Category Archives: Uncategorized

Uncategorized

“One of these things is not like the other!” (A primer on telling the difference between studies!)

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share2heartI love sharing a great resource, don’t you?

Today, I stumbled onto Study Design 101   at https://himmelfarb.gwu.edu/tutorials/studydesign101/index.html

If you’re a research afficianado, then you probably already know that some types of research studies are considered stronger than others.   Stronger ones are those that support a hypothesis that X really did cause a change in Y.  [For example, study results that suggest that a pain script (X) really does improve patient satisfaction with pain management (Y)]

strongYou may even know that meta-analyses of randomized controlled trials are the strongest type of research evidence and that case studies are considered the weakest.  (Expert opinion that is not research at all is even below that.)

But….are you clear on what a meta-analysis, a case study, a cohort study or a randomizedquiz controlled trial is?   If not or if you want a review, Study Design 101 is for YOU!   Check it out.  Short descriptions followed by 2 question quizzes for self-testing will keep you on track.   Enjoy.

 

evidence based practice, Uncategorized

Not Just The Thought That Counts! (or is it?) Evidence-based gift giving.

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Is it just the thought that counts?  or not?   (Probably depends on the relationship between giver & recipeient as per Paul Tournier’s The Meaning of Gifts that I highly recommend.)

In the meantime enjoy this article in the Washington Post on the holiday evidence for picking the best kinds of gifts.   OR as it is actually titled: “The trick to not giving a terrible gift this year”

Critical Thinking: Note the outcome measures cited for each study:

  1. Were they direct or indirect; & what is the advantage of eachgifts
  2. Were they self-report or observation; & what are the pros & cons of each?
  3. Were the studies descriptive? or experimental?   What does that tell you about cause & effect?
  4. Read Tournier’s tiny book, The Meaning of Gifts & draw your own conclusions.

For more info:  Ask yourself what you would most like for Christmas & check out your friends wishlists!   Check some of the studies cited in the Washington Post article, including Gino & Flynn (2011) evidence on preferences for $, solicited gifts, & unsolicited gifts.  The findings might surprise you:  http://www.sciencedirect.com/science/article/pii/S0022103111000801

 

 

Publishing, Uncategorized, Writing

A FAB resource if you want to let your light shine: Writing for publication

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sunshineWant to write for publication?   CHECK OUT NURSE AUTHOR & EDITOR as one of the best places to learn to improve your writing:  http://naepub.com/

 

A few suggestions from me

  1. You should have the goal of disseminating a project that will help others. Just trying to publish “something” won’t take you far.   Figure out the unique twist of your ideas.  Talk it over with colleagues & see what they find interesting.
  2. Select as many journals from this list or other lists that you think might be interested:    https://nursingeditors.com/journals-directory/
  3. Write a query email to each journal to see if they are interested.  NOTE: some journals will tell you what format your query should follow.  You can write as many query letters as you want.
  4. Pick a journal from those interested.   YOU CAN SUBMIT YOUR ARTICLE TO ONLY 1 JOURNAL at a time.  If that journal rejects you can then submit to 1 other, and so on.
  5. Edit your paper with that journal’s audience in mind.writing-hand
  6. Get a peer to read thoroughly and critique your article!  THEN you have to LISTEN to all their concerns.  If something is unclear to a peer, it will probably be unclear to a peer-reviewer.
  7. Format & submit EXACTLY, EXACTLY as they ask on the journal instructions to authors.  (If you want to annoy editors and reviewers just ignore their instructions to potential authors.)
  8. Wait & keep your fingers crossed
  9. If they turn back to you for revisions that is a GOOD SIGN.  It means they’re interested and you should address every concern.
  10. Resubmit

question1FOR MORE INFORMATION: Check our Nurse Author & Editor for sure! http://naepub.com/

evidence based practice, Meta-analysis, pain assessment, Pain management, research, Research design, Uncategorized

Ouch! Whose Pain Feels Worse?

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levels-of-evidenceIs pain experience as diverse as our populations?  This week I came across an interesting meta-analysis.

A meta-analysis (MA) is one of the strongest types of evidence there is. Some place it at the top; others, 2nd after evidence-based clinical practice guidelines.  (For more on strength of  evidence, click here.)

MA is not merely a review of literature, but is a statistical integration of studies on the same topic.  MA that is based on integration of randomized controlled trials experiment(RCTs) or experimental studies is the strongest type of MA.  MA based on descriptive or non-experimental studies is  a little less strong, because it just describes things as they seem to be; & it cannot show that one thing causes another.

MA example: This brand, new MA included 41  peer-reviewed, English-language, experimental studies with humans:  Kim HJ, Yang GS, Greenspan JD, Downton KD, Griffith KA, Renn CL, Johantgen M, Dorsey SG. Racial and ethnic differences in experimental pain sensitivity: Systematic review and meta-analysis. Pain. 2016 Sep 24 [Epub ahead of print] doi: 10.1097/j.pain.0000000000000731. PMID: 27682208.    All 41 studies used experimental pain stimuli such as heat, cold, ischemic, electrical and others and compared differences between racial/ethnic groups.

