A National Scoping Study on Barriers to Conducting and Using Research Among Nurses in the United Arab Emirates.

It is important that nurses fully engage with the development and use of evidence-based practice so they can influence policy and improve patient care. There are significant challenges in developing nursing research and evidence-based practice in the United Arab Emirates (UAE). Therefore, the UAE Nursing and Midwifery Council formed a Scientific Research Subcommittee to lead the development of nursing research. Following a literature review to assess the status of nursing research in the UAE, the Subcommittee initiated a study to clarify UAE nurses' perceptions of barriers to implementing research. The results were expected to enable comparisons with other countries and establish a baseline on which to build and prioritize initiatives to address identified barriers. A cross-sectional design with convenience sampling was used to survey 606 nurses from across the UAE. The survey included the BARRIERS questionnaire and was administered online and in paper-based formats. The top three nurse-perceived barriers that affected nurses' use of research in the UAE (in descending order) were as follows: lack of authority to change patient care procedures, insufficient time to read research, and insufficient time on the job to implement new ideas. The highest ranked barriers to nurses conducting research in the UAE were lack of time and competing demands for time. The findings of this survey and a published literature review informed development of a strategy to address identified barriers to nurses in the UAE using and conducting research. This multifaceted strategy includes initiatives to reform policy and practice at local and national levels.

Heparin versus normal saline for patency of arterial lines.

BACKGROUND: For most patients who require intensive care, the success of clinical decision making and interventions is dependent on the accuracy of different physiological variables measured or obtained from samples using an arterial catheter. Maintaining the patency of these catheters is therefore essential for obtaining accurate measures, minimizing patient discomfort and reducing expenses incurred when an occluded catheter requires replacement. Uncertainty exists amongst clinicians as to best practice surrounding the contents of the arterial catheter flush solution (heparin or saline). The use of heparin is more expensive and is accompanied by significant risks such as haemorrhage, hypersensitivity and heparin-induced thrombocytopenia (HIT). OBJECTIVES: The objective of this review was to evaluate whether normal saline is as efficacious and safe as heparin in maintaining the patency of arterial intravascular catheters in adult patients without a haematological disorder. SEARCH METHODS: Randomized clinical trials (RCTs) were identified through electronic database searches: Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, part of The Cochrane Library; MEDLINE (Ovid, 1966 to March 2013); EMBASE (Ovid, 1988 to March 2013) and CINAHL (1988 to March 2013), using specific strategies as advised by the Cochrane Anaesthesia Group search specialist. We contacted trial authors to ask for additional information as needed. SELECTION CRITERIA: Randomized controlled trials and quasi-randomized studies irrespective of blinding or language that compared an arterial catheter flush solution comprising any dose of heparin versus an infusion of normal saline only. DATA COLLECTION AND ANALYSIS: Two review authors independently screened for methodological quality and extracted data from all identified studies that met the protocol inclusion criteria. MAIN RESULTS: A total of seven studies (606 participants) met the inclusion criteria and measured the primary outcome of interest. All studies were at unclear to high risk of bias. Given the high degree of clinical and statistical heterogeneity of the included studies, no meta-analysis was completed. The results from individual studies that compared heparin at a dose of 1 to 2 IU/mL under continuous pressure were imprecise and do not provide definitive evidence of a difference. The observed difference with a dose of heparin increased to 4 IU/mL came from only one study of 30 participants, and the quality of the reported data was poor. Similarly. consistency in assessment and reporting of adverse events such as haematoma, insertion site infection and limb ischaemia was poor. Further research with well-defined primary and secondary outcome measures using a stratified sampling process that accommodates for the different heparin doses commonly used in clinical practice is needed to confirm the trends seen in research results now reported in the literature. AUTHORS' CONCLUSIONS: The available evidence is of poor quality because of risk of bias and does not provide sufficient information to support the effects of adding heparin (1 to 2 IU/mL) to a maintenance solution (pressurized to deliver 3 mL of flush solution per hour) of 0.9% normal saline in maintaining the patency and functionality of arterial catheters.

Learning Huddles- an innovative teaching method.

The idea of bringing front-line staff and bedside caregivers together for frequent but short briefings about key patient care safety issues has proven a highly effective method within the Quality Improvement realm. The authors share the design and development of an innovative teaching method: Learning Huddles that has proven effective in improving patient outcomes in a complex quaternary healthcare facility. This 'just in time' teaching method has been successful in helping to promote a learning environment, where the essential 'need to know' is packaged in a format that engages and keeps the front-line caregivers up to date with the knowledge and practices they need in order to provide high quality, safe, compassionate care. The key elements that comprise the design of learning huddles are shared and available for clinical educators to utilize. It is the authors hope that through sharing the success of learning huddles in one complex quaternary facility will result in the design, implementation and sharing of learning huddles across a variety of healthcare settings, ultimately benefiting patients and caregivers alike.

