Sacred cow gone to pasture: a systematic evaluation and integration of evidence-based practice.

BACKGROUND: Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary. PURPOSE: This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP). METHODS: A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, "Sacred Cow: Gone to Pasture," was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers' Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration. RESULTS: Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing. LINKING EVIDENCE TO ACTION: A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings.

Simulation to Train Pediatric ICU Teams in Endotracheal Intubation of Patients with COVID-19.

To prevent transmission of severe acute respiratory syndrome coronavirus 2 to healthcare workers, we must quickly implement workflow modifications in the pediatric intensive care unit (PICU). Our objective was to rapidly train interdisciplinary PICU teams to safely perform endotracheal intubations in children with suspected or confirmed coronavirus disease 2019 using a structured simulation education program. METHODS: We conducted a quality improvement study in a tertiary referral PICU. After developing stakeholder-driven guidelines for modified intubation in this population, we implemented a structured simulation program to train PICU physicians, nurses, and respiratory therapists. We directly observed PICU teams' adherence to the modified intubation process before and after simulation sessions and compared participants' confidence using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale range 0: do not agree to 2: strongly agree regarding statements of confidence). RESULTS: Fifty unique PICU staff members participated in 9 simulation sessions. Observed intubation performance improved, with teams executing a mean of 7.3-8.4 out of 9 recommended practices between simulation attempts (P = 0.024). Before undergoing simulation, PICU staff indicated that overall they did not feel prepared to intubate patients with suspected or confirmed SARS-CoV-2 (mean SET-M score 0.9). After the simulation program, PICU staff confidence improved (mean SET-M score increased from 0.9 to 2, P < 0.001). CONCLUSION: PICU teams' performance and confidence in safely executing a modified endotracheal intubation process for children with suspected or confirmed SARS-CoV-2 infection improved using a rapidly deployed structured simulation education program.

How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List.

Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.