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Guidelines for the critique of nursing research articles

The overall goal of a research critique is to evaluate a study’s merits and its applicability to clinical practice. A research critique goes beyond a review or summary of a study, and it carefully appraises a study’s strengths and limitations. By evaluating a study’s component parts, the critique should assess objectively a study’s validity and significance.
Several guidelines for the appraisal of evidence—in the form of meta-analyses, systematic reviews, and clinical practice guidelines—have been published in print and online. In addition to nursing research textbooks, several published guidelines for how to review single research studies can help nurses in their journal club endeavors. The following resources specifically target the critical appraisal of research studies:

  • Critical appraisal tools developed by the Critical Appraisal Skills Program, (suitable for all types of studies) NHS Trust-Public Health Resource Unit. (www.caspinternational.org)
  • Critical appraisal worksheets in the EBM Toolbox, Center for Evidence-Based Medicine at Oxford (www.cebm.net).
  • Users’ Guide to Evidence-Based Practice. Site maintained by the Canadian Centre for Health Evidence (www.cche.net/text/usersguides/therapy.asp). (Originally published in the Journal of the American Medical Asociation.)

The level of discussion at the initial journal club meetings will depend on the facilitator’s knowledge base. Nurses who have completed graduate-level research courses will be able to guide the group so that all questions can be answered and discussed. It may not be possible, however, to have a registered nurse with a master’s degree serve as a facilitator for every journal club. If this is the case in your organization, consider limiting how many journal clubs meet to ensure adequate mentorship. Another choice is to have baccalaureate-prepared nurses serve as facilitators and understand that, in the beginning, certain questions may pose a challenge to the group. In that case, the group should agree to discuss as many of the questions as possible and to skip over questions they find difficult. The facilitator can then follow up with someone who can clarify the difficult areas of the critique. With experience, educational sessions, and mentoring, nurses’ knowledge and confidence levels will continue to increase. Evidence-based practice, like any new skill, takes practice. Journal clubs are a great way to learn the skills necessary to evaluate the evidence and to decide whether it’s applicable to specific practice areas.

Source: Evidence-Based Practice Made Simple

The Roots of Peer Review

The following is an excerpt from Nursing Peer Review, Second Edition

Medical staffs have been peer reviewing their cases for decades, and as fellow professionals, we must hold ourselves to the same high standards. Nurses are professionals who must hold each other accountable and evaluate patient care so we can eliminate system and human errors. Nurses are no different than physicians in this way.

 

An early crusader for quality improvement, E. A. Codman helped develop the concept of outcomes management in patient care. He was a proponent of peer review and quality programs for healthcare delivered at the hospital level.

 

Practicing in the early 20th century, Codman was a founder of the American College of Surgeons and its Hospital Standardization Program. Eventually, that program would morph into what we know today as The Joint Commission. His statement from 1916 calling for review and transparency are as relevant today as they were a hundred years ago:
I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyze their results to find their strong and weak points, must compare their results with those of other hospitals, must care for cases that they can care for well and avoid attempting to care for cases which they are not qualified to care for well, must welcome publicity, not only for their successes, but for their errors. Such opinions will not be eccentric a few years hence.

—E. A. Codman, A Study in Hospital Efficiency, 1916

 

Codman would likely be happy to see today that the practice of physicians reviewing the work of other physicians—peer review—is a common practice and is considered to be a crucial element of ensuring that quality medical care is provided to patients.

 

That element is just as crucial in the nursing profession. The major reason for implementing a peer review process is to improve patient care. If nothing else, peer review is the right thing to do to protect the patient from potential harm. It is just a matter of time before external accreditation agencies, the government, and your hospital will require a formal peer review process of nurses.

 

More and more, healthcare organizations are required to be transparent about quality performance metrics. While the information that is publically reported is aggregate data, it is important for the healthcare organization to know person-specific performance data so that they can drive improved patient outcomes.

 

Typically, the outliers or underperformers are a small number of nurses who may not know they are not performing to the standard of care. It is important to give them specific and periodic performance feedback so that they can adjust their care model. Additionally, providing performance data to nurses helps them understand where they rank among their peers. When doing so, it is important to report the data in an anonymous way so that each nurse is uniquely identified using a coding system. This can be useful when metrics are performance based and specific in nature. Transparency is the way of the future, and moving in that direction will help the nursing infrastructure catch up with performance models used by physicians.

