Assessing Evidence-Based Practice Knowledge: An Innovative Approach by a Nursing Research Council

OBJECTIVE

The aim of this study was to describe the structure and processes implemented by nursing research councils to conduct a nurse-led research study at an urban community teaching hospital.

BACKGROUND

We assessed nurses' knowledge, skills, and attitudes toward evidence-based practice (EBP) to inform development plans.

METHODS

This is an institutional review board-approved single-site cross-sectional anonymous online survey (Evidence-Based Practice Questionnaire [EBPQ]) emailed to 850 participants. Data were analyzed using SPSS v25 (Armonk, New York).

RESULTS

Initial response rate was 11%. Deployment of new strategies achieved an overall response rate of 57.5%. EBPQ subscale scores were highest for "attitude," followed by "knowledge/skills," and "practice." Lowest-scoring items included critical appraisal of literature, converting information needs into a question, time for new evidence, information technology, and research skills.

CONCLUSIONS

Our EBPQ scores were consistent with prior findings. Our strategies provide a framework for other institutions in similar stages of implementing EBP and nurse-led research initiatives.

Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries— To Be or Not To Be?

BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries- To Be or Not To Be?

BACKGROUND

Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered.

PURPOSE

The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is.

METHODS

Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article.

RESULTS

Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described.

CONCLUSION

A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

A Descriptive Study to Explore the Effect of Peristomal Skin Complications on Quality of Life of Adults With a Permanent Ostomy

Approximately 1 million people are living with an ostomy, and 100 000 to 130 000 new ostomies are created each year. The exact incidence and prevalence of complications are unknown but have been reported to be as high as 70% and to affect quality of life (QoL). Using convenience sampling methods, a descriptive study was conducted to explore QoL scores and peristomal complications reported by adults with a permanent ostomy attending the 2009 United Ostomy Associations of America conference. Attendees who had a permanent ileostomy, colostomy, or urostomy; were at least 18 years of age; and able to read and speak English were invited to participate. Participants completed a paper/pen survey containing questions about demographics (age, gender, marital status), ostomy (time since and reason for surgery, ostomy type), and peristomal complication variables (number and type, who provided help, and satisfaction with treatment rated on a Likert-type scale from 0 [not satisfied] to 100 [completely satisfied]). QoL data were collected using the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ), which consists of 2 sections - Lifestyle Impact and Quality of Life Impact - and measures 4 QoL domains on a scale of 1 (lower) to 10 (higher) QoL. Descriptive statistics (means, standard deviation, frequencies, percentages) were used to describe the demographic, ostomy, and peristomal complication variables. Univariate analyses of covariance were used to investigate the relationships among QoL scores and peristomal complications, and the number of different complications was correlated with the QoL total score using hierarchical multiple regression analysis. Of the 230 eligible participants invited, 140 (the majority women [83, 59.3%], with an ileostomy [86, 61.4%], and a diagnosis of ulcerative colitis [55, 39.3%]) met inclusion criteria and completed the survey. The majority of participants were married both before (97, 69.3%) and after (88, 62.9%) surgery; the mean QoL score was 7.56 (SD 1.59). The mean number of complications was 0.83 (SD 1.03); approximately one third of participants experienced allergic contact dermatitis (43, 32.3%), and persons with irritant contact dermatitis reported significantly lower QoL total scores (mean 6.64 [SD 1.64], P = .02) than those without this complication (mean 7.77 [1.56]). Of those with complications, most saw an ostomy nurse (33, 47.8%), but many did not see anyone for help with their complications (24, 16.3%). Persons who sought help were generally satisfied with the help received (mean satisfaction score 77.94 ± 24.71). In this study, allergic contact dermatitis was the most common peristomal complication reported. Irritant contact dermatitis negatively affected QoL, and almost half of the participants sought the help of an ostomy care nurse. The results of this study suggest patients may benefit from more education about peristomal complications and the reporting of appliance-related contact dermatitis. Studies examining the presence of peristomal skin complications and their influence on QoL, as well as availability of and access to follow-up care with qualified ostomy nurses, are needed.

Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy

Subatmospheric pressure dressing (SPD) has been commercially available in the United States since 1995 as the vacuum-assisted closure (VAC) device. SPD increases local blood flow, decreases edema and bacterial count, and promotes the formation of granulation tissue. Despite recent clinical successes with the use of SPD in a variety of wound types, problems may occur with application of VAC system in certain areas of the body. The main limitation occurs when attempting to maintain an airtight seal over irregular surfaces surrounding a wound. For example, application of the adhesive drape and creation of a seal are particularly difficulty in the hip and perineum. In addition, wounds of the lower extremity can occur in multiple sites, posing the problem of providing a vacuum dressing to more than one wound from one suction pump machine. To address these challenging clinical wounds, we have developed techniques to allow the successful application of SPD to sacral pressure ulcers near the anus, and to multiple large lower extremity ulcers.