Implementing the evidence translation-based resilience care model on family caregivers of stroke patients: a best-practice implementation project.

OBJECTIVES: The aim of this project was to promote for the family caregivers of stroke patients the resilience evidence translation care model in the community. INTRODUCTION: Stroke is the main cause of disability among many patients with chronic diseases. Resilience helps family caregivers facing the consequences of adversity and stress to have a positive outcome. METHODS: The study utilized clinical audit strategies under the JBI Practical Application of Clinical Evidence System module. Three audit criteria for the caregivers of stroke patients were considered. A preimplementation audit was conducted with eight nurses and 30 caregivers to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A postimplementation audit was conducted using the same number of samples at 8 weeks for the caregivers to evaluation, and the outcomes using follow-up audit. RESULTS: The three criteria showed an improvement: nurses who received education about resilience care protocols, criterion 1 from 0 to 100%, criterion 2 from 0 to 100%, criterion 3 from 0 to 90%. The results showed that the average resilience of caregivers increased from 17.47 (SD ±â€Š1.94) to 18.33 (SD ±â€Š1.54). The resilience scale of pretest and posttest scores were significantly improved ( P  ≤ 0.001). CONCLUSION: The implementation of best practice for enhancing resilience of the family caregivers of stroke patients on the resilience evidence translation care model: a best practice implementation project in community settings is possible. The results indicate that evidence-based practice is an effective method for enhancing the resilience of family caregivers. The strategies contributed to the success of this project, such as scenario simulation education, Objective Structured Clinical Examination, regular weekly audits, and collaboration with project leaders when carrying out caregiver case discussion during clinical practice.

[The Readiness and Mental Construction of Nurses Caring for Patients With COVID-19: An Example From a Medical Center in Northern Taiwan].

The COVID-19 epidemic continues to spread, and frontline health professionals have unfortunately contracted this virus because of exposure while providing clinical care. Based on the painful experience of the previous SARS epidemic in Taiwan, nurses have adopted a standard of care for infection protection that incorporates early prevention and detection. However, international public health experts remain unable to control the infectivity and variability of the COVID19 virus, which increases the mental stress on frontline nurses when performing care. In this paper, which uses a medical center in the north of Taiwan as an example, JBI clinical guidelines, infection control experience, and nurses' awareness, perceived support, and self-efficacy are applied to suggest ways to improve epidemic prevention and mental construction, enhance nurses' psychological empowerment and refection, promote role identity in nursing and self-value, establish health team awareness, strengthen infection protection concepts, and integrate infection control concepts into the nursing models to develop effective standard operating procedures for epidemic prevention management and effectively prevent the spread of the virus and maintain public health.

Prevention and treatment of oral mucositis among cancer patients in the hematology-oncology setting: a best practice implementation project.

INTRODUCTION: Oral mucositis refers to mucosal damage and occurs in the oral, pharyngeal, and laryngeal cavities. When patients with cancer get oral mucositis, the painful condition can cause difficulties in eating, drinking, and swallowing and may compromise the patient's nutritional status. It also may be drastically associated with infections, resulting in longer hospitalizations. OBJECTIVES: The aim of this project was to promote best practices related to oral mucositis prevention and treatment for patients in the hematology-oncology setting. METHODS: This implementation project was conducted in the hematology-oncology setting at a medical center in Taiwan. The current project adopted the clinical audit methodology and integrated Lewin's Change Theory, using the JBI Practical Application of Clinical Evidence System software. Seven audit criteria that represented best practice recommendations for prevention and treatment of mucositis were used. A preimplementation audit was conducted with 30 nurses and 30 patients to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A post implementation audit was conducted with 50 nurses and 50 patients at 4 months after implementing the best practice recommendations for mucositis to determine long-term compliance. RESULTS: The seven criteria showed an improvement: nurses who received education about oral care protocols increased from 40 to 100%, patients who received education about oral care protocols increased from 23 to 98%, and patients who followed oral hygiene care protocols, including brushing of teeth, increased from 27 to 96%. There were small improvements in the following criteria: compliance with ongoing assessment of the oral cavity increased from 97 to 100%, nurses who conducted an oral pain assessment increased from 97 to 98%, and patients who followed the therapeutic oral care regimens increased from 88 to 100%. However, nurses who conducted initial assessment of the oral cavity remained at 96%. CONCLUSION: The implementation of best practice for enhancing prevention and treatment of oral mucositis for cancer patients in four hematology-oncology settings is possible. Lewin's Change Theory underpinned the project, which integrated blended learning strategies and communication skills which contributed to the success of this implementation project.

Prevention of catheter-associated urinary tract infection in neurological post-operation patients: a best practice implementation project.

OBJECTIVE: The objective of this evidence based implementation project was to promote evidence based practice in the prevention of catheter-associated urinary tract infection (CAUTI) in the neurology and neurosurgery units of a Taipei hospital. INTRODUCTION: Catheter-associated urinary tract infection has been associated with increased morbidity, mortality, hospital costs and length of stay. Urinary drainage systems are often reservoirs of infection in patients, thus effective prevention of CAUTI requires an evidence-based approach. The CAUTI incidence in the neurosurgery units of the hospital was 1.86-2.69% urinary catheter days, which ranked as medium when compared to the entire hospital. METHOD: A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool, based on eight audit criteria that represented best practice recommendations for CAUTI. A baseline audit of the neurology and neurosurgery units was performed, followed by the implementation of multiple strategies throughout a 20-week period. A follow-up audit was undertaken after this to assess changes in practice. RESULTS: The post strategy implementation audit results indicated that compliance with clinical guideline recommendations improved considerably. Proper utilization of an appropriate closed drainage system and training of persons maintaining catheters achieved 100% compliance. The guideline recommendation that catheter and drainage bags be changed only when clinically indicated reached 94% compliance. Catheters removed within 24 hours postoperatively improved by more than 50% compliance. Compliance with systemic antimicrobials being clinically indicated and their use justified improved by 25% and documentation on a clinically appropriate indication for ongoing urinary catheterization improved by almost 33.3%. CONCLUSIONS: The implementation project was successful in improving nurses' knowledge and skills related to the prevention of CAUTI. A variety of strategies, such as an education program, simple and clear instruments, collaboration with physicians in caring for patients with a high risk of CAUTI, and multiple educational materials can facilitate implementation of evidence based procedures in clinical practice.