Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study.

Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources.

Using an evidence-based care bundle to improve Thai emergency nurses' knowledge of care for patients with severe traumatic brain injury

There is known variation in Thai nurses' knowledge regarding the best available evidence for care of patients with severe traumatic brain injury. The purpose of this study was to examine the impact of an evidence-based care bundle on Thai emergency nurses' knowledge regarding management of patients with severe traumatic brain injury. A pre-test/post-test design was used. The study intervention was an evidence-based care bundle for initial nursing management of patients with severe traumatic brain injury. Data were collected from 31 Registered Nurses using multiple choice questions. Results revealed a statistically significant improvement in overall knowledge scores after care bundle implementation (p < 0.001). There were statistically significant improvements in five areas of knowledge: understanding of target end-tidal carbon dioxide levels (p < 0.001), implications of hypocapnia in severe traumatic brain injury (p = 0.01), implications of hypercapnia in severe traumatic brain injury (p = 0.02), importance of maintaining head and neck in neutral position (p = 0.05), and administration of sedatives and analgesics in severe traumatic brain injury (p = 0.01). This study suggested that implementation of an evidence-based care bundle improved emergency nurses' knowledge regarding management of patients with severe traumatic brain injury.

Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury

AIMS AND OBJECTIVES: To test the feasibility of an evidence-based care bundle in a Thai emergency department. The specific objective of this study was to examine the impact of the implementation of the care bundle on the initial emergency nursing management of patients with severe traumatic brain injury. BACKGROUND: A care bundle approach is one strategy used to improve the consistency, quality and safety of emergency care for different patients groups, however, has not been tested in patients with severe traumatic brain injury. DESIGN: A pretest/post-test design was used. The study intervention was an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury. METHODS: Nonparticipant observations were conducted between October 2012-June 2013 at an emergency department of a 640 bed regional hospital in Southern Thailand. The initial emergency nursing care was observed in 45 patients with severe traumatic brain injury: 20 patients in the pretest period and 25 patients in the post-test period. RESULTS: There were significant improvements in clinical care of patients with severe traumatic brain injury after implementation of the care bundle: (1) use of end-tidal carbon dioxide monitoring, (2) frequency of respiratory rate assessment, (3) frequency of pulse rate and blood pressure assessment, and (4) patient positioning. CONCLUSION: This study demonstrated that implementation of an evidence-based care bundle improved specific elements of emergency nurses' clinical management of patients with severe traumatic brain injury. RELEVANCE TO CLINICAL PRACTICE: The study suggests that a care bundle approach can be used as a strategy to improve emergency nursing care of patients with severe traumatic brain injury.

Translating research for evidence-based public health: key concepts and future directions

Applying research to guide evidence-based practice is an ongoing and significant challenge for public health. Developments in the emerging field of ‘translation’ have focused on different aspects of the problem, resulting in competing frameworks and terminology. In this paper the scope of ‘translation’ in public health is defined, and four related but conceptually different ‘translation processes’ that support evidence-based practice are outlined: (1) reviewing the transferability of evidence to new settings, (2) translation research, (3) knowledge translation, and (4) knowledge translation research. Finally, an integrated framework is presented to illustrate the relationship between these domains, and priority areas for further development and empirical research are identified.

Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques?

BACKGROUND: There has been a recent proliferation in the development of smartphone applications (apps) aimed at modifying various health behaviours. While interventions that incorporate behaviour change techniques (BCTs) have been associated with greater effectiveness, it is not clear to what extent smartphone apps incorporate such techniques. The purpose of this study was to investigate the presence of BCTs in physical activity and dietary apps and determine how reliably the taxonomy checklist can be used to identify BCTs in smartphone apps.

METHODS: The top-20 paid and top-20 free physical activity and/or dietary behaviour apps from the New Zealand Apple App Store Health & Fitness category were downloaded to an iPhone. Four independent raters user-tested and coded each app for the presence/absence of BCTs using the taxonomy of behaviour change techniques (26 BCTs in total). The number of BCTs included in the 40 apps was calculated. Krippendorff's alpha was used to evaluate interrater reliability for each of the 26 BCTs.

RESULTS: Apps included an average of 8.1 (range 2-18) techniques, the number being slightly higher for paid (M = 9.7, range 2-18) than free apps (M = 6.6, range 3-14). The most frequently included BCTs were "provide instruction" (83% of the apps), "set graded tasks" (70%), and "prompt self-monitoring" (60%). Techniques such as "teach to use prompts/cues", "agree on behavioural contract", "relapse prevention" and "time management" were not present in the apps reviewed. Interrater reliability coefficients ranged from 0.1 to 0.9 (Mean 0.6, SD = 0.2).

CONCLUSIONS: Presence of BCTs varied by app type and price; however, BCTs associated with increased intervention effectiveness were in general more common in paid apps. The taxonomy checklist can be used by independent raters to reliably identify BCTs in physical activity and dietary behaviour smartphone apps.

Evidence-based learning: Interactive, online EBP modules for first year nursing. A case study

Deakin University Library designed a series of six modules to provide interactive, online learning for a first year nursing unit, Understanding Research Evidence. The modules were developed in response to the changing learning requirements of students in the digital age. Delivered using Smart Sparrow software, the modules were designed to assist students in the development and consolidation of their understandings of evidence-based practice (EBP).The development of the modules represents a shift from unilateral communication to interactive content. Previously, online support had largely consisted of static material that was not presented in the context of curriculum. The Library has now developed integrated content that allows for interactivity, but which may also be customised for other purposes or units across all health disciplines.Feedback and data collected from the modules indicate an encouraging degree of engagement with the content. Data also allows the Library to ensure the continuous improvement of the modules. Library staff have also reported on their improved capacity and confidence in creating learning experiences that integrate core information and digital literacy competencies with students' curriculum. Staff also report improvements in their ability to use technologies to create online learning objects.

Coronary angiography observations: evidence-based or ritualistic practice?

Objective: The purposes of this study were to describe the incidence and occurrence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between  current postangiogram observation protocols and the detection of  complications.

Design: This was a prospective descriptive study.

Setting: The study was conducted in 3 university hospitals in Melbourne, Australia.

Patients: Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male.

Results: About 5.1% of patients had 1 or more incidents of bleeding  requiring manual compression. In 4.2% of patients, bleeding occurred within 6 hours of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes, Q3 = 4.31 hours) after angiography. Patients without pressure bandaging bled a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angiography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleeding was detected through the patient’s call for assistance, and in 59.4% of cases nurses noted bleeding while checking the puncture site. Postcatheter observations were recorded 23.70 (SD, 14.60) minutes before the bleeding incident. There were no significant changes in vital signs, systolic blood pressure (P > .05), diastolic blood pressure (P > .05), or pulse (P > .05) before or during a bleeding episode. All were within normal parameters. No neurovascular assessment anomalies were detected.

Conclusion: The use of pressure bandaging has a significant effect on the incidence and pattern of bleeding. Routine vital sign measurement has no relevance in detecting local complications after angiography. The most significant complication is bleeding that requires manual compression. Detection is through frequent puncture site observation and patient recognition and communication.

Evidence-based paediatric practice and its relation to the Cochrane Collaboration

Focuses on the relation between evidence-based pediatric practice and the Cochrane Collaboration on health care. Formation of the collaboration; Aim of Cochrane Collaboration; Reaction of pediatricians to the collaboration; Ways by which the collaboration ensures its relevance to pediatrics and child health.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.