Category Archives: Professional Nursing

Nightingale: Avante garde in meaningful data

In honor of Nurse Week, I offer this tribute to the avante garde research work of Florence Nightingale in the Crimea that saved lives and set a precedent worth following.

Nightingale was a “passionate statistician” knowing that outcome data are convincing when one wants to change the world.  She did not merely collect the data, but also documented it in a way that revealed its critical meaning for care.

As noted by John H. Lienhard (1998-2002): Nightingale coxcombchart“Once you see Nightingale’s graph, the terrible picture is clear. The Russians were a minor enemy. The real enemies were cholera, typhus, and dysentery. Once the military looked at that eloquent graph, the modern army hospital system was inevitable.  You and I are shown graphs every day. Some are honest; many are misleading….So you and I could use a Florence Nightingale today, as we drown in more undifferentiated data than anyone could’ve imagined during the Crimean War.” (Source: Leinhard, 1998-2002)

As McDonald (2001) writes in the BMJ free, full-text,  Nightingale was “a systemic thinker and a “passionate statistician.”  She insisted on improving care by making policy & care decisions based on “the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate.”(p.68)

Moreover, her display of the data brought its message home through visual clarity!

Thus while Nightingale adhered to some well-accepted, but mistaken, scientific theories of the time (e.g., miasma) her work was superb and scientific in the best sense of the word.   We could all learn from Florence.

CRITICAL THINKING:   What issue in your own practice could be solved by more data?  How could you collect that data?   If you have data already, how can you display it so that it it meaningful to others and “brings the point home”?

FOR MORE INFO:

HAPPY NURSE WEEK TO ALL MY COLLEAGUES.  

MAY YOU GO WHERE THE DATA TAKES YOU!

 

 

It was the best of evidence; it was the worst of evidence.

evidencebased practiceEvidence-based practice = best available evidence + expert clinical judgment + patient & family values/preferences.

When clinicians diagnose & treat based on outdated or inadequate knowledge, then outcomes are at best uncertain.  The internet itself is a poor information source; & colleagues may be no more up-to-date that you.

Good sources are the world-wide Cochrane Collaboration and the specific evidence-based Homepractice journals that are beginning to grow–these take best information from the research report all the way through clinical recommendations.   For research reports per se, PubMed is a comprehensive, U.S. tax-supported Findingsdatabase; & there when you find information that fits using your key search terms, you can also look for related articles & get full-text through interlibrary loan or online.  Another strategy is take the article that fits your clinical issue to your librarian, and ask for help in finding more research on the identical clinical issue.

While no one can read everything in the literature, everyone can read something. You can do a focused review on any particular problem.

Critical thinking:  Is there a clinical issue that you think could use a better solution?  Plug related words into PubMed & see what you can learn.question

For more information see fulltext at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC226388/

!!Here they come to save the day!! Toolbox to move from paper to practice

toolsOk, so you found some GREAT, new & improved clinical guidelines that exactly fit the problem that you are trying to solve on your unit.   Now What???   How do you get from the guidelines from paper to practice?  & How do you know that the guidelines are any good any way?   Where are the tools for all this?MightyMouse

Like the old cartoon Mighty Mouse, here comes the Registered Nurses Association of Ontario to save the day!  (cue the music)   You can download a FREE toolkit.  Yes, that’s right.  FREE.

It comes complete with examples & step-by-step instructions.  Check it out!   And if I haven’t been persuasive enough, here’s the table of contents!   This is waaay cooool.  Don’t miss it.

For more info here’s the site to downloadhttp://rnao.ca/bpg/resources/toolkit-implementation-best-practice-guidelines-second-edition

RNAO toolkit download

ZIKA: Evidence-based clinical guidelines to prevent sexual transmission

As  you probably know Zika is already causing problems in an area outside of Miami, FL. CDC has taken the unusual step of issuing a travel warning there. 16743-close-up-of-a-mosquito-feeding-on-blood-pv

Accurate clinician and patient information in the U.S. will become more critical, and your advice to others could save lives as the disease spreads.

imagesCALQ0QK9Some of the best evidence on what to teach is from CDC.  These experts have reviewed the best available literature and developed these clear  evidence-based clinical guidelines to
prevent sexual transmission of Zika
.  Such evidence-based guidelines are considered very STRONG evidence--some of the strongest out there!! (For more see: “I like my “I like my coffee (and my evidence) strong!”)

