Nursing research committee makes plans for the coming year.

Evidence-based practice (EBP) enhances the care of patients and families by guiding nurses in their patient care. Nursing leaders, health care administrators and policy-makers are increasingly requiring that nursing practice be based on the best available evidence. Murdoch (2004) stated that a review and synthesis of existing research is essential to identify the best available evidence. Koop (2002) further reflected on the challenges faced by oncology nurses when there are clinical situations for which there is little or no empirical evidence on which to base nursing decisions. A need to learn skills and gain confidence in identifying the best available evidence frequently motivates staff nurses and clinicians to learn more about critical appraisal of the research literature. At the McGill University Health Centre (MUHC) these needs have prompted nurses to enrol in the research utilization (RU) course that the health centre offers. This column will outline the context and components of the RU course and summarize feedback from participants. Challenges and limitations of this strategy and its relationship to oncology nursing practice are highlighted.     

Evidence-based practice and school nursing.

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.     

Pediatric Oncology Nursing Research in Low- and Middle-Income Countries: Exemplars from Three Regions

ObjectiveThis study examined the status of pediatric oncology nursing research in three low- and middle-income countries (LMICs) as examples across three World Health Organization regions: East Africa, Eastern Mediterranean region, and Latin America.Data SourcesPublished literature was identified from Google Scholar, PubMed, Scielo, Virtual Health Library, and reference lists of some articles.ConclusionThe experiences of the three LMIC pediatric oncology nurses illustrate the situation of nurse research in their setting and identify relevant published literature. The authors highlight the challenges for nurses to conduct research (eg, lack of training, mentors, funding, and opportunities). Local evidence to inform nursing practice in LMICs is needed. Recommendations for ameliorating the situation include increased advanced practice nurse education, physician and hospital support, funding, and protected time.Implications for Nursing PracticePediatric oncology nursing practice is culturally and context-driven and requires locally acquired evidence to support best practices. Only when sufficient, sustainable, and local nursing research training and education is available in LMICs, will this evidence be generated. Nursing research training (eg, master's and PhD programs), funding, and protected time are three key steps to guide and motivate staff nurses as well as academic nurses to participate in research that informs the care of children and adolescents with cancer across all countries and not only those with significant resources.     

Evidence for psychiatric nursing practice: an analysis of three years of published research

Psychiatric and mental health nursing practice continues to be strongly influenced by tradition, unsystematic trial and error, and authority. Yet the need for quality care that is based on the best and most current empirical research is well documented. Achieving evidence-based practice in the psychiatric nursing specialty will require that qualified nurse researchers conduct research relevant for practice and appropriately disseminate that research to those who can best use it, practicing nurses. This State of the Evidence Review analyzed the 227 data-based studies published in the five most commonly read American psychiatric nursing journals from January 2000 through December 2002. Five major research foci were found: global perspectives, psychiatric nurses as subjects, studies of family caregivers, research with clients across the life span, and testing of nursing interventions. About 88% of the studies were conducted in the United States; 63% involved recipients of mental health care services; but only 11% tested psychiatric nursing interventions. Promoting evidence-based practice in psychiatric nursing will require increasing the numbers of psychiatric nurse researchers, enriching the research process (i.e., increasing relevance and appropriate dissemination), and implementing changes in practice that are based on the best and most currently available evidence, rather than on the equivalents of "Old Wives' Tales."     

Oncology nursing: our past is the prologue ... can we author the future?

The development of the standards of care, roles in oncology nursing, and role competencies was an opportunity for Canadian nurses to revisit their professional roots, review and validate their present roles, and revise or reaffirm their future roles. The standards of care for individuals with cancer and their families affirmed the centrality of the individual and family in any nursing interaction and gave voice to the stated needs of Canadians at risk for, or living with cancer. For the first time in Canada, a specialty nursing organization has taken the lead to clearly define contemporary nursing roles and competencies. This new vision has captured the interest of oncology nurses. CANO, the nursing profession, other health care professionals, and health care decision-makers must now also consider how this enlightened view of oncology nursing can be operationalized. The presenters have had the opportunity to "hear" the stories of Canadian oncology nurses and their experiences in striving for excellence in their practice. These stories highlight the evidence supporting the standards of oncology nursing. In addition, the challenges and facilitators for achieving excellence in oncology nursing practice are identified. Through these stories, the future for the development of oncology practice and operationalization of the new standards of care emerges.     

Reading nursing Literature in English: new inputs for practicing nurses

A prerequisite to providing evidence-based care is the ability to comprehend the nursing research literature, most of which is published in English. To facilitate this understanding, a course on "reading the research literature for evidence-based practice in English" was developed by an interdisciplinary team for staff nurses at the University Hospital Basel. The pilot course was offered to nurses who specialized in cancer care. It was led by the oncology Advanced Practice Nurse (APN) from the Department of Medicine. Research articles focusing on the management of chronic illness and cancer pain management were assigned and read. The course consisted of ten 90 minute lessons. The evaluation was designed to address the following questions: 1. Did participation in the course improve the oncology related knowledge of the nurses? 2. Did participation in the course improve the nurses' English language skills? 3. At what level of difficulty did the nurse participants perceive the course to be? 4. Were course participants able to use their newly acquired knowledge to teach their nursing colleagues on the ward? The course evaluation demonstrated that the 15 participants significantly improved their oncology knowledge through this process but that their English skills did not improve. The participants were able to present lectures on their wards based on the course literature, which were positively evaluated by their colleagues and the APN course leader. The participants perceived the course as being sophisticated but also effective at demonstrating the use of English-language research literature for one's own nursing practice.     

Evidence-based practice and nursing: commentary

With changes in health care, it has become clear that nurses need data to establish evidence for their decisions and interventions. Evidence-based practice involves the use of the best evidence available for making clinical decisions about patient care. The identification of the knowledge base for nursing practice contributes to achieving patient outcomes and making nursing practice credible.     

The organizational environment and evidence-based nursing

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.     

Evidence-based practice guidelines and school nursing.

The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses and other health care workers to have research information collected, analyzed, and condensed into specific practice recommendations by experts. This article defines EBP guidelines and discusses the process of guideline development, including identification of topics, systematic literature searches, and evaluation and rating of research. Criteria for determining the quality of existing guidelines are reviewed. The steps needed to develop EBP guidelines specifically for school nursing are discussed.     

Readiness of U.S. nurses for evidence-based practice

Evidence-based practice is a systematic approach to problem solving for health care providers, including RNs, characterized by the use of the best evidence currently available for clinical decision making, in order to provide the most consistent and best possible care to patients. Are RNs in the United States prepared to engage in this process? This study examines nurses' perceptions of their access to tools with which to obtain evidence and whether they have the skills to do so. Using a stratified random sample of 3,000 RNs across the United States, 1,097 nurses (37%) responded to the 93-item questionnaire. Seven hundred sixty respondents (77% of those who were employed at the time of the survey) worked in clinical settings and are the focus of this article. Although these nurses acknowledge that they frequently need information for practice, they feel much more confident asking colleagues or peers and searching the Internet and World Wide Web than they do using bibliographic databases such as PubMed or CINAHL to find specific information. They don't understand or value research and have received little or no training in the use of tools that would help them find evidence on which to base their practice. Implications for nursing and nursing education are discussed.     

Irish psychiatric nurses' self-reported sources of knowledge for practice

Evidence-based practice (EBP) is an approach to health care in which health professionals use the best evidence available to guide their clinical decisions and practice. Evidence is drawn from a range of sources, including published research, educational content and practical experience. This paper reports the findings of a study that investigated the sources of knowledge or evidence for practice used by psychiatric nurses in Ireland. The paper is part of a larger study, which also investigated barriers, facilitators and level of skills in achieving EBP among Irish psychiatric nurses. Data were collected in a postal survey of a random sample of Irish psychiatric nurses using the Development of Evidence-Based Practice Questionnaire. The findings revealed that the majority of survey respondents based their practice on information which was derived from interactions with patients, from their personal experience and from information shared by colleagues and members of the multidisciplinary team, in preference to published sources of empirically derived evidence. These findings are consistent with those of the previous similar studies among general nurses and suggest that Irish psychiatric nurses face similar challenges to their general nursing counterparts in attaining of EBP.     

Shaping advanced nursing practice in the new millennium

OBJECTIVES: To provide a review of converging themes and trends that are shaping advanced practice nursing roles in oncology nursing. DATA SOURCES: Review and research articles, text-books, and organization documents. CONCLUSIONS: The current managed care environment provides many opportunities and challenges for oncology advanced practice nurses. Advanced practice nurses have both clinical and organization competencies that enable them to mediate the clinical needs of patients and organization goals within the health care system. IMPLICATIONS FOR NURSING PRACTICE: Advanced practice nurses can help shape their roles and practice by active participation in the development of systems to support access to clinical and financial information for effective decision making, collaboration among disciplines, and incorporating evidence-based care in their clinical practices.     

Utilization of the Iowa Modelin establishing evidence-based nursing practice

Clinical practice based on tradition or established rituals appears to be widespread amongst a variety of nurses and practice settings. However, tradition-based practice may not necessarily be based on sound scientific evidence and could potentially be harmful to patients or result in inappropriate utilization of resources. Conversely, evidence-based practice is the utilization of the best available empirical evidence in the practice setting, to facilitate sound clinical decision-making. Suctioning ventilated patients is a necessary and important aspect of patient care. However, normal saline instillation prior to suctioning, in order to loosen secretions, remains a common nursing procedure despite research suggesting that there is no clear benefit and in some instances may be harmful. Several models have been developed over the past few years to facilitate nursing practice that is based on research or the best available evidence. The Iowa Model, developed at the University of Iowa Hospitals and Clinics, serves as a framework to improve patient outcomes, enhance nursing practice and monitor health care costs. Moreover, it facilitates the application of empirical evidence to clinical practice. This paper will discuss the utilization of the Iowa Model to promote evidence-based nursing practice, with regard to normal saline instillation prior to suctioning, in the critical care unit of a 100-bed hospital in Hong Kong. Patient, staff and fiscal outcomes will also be reported.     

A COMPARATIVE STUDY OF THE SPIRITUAL PERSPECTIVES AND INTERVENTIONS OF MENTAL HEALTH AND PARISH NURSES

Spirituality is an integral part of holistic nursing practice. Limited research has been done that explores nurses' spirituality and the spiritual interventions they have made with patients in their practice. Much of the extant research has been done on nurses involved in terminal care such as oncology and hospice nursing. This study explores spiritual perspectives and spiritual nursing interventions in two other nursing specialties that require holistic nursing care as well: mental health and parish nurses. The findings indicate that both groups report high spiritual perspective scores and provide a variety of interventions to patients in their practices.     

Genetics and nursing: the interface in education, research, and practice

Genetics is affecting all of health care, including nursing. The way in which nurses think about planning health care must be seen now through a "genetic eye" or lens, and nurses must learn to "think genetically." While efforts to integrate genetics into nursing began in earnest in the early 1980s, this effort did not accelerate until the mid-1990s. Before nursing can fully incorporate genetic knowledge into education and practice in a meaningful way, the ways in which genetics will influence health care must be understood. The basic knowledge, skills, and attitudes needed by health professionals are discussed as well as their integration into education and practice. Opportunities for nursing research in genetics are presented as are possible directions. Recommendations for facilitating the integration of genetics into nursing education, practice, and research are also presented.     

A comparative study of the spiritual perspectives and interventions of mental health and parish nurses

Spirituality is an integral part of holistic nursing practice. Limited research has been done that explores nurses' spirituality and the spiritual interventions they have made with patients in their practice. Much of the extant research has been done on nurses involved in terminal care such as oncology and hospice nursing. This study explores spiritual perspectives and spiritual nursing interventions in two other nursing specialties that require holistic nursing care as well: mental health and parish nurses. The findings indicate that both groups report high spiritual perspective scores and provide a variety of interventions to patients in their practices.     

Research utilization: a challenge for nursing graduate education to improve patient care

To improve patient care, hospitals and other health care facilities are looking to improve patient outcomes through examining how nursing care can be changed or modified based on research. The process of applying research results into clinical practice is called research utilization (RU). In this article, a master's level research utilization course is described. The process of research utilization is highlighted along with specifics regarding course development and evaluation methods. Graduate level research courses such as this one can assist students to demonstrate competency in research utilization including: synthesis of research literature, development of practice guidelines based on research, and identification of strategies to carry out RU protocols and evaluate outcomes.     

Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council

In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization's nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward. The success of the CPC is due to the leadership and commitment of the CNSs. This article describes the structure, process, and outcomes of an effective CPC where CNSs successfully engage frontline clinicians in promoting nursing care that is evidence based. Clinical nurse specialist leadership is increasingly made visible as CNSs effectively involve staff nurses in practice reforms to improve patient outcomes.     

Teaching undergraduate nursing research from an evidence-based practice perspective

We revised the undergraduate nursing research course using levels of evidence as the template with which to organize the course content and learning activities. A primary purpose in restructuring the course using an evidence-based practice framework was to increase student interest and engagement, and to promote the development of practitioners who will continue to learn about and use research. Learning to systematically locate, evaluate, and use the best available research is the hallmark of evidence-based practice and quality improvement initiatives. Students developed these skills as they sought the answer to a specific clinical problem. One of the most significant outcomes of this approach was students' ability to integrate previously fragmented components of research knowledge and to see the relevance of research evidence for providing excellent patient care.