Jean Watson's Theory

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

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

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

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

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

Commentary on Report on Nurses' Tobacco Cessation Behaviors

Research Abstract with Commentary

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

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

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

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

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

Nurses’ Perceptions of their Skills to Counsel Patients

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

*Response set: 1= poor; 5 = excellent

Julie's picks from the nursing literature: November

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

julie's picks for October from the nursing lit

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

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

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

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

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

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

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

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

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

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

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

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

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

Intraoperative Radiation Therapy

Intraoperative Radiation Therapy (IORT)

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

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

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

Poster on our blog presented at the 2009 ANCC Magnet Conference

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

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

Research Abstract with Commentary

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

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

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

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

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

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

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

Vickie's Research Corner

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

Our Magnet Journey to Redesignation

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

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

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

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

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

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

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

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

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

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


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

Vitamin D- the new wonder drug??

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

Cancer Research in Breast Cancer

Cancer Research in Breast Cancer Patients

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

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

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

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

What are the different types of clinical trials?

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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


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

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

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

Don't Miss our Annual EBP Conference, October 2

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

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

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

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

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

New review regarding the benefits of Fish Oil!

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

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

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

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

Research Abstract and Commentary: Topical Opioids

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

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


Commentary by Dana Rutledge

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

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

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

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

compilation of 90+ videos on technology and media literacy

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

Clinical Narratives

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

AHRQ Evidence-Based Practice Update

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

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

Survivorship Education for Quality Cancer Care

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

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

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

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

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

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

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

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

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

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

Check it out!!

Top 50 Nurse Practitioner blogs; we're represented!

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

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

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

Say hello to our new blog team

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

Smoking and Alcohol Intervention before Surgery: Evidence for Best Practice

Research Abstract and Commentary

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

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

Commentary by Dana Rutledge, RN, PhD

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

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

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

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

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

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

Our nursing research blog receives recognition!!

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

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

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

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

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

Quinal L, Harford S, Rutledge DN.

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

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

Vickie's Research Corner

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

Julie's picks from the nursing literature: May 09

Here's some recent articles in the nursing literature of special interest to our readers. St. Joseph Hospital,Orange and CHOC staff may access many of these articles through our library web site.

1. Providing effective evidence-based catheter management.Preview Nazarko L; British Journal of Nursing (BJN), 2009 Apr 9; 18 (7): S4-12 (journal article - tables/charts) ISSN: 0966-0461 CINAHL AN: 2010247109

2. The emerging role of PDAs in information use and clinical decision making. Doran D; Evidence-Based Nursing, 2009 Apr; 12 (2): 35-8 (journal article) ISSN: 1367-6539 PMID: 19321815 CINAHL AN: 2010248444

3, To lower or not to lower? Making sense of the latest research on intensive glycaemic control and cardiovascular outcomes. Evidence-Based Nursing, 2009 Apr; 12 (2): 38 (journal article) ISSN: 1367-6539 PMID: 19321816 CINAHL AN: 2010248445

4. Continuous glucose monitoring improved glycaemic control in pregnant women with diabetes and reduced infant macrosomia. O'Brien B; Evidence-Based Nursing, 2009 Apr; 12 (2): 43 (journal article) ISSN: 1367-6539 PMID: 19321820 CINAHL AN: 2010248449

5. Continuous glucose monitoring improved glucose control in adults but not in young adults or children with type 1 diabetes. Allen NA; Evidence-Based Nursing, 2009 Apr; 12 (2): 44 (journal article) ISSN: 1367-6539 PMID: 19321821 CINAHL AN: 2010248450

6. Vitamin E or vitamin C supplements did not differ from placebo for major cardiovascular events and mortality. Young LE; Evidence-Based Nursing, 2009 Apr; 12 (2): 48 (journal article) ISSN: 1367-6539 PMID: 19321825 CINAHL AN: 2010248454

7. Review: early feeding and delayed feeding after PEG placement do not differ for complications or death within 72 hours. Lindeboom R; Evidence-Based Nursing, 2009 Apr; 12 (2): 50 (journal article) ISSN: 1367-6539 PMID: 19321827 CINAHL AN: 2010248456

8. Occlusive dressings and gauze dressings did not differ for healing open wounds in surgical patients. Gethin G; Evidence-Based Nursing, 2009 Apr; 12 (2): 52 (journal article) ISSN: 1367-6539 PMID: 19321829 CINAHL AN: 2010248458

9. Review: compression plus pharmacological prophylaxis reduces VTE more than monotherapy in high-risk patients. Ladak SS; Evidence-Based Nursing, 2009 Apr; 12 (2): 54 (journal article) ISSN: 1367-6539 PMID: 19321831 CINAHL AN: 2010248460

10. Review: anaemia increases mortality risk in patients with chronic heart failure. Tranmer JE; Evidence-Based Nursing, 2009 Apr; 12 (2): 58 (journal article) ISSN: 1367-6539 PMID: 19321835 CINAHL AN: 2010248464

11. Nurses' triage assessments were affected by patients' behaviours and stories and their perceived credibility. Acorn M; Evidence-Based Nursing, 2009 Apr; 12 (2): 61 (journal article) ISSN: 1367-6539 PMID: 19321838 CINAHL AN: 2010248467

12. Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review.Preview (includes abstract); Lewis R; Neal RD; Williams NH; France B; Wilkinson C; Hendry M; Russell D; Russell I; Hughes DA; Stuart NS; et al.; Journal of Advanced Nursing, 2009 Apr; 65 (4): 706-23 (journal article - research, systematic review, tables/charts) ISSN: 0309-2402 PMID: 19278415 CINAHL AN: 2010221331

