Julie's picks from the Nursing Literature Nov 2006

Happy Holidays!! These current nursing articles with an evidence-based approach really caught my eye. SJH/CHOC employees can access these article through Burlew Medical Library.
Bedard D. Purden MA. Sauve-Larose N. Certosini C. Schein C. The pain experience of post surgical patients following the implementation of an evidence-based approach. [Journal Article, Research, Tables/Charts] Pain Management Nursing. 2006 Sep; 7(3): 80-92. (34 ref)

McKnight M. The information seeking of on-duty critical care nurses: evidence from participant observation and in-context interviews. [Journal Article, Research, Tables/Charts] Journal of the Medical Library Association. 2006 Apr; 94(2): 145-51.

Drenning C. Using the best evidence to change practice. Collaboration among nurses, advanced practice nurses, and nurse researchers to achieve evidence-based practice change. [Journal Article] Journal of Nursing Care Quality. 2006 Oct-Dec; 21(4): 298-301. (17 ref) Burlew carries this journal

Jackson R. Ameratunga S. Broad J. Connor J. Lethaby A. Robb G. Wells S. Glasziou P. Heneghan C. EBN notebook. The GATE frame: critical appraisal with pictures. Evidence-Based Nursing. 2006 Jul; 9(3): 68-71. (7 ref)

Oermann MH. Floyd JA. Galvin EA. Roop JC. Brief reports for disseminating systematic reviews to nurses. Clinical Nurse Specialist. 2006 Sep-Oct; 20(5): 233-40. (33 ref)

Gobel BH. Beck SL. O'Leary C. Nursing-sensitive patient outcomes: the development of the Putting Evidence Into Practice resources for nursing practice. Clinical Journal of Oncology Nursing. 2006 Oct; 10(5): 621-4, 641-3. (9 ref

Galligan M. Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN: The American Journal of Maternal/Child Nursing. 2006 Sep-Oct; 31(5): 298-306. (29 ref) Burlew carries this journal

Lake ET. Cheung RB. Are patient falls and pressure ulcers sensitive to nurse staffing? Western Journal of Nursing Research. 2006 Oct; 28(6): 654-77. (39 ref) Burlew carries this journal

Delmas L. Best practice in the assessment and management of diabetic foot ulcers. Rehabilitation Nursing. 2006 Nov-Dec; 31(6): 228-34. (55 ref) Burlew carries this journal

Helberg D. Mertens E. Halfens RJG. Dassen T. Treatment of pressure ulcers: results of a study comparing evidence and practice. Ostomy/Wound Management. 2006 Aug; 52(8): 60-3, 66, 68 passim. (25 ref) Burlew carries this journal

Resarch Study and Commentary by Dana Rutledge, Phd, RN, Nursing Research Facilitator

RESEARCH STUDY AND COMMENTARY

Schulman-Green, D. et al. (2005). Unlicensed staff members’ experiences with patients’ pain on an inpatient oncology unit. Implications for redesigning the care delivery system. Cancer Nursing, 28, 340-347. Staff at SJO/CHOC can access the full text of this article through the library's web site.

Authors’ Abstract

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice sitaut9on, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses’ aides, and housekeepers (n = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationship with patients, interpreting patients’ pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients’ pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain an expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

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

In this qualitative study, researchers described results of focus groups of unlicensed hospital staff who were asked about experiences with patient and pain. Nurses might be surprised at some of the important ways these staff perceive that they impact pain and its management. Patient care assistants (14, the largest group of staff) noted that they were assessing pain using the 0 – 10 score at the time they did vital signs. They reported having difficulty identifying the nature of pain when patients found the 0-10 scale confusing or difficult to respond to. Is this a problem that could occur at St. Joseph?

Those interviewed mentioned their roles in assisting in patient comfort by giving emotional and physical care. Some use nonpharmacologic pain management techniques such as distraction or listening. These staff members consider comfort care important to their roles. Most unlicensed staff reported communicating patient pain to nursing staff, and consider this one of their most important roles.

As with nurses, unlicensed staff identified challenges to dealing with patients’ pain. One was their overall heavy workloads, which interfered when they wanted to spend time with patients in pain. They emphasized the importance of teamwork, individualizing care, and empathy in caring for their patients.

In the discussion of their results, Schulman-Green and colleagues suggest that care redesign that enhances PCA-nurse relationships, expands training for unlicensed staff, and debriefing at intervals would improve pain management for patients in pain. What do you think?

St. Joseph Hospital PACU Nurses Win Poster Presentation Award

Tracy Dickman, RN, BSN, Clinical Nurse II, Pavilion PACU, Darlene Soriano, BS, MHA, Surgery Support Specialist, Pavilion, OR, and Dana Rutledge, RN, PhD, Nursing Research Facilitator, won first prize among 14 other presentations for a nursing research poster at the recent Joint Southern California STTI Chapters Odyssey 2006 Conference.

This prestigious honor was bestowed along with a plaque at the Ontario conference October 26-27. The poster presentation described an action research project carried out in the Pavilion PACU.

During Fall 2005, Alicia Leal, BSN, RN, CPAN and other PACU staff initially designed the research study that examined patient flow within the Surgery Center. Tracy analyzed the statistical data collected and noticed a potential clinical problem. Tracy then met with Kathy Dureault, RN, MSN, Clinical Educator. Many patients were arriving unprepared to ambulatory surgery (e.g., did not have transportation home or a responsible adult to be with them upon discharge, etc.). Kathy connected Tracy with Dr. Rutledge, who discussed how to evaluate the nature and intensity of the problem using survey methodology.

PACU nurses implemented an action research project. They found that in over 600 patients admitted for surgery, 75% had received the Personal Recovery Plan Pamphlet (PRPP) developed by SJO nurses and disseminated through surgeon’s offices. In all patients who received it, the Plan was perceived as helpful. Of the patients, 78% received a preoperative call from SJO staff. Despite not all patients receiving the pamphlet or call, 99% of patients thought that their preparation for surgery was adequate.

During fall 2006, Darlene called surgeon’s offices, making sure staff understood how the PRP was to be used. She updated and converted them into electronic files available of the English, Vietnamese, and Spanish versions to enable staff to keep copies readily available in offices. The PRP is also now available on the SJO Intranet/website at http://www.sjo.org/ under the Patients and Families link. You can also view the Personal Recovery Plan Pamphlet here. Between Thanksgiving and Christmas, Tracy and PACU nurses will be surveying patients again to determine proportions of patients who have been adequately prepared for their surgeries. They hope to see a change.

Implementing a Sedation Protocol for Ventilated Patients

One of the presentations at St. Joseph Hospital's recent Grand Rounds on Evidence Based Practice and Nursing Research was "Implementing a Sedation Protocol for Ventilated Patients" by Victoria Randazzo, RN, BSN, CCRN, Clinical Nurse IV, Intensive Care.

Victoria discussed the practice change in progress in the Intensive Care Unit. You can review her complete PowerPoint here.

Group Visits for Diabetes Management

One of the presentations at St. Joseph Hospital's (Orange, California) recent Grand Rounds on Evidence Based Practice and Nursing Research was "Group visits for Diabetes Management: an evidence based approach to chronic disease management" by Teresa Ulrich, RN, FNP, Family Nurse Practitioner, La Amistad Health Center.

Teresa educated the audience on “Shared Medical Appointments” and specifically a group at La Amistad focused on diabetes management that started November 2005. An added bonus to her group was the inclusion of family members who could also reinforce the education presented at these group visits. You can view her PowerPoint here.

Five-Minute e-mail Nursing Journal Club

One of the presentations at St. Joseph Hospital's (Orange, California) recent Grand Rounds on Evidence Based Practice and Nursing Research was "Five-Minute e-mail Nursing Journal Club" by Judy Rousch, RN, Clinical II, Critical Care. Judy presented a project she began in 2003. Inspired by the public library’s on-line book club, she began sending small excerpts from scholarly nursing journals to a selected nursing e-mail readership. She highlighted how she dealt with format, copyright protection, etc. You can view her complete PowerPoint here

SJH Action Research: Decreasing Incidence of Bleeding and Hematoma Formation in New Fistulas

Action Research Summary Outline

Investigators:
Carmeleene Baguio MSN, RN Vascular Access Coordinator Renal Center, Dr. Amer Jabara, Renal Center Medical Director, Dialysis Staff in the Outpatient chronic hemodialysis unit

Problem identified:
Bleeding and subsequent hematoma on new fistulas when initially used for hemodialysis. When this occurs the fistula is allowed to rest for 2 weeks. This allows the hematoma and bruising to resolve. Sometimes it takes longer than 2 weeks or the hematoma needs surgical evacuation. This delays the use of the fistula and increases the risk of the fistula failure.

