M G Titler, C Kleiber, V J Steelman, B A Rakel, G Budreau, L Q Everett, K C Buckwalter, T Tripp-Reimer, C J Goode
Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. firstname.lastname@example.org
The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.
A systematic review of the psychometric properties of self-report research utilization measures used in healthcare.
Janet E Squires, Carole A Estabrooks, Hannah M O'Rourke, Petter Gustavsson, Christine V Newburn-Cook, Lars Wallin
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. email@example.com
BACKGROUND In healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization. OBJECTIVES The objectives of this systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity) of these measures. METHODS We conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the Standards for Educational and Psychological Testing. RESULTS Of 42,770 titles screened, 97 original studies (108 articles) were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies) and healthcare decision makers (5 studies). No studies reported data on acceptability of the measures. Reliability was reported in 32 (33%) of the studies, representing 13 of the 60 measures. Internal consistency (Cronbach's Alpha) reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearson's r coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6) reported evidence from any three (out of four possible) Standards validity sources (which, in the case of single item measures, was all applicable validity sources). Level two measures (n = 16) had evidence from any two validity sources, and level three measures (n = 26) from only one validity source. CONCLUSIONS This review reveals significant underdevelopment in the measurement of research utilization. Substantial methodological advances with respect to construct clarity, use of research utilization and related theory, use of measurement theory, and psychometric assessment are required. Also needed are improved reporting practices and the adoption of a more contemporary view of validity (i.e., the Standards) in future research utilization measurement studies.
Froedtert Hospital, Milwaukee, WI 53226, USA. firstname.lastname@example.org
PURPOSE A systematic review of literature and intensive evaluation were conducted using a quality process to assess temporal artery thermometer (TAT) accuracy in an acute-care setting. BACKGROUND Inaccurate temperature measurements were reported following adoption of the TAT. Concern for patient safety and outcomes generated a need to reevaluate use of the TAT. DESCRIPTION OF THE PROJECT Using components of evidence-based practice and intensive evaluation processes, a clinical nurse specialist (CNS)-led team evaluated existing research, assessed current practice, and obtained additional clinical data. OUTCOMES Existing research provides inadequate evidence to support use of the TAT for acutely ill hospitalized patients. Findings from an intensive evaluation indicated low interrater reliability in controlled testing, inaccurate technique by staff despite retraining, lack of nurse confidence in the accuracy of the device, and a need for continuous costly retraining. These findings are consistent with findings in a University HealthSystem Consortium report. SUMMARY AND CONCLUSIONS A multifaceted evaluation process was needed for the team to compile data, identify issues, and make decisions. A recommendation was made to discontinue use of the TAT. IMPLICATIONS : Clinical nurse specialists have the knowledge and ability to provide clinical leadership at a system level. When usual processes result in safety concerns, the CNS provides leadership to identify patterns, provide direction, creatively integrate evaluation processes, synthesize findings, and uses his/her influence within the system to change practice.
Department of Nursing Services and Patient Care,University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA. email@example.com
Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses' organization. Program evaluations are extremely positive, and the long-term impact is described.
Maria R Shirey, Sheila L Hauck, Jennifer L Embree, Tracy J Kinner, Gina L Schaar, Lori A Phillips, Shelley R Ashby, Constance F Swenty, Isabella A McCool
University of Southern Indiana, College of Nursing and Health Professions, Evansville, IN 47712, USA. firstname.lastname@example.org
The literature confirms that much confusion exists regarding the terms quality improvement (QI), evidence-based practice (EBP), and research. A multifaceted approach was used to provide clarity regarding these three equally important concepts. First, the authors present a synthesis of the literature that discusses differences between QI, EBP, and research. Second, the authors introduce a newly created comparative table that synthesizes current literature and showcases differences between QI, EBP, and research. Finally, the authors highlight uses of the comparative table within multiple settings.
Cerebellar assessment for patients receiving high-dose cytarabine: a standardized approach to nursing assessment and documentation.
Sarasota Memorial Hospital, Sarasota, FL, USA. at email@example.com
Cerebellar toxicity is a known potential adverse effect of high-dose cytarabine chemotherapy. Oncology nurses are expected to assess patients receiving high-dose cytarabine for cerebellar toxicity prior to administering each dose. Information regarding cerebellar assessment techniques and documentation of findings is limited in the nursing literature. This article provides nurses with a standardized approach for cerebellar function assessment and documentation of assessment finding for patients receiving high-dose cytarabine therapy.
