ABSTRACT
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 (SDâ±â1.94) to 18.33 (SDâ±â1.54). The resilience scale of pretest and posttest scores were significantly improved ( P â≤â0.001). 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.
Subject(s)
Caregivers , Stroke , Humans , Evidence-Based Practice , Clinical AuditABSTRACT
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 24âhours 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.
