Hybrid journal (It can contain Open Access articles) ISSN (Print) 0026-4075 - ISSN (Online) 1930-613X Published by Oxford University Press[416 journals]
Authors:King H; Hatzfeld J. Pages: 1 - 3 Abstract: Since its inception in 1992, the TriService Nursing Research Program (TSNRP) has focused on facilitating nursing research to optimize the health of military members and their beneficiaries. TSNRP was initially established by congressional directive, but since 2008 has received programmed funding through the Department of Defense.1 Every three years, an active duty senior military nurse scientist is appointed as the Executive Director of TSNRP, but the strategic direction and funding decisions for the program are accomplished by an Executive Board of Directors (EBOD), which consists of the Nurse Corps Chief/Director from the Army, Navy, and Air Force. A six-member Advisory Council provide scientific input into EBOD decisions, and consists of two senior military nurse scientists from each service—one active duty and one reservist. The mission, goals, and research priorities of TSNRP are re-evaluated every 3 to 5 years through a deliberate strategic planning process, which solicits input from the TSNRP community, including the EBOD, Advisory Council, and representative military nurse scholars at all levels, from novice to expert. PubDate: Fri, 15 May 2020 00:00:00 GMT DOI: 10.1093/milmed/usz336 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Hoffman M; Roy D, Zabokrtsky D, et al. Pages: 4 - 6 Abstract: In an unpredictable and complex global environment where our military force must remain globally engaged and adaptive, maintaining the readiness of the force is essential. Within the military health system (MHS), the focus is on quality health care for our beneficiaries, lower cost, and clinical skills sustainment.1 Those goals support our overall mission of generating a readily deployable force with a supporting medical force ready to deliver health care anywhere and at any time. Evidence-based practice (EBP) provides an important tool for our health care professionals to maintain a readiness focus, develop and maintain clinical skills, and provide care that is relevant to both the military and civilian health care communities. The purpose of this editorial is to underscore the support from military nursing leadership to pursue EBP initiatives and the importance of incorporating evidence into decisions made at all levels. PubDate: Fri, 19 Jun 2020 00:00:00 GMT DOI: 10.1093/milmed/usz190 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Augustino L; Braun L, Heyne R, et al. Pages: 7 - 14 Abstract: BackgroundIn 2017, the TriService Nursing Research Program completed a strategic planning session, which identified key barriers to implementing evidence-based practice (EBP) within the U.S. Military Health System (MHS) including a focus on readiness training and deployments, frequent staff moves for military members, and relatively junior nurses in clinical roles. To facilitate EBP at individual military treatment facilities (MTFs), an EPB Facilitator role was developed using an evidence-based model and based on validated EBP competencies.MethodsThis new role was implemented at four MTFs in 2018: Naval Medical Center Portsmouth, 59th Medical Wing at Joint Base San Antonio Lackland, Naval Medical Center San Diego, and David Grant USAF Medical Center at Travis Air Force Base. This case series provides a description of the initial implementation of this role.ResultsCommon enablers and challenges were identified from the experiences at all four sites. These included the importance of incorporating efforts into existing organizational efforts and infrastructure; the value of nurse leaders inviting EBP facilitators to participate and engage in scheduled meetings and committees; the significance of engaging with existing quality, process improvement, and training initiatives; and the benefit of collaborating with advanced practice nurses within the organization. The common challenges for all EBP facilitators were the frequent staff turnover at all levels and a lack of standardization to review and approve EBP initiatives, which makes it difficult to navigate the complete process of project implementation and collaboration across sites. Another challenge has been the difficulty to measure the impact of this role at the MTF and MHS levels.ConclusionsAs EBP efforts continue and the program matures, it is anticipated that the outcomes from the individually completed projects, to include decreases in safety events, fiscal savings, and other improvements in organizational metrics, can be compiled to demonstrate the collective impact of these roles within the MHS. PubDate: Wed, 06 May 2020 00:00:00 GMT DOI: 10.1093/milmed/usz460 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Scallan R; Gerathy S, Price J, et al. Pages: 15 - 20 Abstract: ABSTRACTINTRODUCTION AND SCOPE OF THE PROBLEMSurgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a preoperative antiseptic bathing regimen on an inpatient medical-surgical telemetry unit using 4% chlorhexidine gluconate (CHG), and to compare SSI rates with this new protocol to previous SSI rates on the unit.MATERIALS AND METHODSA literature review guided the development of the protocol and clinical