Research Abstract with Commentary

Authors’ Abstract

The use of "as needed" or "pro re nata" (PRN) range opioid analgesic orders is a common clinical practice in the management of acute pain, designed to provide flexibility in dosing to meet an individual's unique needs. Range orders enable necessary adjustments in doses based on individual response to treatment. However, PRN range opioid orders have recently come under scrutiny as a source of confusion and as a medication management safety issue. How nurses administer range orders may vary based on their interpretation of the intent of an order, inadequate knowledge of analgesic titration, or exaggerated concerns about opioid safety.

The purpose of this study was to investigate nurses' opinions of the appropriate implementation of range orders. Six hundred two nurses from one large academic medical center and one multihospital system completed an online survey using theoretic clinical vignettes to examine their opinions of appropriate analgesic administration practices.

The majority of participants chose appropriate responses to the vignettes; however, there was a great deal of variability in responses. Those who had attended pain management courses were more likely to have a higher percentage of appropriate responses than those who had not attended courses. Years in practice and educational level were not significantly related to percentage of appropriate responses; however, there was a trend for nurses with a master's degree to have a higher percentage than nurses with other educational preparation. Consideration of opioid pharmacokinetics can provide logic to develop a new paradigm where range orders are replaced with orders that provide more explicit instructions to titrate an opioid to the most effective dose.

Gordon, D. B., Pellino, T. A., Higgins, G. A., Pasero, C., & Murphy-Ende, K. (2008). Nurses' opinions on appropriate administration of PRN range opioid analgesic orders for acute pain. Pain Management Nursing, 9, 131-140.


Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator, & Mary Welly, RN, BSN, Clinical Educator

This fascinating article documents the difficulty that nurses face in administering PRN opioid pain medications ordered using dose ranges. In the literature review, authors delineate a brief history of safety initiatives that have led to the need to understand dose range administration issues. Changes in The Joint Commission expectations in the past decade have changed ordering habits of physicians, but have not necessarily clarified best practice for nurses.

The clinical problem addressed stems from nurse confusion with PRN range orders in terms of (a) which dose to administer within the range and (b) the total time interval during which the maximum dose can be administered. The study aim was to document nurse opinions of correct practice given 4 specific patient scenarios developed by the authors. The authors note that the “correct” answers (that they determined) are not absolute. In fact, due to disagreement among the researchers, they did not score responses to one of the scenarios. Correctness was based upon drug pharmacokinetics, patient assessment parameters, side and adverse effects and their interpretation, and administration issues.

Nurses surveyed came from several hospitals in the mid-Atlantic and Midwestern US. Response rates were 36% of nurses emailed a participation invitation, 11% of nurses who saw a posted invitation. These rates are typical of nurse response rates to similar surveys. When interpreting results, however, one must think about the nurses who chose NOT to respond, and how the non-respondents may be different from respondents. Survey respondents were similar to St. Joseph nurses by education (67% BS or higher; 57% of SJH nurses have a BS or higher based upon 2007 NDNQI data). Respondents were experienced (47% had been in nursing 16 years or greater, and primarily worked medical/surgical or intensive care (69%).

The discussion of results delineates options selected by nurses according to the authors’ determination of “correctness.” A key concept was titration, which is determination of “effective dose by giving graduated increases or decreases in the amount of the drug” (p. 138). Titration of oral drugs is similar to that of intravenous drug titration that may be more familiar to nurses. The authors note that accurate and safe titration may require a more lengthy order set or use of pre-established protocols than is normally used in hospitals.

Implications from the results indicate that a substantial portion of nurses (1/3 to ½) would under medicate or delay medicating patients in pain using PRN range dosing even where a patient exhibited no side effects. Another issue pointed out was that 43% of nurses did not cite sedation as one of three factors to consider when selecting opioid dose, perhaps indicating lack of appreciation of the importance of sedation assessment.

Of interest was the finding that 21% of nurses would give a dose less than what was ordered without calling a physician first. This finding was documented in numerous earlier studies as well, particularly with opioids. It certainly merits discussion among nurses in terms of what this means for nurse/physician communication and for pain management. Authors conclude that “flexibility in dosing made possible by a range order does not include adjusting the dose limits of the order” (p.139).

Do nurses at St. Joseph have a policy or protocol in place to direct practice for PRN opioid range dosing? If so, how many are aware of it? How many practice using it? Are there practice situations that are unclear as to “best” practice? We would urge further discussion by nurses at St. Joseph on your units as to these issues.

NOTE: Policy RX-475 Medication Ordering Procedures (approved 01/08) notes that “medication orders should NOT be written with dosage ranges” unless the order titrates to specific outcomes or doses matched to specific clinical parameters are allowed (such as the scenarios in the Gordon et al. study). Interpretation of dose and frequency ranges in this policy are in section II.C. 2. a. and 3.

A consensus statement about PRN medications is available from the American Society for Pain Management Nursing and the American Pain Society at Gordon et al. (2004). The use of “as-needed” range orders for opioid analgesics in the management of acute pain. Pain Management Nursing, 5, 53-58.

Tips and tricks for searching CINAHL on EBSCO

Burlew Medical library users-- did you know that there are over 130 one hour CE modules on CINAHL via EBSCO? In order to see the full list, just click on the CE MODULE in the lower left hand section of the CINAHL search page and then hit search. According to CINAHL " Each CEU module consists of course material, an interactive review and a competency test with a certificate of completion. As of April 2006, CINAHL education has received International Association for Continuing Education and Training (IACET) accreditation. The American Nurses Association accepts IACET accredited continuing education.

Depending on the course, it can take from one to several hours to complete a CE course. A course must be completed in a single session. You cannot save a partially-completed course and return to it at a later time." I am told that at St. Joseph Hospital in Orange, you would be required to keep your own paperwork regarding these CE's rather than sending the paperwork to Clinical Education. You will also need to do a quick free registration with CINAHL in order to obtain the CE. The topics available range from post traumatic stress disorder to pregnancy in adolescents: fathers. Check it out!!

Tips and Tricks for using CINAHL on EBSCO: ask a librarian

Lbrary users at Saint Joseph Hospital in Orange and Children's Hospital of Orange County-- did you know that you can send the search strategy you used to search CINAHL on EBSCO to the staff of Burlew Medical Library for review? We will receive your questions about searching CINAHL or your search strategy for review by email. Within a short time, we'll either get back to you with a. suggestions as to how to improve your search b. re-do your search for you c. answers to your search questions.

It's very easy to use this "Ask a Librarian" feature. While in CINAHL on EBSCO, simply click on the "Ask a Librarian" icon in the upper right hand corner of your search page. The form that you see here appears. Enter your name, your email and your question. By default, your lit search strategy will be included so that we can review it. It's that simple!!

3 more nursing research articles from St. Joseph Hospital in Orange, California

Efforts led by Dana Rutledge, RN, PhD, Nursing Research Facilitator and the Nursing Research Council at St. Joseph Hospital in Orange, California are reaping rewards. Three recent articles published by nursing staff at St. Joseph Hospital are :

1. Holist Nurs Pract. 2008 Nov-Dec;22(6):324-35.Uncovering and recognizing nurse caring from clinical narratives.

Norman V, Rutledge DN, Keefer-Lynch AM, Albeg G.St Joseph Hospital, Orange, California 92868, USA. Vivian.Norman@stjoe.org

In an exploratory descriptive study using nurse-written clinical narratives,dimensions of Watson's Theory of Caring are reflected in nurses' descriptions of specific clinical events or situations, and narratives of nurses who are lessexperienced differ in terms of the caring dimensions than do those of moreexperienced nurses.

2. MEDSURG Nursing 2008 Oct;17(5):312-316. Medical Emergency team Implementation: experiences of a mentor hospital.

Jamieson Eleanor, Ferrell Carmen, Rutledge Dana N. St. Joseph Hospital, Orange, California 92868, USA. Eleanor.Jamieson@stjoe.org

Rapid response teams (RRTs) provide assessment and early intervention for patients not in critical care.The implementation of RRT using an evidence-based practice framework, which led to decreased resuscitations, critical care transfers, overall mortality, and cost, is described.

