What are RSS feeds?

Not really sure what RSS feeds are or how they might help you keep updated? If your library has OVID databases, the new OVID SP has the capability to subscribe to tables of contents of OVID journals through the RSS technology.

Burlew Medical Library at St. Joseph Hospital in Orange, California has developed a brief document that will explain the RSS technology and give you some ideas as to how you might use RSS.

For instance, some of the RSS feeds to which I subscribe are:

Nursing Research table of contents
Krafty Librarian blog
Pubmed search on autistic disorder
Shifted Librarian blog
Consumer Health Forum
Reuters Health

I valiantly try to set time aside once a week to visit my bloglines reader and catch up on all my new feeds. It's really a " one stop" approach to shopping for the new information that meets your particular interests.

Does anyone in the blogosphere want to share how they use RSS technology and what their favorite nursing feeds are?

Systematic Review Made Simple for Nurses

There is an excellent article in SGH Proceedings v 16(2):104-110 2007 by Leong Siew Teing titled Systematic Review Made Simple for Nurses. This article is available as free full text. The SGH Proceedings is a refereed scientific journal of the Singapore General Hospital. The article also highlights a three phase lit search strategy recommended by the Joana Briggs Institute (JBI).

Cochrane Collaboration on YouTube

Evidenced based resources on YouTube-- who would have thought!!

View this brief 7 minute videotape that gives a great overview of the Cochrane Collaboration and the Cochrane Library.

Abstract with Commentary

Abstract and Commentary

Robinson, S. et al. (2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURG Nursing, 16, 157-161.

Author’s Abstract

Studies indicate 40% of indwelling urinary catheters are unnecessary in hospitalized patients (Gardam, Amihod, Orenstein, Consolacion, & Miller, 1998; Gokula, Hickner, & Smith, 2004). The results of a protocol developed to limit catheter use are described.

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

The project was framed in the Iowa Model of Evidence-Based Practice (EBP; Titler et al., 2001), the same model adopted at St. Joseph Hospital. Nurses at a large tertiary care center identified a potential problem: inappropriate use of indwelling urinary catheters. The trigger to action was guidelines developed by the Nurses Improving Care to Health System Elderly (NICHE). The guidelines recommend limiting catheters to elders with very specific problems such as urinary retention.

Chart audits of patients with indwelling catheters found 17% with documented urinary tract infections (UTI). A team was formed to develop a protocol to encourage more appropriate use of indwelling catheters. This group reviewed 32 articles on the topic, about half of which were rated as strong evidence sources. Based upon the evidence, they determined when urinary catheters are appropriate in hospitalized patients.[1]

A pre-protocol chart audit indicated that 35% of patients had a urinary catheter at some time during hospitalization. Of these, 42% had no appropriate reason for catheter use. Only 70% had an order for insertion. Almost 40% were inserted in the emergency department. Almost 2/3 were not removed until day of discharge. Symptoms of UTI developed in 38% of patients.

A 2-week pilot test was done with nurses requesting an order for removal of the catheter unless it was used for one of the criteria in the footnote below, along with use in patients 48 hours post surgery. Afterwards, mean days that catheters were in place dropped from 8.6 to 4.5 days, orders to remove increased (43% to 93%), documentation of removal increased (57% to 87%), and only 7% of patients had catheters in on discharge day. In the pilot group, only13% had UTI symptoms.

To institute this change in practice (nurses asking for catheter removal), a multi-method educational effort ensued. Pilot outcomes were disseminated, along with findings from the literature. Physicians were educated at several formal gatherings. This manuscript does not describe outcomes from the full scale implementation.

Can you think of which patients at SJH may have inappropriate urinary catheters? What methods could be used to decrease their use? What resources would be needed to implement these methods?

Titler, M.G. et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care.
Critical Care Nursing Clinics of North America, 13, 497-509.

[1] For bladder irrigation or instillation of medication; to provide relief of urinary tract obstruction; to permit drainage in persons with neurogenic bladder dysfunction or urinary retention not manageable by other means; to obtain accurate intake and output in critically ill patients; to aid in urologic or related surgery; to manage urinary incontinence in persons with stage 3 or 4 pressure ulcers; and to promote comfort care in the terminally ill

Medcal Library Association's white paper on magnet recognition

Our blog is mentioned in the Medical Library Association's white paper: Magnet Recognition Program Collaboration Proposal: The American Nurses Credentialing Center and the Medical Library Association. One of the sections deals with Librarians' contributions to their institutions' magnet journey and gives examples of nurse/librarian collaborations. Our blog is mentioned at the end of this section and is the only activity of this kind listed in the contribution section. Way cool!!

Julie's picks from the Nursing Literature Oct 2007

Check out these "picks" from recent articles dealing with nursing research or evidence based nursing.

1. Wilhelmsson S. Lindberg M. Prevention and health promotion and evidence-based fields of nursing -- a literature review. International Journal of Nursing Practice. 2007 Aug; 13(4): 254-65. (27 ref) Burlew has some online access, no print issues. AN: 2009640528 NLM Unique Identifier: 17640247.
NLM Serial ID Number9613615
ISSN

2. Matchim Y. Armer JM. Measuring the psychological impact of mindfulness meditation on health among patients with cancer: a literature review. Oncology Nursing Forum. 2007 Sep; 34(5): 1059-66. (41 ref) Burlew carries this journal AN: 2009667780 NLM Unique Identifier: 17878133.
NLM Serial ID Number7809033
ISSN

3. Rawson KM. Newburn-Cook CV. The use of low-dose warfarin as prophylaxis for central venous catheter thrombosis in patients with cancer: a meta-analysis. Oncology Nursing Forum. 2007 Sep; 34(5): 1037-43. (30 ref) Burlew carries this journal AN: 2009667778 NLM Unique Identifier: 17878131.
NLM Serial ID Number7809033
ISSN

4. Jansen CE. Miaskowski CA. Dodd MJ. Dowling GA. A meta-analysis of the sensitivity of various neuropsychological tests used to detect chemotherapy-induced cognitive impairment in patients with breast cancer. Oncology Nursing Forum. 2007 Sep; 34(5): 997-1005. (35 ref) Burlew carries this journal AN: 2009667775 NLM Unique Identifier: 17878128.
NLM Serial ID Number7809033
ISSN

5. 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) AN: 2009153576 NLM Unique Identifier: 16573728.
NLM Serial ID Number8916634
ISSN

6. Mickle J. Reinke D. A review of anemia management in the oncology setting: a focus on implementing standing orders. Clinical Journal of Oncology Nursing. 2007 Aug; 11(4): 534-9, 590-4. (19 ref) Burlew has some years. AN: 2009646490 NLM Unique Identifier: 17723966.
NLM Serial ID Number9705336
ISSN

7. Moore SM. Duffy E. Maintaining vigilance to promote best outcomes for hospitalized elders. Critical Care Nursing Clinics of North America. 2007 Sep; 19(3): 313-9. (40 ref) Burlew carries this journal AN: 2009660369 NLM Unique Identifier: 17697952.
NLM Serial ID Number8912620
ISSN

8. Kelly T. Howie L. Working with stories in nursing research: Procedures used in narrative analysis. International Journal of Mental Health Nursing. 2007 Apr; 16(2): 136-44. (37 ref) AN: 2009544947 NLM Unique Identifier: 17348965.
NLM Serial ID Number101140527
ISSN

9. Closs SJ. Postoperative ibuprofen increased bleeding complications in hospital and did not improve pain or physical function at 6-12 months after total hip replacement. Evidence-Based Nursing. 2007 Apr; 10(2): 57. (5 ref) Burlew has some online access, no print issues. AN: 2009552902 NLM Unique Identifier: 17384109.
NLM Serial ID Number9815947
ISSN

10. Stone C. Rowles CJ. Nursing students can help support evidence-based practice on clinical nursing units. Journal of Nursing Management. 2007 Apr; 15(3): 367-70. (13 ref) Burlew has some online access, no print issues. AN: 2009546843 NLM Unique Identifier: 17359437.
NLM Serial ID Number9306050
ISSN0966-0429

11. Garbett R. Hardy S. Manley K. Titchen A. McCormack B. Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise. Journal of Nursing Management. 2007 Apr; 15(3): 342-7. (23 ref) Burlew has some online access, no print issues. AN: 2009546840 NLM Unique Identifier: 17359434.
NLM Serial ID Number9306050
ISSN

