Knowledge Of Evidence-based Guidelines Research Articles

Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections.

It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.

Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events: A qualitative descriptive study

ObjectiveTo explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. DesignA qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. SettingThe study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. MethodsIndividual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. FindingsFour major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. ConclusionsThese themes helped to explain previously reported deficits in nurses’ knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units.

Nursing students' knowledge on the management of peripheral venous catheters at Wollega University.

BackgroundAdherence to the best standards of nursing practice is the fundamental principle to improve patient outcome and prevent nursing procedure related-infections. A peripheral venous catheter (PVC) is the most common invasive procedure performed in nursing care. Its poor performance could expose patients to bloodstream-related infections. The present study aimed to assess post-basic nursing students’ knowledge of evidence-based guidelines on the management of peripheral venous catheters.MethodsA cross-sectional study design was conducted on May 01–03, 2019, using a convenient sample 239 among post-basic nursing students in Wollega University.ResultsThe study result showed that nursing students’ had a low mean (4.1±1.52) of knowledge about PVC procedure management. Only 41% of the respondents have adhered to recommendations of CDC guidelines. Among the provided options of the items, none achieved 100% correct answers. The majority of nursing students (77%) responded that antiseptic handwashing is always performed before insertion of PVCs. Meanwhile, few students (5%) correctly answered that the infusion set is recommended to be removed after 96 hours when neither lipids nor blood products are administered. In multivariable regression analysis, nursing students who had received training (AOR = 2.9, 95% CI (1.6, 5.1)) and who were younger (AOR = 2.4, 95% CI (1.3, 4.3)) significantly associated with a higher score of knowledge.ConclusionsThis study finding shows that an overall level of knowledge of post-basic nursing students is inadequate. Measurements such as an increase in the provision of adequate training by nurses educators based on evidence-based guidelines could improve the post-basic nursing students’ knowledge.

Assessing nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters: A multicentre cross-sectional study

BackgroundInserting Peripheral Venous Catheters (PVCs) is one of the most routinely performed invasive procedures in nursing care and, if not well managed, it could expose patients to bloodstream-related infections. Knowledge of guidelines for the management of PVCs is fundamental to arise nurses and nursing students (NSs)' awareness on the importance of recommendations' adherence for clinical practice improvement. ObjectiveTo determine NSs' theoretical knowledge of evidence-based guidelines for management of PVCs and investigate potential predictive factors associated to recommendations' adherence. DesignCross-sectional. SettingsThe study was carried out (March–September 2015) in seven Universities of three Regions of Italy (Marche, Abruzzo, Emilia Romagna). ParticipantsA convenience sample of NSs (n = 1056) was involved. MethodsWe collected data using a 10-items validated questionnaire assessing: knowledge of NSs' PVC guidelines and socio-demographic characteristics of the sample. ResultsMost participants were female (74.8%), mean age: 22.4 years (DS = 3.9); attending the first, second and third year of Bachelor in Nursing (34.8%; 32.9%; 32.3%, respectively); with at least one year of training experience (32.1%). Most of incorrect answers given by NSs concerned the right way to wash hands before CVPs insertion (33.5%); the replacement of administration set <24 h when neither lipid emulsions nor blood products have been infused (79.7%); the choice of dressing to cover insertion site (59.3%); the use of steel needles to administer drugs (60.9%); the use of antibiotic ointment (68.7%); the correct concentration of chlorhexidine before PVCs' insertion (70.7%).In multivariate analysis, a higher level of education and an increased number of years of training experience and wards attended, were associated with better test scores.“Infusionset removal after 24 h when lipids or blood products are administered” (75.4%). ConclusionsNSs' overall level of knowledge to some recommendations is inadequate. Nurse educators should emphasize on the importance of Evidence-based guidelines' knowledge in order to promote the translation of theory into practice of NSs.

Nursing Management of Pediatric Sepsis

Shock is defined as a complex clinical syndrome caused by an acute failure of circulatory function, with depleted tissue and organ perfusion, where delivery of oxygen and substrates to body tissues as well as removal of metabolic waste products are inadequate. The role of the nurse is to be immediately involved in the assessment of patients at risk for developing sepsis and in their treatment. Nurses’ knowledge of evidence-based guidelines can help ensure patients with sepsis can receive therapies, which are based on the latest scientific evidence. The purpose of this article will be to present an overview of the evidence-based recommendations for the treatment of pediatric patients with sepsis, highlighting the role of nursing management.

Intensive care nurses' knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia

Nonadherence to evidence-based guidelines for the prevention of ventilator-associated pneumonia (VAP) has been reported. As a lack of knowledge may be a barrier for adherence, this study aimed to determine intensive care nurses' knowledge of evidence-based guidelines for VAP prevention.

Challenges to Performance-Based Assessment for Community Physicians

The Joint Commission on Accreditation of Healthcare Organizations requires accredited organizations to assess individual competency of physicians granted membership on the medical staff. Verification of the competency of physicians caring for children in the acute-care setting presents a particular challenge for the clinical privileging of community physicians. At Cincinnati Children's Hospital, a knowledge-based reappointment method was developed and implemented. Using a case-based self-test, the initial phase measured physicians' knowledge of evidence-based guidelines for three common pediatric inpatient diagnoses. Future methods for tracking individual performance of community-based generalists at the time of reappointment were explored through a physician survey. Response was positive. This process may help keep community physicians engaged as vital members of the hospital staff.