Clinical Nursing Practice Guideline Research Articles

A cross-sectional study on Chinese oncology nurses’ knowledge of bone health among cancer patients

ObjectiveTo understand the knowledge status, obstacle factors, and management confidence of oncology nurses on the bone health of cancer patients, and in addition to provide reference for establishing bone health knowledge training system for oncology nurses and guiding them to manage bone health of cancer patients.MethodsA total of 602 nurses engaged in oncology nursing in 6 hospitals in Hebei Province were selected by cluster sampling, and an online anonymous survey was conducted by sending questionnaires to oncology nurses from the Hebei Cancer Prevention and Control Association. The questionnaire was developed by the study team. There are 4 parts, namely general information, nurses’ role and job responsibilities, knowledge of skeletal-related events (SREs) and cancer treatment–induced bone loss (CTIBL), and understanding and confidence in bone health management, for a total of 33 questions.ResultsThirty-seven percent of oncology nurses received training on bone health and other related contents; 40.48% of oncology nurses used domestic and foreign guidelines when managing patients with bone metastases or CTIBL. Only approximately one-third of oncology nurses had confidence in managing the side effects of bone metastases and bone modification drugs and identifying patients at risk of CTIBL and fracture; only 33.04% of oncology nurses believed that weight-bearing exercise can prevent bone loss; less than 50% of oncology nurses believed that aromatase inhibitor therapy, ovarian suppression therapy, androgen deprivation therapy, and low body weight were risk factors for pathological fractures. The reasons that hindered oncology nurses from optimizing the management of patients with bone metastases and understanding the preventive measures and risk factors for bone loss mainly included lack of relevant knowledge training, lack of understanding of effective intervention measures, and lack of training and professionalism of specialized nurses, including insufficient development time and guidelines for clinical nursing practice.ConclusionManagers must continuously improve the training system of oncology nurses, enrich the content of training pertaining to bone health for cancer patients, formulate clinical nursing practice guidelines, and give oncology nurses more time for professional development.

A Study to Evaluate Effectiveness of Clinical Nursing Practice Guidelines Among Nurses Towards Patient’s Satisfaction in Critical Care Unit at Selected Hospital, Bangalore

Patient satisfaction is a concrete criterion for evaluation of health care and therefore quality of nursing care. It provides crucial information for healthcare managers by providing important resources for processes such as those involved in measuring patients’ expectations and satisfaction with nursing care quality, improving nursing service quality through identification of areas of failure and planning and implementing necessary training. Evaluation of health care involves defining the objectives of care, monitoring healthcare inputs, measuring the extent to which the expected outcomes have been achieved and assessing the extent of any unintended or harmful consequences of the intervention that is undertaken by the help of clinical nursing practice guidelines.

Effect of Clinical Nursing Practice Guidelines regarding Percutaneous Coronary Interventions on Patients' Anxiety and Satisfaction

Context: The quality of delivery the healthcare must be improved due to the quick changes in the health care. Patient satisfaction is a key determinant of the quality of healthcare and demonstrates the provider's ability to meet patients' needs.
 Aim: To determine the effect of clinical nursing practice guidelines regarding PCI on the patients' anxiety and satisfaction.
 Methods: The current quasi-experimental research included 106 newly admitted patients to the cardiac care unit at King Abdullah Medical City divided into two group 53 patients for control group and 53 patients for intervention group. Patients’ satisfaction was measured by patient satisfaction with nursing care questionnaire and State-Trait Anxiety Inventory was used to assess anxiety of the patients. Online questionnaires for patients’ anxiety and satisfaction were utilized for data collection.
 Results: There was a statistically significant difference related anxiety among the intervention group before and after implementing clinical nursing practice guidelines. Patient’ satisfaction was a statistically significant difference between the intervention group and control group after the implementation of clinical nursing practice guidelines.
 Conclusion: Implementing clinical nursing practice guidelines decreases anxiety and enhances satisfaction among patients undergoing PCI.
 Keywords: Anxiety, Practice guidelines, Percutaneous coronary interventions, Patients' satisfaction.

Critical Review III to Standardize the Textbooks of Fundamentals of Nursing: Nutrition, Urinary and Bowel Elimination Needs

Purpose: To identify the discrepancies in the textbook of fundamentals of nursing in nutrition and elimination needs in terms of number, range, definition and etc.Methods: The 10 textbooks which are the most frequently used were selected and reviewed. After then compared it with the protocols of essential nursing skills of Korean Accreditation Board of Nursing Education and evidence-based clinical nursing practice guidelines of Korean Hospital Nurses’ Association.Results: The most significant discrepancies in nutrition domain were criteria of obesity, confirmation of nasogastric tube placement. In elimination domain, there were several mixed or miss uses of French and number unit in catheter size. And appropriate catheter size for urinary catheterization and enema is different to books and guidelines.Conclusion: In order to conduct an effective resource in education of nursing, textbooks need to be revised constantly and contain the recent researches and guidelines.

