After holding the first Nursing Research Symposium in May, nurses at Montefiore Medical Center in the Bronx, N.Y., recognize that evidence-based practice is a top priority in patient care.
Jane O'Rourke, RN, DNP, NEA-BC, CENP, director of nursing for evidence-based practice, initiated an Internal Review Board-approved pilot study to assess staff readiness for evidence-based practice. "We now want to pair staff nurses with nurse scholars so we can change clinical practice based on evidence-based practice," O'Rourke said.
Doctorally prepared nurses on staff and those from local colleges will guide staff nurses in identifying pertinent clinical questions and researching the literature. Based on their findings, nurses will change practice through the facility's policies and procedures or validate existing practices.
With the support of O'Rourke and the research committee, nurses actively are involved in investigating practice issues, such as preventing skin breakdown in pediatric patients, how silent hospitals help healing, how bar coding saves lives and guided imagery for pain management by children with sickle cell disease.
Team model
[caption id="attachment_" align="alignright" width="195"] Ngoc-Lan Ha, RN, med/surg staff nurse, left, and Tita Aguilar-Niere, RN, administrative nurse manager, implemented Montefiore's nursing care team model on NW8W, a med/surg unit.[/caption]
Every component of the facility's nursing care team model is based on evidence-based practice. Piloted in March and April 2010 on the med/surg unit, the model has been introduced and implemented on all hospital units.
Units are divided into two districts, with a charge nurse and care team assigned to each district. At intershift bedside report, patients talk with the nurse who has been caring for them along with the nurse who is going to be with them for the upcoming shift to discuss goals that have been accomplished and future goals. "Nurses have their own computer on wheels for the shift, and it also has improved their time spent at the bedside," said Mona Holt, RN, BSN, patient care coordinator of the progressive care unit. Nurse managers also round every day to learn about each patient's concerns and validate care.
In pediatrics, family-centered rounds have helped parents, staff and patients get "on the same page," said Mary Kate Walker, RN, BSN, staff nurse, hematology/oncology, Children's Hospital. "We get more details and valuable information about the child, and parents feel better because they know we are hearing what they are saying."
Time for patients
Also incorporated into the model are unit interdisciplinary huddles, which have improved staff communication, and a no-pass zone initiative, which has improved nurses' response time to call bells and has helped make patients feel safe, said Edward Gaerlan, RN-BC, med/surg staff nurse. "In our no-pass zone, no one walks by a room that has a call bell on. We all feel responsible for the patients on our unit," Gaerlan said.
Units have implemented a Take 5 initiative, in which nurses sit and talk with their patients as part of patient care. "In our Take 5 and, in some cases, Take 10, we spend time with patients to show our concern, whether it be with words or touch," Gaerlan said. He was recognized with the Joan H. Bilder Award for his excellence in nursing practice, dedication to patient care and commitment to education, in which Bilder, former associate director of nursing at Montefiore, believed.
"With all of our efforts, accountability to our patients has automatically increased, and we have been recognized with a nursing team award," said Tita Aguilar-Niere, RN, CEN, MS, NE-BC, med/surg administrative nurse manager.
