This is a graded discussion: 50 points possible
Hi Class,
- CO4 Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO 4)
Your capstone change project begins this week when you identify a practice issue that you believe needs to change. The practice issue must pertain to a systematic review that you must choose from a List of Approved Systematic Reviews for the capstone project, whose link may be found in the guidelines for the Week 3 Capstone Project: Milestone 1 assignment page.
- Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
- Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
- Relate how you developed the question.
- Describe the importance of this question to your clinical practice previously, currently, or in the future.
- Describe what a research-practice gap is.
Scott
As an Occupational Health Nurse, our role as described by The American Association of Occupational Health Nurses (2016) is to provide for and delivers health and safety programs and services to workers, worker populations, and community groups. The focus is on promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards. So, promoting health and wellness is important in ensuring a healthy worker population. For the capstone project, I have selected this article about promoting healthy pregnancy with diet and exercise – Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. on Diet or exercise, or both, for preventing excessive weight gain in pregnancy.
My PICO question would be,
Among pregnant women, does implementing a healthy diet and exercise, as compared to not implementing health diet and exercise, help to reduce excessive gestational weight gain (GWG)?
P – Pregnant women
I – include healthy diet and exercise during pregnancy
C – Nonhealthy diet and no exercise
O – reduce excessive gestational weight gain (GWG)
I have encountered many pregnant employees, that have come to our clinic that are not aware of the “Healthy Pregnancies, Healthy Babies” program offered by our organization. This program is available to all benefitted employees, the program involves health coaching, free prenatal vitamins, and up to $250 cash incentives. When asked about their pregnancy, a large majority of these women has not considered a change in their diet or importance of exercise during their pregnancy. Most women would increase the amount of food intake but not consider the health risk or benefit from the type of food consumed. I would educate the employee of the importance of eating a healthy diet and exercising to maintain a healthy pregnancy weight to prevent pregnancy complications.
A research-practice gap is defined as insufficient or imprecise information, biased information, inconsistency and, or incorrect information from wrong population or wrong outcome in the ability to reaching a conclusion for a research (Carey, Yon, Beadles & Wines, n.d).
References:
American Association of Occupational Health Nurses ( 2016). Retrieved from http://aaohn.org (Links to an external site.)
Carey, T., Yon, A., Beadles, C. &Wines, R. (n.d). Identifying and Prioritizing Research Gaps. The Cecil G. Sheps Center For Health Services Research. Retrieved from https://www.pcori.org/assets/Identifying-and-Prioritizing-Research-Gaps1.pdf (Links to an external site.)
Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.
“Healthcare-associated infections (HAIs) are a major threat to patient safety and are associated with mortality rates varying from 5% to 35%” (Flodgren,2013) One of the most prolific is the CAUTI. Many of the long-term catheters placed in my hospital start in the ED. Truthfully, not one of the most aseptic environments in the hospital. We were always hearing about the CAUTI rate and how bad it was. The sterile technique was more of a good idea than actual practice. Between stroke scales, CT, two large bore iv’s above the wrist, titrating drips and TPA, ect…, oh crap, the patient in two is seizing again, somebody get a cath in room four before we roll for the OR!! The focus is strictly on stabilizing, worry about the possible UTI after we save the guys life, in other words, just get it in now! A couple of years ago we started bringing ICU nurses into the ED to care for the ICU patients once they were stable. We started to learn about how a patient could be lost, after we saved their life. They wanted to teach, and we were eager learn. As the patient was stabilized the ICU nurse would come in and slowly take over, showing us how to do things in ways we never had before. Many times, a patient that would just get an indwelling cath, now will get an alternative. Our nurses were being rabid about maintaining a sterile field. The overall CAUTI infection rate dropped. Times change, staff changes, hospital programs change, without that constant highly trained advocate there reminding us of the long term real consequences and constantly helping us improve our game, the CAUTI rate is climbing again. All our nurses are very well trained, they are also very overworked. When multiple critical patients are inbound, the pressure to clear the recess rooms can be enormous.
For my capstone project I have selected the article Interventions to improve professional adherence to guidelines for prevention of device-related infections. (Flodgren 2013) Specifically, devices placed in ED patients admitted to the hospital. My question is,
Among ED patients admitted to the hospital, does having a specially trained nurse advocate on the unit, compared to current individual practice and training, reduce hospital acquired catheter infections?
The research- practice gap is clear, while we know what is important, is not always placed at the top of the list because the consequences, while understood clinically, are in the future, therefore easy to be ignored today. “One nurse with accountability for implementing a simple evidence-based protocol can dramatically decrease the total incidence of hospital-acquired CAUTI.” (Quinn, 2015) If we place a nurse champion in the action, with the responsibility, holding everyone accountable in the moment, at the beginning in the ED, I suspect their influence can decrease these device related infections and help narrow the research- practice gap.
References
Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. The Cochrane Database Of Systematic Reviews, (3), CD006559. doi:10.1002/14651858.CD006559.pub2
Quinn P. Chasing Zero: A Nurse-Driven Process For Catheter-Associated Urinary Tract Infection Reduction in a Community Hospital. Nursing Economic$ [serial online]. November 2015;33(6):320-325. Available from: Academic Search Complete, Ipswich, MA. Accessed March 5, 2018.
Hey Guy,
You did a very job with your clinical question. You are good to go with the next steps of your project! 🙂
Scott
Great post. HAI’s are definitely a big threat to our patient’s safety, and with patient safety being one of our top priorities it’s a must we try and reduce the number of HAI’s. I enjoyed reading your post from the standpoint of an ER nurse. Your honesty about how things are really done down there opened the eye to other nurses on how aeseptic technique isn’t always used at its best. I have only been a nurse for two years, and I only have worked med surg, so it’s quite interesting to see your point of view. I now have a better understanding. Good job!
Kierra
Your project seems interesting. I am similarly working on reducing CAUTI’s in my area of work. Nurse-driven evidence-based practice processes are of utmost importance in improving patient care outcomes. However, nurse compliance to the implemented care bundles remains an obstacle that leads to hospital-acquired infections (HAI’s), a National Patient Safety Goal of Joint Commission, (Woten et al, 2017).
I suggest that rotation within the business and finance departments should be part of our mandatory nursing training. We all need to realize that without hospital reimbursement, there will be no money for raises, equipment purchase or repair, (Rau, 2015). It is just like paying the bills at home, if the children never see the actual amount of the bills and your take-home pay, they will never grasp the concept of the value of your dollar. Good job Guy.
Marlene.
References
Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/
Woten, M. B., & Mennella, H. A. (2017). National Patient Safety Goals (Joint Commission, 2016): Limiting Use and Duration of Indwelling Urinary. CINAHL Nursing Guide.
For instance, there exist many researches that suggest possible solutions towards addressing HAI, but in practice these solutions may not be effectively implemented either caused by relevance in the modern setting, or lack of knowledge being passed on clinical practitioners. The research-practice gap greatly undermines research efforts to solve clinical solutions.
Charlyne
Does developing and implementing a multifaceted intervention bundle help lower the instance of central-line-associated bloodstream infections?
Our CLABSI bundle involves having to dawn mask, headgear, gown, and sterile gloves when having to access a central line which is a big addition to the hospital’s policy when accessing central lines. The main reason for this is because our unit policy is to give back the patients waste when drawing from the central line. In other units, the nurses are not allowed to give back the waste without having an MD order. But since their CLABSI rates are higher would implementing our bundle decrease their infection rates?
A research-practice gap is an area in which there is missing and/or insufficient information that makes it impossible to come up with a solid conclusion to a question.
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.
