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New AJCC column highlights evidence for common clinical practices.


Nursing care is increasingly complex and demanding. New equipment, new procedures and new science all vie for attention. How can nurses quickly assess the latest research on a particular topic? Nursing practice must be based on the best available evidence, and all members of the critical care team must be cognizant of the latest science if they are to provide the best, most effective and safest-possible patient care.

A new, regular feature in the American Journal of Critical Care, "Clinical Evidence Review," seeks to unveil available scientific evidence to answer common questions faced in contemporary clinical practice. Is normal saline instillation prior to endotracheal suctioning helpful or harmful? How important is lead positioning in ST segment monitoring? What is the best way to manage intracranial hypertension? Are the results of blood pressure measurements at sites other than the forearm reliable?

These and other practical clinical questions are the focus of the new feature, written by Margo A. Halm, RN, PhD, CCRN, a clinical nurse specialist and director of nursing research and quality at United Hospital in St. Paul, Minn., where she leads and mentors staff in principles of clinical research and evidence-based practice.

According to co-editor Kathy Dracup, RN, DNSc, the idea for this feature came from AJCC's readers themselves. "In our readership surveys, nurses consistently ask for evidence-based practice recommendations that are easy to access. Everyone recognizes that the days of basing nursing care on tradition, tenure and tenacity are over, but how can clinicians quickly find the answers to their clinical questions? Halm's feature is designed to provide those answers."

In her first column, Halm discusses chest tube manipulation, offering an overview of the evidence dealing with whether milking or stripping chest tubes increases patency and prevents cardiac compression in postoperative cardiac surgery patients. Based on current evidence, she notes that "stripping chest tubes may significantly increase negative intrathoracic pressures that could cause harm," thereby impairing patients' postoperative recovery.

The article, "To Strip or Not to Strip? Physiological Effects of Chest Tube Manipulation," appears in the November 2007 issue of AJCC.

AJCC is a peer-reviewed scientific journal published six times a year (January, March, May, July, September and November) by the American Association of Critical-Care Nurses. The journal offers evidence-based interdisciplinary knowledge to advance the science and art of high-acuity and critical care practice. AACN members receive AJCC as a membership benefit. To read Clinical Evidence Review and other valuable AJCC content online, visit
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Publication:AACN News
Geographic Code:1USA
Date:Nov 1, 2007
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