Purpose of the project:
To investigate the factors or reasons that cause excessive bleeding when new fistulas are initially used.

Evidence/Research:
The arteriovenous fistula (AVF) is the “gold standard) for vascular access. Fistulas have the longest longevity (75% working at 3 years, least likely to be infected (35x less than central venous catheters, 10x less than grafts), and lowest mortality (3x less than central venous catheters).

The Kidney Disease Outcomes Quality Initiative (National Kidney foundation, 2001) and the American Nurses Nephrology Association (ANNA) Standards and Guidelines of Clinical Practice for Nephrology Nursing recommend the AVF as the first choice of access.
The Fistula First Initiative recommends that 66% of patients on chronic hemodialysis use fistula as their primary access by year 2009.
Evidence shows that skill is required in creating and cannulating new fistulas.
28-53% of fistulas never mature to support dialysis ( Beathard, 2006 American Society of Nephrology)

According to Brouwer, 2003 a new fistula must be treated with great care to prevent damage. The goal is to help the access to mature into a long-term lifeline for the patient. She has recommended some guidelines in the care of this new fistula.
Several factors impact effectiveness of fistula placement and function. A multidisciplinary approach to evaluating and managing fistula maturation increases the chance of success.

Action Plan:
I discussed this problem with St. Joseph Hospital research council chair, Dana Rutledge, Dr. Jabara, Medical director of the Renal Center, the experienced dialysis nurses and technicians to get input on how what they thought was causing this problem. Based on current guidelines in the successful use of new fistulas a data collection tool was created to collect retrospective and prospective data on patients with new fistulas. This information consisted of possible factors that could affect bleeding and subsequent hematoma when new fistulas are initially used.
Retrospective and prospective data was collected on patients that had new fistulas that were being used for the first time. I informed the staff of what the plan was to address this problem.
During the data prospective data collection the staff was aware to check patient’s heparin dose based on the ACT’s, coumadin and other oral blood thinners that patient might be taking, patient education on holding needle sites post dialysis. As Vascular Access coordinator, I collected the data and facilitated patient referral to Interventional Radiology or vascular surgeon. I also did staff and patient education in the clinical area while data was being collected.

Outcomes:
Data was collected on six retrospective and six prospective patients that had new fistulas. Data included: Age of fistula when initially used, needle size used, heparinization during dialysis, other anticoagulants that patient was on, activated clotting times (ACTs), other bleeding issues, patient medical history associated with hematologic disorders, prescribed and/or complementary or alternative medications used by the patient and physical examination of the fistula.
Chart review was done using the data collection tool. Retrospective data showed that four of these patient’s ACTs were prolonged. Two were on coumadin, and two patients had narrowing of the fistula. Heparin dose was adjusted according to the ACT result.
For the prospective patients, heparin dose was evaluated and adjusted based on the ACT’s. This was done prior to using the fistula for the first time. Four of the patients did not have any bruising after the fistula was initially used. Two had minor bruising. This was related to needle manipulation since the fistula was not mature to support dialysis.
How is this significant?

There was a significant decrease in the incidence of bleeding after new fistulas were used for the first time.

Recommendations:
There will be an increase of new fistulas as a result of the Fistula First Initiative.
Systematic assessment of the new fistula before first use is imperative. Using the data collection tool created for this research will be useful in assessment of new fistula.
Patient and staff education on care of fistula and graft infiltrations to promote longevity in the use of these accesses.

Knowledge and Attitudes of SJH Nurses on Pain and Management

On Friday, November 3, 2006, St. Joseph Hospital (SJH), Orange California held the second annual session of Nursing Grand Rounds focused on Evidence Based Practice and Nursing Research. The four hour presentation was developed by Dana Rutledge, RN, PhD, Nursing Research Facilitator and Sharon Kleinheinz, RN, MS, Clinical Educator. One of the presentations was by Maureen Mikuleky RN, BA, MA, Director of Cancer Services and dealt with the findings of a recent questionaire Knowledge and Attitudes of SJH Nurses on Pain Management. You can view the PowerPoint presentation here.

85 million Americans CAN be wrong

A recent PEW Internet survey demonstrates that of the 80% of American Internet users who ahe searched for health information, only 25% check the source and date of the information all of most of the time. That translates to approximatel 85 million Americans whoa re "gathering health advice onlnie without consistently examining the quality indicators of the information they find. View the full PEW report here

To make sure YOU know how to evaluate health information sources on the WWW, check out some of these tools:

National Library of Medicine's Evaluating HealthInformation: a tutorial

Health on the Net (HON) Code of Conduct for medical and health Web sites

Critical Care Sedation Team

At St. Joseph Hospital, our mission is to deliver safe care and use best practices based on research and the best evidence. Implementation of a practice change is not easy, but will be successful with a dedicated and enthusiastic multidisciplinary team.

The sedation team has been meeting as a group for over one year now. We have added members and some members have left. But the goal remains clear: to develop an approach to patient centerd care of the Critical Care patient who is on the ventilator and in need of sedation. The goal of this plan was to reduce the amount of time the patient spent on the ventilator. We would accomplish this by giving the patient the best sedation at the correct levels for their individual needs. The plan included a daily awakening to assess for readiness to com off the ventilator rather than leave the patient sedated longer than necessary.

Victoria Randazzo, who is the champion of this issue as well as the chairperson of the committee, has brought together a multidisciplinary team to improve the care of this group of patients. Her team consists of Intensivist, Pharmacists, Nursing Clinical Educator, Critical Care unit management and 10 members of the nursing staff, Respiratory Department management and staff as well as Dana Rutledge, the Nurse Research Facilitator.

The team has worked together to develop a set of physician orders that adhere to the policy and procedure that Victoria authored. An education module for the critical care nursing staff was developed with input from everyone. The entire critical care staff attended the in-service which was taught completely by the nurses on the sedation team.

Following this education process, the physician orders were distributed and our plans then went into effect. In addition to this core education, one of the Intensivists provided an education seminar for the critical care staff on agitation and sedation in general. He and a sub group are working on developing a set of physician orders for the non-ventilated critical care patient.

We have just started to proceed with chart review, but we've discovered a decrease in need for patient restraints already. We expect to find fewer self-extubations and a shorter time on the ventilator with subsequent decreases in VAP as well as decreased of LOS.

We have increased patient comfort and our family survey revealed improved satisfaction when receiving care from a kind, loving nurse who is now able to efficiently reduce the agitation and maintain comfort for their loved ones while on the ventilator. The long term team effort - where all disciplines were working toward enhanced patient outcomes - increased the collegial relationship between physicians, staff nurses, respiratory therapy and pharmacy.

New/updated reviews on Cochrane of interest to nurses

The following new or updated reviews from issue 3, 2006 Cochrane Library may be of special interest to nurses. To read the complete review you will need to access the subscription to the Cochrane Library. Nurses at St. Joseph Hospital,Orange and CHOC may access the Cochrane library through the library's web site.

New Reviews of special interest to nurses:

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

Breastfeeding or breast milk for procedural pain in neonates

Dressings for healing venous leg ulcers

Drugs for preventing postoperative nausea and vomiting

Exercise for type 2 diabetes mellitus

Routine prophylactic drugs in normal labor for reducing gastric aspiration and its effects

Updated review of special interest to nurses:

Aerobic exercise for women during pregnancy

Double gloving to reduce surgical cross infection

Fetal electrocardiogram (ECG) for fetal monitoring during labor

Mechanical devices for urinary incontinence in women

Preoperative hair removal to reduce surgical site infection

School-based programmes for preventing smoking

Telephone counseling for smoking cessation

Cochrane provides free evidence summaries to support decision making during disasters

The Evidence Aid project: Resources for natural disasters and other healthcare emergencies

The following information is taken directly from the Cochrane website.

