Joanne Booth

Achieving evidence-based nursing practice: impact of the Caledonian Development Model

AIM To determine the impact of the Caledonian Development Model, designed to promote evidence-based practice. BACKGROUND The model features practice-development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college. METHODS Twenty-four nurses, from 18 practice sites formed three communities of practice, each selecting evidence-based guidance to implement. A modified group supervision framework empowered nurses to champion local implementation. Outcomes were determined at 6 months. RESULTS Eighty per cent of the patient-related criteria and 35% of the facilities criteria were achieved. The Revised Nursing Work Index indicated these nurses experienced greater autonomy (P = 0.019) and increased organizational support (P = 0.037). Focus groups revealed a deepening organizational support for the initiative over time, illuminated work-based learning challenges and overall enthusiasm for the approach. CONCLUSION Implementation of the model effectively promoted evidence-based practice, most notably at the level of the individual patient. IMPLICATIONS FOR NURSING MANAGEMENT Time and budgetary constraints necessitate smart, value for money approaches to developing evidence-based practice and improved care standards. This work demonstrates an effective model that strikes a balance between individual and group learning, virtual and real-time activities, coupled with resource pooling across organizations and sectors.

A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care

OBJECTIVE To assess preliminary effects of a program of transcutaneous posterior tibial nerve stimulation (TPTNS) on lower urinary tract symptoms and number of episodes of urinary and fecal incontinence in older adults in residential care homes and the feasibility of a full-scale randomized trial. DESIGN Pilot randomized single-blind, placebo-controlled trial. SETTING Seven residential care homes and 3 sheltered accommodation complexes in the United Kingdom. PARTICIPANTS Thirty care home residents aged 65 and older with urinary or bowel symptoms and/or incontinence. INTERVENTIONS Twelve 30-minute sessions of TPTNS or sham stimulation (placebo). MEASUREMENTS Lower urinary tract symptoms using American Urological Society Symptom Index, urinary incontinence using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), postvoid residual urine volumes using portable bladder scanning, bowel symptoms and fecal incontinence using selected ICIQ questions. RESULTS Total American Urological Society Symptom Index scores improved, showing a median reduction of 7 (interquartile range [IQR] -8 to -3) in the TPTNS group and a median increase in the sham stimulation (placebo) group of 1 (IQR -1 to 4) (Mann-Whitney U 16.5000, Z -3.742, P < .001). Total ICIQ-SF scores improved by a median of 2 (IQR -6 to 0) in the TPTNS group and 0 points (IQR -3 to 3) in the sham stimulation group (Mann-Whitney U 65.000, Z -1.508, P = .132). Significant reduction was found in postvoid residual urine of 55 mL in the TPTNS group (t = -2.215, df 11.338, P = .048). Bowel urgency improved in 27% of the TPTNS group compared with 8% of the sham group (χ(2) 2.395, df 2, P > .302), fecal leakage improved in 47% of the TPTNS group compared with 23% of the sham group (χ(2) 4.480, df 2, P > .106); however, these differences were not significant. No adverse effects were reported by older adults or care staff. CONCLUSION TPTNS is safe and acceptable with evidence of potential benefit for bladder and bowel dysfunction in older male and female residents of care homes. Data support the feasibility of a substantive trial of TPTNS in this population.

Multimodal Secondary Prevention Behavioral Interventions for TIA and Stroke: A Systematic Review and Meta-Analysis

