Significance of an Online Evidence-Based Practice Education Module for Acute, Ambulatory, Public, and School Health Nurses.

Recent surveys of Magnet facilities and nurses found low rates of implementation of evidence-based practice in U.S. health care settings. Nursing Experts: Translating the Evidence (NExT) is a collaboration of nurses and librarians providing free online evidence-based practice nursing education benefiting nurses in all settings. The NExT online modules empowered participants to efficiently access valuable resources to inform and improve their practice in a convenient, accessible, self-paced format. Quantitative and qualitative evaluation methods and the value of collaboration are discussed. [J Contin Educ Nurs. 2023;54(4):176-184.].

NHS mental health services' policies on leave for detained patients in England and Wales: A national audit.

WHAT IS KNOWN ON THE SUBJECT?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge. Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective. While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The leave policies of NHS mental health services in England and Wales are highly inconsistent. The extent to which policies are consistent with guidance differs depending on which service is providing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is very likely that, because of inconsistencies between services and policies, practice also differs. Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey. Policymakers need to revisit leave policies in light of evidence from this study. ABSTRACT: INTRODUCTION: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies. AIM: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. METHOD: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave-related terms were extracted and analysed. RESULTS: Fifty-seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain-level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. DISCUSSION: Mental health professionals are inconsistently supported by the policy in their leave-related practice. This could potentially contribute to inconsistent practice and leave-related patient outcomes. IMPLICATIONS FOR PRACTICE: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs.

Focus on nursing point-of-care tools: application of a new evaluation rubric.

Objective: Point-of-care tools (PoCTs) provide evidence-based information on patient care and procedures at the time of need. Registered nurses have unique practice needs, and many PoCTs are marketed to support their practice. However, there is little reported evidence in the literature about evaluating nursing-focused PoCTs. Case Presentation: The investigators developed a rubric containing evaluation criteria based on content, coverage of nursing topics, transparency of the evidence, user perception, and customization of PoCTs for supporting nursing practice. The investigators selected five PoCTs cited in the literature and of interest to local nursing leadership: ClinicalKey for Nursing, DynaMed, Lippincott's Advisor and Procedures, Nursing Reference Center Plus, and UpToDate. Application of the rubric found Lippincott had the highest coverage of diagnoses, while ClinicalKey for Nursing had strong content focused on interventions and outcomes. Nursing Reference Center Plus provided the most well-rounded coverage of nursing terminology and topics. DynaMed and UpToDate were more transparent with indicating conflict of interest, but both had lower coverage of nursing terminology, content, and care processes. Conclusion: None of the five PoCTs strongly met all of the evaluated criteria. The rubric developed for this study highlights each PoCT's strengths and weaknesses that can then be used to inform the decision-making process based on priorities and budget. The investigators recommend licensing a nursing PoCT and a PoCT like DynaMed or UpToDate to provide comprehensive, evidence-based, patient care coverage and to meet the diverse information needs of nurses.

Effectiveness and experiences of mental health nurses in cases of medical emergency and severe physiological deterioration: A systematic review.

BACKGROUND: From a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses' delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated. OBJECTIVES: To systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient. DESIGN: A systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Multiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms. REVIEW METHODS: Inclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses' emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted. RESULTS: A total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice. CONCLUSIONS: There are currently no validated instruments to investigate mental health nurses' emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups' emergency care-related practice.

Understanding the role of m-health to improve well-being in spouses of patients with bipolar disorder.

OBJECTIVES: Spouses and partners of individuals with bipolar disorder (BD) experience significant burden. As there are some limitations to standard psychosocial caregiver interventions, mobile health technology (mHealth) may be a way to reduce burden and improve well-being in these caregivers. The purpose of this study was to explore how the well-being of spouses or partners of patients with BD can be improved through mHealth technology. METHODS: Using a qualitative design, we conducted five focus groups and one in-depth individual interview to collect information from participants about what they would expect from such a device. The sample consists of thirteen participants (eleven spouses and two partners). The age range was 29-65, with eight females and five males. Data were collected using minimally structured interviews and independently analyzed by the authors using content analysis. RESULTS: Results indicated that the mHealth device many be helpful in at least six areas: reduction of stressors, decreased social isolation, improving communication in the relationship between the spouses, speaking with children about the illness, managing medications, and providing information on resources. CONCLUSION: Mobile health technology may be a feasible, available, and cost-effective support tool for spouses and partners of individuals with BD, especially in reducing caregiver stress. Future research is needed to develop the application and test its effectiveness on health outcomes in a larger trial.

Systematic review of therapeutic leave in inpatient mental health services.

AIM: To identify, critically evaluate, and synthesise the empirical evidence about therapeutic leave from mental health inpatient settings. BACKGROUND: "Leave" occurs when a mental health inpatient exits the hospital ward with the appropriate authorisation alone, or accompanied by staff, family, or friends. Limited research has previously addressed therapeutic as opposed to unauthorised leave, and the evidence-base has not been systematically evaluated. DESIGN: Systematic review methodology following relevant Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidance. DATA SOURCES: Multiple electronic databases (CINAHL; Criminal Justice database; PsycARTICLES; Scopus; OpenGrey; Cochrane; GoogleScholar) for papers published from January 1967 to July 2017. REVIEW METHODS: Information was extracted under the following headings: study, purpose/aims, sample, country, setting, design and data collection method(s), data collection instrument, and results. Papers were assessed, as per the hierarchy of scientific evidence, and where there was sufficient data, we calculated a range of standardised rates of leave incidence. RESULTS: Standardised leave rates in forensic settings reflect security level. There was little meaningful information on which to base calculation of rates for civil settings. The strongest evidence supports leave used for supervised discharge; other forms of leave lack an evidence base and decisions appear to be made on the basis of heuristic rules and unsupported assumptions. Clinical decision making about therapeutic leave cannot claim to be evidence-based. CONCLUSION: Research is urgently needed to provide information about how leave is managed, the best ways to support leave, and what happens on leave.