to identify, using predefined criteria, the best quantitative and qualitative original and review articles on the meaning, cause, course, assessment, prevention, treatment, or economics of health problems managed by nurses and on quality improvement
to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant
to disseminate the summaries in a timely fashion to nurses
The RCN Publishing Company Limited and the BMJ Publishing Group publish Evidence-Based Nursing.
Another concern is that when a report on substandard nursing care is published, nurse education always seems to be blamed for being too academic and not linking theory to practice sufficiently. I am not saying that education does not have a role to play but nursing students in the UK spend 50% of their time in practice. Clinical colleagues have to be held responsible for poor practice too.
Evidence...]]>
Statistical probability or p values reveal whether the findings in a research study are statistically significant, meaning that the findings are unlikely to have occurred by chance. To understand the p value concept, it is important to understand its relationship with the α level. Before conducting a study, researchers specify the α level which is most often set at 0.05 (5%). This conventional level was based on the writings of Sir Ronald Fisher, an...]]>
The study findings that motivational interviewing improves mood and reduces mortality a year after acute stroke should inform clinical practice guidelines. More trial data are needed to examine factors such as whether frequency of motivational interviewing sessions is more important than time frame, whether there are differences in therapist effects and whether there are differences using a training and supervision manual when applying motivational interviewing. More research is needed to explore the mechanisms by which motivational interviewing is effective and how it influences mood and survival.
Depression is common after a stroke, and, if it occurs early, it can inhibit recovery as depressed patients often lack motivation to participate in rehabilitation and leisure and social activities. Psychological treatments, if initiated early poststroke, are more likely to prevent and/or treat depression.
Motivational interviewing is...]]>
Critical care nurses are more likely to recommend intensive end-of-life (EOL) care compared with physicians who routinely work in critical care settings. Patients with advanced age, comorbidity and limited functional status are less likely to use technologically intensive EOL care.
Further evaluation of the complex interactions of factors associated with critically ill patients, family members and healthcare professionals are needed to guide the development of decision support strategies at EOL. Novel decision support strategies should consider tailored approaches to overcome patient and healthcare professional factors and facilitate informed decision-making at EOL.
Despite the intense use of technology and aggressive medical care, intensive care units are common places of EOL decision-making and death.
Nurses need to pay attention to the well-being of partners of men who have myocardial infarcts. Nurses need to explore the effect of a myocardial infarction on the relationship dynamics for example, communication patterns and intimacy. Further research should quantify how relationships change post infarct, over and above the effect on sexual intimacy.
Women play a significant role in recovery after a heart attack of their male partners.
The increased risk of type 2 diabetes mellitus (T2DM) in obese children and adults is well-established, but it is not clear if the age of onset or the duration of obesity is an independent risk factor for T2DM in adults. Adults with obesity since childhood or young adulthood had the highest body mass index (BMIs) and the greatest risk of T2DM. Non-obese adults who were obese children had an increased risk of elevated HbA1c, suggesting that childhood obesity may be an independent risk factor for T2DM in adulthood.
Obesity has become the most common health problem of children and adults in the developed world. Obesity rates in the USA have levelled off as of 2008, with a prevalence of 32.2% among men, 35.5% among women,
Patients with severe pain are found in all clinical settings; The use of pain assessment tools by nurses is generally poor; The use of a pain assessment tool is a means of involving patients in their pain management; Patients' satisfaction with involvement in their pain management is an area worthy of further research.
Pain assessment, using an appropriate assessment tool, is a quality of marker
Wadensten et al...]]>
The internet can deliver some elements of multidisciplinary pain care to patients (and clinical practices) where such services are desired but often unavailable. Cognitive-behavioural therapy (CBT) is a non-pharmacological intervention for pain that appears in this study to have the greatest number of high-quality studies supporting its use over the internet as a means of decreasing pain, improving functional status and decreasing treatment costs. The effects of internet-delivered CBT appear comparable with those of more traditional face-to-face treatment delivery, although none of the studies reviewed made this direct comparison.
Pharmacological pain treatments and interventional pain treatments (ie, injection therapies and surgery) are common approaches to chronic pain management. A large empirical literature supports other non-pharmacological interventions such as CBT, behavioural therapy and exercise modalities. These less costly interventions are less common in routine practice...]]>
Patient concerns and beliefs about medication are associated with overuse and underuse of medication. Identifying and addressing these concerns may improve adherence. Further research is needed to examine whether training of healthcare practitioners (including nurses) has an effect on patients' concerns and medication adherence.
Chronic non-malignant pain is a long-lasting condition, with a complex pathophysiology, often accompanied with dysfunctional pain behaviour. Chronic pain affects about 19% of the population in Europe.
