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AnteayerWorldviews on Evidence-Based Nursing

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Abstract

Background

In countries with concentrated HIV epidemics, optimizing screening to reach individuals with undiagnosed infection is essential. The DICI‐VIH study, a cluster‐randomized crossover trial conducted in eight French emergency departments (EDs), found that a strategy combining nurse‐driven targeted HIV screening with routine diagnostic testing was effective.

Aim

The aim was to investigate factors associated with the implementation of HIV screening targeting key populations in EDs.

Methods

A self‐administered questionnaire was distributed at registration to patients aged 18–64 years and able to give consent during the DICI‐VIH intervention. Based on their responses, those belonging to key populations were offered a rapid test by triage nurses. Two key stages of the process were evaluated: questionnaire distribution by providers and test acceptance by patients. Patient information, daily workload, and ED characteristics were collected. The associations between these variables and (a) the proportion of questionnaires distributed and (b) the proportion of tests accepted were evaluated using multilevel modeling in order to examine differences in screening implementation between EDs.

Results

Questionnaire distribution proportions varied from 23% to 48% across EDs. They were higher on weekdays than weekends (odds ratio, OR: 3.77; 95% CI: 3.57–3.99) and when research staff participated (OR: 1.31; 95% CI: 1.26–1.37). They decreased over time (OR: 0.76; 95% CI: 0.71–0.82; 4th [Q3] vs. 1st quartile [Q0] of intervention days) and with increased patient flow (OR: 0.61; 95% CI: 0.56–0.67; Q3 vs. Q0 of eligible patients). Test acceptance varied from 64% to 77% across EDs, increased with research staff participation (OR 1.20; 95% CI: 1.03–1.40), and decreased over time (OR: 0.75; 95% CI: 0.60–0.92; Q3 vs. Q0). Patients who accepted were more likely to be younger (OR: 0.76; 95% CI: 0.61–0.96; 50–64‐year‐old vs. 30–39‐year‐old patients).

Linking Evidence to Action

Patient flow, intervention duration, weekdays, and research staff participation were important determinants of targeted screening implementation. These findings could help guide future implementation in similar settings.

Emotional Expression of Persons with Dementia: An Integrative Review with Implications for Evidence‐Based Practice

Abstract

Background

The ability to express emotion typically is preserved longer than language and cognitive function in persons living with dementia. Emotional expression may be an important indicator of underlying individual needs and feelings and may therefore facilitate person‐centered care.

Aims

This review aimed to examine how emotional expression has been described, measured, and utilized in empirical studies.

Methods

The design of this study was an integrative literature review. A systematic search was conducted through electronic databases using defined search terms. Articles published up to March 2018 were included. The method proposed by Whittemore and Knafl was used for data synthesis and review integration. Quality appraisal of the selected articles was evaluated by the Mixed Methods Assessment Tool.

Results

Most of the articles used feeling‐related terms without specific definitions. Less frequently, terms such as affect, emotion, and mood were defined. Although these terms were used interchangeably in the articles, affect, which was defined as expressed emotion in general, was a comprehensive term to encompass other terms. Measurement of emotional expression was performed using observational methods, with direct observation or video recording using a hand‐held camera. In both cases, observed emotion was coded with diverse methods or tools. In studies, the emotional expression was utilized as (a) an outcome to demonstrate the effect of interventions, (b) a factor to show relationship with other variables, or (c) an observed value itself.

Linking Evidence to Action

This review provides insights about measurement options for emotional expressions among persons with dementia in long‐term care. Long‐term care staff should pay attention to emotional expression of persons with dementia to understand underlying unmet needs. Development of adequate measurement of emotional expression could facilitate development of emotion‐oriented intervention program to improve psychological well‐being and the behavioral and functional health of persons living with dementia.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 16, Issue 4, Page 251-251, August 2019.

Implementing Follow‐Along Physical Activity Videos with People Living With Chronic Conditions: A Feasibility Study

Abstract

Background

Compelling evidence supports multiple benefits of physical activity (PA) even in small bursts. Less than 50% of Americans achieve recommended PA levels, lower still for individuals living with chronic illness or disease.

Purpose

The purpose of this study was to develop and evaluate the feasibility and preliminary effects of 3‐min follow‐along video scenarios to promote brief episodes of low–moderate levels of PA among individuals with chronic diseases.