"This website highlights evidence relevant to the effects of interventions. Its aim is to help people making decisions about health care in natural disasters and other healthcare emergencies. The topics were originally identified as priorities by people in the regions affected by the 2004 tsunami, and relate to interventions that might be used or available. Where possible, a structured summary ('Evidence Update') or another summary has been prepared, based on one or more Cochrane reviews. If a summary is not available but a relevant Cochrane review exists, a link is given to the review in The Cochrane Library. If a suitable Cochrane review is not available, there are links to other sources of evidence, in particular to topics in the BMJ's Clinical Evidence. (The inclusion of links to material from outside The Cochrane Collaboration does not imply endorsement of that material by the Collaboration.) More information on Evidence Aid is available here. If you would like to comment or ask questions, please email reviews@cochrane.org. "

Infectious diseases
Injuries and wounds
Rebuilding of communities and infrastructure
Mental health
Nutrition
Rehabilitation

National Institute of Nursing Research celebrates 20th Anniversary

Happy 20th anniversary National Institute of Nursing Research!! Read about the anniversary celebration.

NIH awards $700M to speed translational research at centers nationwide

The NIH this week announced the first 12 participants in a new national consortium charged with speeding the translation of cutting-edge research into clinical practice. The grants will award 12 universities approximately $700 million over the next five years, with plans to distribute an additional $500 million to as many as 60 academic medical centers by 2012. As part of the network, centers will act as “discovery engines” that pool research data to identify scientific discoveries and apply them to real-world patient care, emphasizing improvements among underserved populations, interdisciplinary collaboration among scientists and providers, and the development of clinical informatics tools. For example, the University of California-Davis plans to use its $24.8 million grant to study chronic disease management and establish a new center for clinical and translational research, while the University of Pittsburgh will launch a patient registry program that can be tapped to identify candidates for clinical trials. The director of the NIH notes that the program marks the “first systematic change in our approach to clinical research in 50 years” (NIH release, 10/3; Neergard, AP/Yahoo! News, 10/3; Portland Business Journal, 10/3).

Julie's picks from the Nursing Literature September

These articles caught my eye from our September 2006 current awareness search on nursing research/evidence based nursing. Staff at St. Joseph Hospital of Orange and Children's Hospital of Orange County can request copies from Burlew Medical Library or, in many cases, can obtain the full text online through the library's web site. Other individuals should contact the libraries at their institutions.

Accession Number 2009257259 NLM Unique Identifier: 16931921.Author Chulay M.Title Good research ideas for clinicians.Source AACN Advanced Critical Care. 2006 Jul-Sep; 17(3): 253-65. (20 ref)

Accession Number 2009232221 NLM Unique Identifier: 16684165.Author Ng WQ. Neill J.Title Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review.Source Journal of Clinical Nursing. 2006 Jun; 15(6): 696-709. (34 ref)

Accession Number 2009172164 NLM Unique Identifier: 16620252.Author Crenshaw JT. Winslow EH.Title Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth.Source JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2006 Mar-Apr; 35(2): 257-64. (40 ref)

2009230807 NLM Unique Identifier: 16801357.Author Gray-Miceli DL. Strumpf NE. Johnson J. Draganescu M. Ratcliffe SJ.Title Psychometric properties of the post-fall index.Source Clinical Nursing Research. 2006 Aug; 15(3): 157-76. (30 ref)

Nursing Research. 2006 Jul; 55(4S): Supplement note: the entire supplement is on smoking cessation

2009210546 NLM Unique Identifier: 16707539.Author Dew PL.Title Is tympanic membrane thermometry the best method for recording temperature in children?Source Journal of Child Health Care. 2006 Jun; 10(2): 96-110. (56 ref)

2009237092 NLM Unique Identifier: 16825921.Author Vitale A.Title The use of selected energy touch modalities as supportive nursing interventions: are we there yet?Source Holistic Nursing Practice. 2006 Jul-Aug; 20(4): 191-6. (36 ref)

Cedars Sinai in Los Angeles: novel approach to increase handwashing

As reported in the Sept 27, 2005 Daily Briefing from the Advisory Council"

"Cedars-Sinai (Calif.): Takes novel approach to promoting hand hygiene
09/27/2006
Having exhausted traditional avenues for achieving widespread compliance with hand hygiene guidelines, Los Angeles-based Cedars-Sinai Medical Center adopted an unconventional approach to raising physician awareness and effecting behavioral change, according to a column in the New York Times Magazine. The hospital’s former chief of staff launched a widespread hand hygiene compliance effort after returning from a cruise, during which he noticed that crewmembers—who dispensed hand sanitizer during the re-boarding process and in the buffet line—were more vigilant than hospital-based providers about proper hand hygiene. Initially, Cedars-Sinai “gently cajole[d] the doctors” with faxes, e-mails, and posters advertising hand hygiene guidelines. Recognizing the need for more proactive intervention, the facility enlisted nurses to police physicians’ compliance, distributed bottles of hand sanitizer in the physician parking lot, and deployed a “Hand Hygiene Safety Posse” to award $10 Starbucks gift cards to physicians who were “caught” washing their hands. Administrators note that although these efforts raised compliance from 65% to 80%, the facility still fell short of the JCAHO-mandated 90% threshold. To take the facility’s performance to the next level, a hospital epidemiologist cultured the hands of providers involved in the hand hygiene effort and created a screensaver to be displayed on every hospital computer featuring images of the “disgusting and striking” bacteria revealed by the cultures. According to administrators, the screensavers helped push compliance to nearly 100%, a level that the facility has sustained ever since (Dubner/Levitt, 9/24). "

Jean Watson's theory selected as framework at St. Joseph Hospital, Orange, California

Saint Joseph Hospital in Orange, California has selected Jean Watson's Theory of Human Caring as the framework on which we base our nursing practice. Burlew Medical Library has prepared a selective bibliography of articles by or about Watson from 1996-. This list of articles is in part 1 (articles available to SJO/CHOC employees) and part 2 (articles which could be ordered for SJO/CHOC employees. SJO/CHOC employees need only contact Burlew Medical Library to request any of these articles. Individuals at other entities should contact their own medical libraries.

Additionally, we will be offering a special viewing of a moving and inspirational DVD on the "Theory of Human Caring" which was produced by SJH nurses.

One hour sessions are scheduled in the Zhoul auditorium on

Monday Sept 18 12:00 noon to 1:00 pm 2006
Tuesday Sept 19 7:30 am - 8:30 am
Tuesday Oct 3 7:30 - 8:30 am
Monday Oct 16 12:00 noon to 1:00 pm
Friday Nov 3 7:30 am - 8:30 am
Monday Nov 6 12:00 noon -1:00 pm

No registration is required and breakfast/lunch will be served to St. Joseph Hospital of Orange staff.

Along these same lines, there is a very cool Nursing Theory Link page out of Clayton State University Department of Nursing where you can read about many nursing theories.

Evidence Based Library Science Conference

Evidence Based Library & Information Practice4th International Conference"Transforming the Profession"May 6-11, 2007, Chapel Hill-Durham, North Carolina, USA http://www.eblip4.unc.edu/ The Evidence Based Library and Information Practice Conference(EBLIP4) is an exciting international event that has emerged inresponse to the growing interest among all types of libraries in usingthe best available evidence to improve information practice. The conference on May 6-9, 2007 in Chapel Hill, North Carolina will be followed by two days of continuing education. The conference provides a forum for the presentation of high quality papers and posters aswell as examples of how EBLIP is being implemented in library and information settings around the globe. EBLIP4 invites submissions for contributed papers and posters including both original research and innovative applications of EBLIP in library and information management. Papers that deal with library support of evidence-based practice in other fields such as health, social work and public policy are also welcome.

Full instructions to authors may be found at http://www.eblip4.unc.edu/ Chapel Hill-Durham is located in the middle of the Eastern United States close to the Raleigh-Durham international airport. This central location in the Research Triangle area is only a short drive from scenic locations in North Carolina. The beaches are approximately two hours to the east and the mountains are two hours to the west. Washington DC is a 4.5 hour drive or 30 minutes by air. Important Dates

December 1, 2006 Submission deadline for abstracts for papers and posters
February 11, 2007 Final decisions for accepted papers
February 15, 2007 Final decisions for accepted posters
March 15, 2007 Submission deadline for full papers

Carol Perryman MSLISTRLN Doctoral FellowSchool of Information & Library ScienceUniversity of North Carolina at Chapel Hill

Study: Nurses Lack IT training

A new study in eWeek finds that most nurses receive minimal or no IT training. Information literacy is integral to an understanding of how to approach Evidence Based Nursing.

Please post your comments below if you have any great ideas/suggestions on this topic.

