Strategic planning for research use in nursing practice.

BACKGROUND/OBJECTIVE: To prepare for a culture change to integrate research utilization into daily nursing practice, the authors conducted a descriptive survey of all registered nurses (RNs) in an integrated healthcare delivery system. The purposes of this study were to assess RNs' knowledge, attitudes, and practices (KAP) of nursing research activities, assess factors that support a research environment, and determine facilitating and challenging factors related to conducting regional nursing research. METHODS: A 33-item survey based on the Iowa Model for Evidence-Based Practice was developed, validated, and determined to be reliable by the authors. Site coordinators organized and managed the orientation, administration, and collection of data from the 2,736 registered nurses who worked in 6 hospitals, 65 affiliated clinics, and 3 business units. Narrative notes taken by study investigators were analyzed for themes to determine challenging and facilitating factors for conducting regional research. RESULTS: Education and job title significantly predicted knowledge and ability to perform research activities but was not related to willingness to engage in research activities. Several environmental factors were associated with knowledge of, willingness to engage in, and ability to perform research utilization activities. Challenging and facilitating factors to conducting regional research were identified. CONCLUSIONS/IMPLICATIONS: Our research environment is changing to value research as shown in the philosophy, conceptual framework, and bylaws for the professional nursing staff. Novice-to-expert research utilization expectations are included in the promotional model for nursing. All RN job descriptions and the annual performance tool were revised to include responsibilities related to research activities. The Iowa Model for Evidence-Based Practice was adopted as the method for creating practice validation and change. Train-the-trainer educational and experiential sessions are being designed for nurse leaders; all new RN employees complete a self-assessment tool of research utilization knowledge and the nursing division strategic goals incorporate research utilization expectations. The elements of this plan may be useful for nurse executives. Healthcare systems are restructuring throughout the world and within the United States. These changes are occurring to better meet the evolving healthcare needs of the population through cost-effective approaches. Within the United States, emerging organized healthcare systems require research related to patient care outcomes and the health systems that can best address them.

Explication of the construct of shared care and the prevention of pressure ulcers in home health care.

The purpose of this investigation was to render a more complete understanding of subjective perceptions of pressure ulcers from the perspective of family dyads, and to study the effect of these subjective experiences on preventive behaviors and pressure ulcer outcomes. A naturalistic inquiry, combined with objective measures, was used. Twenty-one dyads participated in four in-depth interviews to explore how they mentally represented and responded to the risk of pressure ulcers. Through the process of concept development, a lay representation of pressure ulcers was developed. This process produced a new concept, identified as "shared care," that explained how the dyad's interaction influenced preventive behavior. Shared care consists of three elements: communication of symptoms, decisions about how to respond to symptoms, and appraisals of reciprocity. Two contrasting patterns of care were identified: shared and directed/discrepant. In the shared care group, 10 patients were at risk for pressure ulcers but only 4 developed ulcers. In this discrepant care group, 3 patients were at risk and 2 developed pressure ulcers. Shared care was a pattern of interaction used successfully by family members to prevent pressure ulcers in patients at risk.

Pressure ulcer management in home health care: efficacy and cost effectiveness of moisture vapor permeable dressing.

This prospective randomized study was conducted in the home care setting to compare healing rates and costs of two different dressings for pressure ulcers: the gauze and tape dressing and the transparent moisture vapor permeable dressing (MVP). Demographic variables, healing rates, and cost of treatment were statistically analyzed for 77 pressure ulcers (48 patients). Each wound was randomly assigned to either a gauze dressing or a MVP dressing. Initial ulcer grade (Shea criteria) and measurements were determined at the start of treatment and weekly for an eight-week period. Photographs of the wound were taken at the beginning and end of treatment. The same protocol for irrigating the wound and relieving pressure was followed for both dressing groups. The median improvement for the grade II group was 100% for the MVP (n = 22) and 52% for gauze (n = 12), p less than 0.05 (Wilcoxon rank sum test). The healing rates for grade III ulcers were not significantly different in the two dressing groups. The mean (eight-week) labor and supply cost per ulcer using the MVP was $845, while that for gauze treatments was $1359, p less than 0.05 (Wilcoxon rank sum test). The cost difference for grade III ulcers was not significant in the two dressing groups. The MVP improved the healing rate and was more cost effective for grade II ulcers. Both gauze and MVP dressings proved effective for the treatment of grade III ulcers.

Computer-assisted urodynamics.

We have assembled a computer hardware system and have written software programs that convert analogue urodynamic input to digital data. This has allowed for 1) extremely accurate recording of urodynamic events with a higher frequency response than existing units, 2) data storage of urodynamic events in digital form on floppy disks, 3) retrieval and plotting of urodynamic studies during and at times remote from the study performance, and 4) manipulation of the parameters in the urodynamic study for patient care and research purposes. Software is now available for the performance of cystometrograms (volume, total pressure, intravesical pressure and dP/dt), electromyograms, flow studies and dynamic renal pelvic pressure testing. Programs are in the development phase for computer analysis of urodynamic studies.

Minicomputer enhancement of scintillation camera images using fast Fourier transform techniques.

Minicomputer methods were developed to enhance lesions in scintillation camera images. This study was directed towards improving the diagnostic quality of liver images. A PDP-12 digital computer was interfaced to a Pho/Gamma HP III scintillation camera and programmed to carry out two-dimensional frequency-domain analysis and processing as an on-line operation. A two-dimensional frequency spectrum is produced. An interactive program allows the operator to construct graphically a frequency-domain filter and apply it to the data matrix. The filter is optimized using the image of a known phantom and then applied unchanged to the clincial liver image. An inverse Fourier transform produces an enhances image in the spatial domain. Significant enhancement of both phantom and liver images has been obtained.