Evidence-based Practice Project Research Articles

Decreasing 30-day hospital readmissions by addressing social determinants of health using a bundled discharge approach: An evidence-based practice project recommendations.

Evidence from the literature suggests that social determinants of health (SDOH) account for 80% of health outcomes and are associated with hospital readmissions. Readmissions negatively impact the quality of life of patients and increase healthcare costs. The Agency for Healthcare Research and Quality reports that there were 3.8 million 30-day adult hospital readmissions in 2018 with an average readmission cost of $15,000. A literature search in CINAHL, PubMed, ClinicalKey, Google Scholar, and Medline databases using the keywords "SDOH", "social determinants of health", "healthcare disparities", "patient discharge", "readmission", "interdisciplinary", and "multidisciplinary" yielded 287 articles. After title and abstract screening and a full-text review of 90 articles, five articles were selected for critical appraisal. We used the critical appraisal skills programme (CASP) and Appraisal of Guidelines for Research & Evaluation II (AGREE II) tools for the selected articles' appraisal process. Ten high-quality strong evidence recommendations emerged from the evidence review process. These recommendations were bundled together to create an evidence-based methodology to decrease 30-day readmissions. The findings provide strong evidence of the effectiveness of a bundled discharge approach in reducing hospital readmissions and improving patient outcomes.

Reporting guidelines for evidence-based practice projects: A Delphi study and publication checklist.

Evidence-based practice (EBP) is the cornerstone of sound patient care. Despite the known importance of disseminating EBP, of the 600 reporting guidelines registered with the EQUATOR network, none exist on reporting an EBP project. This lack of guidance leads to publications that lack rigor and discourages more novice writers who may not know where to begin. The purpose of this study was to establish Reporting Guidelines for EBP projects by achieving consensus among subject matter experts (SMEs) regarding the required components for a high-quality report. This study followed a modified Delphi technique. The first round solicited free-text responses regarding reporting sections and sub-sections. The team analyzed these results and incorporated information from the literature to generate items for the second round. In the second and third rounds, participants ranked each section on a Likert scale of 1-4 (not relevant to extremely relevant) and provided free-text revision suggestions. Items that reached a 70% consensus moved from one round to the next. SMEs reached consensus on 6 sections and 30 sub-sections. Sections address the process for determining best practice recommendations as well as implementation into practice. Headers include (1) "Introduction," (2) "EBP Design," (3) "Methods to Generate Recommendations," (4) "Evidence Findings," (5) "Implementation," and (6) "Conclusion." All items are unaffiliated with specific EBP models, hierarchies, or question formats. The Reporting Guidelines for EBP Projects is a checklist of items with associated descriptors that should be addressed in articles reporting an EBP project. The intention is to provide a roadmap of the items required to publish EBP efforts. It is meant to create a set of expectation for journal editors to provide concrete guidance for authors and elevate the quality and quantity of EBP projects in the literature.

A Clean You Can Trust: Using an Evidence-Based Bundle to Transform Point-of-Use Treatment for Reusable Medical Devices at a Military Treatment Facility

ABSTRACT Introduction Throughout surgical and invasive procedures, reusable instruments and flexible endoscopes become soiled with organic and inorganic materials. When these substances are permitted to dry, a matrix of microbial cells, called biofilm, forms on the surface of devices, irreversibly binding and subsequently impeding the disinfection and sterilization process. To prevent biofilm formation from occurring, devices must be continuously flushed and wiped with water throughout the procedure and at the end of the case. This process, known as point-of-use treatment (POUT), is the critical first step in the decontamination of medical devices. Poor compliance with POUT can increase patient morbidity and mortality and result in failing hospital accreditation. Materials and Methods An interdisciplinary team used the Plan-Do-Study-Act (PDSA) to develop and implement an audit assessing 29 evidence-based criteria for POUT treatment. Each PDSA cycle supported evidence-based opportunities addressing feedback, workflow analysis, policy development, competency assessment creation, training module development, and infection prevention grand rounds. Four audits were performed over ten months to achieve improved organizational POUT compliance. Results Implementing recurrent PDSA cycles that included audits with feedback led to an evidence-based bundle of policies, competencies, and training for 34 different clinical areas. These interventions resulted in a 26% compliance increase (66% to 92%). Program-specific improvements included flexible endoscopes (+4%) and reusable instruments (+20%). Conclusions Multimodal evidence-based initiatives to improve compliance with workflow processes is a translatable POUT evidence-based practice project for similar Defense Health Agengy facilities. Workflow processes can be vetted and distributed using interdisciplinary teams to ensure viability, sustainability, and conformity with organizational requirements, resulting in a more ready force.

