Promoting evidence-based practice and translational research.

Evidence-based practice (EBP) is an evolutionary step in the nursing model of excellence in professional practice at the Hospital of the University of Pennsylvania. A healthcare culture focused on excellence and world-class patient care requires that nursing research and EBP are integrated into the professional practice model and nursing care delivery. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research. This article describes the systems and structures in place to provide staff with resources in order to translate research and deliver EBP and the multiple initiatives in disseminating evidence to the point of care.

Quality and nursing: moving from a concept to a core competency.

The growing focus on providing high-quality care suggests that nurses' involvement in quality activities is likely to increase in coming years. By actively participating in the improvement of health care, nurses benefit their patients and stimulate joy in work.

Parental response to child's isolation during the SARS outbreak.

OBJECTIVES: To examine the needs, uncertainties, and experiences of parents during their child's hospitalization with highly suspected severe acute respiratory syndrome (HSS), and to identify ways to improve their psychological preparedness and communication with health care professionals and their isolated children during future infectious disease outbreaks. METHODS: Qualitative, semistructured interviews were conducted in July 2003 with parents of HSS pediatric patients. Seventeen HSS patients were hospitalized in a pediatric outpatient clinic of a major academic medical center in Hong Kong, between March 20 and May 28, 2003, during severe acute respiratory syndrome (SARS). Seven parents (41%) consented to participate in the study. RESULTS: Four major themes were identified from the interviews: 1) fear of immediate isolation and infection control procedures, 2) sources of anxiety, 3) coping, and 4) communication with children and health care professionals. CONCLUSIONS: Findings indicate a need to improve the psychological preparedness of the parents regarding the child's immediate isolation during hospitalization. Ample preparation and appropriate communication among parents, health care workers, and children might minimize fear and anxiety, sustain trust, and facilitate mutual understanding during an infectious disease outbreak.

Promoting interprofessional education.

The work of the Institute of Medicine and others has clearly demonstrated that when healthcare professionals understand each others' roles and are able to communicate and work effectively together, patients are more likely to receive safe, quality care. Currently, there are few opportunities to bring faculty and students in pre-licensure programs from multiple disciplines together for the purpose of learning together about each others' roles, and practicing collaboration and teamwork. Designing and implementing interprofessional education offerings is challenging. Course scheduling, faculty interest and expertise in interprofessional education (IPE), a culture of IPE among faculty and students, and institutional policies for sharing course credit among schools are just a few of the challenges. This article explores the concept of IPE, and how faculty in schools of nursing might take the lead to work with colleagues in other health profession schools to prepare graduates to understand each others' roles, and the importance of teamwork, communication, and collaboration to the delivery of high quality, safe patient care.

Clinical alarms: improving efficiency and effectiveness.

The clinical environment contains a plethora of bells, beeps, and buzzers. As clinicians, each audible disruption in the care environment must be analyzed to decide if the sound or visual is clinically significant. Alarms may signal a clinically significant change in a patient's condition (true positive), an alarm violation that is clinically insignificant (false positive), or a reflection of poorly set monitoring parameters. Our challenge is to develop monitors that are sensitive and specific. This coupled with protocols that are designed for a specific population, and customized for each individual patient, enable the caregiver to maximize the use of monitoring systems and ensure patient safety. This article guides the critical care nurse through an assessment of alarms in the critical care environment, beyond the cardiorespiratory alarms, assessing the impact of clinical and environmental alarms.

Nurse practitioners in pediatric critical care: results of a national survey.

The nurse practitioner in pediatric critical care is a distinct advanced practice nursing role that has seen a tremendous increase in development and implementation over the past 10 years. There is a paucity of literature on this unique and valuable role. A total of 74 nurse practitioners practicing in pediatric critical care were surveyed. Part I of the survey solicited descriptive information of the nurse practitioner including background, work environment, reporting structure, and salary. The respondents also identified their role responsibilities that included direct patient management, nursing and medical education, coordination of care, research, and consultation. Part II of the questionnaire addressed skill level and need for supervision for technical procedures and leadership activities. These respondents described expert or proficient skill levels for the majority of technical procedures (ie, lumbar puncture, central line placement) and leadership activities (ie, discharge planning, participation in medical rounds). This is the first published report to delineate the role of the nurse practitioner in pediatric critical care based on responses from a national survey.

Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains.

PURPOSE: The problem of medication safety came to public attention largely through a chemotherapy error, and the high toxicity and low therapeutic index of anticancer medications make safety in their prescription and administration critical. We have undertaken a thorough revision of our systems for inpatient chemotherapy. METHODS: We participated in a multi-institutional collaborative effort of the Institute for Healthcare Improvement, and used their rapid cycle change method. Particularly powerful systems change concepts were driving out fear, "trapping" errors and learning from them, focusing on outcome rather than on input, simplifying and standardizing, using constraints and "forcing functions," reducing handoffs, and paying attention to human factors. RESULTS: Applying these concepts to our chemotherapy delivery system, we have achieved an 84% decrease in the number of chemotherapy errors that actually reach patients per 1,000 chemotherapy doses, and have sustained that improvement for 5 years. CONCLUSION: Factors contributing to our success include the rapid cycle change method, strong support from hospital administration, grassroots participation, and a tradition of interdisciplinary cooperation. Computerized direct physician order entry and cooperative group participation have had mixed effects. Continued efforts at improvement have been key to holding our gains. Although specific problems and changes may not be relevant to other organizations, the concepts and methods we used are generally applicable.

Challenges of advanced practice nursing in pediatric acute and critical care: education to practice.

The APN role of the future is dependent on our ability to document through research that NPs, CNSs, and the consolidated role of the NP/CNS plays a critical role in the delivery of high quality cost-effective care. Further information is needed regarding how the APN contributes to and enhances the care delivered by the healthcare team. Cost effectiveness and quality outcome studies are needed including those that describe morbidity and mortality rates, patient satisfaction, and cost effectiveness of models of care that includes APNs. Brooten and Naylor suggest the inclusion of sensitive nursing outcomes, including functional status, mental status, stress level, satisfaction with care, caregiver burden, cost of care. Defining and clarifying the APN functions and qualities of scope of practice is imperative. Perhaps there are populations best served by APNs. Contributions such as continuity, consistency of care, attention to issues such as immobility, skin integrity, and health promotion may have a value added effect. Time motion studies and process logs may add to the information about APNs in pediatric acute and critical care. Professional certification validating competence is essential for the practice of APNs caring for sick children and their families. A disparity exists between the primary care examination now available and the practice of NPs in pediatric acute and critical care. A certification examination is needed with content consistent with the practice of pediatric acute care NP. APNs must possess sufficient knowledge and skill to meet the needs of patients and families in the changing healthcare environment. According to Strodtbeck and colleagues, flexibility, ability to be a self directed learner, critical thinking, relationship skills, and leadership skills including interpersonal insight, interpersonal competence, and ability to stimulate group discussion will serve APNs well as they move into the century. Transitioning brings exciting opportunities along with challenges. Using a blend of abilities, the pediatric acute care APN can provide optimal care to sick children and families.

What do pediatric nurses do? Results of the role delineation study in Canada and the United States.

The National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) is responsible for developing, maintaining, and administering the general pediatric nursing certification examination. A key feature is to ensure that the template used to construct the examination is formulated on the basis of current practice in pediatric nursing. Changes in health care require that a formal examination be conducted every 7-10 years to assess current practice and revise the test specifications as indicated. The purpose of this study was to identify the roles and responsibilities of the general pediatric nurse as a first step in continuing the job-related certification examination program. The purpose was to also analyze areas of knowledge, skill, and ability for pediatric nurses.