question. A unit project was conducted using SSI rates from an inpatient military medical-surgical telemetry unit over 4 yr. From 2014 to 2016, 3 yr before implementing the protocol, a non-standardized CHG scrub was compared to 12 mo after implementing the standardized 4% CHG protocol in 2017 using up to four daily washings (three evenings and one morning surgery) on inpatient admissions to the unit. SSI rates were compared.RESULTSAfter implementing a 4-d preoperative bathing regimen with 4% CHG for patients scheduled for surgery, SSI rates decreased from an average rate of 0.0072 infections (7.2 infections per 1,000 surgeries) to 0.0035 infections (3.5 infections per 1,000 surgeries) in the subsequent year of data collection. Although not a statistically significant change, further analysis using a Bayesian Poisson regression model found an 84% probability the new protocol would lower SSI rate by 1 or more cases per 1,000 surgeries on this inpatient unit.CONCLUSIONThe findings suggest the proposed approach to control infection that may reduce the number of SSIs on a military medical-surgical unit, but this needs to be demonstrated through further longitudinal research on military surgical units. PubDate: Fri, 19 Jun 2020 00:00:00 GMT DOI: 10.1093/milmed/usz186 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Kertes S. Pages: 21 - 27 Abstract: ABSTRACTPatients with the medical diagnosis of obstructive sleep apnea (OSA) and those with undiagnosed OSA have greater chances for adverse events during surgical procedures related to their medical condition. Early identification of at-risk OSA patients can help mitigate associated adverse events. The purpose of this project was to implement a preoperative process to provide early identification of at-risk OSA patients in the preadmission unit, at a large military level I trauma center in central Texas. The Population, Intervention, Comparison, Outcome, Time (PICOT) question for this project is: “In the adult surgical population, how does the routine use of the STOP-Bang Questionnaire compared to non-standardized assessment influence the identification of OSA during the preadmission processing in a military health care treatment facility'” Following the implementation of the standardized use of the STOP-Bang Questionnaire, the identification of early at-risk OSA patients increased from 23% (based on a medical diagnosis of OSA) to 54% with an intermediate and high-risk OSA. Early identification of OSA has an impact on the decisions made to augment and enhance the patient-specific tailored care for each at-risk OSA surgical patient. Potential adverse events may be diminished or eliminated with the early identification of OSA patients. Preoperative policies that support the utilization of preoperative screening for OSA will improve the overall quality and safety of care provided to surgical patients. PubDate: Fri, 19 Jun 2020 00:00:00 GMT DOI: 10.1093/milmed/usz187 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Bargmann A; Brundrett S. Pages: 28 - 34 Abstract: INTRODUCTIONFalls during hospitalizations can increase the length and cost of a hospital stay. Review of patient safety reports on a 26-bed medical-surgical telemetry unit revealed that the number of falls went from 6 in 2015 to 12 in 2016. The reports identified a knowledge gap in the patient population and nursing staff related to high fall risk interventions. A literature review suggests that patient-staff safety agreements, in combination with proper implementation of Clinical Practice Guidelines, can successfully increase education and adherence to fall prevention measures and reduce the number of inpatient falls.MATERIALS AND METHODSThe objective of this evidence-based practice project was to determine if the implementation of a patient fall safety agreement in combination with an existing evidence-based fall prevention bundle reduces the number of falls. Based on the literature review, the unit developed a multicomponent fall prevention program that emphasizes staff and patient education. The program consists of (1) assessment of the patient’s fall risk using the Johns Hopkins Fall Assessment Tool, (2) daily patient education on factors contributing to the patient’s fall risk during the shift assessment, (3) an educational handout on fall risk factors maintained at the bedside, (4) ensuring compliance with implementation of previously existing fall prevention measures, and (5) a patient fall safety agreement.RESULTSDuring the first 4 months, the fall rate decreased by 55% and staff compliance with interventions for high fall risk patients increased to 89%. To achieve added compliance, the unit implemented an incentive program, which resulted in the increased adherence to the fall risk interventions. The unit experienced 87 and 88 consecutive fall-free days, which was the longest consecutive days since May 2015. This project has reached sustainment and the unit continues to see a low fall rate, well below the national average for medical-surgical units.CONCLUSIONOne of the largest obstacles to this project was staff and leadership turnover. However, the project found that patient fall safety agreements facilitate a dialogue among staff and patients as well as encourage patients to take ownership of their own care. They improve