNursing,
    2010 Apr; 13 (2): 46 (journal article) ISSN: 1367-6539 PMID: 20436146
    CINAHL AN: 2010668594
17. How professional nurses working in hospital environments experience
    moral distress: a systematic review.McArthur A; Journal of Advanced
    Nursing, 2010 May; 66 (5): 962-3 (journal article - abstract) ISSN:
    0309-2402 PMID: 20423356 CINAHL AN: 2010620396

18. The journey to Magnet®: establishing a research
    infrastructure.(includes abstract); Steele-Moses SK; Clinical Journal
    of Oncology Nursing, 2010 Apr; 14 (2): 237-9

19. Preoperative skin cleansing with chlorhexidine-alcohol reduces
    surgical site infection after clean-contaminated surgery compared with
    povidone-iodine.Mimoz O; Evidence-Based Nursing, 2010 Apr; 13 (2):
    36-7 (journal article) ISSN: 1367-6539 PMID: 20436136 CINAHL AN:
    2010668584
20. Nicotine patch plus lozenge gives greatest increases in abstinence
    from smoking at 6 months compared with placebo; smaller effects seen
    with nicotine patch alone, bupropion or nicotine lozenges alone or
    combined.Buchanan L; Evidence-Based Nursing, 2010 Apr; 13 (2): 50-1
    (journal article) ISSN: 1367-6539 PMID: 20436150 CINAHL AN: 2010668598
21. Cohort study finds nine times increased overdose risk (fatal plus
    non-fatal) in patients receiving 100 mg/day for 90 days compared with
    1-20 mg/day opioids for chronic non-cancer pain, but wide CI and
    possibility of unmeasured confounders.Hochman JS; Pergolizzi J;
    Evidence-Based Nursing, 2010 Apr; 13 (2): 55-6 (journal article) ISSN:
    1367-6539 PMID: 20436154 CINAHL AN: 2010668602
22. Telephone-delivered collaborative care for post-CABG depression is
    more effective than usual care for improving quality of life related to
    mental health.Gallagher R; Evidence-BasedNursing, 2010 Apr; 13 (2): 37
    (journal article) ISSN: 1367-6539 PMID: 20436137 CINAHL AN: 2010668585
23. Systematic review finds no difference in effect between home and
    centre-based cardiac rehabilitation on mortality, morbidity and
    modifiable risk factors in patients with CHD.Parry M;
    Evidence-BasedNursing, 2010 Apr; 13 (2): 38 (journal article) ISSN:
    1367-6539 PMID: 20436138 CINAHL AN: 2010668586
24. Ginger reduces severity of nausea in early pregnancy compared with
    vitamin B6, and the two treatments are similarly effective for reducing
    number of vomiting episodes.Smith C; Evidence-BasedNursing, 2010 Apr;
    13 (2): 40 (journal article) ISSN: 1367-6539 PMID: 20436140 CINAHL AN:
    2010668588
25. Hand hygiene and facemask use within 36 hours of index patient
    symptom onset reduces flu transmission to household contacts.Gould D;
    Evidence-BasedNursing, 2010 Apr; 13 (2): 44 (journal article) ISSN:
    1367-6539 PMID: 20436144 CINAHL AN: 2010668592
26. Low specificity and high false-positive rates limit the usefulness
    of the STRATIFY tool and clinical judgement in predicting falls in
    older patients in an acute hospital setting.Healey F;
    Evidence-BasedNursing, 2010 Apr; 13 (2): 54 (journal article) ISSN:
    1367-6539 PMID: 20436153 CINAHL AN: 2010668601
27. Where to find help when you need it: EIDM resources.Dobbins M;
    Reflections on Nursing Leadership, 2010 1st Quarter; 36 (1). (2p)
    (journal article) ISSN: 1527-6538 CINAHL AN: 2010641747

SlideWorld: a portal for medically oriented powerpoints

2010-06-16T14:48:00.000-07:00

Are you looking for downloadable PowerPoints that you can use for patient teaching/nursing instruction? Slideworld may be just what you're looking for.

For instance, there is a slide show on Asthma Pathophysiology which is both 5 star rated and has received

over 3800 hits.

SlideWorld is a powerful resource for PowerPoint Slide Presentations.

It is a web resource designed to facilitate the educational process of

medical professionals. As you know, slide presentations have become

one of the key ways of facilitating education and a way of

communicating new scientific developments. Academic faculties and

clinicians in practice from worldwide have contributed to the web

portal.

Take the Quick Tour of SlideWorld .

More than 5 million ppt presentations are searchable by both broad categories and textword searches. Slideworld employs web 2.0 technologies allowing you to rate presentations as well as incorporate them into

your tweets and other social networking tools. Registration is both free and easy. Medically orientated

PowerPoint templates are also available for purchase for a small fee. Upload your own presentations to share information and receive a wider viewership.

Enjoy!!

New article published by Loucks, Rutledge, Hatch and Morrison: St. Joseph Hospital, Orange

2010-05-26T09:22:00.000-07:00

Congrats to Jeanine Loucks, Dana Rutledge, Beverly Hatch and Victoria Morrison for their newly published article. The article is so new it hasn't yet ( as of 5/26/10) been picked up PubMed or CINAHL.

Rapid Response Team for Behavioral Emergencies

Jeannine Loucks St. Joseph Hospital, Orange, CA, USA, jeannine.loucks@stjoe.org
Dana N. Rutledge
St. Joseph Hospital, Orange, CA, USA, California State University Fullerton, Fullerton, CA, USA
Beverly Hatch
St. Joseph Hospital, Orange, CA, USA
Victoria Morrison
St. Joseph Hospital, Orange, CA, USA
Behaviors of patients with psychiatric illness who are hospitalizedon nonbehavioral health units can be difficult to address bystaff members. Instituting a rapid response team to proactivelyde-escalate potential volatile situations on nonpsychiatricunits in a hospital allows earlier treatment of behavioral issueswith these patients. The behavioral emergency response team(BERT) consists of staff members (registered nurses, socialworkers) from behavioral health services who have experiencein caring for patients with acute psychiatric disorders as wellas competence in management of assaultive behavior. BERT serviceswere trialed on a medical pulmonary unit; gradual housewideimplementation occurred over 2 years. Tools developed for BERTinclude an activation algorithm, educational cue cards for staff,and a staff survey. Results of a performance improvement surveyreveal that staff nurses have had positive experiences withBERT but that many nurses are still not comfortable caring forpsychiatric patients on their units.

Key Words: rapid response team • psychiatric emergencies • behavioral health • psychiatric nursing • de-escalation • Iowa Model of Evidence-Based Practice

Journal of the American Psychiatric Nurses Association, Vol. 16, No. 2, 93-100 (2010)
DOI: 10.1177/1078390310363023

MedlinePlus Redesign Preview

2010-05-24T08:20:00.000-07:00

MedlinePlus Redesign Preview

Medline Plus and Medline Plus Espanol are receiving a major overhaul and redesign in the summer of 2010. If you are not already familiar with Medline Plus, it is the #1 most authoritative and reliable source of lay information for the health consumer. All topics are available in both English and Spanish and many topics are available in a multitude of other languages. In many cases, you will also have a video or tutorial available on your topic. Amomg other improvements, the redesigned Medline Plus will incorporate new web 2.0 technologies as well.

Medline Plus encourages comments and suggestions regarding this redesign.

Check it out!!

Julie's picks from the literature: April 2010

2010-05-21T14:04:00.000-07:00

Check out these new articles either on the topic of evidence based nursing or key nursing research articles. Staff at St. Joseph Hospital in Orange or Children's Hospital of Orange County may be able to access some of the full text through the medical library's website .

1. Evidence-based nursing. Stop "knowledge creep".Pape T; Richards B; Nursing Management, 2010 Feb; 41 (2): 8-11 (journal article -

tables/charts) ISSN: 0744-6314 PMID: 20142671 CINAHL AN: 2010582834

2. Evidence-based guideline: wandering [corrected] [published erratum

appears in J GERONTOL NURS 2010 Mar;36(3):1p].Futrell M; Melillo KD;

Remington R; Schoenfelder DP; Journal of Gerontological Nursing, 2010

Feb; 36 (2): 6-16 (journal article - glossary, questionnaire/scale)

ISSN: 0098-9134 PMID: 20151627 CINAHL AN: 2010552782

3. Utilizing a mock trial to demonstrate evidence-based nursing

practice: a staff development process.(includes abstract); Staffileno

BA; McKinney C; Journal for Nurses in Staff Development, 2010 Mar-Apr;

26 (2): 73-6 (journal article) ISSN: 1098-7886 PMID: 20354408 CINAHL

AN: 2010620225

4. A unique collaborative nursing evidence-based practice initiative

using the Iowa model: a clinical nurse specialist, a health science

librarian, and a staff nurse's success story.(includes abstract); Krom

ZR; Batten J; Bautista C; Clinical Nurse Specialist: The Journal for

Advanced NursingPractice, 2010 Mar-Apr; 24 (2): 54-9 (journal article -

tables/charts) ISSN: 0887-6274 PMID: 20168139 CINAHL AN: 2010583113

5. Use of research by nurses during their first two years after

graduating.(includes abstract); Forsman H; Rudman A; Gustavsson P;

Ehrenberg A; Wallin L; Journal of Advanced Nursing, 2010 Apr; 66 (4):

878-90 (journal article - research, tables/charts) ISSN: 0309-2402

PMID: 20423375 CINAHL AN: 2010587577

6. The role of the clinical nurse specialist in facilitating

evidence-based practice within a university setting.(includes

abstract); Tuite PK; George EL; Critical Care Nursing Quarterly, 2010

Apr-Jun; 33 (2): 117-25 (journal article - algorithm, tables/charts)

ISSN: 0887-9303 PMID: 20234200 CINAHL AN: 2010612060

7. Nursing handoffs: a systematic review of the literature:

surprisingly little is known about what constitutes best

practice.(includes abstract); Riesenberg LA; Leitzsch J; Cunningham JM;

American Journal of Nursing, 2010 Apr; 110 (4): 24-36 (journal article

- CEU, exam questions, research, systematic review, tables/charts)

ISSN: 0002-936X PMID: 20335686 CINAHL AN: 2010612001

8. NNN language and evidence-based practice guidelines for acute

cardiac care: retaining the essence of nursing.(includes abstract); Van

Horn ER; Kautz DD; Dimensions of Critical Care Nursing, 2010 Mar-Apr;

29 (2): 69-72 (journal article - tables/charts) ISSN: 0730-4625 PMID:

20160543 CINAHL AN: 2010598180

9. What makes a phenomenological study phenomenological? An analysis of

peer-reviewed empirical nursing studies.Norlyk A; Harder I;

Qualitative Health Research, 2010 Mar; 20 (3): 420-31 (journal article

- research, tables/charts) ISSN: 1049-7323 PMID: 20068190 CINAHL AN:

2010568773

10. Othering: difference understood??: A 10-year analysis and critique

of the nursing literature.(includes abstract); Canales MK; Advances in

Nursing Science, 2010 Jan-Mar; 33 (1): 15-34 (journal article -

research, systematic review, tables/charts) ISSN: 0161-9268 PMID:

20010068 CINAHL AN: 2010598159

11. Documenting an EBP project: guidelines for what to include and

why.(includes abstract); Worral PS; Levin RF; Arsenault DC; Journal of

the New York State Nurses Association, 2009 Fall-2010 Winter; 40 (2):

12-9 (journal article - tables/charts) ISSN: 0028-7644 PMID: 20415269

CINAHL AN: 2010608331

12. Putting evidence-based practice into your practice: a CE activity.

Journal of the New York State Nurses Association, 2009 Fall-2010

Winter; 40 (2): 28-31 (journal article - CEU, exam questions) ISSN:

0028-7644 CINAHL AN: 2010608360

13. How much time do you spend reviewing research per week?Mourfield NM;

Medcalfe S; Nursing Management, 2009 Dec; 40 (12): 13-4, 16, 18

(journal article - research, tables/charts) ISSN: 0744-6314 PMID:

19966545 CINAHL AN: 2010589640

14. Inspiring change. Using PICO and the brief report to answer clinical

questions.Elkins MY; Nursing, 2010 Apr; 40 (4): 59-60 (journal

article) ISSN: 0360-4039 PMID: 20234276 CINAHL AN: 2010612406

2010 Nursing Web Awards: nominations end May 23!! Polls open May 25 and end May 31

2010-05-20T20:33:00.000-07:00

OnlineCollegeGuru.com has asked us to announce their first award categories for best Nursing Web sites. Please note that there is a category for Best Nursing Blog-- if you feel inclined to nominate our blog, Nursing Research: Show me the Evidence! we would be most appreciative.

2010 Nursing Web Awards

Sponsored by OnlineCollegeGuru.com

17 May 2010 Nursing Web Awards Begins!

Noticing that there is a web award for practically every category except nursing, I’ve decided to create this award to honor all the great nursing websites/blogs!
How this will work

Nomination
Visit each of the following categories and leave an comment with the your nomination for that section. Include why you are nominating the website/app. You are allowed to nominate your own website.

Here's a link to the awards website http://onlinecollegeguru.com/awards/nursing/2010/2010-nursing-web-awards-begins/

•Best Nursing Blog of 2010

•Best New Nursing blog of 2010

•Best/Influential Post of 2009-2010

•Top Nursing Twitterer of 2010

•Most Useful Nursing Website of 2010

•Most Useful Web/Mobile Tool for Nurses of 2010

Nominations will end 00:00 GMT on Sunday May 23rd 2010.

Each user are allowed to vote once, your IP will be recorded to prevent vote fraud.

The Polls will open: Tuesday May 25th 00:00 GMT.

The Polls will end: Monday May 31st 00:00 GMT.

Round 2 Voting – Final Nominees

The polls will be tallied, nominees that received the most votes for each category will be chosen for round 2 of polls.

Round 2 Polls opening TBA.

Winners – Prizes!

The winners will be chosen based on number of votes and prizes will be awarded (if applicable).

Prizes will be in Kiva Gift Certificates – you can either cash it or lend it to the poor.

•Winners for Best Nursing Blog, New Nursing Blog, and Influential Posts will receive $150 Kiva gift certificates each.

•1st Runners up for Best Nursing Blog, New Nursing Blog, and Influential Posts will receive $75 Kiva gift certificates each.

•2nd Runner up for Best Nursing Blog, New Nursing Blog, and Influential Posts will receive $25 Kiva gift certificates each.

I don’t have any monetary prizes for the following categories, except a sweet badge you can use on your website and bragging rights.

•Top Nursing Twitterer of 2010

•Most Useful Nursing Websites of 2010

•Most Useful Web/Mobile Tool for Nurses of 2010

2010 Awards Categories

Best Nursing Blog of 2010

Best New Nursing blog of 2010

Best/Influential Post of 2009-2010

Top Nursing Twitterer of 2010

Most Useful Nursing Website of 2010

Most Useful Iphone App for Nurses of 2010

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Julie's picks from the literature: March

2010-04-14T15:41:00.000-07:00

Here are my picks from the most recent nursing articles dealing with nursing research and evidence based nursing. Staff at St. Joseph Hospital in Orange and Children's Hospital of Orange County may be able to access some of these articles via the library's website.

1. A nursing clinical decision support system and potential predictors
of head-of-bed position for patients receiving mechanical
ventilation.(includes abstract); Lyerla F; LeRouge C; Cooke DA; Turpin
D; Wilson L; American Journal of Critical Care, 2010 Jan; 19 (1): 39-47 (journal article - research) ISSN: 1062-3264 PMID: 20045847 CINAHL AN: 2010530899

2. Breast cancer screening behaviors of African American women: a comprehensive review, analysis, and critique of nursing research.(includes abstract); Conway-Phillips R; Millon-Underwood S;
ABNF Journal, 2009 Fall; 20 (4): 97-101 (journal article - research, systematic review) ISSN: 1046-7041 PMID: 19927894 CINAHL AN: 2010522060

3. Do calculation errors by nurses cause medication errors in clinical practice? A literature review.(includes abstract); Wright K; Nurse Education Today, 2010 Jan; 30 (1): 85-97 (journal article - research,
systematic review, tables/charts) ISSN: 0260-6917 PMID: 19666199 CINAHL AN: 2010543404

4. Evidence-based practice: step by step. Igniting a spirit of inquiry: an essential foundation for evidence-based practice: how nurses can build the knowledge and skills they need to implement ERP.(includes
abstract); Melnyk BM; Fineout-Overholt E; Stillwell SB; Williamson KM; American Journal of Nursing, 2009 Nov; 109 (11): 49-52 (journal article - tables/charts) ISSN: 0002-936X PMID: 19858857 CINAHL AN: 2010536578

5. Cultivating quality. Shared governance supports evidence-based practice: the experience of perioperative nurses at Children's Hospital Boston can serve as a model for others.(includes abstract); Waddell
AWG; American Journal of Nursing, 2009 Nov; 109 (11): 53-7 (journal article - pictorial) ISSN: 0002-936X PMID: 19858858 CINAHL AN: 2010536579

6. Generalizability and transferability of meta-synthesis research findings.(includes abstract); Finfgeld-Connett D; Journal of Advanced Nursing, 2010 Feb; 66 (2): 246-54 (journal article - research) ISSN: 0309-2402 CINAHL AN: 2010539481
7.Walk the walk to reduce catheter-related bloodstream infections.(includes abstract); Hatler C; Hebden J; Kaler W; Zack J; American Nurse Today, 2010 Jan; 5 (1): 26-31 (journal article - CEU,
exam questions, pictorial) ISSN: 1930-5583 CINAHL AN: 2010546030

8.Leadership: the critical success factor in the rise or fall of useful research activity.(includes abstract); Henderson A; Winch S; Holzhauser K; Journal of Nursing Management, 2009 Dec; 17 (8): 942-6
(journal article) ISSN: 0966-0429 PMID: 19941567 CINAHL AN: 2010485576

9. Controlling bias in complex nursing intervention studies: a checklist.(includes abstract); Campbell-Yeo M; Ranger M; Johnston C; Fergusson D; Canadian Journal of Nursing Research, 2009 Dec; 41 (4):
32-50 (journal article - questionnaire/scale) ISSN: 0844-5621 PMID: 20191712 CINAHL AN: 2010529009

10. Applying the Stetler Model of Research Utilization in staff development: revitalizing a preceptor program.(includes abstract); Romp CR; Kiehl E; Journal for Nurses in Staff Development, 2009 Nov-Dec; 25
(6): 278-86 (journal article - CEU, exam questions, research,
tables/charts) ISSN: 1098-7886 PMID: 19955975 CINAHL AN: 2010506957

11. Writing an appropriate methods section for a research article: procedure, instruments/measurements and analysis.Lambert VA; Lambert CE; Thai Journal of Nursing Research, 2009 Oct-Dec; 13 (4): 245-8
(journal article) ISSN: 0859-7685 CINAHL AN: 2010545155

12. Review summaries: evidence for nursing practice. Blood donor skin preparation with alcohol vs. alcohol plus any antiseptic for preventing bacteraemia or contamination of blood for transfusion.Jayasekara R;
Journal of Advanced Nursing, 2010 Feb; 66 (2): 257-8 (journal article - abstract) ISSN: 0309-2402 CINAHL AN: 2010555036

13. Review summaries: evidence for nursing practice. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery.Jayasekara R; Journal of Advanced Nursing,
2010 Feb; 66 (2): 258-9 (journal article - abstract) ISSN: 0309-2402
CINAHL AN: 2010555037

14. Opportunities and challenges: wound and skin alterations of obesity.Zuelzer HB; Bariatric Nursing & Surgical Patient Care, 2009 Dec; 4 (4): 283 (journal article - abstract) ISSN: 1557-1459 CINAHL AN: 2010554679

Web based course on Health Literacy-- CNE for Nurses

2010-04-14T13:39:00.000-07:00

Health Literacy has become such an important topic that some are now referring to it as the "Fifth Vital Sign"-(new health literacy screening tool-- the Fifth Vital Sign). The CDC has developed a web based tutorial titled "Health Literacy for Public Health Professionals". Although this is geared to public health professionals, it will also be of great interest to nurses and comes with 1 CNE. You will need to register for the course and complete an evaluation in order to earn the CNE.

For more resources on Health Literacy, visit:

AHRQ
National Library of Medicine resources on Health Literacy
USDHS-- plain language thesaurus
California Health Literacy Initiative

Mammogram Advice a Health Threat

2010-03-22T12:57:00.000-07:00

The recent announcement by the U.S. Preventive Services Task Force, a national panel of medical officials tasked with reviewing clinical data and making recommendations about preventive care, has generated considerable confusion about the role of mammography and threatens to undo years of beneficial public and physician education and behavior adaptation.

Since the news broke about the recommendation last month, our team of breast cancer specialists has been inundated by questions, concerns and comments from women.
Until 1990, the breast cancer death rate in the United States had remained unchanged for 50 years. With the introduction of screening mammography, there was an abrupt and sustained decrease in the breast cancer death rate by 30 percent over the past 20years. The new USPSTF guidelines threaten to reverse the significant progress that has been made over the past two decades.

The task force recommends against routine screening mammography for women ages 40-49. However, there is ample scientific evidence that women in their forties can expect an equivalent decrease in breast cancer mortality due to screening mammography as compared to women 50 and older. Population studies in Sweden have shown a 40 percent decrease in breast cancer mortality in women ages 40-49 who underwent screening.

The incidence of breast cancer rises steadily with age, but there is no dramatic increase at age 50. The probability of being diagnosed with breast cancer among women in their forties is 1.44 percent as compared with 2.63 percent among women in their fifties. Meanwhile it has been estimated that 40 percent of the years of life saved by screening can be attributed to women diagnosed under the age of 50.

The task force advises only those women in their forties who are at high risk to undergo screening. However, it should be emphasized that only 10 percent to 25 percent of breast cancers occur in women at high risk. The majority of breast cancers arise in women with no special risk factors.

Yearly screening may be especially important for younger women because they tend to have faster growing cancers. Lengthening the screening interval to two years will diminish the survival benefit for all women and ultimately contribute to more treatment related toxicity because more cancers will be diagnosed at a later stage.
Physical exam, whether practiced by a woman herself or her doctor, will always be complementary to any breast-imaging technique.

Women should remember to bring any changes to their doctor's attention regardless of how soon after a negative mammogram they occur. We can each cite many personal instances where a woman's self exam led her to a doctor for follow up, sometimes with life-saving consequences.

In conclusion, the breast specialists at the Center for Cancer Prevention and Treatment at St. Joseph Hospital do not support the revised screening mammography guidelines recently issued by the Task Force and strongly urge women 40 and older to continue annual screening mammography. Better yet, talk to your own doctor about your risk factors and make a decision together about your breast health. It could save your life.

Research Abstract and Commentary: Aromatherapy Massage

2010-03-17T11:31:00.000-07:00

Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer: A Multicenter Randomized Controlled Trial

Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, Ramirez AJ. Journal of Clinical Oncology, 25, 532-538.

PURPOSE: To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice.
PATIENTS AND METHODS: 288 cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone.
RESULTS: Patients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively.
CONCLUSION: Aromatherapy massage does not appear to confer benefit on cancer patients' anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This randomized controlled trial contributes to the body of evidence about the effectiveness of complementary therapies in cancer, specifically the use of aromatherapy massage (AM). There have been complaints that the “evidence” about complementary therapies is weak or nonexistent. This gives little credence to providers who wish to use these therapies. This study gives strong evidence that in the short-term (two weeks after AM was completed) cancer patients who received AM had less anxiety than patients who did not receive AM. They did not have less depression or other symptoms (e.g., pain, fatigue, nausea and vomiting, global quality of life).

The study intervention was massage with essential oils delivered by massage therapists over 1 hour weekly for 4 weeks. Patients in the treatment group received at least one treatment. Patients in the control group received access to psychological support as part of their cancer care. Patients recruited to the study had been referred to complementary therapy services by a cancer health professional.

Of interest to hospital nurses is that in a pilot study of 57 patients receiving AM, patients showed significantly decreased average anxiety levels immediately after the treatment. This endpoint was not of interest to the researchers, but would be to hospital nurses. This means that immediately following a 1-hour massage with essential oils, patients had less anxiety – on average. No adverse effects from the AM were reported.

Julie's picks from the Feb 2010 literature

2010-03-03T08:55:00.000-08:00

Here are my picks from the recent literature on Nursing research and evidence based nursing. Staff at St. Joseph Hospital in Orange or CHOC may be able to access some of the full text via the library website. Staff may also request that Burlew Medical Library provide them with the full text.

1. Nursing pedagogy and the intergenerational discourse.(includesabstract); Earle V; Myrick F; Journal of Nursing Education, 2009 Nov; 48 (11): 624-30 (journal article) ISSN: 0148-4834 CINAHL AN: 2010467042

2. Smoking cessation interventions in cancer care: opportunities for oncology nurses and nurse scientists.(includes abstract); Cooley ME; Lundin R; Murray L; Annual Review of Nursing Research, 2009; 27:
243-72 (journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521100

3. Theories used in nursing research on smoking cessation.(includes abstract); O'Connell KA; Annual Review of Nursing Research, 2009; 27: 33-62 (journal article - research, systematic review, tables/charts)
ISSN: 0739-6686 CINAHL AN: 2010521092

4. Nurses' use of qualitative research approaches to investigate tobacco use and control.(includes abstract); Schultz ASH; Bottorff JL; McKeown SB; Annual Review of Nursing Research, 2009; 27: 115-44
(journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521095

5. Nursing interventions in tobacco-dependent patients with cardiovascular diseases.(includes abstract); Shishani K; Sohn M; Okada A; Froelicher ES; Annual Review of Nursing Research, 2009; 27: 221-42
(journal article) ISSN: 0739-6686 CINAHL AN: 2010521099

6. A review of research by nurses regarding tobacco dependence and mental health.(includes abstract); Sharp DL; Blaakman SW; Annual Review of Nursing Research, 2009; 27: 297-318 (journal article -
research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521102

7. Nursing research in tobacco use and special populations.(includes abstract); Browning KK; Baker CJ; McNally GA; Wewers ME; Annual Review of Nursing Research, 2009; 27: 319-42 (journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521103

8. Simulation-based learning in nurse education: systematic review.(includes abstract); Cant RP; Cooper SJ; Journal of Advanced Nursing, 2010 Jan; 66 (1): 3-15 (journal article - research, systematic review, tables/charts) ISSN: 0309-2402 CINAHL AN: 2010503799

