Cultivating evidence-based practice through mentorship.

BACKGROUND: Nurses' use of evidence-based practice (EBP) improves patient outcomes through provision of optimal patient care. AIM: The Evidence-Based Practice Mentorship Program (EBPMP) is a self-directed, year-long immersion program implemented for staff nurses to experience the EBP process with close mentor support. The aim of this program is to bolster a culture of EBP at a single large pediatric quaternary care hospital in the Northeast. RESULTS: A total of 81 nurses across 4 cohorts participated in this organization wide program from 2016 to 2019. To date the program has produced 46 internally and externally disseminated EBP projects. Of the graduates, 7-nurse mentees have become formal EBPMP mentor's, 3 have applied and been accepted into the organizational based Nursing Science Fellowship to carry out clinical inquiry projects to fill important literary gaps, and 6 have received promotions or career advancements. Most importantly, graduates have anecdotally reported that program participation inspired deeper critical reflection of patient care. SUMMARY: Utilizing mentorship to facilitate EBP was a key educational strategy for the busy mentors and mentees, as many of the nurse participants were direct care providers. This self-directed program resulted in a high project completion rate leading to continued organizational support for the program, which is now in its fourth year.

Perceptions of Pain Treatment in Pediatric Patients With Functional Gastrointestinal Disorders.

OBJECTIVES: Individual understanding of and expectations for chronic pain treatment can influence treatment adherence and thus success, but little is known about these critical factors in parents and children presenting with pain-predominant functional gastrointestinal disorders. The aim of this study was to identify parent and patient understanding of pain-predominant functional gastrointestinal disorders, expectations for treatment, and interventions utilized before presenting to a multidisciplinary clinic. MATERIALS AND METHODS: This was a prospective study of patients evaluated in a Multidisciplinary Functional Abdominal Pain Program. Before the clinic visit, parents and patients completed questionnaires regarding their understanding of chronic pain, perceptions of abdominal pain contributors, expectations regarding treatment, and identification of previous interventions utilized. RESULTS: Participants were knowledgeable regarding the biology of chronic pain. Perceptions of contributors to abdominal pain included a sensitive stomach, general stress, and nerves/worry. Most had attempted to treat their pain with medication, exercise or physical therapy, or a psychological treatment. Participants reported that receiving a definite diagnosis would be the most helpful intervention, followed by psychological treatment. DISCUSSION: Participants were knowledgeable regarding chronic pain, but still indicated that receiving a definite diagnosis would be the most helpful intervention. Most had tried multiple interventions and did not believe that further medication, testing, or surgery would solve their pain. Instead, parents presenting at this Functional Abdominal Pain Program appeared most hopeful about the benefits of multidisciplinary treatment approaches including psychological interventions, a focus on activity and functioning, and complementary and alternative medicine interventions.

Competency-based Professional Advancement Model for Advanced Practice RNs.

The process of developing a 3-tiered advanced practice RN (APRN) competency-based professional advancement model at Boston Children's Hospital is described. The model recognizes the contributions of entry-level and expert APRNs to advanced clinical practice and outcomes, impact, and leadership, while incorporating the tenets of Patricia Benner's Novice to Expert Model and the American Association of Critical- Care Nurses Synergy Model of Care.

Multidisciplinary Treatment Reduces Pain and Increases Function in Children With Functional Gastrointestinal Disorders.

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents, frequently resulting in extensive testing, school absenteeism, disability, and poor quality of life.1-3 FGIDs result from a complex interplay between genetic predisposition, biological triggers, and psychosocial triggers, and are best explained by the biopsychosocial model.1 Although this implies the necessity of multidisciplinary treatment, studies showing the efficacy of such an intervention are lacking. We describe the outcome of children with severe FGIDs treated in a multidisciplinary program.

Author Correction: Comparing Sanger sequencing and high-throughput metabarcoding for inferring photobiont diversity in lichens.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Oxygen therapy in adult patients. Part 2: promoting safe and effective practice in patients' care and management.

The assessment, care and management of patients requiring oxygen therapy are key aspects of a nurse's role. Although oxygen therapy is an important treatment for many clinical conditions, it carries risks and complications; therefore, nurses and other health professionals have a responsibility to ensure safe and effective practice along with maintaining and developing their knowledge and skills in this therapy. The relevant aspects of physiology and pathophysiology were explored and discussed in part one of this article ( Rolfe and Paul, 2018 ). The aims of the second part are to discuss: (1) the indications for oxygen therapy; (2) the principles of assessment, care and management of adult patients requiring oxygen therapy; and (3) recommendations for the safe and effective use of oxygen devices, along with the potential complications.