the safety of patients and create a collaborative environment for nurses to conduct safe, quality patient care. PubDate: Fri, 08 May 2020 00:00:00 GMT DOI: 10.1093/milmed/usz411 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Migliore L; Chouinard H, Woodlee R. Pages: 35 - 42 Abstract: Introduction: Implementation and sustainment of evidence-based practices (EBPs) are common challenges faced by healthcare organizations. The Clinical Research and Practice Collaborative, an evidence-based initiative implemented at a large Military Treatment Facility, addresses EBP implementation and sustainment by expanding the culture of nursing clinical inquiry and broadening nursing research efforts to include EBP. The evidence-based intervention of scheduled, intentional, intraprofessional collaboration between PhD nurse scientists and advanced practice registered nurses as compared to previous methods of spontaneous, consultative collaboration, focuses on developing support for nursing research and EBP initiatives. Materials and Methods: A 2-year pre- and 2-year post-implementation timeframe compared outcomes (proposals, publications, posters) from individual and collaborative nursing research and EBP initiatives. Results: Although nursing research initiatives remained stable, research publications and posters were reduced by 63%, EBP initiatives grew 450%, EBP publications and collaborative nursing initiatives for both research and EBP increased. Additionally, EBP Council membership rose 300%, and an intraprofessional cadre was formed during the implementation. Conclusions: Intentionally scheduled collaboration between PhD nurse scientists and advanced practice registered nurses is a promising model to promote an expanded culture of nursing clinical inquiry and should be considered for medical facilities seeking to enhance EBP and nursing research efforts. PubDate: Wed, 08 Jan 2020 00:00:00 GMT DOI: 10.1093/milmed/usz447 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Talbot L; Wilson C, Nayback-Beebe A, et al. Pages: 43 - 49 Abstract: ABSTRACTThis is a review of the proceedings of the first Military Nursing Back Pain Summit focusing on nursing’s role in preventing and managing back pain. The purpose of the summit was to present the state of the science in back pain and to identify key gaps in research, policy, education, and treatment that could be undertaken by military nurses, nurse leaders, nurse practitioners, and nurse scientists. Several key points were highlighted during the summit: (1) back pain is multifactorial and preventable; (2) military service members have unique risk factors for developing back pain; (3) both acute and chronic back pain impact readiness and sustaining readiness is the primary mission of military medicine; (4) back pain is most effectively managed with multiple treatment approaches; (5) military culture must pivot away from an attitude of ignoring persistent pain or “toughing it out” to prevent acute back pain from becoming chronic; (6) integrating military nurses within operational units will be important for effective prevention, education, screening, and treatment within dispersed Multi-Domain Operations; and (7) early self-management is an important area for nursing research and intervention to empower service members to maintain and sustain their back health. The various presentations and panels from the meeting are summarized. PubDate: Fri, 19 Jun 2020 00:00:00 GMT DOI: 10.1093/milmed/usz238 Issue No:Vol. 185, No. Supplement_2 (2020)
Authors:Bridges E; McNeill M. Pages: 50 - 53 Abstract: ABSTRACTCare under operational conditions is complex and unique. Although there is a growing body of evidence to inform this care, very few resources address operational nursing care. To address this issue and the lack of a compilation of relevant studies and evidence-based guidelines, the TriService Nursing Research Program Battlefield and Disaster Nursing Pocket Guide was created. The pocket guide has been updated and incorporates new and emerging evidence and also showcases the focused operational research of military nurse scientists. Eight thousand copies of the second edition of the guide, which curates a comprehensive body of literature related to operational nursing care, are being distributed to the three services. Military nurse scientists and multidisciplinary clinical experts contributed to the guide, with the content undergoing critical review by experts in operational care. This article summarizes the development of the pocket guide, summarizes some of the updates from the first edition, and demonstrates the integration of the guide into the major phases of evidence translation: knowledge, creation, and distillation; diffusion and dissemination; and adoption, implementation, and institutionalization. The incorporation of the pocket guide into readiness training reflects a goal of TriService Nursing Research Program to “develop and strengthen the Triservice community of nurse scholars to generate new knowledge in military nursing and translate it into practice” and an unending commitment to bring world class care to those in harm’s way. PubDate: Fri, 19 Jun 2020 00:00:00 GMT DOI: 10.1093/milmed/usz290 Issue No:Vol. 185, No. Supplement_2 (2020)
Hybrid journal (It can contain Open Access articles)