9. Cultivating quality. Implementing surgical smoke evacuation in the operating room: a nurse-led initiative changes policy to provide health care workers and patients more protection.(includes abstract); Waddell
AWG; American Journal of Nursing, 2010 Jan; 110 (1): 54-8 (journal article - pictorial, review, tables/charts) ISSN: 0002-936X PMID: 20032670 CINAHL AN: 2010518193

10. Use of three evidence-based postoperative pain assessment practices by registered nurses.(includes abstract); Carlson CL; Pain Management Nursing, 2009 Dec; 10 (4): 174-87 (journal article - research,
tables/charts) ISSN: 1524-9042 PMID: 19944373 CINAHL AN: 2010508818

11. Music as a nursing intervention for postoperative pain: a systematic review.Engwall M; Duppils GS; Journal of PeriAnesthesia Nursing, 2009 Dec; 24 (6): 370-83 (journal article - research, systematic review,
tables/charts) ISSN: 1089-9472 PMID: 19962104 CINAHL AN: 2010513653

12. A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET).(includes abstract); Jones L; King L; Wilson C; Journal of Clinical Nursing, 2009 Dec; 18 (24): 3379-90
(journal article - research, systematic review, tables/charts, teaching materials) ISSN: 0962-1067 CINAHL AN: 2010472833

13. A collaborative protocol on oxytocin administration: bringing nurses, midwives and physicians together.Mandel D; Pirko C; Grant K; Kauffman T; Williams L; Schneider J; Nursing for Women's Health, 2009 Dec-2010 Jan; 13 (6): 480-5 (journal article - tables/charts) ISSN:
1751-4851 PMID: 20017777 CINAHL AN: 2010499698

14. Is nurse-managed blood glucose control in critical care as safe and effective as the traditional sliding scale method?(includes abstract); Adams G; Hunter J; Langley J; Intensive & Critical Care Nursing, 2009
Dec; 25 (6): 294-305 (journal article - research, systematic review, tables/charts) ISSN: 0964-3397 PMID: 19850481 CINAHL AN: 2010516840

15. Development and implementation of an oral care protocol for patients with cancer.(includes abstract); Sieracki RL; Voelz LM; Johannik TM; Kopaczewski DM; Hubert K; Steele-Moses SK; Clinical Journal of
Oncology Nursing, 2009 Dec; 13 (6): 718-22 (journal article - pictorial) ISSN: 1092-1095 PMID: 19948471 CINAHL AN: 2010497856

16. The effect on infected wound of topical silver and silver dressing: a view of evidence-based nursing PC6-37.Shiao C; Liu H; World Council of Enterostomal Therapists Journal, 2009 Oct-Dec; 29 (4): 29-30
(journal article - abstract, research, systematic review) ISSN: 0819-4610 CINAHL AN: 2010543560

17. Collaborating across services to advance evidence-based nursing practice.(includes abstract); Kenny DJ; Richard ML; Ceniceros X; Blaize K; Nursing Research, 2010 Jan-Feb; 59 (1): Supplement: S11-21 (journal article - tables/charts) ISSN: 0029-6562 PMID: 20010273 CINAHL AN:
2010518133

18. Design and validation of an instrument to measure nursing research culture: the Nursing Research Questionnaire (NRQ).(includes abstract); Corchon S; Watson R; Arantzamendi M; Saracíbar M; Journal of Clinical Nursing, 2010 Jan; 19 (1-2): 217-26 (journal article - research, tables/charts) ISSN: 0962-1067 CINAHL AN: 2010510245

19. The role of the CNS in achieving and maintaining Magnet® status.(includes abstract); Walker JA; Urden LD; Moody R; Journal of Nursing Administration, 2009 Dec; 39 (12): 515-23 (journal article -
research, tables/charts) ISSN: 0002-0443 PMID: 19955965 CINAHL AN: 2010503484

20. Registered nurses' application of evidence-based practice: a national survey.(includes abstract); Boström A; Ehrenberg A; Gustavsson JP; Wallin L; Journal of Evaluation in Clinical Practice, 2009 Dec; 15
(6): 1159-63 (journal article - research, tables/charts) ISSN: 1356-1294 CINAHL AN: 2010522845

21. Seeing through the clouds in evidence-based practice.(includes abstract); Russell-Babin K; Nursing Management, 2009 Nov; 40 (11): 26-33 (journal article - CEU, exam questions, pictorial, tables/charts)
ISSN: 0744-6314 PMID: 19901753 CINAHL AN: 2010497587

22. Evidence-based practice: step by step. The seven steps of evidence-based practice: following this progressive, sequential approach will lead to improved health care and patient outcomes.(includes abstract); Melnyk BM; Fineout-Overholt E; Stillwell SB; Williamson KM; American Journal of Nursing, 2010 Jan; 110 (1): 51-3 (journal article) ISSN: 0002-936X PMID: 20032669 CINAHL AN: 2010518192

23. Creating quality evidence summaries on a clinician's schedule.McGee S; Clark E; Journal of Nursing Administration, 2010 Jan; 40 (1): 7-9 (journal article - tables/charts) ISSN: 0002-0443 PMID: 20010371 CINAHL AN: 2010519062

H1N1 Vaccination Keeps You and Your Patients Safe

2010-02-24T08:16:00.000-08:00

Oncology nurses are aware of the need to prevent infection in neutrapenic patients. But what about preventing your own infections? Although the number of H1N1 cases in oncology nurses has not been measured, the illness poses a risk from two fronts: We may be seeing infected patients in our daily practice and we also run the risk of giving the virus to uninfected patients and co-workers.

Immunocompromised patients may not benefit from vaccination because they are not always able to mount an adequate immune response. thus preventing nurses from developing the infection and passing it along to those patients becomes a high priority. Unfortunately, limited sick leave, staffing issues and peer pressure may promote some nurses with mild symptoms to come to work, risking coworkers and patients.

According to the Centers for Disease Control and Prevention (CDC, 2009), nurses in any treatment setting should receive the vaccine. Although the Joint Commissions suggests optional vaccination with a provision to opt out for religious or medical reasons. However, attempting to force vaccination for hospital nurses has resulted in pending legal action. In 2009, less than half of hospital healthcare workers were vaccinated against the flu (CDC, 2009).

The CDC (2009) indicated that H1N1 treatment should not wait for laboratory confirmation. In addition, a negative rapid test does not rule out influenza. The antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza)can reduce the severity and duration of and complications from H1N1 and are recommended for individuals with suspected or confirmed influenza requiring hospitalization.

Centers for Disease Control and Prevention. (2009). Seasonal influenza vaccination
resources for healthcare professionals. Retrieved December 22, 2009, from http://www.cdc.gov/flu/professionals/vaccination/index.htm

Dark Chocolate is Good for the Heart!

2010-02-18T09:48:00.001-08:00

Do you have a box of Valentine chocolates that you aren't sure you should eat? Well if they are dark chocolate then you are in luck! According to a literature review published earlier this month on complimentary medicine in cardiology- dark chocolate is a champion for heart health.
(Posted: 02/05/2010; Pharmacotherapy. 2010;30(1):109 © 2010 Pharmacotherapy Publications).
The literature review shows strong evidence that dark chocolate can prevent cardiovascular disease by decreasing CRP (C reactive protien) levels which is associated with inflammation and coronary artery disease. It has also been found to dcrease platelet reactivity and in one study lowered LDL-C by 6% and raised HDL-C by 9% over only a week of daily dark chocolate consumption!
It can help mitigate the endothelial inflammatory effects of smoking as well.
In one study of 22 heart transplant patients - significant coronary vasodilitation, decreased platelet adhesion, and improved coronary vascular function was seen only 2 hours after consumption of a Nestle Intense(70% cocoa content) Bar. A study of 44 adults with prehypertension found that daily dark chocolate consumptionr reduced both systolic and diastolic blood pressures. It was also found to increase levels of S-nitrosoglutathione- a vasodilative nitric oxide.
While we know that dark chocolate has other health benefits- during Women's Heart Health month it is encouraging to see the evidence that a daily indulgence of dark chocolate is good for us! So enjoy your chocolate knowing that you are doing something good for your heart.

References:
Di Giuseppe R, Di Castelnuovo A, Centritto F, et al. Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population. J Nutr. 2008;138:1939–1945.
Allen RR, Carson L, Kwik-Uribe C, Evans EM, Erdman JW. Daily Consumption of a Dark Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol. J. Nutr. 2008;138:725–731.
Hamed MS, Gambert S, Bliden KP, et al. Dark Chocolate Effect on Platelet Activity, C-reactive Protein, and lipid profile: A pilot Study. South Med J 2008;12(101):1203–1208.
Hermann F, Spieker LE, Ruschitzka F, et al. Dark chocolate improves endothelial and platelet function. Heart 2006;92:119–120.
Flammer AJ, Hermann F, Sundano I, et al. Dark Chocolate Improves Coronary Vasomotion and Reduces Platelet Reactivity. Circulation. 2007;116:2376–2382.
Taubert D, Roesen R, Lehmann C, et al. Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide. A Randomized Controlled Trial. JAMA. 2007;298(1):49–60.

Cochrane News for 2010: podcasts, journal clubs and more!!

2010-02-01T13:37:00.000-08:00

The Cochrane Library Issue 1, 2010 – Now Published

January, 2010 Cochrane Reviews cover a diverse range of subjects and includes 98 new reviews and 139 updated reviews. Many studies are of special interest to nurses-- one in particular is Restricting oral fluid and food intake during labor

To highlight just a few other new studies, see:

Cervical Cancer: Combined Drug and Radiotherapy Improves Survival

NSAIDs May Be More Effective Than Paracetamol For Period Pain

Vitamin D Supplementation Can Reduce Falls In Nursing Care Facilities

Hypertension: Beta-Blockers Effective In Combination Therapies

Parkinson’s: Treadmill Training Improves Movement

HIV: Positive Lessons From Home-Based Care

Did you know that you can also listen to Cochrane podcasts? Also consider joining the Cochrane journal club. To access the full text of any Cochrane review, SJO/CHOC staff should access Cochrane on EBSCO through Burlew Medical Library's website.

New Abstract and Commentary

2010-01-27T09:44:00.000-08:00

Effectiveness of an Aspiration Risk-Reduction Protocol (Authors’ Abstract)

BACKGROUND: Aspiration of gastric contents is a serious problem in critically ill, mechanically ventilated patients receiving tube feedings.
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a three-pronged intervention to reduce aspiration risk in a group of critically ill, mechanically ventilated patients receiving tube feedings.
METHODS: A two-group quasi-experimental design was used to compare outcomes of a usual care group (December 2002-September 2004) with those of an Aspiration Risk-Reduction Protocol (ARRP) group (January 2007-April 2008). The incidence of aspiration and pneumonia was compared between the usual care group (n = 329) and the ARRP group (n = 145). The ARRP had three components: maintaining head-of-bed elevation at 30 degrees or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes.
RESULTS: Two of the three ARRP components were implemented successfully. Almost 90% of the ARRP group had mean head-of-bed elevations of 30 degrees or higher as compared to 38% in the usual care group. Almost three fourths of the ARRP group had feeding tubes placed in the small bowel as compared with less than 50% in the usual care group. Only three patients met the criteria for the high gastric residual volume algorithm. Aspiration was much lower in the ARRP group than that in the usual care group (39% vs. 88%, respectively). Similarly, pneumonia was much lower in the ARRP group than that in the usual care group (19% vs. 48%, respectively).
DISCUSSION: Findings from this study suggest that a combination of a head-of-bed position elevated to at least 30 degrees and use of a small-bowel feeding site can reduce the incidence of aspiration and aspiration-related pneumonia dramatically in critically ill, tube-fed patients.
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59, 18-25.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This fascinating study exemplifies excellent translational research. Translational research involves moving research findings into practice with a rigorous and systematic evaluation of adherence to the new practice and patient outcomes.
Description of elements in the care bundle being “tested” follow along with the rationale for the use of each practice.
1. Keeping patients who receive tube feedings in an elevated head-of-bed position (at least 30°); this practice has been found to decrease pneumonias caused by aspiration of tube feedings. The likelihood that patients are kept in the elevated positions has been found to increase when physician orders include this practice.
2. Feeding patients in the distal small bowel; this practice reduces the likelihood of gastroesophageal reflux, and the risk of microaspiration. Small bore feedings tubes can be placed in the distal small bowel by trained nurses.
3. Using an algorithmic approach to dealing with high gastric residual volumens (> 500 ml); this practice involves feeding disruptions, and can involve prokinetic drugs.
As can be seen from the results of the study, adherence to the bundle was good for elevated positioning and tube placement. Only 3 patients qualified for use of the algorithm for high residual volume; none received care based upon the algorithm. Thus, the findings show significantly improved patient outcomes given use of 2 of the 3 bundle elements. Nurses caring for critically ill, mechanically ventilated patients who receive tube feedings may want to consider use of the 2-factor bundle (HOB ↑ 30°; feeding tube placement in distal small bowel).

Find it Fast!! Video Tutorial series from Yale University on EBM

2010-01-27T09:01:00.000-08:00

Find it Fast! is a series of 10 video tutorials which highlights a variety of resources used in Evidence Based Medicine including The Cochrane Library, Clinical Evidence, Clinical Queries in Medline and more. In addititon, these video tutorials also cover issues such as "how to ask a clinical question" using the PICO framework. This video series is easy to understand and lends a valuable perspective on the basics of EBM. While specifically oriented to Medicine, much of the information applies equally well to Evidence Based Nursing. Thank you Harvey Cushing/John Hay Whitney Medical Library at Yale!!

