Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective ...psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost.
This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory CMAI), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version NPI-NH), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale QUIS), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group.
These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting.
ISRCTN Registry ISRCTN62237498.
Background
Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence‐based practice (EBP). An ...educational intervention on EBP was implemented to promote emergency nurses’ use of EBP, and the effectiveness of it was evaluated.
Aims
This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses’ EBP attitudes, knowledge, self‐efficacy, skills, and behavior. The study also examined learners’ satisfaction with the EBP educational intervention.
Methods
A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12 months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N = 40) received EBP education while the control group (N = 40) completed self‐directed EBP education. The primary outcomes were emergency nurses’ EBP attitudes, knowledge, self‐efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education.
Results
Thirty‐five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p < .05) improvements and differences between groups in EBP attitude, self‐efficacy, or behavior immediately after the EBP education. At the 6‐month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self‐efficacy than the control group. At the 12‐month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions.
Linking Evidence to Action
The EBP educational intervention implemented in this study had a positive effect on emergency nurses’ EBP attitudes, knowledge, self‐efficacy, skills, and behavior. The effects of the education appeared the best 6 months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self‐efficacy, skills, behavior, and satisfaction with the education.
Background
Implementation of evidence‐based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses ...and clinicians across the country.
Aim
The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid‐level Leader, and Direct Care Nurse) attending a 5‐day EBP continuing education skill‐building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative.
Methods
A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System‐Wide Implementation of Evidence‐Based Practice, Evidence‐Based Practice Beliefs, Evidence‐Based Practice Implementation, and Evidence‐Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year.
Results
Participants’ EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12 months.
Linking Evidence to Action
A team‐based EBP skill‐building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.
American health care is facing unprecedented challenges due to population aging, chronic disease prevalence, and financial restructuring. The Affordable Care Act (ACA) is transforming the primary ...care landscape from a reactive, episodic, fee-for-service system to a proactive, preventive, value-based system. A proactive, preventive, and value-based primary care model requires Registered Nurses (RNs) prepared to lead integrated, team-based, coordinated, and proactively managed care. The Health Resources and Service Administration (HRSA) forecasted an inadequate supply of RNs prepared to meet future primary care demands and highlighted the lack of education as a key problem. The primary care RN workforce shortage requires immediate attention by academic, political, and research stakeholders. HRSA has responded with academic funding to increase primary care RN education.
This article describes key barriers and resolutions one HRSA-funded academic institution experienced while implementing a primary care RN education program, along with research implications for the future of primary care nursing.
This article describes the project's stakeholder, faculty, and student engagement methods. This article also describes the clinic RN preceptor development program, and depicts the Primary Care RN Education Program Student Clinical Experience Preceptorship Model.
Nursing education must align with transforming healthcare models while anticipating potential barriers and resolutions to enhancing curriculum with primary care nursing education and clinical experiences. This article provides insight for other academic institutions interested in developing primary care curriculum and academic-clinic partnership models to foster community-based primary care clinical experiences.
Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. ...Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin’s thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.
The purpose of this study was to develop and evaluate the effectiveness of a quick response code-based nursing education program to improve the competence of operation and recovery room nurses. An ...experimental methodological design was used to develop a quick response code-based nursing educational program and analyze its effects and nurses' satisfaction with its use. The quick response code-based nursing education program was developed in five steps based on the ADDIE model: analysis, design, development, implementation, and evaluation. The program was built on smartphones, and a Web site was linked to it. After testing the program for 40 days, nurses' attitudes toward various medical devices were significantly less negative. Nurses were able to use a large number of medical devices and were highly satisfied and willing to engage with the quick response code-based nursing educational program. In the context of nursing education, introducing educational content using quick response codes helps to improve nurses' knowledge and competence in providing high-quality nursing care and medical services.
In July 2007, the Neonatal Cardiopulmonary Resuscitation (NCPR) program in Japan was launched to ensure that all staff involved in perinatal and neonatal medicine can learn and practice NCPR based on ...the Consensus on Science with Treatment Recommendations developed by the International Liaison Committee on Resuscitation. In 1978 in North America, a working group on pediatric resuscitation was formed by the American Heart Association Emergency Cardiac Care Committee and concluded that the resuscitation of newborns required a different strategy than the resuscitation of adults. The original first edition of the Neonatal Resuscitation Program textbook was published in 1987. The NCPR program consists of three courses for health-care providers and two courses for instructors. A course and B course are for newly certified health-care providers and course S is for health-care providers who are renewing their certification. As of 31 March 2019, 3,227 advanced instructors (I instructor) and 1,877 basic instructors (J instructor) were trained to teach A, B, and S courses to health-care providers on the basis of their license. In total 7,075 A courses and 4,012 B courses were held; 131 651 people attended A course or B course of the NCPR program, and 77 367 were certified. A total of 1,865 S courses, which were developed in 2015, were held and 12 875 people attended this course. Here, we introduce the background, purpose, history, and content of the development of the NCPR program in Japan.
ABSTRACT
Background
Multiple reasons are cited for why nurses do not incorporate evidence into clinical practice, including lack of knowledge and skills, training, time, and organizational support.
...Aims
To investigate the effectiveness of a mentor training program on mentors’ perceptions of knowledge, attitude, skill, and confidence levels, and organizational readiness related to evidence‐based practice (EBP) and research utilization; and to investigate the effectiveness of creating a formalized structure to enculturate EBP in order to prepare nurses to incorporate EBP into clinical practice on nurses’ perceptions of knowledge, attitude, skill levels, barriers, nursing leadership, and organizational support related to EBP and research utilization.
Methods
A two‐group pretest–posttest quasi‐experimental, interventional design was used. A convenience sample of 66 mentors and 367 nurses working at a five hospital integrated healthcare system located in the Southeastern United States participated.
Findings
Nurse mentors’ knowledge, attitude, skill level, and organizational readiness related to EBP, t = −8.64, p < .001, and confidence, t = −6.36, p < .001, improved after training. Nurses’ knowledge, attitude, and skill level related to EBP, t = −19.12, p < .001, and barriers to research utilization, t = 20.86, p < .001, EBP work environment t = −20.18, p < .001, and EBP nurse leadership, t = −16.50, p < .001, improved after a formalized structure was implemented.
Linking Evidence to Action
EBP mentors are effective in educating and supporting nurses in evidence‐based care. Leaders should use a multifaceted approach to build and sustain EBP, including developing a critical mass of EBP mentors to work with point of care staff.
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