January 11, 2018

A new survey of United States nurses by The Ohio State University College of Nursing indicates marked deficits in evidence-based practice (EBP) competency. The study’s authors find that these deficits threaten the ability to provide high-quality, safe and cost-effective care.

Published recently in Worldviews in Evidence-Based Nursing, the Ohio State research team’s anonymous online survey of 2,344 nurses working in 19 hospitals and healthcare systems nationwide found that nurses reported they were not yet fully competent in meeting the profession’s 24 EBP competencies.

EBP is a life-long, problem-solving approach to clinical practice that integrates the best evidence from well-designed studies with a patient's preferences and values and a clinician's expertise. Findings from multiple studies have supported that, when patients receive evidence-based care from healthcare providers, healthcare quality, safety and patient outcomes improve and costs decline. EBP also empowers clinicians and leads to higher levels of engagement, teamwork and job satisfaction. However, research has shown that multiple barriers prevent clinicians from consistently implementing EBP, including inadequate knowledge and skills in EBP, barriers in academia that impede how EBP is taught, healthcare cultures that are steeped in tradition (e.g., “that is the way we do it here”), misperceptions about the time it takes to implement EBP, leaders and managers who do not embrace, model and support EBP and lack of EBP mentors available to assist point-of-care providers with evidence-based care. 

Nurses who responded to the survey were asked to report their level of competency for each of the 24 EBP competencies on a scale spanning four categories – “not competent,” “need improvement,” “competent” and “highly competent.” For all but one category, respondents reported falling between the “need improvement” and “competent” levels. Nurses reported themselves as not competent in leading transdisciplinary teams to implement EBP.  

“Our findings concern us greatly because lack of competency in and delivery of EBP threatens the quality and safety of healthcare and hinders our efforts to ensure positive outcomes for patients,” said Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, who led the study. Melnyk serves as vice president for health promotion, university chief wellness officer and professor and dean of the College of Nursing at Ohio State. She is also executive director of the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, which is based at Ohio State.

Other key findings included:

  • Nurses with stronger beliefs in the value of EBP reported higher competency levels.
  • Younger nurses and those with higher levels of education, (i.e., master’s degrees), reported higher EBP competency.
  • EBP competency scores were not significantly different between nurses who worked in Magnet-designated hospitals and non-Magnet facilities.
  • Nurses with higher knowledge of EBP reported greater competency.
  • Nurses who had more mentorship in EBP and worked in cultures that support it reported higher levels of competency. 

“Clearly, educators and healthcare leaders must intensify their efforts to provide the infrastructure, culture and educational resources to ensure that nurses and other health professionals are competent in delivering evidence-based care,” Melnyk said. “Academic programs that prepare nurses and all health professionals should ensure competency in EBP in students by the time of graduation, and healthcare systems should set it as an expectation and ongoing standard for all clinicians.”

Joining Melnyk in designing and conducting the survey were six Ohio State colleagues: Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC, FAAN; Cindy Zellefrow, RN, DNP, LSN, PHNA-BC;  Sharon Tucker, RN, PhD, FAAN; Bindu Thomas, MEd, MS; Loraine T. Sinnott, PhD; and Alai Tan, PhD.

September 25, 2017

Loren Wold, PhD, FAHA, FCVS, associate professor and director of biomedical research at The Ohio State University College of Nursing, has been awarded a $1.56 million four-year grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) for the study entitled, “Defining the Impact of E-cigarettes on Cardiac Pathophysiology.” This study will be performed in collaboration with Philip Binkley, MD; Paul Janssen, PhD, FAHA; Ahmet Kilic, MD; and Peter Mohler, PhD, of The Ohio State University College of Medicine.

The study points out that while conventional cigarettes and air pollution have already been linked to adverse cardiovascular outcomes, little is known about the effects of e-cigarettes. Calling e-cigarettes a “new source of emissions” of toxic gasses and fine particulate matter, the study states, “It remains unknown if e-cigarette use increases inflammation and fibrosis long-term, leading to structural and functional damage to heart and vasculature.” The study proposes to define the impact of e-cigarette aerosol exposure on cardiac physiology,  the function of key cardiac cell populations and key primary human cardiac cell populations. 

“The increased use of e-cigarettes is alarming, particularly because there is limited data on how the heart is affected by exposure from e-cigarette smoke,” said Wold.

Wold’s lab work focuses on external triggers of cardiovascular disease, with special emphasis on the role of cancer cachexia and air pollution, investigating how the cardiovascular system is affected by these stressors. He is currently principal investigator (PI) of two other NIH R01-funded studies: “mechanisms of exposure-induced tissue functional and pathological changes in a mouse model of Alzheimer’s Disease,” and “muscle function and depression-like behavior in a mouse model of cancer fatigue.” In addition, he is co-investigator of a new (effective Sep. 1, 2017) R01-funded study of the effects of World Trade Center dust on cardiopulmonary function.