3. Journal of Emergency Nursing 2008 article in press. Guesting area: an alternative for boarding mental health patients seen in emergency departments.

Winokur Elizabeth J, Senteno, John M. St. Joseph Hospital, Orange, California 92868, USA. Beth.Winkour@stjoe.org

SJH/CHOC staff may access all of the above articles full text by calling the medical library at 714 771-8291 or via our website http://www.burlewmedicallibrary.org/

Congrats all!!

Our very own Victoria Morrison, MSN, FNP, RN and Dana Rutledge, PhD, RN have written a nice article which talks about our exploration into evidence based nursing practice at St. Joseph Hospital in Orange, California as well as this blog. The article appears in the Oct 27, 2008 edition of Advance for Nurses and can be viewed here. Thanks for the recognition!!

Julie's picks from the Nursing Literature Sept 2008

1. Carter-Templeton H. McCoy T. Are we on the same page?: a comparison of intramuscular injection explanations in nursing fundamental texts. MEDSURG Nursing. 2008 Aug; 17(4): 237-40. (23 ref) Burlew carries this journal

2. Steis MR. Fick DM. Are nurses recognizing delirium? A systematic review. Journal of Gerontological Nursing. 2008 Sep; 34(9): 40-8. (41 ref) Burlew carries this journal AN: 2010019926.

3. Howland L. Sullivan-Bolyai S. Bova C. Klar R. Harper D. Schilling L. The research advisory committee: an effective forum for developing a research dynamic environment. Journal of Professional Nursing. 2008 Jul-Aug; 24(4): 241-5. (7 ref) Burlew carries this journal AN: 2010002211 NLM Unique Identifier: 18662660.

4. Aagaard H. Hall EO. Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis. Journal of Pediatric Nursing: Nursing Care of Children and Families. 2008 Jun; 23(3): e26-36. Burlew carries this journal AN: 2009945721 NLM Unique Identifier: 18492543.

5. Milton D. Pipe TB. Hatler C. Brewer BB. LaMar K. Clark C. Estrada N. Clarifying the role of director of nursing research in clinical settings: expectations and challenges. Nurse Leader. 2008 Aug; 6(4): 29-33. (1 ref) AN: 2010001937.

6. Ehrlich-Jones L. O'Dwyer L. Stevens K. Deutsch A. Searching the literature for evidence. Rehabilitation Nursing. 2008 Jul-Aug; 33(4): 163-9. (13 ref) Burlew carries this journal AN: 2009964891 NLM Unique Identifier: 18686909.

7. Schnautz LS. Rowley D. Hypothermic coma: catapulting evidence-based research into everyday practice. Critical Care Nursing Clinics of North America. 2008 Sep; 20(3): 321-6. (9 ref) Burlew carries this journal AN: 2009997531 NLM Unique Identifier: 18644516.

8. Reavy K. Tavernier S. Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing. 2008 Apr; 39(4): 166-72. (17 ref) Burlew carries this journal AN: 2009897763 NLM Unique Identifier: 18429370.

9. Giuliano KK. Polanowicz M. Interpretation and use of statistics in nursing research. AACN Advanced Critical Care. 2008 Apr-Jun; 19(2): 211-22. (13 ref) Burlew carries this journal AN: 2009918227.

10. Ridley RT. The relationship between nurse education level and patient safety: an integrative review. Journal of Nursing Education. 2008 Apr; 47(4): 149-56. (35 ref) Burlew has some online access, no print issues. AN: 2009885996 NLM Unique Identifier: 18468291.

11. Carlson CL. Plonczynski DJ. Has the BARRIERS Scale changed nursing practice? An integrative review. Journal of Advanced Nursing. 2008 Aug; 63(4): 322-33. (66 ref) Burlew has some years. AN: 2009985207 NLM Unique Identifier: 18727758.

12. Ritchey T. Stichler JF. Determining the optimal number of patient rooms for an acute care unit. Journal of Nursing Administration. 2008 Jun; 38(6): 262-6. (10 ref) Burlew carries this journal AN: 2009956418 NLM Unique Identifier: 18562828.

13. Taylor S. Allen D. Visions of evidence-based nursing practice. Nurse Researcher. 2007; 15(1): 78-83. (13 ref) Burlew has some online access, no print issues. AN: 2009700404.

14. Happell B. Conference presentations: developing nursing knowledge by disseminating research findings. Nurse Researcher. 2007; 15(1): 70-7. (44 ref) Burlew has some online access, no print issues. AN: 2009700403.

15. Clancy K. Experiences of a novice researcher. Nurse Researcher. 2007; 14(4): 27-38. (28 ref) Burlew has some online access, no print issues. AN: 2009636063 NLM Unique Identifier: 17702141

16. Singleton J. Levin R. Educational innovations. Strategies for learning evidence-based practice: critically appraising clinical practice guidelines. Journal of Nursing Education. 2008 Aug; 47(8): 380-3. (14 ref) Burlew has some online access, no print issues. AN: 2009993343.

17. Chesla CA. Translational research: essential contributions from interpretive nursing science. Research in Nursing & Health. 2008 Aug; 31(4): 381-90. (54 ref) AN: 2009978376 NLM Unique Identifier: 18231973.

18. Scott SD. Pollock C. The role of nursing unit culture in shaping research utilization behaviors. Research in Nursing & Health. 2008 Aug; 31(4): 298-309. (59 ref) AN: 2009978375 NLM Unique Identifier: 18231975.

19. Tod AM. Bond B. Leonard N. Gilsenan IJ. Palfreyman S. Exploring the contribution of the clinical librarian to facilitating evidence-based nursing. Journal of Clinical Nursing. 2007 Apr; 16(4): 621-9. (37 ref) Burlew has some online access, no print issues. AN: 2009560203 NLM Unique Identifier: 17402942.

CASP: Critical Appraisal Skills Programme

Do you know about CASP? I just learned about these very useful tools developed by the Public Health Resource Unit at NHS. They provide you with a list of questions to ask when appraising various research study formats. For instance, there is a list of 10 detailed questions to ask when evaluating a randomized cointrol trial. Many of the questions were adapted from Guyett GH, Sackett DL and Cook DJ. Users' guides to the medical literature.II. How to use an article about therapy or prevention. JAMA 1993;270(21):2598-2601 and JAMA 1994;271(1):59-63.

This so simplifies the analysis process!!

Research Abstract with Commentary: Value of Nurse Internships

Abstract: New Graduate Transitioning: Necessary or Nice?

This study investigated the influence of personal factors, orientation, continuing education, and staffing shortage on the satisfaction, intent to leave their job, and intent to leave the profession of a random sample of new graduate nurses from varied facilities and geographic locations. It further examined the influence of personal factors and orientation on turnover rates among new graduate nurses. The findings indicate that orientation programs are essential to the retention and satisfaction of new graduate nurses. Given current economic constraints, this study supports nurse executives' ability to advocate for and receive funding for transition-to-work programs as well as the placement of new graduate nurses in well-staffed units.

Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate transitioning: Necessary or nice? Applied Nursing Research, 21, 75-83.

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

This timely study begins to fill a gap in nursing literature related to what factors can predict new graduate job and career satisfaction as well as actual job turnover. A well developed framework predicts that (a) anticipatory socialization (characteristics of education, experience, and expectations) can predispose or protect the new graduate from reality shock, and (b) organizational socialization (things that happen to the new nurse in the first two years of nursing such as orientation, unit culture, staffing) can enhance or inhibit work adjustment. The outcomes of job and career satisfaction, intent to stay, turnover can be predicted by factors within each of these two categories.

Using already collected data (this is called secondary analysis) from a random sample of North Carolina new graduates (< 2 years from graduation from initial RN program), researchers evaluated how this model worked with 329 nurses. They adequately described the variables they used, and ran multiple analyses to look for relationships in the model. One of the drawbacks of using already collected data is that not all factors the researchers wanted to evaluate were measured, and some that were measured contained “missing” data. However, they were able to draw several important conclusions.