Background Guidelines recommend implementation of multimodal interventions to help prevent recurrent TIA/stroke. We undertook a systematic review to assess the effectiveness of behavioral secondary prevention interventions. Strategy Searches were conducted in 14 databases, including MEDLINE (1980-January 2014). We included randomized controlled trials (RCTs) testing multimodal interventions against usual care/modified usual care. All review processes were conducted in accordance with Cochrane guidelines. Results Twenty-three papers reporting 20 RCTs (6,373 participants) of a range of multimodal behavioral interventions were included. Methodological quality was generally low. Meta-analyses were possible for physiological, lifestyle, psychosocial and mortality/recurrence outcomes. Note: all reported confidence intervals are 95%. Systolic blood pressure was reduced by 4.21 mmHg (mean) (−6.24 to −2.18, P = 0.01 I2 = 58%, 1,407 participants); diastolic blood pressure by 2.03 mmHg (mean) (−3.19 to −0.87, P = 0.004, I2 = 52%, 1,407 participants). No significant changes were found for HDL, LDL, total cholesterol, fasting blood glucose, high sensitivity-CR, BMI, weight or waist:hip ratio, although there was a significant reduction in waist circumference (−6.69 cm, −11.44 to −1.93, P = 0.006, I2 = 0%, 96 participants). There was no significant difference in smoking continuance, or improved fruit and vegetable consumption. There was a significant difference in compliance with antithrombotic medication (OR 1.45, 1.21 to 1.75, P<0.0001, I2 = 0%, 2,792 participants) and with statins (OR 2.53, 2.15 to 2.97, P< 0.00001, I2 = 0%, 2,636 participants); however, there was no significant difference in compliance with antihypertensives. There was a significant reduction in anxiety (−1.20, −1.77 to −0.63, P<0.0001, I2 = 85%, 143 participants). Although there was no significant difference in odds of death or recurrent TIA/stroke, there was a significant reduction in the odds of cardiac events (OR 0.38, 0.16 to 0.88, P = 0.02, I2 = 0%, 4,053 participants). Conclusions There are benefits to be derived from multimodal secondary prevention interventions. However, the findings are complex and should be interpreted with caution. Further, high quality trials providing comprehensive detail of interventions and outcomes, are required. Review Registration PROSPERO CRD42012002538.

The relationship between urinary bladder control and gait in women

Urinary incontinence and OAB are associated with increased falls risk in older people suggesting a potential relationship between bladder functioning and control of gait. To begin to understand the possible interaction between gait and bladder control this exploratory study aimed to examine the effects of controlling the bladder on gait parameters in healthy adult women.

A grounded theory of taking control after fall-induced hip fracture

Purpose: We applied the grounded theory method to explore the post discharge concerns of older people after fall-induced hip fracture repair. It was anticipated that this understanding would increase awareness of issues that may impact on recovery and rehabilitation. Method: Semi-structured interviews were carried out with 19 older people after discharge home. Initially, purposive sampling guided data collection and thereafter theoretical sampling was employed. Interviews were analysed using the constant comparative method. Results: We generated a theory of how older people ‘take control’ after hip fracture. Conceptually, taking control was about ‘balancing’ and was both a process and a range of strategies. The three stages of the process that people moved through were: ‘going under’, ‘keeping afloat’ and ‘gaining ground’. Nautical metaphors conceptualise the precarious and unstable conditions that older people faced as they struggled to regain their independence. Older people struggled to balance help and risk, in their attempt to manage their concerns relating to losing control of their future independence. Conclusion: Older people are vulnerable to losing a sense of control after a health trauma. This theory adds a new dimension to our understanding of recovery from hip fracture and highlights that older people and their families need tailored information and support to enable them to take control safely and appropriately. Implications for Rehabilitation Older people are vulnerable to losing a sense of control after traumatic injury such as hip fracture. Our research suggests that older people engage in a precarious process of balancing as they strive to take control after fall induced hip fracture. Successful balancing entails the provision of tailored information and support. This theoretical explanation aims to help practitioners understand the older person’s perspective of recovery from traumatic injury in a new light.

Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial

BackgroundUrinary incontinence (UI) affects half of patients hospitalised after stroke and is often poorly managed. Cochrane systematic reviews have shown some positive impact of conservative interventions (such as bladder training) in reducing UI, but their effectiveness has not been demonstrated with stroke patients.MethodsWe conducted a cluster randomised controlled feasibility trial of a systematic voiding programme (SVP) for the management of UI after stroke. Stroke services were randomised to receive SVP (n = 4), SVP plus supported implementation (SVP+, n = 4), or usual care (UC, n = 4).Feasibility outcomes were participant recruitment and retention. The main effectiveness outcome was presence or absence of UI at six and 12 weeks post-stroke. Additional effectiveness outcomes included were the effect of the intervention on different types of UI, continence status at discharge, UI severity, functional ability, quality of life, and death.ResultsIt was possible to recruit patients (413; 164 SVP, 125 SVP+, and 124 UC) and participant retention was acceptable (85% and 88% at six and 12 weeks, respectively). There was no suggestion of a beneficial effect on the main outcome at six (SVP versus UC: odds ratio (OR) 0.94, 95% CI: 0.46 to 1.94; SVP+ versus UC: OR: 0.62, 95% CI: 0.28 to 1.37) or 12 weeks (SVP versus UC: OR: 1.02, 95% CI: 0.54 to 1.93; SVP+ versus UC: OR: 1.06, 95% CI: 0.54 to 2.09).No secondary outcomes showed a strong suggestion of clinically meaningful improvement in SVP and/or SVP+ arms relative to UC at six or 12 weeks. However, at 12 weeks both intervention arms had higher estimated odds of continence than UC for patients with urge incontinence.ConclusionsThe trial has met feasibility outcomes of participant recruitment and retention. It was not powered to demonstrate effectiveness, but there is some evidence of a potential reduction in the odds of specific types of incontinence. A full trial should now be considered.Trial registrationISRCTN Registry, ISRCTN08609907, date of registration: 7 July 2010.

The Potential of Communities of Practice to Promote Evidence-Informed Practice Within Nursing Homes

Debbie Tolson, PhD, MSc, BSc (Hons), RGN, Andrew Lowndes, MSc, BA, RNT, RCNT, RN,Joanne Booth, PhD, BSc (Hons), BA, RN, RNT, Irene Schofield, PhD, MSc (Gerontology), RNT, RGN,and Ann Wales, PhD, BSc (Hons), DipLib, MBEHealth care providers are increasingly seeking new tech-nologiestoimprovequalityandcosteffectiveness.

Self-management of urinary and fecal incontinence

Overview Widely used by patients to control symptoms of chronic conditions such as diabetes, asthma, and arthritis, self-management can also help patients with urinary or fecal incontinence. The authors discuss the principles of self-management, the behaviors and skills self-managing patients need to acquire, and the nurses role in reinforcing their use. They then describe strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence.

Exploring older peoples' experiences of nocturia: A poorly recognised urinary condition that limits participation

Purpose. This study sought to understand the experience of living and coping with nocturia, from the perspective of community-living older men and women. Method. Individual semi-structured interviews were undertaken with 32 older people with self-reported nocturia of twice nightly or more. Results. Four key characteristics of nocturia were identified. Nocturia was described as simultaneously debilitating, frustrating, distressing and puzzling. It impacted on sleep patterns and quality, personal relationships and increased the fear of falling among older people when rising to use the toilet at night. Previously unrecognised variability and unpredictability in the condition were highlighted features. Nocturia was not prioritised for health intervention. There were gender differences in initial help-seeking however once prostate disease was eliminated, self-management strategies to cope with the effects of nocturia were the norm. Conclusions. This study indicates that nocturia has a widespread and profound influence on older peoples quality of life and participation, despite being regarded as a relatively benign condition by both older people and health professionals. Several features of the condition, which have the potential for great impact, are poorly recognised in particular its variability and unpredictability.

Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse‐led research agenda

AIM To determine the top 10 research priorities specific to stroke nursing. BACKGROUND It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. DESIGN Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. METHODS Between September - November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. RESULTS During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. CONCLUSIONS The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke.