Evidence-based Nursing Practice Guidelines Research Articles

Prevention of Injuries in Children with a Peripheral Intravenous Catheter: A Modified Evidence-Based Nursing Practice Guideline

Many children in African hospitals need a peripheral intravenous catheter (PIVC). Babies and children are particularly susceptible to serious harm from PIVC-related injuries. Nurses often regard a PIVC as a routine, low-risk intervention. Globally recommended practices include establishing a structured care pathway, recognising that PIVC management begins before insertion. Evidence-based care for children with PIVCs reduces complications and healthcare costs. Existing guidelines on managing PIVCs in infants and children are generally written for higher-resourced settings or are not specific to a paediatric population. This study aimed to review existing practice guidelines to provide accessible and implementable guidelines for caring for hospitalised babies and children up to the age of 13 years, in lower-resourced paediatric in-patient health facilities in Namibia. We applied a structured process for modifying existing high-quality guidelines developed in higher-resourced settings for implementation in lower-resourced contexts. This process involved identifying suitable guidelines for modification and rigorous guideline modification, resulting in a context-specific guideline. The modified guideline ensured that recommended practices related to pain management, difficult insertions and infection prevention are implementable. However, seeing PIVCs as unlikely to cause serious harm can lead to insufficient assessment and surveillance of PIVC injuries. We therefore produced a user-friendly guideline focused on high-impact areas of nursing practice, emphasising that nurses can avoid injury to children by properly managing a PIVC.

Effect of Implementing Evidence-Based Nursing Practices Guidelines Related to Post-Partum Care on Maternity Nurses' Performance

Context: Delivering high-quality care that improves patients' health outcomes necessitates using evidence-based nursing practice (EBNP).
 Aim: This study aimed to evaluate the effect of implementing evidence-based nursing practice guidelines related to postpartum care on maternity nurses' performance.
 Methods: One group (pre/post-test) is studied in a quasi-experimental study. The study was carried out at the postnatal unit of the Obstetrics and Gynecology department of Benha University Hospital. A convenient sample included all maternity nurses working in the previously mentioned setting. Three tools are used for data collection: A self-administered questionnaire includes an assessment of socio-demographic characteristics of the studied maternity nurses, an assessment of maternity nurses' knowledge regarding evidence-based practices about postpartum care, an observational checklist regarding evidence-based nursing practice during the postpartum period, and barriers scale of nurses in implementing evidence-based practices.
 Results: The study revealed a mean nurses' age of 33.6±9.867, and 55.4% had baccalaureate degrees in nursing sciences. 60% of them depend on the internet as a source of information. The present study findings a highly statistically significant difference between pre-intervention, immediate post-intervention, and follow-up (p<0.0001) regarding nurses' knowledge and practice concerning postpartum evidence-based nursing practice. The barriers assessment revealed that 84.5% of the nurses agreed they did not have time to read the research.
 Conclusion: Maternity nurses' performance in postpartum care significantly improved after implementing evidence-based practice guidelines. The study recommended encouraging continuous educational training programs and workshops for nurses regarding evidence-based nursing in obstetrics and gynecological unit.

Adaptation and Verification of an Evidence-Based Nursing Practice Guideline for Infection Control in Long-Term Care Hospital

Adaptation and Verification of an Evidence-Based Nursing Practice Guideline for Infection Control in Long-Term Care Hospital

Development and Effectiveness of Practice Application Program of Intravenous Infusion Evidence-Based Nursing Practice Guideline - for Small and Medium Sized Hospitals