At The Ohio State University, Wold is involved in training undergraduates, graduate students, medical students and postdoctoral Fellows in basic lab techniques, as well as tools for effective manuscript and grant writing. He also serves as the editor-in-chief of the Elsevier journal Life Sciences.

July 12, 2017

Loren Wold, PhD, FAHA, FCVS, associate professor and director of biomedical research at The Ohio State University College of Nursing has been awarded a $3.89 million grant from the National Institutes of Health/National Institute on Aging (NIH/NIA) for his study entitled “Mechanisms of exposure-induced tissue functional and pathological changes in a mouse model of Alzheimer’s Disease.” This study will be performed in collaboration with Colin Combs, department chair for biomedical sciences at University of North Dakota, and Federica del Monte, PhD, MD, associate professor at the Medical University of South Carolina. 

Citing statistics from the World Health Organization, the study states that exposure to ambient pollution is responsible for more than 13 million deaths annually and has been associated with cardiovascular morbidity, mortality and poorer cognitive function in the aging population. “Alzheimer dementia and heart failure are a growing plague worldwide, [and] the recognition of their combinatory triggers and potential coexistence is an alarming prospective.” The study proposes to explore the role and mechanisms by which air pollution induces the development and progression of brain and heart diseases, both of which are worsened by exposures.

“Our overall goal is to determine the time course of plaque formation in the brains and hearts of animals with Alzheimer’s, in order to potentially define a biomarker for Alzheimer’s disease,” Wold said. “Recent discoveries by collaborator Dr. del Monte at Harvard Medical School (now at the Medical University of South Carolina) determined that beta-amyloid plaques, the plaques known to cause neurocognitive effects in [the hearts of] patients with Alzheimer’s disease, are also present in the brain of these patients. We are now poised to determine whether the plaques form in the heart prior to the brain.” If so, Wold and his associates hope to find a way to prevent the neurological issues associated with Alzheimer’s disease by quenching the protein aggregates in the heart before they spread to the brain.

Wold has also been funded by the NIH for his work focused on external triggers of cardiovascular disease, with special emphasis on the role of cancer cachexia and air pollution, investigating how the cardiovascular system is affected by these stressors.

At The Ohio State University, Wold is involved in training undergraduates, graduate students, medical students and postdoctoral Fellows in basic lab techniques as well as tools for effective manuscript and grant writing. He also serves as the editor-in-chief of the Elsevier journal Life Sciences.

May 03, 2017

A study by three College of Nursing faculty revealed that social smokers—those who smoke occasionally in social situations—are at the same risk for high blood pressure and high cholesterol as everyday smokers. This nationally representative study surveying 39,555 people and published in the American Journal of Health Promotion was authored by Kate Gawlik, DNP, RN, ANP-BC, FNP-BC, assistant professor of clinical practice; Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing; and Alai Tan, PhD, research associate professor.

September 16, 2016

According to a study published on Sept. 16 in the American Journal of Preventive Medicine, hospitalized smokers are more likely to quit after a nurse explains dangers and benefits to them before they are released. Sonia A. Duffy, PhD, RN, FAAN, Mildred E. Newton Professor in the College of Nursing at Ohio State, is the lead author on the study.

March 06, 2014

Patients in intensive care units (ICUs) are often put on ventilators, sedated and/or immobilized for part of their stay. Unfortunately, all of these procedures can also put them at risk for delirium, which can be debilitating and have longterm negative effects. A new study published in Critical Care Medicine finds that implementing a set of practices to encourage patients’ mobility and reduce sedation effectively reduces delirium and the need for a ventilator and increases patients’ mobility during hospitalization, which decreases weakness.

The study, funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), tested the effectiveness and safety of implementing a bundled set of evidence-based practices into everyday practice in the ICU. It is called the ABCDE bundle, for Awakening and Breathing Coordination, Delirium monitoring and management and Early mobility.

The research team, led by Michele Balas, RN, PhD, APRN-NP, CCRN, assistant professor at the The Ohio State University, and William Burke, MD, professor of psychiatry and vice chair for research at the University of Nebraska Medical Center, examined the results of having a nurse-led interdisciplinary team use the bundle with roughly 150 patients in five adult ICUs, one step-down unit and an oncology/special care unit in a medical center and compared their outcomes with those of a similar group of patients in the same setting prior to implementation of the bundle.

Patients in the study who were managed with the ABCDE bundle spent more days breathing without a ventilator (a median of 24 days compared with a median of 21 days). Fewer of those patients experienced delirium, compared with the other group (48.7 percent compared with 62.3 percent), and delirium duration was reduced by one day. Patients treated with the bundle had twice the odds of getting out of bed at least once during their hospital stay, and lower hospital mortality (11.3 percent compared to 19.9 percent).

