Achieving evidence-based nursing practice: impact of the Caledonian Development Model

Aim To determine the impact of the Caledonian Development Model, designed to promote evidence‐based practice. Background The model features practice‐development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college. Methods Twenty‐four nurses, from 18 practice sites formed three communities of practice, each selecting evidence‐based guidance to implement. A modified group supervision framework empowered nurses to champion local implementation. Outcomes were determined at 6 months. Results Eighty per cent of the patient‐related criteria and 35% of the facilities criteria were achieved. The Revised Nursing Work Index indicated these nurses experienced greater autonomy (P = 0.019) and increased organizational support (P = 0.037). Focus groups revealed a deepening organizational support for the initiative over time, illuminated work‐based learning challenges and overall enthusiasm for the approach. Conclusion Implementation of the model effectively promoted evidence‐based practice, most notably at the level of the individual patient. Implications for nursing management Time and budgetary constraints necessitate smart, value for money approaches to developing evidence‐based practice and improved care standards. This work demonstrates an effective model that strikes a balance between individual and group learning, virtual and real‐time activities, coupled with resource pooling across organizations and sectors.     

Unreconciled inconsistencies: a critical review of the concept of social justice in 3 national nursing documents

A critical review of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement, and Nursing: Scope and Standards of Practice provides evidence that these documents present an inconsistent, ambiguous, and superficial conceptualization of social justice, and do not offer an adequate framework for nurses to address underlying issues that affect health outcomes. Despite expansive references to the historic role of nursing in social reform, the documents implicitly reinforce nursing practice directed toward the individual nurse-patient relationship and give short shrift to nursing models that endorse broad systems change intended to improve health.     

Profile of advanced nursing practice in Spain: A cross‐sectional study

In this study, we described the profile of advanced nursing practice in Spain. A cross‐sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence‐based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study.     

Admiral nursing competency project: practice development and action research

Aims and background. Admiral Nurses are specialist dementia care nurses working in the community with carers of those who have a dementia. The aim of the competency project (2000–2003) was threefold. Firstly to work collaboratively with these specialist nurses to facilitate the development a competency framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's Higher Level Practice standard. Design and methods. The two complementary approaches of emancipatory action research and systematic practice development were adopted. Methods were taken from action research and systematic practice development approaches with an emphasis on promoting and enabling enlightenment, critical reflection, ownership and creating the best conditions for long‐term commitment to the competency framework. Results. The main outcome from this project was the development of a specialist nursing competency framework. The Admiral Nurses’ Competency Framework is made up of a set of eight core competencies with three levels of competency statements, loosely structured around the Higher Level Practice standard, and guidance documentation to illustrate how work‐based evidence can be generated to demonstrate competence. There were also process‐derived outcomes associated with combining systematic practice development with emancipatory action research that had an impact on the culture. The main outcomes here were that practitioners engaged in and experienced learning about how to research their own practice and the consequences of doing this. They also learnt about specialist nursing practice more widely than Admiral Nursing. Finally, there was some increase in awareness about the culture within their teams and organizations. The final competency framework reflects the needs of the service, is owned by the majority of practitioners and project commissioners and this has had a positive impact on implementation. Conclusion. In this paper, we report on combining systematic practice development with action research to achieve immediate project aims. In addition we show how a project of this nature can contribute to developing skills in practitioners necessary for cultural changes in practice and contributes to wider issues of modernization within nursing and health care. Relevance to clinical practice. This competency framework will enable Admiral Nurses to demonstrate their level of specialist practice, as individuals and collectively as a service and it also promotes the principles of nurses as life long learners. This may have relevance to other groups of specialist nurses. The project has widespread relevance for two reasons. Firstly, it shows that nurses can be involved in designing and testing a competency framework as collaborators. Secondly, that to achieve this within the spirit of approaches, such as systematic practice development and action research, can be testing for all collaborators even were there is a shared or espoused aim.     

循证护理:理论与实践

长期以来 ,护理实践的特点就是按照工作程序提供护理服务 ,在用科学证据指导临床护理决策和行动方面存在局限性。在讲求证据的年代 ,护士应积极寻求现时的证据来更新知识结构 ,增强解决问题的能力 ,为病人提供高效优质的护理 ,以满足 2 1世纪循证的要求 ,迎接所面临的挑战。循证护理实践就是实现此目标的一个很好的方法。文章从认识循证医学的内涵及以科学证据为基础的实践对临床护理服务影响的角度出发 ,主要讨论证据的质量分级、循证护理实践的主要步骤及其与临床路径的相互关系、我国循证护理实践现状、护理人员实施循证护理面临的挑战。     

Recognition of expertise: an important concept in the acquisition of nephrology nursing expertise

The present article, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept of recognition of expertise. The study used grounded theory methodology and involved 17 registered nurses who were practising in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participant observations and interviews. According to nurses in this study, patients, doctors and other nurses recognized that some nurses were experts while others were not. In addition, being trusted, being a role model and teaching others were important components of being recognized as an expert nephrology nurse. Of importance for nursing, the results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.     

Clinical indicators as measures of mental health nursing standards of practice in New Zealand

This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritized in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 District Health Board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. We discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.     

Exploring nursing expertise: nurses talk nursing

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.     

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.     

Using nursing practice guidelines for the prevention of multidrug‐resistant tuberculosis among hospitalized adult patients in Bangladesh

Multidrug‐resistant tuberculosis (MDR‐TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well‐validated clinical guidelines for the prevention of MDR‐TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR‐TB (NPG: MDR‐TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR‐TB during pre‐ and postimplementation of the guidelines. Significant differences between pretest and post‐test mean scores of nursing practice for the prevention of MDR‐TB in case finding and case holding were found in three levels of wards, including Level 0 (non‐TB), Level 1 (TB) and Level 2 (MDR‐TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR‐TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.     

Evidence‐based nursing: clarifying the concepts for nurses in practice

Aim. To provide a critical analysis of key concepts associated with evidence‐based nursing (EBN) to substantiate an operational definition for nurses to use in practice. Background. Despite the plethora of literature surrounding what evidence‐based nursing is and is not and how it differs from its cousins, evidence‐based medicine and evidence‐based practice, nurses still struggle to get evidence into practice. Several reasons for this have been reported, for example, a lack of understanding about what evidence‐based nursing means or time to engage with and apply the evidence into practice. Design. An in‐depth critical review and synthesis of literature was undertaken. Method. Using the key words; evidence‐based nursing, evidence‐based medicine and evidence‐based practice 496 articles were yielded. These articles were limited to 83. Using Burns and Grove’s (2001) phased approach to reviewing the literature the articles were critically reviewed and categorised into key concepts and themes. Results. The in‐depth critical review and synthesis of the literature demonstrated that evidence‐based nursing could be defined as a distinct concept. The review clearly shows that for evidence‐based nursing to occur, nurses need to be aware of what evidence‐based nursing means, what constitutes evidence, how evidence‐based nursing differs from evidence‐based medicine and evidence‐based practice and what the process is to engage with and apply the evidence. Conclusion. The in‐depth critical review and synthesis of the evidence‐based nursing literature reinforces the need to consolidate a position for nursing in the evidence‐based field. The review confirms that evidence‐based nursing can be defined and conceptualised; however, for nurses to engage and apply with the evidence‐based processes they need to be informed of what these are and how to engage with them in practice. Relevance to clinical practice. This paper examines the concept of evidence‐based nursing and its application to clinical practice.     

我国建立临床护理实践标准的意义

通过在实践中贯彻护理程序来实现护理的专业化,同时将护士提高为在人类健康服务中能够独立思考、决策和行动的专业角色,已经成为世界护理发展的目标与潮流。中国护理的历史与现实,决定了必须经过以“护理临床与管理同时系统地贯彻护理程序”为基本特征的护理改革,才能实现这样的目标。本文借鉴美国护士协会最新修订的“临床护理实践标准”,认为建立中国临床护理实践标准也是目前中国护理改革的一项紧迫任务。重点讨论了护理程序作为中国护理实践的基础和建立临床护理实践标准在中国护理专业化进程中的意义以及在中国护理改革这一系统工程中的重要作用。     

Exploring the future of gerontological nursing outcomes

This paper explores some of the global challenges in gerontological nursing and suggests that nurses need to be able to identify better more appropriate person‐centred outcomes, to justify their own worth in caring for older people. It highlights some of the methodological difficulties of measuring outcomes for older people and, more generally, of determining the value and contribution of nursing. It argues that, to address some of these methodological challenges, more participative approaches to research are needed, highlighting the particular value of action research. It suggests that if research is to be meaningful to both older people and those caring for them, there is an urgent need for gerontological nursing research to become much more person‐centred and practice/action oriented.     

The clinical learning portfolio: a practice development experience in gerontological nursing

Background. Assessment of clinical practice in post registration programmes can require a different focus to capture the essence of learning at a higher level. There are differences of opinion in the literature on the potential use of the portfolio as an assessment method. Aims. The aims of this paper are to describe the use of a portfolio of evidence‐based practice and reflection to assess clinical learning in a Higher Diploma in Gerontological Nursing Programme and to present the findings of a pilot evaluation of this assessment. Design and method. The evaluation was conducted by postal questionnaire distributed to the first cohort of students following graduation from the programme in 2002. Results and conclusions. Arising from this exploration of the student experience, it appears that the use of a portfolio in addition to formative assessment, can promote a link between theory and the advancement of gerontological nursing practice.