Determining the Effects of Complex Education on Primary Care Nurse Practitioners' Self-efficacy in Advance Care Planning for Healthy Adults.

Advance care planning is a process in which capable adults communicate their preferences for medical care in case of incapacitation. Regardless of health status, most adults are interested in advance care planning conversations and prefer providers to initiate these discussions. Primary care nurse practitioners are ideally positioned to lead these conversations but lack knowledge, confidence, and communication skills to do so. This project aimed to develop, implement, and evaluate an educational program for primary care nurse practitioners regarding leading advance care planning conversations with healthy adults. This evidence-based practice project used the Advance Care Planning Self-Efficacy Scale to measure primary care nurse practitioners' self-efficacy after completing a complex educational program. The educational program was developed based on a nationally recognized program incorporating didactic, observational, and role-play learning. The findings of this project indicated that providing complex education was an effective intervention immediately and after 3 months ( P = .018 and P = .023, respectively). The results indicate that educating nurse practitioners is an effective intervention for increasing their self-efficacy in leading advance care planning conversations with healthy adults over 3 months, recommending additional intervention at least earlier than 6 months.

Changing Peripheral Intravenous Catheter When Clinically Indicated: First Evidence-Based Practice Project in Makkah, Saudi Arabia

Changing Peripheral Intravenous Catheter When Clinically Indicated: First Evidence-Based Practice Project in Makkah, Saudi Arabia

Integrating Evidence-Based Screening, Brief Intervention, and Referral to Treatment Into a Family Nurse Practitioner Program.

Substance use disorder (SUD)-and more specifically opioid use disorder-is a national epidemic. With the increasing amounts of people suffering from SUD, all healthcare professionals should be educated to identify substance abuse, provide a brief intervention, and refer patients for treatment when indicated. The purpose of this project is to integrate the SBIRT into the curriculum of a graduate-level family nurse practitioner (FNP) program in southeastern Pennsylvania and to determine if educating FNP students on the SBIRT process increases their knowledge of SUDs and their treatment and increases their motivation to work with patients with SUD. The measurements used were as follows: shortened Alcohol and Alcohol Problems Perception Questionnaire (S-AAPPQ), shortened Drug and Drug Problems Perception Questionnaire (S-DDPPQ), a 10-question knowledge test, and demographic data. All subscales of the S-DDPPQ, the S-AAPPQ, and the knowledge test showed a statistically significant change from the pretest score means and to posttest means. This evidence-based practice project supports the integration of SBIRT education into FNP programs to increase their ability to identify and treat individuals with SUDs.

Goal-oriented temperature management in severely traumatized children in the emergency department: an evidence-based practice project.

Hypothermia commonly occurs in trauma patients. Evidence-based practices for hypothermia prevention are not strictly followed by all medical staff in the emergency department. This study aimed to assess compliance with evidence-based practices regarding goal-oriented temperature management for severely traumatized children in a Chinese hospital. This project used the JBI Evidence Implementation Framework to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. A goal-oriented temperature management strategy for trauma patients was developed based on the identified barriers, along with a simulation training module, and the supply of warming materials. Field observation, review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices. Twelve criteria were audited in the baseline and follow-up audits, with 11 and 37 trauma patients, respectively. In the follow-up audit, compliance with all criteria increased, with a reduction in shivering and cold discomfort scores. Except for two patients who died, hypothermia did not occur in any of the patients. The JBI Evidence Implementation Framework was used to successfully improve compliance with best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff. http://links.lww.com/IJEBH/A234.

Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery.

Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.

Weighted Blanket: An Anxiety Reduction Tool in the Outpatient Oncology Infusion Setting.

Adults with cancer experience a significantly higher level of anxiety compared with the general population. Anxiety is reported at diagnosis and throughout the cancer trajectory, and it is particularly heightened at the initiation of infusion treatments. In 2020, the COVID-19 pandemic exacerbated anxiety levels in patients receiving cancer treatments. This evidence-based practice project evaluated the feasibility and effectiveness of using medical-grade weighted blankets to reduce anxiety in patients with cancer receiving the first two infusion treatments in the ambulatory setting. Patients completed a modified version of the Visual Analog Scale for Anxiety to self-report anxiety pre- and postimplementation. Patients and nurses completed feasibility surveys. Patients reported reduced anxiety after using a weighted blanket and described weighted blankets as comforting and soothing. More than 90% of surveyed patients agreed or strongly agreed that the blanket was comfortable, not too heavy, and easy to put on, and did not interfere with nursing care or their own activities. Nurses valued the ease of use and adherence to infection control standards.

The Evidence-Based Practice Process Steps 4, 5, and 6: Integration, Evaluation, and Dissemination.

This is the final column in a series of columns that began with the January/February 2021 issue of Neonatal Network, describing the evidence-based practice (EBP) project. The series has taken the reader through sparking the spirit of inquiry, asking a compelling question, and searching and critically appraising the literature. This column will briefly describe the final three steps: step 4, the integration of evidence with clinical expertise and patient/family preferences; step 5, the evaluation of outcomes of practice changes based on evidence; and step 6, the dissemination of the outcomes of the EBP change.

Implementing an Evidence-Based Functional Pain Assessment Scale in an Adult Inpatient Unit

BackgroundThe focus on pain assessment using a single, one-dimension pain assessment scale can be problematic. Locally, challenges we faced with this were; a) pain was percieved as not being effectively managed, b) patients with chronic pain were not having their pain adequately controlled, and c) misconceptions and subsequent confusion between health care teams and patients related to what pain intensity scores mean to each individual. AimsThe purpose of this paper is to describe an evidence-based practice project aiming at improving pain assessment through the implementation of a Functional Pain Scale (FPS) on an adult inpatient cardiothoracic unit. DesignThe Iowa Model-Revised and the Implementation Strategies for Evidence- Based Practice Guide served as the framework for this project. SettingOver an 18-month period at a academic tertiary medical center in the midwest. Participants/SubjectsStaff and patients on an adult inpatient 48-bed medical and surgical cardiothoracic unit. MethodsFollowing a synthesis of the evidence, implementation of the FPS required various strategies, such as, individualized patient and staff education, audit and feedback, a pain policy revision, and creating documentation in the electronic medical record. Evaluation of the FPS consisted of patient and staff surveys pre- and postimplementation to assess knowledge, attitudes, and behaviors. ResultsAfter the pilot period, over 75% of the patients preferred to use the FPS and almost all the patients found the scale easy to use. Nurses reported an increase in perception that pain documentation was complete, that the FPS allowed them to accurately document their patients’ pain experience, and that their patients were well informed of their pain management plan. ConclusionsThis project supports successful implementation of the FPS within nursing workflow. The goal of using the FPS is to change pain management discussions from an intensity reduction to meeting goals of care, aligning expectations, and creating common language among patients and providers.

A Half-Day Camp Program for Adolescents Affected by Childhood Cancer.

