Donna J. Munroe

Fostering evidence-based practice in a rural community hospital.

Few can deny the importance of evidence-based practice (EBP) to nursing care delivery in acute care. Most nurse administrators would agree that EBP should be ‘‘usual and customary’’ nursing activity in their organizations. This is a challenging goal because many nurses do not understand nor have the skills to seek and apply evidence to their day-to-day practice. Therefore, to successfully promote EBP, nursing leadership must use strategies that will simultaneously educate, stimulate, and support all nursing personnel in identifying clinical nursing issues and searching for evidence-based nursing interventions to address these issues. Nowhere is this a greater challenge than in rural healthcare agencies. Available resources for EBP education and on-site support can be very limited. Knowledge, skill, and attitudes regarding EBP and research utilization by nurses have been reported, with various nurse characteristics, facilitators and barriers identified. Nursing and EBP Sigma Theta Tau International defined evidence-based nursing as ‘‘an integration of the best evidence available, nursing expertise and the values and preferences of the individuals, families and communities served.’’ Research utilization is a component of evidence-based nursing because it involves using research findings (evidence) as a basis for practice. Rycroft-Malone and her associates observed that few nursing interventions rely solely on research that is translated to direct practice. Instead, clinical decision making, composed of research, clinical experience, and patient experience, is the basis for nursing practice. Clinical practice guidelines are a prominent source of EBP. However, Woolf observed that these guidelines often do not change practitioner behavior. He devised a framework to explain the use of clinical practice guidelines by physicians, which characterized barriers and facilitators. Key factors in this framework are practitioner knowledge of and attitudes toward EBP and organizational support for the implementation of EBP.

Is the Hospitalʼs Magnet Status Linked to HCAHPS Scores

This study identified a significant link between Magnet hospitals and higher HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores across 110 Illinois hospitals. Compared with registered nurse nursing hours per patient-day and registered nurse turnover rate, Magnet status was a stronger contributor to the HCAHPS scores. A moderate to strong, reverse relationship between hospitals percentage of African American patients and HCAHPS scores suggests a need for strengthening culturally sensitive nurse-patient communications.

Culture-change training: nursing facility staff perceptions of culture change.

Identifying effective alternative strategies for training staff and implementing culture change can be useful to nursing facilities striving to provide optimal resident-centered care. This study assessed the perceptions of nearly 400 nursing facility staff experiencing organizational culture change. Formal and informal training methods were used. We used a pre- and post-test to evaluate leadership practices and 6 subscales related to culture change (systemwide culture change, resident choice, organization design, empowering supervision, job design, decision making, and permanent assignments). Staff of formally trained facilities perceived improvements in all subscales; 2 were statistically significant (resident choice and organization design). Respondents for informally trained facilities identified improvement in decision making, although this was not statistically significant. Formalized culture-change training produced better outcomes than did the informal strategy. Culture change is a complex process and may continue to evolve over time. A 3-year evaluation period may be insufficient to demonstrate the full extent of these changes.

BUILDING A PROFESSIONAL ENVIRONMENT IN LONG-TERM CARE: The Role of Clinical Career Development

1. To be successful, an organizational career development program must include a differentiation of the responsibilities for which the various parties (employer, employee, career counselor) will be held accountable. 2. Project outcomes revealed that the career mobility program was attractive to nursing personnel and facility management personnel alike. However, it was more attractive to nonlicensed than licensed personnel. 3. Of the staff who participated and were promoted, the majority remained in their jobs. The program was most successful in enhancing retention with personnel who received within-level promotions. 4. The process of career development requires collaboration and support from all levels of leadership and staff throughout the organization. A career development program, including a career mobility program with a strong career counseling component, can serve as a catalyst in professionalizing the long-term care work environment.