Implementation of Clinical Nursing Practice Guideline for Treatment of Multiple Injury Patients Admitted to Emergency Department

Background: Trauma injury is the leading cause of death in Thailand. Multiple injury patients who receive nursing intervention according to the clinical nursing practice guideline for multiple injury patients are thought to be safer and less likely to experience complications. However, outcomes of using the guideline have yet to be systematically evaluated. Objective: The present study aimed to assess outcomes experienced by multiple injury patients after implementation of the clinical nursing practice guideline. Materials and Methods: The present study was a retrospective study. Patients enrolled in the study were over 18 years old and had been admitted to the Emergency Department of Srinagarind Hospital between January and December 2019 with an injury severity score (ISS) greater than or equal to 16. Results: A total of 83 patients were enrolled, 70 (84.34%) of whom were male. The mean age of the patients was 36.33 years. Most of the injuries were caused by blunt force trauma (98.80%). The mean ISS was 28.10+8.50. The clinical nursing practice guideline for multiple injury patients had a 96.71% adherence rate, with 5 activities that had a 100% adherence rate: triage, circulation with hemorrhage control, disability assessment, exposure & environment control, and evaluation. Conclusion: In practice, nurses followed the guideline to a high degree. Systolic blood pressure, pulse rate, body temperature, and oxygen saturation were improved factors after implementation of the clinical nursing practice guideline for multiple injury patients. Keywords: Clinical nursing practice guideline, Multiple injury patients, Nursing outcomes

Effect of Implementing Clinical Nursing Practice Guideline for Mild Traumatic Brain Injury at Bangkok Pattaya Hospital

Effect of Implementing Clinical Nursing Practice Guideline for Mild Traumatic Brain Injury at Bangkok Pattaya Hospital

Evidence-based Clinical Nursing Practice Guideline for Management of Inpatient Falls: Adopting the Guideline Adaptation Process

Purpose: Despite research efforts, current fall rates are still higher than expected. To approach this problem, we developed guidelines on preventing falls in hospitals.Methods: Four guidelines were selected by the K-AGREE II process. Recommendations from each guideline were retrieved and evaluated based on the quality of evidence and the strength of the recommendations. Recommendations followed the grading system of the Korean Hospital Nurses Association’s Guideline Adaptation Manual. In the external review, 13 practice nurses from 5 hospitals and 13 panel experts including doctors, nursing managers, and pharmacists participated.Results: The final guideline consisted of 5 sections and 341 recommendations. The first two sections were composed of recommendations for institutional readiness for change process and management, and Section 3 was divided into assessment of risk factors, preventive intervention and post-fall management. The summary of falls risk factors included seven components. Multifaceted interventions were modeled into six strategies. The final sections consisted of recommendations for implementing fall improvement programs and for sustaining effective prevention programs.Conclusion: Given that falls result from various combinations of risk factors, the present guideline contains multifaceted assessments and interventions including risk-targeted strategy. This guideline will contribute to decreasing fall rates in hospitals by stimulating compliance with evidence-based practice.

Effect of a Clinical Nursing Practice Guideline of Enteral Nutrition Care on the Duration of Mechanical Ventilator for Critically Ill Patients

PurposeEarly enteral nutrition (EN) can improve clinical outcomes in critically ill patients. This study aimed to evaluate the effects of this clinical nursing practice guideline (CNPG) of EN care on the duration of mechanical ventilator in critically ill patients to investigate whether it was able to improve clinical outcomes. MethodsThis study compares a pretest-posttest design for the two groups, which was done before and after to determine the effects of a CNPG of EN care on the duration of a mechanical ventilator in critically ill patients. This study was performed on 44 critically ill patients admitted to the intensive care unit (ICU). The patients were divided into two groups according to EN. For the intervention group, CNPG started within the first 48 hours of admission to the ICU, and for the control group, they received standard nursing care. ResultsAfter the implementation, it showed significant associations between the duration of mechanical ventilator in ICU. The intervention group who received the CNPG had significantly shorter starting time of EN and a reduced duration of mechanical ventilator than those in the control group (p < .001). ConclusionA CNPG for EN care reduced the duration of mechanical ventilator. This could possibly improve the delivery of target calories when compared with current standard practice and improve the outcome of critically ill patients.