12. Jansen J. van Weert J. van Dulmen S. Heeren T. Bensing J. Patient education about treatment in cancer care: an overview of the literature on older patients' needs. Cancer Nursing. 2007 Jul-Aug; 30(4): 251-60. (35 ref) Burlew carries this journal AN: 2009646256 NLM Unique Identifier: 17666973.
NLM Serial ID Number7805358
ISSN

13. Dunne M. Kelvin J. Derby S. Montefusco M. Cawley K. Lucas J. Gilman J. Bringing the evidence to practice: development of guidelines for mucositis prevention and management in patients receiving cancer therapies. Oncology Nursing Forum. 2006 Mar; 33(2): 396-7. Burlew carries this journal AN: 2009169830.
NLM Serial ID Number7809033
ISSN

14. Baldwin KM. A case for using evidence-based assessment scales. American Journal of Critical Care. 2007 Jul; 16(4): 394-5. (10 ref) Burlew carries this journal AN: 2009616894 NLM Unique Identifier: 17595372.
NLM Serial ID Number9211547
ISSN

15. Labeau S. Vandijck DM. Claes B. van Aken P. Blot SI. Critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. American Journal of Critical Care. 2007 Jul; 16(4): 371-7. (32 ref) Burlew carries this journal AN: 2009637067 NLM Unique Identifier: 17595369.
NLM Serial ID Number

16. James V. Clark JM. Focus. Benchmarking research development in nursing: Curran's competitive advantage as a framework for excellence. Journal of Research in Nursing. 2007; 12(3): 269-87. (34 ref) AN: 2009645900.
NLM Serial ID Number101234311
ISSN1744-9871

17. Woodward V. Webb C. Prowse M. Focus. The perceptions and experiences of nurses undertaking research in the clinical setting. Journal of Research in Nursing. 2007; 12(3): 227-44. (67 ref) AN: 2009645892.
NLM Serial ID Number101234311
ISSN

Archives of Disease of Childhood launches two new blogs

Archives of Disease of Childhood has launched two new blogs. While these blogs don't directly pertain to nursing research or evidence based nursing, I wanted to bring them to your attention as I believe they offer some innovative ideas for us. Wouldn't it be cool if we were able to highlight key nursing articles in one sentence as the Precis blog does? For those of you accessing this blog from St. Joseph Hospital, Orange or Children's Hospital of Orange County, you will be able to click on the full text of the article.

1. The Précis Blog Précis starts with the idea that any good paper can be summarised in one sentence. That sentence may sometimes be complex, and should normally leave you wanting to know more, but it will contain the core of what the paper is about. This is, by its nature, idiosyncratic, and hopefully sometimes controversial. The blog focuses on the online first part of ADC:

2. The Archimedes Blog You'll be familiar with Archimedes, the bimonthly section of evidence-based questions and answers, and with the Archimedes blog you: Get to see the questions as they are being asked, and can comment on the answer you expect to see. Can argue about the interpretation of evidence from the published topic report. Can add new information to older reports. There are also teaching tips, bite-sized explanations of EBM concepts and links to other places where the practice of evidence-based child health can be discussed.The bloggers explain why they think this is important in an editorial in the November issue of ADC.
Don't forget to sign up for the Blog RSS feeds so you don't miss anything.

Research Interview

First of all I would like to thank all the nurses who have been interviewed for allowing us to showcase their projects. Secondly I would like to wish Happy Holidays to everyone!
We are now coming to the end of an exciting year in evidence-based practice and research here at St. Joseph Hospital with many new projects to come in 2008. As you have seen from the other articles our nurses are busy! This issue I would like to introduce you to Kathleen Close, the Colorectal Nurse Navigator here at St. Joseph Hospital and her study is called “Gum Chewing for Post-Colorectal Surgery Patients.”

Q. What is your study about?
A. “My study is about determining ways to prevent ileus following colorectal surgery. We need to know if providing patients with gum after colorectal surgery decreases their incidence of time to flatus and bowel movements and if this leads to a decrease in ileus.”

Q. Is it an EBP/ResearchProject?
A. “This is retrospective pre/post comparative study.”

Q. What made you interested in this project?
A. “As the Nurse Navigator for colorectal patients I am responsible to identify and follow-up on any patients who have been newly diagnosed with any type of colorectal disease. I follow them from the time of diagnosis, through surgery, and then post surgery. I am available to them 24 hours, 7 days a week until they are home and comfortable. Our colorectal cancer patients I keep in touch with on an ongoing basis because I help coordinate our support group. Due to this role I really decided to look in to the research and see if there was any information on decreasing ileus to help these patients after their surgeries. As the Colorectal Nurse Navigator I love my role and I love my patients, therefore I want to decrease any complications they might have if I can.
My daughter heard an article being discussed on the radio one morning from JAMA as a possible health program and told me about it. I had our library pull all the current articles regarding this study and the Japanese study was among the articles I received which is called, “Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy”, (Asao, T. et al. 2002). These researchers found patients undergoing laparoscopic colectomy for colorectal cancer who chewed sugarless gum three times per day passed flatus and defecated sooner than did patients who did not with good significance (p<. 01). I thought this is great! Especially since the amount of literature on this subject is very limited.”

Q. How did you go about doing your research?
A. “After reading this article and a few others, my daughter and I decided I should try to replicate this study. So I presented the idea to the three physicians I work with and we decided this would be a great idea. I then brought the idea to Dana Rutledge in the Nursing Research Department and we worked on the logistics as far as what type of study I should do, how many charts, and what information we should be looking at. We used the other studies I looked at as a basis for data collection. We developed a tool to audit my charts. I then went to the IRB and presented my project. Once approved, I was on my way. Since then I have been working with you to collect my data. We will soon be analyzing the data.”

Q. What are your expected outcomes?
A. “Well initially, I was really hoping we would see a difference with gum chewing, but at this point after collecting the data I noticed there was not a decrease in ileuses. One study actually said that gum chewing might be a safe way to provide benefits of stimulation without the same complications of feeding (Asao, T. et al) but I’m not sure if the data we found actually has the same results. Since we don’t have statistical analysis yet, I do not know statistically what we have actually found. It is so hard to know what your research will lead you too.”
Q. Have you done research before? If so what did you learn?
A. “ Yes, I was involved in drug research with Bristol Meyers on a drug many years ago. The drug was to help with diagnosis and prevention of early Alzheimer’s but the medication never made it to the market. I never actually found out what the results were. I thought the medication actually made a difference but the patients may have done better because we gave them a lot of attention, so it could have been a placebo effect.”
Q. Will you do an EBP/research project again?
A. “Yes. I enjoy doing research. My results may help other people regardless of positive or negative outcomes. Research also helps find new and exciting questions and answers. I don’t really find research to be that difficult once you start. The biggest problem has been getting other people excited initially about the project. But once I got everyone on board, it took off. Working with you made data collection easier since we had a great system worked out for getting the charts from medical records. Once I got a system with auditing the charts, it actually went fast! I am looking forward to our analysis.

References

Asao, T. et al. (2002). Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. Journal of the American College of Surgeons, 195, 30-32.

Oct 3 2007 Nursing Research Council KEY POINTS

We will now post a "key points" summary of each of our monthly Nursing Research Councils:

October 3, 2007 Nursing Research Council – KEY POINTS


The Research Reflection prompted the Council to discuss a possible new project for blood pressure screening in the ED.

There are now two RN members of the IRB Committee and nursing projects are beginning to receive expedited reviews.

There were reports on the progress of all ongoing projects.

Education was provided on EBP nursing competencies. Dana Rutledge and Vickie Morrison will incorporate these competencies into next year’s EBP classes.

Eleanor Jamieson, Carmen Ferrell and Dana Rutledge have an article accepted for publication in Med Surg Nursing. The topic is outcomes from the MET Team.

The Nursing Research Blog Committee will meet in December for an update and additional training.

The Council will continue to invite new members and talk about EBP on their units.

There will be a special EBP presentation at Nursing Grand Rounds on November 19. Breakfast will be served.

Do patients coming in to the emergency department for minor injury display psychiatric comorbidities?

