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.     

The development and current status of men in the nursing profession

Nursing has been a quintessentially female-dominated occupation throughout much of its history. Today, educational developments, changes in healthcare service models and promotion of gender equality in education and employment have opened the doors to males to play increasingly important roles in the healthcare services as nursing professionals. The responsibilities of male nursing staff are expected to continue to increase. It remains difficult for male nurses to escape traditional gender stereotypes in nursing. The impact of personal characteristics, occupational roles, and professional identification in real practice are major issues of concern. This study reviewed relevant literature to identify factors of influence on male nursing staff professional practice. We hope this study can be a reference for future research on male nursing staff development, and that male nurses will increasingly create personal core values in a multi-discipline, cross-professional healthcare team, and exercise their abilities as a complement to female nurses.     

The relevance of globalization to nursing: a concept analysis

GROOTJANS J. & NEWMAN S. (2013) The relevance of globalization to nursing: a concept analysis. International Nursing Review 60 , 78–85 Background: This paper emerged alongside the development of learning materials for a new unit of study on global health and nursing. The proposed unit was for inclusion in a graduate entry master of nursing course leading to registration. It became evident that there has been growing attention within the nursing literature to the demands of an increasingly globalized world and the subsequent challenges confronting nursing as a profession. At the same time, the literature is inconsistent and contains mixed messages with regard to how nurses and nursing might respond to these challenges. Aim: This paper aims to (i) present the findings of a narrative analysis of the current nursing discourse on globalization, and (ii) to identify directional cohesiveness for the nursing profession in the seemingly disparate literature. Method: Concept analysis following extensive literature review. Findings: Several nursing authors argue that nurses globally are increasingly sharing concerns expressed by nurses at a local level. Concerns such as the future sustainability of the profession and more specifically practice concerns such as the continuing failure of nurses to adequately deal with social justice issues requires careful consideration by every nurse. While strategies recommended for dealing with these concerns lack a cohesive thread, some interesting themes and innovative recommendations have emerged. For example, the need for nurses to consider replacing environmental considerations with ecological considerations and that nurses consider preventative nursing practice beyond the immediate needs of clients and from a more global perspective.     

Exploring the heart of ethical nursing practice: implications for ethics education

The limitations of rational models of ethical decision making and the importance of nurses' human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses' ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice.     

Drug‐seeking: A literature review (and an exemplar of stigmatization in nursing)

Despite its lack of conceptual clarity and uniform definition, the term drug‐seeking is used frequently by nurses from a variety of practice environments. The drugs patients are referred to as seeking are often pain medications. This is important because nursing has widely adopted a patient‐centric definition of pain. Nursing also has a robust ethical code that places high value on human dignity and nurses’ role in patient advocacy. A review of literature was conducted with the aims of describing whether/how the term drug‐seeking has changed over time and to determine whether the use of the term in nursing literature is consistent with nursing values. Use of the term has shifted from objective counts of patient requests for medication to a confusing mixture of observable patient behavior and subjective interpretations of patient motivation. Its use is not consistent with nursing values. It is, in fact, a good illustration of stigmatization in nursing. Stigmatization is contrary to nursing values. Nurses in practice, research, education, authors, reviewers, and editors all have a role in ending this stigmatization.     

The determinants of psychiatric nursing practice: a comparison of sociological perspectives

This paper commences by observing that psychiatric nurses tend not to interact with their clients in a therapeutic fashion It is not clear, however, whether this is due to the nature of psychiatric institutions or to the attitudes of individual nurses Contrasting social theories which posit either the importance of social structures, or of individual interpretations as determinants of behaviour, are outlined These are then applied to the problem of psychiatric nursing practice It is argued that while there are strengths in both theoretical positions, neither on their own can adequately characterize the complexity of the problem Rather than attempting to explain influences upon psychiatric nursing practice in terms of either structure or action, we should appreciate the importance of, and relationship between, both factors Given the rapid changes occurring in mental health nursing, research into factors influencing practice will become increasingly important In order to explain developments adequately, researchers will need to take account of the duality of structure and action     

The use of challenge studies in biobehavioral nursing research

With the rapid growth of biotechnology, developments in psychopharmacology, and advances in the understanding of biobehavioral relationships, psychiatric nursing is presented with exciting new opportunities for research related to clinical practice. Although challenge strategies have been developed largely within the medical subspecialties, this article describes the application of pharmacological challenge testing to assist in the understanding of biobehavioral relationships pertinent to psychiatric nursing. This article presents examples of challenge strategies and their relevance to clinical practice. The use of the challenge method in psychiatric nursing research and future directions are discussed.     

Translating person-centred care: a case study of preceptor nurses and their teaching practices in acute care areas

Aims and objectives. The research aims to explore how preceptors interpret, operationalize, document and teach person‐centred care as they guide students within an acute surgical environment. Background. Person‐centred care is a term that is widely used in the nursing literature; however, its interpretation in nursing practice remains virtually unexplored. This is of great significance to nurses in general but to Irish nurses in particular on whom this study is focused. As preceptor nurses have been identified as key people in the education of clinical students, it was considered important to explore how clinical preceptors promote person‐centred care to current undergraduate nursing students. Design and method. Using a case study design and a qualitative approach, six preceptors were chosen to participate in this study. Data were collected by means of participant observation, review of nursing care records and semi‐structured interviews. Data were analysed in two stages. The first stage involved the identification of themes. In the second stage data were analysed using a number of propositions to examine and explain what was gleaned from the data in the context of what was originally identified in the literature. Results. Findings highlighted that preceptors had a limited conception of person‐centred care. Measures of care reflected the medical model of nursing. Beyond that, preceptors expressed care in terms of good manners or respectful etiquette. Preceptors also had limited appreciation of what learning entails and were sceptical about classroom theory other than what they considered essential for safe practice. Conclusions. This study highlights that preceptors need both internal and external support to implement the changes advocated by the Commission in Nursing in 1998 , the Nursing Education Forum in 2000 , the Department of Health and Children in 2001 and An Bord Altranais in 2003 . Relevance to clinical practice. Person‐centred care is a relatively new concept in nursing and recommended for practice. Preceptors need facilitation with its implementation. In an effort to promote changes in the delivery of health care, it is suggested that university‐based lecturers empower students to practice evidence‐based nursing as students and subsequently as qualified nurses.     

Leadership for learning: a literature study of leadership for learning in clinical practice

Aim To report a literature study of leadership for learning in clinical practice in the United Kingdom. Background Previous research in the United Kingdom showed that the ward sister was central to creating a positive learning environment for student nurses. Since the 1990s, the ward mentor has emerged as the key to student nurses’ learning in the United Kingdom. Methods A literature study of new leadership roles and their influence on student nurse learning (restricted to the United Kingdom) which includes an analysis of ten qualitative interviews with stakeholders in higher education in the United Kingdom undertaken as part of the literature study. Results Learning in clinical placements is led by practice teaching roles such as mentors, clinical practice facilitators and practice educators rather than new leadership roles. However, workforce changes in clinical placements has restricted the opportunities for trained nurses to role model caring activities for student nurses and university based lecturers are increasingly distant from clinical practice. Conclusions and implications for practice Leadership for learning in clinical practice poses three unresolved questions for nurse managers, practitioners and educators – what is nursing, what should student nurses learn and from whom? Implications for nursing management Leadership for student nurse learning has passed to new learning and teaching roles with Trusts and away from nursing managers. This has implications for workforce planning and role modelling within the profession.     

Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision‐making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer‐reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.     

Community development: theoretical and practical issues for community health nursing in Canada

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature This paper provides background information on the historical origins of community development work through an extensive review of the literature As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science These include economic development models, education models both formal and informal, confrontational models, and empowerment models Each is discussed, and the relevance for community health nursing practice is critiqued Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health However, much additional work will be needed to test out models for community development in actual practice Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population     

Clinical judgement and decision-making in nursing - nine modes of practice in a revised cognitive continuum

Title. Clinical judgement and decision‐making in nursing – nine modes of practice in a revised cognitive continuum Aim. This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision‐making in nursing. Background. The importance of nurses’ developing and applying sound clinical judgement is reflected in an international classification of nursing practice. Cognitive continuum theory synthesizes rival and complementary approaches to decision theory in an accessible format, which has been applied in medicine, and various nursing scholars have advocated its use to enhance the effectiveness of nurses’ clinical judgement and decision‐making. Method. Parse’s structure and process criteria are applied in critiquing the relevance of cognitive continuum theory to nursing. Findings. Cognitive continuum theory illustrates how different judgement tasks are suited to different thought processes and how matching the two can optimize decision‐making. However, existing modes of inquiry applied to medicine emphasize experimental research, ignoring many alternative approaches used in nursing. A revised version of the cognitive continuum is developed, incorporating examples of nursing judgements and decisions, a broader evidence base, an ethical dimension, and evaluative competence criteria. Conclusion. The revised cognitive continuum promotes awareness of the nature and the variety of patient‐centred judgement tasks and decisions in nursing, how to select the most suitable intervention tactic from available options, and the fallibility of all forms of human judgement from intuitive/experiential to analytic/rational. Hence, it is recommended for use as an educational tool and practice guide to facilitate theory development and the practice of judgement and decision‐making in nursing.     

The design of written information for cardiac patients: a review of the literature

? Written information is a form of communication that is being recognized by nurses as increasingly important, and a large amount of information is now being produced. ? Now that patient turnover is becoming more rapid and hospital stays shorter, thus leaving less time for face‐to‐face patient education, nurses are increasingly relying on the written word to supplement verbal information‐giving. ? It is vital that written materials, whatever their source, should be of the highest quality. Nowhere is this more relevant than in the case of post‐coronary patients. ? In view of the dearth of research‐based cardio‐specific literature, this review examines the broader literature and offers guidelines for nurses who wish to produce their own information. ? Format and presentation of written materials rather than content are the focus and the issues and conclusions are applicable to nurses working in fields other than cardiac nursing.     

Choose your doctorate

Aims and objectives. The development of education options for nurses has been inexorable and it is increasingly the case that senior nurses are considering a doctorate as the logical next step in their educational career. Such individuals need to make important decisions as to whether they should embark on a taught doctorate, professional doctorate or a traditional PhD. Each of these options will necessitate a considerable investment in time and money as well as the sacrifice of quality time and spare time over a significant number of years. A doctorate is not for everyone. Those still reading this text may be asking ‘could this possibly be for me'? This paper will try to help the reader decide which if any option to take. Background. It is suggested that nurses will now turn to the doctoral degree as their next adventure in academic study. It is argued that this development is not being controlled by management forces and indeed cannot be controlled by them. This last is chiefly because the move towards doctoral education is led by individuals who choose to study for a doctorate simply because they can. The paper considers what choices are available to nurses who wish to pursue a doctoral programme of study. In particular, this paper considers what new developments in doctoral courses are becoming available and what advantage there may be in studying for one of the newer professional doctorates rather than a traditional PhD. Method. The material here is the result of a review of the literature on recent developments in doctoral education for nurses. The existing provision by UK and other universities was also reviewed, the data being collected by an informal review of universities’ advertising material. Conclusions. It is inevitable that some nurses who are already qualified to degree and masters degree will take advantage of the doctoral degree opportunities which now newly present themselves. For nurses in practice, the advantages of the professional doctorate is that it is more structured, enables more peer and academic support and is more practice orientated. It is suggested that the move towards doctoral programmes for nurses will present one of the most important evolutionary changes in the practice of nursing. Relevance to clinical practice. It is suggested that doctoral education for nurses will increase in prevalence and that this process of change is already underway. Doctoral education will provide practitioners with the experience and skills required to conduct research and further develop practice. For individual practitioners, doctoral education will enhance self‐confidence in an increasingly technical and complex arena and in a practice discipline that is becoming ever more politically charged. The professional doctorate appears to be particularly suited to senior nurse practitioners. What remains is for us to accept this new challenge and to shape its development for the benefit of the practice of nursing.     

A non-theorist's perspective on nursing theory: issues of the 1990s

The basis of all nursing endeavors, including practice and research, lies in theory. While nursing theorists are postulating and debating, practicing nurses are continuing with their daily routines and are often unaware that the world of nursing theory is changing. It is important, however, for all nurses to keep abreast of the latest developments in nursing theory. This article discusses some of the key developments within nursing theory based on a review of the nursing literature from 1990 through 1999.     

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.