Blog Post #2: Model of Nursing Practice Regulation NURS 308

The nursing scope of practice is a complex system of rules, regulations, and recommendations that govern nursing. Each action taken by a nurse must fall within that scope of practice. In 2006, the American Nurses Association (ANA) created a model to describe how different stakeholders help determine the nursing scope of practice: the Model of Professional Nursing Practice Regulation (American Nurses Association [ANA], 2015, p. 33). In this post I’ll describe how a routine nursing task, foley catheter insertion, fits within this model of nursing practice regulation.

The Model of Professional Nursing Practice Regulation is a pyramid, with the ANA’s Nursing: Scope and Standards of Practice as well as the Code of Ethics for Nurses making up the foundation of the pyramid (ANA, 2015, p. 35). Foley catheter insertion, while not explicitly mentioned in the Scope and Standards of Practice, fits best within Standard 5, Implementation (ANA, 2015, p. 61). The nurse collaborates with the health care consumer and health care provider to implement the plan of foley catheter insertion in order to accurately measure hourly urine output in the critically ill patient, and utilizes evidence-based strategies to do so safely and minimize risk of infection (ANA, 2015, p. 61). The participants at this level of the model are the ANA and other professional organizations, nurses, health care consumers, and educational organizations (ANA, 2015, p. 35).

The next level up on the pyramid of Professional Nursing Practice Regulation is Nurse Practice Act, and rules and regulations for the state in which a nurse is licensed (ANA, 2015, p. 35). The Nurse Practice Act for the state of Virginia also does not explicitly mention foley catheter insertion as a part of nursing practice (Code of Virginia, 2019). However, the Virginia Board of Nursing does recommend the use of their Decision-Making Model for Determining RN/LPN Scope of Practice when the Nurse Practice Act does not explicitly prohibit or allow an action (2018). When the Nurse Practice Act is unclear, a nurse should consider the standards of professional nursing organizations, the policies of the nurse’s employer, current literature, and the behaviors of a prudent nurse in a similar situation (Virginia Board of Nursing, 2018). I will elaborate about the policies and procedures at VCU Health when discussing the next level on the pyramid. However, current literature indicates that foley catheter insertion by a registered nurse is appropriate. The Centers for Disease Control and Prevention recommend that foley catheters be placed by “health care personnel, family members, or patients themselves” as long as they are “properly trained” (Centers for Disease Control and Prevention, 2015). A prudent nurse who has been trained in foley catheter insertion would place the catheter. The participants at this level on the pyramid are the Virginia Board of Nursing, legislators, lobbyists, the National Council of State Boards of Nursing, voters, and nurses (ANA, 2015, p. 35).

The next level on the pyramid consists of the policies and procedures of the institution where the nurse is working (ANA, 2015, p. 35). VCU Health has policies in place which allow registered nurses to insert foley catheters. For example, foley catheter insertion is listed under nursing procedures in the Lippincott procedure manual on the VCU Health Intranet (Wolters Kluwer, 2021). The participants at this level on the pyramid are VCU Health, hospital administration including nurse managers, and nurses (ANA, 2015, p. 35).

Finally, the peak of the pyramid for the Model of Professional Nursing Practice Regulation is self-determination by the nurse performing the action (ANA, 2015, p. 35). At this point in nursing practice regulation, the nurse uses her own clinical judgment to ensure that her actions are safe, prudent, and are evidence-based (ANA, 2015, p. 35). For the example of foley catheter insertion, a nurse would assess her training and education to ensure that she has the skills and knowledge to safely place the foley. At this level of the pyramid, the participants are the nurses themselves (ANA, 2015, p. 35).

Using this Model of Professional Nursing Practice Regulation can help professional nurses self-determine their unique circumstances as it relates to the nursing scope of practice, because varying state laws, organizational policies, and education all influence a nurse’s practice (ANA, 2015, p. 36). The model also helps identify the stakeholders involved at each level of nursing practice regulation (ANA, 2015, p. 35). Diligent use of the Model of Professional Nursing Practice Regulation helps nurses promote “safe, quality, evidence-based nursing practice decisions” that lead to positive patient outcomes (ANA, 2015, p. 36)

 

 

References

American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd

edition. American Nurses Association.

