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AnteayerWorldviews on Evidence-Based Nursing

Interventions to Support Adolescents With Cancer in Decision‐Making: A Systematic Review and Meta‐Analysis

Abstract

Background

Adolescents have autonomous views and participatory rights. There is increasing support for involving adolescents with cancer in the healthcare decision-making process.

Aims

The purpose of this study was to synthesize current knowledge to identify major components and outcomes of interventions to enhance shared decision-making (SDM) by adolescents with cancer during and after treatment.

Methods

Six electronic databases (PubMed, CINHAL, MEDLINE, Cochrane, EBSCO, and Web of Science) were searched from their inceptions to February 2020. Eligibility criteria were intervention studies, studies of interventions to support adolescents with cancer involved in SDM, and studies of patients diagnosed with cancer between 10 and 18 years of age. Data extraction and quality appraisal were conducted by using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias Tool.

Results

Of 331 citations, five studies with a total of 648 participants aged between 13 and 21 years met inclusion criteria. Interventions included structured sessions held one to three times per week. SDM engagement strategies incorporated weekly assignments, live action videos, brochures, Five Wishes© advance directives, and follow-up counseling. Treatment preference congruence in adolescent and parent dyads was higher in intervention groups. Meta-analysis was performed on two studies and demonstrated statistically significant improvements in decision quality at 6 months (z = 3.37, p = .001; 95% CI = .174–.657) and 12 months (z = 3.17, p = .002; 95% CI = .150–.633) after SDM interventions in adolescent cancer survivors. No adverse events among patients were found, although anxiety scores increased in families in an intervention group.

Linking Evidence to Action

This review identified essential components of SDM interventions. Our findings may guide the future design of interventions to support high-quality decision-making by adolescents with cancer. Coaching can educate adolescent cancer survivors on quality decision-making methods and can improve the quality of consequent decisions. More research is needed to determine outcomes of SDM interventions.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale

Abstract

Background

Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden.

Aim

The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions.

Methods

This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser–Meyer–Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach’s α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale.

Results

Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42–.072) for the correlations between the shortened and longer scales.

Linking Evidence to Action

The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Admission Braden Scale Score as an Early Independent Predictor of In‐Hospital Mortality Among Inpatients With COVID‐19: A Retrospective Cohort Study

Abstract

Background

The COVID-19 pandemic has put a strain on health systems. Predictors of adverse outcomes need to be investigated to properly manage COVID-19 patients. The Braden Scale (BS), commonly used for the assessment of pressure ulcer risk, has recently been proposed to identify frailty.

Objective

To investigate the predictive utility of the BS for prediction of in-hospital mortality in a cohort of COVID-19 patients admitted to non-ICU wards.

Methods

We conducted a retrospective single-center cohort study evaluating all patients with SARS-CoV-2 infection consecutively admitted over a 2-month period (from March 6 to May 7, 2020) to the COVID-19 general wards of our institution. Demographic, clinical, and nursing assessment data, including admission BS, were extracted from electronic medical records. Univariable and multivariable logistic regression models were used to explore the association between the BS score and in-hospital death.

Results

Braden Scale was assessed in 146 patients (mean age 74.7 years; 52% males). On admission, 46 had a BS ≤ 15, and 100 patients had a BS > 15. Mortality among patients with BS ≤ 15 was significantly higher than in patients with BS > 15 (45.7% vs. 16%; p < .001). On multivariable regression analysis, adjusting for potentials confounders (age, Barthel scale, chronic kidney disease, atrial fibrillation, and hypertension), the admission BS remained inversely associated with the risk of in-hospital mortality (OR = 0.76; 95% CI [0.60, 0.96]; p = .020).

Linking Evidence to Action

Admission BS could be used as a simple bedside predictive tool able to early identify non-ICU COVID-19 patients with poor prognosis who might benefit from specific and timely interventions.

Function of a Psychological Nursing Intervention on Depression, Anxiety, and Quality of Life in Older Adult Patients With Osteoporotic Fracture

Abstract

Background

Osteoporotic fracture is a serious complication of osteoporosis. The long-term therapy process and the heavy restriction to physical activities give rise to a psychological burden on osteoporotic fracture patients, especially older adult patients. Psychological nursing interventions significantly alleviate negative emotional reactions in cancer patients. This research aimed to investigate the function of psychological nursing interventions in the reduction of depression and anxiety and the improvement of quality of life in older adult patients with osteoporotic fracture.

Methods

Osteoporotic fracture patients (n = 106) were divided into control group (n = 53) or intervention group (n = 53). In the control group, the participants were given conventional nursing care. In the intervention group, the participants were given psychological nursing interventions. Anxiety, depression, and quality of life were evaluated and compared between the two groups.

Results

After 5 weeks of psychological nursing intervention, the anxiety and depression scores significantly decreased in the intervention group. The Mental Function in Quality of Life Questionnaire of the European Foundation for Osteoporosis score also decreased in the intervention group.

