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Simulation: Experiential, Safe Learning in Healthcare

22 Aug, 16 | by hnoble

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Dr Ian Walsh, @Bigianbo – Queen’s University Belfast, School of Medicine i.walsh@qub.ac.uk

Simulation is encountered increasingly in healthcare education, throughout both undergraduate and postgraduate arenas. Particularly in key areas such as patient safety, it has evolved significantly from simulated clinical tasks deploying high fidelity manikins to replication of complex clinical scenarios addressing nontechnical skill issues such as communication, decision making and teamworking.

A succinct description is: “an educational technique that allows interactive, and at times immersive activity by recreating all or part of a clinical experience without exposing patients to the associated risks”1

The need for a “uniform mechanism to educate, evaluate, and certify simulation instructors for the health care profession” was recognized by McGaghie et al. in their critical review of simulation-based medical education research2.

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Mission Possible – Putting Neonatal Pain Knowledge into Action

14 Aug, 16 | by josmith

Dr Denise Harrison (RN, PhD), Associate Professor, Chair in Nursing Care of Children, Youth and Families, University of Ottawa &  Children’s Hospital of Eastern Ontario (CHEO) Research Institute dharrison@cheo.on.ca OR denise.harrison@uottawa.ca

This week’s EBN Twitter Chat is being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), between 1900-2000 (British Summer Time) and is a joint venture with the Council of International Neonatal Nurse (COINN) conference 2016 being lead by Dr Densie Harrison. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

We have the knowledge how to reduce pain in sick and healthy newborns during routine, frequently occurring painful procedures – breastfeeding,1 skin-to-skin care2 or very small volumes of sweet solutions, either sucrose3 or glucose.4 Evidence from randomized controlled triaAlice Englishls – synthesized into systematic reviews – further distilled into clinical practice guidelines and finally concentrated into usable evidence; YouTube videos showing these strategies during bloodwork (BSweet2Babies & Power of Parent’s touch) give us ample knowledge and tools to inform our practice and help us translate the knowledge into action. Yet, studies of newborn pain practices around the world continue to show that neonatal pain in under-treated We do not consistently facilitate parents to breastfeed or hold their babies skin-to-skin during procedures, and sweet solutions are not always made available.5 Ultimately, the babies we care for in our Neonatal Intensive Care Units, Special Care Units, other hospital wards and even our healthy newborn babies suffer from pain that is easily preventable.

In our COINN pain panel titled Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coMotherSCCVideoinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and live Twitter Chat (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), we will work together as neonatal pain champions in our organizations, to work at best ways to put our neonatal pain knowledge into action. Our panel includes our audience @COINN2016, as well as Dr Linda Franck, Dr Bonnie Stevens, Dr Marsha Campbell-Yeo (‏@DrMCampbellYeo),and myself, as the Session Chair (@dharrisonCHEO). Our discussion will include myths surrounding recommended pain care; effectiveness of maternal-led interventions to reduce procedural pain; ways we can support and empower parents and facilitate their role as partners in pain care, and improving practices at the organizational level.

I really look forward to our session, our speakers and, from our audience, ways to move forward to embed our knowledge into normalized pain management practices.

1         Shah PS, Herbozo C, Aliwalas LI, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012. DOI:10.1002/14651858.CD004950.pub3.

2         Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014. DOI:10.1002/14651858.CD008435.pub2.

3         Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2013 2016; DOI:10.1002/14651858.CD001069.pub5.

4         Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of non-sucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153–61.

5         Harrison D, Reszel J, Wilding J, et al. Neuroprotective Core Measure 5: Neonatal Pain Management Practices during heel lance and venipuncture in Ontario, Canada. Newborn Infant Nurs Rev 2015; 15: 116–23.

The Power of a Parent’s Touch on Newborn Procedural Pain

14 Aug, 16 | by josmith

Dr Marsha Campbell-Yeo PhD RN, Neonatal Nurse Practitioner, Associate Professor and Clinician Scientist, School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health Centre marsha.campbellyeo@iwk.nshealth.ca

No parent wants toBaby SSC image for ebnjc see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event with preterm and sick babies ofte
n undergoing on average 12 painful procedures every day with the majority receiving little or no pain relief. In addition to the immediate pain and stress babies experience during these procedures, the
se babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. This has to change.

