Danielle's Picks from the Literature - December 2011

LAST PICKS for 2011!!

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

Evidence-Based Nursing. Safe patient handling: Is your facility ready for a culture change?
Cadmus, Edna; Brigley, Patricia; Pearson, Madelyn;
Nursing Management, 2011 Nov; 42 (11): 12-5

Development of a Radiation Skin Care Protocol and Algorithm Using the Iowa Model of Evidence-Based Practice.
Bergstrom, Kelli;
Clinical Journal of Oncology Nursing, 2011 Dec; 15 (6): 593-5
Abstract: Limited evidence-based standards of care exist in the management of irradiated skin; therefore, the development of a skin care protocol is necessary to improve patient outcomes. This article describes the use of the Iowa Model of Evidence-Based Practice to Promote Quality Care as a framework to identify and validate current evidence. The resulting radiation therapy algorithm provided a succinct guideline for nurses to direct the prevention and management of skin damage secondary to radiation therapy, thus improving quality care.

Putting Evidence Into Practice.
Von Ah, Diane; Jansen, Catherine; Allen, Deborah Hutchinson; Schiavone, Rosalina M.; Wulff, Jennifer;
Clinical Journal of Oncology Nursing, 2011 Dec; 15 (6): 607-15
Abstract: Cognitive impairment is a clinically complex symptom commonly experienced by cancer survivors. Although research in this area has grown, many questions remain regarding underlying mechanisms, trajectory, and specific interventions nurses can offer patients to prevent, treat, and manage cognitive impairment effectively. As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for cognitive impairment in cancer survivors. The studies were categorized into nonpharmacologic interventions, including complementary and alternative therapies and cognitive training, and pharmacologic interventions, including psychostimulants and erythropoietin-stimulating agents. Using the ONS PEP Weight of Evidence Classification Schema, the levels of evidence for these interventions were consistent with the categories of effectiveness not established or not recommended for practice. Additional research is needed to identify effective preventive and treatment strategies for cognitive impairment in cancer survivors.

A discussion of approaches to transforming care: contemporary strategies to improve patient safety.
Burston, Sarah; Chaboyer, Wendy; Wallis, Marianne; Stanfield, Jane;
Journal of Advanced Nursing, 2011 Nov; 67 (11): 2488-95
Abstract: A discussion of approaches to transforming care: contemporary strategies to improve patient safety. Journal of Advanced Nursing 67(11), 2488-2495. Abstract Aim. This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group^®. Background. International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Data sources. Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. Discussion. A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. Implications for nursing. These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. Conclusion. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes.

A Practical Communication Strategy to Improve Implementation of Evidence-Based Practice.
Diedrick, Lee A.; Schaffer, Marjorie A.; Sandau, Kristin E.;
Journal of Nursing Administration, 2011 Nov; 41 (11): 459-65

Putting Evidence Into Practice.
Feight, Deborah; Baney, Tara; Bruce, Susan; McQuestion, Maurene;
Clinical Journal of Oncology Nursing, 2011 Oct; 15 (5): 481-92
Abstract: Radiation dermatitis, or radiodermatitis, is a significant symptom caused by radiation therapy for the treatment of cancerous and noncancerous conditions. Radiodermatitis can negatively affect patients' physical functioning and quality of life. The Oncology Nursing Society coordinated a Putting Evidence Into Practice (PEP) project team to develop a PEP resource summarizing current evidence for the management of patients with radiodermatitis. Oncology nurses play an important role in educating, assessing, and monitoring patients for this symptom. Many common nursing interventions for radiodermatitis are based on tradition or opinion and have not been researched thoroughly. In addition, evidence to support some current interventions in practice is lacking. This article presents information concerning radiodermatitis, summarizes the evidence-based review for its prevention and management, and identifies gaps in the literature, as well as opportunities for research, education, and practice.

Factors affecting evidence translation for general practice nurses.
Mills, Jane; Field, John; Cant, Robyn;
International Journal of Nursing Practice, 2011 Oct; 17 (5): 455-63
Abstract: Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.

Spotlight on Outcomes. Data-Driven Decision Making: A Nursing Research and Evidence-Based Practice Dashboard.
Mick, JoAnn;
Journal of Nursing Administration, 2011 Oct; 41 (10): 391-3 (

Engaging and Developing Research Leaders in Practice: Creating a Foundation for a Culture of Clinical Inquiry.
Stanley, Terry; Sitterding, Mary; Broome, Marion E.; McCaskey, Marjorie;
Journal of Pediatric Nursing, 2011 Oct; 26 (5): 480-8
Abstract: This article describes the first formative year experience of a research council in a children''s hospital within a Magnet-designated hospital system. The vision, transformational leadership structure, and implementation strategies used during the first year of formation of a Nursing Research and Evidence-Based Practice Council (NREBPC) are delineated and reflect Magnet components and sources of evidence (American Nurses Credentialing Center [ANCC], 2008). The use of the nursing excellence framework (ANCC, 2008) coupled with principles of adult learning to expand the knowledge and skills of nurses on the NREBPC are described and examples provided. Initial outcomes in terms of nurses'' leadership for research studies and planned documentation of additional metrics that have the potential to improve care through the development of a culture of inquiry are proposed.

Engaging with children in research: Theoretical and practical implications of negotiating informed consent/assent.
Lambert, Veronica; Glacken, Michele;
Nursing Ethics, 2011 Nov; 18 (6): 781-

Impacting Practice Through Evidence-Based Education.
Sciarra, Erica;
Dimensions of Critical Care Nursing, 2011 Sep-Oct; 30 (5): 269-75
Abstract: Evidence-based practice has been demonstrated to positively impact patient outcomes, yet nurses are having difficulty incorporating it into their practice. The purpose of this study was to determine the educational needs of intensive care unit nurses regarding evidence-based practice and to implement a strategy to meet those needs. Evidence-based practice education in this pilot study was shown as an effective catalyst to nurses beginning and participating in evidence-based practice that could potentially improve patient outcomes.

The experience of critiquing published research: Learning from the student and researcher perspective.
Knowles, Judie M; Gray, Morag A;
Nurse Education in Practice, 2011 Nov; 11 (6): 390-4
Abstract: This paper commences with affirmation of the importance of research critique within academic programmes of study, and the context of this skill within the nursing profession. Judie (student) shares an experience from a Professional Doctorate in Education (EdD) assignment that involved selecting and critiquing a piece of published research. "The qualities of an effective mentor" (Gray and Smith, 2000) was critiqued using the Critical Appraisal Skills Programme (CASP, 2006) framework. Morag was the researcher and co-author (Gray and Smith, 2000) and was subsequently contacted by Judie for the purposes of validating her critique assignment. On the tenth anniversary since publication of her PhD research findings Morag reflects on the original article in the light of Judie's critique and shares evaluative comments. Some of the assignment critique is validated by Morag, whilst some of the evaluation demonstrates unreliability of critique shown by Judie. Discussion surrounding sufficiency of research critique through systematic examination of a published article, versus an original research report such as a thesis ensues. The student and researcher/author reveal their learning from this collaborative experience and conclude with recommendations for; setting critique assignments; authors publishing their research findings; and students undertaking critique assignments.

Tips for Getting Published in the Nursing Literature

The editorial team at Research in Nursing and Health (RINAH) have created these helpful videos with tips on writing for publication & getting an article published.

Part I - Getting Started
http://youtu.be/E3_uExz8m9g

Part II - How to Succeed in Publication
http://youtu.be/-Iahw0QD8-w

Part III - Submission Process for a Research Journal
http://youtu.be/E3_uExz8m9g

Also, check out their free Virtual Issue - Helpful Editorial Hints for Getting Published.

