Systematic Review: Bridging the Gap in RPN-to-RN Transitions.

PURPOSE: To review the evidence examining the influences of successful education and professional role transition for registered practical nurses (RPNs) pursuing a baccalaureate degree in nursing (BScN) and registered nurse (RN) licensure through RPN-to-RN bridging programs. DESIGN: Systematic review of papers published between 1995 and 2014 that evaluated students' education and professional role transitions from RPN to RN. METHODS: Thirty-nine papers were selected that observed or studied the change or transition in designation from RPN to RN, or its equivalent, through bridging programs and analyzed thematically according to Meleis, Sawyer, Im, Hilfinger Messias, and Schumacher's transition model. FINDINGS: Personal, community, and social conditions related to preparation for entry, program enrolment, and postgraduate clinical integration influence successful education and professional role transitions for RPN-to-RN bridging students. CONCLUSIONS: Providing key transition supports may enhance the potential for successful student transition into and throughout a bridging program, but further research is necessary to enhance this understanding and to recommend best practices for optimizing students' success. CLINICAL RELEVANCE: The evidence from this review identifies facilitators and barriers to successful education and professional role transition for RPN-to-RN bridging students, and identifies important considerations for future research.

Care transitions: a systematic review of best practices.

This article reports results from a systematic review used to inform the development of a best practice guideline to assist nurses in understanding their roles and responsibilities in promoting safe and effective client care transitions. A care transition is a set of actions designed to ensure safe and effective coordination and continuity of care as clients experience a change in health status, care needs, health care providers, or location.

A systematic review of the effectiveness of advanced practice nurses in long-term care.

AIM: To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long-term care residential settings. BACKGROUND: Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted. DESIGN: Quantitative systematic review. DATA SOURCES: Twelve electronic databases were searched (1966-2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group. REVIEW METHODS: Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria. RESULTS: Four prospective studies conducted in the USA and reported in 15 papers were included. Long-term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services. CONCLUSION: Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long-term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.

CREB downregulation in vascular disease: a common response to cardiovascular risk.

OBJECTIVE: To examine the impact of low-density lipoprotein (LDL), an established mediator of atherosclerosis, on the transcription factor cAMP-response element-binding protein (CREB), which is a regulator of vascular smooth muscle cell (VSMC) quiescence. METHODS AND RESULTS: VSMC CREB content is diminished in rodent models of diabetes and pulmonary hypertension. We examined aortic CREB content in rodent models of aging, hypertension, and insulin resistance, and we determined nuclear CREB protein in the medial VSMC of high-fat-fed LDL receptor-null mice. There was significant loss of CREB protein in all models. In vitro, primary culture rat aortic VSMC exposed to LDL and oxidized LDL exhibited a rapid, transient increase in CREB phosphorylation and transient phosphorylation/activation of Akt, ERK, JNK, ans p38 MAPK. Exposure to oxidized LDL, but not to LDL, for 24 to 48 hours decreased CREB protein in a dose-dependent fashion and led to nuclear exclusion of CREB. Pharmacological reactive oxygen species scavengers and inhibition of ERK activation blocked oxidized LDL-mediated CREB downregulation. CONCLUSIONS: These data support a model wherein loss of VSMC CREB protein, which renders these cells more susceptible to activation and apoptosis, is a common pathological response to vascular injury and potentially contributes to plaque progression.

Inactivity and Its Associated Factors in Adults Scheduled for Noncardiac Surgery: The PAMP Phase I Study.