As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and wellbeing but they are not always involved in critical care settings. Over my time at the bedside, I noticed that the power of touch could have a positive impact on infants and mothers. So I decided to study this. We found that Skin-to-Skin Contact (SSC), sometimes called kangaroo care, where an infant lies directly on a mothers’ chest, between moms and infants has powerful benefits and can even significantly decrease pain responses in preterm and full term infants undergoing a single painful procedure such as blood collections and needle pokes. However, it is not just mothers that can provide pain relief – fathers, alternative care providers and co-bedding twins have been found to effectively reduce pain during procedures as well!

Despite these positive findings related to pain management in newborns, pain is still associated with regular procedures and continues to be undermanaged for these infants during their hospital stay. A significant challenge remains related to practice change in the NICU. We found that while nurses reported fewer concerns over time related to helping mothers provide SSC as a pain-relieving strategy in the NICU, the amount of the time SSC was actually used did not change.tumblr_maq3vwaULq1rog5d1o1_500

Knowing the positive impact that families can have on minimizing pain during painful procedures by simply asking for it is something that I felt I had to get into the hands of parents. Therefore, I created a parent friendly video titled “Power of a Parent’s Touch” that is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 156,000 views so far in over 150 countries around the world!

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years! Parents are one of our most underutilized resources to help relive this pain.

We need to change that. Parents can make a difference.

Join COINN live Twitter Chat – Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

Let’s do it With Parents!

14 Aug, 16 | by josmith

Professr Family Health care, School of Nursing, Univisrt of California San Francico Linda.Franck@ucsf.edu @lfranck77 @UCSFnurse @UCSFPTBI

Joining together for COINN 2016 is a wonderful opportunity to reflect on how far we’ve come – and where we still need to do better – in preventing and treating neonatal pain. As I think about the role of parents as partners in neonatal pain management, we seem to be on a 15 year cycle of paradigm shifts in our thinking.

It wasn’t until the mid-1980s that neonatal pain was first recognized as a serious health condition, and parents played an important role in bringing public attention to the untreated pain of infants in neonatal intensive care units. Then, in the early 2000’s we started asking parents about their views on how we were managing infant pain and, guess what? – they had many questions, worried about how not being able to comfort their baby meant that they weren’t able to be a good parent, and parents wanted to be more involved, but didn’t know how.

This realization began a very fruitful era of research where we all discovered that parents were our best “medicine” for preventing or treating much of the day-to-day pain that infants experienced. We learned it was safe and effective – often more safe and effective than traditional analgesics. We also discovered that nurses were more attentive to infant pain assessment and management when parents were more actively involved. Involving parents in infant’s comfort care is a classic “win-win” example – reducing a serious adverse outcome of neonatal intensive care for infants, and promoting confidence and competence of new parents.94368575-4ABE-44D8-96B0-AFFCEF303AC3

And now in 2016, it is time to take the next big leap in knowledge and action to continue to improve infant pain prevention and manage. Let’s include parents as full partners from the very beginning of this next idea generation. I can’t wait to see what great new innovations our nurse-parent partnership will discover together!!

http://familynursing.ucsf.edu/resources-parents

 

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (British Summer Time)

Mission Possible – Prioritize Pain Prevention

14 Aug, 16 | by josmith

Professor Bonnie Stevens, Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada b.stevens@utoronto.ca

We hbabyskintoskinave heard repeatedly about the high numbers of painful procedures undertaken with hospitalized neonates and their potential consequences. We are also aware of insufficient practices to treat the pain associated with these procedures. This inadequacy is often attributed to lack of knowledge of care providers, when really it is a lack of organizational commitment to decreasing pain and changing behavior.

I have devoted my research career to studying pain in infants. However, even with 50 infant  pain measures and multiple systematic reviews synthesizing pain-DadSSCrelief strategies for health care professionals (e.g. sucrose [1]) and parents (e.g. skin-to-skin care and breastfeeding), effectively implementing these strategies remains challenging. Therefore, I have refocused my research within implementation science to determine how healthcare organizations can effectively change practice and influence practice, research and policy agendas.

I believe that evidence or champions alone cannot change behavior or outcomes. Institutions need to prioritize pain prevention and demonstrate their commitment at the point of care. They can facilitate dialogue amongst health care providers, support leaders and the efforts of local champions, and provide resources. Without organizational support for pain relief, the best evidence and individual efforts will go unnoticed.I have completed a large national study, funded through the Canadian Institutes of Health Research, where with strong leadership, committed resources and local champions, hospital units improved pain assessment and treatment and decreased procedural pain in children [2,3]. However, this approach, which supported an on-site research nurse was not feasible or sustainable [4].

