From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?

ObjectivesNurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings.Data SourcesWe reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership.ConclusionIn this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings.Implications for Nursing PracticeAlthough future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.     

Perceptions and concerns about sustainable healthcare of nursing students trained in sustainability and health: A cohort study

AimTo describe nursing students' perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing.BackgroundSustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students' perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources.DesignA cohort study with an inductive content analysis of open-ended questions included in a survey.MethodsThe study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources’ used in healthcare and their perceptions of the impact of climate change on the nursing profession.ResultsStudents identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on 'low environmental impact nursing care' when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require 'nursing leadership in environmental awareness'.ConclusionsStudents demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care.Tweetable abstractStudents demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.     

Job control,work-family balance and nurses’ intention to leave their profession and organization: A comparative cross-sectional survey

BackgroundThe shortage of nurses is a problem in many countries. In Japan, the distribution of nurses across different care settings is uneven: the shortage of nurses in home healthcare and nursing homes is more serious than in hospitals. Earlier research has identified numerous factors affecting nurses’ intention to leave work (e.g., job control, family-related variables, work-family conflict); however, these factors’ levels and effect size may vary between nurses in hospitals, home healthcare, and nursing homes.ObjectivesThis study measured job control, family-related variables, and work-family conflict among nurses in hospitals, home healthcare, and nursing homes, and compared these variables’ levels and effect size on nurses’ intention to leave their organization or profession between these care settings.DesignThe research design was cross-sectional.MethodsParticipating nurses from hospitals, home healthcare facilities, and nursing homes self-administered an anonymous questionnaire survey; nurses were recruited from the Kyushu district of Japan. Nurses from nine hospitals, 86 home healthcare offices, and 107 nursing homes participated. We measured nurses’ intention to leave nursing or their organization, perceived job control, family variables and work-family conflict. We analyzed 1461 participants (response rate: 81.7%).ResultsThe level of job control, family variables, and work-family conflict affecting nurses varied between hospitals, home healthcare, and nursing homes; additionally, these variables’ effect on nurses’ intention to leave their organization or profession varied between these care settings. Work-family conflict, family variables, and job control most strongly predicted nurses’ intention to leave their organization or profession in hospitals, home healthcare, and nursing homes, respectively.ConclusionsInterventions aiming to increase nurse retention should distinguish between care settings. Regarding hospitals, reducing nurses’ work-family conflict will increase nurse retention. Regarding home healthcare, allowing nurses to fulfill family responsibilities will increase nurse retention. Regarding nursing home nurses, increasing nurses’ job control will increase nurse retention.     

A systematic review of the effectiveness of advanced practice nurses in long‐term care

Aim

To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long‐term care residential settings.

Background

Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.

Design

Quantitative systematic review.

Data sources

Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.

Review methods

Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

Results

Four prospective studies conducted in the USA and reported in 15 papers were included. Long‐term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.

Conclusion

Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long‐term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.     

Introduction of patient electronic medical records (EMR) into undergraduate nursing education: An integrated literature review

BackgroundTo prepare student nurses for clinical practice where patient electronic medical records (EMR) competence is required, nursing undergraduate curricula must provide simulation access to developing this skill set. At this stage, however, the integration of electronic documentation into the Australian undergraduate nursing curriculum has been piecemeal.AimThe aim of this integrated literature review was to identify benefits and challenges for faculty nursing staff and nursing students in relation to the integration, use and evaluation of EMR in an undergraduate nursing program.MethodsA systematic search of relevant peer-reviewed research and project report articles was conducted in the electronic databases. Generic qualitative thematic analysis was then undertaken with themes generated from the data itself.ResultsFifty eight articles were identified, of these 23 were found to meet the inclusion criteria. Three major themes were identified: 1) Advantages of using EMR in academic settings, 2) Identified Challenges and Limitations of EMR programs; and 3) Developing an academic EMR program and implementing EMR education program in stages. All papers acknowledged that EMR will be standard in healthcare and should be viewed as an ‘essential tool’ for inclusion in undergraduate nursing programs.Conclusion and implications for practiceThere is a significant increase of electronic technology in healthcare settings, especially relating to patient documentation. Therefore, teaching the use of EMR in the simulated clinical learning environment for new healthcare providers such as nursing students is essential. The papers reviewed identified an urgent need for higher education nursing programs to support undergraduate nursing students and faculty staff to ensure EMR can be implemented effectively into the undergraduate nursing curriculum.     