Framework of care: communicating the structure and processes of care.

AIM: This article attempts to present a 'macro view' of the role and nature of an organization's Framework of Care (FrOC). This 'view' arises from a critical reflection on the available literature and the combined professional experience of the authors, who have worked in a variety of healthcare systems and settings in Australia, North America, United Kingdom, and the Middle East. BACKGROUND: FrOC can be defined as the systems and processes within an organization that structure the delivery of care. These systems and processes are made evident in a series of documents, such as the Mission and Vision statement, Policies and Procedures, Standards of Care, Clinical Practice Guidelines, Clinical Pathways, and Protocols. These frameworks can provide structure for important organizational activities such as clinical audits, quality management and clinical information system (CIS) 'decision support', thereby supporting clinicians in their efforts to deliver high-quality, evidence-based care. How a healthcare organization structures its systems and processes of care directly impacts the patient and caregiver experience - made evident in patient and staff satisfaction with the services provided. RECOMMENDATIONS: Mapping out and understanding an organization's FrOC is a critical first step for interprofessional teams attempting to implement evidence into practice and/or accreditation teams and expert consultants critiquing the performance of an organization.

The measurement of collaboration within healthcare settings: a systematic review of measurement properties of instruments.

BACKGROUND: There is a growing call by consumers and governments for healthcare to adopt systems and approaches to care to improve patient safety. Collaboration within healthcare settings is an important factor for improving systems of care. By using validated measurement instruments a standardized approach to assessing collaboration is possible, otherwise it is only an assumption that collaboration is occurring in any healthcare setting. OBJECTIVES: The objective of this review was to evaluate and compare measurement properties of instruments that measure collaboration within healthcare settings, specifically those which have been psychometrically tested and validated. INCLUSION CRITERIA, TYPES OF PARTICIPANTS: Participants could be healthcare professionals, the patient or any non-professional who contributes to a patient's care, for example, family members, chaplains or orderlies. The term participant type means the designation of any one participant; for example 'nurse', 'social worker' or 'administrator'. More than two participant types was mandatory. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The focus of this review was the validity of tools used to measure collaboration within healthcare settings. TYPES OF STUDIES: The types of studies considered for inclusion were validation studies, but quantitative study designs such as randomized controlled trials, controlled trials and case studies were also eligible for inclusion. Studies that focused on Interprofessional Education, were published as an abstract only, contained patient self-reporting only or were not about care delivery were excluded. OUTCOMES: The outcome of interest was validation and interpretability of the instrument being assessed and included content validity, construct validity and reliability. Interpretability is characterized by statistics such as mean and standard deviation which can be translated to a qualitative meaning. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The databases searched included PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Emerald Fulltext, MD Consult Australia, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Informit Health Databases, Scopus, UpToDate and Web of Science. The search for unpublished studies included EThOS (Electronic Thesis Online Service), Index to Theses and ProQuest- Dissertations and Theses. METHODOLOGICAL QUALITY: The assessment of methodological quality of the included studies was undertaken using the COSMIN checklist which is a validated tool that assesses the process of design and validation of healthcare measurement instruments. DATA COLLECTION: An Excel spreadsheet version of COSMIN was developed for data collection which included a worksheet for extracting participant characteristics and interpretability data. DATA SYNTHESIS: Statistical pooling of data was not possible for this review. Therefore, the findings are presented in a narrative form including tables and figures to aid in data presentation. To make a synthesis of the assessments of methodological quality of the different studies, each instrument was rated by accounting for the number of studies performed with an instrument, the appraisal of methodological quality and the consistency of results between studies. RESULTS: Twenty-one studies of 12 instruments were included in the review. The studies were diverse in their theoretical underpinnings, target population/setting and measurement objectives. Measurement objectives included: investigating beliefs, behaviors, attitudes, perceptions and relationships associated with collaboration; measuring collaboration between different levels of care or within a multi-rater/target group; assessing collaboration across teams; or assessing internal participation of both teams and patients.Studies produced validity or interpretability data but none of the studies assessed all validity and reliability properties. However, most of the included studies produced a factor structure or referred to prior factor analysis. A narrative synthesis of the individual study factor structures was generated consisting of nine headings: organizational settings, support structures, purpose and goals; communication; reflection on process; cooperation; coordination; role interdependence and partnership; relationships; newly created professional activities; and professional flexibility. CONCLUSIONS: Among the many instruments that measure collaboration within healthcare settings, the quality of each instrument varies; instruments are designed for specific populations and purposes, and are validated in various settings. Selecting an instrument requires careful consideration of the qualities of each. Therefore, referring to systematic reviews of measurement properties of instruments may be helpful to clinicians or researchers in instrument selection. IMPLICATIONS FOR PRACTICE: Systematic reviews of measurement properties of instruments are valuable in aiding in instrument selection. This systematic review may be useful in instrument selection for the measurement of collaboration within healthcare settings with a complex mix of participant types. Evaluating collaboration provides important information on the strengths and limitations of different healthcare settings and the opportunities for continuous improvement via any remedial actions initiated. IMPLICATIONS FOR RESEARCH: Development of a tool that can be used to measure collaboration within teams of healthcare professionals and non-professionals is important for practice. The use of different statistical modelling techniques, such as Item Response Theory modelling and the translation of models into Computer Adaptive Tests, may prove useful. Measurement equivalence is an important consideration for future instrument development and validation. Further development of the COSMIN tool should include appraisal for measurement equivalence. Researchers developing and validating measurement tools should consider multi-method research designs.

