First-line managers' experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study.

BACKGROUND: First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context. PURPOSE: To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care. METHODS: This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed. RESULTS: To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation. CONCLUSIONS: Although first-line managers know how to effectively implement CPGs, an organization's terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation. TRIAL REGISTRATION: The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.

Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics.

OBJECTIVE: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics. BACKGROUND: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience. METHODS: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program. RESULTS: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction. CONCLUSIONS: Interventions targeting frontline leaders positively impact CN performance.

Effect assessment of the application value of evidence-based nursing intervention in operating room nursing: A protocol for a systematic review and meta-analysis.

BACKGROUND: The advantages of evidence-based nursing (EBN) intervention in health care settings have been widely disseminated to nurses throughout the world. More researches are reporting the effectiveness of EBN intervention in operating room nursing. However, the results are inconsistent. This study focuses on conducting a meta-analysis and systematic evaluation aimed at determining the usefulness of EBN intervention in operating room nursing. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols criteria were used to write this paper. We will look for relevant studies from 2 Chinese databases (China National Knowledge Infrastructure and Wanfang database and also from 3 English databases such as Web of Science, Cochrane Library, PubMed, and EMBASE), to locate all relevant randomized controlled trials and observational studies assessing the application value of EBN intervention in operating room nursing from their commencement to June 2021. Separately, 2 authors will choose the studies, do the data extract and conduct the assessment probing into the likelihood of bias. If there is a disagreement, it will be resolved by the third author. RevMan 5.3 software and Stata 15.0 software will be used to conduct the meta-analysis. RESULTS: The usefulness of EBN intervention in operating room nursing will be assessed in this study. CONCLUSION: The purpose of this research is to conclude the value of EBN intervention in operating room nursing and the quality of current data. ETHICS AND DISSEMINATION: Since there is no requirement for data on the individual patient, hence there will be no need for ethical approval. OSF NUMBER: DOI 10.17605/OSF.IO/MSXNF.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale.

BACKGROUND: Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden. AIM: The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions. METHODS: This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach's α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale. RESULTS: Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42-.072) for the correlations between the shortened and longer scales. LINKING EVIDENCE TO ACTION: The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Function of a Psychological Nursing Intervention on Depression, Anxiety, and Quality of Life in Older Adult Patients With Osteoporotic Fracture.

BACKGROUND: Osteoporotic fracture is a serious complication of osteoporosis. The long-term therapy process and the heavy restriction to physical activities give rise to a psychological burden on osteoporotic fracture patients, especially older adult patients. Psychological nursing interventions significantly alleviate negative emotional reactions in cancer patients. This research aimed to investigate the function of psychological nursing interventions in the reduction of depression and anxiety and the improvement of quality of life in older adult patients with osteoporotic fracture. METHODS: Osteoporotic fracture patients (n = 106) were divided into control group (n = 53) or intervention group (n = 53). In the control group, the participants were given conventional nursing care. In the intervention group, the participants were given psychological nursing interventions. Anxiety, depression, and quality of life were evaluated and compared between the two groups. RESULTS: After 5 weeks of psychological nursing intervention, the anxiety and depression scores significantly decreased in the intervention group. The Mental Function in Quality of Life Questionnaire of the European Foundation for Osteoporosis score also decreased in the intervention group. LINKING EVIDENCE TO ACTION: Psychological nursing interventions alleviate anxiety and depression in older adult osteoporotic fracture patients and enhance their mental function.

Adverse Health Effects of Frailty: Systematic Review and Meta-Analysis of Middle-Aged and Older Adults With Implications for Evidence-Based Practice.

BACKGROUND: Scholars have noted that frailty easily leads to functional deterioration and proneness to complications. Little literature addresses the stages of frailty in middle-aged and older adults and the effects of frailty on overall health. AIMS: This study explores the effect of different stages of frailty on the prospective health (falls, bone fractures, disability, dementia, hospitalization, and death) of middle-aged and older adults. In addition, different frailty indicators were compared to determine their usefulness in predicting future adverse health outcomes. METHODS: The authors of this study separately reviewed and extracted data from the literature obtained while searching the following keywords: "frailty" OR "frail" and "fall" OR "disability" OR "fracture" OR "hospitalization" OR "mortality" OR "cognitive function" "dementia" OR "Alzheimer's disease" and "middle-aged people" OR "older people" OR "elderly" OR "geriatric" OR "senior." The literature search was performed from January 2001 to November 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Specifically, we performed a systematic literature search in multiple databases-Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library-and analyzed all obtained literature results using a random-effects model. RESULTS: We collected a total of 29 prospective studies for the systematic literature review and meta-analysis. The main results indicated that the frail groups had significantly higher risks of adverse health effects (falls, bone fractures, disability, dementia, hospitalization, and death) than the robust or prefrail groups. LINKING EVIDENCE TO ACTION: Frailty is a crucial healthcare topic among geriatric syndromes. Considering that older adults with frailty are most likely to develop severe adverse health outcomes, professional nursing personnel should assess frailty among middle-aged and older adults and offer relevant care strategies to reduce the adverse effects of frailty in this population.