Management of language discordance in clinical nursing practice — A critical review

BackgroundLanguage plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice.ObjectivesThis critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing.DesignA critical review of the literature was performed and 24 relevant research papers were included.Data sourcesA search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA).Review methodsBoth authors independently screened the titles (n = 299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP).FindingsIn total, 24 publications met the inclusion criteria. Most of the studies (n = 20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language.ConclusionsHealth care institutions should provide more strategies for clinical practice to overcome language discordance.     

Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit: A scoping review

ObjectiveTo identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions.MethodologyA scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains.ResultsSeven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported.ConclusionRestraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.     

The impact of helicopter emergency medical service on acute ischemic stroke patients: A systematic review

BackgroundHelicopter emergency medical services (HEMS) is commonly elected transport for acute ischemic stroke (AIS) known as a time-critical illness.AimTo conduct a systematic review in order to explore the HEMS impact on healthcare status, process and outcome measures for AIS patients.MethodsA systematic search was conducted of PubMed, Medline, CINAHL, Cochrane Library and Google Scholar. The gray literature and reference lists of included articles were also searched. Thirty studies met inclusion criteria.ResultsUsing Donabedian's framework, two studies focused on the impact on healthcare structure, twenty-three explored the impact on process measures, and five focused on clinical outcomes. HEMS structure implications could not be assessed due to insufficient studies. HEMS showed no significant outcome benefit compared to ground emergency medical services (EMS) and the impact on process measures was ambiguous.ConclusionsHEMS necessity varied considerably between studies. More robust studies are needed for detection of the most suitable use of HEMS in AIS.     

One in 11 Cochrane Reviews Are on Rehabilitation Interventions,According to Pragmatic Inclusion Criteria Developed by Cochrane Rehabilitation

ObjectiveTo identify all published protocols and reviews in the Cochrane Library relevant to the scope of practice of rehabilitation; to test pragmatic criteria to identify rehabilitation interventions; to begin categorizing reviews according to the professionals involved in delivering the intervention and broad areas of clinical practice.Data SourcesCochrane Database of Systematic Reviews.Study SelectionWe screened all published reviews and protocols in the Cochrane library.Data ExtractionWe built an online relational database into which we imported titles and abstracts of all reviews and protocols published in the Cochrane Library from 1996 to August 2018. We recruited rehabilitation professionals worldwide through Cochrane Rehabilitation’s social media to find and tag rehabilitation reviews in this database. One rehabilitation physician and 1 allied health professional independently tagged each title against prespecified criteria. The Cochrane Rehabilitation Review Committee examined disagreements between contributors for any uncertainties about how to categorize a review. We revised and improved our preliminary criteria for identifying rehabilitation interventions as the work progressed.Data SynthesisWe identified that 9.4% of all Cochrane publications (894/9471 reviews and protocols) are directly relevant to the practice of rehabilitation. The professional groups whose interventions were most frequently the subject of rehabilitation reviews and protocols were rehabilitation physicians and physical therapists. We also identified a final list of inclusion and exclusion criteria for reviews on rehabilitation interventions.ConclusionMany Cochrane Reviews are directly relevant to rehabilitation. Cochrane needs to consider the rehabilitation community a major stakeholder in all its work. The pragmatic criteria we tested are offered for future discussions on the identification and categorization of rehabilitation interventions by stakeholders worldwide. This work will support the spread of content from the Cochrane Library to rehabilitation professionals and guide future research.     

