Tag Archives: nurse

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.   

Is a Picture Worth 1,000 words?

Sometimes the best way to answer a research question is to have the participants draw pictures & explain them.  In fact, some have identified art as a powerful communication tool between children and researchers.   The pictures are then analyzed for themes that show up in the drawings.  No numbers or statistics are used.

Methods: When Brady (2009) wondered how children defined a “good nurse,” she asked 22 ethnically diverse, hospitalized girls and boys aged 7-12 years to draw a picture of a good nurse and a bad nurse.  After the children drew their pictures she asked them to tell her what the nurse was wearing and doing.

Results & discussion: What did the pictures say? Drawings and comments suggested that the children focused on these 5 thematic characteristics for a good nurse:  “communication; professional competence; safety; professional appearance; and virtues,” (p.543) such as honesty, listening, kindness, trustworthiness, & being reassuring & fun. 11-year-old Jason communicated some of it in GoodNurse_BadNurse2Figure 4 on page 552.   12-year-old Luke also showed a sharp contrast in Figure 7 on page 556 that is at the top of this blog.  Children valued a reciprocal relationship with their nurses, caring, and safe/professional behavior. Play was one of many things important to them.

Commentary: While the sample is not representative of a larger group and I would question the authors claim to use grounded theory, the study forms the basis for further research.  Additionally these ideas can help us listen more closely to our own pediatric patients.   It would be particularly interesting to compare these 5 themes to how adult patients of various ages describe a good nurse and a bad nurse.

Critical thinking:  How do you think these children’s perspectives compare with the perspectives of your own pediatric patient population?QUESTION

For more information: See Brady, M. (2009). Hospitalized children’s views of the good nurse, Nursing Ethics, 16(5). doi: 10.1177/0969733009106648

Stand & Deliver: Evidence for Empathy in Action

Patient Pain Satisfaction.  It’s a key outcome of RN empathy in action.CARE

Imagine that you are hospitalized and hurting.   During hourly rounds the RN reassures you with these words:We are going to do everything that we can to help keep your pain under control. Your pain management is our number 1 priority. Given your [condition, history, diagnosis, status], we may not be able to keep your pain level at zero. However, we will work very hard with you to keep you as comfortable as possible.” (Alaloul et al, 2015, p. 323).

Study? In 2015 a set of researchers tested effectiveness of the above pain script using 2 similar medical-surgical units in an academic medical center—1 unit was an experimental unit & 1 was a control unit.  RNs rounded hourly on both units.  handsOn the experimental unit RNs stated the script to patients exactly as written and on room whiteboards posted the script, last pain med & pain scores.  Posters of the script were also posted on the unit.   In contrast, on the control unit RN communication and use of whiteboard were dependent on individual preferences.  Researchers measured effectiveness of the script by collecting HCAHPS scores 2 times before RNs began using the script (a baseline pretest) and then 5 times during and after RNs began using it (a posttest) on both units.

Results? On the experimental units significantly more patients reported that the team was doing everything they could to control pain and that the pain was well-controlled (p≤.05). And while experimental unit scores were trending up, control unit scores trended down. Other findings were that the RNs were satisfied with the script, and that RNs having a BSN or MSN had no effect.

Conclusions/Implications?When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.” (p.321) [underline added]

Commentary: While an experiment would have created greater confidence that the script caused the improvements in patient satisfaction, an experiment would have been difficult or impossible.  Researchers could not randomly assign patients to experimental & control units.  Still, quasi-experimental research is relatively strong evidence, but it leaves the door open that something besides the script caused the improvements in HCAHPS scores.

questionCritical thinking? What would prevent you from adopting or adapting this script in your own personal practice tomorrow?  What are the barriers and facilitators to getting other RNs on your unit to adopt this script, including using whiteboards?  Are there any risks to using the script?  What are the risks to NOT using the script?

Want more info? See original reference – Alaloul, F., Williams, K., Myers, J., Jones, K.D., & Logsdon, M.C. (2015).Impact of a script-based communication intervention on patient satisfaction with pain management. Pain Management Nursing, 16(3), 321-327. http://dx.doi.org/10.1016/j.pmn.2014.08.008

Don’t Just Wish Upon Falling Stars: Take Evidence-based Action

The Joint Commission (TJC) published, Preventing falls and fall-related injuries in health care facilities, a new Sentinel Alert #55 on September 28, 2015 at http://www.jointcommission.org/assets/1/18/SEA_55.pdf

What’s the problem? Falls with serious injuries are among the top 10 events reported to TJC.   Analysis of that data shows that contributing factors are related to:

  • Inadequate assessment
  • Communication failures
  • Lack of adherence to protocols and safety practices
  • Inadequate staff orientation, supervision, staffing levels or skill mix
  • Deficiencies in the physical environment
  • Lack of leadership (page 1)

What to do?   Here are TJC recommendationsAction Plan

  1. Raise awareness of falls resulting in injury
  2. Establish an interprofessional falls committee
  3. Use a reliable, valid risk assessment tool
  4. Use EBP
    1. Standardized handoff including risk for falls
    2. One-to-one, bedside education of patients (& families?)
  5. Conduct post-fall management, which includes: a post-fall huddle; a system of honest, transparent reporting; trending and analysis of falls which can inform improvement efforts; and reassess the patient (page 2)

questionCritical thinking:  How would you apply AHRQ toolkit: Preventing Falls in Hospitals to your unit.

