Mary A. Wickline

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

Objective: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development. Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice. Conclusions: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

Multi‐institutional study of barriers to research utilisation and evidence‐based practice among hospital nurses

AIMS The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. BACKGROUND Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. DESIGN   Cross-sectional study. METHOD Data were collected between December 2006-January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. RESULTS The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions.  It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. RELEVANCE TO CLINICAL PRACTICE In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice.

Regional Evidence-Based Practice Fellowship Program: Impact on Evidence-Based Practice Implementation and Barriers

This quasi-experimental, pre- and posttest study evaluated the impact of a 9-month collaborative regional evidence-based practice (EBP) fellowship program on practice, attitude, knowledge, and perceived barriers associated with implementation of EBP. Three annual cohorts (N = 142) of nurses attending a fellowship program from 2008 to 2010 participated in this study. Paired t tests showed statistically significant increases in practice (+.82; p < .001) and knowledge/skills (+.78; p < .001) associated with EBP, but showed no change in attitude (+.16; p = .198). All four Barriers subscales showed statistically significant decreases (−.10 to −.31; p = .036 to <.001). Hierarchical multiple regression analyses showed that the barriers explained 6.8%, 8.9% and 13.9% of variances in practice, attitude and knowledge/skills, respectively. The collaborative regional fellowship program improved the practice and knowledge/skills associated with EBP. The barriers were significant predictors of the EBP implementation among the targeted group of nurses participating in the fellowship program.

Assessing RN-to-RN peer review on clinical units.

AIM The primary purpose of this study was to measure informal registered nurse (RN)-to-RN peer review (defined as collegial communication about the quality of nursing care) at the work-unit level. METHODS Survey design with cluster sampling of 28 hospital or ambulatory care units (n = 541 respondents). Results were compared with existing patient safety and satisfaction data. A chi-squared test was used to compare responses against nurse characteristics. RESULTS Nurses agreed that RN-to-RN peer review takes place on their units, but no correlation with patient safety and satisfaction data was found. Misunderstandings about the meaning of peer review were evident. Open-ended comments revealed barriers to peer review: fear of retribution, language barriers and lack of professionalism. CONCLUSIONS Nurses need clarification of peer review. Issues with common language in a professional environment need to be addressed and nurses can learn collaboration from each others cultures. IMPLICATIONS FOR NURSING MANAGEMENT Managers should support RN-to-RN peer review on clinical units. Methods used here may be useful to assess current departmental nurse peer review.

Health Literacy: Collaborating to Educate Professionals

Limited health literacy is a pervasive problem in the United States that affects both the health of the individual and the economics of the health care system. Being able to easily recognize a persons health literacy can be a challenge. Certain factors, including formal education, ethnicity, and socioeconomic status, have a tendency to correlate with limited health literacy. Librarians can facilitate and improve communication in raising awareness through collaboration with clinicians. Statistics related to health literacy are provided, and red flag behaviors are noted.

The Medical Library Association Guide to Data Management for Librarians

Lisa Federer, AHIP, of the National Institutes of Health (NIH), along with authors from the National Library of Medicine (NLM) and highly reputable universities, introduces readers to the theoretical and data life cycle aspects of data management and then offers practical examples from academic health sciences and hospital environments.

Managing Your Library and Its Quality: The ISO 9001 Way

The title drew me to this book, Managing Your Library and Its Quality, and its eight basic principles represent a common core to quality management. Management of any service organization is about successfully aligning people and cost-effective use of resources with a carefully crafted organizational mission. The first four chapters of the book are about the standard itself. Chapter one reviews the eight basic principles of quality management, upon which the International Standards Organizations (ISOs) series 9000 is based: customer orientation, leadership, involvement of people, a process approach, a systematic approach to management, continual improvement, a factual approach to decision making, and mutually beneficial supplier relationships. This is followed by chapters on the history and evolution of the ISO 9000 standards, and part 1 ends with specific examples of libraries where the ISO 9001 standard is used as a management model. This puts the reader about a quarter of the way through the book. The next section, part 2, is a painstakingly detailed explanation of applying this quality management system in a way that makes a library compliant with the 9001 standard. Ten chapters each focus on a core element of quality management and offer a detailed breakdown of ISO 9001, line by line (for example, “Control of documents” [4.2.3]). After each element is called out, there are consistent sections on “What is this requirement, and what happens if one does not meet this requirement?” followed with a “How to Implement” section for that ISO 9001 quality management element. The last chapter in part 2 describes the certification process. The final chapter of the book offers a brief analysis of ways to improve this quality management system. There is an extensive reference list, and the book is indexed. On the face of it, this is a reliable, sensible organization of the book that serves as an excellent reference for managers attempting to write a quality management policy. However, it comes across more as a book about the standard and trying to make a library fit the standard than about a model for managing a library. Information professionals in hospital environments that already use the ISO 9001 approach to management will find this book to be a useful tool for writing the librarys quality management policies. This book will be most useful to people who simply need an interpretation of how to apply the required standard to management of the library within that business. New library directors who do not mind reading dense policy will likely find the book helpful in its detail. Many people managers, though, may find it difficult to slog through. The concept of managing according to an international standard gives the book a bit too much of a policy-wonk style. Library directors in a US academic or public library setting might find Evans and Alires Management Basics for Information Professionals (ALA Neal-Schuman; 2013; ISBN: 978-1-55570-909-9) to be a more approachable text.