Resources for teaching EBM

David Rothman from Syracuse, NY, just posted on his blog a very comprehensive list of resources for teaching EBM/Evidence Based Medicine. Most of the resources were compiled by puting a call out to the MEDLIB-L for assistance.

Pressure Ulcers among Eldery Patients Early in Hospital Stay: Abstract with commentary by Dana Rutledge, RN, PhD

Abstract: Pressure Ulcers among Elderly Patients Early in Hospital Stay

Background. Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence.
Methods. A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Services at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified a either preexisting, possibly hospital-acquired, or definitely hospital-acquired.
Results. There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.25 (95% confidence interval, 5.4% - 7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status.
Conclusions. A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person’s hospital stay.
Baumgarten, M. et al. (2006). Pressure ulcers among elderly patients early in hospital stay. Journal of Gerontology: MEDICAL SCIENCES, 61A, 749-754.

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

Were you surprised at any of the predictors of pressure ulcers in this hospitalized elderly patients? You probably were not. Studies using the Braden Pressure Ulcer Risk Assessment Scale confirm that problems with moisture, mobility/activity, and nutrition are all predictors of pressure ulcer development. What is new about the Baumgarten et al. study is that in 6.2% of the patients, pressure ulcers developed within 3 days of hospital admission!! Earlier studies have not specifically looked at this time interval.
What were the strengths and limitations of the study. Strengths include the large sample size, use of 2 hospitals (one in Pennsylvania, one in Oregon), the large sample of African Americans, and use of trained research nurses to evaluate the study measures. Limitations are that the study involved only a brief one-time observation of the patients and that hospital-acquired and preexisting pressure ulcers may have been somewhat misclassified.
Taking these into account, what is the take home message for the practicing nurse? Elderly patients admitted to medical units may be prone to develop pressure ulcers within 3 days of admission. Thus, given recent trends towards shorter hospital stays, the potential for breakdown is high. Nurses MUST put preventive measures into place early!!

Trip database-- free access

Trip Database :Turning Research into Practice

For the last 4 years, the Trip database has been a subscription service, but as of Sept 2006, it is once again a free resource. TRIP describes itself as " the Internet's leading resource for Evidence-Based Medicine allowing users to easily and rapidly identify the highest quality evidence from a wide range of sources." This site has recently been evaluated by a team from the Centre for Evidence-Based Medicine. Although not nursing focused, this free resource is a great one-stop source for answering clinical questions. The site supports Boolean searching and returns results that you can then filter by such entities as : evidence based synopses, clinical questions, systematic reviews, guidelines, e-textbooks, clinical calculators and even by medical speciality. You can also sign up for the Trip Blog on their web site.

Evidence Based Nursing Blog "Down Under"

I have come across a blog devoted to "Evidence-Based Nursing & Midwifery" which is being published by Stephen Barnett Darwin from Northern Territory, Australia. This site does primarily emphasize evidence based nursing from a OB/midwifery perspective.

A Nursing Evidence Based Practice Tutorial

We previously blogged about "The Evidence Based Knowledge Portal which was developed by the Eskind Biomedical Library at Vanderbilt with grant funding and includes tutorials addressing facets of statistical analysis and critiquing the medical literature as well as virtual practice cases that allow users to explore principles of EBM. This is an amazing tutorial but its orientation is toward medicine rather than nursing. Dana Rutledge recently told me about a great Evidence Based Practice Tutorial from Penn State University Libraries that is very comprehensive and oriented towards nursing. This tutorial also offers audio and some video and details the four overall steps in Evidence Based Practice. Two clinical scenarios are offered and the user also has available to them a listing of appraisal tools and an extensive list of EBP terminology.

Our blog discussed in Evidence Soup blog

Evidence Soup : show me the evidence : looking at uses and absues of evidence in everyday life is a very interesting blog put together by Tracy Allison Altman. This blog is not devoted exclusively to healthcare, but does concentrate on medical/nursing issues. It's interesting that both our blogs have subtitles along the lines of "show me the evidence"!!. On August 11, Evidence Soup gave our blog a nice plug. Thanks.

Julie's August picks from the literature

Some of these recent articles really intrigued me. Employees at St. Joseph Hospital, Orange or Children's Hospital of Orange County can access these online or request them through Burlew Medical Library. Others should consult medical libraries with whom they have privileges.

Accession Number 2009223633 NLM Unique Identifier: 16816597.Author Coopey M. Nix MP. Clancy CM.Title Translating research into evidence-based nursing practice and evaluating effectiveness.Source Journal of Nursing Care Quality. 2006 Jul; 21(3): 195-202. (9 ref)

Accession Number 2009232462 NLM Unique Identifier: 16767023.Author Giuliano KK.Title Continuous physiologic monitoring and the identification of sepsis: what is the evidence supporting current clinical practice?Source AACN Advanced Critical Care. 2006 Apr-Jun; 17(2): 215-23. (36 ref)

Accession Number 2009232451 NLM Unique Identifier: 16767019.Author Albert NM.Title Evidence-based nursing care for patients with heart failure.Source AACN Advanced Critical Care. 2006 Apr-Jun; 17(2): 170-85. (41 ref)

Accession Number 2009211028 NLM Unique Identifier: 16766627.Author Munro CL. Grap MJ. Jablonski R. Boyle A.Title Oral health measurement in nursing research: state of the science.Source Biological Research for Nursing. 2006 Jul; 8(1): 35-42. (47 ref)

Nursing Administration Quarterly issue devoted to Evidence-based Practice

Nursing Administration Quarterly v 30(3) July-Sept 2006 devotes the entire issue to Evidence-based Practice: impact on nursing administration. Saint Joseph Hospital of Orange,California and Children's Hospital of Orange can access this issue full text via Burlew Medical Library's website. Find out whether your library has access to this important issue.

Table of Contents
Evidence-based Practice: Impact on Nursing Administration.
Brown, Barbara J. EdD, RN, CNAA, FAAN, FNAP, Editor-in-Chief[From the Editor]


2
pg. 191-192Evidencing the Value of Nursing Practice.
Porter-O'Grady, Tim EdD, APRN, FAAN[Guest Editorial]

3
pg. 193-202Quantifying Patient Care Intensity: An Evidence-based Approach to Determining Staffing Requirements.
Beglinger, Joan Ellis MSN, MBA, RN, FACHE, FAAN[Article]

4
pg. 203-210Using Diffusion of Innovation Concepts to Enhance Implementation of an Electronic Health Record to Support Evidence-based Practice.
Geibert, Robert C. EdD, RN[Article]

5
pg. 211-220Constructing a Team Model: Creating a Foundation for Evidence-based Teams.
Porter-O'Grady, Tim EdD, APRN, FAAN; Alexander, Daniel R. MS; Blaylock, Jo MS; Minkara, Nazem MS; Surel, Dominique MBA[Article]

6
pg. 221-227Patient Care Transformation: The Plan and the Reality.
Drexler, Diane RN, MBA, CNO; Malloch, Kathy PhD, MBA, RN, FAAN[Article]

7
pg. 228-235On the Scene at Banner Estrella Medical Center, the Hospital of the Future.
Dobson, Christina MSN, RN, FNP-C; Meythaler, Denise BSN, RN; Wong, Paul BSN, RN, CCRN, CEN, CPAN; Ramirez, Chuck BA, RRT[Article]

8
pg. 236-242Diffusion of Innovation: The Leaders' Role in Creating the Organizational Context for Evidence-based Practice.
Crow, Gregory EdD, RN[Article]

9
pg. 243-251What Goes Around Comes Around: Evidence-based Management.
Williams, Lauren L. EDM, RN[Article]

10
pg. 252-265Evidence-based Practice: How Nurse Leaders can Facilitate Innovation.
Shirey, Maria R. MS, MBA, RN, FACHE, CNAA, BC[Article]

11
pg. 266-272Perceptions and Characteristics of Registered Nurses' Involvement in Decision Making.
Mangold, Kara L. MS, RN; Pearson, Kristina K. MS, RN, OCN; Schmitz, Julie R. MS, RN; Scherb, Cindy A. PhD, RN; Specht, Janet P. PhD, RN, FAAN; Loes, Jean L. MS, RN[Article]

12
pg. 273-284Perceptions, Knowledge, and Commitment of Clinical Staff to Shared Governance.
Frith, Karen PhD, RN; Montgomery, Meryl MSN, RN[Article]

13
pg. 285-290Comparison of Native Versus Nonnative English-speaking Nurses on Critical Thinking Assessments at Entry and Exit.
Whitehead, Tanya D. PhD[Article]

14
pg. 291-294Evidence-based Practice: How Nursing Administration Makes IT Happen.
Simpson, Roy L. RN, C, CCMA, FNAP, FAAN[Nursing Informatics]

15
pg. 295-299SBAR and Nurse-Physician Communication: Pilot Testing an Educational Intervention.
Hamilton, Patti PhD, RN; Gemeinhardt, Gretchen PhD; Mancuso, Peggy PhD, RN, CNM; Sahlin, Claire L. PhD; Ivy, Lea MA, RN[Research Abstracts]

16
pg. 300Handbook of Diabetes Management.
Falter, Betty MS, RN, CNAA, BC[Book Review: Books for Nursing Administrators]

Resources for Evidence-Based Nursing from McMaster University

McMaster University has created a terrific Resources for Evidence-Based Nursing which is based on the Haynes model.

