Implementing screening for social determinants of health using the Core 5 screening tool.

Social determinants of health (SDOH) have been documented to underpin 80% of overall health and are being increasingly recognised as key factors in addressing tertiary health outcomes. Yet, despite the widespread acceptance of the association of SDOH with health outcomes, more than two-thirds of hospitals do not screen for social risk factors that indicate individual-level adverse SDOH. Such screening for social risk factors represents the first step in connecting patients with resources and documents the prevalence of social needs. The aim of this project was to implement the Core 5 social risk screening tool and evaluate its efficacy and usability in identifying social risk factors in a presurgical spine population. Prior to this implementation, screening for social risk had not been performed. The Model for Improvement provided a framework for implementing and evaluating the Core 5 social risk screening tool. Methods included implementation of a patient self-report social risk screening tool, referral workflow to connect patients with needed resources and evaluation of staff feasibility in using the Core 5 tool. The results indicated that the screening tool identified patients with social risk factors and staff reported perceptions of efficacy and usability in clinical workflow. Overall, 52 of 88 (59%) of subjects in the presurgical spine population were effectively screened. Of these, five patients (10%) had identified social needs that needed to be addressed prior to surgery. The staff usability survey for the Core 5 tool demonstrated high acceptance and usability, with an average score of 4.4 (out of 5). Future work should evaluate the efficacy of the screening tool in other ambulatory and tertiary settings.

Impact of Therapeutic Music Listening on Intensive Care Unit Patients: A Pilot Study.

This pilot study investigated the association between patient-specific, therapeutic music listening as a nursing intervention for mechanically ventilated patients, and the proportion of time those patients were considered to have intensive care unit delirium. The pilot study used the person-centered nursing framework as its theoretic foundation. Findings from an intimate prospective cohort design encourage an expanded look at potential benefits of therapeutic music listening in large, multisite, randomized clinical trials. Research and practice implications are discussed.

Effect of Evidence-Based Practice (EBP) Courses on MSN and DNP Students' Use of EBP.

PURPOSE: The purpose of this study was to evaluate the effect of evidence-based practice (EBP) courses on nursing students' attitudes, perceived support from their professional network, self-efficacy, knowledge, and implementation of EBP. DESIGN: This study utilized a two-group, pre- and posttest design with 190 Masters of Science in Nursing (MSN) and 37 Doctorate of Nursing Practice (DNP) students. METHODS: An EBP instrument based on the theory of planned behavior was administered both before and after the EBP course (the intervention). FINDINGS: Both the pre- and posttest were completed by 126 students for a 56% response rate. No significant differences between the MSN (n = 102) and DNP (n = 24) students were found in precourse scores on any of the subscales except behavior, with the DNP students reporting they performed more EBP behaviors in the clinical setting. Overall, student scores on three of the four subscales of the EBP instrument (attitudes, self-efficacy, and behavior) significantly increased pre- to postcourse. The self-efficacy subscale demonstrated the greatest pre- to postcourse change scores. When the DNP and MSN students were compared, change scores on attitudes and self-efficacy remained significant in both groups. There was a significant positive change in EBP behavior only for the MSN students. Knowledge scores increased significantly only for the DNP students. LINKING EVIDENCE TO ACTION: EBP courses can increase self-reported EBP behaviors in the clinical setting, especially in MSN students. A precourse student evaluation will help faculty determine their learning needs in order to develop appropriate learning activities to support their acquisition of the essential knowledge, skills, and abilities to use EBP in the clinical setting. Administering the same evaluation postcourse can help faculty evaluate the effectiveness of their teaching. As a result, advanced practice nurses will be better equipped to facilitate and promote the implementation of EBP to support high-quality care and improved health outcomes.

Translation of Evidence-Based Practice: Quality Improvement and Patient Safety.

Using knowledge gained from the disciplines of nursing, medicine, health care management, and medical and health services research, the quality improvement movement attempts to mobilize people within the health care system to work together in a systematic way using evidence based strategies and tactics to improve the care they provide. In this valuable work, discipline-specific knowledge is combined with experiential learning and discovery to make improvements. Quality improvement provides a knowledge-based framework and methods for the change agent to work toward a more predictable, effective, efficient, reliable, equitable, patient-centered care health care system.

Reducing Pressure Injuries in the Pediatric Intensive Care Unit.

This quality improvement project used the Model for Improvement including the Plan-Do-Study-Act cycle of change framework to educate pediatric intensive care unit (PICU) nurses on risk factors for pediatric pressure injuries and prevention strategies, improve turning compliance for PICU patients, and implement an electronic trigger to order nutrition consultations on all patients with a Braden Q score less than 16. The quality improvement project decreased preventable patient harm to PICU patients by decreasing the pressure injury incidence rate from 8% to 3% in the 6-week time period.

Implementation of a Nurse-Driven CAUTI Prevention Algorithm.

The cardiovascular thoracic step-down unit of an urban academic medical center had 4 catheter-associated urinary tract infections (CAUTIs) in 2 months compared with 5 in the previous year. The nursing literature showed that the implementation of nurse-driven algorithms for early removal of indwelling urinary catheters (IUCs) decreased the catheter days and risk of CAUTIs. Using the Model for Improvement, the nurse leader performed daily IUC rounds to enforce the removal algorithm and visual management tools to identify IUC removal barriers. The quality improvement project resulted in fewer catheter days, the implementation of evidence-based practice, and no new CAUTIs.

Development and Validation of an Evidence-Based Practice Instrument for Nursing Students Based on the Theory of Planned Behavior.

BACKGROUND AND PURPOSE: This study developed and validated a theory of planned behavior (TPB)-based self-report instrument to measure nursing students' attitudes toward evidence-based practice (EBP), perceived support, self-efficacy, and implementation of EBP. METHODS: There were 348 nursing students at 1 university who completed the measure as a pretest at the beginning of a course designed to teach them about EBP; 164 at the end of the course as a posttest. RESULTS: Doctor of Nursing Practice (DNP) students reported higher EBP implementation scores than Master of Science in Nursing (MSN) students who, in turn, had higher scores than prespecialty students. At the pretest, self-efficacy and network support accounted for 31% of the variance in EBP implementation. CONCLUSIONS: Evidence provides initial support for the reliability and validity of this 4-part EBP instrument based on the TPB.

Educating DNP students about critical appraisal and knowledge translation.

Consumers expect that health care providers will use the best evidence when assisting them in making decisions about treatment options. Nurses at all educational levels report that they lack knowledge to critically appraise research studies and the skills to effectively implement evidence-based practice (EBP) in their clinical settings. Organizational culture and management support of innovation are critical factors in the adoption of EBP. Doctor of Nursing Practice (DNP) graduates can have a pivotal role in the transfer of knowledge to practice, yet critical appraisal and EBP competencies for DNP and Master of Science in Nursing (MSN) students have not been well differentiated in nursing curricula. Also students' attitudes toward EBP, self-efficacy beliefs, utilization, and knowledge gaps are rarely evaluated before courses are designed. This article reports on the development of a DNP-level EBP course to help students evaluate and apply research findings to clinical practice.