Centers for Disease Control and Prevention. (2015). Summary of Recommendations. Infection Control.

https://www.cdc.gov/infectioncontrol/guidelines/cauti/recommendations.html

 

Code of Virginia, Chapter 30, § 54.1-3000 et seq. (2019).

http://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/Chapter_30_Nursing.pdf

Virginia Board of Nursing. (2018). Decision-Making Model for Determining RN/LPN Scope of Practice.

https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/guidance/90-23.pdf

 

Wolters Kluwer. (2021). Lippincott Procedures and Skills. Virginia Commonwealth University Intranet.

https://vcuhealth.sharepoint.com/Pages/Home.aspx

 

 

Blog Post #1: Reflection on Regulatory Agencies and Advisory Opinions

On July 10, 2020, the South Carolina State Boards of Nursing, Medical Examiners, and Pharmacy released a joint advisory opinion regarding the administration of low-dose ketamine by nurses in the acute care setting for pain management purposes. Ketamine for sedation or anesthesia were not considered. The advisory opinion indicates that nurses in South Carolina may administer low dose ketamine infusions (using a locked pump) or may give low dose ketamine via IV push if they are in the ED or PACU (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). The order for ketamine must originate from an attending physician and should involve a 48-72 hour stop date (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). Patients must be monitored for side effects such as respiratory depression, hallucinations, nystagmus, and unresponsiveness (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020).

Three regulatory agencies were involved in issuing this advisory opinion: The South Carolina State Board of Nursing, the South Carolina State Board of Medical Examiners, and the South Carolina State Board of Pharmacy. All three agencies function to protect the public, but each has a slightly different focus (South Carolina Department of Labor, Licensing, and Regulation [SC LLR], n.d.-a). The Board of Nursing regulates the licensure of nurses, approves nursing schools, and handles the disciplinary process for nurses who fail to meet standards (SC LLR, n.d.-b). The Board of Medical Examiners also handles licensure and disciplinary action against licensed individuals, but for licensing physicians, physician assistants, and respiratory care practitioners, among others (SC LLR, n.d.-a). The State Board of Pharmacy “regulates the practice of pharmacy,” including the licensure of pharmacists and the certification of pharmacy techs (SC LLR, n.d.-c). Beyond licensure, the Board of Pharmacy also regulates anyone who distributes, sells, or manufactures drugs or devices in South Carolina (SC LLR, n.d.-c).

The advisory opinion of South Carolina regarding nurse administration of low-dose ketamine is slightly different from the advisory opinion released by the Arizona Board of Nursing (2020). The advisory opinion in Arizona was released by the Board of Nursing alone, rather than as a join opinion with other regulatory agencies (2020). In Arizona, nurses may give low-dose ketamine IV or intranasal for pain control, depression, and sedation (Arizona State Board of Nursing, 2020). However, if the ketamine were prescribed for moderate or deep sedation purposes, the nurse would need to consult a different advisory opinion (Arizona State Board of Nursing, 2020). Nurses may also administer low-dose ketamine as an IV bolus, as long as the unit has appropriate monitoring equipment for unintended sedation, and there is an ACLS/PALS certified provider available in the department (Arizona State Board of Nursing, 2020). In South Carolina, nurses may not give ketamine intranasally or via bolus, and only ED/PACU nurses may administer it via IV push (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). The Arizona advisory opinion was more specific than South Carolina in that it defined the necessary education required for nurses to administer ketamine, as well as other terms used throughout the opinion (Arizona State Board of Nursing, 2020). The Arizona advisory opinion also included a section of cited references (Arizona State Board of Nursing, 2020).

 

References

Arizona State Board of Nursing. (2020). Advisory opinion: ketamine administration. https://azbn.gov/sites/default/files/2020-08/AO%20Ketamine%20Administration%20rev%205.2020.pdf

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-a). South Caroline Board of Medical Examiners. https://llr.sc.gov/med/

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-b). South Caroline Board of Nursing. https://llr.sc.gov/nurse/

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-c). South Caroline Board of Pharmacy. https://llr.sc.gov/bop/

South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy. (2020). Joint advisory opinion issued by the South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy regarding the administration of low dose ketamine infusions in hospital settings, including acute-care, by nurses. https://llr.sc.gov/nurse/pdf/Low%20Dose%20Ketamine%20Joint%20Advi

sory%20Opinion%20Approved.pdf

Journal Reflections on Nursing Practice Standards (1-6) & Professional Performance Standards (7-17) NURS 308

Nursing Practice Standards

Standard 1: Assessment

As a registered nurse on a burn unit, I perform initial head-to-toe assessments on my adult and pediatric patients, as well as follow up assessments based on the patient’s level of acuity (critical, progressive, or general level of care).

