Comprehensive therapeutic benefits of Taiji: a critical review

This literature review offers physical rehabilitation professionals an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. A critical analysis distinguishes between what is known from controlled clinical research and what is suggested in preliminary research. Of >200 published reports examined, 17 controlled clinical trials were judged to meet a high standard of methodological rigor. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Preliminary research on implementation feasibility of Taiji programming exists for a variety of clinical populations. Further controlled clinical study is justified for a wide variety of clinical contexts.     

Collaborating with practitioners in teaching and research: a model for developing the role of the nurse lecturer in practice areas

Collaborating with practitioners in teaching and research: a model for developing the role of the nurse lecturer in practice areas The integration of nurse education with higher education in the United Kingdom, has highlighted an uncertainty over the clinical role of nurse lecturers. Although benefits have been identified from lecturers maintaining strong links with clinical practice, the evidence suggests that nurse lecturer participation in practice areas is limited. This paper reports a strategy for developing the clinical role of the nurse lecturer through collaborating with practitioners in teaching and research. An action research project designed to implement and evaluate a teaching programme for pre-registration nursing students was developed. The research aimed to evaluate the programme and identify the benefits for students, practitioners and the nurse lecturer in collaborating in teaching on the programme. Ethical approval was granted from the local research ethics committee. Data were collected in three ways: questionnaires to 17 students; focused interviews with nine practitioners; and analysis of the reflective diary kept by the lecturer. Findings identified the success of the teaching programme and also revealed substantial benefits for students, practitioners and the lecturer. Selected findings are used to demonstrate how the liaison, teaching, clinical practice and research elements of the nurse lecturer's clinical role could be developed. The project was small scale and grounded within a specific context and thus may not be applicable to other settings. However, it is suggested that collaboration between nurse educationalists and practitioners in this way offers a potential model for developing the clinical role of the nurse lecturer.     

Attitudes of nursing staff to the autopsy

We assessed the views of hospital nurses on the autopsy, using a questionnaire which was distributed by hand to all qualified nurses working at Manchester Royal Infirmary during a 48-h period. We found that many respondents (43%) had had occasion to discuss autopsy with relatives, and the majority (90%) would like to learn more about counselling the bereaved. Few (15%) clearly understood the legal distinction between coroners' and hospital autopsies. Almost all (97%) thought the main reason for autopsy was determination of the cause of death, and only 12% supported a role in clinical audit. More respondents saw benefits for doctors rather than for nurses, and only 56% perceived a benefit for relatives. In general, nursing staff have a more positive view of the autopsy than we anticipated, and we would advocate making more information about the benefits of autopsy available to nurses.     

Doing clinical research: the challenges and benefits

The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses' experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.     

How--and why--to request an autopsy

Autopsy remains the touch-stone of diagnosis, but clinicians are often reluctant to request the procedure because of their discomfort in approaching the family. Fundamental to a successful autopsy request is sensitivity for the family's feelings, which bespeaks respect for the deceased and the family. For example, in announcing the death and requesting autopsy, the clinician should bring the family to the hospital and talk with them privately. If they have questions or reservations about autopsy, the clinician should answer honestly and simply, stressing the benefits of the procedure to the family and society as a whole. Since the manner of request influences the family's decision in about one third of cases, efforts at overcoming personal reluctance in requesting autopsy are worthwhile. Clinical excellence develops through effort and practice in this activity as in any other.     

Justification for conducting neurological clinical trials as part of patient care within private practice

The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re‐imbursement of trial‐related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up‐to‐date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry‐sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start‐Up Managers or Drug Safety Associates.     

Implementing evidence-based practice in clinical situations

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.     

Evidence-based practice -- imperfect but necessary

Evidence-based practice implies the systematic use of best evidence, usually in the form of high quality clinical research, to solve clinical problems. This article considers a series of objections to evidence-based physiotherapy including that (1), it is too time-consuming, (2), there is not enough evidence, (3), the evidence is not good enough, (4), readers of clinical research cannot distinguish between high and low quality studies, (5), clinical research does not provide certainty when it is most needed, (6), findings of clinical research cannot be applied to individual patients, (7), clinical research does not tell us about patients' true experiences, and (8), evidence-based practice removes responsibility for decision making from individual physiotherapists. We argue that, while there is some truth in each of these objections, they need to be weighed against the potential benefits of evidence-based practice. The overwhelming strength of the evidence-based approach to clinical practice is that it takes full advantage of the only potentially unbiased estimates of effects of therapy - those which are derived from carefully conducted clinical research. The evidence-based practice model may be imperfect, but it may be the best model of clinical practice that is currently available.     

