The Colorado Patient-Centered Interprofessional Evidence-Based Practice Model: A Framework for Transformation

Spiritual practices and effects of spiritual well-being and depression on elders' self-perceived health

As the population is quickly ageing, strategies for helping elders to maintain and promote good health and well-being are urgently needed. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Delivering culturally competent care is necessary for taking care of elders. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Spiritual well-being has been found particularly important for older adults' overall health. This descriptive, correlational and predictive study used data that was collected from a convenience sample (N = 150) to examine the effects of spiritual well-being on the relationship between depression and self-perceived health, and to describe spiritual practices commonly used by Taiwanese elders. Findings from this study revealed that spiritual well-being was positively correlated with self-perceived health, negatively associated with depression, and significantly mediated the relationship between depression and self-perceived health. Relaxation and exercise were the most commonly used spiritual practices by Taiwanese elders. Findings from this study support the important role of spiritual well-being in elders' health and add to the body of knowledge about the spiritual practices used by Taiwanese elders. Nurses and health care providers should deliver culturally appropriate spiritual care to enhance spiritual well-being for elders to maintain good health for diverse elder population.

MODELOS PARA A IMPLEMENTAÇÃO DA PRÁTICA BASEADA EM EVIDÊNCIAS NA ENFERMAGEM HOSPITALAR: REVISÃO NARRATIVA

RESUMO Objetivo: identificar modelos para implementação da prática baseada em evidências na Enfermagem hospitalar. Método: Revisão narrativa da literatura. Após a identificação dos modelos, realizou-se uma busca de referências específicas sobre o tópico de interesse e procedeu-se a leitura dos artigos publicados. Resultados: são apresentados 16 modelos para a utilização de pesquisas na prática de enfermeiros hospitalares, publicadas no período de 1970 a 2015. Foram descritas as etapas para a implementação dos modelos, com ênfase nos tipos de evidências e abordagens para utilização das pesquisas. Conclusão: na análise dos pressupostos dos modelos descritos, pode-se inferir que a utilização de pesquisas na prática de enfermeiros hospitalares requer conhecimento e competências para além dos usuais no exercício cotidiano do trabalho. Desta maneira, o desafio para o cenário nacional perfaz o desenvolvimento de modelos próprios, específicos para a realidade vivenciada ou, ainda, a elaboração de iniciativas que retratem a implementação e/ou adaptação dos modelos propostos em âmbito internacional.

Nurse Practitioner Fracture Liaison Role: A Concept Analysis

BACKGROUND

With the worldwide growing aging population, the high prevalence of osteoporosis-related fractures is associated with high morbidity and mortality. Healthcare costs for treating fractures and subsequent complications will increase to $25 billion by 2025.

PURPOSE

This article articulates a comprehensive concept analysis of the nurse practitioner fracture liaison (NPFL) role to provide new insights into the role of nurse practitioner in osteoporosis care coordination.

METHODS

Walker and Avant's concept analysis framework was used to identify the attributes, antecedents, consequences, and empirical referents of the NPFL role. Model cases illustrated real-life examples of the NPFL role.

CONCLUSION

The impact of NPFL role is rather novel in promoting healthy bone living at local, national, and international communities. Linking the refined outcome of the concept analysis of the NPFL role to osteoporosis care helps close osteoporosis care gaps, improve healthcare outcomes, and alleviate financial burden by reducing secondary fracture and complications.

Continuing to challenge practice to be evidence based

Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.

Implications of holding ideas of evidence-based practice in nursing

The author of this paper examines emerging implications of holding ideas about evidence and evidence-based practice. Evidence has a very specific role in the delivery of safe clinical care, but it is creating a serious problematic for the practice of nursing. It is proposed that: evidence-based practice be re-situated or reconstructed as a collective and organizational responsibility and not the responsibility of individual nurses in practice; nurses re-focus on articulating a more ethical foundation for praxis, one that emerges from nursing philosophy and one that is co-constituted with persons/families/groups; and nurse leaders and educators establish teaching-learning and practice environments that enable a peer-to-peer process of critical review and curious inquiry of available evidence in the contexts of shared work.

Nurse-driven quality improvement interventions to reduce hospital-acquired infection in the NICU

Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units. Central line-associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) are costly, preventable infections targeted for eradication by the Centers for Disease Control and Prevention. After evaluation of current practice and areas for improvement, neonatal-specific CLABSI and VAP bundles were developed and implemented on the basis of available best evidence. The overall goal was to reduce infection rates at or below benchmarks set by National Healthcare Safety Network. All neonates with central lines (umbilical or percutaneous) and/or patients who were endotracheally intubated were included. All patients were risk stratified on the basis of weight per National Healthcare Safety Network reporting requirements: less than 750 g, 751-1000 g, 1001-1500 g, 1501-2500 g, and greater than 2500 g. The research was conducted as a quality improvement study. Neonatal-specific educational modules were developed by neonatal nurse leaders for CLABSI and VAP. Bundle development entailed combining select interventions, mainly from the adult literature, that the nurse leaders believed would reduce infection rates. Nursing practice guidelines and supply carts were updated to ensure understanding, compliance, and convenience. A CLABSI checklist was initiated and used at the time of line insertion by the nurse to ensure standardized infection control practices. Compliance audits were performed by nurse leaders weekly on intubated patients to validate VAP bundle implementation. CLABSI and VAP bundle compliance was audited and infection rates were measured before and after both bundle implementations following strict National Healthcare Safety Network inclusion criteria for CLABSI and VAP determination. The reduction in CLABSI elicited 84 fewer hospital days, estimated cost savings of $348,000, a 92% reduction in CLABSI (preintervention to postintervention), and a reduction in central line days by 27%. The reduction in VAP resulted in 72 fewer hospital days, estimated cost savings of $300,000, 71% reduction in VAP (preintervention to postintervention), and a reduction in vent days by 31%. Nurses are central in hospital efforts to improve quality care. The bundled interventions provided the nurses with a structure to successfully implement a systematic process for improvement. Nursing leaders ensured that bundles were implemented strategically and provided consistent and specific feedback on intervention compliance with quarterly CLABSI and VAP rates. Real-time feedback assisted the registered nurses, neonatal nurse practitioners, and physicians appreciation of the effectiveness of the change in practice. Finally, empowering the bedside nurse to lead the bundle implementation increased personal ownership and compliance and ultimately improved practice and patient outcomes.