Standard 2: Diagnosis

Once I have collected my assessment data, I use this data to identify actual or potential risks to the patient’s health, and formulate appropriate nursing diagnoses that fit the overall picture. I use these nursing diagnoses as a starting point to guide my development of a plan of care for the patient. Many patients in the burn unit have a primary nursing diagnosis of impaired skin integrity related to burn injury as evidenced by open wound beds, erythema, and the presence of biofilm.

Standard 3: Outcomes Identification

After determining the appropriate nursing diagnoses, I collaborate with the patient, health care provider, and other health professionals to determine expected outcomes. I formulate outcomes that are specific, measurable, attainable, realistic, and timely. For example, I might formulate an outcome that says the patient with a impaired skin integrity will walk to the shower, clean his wounds and undergo a burn dressing change by the end of the shift.

Standard 4: Planning

Next I collaborate with the patient, health care provider, and other health professionals to come up with a plan to help the patient meet the established outcomes. The plan is evidence-based and individualized to the patient’s specific goals, preferences, and needs. In the example of working with a patient to get the dressing change and shower completed, I would ask the patient what time they would like to shower. Then, I would plan to administer PO pain medication 30-45 minutes prior to the patient getting in the shower to help decrease their pain. I would also coordinate with the health care provider to ensure the doctor will be available to visualize the wounds once the patient is done showering. I would also plan to have all of the wound care supplies ready, and the shower set up with anything the patient needs, prior to the selected time.

Standard 5: Implementation; Standard 5A: Coordination of Care; Standard 5B: Health Teaching & Health Promotion

With a plan in place, I work with the patient and the entire health care team to carry out the plan while delivering culturally congruent, therapeutic care. I incorporate health teaching and health promotion strategies throughout the plan implementation, and assist with coordinating different facets of care related to the care plan. To continue with the above example, I would educate the patient about how to remove bandages, clean the wounds, remove biofilm from the wound bed, and apply clean bandages. If the patient’s family members were going to help the patient upon discharge, I would coordinate their presence during wound care, and help educate them about the steps for wound care. I would promote independence by allowing the patient and family to be hands on during care. I would also engage in health promotion strategies by ensuring the patient has access to distilled water for wound care at home and that they understand PRN pain medication safety.

Standard 6: Evaluation

When the plan has been executed, I talk to the patient and analyze the assessment data to evaluate the patient’s progress towards completing their outcomes. If necessary, I modify the outcomes and plan to fit the needs of the patient. I communicate my evaluation to the health care team. In the above example, if the patient was having significant pain during the shower process, I would evaluate that the outcome had not been met, because the patient was not able to fully clean the wounds due to pain. I would then communicate this with the patient and provider, and change the outcomes and plan. The new outcome could be that the patient will have only moderate to mild pain during the shower for next shift, and the new plan could involve the doctor ordering a different type of PRN pain medication.

 

Professional Performance Standards

Standard 7: Ethics

The academic framework for my ethical practice is rooted in learning from nursing school as well as additional college coursework. NURS 307, Foundations of Professional Nursing I at VCU, included a module about ethics in nursing, as well as many readings about ethics. NSG 230, Advanced Professional Nursing Concepts at Reynolds Community College, also included modules about ethics. Beyond nursing school, I’ve also taken a course called RELG 260, Theology, Ethics, and Medicine at UVA which was a full semester about ethics in health care, and how various religious beliefs influence those ethical ideals. I incorporate the ANA Code of Ethics into my daily practice. I strive to balance the ethical principles of beneficence, patient autonomy, nonmaleficence, and justice into my practice each day. I ensure my patients’ privacy and confidentiality are maintained at all times. I approach my practice with compassion and a nonjudgmental attitude which allows me to maintain therapeutic relationships with my patients and colleagues.

