| Principal Investigator: | Carin Adams, BSN, RN, CPN |
| Organization: | Cook Children’s Hospital |
Abstract
Problem
Nurses in a pediatric inpatient unit noted poor outcomes in some children with end-stage renal disease admitted with unstable hypertension. When they found no published guidelines for nursing management of such patients, they went to the evidence to create their own.
Evidence
With the help of medical librarians, the author developed a search of relevant literature in MEDLINE, CINHAL, BLACKWELL SYNERGY data bases, and the National Guideline Clearinghouse. With the help of a nursing research consultant, nurses on the unit evaluated research reports and evidence summaries, excluded irrelevant reports and compiled their findings.
Strategy
Using the evidence and recommendations from stakeholders, including nursing management and local pediatric nephrologists, nurses constructed a protocol to guide nursing care of pediatric renal patients with unstable hypertension. Staff nurses piloted the protocol. After further refinement, the protocol was presented to the institution’s policy committee and ultimately approved as unit policy.
Practice Change
Nurses abandoned an incoherent approach to care that lacked defined monitoring parameters, expected outcomes, and safety net responses for deteriorating patients. They adopted an evidence-based protocol that supports expert nursing judgment and provides explicit guidance to novice nurses.
Evaluation
The intent of the guideline is to protect patients from effects of end-organ injury, such as stroke and seizures. Evaluation of patient outcomes is still in progress.
Results
Although patient outcome data is not complete, stories from nurses indicate they feel more confident in their care of these challenging children. No poor outcomes have been noted since using the guideline.
Recommendations and Lessons Learned
Nurses learned that evidence is power — power to make positive changes in outcomes for patients, as well as nursing satisfaction. This guideline is recommended as a structured approach to a relatively rare problem. Creating an evidenced-based guideline is recommended as an effective approach to changing any clinical practice.
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