Besides the finding reported in the abstract (above), the following were reported:
· Among new nurses, 54% were dissatisfied with their current job, 55% had already left one job, however, 71% were satisfied with nursing as a career.
· Orientation offered to these nurses ranged from < 1 week to 1 year (huge variability!!). The quality and quantity of orientation were associated with turnover (better/longer predictive of less turnover).
· The strongest predictor of job satisfaction was frequency of staffing shortage on a unit. Nurses reporting weekly shortages were 6 X more likely to be dissatisfied than those with less shortages.

These findings point to the need to give our new graduates the most satisfying orientation possible, and that longer orientation lengths may contribute to job satisfaction, and subsequent retention.

GREY MATTERS: a practical search tool for evidence based medicine

The Canadian Agency for Drugs and Technologies in Health (CADTH) has developed a new, free tool to assist in the process of identifying "gray literature" for evidence based medicine. While this is oriented towards EBM, it does have applicability to Evidence Based Nursing. First off, what exactly is "gray literature"? Gray literature is defined in wikipedia as "... a term used variably by the intelligence community, librarians, and medical and research professionals to refer to a body of materials that cannot be found easily through conventional channels such as publishers, "but which is frequently original and usually recent" in the words of M.C. Debachere". It goes without saying that gray literature usually does not appear in customary databases such as Pubmed and CINAHL. There are several resources for identifying gray literature but none are quite as comprehensive as the newly released tool from the CADTH GREY MATTERS: a practical search tool for evidence based medicine.
To access this tool, scroll down the page to Information Services and follow instructions to download the document.

While most of us would never go through this intensity of research for clinical topics, if you are developing a meta-analysis or systematic review, this could be useful. This tool will help you search for evidence based topics in both the international and US grey literature.

Taking research posters to the units

The Nursing Research Council at St. Joseph Hospital in Orange, California is activating its plan to take research to the units. Members of the Research Council were charged with finding a current nursing research article which might have special application to their specific unit. Leaders of the Nursing Research Council developed a template poster which summarizes a key article into the following sections:

The Research Question

• Methods


• Results


• Discussion


• Implications for SJH Nursing Practice

Of special note is the section noting implications for St. Joseph Hospital nursing practice. An effort is made to show how the practice implications may mesh with our hospital's values and with our Watson nursing model. The posters will be placed in a unit's lounge area and are intended to make the salient points of a complex research article more accessible and increase interest in nursing research. This photo shows team members at a working meeting in which they identified an article of interest and then summarized it into this reseach poster template.

CINAHL on EBSCO

Beginning in January 2009, CINAHL, the nursing and allied health database will no longer be available on the OVID platform. Instead, CINAHL will be exclusively offered on the EBSCO platform. Burlew Medical Library is now offering access to EBSCO CINAHL via our library web site (password protected for staff of St. Joseph Hospital, Orange and Children's Hospital of Orange County). I will begin to showcase a variety of "tips and tricks" for searching EBSCO CINAHL so that everyone can prepare themselves for this transition. As a beginning, here are some links to EBSCO provided tutorials/online help:

An introduction to Using CINAHL with Full Text

A powerpoint tutorial on EBSCO 2.0 databases (not specifically CINAHL)

Commentary on Systematic REview Focused on EOL Care in Those with Different Cultural Affiliations

Abstract and Commentary

Thomas, R., Wilson, D. M., Justice, C., Birch, S., & Sheps, S. (2008). A literature review of preferences for end-of-life care in developed countries by individuals with different cultural affiliations and ethnicity. Journal of hospice & Palliative Nursing, 10, 142-161.

Author’s Abstract

Anticipatory decision making about end-of-life care (EOL care) is predominantly a North American concept. Researchers investigated four themes: advance directives, life support, communication, and decision making. Substantial differences exist among cultural groups in the percentages with living wills/advance directives, and they are less frequent for those with family-centered decision making or with less trust in the healthcare system. African Americans prefer life support more than Asian Americans or European Americans. Cultural groups vary in their preferences about communicating terminal diagnoses. Non-English-speaking patients perceive communication as a barrier to care. Mexican Americans, Korean Americans, and Canadian First Nations emphasize family-based decision making at the end of life, and European Americans emphasize patient autonomy.

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

In this systematic review[1], authors carefully describe the procedure they used to find studies to critically appraise. They focused on studies with data concerning preferences of minority or cultural groups about EOL care. Thomas and colleagues evaluated 26 varied studies that collected data from quite heterogeneous samples (from nursing home residents to persons 50 and older who died as inpatients in one California hospital). Their content analysis of study findings led to four themes, which they describe well.

Advanced directives (ADs) were addressed primarily in US studies and focused on living wills or durable power of attorney. While many in most cultural groups were aware of ADs, several samples indicate lack of awareness in groups of Mexican Americans and the majority of some Asian Americans. Fewer persons sampled actually had an AD (0-28%) while more had a health care proxy named (but not necessarily a durable power of attorney). Attitudes towards ADs varied with groups less likely to desire an AD having strong religious believes and rituals. One international study indicated that ADs are primarily an American phenomenon although people in other countries believe they are a good idea.

Mostly in US studies, cultural group preferences for life support were gathered via descriptions of how many people actually had DNR orders along with attitudes towards DNR in different cultural groups. Findings differed across studies with one study showing that Asian Americans prefer no resuscitation and another showing that Japanese prefer DNR while Chinese do not. African Americans and Mexican American were most likely to desire life support while European Americans were least likely. Preferences of family members influenced decisions about life support and disagreements existed between some individuals and their families.

Communication about preferences for EOL care was studied in several countries. Mention was made of the “Western way” of informing people about terminal illnesses as being abrupt and even terrifying. Barriers to communication include language issues, pressures on family and caregivers, lack of choice of care options, and fear of signing documents. Facilitators include inclusion of family members in discussions and availability of medical specialists. Thus, “cultural group understandings and preferences are a major potential influence on the type of communication that occurs around EOL care issues” (p. 154).

The role of family in EOL decision making varies across cultural groups with several groups desiring family-centered decision making (African American, Mexican/Latin American, Japanese, Arab American) and others autonomous decision making (European American, German). Many groups dislike using sedation as a medical intervention since it blocks clear thinking and somnolence/confusion.

Conclusions drawn are difficult since most studies analyzed investigated cultural differences within one country (usually US) or focused on one aspect of EOL care. However, all highlight the importance of being aware of and sensitive to cultural group preferences. Those caring for persons at the EOL need to “ask pertinent questions and be willing to listen to and heed the answers” (p. 160).

References

Cook, D. J., Mulrow, C. D., & Haynes, R. B. (1999). Systematic reviews: Synthesis of best evidence for clinical decisions. Annals of Internal Medicine, 126, 376-380.

[1] Systematic review - involves the application of scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific clinical question; a type of systematic review, meta-analysis uses statistical methods to combine and summarize findings from several studies; useful characteristics of a systematic review: clear reporting of information obtained using rigorous methods (Cook, Mulrow, & Haynes, 1999)

Julie's picks from the Nursing literature: July 2008

Here are some interesting reads from the current nursing literature around the issues of evidence based nursing or nursing research. Staff at St. Joseph Hospital (Orange, Ca) and Children's Hospital of Orange County may access or request these articles via the library's website.

1. Bertaut Y. Campbell A. Goodlett D. Implementing a rapid-response team using a nurse-to-nurse consult approach. Journal of Vascular Nursing. 2008 Jun; 26(2): 37-42. (12 ref) AN: 2009939962 NLM Unique Identifier: 18492556.

2. Hagedorn ME. Zahourek RP. Research paradigms and methods for investigating holistic nursing concerns. Nursing Clinics of North America. 2007 Jun; 42(2): 335-53. (85 ref) Burlew carries this journal AN: 2009934325 NLM Unique Identifier: 17544686.

3. Sprague AE. Oppenheimer L. McCabe L. Graham ID. Davies BL. Knowledge to action: implementing a guideline for second stage labor. MCN: The American Journal of Maternal/Child Nursing. 2008 May-Jun; 33(3): 179-88. (25 ref) Burlew carries this journal AN: 2009932616 NLM Unique Identifier: 18453908.

