Evidence-Based Practice Committee Research Articles

Cultivating Quality: Implementing Surgical Smoke Evacuation in the Operating Room

Inspired by a presentation at an educational conference, two operating room (OR) nurses at Children's Hospital Boston raised concerns at the hospital's perioperative evidence-based practice committee meeting about the potential hazards associated with exposure to surgical smoke and aerosols. The nurses initiated a safety project involving the use of smoke evacuation devices in ORs. The subsequent policy development took two years and involved a literature review, a survey of other institutions, and the support of numerous stakeholders. A utilization review and supportive educational initiatives are ongoing.

Evidence Based Practice Committee

Purpose: Mindful of the importance of assuring projects for process improvement are formatted with evidence based practice guidelines. Our PACU (perianesthesia recovery room) developed our own unit-based “Evidence Based Practice (EBP) Committee” to monitor projects and provide consistency in their progress.

Theories of Medical Decision Making and Health: An Evidence-Based Approach

In this special section of Medical Decision Making, 3 developers of evidence-based theories of medical decision making and health present their approaches: Fishbein (theory of reasoned action); Prochaska (transtheoretical model); and Reyna (fuzzy-trace theory). Spring, chair of the Evidence-Based Practice Committee of the Society for Behavioral Medicine, follows with a commentary on the 3 approaches and many other topics of keen interest to researchers concerned with the science of decision making and behavioral change, as applied to both patients and health care providers. Although this special section sprang from a symposium at the Annual Meeting of the Society for Medical Decision Making (SMDM), the authors have gone beyond their addresses to summarize the major findings and rationale for each of their positions. The practical payoff to the reader is a brief introduction to current theories that have evidence behind them, theories that are apt to improve assessments, prevention programs (e.g., risk communication), and intervention efforts in medical decision making and health, including decision aids.

Increasing Understanding of Nursing Research for General Duty Nurses: An Experiential Strategy

Misconceptions and trepidation about research abound among practicing nurses. However, in light of the movement toward increasing accountability to consumers and the concurrent drive toward evidence-based practice, the need for nursing research can no longer be ignored. Innovative approaches to augment nurses' training and education in research and evidence-based practice must be incorporated into continuing education programs. The Nursing Research and Evidence-Based Practice Committee of a large tertiary care teaching hospital in Winnipeg, Manitoba, Canada, developed a series of opportunities for staff nurses to participate in research projects and have ongoing exposure to the steps in the research process. The Great Canadian Cookie Experiment was an opportunity to participate in quantitative research. Qualitative data from patients' thank you cards were analyzed in an interactive fashion during luncheon seminars held during Nursing Week in 2 subsequent years. A survey of nurses who participated in the luncheon seminars indicated an overall increase in their knowledge about qualitative research methods and an appreciation for participating in the process of nursing research. Continued visibility of nursing research will contribute to changing nurses' attitudes toward fostering an evidence-based approach to clinical practice.

The Use of Knee-Length Versus Thigh-Length Compression Stockings and Sequential Compression Devices

Nurses on an Acute Care Evidence Based Practice Committee, creating a policy to increase patient compliance with thromboembolic deterrent stockings (TEDS) and sequential compression devices (SCDs) for deep vein thrombosis prophylaxis, found limited literature on patient preference and response to this treatment. The study purpose was to determine whether knee-length or thigh-length TEDS and/or SCDs were more comfortable, correctly applied, and worn by patients, and to assess patient reasons for noncompliance. A patient survey and observational data tool was designed. Six surveyors collected data (interrater reliability = 93%) from 137 randomly selected patients with orders for TEDS and/or SCDs admitted to acute care medical or surgical nursing units. Most patients wore thigh-length SCDs and TEDS. However, only 29.2% (n = 40) had SCDs on them at the time of survey, and 62.8% (n = 86) were compliant with TEDS. The most common reasons given for noncompliance with SCDs were that the devices were not reapplied after bathing or ambulating, or were removed because they were hot or itchy. Complaints of discomfort were highest among patients wearing thigh-length SCDs and TEDS. Problems with fit were 50% higher in those who wore thigh-length TEDS, and involved stockings that created restricting bands. Most patients understood the purpose of treatment, and older patients were more compliant than younger patients. Knee-length TEDS and SCDs are more comfortable for patients, encourage higher levels of compliance with treatment, do not pose a risk for venous stasis to patients by creating restricting bands, and are less expensive. Patients need ongoing education to resume wearing TEDS and SCDs after activities of daily living, and knee-length stockings and devices would be easier to reapply. The policy in our institution was changed for the use of knee-length compression stockings and SCDs.