Worldviews on evidence-based nursing
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Worldviews Evid Based Nurs · Jan 2007
ReviewAudit and feedback as a clinical practice guideline implementation strategy: a model for acute care nurse practitioners.
The transfer of research evidence into practice and changing provider behavior is challenging, even when the advantages are strong. Despite the availability of supportive care clinical practice guidelines (CPG), consistent integration of these principles into practice has not been achieved. The failure of dissemination strategies has been identified as a key barrier to successful implementation. A potentially effective approach to facilitating the transfer of research evidence into practice is audit and feedback. Audit and feedback is a summary of provider performance over a specified period of time, with or without recommendations to improve practice. ⋯ Recognized in medicine as a valuable intervention to improve healthcare quality, audit and feedback is a strategy that has not been widely studied in nursing. Although cancer pain cannot always be entirely eliminated, appropriate use of available therapies can effectively relieve pain in a majority of patients. This article is a review of the literature on audit and feedback as a professional practice change strategy and indicates a model for operationalizing the intervention.
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Worldviews Evid Based Nurs · Jan 2007
Multicenter StudyFactors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders.
Clinical practice guidelines are promising tools for closing the research evidence-practice gap, yet effective and timely implementation of guidelines into practice remains fragmented and inconsistent. Factors influencing effective guideline implementation remain poorly understood, particularly in nursing. A sound understanding of barriers and facilitators is critical for development of effective and targeted guideline implementation strategies. ⋯ Best practice guideline implementation strategies should address barriers related to the individual practitioner, social context, and organizational and environmental context, and should be tailored to different groups of stakeholders (i.e., nursing staff, project leaders and administrators). Health care administrators need to recognize the "real" costs and complexity associated with successful implementation of guidelines and the need to ensure corporate commitment at the onset.
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Worldviews Evid Based Nurs · Jan 2007
Multicenter StudyIncontinence: assessment, diagnosis, and management in two rehabilitation units for older people.
Incontinence of both bladder and bowel is a major health care problem and adversely affects the lives of many people living at home or in health service facilities. The prevalence and severity of incontinence is a global concern that has, in recent years, prompted investigation across several countries. Current approaches to continence care indicate an emphasis on safety and reduction of risk, rather than on detailed individualised assessment and management. ⋯ Because incontinence remains an issue for older people and the clinical implications of sustained incontinence are multifaceted, strategies should focus on the development of practice towards evidence-based multidisciplinary approaches to continence promotion and management.
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Worldviews Evid Based Nurs · Jan 2006
ReviewEvidence base for practice: reduction of restraint and seclusion use during child and adolescent psychiatric inpatient treatment.
Restraint and seclusion of children has great potential for harm. Since the mid-1980s, psychiatric inpatient personnel for children and adolescents have put considerable energy in reducing the use of extreme measures of aggression management. While the use of restraints is a particular problem in the United States, aggression management and means of control in psychiatric settings is an international issue. ⋯ Recommendations include taking a view of restraint and seclusion as emergency measures to address dangerous aggression, not interventions examined in controlled studies. As such it is suggested that sites pool data on restraint use and reduction efforts to create a database for benchmarking and studying variations among hospitals. Furthermore, attention should also be given to developing additional means for addressing aggressive behaviors.