Want more info?   For tools, resources, & more details on above, see Joint Commission (2015, September 28). Preventing falls and fall-related injuries in health care facilities, Sentinel Event Alert, Issue 55.  Retrieved from Joint http://www.jointcommission.org/assets/1/18/SEA_55.pdf

“When Science Meets Sacred Cows”

Sometimes the scientific evidence is clear….but no one wants to change what they are doing.

Change is hard if providers, media, or members of the public are in love with keeping things the way they are, or have a vested interest in the status quo, or perhaps just don’t like change…or the evidence.  (Maybe we’re all a little guilty of this.)cow nosw

Check out this free, full-text editorial available through PubMed: http://www.o-wm.com/content/when-science-meets-sacred-cows  (Source: 2010 OWM).

Critical Thinking: What sacred cows should be put out to pasture in your or others’ practice?  What about using the Trendeleberg position to treat hypotension, checking foley balloons before insertion, other?  List a few areas where your organization HAS changed practice based on evidence.  What were the barriers & facilitators?

A 33,000 foot view: The Abstract

 Abstracts are great; abstracts are not enough!
An abstract will not give you enough information to accurately apply the study findings to practice.   An abstract typically summarizes all the other sections of the article, such as  the question the researcher wanted to answer, how the researcher collected data to answer it, and what that data showed.  This is great when you are trying to get the general picture, but you should Never assume that the abstract tells you what you need to know.
airplaneWingIsland
Abstracts can mislead you IF you do not read the rest of the article.  They are only a short 100-200 words and so the authors have to leave out key information.   You may misunderstand study results if you read only the abstract.   An abstract’s 33,000 foot level FootprintsInSand
description of a study, cannot reveal the same things that you can learn from an up-close look at details.  You want to know exactly who was in the study, exactly what the researcher did, & exactly how outcomes were measured!  You want to follow the researcher’s footprints up close, not just do a fly-over.
So…what is the takeaway?  Definitely read the abstract to get the general idea.  Then read the article beginning to end.  Don’t give up reading the full article just because some parts of the study may be hard to understand.  Just read and get what you can. Then try a re-read or get some help understanding any difficult sections.   This is an important step toward EBP.   [revised from my former blogsite]
Critical thinking:  What info is missing from this abstract at this link that you would want to know before using the findings of this pain study to practice?
http://www.ncbi.nlm.nih.gov/pubmed/25659796QUESTION

“Take 5!” (minutes to learn about 4 search strategies)

“TAKE 5” minutes to learn about 4 best strategies to find nursing research articles. Watch the video at this link: https://www.youtube.com/watch?v=Em7b9jr-ZK8&list=PLQKD1cO-QY3Rt2PaLd3dykeL4HZo7mCZv&index=7

(Well it’s technically 5:23 minutes, but as with calories, who’s counting?)

A great place to use these 4 strategies is the highly comprehensive and reliable PubMed database. You already pay for that publicly available healthcare research database with your tax dollars, so go to http://www.ncbi.nlm.nih.gov/pubmed/ and get your money’s worth!   PubMed even has a link to show you how to use those 4 strategies specifically on PubMed. (Check that out at http://www.nlm.nih.gov/bsd/disted/pubmedtutorial/020_340.html)

One of your search terms can be nurs* if you want a better chance of finding only nursing articles. You’ll know what that little asterisk means after you “TAKE 5!” with the first video link.

Some PubMed articles are free for you to print or save. Many are not. That means you will need to take the list of articles that you found in your search to your hospital librarian for help. OR if you have access to library databases through a school you can find full text of most articles there or order them through interlibrary loan.

If you don’t have access to library databases yourself, here’s a good way to work with a hospital librarian.

  1. Use the 4 search strategies to find relevant articles on PubMed.
  2. Give that list of articles to your librarian who is likely to have a budget and time to pull the full articles for you.
  3. If you find only one article that fits the problem you are trying to solve, you can take that article to the librarian and ask the person to find you more like that one.

Another public database is Google Scholar, but it is not as accurate or thorough. For its strengths and weaknesses and how to use it well, you might find this handout useful (https://www.dit.ie/media/library/documents/kevinst/Guide%20How%20to%20use%20Google%20Scholar.pdf).

Happy evidence hunting!