Development of the Evidence-Based Protocol:Back to Basics Bundle of Nursing Care


Name: Linnea Axman

Rank: CAPT

Organization: The Geneva Foundation

Performance Site: Naval Medical Center, San Diego

Year Published: 2008

Abstract Status: Final


Despite the longstanding belief that AM and PM care are part of "good" nursing care, there is virtually no evidence-based literature that supports the use of the combined elements (e.g., bathing including oral care and skin care, and comfort measures including back rub). In fact, AM and PM care are not being taught in many professional schools of nursing and clinical hours devoted to bedside care have been reduced at Navy Hospital Corps School. This failure to provide basic nursing care was the initial trigger for this evidence-based practice (EBP) project with patient satisfaction surveys identifying "hygiene needs not met" as often as 50 percent of the time. Nursing staff have reported lack of attention to basic hygiene needs and disruption in skin integrity in war-wounded returnees from Operation Iraqi Freedom; both may contribute to infection and may at least in part be attributable to lack of basic nursing care. Ineffective delivery of basic nursing care has been shown to contribute to healthcare associated infections, surgical-site infections, and pressure ulcers.The proposed EBP project is unique because it revisits basic (essential) nursing care, approaching the subject by translating science into a cohesive practice guideline for delivery of basic nursing care. Described as The Basic Bundle of Nursing Care (BBNC), the care provided as a bundle results in greater improvement in patient outcomes than when each element of care is considered independently. This guideline will include comfort and hygiene measure that are general enough to be used across nursing specialties and branches of services, and will potentially have utility in shipboard and other deployment settings. The BBNC will maximize care, assessment, and early intervention by grouping periodic activities such as repositioning, assessing skin, offering toileting opportunities, and other comfort measures. By combining these activities, the nursing staff will be provided an opportunity to complete multiple tasks while in the patient's room increasing the likelihood that they will be performed and documented.The practice guideline proposed in this EBP project is sustainable. Real-world implementation strategies will be used in this EBP project including a Train-the-Trainer educational intervention, documentation of activities using the electronic nursing note, and use of existing patient care products and data collection and surveillance tools. Intervention effectiveness, feasibility, and cost will be evaluated and reported.Products of this EBP project will include The Evidence Based Practice Guideline: The Basic Bundle of Nursing Care, The Back to Basics Intervention, an educational intervention that offers the sustainability of a Train-the-Trainer approach, the ability to diffuse the innovation through the structure of nurse and corpsmen internship and orientation programs, and recommendations for future EBP projects and research studies aboard ships and in other deployment settings.


Final Report is available on NTRL: