T he idea of sharing clinical experiences to improve patient care is not new to nurses. Florence Nightingale published her observations on cleanliness, nutrition, and fresh air in Notes on Nursing 1 in 1860. Her work was the start of evidence-based nursing practice. More than 150 years and thousands of research studies later, the use of evidence to guide nursing practice is the expected standard of practice for both individual nurses and health care organizations. Scope and Standards of Practice 2 and Code of Ethics 3 of the American Nurses Association both call for nurses to incorporate research evidence into clinical practice. Schools of nursing have added content on evidence-based practice to their curricula. 4 Despite these efforts, barriers inhibit implementation of changes based on published evidence into bedside patient care. Overall, the barriers involve the characteristics of the nursing profession, organizational dynamics, and the nature of the research.5,6 Studies 7,8 have consistently indicated that a nurse's inability to both determine what evidence is ready for implementation into practice and then successfully develop processes to sustain an evidence-based practice change is a barrier. Evidence-Based Practice Evidence-based nursing care is informed by research findings, clinical expertise, and patients' values, and its use can improve patients' outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice. (Critical Care Nurse. 2014;34[2]:58-68) 58 Choosing the Best

Pharmacologic and nonpharmacologic interventions were evaluated, resulting in recommended for practice rating for catheter care bundles, antimicrobial prophylaxis, vaccination for specific populations, and implementation of contact precautions for resistant organisms.

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The increasing survival rate from pediatric cancer has been one of the greatest accomplishments in the medical world in the 20th century. However, as young adult survivors move into adulthood, they must face the long-term side effects of their treatments. For such individuals, the transition to adulthood is complicated by their fragile medical and psychological state. The purpose of this article is to review current transition research and tailor basic principles to meet the needs of pediatric cancer survivors. Advanced practice nurses can take an active role in transitional planning by serving as coordinators and ensuring implementation of these needed services. The goal is to create an environment conducive to a smooth, problem-free transition to adult care.

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