This study was conducted to develop and test the effects of a program for practice application of intravenous infusion evidence based nursing practice (EBP) guidelines in small and medium-sized hospitals. A mixed method research design was used, combining non-equivalent control group pre-post test design with qualitative study analysis. The subjects consisted of 55 nurses. The practice application program was developed based on the Advancing Research and Clinical practice through close Collaboration (ARCC) model. Data were collected for analysis in the following areas: nurses' EBP organizational culture and readiness, EBP beliefs, EBP implementation, importance about intravenous infusion, and performance about intravenous infusion, with data assessed using valid and reliable instruments. Patient outcomes were collected from the hospital's medical records. Data were analyzed using t-test, χ²-test, and Shapiro-Wilk test, with qualitative content analysis used for interview data. Following the intervention, nurses' EBP organizational culture and readiness, EBP beliefs, EBP implementation, and performance of intravenous infusion and perceptions of its importance showed significant improvement in the experimental group. Phlebitis rates decreased in the experimental group compared to the control group. This program is effective to improve nurse's perception and practice of evidence based nursing. Therefore we recommend to use this program at same levels of hospitals.

Development and Effect of Evidence-based Nursing Practice Guidelines for Pain Management in Patients with Dementia

Purpose: This study aimed to develop evidence-based nursing practice guidelines for pain management in patients with dementia and to verify their effects. Methods: Guidelines were developed according to the Clinical Practice Guideline Adaptation Manual. Additionally the quality of six guidelines was evaluated using the AGREE (Appraisal of Guidelines for Research & Evaluation) tool. Subsequently, the guidelines were translated into Korean and a preliminary set of guidelines was established. After a group of experts confirmed the content validity of the guidelines, the Korean version was applied to clinical settings for 4 weeks, to examine their applicability. Data was collected from April to August 2017. The dependent variables were nurses’ knowledge and attitudes about pain management in patients with dementia, pain assessment frequency, use of pharmacological and nonpharmacological intervention to reduce pain, and subjective and objective pain scores of patients with dementia. Data were analyzed using an independent t-test, Mann-Whitney U test, Wilcoxon Signed Ranks test, and analysis of covariance with SPSS/WIN 22.0. Results: Nurses in the experimental group had a higher degree of knowledge and more positive attitudes regarding pain management, and they reported a higher frequency of pain assessment as compared to those in the control group. As compared to patients in the control group, those in the experimental group had more days of regular treatment with analgesics and were provided with a higher analgesics dose as well as more frequently received physical and relaxation therapies. The two groups did not show significant differences in subjective and objective pain scores. Conclusion: The present findings indicates that the evidence-based guidelines for pain management developed in this study were effective in helping nurses and patients with dementia to resolve their pain for which they were currently seeking treatment.

Current Status and Implementation Strategies of Evidence-Based Nursing Practice Guidelines in Korea

Current Status and Implementation Strategies of Evidence-Based Nursing Practice Guidelines in Korea

Identifying and prioritizing topics for evidence-based geriatric nursing practice guidelines in Korea.

Despite the increasing population of elderly individuals in Korea, there are no evidence-based geriatric nursing practice guidelines. This study aimed to identify and prioritize topics related to the development of evidence-based geriatric nursing practice guidelines in long-term care facilities in Korea. To identify potential topics, 89 nurses responded to a questionnaire on activities that require further evidence and/or standardization in the long-term care facility setting. To prioritize these topics, 14 geriatric nursing experts completed surveys to prioritize five categories. The collected data included 240 clinical topics, which were classified into 41 subcategories and 18 main categories. According to topic prioritization by the geriatric nursing experts, the following were the most heavily weighted categories: fall prevention, position change and prevention of pressure ulcers. The development of standardized guidelines based on these results may help improve the quality of geriatric care and quality of life of older individuals. The small number of respondents may be a limitation of this study, and further study is needed to expand the population. The development of evidence-based nursing guidelines based on the present findings will help improve the quality of nursing in long-term care facilities. Additionally, health policies and systems, such as introduction of a fee for nursing services for older individuals based on the evidence, are worth considering.

Development of Evidence-based Nursing Practice Guidelines for Cold Application in Adult Care

This paper is a basic research project(NRF-2014R1A1A3052149) funded by the Government of Korea(Future Creation Science Department) with the support of the Korea Research Foundation.

