Evidence-based Nursing Care Research Articles

Effect of Evidence-based Nursing on Perioperative Nursing of Patients with Gastric Cancer

To explore the therapeutic effect of evidence-based nursing on the perioperative care of gastric cancer patients. 81 patients with gastric cancer hospitalized in our department from September 2018 to September 2019 were randomly divided into 40 experimental group and 40 control group; the control group used conventional nursing intervention and the experimental group used evidence-based nursing intervention to compare the surgical index, mental and emotional, clinical index, visual analogue scoring system score and complications of the two groups. The results showed that there were no statistically significant differences in intraoperative bleeding and operation time between the two groups, and the amount of intraoperative fluid replenishment was significantly lower in the experimental group than in the control group; after the nursing intervention, the Self-rating Anxiety Scale and Self-rating Depression Scale scores of the experimental group were lower than those of the control group at 1 d preoperatively and 3 d postoperatively (p<0.05); the Self-rating Anxiety Scale and Self-rating Depression Scale scores of the experimental group were lower than those of the control group at 6 h, 24 h and 72 h postoperatively (p<0.05). The visual analogue scoring system scores were all lower than those of the control group (p<0.05); the time of getting out of bed after surgery, the time of first postoperative exhaustion, the time of postoperative ureter extraction, the time of early feeding, the time of semi-liquid diet, and the time of postoperative hospitalization were all shorter in the experimental group than in the control group, and the costs were lower than those of the control group, and the differences were statistically significant (p<0.05). The comparison between groups was significantly different (p<0.05). The clinical application of evidencebased nursing care in the perioperative nursing coordination of gastric cancer radical surgery can not only reduce postoperative complications, but also shorten hospitalization time and help promote patients recovery, which is worth promoting.

Gestión del cuidado de enfermería basada en la evidencia

Objetivo: Describir la importancia de la gestion del cuidado de enfermería basada en la evidencia. Metodología: De tipo documental; bajo el enfoque del método hermenéutico. El corpus de la investigación la constituyeron los documentos bibliográficos seleccionados que permitieron describir la importancia de las variables en estudio. Conclusión: Existe buena atención al desarrollo disciplinario en la gestion del cuidado de la enfermería, generando la necesidad de una integración efectiva entre las concepciones o postulados teóricos y sus proyecciones sobre la práctica cotidiana de la enfermería.

Comparing the association of cardiovascular nursing care with blood pressure and length of stay of in-patients with coronary artery disease in Wuhan, China.

Coronary artery disease is a leading cause of morbidity and mortality worldwide. Comorbidity-like hypertension has been among the major risks of coronary artery disease. Recent evidence identified multiple benefits of cardiovascular nursing care to coronary patients. However, little has been appraised on benefits regarding patients' blood pressure control and length of hospitalisation. To compare the association of cardiovascular nursing care delivered to coronary artery patients with patients' blood pressure and length of stay. Records based retrospective design was applied at a large teaching hospital in Wuhan, China. SPSS 21 version was used for data entry and analysis with univariate and multivariate logistic regression models for comparing study variables. Of 300 patients, 224 (74.7%) were known to be hypertensive and admitted with subnormal blood pressure. Cardiovascular nursing care like "assess to grade pain severity on 1-10 scale" and "counsel patient to cope with stress" were six and three times more likely to contribute improved patients' blood pressure (AOR=5.8; 95%CI: 2.8-12.2, p=0.001) and (AOR=3.1; 95%CI: 1.2-7.8, p=0.015) respectively. No significant difference with length of stay (p>0.05). There is a possibility of coronary artery patients to recover with normal blood pressure following reception of evidence-based cardiovascular nursing care.

Implementation of the Nursing Process Based on Betty Neuman Model in Kidney Transplant Patients: A Study in the Field

Background: Proper use of nursing models and theories is an important step in improving patient care standards and quality of life. The growing trend of kidney failure and subsequent kidney transplantation in the country shows the importance of creating a proper structure in nursing patient care for transplant patients and recognizing the stressors that affect these patients. Objectives: This study aimed to investigate the ability of the Betty Neuman model to provide a comprehensive model for nursing care of clients undergoing kidney transplantation. Methods: This clinical and clinical study was performed on the client of the kidney transplant candidate based on the application of Betty Neuman system theory. During the data collection, the interactions between the client’s five variables were examined and the stressors and resources in the internal, inter, and extra-individual domains were identified. Nursing diagnoses were created in accordance with the North American International Nursing Diagnostics Association (2018 - 2018) classification, and then nursing interventions were designed and implemented at three levels of prevention. Results: The results of the study of physiological, psychological, social, evolutionary, and spiritual variables, as well as interpersonal and extra-individual stressors, were 7 potential and actual nursing diagnoses. Conclusions: Designing and applying a nursing process based on this model is a holistic and systematic attitude toward the client that requires proper, efficient, and evidence-based nursing care but increases the need for nursing human resources.