Standard 8: Culturally Congruent Practice

To help me expand my understanding of practicing nursing in a way that is culturally congruent, I attended a webinar called Cultivating Cultural Competence and Inclusion through VCU Health. This course promoted cultural humility and helped me reflect on my implicit biases to help me better care for my patients regardless of gender, race, or age. In my practice I care for patient of all ages, races and ethnicities, gender identities, sexuality, and religious affiliations. I strive to care deeply for my patients like I would my own family member, and be open and respectful to cultural backgrounds which are different from my own. Some of my clinical experiences from nursing school have also helped me develop my culturally congruent practice. For example, as a part of NSG 200, Health Promotion and Assessment at Reynolds Community College, I worked with a group to teach STI prevention and sex education to the LGBT community.

 

Standard 9: Communication

In nursing school, I learned about different strategies one can use to communicate therapeutically. NSG 211, Clinical Concepts II at Reynolds Community College, specifically dialed into therapeutic communication skills. I use those skills each day as a part of my nursing practice, not only when communicating with my patients and their families, but also when talking to my colleagues and the medical team. I also utilize resources to ensure effective communication is taking place. When a patient does not speak English or is uncomfortable using English to discuss the care plan, I use a Cyracom translator or Marti video translator to respectfully communicate with the patient.

 

Standard 10: Collaboration

Collaboration is an essential part of my nursing practice. I collaborate with the patient and the care team to ensure the plan of care is appropriate for the patient and is carried out effectively. For my ICU patients, I participate in morning round with the ICU team of doctors to help the providers better understand the patient’s current condition, communicate nursing and patient needs, ask questions, and establish goals for the day. For progressive and general level of care patients, I also participate in daily rounds with the physical therapist, occupational therapist, social worker, care coordinator, and clinical coordinator to assess the patient’s needs and barrier to discharge, and strategize together to come up with an appropriate plan.

 

Standard 11: Leadership

In my practice I work with assistive personnel daily, and I work with these team members to ensure their workload is manageable and appropriate when considering which tasks to delegate to them. I communicate respectfully and openly, and maintain responsibility for any tasks I’ve delegated. I also use therapeutic communication strategies to handle any conflict that arises at work, whether it involve the patient, a family member, or a colleague. I am also a member of the American Association of Critical Care Nurses (AACN).

 

Standard 12: Education

I am currently advancing my education by pursuing a Bachelor of Science in Nursing through VCU School of Nursing. Additionally, I am completing a 90 critical care competencies course through the AACN. This RamPages website serves as a portfolio which provides evidence of my continuous journey towards furthering my nursing education.

 

Standard 13: Evidence-based Practice & Research

NURS 301, Nursing Informatics, and NURS 307, Foundations of Professional Nursing I at VCU, have both transformed my understanding of evidence-based practice (EBP) and my research skills. NURS 301 honed in on my database searching skills, which are foundational to EBP and research. NURS 307 taught me how to formulate a PICO question, write a literature review, and appraise the quality of sources found during a database search. In my practice, I am currently participating in an EBP project on my unit as a part of the Nurse Residency Program, which is focused on determining the best way for nurses to assess anxiety for burned patients.

 

 

Standard 14: Quality of Practice

I engage in formal peer review processes as a part of my practice. Additionally, I document my assessment data, interventions, and other nursing data in a consistent way to support quality improvement initiatives and audits.

 

Standard 15: Professional Practice Evaluation

As a new nurse, I participated in a 16 week preceptorship program which involved daily evaluation of my practice and my progress over time. I am currently completing a formal self-evaluation process that involves writing detailed exemplars to explain how my nursing practice meets organizational and professional standards. After completing the self-evaluation portion, I will be reviewed by my peers and supervisors in another formal evaluation process. During this evaluation process, I will set goals with management that are consistent with the practice and professional standards of nursing.

 

Standard 16: Resource Utilization

I work with the patient and the patient’s family to identify the patient’s needs as a part of the discharge process. I help pinpoint areas that could negatively affect their ongoing care, and then help the patient find resources in the community that can help address that need. I ensure that patients have adequate wound care supplies when I am discharging them, and work with the social worker and care coordinator to make sure additional supplies will be delivered to them. If the patient needs assistance at home, I help coordinate that as well. I incorporate telehealth into my practice when patient’s family members cannot come into the hospital, especially with the restricted visitor policy associated with Covid-19. I use video calls to help the family learn and participate in wound care. I also provide the patient with information about supportive community resources, such as setting pediatric patients up to attend Central Virginia Burn Camp, or providing information about the Phoenix Society support group for burn survivors.