Julie's picks for January from the nursing lit

2010-01-25T15:19:00.000-08:00

Here's one New Years resolution you can easily keep!! Catch our monthly picks from the EBN nursing literature! Staff at St. Joseph Hospital , Orange or Children's Hospital of Orange County may be able to access many of these articles through Burlew Medical Library's website or ask library staff to obtain the full text for them.

1. Thrombolysis administration by nurses: an evolving UK evidence

base?(includes abstract); Sloman M; Williamson GR; International Emergency Nursing, 2009 Oct; 17 (4): 193-202 (journal article - research, systematic review, tables/charts) ISSN: 1755-599X PMID: 19782332 CINAHL AN: 2010453128

2. Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting.(includes abstract); Estrada N; Worldviews on
Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 200-9 (journal article) ISSN: 1545-102X CINAHL AN: 2010504911

3. The latest evidence on the effectiveness of behavioral counseling interventions with adults.Melnyk BM; Worldviews on Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 250-4 (journal article)
ISSN: 1545-102X CINAHL AN: 2010504917

4. Factor V Leiden: impact on infusion nursing practice.(includes abstract); Weinstein SM; Journal of Infusion Nursing, 2009 Jul-Aug; 32 (4): 219-23 (journal article) ISSN: 1533-1458 PMID: 19606001 CINAHL AN: 2010352064

5. Sleep in adolescence: a review of issues for nursing practice.(includes abstract); Vallido T; Peters K; Brien L; Jackson D; Journal of Clinical Nursing, 2009 Jul; 18 (13): 1819-26 (journal article - research, systematic review) ISSN: 0962-1067 PMID: 19638045 CINAHL AN: 2010314625

6. Nursing resources and patient outcomes in intensive care: a systematic review of the literature.(includes abstract); West E; Mays N; Rafferty AM; Rowan K; Sanderson C; International Journal of Nursing
Studies, 2009 Jul; 46 (7): 993-1011 (journal article - research, systematic review, tables/charts) ISSN: 020-7489 PMID: 17964577 CINAHL AN: 2010351654

7. Evaluating central venous catheter care in a pediatric intensive care unit.(includes abstract); Hatler C; Buckwald L; Salas-Allison Z; Murphy-Taylor C; American Journal of Critical Care, 2009 Nov; 18 (6):
514-20 (journal article - research, tables/charts) ISSN: 1062-3264 PMID: 19880953 CINAHL AN: 2010464302

8. Hourly rounds: what does the evidence indicate? Halm MA; American Journal of Critical Care, 2009 Nov; 18 (6): 581-4 (journal article - research, systematic review, tables/charts) ISSN: 1062-3264 PMID:
19880960 CINAHL AN: 2010464309

9. Acute confusion/delirium.Sendelbach S; Guthrie PF; Schoenfelder DP; Journal of Gerontological Nursing, 2009 Nov; 35 (11): 11-8 (journal article - pictorial, review, tables/charts) ISSN: 0098-9134 PMID:
19904851 CINAHL AN: 2010471514

10. Lessons learned while conducting a clinical trial to facilitate evidence-based practice: the neophyte researcher experience.(includes abstract); Brim CB; Schoonover HD; Journal of Continuing Education in
Nursing, 2009 Aug; 40 (8): 380-4 (journal article) ISSN: 0022-0124 PMID: 19681576 CINAHL AN: 2010368156

11. Glycemic control in the hospital: how tight should it be?(includes abstract); Kessler C; Nursing, 2009 Nov; 39 (11): 38-44 (journal article - CEU, exam questions, pictorial, tables/charts) ISSN:
0360-4039 PMID: 19859000 CINAHL AN: 2010464169

12. Metasynthesis: a goldmine for evidence-based practice.(includes abstract); Beck CT; AORN Journal, 2009 Nov; 90 (5): 701-2, 705-10 (journal article - tables/charts) ISSN: 0001-2092 PMID: 19895928 CINAHL AN: 2010470525

13. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia.Hooper VD; Chard R; Clifford T; Fetzer S; Fossum S; Godden B; Martinez EA; Noble KA; O'Brien D; Odom-Forren J; et al.; Journal of PeriAnesthesia Nursing, 2009 Oct; 24 (5): 271-87
(journal article - algorithm, tables/charts) ISSN: 1089-9472 PMID: 19853810 CINAHL AN: 2010471997

14. Review summaries: evidence for nursing practice. Brief interventions for heavy alcohol users admitted to general hospital wards.Jayasekara R; Journal of Advanced Nursing, 2009 Dec; 65 (12): 2511-2 (journal
article - abstract) ISSN: 0309-2402 CINAHL AN: 2010502042

15. A review of cohort study design for cardiovascular nursing research.(includes abstract); Hood MN; Journal of Cardiovascular Nursing, 2009 Nov-Dec; 24 (6): E1-9 (journal article - abstract) ISSN:
0889-4655 PMID: 19858946 CINAHL AN: 2010464140

The best medical iphone apps for nurses and doctors

2010-01-25T15:00:00.000-08:00

Check out this great compilation of the best iPhone and iPod apps for nurses from go student nurse .

Also, see this categorized list of 55 apps for doctors and medical students brought to you by http://www.softwareadvice.com/medical/

Kresge Library at Scripps Clinic and Green Hospital has a wonderful, ongoing compilation of medical app links for Apple, Android, Palm, and Blackberry Devices. Also, just come across a post from Kevin Pho, MD who runs the popular medical blog KevinMD.com. This post opines "Why doctors should choose Google Android over the iPhone for medical apps"

How to help Haiti

2010-01-20T12:57:00.000-08:00

Normally I wouldn't post requests for donations, but under the circumstances this seems appropriate. "International Medical Corps is a global, humanitarian, nonprofit organization, founded by volunteer doctors and nurses and dedicated to saving lives and relieving suffering through relief and development programs. There are still thousands of patients seeking treatment of which approximately 80% are in need of surgery and are running out of time - especially with the tremendous aftershocks still devastating this country. The team is treating crush injuries, trauma, substantial wound care, shock and other critical cases with the few available supplies - And they're in it for the long haul. I would love your help spreading the word by blogging or tweeting about IMC's rescue efforts. We've put up a blogger friendly widget here on our site:
http://www.imcworldwide.org/haiti
With the widget it's really easy to let your readers know that donating $10 to help the people of Haiti is as simple as sending a text message of the word "haiti" to 85944. "

I also want to mention Doctors without Borders .
This article in the NY Daily News gives a comprehensive list of vetted donation organizations that have received high ratings from the American Institute of Philanthropy .

FYI-- I also came across this link from the American Psychological Association on "Managing your distress about the earthquake from afar"

Check out our new blog: Flat Maggie's Magnet Blog

2010-01-18T16:48:00.000-08:00

We have started a new blog at St. Joseph Hospital in Orange. Flat Maggie's St. Joseph Hospital (Orange) Blog details her adventures and learnings as she tours around our hospital and learns about our efforts toward Magnet re-designation. The concept of “Flat Maggie” is based on the concept of “Flat Stanley” which has been widely used in the education arena. Flat Stanley is meant to facilitate letter-writing by schoolchildren to each other as they document their adventures with Flat Stanley.

Julie's picks for Dec from the nursing lit

2010-01-13T10:07:00.000-08:00

Check out these recent nursing articles dealing with nursing research or EBN. Staff at St. Joseph Hospital in Orange/CHOC can access some of these articles through the library's website

1. Review summaries: evidence for nursing practice. The impact of
hospital visiting hours policies on paediatric and adult patients and
their visitors.Moola S; Xue Y; McArthur A; Journal of Advanced
Nursing, 2009 Nov; 65 (11): 2293-4 (journal article - abstract,
tables/charts) ISSN: 0309-2402 PMID: 19832749 CINAHL AN: 2010445839

2. Review of the evidence for treatment of children with Autism with
selective serotonin reuptake inhibitors [corrected] [published erratum
appears in J SPEC PEDIATR NURS 2009 Oct;14(4):301].(includes abstract);
West L; Brunssen SH; Waldrop J; Journal for Specialists in Pediatric
Nursing, 2009 Jul; 14 (3): 183-91 (journal article - research,
systematic review, tables/charts) ISSN: 1539-0136 PMID: 19614827 CINAHL
AN: 2010343341

3. One hospital's "peanutty" path to MAGNET designation.(includes
abstract); Bennett S; Raupers D; Hicks M; Schoener L; American Nurse
Today, 2009 Sep-Oct; 4 (8): 59-60 (journal article - tables/charts)
ISSN: 1930-5583 CINAHL AN: 2010447020

4. Teaching levels of evidence: the Santa project.Burton M;
Dilts-Skaggs MK; Journal of Nursing Administration, 2009 Oct; 39 (10):
412-4 (journal article - tables/charts) ISSN: 0002-0443 PMID: 19820522
CINAHL AN: 2010450326

5. Structured review: evaluating the effectiveness of nurse case
managers in improving health outcomes in three major chronic
diseases.(includes abstract); Sutherland D; Hayter M; Journal of
Clinical Nursing, 2009 Nov; 18 (21): 2978-92 (journal article -
research, systematic review, tables/charts) ISSN: 0962-1067 PMID:
19747197 CINAHL AN: 2010442812

6. Evidence-based guideline for suctioning the intubated neonate and
infant.(includes abstract); Gardner DL; Shirland L; Neonatal Network,
2009 Sep-Oct; 28 (5): 281-302 (journal article - practice guidelines,
research, systematic review, tables/charts) ISSN: 0730-0832 PMID:
19720593 CINAHL AN: 2010389820

7. Clinical practice guidelines: What are they? Where are they? How
good are they?Smith JR; Donze A; Neonatal Network, 2009 Sep-Oct; 28
(5): 343-50 (journal article - tables/charts) ISSN: 0730-0832 PMID:
19720600 CINAHL AN: 2010389825

8. Implementing a journal club in a palliative care setting: a link in
the chain of evidence-based practice.(includes abstract); O'Connor L;
Bennett P; Gardner A; Hawkins MT; Wellman D; Collegian, 2009; 16 (3):
147-52 (journal article - research, tables/charts) ISSN: 1322-7696
PMID: 19831148 CINAHL AN: 2010424123

9. Evidence-based practice. Accessing and deaccessing ports: where is
the evidence?Camp-Sorrell D; Steele-Moses SK; Clinical Journal of
Oncology Nursing, 2009 Oct; 13 (5): 587-90 (journal article -
pictorial, research, tables/charts) ISSN: 1092-1095 PMID: 19793716
CINAHL AN: 2010441057

10. A case study in evaluating infrastructure for EBP and selecting a
model.(includes abstract); Newhouse RP; Johnson K; Journal of Nursing
Administration, 2009 Oct; 39 (10): 409-11 (journal article - case
study, tables/charts) ISSN: 0002-0443 PMID: 19820521 CINAHL AN:
2010450325

11. Research education for clinical nurses: a pilot study to determine
research self-efficacy in critical care nurses.(includes abstract);
Swenson-Britt E; Reineck C; Journal of Continuing Education in
Nursing, 2009 Oct; 40 (10): 454-61 (journal article - research,
tables/charts) ISSN: 0022-0124 PMID: 19831327 CINAHL AN: 2010443034

Another article published out of St. Joseph Hospital, Orange with a nurse as lead author

2010-01-06T14:09:00.000-08:00

Congratulations to the following St. Joseph Hospital, Orange authors for their recent article entitled "One kidney transplant center's experience: linking process improvements and Medicare/Medcaid conditions of participation" in

Progress in Transplantation 19(4):326-332 2009 Dec.

Wendy Escobedo, RN, BSN, CCTN

Peter Hosseinpour, PharmD

Marlene Abe, RN, BS CPTC

J. Michael Cecka, PhD

Ervin P Ruzics, MD

Staff at St. Joseph Hospital, Orange/CHOC may access the full text of this article through the CINAHL database via the library's website.

Jean Watson's Theory

2009-12-21T10:28:00.000-08:00

Jean Watson Theory of Human Caring: Caritas Process Five
The following discussion of Caritas Process Five is from Jean Watson’s newest book: Nursing: The Philosophy and Science of Caring, 2008 edition, published by University of Colorado Press
Carative Factor 5: Promotion and Acceptance of the Expression of Positive and Negative Feelings has evolved into Caritas Process 5: Being Present to, and Supportive of, the Expression of Positive and Negative Feelings

This Caritas Process cannot be discussed without realizing how essential it is to the development of a trusting-caring-healing relationship. Acceptance of another’s feelings, when positive is easy. But, accept even the negative feelings, and a deep trust, an authentic relationship can develop. “When one is able to hold the tears or fears of another without being threatened or turning away, that is the act of healing and caring.” Although we think of positive emotions and negative emotions, there is no right or wrong to our feelings; they just are. Expression of strong emotions may be due to intellectual-emotional dissonance (incongruity or conflict). The Caritas Consciousness Nurse may be the only one to hear and see and accept the person behind the strong emotions that frequently accompany illness, encouraging the patient to release the feelings that were due to fear, anger, and confusion. It is precisely during this time that the nurse’s equanimity (evenness of mind, even under stress) may help them to regain control and stability. This deepens the authentic, caring relationship to enhance healing and become “healthogenic”.
View my guestbook

Podcast on Intro to EBN by Rebecca Kolb, RN, BSN, CEN

2009-12-14T10:04:00.000-08:00

Check out this excellent podcast by Rebecca R Kolb, RN, BSN, CEN which provides an introduction to Evidence Based Nursing including a succinct explanation of the Johns Hopkins Evidence-Based Practice Model .

