Connecting Evidence-Based Practice and Clinical Practice Guidelines With Bachelor of Science in Nursing Students.

ABSTRACT: Research has demonstrated the ability of evidence-based practice (EBP) to enhance quality and reliability of health care, improve health outcomes, and reduce cost and health disparities. Nursing curricula often lack best practices for teaching EBP, as well as actual EBP course content, objectives, and activities, to advance student understanding of EBP. The unfortunate results are nurse graduates who do not value or perceive that they can use EBP. This study implemented an EBP assignment assessing clinical practice guidelines as a means of improving EBP beliefs in senior-level nursing students.

Implementation and Evaluation of Diabetes Clinical Practice Guidelines in a Primary Care Clinic Serving a Hispanic Community.

BACKGROUND: Diabetes is a major health concern in the United States. Poor quality diabetes care leads to negative outcomes affecting patients and healthcare systems. Research shows evidence-based clinical practice guidelines from the American Diabetes Association, Standards of Medical Care in Diabetes-2017, have improved outcomes in management of diabetes. AIMS: The aim of this improvement project was to improve diabetes care and outcomes in a primary care clinic serving a Hispanic community in Miami-Dade, Florida. Specific objectives of the project were to improve primary care provider attitudes and knowledge of American Diabetes Association guidelines and outcomes in patients with diabetes. METHODS: This two-phase quality improvement project used a pre- and post-test study design. In Phase I, the Diabetes Attitude Survey was administered to determine primary care provider attitudes and knowledge of guidelines. Based on survey results, a 2-hr educational intervention was developed to inform providers regarding the American Diabetes Association clinical practice guidelines. In Phase II, data were collected for 19 clinical quality diabetes outcome measures from agency reports. Guidelines were implemented into practice, and intervention effectiveness was evaluated. RESULTS: Statistical analysis (paired-sample t-test) revealed postintervention improvement in provider knowledge and attitudes, and patient outcomes. Findings suggest the intervention led to improvements in the quality of diabetes care in this Hispanic clinic. LINKING EVIDENCE TO ACTION: Project success supports the importance of evidence-based clinical practice guideline use to achieve better diabetes outcomes. Implementation of the American Diabetes Association Standards of Medical Care in Diabetes to improve patient outcomes is strongly recommended. It is equally important that clinical agencies educate and update primary care providers to achieve best practice and best patient diabetes outcomes. Other healthcare professionals can use this project design to provide culturally competent care to patients with diabetes.

EBP Design and Translation: Teaching How to Begin a Scholarly Practice Project.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Motivating parents to promote cardiovascular health in children.

BACKGROUND: Identifying risk factors for cardiovascular disease (CVD) early in life gives advanced practice nurses an opportunity to educate parents about choices that promote long-term heart health. The addition of universal lipid screening to 9- to 11-year-old well-child examinations opens a time interval that is adequate for conversations related to cardiovascular health. OBJECTIVE: The objective of this study was to determine if the use of a 10-minute health promotion plan that includes identification of child modifiable CVD risk factors would have an effect on parental intent to engage in lifestyle changes that promote heart health in 9- to 11-year-old children. METHODS: The quasi-experimental pilot study involved 26 English-speaking parents of 9- to 11-year-old children during routine well-child examinations. Participants completed questionnaires before and after receiving a health promotion plan and the child's modifiable CVD risk screening results. The advanced practice nurse-researcher analyzed the questionnaires to evaluate parental intent to promote lifestyle changes. RESULTS: Increases were seen in concern for the child's future heart health and in awareness of diet and exercise recommendations. Participants were likely to encourage more fruits and vegetables (100%), limit "screen time" (96%), encourage physical activity (92%), and limit sugar-sweetened beverage intake (96%). Factors identified as most influential on participant decision to encourage change were the child's body mass index (38.46%), lipid screening results (23.08%), and "other"-tobacco smoke exposure (15.38%), which closely approximate national prevalence for each risk category. CONCLUSIONS: The American Academy of Pediatrics recommends lipid screening once for all children between 9 and 11 years of age. In this study, outlining recommendations for good health and identifying modifiable CVD risk factors showed a positive effect on parental intent to encourage lifestyle changes. Further research is needed to advance the science of CVD prevention and risk reduction in children.

