The hospital environment becomes routine for nurses, but not for acutely ill children. In fact, hospitalization of a child is a stressful time not only for the child but for the child’s family. The PICU is particularly stressful because of the extensive use of machines, tubes, and alarms in that environment. Patients are continuously monitored by machines, nurses, or both; after a while, patients’ families become acclimated to the environment and the presence of PICU nurses provides a sense of security and safety. During recovery, children are transferred from the PICU to an unfamiliar environment. During this time, transfer anxiety develops in both the child and the child’s family. They are not only leaving a familiar environment, they are also leaving familiar personnel and monitoring equipment. Lack of preparation and information about the transfer is an overriding cause of stress and anxiety in these families.

The need to promote evidence-based health care practices has been recognized for some time, yet challenges in implementation continue. Facilitation of evidence-based practice must occur at the organization and unit levels to assure integration. Research that provides an understanding of what makes an organization successful in use of evidence-based practice is limited, and tools to assess the organizational culture are needed. The majority of related research identifies barriers to research use. Research identifying how to assess and improve organizational variables that promote use of evidence-based practice is needed, but our understanding is growing. The need to understand organizational context is so compelling that the topic is identified as a top research priority.

Aspiration pneumonia is a serious complication of mechanical ventilation and enteral tube feedings. It results in increased patient mortality, increased length of hospital stay, and increased healthcare costs. This article describes an evidence-based practice approach to the creation of an enteral feeding protocol and an aspiration risk reduction algorithm. These tools were piloted in a Medical Intensive Care Unit at a Midwest tertiary care center. Chart audits show an increase in the percentage of patients who reach their goal rate for enteral feedings from 78% to 85%. Reported aspiration pneumonias decreased from an average count of 4.8 patients per month to 4.3 per month and ventilator-associated pneumonia rates decreased from 6.8 to 3.2 per 1000 patient days.

Nurses’ practice of listening to bowel sounds was first proposed in 1905 and continues today, largely unquestioned. The authors developed a project to determine whether any compelling evidence exists for using this method to assess for the return of gastrointestinal (GI) motility following abdominal surgery. Literature on the subject was evaluated and an assessment of nursing practice was conducted. Based on the literature review and the assessment, a nursing practice guideline was developed, implemented, and evaluated. (Note that the nursing practice guideline outlined in this article was evaluated for use with abdominal surgery patients only and hasn’t been evaluated in and may not be appropriate for other patient populations). The results were positive and indicate that clinical parameters other than bowel sounds, such as the return of flatus and the first postoperative bowel movement, are appropriate in assessing for the return of GI motility after abdominal surgery. Bowel sound assessment was discontinued and patient outcomes were evaluated to make sure that the practice change had no adverse effect on patients’ recovery.

Implementing evidence-based practice is a complex but valued process that requires support for nurses to make it a reality in care delivery. To address this, an Evidence-Based Practice Staff Nurse Internship was developed at the University of Iowa Hospitals and Clinics in the United States.

This article reports an evidence-based practice project using the Iowa Model of Evidence-Based Practice to Promote Quality Care for a common nursing procedure, nasogastric tube placement verification in children. Little research exists regarding the care of nasogastric tubes in children, and traditional verification methods prevail. Auscultation of air insufflation over the abdomen is still used to check placement in many settings, despite research dating back to the 1980s questioning this approach. X-ray remains the only certain way to verify placement, but getting an X-ray before each feeding would be costly and impractical. Additional bedside methods are needed. Project results demonstrate a decrease (93.3% to 46.2%) in the use of auscultation and improved use of other, more reliable methods to determine nasogastric tube placement. Changing practice can be challenging. However, with persistence and re-infusion, this project provides an important example of how the evidence-based practice process leads to excellence and improves patient care.