Purpose/Objectives:
To describe the role of the clinical nurse specialist (CNS) in applying an evidence-based practice model to implement standards addressing the unique physiological and developmental needs of vulnerable late-preterm infants.
Significance:
In 2005, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) launched initiatives addressing the unique needs of late-preterm infants of 34 and 37 weeks gestation, accounting for 71% of preterm births. The standards focused on neonatal functional status, nursing care practices, care environment, and role of families in the hospital and after discharge. Prematurity is one of the most significant threats to infants. Although late-preterm infants may appear to be smaller versions of term infants, they are at high risk for problems related to immaturity of each body system, thermoregulation, hypoglycemia, jaundice, and feeding. Prematurity may negatively impact on outcomes, provide challenges to families, and result in increased costs to both the parents and the organization.
Design:
The Iowa Model of Evidence-Based Practice to Promote Quality Care is used to demonstrate the processes of implementing evidence-based practice changes for care of the late-preterm infant. Practice changes were accomplished during a 4-year period, in contrast to 17-24 years typically cited for implementation of research into practice.
Methods:
Led by the maternity CNS, the unit-based nursing committees reviewed literature, assessed current practices, and implemented practice changes. The CNS collaborated with maternity center, labor and delivery, NICU, and pediatricians. Practice changes included late-preterm infant order sets, parent education materials, car-seat challenge testing, gestational age assessment tool, skin-to-skin contact, sleepers for thermoregulation, hyperbilirubinemia assessment/management, and staff education.
Findings:
Improved nursing practice based on gestational age rather than routine care, parent education specific to needs of late-preterm infants, early breastfeeding initiation/follow-up, increased staff awareness of vulnerability of late-preterm infant, increased collaboration between nurses and physicians, and timely postdischarge follow-up.
Conclusions:
A model of evidence-based practice guided the processes that indicated a sufficient research base for practice change. The development of tools to promote gestational-age-appropriate standards has enhanced care and reduced risks to the late-preterm population.
Implications for Practice:
Using a model of evidence-based practice can expedite application of research to practice to improve patient outcomes.
Section Description
The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.
A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.
The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.
Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.