Encyclopedia of Family Health

Family both affects and is affected a persons health—through environment, socioeconomics, and psychology, among many other factors. Nearly 400 health experts, both academics and clinicians, provide brief articles on health in the context of the family in the Encyclopedia of Family Health. The primary audience for this reference is US health care providers, researchers, and educators; however, articles are written in plain, straightforward language accessible to students and the general public. Two doctoral-prepared nurses are the content editors of this 2-volume encyclopedia, and the editorial board is composed of 10 primarily US-based members from family medicine, nursing, child psychiatry, and social work. Article authors are mostly from the United States with about 15% from other countries. Author institutional affiliations are broadly based from the well-known Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Mayo Clinic, and the Institute for Patient- and Family-Centered Care, as well as a large number of researchers from universities and a few clinicians in private practice. This encyclopedia gathers together valuable articles on the interrelatedness of family and health. One example is the article on bipolar disorders and the family, which points the reader toward “expressed emotion” literature as it relates to family members. While the physician recognizes mental illness as an illness, family members might attribute the patients behavior to other factors. The patients illness affects the family, but family attitudes can also affect the patients health. This article raises the issue of interpersonal relations in the family of a patient with a bipolar disorder and suggests family-focused therapy as one intervention that has shown promise in combination with medications. While the content is excellent, Sage has not lived up to its standards for design and editorial production. Organization and navigation of these two volumes leave a great deal to be desired. There is an alphabetical “List of Entries” at the front of each volume (each covering the entire set) and a “Readers Guide” in the first volume only. The “List of Entries” is nothing more than an alphabetical list of article titles with no page numbers. Articles are located by searching for the first word of titles at the top of each page throughout the two volumes, so readers would have to think of the first word of a title to find that article. The “Readers Guide” is a better finding aid in that articles are categorized into eleven topics, making it useful for locating related article titles, but this appears only in the first volume and has no page numbers either. An index at the back of the second volume has page numbers, but the index itself is not a comprehensive subject index. It still largely relies on the reader to think of the title word to find an article. For example, the index has no entry for “insurance,” but the book has an article titled, “Cost of Medical Care and Existing National, State, and Private Pay Avenues for Families.” There is an index entry for the article titled, “Communication in Families Related to Health and Illness,” but while family communication is a major aspect of the article on bipolar disorders, it is not referenced under “communication” in the index. The “Readers Guide” topics include at-risk conditions and at-risk situations (covering addiction, death from unnatural causes, elder abuse, incest, rape, suicide, war, etc.); education of health care providers; factors influencing family health (socioeconomic, cultural, and religious perspectives); discussions of families experiencing acute physical and mental illness, chronic physical and mental health conditions, and transitions (covering abortion, adoption, marriage, divorce, job loss, death, parenting, same-sex partner rights, etc.); family and the health care system (related to access to health care); family health assessment; family health perspectives (theory and research); family interventions (counseling and caregivers); and genetics and families. The encyclopedia, however, is organized by article titles, not by these topics. The content editors offer suggestions for approaching the work by recommending reading three articles that place the family as the central, defining context of health. They then recommend reading the first article, “The Relationship of Family to Health: Historical Overview.” Entries then begin and are listed alphabetically by article title, with A–G contained in the first volume and H–Z in the second. Articles are brief, readable, and directly applicable. All articles list sources and provide suggestions for further reading. There is also an appendix of additional resources at the back of the second volume covering the entire work. This work is unique in that it offers a family framework to diseases and conditions. It is not a disease-oriented source such as the Merck manuals or a consumer-health encyclopedia like the Cornell Illustrated Encyclopedia of Health or Family Health & Medical Guide from the American Academy of Family Physicians. Nor is it like the more extensive (and expensive) profession-specific works from Springer such as Encyclopedia of Behavioral Medicine. This encyclopedia offers important psychosocial perspectives about health as it relates to the family unit and is intended to aid clinical practitioners. Because of the strength of the content, the Encyclopedia of Family Health would be a useful addition to biomedical or hospital libraries or any library serving health care providers or students of medicine, nursing, or allied health professions. In the United States, health care frequently focuses on the individual in isolation. Doctors see patients in their offices and focus on the present disease or condition. This work considers patients in the broader context of their lives and seeks to assist physicians and others in assessment and treatment with a more holistic, interdisciplinary, and family-centered approach.