Hong, A. L., Sawyer, M. D., Shore, A., Winters, B. D., Masuga, M., Lee, H., & … Lubomski, L. H. (2013). Decreasing Central-Line-Associated Bloodstream Infections in Connecticut Intensive Care Units. Journal For Healthcare Quality: Promoting Excellence In Healthcare, 35(5), 78-87. doi:10.1111/j.1945-1474.2012.00210.x
Among PICU patients, does implementing a multifaceted evidence based CLABSI bundle, as compared to the current practice, help to decrease the rate of CLABSIs?
How does that sound?
That revised question sounds a whole lot better.
Thank you.
Working with oncology patients does expose this patient population more at risk for infection due to myelosuppression. Most of the oncology patient that are currently receiving treatment does have an implanted port to use for treatment. In my previous healthcare organization that I worked, accessing port was part of the routine, nurses had to be train and utilized aseptic technique.
My PICO question would be:
Does adhering to strict clinical interventions such as utilizing strict aseptic techniques (the use of gown, using alcohol based to cover tip and bio patch dressing containing chlorohexidine–central line bundle), reducing the duration of time using CVC and education training in preventing infection reduces the incidence of HAI in outpatient setting?
P- Outpatient oncology patients with central line.
I- Utilizing clinical interventions
C- Not utilizing clinical interventions
O- The rate of HAI in outpatient oncology patient
It is important to consider EBP and utilized information and applied it to our practice to effectively care for the patient with best possible outcome. This topic is important because from EBP, nurses can learn what has been proven to work to prevent infection from HAI. With oncology patient it is imperative that we prevent any type of infection because this patient population is already vulnerable and cannot afford to be sicker from HAI. “cases may be preventable if current evidence-based strategies of infection prevention are used during the insertion and maintenance of invasive devices “(Umscheid 2011).
Research gap practice is when information that has been research is not disseminated. It is imperative that in research information that has been founded to be effective will be available. “The use of a range of communications industry techniques was vital in establishing effective communication channels to share interim and final research findings. The benefits of using a selection of key techniques is examined and recommendations are made that could help other researchers capitalize on professional communication approaches to help ensure the impact of their work is fully realized” (Hewison et all, 2016).
Kristine
Reference:
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.
Hewison, A., & Rowan, L. (2016). Bridging the research-practice gap. British Journal Of Healthcare Management, 22(4), 208-210. doi:10.12968/bjhc.2016.22.4.208
https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114796811&site=ehost-live&scope=site
Great job Kristine! I do have a couple of suggestions. Include your population just as you have it in your P section. Also, you may want to narrow your focus a little more with your implementation. Or you may could just use the word bundle to sum it up. For instance:
Among oncology patients with central lines, does the implementation of an evidence based CLABSI bundle, as compared to not using a bundle, help to decrease the rate of CLABSIs?
Does that make sense?
Scott
For pregnant women, Will making a lifestyle change when it comes to diet and exercise vs not making any diet/exercise lifestyle changes, prevent gestational diabetes?
P- (Patient, population, or problem): Pregnant women
I- (Intervention): Diet and exercise
C- (Comparison with other treatment/current practice): No exercise or diet changes
O- (Desired outcome): Gestational diabetes prevention
A research gap is a missing piece of research, it the part of the research that hasn’t been explained or explored and without that information a conclusion cannot be made.
References
Framework for identifying research gaps | Resource Details | National Collaborating Centre for Methods and Tools. (n.d.). Retrieved March 06, 2018, from http://www.nccmt.ca/knowledge-repositories/search/118
Koivusalo, S. B., Rono, K., Klemetti, M. M., Roine, R. P., Lindstrom, J., Erkkola, M., & … Pöyhönen-Alho, M. (2016). Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care, 39(1), 24-30. doi:10.2337/dc15-0511
Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.
Among pregnant women, will making a lifestyle change when it comes to diet and exercise, as compared to not making any diet and exercise lifestyle changes, help to decrease the incidence of gestational diabetes?
Scott
Yes, Professor O’Quinn. That does sound much better, Thank you for all of your help and guidance.