Development of Evidence-based Nursing Practice Guidelines for Peripheral Intravenous Catheter Management in Hospitalized Children and Adult

Aims: The purpose of this study was to report on the development of evidence-based practice guidelines.Design: Developmental research for practice guidelines.Methods: The guidelines developmental process was designed according to a procedure provided by Scottish Intercollegiate Guidelines Network (SIGN). A first step, key clinical questions were selected. Next, 74 studies were selected from studies of 719 according to a search strategy, and then methodological quality of those studies was evaluated using assessment tool of SIGN. After the evaluation of draft guidelines including recommendations and their grades, the contents were modified. Last, definitive guidelines were evaluated using Appraisal of Guidelines for Research and Evaluation (AGREE) tool.Result: The guidelines consist of three categories and 64 recommendations, i.e. nine recommendations for user before peripheral intravenous catheterization (PIVC), 26 recommendations during PIVC, and 29 recommendations after PIVC. Content validity was revealed to 70-78% by experts’ agreement. Conclusion: These guidelines were completed throughout systematic reviews and evaluations by clinical experts. Their contents are also included about overall managements for PIV therapy. Therefore these guidelines could help PIV practitioners to make evidence based decision.Relevance to clinical practice: The method and result of this study are described specifically in figures, tables and appendix, which could give guidance to nurses who develop guidelines regarding other subjects.

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

Establishment and application of prevention and control guideline for radiotherapy-induced oral mucositis based on evidence

Objective Through establishment of prevention and control guideline for radioactive oral cavity mucositis (radiotherapy-induced oral mucositis, RTOM), to guide nursing staff to strengthen the prevention and control for RTOM in patients with head and neck tumor, thereby improving the quality of nursing. Methods Through evidence-based literature retrieval, interview chemoradiation division staff and RTOM cases, the common problems in nursing management of RTOM prevention and control were concluded and analyzed. According to related evidence-based nursing practice, prevention and control guidelines was established. Through establishment of a multidisciplinary team and process for prevention and control of RTOM, strengthening RTOM specialty and related assessment scale training, health education propaganda material and quality control measures were made. Results After the implementation of prevention and control guidance, the incidence of grade Ⅲ RTOM reduced to 16.7% from 40.0%; pain score (Numerical Rating Scale, NRS) reduced from (3.90±0.76) points to (1.67±1.07) points (P<0.05). Conclusions The prevention and control guideline has better clinical guidance on RTOM in patients with head and neck tumor. Key words: Head and neck tumor; Radiation therapy; Oral mucositis; Management

Nursing Practice Guidelines in China do Need Reform: A Critical Appraisal Using the AGREE II Instrument.

An increasing number of nursing practice guidelines (NPGs) of varying methodological and reporting quality have been issued and published in international journals. Currently, the quality of NPGs in mainland China has not been explored. To assess the quality of NPGs in China mainland using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. The authors searched the electronic databases of Chinese Biomedical Literature Database, China National Knowledge Infrastructure, The VIP Database, Wan Fang Database, Chinese Master's Theses Full-Text Database, China Doctor Dissertation Full-Text Database, and China Proceedings of Conference Full-Text Database and the web of China Guideline Clearinghouse for NPGs in China published from the inception of databases to December, 2013. Four independent assessors rated the quality of each guideline using AGREE II. The authors classified NPGs into two types: evidence-based NPG (EB-NPG) and consensus-based NPG (CB-NPG), and compared their quality. The authors also considered whether the quality of NPGs changed over time. Forty-two NPGs were appraised. Methodological rigor and reporting of NPGs were poor. Across all guidelines, the appraisers assigned the highest scores to the domain "scope and purpose," and the lowest scored to the domain of "editorial independence." EB-NPGs were significantly superior to the CB-NPGs in the domains of "stakeholder involvement," "rigor of development," and "editorial independence." There was no improvement over time for all domains. This research found an absence of a systematic guideline development methodology and a tendency to rely on expert opinion in the process of developing NPGs. The readers should consider these flaws and limitations when using recommendations in those NPGs.