 

Standard 17: Environmental Health

I promote a clean and safe environment at my workplace each day, by tidying the patients room and cleaning equipment according to best practices. I utilize appropriate personal protective equipment based on the patient’s condition, and wear a hand hygiene badge to ensure that I am washing my hands before entering a patient’s room, and after leaving the room.

Career Vision Plan

References

Jill Jones, Nurse Manager, Evans-Haynes Burn Unit

jill.bates@vcuhealth.org

(804) 828-4083

 

Tiffany Lord, Nurse Clinician, Evans-Haynes Burn Unit

tiffany.lord@vcuhealth.org

(804) 325-2896

 

Dr. Nancy Husson, Professor of Nursing Informatics at VCU

nhusson@vcu.edu

(804) 828-3375

Licenses & Certifications

Registered Nurse: active, unencumbered RN license in the state of Virginia, with multi-state privileges (compact designation)

BLS CPR certified

Advanced Cardiac Life Support (ACLS) Provider certified

Resume

Adriana Bailey

AAS, RN

Richmond, VA

(804) 661-4422

adrianabailey14@gmail.com

Professional Summary

Registered nurse with 1 year experience working in critical care with adult burn and trauma patients, as well as progressive and general level of care adult and pediatric patients. Team-oriented, hard working nurse who provides exceptional patient care with a compassionate attitude. Experience with burn wound care & fluid resuscitation. Excellent patient educator and advocate.

 

Work History

  • Registered Nurse, Evans-Haynes Burn Center
    • Virginia Commonwealth University Health System, 6/20 – present
  • Care Partner, Medicine Specialty Unit
    • Virginia Commonwealth University Health System, 8/17 – 06/20
  • Emergency Department Technician
    • University of Virginia Health System, 6/15- 08/17

 

Education

  • Bachelor of Science in Nursing candidate
    • Virginia Commonwealth University, Richmond, VA, anticipated graduation December 2022
  • Associates of Applied Science
    •  Reynolds Community College, Richmond, VA, summa cum laude
  • Bachelor of Science in Chemistry
    • University of Virginia, Charlottesville, VA

 

Licenses & Certifications

  • Registered Nurse: Virginia, #0001297939, expires: 5/31/23
  • Advanced Cardiac Life Support (ACLS), American Heart Association, expires: 4/30/23
  • Basic Life Support RQI Healthcare Provider (BLS), American Heart Association, expires: 6/30/21

 

Awards & Associations

  • Novice Nurse Exemplary Practice Award, VCU Health, 2021
  • Daisy Award, VCU Health, 2020-2021
  • Member, American Association of Critical Care Nurses, since 2020
  • Volunteer, Emergency Medical Technician, Western Albemarle Rescue Squad, 2014-2017

Bio

Hello all! My name is Adriana Bailey, and I am an RN at VCU Health. I work in the Evans-Haynes Burn Center. Below is a picture of me (on the left) and my partner, E. When I’m not at work, I enjoy cooking, running, and reading. This RamPages site serves as a portfolio documenting my professional development as I pursue my BSN through VCU’s School of Nursing.

Contact me via email at: baileyae2@vcu.edu

Final Portfolio Evaluation NURS 307

Self-Reflection:

Over the past semester of the BSN program, I’ve really become attuned to the idea of professionalism within the field of nursing. During my associate’s program, everything was focused on the ANA Standards of Practice, with little to no consideration of the Standards of Professional Performance. While I did emerge from the associate’s program able to care for a patient, I really did not have any sort of professional identity. Through my work in NURS 307, Foundations of Professional Nursing I, I learned about nursing history and the fight for professionalization over time. This knowledge really helped me to connect to this professional identity, and understand the gravity and necessity of baccalaureate education for nursing.

