Testing of the Nursing Evidence-Based Practice Survey.

BACKGROUND: Clinicians' knowledge and skills for evidence-based practice (EBP) and organizational climate are important for science-based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses' (RN) self-reported EBP. AIMS: Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey. METHODS: The study employed a descriptive cross-sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert-type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons. RESULTS: One thousand one hundred and eighty-one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings. LINKING EVIDENCE TO ACTION: Nurses' knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence-based outcomes and tailors future EBP initiatives.

Nurse leaders' perceptions and experiences of leading evidence: A qualitative enquiry.

AIM: The aim of this study was to describe nurse leaders' perceptions and experiences of leading evidence-based practices (EBP). BACKGROUND: Leaders can promote EBP in nursing with their own personal example and by striving to renew structures, processes and working cultures. However, previous studies have shown that nurse leaders have tended to be passive with regard to EBP. METHODS: An interview study using general qualitative methods. In total, 33 individual interviews and seven focus groups of leaders were conducted in 2015 and 2017. Data were analysed thematically. RESULTS: The respondents were unfamiliar with EBP as activities that lead to effective patient care. EBP were described as indistinguishable from other practices, lost and random. Overall, they lacked competence with EBP. The activities of nurse leaders do indicate a tentative commitment to EBP, but their main goals seem to be maintaining the status quo. CONCLUSION: Unfamiliarity with EBP reflects adversely on the operations of an entire organisation. The nurse leaders have an opportunity to enhance their understanding with EBP, which will lead to the renewal and improvement of the operating culture and the quality of strategic leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should take clear responsibility for EBP on the strategic, operational and educational level.

Co-creation and co-production in health service delivery: what is it and what impact can it have?

EBN engages through a range of online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

Evidence-based practices in Finland based on nurse professionals' descriptions.

AIM: Evidence-based practices (EBPs) seek to promote the implementation of interventions that are effective, appropriate, feasible and meaningful for patients. The current demand for updated EBPs in Finland is shaped by national legislation. This study's aim was to describe nurses', nurse directors' and clinical nurse specialists' (CNSs') perceptions of how well EBPs are being implemented in nursing in Finland. METHODS: In this quantitative descriptive study, the data were collected with an e-questionnaire distributed in Finland in 2017 and analysed using descriptive statistical methods. RESULTS: A total of 1063 nurses and 340 nurse directors and CNSs participated. The majority of nurses (64%, n = 669) reported that evidence is not clearly used to develop clinical practices. Most nurses (67%, n = 702) and over half of nurse directors and CNSs (57%, n = 184) also observed that knowledge of evidence-based protocols is not widespread within their organizations. However, 39% of nurses (n = 407) and 53% of nurse directors and CNSs (n = 171) stated that they are developing EBPs. CONCLUSION: The results indicate that nurses need more support to implement EBPs.

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.

OBJECTIVE: To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. DATA SOURCES/STUDY SETTING: Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. STUDY DESIGN: A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. DATA COLLECTION: Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. PRINCIPAL FINDINGS: The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. CONCLUSIONS: Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.

Evaluation of Telemetry Utilization on Medical-Surgical Units.

Alarm fatigue is the most common contributing factor in alarm-related sentinel events. Researchers have demonstrated a 35% overuse of telemetry, a key factor in alarm fatigue. This project evaluates practice patterns for the ordering and discontinuation of telemetry on medical-surgical units. Practice patterns were reviewed to determine if they aligned with the American Heart Association evidence-based practice guidelines for telemetry monitoring and whether the order indication was congruent with the patient's clinical status. Nurse's attitudes and practices related to alarm safety were evaluated.

Design of Genuine Birth Environment: Midwives Intuitively Think in Terms of Evidence-Based Design Thinking.

