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.

Implementation Science Training and Resources for Nurses and Nurse Scientists.

PURPOSE: The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science. ORGANIZING CONSTRUCT: There is a push for providing safe, effective, patient-centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence-based practices to improve quality of care. METHODS: We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice. FINDINGS: Implementation-trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings. CONCLUSIONS: Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science. CLINICAL RELEVANCE: Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science-trained nurses are in a position to be excellent improvers for meaningful change in practice.

Enacting evidence-based practice: pathways for community nurses.

Community nurses are expected to deliver evidence-based practice, which is challenging given the diversity and breadth of the evidence base from which they can draw. This study aimed to explore community nurses' experiences of implementing change in their practice. Qualitative semi-structured interviews (n=9) and focus groups (n=2) with community nurses (n=17) were conducted. Three pathways to introduce change in practice were identified by participants: bottom-up, top-down and collaborative pathways. These are based on the nature of the proposed change, the available evidence, 'buy in' from colleagues and issues around implementation. The findings identify approaches to implementing change in community nursing practice. Practitioners would benefit from support to navigate the complex process of change through managerial support, ongoing education, accessible online resources and support through a practice development role.

Content validation of the evidence-based nursing practice assessment tool.

BACKGROUND: The authors designed the evidence-based nursing practice assessment tool (EBNPAT) to measure the competence of nurses in using the five-step evidence-based practice model: ask, acquire, appraise, apply and assess. However, they needed to assess its content validity to show it is a valid tool. Assessing the content validity of a newly developed measurement scale is often challenging. Although the content validity index (CVI) is widely used in nursing research, it is limited to evaluating the chance of variation in agreement and consistency among reviewers of the content. AIM: To demonstrate the content validity of EBNPAT. DISCUSSION: An expert panel of 42 nursing and health academics and researchers evaluated the representativeness, comprehensiveness and clarity of each construct item on EBNPAT. They then rated their agreement on a four-point ordinal scale. The authors used the item-CVI (I-CVI) augmented with the intraclass correlation coefficient (ICC) and Cronbach's to assess the results and determine the content validity of EBNPAT. All I-CVIs for representativeness, comprehensiveness and clarity of the EBNPAT items were greater than 0.9 and the overall agreement and consistency among experts were greater than 0.65. The strengths of this study were the good sample size and the substantial consensus among experts in their view of assessing competence in evidence-based practice. CONCLUSION: High content validity of all construct items supports the progression to the next step in psychometric evaluation of EBNPAT. IMPLICATIONS FOR PRACTICE: This paper has demonstrated a sophisticated statistical approach for evaluating content validity that may be of use to developers of measurement scales in the future.

Supporting Clinical Nurses Through a Research Fellowship.

After reviewing the literature, nurses at the bedside seeking answers to clinical questions may find their inquiries remain unanswered. This article describes the yearlong Research Fellows Program in which candidates, funded for 12 hours per month of research release time, answered formal research questions in a curriculum designed to provide the skills to complete their study. Five have completed their studies; 1 has received a grant to continue. Two are in process of submitting manuscripts to journals.

Is it time for a review of the way that NICE guidelines are developed, presented and used to inform policy and practice?

Catherine Lowenhoff emphasises the need to share the uncertainties inherent in the National Institute for Health and Care Excellence guidelines with policy makers, commissioners, regulators, managers and clinicians to facilitate the paradigm shift from evidence-based practice to evidence-informed practice.

Cancer-Related Pain: Assessment and Management With Putting Evidence Into Practice Interventions
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Many evidence-based pharmacologic and nonpharmacologic strategies exist to manage acute, chronic, refractory, and breakthrough cancer pain. This supplement includes an overview of cancer pain assessment, which is the foundation of pain management. Following the overview are four systematic reviews covering 462 studies on cancer pain management. The Oncology Nursing Society Putting Evidence Into Practice (PEP) expert panel summarized the evidence and provided recommendations for practice based on PEP guidelines.

Identifying Critical Factors in Determining Discharge Readiness from Skilled Home Health: An Interprofessional Perspective.

A lack of readiness for discharge from skilled home health can result in adverse events among older adults. The purpose of the current study was to explore interprofessional home health clinician perceptions of the factors they consider important to determine readiness for discharge among skilled home health recipients. A qualitative descriptive study was conducted using four focus groups among 32 interprofessional clinicians from one large skilled home health agency and two telephone interviews with home visiting physicians. A semi-structured interview guide was followed. Qualitative content analysis was used for manifest coding and then thematic analysis. Five themes emerged: (a) patient safety, (b) long-term plan is in place, (c) reached maximum self-care potential, (d) presence of a willing and able caregiver, and (e) patient attributes. The goal of this line of inquiry is to develop an evidence-based home health discharge decision support tool to provide a standardized approach in determining readiness for discharge from skilled home health services. [Res Gerontol Nurs. 2016; 9(6):269-277.].

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

A Clinical Protocol for the Assessment of Obesity: Addressing an Epidemic.

The purpose of this article is to discuss the importance of addressing obesity, a national epidemic. Furthermore, the paper focuses on the utilization of a clinical practice protocol for identifying patients who are obese or at risk for obesity in the primary care setting. The practice protocol includes guidelines for assessment, documentation, and a consistent educational intervention for the identified priority population. The rapidly increasing incidence of obesity in our primary care practices supports the need for evidence-based approaches to ensure consistent assessment and documentation, thereby increasing the potential for weight management and obesity reduction.

Decreasing the length of stay in phase I postanesthesia care unit: an evidence-based approach.

