The future of nursing science: Consilience in evidence-based practice

@#<p style="text-align: justify;">Nursing science needs to adopt a paradigm that can be used to apply its knowledge. Notably, how nursing science is applied in nursing practice or education remains confusing. This article aims to discuss the pros and cons of the two ways to implement nursing science, that is, evidence-based practice (including translational research and research utilization) and intuitive nursing. Also, I differentiated evidence-based practice (EBP), translational research (TR), and research utilization (RU). I argued that EBP as the paradigm of choice will be the optimal strategy for the future of nursing science. Adopting EBP improves patient, organizational, and staffing outcomes. While basing clinical decisions on intuition alone may imperil patient's safety due to multiple cognitive biases inherent in our intellectual devices. Combining EBP, TR, RU, and intuitive nursing resulted in a model Consilience in Evidence-based Practice. Implications of the model for nursing practice, education, and research were also discussed.</p>

Nurturing the seeds of evidence-based practice: Early ambulation among cardiac surgery patients

Background@#Cardiovascular disorders continue to be the most prevalent cause of morbidity and mortality in the Philippines and worldwide. Surgical treatments used to manage cardiovascular disorders (unfortunately) have multiple complications. As part of the health care team, nurses need to develop interventions that are safe, scientifically grounded, and cost-effective in order to counteract these complications. One of the nursing interventions that can be implemented is early ambulation. @*Aim@#To search, appraise, and synthesize the best evidence surrounding early ambulation among cardiac surgery patients.@*Methods@#This study employed an evidence-based review method suggested by Melnyk and Fineout-Overholt (2005). Systematic literature search was done to the following databases: Cochrane, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Joana Briggs Institute (JBI), MEDLINE, National Guideline Clearinghouse (NGC), and Nursing/Academic edition. Post-operative patients who have undergone coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) are included in this study. The final review also included six articles. @*Results and Discussion@#Findings show that early ambulation among patients who underwent coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) improves patient care outcomes (i.e., reduce complications such back pain, puncture bleeding, and urinary discomfort, improves general well-being, and decrease health care costs). Parameters for early ambulation (ranges from 3 hours to 24 hours) and late ambulation (ranges from 12 hours to 48 hours) are used in the study reviewed. The non-randomized comparative study found that the complication rate in the early ambulation group is not increased compared to the late ambulation group (test for non-inferiority p= 0.002). Randomized controlled trial found out that early ambulation among cardiac surgery patients could reduce back pain (OR=0.19, 95% CI: 0.08-0.45, p<0.001), decrease urinary discomfort (OR=0.35, 95% CI:0.14-0.90, p=0.03) for very or unbearable urinary discomfort, and general-well being (p=0.0005 for vitality scale and p=0.014 for the total general well-being). Furthermore, early ambulation group reported decrease in hospitalization costs (less charge of $105 or Php 5,040).

The effect of psychoeducation for depression: A meta-analysis 2010-2016

@#<p style="text-align: justify;"><strong>BACKGROUND/OBJECTIVE:</strong> Depression is a global mental health problem. Therefore,mental health professionals need to develop interventions that are evidence-based and  cost-effective.  One  of  the  psychosocial  interventions  is  psychoeducation. However, a recent Google search on the effect of psychoeducation for depression suggests conflicting results calling for an analysis of studies to establish psychoeducation  effectiveness.The  goal  of  the  meta-analysis  is  to  examine randomized  controlled  trials (RCTs) overall effectiveness of psychoeducation for depression.<br /><strong>METHODS: </strong>EBSCOhost, PsychINFO, and Science Direct databases were searched using  the  keywords  'psychoeducation,'  'group  psychoeducation,'  'mental  health education,' 'depression,' 'depressive disorder,' and 'dysthymia' with year restriction of  2010-2016.  In  this  meta-analysis,  the  effect  size  (using  Hedges'  g  value),  Q statistics, and I2  were calculated under the random effects model aided by CMA v.3.To test for publication bias, trim-and-fill analysis, and fail-safe N were computed too.<br /><strong>RESULTS:</strong> A total of 1,560 patients from 11 studies were included in this analysis.Post-intervention results had Hedges' g-value of -0.293 (95% CI= -0.552--0.035) of psychoeducation for depression meaning low effect. Although notably, the overall effect size leans towards psychoeducation. The p-value is significant at .05 level,favoring  psychoeducation  (p=0.026).  The  studies  were  also  found  to  be  highly 2 heterogeneous (Q(10) = 55.467, p<.05, I 2 =81.971) under the random effects model, suggesting  high  inconsistency  on  the  studies  included  in  this  meta-analysis.  In testing for publication bias, the imputed effect size using trim-and-fill approach was -0.38558 (95% CI= -0.64926- -0.12189) while the result of fail-safe N suggested that 48 nil or null results would be needed to increase the p-value associated with the average effect above an alpha level of 0.05.<br /><strong>CONCLUSIONS:</strong> This  meta-analysis  may  suggest  that  psychoeducation  has  low effect on depression. Longer and more interactive approach can be done to ensure its long-term and maximal effectiveness. Publication bias is unlikely in this meta-analysis.  The  findings  provide  valuable  information  for  future psychoeducation   to   improve   content,   design,   quality,   and process that will benefit patients with depression.</p>

Wellness within illness: An evolutionary concept analysis

@#<p style="text-align: justify;">The concept of wellness has no single, universal acceptable definition. The situation gives room to developing and refining wellness both as a concept and an experience. This paper aimed to substantiate the concepts surrounding wellness within an illness experience. Beth Rodger's evolutionary method of concept analysis provided the organizing framework for this paper. The data source was a search of literature published from 2010-2016 on CINAHL, Medline, EBSCO, and Google scholar database. Trailing process is organized with particular focus on antecedents, attributes, and consequences.</p> <p style="text-align: justify;">The analysis found four attributes of wellness within illness namely: normalizing, independence, empowerment, and finding meaning strengthened by antecedents such as strong social support, motivation, constructive coping strategies, and cognitive reframing. Subsequently these may lead to adaptation to illness, being well, and living to illness. Looking at wellness and illness in dichotomy may lead to rote deftness thus expansion of the panorama of wellness within an illness experience may lead to more depth on the scientific understanding and varied application. Increased conceptual understanding and knowledge development on wellness will enable nurses in facilitating patient's adaptation during illness.</p>