title: Direct care nurses on the shared governance journey towards positive patient outcomes.
abstract: OBJECTIVE
  To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing.
  
  
  BACKGROUND
  Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions.
  
  
  METHODS
  This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes.
  
  
  METHODS
  Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change.
  
  
  CONCLUSIONS
  Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted.
  
  
  CONCLUSIONS
  This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kneflin
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: O'Quinn
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Geigle
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Mott
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Nebrig
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Munafo
mesh_terms: D000328:Adult; D001494:Baths / Q000451:nursing*; D002648:Child; D002662:Child Health Services; D002710:Chlorhexidine / Q000008:administration & dosage; D003659:Decision Making, Organizational; D004202:Disinfectants / Q000008:administration & dosage; D006801:Humans; D017146:Models, Organizational; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010371:Pediatric Nursing; D011367:Professional Staff Committees / Q000458:organization & administration*
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine
keywords: child nursing; clinical guidelines; collaboration; evidence-based practice; hospitalised child; nursing intervention; nursing practice; paediatrics