1. 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

2. 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

3. 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)

4. 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

5. 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

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

7. A regular joint meetings for the two ICUs

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

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

10. Staff Impact
Staff Involvement

11. Staff Impact
Attendance

12. 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.

13. 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

14. Questionnaire Findings
Benefits of the Journal Club Participation

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

16. Questionnaire Findings
Arrangement of the meeting

17. Questionnaire Findings
Arrangement of the meeting (Cont’d)

18. 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

19. 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 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 )
The midaxillary line may subject to less interpretation ( Cheatham M.L., et al , 2008)

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

21. 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

23. 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.

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

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

26. Thank you