Inquiry in baccalaureate nursing education: fostering evidence-based practice

With the increasing emphasis on evidence-based nursing practice, nurse educators need to more fully implement teaching strategies that help students gain critical thinking skills related to inquiry and understand the importance of evidence-based nursing practice. Research and scholarship emphases in one baccalaureate nursing program, student-identified benefits, and challenges associated with incorporating inquiry across the curriculum are described in this article. In clinical journal entries, students described the following benefits associated with curricular emphasis on inquiry: increased interest in evidence-based nursing practice and participating in the generation of research; enhanced critical thinking skills through the development of knowledge, experience, and competencies; increased motivation to continue professional growth and development by participating in lifelong learning; the desire to become better consumers of research findings; better understanding of the "real world" of clinical research; and increased desire to pursue graduate studies in nursing. The challenge to promote student growth toward competence in the application of evidence-based principles in clinical practice is ongoing.     

Autopsy 101 (CE)

Although autopsy remains the only definitive way to confirm and sometimes diagnose disease, the autopsy rate has continued to decline during the past 3 decades. Despite numerous publications citing its value, the nursing literature lacks information addressing the benefits and implications of the autopsy to nurses who provide direct care to older adults. This article provides geriatric nurses with information about the benefits, purpose, process, and barriers of autopsy to better inform nurses as they ease family concerns and assist physicians in obtaining consent for autopsy.     

The evolution of a clinical scholars program through a pediatric nursing academic-practice partnership

Academic-practice partnerships have the potential to improve clinical outcomes through joint initiatives focusing on nursing. Nurses at the bedside are able to greatly impact care, but often they lack the resources (time, knowledge, and expertise) to enact and facilitate quality improvement initiatives. Through an academic-practice partnership, academic and practice partners can work collaboratively to develop innovative evidence-based practice, quality improvement, and research projects. The benefits of these partnerships are far reaching as they involve faculty, students, and clinicians within the practice. In this article, we describe the development and evolution of a pediatric clinical scholars program that increases nursing engagement for leadership in evidence-based practice, quality improvement, and research projects to improve health outcomes.     

Hormone replacement therapy: primary and secondary prevention

Researchers are far from understanding the mechanism(s) of action of hormone replacement therapy (HRT) on the cardiovascular system. Moreover, the results of clinical trials that can clarify these dilemmas will not be available for several years. As clients seek guidance in making the pivotal decision about taking HRT, it is important that practitioners understand what the current research reveals about its risks and benefits. This article addresses the role of HRT in primary and secondary prevention and includes observational research, clinical trials (completed and in progress), benefits and risks, and implications for clinical practice in counseling patients.     

A new multidisciplinary approach to integrating best evidence into musculoskeletal practice

RATIONALE: The effective integration of research evidence into everyday clinical practice continues to be an important challenge. AIMS: The group aimed to answer locally relevant clinical question and produce recommendations for practice based on the best available evidence. METHODS: Through a new initiative, a multidisciplinary group with a specific interest in musculoskeletal disease has been established in order to help address this problem. The group consists of clinical and academic professionals including physiotherapists, occupational therapists, nurses, clinical researchers and information technology librarians representing the health economy. RESULTS: Results from the group's activities are shared locally through presentations and clinical algorithms and nationally through conference presentations and the National Electronic Library for Health. CONCLUSION: As well as clinical recommendations, other benefits of the group have been improved networking, enhanced continual professional development and identifying areas in need of further research.     

Reflective practice and clinical outcomes: practitioners' views on how reflective practice has influenced their clinical practice

There has been a recent increasing interest in reflective practice in nursing. There is a wealth of literature about its apparent advantages and benefits, but very little empirical research into clinical outcomes consequent to reflective practice. This study attempts an initial exploration into this area. A retrospective, three-phase, multi-method study in a single department of nursing was conducted. The research sample comprised students and former students of the department who had previously participated in an assessed reflective practice course or module. Years of experience, speciality or academic level did not have a significant influence, but the effectiveness of the facilitator was an important factor. The results suggest that reflective practice is regarded highly and that most respondents could identify significant, long-term changes to clinical practice resulting from it.     

A review of the psychosocial aspect of multiple sclerosis

The psychosocial aspects of multiple sclerosis are far-reaching and may have devastating effects on individuals and carers alike. Issues such as the impact of uncertainty, the need to maintain hope and control, and a person's ability to adjust his/her lifestyle to the disease progression are highlighted by recent research. The individualized nature of this chronic illness experience makes comprehensive and ongoing assessment crucial. Evidence from practice suggests that the district nurse's contribution to psychosocial support is hindered by poor role definition. Similarly, while the literature acknowledges the benefits of empowerment, difficulties exist in practice. Collaboration between district nurses and clinical nurse specialists is advocated as a means of integrating best practice and clinical knowledge with community expertise. The need for improved research methodology is identified.     