13.Identifying abuse among women: use of clinical guidelines by nurses and midwives.Preview (includes abstract); Svavarsdottir EK; Orlygsdottir B; Journal of Advanced Nursing, 2009 Apr; 65 (4): 779-88 (journal article - research, tables/charts) ISSN: 0309-2402 PMID: 19183236 CINAHL AN: 2010221332

Julie's picks from the nursing literature:April 09

1. Evidence-based nursing: clarifying the concepts for nurses in practice.(includes abstract); Scott K; McSherry R; Journal of Clinical Nursing, 2009 Apr; 18 (8): 1085-95

2. Evaluating nursing documentation -- research designs and methods: systematic review.(includes abstract); Saranto K; Kinnunen U; Journal of Advanced Nursing, 2009 Mar; 65 (3): 464-76

3. Evidence-based nursing. The SCIP core measures: A dizzying array of issues.Booth J; Nursing Management, 2009 Mar; 40 (3): 10, 12, 14

4. Developing clinical research projects: novice to expert.Siegel JH; Korniewicz DM; Perioperative Nursing Clinics, 2009 Mar; 4 (1): 23-9

5. The latest evidence to guide obesity prevention, policy, and clinical practice with overweight children and adolescents.Melnyk BM; Worldviews on Evidence-Based Nursing, 2009 1st Quarter; 6 (1): 44-8

6. Pain assessment and management in surgical nursing: a literature review.(includes abstract); Bell L; Duffy A; British Journal of Nursing (BJN), 2009 Feb 12; 18 (3): 153-6 (journal article - pictorial, research, systematic review) ISSN: 0966-0461 PMID: 19223798 CINAHL AN: 2010196749

7. PUTTING EVIDENCE INTO PRACTICE: evidence-based interventions to prevent and manage anorexia.(includes abstract); Adams LA; Shepard N; Caruso RA; Norling MJ; Belansky H; Cunningham RS; Clinical Journal of Oncology Nursing, 2009 Feb; 13 (1): 95-102 (journal article - research, systematic review, tables/charts) ISSN: 1092-1095 PMID: 19193554 CINAHL AN: 2010190247

8. Systematic review of the effectiveness of primary care nursing.(includes abstract); Keleher H; Parker R; Abdulwadud O; Francis K; International Journal of Nursing Practice, 2009 Feb; 15 (1): 16-24 (journal article - research, systematic review, tables/charts) ISSN: 1322-7114 PMID: 19187165 CINAHL AN: 2010171910

9. Review summaries: evidence for nursing practice.Stern C; Journal of Advanced Nursing, 2009 Feb; 65 (2): 279-84 (journal article - abstract, tables/charts) ISSN: 0309-2402 CINAHL AN: 2010177689

10. How evidence-based is venous leg ulcer care? A survey in community settings.(includes abstract); Van Hecke A; Grypdonck M; Beele H; De Bacquer D; Defloor T; Journal of Advanced Nursing, 2009 Feb; 65 (2): 337-47 (journal article - research, tables/charts) ISSN: 0309-2402 PMID: 19016923 CINAHL AN: 20101776

11. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center.(includes abstract); Brown CE; Wickline MA; Ecoff L; Glaser D; Journal of Advanced Nursing, 2009 Feb; 65 (2): 371-81 (journal article - research, tables/charts) ISSN: 0309-2402 PMID: 19040688 CINAHL AN: 2010177698

12. Organizational readiness for evidence-based practice.(includes abstract); Gale BV; Schaffer MA; Journal of Nursing Administration, 2009 Feb; 39 (2): 91-7 (journal article - research, tables/charts) ISSN: 0002-0443 PMID: 19190426 CINAHL AN: 2010194939

13. Pediatric perspectives. Pediatric evidence-based practice: using the best available evidence to improve pediatric outcomes.Jones SKB; Pate MFD; AACN Advanced Critical Care, 2009 Jan; 20 (1): 19-25 (journal article - tables/charts) ISSN: 1559-7768 PMID: 19174633 CINAHL AN: 2010190119

14. Perceived effects of specialty nurse certification: a review of the literature.(includes abstract); Wade CH; AORN Journal, 2009 Jan; 89 (1): 183-8, 190-2 (journal article - research, systematic review, tables/charts) ISSN: 0001-2092 PMID: 19121422 CINAHL AN: 2010153499

15. Promoting evidence-based practice through a traveling journal club.(includes abstract); Campbell-Fleming J; Catania K; Courtney L; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jan-Feb; 23 (1): 16-20 (journal article) ISSN: 0887-6274 PMID: 19098510 CINAHL AN: 2010147816

16. Graduated compression stocking and intermittent pneumatic compression device length selection.(includes abstract); Hilleren-Listerud AE; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jan-Feb; 23 (1): 21-4 (journal article - review) ISSN: 0887-6274 PMID: 19098511 CINAHL AN: 2010147817

Book Review: Real Stories of Nursing Research

New book in Burlew Library (WY 20.5 R2877 2010 NSG)
McLaughlin, M. M. K., & Bulla, S. A. (Eds). (2009). Real stories of nursing research: The quest for Magnet recognition. Sudbury MA: Jones & Bartlett.
In Real Stories of Nursing Research: The Quest for Magnet Recognition, real stories and brief research abstracts show that direct care nurses really can do research. We know this at St. Joseph, but it is fun to read these stories, as they come from nurses in Magnet-designated hospitals located in all types of settings. This text includes helpful hints from experts like librarians, statisticians, and IRB reviewers who discuss how to make the research journey smoother. Real Stories of Nursing Research addresses overcoming fears of research and is a fun read.