Scott
Wow, a 11lb 6 oz baby! That is huge. The mother must have been quite uncomfortable carrying a baby that size. Anyway, I agree there are pregnant women that are not concern about their weight and uses pregnancy as an excuse to eat anything they want but not realizing the effects it has on their unborn baby. Eating a healthy diet and exercising is important in maintaining a healthy pregnancy and healthy baby.
The gestational diabetic and the Type 1 diabetic mom surely affects the newborn population – I work in Newborn ICU and it would surely lower our census if mothers were educated and compliant with a healthy diet and exercise. You chose a very relevant and import topic to work on!
Wendi Keller
PS – Believe it or not, I have seen a newborn almost 15 pounds!
All the best to you!
Samara D.
I can not imagine an 11lb+ pound baby. It also sad that this happens to this day. There definitely needs to be more education available to mothers on the importance of diet and exercise. Once there is education on this subject and the mothers are informed of the harm that can come to their babies maybe they will change their habits.
-daniel
Strategies to reduce hospital readmissions are significant in clinical practice. Previously, as a group we were summoned by the management due to increased readmission rate of the patients we recommended for discharge. Additionally, my manager has frequently held a consultative meeting to furnish us a scenario of delicate balance whereby I feel I am delaying some patients from discharge to avoid readmission. However, I am applying the following strategies to manage the patients to circumvent readmission; medication compliance strict follow up, the patient needs assessment, medication reconciliation, telephone follow up, and organizing outpatient appointments. Therefore, theoretical literature on the strategies that nurses can implement to reduce hospital readmission rate is a valid study that ought to assess the significance of its literature vis a vis its effectiveness. For the capstone project, have selected the article Hospital Readmissions. My question is, “What strategies can nurses implement to reduce Hospital Readmissions?”
According to Aromataris & Pearson (2014), research gap is a topic which contains insufficient information such that it limits the capacity to develop a comprehensive conclusion for a research question. Literature reviews on strategies to reduce nursing related hospital readmissions have been extensively conducted. Various summaries provide an overview of these strategies both in current and historical context. Kripalani, Theobald, Anctil, B & Vasilevskis (2014), states that there is a deficit of information that encompasses strategies to reduce readmissions from acute care centers. There have been numerous cases where patients are discharged from high dependency unit and intensive care units to general wards, but within hours they are readmitted to such units. Researchers have not dwelled much on this area. Thus, nurses working in such units lack comprehensive information on how to enhance their service delivery.
References
Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58.
Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.(2014). Reducing hospital readmission: Current strategies and future directions. Annual Review Of Medicine, 65(1), 471-485. doi: 10.1146/annurev-med-022613-090415
Scott
Great topic to discuss. Being a med-surg nurse, I happen to see many frequent flyers in my hospital. I live in a small town where we only have one small community hospital in the county. As a poverty stricken town, many patients are poor with no insurance so they use the hospital as their doctor’s office. Many of the patients do not follow up with their primary, do not pick up their prescriptions, and do not follow doctors orders. Our hospital has implemented many programs within the hospital to help with readmission rates, but it is still climbing. The nurses, case managers, and social workers do an outstanding job during the discharge process serving the patients. I look forward to learning more about resources and plans to help with this issue. Great post!
Kierra
Readmission rate is one important topic that needs to be address as healthcare cost are continue to increase due to readmission. It is unfortunate that now a days patient are being discharge sooner because of reimbursement issue. As nurses we should be the strong advocate for patient to make sure that all necessary steps are being address for the patient to be able to follow up with discharge instruction. Great post.
