Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration.

Background The American Association of Critical-Care Nurses practice alert on verification of feeding tube placement makes evidence-based practice recommendations to guide nursing management of adult patients with blindly inserted feeding tubes. Many bedside verification methods do not allow detection of improper positioning of a feeding tube within the gastrointestinal tract, thereby increasing aspiration risk. Objectives To determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses. Methods This study was part of a larger national, online survey that was completed by 370 critical care nurses. Descriptive statistics were used to analyze the data. Results Seventy-eight percent of nurses used a variety of methods to verify initial placement of feeding tubes, although 14% were unaware that tube position should be confirmed every 4 hours. Despite the inaccuracy of auscultation methods, only 12% of nurses avoided this practice all of the time. Conclusions Implementation of expected clinical practices from this guideline varied. Nurses are encouraged to implement expected practices from this evidence-based, peer reviewed practice alert to minimize risk for patient harm.

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Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

The association between nurse staffing and outcomes for both patients and nurses is not new. In 2002, Aiken and colleagues1 published a landmark study reporting that higher nursing workloads increased odds of patients dying and of nurses experiencing burnout and emotional exhaustion. These relationships, which may partially be explained by missed nursing care, have been confirmed in numerous other studies.2-7 Care omissions may result as nurses experience time pressures that affect surveillance and attention to complex needs of patients.8,9 Thus, inadequate staffing affects patient safety and nurse well-being, further eroding the quality and safety of care. Appropriate staffing ensures an effective match between the needs of patients and their families and the knowledge, skills, and abilities of nurses.10 It has been identified as an essential ingredient of the American Association of CriticalCare Nurses (AACN) framework for a healthy work environment. Growing research has examined the effect of work environments on patient and nurse outcomes, especially as the Magnet Recognition Program has grown. As a culture of excellence evolves, positive practice environments offer benefits to patients, including better safety and quality of care and greater satisfaction with nursing care. Nurses benefit from greater autonomy and control over practice, better relationships with physicians, and higher nurse to patient ratios and workplace safety that increases engagement and job satisfaction and lowers burnout and turnover.9,11-17 The PICO (problem/patient/population, intervention/indicator, comparison, outcome) question that guided this synthesis was “How do nurse staffing and the quality of practice environments affect patient, nurse, and organizational outcomes?”

The Influence of Appropriate Staffing and Healthy Work Environments on Patient and Nurse Outcomes

The most common invasive procedure performed in the hospital setting worldwide is the insertion of a peripheral intravenous catheter. Although use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team. Significant complications related to the presence of a peripheral intravenous site include localized infection, bacteremia, phlebitis, and infiltration or extravasation. Consistent application of evidence-based standards of practice in all aspects of peripheral intravenous catheter care is essential to provide infusion therapy that delivers safe and quality care. Management of peripheral intravenous access in the complex setting of critical care is examined in this article. A case study approach is used to illustrate application of infusion therapy standards of practice in peripheral intravenous catheter insertion, indications for catheter placement, and assessment parameters to enhance early recognition of peripheral intravenous access-related complications.

Peripheral Intravenous Access: Applying Infusion Therapy Standards of Practice to Improve Patient Safety.

Factors enhancing resilience among older adults experiencing disaster: A systematic review

Evidence-based nursing care is informed by research findings, clinical expertise, and patients' values, and its use can improve patients' outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Innovations in the educational process are required to address the divergent needs of nursing students depending on their point of entry, either postbaccalaureate or postmaster's degree preparation. The requirement of the scholarly doctor of nursing practice (DNP) project demands significant student and faculty resources. With the variability of students' education, practice experience, and interest, the expectations of the project need to fit the needs of the adult learner. Linking these projects to clinical settings is an end goal for these efforts which supports the scalability of these programs.Faculty from Rutgers School of Nursing considers practice change and quality improvement a priority in preparation of the DNP graduate. With curricular enhancements, students are considering patient access, safety, and quality from the beginning of their doctoral education. An innovative course series progression was implemented to prepare students for the scholarly practice evaluation. In addition, capstone and residency courses were reformatted to assist students in evaluating models of evaluation, systems of care, and to further define the issue they wish to address through their scholarly inquiry. Throughout the clinical doctoral preparation, students are encouraged to evaluate practice in a standardized critical format and ultimately, execute a scholarly project.By linking these projects to the clinical setting, the DNP program increases its scalability. Connecting the academic institution with the clinical setting allows for increase student access to learning experiences and the capability of scholarly projects to continue in the setting. Faculty resources are well used in this manner. This process allows for continued capacity building within the academic and clinical setting.

Doctor of Nursing Practice Program Capacity Building and Scalability: Improving the Capstone Experience.

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care-educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care educated and certified adult primary care APNs working in an inpatient setting to obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster's certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

Helen Miley

Papers

Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Doctor of Nursing Practice Program Capacity Building and Scalability: Improving the Capstone Experience.

Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster's Acute Care Certification Program.