Improving assessment of child growth in a pediatric hospital setting.

BACKGROUND: Accurate anthropometric measurements are essential for assessing nutritional status, monitoring child growth, and informing clinical care. We aimed to improve height measurements of hospitalized pediatrics patients through implementation of gold standard measurement techniques. METHODS: A quality improvement project implemented computerized training modules on anthropometry and standardized wooden boards for height measurements in a tertiary children's hospital. Heights were collected pre- and post-intervention on general pediatric inpatients under 5 years of age. Accuracy of height measurements was determined by analyzing the variance and by comparing to World Health Organization's defined biologically plausible height-for-age z-scores. Qualitative interviews assessed staff attitudes. RESULTS: Ninety-six hospital staff completed the anthropometry training. Data were available on 632 children pre- and 933 post-intervention. Training did not increase the proportion of patients measured for height (78.6% pre-intervention vs. 75.8% post-intervention, p = 0.19). Post-intervention, wooden height boards were used to measure height of 34.8% patients, while tape measures and wingspan accounted for 42.0% and 3.5% of measurements, respectively. There was no improvement in the quality of height measurements based on plausibility (approximately 3% height-for-age z-scores measurements flagged out of range pre- and post-intervention), digit preference (13.4% of digits pre- and 12.3% post-intervention requiring reclassification), or dispersion of measurements (height-for-age z-scores standard deviation 1.9 pre- and post-intervention). Staff reported that using the wooden board was too labor consuming and cumbersome. CONCLUSIONS: Our findings suggest that efforts to improve anthropometric measurements of hospitalized children have multiple obstacles, and further investigation of less cumbersome methods of measurements may be warranted.

An Adaptation of the Original Fresno Test to Measure Evidence-Based Practice Competence in Pediatric Bedside Nurses.

PURPOSE: Instruments used to assess evidence-based practice (EBP) competence in nurses have been subjective, unreliable, or invalid. The Fresno test was identified as the only instrument to measure all the steps of EBP with supportive reliability and validity data. However, the items and psychometric properties of the original Fresno test are only relevant to measure EBP with medical residents. Therefore, the purpose of this paper is to describe the development of the adapted Fresno test for pediatric nurses, and provide preliminary validity and reliability data for its use with Bachelor of Science in Nursing-prepared pediatric bedside nurses. METHODS: General adaptations were made to the original instrument's case studies, item content, wording, and format to meet the needs of a pediatric nursing sample. The scoring rubric was also modified to complement changes made to the instrument. Content and face validity, and intrarater reliability of the adapted Fresno test were assessed during a mixed-methods pilot study conducted from October to December 2013 with 29 Bachelor of Science in Nursing-prepared pediatric nurses. RESULTS: Validity data provided evidence for good content and face validity. Intrarater reliability estimates were high. LINKING EVIDENCE TO ACTION: The adapted Fresno test presented here appears to be a valid and reliable assessment of EBP competence in Bachelor of Science in Nursing-prepared pediatric nurses. However, further testing of this instrument is warranted using a larger sample of pediatric nurses in diverse settings. This instrument can be a starting point for evaluating the impact of EBP competence on patient outcomes.

Nursing grand rounds: a strategy for promoting evidence-based learning among pediatric nurses.

This paper describes the collaboration of nurses from five specialty units within a large tertiary care pediatric hospital in the development and presentation of Nursing Grand Rounds (NGR). NGR was generated, prepared, and presented quarterly by bedside nurses to their peers in a professional format. NGR lasted 2hours, were simultaneously offered via Webinar, and incorporated literature reviews, guest/expert speakers, and case studies. In addition, attendees were eligible for continuing education credits (CEUs). Based on favorable evaluations, NGR is purported as a creative method for nurses to be kept up-to-date about evidence and knowledge unique to their patient population.

Increasing the practice of questioning among pediatric nurses: "The Growing Culture of Clinical Inquiry" project.

This paper describes an innovative methodology implemented in an acute care pediatric setting to build nurses' confidence and competence in questioning practice. The Growing Culture of Clinical Inquiry (GCCI) project was composed of several evidence-based strategies to attain and maintain a spirit of clinical inquiry. These strategies included PowerPoint presentations, evidence-based practice (EBP) unit champions, patient-intervention-comparison-outcome (PICO) boxes, Clinical Inquiry Posters, summaries of evidence (SOE), layman's SOE, medical librarian in-services, and journal clubs. After 1 year of implementation, the GCCI project was evaluated and found to be a promising methodology for fostering a culture of inquiry among pediatric nurses.

Evidence-based practice competence: a concept analysis.

PURPOSE: To report an analysis of the concept of evidence-based practice competence for nurses using Walker and Avant's (2011) eight-step, iterative concept analysis process as a guide. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID, PsycINFO, and Sociological Abstracts were searched. DATA SYNTHESIS: References were read and analyzed according to associated meanings, usages, attributes, antecedents, consequences, and empirical referents. CONCLUSION: An operational definition for the concept was developed. IMPLICATIONS FOR NURSING PRACTICE: A clear and operational definition of evidence-based practice competence will help guide nurses at all levels of experience to use the best available evidence for improving the quality of care and maximizing patient outcomes.