Methods

Guided by our previous studies and self‐efficacy theory, the program (WellMe in 3© for Patients) was modeled after another program developed for healthcare staff. An advisory panel and a health and fitness expert guided the creation of twelve 3‐min video scenarios that included two individuals living with chronic illness and a fitness leader who guided the PA scenarios and how to adapt them based on limitations. The 12 scenarios included 3 min of aerobic activities, stretching, or balance. Preliminary pilot effects were measured among 39 patients living with chronic conditions for one month. Standardized instruments were used to measure PA levels, PA self‐efficacy (SE), and quality of life (QoL); usability and satisfaction were assessed using researcher‐developed tools. Descriptive and inferential statistics were used to evaluate change over time.

Results

Twelve video scenarios were created tailored to persons with chronic illness. Thirty‐nine participants piloted the program, reporting an average of two chronic conditions. Baseline QoL scores were lower than normative data, self‐efficacy scores were low‐to‐moderate, and PA levels were very low. Participants averaged using one video per day. 62% of participants provided complete self‐reported pre‐ and post‐QoL and SE data and 41% provided pre‐ and post‐PA (accelerometer) data. Significant improvements were found for general health and energy scores, and trends were found for self‐efficacy scores. PA levels were highly variable with nonsignificant increases from baseline. Effect sizes were low–moderate for several measures. About 79% of participants rated program “Very good”; all recommended the program.

Linking Evidence to Action

Physical activity has multiple health benefits for all people including those living with chronic conditions. Even short bouts of physical activity have health benefits. A program of 3‐min follow‐along PA videoclips for individuals living with chronic disease holds promise for clinicians and researchers.

Change‐of‐Shift Nursing Handoff Interruptions: Implications for Evidence‐Based Practice

Abstract

Background

The importance of change‐of‐shift handoffs in maintaining patient safety has been well demonstrated. Change‐of‐shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse‐to‐nurse handoff impact the change‐of‐shift handoff process.

Aims

To describe registered nurses’ perceptions of interruptions experienced during change‐of‐shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change‐of‐shift handoff at the bedside.

Methods

An exploratory descriptive design was used. One hundred nurse‐to‐nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis.

Results and Findings

Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse’s appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff.

Linking Evidence to Action

Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses’ ability to communicate information deemed most relevant to the care of a specific unique patient.

Correlates of Physical Activity During Pregnancy: A Systematic Review with Implications for Evidence‐based Practice

Abstract

Background

Numerous attempts have been made to improve women's physical activity participation during pregnancy, but activity levels remain low.

Aim

To examine systematically the associations of physical activity participation during pregnancy with non‐modifiable correlates (not subject to change) and modifiable theoretical correlates of physical activity.

Methods

This systematic review followed PRISMA (preferred reporting items for systematic review and meta‐analysis) guidelines. It includes cross‐sectional and longitudinal studies that assessed non‐modifiable correlates and modifiable theoretical correlates of physical activity. Five electronic databases were searched for studies published in the English language between 2010 and 2017. An author‐developed data collection tool was used to examine selected variables; effect sizes were determined; and study bias was assessed.

Results

Ten studies were included in the final review. Overall, effect sizes for non‐modifiable correlates of physical activity were small to moderate, except for mental health (d = 1.35) and prior physical activity (d = 0.63). By contrast, modifiable theoretical correlates of physical activity (e.g., self‐efficacy [d = 0.96–1.42] & intention to be physically active [d = 1.62]) had moderate to large effects in the expected direction with physical activity during pregnancy.

Discussion

The findings underscore the importance of developing physical activity interventions for pregnant women that are guided by modifiable theoretical correlates, taking into consideration non‐modifiable correlates of physical activity.

Linking Evidence to Action

Clinicians should help pregnant women to increase self‐confidence in their ability to be physically active and provide anticipatory guidance to overcome barriers to physical activity.

Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice

Abstract

Background

Previous studies on bedside handovers have identified nurse‐related barriers and facilitators for implementing bedside handovers, but have neglected the existing ward’s nursing care system as an important influencing factor.

Aims

To determine the association between the existing nursing care system (i.e., decentralized, two‐tier, or centralized) on a ward and the barriers and facilitators of the bedside handover.

Methods

Structured individual interviews (N = 106) on 14 nursing wards in eight hospitals were performed before implementation of bedside handovers. The structured interview guide was based on a narrative review. Direct content analysis was used to determine the nursing care system of a ward and the degree to which barriers and facilitators were present. Pearson’s Chi‐square analysis was used to determine whether there were associations between the nursing care systems concerning the presence of barriers and facilitators for implementing bedside handovers.

Results

Twelve barriers and facilitators were identified, of which three are new to literature: the possible loss of opportunities for socializing, collegiality, and overview; head nurse’s role; and role of colleagues. The extent to which barriers and facilitators were present differed across nursing care systems, with the exception of breach of confidentiality (barrier), and an existing structured handover (facilitator). Overall, nurses working in decentralized nursing care systems report fewer barriers against and more facilitators in favor of using bedside handovers than nurses in two‐tier or centralized systems.

Linking Evidence to Action

Before implementing bedside handovers, the context of the nursing care system may be considered to determine the most effective process to implement change. Based on these study findings, implementing bedside handovers could be more challenging on wards with a two‐tier or centralized care system.

Evidence‐Based Practice Implementation in a Rural, Community Hospital

Worldviews on Evidence-Based Nursing, Volume 16, Issue 4, Page 327-328, August 2019.

Factors Influencing Undergraduate Students’ Intention to Use Evidence‐Based Practice After Graduation: Development and Validation of a Theory‐Based Prediction Model

Abstract

Background

Despite curriculum requirements for evidence‐based practice (EBP) to be a key component of undergraduate health students’ training, few studies have investigated factors influential to students’ intention to use EBP after graduation. Self‐efficacy is known to mediate and motivate behavior; therefore, it may be a crucial factor linking undergraduate students’ EBP education and adoption of positive EBP behaviors.

Aims

To develop, test, and validate a multivariate, theory‐based prediction model with the outcome of students’ intention to use EBP after graduation.

Methods

A correlational study with structural equation modeling was conducted. Model factors were determined from Bandura's self‐efficacy theory and previous literature. An online survey comprised of seven validated scales and a demographic tool was distributed to a sample of undergraduate nursing and paramedic students. Two episodes of data collection were conducted to test and validate the model.

Results

Evidence‐based practice beliefs directly and significantly influenced student intention to use EBP in both models. Sources of EBP self‐efficacy also had significant but indirect influence on the outcome variable. Overall variance for intention to use EBP was 25% for the initial model and 18% for the validated model.

Linking Evidence to Action

Evidence‐based practice curriculum that supports positive EBP beliefs and integrates Bandura's sources of self‐efficacy has potential to positively influence students’ intention to use EBP after graduation.

A Multisite Health System Survey to Assess Organizational Context to Support Evidence‐Based Practice

Abstract

Background

Implementation and sustainability of a culture of evidence‐based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts.

Aims

To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals.

Methods

A nonexperimental descriptive correlational design was used to conduct a web‐based survey of direct‐care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT).

Results

Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct‐care nurses had lower Culture than managers and lower Social Capital), and work status (full‐time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals).

Linking Evidence to Action

Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses’ contributions, balance nurses’ personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 16, Issue 3, Page 173-173, June 2019.

A Multicountry Study on Nursing Students’ Self‐Perceived Competence and Barriers to Evidence‐Based Practice

Abstract

Background

Nursing education and training are essential in the attainment of evidence‐based practice (EBP) competence in nursing students. Although there is a growing literature on EBP among nursing students, most of these studies are confined to a single cultural group. Thus, cross‐cultural studies may provide shared global perspectives and theoretical understandings for the advancement of knowledge in this critical area.

Aims

This study compared self‐perceived EBP competence among nursing students in four selected countries (India, Saudi Arabia, Nigeria, and Oman) as well as perceived barriers to EBP adoption.

Methods

A descriptive, cross‐sectional, and comparative survey of 1,383 nursing students from India, Saudi Arabia, Nigeria, and Oman participated in the study. The Evidence‐Based Practice Questionnaire (EBP‐COQ) and the BARRIERS scale were used to collect data during the months of January 2016 to August 2017.

Results

Cross‐country comparisons revealed significant differences in EBP competence (= 24.437, < .001), knowledge (= 3.621, = .013), skills (= 9.527, < .001), and attitudes (= 74.412, < .001) among nursing students. Three variables including nursing students’ gender (β = .301, < .001), type of institution, (β = −0.339, = .001), and type of nursing student (β = .321, < .001) were associated with EBP competence. Barriers to EBP adoption included having no authority to change patient care policies (= 1.65, SD = 1.05), slow publication of evidence (= 1.59, SD = 1.01), and paucity of time in the clinical area to implement the evidence (= 1.59, SD = 1.05).

Linking Evidence to Action

Both academe and hospital administration can play a pivotal role in the successful acquisition of EBP competence in nursing students.

Comparing the Effects of Single‐ and Multiple‐Component Therapies for Insomnia on Sleep Outcomes

Abstract

Background

Single‐ and multiple‐component therapies are recommended in professional guidelines for managing chronic insomnia. Systematic reviews point to insufficient evidence of the comparative effectiveness of these therapies, which is required for treatment decision making.

Purpose

To compare the effectiveness of three single‐component and one multiple‐component therapies on short‐term sleep outcomes.

