A systematic review of the literature to support an evidence-based Precepting Program

Aim

To provide a systematic review of the literature regarding development of an evidence-based Precepting Program for nurses transitioning to burn specialty practice.

Background

Burned patients are admitted to specialty Burn Centers where highly complex nursing care is provided. Successful orientation and integration into such a specialized work environment is a fundamental component of a nurse's ability to provide safe and holistic patient care.

Design

A systematic review of the literature was performed for the period 1995–2011 using electronic databases within PUBMED and Ovid search engines.

Data sources

Databases included Medline, CINHAL, ProQuest for Dissertations and Thesis, and Cochran Collaboration using key search terms: preceptor, preceptee, preceptorship, precept*, nurs*, critical care, personality types, competency-based education, and learning styles.

Review methods

Nurses graded the level and quality of evidence of the included articles using a modified 7-level rating system and the Johns Hopkins Nursing Quality of Evidence Appraisal during journal-club meetings.

Results

A total of 43 articles related to competency (n = 8), knowledge acquisition and personality characteristics (n = 8), learning style (n = 5), preceptor development (n = 7), and Precepting Programs (n = 14).

Conclusions

A significant clinical gap existed between the scientific evidence and actual precepting practice of experienced nurses at the Burn Center. Based on this extensive review of the literature, it was determined that a sufficient evidence base existed for development of an evidence-based Precepting Program.     

Development of an inter-professional clinical practice guideline for vocational evaluation following severe burn

Purpose

To develop an inter-professional clinical practice guideline for vocational evaluation following severe burn.

Methods

The Canadian Medical Association's (CMA) handbook on clinical practice guideline and the appraisal of guidelines for research and evaluation (AGREE) were used to develop the guideline. The following steps from the CMA handbook were followed: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal and (4) development of clear recommendations by key stakeholders. The international classification of function and disability was used as a guiding theoretical framework.

Results

The guideline includes recommendations within seven domains: (1) establishing evaluation purpose and consent; (2) history taking and information gathering; (3) assessment of functional systems: body systems and structures; (4) assessment of functional systems: activity limitations and participation restrictions; (5) identification of key personal and environmental factors; (6) analysis and synthesis; (7) development of evaluation recommendations.

Conclusions

This guideline insures that vocational evaluators use an evidence-based approach to systematically assess elements within the individual, the work, workplace, personal and environmental facilitators and barriers to work participation. The guideline may be useful to clinicians, healthcare teams, employers and individuals with severe burns. Future steps will include guideline pilot testing and endorsement.     

The RCT means nothing to me!

Research is a cornerstone of evidence based practice with the randomised controlled trial (RCT) regarded as the ‘gold standard’ for evaluating the effectiveness of interventions. However, it is not uncommon for RCT’s to arrive at conflicting conclusions. This conflict might be explained by the quality of the different studies and their inherent risk of bias. Despite this, discussion and debate around methodological issues is limited in physiotherapy specific journals. It is important that clinicians are aware of the inherent risk of bias within studies and what this means for their practice. Hence, this paper presents a clinically focused methodological discussion with the intention of offering a platform upon which readers can develop their understanding of meaningful critical appraisal and hence gain confidence when reading and appraising published RCT’s.     

护理本科生临床实习期间压力程度和应对方式的相关因素研究

[目的]了解护理本科生临床实习期间的压力程度、应对方式，分析其相关因素，并探索压力程度与应对方式的相关性。[方法]采用问卷调查法，在临床实习前期对80名护理本科生进行调查。[结果]护生的压力程度以中度为主，应对方式较积极。对压力程度有影响的因素：父母职业、家庭子女数和护生类别；对应对方式有影响的因素：专业态度和相关社会实践；积极应对方式与压力程度呈负相关，消极应对方式与压力程度呈正相关。[结论]护理本科生压力程度与父母职业、家庭子女数及护生类别有关，应对方式受专业喜好程度及社会实践经验影响。护理教师应针对性地为护生提供指导和帮助，减轻临床实习期闻的压力．提高实习效果。     

Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines

Background

The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.

社会因素与护理人员静脉穿刺成功率的关系

通过采用自身对照法，对１４名在岗护士两种心态下（正常心态与有社会因素影响）对病人手、足部位浅表静脉穿刺一次成功率进行比较。结果经Ｘ２检验，各单项比较无差异（ｐ＞０．０５），终值比较有显著差异（ｐ＜０．０５）。说明社会因素对静脉穿刺成功率有影响。     

The partnership care delivery model: an examination of the core concept and the need for a new model of care

Aim  This article describes the foundation of an emerging care delivery model based on partnership. It also reflects on and synthesizes the findings of earlier concept analyses of its core concept.
Background  Changes in the delivery of health care services in the United States have been driven significantly by cost containment over the last 20 years. This has resulted in an unprecedented pace of work, fragmentation of care, and medical errors. Fundamental changes are needed to meet the needs of today's health care environment.
Methods  A literature search was done in electronic data bases. Concept analysis papers were reviewed and synthesized.
Results  The antecedents, attributes and consequences of partnership are described and linked to the supporting literature and theoretical models.
Conclusions  Engaging and empowering the patient through partnership seem to be crucial to developing a cohesive and effective model of care delivery. Partnerships among patients, their families, physicians, nurses and other clinicians positively impact on safety, quality of care, satisfaction, outcomes and job fulfillment.
Implications for nursing management  Managers need to foster an environment that allows for stronger reciprocal relationships. They need to facilitate changes in practice that support the development of partnerships among patients, their families and all care providers.