An Innovative Partnership to Improve Student Health: Response to a Community Health Needs Assessment.

This community nursing partnership for student health is a well-recognized innovation, regionally and statewide. The initiative exemplifies 1 department of nursing's commitment to community involvement that originated from the forward thinking of nurse leaders. The journey to engaging intraprofessional partners and firmly establishing the partnership within the community is described.

Evaluation of bedside shift report: A research and evidence-based practice initiative.

This evaluation of bedside shift report describes the process of involving clinical nurses in evidence-based practice (EBP) and research at an academic medical center by using existing structures and resources. Nurse involvement and study findings are described from idea inception to asking the clinical question, searching and synthesizing literature, collecting and analyzing data, interpreting results, and deriving conclusions. Study findings and conclusions demonstrate that nurses' active participation in a clinical relevant project promotes implementation and integration of EBP and research in the practice setting.

Nurses' Perceptions and Attitudes Toward Use of Oral Patient-Controlled Analgesia.

Patient-controlled analgesia (PCA) administered intravenously is a generally well-accepted therapy by nurses and patients. PCA devices are now available for oral medications, allowing patients to self-administer pain pills without requesting them from the nurse. Successful introduction of new pain medication delivery devices can depend on nurses' knowledge and attitudes. The aim of this institutional review board approved project was to evaluate nurses' perceptions and attitudes toward using an oral PCA device for patients' pain. A 4-week study was designed and conducted at an academic medical center on an orthopedic unit and a women's health unit. Nurse participants received education on using the oral PCA device and were invited to complete a pre- and poststudy knowledge and attitude survey regarding pain management. Nurses and patients also completed a questionnaire about perceptions related to using the oral PCA device. Findings showed that nurses' attitudes toward using the oral PCA device were less favorable than those of patients, suggesting that nurses may require additional education for acceptance of this device. Results from 37 nurses showed improvement in overall knowledge and attitudes, from 70.8% pretest to 74.2% post-test. Although improvement was not statistically significant (p = .1637), two items showed significant improvement. Knowledge about the effectiveness of NSAIDS was 27.5% pretest compared with 60.0% post-test (p = .0028); and understanding about use of opioids in patients with a history of substance abuse was 50% pretest compared with 70% post-test (p = .0531). Helping nurses overcome the perceived barriers to use of an oral PCA device has potential implications for better pain management as well as enhanced patient satisfaction.

Implementing and Sustaining Evidence Based Practice Through a Nursing Journal Club.

BACKGROUND: The outcomes based emphasis in nursing and health care delivery requires identification of best available evidence in order to produce quality, safe, and effective patient care. Finding, critiquing, and ultimately implementing the best available evidence for practice is a formidable task for many clinical nurses. Development and implementation of a nursing journal club (NJC) became one organization's successful attempt to help clinical nurses better understand and use best available evidence in actual practice. METHODS: The process and structure for the NJC evolved from an additional activity scheduled outside of work to a fully established endeavor of Nursing Research and Evidence Based Practice Council (NR&EBP). The Nursing Professional Practice Model was foundational to establishing the NJC as a formal component within the NR&EBP Council shared governance structure. Efforts to embed the NJC included taking advantage of resources available at an academic medical center and incorporating them into the council structure. RESULTS: Successful outcomes of the NJC include a quarterly schedule, with topics selected in advance that are based on nursing department as well as organizational driven goals and initiatives. The structure and process in place has eliminated frequently mentioned deterrents to evidence based practice such as not enough time, lack of knowledge, or no immediate application to practice. CONCLUSIONS: Incorporating the NJC as a component of NR&EBP Council has provided clinical nurses time away from clinical care that supports scholarship for nursing practice. Committed leadership and garnering of available resources have been key factors for success.

Predicting Pressure Ulcer Development in Clinical Practice: Evaluation of Braden Scale Scores and Nutrition Parameters.

PURPOSE: Accurate patient assessment and screening for pressure ulcer (PU) is difficult in the clinical setting, and evaluation of nutritional status is especially problematic. The aim of this retrospective study was to determine the extent to which Braden Scale scores and other nutrition screening parameters (body mass index, poor intake, and weight loss) predict PU development in general and heel and sacral ulcers specifically. METHODS: Records of 230 hospitalized patients who developed PU were compared to a matched control group without PU. Logistic regression was used to determine the association of total Braden scores, Braden nutrition subscale scores, and nutrition factors with PU development at any time, within week 1, or within week 2 of hospitalization; and development of sacral and heel ulcers at these same periods. RESULTS: Braden Scale scores on hospital admission were predictive of hospital-acquired pressure ulcer development at some point during the hospital stay; and more specifically Braden scores on day 7 were predictive of PU development within week 2 of hospitalization. Among nutrition screening factors and PU development, a low body mass index showed a statistically significant relationship with sacral ulcer development. CONCLUSIONS: Findings indicate that the overall Braden score is a valid predictor of PU development. Implications for clinical practice to decrease the risk for PU development include appropriate use of reliable and valid scales by nurses along with careful evaluation of nutrition parameters.

Preferences for Care Near the End of Life: instrument validation for clinical practice.

This article presents descriptive data and a psychometric evaluation of the Preferences for Care Near the End of Life (PCEOL) tool developed by Gauthier and Froman. The PCEOL tool identifies dimensions related to care near end of life and asks respondents to consider personal preferences in the context of their values. Analyses were conducted on data from a convenience sample of 68 adults recruited at a workshop series on anticipatory guidance for end-of-life care. Participants included nurses, nursing students, nursing assistants, social workers, and older adults. Findings supporting a 3-factor structure (personal autonomy, healthcare provider input, and spirituality and family) are interpreted and discussed. Implications are given for using the PCEOL tool in nursing care situations.

Effects of hand massage on comfort of nursing home residents.

Patient comfort is a goal of therapeutic nursing practice and a primary nursing function. Residents in nursing homes have many comfort needs including physical, psychospiritual, sociocultural, and environmental. These comfort needs are addressed by various caregivers including nurses, nursing assistants, and family members. Hand massage is a simple comfort intervention that can be incorporated readily into routine nursing care activities and conveys caring through touch, individual attention, and presence. As an intervention, hand massage promotes comfort and facilitates communication between care recipients and caregivers. The purpose of this study was to test the effectiveness of hand massage as an intervention that affects nursing home residents' comfort and satisfaction. Results are presented for 35 participants who received hand massage and 25 participants in a comparison group. Findings showed no significant differences in comfort levels or satisfaction with care over time. Significant group differences, however, were found for comfort and satisfaction when measured at specific time periods. The discussion highlights these mixed findings and presents implications for further development of hand massage as part of nursing home residents' care.

Development of a healthy bladder education program for older adults.

The Healthy Bladder Program was developed as part of an academic and health care partnership and was designed specifically for older adults residing in independent and assisted living. Program content was based on best practices that can be used by nursing staff to provide information about promoting and maintaining bladder health. One hundred eighty older adults, recruited from long-term care retirement communities, attended the 1-hour program. Findings showed that the program was successful in providing bladder health information that older adults could use immediately; suggestions are given for best practice applications.