Karen Kelly Thomas

Continence for Women: A Test of AWHONN’s Evidence-Based Protocol in Clinical Practice

Objective: To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes. Design: Prospective formative evaluation study. Setting: Twenty-one public, private, and other womens health care sites. Participants: Women in ambulatory care settings (N= 1,474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available. Interventions: Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution. Main Outcome Measures: Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness. Results: Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence. Conclusions: This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory womens health care settings, has benefited womens continence status. The results of this project strongly support widespread application.

Cyclic perimenstrual pain and discomfort: the scientific basis for practice.

OBJECTIVE To review and organize the science related to cyclic perimenstrual pain and discomfort for the fifth research-based practice project of the Association of Womens Health, Obstetric and Neonatal Nurses. DATA SOURCES Computerized searches in CINAHL, MEDLINE, and the Cochrane Library, as well as hand searches of cited references. Keywords included cyclic pelvic pain, comfort, pain guidelines, and dysmenorrhea. DATA EXTRACTION All relevant articles prior to 1999 were considered. Thirty-three research-based articles (1992-1999) were reviewed for relevance by the science team as part of the fifth research-based practice project of the Association of Womens Health, Obstetric and Neonatal Nurses. DATA SYNTHESIS The literature review and synthesis resulted in a cogent description of cyclic perimenstrual pain and discomfort and the development of three nursing diagnoses: perimenstrual cyclic pelvic pain, perimenstrual discomfort, and perimenstrual negative affect. Cyclic pelvic pain is a new concept, developed by the science team during the project. Perimenstrual cyclic pelvic pain is an acute, subjective experience defined by pelvic pain that presents in a repeating time frame associated with the menstrual cycle. It is usually clustered with other discomforts and appreciably affects a womans quality of life. Because the science about interventions is complex and extensive, data synthesis led to organization of the interventions within seven categories. CONCLUSIONS Translation of research into practice is essential. Cyclic perimenstrual pain and discomfort is an important clinical issue, yet the science had not previously been comprehensively reviewed with the mission to translate it for nursing practice. Translation of this complex literature was accomplished though an innovative clinical practice guideline and subsequently evaluated in nursing practice through the research-based practice project.

Implementing Evidence-Based Practice: Reducing Risk for Low Birth Weight Through Pregnancy Smoking Cessation

In 1989, the Association of Womens Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research-Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.

Continence For Women: A Test of Awhonn's Evidence-based Protocol in Clinical Practice*

Objective To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes. Design Prospective formative evaluation study. Setting Twenty-one public, private, and other womens health care sites. Participants Women in ambulatory care settings (N = 1474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available. Interventions Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution. Main outcome measures Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness. Results Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence. Conclusions This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory womens health care settings, has benefitted womens continence status. The results of this project strongly support widespread application.

Continence for women: Evaluation of AWHONN's third research utilization project

Objective To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocols implementation into clinical practice. Design Descriptive report of the Association of Womens Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. Setting Twenty-one public, private, and other womens health sites. Participants Women in ambulatory care settings (N = 1474) provided demographic statistics. Methods The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. Main outcome measures Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. Results The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. Conclusions The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

CLINICAL STUDIESThermal Effects of Hooding Incubators

Objective: To determine the effect of covering infant incubators on incubator wall and air temperatures, as well as on infant temperatures. Design: A within-subject ABA design, in which blankets covering the incubators were removed for a 30-minute period and then replaced. Setting: A neonatal intensive-care unit. Participants: Eight medically stable infants (gestational age, 28–33 weeks; birth weight, 913–1,947 g; and postnatal age, 2–39 days). Interventions: Incubator wall and air temperatures as well as infant temperatures were measured during three study conditions: incubators covered (30 minutes), uncovered (60 minutes), and re-covered (30 minutes). Main outcome measures: Incubator air and wall temperature; infant temperature. Results: All incubator walls decreased in temperature after being uncovered; the decrease ranged from 0.6–2.2° C. Conclusion: Although infants maintained relatively stable body temperatures during the uncovered period, the energy cost to their thermoregulatory efforts is unknown.