We have now developed a multiplatform web-based infant pain resource that we will implement and evaluate. The resource consists of a 7-step evidence-based quality improvement strategy for changing behavior and enhancing outcomes. Initial evaluation indicates that health care professionals are highly satisfied and excited about this resource. It is my hope that this strategy will stop the conversation on inadequate procedural pain management and start the dialogue on successful change management.

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

References

  1. B. Stevens, J. Yamada, A. Ohlsson, A. Shorkey, S. Haliburton. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3.
  2. B. Stevens, J. Yamada, S. Promislow, J. Stinson, D. Harrison and The CIHR Team in Children’s Pain. (2014). Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children. Implementation Science, 9, 120.
  3. B. Stevens, J. Yamada, C. Estabrooks, J. Stinson, F. Campbell, S.D. Scott, G. Cummings and CIHR Team in Children’s Pain. (2013). Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 155(1):60-68.
  4. B. Stevens, J. Yamada, S. Promislow, M. Barwick, M. Pinard, CIHR Team in Children’s Pain. Sustainability of pediatric pain outcomes following a knowledge translation booster intervention. Pediatrics (In Press).

Key messages from INANE

7 Aug, 16 | by josmith

Alison Twycross (@alitwy), Editor and Joanna Smith (@josmith175) and Roberta Heale (@robertaheale), Associate Editors, EBN
R Heale photoIMG_0206image

Last week we shared our excitement at the prospect of representing EBN, and presenting the successes and challenges of embedding social media as a core EBN activity at the International Academy of Nursing Editors (INANE), conference.

IMG_0155The opening gala was a great opportunity to network, debate and consider how journals and their editorial teams are shaping nursing, and included a
thoughtful and stimulating presentation of Florence Nightingale’s Reluctant Life in Portraiture by Natasha McEnroe, Director of the Florence Nightingale Museum. http://www.florence-nightingale.co.uk

Our presentation focused on the ways social media activities can be used in nursing journals to engage the journal readership and outline the purpose of social media strategy media activities within EBN, and despite anxieties about web access we managed a live Twitter chat (#ebnjc) demonstration! We shared some of EBN social media successes:

The EBN social media strategy has:

  • Widened our opportunities to engage with our readership
  • Meant we engage with a more diverse audience than the traditional paper journal copy readership.

Other key messages from INANE included:

  • The bad practice / poor reporting of clinical trials outcomes such as reporting favorable results that often are different from those in their original protocol and often negative results aren’t reported. Dr Ben Goldacre unpicked the dodgy scientific claims made by scaremongering journalists, dubious government reports, pharmaceutical corporations, PR companies and quacks; his similar TED talk can be accessed below https://www.ted.com/talks/ben_goldacre_battling_bad_science?language=en
  • A concurrent session led by Alistair Hewison, questioned the need for journal editors to reflect on how they can develop political awareness among their readers (and the stages of political awareness)
  • A keynote on the role of ORCID ID to facilitate identification of an individual’s body of work was a timely reminder of the role of journals in maximizing consistent identifiers for authors and journals.

Getting ready for INANE

31 Jul, 16 | by josmith

Alison Twycross (@alitwy), Editor and Joanna Smith (@josmith175) and Roberta Heale (@robertaheale), Associate Editors, EBN

R Heale photoIMG_0206

Being the editor and associate editors of Evidence base nursing places us not only in a privileged position to contribute directly to the quality of journal content and future directions of the journal, but ultimately to support nurses in practice to base care on the best available evidence. Over the past two years we have been developing our social media strategy as a means to disseminate, share and debate best evidence based practice to people who do not necessarily subscribe to our journal, enabling EBN to reach a wider range of people, some of which may not have been previously aware of EBN’s activities.

Screen Shot 2016-07-25 at 08.20.47

 

We are excited to be representing EBN at INANE, networking with peers, and the opportunity to present the successes and challenges of embedding social media as a core EBN activity. Successes have included:

 

 

Challenges have included:

  • Identifying the best time for Twitter Chats;
  • Ensuring co-hosts have the skills to contribute to online chats;
  • Developing effective ways of advertising and committing time to tweet in advance of Twitter Chats.

We will report the key messages we gained from attending INANE next week.

EBN during August: Spotlighting the role of nurse editors

31 Jul, 16 | by josmith

To coincide with the International Academy of Nursing Editors, during the next two week at Evidenced Based Nursing (EBN) we are spotlighting on the role of nurse editors. The International Academy of Nursing Editors (INANE) was established in 1982, and is an international collaborative of nursing editors and publishers with the primary aim to promote best practices in publishing and high standards in the nursing literature https://nursingeditors.com.

