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.

Lisa Riggs

Papers

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