Pain reliefMain findings?  “AAs [African Americans], Asians, and Hispanics had higher pain sensitivity compared to NHWs [non-Hispanic Whites], particularly lower pain tolerance, higher pain ratings, and greater temporal summation of pain.” (https://www.ncbi.nlm.nih.gov/pubmed/27682208)  (Temporal summation is the increase in subjective pain ratings as a pain stimulus is repeated again and again.)

Critical thinking:  Given that this is a well-done meta-analysis and that the pain was created by researchers in each study, how should this changequestion your practice?  Or should it?   How can you use the findings with your patients?  Should each patient be treated as a completely unique individual? Or what are the pros & cons of using this MA to give us a starting point with groups of patients?  [To dialogue about this, comment below.]

For more info? Request the full Kim et al. article via interlibrary loan from your med center or school Heart Bookslibrary using reference above.   It is available electronically pre-publication.   Also check out my blog on strength of different types of evidence.

Happy evidence hunting. -Dr.H

Data, Data collection, Qualitative research, quantitative research, reading research, research methods, Uncategorized

DATA COLLECTION SECTION! (Methods in the Madness)

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Key point! The data collection section of a research article includes: who collects what data when, where & how.

In previous blogs we’ve looked at title, introduction, and other elements of methods section (design, sample, & setting). In this one let’s take a look at data collection.

Data are a collection of measurements. For example, student scores on a classroom test might be 97, 90, 88, 85, & so on. Each single score is a datum; collectively they are data.

What data are collected is answered in this section. The data (or measurements) can be counting-hashmarksnumbers OR words. For example, numbers data might include patient ratings of their pain on a 0-10 scale. An example of word data would asking participants to describe something in words without counting the words or anything else.  For example, word data might include patient descriptions pain in words, like word-art“stabbing,”  “achy,” and so on.  Sometimes a researcher collects both number and word data in the same study to give a more complete description.  You can see how knowing the patient’s pain rating and hearing a description would give you a much clearer picture of pain.

  • Studies reporting data in numbers are called quantitative studies
  • Studies reporting data in words/descriptions are called qualitative studies
  • Studies reporting number & word data are called mixed methods studies

How the data are collected includes what instrument or tool was used to gather data (e.g., observation, biophysical measure, or self-report) and how consistently & accurately that tool measures what it is supposed to measure (e.g., reliability & validity). Also included is who collected the data and the procedures that they followed—how did they obtain consent, interaction with subjects, timing of data collection and so on.

Now you know!

Critical thinking question: Did these authors use qualitative or quantitative data collection methods?  Coelho, A., Parola, V., Escobar-Bravo, M., & Apostolo, J. (2016). Comfort experience in palliative care, BMD Palliative care, 15(71). doi: 10.1186/s12904-016-0145-0.  Explain your answer.

Evidence based nursing, Medication development, Uncategorized

New Antibiotic Found in Human Nose

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Useless trivia, but interesting old quote from a detective on the ancient “Alvin & the nOSEChipmunks” cartoon: “Everyone with a nose knows the nose knows everything.” 

Check out the very interesting story about a new antibiotic that may fight MRSA and VRE.  A much needed medicinal weapon.  Still lots we don’t know about how well it will work in humans and resistance to it or other unintended consequences.

Want more info? See this article by By Kai KupferschmidtJul. 27, 2016   http://www.sciencemag.org/news/2016/07/new-antibiotic-found-human-nose

Critical thinking: What do you already do to avoid adding to microbial resistance?

 

anecdotal evidence, patient education, public health, Safety, Uncategorized

!!Don’t Go Pokemon Go!! Privacy, malware, safety, and infringement dangers

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Don’t Go Pokemon Go ….& if you must, watch out!  New privacy and safety dangers are being recorded almost every day.  The game is full of health and computer hazards, and has potential to distract workers from their life-saving care.

What is the evidence?  At this point mostly anecdotal reports and the anticipated possibility that healthcare workers could be distracted from life-saving work.  You need to translate this evidence into action.  Why would you do this with such relatively weak research evidence?  Because the risks are far higher to ignore it, & essentially NO risks if you use the evidence.   The BBB lists these problems & makes some suggestions based on incoming reports:

Translating this evidence into practice?  Think before you  Pokemon Go, if at all.  Talk to your patients–when people don’t feel well they are even more likely to be distracted.

Critical thinking?  1) List specific actions that you will do to promote privacy, safety and fight malware and infringement.  These can range from “never download;never play” to…..?    When developing this list specifically address the challenges above. 2) What about patient players?  staff players?  visitor players?  How should you help them to be safe?question

 

Evidence based nursing, Professional Nursing, tjc, Uncategorized

Who ya gonna call? Myth Busters!!

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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!