PURPOSE: The aim of this study was to determine the prevalence of physical inactivity and its associated factors in adult patients admitted to hospital for noncardiac surgery. DESIGN: Cross-sectional study. METHODS: Five hundred able-bodied patients (age ≥45 years) admitted to hospital, also participants in the VISION study, were recruited before noncardiac surgery. The physical activity level (PAL) was assessed with the International Physical of Activity Questionnaire. Logistic regression analysis was conducted to determine the associations between a number of predetermined factors and physical inactivity. FINDINGS: Overall, 59.8% were inactive. Factors associated with inactivity included age, assistance with activities of daily living, and insulin-dependent diabetes. CONCLUSION: A substantial number of patients scheduled for noncardiac surgery are inactive. Elderly patients, those needing assistance, and those with long-lasting diabetes may benefit from PAL assessment before surgery. CLINICAL RELEVANCE: Healthcare providers should identify PALs and monitor for known risk factors to prepare patients for surgical procedures.

A systematic review of the cost-effectiveness of nurse practitioners and clinical nurse specialists: what is the quality of the evidence?

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n = 11), NP-transition (n = 5), NP-inpatient (n = 2), CNS-outpatient (n = 11), CNS-transition (n = 13), and CNS-inpatient (n = 1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

Impaired response to exercise intervention in the vasculature in metabolic syndrome.

Physical activity decreases risk for diabetes and cardiovascular disease morbidity and mortality; however, the specific impact of exercise on the diabetic vasculature is unexamined. We hypothesized that an acute, moderate exercise intervention in diabetic and hypertensive rats would induce mitochondrial biogenesis and mitochondrial antioxidant defence to improve vascular resilience. SHHF/Mcc-fa(cp) lean (hypertensive) and obese (hypertensive, insulin resistant), as well as Sprague Dawley (SD) control rats were run on a treadmill for 8 days. In aortic lysates from SD rats, we observed a significant increase in subunit proteins from oxidative phosphorylation (OxPhos) complexes I-III, with no changes in the lean or obese SHHF rats. Exercise also increased the expression of mitochondrial antioxidant defence uncoupling protein 3 (UCP3) (p < 0.05) in SHHF lean rats, whereas no changes were observed in the SD or SHHF obese rats with exercise. We evaluated upstream signalling pathways for mitochondrial biogenesis, and only peroxisome proliferators-activated receptor gamma coactivator 1α (PGC-1α) significantly decreased in SHHF lean rats (p < 0.05) with exercise. In these experiments, we demonstrate absent mitochondrial induction with exercise exposure in models of chronic vascular disease. These findings suggest that chronic vascular stress results in decreased sensitivity of vasculature to the adaptive mitochondrial responses normally induced by exercise.

Measuring the quality of evidence-based nursing care: NQuIRE - nursing quality indicators for reporting and evaluation data-system / Midiendo la calidad del cuidado de enfermería basado en la evidencia: NQuIRE: sistema de indicadores de calidad en enfermería para reportar y evaluar / Avaliando a qualidade dos cuidados de enfermagem baseada em evidências: NQuIRE: sistema de indicadores de qualidade na enfermagem para referenciar e avaliar

Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) is an international quality improvement initiative to develop and sustain a data-system of nursing-sensitive quality indicators derived from recommendations within the Registered Nurses’ Association of Ontario’s evidence-based best practice guidelines. Objective: The purpose of this article is to provide an overview of the indicator database within the context of the Registered Nurses’ Association of Ontario’s best practice guideline program and Best Practice Spotlight Organization® Designation. Future directions for technical enhancements, quality indicator development and research within the database will also be discussed. Topic: Nursing Quality Indicators for Reporting and Evaluation consists of a database, a data dictionary, including a set of organization-level structural indicators, as well as a set of process and outcome indicators for each best practice guideline, and data collection and reporting processes. Conclusions: The data-system collects, analyzes and reports quality indicator data submitted by health-care service and academic organizations participating in the Registered Nurses’ Association of Ontario’s Best Practice Spotlight Organization® Designation.