Research Abstract with Commentary

Abstract: Psychiatric disorders in patients presenting to the Emergency Department for minor injury

BACKGROUND: Thirty-five percent of all Emergency Department (ED) visits are for physical injury.
OBJECTIVES: To examine the proportion of patients presenting to an ED for physical injury with a history of or current Axis I/II psychiatric disorders and to compare patients with a positive psychiatric history, a negative psychiatric history, and a current psychiatric disorder. METHODS: A total of 275 individuals were selected randomly from adults presenting to the ED with a documented anatomic injury but with normal physiology. Exclusion criteria were: injury in the previous 2 years or from medical illness or domestic violence; or reported treatment for major depression or psychoses. Psychiatric history and current disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual Disorders, 4th edition (DSM-IV), a structured psychiatric interview. Three groups (positive psychiatric history, negative psychiatric history, current psychiatric disorder) were compared using Chi-square and analysis of variance.
RESULTS: The sample was composed of men (51.6%) and women (48.4%), with 57.1% Black and 39.6% White. Out of this sample, 103 patients (44.7%) met DSM-IV criteria for a positive psychiatric history (n = 80) or a current psychiatric disorder (n = 43). A past history of depression (24%) exceeded the frequency of a history of other disorders (anxiety, 6%; alcohol use/abuse, 14%; drug use/abuse, 15%; adjustment, 23%; conduct disorders, 14%). Current mood disorders (47%) also exceeded other current diagnoses (anxiety, 9%; alcohol, 16%; drug, 7%; adjustment, 7%; personality disorders, 12%). Those with a current diagnosis were more likely to be unemployed (p <.001) at the time of injury. CONCLUSIONS: Psychiatric comorbid disorders or a positive psychiatric history was found frequently in individuals with minor injury. An unplanned contact with the healthcare system (specifically an ED) for treatment of physical injury offers an opportunity for nurses to identify patients with psychiatric morbidity and to refer patients for appropriate therapy. Richmond, T.S., Hollander, J.E., Ackerson, T.H., Robinson, K., Gracias, V., Shults, J., Amsterdam, J. (2007). Psychiatric disorders in patients presenting to the Emergency Department for minor injury. Nursing Research, 56, 275-82.

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

The framework for the study – which is not described in the abstract – indicates that when psychiatric disorders occur along with traumatic injury, the potential for disability is substantial. What is remarkable about the findings of this descriptive study is the high numbers of patients with psychiatric conditions, despite the fact that those with major depression and psychoses were excluded. Also impressive is the fact that persons with the fewest resources available to them (those with lower levels of education, the unemployed) were the most likely to have comorbid psychiatric disorders.

Do these patients resemble those seen in the SJH ED for minor injury? Maybe not… there were 57% black patients, which does not reflect an Orange County population. However, the other demographic variables may be more in line with our patients.

What the study did not do was ask what resulted from knowledge of the psychiatric disorder in terms of referrals, or work up in the ED. These aims were beyond the purpose of this study, but are important to consider in thinking about the implications of these findings for SJH nurses. I believe this study points to the potential screening/referral role of nurses in the ED for multiple conditions, such as those described in this article (psychiatric disorders).

Interview with Pam Matten regarding her research on smoking cessation for healthcare professionals

Vickie’s Research Corner

Welcome again to my corner of the newsletter. It is so amazing to know that so many of our nurses are actually doing research. This issue, I would like to introduce you to Pam Matten, Nurse Navigator for the Lung Program here at St. Joseph Hospital, Orange, California. Her study is called “Assessment of community based smoking/tobacco cessation training program for healthcare professionals.”

Q. What is your study about?
A. “My study is educating nurses in the hospital setting to assess patients readiness to quit smoking. Some of our goals include equipping bedside nurses with the confidence and skills to talk to patients about smoking cessation and give a brief intervention. We follow up by providing access to free smoking cessation classes taught by SJH RNs.”

Q. Is it an EBP/ResearchProject?
A. “This is a quantitative research study.”

Q. What made you interested in this project?
A. “ Let me give a little background about my job first. As the Nurse Navigator for the Lung Program I am responsible to identify and follow up on any patients who have been newly diagnosed with lung cancer. I assist patients in navigating their way through chemotherapy, radiation therapy, etc. and link them to the necessary services and support. In addition, I provide patient education and support throughout their treatment.
I also facilitate a lung cancer support group. I am active in identifying patients for clinical trials and organizing the weekly patient management conference. I have a little bit of everything in my job (which keeps it interesting). I work with marketing and business development on "getting the word out" about the Lung Program by meeting with Primary Care Physicians. I also provide education to the community regarding lung cancer. I teach Smoking Cessation/ Readiness to Quit to the clinicians at SJH and I also teach outpatient smoking cessation classes to the community through a partnership with Santiago Canyon College. Just to add to my job, I facilitate a Journal Club for the physicians on lung cancer. I manage the CT Lung Cancer Screening program, which provides low-cost CT lung screening to at-risk-individuals in the community.
I got started in clinical research through Dr. Eunice Chung PharmD. She partnered me with an Oncology PharmD intern, Dr. Tim Chen. Together we developed the clinician education class I mentioned before. We had smoking cessation classes at outpatient sites but nothing for clinicians on the inpatient side. We wanted to design classes that were cohesively linked to our out-patient resources. The goal is to provide easy access to cessation services through our bedside nurses.”



Q. How did you go about doing your research?
A. “Dr. Wong suggested that we tie our education to a clinical trial. We contacted Dana Rutledge, the Nurse Research Facilitator, to see if she would like to be involved. She said yes and helped us develop the study and get us ready for IRB. We had subsequent meetings and began presenting our model and our preliminary data at conferences. Since this is a multi disciplinary effort our research has been presented at nursing conferences and pharmacy conferences, as well.”

Q. What are your expected outcomes?
A. “I am hoping that the nurses will use the materials they are taught to assess smoking practices for inpatients and point them towards the outpatient classes. I want the question of smoking cessation to be assessed easily and continually, like a vital sign. It takes people an average of 10.8 tries over 18 years before they quit for good. Continual assessment by a health care professional has been shown to increase a patient’s likelihood of quitting by 50%. ”

Q. Have you done research before? If so what did you learn?
A. “No, this is the first time I have ever done research. The IRB (Internal Review Board) felt a bit intimidating at first because they can potentially ask you anything about your study. I had two wonderful mentors; Dr. Dana Rutledge and Dr. Siu-Fung Wong who helped me every step of the way. I do think research is very fun, creative, and rewarding. I always thought only scholars or academics could perform research. I now know that any clinician with an interest in bringing about positive change for patients can participate.” I would encourage all clinicians to support evidence-based practice by participating in clinical research.”

Q. Will you do an EBP/research project again?
A. “Yes and I am always looking for opportunities. Once you start a research project it tends to snowball into additional projects. Recently, St. Joseph Hospital Cancer Center received a NCI grant that will focus on many issues including survivorship and health care disparities in the Oncology population. I am looking forward to pursuing clinical trials tied to those projects”.

E-Journal Club #12

Bourgault, Annette M. et al; “Development of Evidence-Based Guidelines and Critical Care Nurses’ Knowledge of Enteral Feeding”, Critical Care Nurse, August 2007 pp17-29.

This is an excellent example of a nurse taking a broad look at the literature on a narrow topic and applying it to her practice. This is evidence based nursing. I especially liked the idea of marking the feeding tube with an indelible marking pen upon insertion after the xray is done. Perhaps this could be applied to ET tubes?
I would like to see some article address the best taping (to the nose) strategy and which tape is best to use!!
The American Association of Critical Care Nurses now offers its’ members free CEU’s. This article has CEU’s attached as do two other excellent articles in this same issue. I found that answering the questions reinforced the article’s message. This journal and the American Journal of Critical Care are complimentary with membership to this association. I think you are more than paid back for your membership costs.

E-Journal Club #11

Williams, Myrtle,Kathryn Jordan, “The Nursing Professional Portfolio: A Pathway to Career Development”, Journal for Nurses In Staff Development, Vol.23(3), 125-131.

ABSTRACT:

Nursing professional portfolios have moved beyond the traditional listing of past experiences and accomplishments. They now provide a format for self-reflection on practice and for goal planning, capturing both the art and the science of nursing. This article describes the experiences of designing and implementing the use of a comprehensive professional portfolio and the benefits realized by individual staff nurses and their managers.

JUDY’S COMMENTS:

I have posted an article like this in the past because I thought it seemed like a great idea. Now this article takes it one step further. I’ve felt that annual reviews are sometimes viewed as a process of futility for the staff. They see it as an opportunity for your boss to complain or assign you a job for the year. And where’s the follow up they always promise?
Last year, I decided to make a summary on PowerPoint. That way I could include some of the great pictures I’d taken of the off or on campus continuing education, the “teams” I was a member of, etc. It was not only a fun project for me, but gave me a different insight in what I wanted to say and how I viewed my own past year in better perspective.