Evidence based nursing, Grounded theory, pain assessment, Pain management, Qualitative research, Uncategorized

Afraid to Relieve Pain? You may have Opiophobia

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fear5In pain management are you afraid to give comfort to your patients with appropriate medications?   Are you afraid to be comforted when in pain?  Have you encountered families or care partners, who are afraid to comfort their loved one in pain by giving pain medications?

In a classic 2002 qualitative study, “Fearing to Comfort,” Zerwekh, Riddell, & Richard identified that RNs, physicians, patients, families, and health systems were afraid to relieve pain with appropriate use of pain medications.  They were Not doing evidence-based practice, but fear-based practice. barrier

Fear barriers include, but are not limited to 1) patients’ fear of addiction, fear of distracting the MD from the main treatment plan, and loss of control; 2) MDs’ avoiding the needs of the dying, fear of rewarding drug-seekers, or equating pain management with euthanasia; 3) RNs’ avoiding pain, failing to switch to palliative goals at end of life,  and fear of killing the patient; 4) families’ fears of addiction, side effects, & killing their loved one; and 5) health facilities’ not giving unique consideration to those at end of life, inadequate staffing, & time constraints (Zerwekh et al., 2002).

This is an issue because irrational problems cannot be simply solved by giving rational Pain fistinformation.   We have to find evidence-based practices that can create a change of heart, if you will.  As Zerwekh et al wrote: “Because fear is so influential in decisions to keep pain under control, palliative educational approaches must go beyond providing information to fill deficits in palliative knowledge.”
We must learn evidence-based ways to overcome fear and control pain.  Why?  Because pain interferes with living life.  Who are we protecting when we fear appropriate pain medications?  Not the patient.

FearRemedy?  Palliative care education must confront the fears and remove them through cognitive restructuring that includes learning to question beliefs about addiction etc.  Role playing, role modeling, and an expert walking through this with the provider or family who is afraid.  Beyond this helping people to recognize their own fears of pain & death, and providing the very best available information on pain management (Zerwekh et al).

CRITICAL THINKING:  Have you been afraid?  Or seen others afraid?  How can you solve this problem using evidence-based practice that = BEST available evidence + Clinical judgment + Patient/family preferences & values? Be specific because if you haven’t yet encountered the problem of fearing to comfort, be assured that you will.fear4

FOR MORE INFORMATION:   Read full text Zerwekh et al (2002) online.   It could change your life & the life of those for whom you care!!

Evidence based nursing, pain assessment, Pain management, Pain script, Uncategorized

“IT’S A PAIN!” Use Evidence to Address Pain Management Myths

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A new threat has emerged in evidence-based management of pain control.  Fear.

Evidence-based practice for pain control has 3 elements:  BEST available evidence + Clinical judgment + Patient/care partner values and preferences.

In the concern over opioid abuse by some patients & professionals, some federal agencies and nonprofits are suggesting that The Joint Commission (TJC) is inadvertently at fault (http://hosted.ap.org/dynamic/stories/U/US_PAINKILLERS_PAIN_MEASURES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT).  HCAHPS questions are also under suspicion.

Pain fistWhile I am not an apologist either for TJC or HCAHPS, my fear is that the government/involved nonprofit fears ignore the data: pain relief is still inadequate for some patients, professionals often under-medicate or don’t believe patients, and some patients have pain crises.  Limiting opioids only to certain diagnoses undercuts evidence-based care.

As a professional RN, you need to check out the best available evidence yourself, use your judgment, and Question1practice pain assessment & management safely. We knowIdea2 that asking patients about suicidal intent does not cause them to commit suicide.  Does asking patients about pain cause them to have it or to treat pain they don’t have?  Hmmm…..

Here are the current TJC standards:  1) The hospital educates all licensed independent practitioners on assessing and managing pain. 2) The hospital respects the patient’s right to pain management. 3) The hospital assesses and manages the patient’s pain.”

Check out this link for truth about the following 5 myths identified by TJC about their standards:  http://www.jointcommission.org/joint_commission_statement_on_pain_management/

  • Myth#1: The Joint Commission endorses pain as a vital sign…. Vital sign
  • Myth #2: The Joint Commission requires pain assessment for all patients….
  • Myth #3: The Joint Commission requires that pain be treated until the pain score reaches zero….
  • #4: The Joint Commission standards push doctors to prescribe opioids….
  • OxycodoneMyth #5: The Joint Commission pain standards caused a sharp rise in opioid prescriptions. This claim is completely contradicted by data from the National Institute on Drug Abuse.”…  [Source=TJC link above]

Of course, RNs & the health team can always do things better, and the above concerns Hypothesissuggest that we might need new studies. I hope only that we won’t jump on the fear bandwagon.   Keep practice EVIDENCE BASED, listen to patient/carepartner preferences & values, & use your judgment.  

CRITICAL THINKING:  How do you assess patient pain?  How could you improve?  How do you apply TJC standards in your setting?

FOR MORE INFORMATION: Do you know what the TJC pain standards are?  Check out the 5 myth link above.