Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey.

BACKGROUND: Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing. AIMS: The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland. METHODS: Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test. RESULTS: Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings. LINKING EVIDENCE TO ACTION: There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Military Nursing Evidence-Based Practice Summit: A Descriptive Analysis of EBP Barriers and Solutions Within the Military Healthcare System.

BACKGROUND: Evidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit. METHODS: A qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team. RESULTS: The study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes. CONCLUSIONS: The results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.

Barreras en la implementación de los resultados de investigación en la práctica / Barriers for the implementation of research outcomes in practice

Objetivo: identificar las barreras para la aplicación de la investigación en la práctica, por parte de académicos y estudiantes universitarios de Enfermería.Métodos: estudio descriptivo transversal. Se incluyeron n= 27 académicos (toda la plantilla eligible) y n= 229 estudiantes de Enfermería seleccionados aleatoriamente. Se administró una cédula de datos sociodemográficos y formativos, y la escala The Barriers, que integra características del profesional, características de la organización, calidad de la investigación, presentación y accesibilidad de la información, y la percepción de que la cantidad de investigación fue “aplastante”. Una mayor puntuación desde 1 a 4 refleja el mayor grado en que cada factor es percibido como una barrera.Resultados: participaron 17 académicos y 229 estudiantes. En el grupo de académicos las barreras mayormente identificadas fueron “La Enfermería no se siente con suficiente autoridad como para cambiar los cuidados al paciente” (media= 3,17; DE= 0,80) y “La Enfermería ve en la investigación pocos beneficios para su actividad profesional” (media= 3,11; DE = 0,85). Mientras que en el de estudiantes fueron “La cantidad de información de investigación es aplastante” (media= 2,36; DE= 1,23) y “Las instalaciones no resultan adecuadas para su implementación”. Los académicos identificaron significativamente más barreras que los estudiantes (p< 0,001) en todos los factores, excepto la calidad de la investigación (p= 0,676).Conclusiones: prevalecieron las barreras para el uso de investigación relacionadas con los factores de características de la organización y de los profesionales, lo cual es congruente con las reportadas por otros estudios realizados en profesionales y/o estudiantes de Enfermería. (AU)

Objective: to identify the barriers for the application of research in practice, by Nursing academics and university students.Methods: a descriptive cross-sectional study, including n=27 academics (all the eligible staff) and n= 229 Nursing students randomly selected. A questionnaire on sociodemographic and training data was administered, and the Barriers scale, which integrates characteristics of the professional, characteristics of the organization, quality of research, presentation and accessibility of information; and the perception that the amount of research is “overwhelming”. A higher score from 1 to 4 shows the higher degree in which each factor is perceived as a barrier.Results: the study included 17 academics and 229 students. In the group of academics, the most identified barriers were: “Nursing staff does not feel they have enough authority in order to change the care for a patient” (mean= 3.17; SD= 0.80) and “The Nursing staff sees limited benefits in research for their professional activity” (mean= 3.11; SD = 0.85). On the other hand, the most identified barriers in the student group were: “The amount of research information is overwhelming” (mean= 2.36; SD= 1.23) and “The premises are not adequate for its implementation”. Academics identified a significantly higher number of barriers than students (p< 0.001) for all factors, except for Quality of research (p= 0.676).Conclusions: there was a prevalence of barriers for the use of research associated with the characteristics of the organization and the professionals, which coincided with those reported by other studies conducted with Nursing professionals and/or students. (AU)

Evaluating the performance of an integrated evidence-based nursing knowledge management (I-EBNKM) platform in real-world clinical environments.