Perceptions of expressed breast milk for preterm infants in Malawian hospitals: A qualitative study

BackgroundExpressed breastmilk (EBM) can support lactation for mothers of preterm infants with underdeveloped feeding skills. However, there may be implementation challenges in resource-limited global health settings.ObjectiveTo explore EBM barriers and facilitators perceived by caregivers and healthcare workers in Malawi.MethodsA secondary analysis of in-depth interviews exploring breastfeeding support at health facilities conducted at three secondary-level district hospitals and one tertiary-level central hospital in southern Malawi. Interviews underwent content analysis in NVivo 12 (QSR International, Melbourne, Australia).ResultsThere were 58 healthcare workers and 54 caregivers interviewed. Caregiver unfamiliarity, maternal exhaustion, and inadequate clinical support/equipment were barriers to EBM practice. Caregiver acceptance was supported by witnessing infant growth. Demonstrations of EBM by healthcare workers and family support also facilitated practice.ConclusionRaising community awareness and extending counselling to family members upon initiation are vital to supporting mothers practice EBM in resource-limited global health settings with chronic staffing shortages.     

Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review

Background and objectiveChronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems. Nurses are the most likely professional group to provide self-management support. This systematic review aims to evaluate the clinical and cost effectiveness of nurse-led self-management for patients with chronic obstructive pulmonary disease in primary care.DesignA systematic review was conducted to identify randomized controlled studies comparing nurse-led self-management interventions to usual careData sourcesSeven electronic databases, including British Nursing Index, MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library and NHS Economic Evaluation Database, were searched for relevant studies.Review methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to guide the structure of the review. The relevance of citations was assessed based on inclusion criteria, with full texts retrieved as required to reach a decision. Data extraction was performed independently by two reviewers. The Cochrane risk of bias tool was used to undertake a quality review. A narrative summary method was used to describe review findings.ResultsTwenty-six articles describing 20 randomised controlled trials were included in the analysis. Self-management interventions were heterogeneous, with a variable number of components, level of support, mode of delivery and length of follow up. The review demonstrated that nurse-led self-management programmes may be associated with reductions in anxiety and unscheduled physician visits and increases in self-efficacy, but definitive conclusions could not be reached. Few studies addressed economic outcomes and the diverse perspectives, time frames and settings made comparisons difficult. Evidence on cost-effectiveness was inconclusive.ConclusionsSome nurse-led self-management programmes in this systematic review produced beneficial effects in terms of reducing unscheduled physician visits, lowering patients’ anxiety and increasing self-efficacy, but there is insufficient evidence to reach firm conclusions on the clinical or cost-effectiveness of the interventions. Further research should aim to identify the optimal components of these programmes and to identify those patients most likely to benefit. The inclusion of economic analyses in future studies would facilitate decisions by policy makers on the implementation of self-management interventions.     

Pain and Analgesic Related Insomnia

ObjectivesThe aim of this review is to describe the effects of analgesics on sleep.Data sourcesSystematic search of the databases of PubMed and the Cochrane Library was performed between January and September 2021.Review/Analysis methodsThe search included all articles on the topic published during the past 20 years (2000-2020). The search strategy was developed using a controlled vocabulary of known studies meeting the inclusion criteria and focused on the following terms: chronic pain, pain, sleep disturbance, insomnia, analgesic, analgesic medication, antidepressants, antiepileptic drugs, nonsteroidal drugs, opioids, and quality of life. Two reviewers independently considered the studies for inclusion in the review, assessed the risk of bias, and extracted data.DesignReview and analysis.ResultsA total of 37 studies met the inclusion criteria: 15 analyzed the effects of opioids, 6 those of nonsteroidal anti-inflammatory drugs and acetaminophen, and 16 the effects of adjuvant analgesics.ConclusionsSleep quality may be adversely affected by a variety of medications used in clinical practice, including those used in analgesic indications. The class of analgesics most affecting sleep quality are opioids.     