AB054. P-22. An international collaborative of Clinical Nursing Practice Guidelines for care of patients with cholangiocarcinoma

Background: Cholangiocarcinomas are highly lethal and rare cancers that account for approximately 3% of all gastrointestinal cancers in the United States. The incidence in the United States is 8 per 100,000. Data from the SEER program suggest 15% of all liver diagnosed cancers are intrahepatic cholangiocarcinoma. Approximately 1/3 of patients are under age 65 at diagnosis. The majority of patients are over 70 years of age. The 5-year survival is estimated to be from 2% to 30%. The purpose of this comprehensive review of literature was to establish evidence-based guidelines for nurses and physicians caring for patients diagnosed with cholangiocarcinoma. The specific aims were to assist physicians and nurses in implementing evidence-based care through an understanding of cholangiocarcinoma patients undergoing, surgery, chemotherapy, radiation therapy, or a clinical trial, and to be able to manage symptoms of biliary obstruction, and toxicities from treatment.

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Establishment of application center of evidence-based nursing best practice guidelines in Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine

Clinical application of practice guideline is the important part in evidence-based nursing. This essay would introduce the foundation of application center of best practice guideline in Dongzhimen Hospital of Beijing University of Chinese Medicine from the background, current status, building of evidence-based team, management and training of organization and propulsion method of guideline project, so as to provide references for the foundation of domestic evidence-based nursing practice center. Key words: Clinical nursing practice guidelines; Registered nurses′ association of Ontario; Best practice organization

An International Collaborative Design of Clinical Nursing Practice Guidelines for Care of Patients With Cholangiocarcinoma Receiving Chemotherapy and Radiation

An International Collaborative Design of Clinical Nursing Practice Guidelines for Care of Patients With Cholangiocarcinoma Receiving Chemotherapy and Radiation

An international collaborative design of clinical nursing practice guidelines for patients with cholangiocarcinoma.

65 Background: Cholangiocarcinoma (CC) accounts for approximately 3% of all gastrointestinal cancers and have a poor incident to mortality rate. The incidence in the United States (US) is 2,000-3,000 cases annually, with this rate steadily increasing during the last twenty years; this trend is not solely observed in US but also seen in Europe, Australia and Japan. The highest incidence is seen in Southeast Asia due to parasitic infection. CC presents many challenges to healthcare professionals due to the anatomic nature of CC (Lowe et al, 2015). The worldwide increase in incidence of CC is indication for the essential development of nursing practice guidelines underpinned by expert evidence and knowledge and regarding the key aspects of care. Methods: A collaboration of nursing professionals representing major cancer research institutions from around the country and the United Kingdom worked together to identify key aspects of care, the aim being to develop Clinical Nursing Practice Guidelines. The process included an exhaustive literature review using Pubmed, Uptodate, Medline, and CINAHL databases; submission of respective institutional practices; group consensus on guideline content, evidence-based scoring assignment and approval by the Cholangiocarcinoma Medical Advisory Board. Results: The guidelines developed include the care of the patient: (1) with external biliary drains and internal bile duct stents, (2) with intractable nausea and vomiting resulting from disease process, (3) with fatigue resulting from disease process, (4) undergoing chemotherapy, (5) undergoing photon radiation, (6) undergoing radiation on a clinical trial, and (7) preparing for liver transplantation. The purpose of the guidelines are to advance the scientific knowledge of the symptoms experienced, quality of life of patients with CCA, establish standards in patient care, and improve quality of care and satisfaction for patients diagnosed with CC. Conclusions: Creation of evidence-based guidelines will provide a springboard for expanded competent knowledge and a model to test for improvement in the care and quality of life of the patient with CC.

The development of clinical nursing practice guideline for prevention of ventilator- associated pneumonia, Medical Nursing Department, Rajavithi Hospital

The development of clinical nursing practice guideline for prevention of ventilator- associated pneumonia, Medical Nursing Department, Rajavithi Hospital

The development of clinical nursing practice guideline for initial assessment in multiple injury patients admitted to trauma ward

Summary Background Missed diagnoses are very common in patients with multiple injuries. To help nurses identify missed injuries, this study aimed to develop and evaluate a clinical nursing practice guideline (CNPG) for the initial assessment of multiply injured patients admitted to the trauma ward in a provincial hospital in southern Thailand. Method The CNPG was developed using evidence-based knowledge of trauma assessment and the Advanced Trauma Life Support guideline. The CNPG was used by 18 nurses working in the trauma ward. They implemented the CNPG with 34 multiply injured patients. The outcome measures of the CNPG use were the nurses' self-reported compliance with the use of the CNPG, the nurses' satisfaction with using the CNPG, and the percentage of missed injuries detected as a result of the use of the CNPG. Results Most nurses (83.33%) reported complying with the CNPG and 72.2% of them indicated that their satisfaction with using the CNPG was at a high level. Missed injuries were discovered at a rate of 14.6% of the total injuries diagnosed in the injured patients within 24h of ward admission. Conclusion Further research needs to be conducted to establish if the CNPG could be more widely applied to improve the quality of care and increase the safety of those with multiple injuries.