Background: Adolescents affected by childhood cancer experience various degrees of psychosocial distress, social isolation, and social support throughout the treatment process. Objective: To create and implement an evidence-based practice project consisting of a pilot half-day camp program to improve social support and connectedness for adolescents affected by childhood cancer. Methods: A pilot half-day camp program was implemented. Twenty adolescent patients, survivors, and siblings (ages 13-18 years) participated in the program. Participants provided basic demographic information and completed pretest, immediate posttest, and 4-week posttest surveys to assess their levels of social support and camp connectedness. Data were analyzed using descriptive statistics and two-tailed Wilcoxon signed-rank test. Results: All measures of social support in adolescent participants affected by childhood cancer trended upward following the conclusion of the program, then trended downward over time, with overall social support and family social support significantly decreasing over time postintervention. Camp connectedness was not significantly impacted by the program. Conclusions: Social support decreases as participants are further out from attending a half-day camp program. This pilot program demonstrated the feasibility of a short-term, local, cost-effective camp program that is scalable to larger groups. Implications for Nursing: Providers should refer adolescents affected by childhood cancer to camp programs for social support. More research is needed to determine if more frequent camp programs sustain a high level of social support in participants.

Strategies for incorporating evidence-based practice into nurse residency programs: A scoping review.

The American Nurses Credentialing Center's (ANCC's) Practice Transition Accreditation Program (PTAP) establishes standards for nurse residency programs to elevate and optimize the skills, knowledge, and attitudes of new nurses participating in nurse residency programs. Evidence-based practice (EBP) is foundational to providing safe nursing care. One of the National Academy of Medicine's (NAM's) 2020 goals stated that 90% of clinical decisions would be supported by the best available evidence to attain the best patient outcomes. Nurse residency programs can benefit from evidence-based strategies to develop EBP competencies in new nurses. The purpose of this scoping review was to synthesize the literature around strategies for incorporating EBP into nurse residency programs across the United States. This scoping review was informed by the JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. Searches were conducted by a health science librarian in PubMed and CINAHL with Full Text. Keywords and their synonyms, Medical Subject Headings (MeSH; PubMed), and Subject Headings (CINAHL with Full Text) were used. Covidence, a literature review management program, was used to organize the literature and manage the review. Title, abstract, and full-text reviews were completed within Covidence using three teams of two independent reviewers. Four hundred and thirty-eight citations were imported into Covidence. Ten articles were retained for the final review. Three strategies for incorporating EBP into nurse residency programs emerged from the literature: (1) exposure of nurse residents to existing organizational resources, (2) completion of online EBP modules, and (3) completion of an EBP project. The incorporation of EBP competencies in nurse residency programs aligns with NAM's and ANCC's goals, yet a paucity of evidence exists to guide curriculum development in nurse residency programs. This scoping review corroborates the need for further research to inform best practices for implementing EBP into nurse residency programs.

Early ambulation protocol after diagnostic transfemoral cerebral angiography: an evidence-based practice project

BackgroundNo uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are prescribed 8-12 h strict immobilization along with bed rest in the supine position after TFA in China, which causes great discomfort to patients.ObjectiveTo evaluate the effect of an evidence-based early ambulation protocol on the prevention of vascular complications and general discomfort in patients following transfemoral cerebral angiography (TFA).MethodsA prospective quasi-experimental study was conducted on 214 patients undergoing TFA with manual compression. Patients in the experimental group were placed supine position for 2 h with a sandbag placed on the wound dressing, followed by a semi-seated position for another 2 h. After this period, patients took 2 h bed rest (move freely) with the sandbag removed, and were allowed to get out of bed 6 h after TFA. Patients in the control group were restricted to an 8 h bed rest in a supine position with the affected leg straight and immobilized. The vascular complications (bleeding, hematoma, ecchymosis) and levels of comfort (low back pain, leg pain, and blood pressure) were evaluated after the procedure. Numeric Rating Scale (NRS) pain scores, systolic blood pressure (SBP); diastolic blood pressure (DBP) were measured hourly for 8 h after TFA.ResultsThere was no significant difference in the two groups with regard to vascular complications including bleeding events (P = 0.621), bleeding volume (P = 0.321), and area of hematoma (P = 0.156).The area of ecchymosis in the experimental group was significantly smaller than the control group (P = 0.031). Compared with the control group, the NRS score for low back pain in the 4th, 5th, 6th, 7th, and 8th hour after TFA were significantly lower (P < 0.05), and the NRS score for leg pain in the 5th, 6th, 7th, 8th hour after TFA were significantly lower (P < 0.05). The SBP and DBP in the 6th, 7th, and 8th hour after TFA were significantly lower than the control group (all P < 0.05).ConclusionsThe evidence-based early ambulation protocol can effectively and safely increase comfort and decrease the pain level for patients undergoing TFA, without change in the incidence of vascular complications.

