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AnteayerWorldviews on Evidence-Based Nursing

Testing of the Nursing Evidence‐Based Practice Survey

Abstract

Background

Clinicians’ knowledge and skills for evidence‐based practice (EBP) and organizational climate are important for science‐based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses’ (RN) self‐reported EBP.

Aims

Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey.

Methods

The study employed a descriptive cross‐sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert‐type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons.

Results

One thousand one hundred and eighty‐one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings.

Linking Evidence to Action

Nurses’ knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence‐based outcomes and tailors future EBP initiatives.

The Impact of the Electronic Health Record on Moving New Evidence‐Based Nursing Practices Forward

Abstract

Background

Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence‐based practice (EBP) initiatives into the electronic health record (EHR).

Purpose

The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence‐based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation.

Methods

A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes.

Results

Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays.

Linking Evidence to Action

Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.

Corrigendum

Worldviews on Evidence-Based Nursing, EarlyView.

Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial

Abstract

Background

Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown.

Aims

To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke.

Methods

A randomized controlled trial was conducted. Patients with acute ischemic stroke (N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects.

Results

A total of 143 participants (94%) completed the study, and 145 were included in the intention‐to‐treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group–time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = −2.31, p = .011; ß = −1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG.

Linking Evidence to Action

A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.

Teaching Core EBP Skills to Postgraduate Nursing Students

Worldviews on Evidence-Based Nursing, EarlyView.

Erratum

Worldviews on Evidence-Based Nursing, EarlyView.

Leisure‐Time Physical Activity and Depressive Symptoms Among Patients With Coronary Heart Disease: The Mediating Role of Physical Activity Self‐Efficacy

Abstract

Background

Despite the positive effect of physical activity on reducing depressive symptoms among patients with coronary heart disease (CHD), the effect of physical activity on depressive symptoms is poorly understood.

Aims

To examine the mediating role of physical activity self‐efficacy in the relationship between leisure‐time physical activity and depressive symptoms in CHD patients.

Methods

This was a secondary data analysis study. A total of 593 CHD patients were included. Data on leisure‐time physical activity, physical activity self‐efficacy, and depressive symptoms were collected by validated questionnaires. Sociodemographic and clinical data were collected via patient interviews and medical records reviewing. The approach of Baron and Kenny was adopted to examine the mediating effect of physical activity self‐efficacy on the association between leisure‐time physical activity and depressive symptoms.

Results

On average, participants aged 56.9 (± 12.5) years old, with 66% male. Statistical analyses showed that leisure‐time physical activity was significantly associated with depressive symptoms (β = −0.041, p = .040) and physical activity self‐efficacy (β = 0.197, p = .001), and physical activity self‐efficacy was significantly associated with depressive symptoms (β = −0.223, p = .001) after adjusting for leisure‐time physical activity. The indirect effect of leisure‐time physical activity on depressive symptoms through physical activity self‐efficacy was also significant (β = −0.044, 95% confidence interval: −0.064, −0.027), suggesting a mediating role of physical activity self‐efficacy on the relationship between leisure‐time physical activity and depressive symptoms.

Linking Evidence to Action

Leisure‐time physical activity is associated with reduced depressive symptoms among CHD patients, and this association is mediated by physical activity self‐efficacy. This mediating model has important clinical implications, where integrating physical activity that is enjoyable and pleasant, and self‐efficacy building elements in physical activity regimens should be considered, so as to improve psychological outcomes among CHD patients.

Integrative Review of Dietary Choice Revealed by fMRI: Considerations for Obesity Prevention and Weight‐Loss Education

Abstract

Background

Emerging findings from neuroimaging studies investigating brain activity associated with dietary behavior are illuminating the interaction of biological and behavioral mechanisms that have implications for obesity prevention. Globally, A total of 1.9 billion adults are overweight, and 650 million are obese. Obesity and being overweight are major risk factors for chronic illness and death. Behaviorally based health interventions have had limited success in curbing the obesity epidemic. Greater understanding of brain responses to food cues will contribute to new knowledge and shape public health efforts in obesity prevention. However, an integration of this knowledge for obesity prevention education has not been published.

Aims

This study links evidence generated from brain activation studies generated in response to diet and food images and highlights educational recommendations for nurses engaged in obesity prevention and weight‐loss education.

Methods

An integrative review of the literature was conducted using the MeSH keywords “magnetic resonance imaging,” “diet,” and “food images” in PubMed, MEDLINE Complete, CINAHL, and Cochrane databases from their first appearance in 2006 through March 2018. Studies published in English and using functional magnetic resonance imaging to measure brain response to diet, and food images were initially identified. Animal models, those whose primary focus was a specific disease, and intervention studies were excluded.

Results

Of 159 studies identified, 26 met inclusion criteria. Findings from neuroimaging studies may help explain the relationship between brain mechanisms and behavioral aspects of dietary choice and inform patient education in obesity prevention. Awareness of this evidence is applicable to nursing education efforts. This review contributes several recommendations that should be considered by nurses providing individualized weight‐loss education.