Assessing The Level Of Utilization Of Evidence-Based Nursing Practice Guidelines Among Nurse Practitioners

Evidence-based practice is the conscientious, explicit and judicious use of current best evidence about the care of individual patient. The practice of evidence-based nursing means integrating individual clinical expertise with the best available external clinical evidence from systematic research and to achieve EBP, the most current and universally acceptable evidence must be applied in making decisions about the care of individual patients. A descriptive survey assessingthe level of utilization of evidence-based nursing practice guidelines among nurse practitioners was conducted at Federal Teaching Hospital, Abakaliki-Nigeria. A total of ninety (90) nurse practitionersparticipated in the study.Findings of this study show that majority of the practitioners had heard about evidence-based nursing practice and while some heard it through formal education, others heard it through their colleagues. A positive attitude and belief towards evidence-based nursing practice (EBNP) among practitioners was equally indicated. The finding shows significant association between nurse practitioners’ knowledge and attitude towards evidence-based nursing practice.Based on the results of the findings, it was concluded that majority of the nursepractitioners working in the Hospital were aware of evidence-based nursing practice and had a positive knowledge and attitude towards EBNP. Despite the above, the nurses still perceived some barriers and facilitators towards implementation of this concept. Based on the findings the researcher recommendedamong others promotion of research use through and conducive as well as supportive environment where innovation is valued and rewarded as conditions that sustain EBNP in the hospital.

Adaptation of evidence-based nursing practice guideline for central venous-port management

Background: There are some differences in the guidelines on management of central venous-port among the units in this hospital. Therefore, we developed evidence-based guidelines to improve the efficiency of nursing practice and quality of patient care. Objective: This study was conducted to develop evidence-based nursing practice guidelines on central venous-port management in Korea. Methods: Guideline adaptation process was conducted according to the evidence-based intravenous infusion nursing practice guideline (Ku mi-Oak, 2012) which was conducted previously according to the guideline adaptation manual version 2.0 developed by NECA (Kim Su Young et al, 2011). Results: The adapted evidence-based nursing practice guidelines on central venous-port management consisted of 18 domains and 94 recommendations. Some of the recommendations included sub-domains which were supported by evidence and grades. The number of recommendations with levels of evidence and gradings were 104, and they were 11.5% of I, 29.8% of II, 58.7% of III. There were 22.1% of A, 30.8% of B, 47.1% of C in the recomended grades. The grade C recommendations of evidence accounted for 47.1% of all the recommendations, which means most of the recommendations did not have enough evidence. Discussion: There are not enough experimental studies to contribute quality evidence for the core questions of the central venous-port management, and furthermore most of the recommendations are mainly from descriptive studies and expert‘s opinions. We suggest to researchers to conduct futher studies on the evidence with grade C recommendations. We need well designed experimental study, especially on the central venous-port patency and heparin locking. Conclusion: The adapted evidence-based nursing practice guidelines on central venous-port management is recommended to be disseminated to nurses on a national scale to improve the efficiency of nursing practice and the quality of patient care.

Evidence Based Nursing Practice Guideline For Post-Lumbar Puncture Patients in neurology ward

Purpose: The purpose of the study was to develop Evidence-based nursing practice guideline for post-lumbar puncture patients in neurology ward and to evaluate the guidelines by applying them to practice. Methods: Eighty patients without preceding headache who underwent Lumbar puncture were selected prospectively. We compared the incidence of post-lumbar puncture headache between bed-rest for 4 hours and 1hours. Results: The post-lumbar puncture headache was found in 13 cases among bed-rest for 4 hours and 1hours groups. The frequency of each group was 25%(10/40) in 4 hours-bed rest group and 7.5%(3/40) in 1 hours-bed rest group. Conclusion: There was no significant difference between two groups ( p-value= .066). 4 hours-bed rest after lumbar puncture is unnecessary.