BACKGROUND: For evidence-based knowledge to be applicable in clinical practice, providing support for and the management of knowledge is required to ensure the effective sharing of appropriate expertise across healthcare organizations. Knowledge management platforms can provide a wide range of benefits related to the activation and establishment of evidence-based practice (EBP) in clinical environments. OBJECTIVES: In this study, we developed an integrated evidence-based nursing knowledge management (I-EBNKM) platform and applied it in real-world clinical environments to evaluate its effectiveness. METHODS: We designed an I-EBNKM platform with three main functions: (1) clinical questioning and knowledge linkage, (2) systematic knowledge management, and (3) knowledge communication. After a two-month long application of the I-EBNKM platform in real-world clinical environments, we evaluated the changes in the levels of knowledge in EBP, attitude, practice, confidence in clinical questioning, individual innovative behavior, innovative organizational culture, and organizational knowledge management. The experimental and control groups consisted of 198 nurses, who participated in the study. RESULTS: After applying the I-EBNKM platform, the levels of EBP knowledge and skills (t = 7.16; p <.001), attitude (t = 6.30; p <.001), practice (t = 7.63; p <.001), confidence in clinical questioning (t = 4.57; p <.001), individual innovative behavior (t = 8.72; p <.001), and organizational knowledge management (t = 7.43; p <.001) differed significantly between the experimental group and the control group. CONCLUSION: The results of this study clearly indicate that the I-EBNKM platform we developed has the potential to enhance nurses' involvement in ensuring effective knowledge management in real-world clinical environments. Therefore, the provision of an innovative digital approach ensuring systematic and timely organizational support among nurses is of critical importance.

Care, lead, and inspire: Infusing innovation into nursing research and evidence-based practice course.

BACKGROUND: Today's nursing workforce is expected to know how to identify and understand research methods and procedures and apply the most current evidence into daily practice. However, teaching evidence-based practice (EBP) in an undergraduate nursing curriculum poses unique challenges in overcoming students' perception of content relevancy to their educational experience, but also offers opportunities for innovation to facilitate critical thinking and clinical application. AIMS: The aim of this article is to report on how teaching and learning innovation was infused into a research and evidence-based practice course and the effect on students' perceptions of course values and effectiveness. METHODS: We used a Plan-Do-Study-Act approach to introduce innovation in an undergraduate course within a university setting. Final student course evaluations were used to measure outcomes on a 5-point Likert scale (1 = low and 5 = high) on the following dimensions: (1) value of overall educational experience, (2) relevancy of course content, (3) improvement in critical thinking, and (4) level of student-instructor interaction. RESULTS: Overall course evaluation scores improved greatly from 2.69 to 3.90 between Spring 2020 and Fall 2021. This finding remained relatively consistent across subsequent semesters (3.79 [Spring 2022], 3.84 [Fall 2022]). Students also reported appreciation and increased engagement and interest with the material after transitioning from examinations to a project-based assignment that allowed them to walk through the steps of EBP in class. LINKING EVIDENCE TO ACTION: We identified and implemented several innovative strategies to improve student outcomes and increase the relevance of the course content. These innovations can be easily incorporated at other universities to enhance delivery and student engagement in this content that is essential to advancing quality care in nursing and developing future nurse scientists and practice leaders who care, lead, and inspire.

Use of "The Knowledge-to-Action Framework" for the implementation of evidence-based nursing in child and family care: Study protocol.

Nurses are increasingly focused on a practice based on scientific knowledge. However, it is important to distinguish high-quality evidence that can be applied in practice from studies of low or dubious scientific quality. Therefore, nurses must base their practice on structural support that allows for the definition of personalized and context-specific interventions. The objectives of this study are to identify the main barriers and facilitators to the evidence-based nursing approach and to implement an Evidence-Based Practice model (EBP) in clinical practice settings. We seek to contribute to evidence-based nursing by promoting professional skills in nurses, using "The Knowledge-to-Action Framework" (KTA). The research focuses on a participatory action research methodology based on the cyclical process of the KTA framework, contemplating the creation of knowledge and the implementation of existing solutions or new solutions through an action cycle. The participants will be nurses and parents/caregivers) from a pediatric service in Northern Portugal. The study will be conducted in 3 phases: phase 1 will identify the priority issues by exploring the barriers and facilitators of EBP from the nurses' perspective and assessing the parents'/caregivers' satisfaction with nursing care. Phase 2 will be divided into (a) the planning and (b) the implementation of the KTA model, where we aim to build and validate (a) a training plan and (b) the implementation of the KTA model. Phase 3 is for the evaluation of the model implementation and sustaining knowledge. It is recognized that there is a large gap between knowledge production and the subsequent implementation of interventions based on the best available evidence. However, this reality is complex and involves several levels of decision and intervention that oscillate from the individual responsibility of each nurse to the organizational dimension.

Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial.