Evaluation of a clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patients

Summary Deep vein thrombosis (DVT) is the third leading cause of morbidity in critically ill trauma patients but it can be prevented by performing appropriate risk assessment and preventive strategies. The purpose of this study was to evaluate of implementing a clinical nursing practice guideline (CNPG) for preventing DVT in critically trauma patients at Songklanagarind Hospital. The CNPG content with 37 items initially developed from evidence-based knowledge related to DVT and its prevention was validated and approved by the consensus of an expert panel. The ‘expert panel' consisted of a clinical (critical surgical patients) nurse specialist, a trauma surgeon, a medical doctor who experts in developing CNPG, and two surgical care nurse educators. The revised 30 from 37 items were tested for reliability thereafter and yielded of 0.90 and 1.00, respectively. Forty-two nurses participated in this study. The effectiveness of this CNPG was evaluated in terms of (1) feasibility and difficulty of using the CNPG, (2) nurse's satisfaction in implementation of CNPG, and (3) the patient's femoral blood flow velocity before and after 7 days. Results have shown that 23 items were performed by more than 90% of nurses and there were 7 items performed at rates lower than 90%. 79% of nurses rated their satisfaction at high ( M =8.06, SD=0.96). There were no differences in femoral venous blood flow velocity before and after 7 days and without signs of DVT. The findings indicated that the use of evidence-based clinical practice guidelines for deep vein thrombosis prevention could enhance the quality of care in terms of early detection for DVT and maintaining blood flow velocity in those patients who are at risk. Further study could be explored to confirm its effectiveness with the large sample size.

Evaluation of clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patients

Deep vein thrombosis (DVT) is a third leading cause of morbidity in critically ill trauma patients but could be prevented by performing appropriate risk assessment and preventive strategies. The purpose of this study was to evaluate the implementation of a Clinical Nursing Practice Guideline (CNPG) for preventing deep vein thrombosis in critically ill trauma patients at Songklanagarind Hospital, Thailand. The CNPG content has 37 items developed from evidence-based knowledge related to prevention of DVT. Forty-two nurses participated in this study. The effectiveness of this CNPG was evaluated in terms of (1) feasibility and difficulty of using the CNPG, (2) nurse's satisfaction in implementation of CNPG, (3) the patient's femoral blood flow velocity before and after 7 days. Data were analyzed using frequencies and percentages.

Development and evaluation of clinical nursing practice guideline for hypothermia management in patients with major trauma at Emergency Department, Songklanagarind Hospital

lower in patients who died than in those who survived. ICU admission rates, MET calls and ED representation rates increased with duration of hypotension. This observational pilot study suggests that sustained prolonged hypotension in ED may be associated with inpatient mortality and morbidity Further studies are needed to provide a better understanding of the risk factors associated with hypotension in the ED, the relationship between physiological surveillance and prevention of hypotension related mortality. Acknowledgement: This project funded by a Northern Health Small Research Grant. Dr. Julie Considine is the Senior Research Fellow who leads the Deakin UniversityNorthern Health Clinical Partnership. Julie is widely published and her work centres around improving patient care by optimising emergency nurses’ clinical decisions by increased use of research evidence in clinical practice and management of clinical risk.

Building competencies for nurse administrators in the Republic of Georgia

To assess the level of competency among nurse administrators in the Republic of Georgia (Georgia) and to recommend interventions to implement effective nursing management practices in a resource constrained setting. The collapse of the Soviet Union in 1991 resulted in deterioration of the healthcare system in Georgia. Even though the 1995 healthcare reformers recognized that baccalaureate educated nurses were essential resources for quality health care, limited resources delayed further steps. Hence, Georgia has struggled to raise nursing education levels and to establish nursing as a professional occupation. Using an exploratory descriptive research technique, surveys of nurse managers were conducted in 2004 and in 2005. This study assessed the level of practice among Georgian nurse administrators compared with the international competencies of the International Council of Nurses. There were no organized procedures to evaluate competencies of nurses on a regular basis. While minimal clinical nursing practice guidelines exist, nurse managers did not fully utilize them for either mentoring the staff nurses or assuring an adequate quality of nursing care. Many nurse managers viewed financial constraints as an obstacle to delivering better nursing care. Recommendations include: (1) establishing effective protocols to evaluate the competencies of nurses, (2) mandating the use of existing nursing guidelines, (3) establishing effective resource inventory systems, and (4) mandating safety education and ensuring a safe work environment.