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Evidence-based practice (EBP) programs for nurses are a strategy to influence the culture of an organization to value and use EBP. It is critical to demonstrate their impact during this time of uncertainty and economic unrest.
This project describes and evaluates a Practicing Nurse EBP Fellowship Program for Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNS) on (1) cost, (2) participants' retention, dissemination of work, and application for an advanced degree; (3) impacts using the Institution of Healthcare Improvement (IHI) Quintuple Aim framework, and (4) EBP culture.
Direct costs were described using actual costs incurred, and salary estimates were pulled from the literature for indirect costs. Secondary data analyses were used to examine retention of the Fellows and the EBP culture. A survey was used to measure participants' self-reports of the dissemination of projects and applications for an advanced degree. The Program Director associated IHI Quintuple aims to each project. Descriptive statistics were utilized to analyze the data.
Forty-seven nurses (RNs and APRNs) participated in the EBP Fellowship Program over 8 years. Annual costs for the program were $106,294.00. All five of the IHI's Quintuple Aim were addressed across the 47 EBP projects. The retention rate was 76.6% for these Fellows who averaged 5 years since completing the program. Twenty-nine percent of respondents had presented their work externally, and 21% had enrolled in or completed a doctoral program (DNP or PhD). There was a decrease observed in the employee engagement question measuring EBP culture.
EBP Fellowship Programs are a cost-effective strategy to invest in clinicians and improve patient and clinician outcomes. Continued support from Chief Nurse Executives for such programs is still needed.
To explore barriers and facilitators to a good death in patients with respiratory disease when advanced respiratory support, including non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP), is used. Specifically, we examined healthcare professionals’ perspectives on what constitutes a good death in this context, how treatment failure is recognised, how decisions to continue or withdraw therapy are made, and the impact of providing this care on staff.
Qualitative study using semistructured interviews and reflexive thematic analysis.
Secondary care services in a large UK National Health Service Trust, including acute medicine, general medicine, respiratory medicine and palliative care.
25 healthcare professionals (19 female, 6 male) from multidisciplinary backgrounds, including doctors, nurses and physiotherapists. Participants self-identified as experienced in the provision of NIV/CPAP at the end of life. Staff working primarily in intensive care units were excluded.
None.
Not applicable.
Healthcare professionals described the complexity of caring for patients dying while receiving or recently withdrawn from NIV/CPAP. Five interrelated themes were identified: beliefs around dying well, symptom management during active treatment, recognition of treatment failure, negotiated decision-making and the process of withdrawal. Staff reported tensions between providing active treatment and ensuring comfort, inconsistent practices regarding symptom control and withdrawal, and conflicts within multidisciplinary teams. Nurses highlighted hidden psychological and relational labour in supporting patients, while doctors often described delays in decision-making to align families with treatment withdrawal.
Caring for patients using NIV/CPAP at the end of life presents ethical, clinical and emotional challenges for staff, patients and families. Variation in practices and perspectives highlights the need for structured training, interdisciplinary approaches and greater recognition of the often hidden relational and emotional labour involved in this work, particularly among nursing colleagues. Further research should evaluate strategies to support consistent and compassionate withdrawal practices.
FreshRSS 