Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework

This article in the March 2018 issue of “Worldviews on Evidence Based Nursing” is by Spooner and colleagues.
Background:  Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited.
Aims:  The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework.
Methods:  This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A post-implementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage).
Results:  Overall (86%, n = 49), TLs’ use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface.
Linking Evidence to Action:  Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and to ensure clinician and organizational needs are met.
The full text of this article as a PDF is available via link from this website


Why do we fail to deliver evidence-based practice in critical care medicine?

Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices | Current Opinion in Critical Care

The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine.

The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains.

Full reference: Weiss, C.H. (2017) Why do we fail to deliver evidence-based practice in critical care medicine? Current Opinion in Critical Care.  Vol. 23 (Issue 5) pp. 400–405


Research Use of Nurses Working in the Critical Care Units

There is a distinct gap between theory and practice with respect to research use in clinical practice, particularly in critical care units, that could be related to the presence of a number of barriers that hinder the use of research findings | Dimensions of Critical Care Nursing


Aims: The aims of the study were to identify barriers and facilitators to research use as perceived by Jordanian nurses in critical care units and to examine the predictors of research use among those nurses.


Conclusions: Research use has not been widely implemented yet in Jordan because of various barriers. The organization-related barriers were the most influential. Factors hindering research use are multidimensional, and optimizing them should be a shared responsibility of nurse managers, researchers, clinicians, and academicians. Further initiatives are required to raise awareness of the importance of using evidence-based practice.

Full reference: Hweidi, I. et al. (2017) Research Use of Nurses Working in the Critical Care Units: Barriers and FacilitatorsDimensions of Critical Care Nursing. 36(4) pp. 226–233

Promoting Evidence-Based Practice at a Primary Stroke Center

Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking | Dimensions of Critical Care Nursing


Objectives: The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility.


Discussion: This nurse education strategy increased RNs’ confidence in ability to explain the path from evidence to bedside nursing care by demonstrating how evidence-based clinical practice guidelines provide current evidence used to create standardized order sets. Although further evaluation of the intervention’s effectiveness is needed, this educational intervention has the potential for generalization to different types of standardized order sets to increase nurse confidence in utilization of evidence-based practice.

Full reference: Case, C.A. (2017) Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy. Dimensions of Critical Care Nursing. 36(4) pp. 244–252

Implementing EBP: in-hospital family-witnessed cardiopulmonary resuscitation

Sak-Dankosky, N. Nursing in Critical Care. Published online: 9 April 2017

Background: In-hospital, family-witnessed cardiopulmonary resuscitation of adults has been found to help patients’ family members deal with the short- and long-term emotional consequences of resuscitation. Because of its benefits, many national and international nursing and medical organizations officially recommend this practice. Research, however, shows that family-witnessed resuscitation is not widely implemented in clinical practice, and health care professionals generally do not favour this recommendation.

Conclusion: Despite existing evidence revealing the positive influence of family-witnessed resuscitation on patients, relatives and cardiopulmonary resuscitation process, Finnish and Polish health care providers cited a number of personal and organizational barriers against this practice. The results of this study begin to examine reasons why family-witnessed resuscitation has not been widely implemented in practice. In order to successfully apply current evidence-based resuscitation guidelines, provider concerns need to be addressed through educational and organizational changes.

Read the full abstract here