Willa Fields

Predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities

Nursing students are strategically positioned to influence adoption of evidence-based practice within the nursing profession. The purpose of this study was to identify the predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities. A cross-sectional survey design was used to study a convenience sample of 436 nursing students (response rate of 63.3%) enrolled at two baccalaureate nursing programs at the beginning of 2007 fall semester in the United States. The surveys included demographic questionnaire and knowledge, attitudes and behaviors questionnaire for evidence-based practice. EBP Knowledge, Attitudes toward EBP and Future Use of EBP subscales demonstrated statistically significant increase in mean scores with advancing academic levels. Confidence in clinical decision-making and clinical preparedness had moderate positive correlation with EBP Use and Future use of EBP. Simultaneous multiple regression analyses indicated that the clinical preparedness and confidence in clinical decision-making were statistically significant predictor variables for EBP use and Future use of EBP. Clinically well-prepared nursing students with high confidence in clinical decision-making are most likely to use evidence-based practice, both in the present and the future.

Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing.

This study measured the knowledge, attitudes, and perceived barriers to teaching evidence-based practice (EBP) among nursing faculty at two schools of nursing with baccalaureate and masters level programs in southwestern United States. Survey instruments included a demographic survey, the Evidence-Based Practice Questionnaire, and the BARRIERS to Research Utilization Scale. Descriptive statistics, Pearsons correlations, and hierarchical multiple regression procedures were employed to analyze the data. The results indicated that masters prepared faculty had significantly higher mean scores in the practice of EBP as compared with doctorally prepared faculty, and although faculty positively viewed EBP, their attitude toward EBP was more positive than their knowledge/skills and practice of EBP. One of the major findings in the study was that traditional research knowledge and skills among faculty does not necessarily translate to a supportive attitude or knowledge of the EBP process or skills in acquiring and appraising evidence. Understanding facultys knowledge, attitudes, and practice of teaching EBP is a critical step to successfully transforming the schools culture to an evidence-based framework for teaching nursing practice, integrating of EBP content into curricula, and ensuring student mastery and appreciation of EBP.

Universal rapid screening for methicillin-resistant Staphylococcus aureus in the intensive care units in a large community hospital

BACKGROUND Health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections constitute a significant risk for hospitalized patients. This study evaluates the costs and effects of comprehensive and state-mandated MRSA screening for intensive care unit (ICU) patients and subsequent contact precautions on the rate of HA-MRSA. METHODS A pre- and postimplementation study was conducted in a 24-bed medical intensive care unit (MICU) and a 15-bed surgical intensive care unit (SICU) at an acute care 536-bed community hospital. This study used computerized records for all patients admitted to ICUs. Costs were estimated from financial records. RESULTS HA-MRSA infection rates did not decline after implementation of ICU screening. Regression analysis demonstrated that patients admitted from skilled nursing facilities, assisted living, and similar facilities were 12 times more likely to screen positive for MRSA as compared with patients admitted from home. The costs to identify each MRSA positive patient were

A Performance Improvement Project to Increase Nursing Compliance with Skin Assessments in a Rehabilitation Unit

1,650 and

Physical attributes of endoscopy nurses related to musculoskeletal problems.

953 for comprehensive and state-mandated periods, respectively. CONCLUSION In low prevalence hospitals without MRSA outbreaks, it is recommended that MRSA screening be conducted on patients admitted from skilled nursing and similar facilities because they are most likely to be colonized with MRSA. Results do not support mandates to conduct screening on all patients admitted to critical care units.

