Son Chae Kim

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

AIMSnThe 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.nnnBACKGROUNDnEvidence-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.nnnDESIGNnu2002 Cross-sectional study.nnnMETHODnData 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.nnnRESULTSnThe 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.u2002 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.nnnRELEVANCE TO CLINICAL PRACTICEnIn 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.

Staff Practice, Attitudes, and Knowledge/Skills Regarding Evidence-Based Practice Before and After an Educational Intervention

BACKGROUNDnTodays clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice.nnnMETHODSnA descriptive pre- and postsurvey design study evaluated clinical staffs practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire.nnnRESULTSnA total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors.nnnCONCLUSIONnAdministering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.

Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality.

INTRODUCTIONnEmergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality.nnnMETHODSnA retrospective chart review investigated all adult patients-admitted through either of 2 academic tertiary medical center emergency departments-who were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre- and post-protocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality.nnnRESULTSnSerum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight (P < .05). There were no in-hospital mortality rate differences between the pre- and post-protocol implementation groups.nnnDISCUSSIONnCompliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets.

Adherence to colorectal cancer and polyps screening recommendations among filipino-americans.

This cross-sectional study explored the perceptions and behaviors toward colorectal cancer screening and the predictors of adherence to colorectal cancer and polyps screening recommendations among Filipino-Americans. A total of 188 participants were recruited from community churches in southern California from September to November 2011. About half of the participants were found to be adherent to the screening recommendations. Multivariate logistic regression analysis revealed the following significant predictors of adherence: having a relative with colon or rectal cancer (odds ratio [OR] = 6.17), having heard of fecal occult blood test (OR = 4.58), strong agreement with benefit of screening in reducing worry about cancer (OR = 2.81), age ≥ 65 years (OR = 2.64) and very easy communication with providers (OR = 2.43). Patient awareness of colorectal cancer screening and its benefits through effective patient–provider communication were significant modifiable predictors of adherence to colorectal cancer and polyps screening recommendations. Nurses could have a major impact in improving screening behaviors through patient education in increasing patient awareness and benefits of cancer screening.

Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model

BACKGROUNDnThe Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables.nnnAIMSnThis study evaluated whether a regional EBP fellowship program improved participants EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling.nnnMETHODSnA pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120).nnnRESULTSnPaired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (β = .24; p = .002) and group attractiveness (β = .22; p = .010).nnnLINKING EVIDENCE TO ACTIONnA regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Impact of Interprofessional Education Among Nursing and Paramedic Students.

Simulation-based interprofessional education is beneficial, but it is not clear whether the nature of the simulation has any impact. A pretest and posttest study was conducted among nursing (n = 131) and paramedic (n = 58) students participating in mass casualty incident (MCI) simulations versus handoff communication simulations. Nursing students had better attitudes toward interprofessional education, as well as higher levels of satisfaction and self-confidence, after handoff communication simulations in comparison with MCI simulations. Active participation in clinical simulations appears to have a greater positive impact on nursing students.

Predictors of Evidence‐Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants

BACKGROUNDnA regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses.nnnAIMSnThis study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants.nnnMETHODSnA total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales.nnnRESULTSnThere were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness.nnnLINKING EVIDENCE TO ACTIONnIn multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.Background nA regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. n nAims nThis study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. n nMethods nA total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. n nResults nThere were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. n nLinking Evidence to Action nIn multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Preoperative Education on Postoperative Delirium, Anxiety, and Knowledge in Pulmonary Thromboendarterectomy Patients

BACKGROUNDnDelirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs.nnnOBJECTIVESnTo evaluate the impact of multifaceted preoperative patient education on postoperative delirium, anxiety, and knowledge and to explore predictors of postoperative delirium, days of mechanical ventilation, and days in the intensive care unit (ICU) in patients undergoing pulmonary thromboendarterectomy.nnnMETHODnA prospective, randomized controlled trial was conducted on consented patients from October 2011 to April 2013. Patients were randomized in a 1 to 1 ratio to receive either an individualized 45-minute multifaceted preoperative education (experimental group, n = 63) or standard education (control group, n = 66). Participants completed the State-Trait Anxiety Inventory and Knowledge Test before and after the education. Data on incidence of delirium, days of mechanical ventilation, ICU days, and cardiopulmonary parameters were collected.nnnRESULTSnThe experimental group had significantly more knowledge about postoperative care (P< .001) and fewer days of mechanical ventilation (P = .04) than the control group. The 2 groups did not differ significantly in anxiety, incidence of delirium, or ICU days. In exploratory multivariate analyses, hearing impairment was a positive predictor for days of delirium (P = .009), days of mechanical ventilation (P< .001), and ICU days (P= .049), whereas the posttest knowledge was a negative predictor for days of mechanical ventilation (P = .02).nnnCONCLUSIONnThe patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.

