Worldviews on evidence-based nursing
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Worldviews Evid Based Nurs · Mar 2011
ReviewMultidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning: a systematic review of literature.
The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care. ⋯ Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.
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Worldviews Evid Based Nurs · Mar 2011
A retrospective exploration of patient-ventilator monitoring intensity, therapeutic intervention intensity, and compliance with lung protective guidelines in a cohort of patients with adult respiratory distress syndrome.
The current approach to mechanical ventilation for adult respiratory distress syndrome (ARDS) and acute lung injury (ALI) involves maintaining key patient-ventilator parameters within established lung protective targets. Monitoring is part of the processes of nursing care believed to guide therapeutic intervention and facilitate compliance with these targets. Empirical relationships between monitoring, therapeutic intervention, and compliance with these practice guidelines have not been adequately explored. ⋯ Compliance with recommended lung protective parameters in the absence of standardized monitoring and intervention protocols is suboptimal. Preliminary evidence of positive relationships between monitoring and both severity of illness and therapeutic intervention was established. Control for nursing and physician practice variation is needed to rule out the influence of surveillance and performance bias on collaborative practice outcomes. Explicit standardized protocols that address the frequency of assessments and interventions along with therapeutic targets are recommended for collaborative practice guidelines.
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Worldviews Evid Based Nurs · Mar 2011
Translating venous thromboembolism (VTE) prevention evidence into practice: a multidisciplinary evidence implementation project.
Venous thromboembolism (VTE) is an important patient safety issue resulting in significant mortality, morbidity, and health care resource expenditure. Despite the widespread availability of best practice guidelines on VTE prevention, we found that only 49% of our patients were receiving appropriate prophylaxis. ⋯ The intervention resulted in a 19% overall improvement in prophylaxis rates, which is a significant achievement for any behavioural change intervention. There is, however, still a significant discrepancy between surgical and medical patient prophylaxis rates, which clearly warrants further attention.