CONSORT statement website redesigned

The CONSORT Group are delighted to announce a redesign of the CONSORT
Statement website.
http://www.consort-statement.org
The CONSORT Statement is an evidence-based, minimum set of
recommendations for reporting randomized controlled trials. It offers a
standard way for authors to prepare reports of trial findings,
facilitating their complete and transparent reporting, and aiding their
critical appraisal and interpretation.
Thanks to the financial support of the UK National Coordinating Centre
for Research and Methodology, the new CONSORT website enhances its
capability to keep up with the growing complexity and increasing impact
of the CONSORT Statement.
Some highlights of the site:
* The definitive version of the CONSORT Statement
* The CONSORT checklist: examples and explanation of each item
* Translations of the CONSORT Statement into ten languages
* Extensions to the main CONSORT Statement for different trial designs,
interventions and data types
* Browsable bibliographies of the evidence underpinning CONSORT
* History and impact of CONSORT
* News articles on the developments of CONSORT
* A full glossary of terms
* A simple yet powerful search facility
Please circulate widely. We will be delighted to hear what you think of
the site.
cheers
Douglas
--
Mr Douglas Badenoch
Director, Minervation Ltd
-------------------------
23 Bonaly Grove
Edinburgh
EH13 0QB
-------------------------
Tel: +44 131 441 4699
Web: www.minervation.com

E-Journal Club #10

Cummings, Greta; Hayduk, Leslie; Estabrooks, Carole, “Mitigating the Impact of Hospital Restructuring on Nurses: The Responsibility of Emotionally Intelligent Leadership”, Nursing Research, January/February 2005, Vol 54(1), p 2-12.

Abstract:
Background: A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care.
Objective: To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts.
Methods: The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets.
Results: Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders.
Discussion: Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

Judy's comments:
The objectives of this original research seem huge. First to develop a theoretical model seemed confusing and impossible to me. Then to take the subject of “emotional intelligence” and adapt it to this model seemed pretty daunting. But the author’s seem to pull it off with little effort and present some thoughtful introspection into some concepts that the bedside nurse doesn’t always dwell on. Specifically, how does her manager affect her working environment.

The subject of ‘emotional intelligence” caught my eye recently. I am still exploring the topic. I also haven’t found many articles that explore the history of the hospital restructuring of the 1990’s, of which I was a part of. Sometimes we don’t value our history enough.

E-Journal Club #9

Rogers, Ann E., Wei-Ting Hwang, Linda D. Scott, Linda H. Aiken, and David F. Dinges, “The Working Hours of Hospital Staff Nurses and Patient Safety”, Health Affairs Vol. 23/4, July/August 2004: pp202-212.

ABSTRACT:
“The use of extended work shifts and overtime has escalated as hospitals cope with a shortage of registered nurses (RNs). Little is known, however, about the prevalence of these extended work periods and their effects on patient safety. Logbooks completed by 393 hospital staff nurses revealed that participants usually worked longer than scheduled and that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours. The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.”

This is the Research Council’s journal club article for August and very timely. I have been in nursing long enough to recall a time when we all changed to twelve hour shifts. I should say “back” to twelve hour shifts, because twelve hour shifts appeared early on in the history of nursing. I wonder why they changed to eight hour shifts?
In the past few years, I’ve also noticed a trend toward some of the staff working more extra shifts. Some of the staff actually works enough extra shifts to qualify as working a “second job”. I have been amazed at their stamina, because I work part time and find that exhausting. I also know these are the staff that management favors for their flexibility and are therefore building up bonus points when in fact management should be worried about the rate of errors this article alludes to.

EVERYONE IS WELCOME! Please join us at the next Nursing Research Journal Club on Wednesday, August 8, 12:00 pm-1:00 pm, Sr. Frances Dunn Building, Classroom I.

E-Journal Club #8

Lokk, Johan, PhD; Arnetz, Bengt, MD, PhD, “Work Site Change and Psychosocial Well-being among Health Care Personnel in Geriatric Wards – Effects of an Intervention Program”, Journal of Nursing Quality Assurance, July, 2002 Vol16(4) pp.30-38

Abstract
"The study evaluated the effect of a change of work site and organization on work environment and psychosocial parameters; the change involved health care personnel at a geriatric hospital. Another aim of this study was to evaluate the effects of a structured psycho-educational intervention program. The study found few changes in the indices of interest on the experimental and control wards. There were, however, significant improvements in social climate, goal quality, and independence of work on the control ward. The investigators postulated that too much external support hampers a group's ability to actively cope with change and might actually lower a group's ability and self-esteem. In order to achieve successful organizational change, psychosocial intervention programs for personnel must be performed by a well-informed, well-chosen, and experienced counselor who is well tailored to the local organization."

I was looking for an article that would focus on the apprehension some of the staff in the hospital have regarding the move in October of this year to a new “wing”. Many of our staff members are new graduates, just trying to cope with learning all the details that your first year brings.
I remember the opening of the third critical care unit here at this hospital not too long ago, and the chaos (stress) that ensued until the small details of where everything is was brought under control. And this “wing” is completely new in design and physical orientation. The visitor waiting room is directly across from the nursing station. How will that work out?

E-Journal Club #7

Lindgren, Vicki A. MSN, RN,CCRN “Caring for Patients on Mechanical Ventilation”, American Journal of Nursing, May 2005, Vol 105/5; pp 50-59.

Summary: “This article addresses several integral areas of care, including weaning from mechanical ventilation, preventing ventilator-associated pneumonia, providing nutritional support, managing anxiety, timing tracheostomy, preventing aspiration and promoting sleep.”

Here is another example of why I like the AJN. This article, although it does not present new research, displays the current abundant research on the subject of mechanical ventilation in critical care. At the end of each section, she highlights “Best nursing practice”, and includes the references to important guidelines and their web addresses.

When Victoria Randazzo first began to develop her sedation protocol ideas here at St. Joseph's, she gathered many of the great articles published on this subject, including many listed at the end of this article. They began the foundation of what she wanted to accomplish and why.

As we continue to use research and evidence based practice, we begin to ask questions of our nursing practice. It is comforting to know that much of what we do is based on current research and a multidisciplinary approach to the answer.

Blog to visit

I just paid this blog a visit and found some interesting comments on generational issues AND some suggestions for change! Judy
http://www.onehealthpro.com/

E-Journal Club #6

Andrews, Tom RN, PhD, Waterman, Heather RN, PhD, “Packaging: a grounded theory of how to report physiological deterioration effectively”, Journal of Advanced Nursing, December 2005, 52(5), pp473-481.

Abstract

Aim: The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors.

Background: The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications.

Method: The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 healthcare support workers).

Findings: Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems.

Conclusion: The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.

Julie's picks from the May literature

These are Julie's picks from the May crop of new articles dealing with EBN or Nursing Research.

1. Plach SK. Paulson-Conger M. Demystifying the research process with participatory learning: a taste of research. Journal for Nurses in Staff Development. 2007 Jan-Feb; 23(1): 45-8. (10 ref) Burlew carries this journal AN: 2009574921 NLM Unique Identifier: 17259821.

2. Harris K. Spinweber C. Dohergy M. Milligan L. Addy L. Hydo B. The integration of a nurse model to increase clinical excellence. Journal for Nurses in Staff Development. 2007 Jan-Feb; 23(1): 12-9. (12 ref) Burlew carries this journal AN: 2009511674 NLM Unique Identifier: 17259816

3. Catania K. Huang C. James P. Madison M. Moran M. Ohr M. Wound wise. PUPPI: the Pressure Ulcer Prevention Protocol Interventions. American Journal of Nursing. 2007 Apr; 107(4): 44-53. (24 ref) Burlew carries this journal AN: 2009566362 NLM Unique Identifier: 17413732.

4. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing. 2007 Mar-Apr; 24(2): 81-94. (49 ref) Burlew carries this journal AN: 2009523593 NLM Unique Identifier: 17332422

5. Levin RF. Feldman HR. The EBP controversy: misconception, misunderstanding, or myth. Research and Theory for Nursing Practice. 2006 Fall; 20(3): 183-6. (9 ref) AN: 2009285308 NLM Unique Identifier: 16986352

6. Shirey MR. Stress and coping in nurse managers: two decades of research. Nursing Economics. 2006 Jul-Aug; 24(4): 193-203, 211. (62 ref) Burlew carries this journal AN: 2009270153 NLM Unique Identifier: 16967890.