thanks,
kristine
In recent times, the hospital I work for has significantly been cracking down on the use of indwelling Foley catheters due to the increase in the occurrence of the hospital associated infection known as Catheter Associated Urinary tract infections (CAUTI). Various hospitals including ours are facing the serious complication we see in catheter associated urinary tract infections. The emergency room I work in has formed a committee that I am a part of that is working on changes that can be made to reduce these occurrences. Being that this is a personal issue I am currently working on, I am choosing this topic as my as my systemic review topic. This is a serious problem for our patients as it can lead to a cascade of complications. CAUTIs are associated with an increased length of hospital stays, increased morbidity and mortality as well as healthcare costs (CDC.gov). The hope for the future is that we can reduce the use of indwelling catheters to only those who have a legitimate clinical reason for the Foley catheter, and that if it is found to be truly necessary, we can get them removed as soon as possible so that we can drastically decrease the occurrence of catheter associated urinary tract infections. My PICOT question has been formulated as follows:
Does an increased length of insertion time lead to increased infection rate in patients with foley catheters?
P- patients with foley catheters
I- Length of time catheter is in place
C- Short-term catheter use vs long-term catheter placement
O- Lower infection rate when catheter used for shorter period of time
T- week-by-week comparison for 3 months
It is required by hospitals to report all CAUTIs to the Center for Medicare and Medicaid Services (CMS). This agency sets many guidelines for hospitals to follow that directly affect their reimbursement for care. The incidence of urinary tract infections can lead to multiple additional health problems including spread of infection to the bladder and kidneys, sepsis and increase in length of hospital stay. As mentioned in Week 2 lesson plan, I will plan my research investigation via the most frequently used methods; our library database search and the World Wide Web.
Research-practice gap is explained as the idea of how evidence can effectively be put into practice with the intentions of reducing morbidity mortality and disability. Miscommunication between researchers and practitioners, and issues such as lack of public awareness, poor financing and a non-supportive political atmosphere are examples of factors that contribute to this problem (NCBI, 2006).
References:
Center for Disease Control. Retrieved from http://www.cdc.gov/HAI/ca_uti/cauti_faqs.html
Chamberlain College of Nursing (2015). NR451 RN Capstone Course: Week 2 lesson. St. Louis, MO: Online Publication
S. Mallonee, C. Fowler, & G. R. Istre. Bridging the gap between research and practice: a continuing challenge. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564411/
P- patients with foley catheters
I- Length of time catheter is in place (this should be what you are wanting to implement to improve the issue)
C- Short-term catheter use vs long-term catheter placement (this is what you are wanting to change based on your implementation above)
O- Lower infection rate when catheter used for shorter period of time (your desired outcome here would simply be a decreased incidence of CAUTIs.
T- week-by-week comparison for 3 months
So this is what I think you are attempting to ask with your question:
Among patients with foley catheters, does short term placement, as compared to long term placement, help to decrease the rate of CAUTIs?
Is that correct?
Scott
Yes. Thank you for the suggestions. Your fixes are exactly what I meant. It is absolutely ironic to me how this topic has become a huge focus at the hospital I work for. The foleys were once freely accessible in the storage room. They are now locked up and only accessible through a request from the charge nurse. At the time of request, a sheet has to be filled out as a checklist. There must be clinical reason to provided by the ED physician and there must be an order in place. The final step is to do the proper documentation in our MEDITECH system. If all of these steps are not followed, the nurse is reprimanded accordingly and repeat offenses are to written up. It is unfortunate that this has become such an issue as it requires more of our time and slows patient care. In an emergency room we are all aware of how much time is of the essence. The issue continues to need work and an effective solution. Luckily I get to work on the issue both at work and in this class!
Thanks again!
Nicole Mas
I agree that CAUTI’s are a major problem for hospitals. One of the way that we have tried to cut down on these infections other than reducing the number, which is also a great idea. Is when possible, use the external catheters on both men and women. I have known about the condom caths for men for a long time. We recently started using external catheters on women. These are called TrueWick and have really helped. They are non invasive and easy to install, they keep moisture away from the skin and help prevent breakdown. They also time because you dont have to clean the dirty linen.