Effect of Soft Silicone Foam Dressings on Intraoperatively Acquired Pressure Injuries: A Randomized Study in Patients Undergoing Spinal Surgery

To examine how the use of a soft silicone foam dressing affects the development of IAPIs in patients undergoing spinal surgery to obtain baseline data supporting evidence-based nursing care. Using a self-controlled study design, 64 patients requiring thoracic or lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were recruited between February 12 and September 1, 2018; 50 patients were eligible. Basic demographic, health, and surgical data were obtained. Before surgery, the left or right side chest and iliac crest areas were randomly assigned to be covered with a soft silicone foam dressing. The areas were assessed at 2 time points: immediately after and 30 minutes after surgery. If an IAPI was present at 30 minutes after surgery, all sites were reevaluated after 7 days. The majority of participants were male (26 participants, 52%). Average patient age was 62.54 (± 13.83) years, with a body mass index of 24.32 (± 4.23) kg/m2. Average length of surgery was 218.4 (± 137) minutes. Immediately after surgery, 26 IAPIs were observed and there was a significant difference between dressed and non-dressed chest areas for the number of IAPIs (4% vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and the difference between IAPIs in the iliac crest area was significant between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1 week, there were no chest or iliac crest IAPIs in the areas that had been covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%) area IAPIs remained when no dressing had been applied. The majority of IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had evolved into a stage 3 injury. The results of this study show that many stage 1 IAPIs do resolve over time and that use of soft silicone foam dressings during spinal surgery can significantly reduce IAPI rates. Additional longitudinal studies are needed to help guide postoperative skin assessment intervals and increase the understanding about the evolution of stage 1 IAPIs.

Assessment of Undergraduate Nursing Students’ Attitudes and Perceptions towards the Use of Computer Technology in Healthcare Settings

The use of computer technology in nursing education and practice has grown exponentially. It has provided advanced opportunities for learning and in the practice of evidence-based nursing care. The study aimed to assess the attitudes of undergraduate nursing students at King Faisal University in Saudi Arabia towards the use of computer technology in healthcare settings. Using a non-probability sampling method, one hundred and fifty (150) nursing students of first, second and third year were selected.

Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients: A prospective observational study

BackgroundAs nasogastric feeding tube insertion is a frequently applied, non-risk-free nursing technique, a high level of evidence-based nursing care is required. Little evidence is available regarding the accurate determination of the insertion length of nasogastric feeding tubes. The method of using the nose-earlobe-xiphoid distance as measurement is inadequate and not supported by evidence. Findings from a recent randomized trial led to an alternative calculation: the corrected nose-earlobe-xiphoid distance formula: (nose-earlobe-xiphoid distance × 0.38696) + 30.37 + 6 cm. ObjectivesTo test the accuracy of the corrected nose-earlobe-xiphoid distance formula for determining the required nasogastric feeding tube insertion length in adults admitted on an intensive care unit and to investigate the probability to successfully obtain gastric aspirate for pH measurement. DesignProspective, single‐center observational study. Participants and methodsAdult intensive care unit patients in a general hospital (N = 218) needing a small-bore nasogastric feeding tube were included between March and September 2018. Correct tip positioning was defined as a tube tip located > 3 cm under the lower esophageal sphincter. Tip positioning was verified using X-ray. ResultsAll nasogastric feeding tube tips were correctly positioned > 3 cm under the lower esophageal sphincter. The chance of successfully obtaining gastric aspirate within 2 h after placement of the tube was 77.9%. ConclusionsWith all tips positioned > 3 cm in the stomach and zero tubes migrating back into the esophagus, the corrected nose-earlobe-xiphoid distance formula can be considered a more accurate method to determine nasogastric feeding tube insertion length.