St. Joseph Hospital (Orange, Calif) sponsors conference on Pain Solutions:evidence based approaches...

St. Joseph Hospital in Orange, California is hosting a conference on October 22, 2006 entitled
"Pain Solutions: evidence based approaches to the care of persons experiencing pain". 8 contact hours will be available for this conference; registrations must be be received by September 22, 2006. Please use this registration form. For more information, please contact Cheri Cancelliere at Cheri.Cancelliere@stjoe.org or call 714 771-8000, x7345.

Show me the Evidence by Catherine Spader, RN

Infusion therapy nurse Eun Kim, RN, BS, C, CRNI (right), shares with Mary Sampson, RN (center) and Judi Murphy, RN, BSN, PNAP III, a new method to clean central line dressing sites that has reduced infection rates by 50%. The method employs chlorhexidine gluconate in place of Betadine Solution. Photo by Winslow Martin

An article in Nursing Spectrum Feb 27, 2006 carries the same title as our blog "show me the Evidence". It describes some real life examples of implementation of EBP by med/surg nurses at Winchester Hospital in Winchester, Mass.

Julie's July Picks from the Nursing Literature

Some of these recent nursing articles really caught my eye. SJH/CHOC staff can obtain these online or request them from Burlew Medical Library. Nurses who are not at SJH/CHOC should check with their own medical libraries.

1. 2009172202 NLM Unique Identifier: 16620259. Ballen LE. Fulcher AJ.
Nurses and doulas: complementary roles to provide optimal maternity care.
JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2006
Mar-Apr; 35(2): 304-11. (34 ref)
Burlew carries this journal

2. 2009165829. Tracy S. Dufault M. Kogut S. Martin V. Rossi S. Willey-Temkin
Translating best practices in nondrug postoperative pain management.
Nursing Research. 2006 Mar-Apr; 55(2S): Supplement: S57-67. (61 ref)
Burlew carries this journal

3. 2009139524 NLM Unique Identifier: 16601511.
Newhouse RP.
Evidence and the executive. Selecting measures for safety and quality
improvement initiatives.
Journal of Nursing Administration. 2006 Mar; 36(3): 109-13. (27 ref)
Burlew carries this journal

4.2009157318 NLM Unique Identifier: 16553707.
Elliott R. McKinley S. Aitken L.
Adoption of a sedation scoring system and sedation guideline in an
intensive care unit.
Journal of Advanced Nursing. 2006 Apr; 54(2): 208-16. (23 ref)
Burlew has some years.

Create Change Website: the changing environment of digitial scholarhship

The Create Change Website, a resource on scholarly communication issues, has been updated to provide faculty with current information, perspectives, and tools that enable them to play an active role in advancing scholarly information exchange in the networked environment. The new Create Change Website is based on the idea that the ways faculty share and use academic research results are changing rapidly and irreversibly. The Website includes sections on digital scholarship and new modes of communication, examples of change in diverse fields, and ways to stay informed about new developments.

New Evidence-Based Knowledge Portal

"The Evidence Based Knowledge Portal, developed by the Eskind Biomedical Library at Vanderbilt with grant funding (NLM grant number 5R01LM007849), includes tutorials addressing facets of statistical analysis and critiquing the medical literature as
well as virtual practice cases that allow users to explore principles of EBM (e.g. number needed to treat, selection bias) in the context of a clinical scenario. Cases include pre-and post- tests to allow users to gauge their knowledge and progress."

You will need to do a very quick registration in order to obtain a free password and you will also need to download Macromedia flash player if you don't already have it. This is a very user friendly tutorial resource that demystifies lots of research concepts such as the advantages and disadvantages of cohort studies and positive and negative predictive values. The virtual practice cases allow you to utilize and reinforce some of your new principles of research. In addition, this portal offers
a Evidence Summary Generator which allows you to create summaries of articles and evidence in a template format.

The Evidence Based Knowledge Portal at Vanderbilt University welcomes your comments/suggestions

  

CHF Team at St. Joseph Hospital, Orange, California

Posted by Julie Smith for Judy Rousch
Pictured above are some of the CHF team

The CMS (which stands for Centers for Medicare and Medicaid Services) Demonstration Project, encourages evidence- based care to patients with these diagnoses:
· Community Acquired Pneumonia (CAP)
· Congestive Heart Failure (CHF)
· Acute Myocardial Infarction (AMI)
· Coronary Artery Bypass Grafts (CABG), and
· Total Joint Replacement (TJR).
Our hospital is required to collect data from patient charts, collated by an outside company, reviewed, and compared to hospitals nationwide. This data is publicly available The current data retrieval required for three of the above diagnosis is:
· One of the current goals of the TJR part of data collection is to ensure that the last dose of antibiotics is administered within 24 hours of the incision “close time”.
· For CAP, the goal is an antibiotic started within 4 hours of arrival, O2 sat or ABG within the first 24 hours of admission, Pneumococcal and Influenza vaccines as appropriate and smoking cessation counseling as appropriate.
· With CHF, the hospital must show that LVF is assessment is documented, detailed discharge instructions are given to the patient and charted. ACE/ARB medication is prescribed for an ejection fraction of <40%, and smoking cessation counseling is begun and charted.
As you can see, this requires a lot of time and effort to ensure these steps are taken both with patient care as well as the actual data retrieval. The team has developed tools for the patient care nurse to use to insure that her patient is receiving these evidence-based recommendations and that the hospital is compliant in providing these services to our patients. For further information or to access help for your patient, contact any member of the 4E/W team, Megan Whalen, the Heart Failure Clinic Nurse Practioner, at extension 8858, Trish Cruz, the Quality Management RN- ext. 8208, or access the Clinical Practice Guidelines for the CHF patient posted in third and fourth floor nursing units, or the CHF Resource Binder. Some of the questions that might come up are:
· What happens when they are confused and disoriented?
· Include family or caregivers
· What if the patient is a DNAR?
· Much of the teaching can be considered palliative care. For example fluid and sodium diet restrictions enable the patient to breathe easier.
· What if they are discharged to a SNF?
· Include the written DC instructions in the envelope to go to the SNF. Sometimes the SNF staff doesn’t know how to care for CHF patients.
· What if the doctor hasn’t ordered an ACEI or ARB for EF<40%
· Call the physician and ask for the medication or the contraindication
· What happens when my patient refuses?
· Document that the patient refuses
· What happens if the doctor doesn’t list the discharge medications and doses?
· Call the physician and ask. If you can’t determine what meds the patient is on, how is the patient supposed to be able to?

Julie's June picks from the literature

Some of these recent nursing articles really caught my eye. SJH/CHOC staff can obtain these online or request them from Burlew Medical Library. Nurses who are not at SJH/CHOC should check with their own medical libraries.