One topic where I’ve gained a deeper understanding is ethics, which lines up with Standard 7 of the ANA’s Standards of Professional Performance. I learned basic ethical concepts in my associate’s courses, but NURS 307 taught me that the entire framework for professional nursing is tied to having a strong ethical code that guides the discipline. Ethics are the foundation upon which our practice and profession is built. This knowledge has given me a sense of pride in our Code of Ethics, as well as the drive to preserve its principles in my own practice.

I’m certainly confident that I’ve made headway with Standard 12, Education! I’ve learned all kinds of new information this semester, between Foundations of Professional Nursing I and Nursing Informatics. From history to evidence-based practice to research skills, this semester has given me new skills and new knowledge, which contribute to the standard of nurses seeking knowledge and competence that reflect current nursing practice.

One of the areas I’ve made the most headway is Evidence-Based Practice and Research, which correlates to Standard 13. NURS 301 and 307 both taught me how to perform a database search. Before this semester, I would not have even known which databases are appropriate for searching out information specifically related to nursing. Now, I can use advanced searching tools in various databases such as PubMed and CINAHL to find credible, academic sources. NURS 301 in particular helped me do a deep dive into MeSH headings, and how they can help me track down needed information. (This database searching also corresponds to Standard 16, Resource Utilization). Prior to this semester, I didn’t know what  PICO question was; now, I’m confident in my ability to generate a quality PICO question. Additionally, prior to this semester I used the terms “EBP,” “research,” and “QI,” interchangeably. NURS 307 helped me tease out the differences between these three avenues of nursing inquiry. This class also provided me with the skills to assess research article quality, when considering whether to include a source for one’s EBP Project. Taken all together, I’ve become significantly more capable and qualified to complete EBP projects for work. I’m applying these new skills currently, through an EBP project for my Nurse Residency Program.

I’ve also learned a lot when it comes to the idea of Quality of Practice (Standard 14). Before this class I would have considered “quality” as a vague idea, but NURS 307 provided many readings that helped me understand the goals of quality nursing care. For example, the IOM report about the future of nursing was very enlightening. That report explained the importance of BSN education as a standard of nursing quality, and opened my eyes to the possibility of obtaining a PhD one day in my career. The module about health care quality tied into concepts related to safety, so now I see quality and safety as being essential to one another.

Below I’ve linked a number of assignments that showcase the work I’ve done in the following areas: quality improvement, research & evidence-based practice, and informatics.

 

Quality Improvement:

 

Research & EBP

  • Literature review: The following link contains a literature review pertaining to pediatric IV infiltration.
  • Progressive PICO Project: NURS 307 helped me develop my ability to write PICO questions. The progressive PICO project culminated in a well developed PICO question and resources related to the subject matter.
  • Evidence Search Assignment: This paper examined the quantity and quality of search results when using a search engine compared to a database search.
  • EBP Journal: This journal entry reflects on the progress I’ve made over the course of this semester specifically regarding evidence based practice.

 

Informatics

Portfolio Update: Professional Standards 13 & 16 NURS 307

American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing

Essential III:  Scholarship for Evidence Based Practice: “Professional nursing practice is grounded in the translation of current evidence into one’s practice”

 

