Adoption of AACN verification of feeding tube placement practice alert by critical care nurses

Abstract

The intent of clinical practice guidelines is to help bridge gaps between evidence and practice, yet there is no correlation between availability of guidelines and changes in practice. Little is known about how critical care nurses adopt guidelines, since few studies have sampled nurses exclusively. This descriptive, exploratory study examined factors influencing adoption of the American Association of Critical-Care Nurses (AACN) Verification of Feeding Tube Placement Practice Alert and four clinical practices recommended by this guideline. An online questionnaire, based on Rogers' Diffusion of Innovations conceptual framework was completed by 370 critical care nurses from 45 states. Fifty five percent were aware of the Practice Alert and 45% had adopted the guideline in practice. Only · 24% of nurses who adopted the guideline had also adopted/implemented all four clinical practices. Practice adoption ranged from 23-94%, although 10-73% of nurses indicated partial adoption, performing practices only some of the time. There was also a gap between nurses being aware of practices (60-98%) and adopting the practices (23-94%). Predictors of AACN Verification of Feeding Tube Placement Practice Alert adoption measured by logistic regression included BSN or higher nursing education (OR · = 2.49), and the guideline characteristics of observability (OR = 1.46) and trialability (OR= 1.37). Predictors of clinical practices included membership in a professional association (OR= 4.09), staff nurse/charge nurse role (OR= 4.01), traditional communication behavior (OR= 2.83), research/web-based communication behavior (OR = 2.11 ), academic medical center (2.11 ), and perception of a policy. Policy was the only significant predictor of all four practices (OR 7.08, 42.71, 17.09, 2.78 respectively). Only practice four, avoidance of auscultation by air bolus method, was associated with Practice Alert adoption, although this was not significant when other practice guidelines were controlled for. Factors influencing nurses' decisions to adopt guidelines within an organization are multifaceted. More research is necessary to obtain a better understanding of these factors to achieve the ultimate goal of increasing translation of evidence into clinical practice.