1. Delgado-Passler P. McCaffrey R. The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. Journal of the American Academy of Nurse Practitioners. 2006 Apr; 18(4): 154-60. (17 ref) 2

2. Gardner MR. Deatrick JA. Understanding interventions and outcomes in mothers of infants. Issues in Comprehensive Pediatric Nursing. 2006 Jan-Mar; 29(1): 25-44. (86 ref)

3. Karkkainen O. Bondas T. Eriksson K. Documentation of individualized patient care: a qualitative metasynthesis. Nursing Ethics. 2005 Mar; 12(2): 123-32. (32 ref)

4. Kehl-Pruett W. Deep vein thrombosis in hospitalized patients: a review of evidence-based guidelines for prevention. DCCN: Dimensions of Critical Care Nursing. 2006 Mar-Apr; 25(2): 53-61. (28 ref)

5. Whall AL. Sinclair M. Parahoo K. A philosophic analysis of evidence-based nursing: recurrent themes, metanarratives, and exemplar cases. Nursing Outlook. 2006 Jan-Feb; 54(1): 30-5. (47 ref)

6. Harrington L. Implementing a hospital-based nursing research program in 30 days. Nurse Leader. 2006 Feb; 4(1): 37-42, 55. (8 ref)

Nursing Literature Mapping: from Med-Surg to Transcultural Nursing and more

The first ever online-only supplement to the Journal of the Medical Library Association (JMLA) has been published freely on PubMed Central. This online symposium deals entirely with the Mapping the Literature of Nursing Symposium.

Nursing Wiki

http://en.nursingwiki.org

NursingWiki is a free multilingual wiki-project for health care and nursing information, that anyone can edit. Since May 2006, 68 free licensed articles in english language have been created. Anyone can contribute his/her knowledge in updating pages – the first steps are very simple! Wiki is the shortened form of the hawaiian adjective "wiki wiki", which describes something as "quick" or "fast". A wiki is a website which allows users to easily and quickly edit, add and remove content; it is therefore an effective tool for collaborative writing. There is a section on "Nursing Research" under construction in this Nursing Wiki. Feel free to contribute content to the Nursing Wiki. This blog is linked with the other nursing related blogs.

Nursing study finds that music relieves symptoms and eases depression in chronic pain patients

siedliecki s.l. & good m. (2006) Journal of Advanced Nursing54(5), 553–562

Effect of music on power, pain, depression and disability
Aim. This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music).

Background. Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated.

Method. A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21–65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II).

Results. The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported.

Conclusion. Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.


Journal of Advanced Nursing Table of Contents

Internet searches : Librarians do it better

According to a study reported today at the Medical Library Association's annual meeting in Phoenix, cancer patients are more likely to find what they are looking for with a librarian-mediated search instead of "going it alone."

This study by Ruti Volk, professional librarian and manager of the Patient Education Resource Center (PERC) at the University of Michigan, demonstrates that "even though the information is supposedly so accessible and everything is on the web, people still need the help of a professional to find information that is relevant to them and that is current, accurate and authoritative. "

AHA/ACC updates Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update

The American Heart Association and the American College of Cardiology on Monday issued updated guidelines designed to ensure optimal treatment of patients with a variety of cardiovascular conditions, including heart disease, acute coronary syndromes, heart attack, and peripheral arterial disease, USA Today reports. The revised recommendations, which are endorsed by the National Heart, Lung, and Blood Institute, were created in light of results from the clinical trials that have been completed since the last recommendations were issued five years ago. For instance, the guidelines suggest that the daily aspirin dose for patients with heart disease or other blood vessel disorders be lowered to between 75 mg and 162 mg per day after a series of clinical trials showed that lower aspirin doses were “just as effective” as higher doses at preventing future heart attacks; however, the guidelines continue to advise that bypass patients receive between 100 mg and 300 mg of aspirin per day for up to one year. In addition, the guidelines for the first time suggest that all patients with chronic heart disease receive a flu vaccination. The guidelines also call for increased use of statins to reduce LDL levels, which now are recommended to be kept under 100 mg per deciliter in all heart disease patients. Other measures included in the revised guidelines “simply highlight tried-and-true means of reining in risk,” such as encouraging heart disease patients to get 30 to 60 minutes of moderate exercise at least five to seven days per week. The guidelines also recommend that a patient’s body mass index remain between 18.5 and 24.8, with waist circumference measuring no more than 40 inches in men and 35 inches in women. For diabetes management, the guidelines suggest that patients receive blood sugar level tests three to four times per year and recommend that the level stay below 7%. According to the report authors, the “aggressive, comprehensive risk-factor management” outlined in the guidelines has been shown in multiple studies to increase survival and prevent complications among heart patients. HealthDay notes that both groups plan to launch a campaign to inform cardiologists and other physicians of the new guidelines (Sternberg, USA Today, 5/15; HealthDay/Yahoo! News, 5/15).

AACN releases annual survey results

The American Association of Colleges of Nursing (AACN) relesed data from their annual survey which shows that enrollment in entry-level baccalaureate nursing programs increased by 13% from 2004 to 2005. Though this increase is welcome, their survey showed that 32,617 qualified applications were denied due to a shortage of nurse educators.

Mapping the literature of nursing: 1996-2000

Take a look at "Mapping the literature of nursing: 1996-2000" by Margaret Allen, Susan Kaplan Jacobs and June R. Levy in J Med Libr Assoc 94(2)206-220 April 2006. This research article represents a "snapshot in time" of the citation patterns of general nursing and specialty generals. It also underscores the interdiciplinary nature of nursing as a profession.

Sense About Science is a UK organization interested in promoting an evidence-based approach to scientific issues. They have a great review document which explains about the process of peer review in research and is especially useful for the non-researcher in evaluating research claims that are touted in the press. Check it out!!

Magnet Crossword Answers

As part of the activities of National Nurses' Week, nurses at SJH have had an opportunity to complete a magnet-themed crossword puzzle. Entries are eligible until 3:00 pm and can be turned in at the staffing office. It has come to our attention, that the answers to a few of the questions are hard to locate. While the winners will be randomly selected and no one will be disqualified for an incomplete or incorrect answer, we thought you might be curious about the correct answers to the crossword puzzle. Click here

Meet Dana Rutledge

Our world-renown (and very modest) Dana Rutledge RN, PhD, is our Nursing Research Facilitator at St. Joseph Hospital in Orange, California. She is with us one day a week and leads our Nursing Research Council, along with Beth Winokur. How she manages to publish and research as much as she does, while at the same time remaining so friendly and approachable is a mystery to me. She very kindly provided me with a copy of her CV. It is so impressive that I hope it doesn't cause the blogosphere to crash!!

St. Joseph Hospital Evidence Based Nursing Practice (cont'd)

Sedation Management and weaning to facilitate extubation in the ICU

Investigator: Victoria Randazzo, RN, BSN, CCRN

Purpose: This multidisiplinary team is looking at the comprehensive way in which sedation (Benzodiazepines, Propofol) is managed in the intubated ICU patient. The intent is to promote a recognition of the ability to wean by using a daily "sedation vacation". The process utilizes a team approach between the staff nurse, the respiratory therapist and the Intensivist. This evidence based practice focuses on reducing ventilator associated pneumonia, shorter patient stays, reduced costs and better patient outcomes.
In addition to tracking patient outcomes, the process involves staff education which is facilitated by the team's ten member nursing staff and the clinical educator. Dr. Duke, one of the physician Intensivists, is offering the ICU staff a class titled "Sedation/Agitation in the Mechanically Ventilated Patient".

The Thrill of the Hunt

Be sure to check out the article in the latest issue of Advance for Nurses that spotlights Dana Rutledge, our own nurse researcher at St. Joseph Hospital. It can also be accessed online Enter "Dana Rutledge" in the search box.

Meet the blog team

The blog team, from left to right are: Judy Rousch, Theresa Ullrich, Julie Smith, Ann Marie Keefer-Lynch, Dana Rutledge and Elaine Go. Not pictured is Linda Privette.

Please submit ideas for posting relating to nursing research/evidence based nursing to Julie at jsmith@sjo.stjoe.org

CDC issues guideline on "pre-conception care"

As part of an effort to reduce infant mortality and improve the health of newborns, the CDC’s National Center on Birth Defects and Developmental Disabilities yesterday issued new “pre-conception care” guidelines that encourage women to “take stock of their health” before attempting to become pregnant, HealthDay reports. The guidelines, which were published this month in the Morbidity and Mortality Weekly Report, were developed based on the results of a two-year “exhaustive data review” by the CDC and more than 35 government, public, and private groups. The guidelines recommend that women contemplating pregnancy schedule a pre-conception physician visit—an appointment that the CDC is urging health insurers to offer coverage for. In addition, the recommendations advise women to control chronic conditions such as high blood pressure, reach or maintain a healthy weight, avoid alcohol, quit smoking, and create “reproductive life plan[s]” with their partners that outline when and how many children couples wish to have. The associate director for program development says although steps to ensure pre-conception health have been recognized as important “for many years, they have really not been a part of the health care system.” Physicians already have embraced the new guidelines, which they say create an “organized approach for [physicians] giving advice to women.” HealthDay notes that the new recommendations will be widely distributed, with many of the sponsoring groups providing links to the recommendations on their official websites

Julie's picks -- current nursing research articles April 2006

Rolfe G. Validity, trustworthiness and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing. 2006 Feb; 53(3): 304-10.