7. Vratny A. Shriver D. A conceptual model for growing evidence-based practice. Nursing Administration Quarterly. 2007 Apr-Jun; 31(2): 162-70. (57 ref) Burlew carries this journal AN: 2009553588 NLM Unique Identifier: 17413511.

8. Shaha M. Rabenschlag F. Burdensome situations in everyday nursing: an explorative qualitative action research on a medical ward. Nursing Administration Quarterly. 2007 Apr-Jun; 31(2): 134-45. (47 ref) Burlew carries this journal AN: 2009553584 NLM Unique Identifier: 17413507.

9. Schiemann D. Moers M. Expert standards in nursing as an instrument for evidence-based nursing practice. Journal of Nursing Care Quality. 2007 Apr-Jun; 22(2): 172-9. (11 ref) Burlew carries this journal AN: 2009552693 NLM Unique Identifier: 17353755.

10. Cooper CL. Nolt JD. Development of an evidence-based pediatric fall prevention program. Journal of Nursing Care Quality. 2007 Apr-Jun; 22(2): 107-12. (16 ref) Burlew carries this journal AN: 2009555080 NLM Unique Identifier: 17353745.

11. Fontenot HB. Transition and adaptation to adoptive motherhood. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007 Mar-Apr; 36(2): 175-82. (15 ref) Burlew carries this journal AN: 2009549935 NLM Unique Identifier: 17371522.

12. Ridley RT. Diagnosis and intervention for occiput posterior malposition. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007 Mar-Apr; 36(2): 135-43. (31 ref) Burlew carries this journal AN: 2009549928 NLM Unique Identifier: 17371514.

13. Muller-Staub M. Lavin MA. Needham I. van Achterberg T. Nursing diagnoses, interventions and outcomes -- application and impact on nursing practice: systematic review. Journal of Advanced Nursing. 2006 Dec; 56(5): 514-31. (92 ref) Burlew has some years. AN: 2009323396 NLM Unique Identifier: 17078827.

14. Freeman T. 'Best practice' in focus group research: making sense of different views. Journal of Advanced Nursing. 2006 Dec; 56(5): 491-7. (24 ref) Burlew has some years. AN: 2009323394 NLM Unique Identifier: 17078825

15. Vaughn F. Wichowski H. Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN Journal. 2007 Mar; 85(3): 589-94, 597-604. (20 ref) Burlew carries this journal AN: 2009540490 NLM Unique Identifier: 17352896.

16. Chi GC. The role of hope in patients with cancer. Oncology Nursing Forum. 2007 Mar; 34(2): 415-24. (45 ref) Burlew carries this journal AN: 2009545021.

17. Vanderboom T. Does music reduce anxiety during invasive procedures with procedural sedation? An integrative research review. Journal of Radiology Nursing. 2007 Mar; 26(1): 15-22. (21 ref) AN: 2009541527.

18. Richards T. Johnson J. Sparks A. Emerson H. The effect of music therapy on patients' perception and manifestation of pain, anxiety, and patient satisfaction. MEDSURG Nursing. 2007 Feb; 16(1): 7-15. (20 ref 2 bib) Burlew carries this journal AN: 2009539240.

E-Journal Club #5

Todd, Betsy MPH, RN, CIC, “Extensively Drug Resistant Tuberculosis”, AJN, Vol.107 (6), June 2007, pp. 29-31.

Abstract: Recent outbreaks highlight the need for improved prevention,

control, and surveillance programs.

I like the American Journal of Nursing because their articles are short, to the point and usually timely (as well as informative). This week’s article has all of these characteristics as well as some pretty impressive graphics if you visit the journal in person or on-line at the Burlew library’s web site “Burlew On-Line Journals”.

I found this an excellent article to supplement an understanding to the recent news report on a drug resistant tuberculosis patient who was flying a commercial plane internationally.

While the article addresses the history and need for control, how will that control be achieved? How are an individual’s rights and responsibilities balanced? It is enlightening to understand the prevalence of this type of TB.

Summary of the 6th Annual Evidence-Based Practice Conference at UCLA

Victoria Morrison, RN, BSN, Nurse Research Assistant at St. Joseph Hospital in Orange, Calfiornia, recently attended the 6th Annual Evidence-Based Practice Conference at UCLA. Here is her summary :

On April 26, 2007, I went to the 6th Annual Evidence-Based Practice Conference at UCLA, “Empowering Patients and Nurses As Partners in Evidence-Based Care.” I thought I would share some of the keynote speaker’s ideas on evidence-based practice. The keynote speaker, Bernadette Mazurek Melnyk, PhD, RN, CPNP/NPP, FAAN, FNAP, is the Dean and Distinguished Foundation Professor in Nursing at Arizona State University. She kindly emailed me and gave me permission to use excerpts from her lecture to put on our blog.

According to Dr. Melnyk, evidence-based practice (EBP) is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values. The aim of EBP is to make decisions about types of care . Resources available also must be considered in decision-making.
As nurses, we must accelerate EBP because despite an aggressive research movement, the majority of findings from research often are not integrated into practice. Dr. Melnyk poignantly noted that it takes approximately 17 years to make a change, so we as health providers need to get a move on to make things happen. Often practices within nursing are routed in tradition and are often outdated; they do not lead to the best patient outcomes. Even traditional continuing education conferences do not significantly improve clinical performance and as nurses we need to improve clinical outcomes and performance. Also EBP must be implemented to advance our profession and enhance life-long learning and keep our practices up to date. In the future, it is quite possible that 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence. Therefore we need to be practicing EBP.

EBP affects patient’s physiological, psychosocial, and functional status. As pointed out by Melnyk, EBP improves outcomes and outcomes reflect IMPACT! This then leads to a positive effect on the health system.

A study by Pravikoff, Tanner, and Pierce (2005) looked at registered nurses in the U.S. The researchers found that 34.5% of the sample only needed information infrequently, almost half were not familiar with the term “evidence-based practice,” and more than half believed that their colleagues use research findings in their practice. This study also showed that most nurses do not search information resources to gather practice information and only 27% had any instruction in using electronic databases.

Barriers to evidence-based practice in the Pravikoff et al. study included “lack of value for research.” Organizational barriers for using information in practice included “presence of other goals with a higher priority.” Researchers concluded that “RNs in the United States aren’t ready for evidence-based practice because of the gaps in their information literacy and computer skills, their limited access to high quality information resources, and above all, the attitudes toward research” (Pravikoff et al., 2005 p. 50).

Knowing this information, how do we get EBP into practice? This is the burning question when there are such visible barriers. According to Melnyk, we must become key facilitators of EBP or champions. This roles involves obtaining knowledge and skills of EBP, understanding that EBP improves care and outcomes, believing in the ability to implement EBP, developing mentor(s)/teachers who are skilled in EBP, and gaining administrational/organizational support. In making patient care decisions, we must use our clinical judgment and expertise, access up-to-date evidence, and consider patient’s preferences and values to make a decision.

Dr. Melnyk lists five steps as the process of EBP:
1. Ask the burning clinical question in PICO format
Patient population
Intervention of interest
Comparison intervention or group
Outcome
2. Collect the best evidence. Search first for systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based clinical practice guidelines (http://www.guideline.gov/).
3. Critically appraise the evidence.
4. Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.
5. Evaluate the outcome.

So remember, evidence-based practice improves outcomes for patients, and nursing is all about the patients! This conference again renewed my own enthusiasm for EBP. I would again like to thank Bernadette Melnyk and Arizona State University for sharing her power-point presentation.

References
Melnyk, B. (April 2007). Empowering patients and nurses as partners in evidence-based practice. Power-point presentation given at UCLA Conference.

Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-50.

E-Journal Club #4

Selling, Kathleem, M.D., Theodore E. Warhentin, M.D., Andreas Greinacher, M.D., “Heparin-induced Thromocytopenia in Intensive Care Patients”, Critical Care Medicine, April 2007: vol.35:4 pp.1165-1176.

