Implementing Evidence Informed Practice Changes: Barriers, Facilitators, and Work Environments.

OBJECTIVE: This study examined nurses' perspectives about the barriers and facilitators to implementing research findings and evidence into practice. BACKGROUND: Work environments play an essential role in implementation and innovation; however, much of the research regarding evidence-based practice focuses on nurses' knowledge and skills, leaving the work environments unexamined. METHODS: A mixed method survey design was used. Data collection included an electronic survey and open questions. Analysis included descriptive statistics and narrative analysis using the Consolidated Framework for Implementation Research. RESULTS: Attitudes about implementing evidence into practice were positive. Identified barriers included lack of time and knowledge, change fatigue, and complex internal processes; facilitators included supportive colleagues, knowledgeable mentors, and access to libraries and other resources. CONCLUSIONS: Implementing evidence into practice is facilitated by committing organizational resources, fostering supportive work environments, integrating evidence into quality improvement projects, offering continuing education, and reducing the complexity of translating evidence into practice and the number of institution-wide initiatives.

Magnet® and Pathway to Excellence®: Focusing on Research and Evidence-Based Practice.

Healthcare organizations seeking to achieve or maintain Magnet or Pathway to Excellence designation are increasingly challenged to demonstrate how nurses are leading or are engaged in research and evidence-based practice. This article describes common barriers to and effective strategies for developing a culture of research and evidence-based practice, with recommendations for Magnet- and Pathway-seeking organizations.

Creating Microclimates of Change: Transparency in Disseminating Nursing Quality Performance Data.

OBJECTIVES: Study objectives were to: 1) explore how nursing care quality data (NCQD) was understood and interpreted; and 2) identify, compare, and contrast individual and group responses. BACKGROUND: Little evidence exists on how to best disseminate NCQD information. This study explores the outcomes of implementing an NCQD and human-interest information slide show across an inpatient surgery nursing service line using electronic screens. METHODS: Methods included semistructured interviews, qualitative analysis, and diagramming. RESULTS: The human-interest content most often attracted viewers' attention, but they were also exposed to NCQD. Interpretations and understandings differed among groups and between individuals. Among staff members, the human-interest content facilitated team-building, whereas NCQD provided meaningful recognition. Nursing care quality data evidenced the efforts that were being made to improve and provide excellent patient care. CONCLUSIONS: Using innovative dissemination methods can enhance understanding of NCQD among clinical providers. Creating microclimates of change and innovation within complex healthcare environments can benefit staff members and patients.

Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking hispanic immigrants.

This article is a report of qualitative findings of a mixed-methods study of the relationships among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes mellitus (T2DM) self-management among limited-english-proficient recent Hispanic immigrants, a population with increased incidence of T2DM and barriers to successful T2DM management. Semi-structured interviews were conducted with 30 participants, and physiological and demographic data also were collected. The participants generally attributed developing the disease to strong emotions and viewed T2DM as a serious disease. Although a majority understood the importance of exercise and diet in T2DM self-management, other aspects such as medication adherence were not well-understood. Obstacles to effective T2DM self-management were negative interactions and communications with health care providers and other personnel, cultural stigma related to the disease, financial constraints, immigration status, and the complexity of the disease. Suggested interventions to improve the care and self-management of this at-risk population are discussed.

Cultural Awareness Among Nursing Staff at an Academic Medical Center.

OBJECTIVE: The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. BACKGROUND: Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. METHODS: In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. RESULTS: The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. CONCLUSIONS: In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

Caregiver Fatigue: Implications for Patient and Staff Safety, Part 1.

OBJECTIVE: This article describes the profound impact of fatigue and the process by which 1 academic medical center assessed fatigue levels, and associated factors, among nursing personnel in their effort to develop a comprehensive fatigue management program. BACKGROUND: To adequately perform amid high patient acuity and in today's fast paced healthcare environment, nurses must be attentive and react quickly and appropriately with clear judgment and reasoning-abilities that can be greatly impaired by fatigue. Nursing leaders are instrumental in systematically addressing work-related fatigue and implementing processes designed to prevent fatigue and overwork; however, baseline measures are necessary if the efficacy of these initiatives is to be assessed. METHODS: The 15-item Occupational Fatigue Exhaustion/Recovery scale was used to assess current fatigue levels among nursing staff at a university medical center. Demographic and schedule-related questions were used to examine the characteristics of the population and identify any associated factors. RESULTS: Work-related fatigue is prevalent among all nursing staff, but differences were noted based on the respondent's position, age, and typical work shift. CONCLUSIONS: Nursing administrators and shared governance councils can address the factors contributing to work-related fatigue and negatively impacting nursing personnel's ability to rest and recuperate. Nurse leader involvement is needed to develop comprehensive fatigue reduction strategies.

Caregiver Fatigue: Implications for Patient and Staff Safety, Part 2.

Fatigue negatively affects healthcare workers' health and well-being, decreases patient safety, and negatively impacts the work environment. Although individual lifestyle choices influence fatigue levels, much responsibility lies with nursing administrators to prevent situations that may result in sleep deprivation or overwork. This article, the 2nd in a 2-part series, describes the results that were achieved from a fatigue reduction intervention.