“Even though the team didn’t fully and consistently adhere to the bundle protocol, we saw significant differences in the two groups of patients,” said Balas. “And those differences make a difference over the long run for patients. Reducing delirium, increasing mobility and reducing reliance on the ventilator while a patient is in the hospital also reduces that patient’s weakness, reduces psychological stress and can help speed up recovery after discharge.”

The ABCDE bundle uses the best available evidence on delirium, immobility, sedation and analgesia, and ventilator management in the ICU. It is a bundle of interventions tested in clinical trials that have been adapted for everyday use in the ICU. The bundle is founded on three primary principles: improving communication among members of the ICU team, standardizing care processes and breaking the cycle of oversedation and prolonged attachment to a ventilator that can lead to delirium and weakness.

The ABCDE bundle, which was developed by E. Wesley Ely, MD, MPH; Eduard Vasilevskis, MD; and their colleagues at Vanderbilt University, includes nurse-implemented, protocol-directed sedation; daily interruption of a patient’s infusion of sedatives until the patient can follow simple commands or becomes agitated (spontaneous awakening trials); periodically taking a patient off a ventilator to breathe on his or her own (spontaneous breathing trials); screening patients for delirium using either the Confusion Assessment Method-ICU or the Care Delirium Screening Checklist; and introducing physical and occupational therapy as soon as possible. Ely and Vasilevskis served as consultants on this project.

“This study confirms that the ABCDE bundle, although complex, is an effective intervention for improving patient outcomes,” said Burke. “With this study, we also established that it is possible for a hospital team to safely implement this intervention on a daily basis in the ICU.”

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation.

For more than 40 years, the Robert Wood Johnson Foundation has worked to improve the health and healthcare of all Americans. It is striving to build a national culture of health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit rwjf.org. Follow the Foundation on Twitter at twitter.com/rwjf or on Facebook at facebook.com/RobertWoodJohnsonFoundation.

April 24, 2012

Hospital recognition for nursing excellence plays a role in improving outcomes for very low birth weight infants

Babies born weighing less than 1500 grams (just under three pounds, five ounces) are among the highest risk pediatric patients in hospitals. They account for only 1.5 percent of births but over half of infant deaths. One in four infants dies in the first year of life, and 87 percent of those deaths occur within the first month. Now a new interdisciplinary study reveals that these delicate infants fare better in hospitals that have earned Recognition for Nursing Excellence (RNE) and are designated magnet hospitals by the American Nurses Credentialing Center (ANCC).

While they are in the hospital, very low birth weight (VLBW) infants require an intense level of nursing care, and nurses caring for these babies must make complex assessments, implement highly intensive therapies and make adjustments in care based on the patient’s response. The study, published in the current issue of the Journal of the American Medical Association and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research suggests that the focus on nursing excellence in magnet hospitals improves the care VLBW infants receive and their outcomes.

Eileen T. Lake, PhD, RN, FAAN, associate director of the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania, and Jeannette A. Rogowski, PhD, professor in the Department of Health Systems and Policy in the School of Public Health at the University of Medicine and Dentistry of New Jersey, led the research team, which also included Thelma Patrick, PhD, RN, associate professor at the College of Nursing at The Ohio State University.

The team studied the outcomes of 72,235 VLBW infants weighing between 501 and 1500 grams (roughly one pound, .65 ounces and 3 pounds, five ounces) born in hospitals and placed in neonatal intensive care units (NICUs) between Jan. 1, 2007, and Dec. 31, 2008. They measured the infants’ rates for seven days, 28 days and hospital-stay mortality; severe intraventricular hemorrhage; and nosocomial (blood or cerebrospinal fluid) infection.

Despite having more risk factors than VLBW infants in the non-RNE hospitals, babies in the RNE hospitals had lower rates of death, hemorrhage and infection. Researchers also recorded the racial and ethnic composition of the infant sample and noted that the proportion of non-Hispanic black infants born in RNE hospitals was significantly lower than the proportion of non-Hispanic black infants in non-RNE hospitals.

“Nurses working with these high-risk babies, usually in the NICU, must constantly be on their toes to monitor their patients for subtle changes or signs of distress that could signal cardiac, respiratory or neurologic problems,” said Lake. “They also have to maintain a scrupulously hygienic environment, especially where catheters are concerned. Hospitals that receive RNE designation are evaluated for many of the attributes associated with nursing excellence, including exemplary professional practice, and implementing new knowledge, innovations and improvements.”

ANCC’s Magnet Recognition Program recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Organizations are evaluated for evidence that they have achieved five key elements: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations and improvements; and empirical outcomes. It generally takes two years for a healthcare organization to achieve Magnet status and hospitals must undergo a re-designation process every four years and provide interim reports. Only seven percent of U.S. hospitals are magnet hospitals.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, click here or follow on Twitter at @INQRIProgram.

The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing our country. As the nation's largest philanthropy devoted exclusively to health and healthcare, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For 40 years, the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and healthcare of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit rwjf.org.