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X-ray Confirmation.

BACKGROUND: Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. AIMS: To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. METHODS: The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). RESULTS: Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. LINKING ACTION TO EVIDENCE: Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Assessing Evidence-Based Practice Knowledge: An Innovative Approach by a Nursing Research Council.

OBJECTIVE: The aim of this study was to describe the structure and processes implemented by nursing research councils to conduct a nurse-led research study at an urban community teaching hospital. BACKGROUND: We assessed nurses' knowledge, skills, and attitudes toward evidence-based practice (EBP) to inform development plans. METHODS: This is an institutional review board-approved single-site cross-sectional anonymous online survey (Evidence-Based Practice Questionnaire [EBPQ]) emailed to 850 participants. Data were analyzed using SPSS v25 (Armonk, New York). RESULTS: Initial response rate was 11%. Deployment of new strategies achieved an overall response rate of 57.5%. EBPQ subscale scores were highest for "attitude," followed by "knowledge/skills," and "practice." Lowest-scoring items included critical appraisal of literature, converting information needs into a question, time for new evidence, information technology, and research skills. CONCLUSIONS: Our EBPQ scores were consistent with prior findings. Our strategies provide a framework for other institutions in similar stages of implementing EBP and nurse-led research initiatives.

Interprofessional Communication: Integrating Evidence to Enhance Systems During a Pandemic.

BACKGROUND: The COVID-19 pandemic placed challenges on interprofessional communication patterns among clinical care teams at a time when effective communication was greatly needed. The development of enhanced systems for communication that integrate the latest evidence and communication technologies can offer a solution to this crisis. OBJECTIVES: This article provides a framework for ways in which nursing teams can develop evidence-based enhanced interprofessional communication systems during a pandemic. METHODS: Based on communication models and related technologies, this article reviews strategies to enhance interprofessional communication. Two case studies are included that illustrate how nursing teams can enhance communication during a pandemic. FINDINGS: To improve communication during a pandemic, clinicians can incorporate interprofessional communication models in clinical practice and apply enhanced communication strategies.

Critical Care Considerations in Adult Patients With Influenza-Induced ARDS.

TOPIC: Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE: Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE: To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED: This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

Institutional Challenges and Solutions to Evidence-Based, Patient-Centered Practice: Implementing ICU Diaries.

BACKGROUND: Although diaries are an evidence-based practice that improves the quality of life of patients in an intensive care unit and their loved ones, centers in the United States are struggling to successfully implement diary programs in intensive care units. Currently, few published recommendations address how to facilitate implementation of a diary program, and how to effectively sustain it, in an intensive care unit. OBJECTIVES: To discuss challenges with implementing diary programs in intensive care units at 2 institutions in the United States, and to identify solutions that were operationalized to overcome these perceived difficulties. METHODS: The teams from the 2 institutions identified local barriers to implementing diaries in their intensive care units. Both groups developed standard operating procedures that outlined the execution and evaluation phases of their implementation projects. RESULTS: Barriers to implementation include liability and patient privacy, diary program development, and implementation and sustainability concerns. Various strategies can help maintain clinical and family member engagement. CONCLUSION: Through a team's sustained dedication and a diligent assessment of perceived obstacles, a diary program can indeed be implemented within an intensive care unit.

Evidence-Based Practice Competencies for RNs and APNs: How Are We Doing?

As we approach the end of 2020, the Year of the Nurse and Nurse Midwife, it is a good time to reflect on our evidence-based practice (EBP) competencies through a review of a recent study by Melnyk and colleagues. Before describing these competencies, our progress in achieving EBP competency, and the effect competency status has on health care quality, safety, and patient outcomes, this column reviews the definition of EBP and provides a high-level overview of the steps of EBP as defined in Melnyk and Fineout-Overholt.

Depression treatment research in people with cancer does not reflect cancer prevalence: findings from a systematic review.