Evidence-based health care in pediatrics.

This article examines current trends in the type and quality of systematic reviews underpinning the evidence base for pediatric health care. A case study is used to highlight the quality standards for the conduct and publication of systematic reviews and the processes being used to transition the evidence produced from systematic reviews into the everyday systems and processes of care.

Presenting and interpreting findings.

This article is the sixth and last in a series on the systematic review from the Joanna Briggs Institute, an international collaborative supporting evidence-based practice in nursing, medicine, and allied health fields. The purpose of the series is to describe how to conduct a systematic review-one step at a time. This article details what should be included when presenting the findings of a systematic review to ensure they can be translated into clinical practice.

The ability of environmental healthcare design strategies To impact event related anxiety in paediatric patients: A comprehensive systematic review.

EXECUTIVE SUMMARY: Background Children's' hospitals are by definition hospitals specialized in all aspects of children's care, but are they and if so, how is that achieved? Are healthcare facilities more than a 'space' in which to ask medical questions, seek answers and obtain treatment? Some suggest that the very design of a space can positively or negatively impact healing, hence the term referred to by those in the architectural community as 'healing spaces'. To date empirical studies to provide evidence to this effect, although growing in number, are still few. What is known is that hospitals, doctor's offices and dental offices alike unintentionally create an atmosphere, particularly for children, that add to an already heightened level of anxiety and fear. Designing a children's hospital, unlike a generalist facility, presents a unique and significant challenge. Those involved in designing such hospitals are faced with the opportunity and responsibility to care for and respond to the needs of children across the age spectrum; infants to toddlers, school aged children to adolescents. As healthcare professionals and architects, it is our responsibility to create healthcare facilities that are of purposeful design; anticipating and alleviating children's anxiety and fear wherever possible.Objectives The objective of this systematic review is to evaluate the effects of environmental design strategies in healthcare institutions such as hospitals and dental offices on event-related anxiety in the paediatric population.Inclusion Criteria This comprehensive systematic review involved children from the age of 1 to 18 years of age admitted to a healthcare facility with the primary outcomes of interest being four key design strategies: positive distraction; elimination of environmental stressors; access to social support and choice (control); and connection to nature.Search Strategy Using the Joanna Briggs defined three step search strategy, both published and unpublished studies were sought from the period of 1980 to 2010.Methods of the Review Data for each study was extracted and assessed by two independent reviewers for methodological validity prior to inclusion in the review using the Joanna Briggs Institute standardised critical appraisal instruments for Qualitative data (JBI-QARI) and for the Meta Analysis of Statistics Assessment (JBI-MAStARI).Results Twenty studies were reviewed, seven of a descriptive experimental design, three of mixed methodologies and thirteen of various qualitative research design methodologies inclusive of Observational, Grounded Theory, Ethnography and Phenomenology.Conclusions The design of the built environment does have the ability to impact either positively or negatively the level of anxiety and fear that children experience when exposed to a healthcare setting. The coping strategies engaged by and unique to each paediatric age group need to not only be understood but supported and reflected in the built environment.Implications for research Architects and healthcare researchers need to collaborate to establish a solid base of evidence related to this important area of interest. Irrespective of the challenges that researchers face in attempting to randomise, manipulate and control the numerous environmental variables that impact a question such as this, such challenges need not, nor should not, prevent or discourage future research. An innovative solution to the challenges faced by researchers in this field is the use of computer modelling and/ or simulation of the hospital environment. Through the use of simulated environments researchers can directly observe user preferences and/ physiological responses.Implication for practice This review highlights an insightful look into the preferences of children as consumers. Although sample sizes were small and results were not quantified in measurable outcomes, the ability for such studies to inform design should not be underestimated. Design strategies both from a practical perspective of minimal cost to construction projects warranting extensive resources are discussed.