Danielle's Picks from the Literature - November 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

1. What is a randomised controlled trial?
Nelson, Andrea;
Evidence Based Nursing, 2011 Oct; 14 (4): 97-8

2. Evidence-Based Nursing. 10 ways to practice evidence-based staffing and scheduling.
Reese, Susan M.;
Nursing Management, 2011 Oct; 42 (10): 20-4

3. Implementing evidence-based practice: real-life success stories.
Reflections on Nursing Leadership, 2011 3rd Quarter; 37 (3). (2p)

4. Searching for Evidence Regarding Using Preoperative Disinfection Showers to Prevent Surgical Site Infections: A Systematic Review.
Jakobsson, Jenny; Perlkvist, Agnetha; Wann-Hansson, Christine;
Worldviews on Evidence-Based Nursing, 2011 3rd Quarter; 8 (3): 143-52
Abstract: Background: Postoperative surgical site infections (SSI) are the third most common health care associated infection. Even though several studies have pointed out the benefits of disinfection showers prior to surgery in order to reduce SSI, it remains unclear how to optimize this disinfection procedure. Aim: To find evidence for how many times preoperative disinfection showers should be performed in order to reduce bacterial colonies and minimize the risk of SSI. Method: A comprehensive literature search of multiple databases published during 1986S2008, supplemented by a manual search of the references in all relevant articles. Protocols were used in quality assessment and the data synthesis is descriptive in a narrative form. Results: The 10 studies included had different designs, interventions, and samples, which makes it difficult to compare them. Moreover, the quality of the reviewed studies varied and only four had a high level of evidence. Therefore, the results failed to give an unambiguous answer about the optimal number of preoperative showers, so only assumptions can be made. It is quite obvious, however, that preoperative disinfection showers with chlorhexidine gluconate (CHG) are effective from a microbiological point of view since eight of the reviewed studies showed a sharply reduced skin flora after using CHG. Conclusions: Currently, clear evidence for how many times preoperative disinfection showers should be performed to minimize the risk of SSI is missing. This highlights the need for further research that focuses on the number of preoperative disinfection showers in relation to SSI, in order to obtain optimal effect. Until then, it would be wise to follow previouslymade recommendation of three to five preoperative showers. Moreover, in order to have the intended effect of preoperative disinfection, it is important that health care professionals have the knowledge to guide patients with information and clear instructions about disinfection shower procedures.

5. Teaching and Learning about the Impact of Evidence-Based Practice Implementation.
Wilkinson, Joyce E.; Kent, Bridie; Hutchinson, Alison; Harrison, Margaret B.; Worldviews on Evidence-Based Nursing, 2011 3rd Quarter; 8 (3): 187-88

6. Factors affecting evidence translation for general practice nurses.
Mills, Jane; Field, John; Cant, Robyn;
International Journal of Nursing Practice, 2011 Oct; 17 (5): 455-63
Abstract: Mills J, Field J, Cant R. International Journal of Nursing Practice 2011; 17: 455-463 Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.

7. Creating a Unit-Based Resource Nurse Program.
Quinn-O'Neil, Beth; Kilgallen, Mary Ellen; Terlizzi, Janice A.;
American Journal of Nursing, 2011 Sep; 111 (9): 46-51

8. Bridging the Theory-Practice Gap.
Tart, Rebecca Creech; Kautz, Donald D.; Rudisill, Kimberly D.; Beard, Edward L.; Nurse Educator, 2011 Sep-Oct; 36 (5): 219-23

9. The experience of critiquing published research: Learning from the student and researcher perspective.
Knowles, Judie M; Gray, Morag A;
Nurse Education in Practice, 2011 Nov; 11 (6): 390-4
Abstract: This paper commences with affirmation of the importance of research critique within academic programmes of study, and the context of this skill within the nursing profession. Judie (student) shares an experience from a Professional Doctorate in Education (EdD) assignment that involved selecting and critiquing a piece of published research. "The qualities of an effective mentor" (Gray and Smith, 2000) was critiqued using the Critical Appraisal Skills Programme (CASP, 2006) framework. Morag was the researcher and co-author (Gray and Smith, 2000) and was subsequently contacted by Judie for the purposes of validating her critique assignment. On the tenth anniversary since publication of her PhD research findings Morag reflects on the original article in the light of Judie's critique and shares evaluative comments. Some of the assignment critique is validated by Morag, whilst some of the evaluation demonstrates unreliability of critique shown by Judie. Discussion surrounding sufficiency of research critique through systematic examination of a published article, versus an original research report such as a thesis ensues. The student and researcher/author reveal their learning from this collaborative experience and conclude with recommendations for; setting critique assignments; authors publishing their research findings; and students undertaking critique assignments.

10. Translating Caring Theory Into Practice.
Tonges, Mary; Ray, Joel;
Journal of Nursing Administration, 2011 Sep; 41 (9): 374-81

11. Measuring Caring--The Next Frontier In Understanding Workforce Performance and Patient Outcomes.
Nelson, John W.;
Nursing Economic$, 2011 Jul-Aug; 29 (4): 215-9

Danielle's Picks from the Literature - October 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

Evidence-Based Nursing Practice: Is It Really Necessary?
Elliott, Rowena W.;
Nephrology Nursing Journal, 2011 Jul-Aug; 38 (4): 309-36

Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing.
Currey, Judy; Considine, Julie; Khaw, Damien;
Journal of Advanced Nursing, 2011 Oct; 67 (10): 2275-83
Abstract: Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing. Journal of Advanced Nursing 67(9), 2275-2283. Abstract Aims. This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion. The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses.
Gerrish, Kate; McDonnell, Ann; Nolan, Mike; Guillaume, Louise; Kirshbaum, Marilyn; Tod, Angela;
Journal of Advanced Nursing, 2011 Sep; 67 (9): 2004-14
Abstract: The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing 67(9), 2004-2014. Abstract Aim. To identify approaches used by advanced practice nurses to promote evidence-based practice among clinical nurses. Background. Barriers encountered at individual and organizational levels hinder clinical nurses in their ability to deliver evidence-based practice. Advanced practice nurses are well placed to promote evidence-based practice through interactions with clinical nurses. However, little is understood about how advanced practice nurses might realize this potential. Method. A multiple instrumental case study of 23 advanced practice nurses from hospital and primary care settings across seven Strategic Health Authorities in England was undertaken in 2006. Data collection comprised interviews and observation of advanced practice nurses and interviews with clinical nurses and other healthcare professionals. Data were analysed using the Framework approach. Findings. Advanced practice nurses acted as knowledge brokers in promoting evidence-based practice among clinical nurses. Knowledge management and promoting the uptake of knowledge were key components of knowledge brokering. Knowledge management involved generating different types of evidence, accumulating evidence to act as a repository for clinical nurses, synthesizing different forms of evidence, translating evidence by evaluating, interpreting and distilling it for different audiences and disseminating evidence by formal and informal means. Advanced practice nurses promoted the uptake of evidence by developing the knowledge and skills of clinical nurses through role modelling, teaching, clinical problem-solving and facilitating change. Conclusion. The role of advanced practice nurses in knowledge brokering is complex and multi-faceted. It extends beyond the knowledge management, linkage and capacity building identified in the literature to include active processes of problem-solving and facilitating change.

The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: Pre-test post-test comparative study.
Aitken, Leanne M.; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn;
International Journal of Nursing Studies, 2011 Aug; 48 (8): 918-25
Abstract: Abstract: Background: Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. Objectives: To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses’ perceptions of the practice environment and work satisfaction. Design: Pre-test post-test 2 group comparative design. Settings: Two intensive care units in tertiary teaching hospitals in Australia. Participants: A convenience sample of registered nurses (n =244) working full time or part time in the participating intensive care units. Methods: Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Results: Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological – individual, psychological – family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre – 4.85±0.93; post – 5.36±0.89, p =0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p <0.05). Conclusions: Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability.

Maintaining a Full House for Research Involvement Among Float Pool Nurses.
Egbert, April; Lincicome, Amber; Elam, Ashley; Shinkle, Mary; Long, Lisa English;
Journal of Pediatric Nursing, 2011 Aug; 26 (4): e24-5

Advancing Nursing Research Through a Mentorship Program for Staff Nurses.
Gawlinski, Anna; Miller, Pamela S.;
AACN Advanced Critical Care, 2011 Jul-Sep; 22 (3): 190-200

Nurse Champions: A Key Role in Bridging the Gap Between Research and Practice.
White, Carole L.;
JEN: Journal of Emergency Nursing, 2011 Jul; 37 (4): 386-7

Research using blogs for data: Public documents or private musings?
Eastham, Linda A;
Research in Nursing & Health, 2011 Aug; 34 (4): 353-61
Abstract: Nursing and other health sciences researchers increasingly find blogs to be valuable sources of information for investigating illness and other human health experiences. When researchers use blogs as their exclusive data source, they must discern the public/private aspects inherent in the nature of blogs in order to plan for appropriate protection of the bloggers' identities. Approaches to the protection of human subjects are poorly addressed when the human subject is a blogger and the blog is used as an exclusive source of data. Researchers may be assisted to protect human subjects via a decisional framework for assessing a blog author's intended position on the public/private continuum. © 2011 Wiley Periodicals, Inc. Res Nurs Health 34:353-361, 2011.