Geographic analysis of cardiac interventional services in Alabama.

BACKGROUND: Cardiovascular disease is the leading cause of death in the state of Alabama. The purpose of this study was to explore the geographical accessibility of the Alabama population to cardiac interventional services (CISs) for the treatment of acute myocardial infarction. METHODS: A descriptive ecological study design was used. Census tract-level population census data were used to describe access to CIS in Alabama. Descriptive analysis was conducted within a geographical information system (GIS) and provided empirical measures of travel time, calculated population proportions, and generated maps for visual identification of areas of low access. Descriptive statistics are reported as proportions (percentages) of the population with access by travel time. FINDINGS: The GIS analysis revealed that 58.2%, 85.9%, and 96.0% of the total Alabama population were within 30-, 60-, or 90-minute travel time, respectively, of a hospital with CIS. Maps provided visualization of CIS coverage areas for Alabama. One distinct area within the Alabama Black Belt was at greater than 90 minutes from a hospital with CIS. This area is known as a mostly black, impoverished population subject to health disparities. CONCLUSIONS: The GIS showed that 96% of the Alabama population is within 90-minute travel time of a hospital with CIS. For the best outcomes to occur allowing adequate time for symptom recognition, travel time, and 30-minute door-to-needle time, only 85.9% and 58.2% are within 60- and 30-minute travel time, respectively.

Implementation and evaluation of a self-care toolkit for caregivers of families with dementia.

BACKGROUND: Family caregivers who care for individuals with dementia are more likely to develop chronic stress, major depression, anxiety, and physical health disorders and they have a higher mortality rate compared with the general population. LOCAL PROBLEM: Caregivers are at an increased risk of physical and mental disorders. Many report that they are fatigued and need more forms of support. METHODS: This project involved a convenience sample of 35 family caregivers who cared for family with dementia. Prequestionnaires and postquestionnaires were used to determine improvements in caregiver health and well-being and caregiver resources for supportive services as well as reduction in caregiver stress. INTERVENTIONS: An evidence-based educational class was developed and implemented based on the Family Care Alliance (FCA): Taking Care of YOU: Self-Care for Family Caregivers Toolkit. The project aimed to (1) assess two FCA recommended domains: caregiver health and well-being and caregiver resources for supportive services and (2) reduce caregiver stress. RESULTS: Stress Inventory results showed notable change in high risk/low risk categorization from pretest to posttest. At pretest, 31 caregivers were categorized as at high risk for unhealthy levels of stress, but posttest showed only 9 caregivers were so categorized. Approximately, 70% of those at high risk at pretest were categorized as low risk at posttest. CONCLUSIONS: This project validated that evidence-based educational interventions can improve caregiver knowledge and self-care. Continued support may be promoted by incorporating education and offering resource brochures to caregivers during primary care visits.

Walking the Walk: Integrating Evidence Into Clinical Experiences.

Professional nurses are called to provide nursing care using an evidence-based approach. Health-care professionals are challenged to break away from old traditions and search for ways to improve health. Evidence-based practice (EBP) must be threaded throughout nursing curricula to produce critically-thinking professional nurses who will be meeting new and significant health-care challenges. Nursing education must be grounded in the translation of current evidence into practice. Nurse educators must acknowledge the obstacles faced when teaching concepts of research to students who have chosen a practice-focused career. The words evidence-based practice may be intimidating to nursing students. Nurse educators must shift this paradigm to invite students to realize that EBP is an integral component of modern health care that bridges the gap between health-care practices and improved patient outcomes. Faculty in a baccalaureate Adult Health course developed a unique approach inviting students to apply evidence to their student clinical experiences. Survey results showed that this innovative approach increased students' "excellent" or "good" understanding toward EBP concepts from pre-implementation scores of 46% to post-implementation scores of 94%. This active learning strategy allows students to "walk the walk" of EBP rather than simply listen to the "talk."

A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum.