Oxygen therapy in adult patients. Part 1: understanding the relevant physiology and pathophysiology.

Oxygen therapy is a treatment commonly used for adult patients in clinical and community settings. It is therefore important that nurses and other members of the healthcare team caring for patients requiring oxygen therapy have knowledge of the relevant physiology and pathophysiology, along with the safe and effective use of oxygen devices, patient monitoring and oxygen prescribing. This two-part article aims to explore and discuss these aspects in relation to current evidence and best practice recommendations that members of the healthcare team can apply when caring for such patients in a range of settings. Part one discusses the physiology of respiration and the importance of adequate oxygenation within the human body; it covers other relevant physiology and pathophysiology, along with the reasons why adult patients may require oxygen therapy. The authors describe the physiology and pathophysiology associated with the uptake and delivery of oxygen from the lungs to the body cells. Oxygen devices will be discussed in the second article, along with the importance of patient assessment, care, management, safety and patient monitoring.

Comparing Sanger sequencing and high-throughput metabarcoding for inferring photobiont diversity in lichens.

The implementation of HTS (high-throughput sequencing) approaches is rapidly changing our understanding of the lichen symbiosis, by uncovering high bacterial and fungal diversity, which is often host-specific. Recently, HTS methods revealed the presence of multiple photobionts inside a single thallus in several lichen species. This differs from Sanger technology, which typically yields a single, unambiguous algal sequence per individual. Here we compared HTS and Sanger methods for estimating the diversity of green algal symbionts within lichen thalli using 240 lichen individuals belonging to two species of lichen-forming fungi. According to HTS data, Sanger technology consistently yielded the most abundant photobiont sequence in the sample. However, if the second most abundant photobiont exceeded 30% of the total HTS reads in a sample, Sanger sequencing generally failed. Our results suggest that most lichen individuals in the two analyzed species, Lasallia hispanica and L. pustulata, indeed contain a single, predominant green algal photobiont. We conclude that Sanger sequencing is a valid approach to detect the dominant photobionts in lichen individuals and populations. We discuss which research areas in lichen ecology and evolution will continue to benefit from Sanger sequencing, and which areas will profit from HTS approaches to assessing symbiont diversity.

Measuring Nurses' Value, Implementation, and Knowledge of Evidence-Based Practice: Further Psychometric Testing of the Quick-EBP-VIK Survey.

BACKGROUND: The Quick-EBP-VIK is a new instrument for measuring nurses' value, implementation, and knowledge of EBP. Psychometric testing was conducted in two parts. Part 1 describes the tool development and validity testing which resulted in the development of a 25-item survey after receiving ≥0.80 Item-Level Content Validity Index for both clarity and relevance. Part 2 describes psychometric testing was necessary to assess additional types of validity and reliability. AIM: The purpose of this paper is to further describe the psychometric testing of the Quick-EBP-VIK survey instrument. METHODS: This descriptive study was designed to assess test-retest reliability, internal consistency and construct validity via a web-based survey. The survey instrument was e-mailed to all nurses at the study hospital. Nurses who responded to the first survey (Wave 1) received another e-mail invitation to complete the survey instrument again (Wave 2) for the purpose of assessing the test-retest reliability of the instrument. RESULTS: A total of 1,177 deliverable e-mails were sent to all nursing staff at one free standing pediatric hospital with Magnet® designation in the northeast. A total of 382 nurses returned completed surveys, indicating a 32.5% response rate for Wave 1. A total of 131 nurses responded to Wave 2 indicating a response rate of 34.3%. The intraclass correlation coefficients for the items included in the final instrument ranged from 0.43 to 0.80 and were deemed sufficient. These represent a sufficient intraclass correlation coefficient. The Cronbach's Alpha values for each of the three domains are all higher than 0.7 indicating that the items of each of the measurement dimension are internally consistent. However, the composite reliability of the third domain was slightly lower than 0.7 when using Raykov's Rho. LINKING EVIDENCE TO ACTION: The Quick-EBP-VIK instrument has gone through rigorous comprehensive testing and has demonstrated good psychometric properties.

Impact of the early initiation of feedings on hospital length of stay in children post-PEG tube placement.