Keeney S. Hasson F. McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. Journal of Advanced Nursing. 2006 Jan; 53(2): 205-12

Weaver K. Olson JK. Understanding paradigms used for nursing research. Journal of Advanced Nursing. 2006 Feb; 53(4): 459-69.

Upton D. Upton P. Development of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing. 2006 Feb; 53(4): 454-8

Marklew A. Body positioning and its effect on oxygenation -- a literature review. Nursing in Critical Care. 2006 Jan-Feb; 11(1): 16-22

Lindberg DA. Integrative review of research related to meditation, spirituality, and the elderly. Geriatric Nursing. 2005 Nov-Dec; 26(6): 372-7

Pearson A. 30th Anniversary commentary on MacGuire J.M. (1990) Putting nursing research findings into practice: research utilization as an aspect of the management of a change. Journal of Advanced Nursing 15, 614-620. Journal of Advanced Nursing. 2006 Jan; 53(1): 73-4. (6 ref)

Houldin A. Curtiss CP. Haylock PJ. Executive summary: the state of the science on nursing approaches to managing late and long-term sequelae of cancer and cancer treatment. American Journal of Nursing. 2006 Mar; 106(3): 54-9.

Marchiondo K. Teaching tools. Planning and implementing an evidence-based project. Nurse Educator. 2006 Jan-Feb; 31(1): 4-6

Pepler CJ. Edgar L. Frisch S. Rennick J. Swidzinski M. White C. Brown T. Gross J. Strategies to increase research-based practice: interplay with unit culture. Clinical Nurse Specialist. 2006 Jan-Feb; 20(1): 23-33.

Duffy ME. Using research to advance nursing practice. Resources for determining or evaluating sample size in quantitative research reports. Clinical Nurse Specialist. 2006 Jan-Feb; 20(1): 9-12.

Craig SE. Does nurse-led pre-operative assessment reduce the cancellation rate of elective surgical in-patient procedures?: a systematic review of the research literature. British Journal of Anaesthetic & Recovery Nursing. 2005; 6(3): 41-7

Weekend Immersion in Nursing Informatics July 28-30, 2006 St. Joseph Hospital, Orange, California

This conference focuses on information technology trends and issues facing the nursing professional and provides a comprehensive examination of nursing informatics theories, systems analysis and the impact of human factors. As the use of computers in healthcare becomes increasingly critical, it is essential to provide nurses with skills and knowledge in information management. Please click here for the brochure/registration http://www.ania.org .(scroll down home page for brochure) For more information, please contact Linda Privette at Linda.Privette@stjoe.org or 714/771-8000, ext. 2698.

Evidence-based Projects Involving Nursing at St. Joseph Hospital, Orange California

St. Joseph Hospital
Nursing Evidence-based Projects

1. Assessment of community based smoking/tobacco cessation training program for healthcare professionals

Investigators: Tim Chen, PharmD; Pamela Matten R.N., O.C.N.; Siu-fun Wong, PharmD

Purpose: To determine the effectiveness of a community based tobacco cessation training program for healthcare professionals.
Methods: Rx for Change: Clinician-Assisted Tobacco Cessation is a 7-8 hr tobacco cessation training program designed for use in pharmacy schools. Using the basis of Rx for Change, a 3-hour modified multidisciplinary program, incorporating 2-hour lecture-based module (behavioral counseling and pharmacotherapy) and 1-hour interactive session with role-playing, will be held 3 times per year. Initial program participants will be inpatient nurses. Due to the nature of the nurses’ patient contact, the program will emphasize on first 4 of the 5A’s (Ask, Advise, Assess, Assist, Arrange). Outcomes research evaluating the effectiveness of the training program will be conducted using pre, post, and follow-up surveys at 3, 6, and 12 month.

2. Time and motion study to evaluate the costs of cardioversion for atrial fibrillation

Investigators: Suzanne A. Feigofsky, MD; Donald J. Mahon, MD; Warren D. Johnston, MD; Tyson Cobb, MD; Thomas Kim, MD; Mila Garcia, NP; Beverly Niemeyer, RN

Purpose: The goals of this study are to quantify costs of both direct current cardioversion and pharmacologic cardioversion for treating atrial fibrillation and to evaluate the responsiveness of two new questionnaires to assess the symptoms and health-related quality of life impact of atrial fibrillation.

3. Oral care attitudes in ICU nurses

Investigator: Dana Rutledge, RN, PhD

Purpose: To obtain information about current oral care practice; oral care training; and nurses’ attitudes related to oral care in intensive care unit.
Methods: This comparative pre/post study aims to describe oral care practices, training, and nurses’ attitudes along with VAP rates before and after the implementation of an evidence-based oral care protocol in intensive care units (ICU) at a community hospital. The research sample consists of RNs working the intensive care units (ICU). Nurses will be evaluated for attitudes and knowledge about oral care before and after a change in oral care practices. VAP rates in ICUs 3 months prior to an oral care protocol change and those 3 months after will be compared.

4. Examining the factor that influence males decisions to choose nursing as a career

Investigator: Sabrina Valentine, RN, BSN

Purpose: To explore the factors that influence men to enter nursing as a
career.

5. Knowledge and attitudes assessment toward pain management of registered nurses at St. Joseph Hospital

Investigators: Maureen Mikuleky, RN; Dana Rutledge, RN, PhD; Carmen Belasario, RN; Shivi Dixit, RN, BSN

Purpose: To determine the current knowledge and attitudes of St. Joseph Hospital registered nurses by shift and department. Based upon the unit-based knowledge and attitudes, to develop and implement unit-specific educational interventions, and then, reevaluate unit-based knowledge and attitudes toward pain management.

6. Presenting symptoms for acute coronary syndrome study

Investigators: Beth Winokur, RN, MSN, CEN; Joseph Barrea, RN, BSN; Amy Waunch, RN, MSN, CEN; John Senteno, RN, BSN

Purpose: To describe presenting symptoms of patients with acute coronary syndrome (ACS) admitted to the emergency department, and to describe symptoms by sex and by ethnic groups. Also, to determine if patients with ACS who desire interviews in a language other than English differ in the symptoms reported on 2nd (non-initial) interview done by a person speaking the patient’s language.

7. CalNOC Partners for Quality TRIP to Reduce Hospital Falls
Investigators: Kathleen Penzes, R.N.
(Include in summary – no info in IRB other than policies)

8. Clinical Narratives: Evaluation for Components of Caring

Investigators: Dana Rutledge, PhD, RN

Purpose: To analyze clinical narratives written by nurses at St. Joseph Hospital.
Methods: This descriptive study aims to analyze clinical narratives written by nurses at St. Joseph Hospital in order to determine the following questions.
1. What types of patient care experiences do nurses consider as “a clinical experience that reflects an incident in which they feel their intervention or their relationship with their patient made a difference “?
2. To what extent do the narrative experiences describe specific caring behaviors by nurses (e.g., spending time with the patient, being hopeful for the patient)?
3. To what extent are the five dimensions of Watson’s Theory of Caring reflected in the narratives?
4. Do narratives of nurses who are less experienced (new graduates or orientees) differ in terms of the caring dimensions than are narratives of experienced nurses at St. Joseph Hospital?
5. If a difference is present, does the magnitude of the difference change over time (as the Watson Model is incorporated into care at St. Joseph Hospital)?

9. Emergency Department Pediatric Temperature Study

Investigators:Amy Waunch, MSN, CEN, FNP, Michael Vicioso, RN; Christine Marshall, RN, MSN, Beth Winokur, RN, MS, CEN

Purpose: To compare temple thermometer readings in emergency department patients 17 and younger with oral, rectal, and axillary temperature. A study sub-aim is: Inpatients who have received antipyretics, to evaluate the presence of a “lag” in any temperature measure (oral, rectal, axillary, temporal) compared to the others due to physiologic responses to the antipyretic.
Design: A correlational comparative study is proposed.
Sample: In the SJH ED, 300 pediatric patients 4 – 17 years of age (Group 2) and 300 infants and children less than 4 years (Group 1) will be invited to join the study. In order to gain maximal variability in temperature, children most likely to have fever will be preferentially recruited.

