Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council.

In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization's nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward. The success of the CPC is due to the leadership and commitment of the CNSs. This article describes the structure, process, and outcomes of an effective CPC where CNSs successfully engage frontline clinicians in promoting nursing care that is evidence based. Clinical nurse specialist leadership is increasingly made visible as CNSs effectively involve staff nurses in practice reforms to improve patient outcomes.

Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.

BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included. CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.