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- The TriService Nursing Research Program and Evidence-Based Practice:
Advancing Care for Service Members and Beneficiaries-
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Pages: 1 - 4
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad316
Issue No: Vol. 189, No. Supplement_1 (2023)
- Military Nursing Evidence-Based Practice Summit: A Descriptive Analysis
of EBP Barriers and Solutions Within the Military Healthcare System-
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Pages: 5 - 13
Abstract: ABSTRACTBackgroundEvidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit.MethodsA qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team.ResultsThe study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes.ConclusionsThe results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad343
Issue No: Vol. 189, No. Supplement_1 (2023)
- Clinical Inquiry in Nursing Readiness Fellowship: Increasing Air Force
Nurse Corps Evidence-Based Practice Leadership Infrastructure-
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Pages: 14 - 23
Abstract: ABSTRACTBackgroundIncreasing demands to generate, translate, and implement evidence into practice in manpower and budget-constrained environments triggered innovative support for the nursing scientific community. The Clinical Inquiry in Nursing Readiness (CINR) fellowship is a solution to integrate readiness into clinical inquiry priorities and develop future experts in the field.MethodsThis article describes the fellowship program structure, implementation, and contributions to nursing science, readiness, and professional development. We share specific recommendations based on our experiences to enhance and sustain this valuable fellowship program.ResultsSix fellows have completed the CINR fellowship since its launch in July 2019. Fellows garnered $40,000 in grant funds for five evidence-based practices, two research studies, and six clinical inquiry initiatives. So far, the fellows have produced 20 knowledge products: Three published manuscripts, three evidence-based resource toolkits, nine professional conference presentations (one international), five professional certifications, a variety of organization-wide leadership briefings, and two military decorations specific to the pandemic response.ConclusionsEstablishing a fellowship program to develop a pipeline of readiness-focused nurse scientists and evidence-based practice experts builds future capacity for the enterprise while professionally developing individual nurses for advanced degrees and clinical inquiry leadership roles. Individuals and organizations aspiring to promote a culture of nursing inquiry may benefit from fellowships such as the CINR program.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad083
Issue No: Vol. 189, No. Supplement_1 (2023)
- Periop 101: Improving Perioperative Nursing Knowledge and Competence
in Labor and Delivery Nurses Through an Evidence-Based Education
and Training Program-
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Pages: 24 - 30
Abstract: ABSTRACTIntroductionTo reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience.Materials and MethodsThe purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, “For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)'” We implemented Periop 101: A Core Curriculum—Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised.ResultsWe found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency.ConclusionsWe recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad287
Issue No: Vol. 189, No. Supplement_1 (2023)
- Advancing Readiness Through Military Programs: An Evidence-Based Practice
Perspective-
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Pages: 31 - 38
Abstract: ABSTRACTIntroductionMilitary nurses comprise the largest percentage of military health care providers. In the current military health care system, they have two roles: (1) Patient care in military treatment facilities (MTFs) and (2) patient care during combat operations. Although in MTFs, the military nurse’s roles are similar to those of their civilian counterpart, their roles are unique and varied in the combat operational environment. These combined roles lead to questions regarding readiness training to ensure that nurses are proficient in both MTFs and combat operational settings where treatment requirements may differ. The purpose of this paper is to (1) present the current state of educational readiness programs to maintain a ready medical force that entail formal teaching programs, military–civilian partnerships, and joint exercises of combat simulations, and (2) identify gaps as presented in an evidence-based practice educational panel.MethodsOn March 11, 2022, TriService Nursing Research Program hosted the virtual First Military Evidence-Based Practice Summit from the Uniformed Services University of the Health Sciences in Bethesda, MD. As part of the summit, an evidence-based practice education panel discussed the availability of current evidence-driven military medical readiness programs and identified gaps in the integration of military readiness for nursing personnel into the Defense Health Agency and Armed Services.ResultsThe panel participants discussed the separate requirements for training within the MTFs and in combat operational settings. The available training programs identified by the panel were primarily those developed in local MTF settings to meet local needs. Although these programs support the MTFs’ peacetime mission, competing roles, limited time, and limited funds contributed to limited preparation of nursing personnel in skills associated with combat-related injuries and illnesses. Prolonged casualty care has become an important focus for the Department of Defense as greater considerations are directed to wartime operations in austere expeditionary environments. Although there is some training available that is specific for prolonged casualty care, the focus has been the adaptation of combat casualty care during contingency operations. A keynote here was the concept that combat casualty care training must include both development of individual skills and integration of the team since maximal care can be achieved only when the individual and the team operate as a unit. A key point was the utility of central repositories for storing information related to training a ready medical force at individual and unit levels and that these repositories could also be used to collect and facilitate the accession of current evidence-based information.DiscussionOptimal patient care at all levels of the military health system requires training that maximizes individual and unit skills specific to the environment at an MTF or in a combat operational setting. Training must be designed to incorporate evidence-driven knowledge in all military settings with guidance that is specific to the environment.ConclusionEnhanced communication of evidence-based training and knowledge is an important component of maintaining a ready medical force for broader medical support of combat contingency operations.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad230