 

The goals and benefits of peer review include:

  • Improving the quality of care provided by individual nurses
  • Monitoring the performance of nurses
  • Identifying opportunities for performance improvement
  • Identifying system-wide issues
  • Identifying educational needs of nurses

If the process of peer review is to be effective, then a formal structure must be created to allow for the tracking and trending of information and the identification of potential system or human failures. Case review is useful for this, as it presents opportunities to identify failures through investigation so nurses and other team members can correct them before injury occurs in another patient or patients.

Top RN to BSN Releases 50 Best Online RN to BSN Programs for 2017

Top RN to BSN, an independent online guide that ranks higher education and career options for current and prospective nurses, released their 50 Best Online RN to BSN Programs 2017.

From their press release:

“With the demands of contemporary nursing–some due to an aging and booming population, some from the complexities of the healthcare system, and some from a critical nursing shortage that results in long, stressful hours–many working RNs are returning to school to develop their skills and improve their credentials for promotion. Of course, the extremely demanding hours of most nurses make night school challenging, much less taking an absence to go to an on-campus program full-time. Online RN to BSN bridge or degree completion programs have emerged in recent years to give busy nurses the opportunity to earn their bachelor’s degree on their own time, from every kind of higher education institution. Top RN to BSN has used the most current data and statistics to put together an authoritative, unbiased guide to the best opportunities, combining quality, affordability, and career success to guide prospective BSN students to the best choices for their needs.

Top RN to BSN ranks online programs using three data points: reputation according to US News & World Report ranking; graduate salary according to College Scorecard data; and affordability based on the school’s non-resident tuition rate.

The top three Best Online RN to BSN Programs for 2017 are: 1) CUNY School of Professional Studies in New York, New York; 2) University of Arkansas in Fayetteville, Arkansas; (3) University of Massachusetts at Amherst, Massachusetts.”

You can find the full list here.

Consider how personal bias affects peer review

Human nature contributes to bias by allowing us to use psychological “shortcuts” to reduce complexity and ambiguity in the world. We all wish that life were simpler, and our brains try to accommodate this wish by finding shortcuts to decisions by relying on past patterns of thinking. This enables us to provide a rational response within the context of a simpler and less-threatening world. The two main types of bias related to human nature are personal bias and group bias.

Personal bias has two aspects: emotion and thought. These biases come from our view of the world that is created by the sum of our individual experiences: where we grew up, our parents’ values, how our friends act, and how we were trained. Although we might make conscious efforts to overcome personal bias, we all retain some degree of it as part of our individuality.

Personal bias is more likely to affect peer review when individuals are not accountable for their decisions. This is not because these are bad people—they are simply good people in a flawed system. The case studies in this book provide several examples of peer review structures and procedures that, prior to redesign, increased the likelihood of personal bias, such as having a department chair conduct the entire case review process from case screening to decision. To reduce personal bias in peer review, consider requiring reviewers to provide a written rationale for their findings (even on care-appropriate cases), having a committee make the final decision on all cases, and implementing clear conflict of interest practices.

Group bias occurs when a group of individuals has a shared set of beliefs or experiences that result in a relatively predictable way of thinking or responding. This concept of “groupthink” results in the group tending to accept information that meets its common paradigm and reject, or at least not consider, information that doesn’t fit within it.

Lack of diversity in a group can create this bias. Therefore, to avoid group bias, structure the group to ensure that other views are included. There are two types of group bias that tend to affect peer review: professional bias (e.g., physicians think differently than nurses) and specialty bias (e.g., surgeons think differently than internists). One of the main reasons that medical staffs implement some form of multi-specialty peer review committees is that such committees reduce the likelihood of groupthink by bringing all perspectives to the table.

Source: Peer Review Benchmarking

Blogging can be an innovative tool for nursing educational sharing

With the time-crunch worse than ever, it can be difficult to find the time to keep up with the latest in your facility, let alone the wider world of nursing. Early research conducted by Critical Care Nurse (CCN) suggests that blogs can be an effective means of communicating the latest hospital policies and best practices.