Abstract

“Objective: To summarize new information on frequency of heparin-induced thrombocytopenia (HIT) in patients treated in intensive care units (ICU), developments in the interpretation of assays for detecting anti-PF4/heparin antibodies, and treatment of HIT patients.
Study Selection: All data on the frequency of laboratory-confirmed HIT in ICU patients were included; for laboratory testing of HIT and treatment of patients, this review focuses on recent data that became available in 2005 and 2006.
Data Extraction and Synthesis: HIT is a potentially life-threatening adverse effect of heparin treatment caused by platelet-activating antibodies of immunoglobulin G class usually recognizing complexes of platelet factor 4 and heparin. HIT is more often caused by unfractionated heparin than low-molecular-weight heparin and is more common in postsurgical than in medical patients. In the ICU setting, HIT is uncommon (0.3-0.5%), whereas thrombocytopenia from other causes is very common (30-50%). For laboratory diagnosis of HIT antibodies, both antigen assays and functional (platelet activation) assays are available. Both tests are very sensitive (high negative predictive value) but specificity is problematic, especially for the antigen assays, which also detect nonpathogenic immunoglobulin M and immunoglobulin A class antibodies. Detection of immunoglobulin M or immunoglobulin A antibodies could potentially lead to adverse events such as bleeding if a false diagnosis of HIT prompts replacement of heparin by an alternative anticoagulant. For treatment of HIT, three alternative anticoagulants are approved: the direct thrombin inhibitors, lepirudin and argatroban, and the heparinoid, danaparoid (not approved in the United States). Recent data indicate that the approved dosing regimens of the direct thrombin inhibitors are too high, especially in ICU patients.
Conclusions: HIT affects <1%>

I thought this study interesting, although HIT is not a new concept. However, the author does not suggest a dosage regimen nor lead us to a study or source to find the answer to the problem she poses.
Have you experienced any episodes of HIT in your unit?

PowerPoint presentation on EBP at St. Joseph Hospital, Orange

Dana Rutledge, PhD, RN and Victoria Morrison, BSN, RN recently showcased a PowerPoint presentation on evidence-based practice at our recent National Nurse's Week festivities. This presentation summarizes EBP as it relates to nursing and shows a decision flow chart describing the Iowa Model on which our EBP is based. Check it out!!

Great article on implementing evidence based practice with Nursing CE units

There is a terrific overview by Susan W. Salmond EdD entitled "Advancing Evidence-Based Practice: a primer" in Orthopaedic Nursing 26(2):114-125 March-April 2007. Reading this article and completing the accompanying post test earns the reader 2 nursing contact hours. The fee is $10 for NAON members and $20 for nonmembers. Even if you're not interested in the CE units, the article is definately worth the read. It covers the paradigm shift that has led to a focus on evidence based practice, barriers to and strategies to overcome barriers to evidence based practice, asking PICO questions, levels of evidence and critically appraising evidence. This article is one of the most cogent and concise summaries of a complicated topic that I have seen. For SJH and CHOC patrons, Burlew Medical Library carries this journal in print but not online. Contact the medical library if you would like a copy.

Julie's picks from the literature April 2007

These current EBN or nursing research articles especially piqued my interest:

1. Pellico LH. Chinn PL. Narrative criticism: a systematic approach to the analysis of story. Journal of Holistic Nursing. 2007 Mar; 25(1): 58-65, 66-8. (54 ref) AN: 2009523418 NLM Unique Identifier: 17325316.

2. O'Malley P. Order no harm: evidence-based methods to reduce prescribing errors for the clinical nurse specialist. Clinical Nurse Specialist. 2007 Mar-Apr; 21(2): 68-70. (17 ref) Burlew carries this journal AN: 2009522842 NLM Unique Identifier: 17308440.

3. Couchman BA. Wetzig SM. Coyer FM. Wheeler MK. Nursing care of the mechanically ventilated patient: What does the evidence say? Part one. Intensive & Critical Care Nursing. 2007 Feb; 23(1): 4-14. (69 ref) AN: 2009510989 NLM Unique Identifier: 17046259.

4. Rattray J. Jones MC. Essential elements of questionnaire design and development. Journal of Clinical Nursing. 2007 Feb; 16(2): 234-43. (41 ref) Burlew has some online access, no print issues. AN: 2009505889 NLM Unique Identifier: 17239058.

5. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing. 2007 Mar-Apr; 24(2): 81-94. (49 ref) Burlew carries this journal AN: 2009523593 NLM Unique Identifier: 17332422.

6. Gerrish K. Ashworth P. Lacey A. Bailey J. Cooke J. Kendall S. McNeilly E. Factors influencing the development of evidence-based practice: a research tool. Journal of Advanced Nursing. 2007 Feb; 57(3): 328-38. (44 ref)

7. Smirnoff M. Ramirez M. Kooplimae L. Gibney M. McEvoy MD. Nurses' attitudes toward nursing research at a metropolitan medical center. Applied Nursing Research. 2007 Feb; 20(1): 24-31. (38 ref) AN: 2009506615 NLM Unique Identifier: 17259040.
NLM Serial ID Number

8. Mitchell SA. Beck SL. Hood LE. Moore K. Tanner ER. Putting evidence into practice: evidence-based interventions for fatigue during and following cancer and its treatment. Clinical Journal of Oncology Nursing. 2007 Feb; 11(1): 99-113, 130-4. (118 ref) Burlew has some years.

9. Tipton JM. McDaniel RW. Barbour L. Johnston MP. Kayne M. LeRoy P. Ripple ML. Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy-induced nausea and vomiting. Clinical Journal of Oncology Nursing. 2007 Feb; 11(1): 69-78, 130-4. (75 ref) Burlew has some years. AN: 2009499475.

10. Logan DM. Culturally and linguistically appropriate services: an overview of policy and safe acute care nursing practice in the United States. Gastroenterology Nursing. 2007 Jan-Feb; 30(1): 29-35. (37 ref) Burlew has some online access, no print issues. AN: 2009517704 NLM Unique Identifier: 17312422

E-Journal Club #3

Newhouse, Robin P., RN, PhD, CNA, CNOR

“Creating Infrastructure Supportive of Evidence-Based Nursing Practice: Leadership Strategies” Worldviews on Evidence-Based Nursing 4 (1), 21–29.

Author’s Abstract:

“Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources.

This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization."

Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice.

Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.”

Commentary

We were just discussion promotion of evidence-based “thinking” in the research council this week. Even though putting research into practice is clear, using this evidence in practice is not always easy, especially when your physician says “I don’t like to use Versed.” I think we as nurses are used to looking toward the physician as the absolute leader. It is a shift in our way of practice to realize we must now, perhaps, remind the physician that that is “not what the literature supports” or that "our new policy" now asks us to do things another way. But if everyone thought and acted this way, it would become part of the work culture.

I like the way this article talks about resources. We have generated a lot of good ideas in our critical care unit. How does the manager decide how much time and money to allocate to each idea?

I would like to thank the Burlew’s librarian, Julie Smith, for her EBN articles in “picks from the literature.” See April 13, 2007, in this blog.

Abstract and Commentary

Callen, B. L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25, 212-217.

Authors’ Abstract
Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged > 55 years. During observation, frequency and minutes of patients’ hallway ambulation were recorded. Of 118 patients considered by nurses as able to walk in the hallways, 18.6% walked once, 5.1% twice, 3.4% more than twice, and 2.9% did not walk at all per 3-hour period. The median minutes for ambulation was 5.5. Frequency of ambulation was as low for patients independent in walking as for those dependent (28% vs. 26%, P=.507). Of the 32 patients who walked in the hallways, most did so alone (46.8%, n=15) or with therapy staff (41%, n=13); few walked with nursing staff (9.4%, n=3) or family (18.8%, n=6). In this setting, hallway walking was very low for hospitalized older patients. If this trend of limited walking is found to be prevalent across other settings, then both independent and dependent patients will require additional interventions to improve ambulation during hospitalization.

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

This is one of few studies that document anything about ambulation in hospitalized patients. Its limitations include the fact that it was an observational study, that determination of patients’ ability to ambulate and need for assistance was based upon nursing judgment, that no data were collected on motivation to walk, and that the study only occurred on weekdays. Despite these limitations, study results point out that medical/surgical patients do not ambulate a lot, and that much ambulation may be driven by “therapy” goals rather than optimizing patient physical function (normal conditioning). This implies that patients who do not have ambulation “ordered” may lose function even if they entered the hospital fully functional. We are all aware of the “hazards of immobility” (Olson, 1967): pathology including cardiovascular, respiratory, gastrointestinal, musculoskeletal, urinary, metabolic, and psychosocial health changes.

