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Research Papers
Development and Evaluation of Evidence-Based Nursing Protocol for Extracorporeal Membrane Oxygenation to Critically Ill Patients
Kim, Soomi , Kim, Chul-Gyu
J Korean Acad Nurs 2023;53(3):275-294.   Published online June 30, 2023
DOI: https://doi.org/10.4040/jkan.22109
AbstractAbstract PDF
Purpose
This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol.
Methods
The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol’s effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses’ outcome variables were evaluated using a questionnaire.
Results
First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001).
Conclusion
This protocol may help prevent infections and pressure injuries in patients, and improve nurses’ satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.
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Development and Effectiveness of Practice Application Program of Intravenous Infusion EvidenceBased Nursing Practice Guideline - for Small and Medium Sized Hospitals
Hong, Inhwa , Eun, Young
J Korean Acad Nurs 2020;50(6):863-875.   Published online December 31, 2020
DOI: https://doi.org/10.4040/jkan.20196
AbstractAbstract PDF
Purpose
This study was conducted to develop and test the effects of a program for practice application of intravenous infusion evidence based nursing practice (EBP) guidelines in small and medium-sized hospitals.
Methods
A mixed method research design was used, combining non-equivalent control group pre-post test design with qualitative study analysis. The subjects consisted of 55 nurses. The practice application program was developed based on the Advancing Research and Clinical practice through close Collaboration (ARCC) model. Data were collected for analysis in the following areas: nurses’ EBP organizational culture and readiness, EBP beliefs, EBP implementation, importance about intravenous infusion, and performance about intravenous infusion, with data assessed using valid and reliable instruments. Patient outcomes were collected from the hospital’s medical records. Data were analyzed using t-test, χ2 -test, and Shapiro-Wilk test, with qualitative content analysis used for interview data.
Results
Following the intervention, nurses’ EBP organizational culture and readiness, EBP beliefs, EBP implementation, and performance of intravenous infusion and perceptions of its importance showed significant improvement in the experimental group. Phlebitis rates decreased in the experimental group compared to the control group.
Conclusion
This program is effective to improve nurse’s perception and practice of evidence based nursing. Therefore we recommend to use this program at same levels of hospitals.
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Original Articles
Nurses' Research Activities and Barriers of Research Utilization
Eui Geum Oh, Hyun Ju Oh, Yoon Jung Lee
Journal of Korean Academy of Nursing 2004;34(5):838-848.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.5.838
AbstractAbstract PDF
Purpose

This study was to describe nurses' research activities, perceptions and performances of evidence-based practice and barriers to the use of research evidence in nursing practice in Korea.

Method

A cross-sectional survey design was used. A questionnaire, except for Barriers Scale, was developed for the study. Data was collected from a convenient sample of 437 registered nurses working at research and education oriented university hospitals.

Result

Nurses' research-related activities were relatively low compared to previous studies. Also perceptions and performances of evidence based nursing practice were low. Preferred informational resources for clinical decision making were identified as ward manuals/clinical guidelines, manager/senior nurses, and literature/research. The major barriers to research utilization were a lack of implication for practice along with inadequate facilitation to implement research evidence and difficulty understanding research written in English. Priorities of barriers factor were Administrator, Communication, Adopter, and Research.

Conclusion

The findings provide directions for future training, education, and managerial policy to achieve successful evidence based nursing practice.

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Structural Model of Evidence-Based Practice Implementation among Clinical Nurses
Hyunyoung Park, Keum Seong Jang
J Korean Acad Nurs 2016;46(5):697-709.   Published online October 31, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.5.697
AbstractAbstract PDF
Purpose

This study was conducted to develop and test a structural model of evidence-based practice (EBP) implementation among clinical nurses. The model was based on Melnyk and Fineout-Overholt's Advancing Research and Clinical Practice through Close Collaboration model and Rogers' Diffusion of Innovations theory.

Methods

Participants were 410 nurses recruited from ten different tertiary hospitals in Korea. A structured self-report questionnaire was used to assess EBP knowledge/skills, EBP beliefs, EBP attitudes, organizational culture & readiness for EBP, dimensions of a learning organization and organizational innovativeness. Collected data were analyzed using SPSS/WINdows 20.0 and AMOS 20.0 program.

Results

The modified research model provided a reasonable fit to the data. Clinical nurses' EBP knowledge/skills, EBP beliefs, and the organizational culture & readiness for EBP had statistically significant positive effects on the implementation of EBP. The impact of EBP attitudes was not significant. The dimensions of the learning organization and organizational innovativeness showed statistically significant negative effects on EBP implementation. These variables explained 32.8% of the variance of EBP implementation among clinical nurses.

Conclusion

The findings suggest that not only individual nurses' knowledge/skills of and beliefs about EBP but organizational EBP culture should be strengthened to promote clinical nurses' EBP implementation.