Linking Evidence to Action

Psychological nursing interventions alleviate anxiety and depression in older adult osteoporotic fracture patients and enhance their mental function.

Evidence‐Based Competency Training Program for Blood Product Administration

ABSTRACT

Background

Health care in deployed military environments requires robust clinical nursing skills to care for patients with traumatic injuries. Blood product administration is a critical skill in which nurses should be competent. However, in non-deployed environments, blood transfusions are performed less frequently, resulting in skill competency loss.

Aims

Our clinical inquiry focused on maintaining competency for infrequently performed nursing skills, specifically blood product administration.

Methods

A literature review and critical appraisal were executed, followed by an evidence-based practice change. A knowledge test, objective and subjective assessment, and training satisfaction evaluation were performed to measure the practice change outcomes. Both inpatient and outpatient nurses were included.

Results

Sixteen articles were identified and appraised. The evidence recommended a blended education approach, that is, lecture plus hands-on practice. Thus, a classroom lecture and simulation scenario were put into practice with an existing computer-based training for blood administration. The nurses met knowledge test standards (≥ 90%) before and after implementation, while skill performance improved by 13% and improved self-competence scores by 7%. Nurses in outpatient settings improved performance scores by 18.4% compared to inpatient nurses, whose scores improved by 9.4%. The simulation scenario completion time decreased by 8.3 minutes post-implementation, and the training program earned a 90% satisfactory rating.

Linking Evidence to Action

A blended education program improves clinical skill performance and enhances confidence in performing critical interventions. Blended education provides a safe learning environment for nurses to be prepared for the management of low-volume patient care emergencies.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 18, Issue 3, Page 155-157, June 2021.

Adverse Health Effects of Frailty: Systematic Review and Meta‐Analysis of Middle‐Aged and Older Adults With Implications for Evidence‐Based Practice

Abstract

Background

Scholars have noted that frailty easily leads to functional deterioration and proneness to complications. Little literature addresses the stages of frailty in middle-aged and older adults and the effects of frailty on overall health.

Aims

This study explores the effect of different stages of frailty on the prospective health (falls, bone fractures, disability, dementia, hospitalization, and death) of middle-aged and older adults. In addition, different frailty indicators were compared to determine their usefulness in predicting future adverse health outcomes.

Methods

The authors of this study separately reviewed and extracted data from the literature obtained while searching the following keywords: “frailty” OR “frail” and “fall” OR “disability” OR “fracture” OR “hospitalization” OR “mortality” OR “cognitive function” “dementia” OR “Alzheimer’s disease” and “middle-aged people” OR “older people” OR “elderly” OR “geriatric” OR “senior.” The literature search was performed from January 2001 to November 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Specifically, we performed a systematic literature search in multiple databases—Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library—and analyzed all obtained literature results using a random-effects model.

Results

We collected a total of 29 prospective studies for the systematic literature review and meta-analysis. The main results indicated that the frail groups had significantly higher risks of adverse health effects (falls, bone fractures, disability, dementia, hospitalization, and death) than the robust or prefrail groups.

Linking Evidence to Action

Frailty is a crucial healthcare topic among geriatric syndromes. Considering that older adults with frailty are most likely to develop severe adverse health outcomes, professional nursing personnel should assess frailty among middle-aged and older adults and offer relevant care strategies to reduce the adverse effects of frailty in this population.

Nurse Practitioners’ Implementation of Evidence‐Based Practice Into Routine Care: A Scoping Review

Abstract

Background

Implementation of evidence-based practice (EBP) is essential for ensuring high-quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care.

Aim

To explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care.

Methods

A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed.

Results

Seven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs’ implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician-driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators.

Linking Evidence to Action

An exploration of NPs’ experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

Core Evidence‐Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements

Abstract

Background

Consensus on evidence-based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context.

Aims

To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries.

Methods

A multi-phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two-round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated.

Results

In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two-round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others.

Linking Evidence to Action

The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students’ and nurses’ perception of competencies required for EBP processes.

Effectiveness of Internet and Phone‐Based Interventions on Diabetes Management of Children and Adolescents With Type 1 Diabetes: A Systematic Review

Abstract

Aims

To synthesize evidence about the impact of Internet and phone-based diabetes education and management on metabolic control, self-management behavior changes, and psychological effects among children and adolescents with type 1 diabetes mellitus (T1DM).

Background

Internet and mobile technologies were commonly used to improve diabetes management among children and adolescents with type 1 diabetes mellitus. The effectiveness of new technology-based diabetes education and management has previously not been synthesized.