Patient length of stay (LOS) in the postanesthesia care unit (PACU) Phase I and Phase II influences patient throughput, staff nurse satisfaction, and financial expenditure. The purpose of this project was to determine if re-education of nursing staff would decrease the LOS in Phase I PACU. The goals of the leadership team were to implement a plan that would result in a decreased LOS, decreased financial expenditure, increased patient throughput, and a change in culture of the work environment. Methods included re-education of nursing staff on American Society of Perianesthesia Nursing (ASPAN) Standards for patient care in Phase I and Phase II PACU. In addition, a pre-survey of the nurses was completed to determine their knowledge of the ASPAN Standards and how they perceived their work environment. Data were collected on the LOS in Phase I for two groups of patients who underwent cystoscopy with stent implantation and hernia repair. The LOS data were collected before and after the staff education. Results of this re-education initiative revealed improved patient throughput, decreased operating room hold time, reduced perioperative expenditure, and an increase in staff nurse satisfaction. An unanticipated result was increased scores on patient satisfaction surveys after the educational initiative.

[The GRADE system]. / Il sistema GRADE.

The Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE Working Group) has developed a system for grading the quality of evidence. Over 20 organizations including the World Health Organization (WHO) have adopted it. The quality of a body of evidence involves consideration of within-study risk of bias (methodological quality), directness of evidence, heterogeneity, precision of effect estimates and risk of publication bias, and the system considers the assessment of the quality of a body of evidence for each individual outcome. The GRADE approach specifies four levels of quality. Randomized trials, usually the highest grade of evidence, can be downgraded depending on the presence of the methodological problems. A brief overview of the grade system is presented.

The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.

BACKGROUND: Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. AIM: The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. METHODS: Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. FINDINGS: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. LINKING EVIDENCE TO ACTION: Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

The Self-assessment for Organizational Capacity Instrument for evidence-informed health policy: preliminary reliability and validity of an instrument.

BACKGROUND: Health policymakers work in organizations that involve multiple competing demands and limited time to make decisions. Influential international policy organizations continue to publish guidance and recommendations without the use of high-quality research evidence. Few studies have described the process with which governments, including health ministries, use evidence to support health policymaking decisions. Research is needed to better understand the psychometric properties of instruments that assess health policy organizations' capacity to use research evidence. AIM: The purpose of this study was to assess the preliminary psychometric properties of an instrument which assesses organizational capacity for evidence use. METHODS: The instrument was administered by telephone survey from January to June 2011 using a purposeful sample of 57 Canadian health policymakers (policy analyst and senior management levels). Reliability of the instrument was assessed with Cronbach's α coefficient and item-to-total correlation for internal consistency; interitem coefficients were used to identify particular item redundancy. Discriminant validity was assessed using the known-group comparison approach, with the independent sample t-test to assess subscale responses of policy analysts and senior managers. FINDINGS: Cronbach's α indicated acceptable internal consistency across its subscales. Discriminant validity analysis revealed a statistically significant difference between policy analysts and senior managers for one subscale. LINKING EVIDENCE TO ACTION: Our study provides a first look at the Self-assessment for Organizational Capacity Instrument's psychometric properties and demonstrates that this instrument can be useful when evaluating government and other organizations' use of evidence to inform decision making. Further testing of this instrument is needed using large and varied samples of policymakers, from policy analysts to senior managers, across varied policymaking contexts. This instrument can be a starting point for government and related organizations to better understand how well it supports evidence use, including its acquisition, appraisal, and use in health policy decision making.

The Baptist Health Lexington evidence-based practice model: a 5-year journey.

There are numerous advantages to basing nursing practice on evidence. Improvements in the quality of patient care, better patient outcomes, decreased healthcare costs, and enhanced work satisfaction for nurses have been described in the literature. Baptist Health Lexington, a community hospital, has experienced a successful 5-year journey integrating evidence-based practice as a result of the development of the Baptist Health Lexington Evidence-Based Practice Model. This journey is described below. Yearly activities, examples of projects, and clinical outcomes are presented.

Evidence-based practice process quality assessment: EPQA guidelines.

BACKGROUND: Nurses are increasingly engaged in evidence-based practice (EBP) processes to answer significant questions and guide nursing practice. However, there are no criteria to evaluate the rigor and quality of EBP projects, making the decision about whether to implement a recommended practice change questionable. AIM: The purpose of this study was to achieve consensus among nationally recognized EBP nurse experts on criteria that could be used to appraise the methodological quality of an EBP project as well as to serve as a guideline to plan for an EBP project. METHODS: A modified two-round Delphi method was used. Twenty-three nationally known EBP experts were invited by e-mail to participate in completing a web-based questionnaire. RESULTS: Items converged after two rounds (response rate [52% (n=12/23) for Round 1 and 35% (n=8/23) for Round 2]) and resulted in the development of the EBP Process Quality Assessment (EPQA) guidelines that include 34 items. IMPLICATIONS: The EPQA guidelines can be used to guide and evaluate the methodological quality of EBP projects. They can be used in practice settings to critically appraise an EBP project prior to translating recommendations into practice. Educators can use the EPQA guidelines as a rubric to evaluate student EBP projects. EPQA guidelines can be utilized in research to assess interventions and to build or improve EBP capacity.

Gaps in nurse staffng and nursing home resident needs.

Trends in nurse staffing levels in nursing homes from 1997 to 2011 varied across the category of nurse and the type of nursing home. The gaps found in this study are important to consider because nurses may become overworked and this may negatively affect the quality of services and jeopardize resident safety. Nursing home administrators should consider improving staffing strategically. Staffing should be based not only on the number of resident days, but also allocated according to particular resident needs. As the demand for nursing home care grows, bridging the gap between nurse staffing and resident nursing care needs will be especially important in light of the evidence linking nurse staffing to the quality of nursing home care. Until more efficient nursing care delivery exits, there may be no other way to safeguard quality except to increase nurse staffing in nursing homes.