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Mixed Method Research Investigating Evidence-Based Practice Self-efficacy, Course Needs, Barriers, and Facilitators: From the Academic Faculty and Clinical Nurse Preceptors
Eui Geum Oh, You Lee Yang, Jae Yong Yoo, Ji Yun Lim, Ji Hyun Sung
J Korean Acad Nurs 2016;46(4):501-513.   Published online August 31, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.4.501
AbstractAbstract PDF
Purpose

The current challenges faced by nurses in providing high quality and evidence-based practice (EBP) supported care require profound changes in nursing education. To understand the changes needed to strengthen EBP education, the researchers examined EBP self-efficacy, course needs, barriers, and facilitators for academic faculty and clinical nurse preceptors to teach EBP in undergraduate nursing curricula.

Methods

For this study, mixed-method approach was used with survey data collected from 73 academic faculty members from 54 universities. Further, 17 clinical nurse preceptors in three academic hospitals provided qualitative data for exploration of barriers and facilitators to teaching EBP. Data analysis used SPSS/WIN 21.0 and content analysis.

Results

Quantitative data showed that although the overall level of self-efficacy among faculty was moderate, the implementation levels were relatively low. Most faculty members agreed with the need to integrate EBP courses into undergraduate nursing curricula. The qualitative data showed that the barriers to teaching EBP were lack of knowledge, skill, and initial investment for teaching EBP; hierarchical, rules-oriented nursing culture; potential learner overloads in processing EBP; limited research dissemination and application. Facilitators were identified as the importance of EBP to the profession of nursing; collaboration in schools and hospitals; and continuing education in teaching/utilizing EBP.

Conclusion

The findings indicate that for successful integration of EBP ni nursing education there is a need for faculty training and integrated EBP courses.

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Special Article
Implementing Evidence into Practice for Best Dementia Care
Myonghwa Park
J Korean Acad Nurs 2015;45(4):495-500.   Published online August 31, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.4.495
AbstractAbstract PDF
Purpose

The purpose of this paper was to discuss the need for translation studies in dementia care and current translational endeavors, and to provide recommendations for evolving evidence-based dementia care.

Methods

A literature review yielded current evidence and translational efforts.

Results

Dementia care interventions need to be implemented at various service levels. Barriers to translation include evidence gaps, lack of the use of a conceptual framework to explain the implementation process, and unsupportive funding mechanisms for applying innovations.

Conclusion

There is clear evidence of the need for and benefits of evidence-based dementia care for patients with dementia, family caregivers, and care professionals. The urgent need now is finding ways to advance translational activities and facilitate future research into translation science.

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Original Article
Adaptation and Evaluation of the Incontinence Care Protocol
Kyung Hee Park, Heejung Choi
J Korean Acad Nurs 2015;45(3):357-366.   Published online June 30, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.3.357
AbstractAbstract PDF
Purpose

This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol.

Methods

The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity.

Results

The experimental group had significantly less severe IAD (t=6.69, p<.001), lower occurrence of pressure ulcers (χ2=7.35, p=.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p=.009) than the control group.

Conclusion

Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

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Review Article
Evidence Based Practice in Long Term Care Settings
Janet K. Specht
J Korean Acad Nurs 2013;43(2):145-153.   Published online April 30, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.2.145
AbstractAbstract PDF
Purpose

The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC.

Methods

Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities.

Results

Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership.

Conclusion

There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

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Original Articles
Comparison of Standardized Peristomal Skin Care and Crusting Technique in Prevention of Peristomal Skin Problems in Ostomy Patients
Seungmi Park, Yun Jin Lee, Doo Nam Oh, Jiyun Kim
J Korean Acad Nurs 2011;41(6):814-820.   Published online December 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.6.814
AbstractAbstract PDF
Purpose

This study was performed to compare the effects of standardized peristomal skin care (SPSC) and crusting technique (CT) on the peristomal skin of ostomates. SPSC was developed by a consensus among the expert group based on a comprehensive review of the relevant literature and hospital protocols.

Methods

A randomized controlled pilot trial with 2 parallel arms was used. A total of 81 ostomates, who were recruited from a tertiary hospital, completed the baseline, 1-month, 2-month, and 3-month follow-up (SPSC group, n=45; CT group, n=36). SPSC consisted of water cleansing and direct application of ostomy appliances. CT involved crusting hydrocolloid powder and patting with water sponge or protective barrier liquid film. The outcomes of the study were assessed by skin problems, such as discoloration, erosion and tissue overgrowth; the domains of the evaluation tool used in examining the peristomal skin. A generalized estimating equation model was used to examine the effects according to time and group.

Results

In both SPSC and CT groups, the likelihood of occurrence of discoloration (OR, 1.99; 95% CI, 1.61-2.46), erosion (OR, 1.87; 95% CI, 1.55-2.25) and tissue enlargement (OR, 1.94; 95% CI, 1.36-2.77) increased with time. There was no significant difference in discoloration between the groups, whereas the probability of erosion (OR, 0.38; 95% CI, 0.16-0.89) and tissue overgrowth (OR, 0.09; 95% CI, 0.02-0.55) was lower in the SPSC group than in CT group.