Methods

PubMed, EBSCO, Cochrane Library, Web of Science, Joanna Briggs Institute Library, and the Chinese databases CNKI and Wanfang were searched from 1989 to March 2020. Two reviewers independently selected randomized controlled trials (RCTs), in English and Chinese, which compared an intervention group of new technology-based diabetes education and management with a control group of usual care. The primary outcomes were metabolic control, such as glycated hemoglobin (HbA1c), and secondary outcomes consisted of behavior changes and psychological effects, such as self-efficacy and quality of life.

Results

A total of 23 RCTs with 1,824 participants met the inclusion criteria. The meta-analysis showed that phone calls could significantly reduce HbA1c (MD = −.17; 95% CI [−.33, −.01]; I 2 = 0%) in children and adolescents with T1DM. New technology-based diabetes education and management could significantly improve self-efficacy (SMD = 0.37; 95% CI [.07, .67]; I 2 = 0%). No benefits on behavior changes and quality of life were identified.

Linking Evidence to Action

New technology-based diabetes education has potential benefits for children and adolescents with T1DM, such as improving metabolic control through phone calls and increasing their self-efficacy of diabetes management. Well-designed RCTs with larger sample sizes and longer intervention duration should be conducted, especially in developing countries.

Using the Theoretical Domains Framework to Identify Barriers and Facilitators to Elder‐Friendly Care Implementation Within a Multi‐Site Academic Health Centre

Abstract

Background

Societal demographic shifts are occurring globally. Within Quebec, Canada, the percentage of adults over 65 (older adults) is predicted to increase from 19.3% to >25.9% by the year 2036. Older adults (OAs) experience hospitalizations more frequently than persons aged 15–64 years old, and hospitalizations for OAs can be detrimental due to naturally occurring physiological changes. To address the needs of this population, the Quebec government mandated that all acute care hospitals implement OA-friendly care standards called AAPA (“l’Approche Adaptée à la Personne Âgée”).

Aims

To describe an approach for identifying barriers and facilitators (BFs) to AAPA implementation at the McGill University Health Centre, an academic healthcare centre in Montreal that provides tertiary and quaternary care.

Methods

Our approach included an organizational quality improvement (QI) model based on the Institute for Healthcare Improvement QI approach and the use of the Theoretical Domains Framework (TDF) to guide the assessment of BFs to AAPA implementation. To identify the BFs of AAPA implementation, themes were generated from the raw data.

Results

In total, 32 barriers and 88 facilitators were identified. Each BF was linked to one or more corresponding domain from the TDF. Seven of the most frequently occurring domains were: (1) knowledge, (2) beliefs about consequences, (3) social/professional role and identity, (4) social influences, (5) environmental context and resources, (6) intentions, and (7) goals.

Linking Evidence to Action

A theory-informed approach, such as the TDF, can be used to facilitate the implementation of evidence-based guidelines.

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X‐ray Confirmation

Abstract

Background

Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death.

Aims

To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU.

Methods

The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits).

Results

Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, “OK to use” order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site.

Linking Action to Evidence

Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes

Abstract

Background

Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care.

Aims

We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient’s preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP.

Methods

A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach.

Results

The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes.

Linking Evidence to Action

Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

Mapping Clinical Barriers and Evidence‐Based Implementation Strategies in Low‐to‐Middle Income Countries (LMICs)

Abstract

Background

Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice.

Aim

To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies.

Methods

A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy.

Results

A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers.

Linking Evidence to Action

Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.

Pre‐Implementation of the Age‐Friendly Health Systems Evidence‐Based 4Ms Framework in a Multi‐State Convenient Care Practice

Abstract

Background

Quality issues in the delivery of healthcare services to older adults and changes in societal demographics call for a social movement to improve the care of older adults in a variety of healthcare settings, including ambulatory care and convenient care clinics.

Aims

To describe the pre-implementation phase to integrate the Age-Friendly Health Systems (AFHS) 4Ms (i.e., What Matters, Medication, Mentation, and Mobility) Framework in 1,100 MinuteClinics (the retail medical clinic of CVS Health) using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (an evaluation implementation framework).

Methods

The CFIR and RE-AIM models guided data collection. Data were collected from all stakeholders (patients, healthcare providers, managers, educators, informatics staff, communications staff, and implementation consultants) via observations, surveys, interviews, focus groups, organizational readiness assessment, stakeholder assessment, and workflow mapping during a 15-month period to identify potential barriers, facilitators, and other opportunities for implementation.

Results

The CFIR and RE-AIM implementation frameworks provided a comprehensive approach to guide the pre-implementation phase of the AFHS 4Ms Framework at the MinuteClinic. The baseline assessments guided by the CFIR revealed important insights in the choice of implementation strategies that were developed and tested in the pre-implementation phase, and the RE-AIM guided meaningful components to the development of the logic model.

Linking Action to Evidence

As more healthcare systems integrate the AFHS 4Ms Framework, the approach reported in this quality improvement project can be used in other settings to facilitate a comprehensive implementation.

Issue Information

Worldviews on Evidence-Based Nursing, Volume 18, Issue 2, Page 71-73, April 2021.
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