Four rights for focusing clinical nurse specialist research: right focus, right projects, right level, and right resources.
Albert, Nancy M; Fulton, Janet S;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Jul-Aug; 25 (4): 165-8

Engaging and Developing Research Leaders in Practice: Creating a Foundation for a Culture of Clinical Inquiry.
Stanley, Terry; Sitterding, Mary; Broome, Marion E.; McCaskey, Marjorie;
Journal of Pediatric Nursing, 2011 Oct; 26 (5): 480-8
Abstract: This article describes the first formative year experience of a research council in a children''s hospital within a Magnet-designated hospital system. The vision, transformational leadership structure, and implementation strategies used during the first year of formation of a Nursing Research and Evidence-Based Practice Council (NREBPC) are delineated and reflect Magnet components and sources of evidence (American Nurses Credentialing Center [ANCC], 2008). The use of the nursing excellence framework (ANCC, 2008) coupled with principles of adult learning to expand the knowledge and skills of nurses on the NREBPC are described and examples provided. Initial outcomes in terms of nurses'' leadership for research studies and planned documentation of additional metrics that have the potential to improve care through the development of a culture of inquiry are proposed.

Can You Hear Me? Facilitating the Voice of Frontline Nurses Through Nursing Research.
Vogelsmeier, Amy;
Western Journal of Nursing Research, 2011 Oct; 33 (6): 743-4

Social Networking & the Nurse

The American Nurses Association has just published a new guideline, Principles for Social Networking and the Nurse. The guideline is intended to cover the benefits and risks of social networking and include the following six principles:

• Nurses must not transmit or place online individually identifiable patient information.


• Nurses must observe ethically prescribed professional patient-nurse boundaries.


• Nurses should understand that patients, colleagues, institutions and employers may view postings.


• Nurses should take advantage of privacy settings and seek to separate personal and professional information online.


• Nurses should bring content that could harm a patient’s privacy, rights or welfare to the attention of appropriate authorities.


• Nurses should participate in developing institutional policies governing online contact.

A free electronic version of the complete guideline is available to all ANA members.

Mosby's Nursing Consult - ANA Edition

The ANA provides Mosby's Nursing Consult - ANA Edition free of charge to it's members. This resource provides:

• Evidence based monographs, reviews the current evidence on a clinical problem and provides recommendations for nursing care


• Practice guidelines from over 150 professional organizations


• Clinical updates, best practice articles written by nurses for nurses

Members can log-in with their ANA username/password to take advantage of this useful resource.

New Nursing Research Toolkit available from the ANA

The American Nurses Association has a new Research Toolkit available free of charge. The Toolkit was developed to help nurses provide evidence-based care and promotes quality health outcomes. It includes a section on introduction to research and evidence-based practice. Access to resources that help the nurse translate evidence into practice and to support nurse researchers are available. While the Tool is free, ANA members only can log in with their username and password to gain access to a research repository containing reviews of research articles. Richard Barry, the librarian at ANA says, "this toolkit will change over time and add new resources to meet your needs." Check out this great new resource to add to your Evidence Based Practice tool belt!

Danielle's Picks from the Literature - August 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

1. Children's nursing research: toward development, drudgery or demise?
Long, Tony;
British Journal of Nursing (BJN), 2011 Sep 8; 20 (14): 873-7
Abstract: This paper, based on a presentation to the UK Association of Chief Children's Nurses, is the author's personal reflection on the nature and future of children's nursing research. Key constitutive elements of this concept are considered to arrive at the conclusion that children's nursing research is research undertaken by children's nurses into questions of relevance to children's nursing practice and services, or wider issues in which children's nursing has a vital role. Three possible futures are presented, of which only the last is positive and desirable: development in line with the reality of practice and population needs. An integrated approach is necessary, with responsibilities both for those in positions of authority in the service and for researchers themselves. In particular, this partnership is essential for children's nursing to evidence the impact of research and for children and young people to reap the greatest benefit from evidence-based practice.

2. Grading recommendations in clinical practice guidelines: randomised experimental evaluation of four different systems.
García CA; Alvarado KP; Gaxiola GP;
Archives of Disease in Childhood, 2011 Aug; 96 (8): 723-8
Abstract: Objective To evaluate the effect of presenting a recommendation in a clinical practice guideline using different grading systems to determine to what extent the system used changes the clinician's eventual response to a particular clinical question. Design Randomised experimental study. Setting Clinician offices and academic settings. Participants Paediatricians and paediatric residents in private and public practice in Mexico. Intervention Case notes of a child with diarrhoea and a question about clinician preference for using racecadotril. The same evidence was provided in a clinical recommendation but with different presentations according to the following grading systems: NICE (National Institute for Health and Clinical Excellence), SIGN (Scottish Intercollegiate Guideline Network), GRADE (Grading of Recommendations Assessment, Development and Evaluation) and CEBM (Centre for Evidence-Based Medicine, Oxford). Main outcome measure Mean change in direction from baseline response (measured on a 10 cm visual scale and a Likert scale) and among groups. Results 216 subjects agreed to participate. Most participants changed their decision after reading the clinical recommendations (mean difference 0.7 cm, 95% CI 0.29 to 1.0; p<0.001). By groups, mean change (95% CI) from baseline was 0.04 (-0.68 to 0.77) for NICE, 0.31 (-0.41 to 1.05) for SIGN, 2.18 (1.48 to 2.88) for GRADE and 0.08 (-0.52 to 0.69) for CEBM (p=0.007 between groups). In a final survey, a small difference was noted regarding the clarity of the results presented with the GRADE system. Conclusion The clinician's decision to use a therapy was influenced most by the GRADE system. Trial registration number NCT00940290.

3. Implementing evidence-based nutrition guidelines: the critical care experience.
Cahill, Naomi E;
Clinical Nutrition Insight, 2011 Aug; 37 (8): 1-5

4. Immunological Methods for Nursing Research: From Cells to Systems.
Morrison, Helena W.; Downs, Charles A.;
Biological Research for Nursing, 2011 Jul; 13 (3): 227-34

5. Spit: Saliva in Nursing Research, Uses and Methodological Considerations in Older Adults.
Woods, Diana Lynn; Mentes, Janet C.;
Biological Research for Nursing, 2011 Jul; 13 (3): 320-7

6. Why and when should we conduct collaborative international oncology nursing research?
Hinds, Pamela S;
Cancer Nursing, 2011 Jul-Aug; 34 (4): 253-4

7. Innovation in engaging hospital staff and university faculty in research.
Zinn, Jennifer; Reinert, Jean; Bigelow, Andrea; Ellis, Waqiah; French, Amanda F; Milner, Frostenia; Letvak, Susan;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Jul-Aug; 25 (4): 193-7
Abstract: PURPOSE: : The purpose of this article was to describe an innovative faculty-staff engagement dinner that was conducted to enhance collaboration between university faculty and hospital staff. Specific steps used to develop the dinner, as well as outcomes gained, are discussed. BACKGROUND/RATIONALE: : Collaborative relationships between academic and clinical nurses may promote nursing research and strengthen mutual interest. Unique stressors and demands of clinical and academic nursing often lead to isolated practice roles. Nursing may require new ways of facilitating collaboration between groups. DESCRIPTION OF THE PROJECT:: A dinner supported by a health system was planned for nursing staff interested in conducting research. Faculty at 2 local universities interested in collaborating with nursing staff were invited. Forty participants attended, including 8 faculty from 2 universities, 17 staff nurses, and 16 nurse leaders. Seven collaborative research projects were initiated following the dinner meeting. INTERPRETATION/CONCLUSION: : Faculty and nursing staff partnerships were established and led to research projects that focused on themes of improving quality. Faculty and nursing staff expressed enthusiasm for the opportunity to connect over shared research ideas. IMPLICATIONS: : Mechanisms for enhancing staff nurse and nurse faculty collaborative relationships are needed to promote nursing research that ensures evidence-based bedside practices. A dinner event was an innovative method to partner nurses at the bedside with faculty with expertise in research methods.