Note that I point out, as do they, that these guidelines are based on the best available evidence which continues to evolve.  (It wasn’t that long ago when experts denied that Zika could be sexually transmitted.  Now we know better.)

what so what what nextScientific evidence is not static. It is dynamic and ever evolving.  This is not a problem with science, but is part of its very nature–that of discovery.

Why this matters: Clinicians should continue to educate all patients about ZIKV sexual transmission risk, to conduct testing for all persons with possible sexual exposure, and to report all cases of ZIKV to local health authorities” (CDC, 2016).

Critical thinking: How might you use this information at work or with the broader public?question

For more information: Check out CDC Zika Virus webpage 

 

Zika Virus: What we know and do not know (O’Malley, 2016)

The public and lots of nurses have lots of questions.   Our evidence-based knowledge is evolving.  Here’s some of the latest (Aug/July 2016).

You can set up a free account with Lippincott to access this 3 page article that translates current research into practice for you.

O’Malley – Zika virus: What we know and do not know: 16743-close-up-of-a-mosquito-feeding-on-blood-pvhttp://www.nursingcenter.com/pdfjournal?AID=3570052&an=00002800-201607000-00005&Journal_ID=54033&Issue_ID=3569996

Strong nursing leadership is essential to evidence-based practice

priority“The Institute of Medicine (IOM) set a goal that, by 2020, the majority of healthcare practices and decisions would be evidence-based.Yet…only three percent of the executive-level nurse leaders surveyed ranked EBNP as a top priority at their own organizations. What’s worse, more than half said EBNP is practiced at their organizations only “somewhat” or “not at all.”  Posted on July 19, 2016HTimothy  at American Sentinel.   

For full text see the source link: http://www.americansentinel.edu/blog/2016/07/19/strong-nursing-leadership-is-essential-to-evidence-based-practice/

Critical Thinking: Given all the demands of the healthcare questionenvironment, how can we make this goal happen.   

Who ya gonna call? Myth Busters!!

MYTH: There is no real payoff in engaging  patients and families.

FACT:  Health care organizations can reap many benefits fromMythBUSted
“activated” patients and families – those who have the knowledge, skills and confidence to manage their own care.

How does engaging patients help?   1) It may increase quality of life by reducing falls, helping patients learn to manage chronic conditions. 2) It can reduce Underuse or Overuse of health services. 3) It may increases reimbursement through improved HCAHPS scores.  And YOU may be more satisfied at work!

TWO EXAMPLES of positive results yielded from partnering with patients and families:
• One hospital that began involving patients and families in safety efforts after a highly publicized preventable death saw a culture shift that improved medication reconciliation and eliminated fatal medication errors during a 10-year period (Johnson & Abraham; Reinersten et al., 2008).
Satisfaction• A health system that began seeking input from patients and families decreased nurse turnover from 15 percent to 5 percent in three years and improved patient, staff and physician satisfaction (Johnson & Abraham).

WHAT CAN I DO TO ENGAGE PATIENTS?  Listen to your patients to identify their level of activation in their care as described, & communicate in ways that move them to the nextNURSEPatient level.

  • At stage 1, people do not yet grasp that they must play an active role in their own
    health, they may still believe that they can just be a passive recipient of care….
  • At stage 2, people may lack the basic facts or have not connected the facts into a larger understanding about their health or recommended health regimens….
  • At stage 3, people have the key facts and are beginning to take action but may lack confidence and skill to support new behaviors….
  • At stage 4, people have adopted new behaviors but may not be able to maintain them in the face of life stress or health crises.”  [source: Hibbard et al. at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955271/]

mythVStruth

FOR MORE INFO, check out the source of above:  Busting the Myths about Engaging Patients and Families in Patient Safetyquestion

CRITICAL THINKING: Think of a strategy that you ALREADY use or that you might start using to move patients up the stages of engagement in their own care. Be specific!