Delays in feeding patients post-percutaneous endoscopic gastrostomy (PEG) tube placement may result in unnecessary prolongation of hospital stay, deprivation of nutrition, and increased healthcare costs. Common practice has been to wait overnight before initiating feedings post-PEG tube placement. Our facility changed existing policy and began feeding children 6 hours post-PEG. The objectives of this article are to (a) describe the effect of early feeding (6 hours postprocedure) on length of hospital stay, and (b) add to the existing data on safety of early feeding post-PEG tube placement in children. A retrospective chart review of 70 patients admitted for PEG tube placement was performed. Patients admitted pre- and postpolicy change were compared for length of hospitalization, time NPO (nothing by mouth), pain scores, pain medication use, and adverse events (Group A: before policy change; Group B: after policy change). No adverse events were identified in either group. Both median time to feeding initiation and hospital length of stay were shorter in Group B. There was no significant difference in reported pain scores or the number of pain medication doses between the two groups. Early initiation of feedings post-PEG led to a shortened length of hospital stay with no increase in adverse events or reported pain.

The role of the nurse practitioner within the Hospital at Night service.

The Hospital at Night (HaN) service uses a multidisciplinary approach to prioritise the care of acutely ill patients overnight. Nurse practitioners (NPs) play a key role in coordinating this service and provide support to ward-based staff. Despite evidence that HaN can positively impact on patient care, it may be met with scepticism owing to changes in how acutely ill patients are assessed overnight. The aim of this study was to identify the perceptions held by nursing and medical staff on the NP role within HaN. A sample of 46 nurses and 52 doctors in an acute hospital completed questionnaires, which were developed based on components of the nurse practitioner role description. Staff's perceptions were generally similar regarding most role components. However, some variations were identified about components such as patient assessment and teaching. Scheduled education sessions can potentially increase staff awareness of NP roles and improve staff collaboration around patients' care overnight.

Tracheostomy care and management in general wards and community settings: literature review.

AIMS AND OBJECTIVES: To identify current perspectives and areas for research regarding care and management of tracheostomized adult patients discharged to general wards and the community. BACKGROUND: The increased number of tracheostomies being performed has led to more tracheostomized patients being discharged to non-specialized areas. Staff within these diverse areas may care for this patient group on an infrequent basis, and may lack the skills, knowledge and confidence to provide safe tracheostomy care. Although several guidelines and quality improvement initiatives have been developed to guide and improve tracheostomy care, concerns continue to be raised regarding this aspect of care. These factors inadvertently create significant risks for example, tube displacement in addition to the risks associated with procedures such as tracheal suctioning. SEARCH STRATEGY: Database searches of MEDLINE, BRITISH NURSING INDEX and CINAHL (1998-2009). Inclusion criteria was literature regarding tracheostomized adult patients discharged to non-specialized areas. Exclusion criteria was paediatric literature. CONCLUSIONS: Although best practice is applied to the care of tracheostomized adult patients in some areas, including support for ward staff from specialist nurses or teams, this is not always formalized or consistent. Furthermore studies indicate a lack of medical follow-up once the patient is discharged from specialized areas with a tracheostomy. Research is very limited in relation to the care and management of tracheostomized adult patients outside specialized areas, yet there is morbidity and mortality associated with this patient group. Staff education is widely recommended, but further development is needed to determine the best methods of delivering education, especially for health care professionals who care for tracheostomized patients on an infrequent basis. RELEVANCE TO CLINICAL PRACTICE: More tracheostomized patients are being discharged to non-specialized areas, and issues have been raised regarding risks to patients. Research is required to determine the best methods of promoting best practice to improve tracheostomy care.

An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE).

Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice.

Short- and long-term impact of critical illness on relatives: literature review.

AIM: This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. BACKGROUND: Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. DATA SOURCES: The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. SEARCH METHODS: Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'. RESULTS: Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. CONCLUSION: Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.

The quality of written information for parents regarding the management of a febrile convulsion: a randomized controlled trial.