4. Beck CT. State of the science on postpartum depression: what nurse researchers have contributed -- part 2. MCN: The American Journal of Maternal/Child Nursing. 2008 May-Jun; 33(3): 151-8. (62 ref) Burlew carries this journal AN: 2009927076 NLM Unique Identifier: 18453904.

5. Hommel A. Bjorkelund KB. Thorngren K. Ulander K. Differences in complications and length of stay between patients with a hip fracture treated in an orthopaedic department and patients treated in other hospital departments. Journal of Orthopaedic Nursing. 2008 Feb; 12(1): 13-25. (59 ref) AN: 2009942226.
NLM Serial ID Number

6. Budin WC. Hoskins CN. Haber J. Sherman DW. Maislin G. Cater JR. Cartwright-Alcarese F. Kowalski MO. McSherry CB. Fuerbach R. Shukla S. Breast cancer: education, counseling, and adjustment among patients and partners: a randomized clinical trial. Nursing Research. 2008 May-Jun; 57(3): 199-213. (42 ref) Burlew carries this journal AN: 2009935230 NLM Unique Identifier: 18496106.
NLM Serial ID Number

7. Mantzoukas S. Facilitating research students in formulating qualitative research questions. Nurse Education Today. 2008 Apr; 28(3): 371-7. (29 ref) AN: 2009922124 NLM Unique Identifier: 17714834.
NLM Serial ID Number8511379 ISSN

8. Brewer B. The Clinical Scholar Model: building the capacity for research and EBP: the Clinical Scholar Model: building capacity in a community hospital. Communicating Nursing Research. 2007 Spring; 40 215. AN: 2009904759.
NLM Serial ID Number

9. Brewer MA. The Clinical Scholar Model: building the capacity for research and EBP: the Clinical Scholar Model: building capacity in a pediatric facility. Communicating Nursing Research. 2007 Spring; 40 214. AN: 2009904755.
NLM Serial ID Number

10. Nyamathi AM. Vision for nursing research over the next half decade. Communicating Nursing Research. 2007 Spring; 40 73-80. (25 ref) AN: 2009871977 NLM Unique Identifier: 17900069.
NLM Serial ID Number

11. de Nijs EJM. Ros W. Grijpdonck MH. Nursing intervention for fatigue during the treatment for cancer. Cancer Nursing. 2008 May-Jun; 31(3): 191-208. (44 ref) Burlew carries this journal AN: 2009921180 NLM Unique Identifier: 18453875.
NLM Serial ID Number7805358

12. Miracle VA. Effective poster presentations. DCCN: Dimensions of Critical Care Nursing. 2008 May-Jun; 27(3): 122-4. (7 ref) Burlew carries this journal AN: 2009922449 NLM Unique Identifier: 18434870.
NLM Serial ID Number

13. Bonner A. Sando J. Examining the knowledge, attitude and use of research by nurses. Journal of Nursing Management. 2008 Apr; 16(3): 334-43. (52 ref) Burlew has some online access, no print issues. AN: 2009853834 NLM Unique Identifier: 18324993.
NLM Serial ID Number

14. Marchionni C. Ritchie J. Organizational factors that support the implementation of a nursing Best Practice Guideline. Journal of Nursing Management. 2008 Apr; 16(3): 266-74. (69 ref) Burlew has some online access, no print issues. AN: 2009853826 NLM Unique Identifier: 18324985. NLM Serial ID Number

Vickie's Research Corner

View my guestbook

Welcome to Vickie’s Research Corner. Summer is here and just like the weather our research is hot! I would like to introduce you to Mary Wright, manager of Labor and Delivery. She has a very wonderful ongoing study called “ Attitudes, Knowledge, and Beliefs of Perinatal Staff Related to Breastfeeding Success.”

What is your study about?
My study examines staff’s knowledge, attitudes, and beliefs of breastfeeding and how these factors impact breastfeeding success with patients.

Is it EBP/Research Study?
A quantitative research study; pretest/posttest design.

What made you interested in this project?
Our hospital was examining initiatives regarding becoming a Baby Friendly Hospital. According to the Baby Friendly Hospital Initiative (BFHI) (2006),”More than one million infants worldwide die every year because they are not breastfed or are given other foods too early. Millions more live in poor health, contract preventable diseases, and battle malnutrition.” In our culture we tend to enforce more formula feeding than breastfeeding and have an increased risk of diarrhea, respiratory and ear infections, and allergic skin disorders (BFHI, 2006). Baby-Friendly USA is the national authority for the BFHI in the United States.
BFHI stated, “In 1992, the Healthy Mothers, Healthy Babies Coalition received a grant from the US Department of Health and Human Services to convene an Expert Work Group to examine the criteria and assessment process of the global BFHI. Wellstart International, which is located in San Diego, California, developed the evaluation materials to support the assessment process. The U.S. Committee for UNICEF supported these efforts financially and with “in kind” services. In January of 1997, Healthy Children Project, Inc. accepted responsibility for the initiative and worked to form Baby-Friendly USA as the non-profit organization, which now implements the Baby-Friendly Hospital Initiative in the United States (2006).
BFHI uses ten steps to aid hospitals in the encouragement of breastfeeding. When I thought about implementing these changes to our staff, I decided I really needed to know current knowledge, beliefs, and attitudes of the staff to understand what we were doing well and what we weren’t and why.

How did you go about your research?
Well, I met Dana Rutledge a lot when I decided to do research on the staff. We began looking at previous studies. We designed a twenty one-item survey tool looking at things that have been done here at St. Josephs and what should be done. I then had to go through the St. Joseph IRB for approval. I also had to go through the IRB at California State Fullerton because this project also became a school project. I then surveyed the nurses, wrote a three chapter thesis, and then inputted the data in an excel file and Dana Rutledge and myself analyzed the data. I then presented my findings at the Sigma Theta Tau induction via a poster.

What are your expected outcomes?
Well I have done the pretest already and have data. Two hundred perinatal staff members were surveyed from the perinatal department. I was pleased with what the nurses did know, such as understanding breastfeeding (BF) should be encouraged and education of reasons why is important. I also found that 90% of the nurses knew that formula wasn’t nutritionally equal to milk. This sounds like a big number but in a perinatal staff this number should be 100%, we are striving for perfect care. I realized that I needed to customize the education to my nurses. We will be performing the post test in 2009 after the nurses have been educated.

Have you done research before? If so what did you learn?
No. I learned that I needed to take good notes when setting up a study as well as how to input data in excel, analyze, and actually understand the data you have collected and what that means to your practice. It is so nice to be able to put the numbers to what I actually knew about the nurses and have other people able to analyze the results.

Will you do research/project again?
YES! I have two projects in the works already. I think I’m crazy! In perinatal we are going to look at gum chewing in post-operative c-section patients. There is no data in the literature and this would be great to see if it decreased post-operative complications such as ileus as in colorectal patients. I am also working with one of the anesthesiologists from here to determine a better way to measure hydration with pulsoximeters more effectively in labor and delivery patients with epidurals.

References

Baby Friendly Hospital Initiaitive (2006). What is the Baby-Friendly Hospital Initiative and why do we need it? Retrieved 06-26-08, from http://www.babyfriendlyusa.org/eng/01.html


Baby Friendly Hospital Initiative (2006). The Ten Steps To Successful Breastfeeding. Retrieved 06-26-08, from http://www.babyfriendlyusa.org/eng/10steps.html

Nursing Research Project on Staff Breastfeeding Education

Mary Wright, RNC, BSN has completed a research study entitled :
Attitudes, Knowledge and Beliefs of Perinatal Staff Related to Breastfeeding Success This study examines staff attitudes to breastfeeding and knowledge deficits and has some interesting implications for improving breastfeeding rates. If you have questions, you can contact Mary Wright at St. Joeseph Hospital in Orange, California via email at Mary.Wright@stjoe.org

Nursing Research Project on Nursing Presence

Ellen Gruwell RNC, NSN and Maryanne Garon, RN, DNSc have completed a research project entitled : Nursing Presence : a secondary analysis of nursing narratives. This study utilized a qualitative, descriptive, phenomenological research method to analyze a sample of 36 narratives written by both novice and experienced nurses. If you have questions or want further information on this project, you can reach Ellen at St. Joseph Hospital in Orange, California by email at Ellen.Gruwell@stjoe.org

A culture of caring: Research abstract and commentary

Abstract and Commentary

Carter, L.C., Nelson, J.L., Siever, B.A., Dukek, s.L., Pipe, T.B., & Holland, D.E. (2008). Exploring a culture of caring. Nursing Administration Quarterly, 32, 57-63.