8. Facebook: A Tool for Nursing Education Research.
Amerson, Roxanne;
Journal of Nursing Education, 2011 Jul; 50 (7): 414-6
Abstract: Facebook is an online social networking Web site that allows users to connect with other users. Nurse educators can use this technology to advance nursing research. Social networks provide new opportunities for locating potential research participants and maintaining contact during the research process. The purpose of this article is to explain how the researcher used Facebook to locate previous nursing students to ask them to participate in a qualitative study. Between 2006 and 2008, 22 nursing students had participated in international trips over a 3-year period. Because the students had graduated and moved to other geographical areas, the researcher had little or no contact information to use to follow-up with them. The researcher used Facebook to locate 18 of the 22 nursing graduates and invite them to participate in a qualitative research study. A discussion of the process and the potential ethical issues are provided.

9. Demystifying nursing research terminology. Part 1.
Welford, Claire; Murphy, Kathy; Casey, Dympna;
Nurse Researcher, 2011; 18 (4): 38-43
Abstract: Aim This article aims to provide clear explanations of the research approaches available for nursing research. Background There are numerous research approaches available to the nurse researcher. There is also some ambiguity in the literature in relation to research terminology and this often leads to confusion about which approach to adopt. Data sources A review of the available and most up-to-date literature. Discussion The most commonly adopted approaches in nursing research are described and discussed. Conclusion This article explains the research paradigms and the rationales for choosing particular paradigms while part two will provide an explanation of the methodological options available to the researcher. A table is included that summarises the key information related to each paradigm. Implications for practice/research These articles will be particularly useful for the novice researcher or for the doctoral student.

10. Obstacles and Drawbacks to Avoid in Qualitative Nursing Research.
Windle, Pamela;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 173-5

11. Magnet status-does it promote holistic health care?
Jackson, Christina;
Holistic Nursing Practice, 2011 Jul-Aug; 25 (4): 175-83

12. Introducing evidence into nursing practice: using the IOWA model.
Doody, Catriona M.; Doody, Owen;
British Journal of Nursing (BJN), 2011 Jul 14; 20 (11): 661-4
Abstract: Evidence-based practice has gained increasing popularity in all healthcare settings. Nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform decisions, actions and interactions with patients, to deliver the best possible care. Within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based. In order for nurses to operate from an evidence-based perspective, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.

13. What is a systematic review?
Clarke, Jane;
Evidence Based Nursing, 2011 Jul; 14 (3): 64

14. Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Majid, Shaheen; Foo, Schubert; Luyt, Brendan; Xue Zhang; Yin-Leng Theng; Yun-Ke Chang; Mokhtar, Intan A.;
Journal of the Medical Library Association, 2011 Jul; 99 (3): 229-36
Abstract: Objective: Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated. Method: A total of 2,100 copies of the questionnaire were distributed to registered nurses in 2 public hospitals in Singapore, and 1,486 completed forms were returned, resulting in a response rate of 70.8%. Results: More than 64% of the nurses expressed a positive attitude toward EBP. However, they pointed out that due to heavy workload, they cannot keep up to date with new evidence. Regarding self-efficacy of EBP-related abilities, the nurses perceived themselves to possess moderate levels of skills. The nurses also felt that EBP training, time availability, and mentoring by nurses with EBP experience would encourage them to implement EBP. The top three barriers to adopting EBP were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles. For literature searching, nurses were using basic search features and less than one-quarter of them were familiar with Boolean and proximity operators. Conclusion: Although nurses showed a positive attitude toward EBP, certain barriers were hindering their smooth adoption. It is, therefore, desirable that hospital management in Southeast Asia, particularly in Singapore, develop a comprehensive strategy for building EBP competencies through proper training. Moreover, hospital libraries should also play an active role in developing adequate information literacy skills among the nurses.

15. Nurturing the Novice Nurse Researcher: Strategies for Librarians.
Nursing & Allied Health Resources Section (NAHRS) Newsletter, 2011 Jul; 31 (3): 8-10

16. Spirituality in nursing: a systematic review of the literature from 2006-10. Pike, Joanne;
British Journal of Nursing (BJN), 2011 Jun 24; 20 (12): 743-9
Abstract: Spirituality in nursing care has been discussed for many years in the nursing press. There has been no literature review that explores only UK literature, and this article updates a literature review carried out in 2006 (Ross, 2006). Aim: The review was designed to investigate the current nursing evidence underpinning the concept of spirituality and its application. Method: A systematic review of the literature was undertaken and a thematic analysis performed following a search for literature using defined dates, databases and search terms. Results: Four major themes emerged from the literature: concept clarification; spiritual care-giving; religion and spirituality; and nurse education. Conclusion: Definitions of spiritual care vary, and the concept of spirituality in nursing is still under development. However, until a common language of spirituality is developed, models of spiritual care developed through research involving mainly nursing staff will be difficult for nurses to apply.

17. Nursing work environment and nurse caring: relationship among motivational factors.
Burtson PL; Stichler JF;
Journal of Advanced Nursing, 2010 Aug; 66 (8): 1819-31
Abstract: Aim. This paper is a report of a study of the relationships among compassion satisfaction, nurse job satisfaction, stress, burnout and compassion fatigue to nurse caring. Background. Nurse caring is the most influential dimension of patient advocation and is predictive of patient satisfaction. Qualitative studies have indicated that nurse caring is a key motivational factor impacting recruitment and retention. Methods. A correlational study of nurses ( N = 126) was conducted in 2008 at a single, academic medical center. The six variables of interest were operationalized using four valid and reliable research instruments: (1) the Mueller McCloskey Satisfaction Scale, (2) the Professional Quality of Life Scale, (3) the Stress in General Scale and (4) the Caring Behaviors Inventory. Results. Pearson Product-moment correlations showed statistically significant relationships between nurse caring and compassion satisfaction ( r = 0DT51, P < 0DT001), nurse job satisfaction subscales ( r = 0DT16-0DT28, P < 0DT05), stress ( r = -0DT21, P < 0DT05), and burnout ( r = -0DT22, P < 0DT01). A statistically significant relationship was found between the nurse caring subscale of knowledge and skill and compassion fatigue ( r = -0DT22, P < 0DT01). Hierarchical multiple regression analysis demonstrated that compassion satisfaction ( R² = 0DT287, [beta] = 0DT536, P = 0DT000) and nurse satisfaction with social interaction opportunities related to work ([beta] = 0DT223, P = 0DT032) explained variability in nurse caring. Conclusion. Fostering compassion satisfaction and social interaction opportunities among nurses may improve nurse caring, potentially sustaining long-term improvements in patient.

18. Quality caring in nursing: applying theory to clinical practice, education, and leadership.
Gottesfeld IB;
Nursing Education Perspectives, 2010 Jul-Aug; 31 (4): 260

Danielle's Picks from the Literature - July 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

1. An Evidence-Based Review of a Lentinula edodes Mushroom Extract as Complementary Therapy in the Surgical Oncology Patient.
Shah SK; Walker PA; Moore-Olufemi SD; Sundaresan A; Kulkarni AD; Andrassy RJ;
JPEN Journal of Parenteral & Enteral Nutrition, 2011 Jul-Aug; 35 (4): 449-58
Abstract: The purpose of this review is to present the currently published evidence regarding the use, efficacy, potential mechanisms of action, and results of published clinical trials regarding the use of a Lentinula edodes mushroom-derived extract (active hexose correlated compound) as complementary therapy in patients with cancer. The authors explore the current preclinical and clinical evidence as it relates to this topic and its potential use in the surgical oncology patient. There has been a growing interest in stimulation of the immune system in trauma, cancer, and surgical patients in general. Little, however, has been written about some-of the supplements in widely used in Japan and China, but relatively unheard of in the United States.

2. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.
Fonarow GC; Yancy CW; Hernandez AF; Peterson ED; Spertus JA; Heidenreich PA;
American Heart Journal, 2011 Jun; 161 (6): 1024-1030.e3

3. How to Read a Paper: The Basics of Evidence-Based Medicine.
Critical Care Nurse, 2011 Jun; 31 (3): 93

4. Evidence-Based Nursing. Getting "research rich" at a community hospital.
Staffileno, Beth A.; McKinney, Cally;
Nursing Management, 2011 Jun; 42 (6): 10-4

5. The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: A Framework for Transformation.
Goode, Colleen J.; Fink, Regina M.; Krugman, Mary; Oman, Kathleen S.; Traditi, Lisa K.
Worldviews on Evidence-Based Nursing, 2011 2nd Quarter; 8 (2): 96-105
Abstract: Background: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. Aim: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. Approach: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.

6. Obstacles and Drawbacks to Avoid in Qualitative Nursing Research.
Windle, Pamela;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 173-5

7. Nursing Journal Club: Bridging the Gap Between Practice and Research.
McClurkin, Sylva L.; Bailey, Lillian; Kwan, Meggie;
Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 192

8. Who uses nursing theory? A univariate descriptive analysis of five years' research articles.
Bond, A. Elaine; Eshah, Nidal Farid; Bani-Khaled, Mohammed; Hamad, Atef Omar; Habashneh, Samira; Kataua', Hussein; al-Jarrah, Imad; Kamal, Andaleeb Abu; Hamdan, Falastine Rafic; Maabreh, Roqia;
Scandinavian Journal of Caring Sciences, 2011 Jun; 25 (2): 404-9
Abstract: Since the early 1950s, nursing leaders have worked diligently to build the Scientific Discipline of Nursing, integrating Theory, Research and Practice. Recently, the role of theory has again come into question, with some scientists claiming nurses are not using theory to guide their research, with which to improve practice. The purposes of this descriptive study were to determine: (i) Were nursing scientists' research articles in leading nursing journals based on theory? (ii) If so, were the theories nursing theories or borrowed theories? (iii) Were the theories integrated into the studies, or were they used as organizing frameworks? Research articles from seven top ISI journals were analysed, excluding regularly featured columns, meta-analyses, secondary analysis, case studies and literature reviews. The authors used King's dynamic Interacting system and Goal Attainment Theory as an organizing framework. They developed consensus on how to identify the integration of theory, searching the Title, Abstract, Aims, Methods, Discussion and Conclusion sections of each research article, whether quantitative or qualitative. Of 2857 articles published in the seven journals from 2002 to, and including, 2006, 2184 (76%) were research articles. Of the 837 (38%) authors who used theories, 460 (55%) used nursing theories, 377 (45%) used other theories: 776 (93%) of those who used theory integrated it into their studies, including qualitative studies, while 51 (7%) reported they used theory as an organizing framework for their studies. Closer analysis revealed theory principles were implicitly implied, even in research reports that did not explicitly report theory usage. Increasing numbers of nursing research articles (though not percentagewise) continue to be guided by theory, and not always by nursing theory. Newer nursing research methods may not explicitly state the use of nursing theory, though it is implicitly implied.

9. Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital.
Jamerson, Patricia A.; Fish, Anne F.; Frandsen, Geralyn;
Applied Nursing Research, 2011 May; 24 (2): 110-3
Abstract: For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.

10. Models to enhance research capacity and capability in clinical nurses: a narrative review.
O'Byrne, Louise; Smith, Sheree;
Journal of Clinical Nursing, 2011 May; 20 (9/10): 1365-71
Abstract: To identify models used as local initiatives to build capability and capacity in clinical nurses. The National Health Service, Nursing and Midwifery Council and the United Kingdom Clinical Research Collaboration all support the development of the building of research capability and capacity in clinical nurses in the UK. Narrative review. A literature search of databases (including Medline and Pubmed) using the search terms nursing research, research capacity and research capability combined with building, development, model and collaboration. Publications which included a description or methodological study of a structured initiative to tackle research capacity and capability development in clinical nurses were selected. Three models were found to be dominant in the literature. These comprised evidence-based practice, facilitative and experiential learning models. Strong leadership, organisational need and support management were elements found in all three models. Methodological issues were evident and pertain to small sample sizes, inconsistent and poorly defined outcomes along with a lack of data. Whilst the vision of a research ready and active National Health Service is to be applauded to date, there appears to be limited research on the best approach to support local initiatives for nurses that build research capability and capacity. Future studies will need to focus on well-defined objectives and outcomes to enable robust evidence to support local initiatives. To build research capability and capacity in clinical nurses, there is a need to evaluate models and determine the best approach that will provide clinical nurses with research opportunities.

11. Evidence-based practice implementation strategy: the central role of the clinical nurse specialist.
Muller, Anne; McCauley, Kathleen; Harrington, Paul; Jablonski, Julie; Strauss, Robyn; Nursing Administration Quarterly, 2011 Apr-Jun; 35 (2): 140-51
Abstract: The Hospital of the University of Pennsylvania Model of Excellence in Nursing Professional Practice serves to fully integrate therole of the clinical nurse specialist (CNS) in the implementation of evidence-based care and the role of organizational change agent. Inthis role, the CNS is responsible for the identification and remedy of system-wide challenges to optimal quality care, mentorship ofclinical nurses both as clinicians and as leaders, and enhancement of interdisciplinary partnerships. Integrating the CNS role as thenursing department knowledge keepers, knowledge seekers and knowledge disseminators able to proactively develop and enhanceinterdisciplinary partnerships required systematic educational sessions and use of outcome measurement tools. Resources have included roledevelopment seminars, individual mentoring and standardization of role expression, across service lines. Development and implementation ofan outcome measurement tool has served to further quantify the contribution of the CNS and standardized role implementation across servicedivisions. This dedication of resources has resulted in a significant number of unit-based and system-wide CNSs, serving as a significantsupport to the clinical nurse's practice and leadership development. This article will describe some of the processes used to enhancethe role of the CNS implementing change and practice improvement at the Hospital of the University of Pennsylvania.

12. Negotiating Journal Authorship: Strategies and Hazards.
Sommers, Marilyn S.;
Clinical Nursing Research, 2011 May; 20 (2): 115-9

13. From Practice to Print: Creating a Thriving Culture of Writing.
Saver, Cynthia;
Nurse Leader, 2011 Jun; 9 (3): 23-5

14. Nurses' and patients' perceptions of caring behaviours: quantitative systematic review of comparative studies.
Papastavrou, Evridiki; Efstathiou, Georgios; Charalambous, Andreas;
Journal of Advanced Nursing, 2011 Jun; 67 (6): 1191-205
Abstract: Aim. This paper is a report of a systematic review conducted to test the hypothesis that nurses and patients perceive the concept of caring in nursing differently. Background. Caring is viewed as the central focus of nursing. However, despite its fundamental place in clinical practice, researchers and scholars have failed in reaching a common definition. This failure has led to eliciting for nebulous interpretations of the concept often leading to perplexity and opposing views between patients and nurses. Data sources. Extensive search was conducted using MEDLINE, CINAHL and EMBASE between March and May 2009 with no publishing time limit and the keywords 'care', 'caring', 'nurse', 'nursing', 'behavio(u)rs', 'patient', 'perception', 'quantitative' and 'comparative'. Review methods. This quantitative systematic review of comparative studies followed the guidance of the Centre for Reviews and Dissemination. A seven-item 'yes' or 'no' checklist was developed and used for appraising the quality status of the selected literature. Narrative summary technique was used to report outcomes. Results. Evidence of incongruence of perceptions between patients and nurses is mainly supported by the literature. Few studies, however, report aspects of congruence. Conclusion. There is considerable evidence of the assertion that there is no congruence of perceptions between patients and nurses as regards to which behaviours are considered caring and intended caring is not always perceived as such by the patient. Further research is needed, however, to generate more knowledge on the relationship between caring behaviours, patient outcomes and health or nursing costs.

15. Self-Care Strategies to Enhance Caring.
Shiparski, Laurie; Richards, Kim; Nelson, John;
Nurse Leader, 2011 Jun; 9 (3): 26-30

16. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey.
Gerrish, Kate; Guillaume, Louise; Kirshbaum, Marilyn; McDonnell, Ann; Tod, Angela; Nolan, Mike;
Journal of Advanced Nursing, 2011 May; 67 (5): 1079-90
Abstract: Aim. This paper is a report of a study to identify factors influencing advanced practice nurses' contribution to promoting evidence-based practice among front-line nurses. Background. Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care given by front-line nurses. Method. A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with frontline nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with Masters qualifications and those with lower qualifications. Findings. Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses' practice. Advanced practice nurses' skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with Masters qualifications perceived themselves to be more skilled in all aspects of evidence-based practice than those with lower qualifications. Conclusion. Advanced practice nurses are well placed as clinical leaders to promote evidence-based practice by frontline nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require Master's preparation.