Linking Evidence to Action

Nurses engaged in patient education for obesity prevention should consider personalized interventions that cultivate internal awareness for dietary adherence, self‐care, exercise, hydration, and mood state; avoid using caloric deprivation approaches, such as skipping breakfast, for weight‐loss interventions; and note the importance of individualized obesity prevention and weight‐loss education.

Authentic Connections Groups: A Pilot Test of an Intervention Aimed at Enhancing Resilience Among Nurse Leader Mothers

Abstract

Background

Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at‐risk moms, including physicians; however, it has not previously been tested with nurse leaders.

Aims

Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self‐compassion and decreased distress, depression, perceived stress, and burnout.

Methods

A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders at Mayo Clinic. AC participants attended group sessions for an hour per week for 12 weeks. Control group members were provided 1 hr per week of free time over 12 weeks. Multiple self‐report psychological measures were completed at baseline, post‐intervention, and 3‐month follow‐up.

Results

The AC Groups intervention was feasible and well‐received by nurse leaders. Session attendance rates averaged 92%. Despite the small n’s, repeated measures of Analysis of Variance showed significantly greater improvements (p < .05) for participants in the AC Groups than control condition for depression, self‐compassion, and perceived stress, with large effect sizes ( 0.18–0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( 0.05 and .07).

Linking Evidence to Action

The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers’ stress by positively impacting indices of well‐being, including depression, self‐compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow‐up periods, and biomarker measures of stress.

A Longitudinal Analysis of Nurse Suicide in the United States (2005–2016) With Recommendations for Action

Abstract

Background

Previous studies have demonstrated nurses are at risk of suicide. This is the first national longitudinal study of U.S. nurse suicide.

Aims

To identify the longitudinal incidence, method, and risks of nurse suicide in the United States.

Methods

2005 to 2016 Centers for Disease Control and Prevention National Violent Death Reporting System retrospective analysis of suicide incident rate ratios (IRR).

Results

A total of 1,824 nurse and 152,495 non‐nurse suicides were evaluated. Nurses were at greater risk of suicide than the general population (female IRR 1.395, 95% confidence intervals [CI] 1.323, 1.470, p < .001; male IRR 1.205, 95% CI 1.083, 1.338, p < .001). Female nurses who completed suicide did so most frequently by pharmacologic poisoning (n = 399, 27.2% vs. n = 8,843, 26.9%), whereby male nurses and the general public used firearms (n = 148, 41.7% vs. n = 57,887, 48.4%). Job problems were more likely in nurses (female odds ratio [OR] 1.989, 95% CI 1.695, 2.325, p < .001; male OR 1.814, 95% CI 1.380, 2.359, p < .001), as well as mental health history (female OR 1.126, 95% CI 1.013, 1.253, p < .027; male OR 1.302, 95% CI 1.048, 1.614, p = .016) and leaving a suicide note (female OR 1.221, 95% CI 1.096, 1.360, p < .001; male OR 1.756 [1.412, 2.181], p < .001).

Linking Evidence to Action

The increased risk of suicide in nurses is congruent with previous reports. The consistency in results increases confidence that findings are generalizable and warrant action. The use of pharmacologic poisoning as a method of suicide, most often by opioids and benzodiazepines, indicates a need for improved identification and treatment of nurses with substance use. Workplace wellness programs need to focus on reducing workplace stressors. Further research is indicated to determine best prevention methods. Policy indications include the need to accurately track gender in nursing, enhance substance use disorder programs, and mandate suicide prevention activities.

Sustainability and Outcomes of a Suicide Prevention Program for Nurses

Abstract

Background

We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse‐centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at‐risk nurses.

Aim

The purpose of this paper is to report the 3‐year sustainability and outcomes of this nurse suicide prevention program.

Methods

Descriptive statistics are provided of program outcomes over the course of 3 years.

Results

Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy‐six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment.

Linking Evidence to Action

The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well‐received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.

The Effects of an Intensive Evidence‐Based Practice Educational and Skills Building Program on EBP Competency and Attributes

Abstract

Background and Significance

Evidence‐based practice (EBP) is a systematic problem‐solving approach to the delivery of health care that improves quality and population health outcomes as well as reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5‐day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time.

Purpose and Aims

The purpose of this study was to evaluate the effects of the 5‐day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time.

Method and Design

A longitudinal pre‐experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5‐day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture.

Results

Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5‐day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP.

Linking Evidence to Action

The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5‐day EBP immersion, regardless of clinicians’ prior educational preparation.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 17, Issue 1, Page 1-1, February 2020.

Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First‐Year Graduate Health Sciences Students

Abstract

Background

Graduate and professional students are reported to have higher than average rates of depression compared to age‐ and gender‐matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety.

Aims

The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first‐year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety.

Methods

A descriptive correlational study design was used with baseline data collected from first‐year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine.

Results

Seventeen percent of incoming students reported moderate‐to‐severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate‐to‐severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control.

Linking Evidence to Action

These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence‐based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well‐being and emphasizing self‐care throughout academic programs also are essential for students to engage in healthy lifestyles.

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