Author’s Abstract

AIM: The delivery of patient-centered care is basic to a large Midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a 36-bed medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. SUBJECTS AND METHODS: The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. RESULTS AND CONCLUSIONS: Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that "caring begets caring," with 2 subthemes: "relationships of care" and "the context of caring." Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring.

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

It is helpful to consider a few details about this study methodology. In order to fulfill their purpose, these authors use a dual method study -- combining a descriptive, comparative survey design (staff plus patients) with a qualitative design using a focus group. The study setting was a medical specialty unit where relationship-based care meant that “nursing staff put at the center of their work a personal relationship with patients and family,… ministering to body, mind, and spirit” (p. 58). Staff completed the Caring Efficacy Scale, a 30-item paper and pencil tool that measures one’s belief in ability to build caring relationships and communicate a caring environment with patients. The tool was deemed to contain the majority of Watson’s carative factors. Patients completed the 10-item Client Perception of Caring Scale, which asks about nonverbal/verbal actions signifying that some aspect of care was carried out by nurses.

Survey respondents were 39% of unit staff (87% RNs; age range 20-60; mean caregiving experience of 7 years; 93% women) and 62 patients (mean age, 65 years; 40% men; 45% with college education). How staff and patients were recruited to be in the study is not mentioned. On average, staff reported they were able to demonstrate caring behaviors and patients had high perceptions of caring. One wonders about the 61% of staff who did not fill out the surveys… what is their perception of ability to give relationship-based care? Unfortunately, although the researchers may have wanted to compare nurse/patient perceptions… because they used different tools for the two groups, direct comparison is impossible. The survey component of the study was fairly ineffective in leading to new knowledge, although the researchers concluded that “nurses’ perceptions of care and patients’ perceptions of care were positive and in alignment” (p. 63).

The focus group (7 RNs, 1 assistant) discussed how to enhance the caring environment. The data discussed from the focus group is quite rich, including categories of care relationships: teamwork, building expertise, personal support from peers, and connecting with patients. The context of caring included the organizational culture, the physical unit, and workload… all of these findings resonate with current situations. A strength of the article is the authors’ ability to discuss relevance of these focus group findings to practice.

Focus group “participants were indeed recognizing that the underlying culture of loving-kindness that keeps a group sustained through periods of time when the environment of caring was stressed by demands and changes” (p.61). This supports the theme that “caring begets caring.” This theme points to the need to recruit and retain staff who embrace caring values, to work for stronger connections with students on units, to promote mentoring among staff, to celebrate caring experiences, and to affirm team and staff member contributions. Specific nurse leader and nurse administrator implications are mentioned by the authors: nurse leader education on therapeutic communication, workflow facilitation, and mutual support; caritas circles for connections of “spiritual renewal and dedication to caring”; establishment of a group ethic that expects care and healing environment with reflective practice.

A new FREE Journal ranking service: SJR-SCImago

The fee-based Science Citation Index now has some competition from the new, free SJR-SCImago Journal & Country rank system. This new service utilizes data from Elsevier's subscription based Scopus database to provide a free source of scholarly journal rankings. Scholars now have an alternative to the previously unchallenged "impact factor" method of comparing the relative importance of journals. The SCImago Journal Rank (SJR) can be used as alternative means of determining the measure of a journal's citation impact. SCImago works by using an algorithm similar to Google's PageRank. Unlike the Impact Factor, SCImago weighs citations from journals according to how highly cited each journal is. Whereas in the standard impact factor approach, every citation has an equal weight. The beauty of the weighted approach by SCImago is that more highly weighted journals such as Nature or New England Journal of Medicine will rank higher. Another difference between the Impact Factor and the SJR is that the SJR calculation looks at citations from a three year period. Because of this, the SJR is a more consistent indicator of trends than impact factors which can vary significantly from year to year.

One major disadvantage of SJR is that the current coverage period for country and journal indicators is only 1996-2007.

You can search SCImago by journal title, keyword, subject and country. You can even create graphs that compare journal titles and export data to Excel.

Here's what the information looks like for the Journal of Advanced Nursing.

Here's a comparison of 4 important nursing research journals:
1999 2000 2001 2002 2003 2004 2005 2006
Nursing Resarch 0.083 0.070 0.097 0.086 0.109 0.111 0.139 0.138
Journal of Advanced Nursing 0.061 0.069 0.069 0.075 0.081 0.083 0.085 0.104
Clinical Nursing Research 0.052 0.058 0.059 0.062 0.063 0.074 0.078 0.091
Western Journal of Nursing 0.050 0.051 0.054 0.055 0.057 0.065 0.079 0.089

Nursing Research Project: Newborn palliative care: experiences of participants in a perinatal comfort care program

Kathryn B. Davies, RNC, BSN, a staff nurse at St. Joseph Hospital in Orange, California, has completed a research project entitled: Newborn palliative care: experiences of participants in a perinatal comfort care program. This research project was completed in pursuit of her Masters in Nursing at California State University, Fullerton. You can view Kathryn's PowerPoint of her poster presentation here. If you have questions, you can email Kathy at Kathy.Davies@stjoe.org

Nursing Research Project: use of anti-emetics and nausea and vomiting in the ambulatory post-operative patient

Lorilee Amlie, Rn, BSN, a staff nurse at St. Joseph Hospital in Orange, California, has completed a research project entitled : A chart audit: use of anti-emetics and nausea and vomiting in the ambulatory post-operative patient. This project was completed in pursuit of her Masters in Nursing at California State University, Fullerton. You can view a PowerPoint of her poster presentation here. If you have questions for Lorilee, you can email her at Lorilee.Amlie@stjoe.org

Our blog recognized as one of the top 100 academic medical blogs!

The ONDD (Online Nursing Degree Directory blog) recently recognized Nursing Research: Show me the Evidence! as one of the top 100 academic medical blogs. Read the entry here and scroll down to the nursing section. Lots of great blogs out there!!

Julie's picks from the literature for April

These recent articles captured my attention as being of special interest to the practice of EBN at St. Joseph Hospital in orange, California.

1. Sawatzky-Dickson DM. Clarke DE. Increasing understanding of nursing research for general duty nurses: an experiential strategy. Journal of Continuing Education in Nursing. 2008 Mar; 39(3): 105-11. (18 ref) Burlew carries this journal AN: 2009854799 NLM Unique Identifier: 18386697.

2. Thompson DS. O'Leary K. Jensen E. Scott-Findlay S. O'Brien-Pallas L. Estabrooks CA. The relationship between busyness and research utilization: it is about time. Journal of Clinical Nursing. 2008 Feb; 17(4): 539-48. (40 ref) Burlew has some online access, no print issues. AN: 2009777688 NLM Unique Identifier: 18205684.

3. Leasure AR. Stirlen J. Thompson C. Barriers and facilitators to the use of evidence-based best practices. DCCN: Dimensions of Critical Care Nursing. 2008 Mar-Apr; 27(2): 74-84. (74 ref) Burlew carries this journal

4. Annells M. O'Neill J. Flowers C. Compression bandaging for venous leg ulcers: the essentialness of a willing patient. Journal of Clinical Nursing. 2008 Feb; 17(3): 350-9. (21 ref) Burlew has some online access, no print issues. AN: 2009777665 NLM Unique Identifier: 18205691.

5. Munroe D. Duffy P. Fisher C. Research for practice. Nurse knowledge, skills, and attitudes related to evidence-based practice: before and after organizational supports. MEDSURG Nursing. 2008 Feb; 17(1): 55-60. (21 ref) Burlew carries this journal AN: 2009820287.