El sistema de indicadores de calidad en enfermería para reportar y evaluar (NQuIRE) es una iniciativa internacional de mejoramiento de la calidad para desarrollar y sostener un sistema de datos de indicadores de calidad de enfermería derivados de las recomendaciones de guías de buenas prácticas basadas en la evidencia de la Asociación de Enfermeras Profesionales de Ontario. Objetivo: El propósito de este artículo es ofrecer un panorama de la base de datos de indicadores dentro del contexto del programa de guías de buenas prácticas de enfermería de la Asociación de Enfermeras Profesionales de Ontario y el programa de centros comprometidos con la Excelencia en Cuidados. Futuras directrices para el mejoramiento técnico, desarrollo e investigación de los indicadores de calidad en la base de datos también serán discutidos. Desarrollo del tema: El Sistema de Indicadores de Calidad en Enfermería para Reportar y Evaluar consta de una base de datos, un diccionario de datos que incluye un conjunto de indicadores estructurales a nivel de la organización, además de un conjunto de indicadores de procesos y resultados para cada guía de mejores prácticas, y procesos de recopilación y reporte de datos. Conclusiones: El sistema de datos recopila, analiza e informa los datos sobre indicadores de calidad presentados por las organizaciones académicas y de servicio de atención médica que participan en el programa de designación como Centro Comprometido con la Excelencia en Cuidados de la Organización de Enfermeras Profesionales de Ontario.

O Sistema de Indicadores da Avaliação de Qualidade na Enfermagem é uma iniciativa internacional de melhoria na qualidade para promover e manter um sistema de dados de indicadores de qualidade na enfermagem decorrentes das recomendações de diretrizes de melhores práticas baseadas em evidências da Associação das Enfermeiras Profissionais de Ontario, no Canadá*. Objetivo: O objetivo deste artigo é fornecer uma visão geral do banco de dados de indicadores no contexto do Programa das Guias* de Boas Práticas na Enfermagem da Associação de Enfermeiras Profissionais de Ontario e o Programa dos Centros Comprometidos com a Excelência nos Cuidados. Orientações futuras para o aprimoramento técnico, pesquisa e desenvolvimento de indicadores de qualidade no banco de dados, também serão discutidos. Temas: O sistema de indicadores de Qualidade na Enfermagem para o Relatório e Avaliação conta com um banco de dados, um dicionário de dados que inclui um conjunto de indicadores estruturais próprio da organização, juntamente com um conjunto de indicadores de processos e resultados para cada guia de melhores práticas, e processos recopilados e dados relatados. Conclusões: O sistema de dados recolhe, analisa e informa os indicadores de qualidade apresentados pelas organizações acadêmicas e os serviços médicos escolhidos como Centros Comprometidos com a Excelência nos Cuidados da Organização de Enfermeiras Profissionais de Ontario.

Leading quality improvement through best practice guideline development, implementation, and measurement science / Liderando mejoras de qualidad el desarrollo, implementación, y medición de las guias de buenas práticas de enfermeria / Liderando com melhor qualidade por meio da elaboraçãp, implementação e avaliação de guias de boas práticas na enfermagem

The quest for evidence-based practice has spurred action by a number of groups worldwide to develop knowledge tools. However, the uptake of knowledge and implementation of clinical practice guidelines in any practice setting requires more than just the awareness and distribution of rigorously developed guidelines. Objective: The objective of this article is to share successful implementation strategies developed by the Best Practice Guideline Program of the Registered Nurses’ Association of Ontario (RNAO), that ensure practitioners are fully aware of the best available knowledge and have adequate supports to translate clinical practice guideline recommendations into their day to day practice. Topics: Details of RNAO’s seven stage process of sound guideline development are provided and RNAO’s Best Practice Spotlight Organization Designation is highlighted as a top implementation strategy that enables organizations to partner with RNAO to implement multiple RNAO Best Practice Guidelines using a systematic planned approach and full participation of staff, with a focus on quality improvement and evaluation. The BPSO Designation is informed by implementation science and is rapidly gaining international acclaim for its effectiveness in creating high levels of nurse and other health provider engagement in quality care, evidence-based practice cultures, and improved health outcomes. Conclusions: Through its leading work in rigorous guideline development, implementation and evaluation, RNAO is successfully transforming nursing practice thorough knowledge on a global scale. (au)