Methods

The data were obtained from 517 persons with chronic insomnia, enrolled in a partially randomized preference trial. They were allocated to the single‐component therapies: sleep education and hygiene (SEH), stimulus control therapy (SCT), and sleep restriction therapy (SRT), or the multiple‐component therapy (MCT). The outcomes, perceived insomnia severity and sleep parameters, were assessed with established measures at pre and posttest. Repeated measure analysis of variance was used to compare the outcomes across therapy groups over time. The clinical relevance of the therapies’ effects was evaluated by examining the effect size and remission rate.

Results

The four therapies differed in their effectiveness in reducing perceived insomnia severity and improving sleep outcomes. SEH was least effective. SCT, SRT, and MCT were moderately effective. SCT and SRT demonstrated slightly higher remission rates than MCT for perceived insomnia severity and some sleep parameters.

Linking Evidence to Action

SCT and SRT are viable single‐component therapies that produce clinical benefits. Single‐component insomnia treatment may be more convenient to implement in the primary care setting due to the reduced number of treatment recommendations compared to MCT.

Improving Provider Readiness for Intimate Partner Violence Screening

Abstract

Background

Intimate partner violence (IPV) is a significant public health issue. Healthcare providers (e.g., nurses, advanced practice nurses, physicians, social workers) have a unique opportunity to prevent and reduce IPV through screening and referral. The objective of this project was to determine the impact of education and a brief screening tool integrated into the electronic medical record (EMR) on readiness to screen for IPV.

Methods

An intervention was implemented that included the EMR integration of a screening tool, creation of an automated resource telephone system and healthcare provider IPV screening and response education. Readiness for screening was evaluated pre‐ and postintervention using the Domestic Violence Health Care Provider Survey Scale (DVHCPSS), which is scored cumulatively and by each of six domains. An unpaired Student's t test was performed.

Results

Mean age (31–40 years of age) and years of clinical practice (11–15 years) was the same for pre‐ (= 96) and postintervention (= 83) survey respondents. There was an overall significant increase in screening readiness (= .003) with significant improvement in “professional role resistance/fear of offending the patient” (< .0001), “blame victim items” (= .0029), “perceived self‐efficacy” (= .0064), and “victim/provider safety” (= .003).

Linking Evidence to Action

Adopting and integrating a validated IPV screening tool into the EMR combined with education was associated with an improvement in overall readiness for IPV screening. Reducing and preventing IPV through universal screening and referral can be accomplished by embedding a standardized readily accessible validated IPV screening tool in the EMR.

Relationship of Depression Scores and Ranges in Women Who Suffer From Fibromyalgia by Age Distribution: A Case‐Control Study

Abstract

Background

Fibromyalgia may be defined as a chronic widespread pain condition that generates a functional impairment with various symptoms, such as depression.

Purpose

The main aim of this research was to compare the Beck Depression Inventory (BDI) scores and depression ranges in women who suffered from fibromyalgia with respect to healthy controls, overall and by age distributions.

Methods

A case–control observational study was performed. Two hundred women with a mean age of 58.61 ± 15.65 years old were recruited. The women were divided into case (women with fibromyalgia) and control (healthy women) groups. The BDI scores and depression ranges were collected.

Results

The depression ranges and BDI scores mean ± SD showed statistically significant differences (< .001) between participants with fibromyalgia (19.30 ± 11.21 points; moderate depression) and healthy controls (6.37 ± 5.35 points; no depression). Regarding the age distributions, statistically significant differences were shown between fibromyalgia and control groups for adults (< .001; 19.06 ± 6.55 vs. 4.69 ± 4.48 points) and older adults (= .001; 20.25 ± 13.79 vs. 7.63 ± 5.47 points), respectively. ANOVA of the BDI scores with two factors and interaction (fibromyalgia presence and age distribution) determined no interaction between the two factors (= .534) and statistically significant differences of BDI scores for fibromyalgia presence (< .001; R 2 = 35.50%), but not for age distribution (= .144).

Linking Evidence to Action

Measurable differences in higher BDI scores and depression ranges were shown in women who suffered from fibromyalgia with respect to healthy controls, regardless of age distribution. Greater probabilities (odds ratio = 15.88) of suffering from some level of depression (according to BDI scores) were found in women with fibromyalgia in comparison with healthy women. Although these findings did not seem to be influenced by age distribution, interventions targeting depression in practice, research, policy, management, or education must equally include adult and older adult women who suffer from fibromyalgia.

Ten Lessons Learned on the Road to Earning a Doctor of Nursing Practice Degree

Worldviews on Evidence-Based Nursing, Volume 16, Issue 3, Page 247-248, June 2019.
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