Danielle's Picks from the Literature - June 2011

Here are my picks from the nursing literature over the past few months. SJO and CHOC employees have access to the full text of many of these articles through the Burlew Medical Library.

1. Evidence-Based Nursing. Changing practice, one clinical question at a time.
Graner, Terry; Sendelbach, Sue; Boland, Lori L.; Koehn, Katheren;
Nursing Management, 2011 May; 42 (5): 14-7

2. Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture.
Makic, Mary Beth Flynn; VonRueden, Kathryn T.; Rauen, Carol A.; Chadwick, Jessica;
Critical Care Nurse, 2011 Apr; 31 (2): 38-62
Abstract: For excellence in practice to be the standard for care, critical care nurses must embrace evidence-based practice as the norm. Nurses cannot knowingly continue a clinical practice despite research showing that the practice is not helpful and may even be harmful to patients. This article is based on 2 presentations on evidence-based practice from the American Association for Critical-Care Nurses' 2009 and 2010 National Teaching Institute and addresses 7 practice issues that were selected for 2 reasons. First, they are within the realm of nursing, and a change in practice could improve patient care immediately. Second, these are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics to be addressed are (1) Trendelenburg positioning for hypotension, (2) use of rectal tubes to manage fecal incontinence, (3) gastric residual volume and aspiration risk, (4) restricted visiting policies, (5) nursing interventions to reduce urinary catheter-associated infections, (6) use of cell phones in critical care areas, and (7) accuracy of assessment of body temperature. The related beliefs, current evidence, and recommendations for practice related to each topic are outlined.

3. Evidence-Based Practice: Perceptions, Skills, and Activities of Pediatric Health Care Professionals.
Bartelt, Tera C.; Ziebert, Carolyn; Sawin, Kathleen J.; Malin, Shelly; Nugent, Melodee; Simpson, Pippa;
Journal of Pediatric Nursing, 2011 Apr; 26 (2): 114-21
Abstract: The purposes of this descriptive study were to evaluate pediatric professional staffs' perceptions of evidence-based practice (EBP), to identify individual and organizational barriers experienced when applying EBP into practice, and to determine differences in perceptions by those attending and not attending an EBP education series. A total of 486 pediatric health care professionals, 56 of whom attended all of the sessions, completed an anonymous online survey. Professional staff participated in and valued EBP activities but identified barriers to full implementation. Participants in the EBP series were significantly different in several positive ways. Implications for further education and research are delineated based on survey results.

4. Implementing and Sustaining Evidence-Based Nursing Practice to Reduce Pediatric Cardiopulmonary Arrest.
Randhawa, Simmy; Roberts-Turner, Renee'; Woronick, Karen; DuVal, Jennifer;
Western Journal of Nursing Research, 2011 Apr; 33 (3): 443-56

5. Launching evidence-based nursing practice.
Whitmer, Kyra; Auer, Christine; Beerman, Linda; Weishaupt, Lynn;
Journal for Nurses in Staff Development, 2011 Mar-Apr; 27 (2): E5-7
Abstract: In one institution's effort to develop nursing staff to use evidence in practice, formation of the Evidence-Based Practice Council was instrumental. This Evidence-Based Practice Council developed its members to support the development of others. Programming strategies included keynote speakers during Nurses Day followed by breakout sessions and programs throughout the year. Traditional means to communicate information as well as the development of an internal Web site were used.

6. Evidence-Based Nursing. Nursing research: Get started!.
Anderson, Tamika L.; Dixon, Kelly H.; Lewallen, Lynne Porter; Jarrett-Pulliam, Cindy;
Nursing Management, 2011 Mar; 42 (3): 20-3

7. Using evidence to improve safety and the quality of health care.
Bucknall, Tracy;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 1-3

8. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.
Bosch, Marije; Halfens, Ruud J. G.; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 4-14
Abstract: Background: Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. Aims: To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. Methods: In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1,274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ? 18) and preventive quality management at ward level. Results: No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. ß 0.32; p < 0.001). Conclusions and Implications: Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way.

9. Translating venous thromboembolism (VTE) prevention evidence into practice: a multidisciplinary evidence implementation project.
Duff, Jed; Walker, Kim; Omari, Abdullah;
Worldviews on Evidence-Based Nursing, 2011 1st Quarter; 8 (1): 30-9
Abstract: Background: Venous thromboembolism (VTE) is an important patient safety issue resulting in significant mortality, morbidity, and health care resource expenditure. Despite the widespread availability of best practice guidelines on VTE prevention, we found that only 49% of our patients were receiving appropriate prophylaxis. Aim: To improve health care professionals' compliance with evidence-based guidelines for VTE prevention in hospitalised patients. Design: A practice improvement methodology was employed to identify, diagnosis, and overcome practice problems. Pre- and post-intervention audits were used to evaluate performance measures. Setting: The study was conducted from September 2008 until August 2009 and took place in a 250-bed acute-care private hospital in metropolitan Sydney, Australia. Intervention: A change plan was developed that attempted to match organisational barriers to VTE guideline uptake with evidence-based implementation strategies. The strategies used included audit and feedback, documentation aids, staff education initiatives, collaboratively developed hospital VTE prevention policy, alert stickers, and other reminders. Results: The proportion of patients receiving appropriate VTE prophylaxis increased by 19% from 49% to 68% (p = 0.02). Surgical patient prophylaxis increased by 21% from 61% to 82% (p = 0.02) while medical patient prophylaxis increased by 26% from 19% to 45% (p = 0.05). The proportion of patients with a documented VTE risk assessment increased from 0% to 35% (p < 0.001). Conclusions: The intervention resulted in a 19% overall improvement in prophylaxis rates, which is a significant achievement for any behavioural change intervention. There is, however, still a significant discrepancy between surgical and medical patient prophylaxis rates, which clearly warrants further attention.

10. Evidence-Based Nursing. How do you support your staff? Promote EBP.
Shivnan, Jane C.;
Nursing Management, 2011 Feb; 42 (2): 12-4

11. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation.
Rosewilliam, Sheeba; Roskell, Carolyn Anne; Pandyan, Ad;
Clinical Rehabilitation, 2011 Jun; 25 (6): 501-14

12. How to Read a Paper: The Basics of Evidence-Based Medicine.
Critical Care Nurse, 2011 Jun; 31 (3): 93

13. Innovativeness of nurse leaders.
Clement-O'brien, Karen; Polit, Denise F.; Fitzpatrick, Joyce
Journal of Nursing Management, 2011 May; 19 (4): 431-8
Abstract: The purpose of the present study was to describe the innovativeness and the rate of adoption of change among chief nursing officers (CNOs) of acute care hospitals, and explore the difference in the innovativeness of CNOs of Magnet hospitals vs. non-Magnet hospitals. There is little evidence to guide the description of innovativeness for nurse leaders, crucial to the implementation of evidence-based practice standards. CNOs of acute care hospitals of New York State participated in a mailed survey which incorporated the Scale for the Measurement of Innovativeness. The response rate was 41% (106/261). The majority of the sample was prepared at the master's level with 5-10 years of experience in the CNO role. A significant relationship was found between the innovativeness scale scores and the innovativeness diversity index. The CNOs who completed more leadership courses had implemented significantly more types of innovations and had higher innovativeness scale scores. Graduate level education, years of CNO experience and leadership course completion were identified as significantly influencing innovativeness of CNOs. The characteristics of innovativeness for nurse leaders presented in the present study may assist organizations, CNOs and the Magnet recognition programme to describe innovativeness that supports organizations to continuously improve the quality of patient care.