La busqueda de prácticas basadas en la evidencia ha estimulado acciones por parte de un número de grupos a nivel mundial para desarrollar herramientas de conocimiento. Sin embargo, la absorción de conocimiento y la implementación de guias de practica clinica en cualquier ambiente clínico requieren más que la concientización y distribución de guias desarrolladas rigurosamente. Objetivo: El objetivo de este artículo es compartir la implementación de estrategias exitosas desarrolladas por el Programa de Guas de Buenas Practicas en Enfermeria de la Asociación de Enfermeras Profesionales de Ontario (RNAO, por sus siglas en ingles), la cual asegura que sus practicantes estén completamente consientes del mejor conocimiento disponible y que tengan el adecuado soporte para transferir las recomendaciones de guías de buenas prácticas clínicas a su práctica diaria. Temas de reflexión: Los detalles del proceso de siete etapas de la RNAO de desarrollo de la guía y el Programa de Directrices sobre las Mejores Prácticas de la RNAO son proporcionadas y resaltadas como estrategias de implementación que permite a las organizaciones asociarse con la RNAO para implementar múltiples guías de buenas prácticas usando un método sistemático planeado y una activa participación del personal, con énfasis en mejoras de calidad y evaluación. El Programa de Directrices sobre las Mejores Prácticas es informado por la ciencia de implementación y esta rápidamente ganando aclamación internacional por su eficiencia en crear altos niveles de cuidado de enfermeria y calidad en el cuidado que las instituciones sanitarias ofrecen, así como mejoramiento y mejores resultados en las practicas basadas en la evidencia. Conclusiones: A través de su labor de liderazgo en el desarrollo, la implementación y la evaluación rigurosa de las guías, la RNAO esta exitosamente transformando las prácticas de enfermería mediante el conocimiento a escala mundial.

O movimento de praticas baseadas na evidência, associado à enfermagem, tem estimulado ações em nível mundial para desenvolver ferramentas de conhecimento. Contudo, assimilar o conhecimento e implementar as diretrizes na pratica clيnica em qualquer ambiente clيnico requer mais do que conscientização e distribuição de guias de orientação desenvolvidas com rigor. Objetivo: O objetivo deste artigo é partilhar a implementação de estratégias bem-sucedidas desenvolvidas pelo Programa de Guias para a Boa Pratica na Enfermagem, da Associação de Enfermeiras de Ontario, (Canada) (RNAO, segundo sua sigla em Inglês), que assegura aos praticantes maior consciência sobre os melhores conhecimentos disponíveis fazendo-os realidade em sua pratica cotidiana, jل que as guias ou manuais de boas praticas baseadas em evidências constituem uma abordagem que possibilita melhorias da qualidade da assistência à saúde. Tَpicos: Os detalhes do processo das sete etapas do desenvolvimento RNAO de Orientação e Diretrizes do Programa de Melhores Praticas RNAO são oferecidas e destacadas como estratégias de implementação que permitem às organizações associadas com RNAO implementar diversas guias ou manuais de boas praticas através de um planejamento sistemático e da participação ativa, com ênfase na avaliação e melhoria da qualidade e da assistência à saْde permanentemente. O Programa das Diretrizes de Melhores Praticas é informado pela ciência da implementação e esta ganhando rápido reconhecimento internacional pela sua eficiência na criação de alto nível nos cuidados da enfermagem e da qualidade nos cuidados que as instituições de saúde oferecem, igualmente pela sua melhoria continua e aprimoramento dos resultados das praticas baseadas em evidências. Conclusões: através do seu protagonismo e liderança no desenvolvimento, implementação e avaliação rigorosa das guias, o RNAO esta transformando exitosamente a pratica da enfermagem, através do seu conhecimento e divulgação mundial. (au)