Make a Start, Make a Difference ... As an ICU nurse, besides busy in our daily work, we also need to alert by new advances and new trends to improve our practise. As a nurse specialist, I need to take up the leading role to think of some methods and strategies to start with which can make a differnce MAK WAI LING Nurse Specialist Intensive Care PMH & YCH HKSAR

Establishing a Nursing Journal Club What I have started is to establish a nursing journal club, what differences I found? To uplift the nursing standard. The is my today’s topic, make a start, make a difference, uplifting the nursing standard by estabhlsihing a nursing journal club. The title is long and yet the journey is also long and which is unstopped. Let’s me share with you the journey that I have expereinced. to Uplifting the Nursing Standard Establishing a Nursing Journal Club

Introduction To improve the quality of bedside nursing care and to promote evidence-based nursing practice …. formation of a nursing journal club can be one strategy to accomplish both goals. (St Pierre, 2005)

Make a Start … Objectives: PMH & YCH Journal Club July 2007 Objectives: To encourage nurses to familiarize themselves with advanced literature in our field of work. To enhance professional development in intensive care nursing To arouse nurses’ interest in research activities As the two unit was integrated, in July 2007 the Nursing Journal Club was start function. It is a joint function for the two ICUs, experience can be shared, the workload for preparing the club can also be shared. The objectives of the journal club was

Implementation Develop a year plan Engage all nurses Develop a yearly timetable – finding a time and place that promotes consistent staff participation APN and Senior RN leading – leadership skill, strong support to the journal club Interested topics – entice staff participation

Implementation Topics selection VAP – area for improvement Puffer fish poisioning – two admission, interest Crush Syndrome – hot topics

A regular joint meetings for the two ICUs

Review ………….One and a half year later,

Staff Impact The interest, attendance and involvement of participants are key elements to measure success. (Kartes & Kamel, 2003)

Staff Impact Staff Involvement

Staff Impact Attendance

Staff Impact Interest An evaluation exercise was done by using a staff feedback questionnaire: To review nurses’ satisfaction To provide them with feedback channel for improvement in future meetings.

Staff Feedback Questionnaire 7 questions on arrangement of the meeting 8 questions on benefits of the journal club participation 2 open questions to express their opinion > 70% respondent rate

Questionnaire Findings Benefits of the Journal Club Participation

Questionnaire Findings Benefits of the Journal Club Participation (Cont’d)

Questionnaire Findings Arrangement of the meeting

Questionnaire Findings Arrangement of the meeting (Cont’d)

Evaluation Evidence of a practice change within your unit is an indication of success. (Kartes & Kamel, 2003) Some changes were observed and implemented based on the discussion generated by the nursing journal club

Changes made * IAP Measurement - More accurate measurement Enhance staff competency Mulbrain (2006) suggested that larger instillation volumes than the usually recommended 50 ml to estimate IAP by bladder pressure may cause clinically relevant overestimation of IAP. Small volumes to a maximum of 25 ml, enough to create a fluid column and to remove air, may be sufficient. Cheatham (2007) & Morgan (2008) also claimed that measurement performed with an instillation volume of no greater than 25 ml of saline with measured 30-60 seconds after instillation to allow bladder detrustor muscle relaxation. Various authors have suggested using symphysis pubis, the phlebostatic axis, the midaxillary line, each of which may result in different IAP measurements within the same patient ( Malbrain et al . 2006) The midaxillary line may subject to less interpretation ( Cheatham M.L., et al , 2008)

Changes made * VAP Implement care bundle Review and revise practice A multi-disciplinary approach

Changes done to reduce VAP in ICU Staff education Weaning Antibiotic Oral hygiene Ventilator bundle DVT prophylaxis Diagnosis Multi-disciplinary Team approach ETT cuff care Sedation vacation Apart from blindly or solely follow the Ventilator Bundle, the ICU experienced nurses also collaborate with the medical staff to stringently look at the diagnosis of VAP, to use antibiotic cautiously and wean the patients from ventilator asap so as to reduce VAP. With the support from doctors, the cooperation from other ICU nurses and supporting staff is also improtant, that is about total quality management. We are working as a team. The Nurse Specialist educate ICU nurses on VAP and implement innovative care, such as tooth brushing on ventilated patents and other proper procedures on ETT care. We also collaborate with the physiotherapists and other health care assistants to participate in the proggramme. A multi-disiplinery team approach is always employed. Intubation technique Peptic ulcer prophylaxis Head up 30 Suctioning technique Care resp. equipment

Conclusion Journal club is a simple way to encourage nurses to keep up to date with current research. Journal club can be a fun and interesting way to improve quality of nursing care by providing the impetus to change practice. Journal club participation promotes continuing professional development and life long learning.

Discussion & Recommendation Make a start Never stop Keep on the journey Make difference Enjoy the success

Special thanks to all staff of ICU (PMH & YCH)

Thank you