Glossary
NK - New Knowledge, Innovation, and Improvements

NK6- The Structure(s) and Process (es) used to evaluate existing nursing practice based on evidence

The JCMC pillars of excellence place patient safety, clinical quality, engagement, and economic health as strategic priority for JCMC.

The JCMC pillars of excellence place patient safety, clinical quality, engagement, and economic health as strategic priority for JCMC. This overarching structure requires healthcare teams to provide care that is grounded on research findings, clinical practice guidelines, and research based evidence. This is an essential component necessary to improve clinical practice and delivery of quality care. Evidence based practices are adopted and implemented by the nursing staff at JCMC. Nurses at all levels are encouraged to support their practice and clinical inquiries, using relevant evidence along with their clinical expertise and the patient values. JCMC supports nurses by ensuring that nurses have ample resources available to evaluate practice and implement change based on their findings.

Health Information Library

Health Information Library

The Health Information Library, located on the third floor provides staff the opportunity to read and utilize research literature available in print and online. Access to the library is available twenty four hours a day to any Medical and Nursing staff members. Twelve computers are available with full text subscriptions to various electronic databases and search engines including:

  • EBSCO
  • Cumulative Index to Nursing and Allied Health (CINAHL)
  • New England Journal
  • AccessMedicine
  • AccessSurgery
  • PubMed
  • National Guideline Clearinghouse
  • BioMed Central
  • eMedicine Institutional edition
  • And More….

In addition, these databases are available to the nursing staff on any computer or workstation on wheels in the facility. Other clinical references available to the nursing staff include Clinical Pharmacology and the Nursing Reference Centerä (NRC).

Evidence Based Resources Available on the Intranet

Health Information Library

EBSCO Nursing Reference Center TM 

The NRC has been available to nursing staff at JCMC since 2008. This comprehensive reference tool was originally requested by the nursing research council, because nurses required relevant clinical resources directly at the point of care. This database offers the most available and recent clinical evidence in a concise and relevant fashion

NRC features:

  • Clinically organized quick lessons
  • Evidence-based care sheets
  • Nursing skills and skill competency checklists
  • Continuing education modules
  • Point-of-care drug information
  • Patient education
  • Best practice guidelines
  • Detailed medical illustrations
  • The latest medical news
  • Legal cases
  • Research instruments
  • Unique point-of-care reference books
  • And more...

When clinical questions arise nurses require immediate access to the information necessary to perform the task’s safely. Quick lessons and Evidence-Based Care Sheets provide a synthesis of evidence in a concise manner. Quick Lessons are documents that represent the best available evidence organized clinically to provide the staff nurse with overviews on diseases and conditions. These documents provide information about diseases including

  • Description of the disease
  • Its signs and symptoms
  • Typical tests the clinician will order to diagnose, or measure progress
  • Interventions nurses will likely be involved in while the patient is in their care

Nurses easily can search the entire database by entering a few keywords in the find field and then clicking on the Search button. The NRC database will display a result list sorted by source type. Tabs are easily accessible on top of the search box for easy access to specific documents such as, Quick Lessons, Skills, Evidence-Based Care Sheets, Drugs, etc. An example of an evidence based care sheet on abdominal compartment syndrome is provided in Appendix NK6-A

EBSCO Nursing Reference Center - Quick Lessons

       

When a clinical question arises and the staff nurse wants to evaluate research findings related to the question, Evidence-Based Care Sheets are available. This document provides an evidence-based summary that was developed via a rigorous systematic process on the topic of interest. The summary is coded with the strengths of the evidence provided so the nurse can evaluate it and determine its applicability to practice.

EBSCO Nursing Reference Center - Evidence Based Care Sheets

An example of an evidence based care sheet on developmental Care Newborn is provided in Appendix NK6-B

The NRC and CINAHL database provided by EBSCO are valuable resources that empowers nurses to provide excellence in clinical practice while fostering new ideas and innovation in practice. In order to increase the usage of these databases education regarding NRC and CINAHL is provided during registered nurse orientation and ongoing through out the year (Appendix NK6-C). In addition, all Nursing Research council members are super users and provide support as needed to nursing staff. The below graphs demonstrate that usage of these databases are on the rise as nurses continue to evaluate existing practice based on evidence.

EBSCO Database Searches 2010

EBSCO Database Usage Report Totals 2010-2011

“ The Nursing Reference Center” is a great resource, It helps me to provide better care to my patients. I can access it easily whenever I need more information about a disease or want to refresh my knowledge about a procedure” Marie Jean BSN, RN - Staff Nurse 7W

“ I use the Nursing Reference Center frequently to provide evidence based educaton to my patients. I use this resource because I know that it is current, easy to read, and is availlable in English and Spanish”. Babitha Babu BSN, RN – Staff Nurse 5W

“The nursing reference center is a valuable resource, I use it when I want to evaluate something I am doing in practice to make sure it is based on the best evidence available” – Donna Heil-Kearney BSN, RN – Staff Nurse Cardiac Step-down

“I use databases very frequenlty, the ones I use the most are Clinical Pharmacology, CINAHL, and the Nursing Reference Center” – Leah De La Cuadra BSN, RN – Staff Nurse ICU

An example of nursing practice changed through the ongoing evaluating of evidence can be seen in the NICU. Greater than 450 babies are admitted to the NICU each year. These premature babies can be as early as 24 week gestation and can weigh as little as 567 grams. These low weight infants require meticulous and diligent around the clock nursing and medical care. The needs of these infants pose a challenging situation for both the baby and the parents. Growing research has demonstrated that the nursing care delivered early on can have lasting outcomes on the baby's life. Nurse Manager Tara Mazzone BSN, RN, and Clinical Educator Michelle Dickerson MSN-ED, RN, NEA-NIC examined the literature regarding the importance of providing developmental care and its impact on the developing nervous system of the premature infant. The literature suggest that children who spend time in the neonatal intensive care unit (NICU) are at risk for long-term complications such as learning difficulties, behavior problems and sensory deficits, believed to result from the impact of the NICU environment.