Some viewers may need to download Quicktime in order to view this.

Commentary on Report on Nurses' Tobacco Cessation Behaviors

2009-12-09T15:20:00.000-08:00

Research Abstract with Commentary

Frequency of nurses’ smoking cessation interventions: Report from a
national survey

Linda Sarna, Stella A Bialous, Marjorie Wells, Jenny Kotlerman, Mary E Wewers and Erika S Froelicher. Journal of Clinical Nursing, 18, 2066–2077.

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control.
Design. Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate).
Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web.
Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy.
Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2,24).
Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions.
Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This timely article describes one in a series of studies done by Sarna and colleagues related to nurses’ roles in international tobacco control efforts. The assumption behind the sample selection (nurses employed at Magnet hospitals) is that this group of nurses may have better tobacco cessation practices compared to nurses at non-Magnet facilities. Specific findings were of interest to those of us at St. Joseph who have been involved in the tobacco cessation education of nurses here (nurses on all units were to have completed the 3-hour classes offered through Clinical Education).
 73% of nurses ask about tobacco use
 62% advise about the risks
 62% assess motivation to quit
 37% assist with patients’ cessation efforts
 19% arrange cessation strategies
 22% refer to resources
Some unpublished data from a year long hospital study of nurses who have taken the St. Joseph class (Matten, Morrison, Rutledge, Chen, Chung, & Wong, 2009) indicate that our class is enhancing these types of nurse behaviors (see table).

Nurses’ Perceptions of their Skills to Counsel Patients

Action* Pre 3 Months 6 months 12 months
(n = 98) (n = 39) (n = 38) (n = 34)
Ask 3.69 (1.1) 4.33 (0.8) 3.87 (1.0) 4.24 (0.7)
Advise 3.06 (1.2) 3.72 (1.0) 3.87 (1.1) 3.85 (0.9)
Assess 2.65 (1.0) 3.28 (1.0) 3.53 (1.2) 3.56 (0.8)
Assist 2.36 (1.2) 3.49 (.9) 3.35 (1.2) 3.59 (1.0)

*Response set: 1= poor; 5 = excellent

Julie's picks from the nursing literature: November

2009-11-25T07:54:00.001-08:00

Here are my picks from the recent articles dealing with evidence-based nursing or nursing research. Staff at St. Joseph Hospital in Orange, California and Children's Hospital of Orange County may be able to access the full text of these via the library's website.

1.
An information technology infrastructure to enable evidence-based nursing practice.(includes abstract); Pochciol JM; Warren JI; Nursing Administration Quarterly, 2009 Oct-Dec; 33 (4): 317-24 (journal article - tables/charts) ISSN: 0363-9568 PMID: 19893445 CINAHL AN: 2010435221

2. Nurse-led care was non-inferior to physician-directed care in
symptomatic moderate to severe obstructive sleep apnoea.Floyd JA;
Evidence-BasedNursing, 2009 Oct; 12 (4): 112 (journal article) ISSN:
1367-6539 PMID: 19779079 CINAHL AN: 2010450231

3. Why nursing has not embraced the clinician--scientist role.(includes
abstract); Mackay M; Nursing Philosophy, 2009 Oct; 10 (4): 287-96
(journal article - review) ISSN: 1466-7681 PMID: 19743972 CINAHL AN:
2010412979

4. The meaning of hope in nursing research: a meta-synthesis.(includes
abstract); Hammer K; Mogensen O; Hall EOC; Scandinavian Journal of
Caring Sciences, 2009 Sep; 23 (3): 549-57 (journal article - research,
systematic review, tables/charts) ISSN: 0283-9318 CINAHL AN:
2010378575

5. Evidence-based nursing. Research ambassadors: bringing findings to
the bedside.Larkin ME; Cierpial CL; Vanderboom T; Anspach K; Grealish
K; Ball S; Griffith CA; Nursing Management, 2009 Oct; 40 (10): 20-3
(journal article) ISSN: 0744-6314 CINAHL AN: 2010436208

6. Nurses' role in detecting deterioration in ward patients: systematic
literature review.(includes abstract); Odell M; Victor C; Oliver D;
Journal of Advanced Nursing, 2009 Oct; 65 (10): 1992-2006 (journal
article - research, systematic review, tables/charts) ISSN: 0309-2402
CINAHL AN: 2010413148

7. 28. The utilization of reflective journals to explore nurses' experience
using mobile information technology to access and use research
evidence.Newman K; Doran D; CIN: Computers, Informatics, Nursing, 2009
Sep-Oct; 27 (5): 336 (journal article - abstract, research) ISSN:
1538-2931 CINAHL AN: 2010425595

8. Nurse-led interventions to reduce cardiac risk factors in
adults.Harvey J; Loar R; Joanna Briggs Institute; Best Practice, 2009;
13 (5): 21-4 (journal article) ISSN: 1329-1874 CINAHL AN: 2010447069

9. Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S
model.Dicenso A; Bayley L; Haynes RB; Evidence-BasedNursing, 2009 Oct;
12 (4): 99-101 (journal article) ISSN: 1367-6539 PMID: 19779069 CINAHL
AN: 2010450221

10. Review: little evidence exists for type of dressing or support
surface or for nutritional supplements for pressure ulcers.Bell-Syer
SE; Evidence-BasedNursing, 2009 Oct; 12 (4): 118 (journal article)
ISSN: 1367-6539 PMID: 19779085 CINAHL AN: 2010450237

11. AACN announces new system to rate evidence. AACN Bold Voices, 2009
Sep; 1 (3): 14 (journal article - brief item, tables/charts) ISSN:
1948-7088 CINAHL AN: 2010402603

12. Core measures for developmentally supportive care in neonatal
intensive care units: theory, precedence and practice.(includes
abstract); Coughlin M; Gibbins S; Hoath S; Journal of Advanced
Nursing, 2009 Oct; 65 (10): 2239-48 (journal article - pictorial,
tables/charts) ISSN: 0309-2402 CINAHL AN: 2010413158

13. Searching for evidence: mission-critical tips.Boss C; Wurmser TA;
Nursing Management, 2009 Sep; 40 (9): 12, 14 (journal article) ISSN:
0744-6314 PMID: 19734750 CINAHL AN: 2010414304

14. Overturning barriers to pain relief in older adults.(includes
abstract); D'Arcy Y; Nursing, 2009 Oct; 39 (10): 32-9 (journal article
- CEU, exam questions, nursing interventions, pictorial, review,
tables/charts) ISSN: 0360-4039 CINAHL AN: 2010431004

julie's picks for October from the nursing lit

2009-11-09T10:22:00.001-08:00

Here are Julie's picks from the current nursing literature dealing with EBN or nursing research. Staff of SJH/CHOC may be able to access the full text of some of these articles via the library's website.

1. Evidence-based nursing. Using EBP flashcards for magnet
preparation.Bliss-Holtz J; Nursing Management, 2009 May; 40 (5): 13-4 (journal article) ISSN: 0744-6314 PMID: 19412075

2. Evidence-based nursing. Your role in hardwiring EBP strategies.Amato
S; Kerber K; Yurko L; Mion LC; Nursing Management, 2009 Jun; 40 (6):
13-5 (journal article - tables/charts) ISSN: 0744-6314 PMID: 19502922

3. Barriers to research utilization among registered nurses practicing
in a community hospital.(includes abstract); Schoonover H; Journal for
Nurses in Staff Development, 2009 Jul-Aug; 25 (4): 199-212 (journal
article - research, tables/charts) ISSN: 1098-7886 PMID: 19657252

4. The development and pilot testing of an instrument to measure
nurses' working environment: the Nursing Context Index.(includes
abstract); Slater P; McCormack B; Bunting B; Worldviews on
Evidence-BasedNursing, 2009 3rd Quarter; 6 (3): 173-82 (journal
article) ISSN: 1545-102X CINAHL AN: 2010402422

5. ICU nurses' oral-care practices and the current best
evidence.(includes abstract); Ganz FK; Fink NF; Raanan O; Asher M;
Bruttin M; Ben Nun M; Benbinishty J; Journal of Nursing Scholarship,
2009 2nd Quarter; 41 (2): 132-8 (journal article - research,
tables/charts) ISSN: 1527-6546 PMID: 19538697

6.
Upgrading the American Association of Critical-Care Nurses'
evidence-leveling hierarchy.(includes abstract); Armola RR; Bourgault
AM; Halm MA; Board RM; Bucher L; Harrington L; Heafey C; Lee RK;
Shellner PK; Medina J; 2008-2009 Evidence-BasedPractice Resource Work
Group of the American Association of Critical-Care Nurses; American
Journal of Critical Care, 2009 Sep; 18 (5): 405-9 (journal article -
tables/charts) ISSN: 1062-3264 PMID: 19723860

7. PERL of wisdom: a tool to help bedside nurses remember available
evidence-based resources... Print, Electronic, Resource Persons, and
Location.Pagani C; Jacalan-Baras J; Creative Nursing, 2009; 15 (2):
85-9 (journal article) ISSN: 1078-4535 PMID: 19507770 CINAHL AN:
2010276560

8. Clinical nurse educators' perceptions of research utilization:
barriers and facilitators to change.(includes abstract); Strickland RJ;
O'Leary-Kelley C; Journal for Nurses in Staff Development, 2009
Jul-Aug; 25 (4): 164-73 (journal article - CEU, exam questions,
research, tables/charts) ISSN: 1098-7886 PMID: 19657246

9. Evaluation of empathy measurement tools in nursing: systematic
review.(includes abstract); Yu J; Kirk M; Journal of Advanced Nursing,
2009 Sep; 65 (9): 1790-806 (journal article - research, systematic
review, tables/charts) ISSN: 0309-2402 PMID: 19694842

10. Promoting evidence-based dysphagia assessment and management by
nurses.(includes abstract); Sandhaus S; Zalon ML; Valenti D; Harrell F;
Journal of Gerontological Nursing, 2009 Jun; 35 (6): 20-7 (journal
article - cartoon, pictorial, research, tables/charts) ISSN: 0098-9134
PMID: 19537291

11. Teaching levels of evidence: the Santa project;Burton, M. Journal of Nursing Administration 2009 Oct;39(10): 412-414.

12. A Case study in evaluating infratructure for EBP and selecting a model;newhouse, R; Johnson, K. Journal of Nursing Administration 2009 Oct; 39(10): 409-11.

Intraoperative Radiation Therapy

2009-10-14T10:30:00.001-07:00

Intraoperative Radiation Therapy (IORT)

St. Joseph Hospital has pioneered a new technology that improves breast cancer outcomes, decreases the amount of post-operative radiation required, preserves healthy breast tissue and increases patient comfort.The hospital remains at the forefront of medical innovation with the introduction of Intraoperative Radiation Therapy (IORT), one of the most advanced forms of radiation therapy available in the United States.

IORT delivers highly targeted beams of radiation directly to a tumor site during surgery. In addition to improving patient outcomes, this direct application improves patient comfort by preserving healthy tissue surrounding the tumor and reducing the amount of radiation patients may need after surgery. For patients and their families, this means less stress and more time for healing.Intraoperative Radiation Therapy (IORT) delivers highly targeted beams of radiation during surgery. Studies show that radiating the tumor site in the breast immediately following tumor resection reduces the risk of the cancer returning.

As Orange County’s first hospital to offer this innovative treatment during breast surgery, Stacey Fischer, Breast Program Nurse Navigator, is also available to assist you and your patients should you have any questions concerning IORT or the Breast Program. She can be reached at (714) 734-6233.

Poster on our blog presented at the 2009 ANCC Magnet Conference

2009-10-09T07:56:00.000-07:00

Our blog, Nursing Research: Show me the Evidence! was presented as a poster at the 2009 ANCC Magnet Conference Oct 1-3 in Louisville, Kentucky. Dana Rutledge, RN, PhD presented the poster on behalf of Julie Smith, MLS, Library Manager. Be sure to check out our blog out at http://evidencebasednursing.blogspot.com/

Commentary on Survey of Public's Knowledge/Attitudes about Resuscitation

2009-10-07T15:40:00.000-07:00

Research Abstract with Commentary

Cardiopulmonary Resuscitation: Knowledge and Opinions Among the U.S. General Public.
State of the Science-Fiction

BACKGROUND AND OBJECTIVE: Cardiopulmonary resuscitation is undertaken more than 250,000 times annually in the United States. This study was undertaken to determine knowledge and opinions of the general public regarding cardiopulmonary resuscitation. DESIGN: Validated multisite community-based cross-sectional survey. OUTCOME MEASURES: Knowledge and opinions about resuscitative practices and outcomes, using hypothetical clinical scenarios and other social, spiritual, and environmental considerations. RESULTS: Among 1831 participants representing 38 states, markedly inaccurate perceptions of cardiac arrest were reported. Participants' mean estimate of predicted survival rate after cardiac arrest was 54% (median 50%, IQR 35-75%), and mean estimated duration of resuscitative efforts in the ED was 28min (median 15min; IQR 10-30). Projected age and health status were independent predictors of resuscitation preferences in a series of 4 hypothetical scenarios. Participants indicated that physicians should consider patient and family wishes as the most important factors when making resuscitation decisions. Participants considered advanced technology and physician communication to be the most important actions during attempted resuscitation. CONCLUSIONS: Inaccurate perceptions regarding resuscitation and survival rates exist among the lay public. Participants indicated strong preferences regarding resuscitation and advance directives.