College of Nursing, University of Nebraska Medical Center, Omaha, NB 68198-5330, USA. firstname.lastname@example.org
The role of culture in evidence-based practice (EBP) is examined using the components of the EBP process as a framework for discussion. Issues that are identified include the recruitment and retention of ethnic groups in research; paternalism and institutional racism in regard to those who cannot afford best practice; and cultural differences between health professionals and patients in their understanding of best practice, health, and illness. Strategies that are suggested to reduce cultural incongruence include shared clinical decision making and development of a cultural knowledge system to improve EBP and outcomes on an organizational level.
Center for Nursing Quality, Professional Development, Research and Informatics, Department of Nursing and Patient Care Services, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. email@example.com
Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
Oral hygiene significantly affects children's well being. It is an integral part of intensive and critical care nursing because intubated and ventilated children in the Pediatric Intensive Care Unit (PICU) are dependent on the health care team to tend to their everyday basic needs. Fourteen articles were identified as being relevant to pediatric oral care in the PICU. These articles were subsequently appraised, and an oral hygiene in the PICU guideline was developed. Research highlighted the relationship between poor oral hygiene in the intensive care unit (ICU) and an increase in dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia. Research and a local, informal audit found the provision of oral hygiene care to PICU children varied widely and was often inadequate. Children in the PICU need their mouths regularly assessed and cleaned. Maintaining consistent, regular, and standardized oral hygiene practices in the PICU will also set an example for children and their families, encouraging and teaching them about the life-long importance of oral hygiene.
J Nurs Manag. 2010 Jan ;18 (1):84-9 20465733
Providing direct care nurses research and evidence-based practice information: an essential component of nursing leadership.
Rush University Medical Center, 600 S. Paulina Street, Chicago, IL 60612, USA. firstname.lastname@example.org
AIMS This commentary describes the reasons, strategies and benefits of providing direct care nurses with research and evidence-based practice (EBP) education. BACKGROUND A component of nursing leadership is to provide nurses opportunities for professional growth and development, yet this can be challenging during a time when resources are constrained and need to be used wisely. EVALUATION Our research and EBP education programmes have been evaluated qualitatively, as well as by the number of research/EBP projects implemented. KEY ISSUES Providing direct care nurses with support and additional education empowers them to seek, critically appraise and integrate research findings into their daily patient care. CONCLUSIONS Direct care nurses, who participated in our programme, demonstrated a strong desire to learn about research and EBP so they could practice using evidence-based care with confidence, thus transitioning from a 'tradition-based' care approach to an evidence-based way of providing care as the standard for nursing practice. IMPLICATIONS FOR NURSING MANAGEMENT Providing a dedicated time for additional education sends a clear message that research and EBP are important elements embedded in patient care. The organisation, then, is seen as an environment that emphasizes the value of research and EBP at the unit and organisational level.
Assessing environmental readiness: first steps in developing an evidence-based practice implementation culture.
Division of Nursing and Newborn Intensive Care, St Louis Children's Hospital, St Louis, Missouri 63110, USA. email@example.com
Significant emphasis has been placed on evidence-based practice (EBP) in today's healthcare systems. Nurses are expected to practice within an EBP framework by using current, reliable, and valid research. However, implementing EBP is not always easy and can be challenging. In order for nurses to provide evidence-based care, they need to be cognizant of organizational factors that can potentially hinder or support an EBP culture. This article provides practitioners with an understanding of how to evaluate environmental readiness for implementation of EBP within their organization. Barriers and facilitators for implementing EBP at the organizational level, at the interdisciplinary team level, and within nursing are also described. To successfully implement EBP, it is important to recognize the interaction between these 3 levels and to highlight the important role nurses play as interdisciplinary team members in supporting an EBP environment.
Other papers by authors:
Improving practice through research: the case of heparin vs. saline for peripheral intermittent infusion devices.
Peripheral intermittent infusion devices are commonly used to administer periodic doses of medications to adults and children. Research findings provide a strong base for changing practice to using saline instead of heparin to flush these devices in children over 28 days old and in adults. This research-based change in practice will enhance the quality of care that patients receive and decrease the costs of their care.
The authors present a review of the research on various methods for determining placement of nasogastric and nasointestinal feeding tubes. They also discuss research on associated risk factors, complications specific to critical care patient populations, and techniques for postpyloric placement. They present research consensus, recommendations for practice, and implementation strategies.
Research, Quality and Outcomes Management, Department of Nursing and Patient Care Services, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary to determine the most effective treatments and the conditions under which they should be used.
Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. firstname.lastname@example.org
Experimental multisite studies are needed to test adoption interventions that promote use of evidence-based guidelines in critical care practice. A research model (see Fig. 2) based on Rogers' diffusion of innovation model provides a conceptual guide for selecting interventions to test in translational research studies. Studies should address the four major areas of innovation adoption:(1) characteristics of the guideline,(2) users of the guideline,(3) methods of communicating the guideline, and (4) the social system in which it is being adopted. It is imperative that researchers study which interventions are most effective in promoting use of critical care evidence-based practices by nurses and physicians and how the social system of critical care environments affects adoption of such practices. Without this empiric knowledge, health care systems have little guidance in how to most effectively promote adoption of scientific evidence to improve care of critically ill patients.
M S Berg, M Dreher, K D Davenport, J Greiner, R E Howell, A H Mutnick, G V Jensen, B A Rakel, F C Johlin, V L Kraus, R C Reiter, K C Leo, J Ryan, J M McCloskey, M L Schlapkohl, M E Shafer, B Szymusiak-Mutnick, M G Titler
College of Nursing, University of Iowa, Iowa City, USA.
Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.
Gerontological Nursing Interventions Research Center, University of Iowa Hospitals and Clinics, Iowa City 52242-1009, USA. email@example.com
BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, critiquing studies, and synthesizing research findings for practice. GNIRC-generated research is disseminated to nurses in practice, and the RDDC links nurses who identify clinical problems in care of the elderly with GNIRC scientists. Currently, 19 RB protocols are offered for dissemination through the RDDC, and 5 protocols are under development. Implementation and evaluation of research-based practices on "Split Thickness Skin Graft Donor Site Care" and "Nasogastric/Nasointestinal Tube Placement" are described. CONCLUSIONS: Lessons learned on the basis of experience in disseminating and implementing research-based practices include the necessity of tailoring them to the local needs of various clinical settings in which they are used, reinfusing them periodically to keep staff motivated, and making them consumer friendly. The challenge remains to integrate these practices into the fiber of organizations and to keep staff educated and motivated to carry out research-based practices to improve the care of the elderly.
Critical Care Nursing Division, University of Iowa Hospitals and Clinics, Iowa City 52242.
This article reviews the other articles in this issue that provide evidence of recent progress in clinical nursing research. The authors, guest editors of this issue, issue a call for further research to develop improvements in clinical nursing practice.
S K Johnson, M A Halm, M G Titler, M Craft, C Kleiber, L A Montgomery, A Nicholson, K Buckwalter, E Cram
Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to:(1) network with other nurses who have similar interests,(2) share knowledge and expertise for designing clinical studies that directly affect daily practice,(3) develop instruments,(4) write grant proposals,(5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.
M A Halm, M G Titler, C Kleiber, S K Johnson, L A Montgomery, M J Craft, K Buckwalter, A Nicholson, K Megivern
This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.
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US Army Med Dep J. ;:41-4 22124871
Establishing a methodology for development and dissemination of nursing evidence-based practice to promote quality care.
US Army Medical Dept Center and School, Fort Sam Houston, TX.
Reducing nursing practice variance by standardization of practice guidelines based on supportive literature has demonstrated improvements in the quality of patient care and positive patient outcomes. The challenge is to link the bedside nurse providing nursing care to subject matter experts well-versed in the critical analysis of clinical practice recom-mendations. This article discusses the restructuring of nursing research departments within Army healthcare facilities to facilitate nursing practice based on supportive evidence and the development of a senior nursing leadership practice council to support dissemination of approved nursing practice guidelines across all Army inpatient medical facilities.
Development of a radiation skin care protocol and algorithm using the Iowa Model of Evidence-Based Practice.
James Hospital and Solove Research Institute, Ohio State University Medical Center-Ackerman, Columbus, OH, USA. firstname.lastname@example.org
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.
Crit Care Nurs Q. ;33 (2):117-25 20234200
The role of the clinical nurse specialist in facilitating evidence-based practice within a university setting.
Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. email@example.com
There are many changes occurring within the healthcare system today, bringing forth multiple challenges for nurses. Changes in reimbursement for hospitals and staffing shortages are impacting the ways that nurses are delivering care. During these changing times, it is essential that healthcare providers strive to maintain high-quality care and patient safety. Utilizing evidence-based practice (EBP) to guide the delivery of care is one way to ensure that high-quality outcomes are achieved. EBP is one of the driving forces to improve clinical practice and ensure patient safety within the healthcare system. The clinical nurse specialist is very instrumental in facilitating quality care and implementing EBP within the healthcare setting. Through the development of a multidisciplinary committee, the clinical nurse specialist can lead professional nurses in the implementation of EBP and facilitate practice changes to improve patient outcomes.
