Biomedical subjects

L Nail

Publications and source records attributed to L Nail.

10 recordsLinked to original sources

PubMed1998

Barriers to research utilization for oncology staff nurses and nurse managers/clinical nurse specialists.

PURPOSE/OBJECTIVES: To describe and compare barriers to research utilization faced by oncology staff nurses and nurse managers/clinical nurse specialists (CNSs) and to compare these to barriers identified by other nurses. DESIGN: Exploratory descriptive. SETTING: National. SAMPLE: Proportional random sample of 2,000 Oncology Nursing Society (ONS) staff nurses (n = 769) from seven practice settings. ONS participants recruited oncology staff nurses (n = 331) and nurse managers/CNSs involved in cancer care (n = 407). METHODS: Mailings, including a demographic questionnaire and Barriers Scale, were sent to ONS nurses, and reminder postcards were sent to increase the return rate. MAIN RESEARCH VARIABLES: Barrier categories: characteristics of the adopter (nurse), organization, innovation (research itself), and communication, individual item barriers. Nurse and worksite characteristics. FINDINGS: Differences existed in oncology nurses' perceptions of the extent to which the adopter, organization, and innovation characteristics served as obstacles to research utilization. Nurse managers/CNSs perceived that each of these acted as a greater barrier than did staff nurses. Both groups perceived communication characteristics as a moderate barrier. Oncology nurses, as a group, responded similarly to other nurse samples regarding research and communication characteristics. Perceptions of oncology nurse managers/CNSs were similar to those of administrators in other studies. Oncology staff nurses rated barriers lower than nurses, including clinicians, in other samples. CONCLUSIONS: For oncology nurses, organization, research, and communication barriers persist as impediments to research utilization. Nurse adopter characteristics may be diminishing as obstacles for staff nurses but not for nurse managers/CNSs. The decreased strength that oncology nurses attributed to barriers may reflect a benefit of practicing nursing in a specialty. IMPLICATIONS FOR NURSING PRACTICE: Decreasing known barriers would facilitate research-based practice in oncology. Nurse leaders can create environments conducive to research utilization by altering existing mechanisms, facilitating access to nursing research experts, supporting time for research utilization efforts, giving authority for practice changes, and offering continuing education related to research utilization processes. Nurse managers/CNSs need to increase their familiarity with research and research utilization, ensuring their awareness of pertinent clinical findings. Perceptual gaps between staff nurses and nurse managers/CNSs regarding research utilization require discussion and formal investigation. Researchers must communicate in clinician-friendly ways. All nurses need to demand and facilitate access to research findings.

Adult↗

PubMed1993

Impact of first-responder defibrillation in an urban emergency medical services system.

OBJECTIVE: To evaluate the impact of adding first-responder defibrillation by fire-fighters to an existing advanced life-support emergency medical services system. DESIGN: Nonrandomized, controlled clinical trial with periodic crossover. SETTING: Memphis, Tenn, a city of 610,337 people, which is served by a fire department-based emergency medical services system. All city ambulances provide advanced life support. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: Twenty of 40 participating engine companies were equipped with an automated external defibrillator and ordered to apply it immediately in all cases of cardiac arrest. The other 20 companies were ordered to start cardiopulmonary resuscitation (CPR) immediately and wait for paramedics to arrive. Every 75 days, group roles were reversed. Care otherwise proceeded according to 1986 American Heart Association guidelines. MAIN OUTCOME MEASURES: Return of spontaneous circulation in the field, survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: During the 39-month study interval, 879 patients were treated by a project engine company. Four hundred thirty-one (49%) of these were found in ventricular fibrillation. Bystander CPR was started in only 12% of cases. Overall, firefighters reached the scene a mean of 2.5 minutes faster than simultaneously dispatched paramedics. Although our automated external defibrillators proved to be reliable and efficacious for terminating ventricular fibrillation and pulseless ventricular tachycardia, patients treated by an automated external defibrillator-equipped engine company were no more likely than CPR-treated controls to be resuscitated (32% vs 34%, respectively), to survive to hospital admission (31% vs 29%), or to survive to hospital discharge (14% vs 10%). Neurological outcomes were also similar in the two treatment groups. CONCLUSIONS: In a fast-response, urban emergency medical services system served by paramedics, the impact of adding first-responder defibrillation appears to be small. Early defibrillation alone cannot overcome low community rates of bystander CPR. Careful attention to every link in the "chain of survival" is needed to achieve optimal rates of survival after cardiac arrest.

Aged↗

PubMed1993

Engineering excellence: options to enhance firefighter compliance with standing orders for first-responder defibrillation.

STUDY OBJECTIVE: To assess the quality of care delivered during first-responder defibrillation and to determine the potential efficacy of modifying existing automated external defibrillator designs to improve first-responder performance. DESIGN: Prospective case series. SETTING: An urban emergency medical services system providing first-responder defibrillation and paramedic care. TYPE OF PARTICIPANTS: Firefighters who completed a four-hour (two-session) course in automated external defibrillator operation. METHODS: Heartstart 2000 defibrillators (Laerdal Medical Corp, Armonk, New York) were used in 241 consecutive resuscitation attempts. Written reports and memory module printouts were abstracted to assess firefighter performance of 11 critical actions. The firefighter's response to each opportunity to perform a critical action was scored using explicit pass/fail criteria. RESULTS: Records of 235 automated external defibrillator uses (97.5%) were submitted for analysis. Firefighters shocked within 15 seconds of a "shock indicated" message in 95% of opportunities and reanalyzed the rhythm within 90 seconds of the third consecutive shock (ie, after one minute of CPR) in 80% of cases. However, firefighters reanalyzed the patient's rhythm too soon in 75% of cases, thereby interfering with recommended intervals of CPR. Firefighters failed to reanalyze the patient's rhythm after device-initiated "check patient" prompts 62% of the time. Memory modules were left in the automated external defibrillator during practice sessions in 64 cases, decreasing available memory to monitor automated external defibrillator use in the field. Three instances of failure to withhold CPR during rhythm analysis resulted in a single inappropriate patient shock. No firefighter was shocked inadvertently. CONCLUSION: Current device algorithms result in effective delivery of the initial three shocks. However, firefighters often fail to interpose recommended intervals of CPR between further attempts at defibrillation. Modification of existing device algorithms to provide additional visual and auditory cues may be preferable to relying on the user to recall accurately all the steps in this infrequently performed procedure.

Allied Health Personnel↗

PubMed1988