10. Patients on 96hrs Continuous Ventilation in ICU: Improving Interdisciplinary Communication and Ethical Decision Making

Investigators: Carmen Ferrell, RN, MS

Purpose: To determine the effects of early ethics interventions in intensive care patients on the ventilator 96 continuous hours on improved team communication and decision making in accord with patient preferences.
Methods: SJH intensive care units will be part of a St. Joseph Health System project to determine the effects of a chaplain/nurse proactive ethics consultancy for patients who have been on 96 hours of continuous ventilation.

Sample: ICU patients who have been ventilated for 96 hours
Setting: All SJH intensive care units (medical, coronary care unit, cardiovascular ICU)
Design: Pre/post evaluation of chart audits on measures to include demographic data (age, ethnicity, race, religion, admitting diagnosis, discharge diagnosis), cost parameters (ventilator days, ICU days, total LOS), issues and decisions communicated and documented.
Intervention: Proactive ethics consultation will occur during daily ICU rounds and will be led by either a chaplain, or Carmen Ferrell, a nursing director. The consultation will occur following chart review that explores the following 7 questions:
• Has the patient created or expressed any directions with respect to treatment?
• Is the patient currently competent?
• Is the patient, the whole team and the family aware of patient’s current diagnosis, prognosis, treatment objectives and alternatives?
• Do any treating physicians anticipate hurdles to recovery. What are they and what are the indicators of response to treatment.
• Is there any discussion or concerns about the limits of treatment for this patient?
• Are the ethical issues identified and understood in the Ready Reference Grid?
• Are there any unaddressed issues regarding patient care, management, patient preferences, or communication?

During rounds, the consultants will raise issues arising in conversations about issues arising from the above questions. These consultants will facilitate ethics discussion on issues arising from the questions. They will assist in the decision making process and bring to the surface difficult questions. If a difficult care dilemma is not easily resolved, the consultants will follow standard protocols per SJH (e.g., palliative care consult), and if necessary, obtain formal consultation through the ethics consultation (ACES) This is the end of the consultation.
Issues raised, discussion ensuing, and outcomes will be charted in the progress notes of the patient record. The attending physician will document necessary decisions/orders.
The intervention will last for 3 months.


11. Conference – October 13, 2006
“Pain Solutions Evidence-based Approaches to the Care of Persons Experiencing Pain”

Conference committee: Dana Rutledge, Peggy Walsh, Geri Westad, Pati Hagen, Pam Riley, Peggy Delmastro, Meri Van Gordon, Shivi Dixit, April Beachler, Vivian Norman, Nickol Frantzich, Mary Welly, Melissa Ogata, Jill Donaldson (Mission Hospital), Gloria Franklin (St. Jude Medical Center), Karen Savage.

Program Objectives:
· Discuss the relationship of scientific evidence to clinical recommendations in pain management
· Describe clinical issues and initiatives related to pain management
· Apply evidence in discussions with clinical cases

Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice

Iowa City, Iowa, September 20-22, 2006 will be the site of the next Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice. This program, developed by Marita G. Titler, PhD, RN, FAAN and Laura Cullen, RN, MA, has a small-group focus, is customized to meet individual needs, and is for nurses in leadership positions who are responsible for promoting EBP within their organizations.
Offered by the Department of Nursing Services and Patient Care at the University of Iowa Hospitals and Clinics since 2002, this Institute repeatedly generates positive comments like, "Great, usable workshop"; "This was the best group I have been involved with for a long time"; "Fabulous!"; "So impressed with the scheduling and program".

For more information or brochure http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpractice/apinstitute.html

Grace Rempel, Clerk
Nursing Research, Quality and Outcomes Management
University of Iowa Hospitals and Clinics
200 Hawkins Drive, T-100 GH
Iowa City, IA 52242-1009
319-384-6737

A Tool for Quantifying Organizational Support for Evidence-based Practice Change

This article, A Tool for Quantifying Organizational Support for Evidence-based Practice Change in Journal of Nursing Care Quality 21(2):110-113, April-June 2006 by Mary Friel Fanning (fanningm@rcbbsc.wvu.edu) and Dororthy W Oakes describes the need for a tool to be used in quantifying the use of labor and nonlabor supplies in a nursing research program. The tool developed by these authors and their team at West Virginia University Hospitals, the Record of Contribution form may be useful to other healthcare leaders who wish to quantify their organization's committment to ongoing nursing research. Saint Joseph Hospital of Orange and CHOC staff may read the full text of this article by logging in to this journal via the library's web site.

Heart surgery patients show no benefit when strangers pray for their recovery

According to the latest study on intercessory prayer in the April 2006 issue of American Heart Journal, heart surgery patients who had strangers pray for them did not incur fewer postoperative complications.

This controversial study should generate some great blogging!!

New Class! An Evidence Based Approach to the Care of the Psychiatric Patient

Department of Clinical Education Presents:
An Evidence Based Approach to the
Care of the Psychiatric Patient
Course Description:
This 4-hour class will examine psychiatric patient care issues concerning mood disorders, schizophrenia and agitation. Through the use of interactive lecture and case studies, the participant will be introduced to evidence based treatment modalities that are applicable to care issues in BHS, the Emergency Department, and the Critical Care and Medical/Surgical Units. Class content is appropriate for healthcare providers, specifically those with RN, MFT or LCSW Certification and in Spiritual Care.
Course Objectives:
Upon successful completion of the course, the participants should be able to:
Describe the presentation of patients in the depressed and manic phases of mood disorders.
Outline appropriate in hospital management for schizophrenic patients.
Evaluate treatment plans for patients with a history of aggressive behavior.

Speakers:
Himasiri DeSilva, MD
Vinayak Shanbhag, MD
Michael Wu, MD
Shelly Aguilar, RNC
Jeannine Loucks, RNC
Christine Pierce, RNC
Coordinators:
Beth Winokur, RN, MSN, CEN
Linda Winston, MFT, CEAP

General Information:
May 3, 2006
(8:00 am-12:00 pm)
St. Joseph Hospital, Orange, California
Zoul Auditorium
$15 refundable registration fee for SJHS Staff. All others $40.
Provider approved by the California Board of Registered Nursing, Provider Number 00156. Four (4) Contact Hours will be given for this course. Administrator of the CE Program is Patti Aubé, RN, MSN. The California LVN Board will accept credits that have been approved by the California BRN.
This course has been approved by the California Board of Behavioral Examiners PCE Number 1276.

Registration For: Evidence Based Approach to Psychiatric Care – May 3, 2006
Name:_________________________________
License #:______________________________
Address:______________________________
Organization:___________________________
City/State/Zip:________________________
Position/Unit:___________________________
Home Phone:____________________________
Work Phone:____________________________
All participants should make their checks payable to St. Joseph Hospital Department of Clinical Education, and mail them along with the above registration form to 1100 West Stewart Drive, Orange, California 92868. Refunds will be given if the request is received prior to the start of the course. No refunds will be given after the course has started. A refundable $15 registration is required for all St. Joseph Hospital, CHOC, and St. Joseph Health System employees. Refunds will be given upon completion of the class.

Save the Date!! St. Joseph Hospital's Nursing Research Council presents:

Pain Solutions:

Evidence-Based Approaches to the
Care of Persons Experiencing Pain
October 13, 2006
7:30am to 4:30pm

Keynote Speaker
Kathleen Puntillo, RN, DNSc, FAAN

For more information or to receive a brochure, please contact St. Joseph Hospital's
Clinical Education Department at 714/771-8000, ext 7495
or email Cheri.Cancelliere@stjoe.org

Orange, California

MedPage Today : a clearinghouse of new and compelling medical news info

http://www.medpagetoday.com Check it out!! (Not specifically nursing related but a great new resource)

Developed by The University of Pennsylvania School of Medicine and a team of
administrators and physicians, MedPage Today is a clearinghouse of new and
compelling medical news information. Along with these accessible and well-
written updates, the site also includes "Teaching Brief" articles which help
clinicians and consumers to understand the implications of these new
discoveries and developments in the medical world. From the left-side of the
homepage, visitors can peruse the latest news updates by specialty,
including psychiatry, nephrology, pediatrics, and others. Visitors who find
that they return to the site frequently may also want to sign up to receive
email updates every morning in their inbox. Overall, the site will be of
interest to medical practitioners as well as the lay public