The cardiac intensive care unit at Brigham and Women’s hospital found that while many of their nurses attended professional educational opportunities, the staff had difficulty sharing information with the entire nurse staff. The staff simply did not have the time for peer-to-peer sharing of educational information. To facilitate educational sharing, the nursing practice council at the facility set up a simple private blog where staff could share what they’ve learned from various educational opportunities, such as professional conferences and panels.

After fifteen months, the hospital conducted a survey to measure the effectiveness of this approach. They found that 86% of their nurses thought the blog was an effective way to share professional education, 81% felt the blog kept them up-to-date on evidence-based practices, and 59% thought the blog led to changes in their practices. While the results are anecdotal and early, the authors of the study suggest that more rigorous research is required.

Does your facility use blogging tools or social media for education and professional development?

Four easy ways to provide patient education

The responsibility of educating patients and their families often falls to nurses, from explaining procedures to providing discharge instructions. This can be one of the most difficult parts of the job, and your staff may have limited time due to staffing issues or an emergency situation. Here are some tips to help educate patients quickly and effectively:

Handouts are your friend: Patients are often given a lot of information all at once, and it can be hard for them to remember every detail, especially in a stressful hospital setting. Having notes and props ready for them can save time and prevent miscommunication, especially when discharging patients. Have your nurses write up the specific instructions and go over them with the patient; use highlighters to mark the most important information. There are a lot of resources and tools available (we have some here) about common procedures and practices that you can use as handouts for patients as well.

Stay concise but informative: Patients are probably only going to remember one or two learning points, so try to emphasize the most important takeaways and leave the rest for your handouts.

Test understanding: It’s important not to assume that your patient is well-informed about their own condition. Even if you think something is obvious, say it anyway! Once you go over the key points, make the patient repeat them back to you; it’s one thing to listen to an explanation, but quite another to have to explain it yourself.

Encourage questions: Even if a patient seems to understand, it’s important to leave time for questions. Ask if they have any concerns about medications or follow-up care; this will help prevent confusion going forward and negative health outcomes.

You can go here for more advice about patient education.

How nurses can reduce patient anxiety

Nurses face challenging patients and their families every day, but understanding the causes of patient stress can reduce the patient’s anxiety and ultimately make your job easier.

Healthcare can be confusing and distressing for many patients. Being admitted to a hospital for any reason can be one of the more stressful events in a person’s life. Because of this, it is important to remember that anxiety is the root cause for many conflicts in healthcare settings; so a difficult patient or family member isn’t necessarily a rude or ornery person most of the time, they may just be experiencing symptoms of anxiety.

The first step in mitigating a patient’s anxiety is to introduce yourself and explain your role in their treatment plan. Explain everything you are going to do and why you are doing it. Patients are inexperienced in healthcare procedures, and it can be easy to take your knowledge for granted. Come armed with hand-outs and as much information as you can; the more knowledgeable the patient feels, they more comfortable they will be.

Next, it is important to listen to your patient and take their needs seriously. Active listening techniques, such as asking open-ended questions, taking an interest in their lives, or checking in on their feelings, can be a vital lifeline to someone suffering from anxiety. Check in with them often, and give them a venue to voice their concerns.

Instead of instructing the patient to relax, demonstrate it! Your demeanor can have a profound effect on a patient’s emotional well-being, so staying cool and collected can relax them in turn. Consider using relaxation techniques like breathing exercises to help them cope with anxiety.

For more tips, click here.

Nurse educator takes to Instagram to help new nurses

Many new nurses have trouble acclimating to their new roles, but one nurse has found new and exciting ways to help them adjust.

Jannel D. Gooden, BSN, RN struggled with her first job in nursing; the first six months were traumatic, confusing, and isolating. After leaving her position, she decided to focus on guiding other novice nurses through the difficult process.

In addition to being a travel nurse in pediatric critical care, Gooden started an Instagram account to teach novice nurses and provide them with a sense of community. Gooden makes videos on the @NoviceisTheNewNurse account, sharing advice, recalling her own experiences as a novice nurse, and answering questions from new nurses.

Some of Gooden’s videos include perspectives from physicians as well. She argues that nurses of all specialties work with physicians every shift, and it is vital that nurses learn to communicate with physicians effectively and develop healthy working relationships. By sharing physician perspectives, Gooden hopes to soften their image for novice nurses, giving them a safe space to hear advice out of the workplace.

To read more about @NoviceisTheNewNurse, access the full story here.