Using Appreciative Inquiry to promote evidence-based practice in nursing: the glass is more than half full

It is now understood that successful implementation of evidence-based practice (EBP) requires a focus on the context of the care setting. While the focal point of many reports is the limitations and barriers, this paper proposes a new approach to "making EBP happen." Appreciative Inquiry (AI), both a method of social research and an organizational development or change intervention, is a novel means to elicit enthusiasm and support for EBP in nursing. Readers will be introduced to the theoretical foundations and assumptions as well as the "4-D Model" of AI. It is proposed that the advanced practice nurse (APN) is in a key position to introduce and support this intervention in healthcare organizations to promote the successful implementation of EBP.     

Nursing students learning transfer from classroom to clinical practice: An integrative review

AimThe aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.BackgroundAs nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students’ learning transfer has not yet been synthesized.DesignThis integrative review was conducted using the Whittemore and Knafl framework.Review methodsEight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute’s critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsTwenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students’ ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.ConclusionsThe information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students’ learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.     

Optimizing emergency department care transitions to outpatient settings: A systematic review and meta-analysis

IntroductionSuboptimal transitions from the emergency department (ED) to outpatient settings can result in poor care continuity, and subsequently higher costs to the healthcare system. We aimed to systematically review care transition interventions (CTIs) for adult patients to understand how effective ED-based CTIs are in reducing return visits to the ED and increasing follow-up visits with primary care physicians.MethodsWe searched multiple databases and identified eligible published RCTs of ED-based CTIs affecting outpatient follow-up rates, ED readmission and hospital admission. Two independent authors reviewed titles and abstracts for potential inclusion and selected studies for full review. Study quality was assessed using the Cochrane risk-of-bias tool. ED-based CTIs were classified using a care continuity framework.ResultsOur search generated 28,807 articles; 112 were selected for full-text review. Data were abstracted from 42 articles that met inclusion criteria. Pooling data from 20 studies (n = 8178 patients) found a relative increase in outpatient follow-up with ED-based CTIs compared to routine care (odds ratio 1.79, 95% confidence interval [CI] 1.43, 2.24). However, ED-based CTIs (20 studies, n = 8048 patients) had no significant effect on ED readmissions (odds ratio 1.02, 95% CI 0.87, 1.20]) or hospital admission after ED discharge (13 studies, n = 5742 patients) (odds ratio 0.99, 95% CI 0.86, 1.14) when compared to routine care. Twenty-two studies encompassed CTIs supporting all three functions of care continuity (information, communication and coordination).ConclusionsED-based CTIs do not appear to reduce ED revisit or hospital admission after ED discharge but are effective in increasing follow-up.     

Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review

ObjectivesTo identify peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services.DesignReview of qualitative and quantitative studies.Data sourcesA comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch.Review methodsAll articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ statement.ResultsEighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers’ perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals’ negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies.ConclusionsThis review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles.     

Physiological machine learning models for prediction of sepsis in hospitalized adults: An integrative review

BackgroundDiagnosing sepsis remains challenging. Data compiled from continuous monitoring and electronic health records allow for new opportunities to compute predictions based on machine learning techniques. There has been a lack of consensus identifying best practices for model development and validation towards early identification of sepsis.ObjectiveTo evaluate the modeling approach and statistical methodology of machine learning prediction models for sepsis in the adult hospital population.MethodsPubMed, CINAHL, and Cochrane databases were searched with the Preferred Reporting Items for Systematic Reviews guided protocol development. We evaluated studies that developed or validated physiologic sepsis prediction models or implemented a model in the hospital environment.ResultsFourteen studies met the inclusion criteria, and the AUROC of the prediction models ranged from 0.61 to 0.96. We found a variety of sepsis definitions, methods used for event adjudication, model parameters used, and modeling methods. Two studies tested models in clinical settings; the results suggested that patient outcomes were improved with implementation of machine learning models.ConclusionNurses have a unique perspective to offer in the development and implementation of machine learning models detecting patients at risk for sepsis. More work is needed in developing model harmonization standards and testing in clinical settings.