INTRODUCTION: Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID. METHODS AND ANALYSIS: Using an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites. ETHICS AND DISSEMINATION: Ethics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman's Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, 'business as usual' ED training schedules and university curricula. TRIAL REGISTRATION NUMBER: ACTRN12621001456842.

How nursing stakeholders in the Republic of Ireland define evidence-based practice and why it matters.

BACKGROUND: Evidence-based practice (EBP) has garnered increasing exposure in professional healthcare discourse over three decades. While the term is used frequently, its interpretation varies widely. An accurate, shared understanding of what EBP means is essential to the achievement of EBP implementation in clinical practice. As part of a national study in the Republic of Ireland, nurses, midwives, educators, and students shared their personal understanding of what EBP was to them. AIM: To establish nurses', midwives', educators', and students' knowledge and understanding of the concept of EBP in the Republic of Ireland. METHODS: In a national study exploring EBP beliefs, implementation, and organizational readiness for EBP among nurses, midwives, educators, and students, an open-ended question invited participants to explain what EBP is, in their own words. Content analysis was used to interpret participants' responses. RESULTS: Five themes emerged from the data from the single open-ended question: (1) varying definitions of EBP, (2) best practice, (3) nurses' and midwives' role in EBP, (4) knowledge, and (5) barriers and facilitators of EBP. The dominant finding centered on the substantial conflation of EBP with research utilization and other concepts such as quality improvement. LINKING EVIDENCE TO ACTION: Poor knowledge and understanding of EBP is a fundamental challenge to EBP implementation. Conflation of EBP with research utilization and other healthcare concepts is not uncommon among nurses and midwives globally and has persisted for some time. This has the potential to hinder the advancement of EBP in nursing and midwifery and, therefore, measures to enhance EBP knowledge and promote EBP implementation are key. Professional regulating bodies, educators, and clinical and educational organizations all have a role to play. The findings from this aspect of this national study offer a realistic, context-specific starting point for tailored educational interventions for clinicians, educators, and students and identify professional and organizational strategies that promote EBP as the expectation and "the way things are done here."

Medical-surgical nurses' EBP beliefs and competencies.

BACKGROUND: The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies. AIMS: The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies. METHOD: A descriptive, cross-sectional design employing survey methodology was used. RESULTS: A total of 1,709 medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2 EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p = .001) or Pathway to Excellence (p = .006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001). LINKING EVIDENCE TO ACTION: Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.

Seeking to Understand: Qualitative Research on Sustainability of Evidence-Based Practice in Acute Care.

OBJECTIVE: The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting. BACKGROUND: There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes. METHODS: A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT). RESULTS: Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care. CONCLUSIONS: Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.

Engaging advanced practice nurses in evidence-based practice: An e-mentoring program.

BACKGROUND: Mentoring is highly valued in the nursing profession and essential to building an evidence-based practice (EBP) culture. However, many organizations have a limited number of EBP mentors, who have limited non-clinical time to engage in mentoring. AIMS: This project aimed to test whether an e-mentoring approach to nursing inquiry could enhance EBP beliefs (EBPB), increase EBP Implementation (EBPI), and improve Organizational Culture and Readiness for System-Wide Implementation of EBP (OCRSIEP). METHODS: A pre-experimental pilot intervention project was implemented utilizing a pretest-posttest design with Advanced Practice Registered Nurses' (APRNs) in clinical practice. The OCRSIEP, EBPB, and EBPI scales were used to measure organizational readiness for EBP implementation, individual beliefs regarding the value of EBP, and the extent to which nurses integrate scientific evidence into their clinical practice, respectively. The Wilcoxon-Signed Rank test was used to analyze the difference between pretest and posttest scores of an EBP E-mentoring program. A post-hoc analysis was performed to calculate effect sizes. [Correction added on 13 May 2022, after first online publication: The Methods section was revised to add additional details.] RESULTS: Eleven APRNs completed the pretest and posttest surveys. When comparing the pre-and post-intervention scores, the median EBPB scores increased from 61 (IQR: 56-69) to 70 (IQR: 64-73), median EBPI scores increased from 13 (IQR: 7-33) to 20 (IQR: 13-31), and median OCRSIEP scores increased from 88 (IQR: 73-97) to 99 (IQR: 90-113). LINKING EVIDENCE TO ACTION: A 12-week Nurse Inquiry E-mentoring Program can leverage the small number of EBP mentors in an organization to improve EBPB. A program lasting longer in duration may also significantly improve EBPI and OCRSIEP scores. By utilizing technology and leveraging economies of scale, exponentially more nurses can be mentored to create and enhance an EBP culture.

Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study.

Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor's or master's degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.

Evaluating Evidences of Effectiveness in Web-Based Nursing Education Program.

BACKGROUND: Web-based education programs are essential in every field of learning, and in nursing coursework, they can contribute towards behavioral development. It is found that emerging approach of web-based nursing programs is overpowering the traditional education methods and provides flexibility in learning and training programs. Therefore, it is considered as a promising medium of learning which can take over the traditional methods because of its effectiveness. OBJECTIVE: A systematic review and meta-analysis was performed for analysis of efficiency and effectiveness of web-based nursing education. This study is aimed at evaluating the evidences which evaluate the effectiveness of the web-based nursing education programs. Material and Methods. Studies were selected from 2008 to 2020 available from various global databases like PubMed, Embase, CINAHL, ProQuest, and Cochrane Library. RESULTS: Five studies were selected for analysis where the results demonstrated no significant difference in the effectiveness of use of web-based nursing educational programs. CONCLUSION: More evidences are required for supporting the efficiency and effectiveness of use of web-based programs for nursing education. Hence, more research is required for evaluating the length of nursing education, evaluating practice-based clinical aspects like success ratio for outcomes of study, type of patients handled, and severity of cases handled for better outcomes.

Analysis of Nursing Effect of Children with Henoch-Schonlein Purpura Based on the PDCA Nursing Model.

By applying the PDCA model to the care of children with Henoch-Schonlein purpura, the nursing process can be divided into four stages: planning, execution, inspection, and treatment. According to the age characteristics and disease progression of pediatric patients, a complete nursing plan is formulated to efficiently implement the nursing content and improve the nursing effect. This paper studies the application of the PDCA nursing model in the nursing of children with Henoch-Schonlein purpura and statistically analyzes the disappearance of skin rash, joint pain relief, disappearance of urine protein, disappearance of gastrointestinal symptoms, etc. Finally, this paper combines the experiment to evaluate the intervention effect of this nursing model and provides reference for the follow-up care of children with Henoch-Schonlein purpura. From the results of experimental research, it can be known that PDCA nursing can improve the comfort of children with Henoch-Schonlein purpura, shorten the time for symptom disappearance, and speed up the recovery process.

Evidencia científica sobre la aplicabilidad del ácido ascórbico en lesiones cutáneas / Scientific Evidence regarding the Applicability of Ascorbic Acid against Skin Lesions

Introducción: Las lesiones cutáneas se caracterizan por la ruptura de la continuidad del tegumento que resulta de varios factores. Así, la atención médica de las personas con lesiones cutáneas debe ser multidimensional e interdisciplinaria entre los profesionales de la salud. Una de las alternativas terapéuticas que viene ganando espacio en el tratamiento de pacientes con lesiones cutáneas es el uso de productos naturales, como el ácido ascórbico. Objetivo: Analizar la mejor evidencia científica sobre el uso del ácido ascórbico como método terapéutico en lesiones cutáneas. Métodos: Revisión sistemática, donde se buscaron estudios en las bases de datos Pubmed, Scopus, Cinahl, Web of Science y The Cochrane Data Base, con investigación dirigida a la aplicabilidad del ácido ascórbico en las lesiones de la piel. Los estudios se analizaron de forma pareada y se clasificaron con respecto a su mejor evidencia científica. Conclusión: Después de analizar los ensayos clínicos, que presentaron solidez científica, se notó que hay un fomento de la contribución del ácido ascórbico a la curación, ya que disminuye el proceso inflamatorio y conduce a la neovascularización, la concentración de macrófagos y la concentración de fibroblastos y fibras de colágeno. Entre los estudios analizados, se evidencia que el uso del ácido ascórbico tiene un efecto en el proceso terapéutico en pacientes con lesiones, pero requiere nuevos estudios para complementar esta tesis(AU)

