Bernadette Mazurek Melnyk

Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.

DESCRIPTION Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for colorectal cancer. METHODS To update its recommendation, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review on 4 selected questions relating to test characteristics and benefits and harms of screening technologies, and 2) a decision analytic modeling analysis using population modeling techniques to compare the expected health outcomes and resource requirements of available screening modalities when used in a programmatic way over time. RECOMMENDATIONS The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. (A recommendation). The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient. (C recommendation). The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. (D recommendation). The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (I statement).

The State of Evidence-Based Practice in US Nurses Critical Implications for Nurse Leaders and Educators

This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master’s versus nonmaster’s degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine’s 2020 goal that 90% of clinical decisions be evidence-based.

The Evidence‐Based Practice Beliefs and Implementation Scales: Psychometric Properties of Two New Instruments

BACKGROUND Implementation of evidence-based practice (EBP) by health professionals is a key strategy for improving health care quality and patient outcomes as well as increasing professional role satisfaction. However, it is estimated that only a small percentage of nurses and other health care providers are consistently using this approach to clinical practice. AIM The aim of this study was to report on the development and psychometric properties of two new scales: (1) the 16-item EBP Beliefs Scale that allows measurement of a persons beliefs about the value of EBP and the ability to implement it, and (2) the 18-item EBP Implementation Scale that allows measurement of the extent to which EBP is implemented. METHODS Nurses (N= 394) attending continuing education workshops volunteered to complete the scales. Data were analysed to evaluate reliability and validity of both instruments. RESULTS Cronbachs alpha was > .90 for each scale. Principal components analysis indicated that each scale allowed measurement of a unidimensional construct. Strength of EBP beliefs and the extent of EBP implementation increased as educational level increased (p < .001) and as responsibility in the workplace increased (p < .001). CONCLUSION In this study, initial evidence was provided to support the reliability and validity of the EBP Beliefs and Implementation Scales in a heterogeneous sample of practicing nurses. EVIDENCE TO ACTION: Use of the scales in future research could generate evidence to guide EBP implementation strategies in practice and education. Results could establish the extent to which EBP is being implemented and its effect on clinician satisfaction and patient outcomes.

The Establishment of Evidence‐Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real‐World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs

BACKGROUND Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. AIM The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. METHODS Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. FINDINGS Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. LINKING EVIDENCE TO ACTION Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.Background Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. Aim The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. Methods Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. Findings Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. Linking Evidence to Action Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

Helping mothers cope with a critically ill child: A pilot test of the COPE intervention

The purpose of this study was to pilot test the effects of a theoretically driven intervention program (COPE = Creating Opportunities for Parent Empowerment) on the coping outcomes of critically ill children and their mothers. Thirty mothers of 1- to 6-year-old children in a pediatric intensive care unit (PICU) were randomly assigned to receive COPE or a comparison program. Mothers who received the COPE program: (a) provided more support to their children during intrusive procedures; (b) provided more emotional support to their children; (c) reported less negative mood state and less parental stress related to their childrens emotions and behaviors; and (d) reported fewer post-traumatic stress symptoms and less parental role change four weeks following hospitalization. Results indicate the need to educate parents regarding their childrens responses as they recover from critical illness and how they can assist their children in coping with the stressful experience.

Promoting Healthy Lifestyles in High School Adolescents: A Randomized Controlled Trial

BACKGROUND Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools. PURPOSE The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention. DESIGN A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012-2013. SETTING/PARTICIPANTS A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial. INTERVENTION COPE was a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics. MAIN OUTCOME MEASURES Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance. RESULTS Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Teens in the COPE group with extremely elevated depression scores at pre-intervention had significantly lower depression scores than the Healthy Teens group (p=0.02). Alcohol use was 12.96% in the COPE group and 19.94% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M=-0.34, 95% CI=-0.56, -0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (chi-square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There also was a trend for COPE Teens to report less alcohol use at 6 months (p=0.06). CONCLUSIONS COPE can improve short- and more long-term outcomes in high school teens. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01704768.

Intervention studies involving parents of hospitalized young children: an analysis of the past and future recommendations.

Hospitalization imposes multiple stressors on young children and their parents that place them at risk for both short-term and long-term negative outcomes. As a result, numerous researchers have developed and tested interventions to enhance coping outcomes in this population. This article describes major sources of stress for hospitalized young children and their parents, outcomes of hospitalization, and major factors influencing adjustment. In addition, a critique of prior intervention studies and recommendations for future research are highlighted.

Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States

USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least

The Brief Cognitive-Behavioral COPE Intervention for Depressed Adolescents: Outcomes and Feasibility of Delivery in 30-Minute Outpatient Visits:

4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than