酒井 郁子

BACKGROUND: Regarding the evidence-based practice (EBP) process, nurses tend to perceive that critical appraisal of research articles is challenging. Though critical appraisal in EBP has been a frequent topic in medical education, implementing and disseminating existing EBP education for nurses are challenging in countries with limited EBP educational resources. This study aimed to evaluate changes in practice, attitude, knowledge and skills of EBP before and after an EBP workshop focused on critical appraisal among advanced practice nurses. METHODS: This study was a before and after educational intervention study. The workshops were provided in small groups in 2017 and 2018. The targeted nurses were certified nurse specialists (CNSs) who provide patient care and are certified as advanced practice nurses. The workshop was designed to include at least one CNS in each group. The Japanese version of the Evidence-based Practice Questionnaire, with four subscales-practice, attitude, and knowledge and skills of research and practice-was evaluated four times: baseline, immediately after the workshop, and 3 and 6 months after the workshop. At the end of the workshop, the participants wrote their learning objectives and plans for improving their critical appraisal of EBP. A self-reflection questionnaire was distributed 3 months after the workshop, and a qualitative descriptive analysis was used. RESULTS: Eleven CNSs participated in this study. Only the score of the knowledge and skills of research showed a statistically significant change. Many participants did not perform critical appraisal of research articles after the workshop. The facilitators were to have a role in integrating research evidence into practice and the barriers to being too busy, personnel transfers, and insufficient conditions. CONCLUSIONS: Self-efficacy for critical appraisal in EBP might increase through the EBP education workshop. Even nurses interested in EBP require ongoing learning opportunities and organizational support for EBP activities. TRIAL REGISTRATION: This study was retrospectively registered with University hospital Medical Information Network Clinical Trial Registry (UMINCTR) on 09/14/2018 (Registration Number. UMIN000034146).

特定行為研修を修了した手術室看護師の知識・技術を活かしたせん妄予防のための周術期看護を明らかにするため,肝切除術を受ける高齢患者に対し,術前から術後まで一貫してせん妄予防を意図して実施した看護を記述した.事例は,慢性疼痛および聴覚障害を伴うせん妄リスクが高い肝切除術を受ける高齢患者であった.筆者は,術前にせん妄予防を意識化するケアを実施し,術中は麻酔科医と治療方針を共有し脳虚血予防を意図して血圧管理を行った.術後は,患者と疼痛緩和方策を共有することで疼痛緩和を図り,リアリティオリエンテーションにより見当識障害予防を行った.手術室特定看護師がせん妄予防を意図した看護実践として,せん妄予防の意識化,脳虚血予防,疼痛緩和を意図し,臨床推論を用いたアセスメントに基づき,せん妄因子の低減という実践を行った結果,2事例ともせん妄ハイリスクであったが発症はしなかった.(著者抄録)