Introduction: Skin lesions are characterized by break in the continuity of tissue resulting from several factors. Therefore, the medical care provided to people with skin lesions must be multidimensional and interdisciplinary. One of the therapeutic alternatives that is increasingly being used for the treatment of patients with skin lesions is the use of natural products, such as ascorbic acid. Objective: To analyze the best scientific evidence on the use of ascorbic acid as a therapeutic method against skin lesions. Methods: Systematic review consisting in search for studies in the databases Pubmed, Scopus, Cinahl, Web of Science and The Cochrane Data Base, with research directed to the applicability of ascorbic acid against skin lesions. The studies were paired and ranked according to their best scientific evidence. Conclusion: After analyzing the clinical trials, which presented scientific solidity, it was noted that there is some promotion of the contribution of ascorbic acid to healing, since it decreases the inflammatory process and leads to neovascularization, to concentration of macrophages, as well as of fibroblasts and collagen fibers. Among the studies analyzed, it is evidenced that the use of ascorbic acid has an effect on the therapeutic process of patients with injuries, but new studies are required to complement this thesis(AU)

Educational Theory and Cognitive Science: Practical Principles to Improve Patient Education.

There can be multiple barriers to implementation of patient education, yet there are also multiple modalities and opportunities for engaging patients. Using frameworks and evidence from multiple disciplines can inform nursing design of patient education approaches. This article provides an introduction to educational theory and cognitive science principles such as constructivism, metacognition, deliberate practice, and cognitive load for consideration in improving the effectiveness and outcomes of patient education.

Nursing Simulation Debriefing: Useful Tools.

The value of simulation-based education can be lost without a structured and purposeful guided debrief where nursing students and health care professionals are able to think critically and reflect on the experiential learning. Debriefing enhances peer-to-peer learning and aids the nursing student in formulating best practice for the next time when this encounter may occur in the clinical setting. Debriefing should be led by a trained facilitator using evidence-based methods to ensure a safe learning environment for nursing students. Debriefing is an essential learning tool that should be considered for application in the classroom, clinical, and laboratory settings.

Effect assessment of the application value of evidence-based nursing intervention in operating room nursing: A protocol for a systematic review and meta-analysis.

BACKGROUND: The advantages of evidence-based nursing (EBN) intervention in health care settings have been widely disseminated to nurses throughout the world. More researches are reporting the effectiveness of EBN intervention in operating room nursing. However, the results are inconsistent. This study focuses on conducting a meta-analysis and systematic evaluation aimed at determining the usefulness of EBN intervention in operating room nursing. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols criteria were used to write this paper. We will look for relevant studies from 2 Chinese databases (China National Knowledge Infrastructure and Wanfang database and also from 3 English databases such as Web of Science, Cochrane Library, PubMed, and EMBASE), to locate all relevant randomized controlled trials and observational studies assessing the application value of EBN intervention in operating room nursing from their commencement to June 2021. Separately, 2 authors will choose the studies, do the data extract and conduct the assessment probing into the likelihood of bias. If there is a disagreement, it will be resolved by the third author. RevMan 5.3 software and Stata 15.0 software will be used to conduct the meta-analysis. RESULTS: The usefulness of EBN intervention in operating room nursing will be assessed in this study. CONCLUSION: The purpose of this research is to conclude the value of EBN intervention in operating room nursing and the quality of current data. ETHICS AND DISSEMINATION: Since there is no requirement for data on the individual patient, hence there will be no need for ethical approval. OSF NUMBER: DOI 10.17605/OSF.IO/MSXNF.

Eliminating Hospital-Acquired Pressure Injuries Caused by Graduated Compression Stockings.

