Linda Bucher

AACN Levels of Evidence: What’s New?

tice related to disease management or skills. As a leader in this area, the American Association of CriticalCare Nurses (AACN) has published numerous resources to help practitioners appraise evidence for integration into clinical practice. Publications such as Practice Alerts, Protocols for Practice, and Procedure Manual contain recommendations for clinical practice based on a comprehensive and scientific review of the evidence. To support these recommendations, AACN developed a hierarchy system to grade the level of evidence. AACN’s grading system was originally referred to as a rating scale and was used to rank individual recommendations according to the level of supporting evidence available (Table 1).

Correlation between the Sedation-Agitation Scale and the Bispectral Index in ventilated patients in the intensive care unit

BACKGROUND Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings. OBJECTIVE To evaluate the correlation between the clinical assessment of sedation using the Sedation-Agitation Scale (SAS) and the assessment using BIS in ventilated and sedated ICU patients. METHODS ICU patients requiring mechanical ventilation and sedation were monitored using the SAS and BIS. Nurses initiated event markers with BIS at the time of SAS assessment but were blinded to BIS scores. RESULTS Data were collected on 40 subjects generating 209 paired readings. Moderate positive correlation between BIS and SAS values was shown with a Spearman Rank coefficient r value of .502 and an r(2) of .252 (P < .0001). Wide ranges of BIS scores were observed, especially in very sedated patients. Strong positive correlation was noted between BIS and electromyography with an r value of .749 (P < .0001). Age and gender significantly influenced BIS/SAS correlations. CONCLUSION In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.

Predicting NCLEX-RN performance: Cross-validating an identified classification procedure

This study was an attempt to cross-validate a procedure from an earlier study for predicting NCLEX-RN performance. In the original study, a discriminant function was developed on 313 baccalaureate nursing graduates (1988 through 1990), which used 15 variables to correctly categorize more than 91 per cent of them on NCLEX-RN performance. This study used 142 subjects who graduated in 1991 and 1992 to evaluate the adequacy of the classification procedure. Subjects in this more recent sample differed significantly from those in the first on several variables, including SAT scores, physiology grades, and nursing grades. Eight-four per cent of the subjects in the cross-validation sample were correctly classified using the original discriminant function. More than 62 per cent of failures and 87 per cent of passes were correctly categorized. These results suggest that it is statistically and ethically sound to use this discriminant function to identify future students in danger of NCLEX-RN failure.

A Study of Perioperative Hyperglycemia in Patients With Diabetes Having Colon, Spine, and Joint Surgery

Patients with diabetes often have impaired wound healing and an increased rate of postoperative complications with surgery. Most research has focused on the effect of hyperglycemia in the postoperative period, but there is limited evidence to guide blood glucose (bG) control throughout the perioperative period. This retrospective study explored the effect of hyperglycemia in the PACU on postoperative complications, length of stay (LOS), and in-hospital mortality in patients with diabetes undergoing spine, colon, or joint surgery. Findings revealed that the total LOS for patients with a PACU bG >200 mg/dL was significantly longer than for patients with a maximum bG of 140 to 200 mg/dL. Further, the rate of total complications increased significantly as bG levels increased. More prospective, controlled studies on the management of perioperative hyperglycemia are recommended for consideration.

First-Time Mothers' Perceptions of Prenatal Care Services

This study sought to uncover information regarding prenatal care services as reported by primiparas. Inadequate prenatal care has been linked with the delivery of low birth weight (LBW) infants and infant mortality. This secondary analysis of a larger study (N = 426) examined the need for and availability, accessibility, and use of prenatal care services by primiparas (n = 141). Results indicated that primiparas delivering LBW infants reported less satisfaction with information on birth control and less information on infant feeding. In addition, mothers of LBW infants reported more often than mothers of normal birthweight infants that transportation and finances were barriers to prenatal care. Childbirth preparation class was the only predictor variable for birth weight in this study.

A novel approach to improving current research awareness: a Web-based Nursing Research Journal Watch.

The Nursing Research Education Committee, part of the Nursing Research Council in a large tertiary care healthcare system, was developed to engage direct care nurses in research activities. This article describes several programs undertaken to meet this goal and details the most current: the development of a Web-based service, the Nursing Research Journal Watch. This innovative service was designed to raise staff awareness of nursing research. Staff development educators will learn how the Nursing Research Journal Watch was developed, launched, and evaluated for consideration in their own institutions.