Marco, C. A., & Larkin, G. L. (2008). Cardiopulmonary resuscitation: Knowledge and opinions among the U.S. general public. State of the science-fiction. Resuscitation, 79, 490-498.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This interesting study, published in 2008, features data collected in 2000. This is disappointing considering the factors that may have changed since 2000. The researchers surveyed people in airport and bus terminals, hospital waiting rooms, shopping malls, and college campuses in Pennsylvania and Ohio. The participants – while closely resembling the data from the U. S. census – may under-represent Hispanic persons, and over-represent older, single, and highly educated persons who are mobile.

It is interesting to note that respondents overestimated success rates for resuscitation results, and that 91% of them were willing to undergo CPR. However, smaller proportions would find the following procedures acceptable:
 74% chest compressions
 64% mouth-to-mouth breathing
 61% electrical shocks (defibrillation)
 54% intravenous medications
 42% artificial breathing on a respirator
 31% large intravenous lines in the neck or groin
This indicates understanding deficits as to what “resuscitation” actually involves!

Anyone interested in replicating the study with our patients and families? The survey used is published with the article, and is available in Spanish.

Vickie's Research Corner

2009-09-17T12:51:00.000-07:00

View my guestbookCan you believe it? Fall is here and the weather is changing. Things at St. Joseph are changing just like the seasons and the new buzz word is Evidence-Based Practice (EBP). As we continue in our journey as a Magnet organization, EBP is pushing its way into the practice of nurses throughout the hospital. Over the past year I have begun to introduce you to our new Clinical Nurse EBP Experts. These are Clinical Nurse III/IV nurses who took an intensive 4 day class to become more familiar with EBP and how this impacts their practice as well as yours. This issue I would like to introduce you to Rashna Thakur and Ellen Gruwell.
Rashna is Clinical Nurse III and works in the Pediatric Renal Center. She has been at this hospital since 1996. She became a Clin III 2 years ago. When asked why she wanted to become an EBP expert she responded that she had no clue what a Clinical Nurse EBP Expert initially was and was encouraged by Ann Marie Keefer-Lynch to apply for the program. Initially when taking the course she felt a rookie in the crowd because everyone else knew about EBP. After taking the course she realized that EBP was great. Knowledge was eye opening! She learned what EBP is and who does it. She now understands how to look for research and apply EBP at the bedside. Rashna feels much more aware of evidence and how we use it. She now makes changes in her practice based on evidence, not tradition.
Taking the class encouraged her to accomplish several goals. Now nurses are cross-training from primarily pediatrics to adults and she helped create the new policy based on EBP. She was able to take what she learned and put it into practice. Rashna was no longer the rookie in the crowd who didn’t understand EBP!
Our second Clinical Expert is Ellen Gruwell. She has been a nurse in the St. Joseph Health system since 1981. Initially she worked for St. Jude and then in 1987 came to SJH. Currently she works in Labor and Delivery as a Clinical Nurse III. Ellen felt that her masters program at California State University Fullerton and meeting Dana Rutledge made the biggest difference in her life for wanting to learn more about EBP and Research, so she decided to become a Clinical Expert.
For Ellen, she learned that there is a lot of buy in for EBP from nursing. It seems that since she has become an expert she is getting the “lingo” out there and the nurses are starting to change their practice and base their decisions on EBP. Her own practice has changed significantly because she is now more excited about potential research that can be done in Women’s Health Services. She feels nursing is a science and needs to be based in science!
She is now looking at car seats a late preterm infant safety when they go home. She is also interested in identifying how nurses cope in labor and delivery.
Both nurses were from very different areas but both were changed by the world of evidence-based practice and both are changing practice at the bedside!

Our Magnet Journey to Redesignation

2009-09-16T14:23:00.000-07:00

The Magnet Recognition Program is the nation’s highest honor for nursing and recognizes excellence in Leadership, Practice, and Patient Outcomes. This prestigious award is administered by the American Nurses Credentialing Center (ANCC), who provides individuals and organizations throughout the nursing profession with the resources they need to achieve practice excellence.

To achieve Magnet status, a hospital must demonstrate a culture of excellence in nursing care as well as sustain and demonstrate the 14 Forces of Magnetism in the practice of nursing. The facility must also foster a nursing environment that is exciting, supportive, and intellectually stimulating.

The Magnet Recognition program focuses on advancing 3 goals within each applicant designee:
* Promoting quality in a setting that supports professional practice
* Identifying excellence in the delivery of nursing services to patients
* Disseminating “best practices” in nursing services

The Next Generation of Magnet:
The 14 Forces of Magnetisms have been redesigned and integrated into The 5 Model Component. This allows for a more focused approach and decreased redundancy. With the 14 Forces as the foundation, the 5 Model Components will be the primary basis for achieving Magnet recognition.

St. Joseph Hospital's Journey continues as we move forward with our gathering of evidence. The Steering Committee and Magnet Ambassadors are currently in the process of accruing and submitting data in their respective component groups. This data will be reviewed and placed in the most appropriate area within the Magnet documents we will submit next year. More to come on our progress...

New article published by staff at St. Joseph Hospital, Orange

2009-09-16T11:39:00.000-07:00

Congratulations to Beth (Elizabeth) Winokur, RN, MSN, CEN and John Senteno, RN, MSN, CEN from St. Joseph Hospital in Orange, California on their recent publication in the September issue of Journal of Emergency Nursing.

Winokur EJ, Senteno JM. Guesting area: an alternative for boarding mental health patients seen in emergency departments. J Emerg Nurs. 2009Sep;35(5):429-33. Epub 2008 Oct 17. PubMed PMID: 19748023.

Staff at St. Joseph Hospital, Orange and Children's Hospital of Orange County can read the full text of this article through the link to Journal of Emergency Nursing on the library's website.

2009-09-04T10:18:00.000-07:00

The following article appeared in Working Nurse v. 90 Aug 24, 2009 on Nursing Research at St. Joseph's

By Beth Duggan
Have you ever wondered why a procedure is done a certain way? Or why a certain action is taken? If your answer is, “Because it’s always been done that way,” then you’d benefit from a little nursing research.
Not clear on what that is? Let Dana Rutledge, RN, Ph.D., facilitator of the Office of Nursing Research at St. Joseph, enlighten you.
“Nursing research involves multiple steps,” she said. “Thinking of the research question, reviewing the literature to see what else is known on the topic, developing a research plan, seeking approval from the institutional review board, collecting data, analyzing data, and disseminating the results through a written report or poster.”
According to Ms. Rutledge and her assistant, Vickie Morrison, RN, MSN, FNP, this kind of research is important because the results offer a chance to improve patient outcomes. And nurses who stay current about evidence in their area are more likely to use best evidence.A Culture of Inquiry
St. Joseph’s nursing research department started in June 2004 as the hospital began its journey toward magnet status. Lacking a Ph.D.-prepared nurse who could conduct the research, they brought in Ms. Rutledge, who is also a professor in the nursing department at California State University, Fullerton.
Through her facilitation and the work of Ms. Morrison, the research office has, according to the staff, “led to a culture of inquiry, and the desire to base nursing care practices on best evidence.” Inquiring nurses at St. Joseph have been performing both evidence-based practice changes and research, and some have even submitted abstracts to conferences for podium and poster presentations about projects that have been completed.
One such case was a group of nurses in the ambulatory post-anesthesia care unit. Their research found that patients were not fully prepared for their surgical experience, which led to changed materials sent to physicians’ offices and phone calls made to patients before their procedure to help them feel more prepared. The results were presented as a poster at a regional conference.
The two nurses say the biggest challenge in their work has been getting word out that there is a Nursing Research Office, so in 2007 they visited almost all the departments in the hospital that employ nurses to discuss what the Office of Nursing Research does and to find out what questions nurses have about their own practice.
The success of that initiative has bred more success for the office, which means juggling multiple projects at once.
“Right now we have two manuscripts to nursing journals that we submitted with study results, both of which require revisions,” said Ms. Morrison. “We have four newly approved studies that are in the beginning phases of data collection; we have two studies that are ready for data analysis; and the rest are all in the data collection phase. Then there are three groups of nurses who are in the preparation phases.”Evidence-based Blog
In March 2006, Julie Smith, MLS, AHIP, the medical librarian at St. Joseph, wanted to give a unique contribution and enhance the arena of EBP and nursing research. This led her to the Internet, where she developed a blog http://evidencebasednursing.blogspot.com dedicated to “bringing awareness to current nursing literature, conferences, resources and tutorials.”
The first team nursing blog dedicated to EBP and research, it is full of useful information such as how to read research articles, how to create a poster for dissemination, and new information on EBP. It also gives tips for searching on St. Joseph’s and Childrens Hospital Orange County’s research databases. To date the site has received approximately 71,000 hits, which averages to 102 daily and 3,060 each month.
“Evidence-based practice in nursing is constantly changing with new research and new evidence,” Ms. Rutledge said. “The most important significance for EBP is the fact that nurses are learning how to use evidence at the bedside to improve patient outcomes. EBP provides a solid foundation for nursing to change practice in a manner that is systematic and credible.”
Beth Duggan is the editor of Working Nurse.

Vitamin D- the new wonder drug??

2009-09-03T10:12:00.000-07:00

The September issue of The American Journal of Medicine (Volume 122, Issue 9) has an extensive review of the research on the benefits of Vitamin D. The article notes that over 1/2 of the world's population is Vitamin D deficient. We used to think that Vitamin D was only important for healthy bones but recent research has shown that Vitamin D affects our health in many other ways.
Vitamin D is important in bone health- one study showed that given 800iu/d of Vit D- persons aged 65-85 years of age had 1/3 reduced fracture risk.
Vitamin D is also needed for muscle development and function- one study has shown a 22% decrease in falls related to improved neuromuscular function with Vitamin D supplementation. Vitamin D is found to decrease muscle degeneration and increase reaction time and motor response which also decreases fall and therefore fracture risk.
Vitamin D has also been linked to chronic pain. Numerous studies have tied low levels of vitamin D to persistent musculoskeletal and neuropathic pain. Persons with chronic pain that has no obvious cause should be tested vitamin D deficiency.
Vitamin D is involved in the immune response and autoimmune diseases. Research has found a 40% lower risk of multiple sclerosis in women taking vitamin D supplements. Lupus and rheumatoid arthritis symptoms are more severe in those who are vitamin D deficient.
It seems that Vitamin D influences insulin sensitivity and beta cell function as well. Up to a 60% increase in insulin sensitivity was found in persons with greater than 30ng/ml serum vitamin D levels compared with those that have less than 10ng/ml. One study showed an 80% decreased risk of developing diabetes type 1 in children supplemented with 2000 iu/d of vitamin D in the first year of life. These children were followed for 20 years.
It appears that vitamin D is also involved in brain function. Older adults with low vitamin D levels performed worse on the mini mental status exam and showed more memory problems and depression than those with normal vitamin D levels. One large study found a correlation with depression severity and low vitamin D levels.
Some studies show a decrease in cancer risk and mortality associated with vitamin D. Vitamin D has been found to be antiproliferative, promote cell differentiation, and induce apoptosis, among other anti-cancer properties. Numerous studies have shown benefit in prevention and mortality in colorectal cancer, pharyngeal cancer and leukemia, as well as decreased breast cancer risk and decreased mortality from melanoma.
There is evidence that vitamin D has a role in cardiovascular health. Vitamin D is thought to influence the reticular activating system, vascular calcification, smooth muscle proliferation, and inflammation. Studies suggest that vitamin D deficency is an independent risk factor for myocardial infarction in men. Higher vitamin D levels are shown to decrease vascular calcification. Due to it's potent effect on vascular endothelial cells- vitamin D can lower blood pressure. It also seems to have a role in preventing cardiomyopathy- at least in hemodialysis patients.
All cause mortality is decreased by at least 7% in a meta-analysis of 18 randomized trials of vitamin D supplementation.
What do we do now?
Serum Vitamin D levels can by checked by ordering a 25(OH)D serum analysis. A result of 30ng/ml is considered normal although due to variations in laboratory results the current recommendation is to aim for 35-40ng/ml as an optimum level. Some suggest that all individuals be screened for vitamin D levels.
While we synthesize vitamin D from sun exposure- it is not recommended due to skin cancer risk and photoaging effects on the skin. Oral supplementation in the form of vitamin D3 is most effective. While dosage recommendations vary- from 200IU per day and up- it is safe to take larger doses- so1000-3000IU/d may be recommended in the near future.
Clearly there is overwhelming evidence that vitamin D deficiency is widespread and that suppplementation is inexpensive and highly beneficial. For more information refer to the original article and the 108 references that accompany it.

Cancer Research in Breast Cancer

2009-09-03T08:25:00.000-07:00

Cancer Research in Breast Cancer Patients

St. Joseph Hospital performs more clinical trials than any other community hospital in Orange County. And, continued advances in cancer care and prevention are the direct result of participation in clinical trials. National evidence from a wide range of studies suggests that cancer patients diagnosed and treated in a setting of multi-specialty care and clinical research may live longer and have a better quality of life.

As a participant in the NCI Community Cancer Centers Program (NCCCP) Pilot, The Center for Cancer Prevention and Treatment is committed to offering residents of Orange County, Southern California and beyond access to research-based cancer care. By expanding clinical trials and cancer care we hope to make it easier to receive high-quality cancer screening, prevention, treatment and palliative care services.

Clinical trials that are well designed and well executed are the best approach for eligible participants to:

Play an active role in their own health care.
Gain access to new research treatments before they are widely available.
Obtain expert medical care at leading health care facilities during the trial.
Help current and future cancer patients by contributing to medical research.

What are the different types of clinical trials?

Treatment trials test experimental treatments, new combinations of drugs or new
approaches to surgery or radiation therapy.

Prevention trials look for better ways to prevent disease in people who have never had the
disease or to prevent a disease from returning. These approaches may include medicines,
vaccines, vitamins, minerals or lifestyle changes.

Diagnostic trials are conducted to find better tests or procedures for diagnosing a particular
disease or condition.

Screening trials test the best way to detect certain diseases or health conditions.

Quality of Life trials (or Supportive Care trials) explore ways to improve comfort and the
quality of life for individuals with a chronic illness.

As the Nurse Navigator for the Breast Program, I am excited to announce that the Research department at the Center for Cancer Prevention and Treatment has recently opened the 9th and 10th clinical trial for breast cancer patients. It is part of my responsibility as the Nurse Navigator for the Breast Program to serve as a reliable source of information about available research trials. I also serve as a vital link for cancer research by demonstrating familiarity with available program-specific trials, the associated eligibility and exclusion criteria, and the informed consent content and process. I assist the Research Department with communication and coordination of required research information, as needed and provide routine updates on patient status with the managing physician and the Cancer Research Department.

The following are a list of the clinical trials we have available at this time:

NSABP B-40 (Neo-Adj): A Randomized Phase III Trial of Neoadjuvant Therapy in Patients with Palpable and Operable Breast Cancer Evaluating the Effect of Pathologic Complete Response.

NSABP B-41 (Neo-Adj): A Randomized Phase III Trial of Neoadjuvant Therapy for Patients with Palpable and Operable HER2-Positive Breast Cancer.

ACOSOG Z1031 (Stage II-III Neo-Adj): A Randomized Phase III Trial in Postmenopausal Women w/ Clinical Stage II and III Estrogen Receptor Positive Breast Cancer.

Dune Medical Devices (DCIS): Margin Probe, a Device for Intraoperative Assessment of Margin Status in Breast Conservation Surgery.

NSABP B-43 – (DCIS - NCCCP PRIORITY TRIAL):
A Phase III Clinical Trial Given Concurrently with Radiation Therapy and Radiation Therapy Alone for Women with HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy.

NSABP B-39 (Stage 0-II): A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) versus Partial Breast Irradiation (PBI) for Women with Stage 0, I, Or II Breast Cancer.

ECOG PACCT-1 (Adjuvant NCCCP PRIORITY TRIAL): Program for the Assessment of Clinical Cancer Tests (PACCT-1): Trial Assigning Individualized Options for Treatment.

Endurance Exercise (Stage 0-II): Effects of Endurance Exercise on Bio-behavioral Outcomes of Fatigue - A Pilot Study.

NSABP B-42 (Stage I-IIIA NCCCP PRIORITY TRIAL): A Clinical Trial to Determine the Efficacy of Five Years of Letrozole Compared to Placebo in Patients Completing Five Years of Hormonal Therapy Consisting of an Aromatase Inhibitor (AI) or Tamoxifen Followed by an AI in Prolonging Disease-Free Survival in Postmenopausal Women with Hormone Receptor Positive Breast Cancer.

NSABP B-46-I (Stage I-IIIB): A Phase III Clinical Trial Comparing the Combination of TC Plus Bevacizumab to TC Alone and to TAC for Women with Node-Positive or High-Risk Node-Negative, HER2-Negative Breast Cancer.

For more information about clinical trials for breast cancer, please contact Stacey Fischer, RN, BSN, OCN, Nurse Navigator for the Breast Program at (714)734-6233 or the Research Department at the Center for Cancer Prevention and Treatment at (714)734-6200.

Learning from research on the information behaviour of healthcare professionals: a review of the literature ...with a focus on emotion

2009-08-28T15:09:00.001-07:00

Just came across this fascinating article ( at least to me): Learning from research on the information behaviour of healthcare professionals: a review of the literature 2004- 2008 with a focus on emotion. Fourie, Ina. Health Information & Libraries JournalVolume 2009 26(3):171 - 186. This study is a very detailed analysis of the scant literature on the role that "emotion" plays in health provider's information seeking behavior. Emotion goes way beyond what we might initially think and extends to include nine identified themes. Just a few of these 9 identified themes include: "difficulty in identifying and expressing information needs and information behavior", "uncertainty and anxiety", the role that personality and coping skills play and the role that self confidance and attitude play. The author even offers a detailed table with a large number of suggestions as to how Library and Information Science(LIS) professionals might impact or ameliorate the information seeking barriers of "emotional issues". One quote that really resonated with me from MacIntosh-Murrray and Choo in their article "Information behavior in the context of improving patient safety" Journal of the American Society for Information Science and technology 2005 56:1332-1345 "...front line staff are task driven, coping with heavy workloads that limit their attention to and recognition of potential information needs and knowledge gaps" However, a surrogate in an information-related role, an "information/change agent"-may intervene successfully with staff ..." What do you all think? any innovative ways in which librarians can better play this role as an information surrogate?

Don't Miss our Annual EBP Conference, October 2

2009-08-26T17:00:00.000-07:00

Please join us for the St. Joseph Hospital 5th Annual Evidence-Based Practice Conference, “Evidence Based Approaches to Infection Prevention and Management” on Friday, October 2 from 8-4:30pm at St. Joseph Center, Orange, Ca. This 8-hour course will include various speakers from St. Joseph Hospital as well as from local healthcare agencies.

Topics will include: Influenza, HealthCare Associated Infections, Current Legislation, Biofilm, Community Trends in TB and others.
This annual conference has been one of our best attended classes of the year and will prove to be another interesting and educational event. Learn the latest and improve your clinical practice!
Registration is NOW available for St. Joseph Hospital Employees through our new on-line registration through CareNet.

For those interested from outside St. Joseph Hospital, please call the Clinical Education Department for further information about registration at (714) 771-8000, extension 17345. Cost for the entire day is $75.00. Space is limited and early registration is recommended.

Journal of Nursing Administration devotes current supplement to "Magnet"topics

2009-08-17T16:46:00.001-07:00

The July/August 2009 supplementary issue of Journal of Nursing Administration is devoted entirely to "The Evidence for
Magnet® Status". Articles that look especially interesting include: "Workplace Empowerment and Magnet Hospital Characteristics as Predictors of Patient Safety Climate" and "Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes". Employees of St. Joseph Hospital, Orange and CHOC may access the full text of the articles via the library's website. Others should contact the medical library at your institution.

New review regarding the benefits of Fish Oil!

2009-08-12T16:27:00.000-07:00

On August 3, 2009 the Journal of the American College of Cardiology published a paper reviewing the evidence of the benefits of fish oil or Omega-3 polyunsaturated fatty acids (PUFAs).

The findings support the use of fish oil for everyone- not just heart patients! The evidence supports that fish oil prevents as well as treats cardiovascular disease. Fish oil has been found to prevent heart failure as well as decrease hospitalization and death in both heart failure and post-MI patients. It has shown to reduce arrhythmias as primary and secondary prevention- particularly in atrial fibrillation (AF). Fish oil also helps to prevent atherosclerosis and there is data to suggest it helps in hyperlipidemia.

The optimal dose of fish oil- as measured by EPA/DHA is at least 500 mg per day for prevention and 800-1000mg per day for those with known heart disease. This can be accomplished with supplements or eating fatty fish such as salmon, tuna, mackerel, or sardines. Healthy persons would need 2 servings per week while heart patients would require 4 or 5 fish servings per week.

Further study is needed to determine optimal mix of EPA to DHA and mechanisms of action in arrhythmias, atherosclerosis and primary myocardial disease. The abstract of the paper is free at http://content.onlinejacc.org/cgi/content/abstract/54/7/585 and a synopsis of the article is available at the heart.org then go to heartwire( you must sign in for a free membership) to access the article dated 8/10/09.

Research Abstract and Commentary: Topical Opioids

2009-08-12T08:49:00.000-07:00

Effectiveness of Topical Administration of Opioids in Palliative Care: A Systematic Review [Authors' Abstract].
The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. This systematic review aimed to assess the quality of published literature and to examine whether topical opioids are effective in controlling pain in palliative care settings. After a systematic literature review, 19 studies (six randomized controlled trials [RCTs] and 13 case reports) met the inclusion criteria for the review. Eighteen studies favored topical opioids in pain relief, as evidenced by reductions in post-treatment pain scores, but time to onset and duration of analgesia varied widely. Because of the heterogeneity of the studies, meta-analysis was not possible. Despite clear clinical benefits described in small RCTs, there is a deficiency of higher-quality evidence on the role of topical opioids, and more robust primary studies are required to inform practice recommendations. N-of-1 trials should be encouraged for specific clinical circumstances.

LeBon, B., Zeppetella, G., & Higginson, I. J. (2009). Effectiveness of topical administration of opioids in palliative care: a systematic review. Journal of Pain & Symptom Management, 37, 913-7.

Commentary by Dana Rutledge

The clinical problem of painful skin and mucosal lesions is a challenge in all settings, but particularly in palliative care where systemic opioids may not be sufficient for pain relief or where patients may resist systemic opioids due to unfavorable side effects. This systematic review used the Centre for Evidence-Based Medicine methods, and was done appropriately, although the last search for primary studies was done in August 2006 and the publication date is May 2009 (a long window of time for newer studies to have been published).
Findings showed that topical opioids were used for both malignant and nonmalignant wounds as well as oropharyngeal mucositis. Applications for skin wounds were 1-6 times daily and every 2-3 hours for mouthwashes. Opioids were administered in a variety of carriers (e.g.., hydrogel). The primary finding was pain relief following use of topical opioids. Secondary findings indicated that 0.1% diamorphine (heroin) led to pain relief in one hour with duration between 24 and 48 hours, while topical morphine relieved pain immediately to 60 minutes after administration and lasted 2 to 45 hours in ulcers and one to four hours in mucositis.
Scarce reports were found related to adverse effects. Primarily reported were local effects such as itching, burning, and discomfort. Possible administration problems existed with exudates and possible tolerance with prolonged usage.
Due to the intrinsic difficulties with studies in palliative care patients (heterogeneity, low recruitment, high drop out rates), the authors recommended N of 1 trials. In N of 1 trials, a single subject receives a treatment or placebo in a randomly assigned order; data are collected on outcomes to determine effect in this one patient. For example, a palliative care patient with a wound might be set up to receive 6 days of treatment (3 days of a topical opioid/3 days of placebo; order determined in a random manner) with pain monitored carefully for severity, onset of pain relief, adverse effects etc.

New Cochrane study: Reducing blood pressure below 140/90 brings no clinical benefit

2009-08-03T08:45:00.000-07:00

Cochrane reviews are considered by most to be the Gold standard in evidence based medicine. This resource is updated every three months and now has nearly 20,000 voluntary reviewers. As such, the Cochrane systematic reviews have a well deserved global reputation. One of the newest reviews that is getting a lot of press is Treatment blood pressure targets for hypertension. This study is particularly important as so many guidelines are recommending even lower blood pressure targets. The summary in this review states: "Main results No trials comparing different systolic BP targets were found. Seven trials (22,089 subjects) comparing different diastolic BP targets were included. Despite a -4/-3 mmHg greater achieved reduction in systolic/diastolic BP, p<>Authors' conclusions .Treating patients to lower than standard BP targets, ≤140-160/90-100 mmHg, does not reduce mortality or morbidity. Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients. "

SJO/CHOC library users can access the full Cochrane report through the library's web site: http://www.burlewmedicallibrary.org

compilation of 90+ videos on technology and media literacy

2009-07-24T10:14:00.001-07:00

I have just come across a very cool podcast site which has made an excellent compilation of videos ( mostly youtube) available to anyone as education tools on the topics of technology and media literacy. More than 90 links to videos are freely available and would be excellent additions to education presentations. Kudos to Dr. Alec Couros, a professor of educational technology and media at the Faculty of Education, University of Regina who created EdTech Posse .

Clinical Narratives

2009-07-22T16:54:00.000-07:00

Clinical Narratives are nurse stories of caring. At St. Joseph Hospital, clinical narratives are submitted to the Clinical Development Council as part of the Clinical Advancement process to move up the ladder from Clinical Nurse II to Clinical Nurse III (CN III) or Clinical Nurse IV (CN IV). As each proficient (CN III) and expert (CN IV) comes before the Clinical Development Council for advancement, they read their narrative aloud and have an opportunity to answer questions. The richness of their stories are shared.
The clinical narratives are also written by New Grads during the New Grad program. These narratives are submitted to the Clinical Development Council anonymously, and as we read them, we identify themes. The themes help to define nursing practice at St. Joseph Hospital. Over the years, the themes identified have opened up dialog and changes in our practice.
The Clinical Nurse IIs (CN II) are asked to write narratives during the months of July and August. The majority of RN’s at St. Joseph Hospital are CN IIs, but we tend to get fewer narratives from the CN IIs. In an attempt to encourage the CN IIs to write their stories, we are trying something new: Clinical Narrative Mentoring sessions. We are hoping that offering encouragement and 1:1 writing assistance will help to bring forth more nurse stories to share. I suppose the motivation to write a narrative is less for the CN IIs than the rest of the nurses, and as a consequence, we are missing hearing the voice of the majority of our wonderful nurses.