BACKGROUND: One in six people with cancer will develop depression at some point in their care. Untreated depression affects quality of life, cancer care satisfaction and healthcare expenditure. Treatments for this vulnerable heterogenous population should be evidence based and specific. A common sentiment is that psychiatric research does not reflect the prevalence of patients with cancer and comorbid depression and is biased towards certain cancers, but this has not been empirically shown. STUDY SELECTION AND ANALYSIS: A systematic review of studies on psychological and pharmacological treatments for depression in people with cancer was conducted. Of 4621 papers identified from a search of PubMed and PsycINFO up to 27 June 2020, 84 met inclusion criteria (eg, adults with cancer; depression diagnosis; treatment study) and comprised 6048 participants with depression with cancer. FINDINGS: Cancer types are not proportionally represented in depression research in accordance with their incidence. Breast cancer is over-represented (relative frequency in research 49.3%, but 11.7% of global cancer). Cancers of the head and neck and bone and soft tissue were close to parity. All other cancers are under-represented. Representativeness varied 40-fold across different cancers. CONCLUSIONS: The evidence base for depression treatments is dominated by a single cancer. Given heterogeneity in cancer populations (eg, stage of illness; psychological impact; cancer treatments), it is possible that depression treatments may not have the same benefits and harms across all cancers, impeding the ability to offer people with different cancers the best depression treatment. While the dominant opinion within this research field is that a cancer bias exists, this is the first study to demonstrate as such.

Evidence-Based Practice Competency and Related Factors Among Nurses Working in Public Hospitals.

This study aimed to describe the status and related factors of evidence-based practice (EBP) competency among nurses in China. A convenience sample of 1036 nurses were recruited from 13 public hospitals in Shanghai through an anonymous online survey. Nurses' demographic data, working data, and evidence-based nursing (EBN)-related conditions were collected by a structured questionnaire and EBP competency was assessed using the Chinese version of Evidence-based Nursing Competency Rating Scale (EBNCRS). The original score of EBNCRS among nurses was not good. The original score of evidence searching, critical appraisal, and synthesis subscale was lower than the original score of evidence transfer, situation assessment, and evidence implementation subscale. Nurses' age, hospital level, and perceived EBN knowledge were identified as significant related factors of EBP competency. There is an urgent need to upgrade the EBP competency of nurses in Shanghai, especially competency in evidence transfer, situation assessment, and evidence implementation.

Oncology Nurse Informaticists: An Evolving Role to Support Nursing Practice.

Nursing informatics is an evolving field in the burgeoning context of technologic and digital advances in health care. Nurse informaticists are integral in translating these advances into evidence-based clinical practice to improve the quality and safety of patient care and professional practice. This article describes the role and operationalization of nurse informaticists in the oncology setting. A case study is presented to exemplify how nurse informaticists can lead interprofessional teams in evaluating opportunities for process or quality improvement and implementing and evaluating digital solutions to improve oncology care.

Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: A cross-sectional study in Poland.

BACKGROUND: Achieving high quality care through full use of potential stemming from the use of the principles of evidence based practice (EBP) requires adequate shaping of student attitudes toward EBP already at an early stage of education, as well as teaching in the scope of knowledge and skills essential to apply EBP in future professional work. Therefore, nursing educators need a tool to assess competency in EBP. This study aims to present the adaptation of the psychometric test and setting norms to the Polish version of the Evidence Based Practice Competence Questionnaire (EBP-COQ_P). METHODS: Poland-wide multicentre study, cross-sectional validation design, a representative sample of 1636 nursing students. The EBP-COQ_P was validated in terms of content validity through an expert review. The EBP-COQ_P was administered to evaluate test reliability and validity. Settings norms for the Polish nurse population were also done. RESULTS: Confirmatory factor analysis demonstrated that 25 items are grouped into three categories which define competences related to EBP: attitude, knowledge, and skills. Cronbach's alpha was 0.856 for the entire questionnaire. EBP-COQ_P had good parameters of absolute stability. EBP-COQ_P was also characterized with external construct validity. Measurement with the use of EBP-COQ_P allowed for a good differentiation of the respondents in terms of their expertise in EBP (known-groups validity). CONCLUSIONS: In terms of reliability and validity, EBP-COQ_P is compared with its original version. EBP-COQ_P may be used in educational practice (graduate and postgraduate education). Polish norms set for a representative group of nursing students may serve as a benchmark for the results obtained from individual and group measurements.

Bridging the Gap Between Clinical Practice and the AACN Practice Alert on Pulmonary Artery/Central Venous Pressure Monitoring in Adults.

Measuring and documenting accurate data from pulmonary artery and central venous pressure catheters is an important responsibility of critical care nurses. The American Association of Critical-Care Nurses Practice Alert titled Pulmonary Artery/Central Venous Pressure Monitoring in Adults provides evidence-based standards against which nurses can compare their practice related to obtaining valid hemodynamic data. Identifying and acting on improvement opportunities is also a nursing responsibility and helps to ensure that patients with pulmonary artery or central venous pressure catheters receive high-quality care. This article reviews various strategies to compare nursing practice to the Pulmonary Artery/Central Venous Pressure Monitoring in Adults Practice Alert and to close identified gaps in clinical practice.