Thanks for your response. CAUTI is certainly a growing issue in hospitals everywhere. The external catheter use for both men and women is an excellent suggestion. Any non invasive alternative is always welcomed. I was in fact un aware that a female external Cather even was even an option. I don’t believe they have them in our inventory or perhaps not in the emergency room I work for. I’m actually going ask if we have them available to us in other departments of the hospital and if not, suggest that we look in to stocking them at our hospital. They can also save us from having to go through the lengthy process we currently have in place to simply obtain a Foley catheter for an emergency case. This collaboration between healthcare professionals is exactly how this issue will ultimately be solved.
Thanks
Nicole Mas
From a working nurse standpoint, these things are truly amazing. I have so many patients suffering from forms of incontinence that would generally just get a indwelling cath. Worse yet in a effort to prevent hospital infection rates they might not get a cath. This means they are just laying in bed slowly dribbling urine into diapers or bedding. This is not only humiliating for the patient, it can lead to horrible skin breakdown. I suspect that many of the wounds coming from long term care places are caused by urine against the skin for long periods of times. The external cath solves this problem, is easy to place and works wonders. Once I identify a candidate and get the cath in place, I no longer have to constantly roll patients and change out bedding. It is a work time saver.
I too have experienced the amazing external female catheters with the same results as Guy. We first starting using them for incontinent patients after our post procedure de-cath protocol was put into place as a transition but have started using them in place of Foley catheters in order to further reduce the risk of infection.
http://www.purewick.com/how-does-purewick-work/
Great post. I agree with you CAUTIs are an increasing problems. The hospital I work at also has initiates to reduce the amount of CAUTIs. We have a protocol to was CHG wipes for baths for everyone with a foley catheter, as well as wiping the catheter with CHG and most recently using therawox to clean the catheter. This is a topic we need to improve on. CAUTIs can cause many other problems, which can be prevented.
It may be important to develop ways in which relevant and reasonable results from researches conducted could be implemented within clinical settings. If this is attained, for instance, problems such as HAI could be easily addressed considering the depth of researches available proving possible solutions to the problem.
Charlyne
I am currently working in level 4 neonatal intensive care unit. Although I am not working directly with pregnant women, I am taking of care neonates which involve the mom postpartum. I take care of neonates that have medical issues post delivery due to excessive weight gain during pregnancy. I chose the article about diet and exercise during pregnancy to prevent excessive weight gain.
Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.
My PICO clinical question:
P- Pregnant women
I- healthy diet and exercise during pregnancy
C- Unhealthy diet and no exercise
O- Reduce excessive gestational weight gain
During pregnancy, does implementing a healthy diet and exercise, reduce excessive gestational weight gain?
“A research gap is defined as a topic or area for which missing or insufficient information limits the ability to reach a conclusion for a question” (Saldanha & Mckoy, 2011). You must have enough information and research to answer a clinical research question in order to implement change in practice.
Robinson, K.A., Saldanha, I.J., & Mckoy, N.A. (2011). Frameworks for determining research gaps during systematic reviews. Methods Future Research Needs Report No. 2. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. HHSA 290-2007-10061-I). AHRQ Publication No. 11-EHC043-EF. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from: http://www.nccmt.ca/knowledge-repositories/search/118 (Links to an external site.)
Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.
Chamberlain Library Permalink:
http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1002/14651858.CD007145.pub3/full (Links to an external site.)
Among pregnant women, does implementing a healthy diet and exercise, as compared to no healthy diet and exercise, help to reduce gestational weight gain?
Scott
I enjoyed reading your post. I agree with you. Exercising is significantly important during pregnancy as well as eating healthy. Exercising, eating healthy, and managing weigh can definitely reduce complications during pregnancy and help the mother to have a healthy baby.
Edlyne
Professor and class,
The systematic review I have chosen for the capstone project is: Caregiver-mediated exercises for improving outcomes after stroke.
Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser-Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database of Systematic Reviews 2016, Issue 12, Art. No.: CD011058. doi:10.1002/14651858.CD011058.pub2.