Perceived impact of faculty practice on nurse practitioner education

BackgroundFaculty practice is believed to positively affect health education, however limited research exists on the impact of faculty practice on nurse practitioner education.PurposeThe purpose was to explore the perceived impact of faculty practice on nurse practitioner education.MethodsA preliminary mixed methods approach was used to evaluate nurse practitioner student and faculty perspectives on the impact of faculty practice on nurse practitioner education. Student group interviews were conducted and practicing faculty were surveyed.ResultsStudy findings included student and faculty-perceived benefits and challenges of faculty practice on nurse practitioner education. Specific benefits were increased access to faculty preceptors and clinical sites for nurse practitioner students, influencing faculty-developed education materials, increased number of real-world examples, faculty credibility, applying evidence-based practice, and overall improvement in the quality of teaching. Specific challenges were time, faculty availability to students, managing multiple roles, and clinical sites not conducive to precepting.ConclusionThis study provided preliminary information on the perceived impact of faculty practice on nurse practitioner education including the benefits and challenges. Findings support faculty practice as having a positive perceived impact on nurse practitioner education.     

EVIDENCE – BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY

A push for the use of evidence‐based medicine and evidence‐based practice patterns has permeated most health care disciplines. The use of evidence‐based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision‐making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well‐being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence‐based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.     

Research translation: a new frontier for clinical laboratories.

Translational research and translational medicine (referred to hereafter as translational research) are interchangeable terms that underline the pressing need to translate into practical benefits for those affected by disease the extensive investments divested by the private and public sectors in biomedical research. For people more directly involved in clinical practice (physicians, clinical laboratory professionals and patients), translational research responds to the need to accelerate the capture of benefits of research, closing the gap between what we know and what we practice. This basically means the transfer of diagnostic and therapeutic advances proven effective in large, well-conducted trials (and, therefore, evidence-based) to daily medical practice. Translational research should be regarded as a two-way road: bench to bedside, and bedside to bench. In particular, to make possible a more effective translation process, a new road map should be implemented through interaction and cooperation between basic researchers, clinicians, laboratory professionals and manufacturers. Some examples of recent developments in clinical laboratory testing, including markers of cardiovascular diseases, clinical proteomics and recombinant allergens, may explain the importance of careful evaluation of all variables that allow the introduction of such new insights into clinical practice to assure better clinical outcomes. The vital role of laboratory medicine in the delivery of safer and more effective healthcare requires more careful evaluation not only of the analytical characteristics, but also of any other variable that may affect the clinical usefulness and diagnostic performances of laboratory tests, thus allowing more accurate interpretation and utilization of laboratory information.     

Moving from institutional dependence to entrepreneurialism. Creating and funding a collaborative research and practice development position

Aims of the paper. The paper describes the creation of, the rationale behind and the external funding of a collaborative research‐clinical practice development position. The paper also demonstrates the benefits of nursing's collaboration with external funding bodies and the value of moving from our traditional position of assuming that ‘the hospital’ will always provide. Background. There is a constant refrain that nursing must become more ‘research‐based’ and develop an active research culture. In harsh financial times however, funding for research development is scarce. Nurses can respond to this by bemoaning the lack of money or by taking an entrepreneurial approach, creating innovative project proposals that develop new partnerships and attract external funding. Discussion. Institutional support for clinical research is often more verbal than financial as most health care systems are experiencing extreme financial stringencies. Nurses need to reconsider the notion that every initiative must automatically be funded by the institution. In this paper we show how in a busy major hospital, clinicians and researchers collaborated to create and fund the kind of innovative research and practice development position that may be impossible to fund through existing budgets. Conclusion. With creativity and determination, nurses can challenge the orthodoxy that they are solely dependent on institutional funding. If there is a clear project vision, a convincing rationale, a strongly argued ‘business case’ and a passionate and persistent team, then innovative new projects and positions can be realized. Relevance to clinical practice. Developing clinical focused, practice based research is now a worldwide policy and practice imperative for nurses. Unfortunately, current levels of institutional funding are unlikely to support research promotion positions and initiatives. This paper outlines an approach to securing funding for research initiatives that can create exciting new positions and develop productive partnerships between researchers, clinicians and external agencies.