Effect of Evidence-Based Nursing Care Guidelines on the Quality of Care of Patients in Neurosurgical Intensive Care Units

Background: Evidence-based nursing care guidelines are important tools for increasing the quality of nurses’ clinical work. Objective: The aim of this study was to investigate the effect of implementing evidence-based nursing care guidelines on the quality of care of patients admitted to the Neurosurgical Intensive Care Units (NICUs). Methods: This is a quasi-experimental study on 54 nurses in NICUs of hospitals affiliated to Qazvin University of Medical Sciences selected using a convenience sampling technique and divided into two groups of intervention and control. The intervention included the teaching of evidence-based nursing guidelines and their implementation by the nurses. Before and two months after the intervention, the demographic characteristics and the quality of nurses’ patient care in both groups was evaluated by using a demographic form and a standard checklist with 37 items designed based on the standards of practice for All Registered Nurses (ANA). Data were analyzed in SPSS software using descriptive statistics (Mean±SD), and paired t-test, independent t-test and chi-square test. Findings: The mean score of nursing care quality in the two groups was not significantly different before intervention (P&gt;0.05). After intervention, the mean score was 25.11±6.2 in the intervention group and 20.29±5.3 in the control group, and the difference was statistically significant (P&lt;0.05). Conclusion: Implementation of evidence-based nursing care guidelines can improve the quality of nursing care. Therefore, it is recommended that the teaching of evidence-based nursing care guidelines should be on the agenda of the hospitals’ education unit and related departments.

Application Value of Evidence-based Nursing in Patients with Multiple Myeloma and Evaluation of Nursing Quality

<i>Objective</i> to explore the application value and quality of evidence-based nursing in patients with multiple myeloma. <i>Methods</i> A total of 92 patients with multiple myeloma from December 2016 to December 2019 were selected as observation objects, and they were divided into control group 46 and observation group 46 according to the order of admission. The control group was given routine nursing care, and the observation group was given evidence-based nursing care. The bone pain relief rate, Pittsburgh Sleep Quality Score (PSQI), anxiety self-rating scale (SAS) score, depression self-rating scale (SDS) score and nursing quality were compared between the two groups. <i>Results</i>: The relief rate of bone pain in the observation group was higher than that in the control group (P <0.05). The quality of sleep, sleep time, sleep time, sleep efficiency, sleep disorders, daytime dysfunction scores and PSQI total scores in the observation group were lower than those in the control group after nursing (P <0.05). P <0.05); SAS and SDS scores in the observation group were lower than those in the control group after nursing (P <0.05). After the implementation of evidence-based nursing, the quality of basic nursing, specialist nursing, critical care, ward management, and health education nursing care of nursing staff was higher than that before implementation (P <0.05). <i>Conclusion</i> Applying evidence-based nursing to patients with multiple myeloma can improve bone pain relief, improve sleep quality, reduce anxiety and depression, and improve the quality of care.

RESOURCES REQUIRED IN CLINICAL PATHWAY FOR TYPHOID FEVER TREATMENT AT KALIWATES GENERAL HOSPITAL IN 2017

Background: A clinical pathway is a concept of an integrated service which describes the stages of healthcare services from the admission until the return of patients based on the medical service standards and evidence-based nursing care with measurable results. Kaliwates General Hospital is an accredited hospital with a clinical pathway. Typhoid case was the highest disease in 2017 at Kaliwates General Hospital.Aims: This study aims to describe the resources at Kaliwates General Hospital in the implementation of clinical pathways, especially typhoid fever treatment.Method: This study was a descriptive and qualitative study. Nine respondents were selected using purposive sampling, including one internist and the quality team at Kaliwates General Hospital. The variables studied include human resource factors, budget factors, method factors, and time factors.Results: The results suggested that the human resources at Kaliwates General Hospital had high commitment, motivation, and moderate knowledge in the implementation of clinical pathways. All equipment and documents were considered adequate. The communication among the implementers was good, but compliance and training for staffs were considered less prominent. The task division of each staff was fairly distributed even though the pharmacy unit perceived that the division was quite unfair.Conclusion: The implementation of the clinical pathway for typhoid fever treatment at Kaliwates General Hospital runs quite well. The hospital must identify and plan staff training regularly, prepare the job description appropriately, and perform performance appraisal based on the job description that has been developed.Keywords: clinical pathway, typhoid fever, resource.

Early enteral nutrition: indications, benefits and complications

It is important in veterinary practice that registered veterinary nurses (RVNs) are knowledgeable regarding identifying patients in need of nutritional support, in order to continually strive for a high standard of evidencebased nursing care and improve patient outcomes. In gaining this knowledge, RVNs can feel empowered to work alongside the veterinary surgeon (VS) to suggest the most appropriate feeding method, in addition to explaining all benefits and complications accurately to clients for informed consent to be obtained. Early enteral nutrition brings many benefits such as dramatically improving patient outcomes by preventing any adverse effects of malnutrition, which could lead to a reduction in length of hospitalisation. Shortened hospital stays could mean that patients resume their normal routine in a familiar, home environment more quickly.

Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective?

Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. However, dexmedetomidine appears to have a promising role in delirium management. This review includes an overview of the pathophysiology and types of delirium and describes 2 established tools used to screen for delirium. Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.

Viviendo en la incertidumbre después de un macroadenoma pituitario: un caso de estudio

Introducción: La Teoría de la Incertidumbre frente a la Enfermedad es una teoría de enfermería intermedia que explica los procesos que los individuos con enfermedades crónicas atraviesan con el objetivo de lograr la adaptación. Esta teoría describe antecedentes de la incertidumbre, mecanismos de valoración y estrategias de afrontamiento para adaptarse a nuevas condiciones. Objetivo: Demostrar la integración del proceso de enfermería, lenguaje estandarizado y la Teoría de la Incertidumbre en la Enfermedad en el cuidado de una persona con complicaciones físicas y psicosociales tras un macroadenoma hipofisiario. Metodología: Los datos fueron recolectados a través de entrevistas con el paciente, examen físico y el expediente médico. La Teoría de la Incertidumbre frente a la Enfermedad de Mishel, lenguajes estandarizado para describir los diagnósticos, intervenciones y resultados y evidencia científica fueron utilizados para desarrollar el plan de cuidados. Presentación del caso: La teoría de la incertidumbre permitió seleccionar el diagnóstico principal (Afrontamiento ineficaz relacionado con incertidumbre), el cual se abordó con los NIC: mejorar el afrontamiento y enseñanza: proceso de la enfermedad, los resultados medidos fueron NOC: nivel de estrés y conocimiento: manejo de la enfermedad crónica. La efectividad de este enfoque fue reflejado en la mejora de los indicadores. Conclusiones. La identificación de una teoría que pueda explicar los hallazgos y guiar las intervenciones fortalece la calidad del cuidado de enfermería. Esta integración facilita un cuidado de enfermería personalizado y basado en la evidencia.

Two-month breathing-based walking improves anxiety, depression, dyspnoea and quality of life in chronic obstructive pulmonary disease: A randomised controlled study.

To examine the effects of the two-month breathing-based walking intervention and its follow-up on anxiety, depression, dyspnoea and quality of life in patients with chronic obstructive pulmonary disease. Mind-body-related exercises improve bio-psychological symptoms and quality of life in chronic diseases, but these improvements are not proven for chronic obstructive pulmonary disease. This was a randomised controlled study and applied the Consolidated Standards of Reporting Trials (CONSORT) statement. Outpatients diagnosed with chronic obstructive pulmonary disease were recruited from a medical centre in Taiwan and randomly assigned to two groups. The walking group (n=42) received breathing, meditation and walking for two months, and the control group (n=42) did not. Data from the outcomes of anxiety, depression, dyspnoea and quality of life were collected at baseline and in Month 1, Month 2 and Month 3. Clinical trial registration was done (ClinicalTrials.gov.: NCT03388489). The results showed significant changes in anxiety, depression, dyspnoea and quality of life in the walking group across three months, compared to those in the control group and at baseline. This breathing-based walking intervention is promising to achieve bio-psychological well-being for patients with chronic obstructive pulmonary disease. This breathing-based walking, as a mind-body exercise, could serve as an evidence-based nursing care that contributes to improving anxiety, depression, dyspnoea and quality of life in stable chronic obstructive pulmonary disease outpatients. The feasibility and acceptability of the breathing-based walking were met the requirement of the chronic obstructive pulmonary disease outpatients, which could be considered as home-based exercise.

Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU.

Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful. Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU. An observational pre-/postdesign was used. Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing. This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.

The impact of implementing an educational intervention to enhance a family-oriented approach in specialised palliative home care: A quasi-experimental study.