An integrative review: fatigue among nurses in acute care settings.

OBJECTIVE: The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies. BACKGROUND: Work-related fatigue negatively affects patient safety and nurses' well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented. METHODS: This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings. RESULTS: Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue. CONCLUSIONS: Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants.

INTRODUCTION: Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS: Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS: Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION: Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION: Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.

The Space Between: Transformative Learning and Type 2 Diabetes Self-Management.

INTRODUCTION: Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants. METHOD: All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach. RESULTS: Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals' self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning. CONCLUSION: Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients' acceptance and transition into treatment.

Nurses' Short Peripheral Catheter Flushing Practices: Implications for Patient Care, Nursing Education, and Policy.

Nursing practice and institutional policies regarding short peripheral catheter (SPC) flushing vary. These variations result in a lack of understanding about the factors that influence nurses' SPC flushing practices and leave their effect on outcomes unexplored-information that could potentially enhance nurses' clinical education, institutional policy efforts, and patient care. Using a mixed-methods design, this study examined SPC flushing practices and outcomes among a cohort of medical-surgical nurses and explored their rationale for flushing. Trends were noted in the timing of flushes, and the factors that influenced nurses' SPC flushing practices included patient acuity, experience, and workload.

Evaluating the Efficacy and Use of Vein Visualization Equipment Among Clinical Nurses in an Intermediate Care Environment.

This study compared traditional short peripheral catheter (SPC) insertion methods with 2 vein visualization equipment models among a general patient population on a surgical step-down unit based on first-attempt success rates and the time required to achieve catheter insertion. The experiences of clinical nurses using the ultrasound and vein visualization equipment were also explored. No significant statistical differences were found between the insertion methods, based on 90 unique SPC insertion attempts. However, nurses reported that using the vein visualization equipment informed patient care, facilitated communication among members of the health care team, and facilitated second SPC insertion attempts. Nursing staff also used the equipment more often after the study concluded.

Maintaining Short Peripheral Catheter Patency: A Comparison of Saline Lock Versus Continuous Infusion in the Acute Care Setting.

Sparse evidence exists about how short peripheral catheter (SPC) duration is affected by the presence of a saline lock versus continually infusing fluids. Often the choice to lock an SPC with saline is based on provider preference, rather than available evidence or patient-centered factors. This study compared the duration of 85 SPCs: locked with saline versus continuously running fluids. A secondary analysis considered the influence of a number of intermittent medications and flushes. Although the saline-locked group had a slightly longer duration time, it was not statistically significant. Factors such as desire to ambulate or nighttime saline flushes merit consideration in SPC care decisions and standardized nurse-driven protocols.

Assessing nurses' adherence to a central line maintenance care checklist on a pediatric inpatient unit.

Adherence to evidence-based central line maintenance practices remains a challenge, particularly in complex patient populations. Using an evidence-based observational checklist, areas of nonadherence were identified and a focused educational intervention was developed, resulting in improved adherence across all aspects of the central line maintenance care bundle.

Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants.

This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.

Transformative learning and graduate nurses' understanding of the complexities of diabetes self-management.

Clinical nurses are increasingly responsible for facilitating and providing diabetes education in the acute care setting. However, research suggests that the lack of awareness about the psychosocial factors that influence diabetes self-management impairs the nurse's ability to effectively and comprehensively support the patient's self-management efforts. This mixed-methods design of the research study describes how transformative learning, in conjunction with critical reflection, enhanced graduate nurses' understanding of the psychosocial aspects of diabetes self-management and improved their ability to provide patient-centered care.

A comparison of patient pain responses and medication regimens after hip/knee replacement.

BACKGROUND: Increased emphasis on adequate pain control as a patient expectation and a change in professional practice standards has prompted research on new mechanisms of pain medication delivery in an effort to improve outcomes and efficacy. PURPOSE: The purpose of this study was to compare pain scores of patients receiving extended release epidural morphine (EREM) with those receiving traditional pain control regimens. DESIGN/METHODS: Retrospective chart reviews were performed on all patients who had had first-time, elective, nontraumatic, unilateral hip or knee replacement from January to June 2006. All patients received either intraoperative EREM or a traditional pain control regimen. Medication regimens were coded and noted at patients' arrival on the unit (baseline), at 16 hr, and at 48 hr postoperatively. SAMPLE: The sample consisted of surgical patients (N = 65) having first-time, nontraumatic hip/knee surgery. Of the sample, 39% (n = 25) were men and 61% (n = 40) were women, with a mean age of 65.25 years (SD = 15.28). Knee replacement surgery was the most frequent surgery at 57% (n = 36), with women representing 75% (n = 28) of the total knee surgical procedures. Hip surgical procedures were equally divided between men (n =11) and women (n = 11). RESULTS: Postoperative pain was assessed within 1 hr of admission to the unit for 98.5% (n = 64) of patients and reassessed at 15-17 hr for 90.8% (n = 59) of the sample, suggesting that the assessment and documentation of patient pain level were a high priority for the nurses. Pain scores were not correlated with age during the 3 time points in the study. Women reported a significantly higher level of pain upon admission to the unit than men, t(62) = 2.697, p