14. Evaluating Shared Governance: Measuring Functionality of Unit Practice Councils at the Point of Care.
Creative Nursing, 2011; 17 (2): 87-95

15. Securing Pediatric Peripheral IV Catheters—Application of an Evidence-Based Practice Model.
Hetzler, Robin; Wilson, Marian; Hill, Elizabeth K.; Hollenback, Cheri;
Journal of Pediatric Nursing, 2011 Apr; 26 (2): 143-8
Abstract: Peripheral intravenous catheter (PIV) insertion is a traumatic experience for children and should not be repeated more frequently than necessary. Proper securement of pediatric IVs can preserve catheter life; however, little evidence is available to describe optimal methods. Pediatric nurses at a 246-bed, community-owned district hospital observed they were frequently attempting to rescue or restart PIVs prematurely. In the context of exemplary professional practice, an exploratory evidence-based practice project was designed to increase knowledge about the best practices in maintaining and preserving pediatric PIVs. Data collection and analysis determined that practices were inconsistent and more research is needed to determine the optimal securement practices.

16. Transformational Leadership Required to Design and Sustain Evidence-Based Practice: A System Exemplar.
Everett, Linda Q.; Sitterding, Mary Cathryn;
Western Journal of Nursing Research, 2011 Apr; 33 (3): 398-426

EBP Resource Update: Cochrane Reviews

The folks at The Cochrane Collaboration have been busy in 2011! This year alone they have written over 200 new Systematic Reviews of the medical and nursing literature, intended to guide Evidence Based Practice. Topics are taken from a wide range of disciplines and include such issues as:

• Baby-led versus scheduled breastfeeding for healthy newborns


• Foam dressings for healing diabetic foot ulcers


• Folic acid supplementation for the prevention of anaemia in preterm neonates


• General health checks for reducing morbidity & mortality from disease


• Intensive glucose control versus conventional glucose control for type I diabetes mellitus

Not familiar with Cochrane Reviews yet? Basically, "a Cochrane Review is a systematic, up-to-date summary of reliable evidence of the benefits and risks of health care. Cochrane Reviews are intended to help people make practical decisions." Learn more about Cochrane Reviews and how they can help guide Evidence Based Practice at their website.

Click here for a complete list of Cochrane Reviews. The full text of Cochrane Reviews are available to all SJO & CHOC physicians & staff through the Burlew Medical Library.

Institute of Medicine calls for a "Gold Standard" in the evidence process

Much of my time as a medical librarian involves searching the literature to find guidelines and systematic reviews to inform evidence based clinical practice. This year the Institute of Medicine has put out a call to professional organizations that produce guidelines and conduct systematic reviews to adhere to a "gold standard" for the processes. The IOM's "Standards for Developing Trustworthy Clinical Practice Guidelines" cover 8 key components including: maintaining transparency, rating practice recommendations based on the strength of the evidence, & using systematic reviews that have been conducted based on IOM's standard. Find the full text of both reports here http://www.iom.edu/Reports.aspx.

Danielle's Picks from the Literature - April 2011

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.

Evidence-Based Nursing. Nursing research: Get started!.
Anderson, Tamika L.; Dixon, Kelly H.; Lewallen, Lynne Porter; Jarrett
Pulliam, Cindy; Nursing Management, 2011 Mar; 42 (3): 20-3

Evidence-Based Nursing. How do you support your staff? Promote EBP.
Shivnan, Jane C.;
Nursing Management, 2011 Feb; 42 (2): 12-4

Professional Issues. Scholarship in Nursing: Not an Isolated Concept.
Robert, Ruth R.; Pape, Theresa M.;
MEDSURG Nursing, 2011 Jan-Feb; 20 (1): 41-4

Evidence-based nursing. Does journal club membership empower practice?
Sciarra, Erica;
Nursing Management, 2011 Jan; 42 (1): 17-8

Evidence-based nursing. Enhancing nursing's presence.
D'Alessio, Eileen; Magsalin, Maria; Neville, Kathleen L.; Patten, Constance;
Nursing Management, 2010 Dec; 41 (12): 16-8

Ebp: evidence to practice implementation.
Adams S; Cullen L;
Journal of PeriAnesthesia Nursing, 2011 Feb; 26 (1): 35-7

Following the evidence: planning for sustainable changed: the ebp team makes plans to implement an rrt in their hospital.
Finout-Overholt E; Williamson K; Gallagher-Ford L; Melnyk BM; Stillwell SB; American Journal of Nursing, 2011 Jan; 111 (1): 54-60

Barriers and perceived needs for understanding and using research among emergency nurses.
Chan GK; Barnason S; Dakin CL; Gillespie G; Kamienski MC; Stapleton S; Williams J; Juarez A; Li S;
JEN: Journal of Emergency Nursing, 2011 Jan; 37 (1): 24-31

Evidence-based practice mentors: taking information literacy to the units in a teaching hospital.
Arguelles C;
Journal of Hospital Librarianship, 2011 Jan-Mar; 11 (1): 8-22

A regional evidence-based practice fellowship: collaborating competitors.
Weeks SM; Moore P; Allender M;
Journal of Nursing Administration, 2011 Jan; 41 (1): 10-4

Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model.
Levin, Rona F; Fineout-Overholt, Ellen; Melnyk, Bernadette Mazurek; Barnes, Michael; Vetter, Mary Jo;
Nursing Administration Quarterly, 2011 Jan-Mar; 35 (1): 21-33

The systematic review of literature: Synthesizing evidence for practice.
Rew L;
Journal for Specialists in Pediatric Nursing, 2011 Jan; 16 (1): 64-9

Clinical nurse specialist driving exemplary practice and clinical innovation in a magnet organization.
Gunn, Sharon; Flanders, Sonya; Leeper, Bobbi;
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Mar-Apr; 25 (2): 94

Barriers to translating evidence-based breastfeeding information into practice.
Brodribb W;
Acta Paediatrica, 2011 Apr; 100 (4): 486-90

Implementing an Evidence-Based Practice Change.
Gallagher-Ford, Lynn; Fineout-Overholt, Ellen; Melnyk, Bernadette Mazurek; Stillwell, Susan B.;
American Journal of Nursing, 2011 Mar; 111 (3): 54-60

Clinical nurse specialist multidisciplinary rounds as a strategy to translate evidence-based practice to the bedside.
Johnson, Melissa; Amber, Rhonda; Cahill, Donna; Nolan, Scot; Azuma, Nancy; Davidson, Judy; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2011 Mar-Apr; 25 (2): 80

WJNR Special Issue: Evidence-Based Practice

Check out the April 2011 issue of Western Journal of Nursing Research dedicated to Evidence-Based Practice. Articles focus on the following three topics: approaches and programs to foster EBP, leadership support needed to promote EBP, and case studies of nurses applying evidence to address clinical issues.

Access to the full text is available to all St. Joseph Hospital of Orange and CHOC employees through the Burlew Medical Library website.

New resource about statistical tests

The Journal for Wound Ostomy & Continence Nursing has begun a 6-part series on statistical tests with its January issue. Eberly & Telke have written an easy-to-read essay on comparing means between two samples.

Research Abstract and Commentary:Patient Perspectives on Falls

Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention

Patient falls and falls with injury are the largest category of reportable incidents and a significant problem in hospitals. Patients are an important part of fall prevention; therefore, we asked patients who have fallen about reason for fall and how falls could be prevented. There were two categories for falls: the need to toilet coupled with loss of balance and unexpected weakness. Patients asked to be included in fall risk communication and asked to be part of the team to prevent them from falling. Nurses need to share a consistent and clear message that they are there for patient safety.

Carroll, D. L., Dykes, P. C., & Hurley, A. C. (2010). Applied Nursing Research, 23, 238-241.

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

Given the fact that patients continue to fall, these researchers sought to understand the unique views of patients who had fallen within 48 hrs of their fall while an inpatient in an acute care hospital. They interviewed 9 cognitively intact men and women with ages from 24 to 78 years. Six of the participants had fallen in the past.

Results were fascinating, with cogent excerpts from patient statements. Patients’ reasons given for falling made sense: losing one’s balance while in a hurry to get to the bathroom, being involved in a normal activity while weakened from the condition leading to hospitalization, and not having items within reach. Patients were able to come up with ideas to prevent their own falling in the future: thinking ahead and NOT getting up quickly or without help; asking for help when it is needed, and overcoming the natural instinct to “not bother” the nursing staff; and using appropriate assistive devices (e.g., walkers, slip resistant socks).