Conclusion

SPSC was sufficient in preventing peristomal skin problems of ostomates compared to the CT.

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Adaptation of Evidence-based Surgical Wound Care Algorithm
Jung Yeon Han, Smi Choi-Kwon
J Korean Acad Nurs 2011;41(6):768-779.   Published online December 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.6.768
AbstractAbstract PDF
Purpose

This study was designed to adapt a surgical wound care algorithm that is used to provide evidence-based surgical wound care in a critical care unit.

Methods

This study used, the 'ADAPTE process', an international clinical practice guideline development method. The -'Bonnie Sue wound care algorithm' - was used as a draft for the new algorithm. A content validity index (CVI) targeting 135 critical care nurses was conducted. A 5-point Likert scale was applied to the CVI test using a statistical criterion of .75.

Results

A surgical wound care algorithm comprised 9 components: wound assessment, infection control, necrotic tissue management, wound classification by exudates and depths, dressing selection, consideration of systemic factors, wound expected outcome, reevaluate non-healing wounds, and special treatment for non-healing wounds. All of the CVI tests were ≥.75. Compared to existing wound care guidelines, the new wound care algorithm provides precise wound assessment, reliabilities of wound care, expands applicability of wound care to critically ill patients, and provides evidence and strength of recommendations.

Conclusion

The new surgical wound care algorithm will contribute to the advancement of evidence-based nursing care, and its use is expected as a nursing intervention in critical care.

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The Effect of Treadmill Exercise on Ischemic Neuronal Injury in the Stroke Animal Model: Potentiation of Cerebral Vascular Integrity
Kyoung Ah Kang, Hohyun Seong, Han-Byeol Jin, Jongmin Park, Jongmin Lee, Jae-Yong Jeon, Youn Jung Kim
J Korean Acad Nurs 2011;41(2):197-203.   Published online April 30, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.2.197
AbstractAbstract PDF
Purpose

This study was done to identify whether pre-conditioning exercise has neuroprotective effects against cerebral ischemia, through enhance brain microvascular integrity.

Methods

Adult male Sprague-Dawley rats were randomly divided into four groups: 1) Normal (n=10); 2) Exercise (n=10); 3) Middle cerebral artery occlusion (MCAo), n=10); 4) Exercise+MCAo (n=10). Both exercise groups ran on a treadmill at a speed of 15 m/min, 30 min/day for 4 weeks, then, MCAo was performed for 90 min. Brain infarction was measured by Nissl staining. Examination of the remaining neuronal cell after MCAo, and microvascular protein expression on the motor cortex, showed the expression of Neuronal Nuclei (NeuN), Vascular endothelial growth factor (VEGF) & laminin.

Results

After 48 hr of MCAo, the infarct volume was significantly reduced in the Ex+MCAo group (15.6±2.7%) compared to the MCAo group (44.9±3.8%) (p<.05), and many neuronal cells were detected in the Ex+MCAo group (70.8±3.9%) compared to the MCAo group (43.4±5.1%) (p<.05). The immunoreactivity of laminin, as a marker of microvessels and Vascular endothelial growth factor (VEGF) were intensively increased in the Ex+MCAo group compared to the MCAo group.

Conclusion

These findings suggest that the neuroprotective effects of exercise pre-conditioning reduce ischemic brain injury through strengthening the microvascular integrity after cerebral ischemia.

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Analysis of Research Papers Published in the Journal of the Korean Academy of Nursing-Focused on Research Trends, Intervention Studies, and Level of Evidence in the Research
Hyun-Sook Shin, Myung-Sun Hyun, Mi-Ok Ku, Myung-Ok Cho, Sook-Young Kim, Jea-Sim Jeong, Geum-Hee Jeong, Gyeong-Ae Seomoon, Youn-Jung Son
J Korean Acad Nurs 2010;40(1):139-149.   Published online February 28, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.1.139
AbstractAbstract PDF
Purpose

This study aimed was done to analyze recent trends in nursing research published in the Journal of Korean Academy of Nursing by focusing on the content of nursing interventions and their level of evidence.

Methods

A total of 209 studies published between 2007 and 2008 were reviewed using analysis criteria developed by the researchers.

Results

The number of quantitative studies was greater than that of qualitative studies. There was a slight increase in the number of qualitative studies and studies including elderly populations, which reflects the recent population trend in Korea. More randomized controlled trials with a low risk of bias were needed to support more evidence-based nursing practice. Concerning the low rate of ethical consideration, stricter application of research ethics needs to be encouraged.

Conclusion

The findings of this study suggest the recent trends in nursing research and the direction of nursing research and review in the Journal.

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