PURPOSE: The purpose of this evidence-based practice project was to reduce the incidence of pressure injuries (PIs) from the use of graduated compression stockings in patients on a gastrointestinal (GI) sarcoma surgery unit. Before this project, the standard of care for preventing deep vein thrombosis (DVT) included the use of graduated compression stockings, anticoagulation therapy, and intermittent pneumatic compression devices. We sought to examine the impact on PI and DVT risk of using only anticoagulation therapy and intermittent pneumatic compression devices. METHODS: The pilot phase of the project began in June 2017 when nurses on the GI sarcoma surgery unit initiated a practice change in which graduated compression stockings were removed during the 7 AM shift change and put back on the patient before bedtime. Data on the incidence of DVTs and PIs were already being collected in our institution's electronic health record and safety intelligence reporting system. The project team monitored the incidence of PIs and DVTs throughout the project. After the pilot project concluded in August 2017, the GI sarcoma surgery unit staff continued the practice of taking off graduated compression stockings during the day, until on June 2018 the use of graduated compression stockings was formally discontinued for all surgical patients, both during the day and night. RESULTS: Data collected during the pilot phase revealed that no PIs or DVTs occurred among the 497 study patients on the GI sarcoma surgery unit. From June to October 2017, the unit cared for a total of 856 patients and PI and DVT rates remained at zero. From the start of the pilot project in June 2017 to October 2018 (five months after the discontinuation of graduated compression stockings on all surgical units) the unit cared for 3,141 patients-an average of 174 patients per month-and had a zero rate of PIs and DVTs. CONCLUSIONS: We found that the use of graduated compression stockings confers more risks than benefits for patients. Our findings prompted the discontinuation of graduated compression stockings use in postoperative patients throughout our institution. In the 17 months after the pilot project was initiated, no PIs occurred among patients in the GI sarcoma surgery unit, which also maintained a zero rate of DVTs.

Signos de vida en la morbilidad de la gestante / Signs of life in the morbidity of pregnant women

Para la valoración de las gestantes es indispensable incorporar parámetros que permitan la identificación de alteraciones de parte del personal de enfermería y medicina. Esta valoración en la atención de salud no se realiza en todas las instituciones en las cuales consultan las gestantes, llevarlo a cabo permite detectar a tiempo las alteraciones clínicas que incrementan la morbilidad y la mortalidad materna. El estudio determina las alteraciones en gestantes cuando se aplica la Escala de Alerta Temprana en una institución de alta complejidad en Colombia. MÉTODO: Investigación observacional descriptiva, en 308 gestantes con más de un día de encontrarse en hospitalización y unidad de cuidados especial obstétrico, recolectando información contenida en las historias clínicas digitales y las evaluaciones realizadas por el personal de salud durante el periodo enero a diciembre del 2017, a través de un formato general de condiciones de salud y la escala de alerta temprana en una institución de alta complejidad. RESULTADOS: La edad de las gestantes se encuentra entre 14 y 45 años. El diagnóstico más frecuente de ingreso fue preclampsia con un 38.2% IC95% (32.62-43.98). La mayor frecuencia de alteraciones está en la tensión arterial sistólica con un 70.1% IC95% (50.75-62.07), tensión diastólica 56.5% IC 95% (50.75-62.07) y alteración respiratoria 28.9% IC (23.97-34.36). Se encontró significancia estadística entre la estancia y los antecedentes patológicos con p < 0.03. Los procedimientos de valoración, diagnóstico y registro oportuno por el personal de enfermería y médico son de vital importancia en la detección precoz de la morbilidad materna extrema

For the assessment of pregnant women, it is essential for nursing and medical staff to incorporate parameters to identify alterations in antenatal health status. This health care assessment is not performed by all institutions that provide antenatal care to pregnant women. Performing antenatal health care assessment assists in the early detection of clinical alterations that can increase morbidity and maternal mortality. The study aims to determine the alterations in pregnant women with the application of the Early Warning Scale in a highly complex institution in Colombia. METHOD: This research is observational, descriptive, and was carried out on 308 pregnant women who were hospitalized or admitted in a Special Obstetric Care Unit (SOCU) for more than one day in a highly complex institution. Data contained in digital medical records were collected and evaluations were carried out by healthcare staff between January 2017 and December 2017, by way of an overall format for health conditions and the Early Warning Scale. RESULTS: The age of pregnant women ranged between 14 and 45 years. The most common diagnosis for admission was preeclampsia with 38.2% CI 95% (32.62-43.98). The highest frequency of alterations was found in systolic blood pressure with 70.1% Confidence Interval (CI) 95% (50.75-62.07), diastolic blood pressure 56.5% CI 95%(50.75-62.07), and respiratory distress 28.9% CI (23.97-34.36). Statistical significance was found between hospital stay and pathological history with p < 0.03. Timely assessment, diagnosis, and registration procedures by nurses and medical staff are of vital importance in the early detection of extreme maternal morbidity