Issue No: Vol. 189, No. Supplement_1 (2023)
- Standardizing Evidence-Based Practice Review Processes Across the Defense
Health Agency Enterprise-
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Pages: 39 - 44
Abstract: ABSTRACTBackgroundThe Defense Health Agency (DHA) Campaign Plan identifies Ready Reliable Care (RRC) as one of the eight strategic initiatives. A critical aspect of RRC is standardizing evidence-based practice (EBP) across Military Health System to include training, technology, equipment, and processes. The TriService Nursing Research Program hosted an EBP Summit to address this expectation.MethodsThe EBP Summit evaluated capabilities and gaps critical for implementing EBP into the DHA. This article summarizes the capabilities and gaps associated with administrative processes and infrastructure standardization, specifically EBP review and approval support processes, as well as utilization of the electronic Institution Review Board (eIRB) software platform.ResultsThe environmental scan across services revealed consistency in procuring Exempt Determination Official reviews and garnering formal determination letters before the start of EBP initiatives. The Army and Navy Nursing Centers for Clinical Inquiry report variability in the utilization of eIRB, although the Air Force centers consistently utilize eIRB to submit proposed EBP. However, there is variability across all services in how the proposal is categorized (EBP, process improvement, and quality assurance) and in the availability of mentoring support for the submission.ConclusionStrategic recommendations to address the identified gaps are establishing a TriService Clinical Inquiry Working Group for process and product standardization, identifying EBP champions for each DHA market to educate and facilitate EBP review and submission processes, and establishing EBP review forums led by EBP subject matter experts. The authors suggest funding for program development and evaluation.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad014
Issue No: Vol. 189, No. Supplement_1 (2023)
- A Scoping Review of Graduate Nurses’ Education and Use of QSEN
Competencies-
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Pages: 45 - 50
Abstract: ABSTRACTIntroductionThe QSEN Institute developed the quality and safety education for nurses (QSEN) competencies for both undergraduate and graduate-prepared nurses to support their development of the knowledge, skills, and attitudes needed to deliver safe, quality care. The purpose of this scoping review was to (1) determine the extent of evidence about the current use of QSEN competencies in graduate nursing curricula and (2) determine the application of the QSEN competencies among graduate-prepared nurses in clinical practice.Materials and MethodsArksey and O’Malley’s methodological framework for scoping reviews was used to explore the literature about the use of the QSEN competencies in graduate nursing education and practice available in PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science. Quality was assessed using Melnyk, Gallagher-Ford, and Fineout-Overholt’s critical appraisal tools.ResultsIn total, 423 articles were reviewed, 10 of which met inclusion criteria; five described quality improvement projects, two addressed curricular design, and three were program evaluations. Only one article described the use of QSEN competencies in practice. Overall, the amount of literature was scant and of low quality. All the articles described the use of QSEN competencies in graduate education except one, which also described them in practice in a graduate nurse residency program.ConclusionsAlthough the QSEN competencies were adopted for use in graduate curricula and practice settings, there is a wide variation in the actual use and application with limited reporting of outcomes. The graduate QSEN competencies can be leveraged to equip nurses with the knowledge, skills, and attitudes to address quality and safety challenges in any nursing environment including the operational environment in deployed and austere settings. This review provides recommendations to address gaps in research, graduate nursing education, and clinical practice.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad097
Issue No: Vol. 189, No. Supplement_1 (2023)
- Perioperative Pressure Injury Prevention Program in a Military Medical
Treatment Facility: A Quality Improvement Project-
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Pages: 51 - 56
Abstract: ABSTRACTIntroductionThe incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning.MethodsWe used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding.ResultsThere was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented.ConclusionThis project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad321
Issue No: Vol. 189, No. Supplement_1 (2023)
- Key Factors to Consider When Implementing an Advanced Practice Registered
Nurse-Led Heart Failure Clinic-
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Pages: 57 - 63
Abstract: ABSTRACTAdvanced practice registered nurses (APRNs) such as clinical nurse specialists and nurse practitioners excel at chronic disease management. Development of an APRN-led heart failure (HF) clinic is an ideal way to manage complex HF patients. However, there are important factors to consider when implementing an APRN-led HF clinic. The purpose of this paper is to provide a consolidation of recommendations to consider when developing and implementing an APRN-led HF clinic. A review of applicable literature within the last 10 years was conducted to determine the key factors to be considered when developing organizational structures and processes for an APRN-led HF clinic. The increasing need for primary care and internal medicine providers supports using APRNs to fill the gap and provide disease management for HF patients. Also, APRNs can impact the overall costs of HF treatment by optimizing postdischarge care and preventing hospitalizations and readmissions. Multiple studies supported implementation of APRN-led HF clinics for disease management to provide complex treatment strategies and comprehensive care to these patients.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad367
Issue No: Vol. 189, No. Supplement_1 (2023)
- Addressing Burnout in the Primary Care Setting: The Impact of an
Evidence-Based Mindfulness Toolkit-
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Pages: 64 - 70
Abstract: ABSTRACTBackgroundBurnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs.PurposeMindfulness-based training can enhance individual HCWs’ abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs’ self-reported stress levels (SRSL).Implementation StrategiesA pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas.ResultsAll HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs’ SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033).ConclusionsMultimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.
PubDate: Fri, 10 Nov 2023 00:00:00 GMT
DOI: 10.1093/milmed/usad277
Issue No: Vol. 189, No. Supplement_1 (2023)
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