6. Owen P. Monahan MF. MacLaren R. Implementing and assessing an evidence-based electrolyte dosing order form in the medical ICU. Intensive & Critical Care Nursing. 2008 Feb; 24(1): 8-19. (54 ref) AN: 2009807209 NLM Unique Identifier: 17686630.

7. Berry AM. Davidson PM. Masters J. Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care. 2007 Nov; 16(6): 552-63. (90 ref) Burlew carries this journal AN: 2009868538 NLM Unique Identifier: 17962500.

8. Fowler S. Leaton MB. Baxter T. McTigue T. Snook N. Research corner. Evolution of nursing research committees. Journal of Neuroscience Nursing. 2008 Feb; 40(1): 60-3. (8 ref) Burlew carries this journal AN: 2009803005 NLM Unique Identifier: 18330412.

Vickie's Research Corner

View my guestbook

Welcome to Vickie’s Research Corner. Spring has sprung and so have many research projects here at St. Joseph Hospital. I would like to introduce you to Lorilee Amlie, the new Nurse Navigator for Melanoma. Lorilee has been with the hospital for many years and used to work in the Outpatient Surgery Center in the Pavilion. She has a very exciting study called “Post-Operative Nausea and Vomiting Chart Review.”

What is your study about?
My study was to identify medical record findings for ambulatory surgery patients who have received intra-operative or post-operative doses of Zofran. I wanted to look at the effects of antiemetics and to determine how many times this antiemetic is given in the OR.

Is it EBP/Research study?
Research study- Retrospective chart review.

What made you interested in this project?
Since I was in graduate school for nursing administration, I was looking for a research project for my Masters in Nursing. Dr. Rutledge brought this project to me two years ago since I worked in outpatient surgery. Initially in surgery there had been a chart review done by someone else who was trying to identify if certain patients had nausea after surgery, especially with certain anesthesiologists. Once I saw the study I realized this was a good idea. Dr. Rutledge and I decided to look at the effects of the drugs themselves, how often antiemetics (specifically Zofran or Ondansetron) were being given, and if they were being ordered as to the recommendations of current guidelines. I know that nausea is a problem and I wanted to see if we could decrease the amount of nausea that patient’s have pre and post-operatively. According to the literature postoperative nausea and vomiting is a distressing, uncomfortable situation that can increase pain and time in the PACU and sometimes leads to unplanned hospitalizations.

How did you go about your research?
For school I had to write the first three chapters of a thesis, which included a literature review. I examined postoperative nausea and vomiting, medication effects, and recommendations of using drugs. Then I had to go through the IRB at SJH and CSUF. Initially my study was rejected with suggestions from the SJH IRB. After making the adjustments I resubmitted and was accepted. After IRB I began to do chart reviews. With the help of the nursing research staff, who helped me to set up a data collection sheet, I collected all my data. We then put it into a database format and Dr. Rutledge ran the statistics in SPSS for me. I then worked on a poster with more excellent input and help from Dr. Rutledge and you. My poster was disseminated at the Induction Ceremony for Sigma Theta Tau and I was inducted into Upsilon Beta, Sigma Theta Tau International Honor Society.




What are your expected outcomes?
Actually, I expected that patients who received Zofran in both the OR and PACU and who experienced nausea would spend more time in the PACU, my study showed a slight difference between these patients, but it wasn't significant. But, my study did show that those who received Zofran 30 minutes prior to the end of the case spent on average 30 minutes less time in the PACU.


Have you done research before? If so what did you learn?
Nope, never. I learned how important and exciting research could be. I also learned that research is very time consuming. The only real negative part for me was when the IRB initially rejected my study but then when they accepted it I felt fabulous. One great thing about research is when you see the results of your research it’s so much fun.

Will you do research/project again?
I hope so. I met with Maria Gonzales in Oncology and saw all the research projects going on in Oncology. Since I am now the Nurse Navigator for Melanoma I will be working on a research project just on Melanoma.

CE article on "Educational Strategies to develop Evidence-Based Practice Mentors"

The current issue of Journal for Nurses in Staff Development has a great article titled Educational Strategies to Develop Evidence-Based Practice Mentors. The article is authored by a team from Johns Hopkins Hospital in Baltimore, Maryland. Not only is the article a good read with descriptions of the model they used, their guidelines for implementation, workshop agendas and EBP workshop evaluations, but it also comes with CE credit. The CE test and instructions are in the same issue and do require a fee payable to Lippincott, Williams and Wilkins.

Dearholt, Sandra L; White, Kathleen M; Newhouse, Robin; Pugh, Linda C; Poe, Stephanie. Educational strategies to develop evidence-based practice mentors Journal for Nurses in Staff Development 24(2) 53-61 March/April 2008. Staff at Saint Joseph Hospital, Orange/Children's Hospital of Orange County can access this article online at Burlew Medical Library's website.

Query about nursing research at St. Joseph Hospital

Question I received recently from a fellow nurse, and my response to her....

Hi Dana,
I am taking over the Nursing research council here at xxxxx and absolutely love your website. I love the idea of your journal club, can you give me some more details on how you got that set up and has it been successful.
Also, how are your meetings set up for the NRC. Do you just have an agenda and give updates on all projects or do you incorporate some work time in those meetings.
I appreciate any advice you can give me because I truly feel like I am floundering. I have been ... here for about 3 years and this new position lacks a team that is motivated and most are floundering like I am and it is important for me to instill motivation and direction. Please help.

xxx- Good luck... I've been at this for ~4 years, and have periods when I feel "success" and those when I wonder what's going on. Patient care is definitely the priority of staff - not nursing research.
My journal clubs have not been wildly successful in terms of #s attending. However, each session (5-6 per year generic sessions, and unit-based sessions upon request) has a heterogeneity of attendees (at this point, I'm still selecting the articles, and the nurses come... usually NOT having read the article). I give an article synopsis, emphasizing Why the authors did the study (I ususally do research articles), what they did (methods... briefly), what they found (briefly), and the so what? Then, the discussion usually takes off on how this might be applicable in our setting. Even though I've been disappointed in turnout, and in the fact that nurses aren't reading, the sessions (around 1 hour at lunchtime - everyone brings lunch) are usually lively, and I think the nurses love the time to really talk about nursing and what the topic is outside of the normal work environment. A couple have led to practice changes - one about using factsheets has led to several projects that use factsheets to disseminate knowledge, one on effects of shiftwork on nurses added to the discussion on whether nightshift nurses should be allowed to sleep on their breaks, etc.
Regarding our Research Council meetings. We meet 10 times per year for 2 hours. Up to this point, meetings have included mostly reports of activities. The first year I did a 20 minute "educational brief" on various research topics to bring folks up to speed on research terminology. Those have not been repeated, but we have new members all the time, so probably should be. We are embarking on a new venture this year .... Did You Know? posters. A task force is working on how to roll this out. Research council meetings (3-4 per year) will be spent actively working on these posters which will involve rotating materials on poster templates and "pushing" these out to units. Optimally, topics will be unit-specific. This is an idea as yet... so will keep you posted.

Julie's picks from the nursing literature for Feb 2008

Patrons of Burlew Medical Library may retrieve the full text of many of these articles via our library web site or call the library to request copies.

1. Fehder WP. Nursing care & management of pathological oral conditions among women and children. MCN: The American Journal of Maternal/Child Nursing. 2008 Jan-Feb; 33(1): 38-44. (31 ref) Burlew carries this journal AN: 2009759201 NLM Unique Identifier: 18158526.

2. 2009766135. Leung SF. Chong SYC. Arthur DG.
Title Reducing medication errors: development of a new model of drug
administration for enhancing safe nursing practice.
Asian Journal of Nursing. 2007 Sep; 10(3): 191-9. (15 ref)

3. Labeau S. Vereecke A. Vandijck DM. Claes B. Blot SI. Critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. American Journal of Critical Care. 2008 Jan; 17(1): 65-72. (28 ref) Burlew carries this journal AN: 2009753997 NLM Unique Identifier: 18158

4. Pinto BM. Floyd A. Methodologic issues in exercise intervention research in oncology. Seminars in Oncology Nursing. 2007 Nov; 23(4): 297-304. (59 ref) Burlew carries this journal AN: 2009742237 NLM Unique Identifier: 18022057.