Healthcare providers' beliefs, attitudes, experiences and knowledge, which guide the care they deliver, are the key factors influencing the quality of palliative care. Education and coaching innovation are needed to translate research outcomes and adopt evidence-based nursing care into practice. To evaluate the impact of an advanced educational and coaching programme in a family systems' nursing approach for palliative care nurses in a home-care setting. A quasi-experimental study using qualitative data from open-ended questions to augment the quantitative outcome study that included a single-group, pre- and post-test design. A total population sample of nurses was recruited from a specialised palliative home care unit at a university hospital. The study utilised two self-reported questionnaires. There was a statistically significant increase in the nurses' critical appraisal of clinical nursing practice related to family nursing after participation in the educational programme than before. No statistical difference was found in items related to nurses' experience of the interaction and reciprocity in the nurse-family relationship after participation in the programme than compared to before or in nurses' cancer-related beliefs. However, there was an overall significant positive change found in attitudes towards families in the total score of the Family Practice Scale. Nurses were also more positive about the further development of their knowledge and skills in advanced family nursing evident in the qualitative data. An advanced educational intervention programme was successful in improving the nurses' knowledge, skills, satisfaction and confidence in relation to applied family nursing approach within the context of caring for families affected by advanced/final stage cancer. However, further refinement of the implementation process is needed to enhance family care improvement and the nurses' professional development in advanced family nursing in specialised palliative care.

Implementation of a high impact intervention to prevent ventilator associated pneumonia – A before and after study

Introduction: Ventilator-associated pneumonia is a common avoidable healthcare associated infection that can develop in ventilated critical care patients. Ventilator-associated pneumonia has a detrimental impact on patient recovery and can increase the burden of care. High impact interventions, such as care bundles, are strategies that can mitigate the risk for ventilator-associated pneumonia and achieve positive patient health outcomes. The aims of this study were to determine the change in uptake of evidence-based nursing care, after implementation of a ventilator care bundle within a tertiary level intensive care unit.

Care in patients with epidermal necrolysis in burn units. A nursing perspective

ObjectiveTo describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries. MethodDescriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results. ResultsAll BU/SUs in Spain (n=12) and seven BU/SUs from a selection of countries completed the questionnaire. A lack of specific nursing protocols on Epidermal Necrolysis was observed in most burn units in Spain. Skin cleansing techniques such as showering were only reported by participants from Spain. Use of antiseptics was less frequent in other countries. Conservative skin management was the most extended practice reported by all participants. The use of vaginal molds to prevent synechiae and coverage of the ocular surface with amniotic membrane to minimize sequelae were rarely reported. Pain assessment was not always documented in sedated patients and few participants reported the use of specific scales for this purpose. All nurses agreed in the need for consensus nursing care guidelines on the disease. ConclusionsNursing care in patients with epidermal necrolysis varied between burn units in Spain. Differences and similarities were observed when compared with burn units in other countries. Genital and ocular care were outdated in all BU/SUs. Pain assessment documentation was suboptimal. Evidence-based nursing care guidelines were generally demanded by all participants to help reduce mortality and morbidity of this rare and often devastating disease.

Basic nursing care: The most provided, the least evidence based - A discussion paper.

To describe and discuss the "Basic Care Revisited" (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. While basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. Discussion paper METHOD: The discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called "Basic Care Revisited" (BCR) as a solution to move forward and improve basic nursing care. To prioritise basic nursing care, we propose a research programme entitled "Basic Care Revisited" that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Revaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes.

Integrating the fundamentals of care framework in baccalaureate nursing education: An example from a nursing school in Denmark.

To describe and discuss the process of integrating the Fundamentals of Care framework in a baccalaureate nursing education at a School of Nursing in Denmark. Nursing education plays an essential role in educating nurses to work within healthcare systems in which a demanding workload on nurses results in fundamental nursing care being left undone. Newly graduated nurses often lack knowledge and skills to meet the challenges of delivering fundamental care in clinical practice. To develop nursing students' understanding of fundamental nursing, the conceptual Fundamentals of Care framework has been integrated in nursing education at a School of Nursing in Denmark. Discursive paper using an adjusted descriptive case study design for describing and discussing the process of integrating the conceptual Fundamentals of Care Framework in nursing education. The process of integrating the Fundamentals of Care framework is illuminated through a description of the context, in which the process occurs including the faculty members, lectures, case-based work and simulation laboratory in nursing education. Based on this description, opportunities such as supporting a holistic approach to an evidence-based integrative patient care and challenges such as scepticism among the faculty are discussed. It is suggested how integration of Fundamentals of Care Framework in lectures, case-based work and simulation laboratory can make fundamental nursing care more explicit in nursing education, support critical thinking and underline the relevance of evidence-based practice. The process relies on a supportive context, a well-informed and engaged faculty, and continuous reflections on how the conceptual framework can be integrated. Integrating the Fundamentals of Care framework can support nursing students' critical thinking and reflection on what fundamental nursing care is and requires and eventually educate nurses in providing evidence-based fundamental nursing care.