AIMS AND OBJECTIVES: To identify whether providing a new information leaflet for parents regarding the management of a febrile convulsion was more effective in comparison with standard leaflets. BACKGROUND: Although information leaflets are frequently recommended within healthcare, their quality is often poor. Furthermore, the evidence regarding the effectiveness of leaflets is inconsistent. Few studies have evaluated the effects of providing leaflets that have been developed to improve their quality. Within the specialty of paediatrics, parents are often unprepared regarding the management of febrile convulsion at home and the provision of supplementary leaflets is recommended, despite limited evidence regarding the effectiveness of this approach. There is also limited evidence regarding whether improving the quality of these leaflets leads to better outcomes, e.g. increasing parents' behavioural knowledge. DESIGN: Double-blind randomized controlled trial. METHOD: One hundred and twenty-six parents of children hospitalized due to benign febrile convulsion were recruited (May 2000-February 2002). Seventy-one parents were randomized to receive the standard care (control leaflet) and 55 parents received the intervention (new leaflet). Data were collected from parents on discharge immediately prior to receiving the intervention and 7-14 days following the intervention via telephone interview. RESULTS: Parents who received the new leaflet found this to be more reassuring and easier to understand than parents who received the control leaflet. No differences between groups were identified regarding the primary outcome, i.e. behavioural knowledge and most of the secondary outcomes, e.g. perceived confidence, state anxiety and satisfaction with the leaflet. CONCLUSION: Although this study provides modest support for the effectiveness of providing high-quality leaflets, further research is required to determine the best methods for optimizing the effectiveness of leaflets provided at hospital discharge. RELEVANCE TO CLINICAL PRACTICE: The quality of leaflets may influence some outcomes, e.g. understanding and reassurance with the written information provided; however, additional strategies to inform parents may be necessary.

Partnership working between a higher education institution and NHS TRUSTS: developing an acute and critical care module.

The underpinning philosophy of preparing nurses to work within a modern National Health Service (NHS) is to ensure patient safety and quality of clinical care. There is increasing recognition that post-registration education should become more clinically focused and adopt a more work-based approach. Critical to the success of such an approach is partnership working between education providers and NHS Trusts. Changes in the delivery of acute care in the NHS have resulted in an increased number of highly dependent patients in both critical and non-critical care areas. This article describes a partnership approach between a Higher Education Institution (HEI) and two NHS Trusts to deliver a degree level module to address the subsequent educational implications of these changes. This approach ensured module credibility and clinical focus. Student feedback confirms the clinical relevance of the module. Staff from the NHS had the opportunity to develop teaching skills by preparing teaching materials, delivering teaching sessions and receiving feedback on these. Areas of good practice were identified and there was sharing of skills, knowledge and expertise between both institutions. Joint working can enhance clinical relevance of educational provision and ensure consistency between theory and practice. In addition, there were a number of wider benefits to both institutions that resulted from this initiative.

Meeting patient and relatives' information needs upon transfer from an intensive care unit: the development and evaluation of an information booklet.

BACKGROUND: Transfer from the intensive care unit to a ward is associated with a significant degree of relocation stress for patients and relatives. This can be stressful for ward nurses due to the dependency levels of patients and the ensuing increased workload. Furthermore the patient may require care, not normally undertaken in that clinical area, e.g. tracheostomy care. Patients may forget the verbal information given to them at the time of transfer and often have limited or no memory of the intensive care unit experience. This can cause anxiety and compound the feelings of stress associated with transfer. Many patients suffer psychological and physiological problems after intensive care unit, which can affect their recovery and quality of life. AIMS: The aim of the study was to develop an evidence-based information booklet for patients and relatives preparing for transfer from intensive care units. DESIGN: This collaborative study used an exploratory design with elements of the action research cycle. The study, conducted in three phases, involved identifying patients' and relatives' information needs around the time of transfer; designing and developing an information booklet; and the introduction and evaluation of the booklet into practice. METHODS: Semistructured interviews were used to elicit the views of patients and relatives regarding their information needs. Members of the multidisciplinary team were involved in identifying and reviewing booklet content. RESULTS: Evaluation identified positive outcomes relating to patients' and relatives' satisfaction with the information and enhanced communication with other wards and health care professionals. The study also highlighted the need for more staff education in relation to patients and relatives needs when transferring to a ward. CONCLUSIONS: This study has demonstrated the value of providing patients and relatives with written information regarding transfer from intensive care units. Furthermore the study confirmed the feasibility and importance of including patients and relatives in the process of booklet development to ensure that their needs for information are being met. RELEVANCE TO CLINICAL PRACTICE: Providing written information as part of a structured discharge plan is recommended. It provides patients and relatives with a resource that they can refer to at any time and that enhances verbal communication. The purpose of this information is to inform and empower patients so that they are better prepared for the transfer and recovery period.