Previous attempts to reduce teenage pregnancy have rarely been theory-based and showed limited success. Simple and inexpensive implementation intention interventions in family planning settings appear to have positive effects on consultations for emergency contraception, pregnancy testing and contraceptive supplies. More research is needed to strengthen the evidence base for sustainable implementation intention effects and how this affects pregnancy rates.
Cost-effective, scalable and evidence-based strategies to reduce teenage pregnancy in the UK are currently not available.
Peer-led programmes appear to be beneficial for adolescent with asthma. Boys appeared to benefit more from the programme as did those with low-socioeconomic status and non-white participants. Wider use should be made of developmentally appropriate adolescent peer-led education programmes inside and outside the school in improving important health outcomes. Further research is needed to evaluate the effectiveness of such programmes over a longer period of time to confirm their sustainability and cost benefit. Research is needed to further investigate the differences noted in this study in relation to gender, socioeconomic status and race.
Asthma is one of the most common chronic diseases among adolescents
In children presenting with vomiting from acute gastroenteritis, ondansetron is a reasonable therapy to allow for successful oral rehydration. Further research on ondansetron and rehydration should investigate the effects of different dosing regimens, time to cessation of vomiting after antiemetic administration, as well as a cost-effectiveness analysis.
Acute gastroenteritis (AGE) is a common reason for a child to require emergency care and hospitalisation. In children under the age of 5 years, dehydration secondary to AGE is responsible for as many as 200 000 hospitalisations in the USA and 24 000 in the UK each year.
In the paediatric population, vomiting is a common presentation of AGE. The mainstay of therapy for AGE is oral rehydration; continued vomiting is a significant barrier to successful rehydration. Traditionally, administration of antiemetics (particularly the older...]]>
Nurses need to understand the importance of iodine for normal thyroid physiology. Nurses need to be aware that teenage schoolgirls may have some degree of iodine deficiency and, if this is the case, provide appropriate dietary advice. Further research is needed to test the relationship of urine iodine levels to clinical outcome measures such as thyroid size measured as total goiter prevalence. Future studies should examine at population outcome measures of thyroid function and size.
Iodine is an essential micronutrient for the production of thyroid hormones. In states of low-iodine intake, the thyroid gland undergoes adaptive changes to conserve and increase uptake of iodine to maintain thyroid hormone production. This is clinically evident in mild states of iodine deficiency such as thyroid enlargement or goiter.
Interventions that include patient tracking, reminder/recall and home visits can improve adolescent immunisation rates and preventive care visit rates. Implementation of interventions aimed at immunisations and preventive care are needed to enhance adolescent care. Research in development and implementation of programmes on a local, regional and national level are needed to address adolescent immunisation rates and preventive care.
Interventions that increase adolescent immunisation rates and preventive care visits are needed. This is demonstrated by data relating to vaccination coverage in the USA for the meningococcus (62.7%), pertussis vaccine (68.7%) and papilloma virus (32%; three doses for adolescent females).
Consistent and valid prenatal screening methods are necessary to document accurate exposure rates to second hand smoke (SHS). Preconceptual parental education regarding the effects of prenatal exposure to SHS could contribute to a reduction in adverse perinatal outcomes. Future research should consider using biochemical markers to determine exposure.
The science is clear that maternal tobacco use during pregnancy has adverse effects on acute and long-term perinatal outcomes. However, evidence regarding outcomes of prenatal SHS exposure is less clear. This study aims to evaluate the effects of SHS on a multitude of perinatal outcomes in women in Atlantic Canada.
Crane et al retrospectively analysed results from a large cohort (n=11 852) of pregnant women using a computerised database to evaluate prenatal SHS exposure on select outcomes. Non-smoking women with singleton gestation were...]]>
The results of this study suggest there is a need to: Monitor women's prepregnant body mass index (BMI). Educate pregnant women about the importance of appropriate weight gain. Prospective studies are needed to identify those factors that impact on gestational weight gain. Longitudinal studies are needed to follow the developmental trajectories of children born to mothers who experience gestational weight loss.
There is a need to define what constitutes adequate weight gain during pregnancy. Paramount to this discussion is the effect of weight gain or loss not only on maternal health but also on the child's short- and long-term health. This is particularly important because of the increasing numbers of pregnant women who are obese; approximately one in five women are obese at the time of their pregnancy.
Researchers who...]]>
The paper's findings align with previous evidence establishing a link between levels of nurse staffing and patient outcomes, and are important for policy makers and other stakeholders to consider. Future evaluations should include all patients who may have been impacted by such policies, and use more rigorous methods to investigate a possible causal link between the policy and those outcomes.
Research has indicated that nurse staffing levels are often related to patient outcomes and this has led some to propose that staffing levels should be set at a statutory minimum; it is not clear, however, whether such policies are effective. Ongoing monitoring and evaluation of policies and practices are essential to the efficiency of healthcare planning and service delivery. An investigation of the impact of the nursing hours per patient day (NHPPD) staffing policy following its...]]>
The study adds to the small evidence base that having more nurses with baccalaureate education and certification is associated with improved patient outcomes (30-day mortality and failure to rescue (death after complications)). More studies are needed to determine the best types of certification and actual practice changes associated with certification.
Certification of staff nurses by accrediting bodies and specialty organisations' attempts to recognise those who have developed expertise in particular areas. While the term certification is also used for advanced nurse practitioners and clinical nurse specialists; this study and commentary only address certification of non-advanced practice nurses. In the USA, certification is offered in 11 areas (not advanced practice) by the American Nurses Credentialing Center (http://www.nursecredentialing.org/Certification.aspx). Further, certification in specialty areas is offered by at least 13 specialty groups (
While there...]]>
Advanced practice nurses (APNs) can play a critical role in facilitating evidence-based practice (EBP). Knowledge brokering (KB) is a key aspect of the APN role which can be leveraged to promote EBP. KB requires specific knowledge and skills. The effect of APNs on EBP implementation by clinical (staff) nurses and on clinical outcomes needs further exploration/measurement.
The barriers and organisational constraints related to EBP have been well described.
Two sessions of dietary portfolio counselling regarding cholesterol-lowering foods can result in a 13% reduction in low-density lipoprotein (LDL) cholesterol. Nurses can easily incorporate advice about cholesterol-lowering foods when counselling patients who require LDL cholesterol reduction. Future studies can determine if advice by nurses on dietary portfolio components can help patients achieve lower LDL cholesterol.
A heart-healthy lifestyle is the cornerstone of primary prevention of cardiovascular disease (CVD). Although conventional dietary advice has proven inferior to statin therapy for lowering serum cholesterol, studies show when certain foods are consumed in combination (dietary portfolio), serum LDL cholesterol (LDL-C) is reduced to a similar degree as first-generation statins.
Delirium is common in long-term care and was associated with physical restraint use in this study, which may worsen mental status and increase falls. Nurses should carefully consider the trigger for behaviours that lead to the use of restraints (untreated delirium, pain or misinterpretation of stimuli) and attempt to manage these behaviours without chemical or physical restraints. More research is needed to better measure environmental factors associated with delirium superimposed on dementia (DSD).
Delirium occurs frequently in older adults and leads to poor outcomes including increased death, higher costs and increased nursing care.
Nurses frequently...]]>
Quality of care in residential facilities is improved when multidisciplinary integrated care is implemented; Further research should focus on identifying which elements of multidisciplinary integrated care are most effective in improving residents' quality of care and quality of life; Future studies should focus on comparing different packages of multidisciplinary integrated care with each other and on evaluating the effectiveness of such packages in different populations including older people with and without chronic illness.
Approximately 10% of Dutch older people aged 75+ live in residential care settings (Boorsma et al).These settings were established to provide ‘sheltered living’ to relatively healthy older people (Boorsma et al). However the profile of older people living in these facilities is changing. Residents are older, have multiple chronic illnesses and more complex healthcare needs (Boorsma et al). Staffing expertise and levels were not intended to meet...]]>
Implications for nursing practice of this research: Malnutrition is not restricted to institutionalised older people with cognitive impairment. Those with cognitive impairment living in regular housing also have an increased risk of malnutrition. Impaired cognitive ability rather than impaired functional ability is associated with malnutrition regardless of housing and living arrangement. Moderate or severe cognitive impairment is associated with malnutrition rather than mild cognitive impairment.
Implications for nursing research in the light of this study: Research to clarify the complex cause-effect relationship between environmental factors and malnutrition needs much larger study populations. Malnutrition should be more precisely defined and measured with a validated tool. Home should be a safe and protective environment for older people therefore, more research should be dedicated to the nutritional status of people with different types and grades...]]>
Rapid assessment of patients with potential stroke is imperative for triage nurses. The Recognition of Stroke in the Emergency Room (ROSIER) scale may help triage nurses rapidly recognise stroke and differentiate between potential stroke and common stroke mimics. The following guidelines are recommended for patients with ischaemic stroke Administration of recombinant tissue plasminogen activator (rt-PA) within 3 h of ischaemic stroke and up to 4.5 h in a select subgroup of patients. Evaluation of stroke symptoms by a physician within 10 min of arrival. Door-to-initiation of rt-PA in 60 min or less for stroke.
A major barrier to worldwide use of thrombolytic therapy is a lack of stroke recognition.