When I read this abstract, I was surprised at the low proportion of walks where the patient was with nursing staff or family. So, in the article, I searched for how they measured this. Walking was observed by a non-staff observer who “sat in a corner of the middle section of the unit;” walking in the rooms was not observed. Each of 3 medical/surgical units were sampled during 3-hour intervals between 8 a.m. and 8 p.m. Each unit was observed for 24 hours. For patients who would be observed (> 55 years), the observer first gathered information about patient activity from the nursing staff. Per observation period and per patient, the observer noted time and duration, route taken, apparent purpose, and presence of human assistance or assistive device. The definition of the walk’s purpose was confusing to me:
· For therapy – patient walking with a nurse or off-unit health professional
· For a purpose other than therapy – walking with a definite goal (e.g., walking to elevator)
· For exercise – walking along or with family with no observable goal
I was unable to reconcile how the researchers differentiated walking with therapy staff or with nursing staff.

So, the actual percentages of walks per category may not make sense, but overall, patients did not walk much. I wonder how much patients at St. Joseph are walking.

Olson, E.V. (1967). The hazards of immobility. American Journal of Nursing, 67, 779–97.

Victoria's Research Corner

As evidence based projects (EBP) and research studies are being done, I wanted to let you know about projects as they are happening. Every newsletter, I will be interviewing someone who is doing either an EBP or a research study. For this newsletter I had the wonderful opportunity of interviewing Terry Zeilinger, Manager of the Mother-Baby Unit, regarding her research study, “Determination of whether 36-hour screening transcutaneous bilirubin adds to knowledge gained from 24-hour screening”.

Q. What is your study about?
A. “We are looking at transcutaneous bilirubins at 36 hours in babies who are born here at St. Joseph’s Hospital during a 3-month period who are not discharged before 36 hours post delivery. The standard of care has been 24-hour bilirubins and then on a PRN (as needed) basis if a baby looks jaundiced. Most babies’ average length of stay is 2 days for a vaginal delivery and three days for a C-section. We are trying to catch babies who are in trouble with abnormal (high) bilirubins to try to avoid complications such as increased dehydration, poor feeding, and ultimately kernicterus.”

Q. Is it an EBP/Research Study?
A. “This is a quantitative research study.”

Q. What made you interested in this project?
A. “We had a baby whose bilirubin was normal at 24 hours. At 40 hours the nurse noticed the baby looked jaundice and took a transcutaneous bilirubin, the level was high. The baby went home and was then readmitted to CHOC for still increased bilirubin. A few other babies were also readmitted post discharge from the Mother/Baby Outpatient Center due to high bilirubins.”

Q. How did you go about doing your research?
A. “I decided to look into the research already available and realized there weren’t any other studies that looked at bilirubins greater than 24 hours. After discussing with a colleague, she suggested I make this a research study. I then went to Dana Rutledge, the Nurse Research Facilitator, and we organized the information. I then had to go the Institutional Review Board (IRB) for approval of my study. Now I am doing chart reviews looking at trending in 24 and 36-hour bilirubins of babies.”

Q. What are your expected outcomes?
A. “We have already started the practice change and the study in the units looking at 36-hour bilirubins and so far, empirically, there are more babies already requiring phototherapy. Hopefully, we will be able to find these “high risk” babies and give intervention, supplementation, and closer follow-up.”

Q. Have you done research before? If so what did you learn?
A. “I did a small project for my Master’s, which looked at finger feeding preterm infants versus bottle-feeding. I learned that although research is interesting there is some frustration with the amount of time it takes. There can be a lot of limitations. You must review policy and procedures, look at articles, go to councils for approval, and possibly change a practice.”

Q. Will you do an EBP/research project again?
A. “I would like to. I definitely have an interest. The mother baby unit based council and myself are looking at alcohol application versus natural cord drying in infants, this may lead to another study.”

American Journal of Critical Care has a new look and adds some "evidence based" features

Michael Muscat, Managing Editor of American Journal of Critical Care, has provided me with this description of the newly redesigned AJCC. Burlew Medical Library users can access via the library's web site the full text of this journal, including the current May 2007 issue featuring the new features and redesign.

"Score another point for evidence-based nursing care and practice. The American Journal of Critical Care (AJCC), the peer-reviewed scientific journal published by the American Association of Critical-Care Nurses (AACN), has just been revised with a new reader-friendly format and more attention paid to everyday clinical challenges. New features include the Clinical Pearls page, which summarizes bedside applications from select articles in the issue, and the AJCC Patient Care Page, which offers AACN best practices following related content in select articles. The May 2007 issue, for example, includes an AJCC Patient Care Page advising readers to seek protocols to address the issue of family presence during CPR and invasive procedures in the ICU. AJCC journal club articles are now accompanied by the EBR or Evidence-Based Review section, which spotlights the primary investigator of the chosen research study and discusses the methodology and implications of that article for clinical practice. The journal is geared toward clinicians in high acuity and critical care and is coedited by a nurse and a physician: Kathy Dracup, dean of the UCSF School of Nursing, and Peter Morris, an associate professor of medicine at Wake Forest University. Those interested should visit the journal's Web site at www.ajcconline.org. The first redesigned issue appeared May 1. "

E-Journal Club #2

Deep Vein Thrombosis in Hospitalized Patients: A Review of Evidence-based Guidelines for Prevention

Kehl-Pruett, Wendy ARNP, MSN, CCRN

Dimensions of Critical Care Nursing, Volume 25(2), March/April 2006, pp 53-59

Author’s Abstract

“Deep vein thrombosis affects many hospitalized patients because of decreased activity and therapeutic equipment. This article reviews known risk factors for developing deep vein thrombosis, current prevention methods, and current evidence-based guidelines in order to raise nurses' awareness of early prevention methods in all hospitalized patients. Early prophylaxis can reduce patient risk of deep vein thrombosis and its complications.”

I originally found this article too simplistic, since at our hospital we utilize the “vent bundle” concept in which anticoagulation therapy and compression teds are highlighted at our unit rounds which take place each day, usually day shift and night shift. Does your unit utilize “unit rounds”?

The “unit rounds” we have for both night shift and day shift seem to be the best way we have to disseminate evidence based practice, from all participants of the healthcare team. It is also the best way to educate and remind staff of a process, old or new, that we intend to focus on until it is accepted practice. Some of our physicians order both the stocking TEDS as well as the compression teds. Is this overkill?

Julie's picks from the nursing literature: March 2007

These articles especially captured my attention from the recent nursing literature dealing with research or EBN

1. Welk DS. How to read, interpret, and understand evidence-based literature statistics. Nurse Educator. 2007 Jan-Feb; 32(1): 16-20. (10 ref) Burlew carries this journal AN: 2009505151 NLM Unique Identifier: 17220762.

2. Sigma Theta Tau study shows majority of nurses rely on evidence-based practice...

3. Fineout-Overholt E. Johnston L. Teaching EBP: implementation of evidence: moving from evidence to action. Worldviews on Evidence-Based Nursing. 2006 4th Quarter; 3(4): 194-200. (21 ref) AN: 2009481523.

4. Abbott CA. Dremsa T. Stewart DW. Mark DD. Swift CC. Adoption of a ventilator-associated pneumonia clinical practice guideline. Worldviews on Evidence-Based Nursing. 2006 4th Quarter; 3(4): 139-52. (43 ref) AN: 2009481519

5. Felber SH. Sylvanus TL. Wilson C. Kapoor R. Library and nursing research collaboration. Journal of Hospital Librarianship. 2006; 6(3): 19-30. (13 ref) AN: 2009383611.

6. Johansson P. Dahlstrom U. Brostrom A. Consequences and predictors of depression in patients with chronic heart failure: implications for nursing care and future research. Progress in Cardiovascular Nursing. 2006 Fall; 21(4): 202-11. (52 ref) Burlew has some online access, no print issues. AN: 2009373963 NLM Unique Identifier: 17170596.

7. Vollman KM. Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU. Critical Care Nursing Clinics of North America. 2006 Dec; 18(4): 453-67. (135 ref) Burlew carries this journal AN: 2009350169 NLM Unique Identifier:

17118300

8. Fonteyn M. Polinski K. Lynch K. McKenna C. Gorman D. Saint-Eloi S. An evidence-based policy to guide nurses in using a power injector to instill contrast media. Oncology Nursing Forum. 2007 Jan; 34(1): 199. Burlew carries this journal AN: 2009484138.

9. Bradshaw A. Price L. Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice. Journal of Clinical Nursing. 2007 Jan; 16(1): 98-103. (35 ref) Burlew has some online access, no print issues. AN: 2009481114 NLM Unique Identifier: 17181671.