Featured Webcast: Millennial Nurse Retention: Bridging the Generation Gap

Wednesday, April 20, 2016

In 2015, the number of millennials in the workplace surpassed baby boomers as the largest segment of workers. This future generation of nurses has very different career expectations than the generations before them. Millennials expect more feedback, greater collaboration, interaction with nurse leaders, an 8-hour workday and better work-life balance. Unlike their parents, they rarely intend to stay with one employer for their entire career—or possibly even more than a few years.

The shift in attitude has many organizations struggling to retain millennials and learning to adjust management strategies to accommodate their unique style. Join Kathy Bonser, Vice President of Nursing and CNO at SSM Health DePaul as she discusses the importance of leveraging the differences to create a win-win environment for staff and frontline leaders.

Take part in this live 60-minute webcast to:

  • Uncover how making changes in leadership behaviors can bridge the generation gap
  • Discover new onboarding processes that support the growing millennial workforce
  • Devise a structured approach to providing regular employee feedback
  • Understand the importance and value of engaging millennials early and often

Agenda:

  • Improving nurse retention, especially in the first year after hire
  • Understand communication preferences
    • Text or call? How to decide
    • Use of social media
  • The importance of strong onboarding and engagement processes
    • Scheduled touchpoints
    • Celebration of milestones
    • The need for performance feedback
  • The need for transparency
    • Explaining the why behind decisions
    • Seeking out nurse feedback and acting on it
    • Shedding light on how their contributions make a difference
  • Live Q&A

HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. HCPro provides 1.0 nursing contact hours for this educational activity.

For more information or to register for the webcast, click here.

Shared decision making has benefits for minority patients

New evidence suggests that shared decision making (SDM) can improve the patient experience for minority groups, particularly LGBTQ patients of color.

Shared decision making aims to include the patient’s perspective when making care decisions and better educate patients about treatment options. SDM acknowledges that each patient is unique, so creating a dialogue between the provider and patient should increase patient engagement and result in better outcomes. As one researcher describes the shift: “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”

This idea of respecting and listening to a patient is at the heart of caring for all patients, but minority patients particularly benefit from an SDM approach. As we discussed in our post about transgender healthcare, an open dialogue and respect for how the patient would like to be addressed goes a long way to build trust for the patient; the same principle applies across minority groups.

The University of Chicago and the Agency for Healthcare Research and Quality have developed a new project called Your Voice! Your Health! aimed at researching SDM’s influence on minority healthcare and facilitate healthcare improvements for the LGBTQ racial and ethnic minority community. The researchers note that the confluence of minority statuses make it particularly difficult for LGBTQ patients of color; as Monica Peek MD, MPH, Associate Professor of Medicine at the University of Chicago Medicine told ScienceLife: “Racial/ethnic, sexual orientation, and gender identity minority status are all marginalized social identities, so they act in concert to further marginalize people who are trying to navigate the health care system.”

Because there is little existing research on LGBTQ patients of color, providers may not have the proper framework or tools for addressing their needs. Peek and her team developed a new conceptual model to illustrate how the patient and physician’s social identities effect SDM. As ScienceLife describes the strategy: “In the end, establishing trust boils down to how well a physician acknowledges her own identities in relation to those of her patients.” According to the group’s research, differences in social identity didn’t matter so long as the provider was compassionate and encouraged an educated dialogue, the hallmarks of a SDM approach.

program, Massachusetts General Hospital (MGH) reviewed what made the initiative a success. At first they relied on physicians to order decision aids and educational materials for patients to encourage informed discussion, but they didn’t see immediate results. Once they trained all staff and involved patients directly, the use of decision aids increased substantially. Leigh Simmons, MD, medical director of the MGH Health Decision Sciences Center, said of the initiative: “There now is a big push toward more team-based care in medicine; and once we started to engage the entire team – including front desk staff, medical assistants and most crucially, the patients – we saw the use of decision aids take off.” Once the full staff and patients embraced the program, physicians reported that they had more advanced discussions with patients and they are able to focus on what’s important to their patients.

Do you use shared decision making practices in your facility? Do you find it easier to connect with patients using these techniques? We would love to hear about it in the comments below!

For more information on the Your Voice! Your Health! project and a useful tool for establishing a patient dialogue, check out the full ScienceLife article.