ABSTRACT
The Clinical Scholar Model serves as an effective framework for investigating and implementing evidence-based practice (EBP) changes by direct care providers. The model guides one in identifying problems and issues, key stakeholders, and the need for practice changes. It provides a framework to critique and synthesize the external and internal evidence. Three EBP projects conducted at a large tertiary care facility in northern New England illustrate the process of using the Clinical Scholar Model.
Subject(s)
Clinical Competence , Diffusion of Innovation , Evidence-Based Nursing/organization & administration , Models, Nursing , Nursing Research/organization & administration , Nursing Staff, Hospital/organization & administration , Bed Rest/nursing , Cardiac Catheterization/adverse effects , Cardiac Surgical Procedures/adverse effects , Education, Nursing, Continuing/organization & administration , Evidence-Based Nursing/education , Humans , Hyperglycemia/etiology , Hyperglycemia/prevention & control , Maine , Nurse's Role , Nursing Research/education , Nursing Staff, Hospital/education , Organizational Innovation , Outcome Assessment, Health Care , Point-of-Care Systems/organization & administration , Postoperative Care/methods , Postoperative Care/nursing , Postoperative Nausea and Vomiting/etiology , Postoperative Nausea and Vomiting/prevention & control , Research Design , Time FactorsABSTRACT
AIM: To discuss the development of a new nursing role in response to the health care crisis in the United States. BACKGROUND: The nursing shortage and fragmentation of care has contributed to the need for nurses who are prepared to laterally integrate care, bring evidence-based practice to the bedside and provide continuity of care to patients and families. EVALUATION: The CNLs review the literature, share their experiences, and discuss outcomes related to improved quality of care. KEY ISSUES: Having clinical nurses with a global perspective acting as facilitators and integrators of care is essential to maintaining a high standard of care. Organizational and management support is critical. The more CNLs that can be embedded in an institution, the more successful the role can be. CONCLUSIONS: The varied utilization of the CNLs in this practice setting has proven its value in a short period of time and facilitated better communication and collaboration among patients and their health care team. IMPLICATIONS FOR NURSING MANAGEMENT: The flexibility and broad scope of this role allows for its use in any practice setting to realize gains in quality outcomes, cost savings, improved patient flow, increased safety, nurse satisfaction and increasing organizational capacity.
Subject(s)
Leadership , Nurse Administrators/trends , Nurse's Role , Nursing, Supervisory/organization & administration , Humans , Nursing, Supervisory/trends , Program Evaluation , United StatesABSTRACT
OBJECTIVE: To demonstrate the multidisciplinary interactions and tools required to effect changes in the processes of care to achieve tight glycemic control (TGC) and reduce deep sternal wound infection (DSWI) rates in patients undergoing cardiac surgery. DESIGN: A retrospective cohort analysis comparing the rate of DSWI before and after implementing a multidisciplinary TGC initiative. SETTING: A cardiac surgical program in a tertiary care community hospital in New England. PATIENTS: A total of 3065 consecutive adult patients undergoing cardiac surgery who were operated on between January 1, 2004, and December 31, 2006. INTERVENTIONS: Evidence demonstrating the relationship between hyperglycemia and DSWI was presented to the multidisciplinary group caring for patients undergoing cardiac surgery. In addition, special emphasis was placed on nursing feedback and in-service training. A cumbersome glycemic management text protocol was replaced with a novel color-coded bedside tool (nomogram) to guide the bedside management of hyperglycemia. Subsequently, an algorithm for the transition to a home regimen was developed, which further improved standardization of care and ease of management. MAIN OUTCOME MEASURES: Hourly blood glucose level monitoring and the incidence of DSWI. RESULTS: Eighteen months after the new program was initiated, the DSWI rate decreased by more than 60% from 2.6% to 1.0%, when compared with the preceding 18 months (P < .001). CONCLUSION: A TGC program using a novel tool in a multidisciplinary setting was successfully and safely established, resulting in sustained improvement in the DSWI rate.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Hyperglycemia/prevention & control , Hypoglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Surgical Wound Infection/prevention & control , Adult , Algorithms , Blood Glucose/metabolism , Cohort Studies , Humans , Hyperglycemia/diagnosis , Hyperglycemia/etiology , Hypoglycemia/diagnosis , Hypoglycemia/etiology , Infusions, Parenteral , Nomograms , Retrospective Studies , Sternum , Surgical Wound Infection/etiology , Surgical Wound Infection/metabolismABSTRACT
Approximately 150 million peripheral intravenous (PIV) catheters are inserted annually in the United States, with a 5% incidence rate of phlebitis as an acceptable benchmark. In 2002, the Centers for Disease Control and Prevention recommended that PIV sites and administration sets be changed at least every 96 hours, yet clinical practice supported that at least 25% of PIV catheters showed no signs of phlebitis at 96 hours' dwell time. This study reports the assessment results of 850 PIV catheters over the indwelling life of the catheter, using the Visual Infusion Phlebitis scale as the measure determining when a PIV should be removed.
