The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

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Concurrent Biological, Electromagnetic Pulse, And Cyber Attacks - A Challenge To The Interagency Response

The U.S. including its military depends on an electrical grid and electricity-based critical infrastructure. An electromagnetic pulse (EMP) and cyber attack can disable not just a significant portion of the electrical grid and critical infrastructure, but also the networkcentric military response to such an attack. There is a large range of actors that might attempt EMP attacks against the U.S.. Health surveillance systems are network-centric, and if mass destruction is the goal of an adversary, launching a biological attack concurrently with EMP and cyber attacks may achieve this goal. Current agency response plans focus on one WMD attack at a time but combined attacks without emergency management plans may compromise a timely response. An EMP and cyber attack could amplify the effects of a biological attack because the loss of the electrical grid and electricity-based critical infrastructure could disable detection and response efforts as well as disrupt interagency efforts to coordinate a medical response. EMP is often perceived as science fiction because the immediate effect does not result in loss of life, but the cascading failures of critical infrastructure will affect civilian and military capabilities to support survival and recovery. Key steps to mitigate the catastrophic effects of an EMP attack should be taken and include: prevent an attack in the first place, prepare so personnel can respond after an attack, protect the critical infrastructure to limit the impact, and recover after an attack to restore power and critical infrastructure