5. Knobf MT. Musanti R. Dorward J. Exercise and quality of life outcomes in patients with cancer. Seminars in Oncology Nursing. 2007 Nov; 23(4): 285-96. (67 ref) Burlew carries this journal AN: 2009742236 NLM Unique Identifier: 1802205

6. Rourke DR. The hospital library as a "Magnet Force" for a research and evidence-based nursing culture: a case study of two Magnet hospitals in one health system. Medical Reference Services Quarterly. 2007 Fall; 26(3): 47-54. (15 ref) AN: 2009651473 NLM Unique Identifier: 17915630.

7. Walker L. Lamont S. The use of antiembolic stockings. Part 1: a literature review. British Journal of Nursing. 2007 Dec 13-2008 Jan 9; 16(22): 1408-12. (23 ref) AN: 2009774725.
NLM Serial ID Number

8. Murphy TH. Labonte P. Klock M. Houser L. Falls prevention for elders in acute care: an evidence-based nursing practice initiative. Critical Care Nursing Quarterly. 2008 Jan; 31(1): 33-9. (14 ref) Burlew has some online access, no print issues. AN: 2009774859.

9. Lynch M. Dahlin CM. The National Consensus Project and National Quality Forum preferred practices in care of the imminently dying. Journal of Hospice and Palliative Nursing. 2007 Nov-Dec; 9(6): 316-22. (34 ref) Burlew carries this journal AN: 2009751680.

10. Eilers J. Million R. Prevention and management of oral mucositis in patients with cancer. Seminars in Oncology Nursing. 2007 Aug; 23(3): 201-12. (71 ref) Burlew carries this journal AN: 2009738961 NLM Unique Identifier: 17693347.

11. Rodriguez W. McCarty D. O'Donnell A. Kane J. Nolan S. Carlese C. How much blood is enough? An evidence-based study on the minimum blood volume required for laboratory tests... Oncology Nursing Society 32nd Annual Congress, April 24-27, 2007, Las Vegas, NV. Oncology Nursing Forum. 2007 Mar; 34(2): 527. Burlew carries this journal AN: 2009561732.

12. Wiener B. Chacko S. Cron SG. Cohen MZ. Guideline development and education to insure accurate and consistent pulmonary artery wedge pressure measurement by nurses in intensive care units. DCCN: Dimensions of Critical Care Nursing. 2007 Nov-Dec; 26(6): 263-8. (4 ref) Burlew carries this journal AN: 2009741185 NLM Unique Identifier: 18090148.

13. McAndrew L. Schneider SH. Burns E. Leventhal H. Does patient blood glucose monitoring improve diabetes control? A systematic review of the literature. Diabetes Educator. 2007 Nov-Dec; 33(6): 991-1010. (62 ref) Burlew carries this journal

14. Povey RC. Clark-Carter D. Diabetes and healthy eating: a systematic review of the literature. Diabetes Educator. 2007 Nov-Dec; 33(6): 931-59. (37 ref) Burlew carries this journal AN: 2009749033 NLM Unique Identifier: 18057263.

15. Horton K. Tschudin V. Forget A. The value of nursing: a literature review. Nursing Ethics. 2007 Nov; 14(6): 716-40. (83 ref) AN: 2009707487 NLM Unique Identifier: 17901183.

16. Gardetto NJ. Carroll KC. Management strategies to meet the core heart failure measures for acute decompensated heart failure: a nursing perspective. Critical Care Nursing Quarterly. 2007 Oct-Dec; 30(4): 307-20. (24 ref) Burlew has some online access, no print issues. AN: 2009683482 NLM Unique Identifier: 17873567.

The A to Z Weight Loss Study

On February 6th- the Nursing Research Council at St. Joseph's reviewed a study published in JAMA in March of 2007 (Vol.297, No.9, 969-977). The study was a randomized clinical trial of 4 weight loss programs in which overweight, premenopausal women. Each group had near 80 participants who were given a book of the diet they were to follow along with 8 weeks of instruction and then followed for 12 months regarding adherence, actual nutrients consumed, affects on glucose, blood pressure and lipids as well as actual weight loss.
The diets were:
Atkins- high protein,fat and very low carbohydrate
Zone- low carbohydrate, moderate protein
LEARN- low fat, high carbohydrate based on national guidelines
Ornish-high carbohydrate,low fat
The outcome was surprising-
The Atkins diet had the highest weight loss average at 10.3 lbs
The Zone diet average was 3.2 lbs
The LEARN diet average was 5.72 lbs
The Ornish diet average was 4.8 lbs

The Atkins diet group had the lowest number of dropouts.
The Atkins diet also higher drops in triglycerides, increased HDL-C, no change in LDL-C and greater decrease in BP than the other groups.

Our discussion was lively-
First we verified that the study was not funded by Atkins Corp.- it was funded by the NIH.
We discussed that perhaps protien and fat created more satiety thus more adherance to the diet.
We are hoping the study will continue to follow the same cohorts to see what the long term effects of the diets might be.
Does the weight loss last?
Is the diet sustainable?
Long term effects on lipids?
We felt one weakness of the study was the inclusion of only premenoupasal women.
Overall though the study design was strong and we believe that the outcomes provide valuable information.

2008 Western Institute of Nursing Conference in California

2008 Conference will be in Southern California!
The 2008 WIN conference will be held on April 17-19, 2008 at the Hyatt Regency Orange County in Garden Grove, California. The conference theme is, “The Circle of Nursing Knowledge: Education, Practice and Research.” Visit the WIN website for more information. Our very own Dana Rutledge, RN, PhD and Beth Winokur, RN, MSN, CEN each have abstracts to be shared at this conference.

THE 24TH EDITION of the ICIRN Essential Nursing Resources list

THE 24TH EDITION of the ICIRN Essential Nursing Resources list is presented as a resource for locating nursing information and for collection development. The list includes print, multimedia, and electronic sources to support nursing practice, education, administration, and research activities.
Open access PDF version, Nursing Education Perspectives, 2007 Vol. 28, No. 5, pp. 276-285.
http://nln.allenpress.com/pdfserv/i1536-5026-028-05-0276.pdf

Open access HTML version:
http://homepages.nyu.edu/~skj1/essentialnursingresources2007.html

Please answer our quick SURVEY on your use of Essential Nursing Resources:
http://tinyurl.com/2l4qdn

THIS LIST was compiled from the contributions of the following representatives of the Interagency Council on Information Resources in Nursing (ICIRN) member agencies:
Richard Barry, Ysabel Bertolucci, Leslie Block, Warren G. Hawkes, Susan Kaplan Jacobs, Aurelie Knapik, Polin P. Lei, Susan Pierce, Juliette Ratner, and Annelle Tanner.
Interagency Council on Information Resources in Nursing
For more information about ICIRN, visit http://www.icirn.org/

Abstract with Commentary

Author’s Abstract

OBJECTIVE: The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. BACKGROUND: Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. METHODS: This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. RESULTS: After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. CONCLUSIONS: Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes.

Hall, L.M., Doran, D., & Pink, L. (2008). Outcomes of interventions to improve hospital nursing work environments. Journal of Nursing Administration, 38, 40-46.

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

The intervention in this study was fairly complex in that individual units determined a workplace change to implement. For 6 months, change development and implementation was facilitated by a trained bachelor’s prepared nurse who devoted efforts solely to this project. Changes included things like enhancing documentation activities, increasing medication supplies, and implementation of a communication tool related to patient transfers. Changes before and 6 months after the workplace change were determined for system data (unit/hospital characteristics), nurse outcome data (surveys on satisfaction, work quality, etc.), and patient outcomes (ADLs, satisfaction, etc.). Analysis involved “nesting” outcomes for nurses within units. Patient outcomes were not nested since different patients were used at data collection points.

Hospitals studied all were in Ontario Canada. Nurses were mostly females (95%) prepared at diploma or certificate level (76%). Experience levels varied with 29% of nurses having less than 5 years and 20% having > 25 years. Most units (60%) used “total patient care delivery model,” which was not defined. Patients were 46% medical, 54% surgical.

Six-month findings indicated positive changes in nurse perceptions of the work and work environment. This is one of few studies that measure change over time with a work environment change (probably due to the complexity of such research designs). Researchers discussed the significant contributions of nurse and unit characteristics on outcomes. For example, RNs with baccalaureate degrees reported higher levels of job stress than those with diplomas… could the “added knowledge and understanding that comes with degree education and the greater sense of accountability” be active in these findings? Unit characteristics such as proportion of part-time nurses also impacted outcomes with units having more part-time nurses having higher average nurse ratings of job satisfaction. Finally, hospital and unit characteristics impacted patient outcomes… patients in teaching hospitals reported better perceptions of quality and increased independence than did community hospital patients.

Implications from this Canadian study are that fairly simple workplace changes can quickly (within 6 months) alter nurse and patient outcomes. Authors described issues with nurse generations, nurse experience, and patient-to-nurse ratios that deserve further study.

Evidence-Based Policy and Procedures

Authors at the University of Colorado Hospital in Aurora have recently authored an article titled Evidence-Based Policy and Procedures: an algorithm for success which appeared in JONA : Journal of Nursing Administration 38(1): 47- 51, January 2008. Library users at St. Joseph Hospital, Orange and CHOC can read the full text of this article online via Burlew Medical Library's website. The authors identified nothing in the literature speaking to evidence-based policy and procedure development. Their EBP Council then identified the steps involved in evidence-based policy development and created a 10-step algorithm with very practical detail. The authors describe their process for systematically critiquing and rating the evidence identified. Another interesting innovation at this Magnet hospital is their requirement for a yearly EBP competency that is required for all clinical nurses. Does anyone out there in the blogosphere know of any other institution that has such a requirement?

Kudos to the authors: Kathleen S. Oman, RN, PhD, CEN, FAEN; Christine Duran, APRN-BC, DNP, CNS, CCTN; Regina Fink, RN, PhD, AOCN, FAAN.

Nursing Grand Rounds at St. Joseph Hospital (written by Sharon Kleinheinz, RN, MSN)

On November 19, 2007, St. Joseph Hospital held the second annual Nursing Grand Rounds dedicated to Nursing Research and Evidence Based Practice projects being conducted at the hospital.

St. Joseph Hospital’s Nurse Research Facilitator, Dana Rutledge, RN, PhD, led the seminar on the use of evidence-based practice in guiding health care decisions and improving patient outcomes.

This 4-hour program featured 10 St. Joseph Registered Nurses providing updates on nursing research studies and evidence-based practice projects that are currently underway at St. Joseph. Projects included the following outcomes and learnings:
· Outcomes of a hospital based MET team (Medical Emergency Team) in terms of decreased codes and decreased transfers of patients from med/surg units to ICUs.
· How adding a sedation protocol and vacation to a ventilator bundle has impacted the intubated patient.
· How preoperative preparation and education for the outpatient surgical patient can decrease cancellation of surgery.
· Reasons for and realities of implementing a study comparing the use of a temporal artery thermometer with oral/ axillary or rectal thermometers in the Emergency Department pediatric patient population.

Also featured were the results of a survey on the nurse’s knowledge and attitudes on breastfeeding, the implementation of education for nursing staff providing smoking cessation information to patients, and an overview of the progress of existing end of life programs for patients.

Dr. Rutledge presented the Iowa model and principles of evidence-based practice that is utilized at St. Joseph. Julie Smith, the manager of the St. Joseph Burlew Medical library provided an update on the EBP Blog and the numerous resources available to assist staff in nursing research and evidence-based projects.

Libraries as "Information Commons"

I came across this really cool blog entry written by the Director of Medical Inforamtics at University of Colorado Hospital. In this entry, libraries are "information commons" and librarians are "knowledge navigators". A nice read on the new directions that medical libraries ahve pursued-- even the ones still called "libraries"

Interview

Welcome to Vickie’s Research Corner. I hope everyone had a wonderful holiday season. Well, here we are in 2008 and we are back to evidence-based practice (EBP) and research projects. This year should be really interesting so watch out for all the new projects coming your way.
For the first project of the year, I would like to introduce you to Amy Waunch. She is the Advanced Practice Nurse (APN) in the Emergency Department.

What is the name of your project?
Emergency Department Pediatric Temperature Study

What is your study about?
The purpose of my study is to compare temporal artery thermometer readings in emergency department patients 17 years and younger with oral, rectal, and axillary temperatures. A study sub-aim is in patients who have received antipyretics, to evaluate the presence of a “lag” in any measure compared to others due to physiologic responses to the antipyretic.

Is it EBP/Research study?
Research- a correlational comparative study.

What made you interested in this project?
Fever is the most common complaint of children seen in a pediatric emergency department (Poiriert et al. 2000). Temperature measurements reflect changes in physiologic status that may require clinical interventions. Accuracy of temperature readings and an understanding of different routes of temperature taking can affect health providers decisions concerning critically ill children and infants. In a busy ED, taking temperatures can be problematic and we were looking at the best method for taking temperatures in children.
A new thermometer, for temporal artery readings has been developed. The temporal thermometer (Exergen Corp., Walterton MA) computes temporal artery temperature by using a heat balance method. This method is noninvasive and more comfortable than rectal temperatures in infants. A representative from the company approached our ED about using this thermometer stating their studies demonstrated this is more or at least as accurate as rectal thermometry.
After looking into the research, I realized there has been no study found comparing temporal artery readings with oral, rectal, and axillary readings among children 17 years or younger admitted to emergency departments. I wanted to insure using the best method possible in our ED instead of taking a sales representatives word. I wanted to actually have research versus opinion. Therefore, I created a study.

How did you go about your research?
I started with a literature review and couldn’t find a clear-cut conclusion on the accuracy of temporal artery thermometry use on pediatric patients presenting to an emergency department. I then investigated the community standard of care for pediatric temperature attainment and learned that practice varies greatly form one hospital to another. I looked to expert opinion from professional organizations such as the American Association of Pediatrics and the American College of Emergency Physicians, again with no consensus.
So I decided to talk to Dana Rutledge to help me do a more extensive literature search. We found there is no gold standard or clear evidence for taking temperatures in pediatric patients. At this point we decided to create a research study. For the study I asked Beth Winokur, the Clinical Educator for the ED, and John Senteno, the Director of ED to help. Dana wrote the proposal and gave input. I formulated a team of interested persons: Christine Marshall, Clinical Nurse IV in the ED; Mike Vicioso, Pediatric Manager in ED; and Beth Winokur. We then applied for the IRB. For the last year we have been trying to accrue patients for the study.

What are your expected outcomes?
I believe we may find that the temporal artery thermometer is inconsistent. I also think we may find that axillary temperatures are inconsistent as well. Data from research states that rectal temperatures are the closest to the core temperature but unfortunately they are the most invasive. I hope to find that the temporal artery thermometer is a reliable and accurate means of obtaining temperatures in pediatric patients in the ED. This method is non-invasive and will cause less anxiety among parents compared to rectal thermometry.

Have you done research before? If so what did you learn?
I have co-investigated randomized clinical trials for asthma when I worked at an allergy office as a Nurse Practitioner. I learned that acquiring data is very detailed oriented. I also learned that the IRB is really designed to keep the best interest of the patients. I actually was pleasantly surprised going through the IRB that our study was approved for an expedited review due to the fact we worked with a vulnerable population.
Research can be very challenging, especially this study! We have had problems with data collection due to time of the RNs acquiring patients, making sure all the coinvestigators were compliant with the CITI training that CHOC’s IRB makes you complete prior to research, and the challenges of the administrative end of paperwork.

Will you do research/project again?
Yes, but next time I will get more help from the beginning and more people involved who are dedicated to the time issue.

References:
Poirier, M.P., Davis. P.H., Gonzalez-del Ray, J.A., & Monroe, K.W. (2000). Pediatric emergency department nurses’ perspectives on fever in children [Abstract]. Pediatric Emergency Care, 16, 9-12.