Each year INANE hosts an international conference, organized by one of its members. The 35th Annual Meeting of INANE is being held in London, on August 1-3, 2016.

EBN Tweeting during August

Although there are no ‘official’ EBN Twitter chats in August we will be continuing to network via Twitter:

Where is our nursing ‘Choose Wisely’?

27 Jul, 16 | by josmith

Enrique Castro-Sánchez (@castrocloud) Associate Editor at Evidence-Based Nursing, Research Fellow at NIHR Health Protection Research Unit at Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Honorary Nurse Consultant in Communication and Patient Engagement, Imperial College Healthcare NHS Trust, London.

Joining EBN journal is proving to be a fantastic personal experience and a great opportunity to help disseminate evidence-based nursing. In my opinion, the notion of avoidable care is intimately linked to such model of practice. The tests and procedures that we should not be doing to our patients does not simply refer to what may be harmful to them, but also to interventions that offer little or no added value to their care.

Engaging in low value care however has got obvious impact, in terms of the potential for iatrogenic events and opportunity costs. Whatever we decide to spend our time, energy and effort on cannot be spent somewhere else. And by the growing body of evidence related to ‘care left undone’ [doi: 10.1111/jan.12976], we already know that our nursing capacity and resources are insufficient.

Interestingly, the need to avoid unnecessary healthcare activities has been recognised around the world. The ‘Choosing Wisely’ initiative (www.choosingwisely.org) was developed in the US and Canada in 2012 with the purpose of encouraging doctors to discontinue interventions that were not evidence-based, harmless and necessary. As a nurse interested in communication and patient engagement, I also celebrate the focus on encouraging patients to make effective decisions about their care. ‘Choosing Wisely’ asked scientific societies and organisations to identify commonly used procedures and treatments that were deemed to be wasteful. The initiative has attracted attention in other countries, including Switzerland, Australia and Netherlands, among others. ‘Choosing wisely’ recently landed in the UK (http://www.bmj.com/content/350/bmj.h2308), although some policies such as ‘Simply Prudent Healthcare’ in Wales (http://www.prudenthealthcare.org.uk/), developed in response to cost and quality challenges, also pointed in the same direction.

And what about nurses?

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Dignity in palliative care across the lifespan

18 Jul, 16 | by josmith

Dr Alison Rodriguez, Lecturer Child and Family Health, University of Leeds2016-07-15 11.02.52

This week’s EBN Twitter Chat on Wednesday 20th July between 8-9 pm (UK time) will be hosted by Alison Rodriguez (@ARodriguez339) Lecturer Child and Family health, University of Leeds and will focus on ‘dignity in palliative care across the livespan. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Patient dignity is a core value/aim of palliative care across the lifespan. Personal dignity is often discussed in relation to independence, so as we become more dependent on others through illness, it is assumed that we lose some of our dignity, or our sense of dignity. Indeed, there are claims that a loss of dignity encourages individuals to seek an assisted or hastened death (Chochinov, 2012). The model of dignity conserving care was developed to provide holistic direction for health professionals (Chochinov, 2002). This model, derived from (adult) patient experience, identifies 3 aspects of dignity:

  1. Illness related – bodily concerns/problems, symptom distress.
  2. Dignity conserving repertoire – individual to the patients psychology and spiritual beliefs – continuity of the self, role preservation, legacy, conserving pride, hope, autonomy, control, acceptance and resilience.
  3. Social dignity – the quality of interactions with others – privacy, boundaries, social support, care tenor, burden to others, bereavement concerns.

Question to consider before the Twitter Chat:

  1. How do you define dignity? What supports your sense of dignity?
  2. Is the model of dignity conserving care relevant to all palliative care populations (including younger populations)?
  3. Given service constraints, are we providing dignified palliative care?
  4. Do we have sufficient access to dignity related palliative/end of life care education and training? Are training needs identified?
  5. To achieve dignity in palliative care should we be reaching out beyond dedicated services and look more at encouraging cultural change? Developing supportive communities? How can this be achieved?

Useful reading

Chochinov, H. M. (2002) Dignity conserving care: a new model for palliative care. JAMA, 287, 2253-2260.

images-1Chochinov, H. M. (2012) Dignity therapy: Final words for final days. Oxford: Oxford University Press.

Wegleitner, K., Heimerl, K. & Kellehear, A. (2016) Compassionate communities: case studies from Britain and Europe. London: Routledge.

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