Department Of Professional Practice & System, St. Louis Children's Hospital, St. Louis Missouri, USA.
The concept of evidence-based practice (EBP) has continued to evolve in the nursing profession as the basis for clinical decision-making. Despite the evidence to support this practice, few nurses at the bedside have received instruction in how to develop a clinical practice question using EBP skills. The EBP Scholars Program was designed at a Midwest pediatric academic hospital to teach EBP skills to enable staff to conduct extensive evaluations of existing literature to improve pediatric patient care. The program provides a comprehensive overview of EBP and the essential components necessary for implementation of EBP in a clinical setting. The development and implementation of an innovative EBP program designed to empower nurses to improve patient outcomes, as well as the lessons learned, are described.
ONS Connect. 2009 Apr ;24 (4):8-11 19413234
Faculty of Nursing and Health Science, Bethlehem University, West Bank, Palestinian Authority.
Are you one of the many oncology nurses who have enhanced their practice with the ONS Putting Evidence Into Practice (PEP) resources? Today's healthcare practice centers on what is known as "evidence-based practice," the goal of which is to provide the best patient care and to improve patient outcomes. Outcomes that address how patients and their healthcare issues are affected by nursing interventions are described as nursing-sensitive patient outcomes. The ONS PEP resources have identified the most effective nursing interventions based on evidence available in the literature and summarized them in a quick-reference format for practicing nurses.
Chief nursing officer turnover: chief nursing officers and healthcare recruiters tell their stories.
The School of Nursing, The University of North Carolina at Chapel Hill, NC 27599-7460, USA. firstname.lastname@example.org
Chief nursing officers (CNOs) develop environments in which quality patient care is delivered and nurses enjoy professional practice. Because of the growing turbulence in this vital role, the American Organization of Nurse Executives conducted a study to examine CNO turnover as described in interviews with CNOs and healthcare recruiters to inform the development of strategies to improve CNO recruitment and retention and ease transition for those who turn over. The authors present the findings from this research and describe American Organization of Nurse Executives' initiatives to address the identified needs.
Learning at the point of care using evidence-based practice resources and clinical decision support.
National Institute for Quality Improvement and Education, Homestead, PA 15120, USA. email@example.com
Leaders in the field in academic settings, professional associations, and those who determine criteria for CE credit should discuss implications and work together to establish appropriate processes to promote learning at the point of care. Clinical decision support and point-of-care learning based on evidence-based practice recommendations reduce variability in care, reduce errors, improve safety, and ultimately improve the quality of patient care.
The power of clinical nursing research: engage clinicians, improve patients' lives, and forge a professional legacy.
University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095, USA. AGawlinski@mednet.ucla.edu
Sparked by the Institute of Medicine's report titled Crossing the Quality Chasm, research-based decision making has been emphasized for improving care. Patients should receive care that is based on the best available scientific knowledge, and care should not vary from clinician to clinician or from place to place. Implementing research-based practices at the bedside is a complex endeavor. It is all too easy to discover that clinically important research findings are either not known by practitioners or not being used in actual practice. Efforts to instill and sustain research-based practices improve significantly when staff nurses are involved with the research from the start. Institutions that are effective in involving clinicians have built a foundation of infrastructures that enable processes for engaging clinicians to take place. What distinguishes effective from ineffective hospital nursing research and evidence-based practice programs is the presence of structures whereby processes can occur that (1) unleash the creativity of staff by securing their involvement early,(2) educate staff by involving them,(3) create internal expertise for research and evidence-based practice, and (4) ensure that patients experience principled implementation of research-based practices to improve their lives. This article describes infrastructures that can ensure and sustain research-based practices while unleashing the talent and creativity of clinicians as they question practice and ponder the merits of current research. Fostering participation in such clinical inquiry will summon professional growth, influence the lives of patients, and help each nurse develop a unique personal professional legacy.
School of Nursing, College of Health and Science, University of Western Sydney, New South Wales, Australia.
This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.
College of Nursing, Michigan State University, East Lansing, MI 48823, USA. firstname.lastname@example.org
OBJECTIVES To describe the needs of family members of older persons undergoing cancer treatment and to examine the interventions designed to alleviate caregiver distress. DATA SOURCES Research studies and published articles. CONCLUSION Interventions to reduce distress for caregivers of older persons with cancer have the potential to lower patients' hospital re-admissions and interruptions in cancer treatment and to improve patients' and caregivers emotional health. IMPLICATIONS FOR NURSING PRACTICE Oncology practitioners must consider the needs of family caregivers when planning and implementing interventions to improve or maintain caregiver health.