OBJECTIVES:The purpose of this study was to evaluate the effect of a research training program on clinicians’ knowledge, attitudes, and practices related to research and evidence-based practice (EBP).BACKGROUND:EBP has been shown to improve patient care and outcomes. Innovative approaches are needed

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Promoting evidence-based practice through a research training program for point-of-care clinicians.

Stroke is a medical emergency and care provided in the first hours is critical in shaping patients’ long-term recovery and prognosis.1 There is robust evidence demonstrating significant reductions in death and disability with early interventions in acute stroke care, including antiplatelet therapy2 stroke unit (SU) care3 and thrombolysis.4 International clinical guidelines for stroke provide key recommendations to guide clinical practice5–8; however, uptake of evidence-based care is variable and often less than optimal.9–14 For example, among patients with ischemic stroke, rates for treatment with intravenous recombinant tissue-type plasminogen activator (r-tPA) are relatively low in the USA (5%)9 and Australia (7%),10 compared with Canada (12%)11 and some European centers (14%).15

Nurses play a pivotal role in rapid identification and triage of patients with acute stroke, initial assessment, and coordinating the timely flow of patients with acute stroke through the health system. Nurses enable delivery of relevant time critical treatments, and rapid transfer to acute SUs for ongoing assessment and provision of further treatment.

The purpose of this article is to highlight nursing’s essential contribution to the expedient delivery of acute stroke care by providing evidence-based recommendations for clinical practice processes of care and models of care where nurses have a pivotal role during the first 72 hours from arrival at the emergency department through to SU care. A more detailed comprehensive overview of nursing and interdisciplinary care for patients with acute ischemic stroke extending beyond the first 72 hours has been published previously.16

Where available in existing guidelines, the class and level of evidence for recommendations shown in tables have been provided using the American Heart Association taxonomy.6 As there is a dearth of evidence from high-quality stroke nursing research, not all the recommendations described …

Triage, Treatment, and Transfer Evidence-Based Clinical Practice Recommendations and Models of Nursing Care for the First 72 Hours of Admission to Hospital for Acute Stroke

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications. Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke. Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke. Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions. Results. There was significant improvement in triage decisions (21AE4% increase in triage category 2, p = 0AE009; 15AE6% decrease in triage category 4, p = 0AE048). Frequency of assessments of respiratory rate (p = 0AE009), heart rate (p = 0AE022), blood pressure (p = 0AE032) and oxygen saturation (p = 0AE001) increased. In terms of risk management, documentation of pressure area interventions increased by 28AE8% (p = 0AE006), documentation of nil orally status increased by 13AE8% (ns), swallow assessment prior to oral intake increased by 41AE3% (p = 0AE003), speech pathology assessment in Emergency Department increased by 6AE1% (ns) and there was 93AE5 minute decrease in time to speech pathology assessment for admitted patients (ns). Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

An evidence‐based practice approach to improving nursing care of acute stroke in an Australian Emergency Department

xiv DECLARATION OF AUTHORSHIP xvi ACKNOWLEDGEMENTS xvii PLEDGE OF ETIENNE DE GRELIET xix

/pdf/implementing-a-forensic-educational-package-for-registered-2u7o0gloes.pdf

Implementing a forensic educational package for registered nurses in two emergency departments in Western Australia

https://www.jenonline.org/article/S0099-1767(12)00392-3/pdf

Bree McGillivray

Papers

An evidence‐based practice approach to improving nursing care of acute stroke in an Australian Emergency Department

The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature.

Implementation of evidence into practice: Development of a tool to improve emergency nursing care of acute stroke