  • Foundations of Professional Nursing 1 (NURS 307, currently enrolled at Virginia Commonwealth University): This course has introduced essential skills for understanding evidence-based practice, such as developing PICO questions, performing a literature review, and comprehensive database searching.
    • Sample PICO question:Background question: What different types of nonpharmacological treatments or therapies are used to decrease anxiety and pain in patients with burn injuries?Foreground question: How does aromatherapy affect pain and anxiety in patients with burn injuries?PICO Question:In patients with burn injuries (P), how does using aromatherapy as an adjunct to pharmacological treatment (I), compared with pharmacological treatments alone (C), affect patients’ pain and anxiety (O) within the length of their hospital admission (T)?
    • Sample Rapid Critical Appraisal of a source from a literature review:Rapid Critical Appraisal (MeInyck & Fineout-Overholt, 2018):
      • Date: 2016
      • Park, S., Jeong, I., Kim, K., Park, K. Jung, M., Jun, S. (2016). The effect of intravenous infiltration
      • management program for hospitalized children. Journal of Pediatric Nursing 31, 172-178. https//dx.doi.org/10.1016/j.pedn.2015.10.013 0882-5963
      • PICO question: In hospitalized pediatric patients (P), how will the implementation of a peripheral intravenous (PIV) infiltration management program (I) compared with standard nursing care for PIVs (C) affect PIV infiltration rates (O)?
      • Purpose of study: The researchers want to know if implementing a PIV infiltration management program, above and beyond standard PIV care, will have an impact on PIV infiltration rate
      • Study design: Quasi-experimental
      • Study description: The study participants included 2,894 pediatric patients (age zero to 19) in a hospital in Korea who had a PIV inserted. The control group was historical, and included pediatric patients admitted from August 1 to October 31, 2011 who received standard care. Standard care included educational posters, educating the patient’s parents about assessing the site for abnormalities, and documenting the IV site upon insertion. The experimental group were pediatric patients admitted to the same hospital and unit from November 1, 2011 to February 28, 2012. The experimental group received standard care, plus the PIV infiltration management program, which asked nurses to assess vein size and quality before attempting an IV. Nurses were also asked to monitor the PIV insertion site, and document findings each shift.
      • Hypothesis: Implementing a PIV infiltration management program will decrease the PIV infiltration rate in hospitalized pediatric patients.
      • Study aims: Show decreased PIV infiltration rates after implementing the PIV management program.
      • Sampling technique: Convenience sampling, as the study participants were all inpatient in one particular hospital in Korea. N = 2,894
      • Dependent variable: PIV infiltration, as measured by the standard scale of the Infusion Nurses Society. This scale is an appropriate measurement of this variable.
      • Data analysis: Chi-square test used to evaluate differences in IV infiltration rates. Two-tailed test with significance level of 0.05 also performed.
      • Validity: The study participants are similar between the control and experimental groups. The intervention is clearly identified. There is a control group. The experimental group received reasonable care. Follow-up is clearly stated. Statistical analysis is appropriate. Outcomes are measured with the same instrument for all participants, and that instrument is valid and reliable.
      • Results: The results are of importance because it indicates that the simple additional techniques used in the experimental group did decrease infiltration rate. Precision is unclear as the confidence interval is not published.
      • Applicability: The results are applicable to the patient population I work with, because I do have pediatric patients on the burn unit. The results are useful for assuring patients and their parents. I would use these study results, because it indicates that initial insertion site selection can play a big role in IV infiltration rates. Whenever possible, it makes sense to avoid joints, areas of curvature, and to consider the child’s mobility and thumb-sucking habits to avoid an area that will be frequently bent.

       

      MeIncky, B. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice.  Wolters Kluwer Health.

  • Nursing Informatics (NURS 310, currently enrolled at Virginia Commonwealth University): This course is teaching essentials of evidence-based practice with a focus on information management and information literacy. Lectures have included multiple webinars on MeSH terms for performing a search in PubMed, and skill building for database searching more generally. One major assignment was the Evidence Based Search Paper, in which the quality of Internet search results were compared to the quality of database search results.Sample of my own writing from the Evidence Based Search Paper:“When comparing the results of the Google search with the PubMed database search, the Google search generated many more sources, even after filters were applied. The Google search resulted in 159 sources, whereas the PubMed search resulted in 21 sources. The quality of the PubMed results was significantly higher than the Google search. The highest quality of evidence available “is derived from meta-analysis of randomized controlled studies (RCTs) and… systematic reviews of RCTs” (Sewell, 2019). 50% (5 out of 10) of the PubMed sources were systematic reviews and meta-analyses, while only 1 out of 30 of the Google sources were systematic reviews. Following systematic reviews, the next highest level of evidence is evidenced derived from a randomized controlled study (Sewell, 2019). 40% (4 out of 10) of the PubMed sources were randomized controlled studies, while the Google search did not produce any randomized controlled studies. Thus, 90% of the PubMed sources were in the top 2 tiers on the hierarchy of evidence, compared to 3.3% in the Google search. All of the PubMed sources were relevant to my interest in treating anxiety in burn patients, compared to only 27% of the Google search. Additionally, all of the PubMed sources came from a peer-reviewed journal, while 50% of the Google sources were peer-reviewed. The Google search also resulted in various problems that I did not encounter during the PubMed search, including duplicate sources, non-English publications, and sources one could not access without paying a subscription fee.”Sewell, J. (2019). Informatics and nursing: Opportunities and challenges. Wolters Kluwer.
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