The Role of the Doctor of Nursing Practice in Promoting Nonpharmacologic Pain and Comfort Management.

In this article the author presents her vision for integration of nonpharmacologic treatments, many taken from whole systems of care (Verhoef et al., 2005), for both pain and comfort management. By combining the evidence-based practice expertise of the clinical nurse specialist role with the knowledge of innovation, systems thinking, health policy, and implementation science acquired in the Doctor of Nursing Practice program, she is engaging interprofessional teams to join her shared vision.

Integrative Review for Patients With Bilateral Total Knee Replacement: A Call for Nursing Practice Guidelines.

BACKGROUND: The aim of this joint project between the National Association of Orthopaedic Nurses and the Association of Rehabilitation Nurses was to develop nursing practice guidelines for patients who experience bilateral knee arthroplasty (BTKA) across the continuum of care. No guidelines existed and an integrative review was completed to address this gap. METHODS: An integrative review of refereed quantitative and qualitative research in published and gray literature was completed to answer the clinical questions: (1) What is the scope of evidence-based nursing interventions for patients undergoing BTKA? (2) What are patients' experiences with BTKA across the care continuum? The scope of the literature search was patients with bilateral and unilateral total knee arthroplasty. An evidence-based system was used to rate the strength of studies that met the criteria for inclusion in this review. RESULTS: The search method identified 588 potential titles but the analysis of the abstracts supported only 128 studies for possible inclusion in this project. The authors independently reviewed these studies and concluded that 126 studies did not meet the inclusion criteria and 2 quantitative studies were eligible for inclusion. CONCLUSIONS: Understanding which interventions are most effective for pain management, functional gains, quality of life, and other nurse-sensitive outcomes is best derived from empirical studies. Most likely, BTKA nursing care is being guided by clinical experts and not by empirical nursing evidence. In the absence of empirical evidence, it is feasible that nurses can extrapolate findings from other studies to guide and support the care of BTKA patients. Research recommendations include the exploration of early mobilization interventions, development of nursing care bundles, and evaluation of patient-centered outcomes at the points of transitional care.

Validation study of the Polish version of the Evidence-Based Practice Profile Questionnaire.

BACKGROUND: Decisions about patient care in clinical practice should be made based on proven scientific evidence of efficacy and safety (i.e., evidence-based practice [EBP]). Currently, there are no available tools in Poland for assessing the knowledge and attitudes of specialists in health sciences towards EBP. Therefore, by validating the Polish version of the original English Evidence-Based Practice Profile Questionnaire (EBP2Q), we may provide an appropriate instrument for assessing EBP. METHODS: The validation group consisted of 1,362 people, including nurses and midwives taking the specialization exam, second-degree students in nursing/midwifery, and staff of selected municipal and clinical hospitals in Warsaw, Pruszkow, and Chelm. The study was conducted from March to June 2014. The following psychometric properties of the EBP2Q were assessed: reliability (Cronbach's alpha coefficient, and test-retest), validity (exploratory factor analysis, Spearman's r correlation coefficient, and assessment of inter-group differences), as well as unidimensionality of domains (principal component analysis). RESULTS: All domains of the EBP2Q were characterized by high reliability (Cronbach's alpha ranging from 0.800 to 0.972). The Polish version showed a strong similarity of factor structure with the original English EBP2Q, indicating that the condition for theoretical validity is fulfilled. Maintenance of the theoretical and discriminative validity and unidimensionality of five domains of the EBP2Q was confirmed. CONCLUSIONS: The Polish version of the EBP2Q is comparable in terms of psychometry to the original English version. This questionnaire can be used to assess knowledge, attitudes, and skills concerning EBP among students and practicing professional nurses and midwives. The future validation of the EBP2Q in other groups of specialists in health sciences may increase the scope of applicability of this tool.

Student life - How to practise effectively.

Referring to the Nursing and Midwifery Council Code's second theme - practise effectively; think what effective nursing care means to you and how this has an impact on the essence of quality care.

Integrative review of benefit levers' characteristics for system-wide spread of best healthcare practices.

AIM: To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice. BACKGROUND: Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun: alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review. DESIGN: An integrative literature review using an adapted Whittemore and Knafl design. DATA SOURCES: A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Google Scholar and grey literature was conducted (January-March 2012) and updated (December 2014). After reading the abstracts, titles and full-text articles, forty (N = 40) research and non-research documents met the inclusion criteria. REVIEW METHODS: Thirty-five documents remained after critical appraisal. A systematic approach was used to analyse and synthesize the data and formulate concluding statements. RESULTS: Data revealed characteristics about alignment (personal, organizational and contextual attributes), permeation plans (phases), leadership for change (types, strategies, position, attitude and support) and supporting and reinforcing structures (types and requirements). CONCLUSION: Benefit levers should be used to promote the spread of evidence-based practices. However, more studies concerning benefit levers, specifically regarding 'alignment' and 'permeation plans', are required to promote system-wide spread of best healthcare practices.

[The local adaptation of clinical practice guidelines]. / L'adattamento locale.

The ADAPTE process is a systematic approach to adapting guidelines produced in one setting for use in a different cultural and organizational context. It ensures that the guideline addresses specific health questions relevant to the context, accounting for the needs, priorities, legislation, policies, and resources in the targeted setting. The ADAPTE process was developed to meet the needs of different user groups, including guideline developers, health care providers, and policy makers at the local, national, and international level. The process is flexible; the transparent and explicit reporting enhances the quality and validity of the adapted guideline. The ADAPTE process is briefly described.

Perinatal staff perceptions of safety and quality in their service.

BACKGROUND: Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. METHODS: The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. RESULTS: Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. CONCLUSIONS: Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.

Simulation education approaches to enhance collaborative healthcare: a best practices review.

Interprofessional simulation can provide health profession program educators with an effective means to prepare future practitioners to engage in meaningful collaboration. This systematic review was conducted to identify best practice recommendations to enhance collaborative healthcare using interprofessional simulation education innovations for learners in pre-licensure nursing programs. Using a systematic review methodology, 375 articles were reviewed and 17 studies met the inclusion criteria. Based on the methodological strength of the research and the impact of the simulation innovations, the following simulation techniques were recommended: high-fidelity human patient simulators, role play, and didactic lecture and audience response didactic lecture, both followed by role play with a standardized patient. Instructor modeling was related to achievement of interprofessional competencies when compared to no modeling. Future research is needed to identify optimal timing for implementing interprofessional education innovations, for development of appropriate evaluation tools, and to determine the effects of collaborative practice on patient care.

Prayer in Clinical Practice: what does evidence support?

A Korean-born U.S. nurse educator shares a perspective on prayer in clinical settings in South Korea and asks what appropriate, ethical prayer practice should be in the United States. A review of research on prayer for health and in nursing practice is offered, concluding with evidence-based suggestions for prayer with and for patients in clinical settings.