The study pointed clear messages to nurses:
• Give anticipatory guidance for patients at risk of falling.
• Help patients feel comfortable asking for help.
• When a patient requests help, respond quickly and positively.
• Think ahead to patients’ needs to prevent their needing to go beyond their capabilities.

Studies like this one which offer patient perspectives are so important for nurses to read and reflect on… please let us know in the Office of Nursing Research (714-771-8120; 12698) if you need help in this.

Danielle's Picks from the Literature - March 2011

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.

Creative partnerships for funding nursing research.

McCann JJ; Hills EB; Zauszniewski JA; Smith CE; Farran CJ; Wilkie DJ;

Western Journal of Nursing Research, 2011 Feb 01; 33 (1): 79-105

Implementation of evidence-based nursing practice: nurses' personal and professional factors.

Eizenberg MM;

Journal of Advanced Nursing, 2011 Jan; 67 (1): 33-42

Lower extremity ulcer management: best practice algorithm.

Simms KW; Ennen K;

Journal of Clinical Nursing, 2011 Jan; 20 (1/2): 86-93

Linking economics and quality: developing an evidence-based nurse staffing tool.

Anderson, E Faye; Frith, Karen H; Caspers, Barbara;

Nursing Administration Quarterly, 2011 Jan-Mar; 35 (1): 53-60

Painful breast lumps in nursing mothers: identifying and treating plugged ducts, mastitis, and abscess.

Balkam JJ;

American Journal of Nursing, 2010 Dec; 110 (12): 65-7

Clinical librarians as facilitators of nurses' evidence-based practice.

Määttä S; Wallmyr G;

Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3427-34

Dissemination of research into clinical nursing literature.

Oermann MH; Shaw-Kokot J; Knafl GJ; Dowell J;

Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3435-42

Virtual journal club connects evidence to practice: an analysis of participant responses.

Lehna C; Berger J; Truman A; Goldman M; Topp R;
Journal of Nursing Administration, 2010 Dec; 40 (12): 522-8

Teaching Research and Evidence-Based Practice Using a Service-Learning Approach.

Balakas K; Sparks L;
Journal of Nursing Education, 2010 Dec; 49 (12): 691-5

Towards Evidence-based Management: Creating an Informative Database of Nursing-Sensitive Indicators.

Patrician PA; Loan L; McCarthy M; Brosch LR; Davey KS;

Journal of Nursing Scholarship, 2010; 42 (4): 4th Quarter: 358-66

Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: bridging the theory practice gap.

Ferrara, Lucille R.;

Research & Theory for NursingPractice, 2010; 24 (4): 213-6

Pilot study to test the use of a mobile device in the clinical setting to access evidence-based practice resources.

Morris J; Maynard V;

Worldviews on Evidence-Based Nursing, 2010 4th QUARTER; 7 (4): 205-13

The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.

Ploeg J; Skelly J; Rowan M; Edwards N; Davies B; Grinspun D; Bajnok I; Downey A;
Worldviews on Evidence-BasedNursing, 2010 4th QUARTER; 7 (4): 238-51

Danielle's Picks from the Literature - January 2011

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. Implementation of evidence-based nursing practice: nurses' personal and professional factors?
Eizenberg MM
Journal of Advanced Nursing, 2011 Jan; 67 (1): 33-42

Abstract: Aims. This paper is a report of a study conducted to explore the relationship between nurses' personal and professional factors and evidence-based nursing practice. Background. Like most health-related professions, nursing is shifting from the traditional intuition-based paradigm to evidence-based nursing practice. Methods. A cross-sectional survey was conducted in 2007 with a convenience sample of 243 nurses from northern Israel, who worked in hospitals or in the community. Associations between background variables and evidence-based nursing practice were examined. For the purpose of finding factors that predicted behaviour, a logistic regression analysis was conducted. Results. The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. Moreover, evidence-based nursing practice was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace. The variables emerging as predicting evidence-based nursing practice were: education, skills in locating various research sources, support of the organization for searching and reading professional literature, knowledge sources based on colleagues and system procedures (inhibiting variable), knowledge sources based on reading professional literature, and knowledge sources based on experience or intuition. Conclusion. The findings point to the need for research-based information, exposure to professional journals and, in particular, organizational support for evidence-based nursing practice.

2. The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.
Ploeg J; Skelly J; Rowan M; Edwards N; Davies B; Grinspun D; Bajnok I; Downey A

Worldviews on Evidence-Based Nursing, 2010 4th QUARTER; 7 (4): 238-51
Abstract: Background: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. Aim: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. Methods: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N = 191) and administrators (N = 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. Results: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. Conclusions and Implications: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidencebased practices to advance positive patient, organizational, and system outcomes.

3. Evidence-based nursing practice in the perioperative setting: a Magnet journey to eliminate sacred cows.
Mellinger E; McCanless L
AORN Journal, 2010 Nov; 92 (5): 572-8

4. 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.

5. Recognizing the evidence and changing practice on injection sites.
Cocoman A; Murray J
British Journal of Nursing (BJN), 2010 Oct 14; 19 (18): 1170-4
Abstract: Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.

6. Exploring the effect of conducting sensitive research.
McGarry J
Nurse Researcher, 2010; 18 (1): 8-14
Abstract: The term 'sensitive research' has become recognised in health and social care research literature generally. It has been used to describe a wide range of topics, undertaken across a variety of disciplines and settings, using a range of methods. Drawing on evidence from other disciplines, this article examines the particular issues and effects that arise for nurses in carrying out sensitive research as the field continues to evolve.

7. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.
Schindler CA; Mikhailov TA; Kuhn EM; Christopher J; Conway P; Ridling D; Scott AM; Simpson VS
American Journal of Critical Care, 2011 Jan; 20 (1): 26-35
Abstract: Background: The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. Objectives: To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Methods: Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. Results: The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable underpads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. Conclusions: The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.

8. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.
Harris J; Kearley K; Heneghan C; Meats E; Roberts N; Perera R; Kearley-Shiers K
Medical Teacher, 2011 Jan; 33 (1): 9-23
Abstract: Background: Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established. Objective: This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making. Methods: We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings. Results: Eighteen studies were included. Studies reported improvements in reading behaviour ( N = 5/11), confidence in critical appraisal ( N = 7/7), critical appraisal test scores ( N = 5/7) and ability to use findings ( N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities. Conclusion: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

9. A 15-step model for writing a research proposal.
Martin CJH; Fleming V
British Journal of Midwifery, 2010 Dec; 18 (12): 791-8
Abstract: On occasion midwives may be required to construct a research proposal. In the current climate of evidence-based practice. Such activity is considered an elemental skill for career progression in both education and service. Examples of where writing a research proposal may be required include: writing an assessment for under and post graduate research modules or designing a dissertation, MPhil, Prof Doc or PhD. Within clinical practice there are also audit and evaluation of practice responsibilities. With these factors at the forefront, this article provides a template specifically designed to direct midwives through the procedures of constructing a research proposal. The purpose of a research proposal is to produce a template of common understanding from which tasks are allocated, divided and discussed by researchers, clinical staff and in some cases participants. The finished product is then used to communicate intent to the ethics committees and grant funding bodies before authorization and money are awarded.

10. Clinical librarians as facilitators of nurses' evidence-based practice.
Määttä S; Wallmyr G
Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3427-34
Abstract: The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice.

11. Teaching Research and Evidence-Based Practice Using a Service-Learning Approach.
Balakas K; Sparks L
Journal of Nursing Education, 2010 Dec; 49 (12): 691-5
Abstract: Because nurses are expected to engage in evidence-based practice (EBP), nursing students must learn to critically evaluate and apply research findings to prepare for professional practice. To connect research and EBP, the focus of a baccalaureate research course was changed from a traditional format to one of evidence appraisal and synthesis. Using an approach that incorporated service-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world. Working with a community partner, students were able to develop PICO (Population, Intervention, Comparison, and Outcome) questions and critically appraise the literature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experience because course assignments had a direct impact on current practice. Research courses taught from an EBP perspective can provide motivation for students to incorporate research into their practice as professional nurses.

12. Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm.
Mallory GA
Nursing Outlook, 2010 Nov; 58 (6): 279-86
Abstract: The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

13. Interdisciplinary evidence-based practice: Moving from silos to synergy.
Newhouse RP; Spring B
Nursing Outlook, 2010 Nov; 58 (6): 309-17
Abstract: Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform.