Care for carers of stroke patients: evidence-based clinical practice guidelines.

Caregivers of stroke patients provide informal care ranging from physical help to psychosocial support. As a result, these caregivers may experience high levels of burden, associated with characteristics of the patients and of the caregivers themselves. This burden can result in a deterioration of the caregivers' health status, social life and well-being. The caregivers may thus be seen as colleagues of professional caregivers in sharing the care for the patient, but they should also be seen as "patients" having problems and special needs themselves. In this paper new Dutch clinical practice guidelines are presented. These guidelines are formulated in response to an expressed need to improve professional support for this group. We believe these guidelines are also relevant for other countries, since the evidence was gathered through systematic searches of international literature and none of the guidelines that we were able to find in other countries already included this evidence. New, or more detailed topics in the Dutch guidelines, in comparison with existing international guidelines, are added (e.g. young children). Three topics concerning caregiver burden are presented in more detail in this paper, which are based on systematic literature searches: partners at risk of burden, assessing burden in caregivers and interventions for caregivers.     

Achieving clinical excellence through evidence-based practice: report of an educational initiative

We live in a political and professional climate which requires us to define, maintain and seek to improve the quality of all aspects of health care practice, not least via underpinning decisions and actions with robust evidence. In order to meet this challenge, staff must be clinically competent, reflective about their practice, committed to delivering a 'First Class Service' and able to work in a truly multidisciplinary way (as opposed to the unidisciplinary model frequently seen in operation). In addition, they need to be research 'literate' and able to contribute positively to the management and sustainment of planned change. For managers, the role of staff development in order to meet these goals is not inconsiderable. This paper discusses the process and outcomes of a successful educational initiative which sought to meet the plethora of challenges that face managers and their staff in the course of trying to achieve these goals.     

Factors influencing the development of evidence-based practice: a research tool

AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses.     

Intramuscular injection: an integrative research review and guideline for evidence-based practice.

Intramuscular injections (IM) are a common yet complex technique used to deliver medication deep into the large muscles of the body. More than 12 billion IM injections are administered annually throughout the world. However, it is not a benign procedure, and unsafe injection practices are estimated to have significant impacts on patient morbidity and mortality and result in millions of dollars in direct medical costs on an annual basis. Although there is significant research, spanning 8 decades, on the procedure and techniques of administering medications by the IM route, instruction materials and clinician practice do not always reflect research-based practice. An integrative review of the literature has resulted in the development of a guideline for evidence-based practice of IM injections. Use of this guideline can assist the clinician to maximize the therapeutic effects of administered medication while minimizing or eliminating patient injury and discomfort associated with IM injections.     

The development and descriptions of an evidence-based case management educational program

Educational preparation is the key to successful case management and better patient outcomes. Closer examination reveals that existing case management education programs often lack a theoretical underpinning. In order to address the issues, this paper describes the development process of using an expanded version of Donabedian's structure-process-outcome framework as a base and program itself. Four main stages were used in the development process. A systematic literature review and needs assessment provided relevant evidence for the program design. Then, a panel review was undertaken and pilot testing initiated with public health nurses. The expert panel review and the findings of the pilot test both supported the selection of the program content and the learning approaches adopted throughout the program. Sixteen hours of workshops provided detailed content on the case management process. Four main learning strategies were chosen based on transformative learning theory and the findings of the needs assessment. The paper provides an example of the development of a program based on existing theory and evidence.     

Conflicting agendas between consumers and carers: the perspectives of carers and nurses

Increasingly, Australian government policy advances an expectation that consumer and carer participation will be present in all aspects of mental health service delivery. A review of the literature suggests that consumers and carers actively seek the opportunity to participate but are frequently hampered by barriers. However, government policy documents tend to discuss consumers and carers with regards to participation as though their needs and desires are essentially similar. This paper presents the findings of a qualitative research project involving in-depth interviews with carers and mental health nurses. The issue of conflict between the issues for consumers and carers emerged as a major theme. This issue is explored and discussed in light of the goals of current mental health policy. It is concluded that conflicting agendas are apparent and must be addressed if genuine participation in service delivery is possible for both consumers and carers.     

Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development,implementation and evaluation of an online toolkit for health professionals

Purpose: Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting. Methods: EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring. Results: The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy’s inception in January 2011. Conclusions: The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians’ use of EBP in order to meet the needs of the clients and families whom they support.

• Implications for Rehabilitation

• A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level.

• Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources.

• EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

     

The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty

ObjectiveTo develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members.MethodsUsing an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool.ResultsSixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool.ConclusionOur online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.     

The 'difficult' nurse-patient relationship: development and evaluation of an e-learning package

Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care. This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed. Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations.     

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.     

Lived experience researchers partnering with consumers and carers to improve mental health research: Reflections from an Australian initiative

Consumer and carer involvement in mental health research is a growing and developing field. Whilst there has been policy and in‐principle support for such involvement from governments around the world, lived experience researchers conducting academic research in partnership with other consumers and carers remains uncommon. ACACIA: The Australian Capital Territory Consumer and Carer Mental Health Research Unit is based at The Australian National University and employs academic researchers with lived experience to undertake research directly relevant to the needs of mental health consumers and carers with the aim of influencing policy and practice. In this study, we share our experience of developing and conducting research within ACACIA to provide a model for meaningfully engaging mental health consumers and carers throughout the research process.     

Promoting evidence-based practice: an internship for staff nurses

Implementing evidence-based practice is a complex but valued process that requires support for nurses to make it a reality in care delivery. To address this, an Evidence-Based Practice Staff Nurse Internship was developed at the University of Iowa Hospitals and Clinics in the United States. PROGRAM OVERVIEW: The objective of this internship is to promote use of evidence by staff nurses to improve patient outcomes. Through a competitive application process, six nurses are accepted in each cohort. The program provides didactic content and dedicated work time on topics interns select (e.g., family pet visitation, sedation management, bowel sounds assessment, guided imagery, family transition to pediatric floor). Interns receive paid clinical release time for participating. ROLES AND RESPONSIBILITIES: Teams include the staff nurse, the nurse manager, and an advanced practice nurse. Responsibilities for each step are assigned to the person with the appropriate expertise. EVALUATION: Interns report understanding the process, appreciate the opportunity for professional growth, and report their objectives are being met. Participants evaluated the program very positively and also provided recommendations for revision (e.g., revising class content). The program resulted in improved quality of care such as increased patient and family satisfaction, decreased length of stay, and cost savings. IMPLICATIONS: Programs that support practitioners through the evidence-based practice process are needed for use in a variety of settings internationally. This unique program supports staff nurses in making evidence-based practice a reality for their work and patients and might be transferable across settings.     

An essential component of the Magnet journey: fostering an environment for evidence-based practice and nursing research

Creating, advancing, and sustaining a practice environment grounded in evidence-based practice and nursing research is essential to achieving Magnet status. The purpose of this article is 2-fold. First, to describe a model for the integration of evidence-based practice. Second, to illustrate how a community hospital used this model as a framework for the integration of evidence-based practice and nursing research as part of its journey toward achieving Magnet status.     

Product evaluation: research for practice.

Which product to choose? Involve staff members in gathering data to make an informed decision.