Misconceptions among nurses about evidence-based practice.

PURPOSE: To delineate the origins and fundamental tenets of evidence-based practice (EBP) and to enhance understanding of this important term. METHODS: A critical review of the literature pertaining to evidence-based practice from the fields of medicine and nursing, including international reports. FINDINGS: The roots of EBP indicate this term is not a synonym for research utilization but rather is the rubric for a set of epistemologic assumptions. Key components of EBP include evidence hierarchies and systematic reviews. Differences were found between the views of EBP presented in papers published by nurses within the US compared to those published by nurses outside the US. CONCLUSIONS: The literature shows incongruity in the interpretation of the basic tenets of the evidence-based paradigm. Additionally, nurses may underestimate implications of the evidence-based movement. These two problems impede nurses' participation as full partners in the advancement of evidence-based practice. They also represent a call to action to achieve a more standardized framework for advancing EBP in nursing.

Lessons learned while collecting ANA indicator data.

Realizing the importance of linking nursing's contribution to quality patient care, a pilot study was conducted to determine whether data regarding the quality indicators proposed by the American Nurses' Association (ANA) could be collected from five acute-care inpatient units at one medical center that is part of a multisite managed care system. Although it was determined that data regarding the ANA quality indicators could be collected at the study site, a variety of unanticipated findings emerged. These findings reflect both discrepancies and congruities between how the investigative team expected the ANA indicators to operate versus what was actually experienced. The lessons learned while collecting ANA indicator data are shared to assist future users and to advance the evolution of the ANA indicators.

Neonatal thermal care, part I: Survey of temperature probe practices.

PURPOSE: To determine nurses' practices regarding skin temperature probes. DESIGN: Data were collected using an anonymous questionnaire, which was returned by mail. Questionnaires were distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servocontrolled incubators and radiant warmers, as well as demographic data. SAMPLE: Eighty-three neonatal nurses. RESULTS: Nurses reported that skin servocontrolled incubators are used widely, but generally only for infants less than 28 weeks gestational age; a high proportion of respondents reported using continuous monitoring of skin temperature in air servocontrol incubators. Although most nurses reported positioning infants to prevent their lying on the probe, 21 percent reported using the same probe site regardless of infant position. Routine changing of the probe cover was reported by a number of nurses. Practices were influenced by individual knowledge, beliefs, and experience as well as by unit protocols, which varied widely.

Neonatal thermal care, part II: Microbial growth under temperature probe covers.

PURPOSE: To determine if temperature probe covers contribute to nosocomial infections by providing an environment for skin microbe colonization. DESIGN: Descriptive, comparative design with infants randomized into two groups: foam probe cover and hydrogel probe cover. Skin cultures were obtained 72 hours after cover placement. Bacterial growth was quantified after 24 and 48 hours. Skin integrity was assessed using visual irritations scores (VIS) every 5 minutes for 30 minutes following cover removal. ANOVA and ANOVA-RM were used to compare amounts of microbes and VIS scores between groups. SAMPLE: Twenty-six medically stable infants, 29 to 34 weeks gestational age, less than 10 days postbirth, and in an incubator. MAIN OUTCOME VARIABLE: Microbial growth and VIS. RESULTS: There were no statistically significant differences in microbial growth and VIS scores between groups (p > .05). Clinical significance was noted in VIS scores. Infants who had foam covers had more sustained irritation scores.

Neonatal thermal care, part III: The effect of infant position and temperature probe placement.

PURPOSE: Accurate management of infant temperature requires appropriate placement of temperature monitoring probes. Currently, there is a lack of consensus regarding placement of skin temperature probes and the effect on temperature monitoring of the infant's lying on the probe. The objective of this study was to compare abdomen and back skin temperatures when infants were positioned supine and prone. DESIGN: A quasi-experimental design was used to randomize infants to prone or supine position. Infant back, abdomen, and axillary temperatures were measured at one-minute intervals with small disposable thermocouples over a one-hour period. SAMPLE: Twenty-three infants, weight 820-2,400 gm, gestational age 27-37 weeks, postnatal age three to ten days. MAIN OUTCOME VARIABLE: Gradient between abdomen and back temperature. RESULTS: Both mean abdomen and mean back temperatures differed significantly by position (t-test, p = .003 and .028, respectively). Weight and postnatal age did not have an effect on the mean difference between abdomen and back temperature. Results indicate that probe placement and infant positioning are important factors altering measurement of skin temperature.

Tracheobronchial trauma associated with airway management in neonates.

Airway management procedures are an integral part of caring for the newborn infant with respiratory compromise. Concomitant with these interventions are latrogenic consequences that result in varying degrees of trauma to the tracheobronchial tree. Common interventions such as intubation, mechanical ventilation, use of heated and humidified gases, and endotracheal suctioning are discussed using research-based literature that evaluates the injury to the trachea and the mucociliary transport system.

Patient satisfaction and loyalty among military healthcare beneficiaries enrolled in a managed care program.

OBJECTIVE: A study was performed to evaluate military beneficiaries' motivation for choosing to change from a civilian managed care system to the military managed care system. BACKGROUND: Concerns about healthcare cost, quality, and access underpin major reform in military healthcare. The military health system (MHS) is implementing managed care through an initiative known as TRICARE. Patient choice and satisfaction are highly relevant to all healthcare delivery systems; they are being explored aggressively in the MHS as TRICARE evolves. METHODS: This descriptive study was conducted using a telephone survey consisting of 63 items derived from four pre-existing instruments as well as five facility-specific questions and demographics. The population of interest targeted military beneficiaries on a TRICARE waiting list who, at the time of enrollment, indicated a desire to receive care at the military facility. RESULTS: Consumers were inclined to return to the military system because of loyalty. Also, this study provided evidence that staff courtesy is important to those who seek healthcare. Good quality and accessibility were verified as essential elements in sustaining a consumer's positive view of and attraction to a particular healthcare system. Cost was proven to be a less substantial factor of consumer decision making. CONCLUSIONS: Surveys such as this give healthcare providers more information about aspects of care, such as patient loyalty and interpersonal dynamics, that attract people to their healthcare delivery systems. For healthcare systems to thrive, consumer influence and the power of patient dissatisfaction must be understood.