OBJECTIVE: The objective of this study is to investigate a development project initiated and led by midwives. BACKGROUND: The aim was to design an environment that could accommodate the wish to support professionalism while creating better and more cohesive patient treatment, improved patient safety, greater efficiency, higher quality, and stronger focus on the patient. THEORY: The theoretical and analytical account is conducted within the framework of design thinking (DT), replacing the traditional evidence-based design approach with an evidence-based design thinking (EBDT) process underpinning participatory DT and co-creation. METHOD: Based on a longitudinal case study on a participatory design process, interviews are conducted. DT principles are used in the analysis of the interviews. RESULTS: Genuineness arises when all users experience that the physical setting optimally underpins the birthing situation. It is essential to make visible the importance of the physical setting to human behavior in any situation. CONCLUSION: This study shows that midwives intuitively do EBDT. EBDT commands awareness of both research, design, midwifery care, and perspectives on space from women giving birth and their relatives. Collectively, that can provide the genuine scope of a healing birth environment.

Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium.

The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.

Obstetric practices performed by nurse-midwives of a hospital natural birth center / Prácticas obstétricas en centro de parto normal intrahospitalario realizadas por enfermeras obstetras / Práticas obstétricas em centro de parto normal intra-hospitalar realizadas por enfermeiras obstetras

Abstract Objectives: To characterize the practices used by nurse-midwives in a Natural Birth Center (NBC) and to verify the maternal and neonatal outcomes. Method: This was a cross-sectional, documentary, retrospective study with a quantitative approach in which the medical records of 300 parturients who gave birth in a state hospital in the city of São Paulo were analyzed. The categories of the World Health Organization (WHO) composed the criteria adopted for the analysis of the obstetric practices. Fisher's exact test or the likelihood ratio and Student t-test were used. Results: The nurse-midwives mostly used category A practices of the WHO. There were no statistically significant associations between practices and perineal outcomes. There was a statistically significant association between the weight of the newborn and the number of neonatal complications, as well as between the delivery position of the primiparous women and clavicle fractures of the newborns. Conclusion and Implications for the practice: Evidence-based practices were followed by the nurse-midwives in the NBC analyzed. The maternal and neonatal outcomes were adequate. There is a need to improve care in the second stage of the delivery in order to avoid behaviors that reflect in neonatal complications. The study makes it possible to reflect on the importance of the continuous evaluation of the care provided.

Resumen Objetivos: Caracterizar las prácticas utilizadas por las enfermeras obstetras en un Centro de Parto Normal (CPN) y verificar los resultados maternos y neonatales. Método: Estudio transversal, documental, retrospectivo, con abordaje cuantitativo, en el cual fueron analizados prontuarios de 300 parturientas que dieron a luz en hospital público de la ciudad de São Paulo. Los criterios adoptados para el análisis de las prácticas obstétricas fueron las categorías de la Organización Mundial de la Salud (OMS). Fueron utilizadas las pruebas, exacto de Fisher o razón de verosimilitud (Likelihood Ratio) y t-Student. Resultados: Las enfermeras obstetras utilizaron mayoritariamente las prácticas de la categoría A de la OMS. No hubo diferencia estadísticamente significativa en las asociaciones entre las prácticas y los resultados perineales. Se observó una diferencia estadísticamente significativa entre el peso del recién nacido y el número de intercurrencias neonatales, así como entre las posiciones de parto de las primíparas con la fractura de clavícula de los recién nacidos. Conclusión e Implicaciones para la práctica: Las prácticas basadas en evidencias son seguidas por las enfermeras obstetras en el CPN analizado. Los resultados maternos y neonatales se mostraron adecuados. Es necesario mejorar la asistencia en el segundo período del parto para evitar conductas que reflejen en las interacciones neonatales. El estudio posibilita la reflexión sobre la importancia de la evaluación continuada de la asistencia prestada.

Resumo Objetivos: Caracterizar as práticas utilizadas pelas enfermeiras obstetras em um Centro de Parto Normal (CPN) e verificar os desfechos maternos e neonatais. Método: Estudo transversal, documental, retrospectivo, com abordagem quantitativa. Analisaram-se prontuários de 300 parturientes que deram à luz em hospital estadual da cidade de São Paulo. Os critérios adotados para a análise das práticas obstétricas foram as categorias da Organização Mundial da Saúde (OMS). Utilizaram-se os testes exatos de Fisher ou razão de verossimilhança (Likelihood Ratio) e t-Student. Resultados: As enfermeiras obstetras utilizaram majoritariamente as práticas da categoria A da OMS. Não houve diferença estatisticamente significativa nas associações entre as práticas e os desfechos perineais. Houve diferença estatisticamente significativa entre o peso do recém-nascido e o número de intercorrências neonatais e entre as posições de parto das primíparas com a fratura de clavícula dos recém-nascidos. Conclusão e Implicações para a prática: As práticas baseadas em evidências são seguidas pelas enfermeiras obstetras no CPN analisado. Os desfechos maternos e neonatais mostraram-se adequados. Há necessidade de melhorar a assistência no segundo período do parto, evitando condutas que reflitam em intercorrências neonatais. O estudo possibilita a reflexão sobre a importância da avaliação continuada da assistência prestada.

Features of recording practices and communication during nursing handover: a cluster analysis.

OBJECTIVE: To record and identify the characteristics of nursing handovers in a tertiary hospital. METHOD: Observational study. Twenty-two nurses participated in 11 nursing handovers in 2015/16, using a recorded audio system and an unstructured observation form. Hierarchical cluster analysis was performed. RESULTS: Thirty characteristics were identified. The nursing handovers were based on the clinical status of patients, and all nurses obtained specialized scientific knowledge specific to the clinical environment. The information used was not based on nursing diagnoses and not in accordance with best nursing clinical practice. The following four clusters emerged among the 30 characteristics: 1) the use of evidence-based nursing practice, 2) the nonuse of evidence-based nursing practice and its correlation with strained psychological environment, 3) patient management and the clinical skills/knowledge of nurses, and 4) handover content, quality of information transferred and specialization. CONCLUSION: Multiple characteristics were observed. The majority of characteristics were grouped based on common features, and 4 main clusters emerged. The investigation and understanding of structural relations between these characteristics and their respective clusters may lead to an improvement in the quality of nursing health care services.

National Study of Nursing Research Characteristics at Magnet®-Designated Hospitals.

OBJECTIVE: To describe the research infrastructure, culture, and characteristics of building a nursing research program in Magnet®-designated hospitals. BACKGROUND: Magnet recognition requires hospitals to conduct research and implement evidence-based practice (EBP). Yet, the essential characteristics of productive nursing research programs are not well described. METHODS: We surveyed 181 nursing research leaders at Magnet-designated hospitals to assess the characteristics in their hospitals associated with research infrastructure, research culture, and building a nursing research program. RESULTS: Magnet hospitals provide most of the needed research infrastructure and have a culture that support nursing research. Higher scores for the 3 categories were found when hospitals had a nursing research director, a research department, and more than 10 nurse-led research studies in the past 5 years. CONCLUSIONS: While some respondents indicated their nurse executives and leaders support the enculturation of EBP and research, there continue to be barriers to full implementation of these characteristics in practice.

Evidence-based nursing outputs and hot spot analysis of the last 5 years in mainland China: Results of a bibliometric analysis.

BACKGROUND: Evidence-based nursing has been highlighted and highly developed in recent decades in mainland China. Nevertheless, little is known about its overall development. AIMS: To gain insights on the overall development of evidence-based nursing in the most recent 5 years and to inform future evidence-based nursing research in mainland China. METHOD: Four Chinese and four English databases were searched with the search terms "evidence-based practice," "nurse or nursing," and "China or Chinese" from 2012 to 2016. Bibliometric and co-word cluster analysis were conducted with the final included publications. RESULTS: A total of 9036 papers published by 13 808 authors in 606 journals were included. Publication numbers were increasing. None of the top ten journals publishing evidence-based nursing papers were core nursing journals. The research hot spots on evidence-based nursing in the recent five years were cardiovascular disease, mental health, and complication prevention. However, little attention has been paid to education for evidence-based nursing. CONCLUSION: Evidence-based nursing has penetrated into various nursing branches in mainland China and become a well-recognized and relatively mature research domain. More importance should be attached to the study design, methodological, and reporting quality of evidence-based nursing projects.