A model for medication safety event detection

Purpose The aim of this quality improvement project was to increase nursing compliance with skin assessments and ultimately decrease Hospital Acquired Pressure Ulcers (HAPUs) in an acute rehabilitation center. Methods Interventions in this quality improvement initiative consisted of education, twice‐weekly skin rounds, nursing assistant participation, and sharing of pressure ulcer data. Results The educational sessions were attended by 80% of the nurses and 95% of the nursing assistants. The remaining nurses and nursing assistants were educated in one‐to‐one sessions, for a total of 100% of the staff. After the education, skin assessments documentation was completed 100% of the time. The March 2010 CalNOC results demonstrated no patients with HAPUs (Figure 2), which demonstrates a zero incidence of HAPUs since December of 2008. Conclusions The education, skin rounds, nursing assistant participation, and sharing of data were instrumental in improving the frequency of skin assessments and the reduction of HAPUs in the rehabilitation unit. Clinical relevance Skin rounds and staff education not only increased nursing accountability and improved documentation of wounds but also helped promote the healing of patients current skin issues.

Reducing Continuous Intravenous Medication Errors in an Intensive Care Unit.

The purpose of this research study was to determine whether specific attributes of endoscopy nurses such as age, body mass, or height contribute to neck, shoulder, or back problems. Study participants included endoscopy nurses who physically assist with endoscopic procedures (hands-on assist). Participants with preexisting neck, shoulder, or back injury prior to employment in endoscopy were excluded. Study participants completed the Standardized Nordic Questionnaire. Results suggested that age or height of less than 68 inches were not contributing factors to neck, shoulder, or back problems. Nurses with a body mass index (BMI) of 25 or more had significantly more upper back problems in the past 12 months. Nurses with BMI of 25 or more and/or those who were taller than 68 inches had a significantly higher incidence of upper and lower back problems that prevented work in the previous 12 months and occurred within the previous 7 days. Nurses with a BMI of 25 or more and/or who are 68 inches or taller should be aware of their higher risk for upper and lower back problems, and adjustments need to be made to their work practice and environment.

Evaluation of an inpatient heart failure screening tool.

BACKGROUND Hospital medication safety event detection predominantly emphasizes the identification of preventable adverse drug events (ADEs) through self-reports. These relatively rare events only provide insight into patient harm and self-reports identify only a small portion of ADEs. A broader system-focused approach to medication safety event detection that uses an array of event detection methods is recommended. This approach illuminates medication system deficits and supports improvement strategies that can prevent future patient risk. OBJECTIVE To: (i) describe a system-focused approach to hospital medication safety event detection, and (ii) present a case illustration of approach application. SYSTEM-FOCUSED MODEL AND METHODOLOGY: A three-level medication safety event detection model that ranges from a narrow harm-focused to broader system-focused approach is described. A standardized cross-level methodology to detect medication safety events is presented. CASE ILLUSTRATION A Level 3 system-focused methodology that incorporated both voluntary and non-voluntary event detection strategies was used in 17 critical care (n = 4), intermediate care (n = 7) and medical-surgical units (n = 6) across two hospitals. A total of 431 events were detected: 78 (18.1%) ADEs and 353 (81.9%) potential ADEs. Of the 353 PADEs, 302 (70.0%) were non-intercepted events. Non-voluntary detection methods yielded the majority of events (367, 85.1%). CONCLUSIONS The incidence of ADEs was low when compared with non-intercepted PADEs. This was indicative of medication safety system failures that placed patients at risk for potential harm. Non-voluntary detection methods were much more effective at detecting events than traditional self-report methods.

Is this the right patient? An educational initiative to improve compliance with two patient identifiers.

MEDICATION ERROR incidents, clinical effects, and associated costs have had national attention since the Institute of Medicine published To Err Is Human. The Institute of Medicine also reported that medication errors are more likely to occur in intensive care units (ICUs), operating rooms, and emergency departments where patient conditions are complex, treatments are invasive, and caregivers have competing priorities.1 Continuous intravenous medications have the greatest potential for error.2 The purpose of this evidence-based project was to evaluate a

Reading as a Nursing Intervention for Agitation in Patients with Anoxic Brain Injury

Heart failure is increasing in incidence, prevalence, and mortality. The purpose of this study was to test the predictive accuracy of a screening tool to identify inpatients with heart failure. The tool demonstrated statistical significance for predictability, with 68.3% sensitivity, 86% specificity, and overall accuracy of 77.5%. The tool facilitated heart failure screening and subsequent implementation of evidence-based therapies.