The clinical question I have formulated using the PICO method, as described by Aromataris and Pearson in The Systematic Review: An Overview, is
P (population) – In Sub Acute Rehab patients on my unit who are recovering from a stroke
I (intervention) – will implementing a caregiver mediated exercise program
C (comparison group) – compared to using our current program alone
O (desired outcome) – improve patient outcomes and transition to next level of care or home
As discussed by the ANA in our readings this week, “registered nurses employ practices that are promotive, supportive and restorative in nature.” (p. 11). Using this principle, I feel the review I have chosen for my project suits the environment I work in. Currently, I am working on a Sub-Acute Rehab (SAR) unit in a Critical Access Hospital. The program is relatively new to our organization and we primarily focused on total joint patients for the first 2 years. Now we have added many other patient types with stroke patients being one. We have found, stroke patients can be very challenging to progress in the short period of time allowed in SAR. Families are often very concerned about the patient’s progress and apprehensive about the transition to home. I feel this review touches on an untapped resource in our current practice, family involvement. If implementing a caregiver mediated exercise program can show benefit for our patients, it would be well worth the efforts.
A research to practice gap is the process gap of getting the evidence based research into practice. According to Grady and Hinshaw, “it is important to determine what gaps in knowledge the research is intended to fill when a problem for study is identified, and subsequently, it is important to assess what can or cannot be said from the research findings” (p.288).
References,
American Nurses Association. (2015). nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000446-201403000-00028&LSLINK=80&D=ovft
Grady, P. A., & Hinshaw, A. S. (2011). Shaping Health Policy through Nursing Research. New York: Springer Publishing Company.
Scott
-
- AdGreat post! I like your research question. I agree with you getting family involvement into the care of the patient will improve outcomes. Exercise is definitely important to be implemented early in the recovery process of stroke patients.
P-CHF patients
I-Multidisciplinary outpatient CHF clinic
C-Traditional follow up
O-Reduce 35 day hospital readmission rates
A research- practice gap is when there is a gap between research and practice. It is the lag between what is known and what is actually practiced.
References:
Boback Zieaien, G. C. (2015). The Prevention of Hospital Readmissions in Heart Failure. NCBI, 379-385.
Olswang, P. J. (2015). Practice-Based Research: Another Pathway for Closing the Research-Practice Gap. Journal of Speech, Language, and Hearing Research, 1871-1882. doi:10.1044/2015_JSLHR-L-15-0243
This a great concept, having an outpatient that consisted of multidisciplinary team as a resource for this patient population is greatly beneficial. With CHF patient having a greater understanding of the disease process will likely reduce the readmission rate because patient hopefully know how to take care of themselves by diet, lifestyle modification and medication compliance. How accessible is the clinic to patient? does patient need referral to be seen at the clinic?
Thanks,
kristine
Research Practice Gap:
The main goal in nursing research is to obtain results that are valid and can be implemented in real life practice to improve nursing care. As much as researchers would like to match what is known with what is actually implemented in practice there is often a gap known as the research practice gap. Nursing education is the bridge between this gap as without knowledge nurses are not able to implement the best practice into their nursing care. It is important for a nurse to understand the reason behind what they do for many reasons including safety and educating their patients to provide the best outcomes. Nursing education is the number one “gap closer” but other things that are important in implementing new strategies based on research. It is important to consider whether or not resources are available, if the intervention is efficient, and easy to implement amongst other things. Nurses are often very busy while working so it is important for researchers, clinical educators and management to keep these things in mind when developing interventions.
Rebecca
Jill
References:
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Mulhall, A. (1997). Nursing research: our world not theirs?. Journal Of Advanced Nursing, 25(5), 969-976. doi:10.1046/j.1365-2648.1997.1997025969.x
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Crooke, P. J., & Olswang, L. B. (2015). Practice-Based Research: Another Pathway for Closing the Research-Practice Gap. Journal Of Speech, Language & Hearing Research, 58(6), S1871-S1882. doi:10.1044/2015_JSLHR-L-15-0243