10. Hoogerduijn JG. Schuurmans MJ. Duijnstee MSh. de Rooij SE. Grypdonck MF. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of Clinical Nursing. 2007 Jan; 16(1): 46-57. (39 ref) Burlew has some online access, no print issues. AN: 2009481109 NLM Unique Identifier: 17181666.

Making a Poster Presentation

The difference between poster and oral presentations is that with a poster presentation, the poster does most of the 'talking' about your project. That is, the material presented conveys the essence of your message. However, that does not mean that you can abandon the poster during the designated time. You have to 'stand-by-your-poster'! Your task as the presenter is to answer questions and provide further details; to bask in praise or suffer difficult questions; and to convince others that what you have done is excellent and worthwhile. A poster presentation should guide each viewer through the basics of the study or project, freeing the presenter to focus on discussion of essential elements of the work. Decisions about poster format and design contribute to efficient and accurate transfer of information using this medium.

A scientific poster is a communication tool that combines a verbal presentation with a visual aid. They are given to a small group of people, are limited in time and range of view, and are informal and interactive. Posters should look as professional as your professional research or project. Poster size specifications will differ for each presentation venue; always plan to use the space well. Incorporating good basic graphic design principles, using good quality art materials and papers, and the use of color as an organizing tool will contribute to the professional approach of this scientific communication. The average interaction time for a poster presentation is 10-15 minutes. You must use visual short-cuts and plan your verbal presentation carefully to do posters well.

Important characteristics for posters to have:
clear scientific value;
viewer-friendly lay-out, i.e., it has a hierarchical organization (“easy to follow sequence”), contains minimal text, has conveniently arranged and understandable graphs, and avoids (where possible) mathematical formulations.
“It takes intelligence, even brilliance, to condense and focus information into a clear, simple presentation that will be read and remembered. Ignorance and arrogance are shown in a crowded, complicated, hard-to-read poster." Mary Helen Briscoe

Poster Guidelines

Succinct title
Background (review of literature, need for project)
Purpose
Project description/methodology and context (sample, setting, etc.)
Outcomes
Implications for nursing
Recommendations

Here are two templates I have shared with nurses in the Orange County region over the past several years. I found the first template (for a rectangular poster made on Powerpoint for professional reproduction) on the internet several years ago, and did not gain permission to publish it. This template allows someone to make a poster for use on a bulletin board surface (attached with tacks or velcro) or for reproduction on foamcore board. The trifold template (you need MS PowerPoint to view) is a modification of the first template that allows someone to reproduce a poster and tack it on a 3x5' tri-fold poster board (for table top display).

SJH Critical Care E-journal Club

Once again, I am starting the e-journal club here at St. Joseph’s. I will post a journal review article every two weeks or so to those people that have requested to be on my mailing list. I will post a summary or the author’s abstract on this blog site so that people can comment here. Judy Rousch, RN, BSN

Kalisch, Beatrice J., PhD, RN, FAAN. “Missed Nursing Care: a Qualitative Study”, Journal of Nursing Care Quality, Vol.21, No. 4, pp. 306-313.

Author’s Abstract:

“The purpose of this study was to determine nursing care regularly missed on medical-surgical units and reasons for missed care. Nine elements of regularly missed nursing care (ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation and surveillance) and 7 themes relative to the reasons for missing this care were reported by nursing staff.”

I found this study simple and yet profound at the same time. Through an e-mail, the author confided that as a consultant to hospitals, these same themes kept coming up over and over again.

I was amazed at the honesty of the replies from the staff interviewed. Would we have the kind of insight this article lets us see if the unit manager asked the staff the same questions? Do some units have an authentic ability to see and handle these issues? How do you feel these time constraint issues are handled on your unit?

Cochrane Database of Systematic Reviews-- news

All documents in the Cochrane Database of Systematic Reviews are now in PDF format. That means no more tweaking the document to make sure that all the tables print and a document that is shorter in its final print version.

Other Cochrane News

"Two Cochrane Reviews to be published in January The Cochrane Library 2007,
Issue 1, report on smoking cessation:

• A recently licensed nicotine receptor stimulant trebles the odds of
stopping smoking. The new anti-smoking drug varenicline was first licensed for use in the UK on 5th December 2006. An early Cochrane Review of its effectiveness shows that it can
give a three-fold increase in the odds of a person quitting smoking. Varenicline is
the first new anti-smoking drug in the last ten years, and only the third, after NRT
and bupropion, to be licensed in the USA for smoking cessation.

• New evidence boosts the conclusion that some antidepressants can
double a smoker’s chance of quitting. The most recent Cochrane review concluded antidepressants bupropion (Zyban) and nortriptyline double a person’s chances of giving up smoking and have few side-effects, but selective serotonin reuptake inhibitors (SSRIs) such as
fluoxetine (Prozac) are not effective. A recently licensed nicotine receptor stimulant trebles the odds of stopping smoking. The new anti-smoking drug varenicline was first licensed for use in the UK on 5th December 2006. An early Cochrane Review' of its effectiveness shows that it can
give a three-fold increase in the odds of a person quitting smoking. Varenicline is the
first new anti-smoking drug in the last ten years, and only the third, after NRT and
bupropion, to be licensed in the USA for smoking cessation.

"Raising Research Awareness through Simple, Fun Activities"

This post was taken from the new hospital librarian's wiki sponsored by the Hospital Libraries Section of the Medical Library Association. It has some very creative promotional ideas that Nursing Research Councils could use or adapt to promote interest in nursing research.


"Following you will find the abstract for the poster presentation we submitted. It is a list of activities we have done with the Research Council at Rex Healthcare. You might find it helpful.

Title: Raising Research Awareness through Simple Fun Activities

Authors: Deniz Ender, Librarian, MLS, AHIP: Sally Williford, RN, MSN, CCRN, Nurse Educator and Joan Cederna-Moss, RN, MSN, Clinical Nurse Specialist, Rex Healthcare, Raleigh, NC.

Objective: The objective of this activity is to increase staff participation in research projects by capturing interest in research and demonstrating the research process through easy, fun, interactive research activities. To foster interest in research, the hospital librarian worked with nurse educators to design several easy-to-implement, interactive activities. A byproduct of these events was the development of an excellent working relationship between the medical library and clinical staff in the hospital.

Methods: Activities that appeal to a variety of learning styles and abilities were planned to raise staff research awareness.Nursing Research Surveys –Surveys were done in 2004 and 2006 to gauge staff opinions regarding research. This year our Research Council will share the results and provide feedback about how concerns were addressed.“Taste tests”– Staff were invited to compare food products (cookies, chips, crackers and cereals) to detect the difference between the “name brand” product and the “low fat, low calorie, or store brand product”. Voting was done via colored beans.Logo contest – Staff were encouraged to submit a design for use as the Research Council’s logo. Entry rules specified that the design must “support evidence-based practice” and must meet facility requirements for logo use.Results: Staff responded with interest to “taste tests”, often asking “when will we know the results?” The results were calculated and communicated using research terminology such as “single blinded study” and “hypothesis” to further boost research awareness. After the selection of the logo/icon “winners”, we plan to showcase the winning designs on our house wide computer log-in screens or bulletin boards. Research awareness activities can be done alone or in conjunction with “Research Awareness Month”.

Conclusion: Our staff eagerly participated in these fun events that raised their interest in conducting research projects. As a result, they are more knowledgeable about the research process and more willing to participate in a study. The library’s role as the “supply garrison” for research information was enhanced through participation in these activities. Other librarians wishing to solidify the library’s essential place in the research process could adapt these activities for use in their hospital. "

Dana Rutledge Phd, RN receives ONS "Ellyn Bushkin Friend of the Foundation Award"

Our very own Dana Rutledge, PhD, RN, Nursing Research Facilitator at St. Joseph Hospital in Orange, California, recently received the prestigious "Ellyn Bushkin Friend of the Foundation Award" from the Oncology Nursing Society Foundation. The ONS Foundation reports that the purpose of the award is to recognize individuals who have provided continuous support to the mission of the ONS Foundation. Nominations are not accepted for this award; rather, the ONS Foundation Board selects the recipient. "The nominee must have demonstrated support of the ONS Foundation by making major financial contributions, coordinating significant fund-raising events, or promoting/enhancing the image of the ONS Foundation". The award is named in the memory of Ellyn Bushkin, an oncology nurse and a past president of the ONS Foundation.

Congratulations Dana!! You are so modest that we had to hear of this award second hand. Hope you don't mind our public congratulations!!