AHRQ Evidence-Based Practice Update

2009-07-22T08:12:00.000-07:00

The U.S. Preventive Services Task Force, which is part of the Agency for Healthcare Research and Quality, recently posted a report entitled : The U.S. Preventive Services Task Force : An Evidence-Based Prevention Resource for Nurse Practitioners.
According to the abstract "Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services.
Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.
Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.
Implications for Practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.
Keywords: Advanced practice nurse (APN); primary care; prevention, clinical practice guidelines; evidence-based practice.Purpose: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services.
Sources: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984.
Conclusions: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs.
Implications for Practice: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services."

Trinite T, Loveland-Cherry C, Marion L. U.S. Preventive Services Task Force: An Evidence-based Prevention Resource for Nurse Practitioners. Originally published in Journal of the American Academy of Nurse Practitioners 21(2009):301-306. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf09/epbnursep/epbnursep.htm

Survivorship Education for Quality Cancer Care

2009-07-20T10:31:00.000-07:00

Survivorship Education for Quality Cancer Care
News Release for Participants of SEQCC
Disseminating Survivorship Education to Cancer Settings

Interdisciplinary teams of physicians, nurses, social workers, and other health professionals such as psychologists, radiation technologists, chaplains, and administrators are involved in the multitude of treatment options for cancer patients during the course of their illness. These professionals however are inadequately prepared to meet the follow up needs of cancer survivors.

I recently attended a comprehensive three-day course for interdisciplinary teams from cancer settings on survivorship care. The City of Hope (COH) Comprehensive Cancer Ceneter received a 5-year grant from the National Cancer Institute to conduct this course. The project is led by Marcia Grant, RN, DNSc, FAAN, principal investigator, Betty Ferrell, RN, PhD, FAAN, and Smita Bhatia, MD co-investigators, and Denise Economu, RN, MN, CNS, project director.

I was one of over 2-person teams from 53 institutions competitively selected from cancer settings across the United States to attend this course. The prinicipal goal of the course is to provide interdisciplinary teams with information on survivorship care issues and resources to implement goals aimed at improving survivorship care in their cancer institutions.

The course was conducted by a distinguised faculty of researchers, educators, authors, and leaders in the field of survivorship care. Topic areas targeted the recommendations from the 2006 Institute of Medicine report, "From Cancer Patient to Cancer Survivor-Lost in Transition." State of the Science lectures addressed quality of life decisions and identified areas of need for survivorship care as well as issues related to insurance coverage, developing survivorhsip clinics and quality care issues. Additional questions or information about future courses can be directed to deconomou@coh.org.

Robert Wood Johnson Foundation, Institute of Medicine Launch Unprecedented Initiative on the Future of Nursing in America

2009-07-14T14:24:00.001-07:00

Robert Wood Johnson Foundation, Institute of Medicine Launch Unprecedented Initiative on the Future of Nursing in America

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3 new search engines compared:Wolfram/Alpha, Bing and Google Squared

2009-07-06T14:54:00.000-07:00

Kudos to the Disrupted Library Technology Jester for doing an excellent comparison of 3 new search engines: Wolfram/Alpha, Microsoft's new Bing and Google squared

Bing is the most like existing search engines whereas the other two search engines are
geared to "fact retrieval". I'm sure you've all seen a lot about these new search engines in
the media but this review is particularly well written and easy to follow.

Check it out!!

Top 50 Nurse Practitioner blogs; we're represented!

2009-07-02T07:59:00.000-07:00

Kudos to the Online Nurse Practitioner Schools site for pulling together an excellent list of the top 50 Nurse Practitioner blogs. Besides seeing our own blog listed, I have learned of several blogs that I'd like to follow including Running a hospital a blog by Paul Levy who is President and CEO of Beth Israel Deaconess Medical Center in Boston .

H.R. 2824 bill on federal support for comparative effective research

2009-06-24T09:07:00.000-07:00

Nursing should be aware of the current Federal Bill H.R. 2824 in support of federally funded comparative effectiveness research. A recent NY Times article gives a good description of this. This potentially has a lot of implications for nursing research.

Say hello to our new blog team

2009-06-17T12:32:00.001-07:00

Say hello to our new nursing research blog team!! From left to right are: Kathy Dureault, Stacey Fischer, Victoria Morrison, Dana Rutledge, Vivian Norman and Julie Smith. Not pictured is Theresa Ullrich. We are looking forward to active participation and lots of new blogging from our new team members.

Smoking and Alcohol Intervention before Surgery: Evidence for Best Practice

2009-06-10T14:33:00.000-07:00

Research Abstract and Commentary

Smoking and hazardous drinking are common and important risk factors for an increased rate of complications after surgery. The underlying pathophysiological mechanisms include organic dysfunctions that can recover with abstinence. Abstinence starting 3–8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections. However, this intervention must be intensive to obtain sufficient effect on surgical complications. All patients presenting for surgery should be questioned regarding smoking and hazardous drinking, and interventions appropriate for the surgical setting applied.

Tonnesen, H., Nielsen, P. R., Lauritzen, J. B., & Moller, A. M. (2009). Smoking and alcohol intervention before surgery: Evidence for best practice. British Journal of Anaesthesia, 102, 297-306.

Commentary by Dana Rutledge, RN, PhD

In this article, Tonnesen and colleagues systematically reviewed literature on the effects of smoking on postoperative pulmonary and wound complications and the effect of hazardous drinking (2-3 drinks/day) on postoperative morbidity. Their review used a research or review method called meta-analysis, whereby reviewers analyze results from individual studies in order to integrate or synthesize results as a whole. Figure 1 below shows their findings regarding the complications found associated with smoking and alcohol for all types of surgeries, in all settings.

The authors then reviewed literature on the effects of preoperative interventions (smoking/alcohol cessation) to evaluate effects on postoperative outcomes. They found that smoking interventions are most likely to enhance wound healing and pulmonary complications, and that they could not state what the “optimal” length or duration of smoking cessation necessary to guarantee success. However, Tonnesen and colleagues found that even short-term interventions led to positive results (on average).

Alcohol cessation interventions are less clear in terms of effect since alcohol use is often not defined similarly across studies, and interventions differ. However, based upon the studies reviewed, Tonnesen et al. support interventions that lead to even short-term abstinence because liver and other organ dysfunction improves after 1-2 weeks of alcohol abstinence.

Based upon these findings and the fact that about 80% of pre-operative patients want help in changing their lifestyle prior to surgery, Tonnasen et al. recommend the following:
• Patients should be screened pre operatively for tobacco and alcohol use in order to determine whether they are daily or non-daily smokers and hazardous (> 2-3 drinks daily) or non hazardous drinkers. This identifies high- and low-risk patients.
• Interventions should be carried out between the referral date for surgery and the date of the operation.
• For both smokers and hazardous drinkers, weekly individual counseling enhances preoperative cessation. Smoking cessation programs from 3-8 weeks may be successful and must include personalized nicotine substitution schedules, diaries of tobacco consumption, advice on smoking cessation, benefits and side-effects, how to manage withdrawal symptoms and weight management strategies. Length of alcohol cessation programs varies but should include personalized alcohol withdrawal symptom treatment, supportive medications, diaries of alcohol intake, advice about alcohol cessation, benefits and side-effects, and management of withdrawal symptoms.

This article documents systematic development of evidence-based recommendations about preoperative care of patients. Nurses at St. Joseph who counsel patients undergoing surgeries should be aware of these recommendations, and help their patients seek smoking and alcohol cessation programs to assist them in preparing for surgery.

Figure 1. Postoperative complications associated with smoking and alcohol use
Postoperative complications attributed to smoking
• Impaired wound and tissue healing
• Wound infection
• Cardiopulmonary complications
Postoperative complications attributed to alcohol
• Postoperative infections
• Cardiopulmonary complications
• Bleeding episodes

Our nursing research blog receives recognition!!

2009-06-02T13:30:00.001-07:00

I'm just writing to let you know that Nursing Research: Show me the evidence! has been named to our list of our top 50 nursing blogs here at ONDG. I thought you and your readers might want to check out the rest of the list. Let me know if you have any feedback, or feel free to leave a comment on the blog post. -- http://onlinenursingdegreeguide.org/2009/top-50-nursing-blogs/

Thanks Online Nursing Degree Guide for the recognition. It's also nice to see the variety of other nursing blogs being recognized.

Article published in Cancer Nursing by St. Joseph Hospital of Orange Authors

2009-05-18T10:20:00.000-07:00

Congratulations to our nurse authors at St. Joseph Hospital of Orange for their newly published article currently listed in the "advance of publication" section of Cancer Nursing. St. Joseph Hospital of Orange and CHOC staff may access this article via our library's "A-Z list of online journals" on our library web site.

Cancer Nurs. 2009 May 13. [Epub ahead of print]
Secondary Traumatic Stress in Oncology Staff.

Quinal L, Harford S, Rutledge DN.

Authors' Affiliations: St. Joseph Hospital, Orange, California (Mss Quinal and Harford and Dr Rutledge); and California State University, Fullerton (Dr Rutledge). The authors can be reached at the following emails: Leonida.Quinal@stjoe.org , Stephanie.Harford@stjoe.org, Dana.Rutledge@stjoe.org

As empathetic caregivers, oncology staff may be prone to secondary traumatic stress (STS). Secondary traumatic stress results from exposure to persons who have experienced trauma and from giving care to such persons. The presence of STS among oncology staff has not been documented. This correlational descriptive study examined STS among oncology staff at a 500-bed Magnet-designated community hospital by determining the presence of individual symptoms and frequency with which diagnostic criteria for STS are met. Also determined were associations between STS demographic characteristics and specific stress-reduction activities.In this study, 43 staff members from an inpatient oncology unit completed mailed surveys. The Secondary Traumatic Stress Scale assessed the frequency of intrusion, avoidance, and arousal symptoms associated with STS; also assessed were use/helpfulness of stress-reduction activities. In this first study to document the prevalence of STS among oncology staff, prevalence ranged from 16% (Bride's method) to 37% (cutoff-score method). Most common symptoms were difficulty sleeping, intrusive thoughts about patients, and irritability. Least common were avoidance of people, places, and things and disturbing dreams about patients. Current use of massage was significantly predictive of not having STS. Ethnicity of staff member was related to having STS. Further research is warranted evaluating STS prevalence in different groups of oncology staff along with the effect of STS on burnout and job retention.
PMID: 19444086 [PubMed - as supplied by publisher]

Vickie's Research Corner

2009-05-14T16:27:00.000-07:00

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Welcome to Vickie’s Research Corner. Spring is here and just like the flowers blooming so are our new group of Evidence-Based Practice Clinical Experts. In 2005-2006, nurses here at St. Joseph Hospital were interviewed and reported that when a clinical question arises they go to nurses at the highest level of the clinical ladder- Clinical Nurse III/IVs. Dr. Dana Rutledge then reviewed education for Clin III/IVs here at SJH and determined that the majority have had not had training in evidence-based practice (EBP). This then raises the question; if staff are asking Clin III/IVs questions could they (Clin III/IVs) be empowered to appropriately use and facilitate others to use EBP, then is it more likely that EBP is enhanced, are nurses more likely to seek evidence beyond that known by their peers?
Dr. Rutledge, with Katie Skelton’s approval and support, designed a two year study to answer these very questions. Starting in May, 2008, Clin III/IVs were encouraged to apply for a seat in the Clinical Nurse Experts in EBP curriculum. Eleven applicants were selected (via blind peer review). Starting in July they attended a four day didactic class (24 hours) extending over a two week period on multiple aspects of EBP, research, and literature search using library resources. During the course of their training they were asked to fill out questionnaires periodically, attend Nursing Research Council meetings, and attend quarterly meetings to discuss goals and projects. At the end of the two years, Dr. Rutledge will analyze the data she has collected and see if this format for increasing EBP to the bedside is working. This is such an exciting project! We are now currently in the process of getting ready for the second group to attend classes starting in July.
Now I would like to introduce you to two of our Clinical Nurse Experts- Christine Marshall and Wendy Escobedo and discuss their experience in this role:
Christine Marshall has been an RN at SJH for 14 years. She currently works in the Emergency Room as a Clin IV. She became a Clin III when the project was started and has since advanced to a Clin IV. She became interested in becoming a Clinical Nurse Expert when she realized Dana Rutledge would teach the class. She was very inspired by her and thought that having her as a teacher at some point in her life would be so much fun. Since she already had an MSN learning more about EBP made sense. For Christine the class taught her the power of EBP for teaching. She has also learned that this role has gained her the title of facilitator for projects within her own unit. Recently she performed an entire literature search on jaundice products for some colleagues and was the expert for the evidence!
Our second Expert is Wendy Escobedo. Wendy currently works as the Inpatient Care Coordinator for the kidney transplant program; she has been at SJH for 7 years, started here as a new graduate, and has been a Clin IV for 1 year. She decided to become a Clinical Nurse Expert because she wanted to make sure that what she was teaching to nurses and patients was EBP based. For Wendy, this class has really changed her practice. She has performed literature searches, developed teaching protocols, and standards of practice, and just sent in a manuscript for review. For Wendy her main goal as an Expert is to empower nurses to ask questions related to EBP and promote practice change as well as make sure her patients are more educated.
Both Clinical Experts are very interested in performing more research and both have ideas for the future. They both feel this class pushed them more into the world of EBP with a better understanding. Each feels that this class gave them the tools to both effectively and confidently teach both patients and nurses as well as empower nurses to ask that most important question- are we making the right choices and are those choices evidence-based in nursing?