The Development and Effects of Evidence-based Nursing Practice Guideline for Cancer Patients with Delirium

Purpose: This study was conducted to develop nursing practice guideline for delirium of cancer patients and to evaluate the effects of the guideline. Methods: Guideline development was done by guideline adaptation and de novo development of recommendations. Participants consists of 13 nurses and 90 cancer patients (intervention group: 36, control group: 44) in oncology unit. One group pre-post test design for nurses and nonequivalent control group non-synchronized design for patients were used. Data were analyzed by χ2 -test, t-test, paired t-test and ANCOVA. Results: Guideline consisted of 3 domains and 106 recommendations. The number of recommendations in each domain were: nursing assessment, 23; nursing intervention, 80; nursing evaluation, 3. There were 5.6% of A, 17.0% of B, 20.8% of C, 56.6% of D in grade of recommendations. There were significant differences in nurse’s knowledge about delirium, nursing performance and care stress of cancer patients with delirium between before and after guideline implementation. There were no significant differences in the incidence of delirium, episodes of delirium, delirium severity, and duration of hospital stay in cancer patients between experimental and control group. Conclusion: Study findings indicate the implementation of evidence-based nursing practice guideline for cancer patients with delirium can be recommended in nursing practice.

Development of Evidence-based Nursing Practice Guidelines for Febrile Children in Emergency Room

Purpose: The purpose of this study was to develop evidence-based nursing practice guidelines for the care of febrile children in the emergency room and to evaluate the guidelines by applying them to practice. Methods: This study was conducted using a methodological design. referring to the Scottish ...

출혈위험이 있는 신부전환자의 혈액투석을 위한 근거중심 간호실무 가이드라인 개발과 적용 및 평가

Purpose: The purpose of this study is to develop evidence-based nursing practice guidelines for hemodialysis in the renal failure patients with risk of bleeding and to evaluate the guidelines by applying it to the practice. Method: Referring to the SIGN, the first draft for guidelines was developed based on the advices and recommendations obtained from the procedure of critical literature analysis. Then, the draft was modified by the procedures of the expert group evaluation and pilot application to the practice. The final draft was evaluated by the expert group using AGREE instrument. Result: The first draft of guidelines was developed through 8 stages of process and was evaluated by seven experts in terms of the appropriateness, applicability, and effectiveness using a 9 point scale. The mean score of 11 items was 7.90 or above. The quality of the final draft was evaluated by 5 experts using the AGREE instrument. The mean standard score was 73.0% or above in the 19 items. Conclusion: The clinical guidelines developed by this research can be utilized as systematic and scientific guidelines for hemodialysis in the renal failure patients with risk of bleeding. In addition, the research can contribute to improving care services.

Evidence-Based Practice

Nahas, Violeta Lopez PhD, RN, FRCNA; Chang, Anne PhD, RN, FRCNA; Molassiotis, Alex PhD, RN Author Information

A situational analysis: the potential to produce evidence-based nursing practice guidelines within a regional neonatal intensive care unit

Aims This paper describes a study which was undertaken to determine the factors which may influence the production of nursing practice guideline (NPG) documents. The aim was to examine the factors which impact on the ability to successfully produce evidence based nursing practice guidelines within a regional neonatal intensive care unit (NICU), in order to develop strategies to assist in the success of such a project. Background Recent government recommendations have highlighted the increasing importance of quality in practice. Supporting infrastructures may not be in place within Trusts and specialist areas to allow for nurses in clinical practice to produce evidence-based guideline documents, in response to these recommendations. Method A situational analysis was utilized, via the application of documentary evidence and semi-structured interviews, to support and give meaning to the construction of a clearer understanding of the project, with the primary focus being from the perspective of the nurses completing the documents. Findings Provision of appropriate resources in terms of time, staffing levels and facilities impact heavily on the ability of nurses to produce evidence-based guidelines documents and their motivations towards doing so. The emphasis given to academic, rather than practice-based, continuing education programmes may not always be relevant when considering ongoing development of quality of care. Conclusion Lack of appropriate resource allocation has meant that a gap exists between the ideals set out by the recent introduction of NHS quality initiatives and the reality facing nursing staff attempting to put those strategies into practice.