1. DIY with Nursing Reference Center Michelle Henley, MLS Instruction & Consultation Services

2. Class outline Describe Nursing Reference Center (NRC) Review evidence-based disease & condition info Locate info on skills & procedures Find patient education handouts Do hands-on exercises with clinical scenarios Get access to NRC via desktop or mobile

3. What is Nursing Reference Center? A one stop shop for evidence-based clinical information at the point of care, including: Diseases & Conditions Quick Lessons & Evidence-Based Care Sheets for 1000s of diseases/conditions Skills & Procedures 800+ skills & procedures overviews Patient Education Handouts in English & Spanish

4. Reports in Diseases & Conditions Quick Lessons –What: Overviews of conditions or diseases –Use for: understanding signs & symptoms Evidence-Based Care Sheets –What: Summaries of evidence for a treatment –Use for: understanding what best evidence says

5. Diseases & Conditions Search term(s) All = Evidence- Based Care Sheets & Quick Lessons

6. Quick Lesson Browse for: alcohol withdrawal syndrome Last updated

7. Evidence-Based Care Sheet Browse for: alcohol withdrawal syndrome Link to Quick Lesson References rated by strength of evidence

8. Evidence rating Best evidence study types are at top of matrix: meta-analysis, systematic review, RCT

9. Case scenario 1 A 55 yo male presents to the ED with chest pain. He is assessed for heart failure and admitted after an abnormal ECG. The physician suspects atrial fib but you are unclear on what symptoms to watch for. BROWSE FOR –heart failure AND atrial fibrillation – Quick Lessons from drop down, Relevancy Ranked BEST RESULT –Heart Failure and Atrial Fibrillation (Sep. 6, 2013) ANSWER –See Signs and Symptoms: AF in the HF patient can manifest as hypotension, pulmonary edema, or cardiogenic shock.

10. Case scenario 2 An adult ICU patient has been on mechanical ventilation for the last 2 days. You are concerned about ventilator-acquired pneumonia (VAP) and have heard probiotics may help in prevention. Whats the evidence, if any, to support that? BROWSE FOR –ventilator associated pneumonia – Evidence-Based Care Sheets from drop down, Relevancy Ranked BEST RESULT Pneumonia, Ventilator-Associated: Prevention (Aug. 3, 2012) ANSWER …administration of probiotics may reduce the incidence of VAP in critically ill patients receiving mechanical ventilation (per 2012 review, 2010 meta-analysis)

11. Skills & Procedures Detailed steps to achieve proficiency in a specific nursing task

12. Procedure example Browse for: oral hygiene intubated Detailed how to Teaching tool

13. Patient Education Use to print or save handouts, customized for patients

14. Abdominal x-ray handout Print as is or customize w/pt. name, dept., etc. Click to change to Spanish

15. Exercise 1 A 55 yo woman is admitted after suffering a mild stroke. Among other recommendations, you want to propose a nutritional plan to prevent recurrence. Could adherence to a Mediterranean diet lower her risk of stroke? 1.Does this search require a review of best evidence? 2.What type of NRC report is best for this question? 3.Search for a report on this topic in NRC 4.Is there good evidence to support adherence to the Mediterranean diet as a means to lower her stroke risk?

16. Exercise 2 A 35 yo man with a previous brain injury to the posterior cortex visits the clinic, complaining of uncontrolled movements of his right hand. You suspect a psychiatric disorder but hear a physician talk of alien hand syndrome. You wonder if thats something from a sci-fi flick or an actual condition. 1.Does this search require a review of best evidence? 2.What type of NRC report is best for this question? 3.Search for a report on this topic in NRC 4.If this is an actual condition, how is it typically assessed?

17. Exercise 3 A 48 yo Spanish speaking woman is diagnosed with poorly controlled insulin-dependent diabetes. The physician recommends insulin pump therapy (aka continuous subcutaneous insulin infusion) as a means of controlling her diabetes. Youve been instructed to insert the pump, teach the patient how to use it and educate the patient about type 2 diabetes before discharge. 1.Locate an overview of the procedure in NRC 2.Find information on how to educate the patient 3.Find a handout the patient can read on type 2 diabetes

18. How to access resource sfghlibrary.ucsf.edu

19. How to access via mobile device. Click here for instructions on how to access on an iPhone or iPad

20. Need more help? Nursing Reference Center guide http://sfghdean.ucsf.libguides.com/NRC Contact me Michelle Henley Barnett-Briggs Medical Library 206-6638 or michelle.henley@ucsf.edumichelle.henley@ucsf.edu