Validity and reliability of sleep promotion questionnaire and predictors of quality of care

Background: Sleep disturbance is common among hospitalized patients. However, sleep promotion is not a high priority for most healthcare providers, which potentially impacts quality of care. Due to a paucity of validated tools to assess sleep promotion, little is known about the relationship between sleep promotion and quality of care. This study was conducted to assess the validity and reliability of a newly-developed instrument, the Sleep Promotion Questionnaire, and to examine sleep promotion as a predictor of quality of care. The Sleep Promotion Questionnaire includes dimensions of attitude, control, unit norms, intention, and behavior that are associated with sleep promotion. Methods: A total of 302 nurses participated in an online survey. The survey included the initial 36-item Sleep Promotion Questionnaire, a quality of care question, Caring Behavior Inventory, and Professional Quality of Life scale. An exploratory factor analysis was performed to determine the factor structure of the Sleep Promotion Questionnaire. The internal consistency reliability as well as the convergent and divergent validities was assessed. Pearson’s correlations and hierarchical multiple regression procedures were performed to explore the predictors of perceived quality of care. Results: Exploratory factor analysis of the Sleep Promotion Questionnaire yielded 28 items in five subscales, comprising Attitude, Control, Unit Norms, Sleep-aid Intention, and Behavior. Convergent and divergent validities were supported (ru2009=u20090.37; ru2009=u2009−0.38, respectively). The Cronbach’s alphas of internal consistency reliabilities of the Sleep Promotion Questionnaire subscales ranged from 0.70 to 0.89. Regression models showed that sleep-promoting Unit Norms was the only significant predictor of perceived quality of care among both ICU and non-ICU nurses (βu2009=u20090.40; βu2009=u20090.28, respectively). Conclusion: The Sleep Promotion Questionnaire appears to be a reliable and valid instrument with satisfactory psychometric properties for assessing sleep promotion, and it seems that having unit norms conducive to sleep promotion may positively impact the quality of care. However, further studies are needed to confirm these results.

Aggressive behaviour risk assessment tool for newly-admitted residents of long-term care homes

AIMnThe aim of this study was to revise the 10-item Aggressive Behaviour Risk Assessment Tool for predicting aggressive events among residents newly admitted to long-term care homes.nnnBACKGROUNDnThe original tool had acceptable sensitivity and specificity for identifying potentially aggressive patients in acute care medical-surgical units, but its usefulness in long-term care homes is unknown.nnnDESIGNnA retrospective cohort study design was used.nnnMETHODSnAll residents admitted to 25 long-term care homes in western Canada were assessed for the risk of aggression using the original tool within 24xa0hours of admission from January 2014 - December 2014 (nxa0=xa0724). Incident reports of aggressive events occurring within 30xa0days of admission were collected. Multiple logistic regression and receiver operating characteristics analyses were performed.nnnRESULTSnFifty-three residents of 724 exhibited aggressive behaviours. The demographic variable of age less than 85xa0years was found to be a positive predictor of aggressive events in multivariate logistic regression model and was added to the tool. The revised six-item Aggressive Behaviour Risk Assessment Tool for Long-Term Care consists of one new item, age less than 85xa0years and five items from the original tool: History of physical aggression, physically aggressive/threatening, anxiety, confusion/cognitive impairment and threatening to leave. The receiver operating characteristics of the revised tool with weighted scoring showed a good discriminant ability with satisfactory sensitivity and specificity at the recommended cut-off score of 4.nnnCONCLUSIONnThe revised six-item tool may be useful in identifying potentially aggressive residents newly admitted to long-term care homes.