Tamaño del efecto para diferencia de medias: aportes complementarios / Mean difference effect size: Complementary contributions

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E-baby integridade da pele: inovação tecnológica no ensino de enfermagem neonatal baseado em evidências / E-baby skin integrity: evidence-based technology innovation for teaching in neonatal nursing

Objective: To develop and validate the serious game e-Baby: skin integrity along with a panel of experts. Method: Methodological research approaching the following development steps: scope definition, game format and functions, script and communication with software developers, creation of prototype with evaluation and production; and validation by four experts using the tool Heuristic Evaluation for Digital Educational Game. Results: The serious game was built in a 3D technology with multimedia including animation and scientific-based content. The educational technology was validated by the experts in all heuristics, and among the all 36 analyzed items. 18 (50%) presented no errors, and regarding the remaining items with any error, none had more than 25% errors within levels 3 and 4, according to Nielsen's classification. Conclusion and implications for the practice: The validated serious game is a virtual simulation educational technology with potential to contribute with learning in nursing and with evidence-based clinical practice.

Objetivo: Desarrollar y validar el juego e-Baby: integridad de la piel junto a un panel de peritos. Método: La investigación metodológica contemplando las etapas de desarrollo: definición de alcance, formato del juego y sus funcionalidades, descripción del guion y comunicación con desarrolladores, prototipaje con evaluación y producción; y validación junto a cuatro peritos utilizando el instrumento Heuristic Evaluation for Digital Educational Games. Resultados: El serious game fue construido en 3D con multimedia incluyendo animaciones y contenido basado científicamente. Validado en todas las heurísticas, dentro todos los 36 ítems analizados, 18 (50%) fueran considerados sin problemas, siendo que en ninguno de los ítems ocurrió más que 25% de problemas clasificados en los niveles 3 y 4, segundo la clasificación de Nielsen. Conclusión e implicaciones para la práctica: El juego validado es una tecnología educativa del tipo simulación virtual con potencial para contribuir con el aprendizaje em enfermería y la práctica basada en evidencias.

Objetivo: Desenvolver e validar o serious game e-Baby: integridade da pele junto a um painel de experts. Método: Pesquisa metodológica contemplando as etapas de desenvolvimento: definição de escopo, formato do jogo e suas funcionalidades, descrição do roteiro e comunicação com desenvolvedores, prototipagem com avaliação e produção; e validação junto a quatro experts utilizando o instrumento Heuristic Evaluation for Digital Educational Games. Resultados: O Serious game foi construído em 3D, com multimídia, incluindo animações e conteúdo embasado cientificamente. Validado pelos experts em todas as heurísticas, dentre os 36 itens analisados, 18 (50%) foram considerados isentos de problemas, sendo que em nenhum dos itens houve mais que 25% de problemas classificados nos níveis 3 e 4, segundo a classificação de Nielsen. Conclusão e implicações para a prática: O serious game é uma tecnologia educacional do tipo simulação virtual, validado, e com potencial para contribuir com a aprendizagem e a prática baseada em evidências.

Improving Nurse Competencies for Using Evidence in Practice: A Pilot Study of the Language of Data Program.

Nursing professional development practitioners are in a key position to use tools that foster nurses' interpretation of research findings for increased use of evidence in practice. An online course was developed to teach statistics as language. The feasibility and efficacy of this "Language of Data" program were examined in a pilot study with a convenience sample from inpatient settings. Recognition and interpretation of statistical symbols significantly improved after the intervention. Knowledge, confidence, and accuracy also improved. The Language of Data program may be used by nursing professional development practitioners to improve nurses' adoption of evidence-based practice by furthering their ability to translate science.

Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention: The Importance of Time Nurses Spend on the Front Line of Implementation.

OBJECTIVE: The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals. BACKGROUND: Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions. METHODS: We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year. RESULTS: Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities. CONCLUSIONS: Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.

A Cross-sectional Study on Evidence-Based Nursing Practice in the Contemporary Hospital Setting: Implications for Nurses in Professional Development.

Evidence indicates that nurses inconsistently engage in evidence-based practice (EBP). This cross-sectional study of 402 nurses at a medical-surgical hospital identifies strategies for augmenting EBP. Nurses' EBP beliefs scores were higher than their EBP implementation scores. Those with baccalaureate/postgraduate degrees had higher EBP beliefs and implementation scores than those with associate degrees or diplomas. Bedside or direct care nurses were less likely to have baccalaureate/higher degrees and had lower EBP beliefs and implementation scores than did those nurses not serving in direct care roles.

Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project.

Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.