The DNP curriculum prepares the graduate for evidence informed improvement translation through coursework integrating improvement, safety, and translation sciences. Innovative leadership skills are necessary to lead inter-professional unit-based and health system opportunities. Equipping the DNP with the necessary skills and competencies to accomplish any type of improvement translation requires exposure to the tools and techniques of these sciences with an emphasis in didactic content. With a foundational knowledge of the principles for improvement, translation and application will follow. It is imperative theoretical underpinnings of translational science are taught, and that the students be expected to apply these concepts in "real word" circumstances. Thus, the DNP student is afforded opportunities during their DNP program to participate in a "learning lab" for evidence informed improvement translation. In essence, the courses within the program are designed to allow conversion from theory into practice.

Integrating Diabetes Guidelines into a Telehealth Screening Tool.

Diabetes is the seventh leading cause of death in the United States and contributes to long-term complications that are costly to healthcare systems. Twenty-five percent of all veterans in the Veterans Health Administration (VHA) have diabetes. The purpose of this article is to describe the development and implementation of a quality improvement project to embed an evidence-based diabetes screening tool, based on Veterans Affairs/Department of Defense diabetes clinical practice guidelines, into the VHA electronic medical record. The objectives of the screening tool were threefold: to promote evidence-based care, to standardize care coordination, and to promote self-management and proper utilization of resources. Record reviews were conducted to evaluate the effectiveness of the screening tool. Results showed an 88 percent increase in the assessment of annual exams and/or labs, a 16.5 percent increase in disease management assessment and offering of services, and a 50 percent increase in goal-setting activity.

A pilot study to evaluate the role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in clinical decisions for pressure ulcer treatment.

The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (χ2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (χ2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally positive but reservations remain. Additional research is being conducted to determine the barriers and facilitators to SCI-PUMT implementation. The SCI-PUMT was the first tool found to be valid, reliable, and sensitive to assess PrU healing in persons with SCI, and studies to examine the prospective validity of using this instrument on ulcer treatment decisions and outcomes are warranted.

Access to cardiac interventional services in Alabama and Mississippi: a geographical information system analysis.

OBJECTIVE: The objective of this study was to determine the contribution of distance to hospitals with cardiac interventional services (CIS) to county age-adjusted myocardial infarction (MI) mortality rates (CAMR) in Alabama and Mississippi counties. METHODS: THE STUDY USED THREE DATA SOURCES: U.S. Census data, Centers for Disease Control and Prevention (CDC) mortality data, and American Hospital Association data. A geographical information system (GIS) was used to measure distance, providing an empirical measure of county access to CIS. Multiple regression analysis was conducted using measures of distance to CIS, county rural status, state, sex, poverty, education, race, and interaction as predictors of CAMR. RESULTS: Regression results indicate that the model significantly predicts CAMR, R(2) = .378, adjusted R(2) = .319, F = 6.321, p < .001. The model accounts for 31.9 percent of the variability. CONCLUSIONS: The results of this study do not lead to the conclusion that cardiac outcomes as measured by CAMR were sensitive to the geographic location of CIS. However, statistically significant interactions supported the sensitivity of CAMR to complex patterns and issues of rural status, poverty, education, and race.

Integrative literature review: a review of literature related to geographical information systems, healthcare access, and health outcomes.

Differences in access to healthcare services and the resulting adverse health outcomes are major public health priorities. The Institute of Medicine and the Department of Health and Human Services have identified the need for strategies to improve access to healthcare services and to support the improvement of health outcomes. The literature documents health disparities associated with healthcare access and health outcomes from a geographic perspective. Place of residence, location of healthcare services, and geography in general are important factors in the analysis of health. Geographical information systems (GISs) are an emerging technology in the analysis of health from a geographical or location context. As a type of information technology, GISs are potentially powerful assessment tools for the investigation of healthcare access, health outcomes, and the possible resulting health disparities. Their ability to integrate health data with mapping functions allows for visualization, exploration, and modeling of health patterns. Application of GIS technology using health data can help in describing and explaining disparities in healthcare access and health outcomes. The studies reviewed demonstrated the use of GISs to investigate various aspects of healthcare access and health outcomes, including environmental variables of Lyme disease, sociodemographic variables and teen pregnancy, geographical disparities in breast cancer mortality by racial groups, PCP and AIDS prevalence, and factors of a leptospirosis disease outbreak. The literature reviewed shows effective integration and analysis of health data using GIS technology.