Tarra Mazzone MSN, RN, NEA-NIC and Rosanna Vales BSN, RN presenting a poster presentation regarding Kangaroo Care at the 2012 Nursing Research Fun Fair
 Tarra Mazzone MSN, RN, NEA-NIC and Rosanna Vales BSN, RN presenting a poster presentation regarding Kangaroo Care at the 2012 Nursing Research Fun Fair  

Armed with this evidence the NICU leadership team implemented a plan to focus on developmental care for the neonates. They increased awareness by educating the nursing staff about developmental care of the new born and how it can positively impact the neurological or neurobehavioral development of infants. This knowledge assisted staff nurses when assessing their patients’ personal characteristics and needs. As discussed previously in TL7, A “Preemie for the day” training course was provided to staff members, to simulate the experience of infants in the NICU environment as compared to infants in a developmentally supportive NICU. This program was successful because it increased awareness and established a sense of urgency amongst the staff.

The nurses in the NICU provide developmental care based on current evidence by implementing an individualized plan of care for their patients. They promote family participation in the care of infants and assist parents in nurturing their infants according to best practices. In order to increase family participation and patient outcomes the NICU staff have adopted many techniques such as positioning, comfort measures, minimizing noxious stimuli, and Kangaroo care (skin to skin contact). In addition, a developmental care committee comprised of staff nurses was initiated. This committee evaluates best practices on developmental care and tackles developmental issues such as cycle lighting and unit traffic noise as well as specific issues, such as promoting skin-to-skin contact and decreasing barriers that may exist. Establishing and accomplishing these goals is an ongoing process and the committee will continue to address them using research findings and best practices

Journal Clubs

Another example of how nursing staff evaluate nursing practice based on evidence is through the use of journal clubs. Journal clubs at JCMC assist nursing staff and leaders to stay current with published research and enhance their ability to critically appraise research articles. It is an excellent forum for nursing staff to address clinical issues and foster the application of best practice. Relevant journal articles are selected by staff nurses for discussion and evaluation. The articles are distributed to the nursing staff on the unit at least one week prior to the scheduled meeting. A staff nurse moderates the journal club session and generates discussions among the group. The dialogue amongst the nurses generates interest in probing the available evidence and its applicability to their practice and patients on their unit.

For example the NICU has a very active Journal Club chaired by Jocelyn DellaCruz-Torres BSN, RN, RNC-NIC and co-chaired by Jessica Chineme BSN, RN.

For more information on the Joint Academic-Joint Leadership Journal Club please refer to SE5

Adverse Events Team

Another structure for evaluating existing nursing practice is through the adverse events team as discussed in SE1. This team often refers to current research findings and best practices to determine if a break in the standards of practice occurred and to implement strategies that promote safe and quality care. An action plan grounded in evidence based practice is implemented after every root-cause analysis to improve the process and prevent future occurrences. This action plan frequently results in policy developments and changes

Policy Development and Review

Evidence based findings is the core of nursing practice. Policies and Procedures are developed and updated regularly to ensure that nurses deliver care grounded on current research findings and evidence based practice. All policies must contain current references from peer reviewed journals published within the last five years maximum. All policies are presented to the Professional Practice Committee for review and approval by the nursing staff prior to submission to the Policy Committee. The Policy Committee composed of nursing leaders evaluates each policy to determine if the best available evidence, nursing expertise, and patient and community values and preferences are considered.

Policy Development and Review

The Policy Committee Members Include:

Policy Committee Members

An example of existing nursing practice that was change as a result of the adverse events team and the policy committee was the evaluation and guideline revisions regarding the flexible fecal incontinence management system. An adverse event in the critical care units occurred due to the long term use of this catheter. This event led to a review of literature on the following:

  • Guidance on skin care and use of the products
  • Indications and contraindications regarding use of device
  • Resources and training needed to insert and remove device

Mabel LaForgia MSN, RN, CCRN was assigned the task of updating the Fecal Management Guideline to reflect best practices and to include additional safety measures (Reference NK6-A). She presented the updated guidelines to the Nursing Quality and Safety Council, Professional Practice Council, and critical care committee for dissemination of the evidence and to gather input from nursing and the interdisciplinary team regarding the new proposed process (Appendix NK6-D). Once the guideline was finalized and approval was granted by the policy committee (Appendix NK6-E), educational sessions were provided to the critical care staff. To view a sample sign-in sheets and a flyer of the educational session, refer to Appendix NK6-F and Appendix NK6-G. Evaluating the literature and making changes to the guideline based on this evidence, assisted in improving the delivery of safe care and reduced the reoccurrence of a future adverse event.