Danielle's picks from the literature November 2010

Here are my picks from the nursing literature published over the last few months. Staff at St. Joseph Hospital or Children's Hospital of Orange County may be able to access some of the full text articles through the Burlew Medical Library.

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

2. Critical care: does profusion of evidence lead to confusion in practice? McKenna H; Nursing in Critical Care, 2010 Nov-Dec; 15 (6): 285-90
Abstract: There have been a plethora of articles on evidence-based practice or its many derivative terms (evidence-based nursing, evidence-based medicine, evidence-based health care, etc.). However, the word 'based' implies an almost unquestioning belief in evidence. I will argue that the term 'Evidence Informed Practice' is probably more accurate. This argument will be underpinned by Archie Cochrane's 'road to Damascus' questioning of the value of soft over hard interventions and challenge what is held up as gold-standard evidence. The differences in definitions of evidence-based practice will also be discussed. Carper's identification of ethical, aesthetic and personal knowing will be used to debunk the myth that empirical evidence is always the gold standard for care and treatment. It will be argued that empirical evidence can be ignored when it clashes with other types of evidence. Finally, the tension between certainty and agreement with evidence will be explored.

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

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

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

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

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

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

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

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

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

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

Clinical Experts Update

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