Occupational Therapy Interventions for Caregivers of People Who Have Experienced Stroke

Abstract Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. Each article in this series summarizes the evidence from published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision-making. In this Evidence Connection article, we provide a case report of a caregiver of a patient who had experienced a stroke. The occupational therapy evaluation and intervention process is described.

Trauma-Informed Care Education Initiative Explores Impact on Perinatal Nurse Secondary Traumatic Stress and Workforce Challenges.

Psychological trauma refers to long-lasting adverse effects on well-being precipitated by the experience of a distressing event or a combination of events. High rates of psychological birth trauma in patients contribute to secondary traumatic stress (STS) in perinatal nurses, creating workplace challenges and resulting in dissatisfaction, apathy, and attrition. Perinatal nurses experience high rates of STS, and researchers have called for a universal standard of trauma-informed care (TIC). However, there is a lack of published results on effectively creating TIC education in this nurse population. A pre/posttest design evaluated an online pilot evidence-based practice project addressing a perinatal nurse education initiative on STS and its correlation with nurse attitudes toward TIC. Participants include perinatal nurses in the United States (n = 29). Two scales measured the program's effect on nurses: the Secondary Traumatic Stress Scale (STSS) and the Attitudes Related to Trauma-Informed Care (ARTIC) scale. A paired t test evaluating pre- and postprogram levels of the STSS showed a decrease in STS (t28 = -3.28, P = .003, Cohen's d = 0.609), the ARTIC scale results showed an increased receptiveness to TIC (t28 = 3.8, P < .001, Cohen's d = 0.706], and a not significant correlation was found between pretest STS and ARTIC scores (Spearman' ρ = -0.248, P = .194). This program supported a significant reduction in nurses' identification of STS. Future perinatal nurse education can expand to build a standard of TIC that is patient-centered and reduces nurse STS.

Climates and associated factors for evidence-based practice implementation among nurses: a cross-sectional study

BackgroundThe organizational climate that fosters and supports the implementation of evidence is a key factor influencing the effective implementation of evidence-based practice (EBP). Nurses, being the largest group of medical staff, play a crucial role in EBP implementation. The perception of the climate for EBP implementation among nurses in their organizations is unknown, especially among Chinese nurses.AimsTo clarify the implementation climate of EBP among Chinese nurses and identify the factors associated with the implementation and development of evidence-based nursing practices.MethodsThis study employed a descriptive cross-sectional study design. From March 2023 to April 2023, a sample of nurses (n = 1260) from two Tertiary care hospitals in central China were selected and surveyed by self-designed social-demographic questionnaire and Implementation Climate Scale. Multiple linear stepwise regression analysis was conducted to determine the predictors of implementation climate.ResultsThe nurses achieved a mean ICS score of 59.10 ± 11.22, with mean scores exceeding 3 points for each sub-dimension and item. In the results of multiple linear regression, income satisfaction, implementation of evidence-based nursing practice project(s) within the unit, experience of evidence-based nursing practice during working life, and specific training or courses in evidence-based nursing practice were predictors of ICS. Of these, income satisfaction was the most significant predictor. These factors could explain 17.5% of the total variance in implementation climate.ConclusionThe climate for implementing EBP in Chinese nursing organizations was relatively strong. Nursing managers can enhance the climate for implementing EBP in their organizations by actively improving salary and enhancing EBP-related trainings and practices.Relevance to clinical practiceUnderstanding nurses’ perceptions of the EBP implementation climate in their organizations can help to identify specific barriers and facilitators to the development of EBP and facilitate its successful implementation.Patient or public contributionClinical nurses were involved in data collection and completed the questionnaires on EBP implementation climate.

Sustained delirium reduction in an inpatient neuroscience unit.

Delirium is described as acute brain dysfunction that often fluctuates throughout the day and is highly prevalent in hospitalized adults. Delirium negatively affects patient outcomes with consequences including decreased cognitive functioning and increased mortality and healthcare costs. Furthermore, neurological patients are at increased risk for developing delirium due to their underlying diagnoses. The purpose of this evidence-based practice project was to evaluate the long-term impact of nursing education and use of trained volunteers to prevent the development of delirium in an inpatient neuroscience unit. This was a pre-post designed evidence-based practice project to educate and prioritize nursing care interventions for delirium prevention compared to a delirium management framework. The interventions included delirium education for nurses and nursing assistants along with the development of a specialized volunteer program to implement non-pharmacological, multi-component delirium prevention interventions. Long-term sustainment and enculturation occurred over the subsequent year. The baseline data collection period included 2520 patients. The intervention period included 4515 patients, with both groups being similar in age, race, gender, and length of stay. The total number of patients with a discharge diagnosis of delirium decreased from 29.2% to 19.8% (p < .001). Fewer patients in the intervention group were discharged to a skilled nursing facility (p < .001) and other post-acute facility (p = .008), along with more patients being discharged to home care (p < .001). This evidence-based practice project demonstrates long-term sustained reduction of delirium in the neuroscience population. Despite the challenges during the COVID-19 pandemic, delirium prevention strategies were found to be effective in decreasing the rate at which patients develop delirium.

An Evidence-Based Practice Project on the Use of Ginger to Manage Primary Dysmenorrhea

Dysmenorrhea is a highly prevalent gynecological symptom that is widely unreported and normalized. When a woman experiences severe menstrual pain without the presence of a pelvic disorder, the pain is categorized as primary dysmenorrhea. Ginger has analgesic and anti-inflammatory properties, which when utilized for primary dysmenorrhea, shows promise in reducing pain. A literature search was conducted using several databases and hand searching to find articles that supported the following question: In adult women with primary dysmenorrhea, how does the use of ginger, compared to not using ginger, affect pain? The databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library (Cochrane Reviews), Nursing and Allied Health (ProQuest), and PubMed were included. Of the 153 articles identified, the following six articles were used for this project: two systematic reviews with meta-analyses, three randomized controlled trials, and one consensus statement. Each piece of evidence utilized the Visual Analog Scale to measure pain intensity, and all the mean pain scores were found to be significantly lower in women who used ginger supplementation. Ginger was used in different doses and for different durations in each of the pieces of evidence, however there was a significant positive relationship between ginger supplementation and reduction of pain in each article. This project identified that there is strong and compelling evidence to recommend using ginger supplementation to reduce pain.

An Evidence-based Practice Project to Evaluate Breathing Exercises on Dyspnea in Patients with Chronic Lung Disease

Introduction: Dyspnea, or difficulty breathing, is a common symptom that affects individuals with chronic lung diseases, such as Chronic Obstructive Pulmonary Disease (COPD), lung cancer, idiopathic pulmonary fibrosis, mesothelioma, and others. Nurses are the most frequently encountered providers at the bedside and have a unique obligation to treat the symptomology of these lung diseases. Nurses are charged with doing no harm and acting in the best interest of the patient; therefore, reducing dyspnea addresses these key ethical considerations (American Nurses Association, 2015).