Nurses ask patient care questions each and every day. How can we solve this problem? How can we help this patient? How can we make this process better? These questions and more can be explored through research, affording BWH nurses the opportunity to add to nursing’s vast body of knowledge. Research is essential for the ongoing advancement of the nursing profession and nurses in all roles are involved in research activities across BWH.
“Nurses are inherently skilled researchers for a variety of reasons,” said Katherine Gregory, PhD, RN, Haley nurse scientist. “First, they are intellectually curious and can make detailed observations about human behavior. Second, they are excellent data collectors. And finally, they are skilled communicators.” These attributes, required of nurses in their clinical roles, are also key components of the scientific method.
Adds Deborah Farina Mulloy, PhD, RN, CNOR, associate chief nurse for Quality and the Center for Nursing Excellence: “Nursing research has tremendous influence on current nursing practice, as we are committed to delivering evidence-based care. It advances patient care outcomes.”
Surveying the Nursing Community
The Nursing Research and Evidence-Based Practice Committee seeks to learn more about and enhance the culture that supports evidence-based practice within the Department of Nursing. Led by co-chairs Lisa Preston, MSN, RN, clinical nurse educator on Shapiro 9/10 and Yvonne Sheldon, BSN, RN, clinical nurse in the NICU, and advisor Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, ANP, FAAN, director of Global Health and Academic Partnerships in the BWH Center for Nursing Excellence, the group meets monthly and is part of the Department of Nursing committee structure. Last year, the committee administered a survey about nurses’ interest in research. “Our goal was to learn how we can engage nurses in evidence-based practice and research endeavors and connect them to the resources they need to take the first step,” said Preston.
The survey found that several barriers keep BWH nurses from engaging in research, such as not having the time to devote to research activities or not feeling equipped with the necessary training, knowledge and resources. Survey results were presented at the International Association of Clinical Research Nurses (IACRN) in November 2014.
Guided by the survey findings, the committee is developing a resource toolkit and a journal club for nurses interested in research.
The Role of Mentorship
According to Susan Lee, PhD, RN, senior nurse scientist, clinical nurses and nurse scientists collaborate to generate knowledge for practice. For example, before 2011, there was little evidence to guide nursing practice around bathing late preterm infants. It was thought that if they were bathed by submersion they may be at greater risk for hypothermia; instead, these newborns received sponge baths. However, BWH nurses noted that the infants did well with submersion. They collaborated with Gregory, who designed a randomized clinical trial to test their hypothesis. The nurses conducted the study and results verified their hypothesis. Publication of the study in 2012 established new bathing practices and informed the Association for Women’s Health, Obstetric, and Neonatal Nursing’s skin care guidelines.
There are several ways nurses can seek mentorship around research. “Anyone who has an idea for a research study is encouraged to attend a committee meeting,” said Sheldon. The Department of Nursing also offers the day-long Immersion in Nursing Research program, an educational training for clinical nurses that covers an introduction to the scientific method, how to write a project plan and how to execute a research project. Last year, the department hosted a series of luncheons for nurses interested in publishing their work.
Nurse scientists who have a doctorate or are enrolled in a doctoral program also meet monthly at the Brigham Doctoral Nursing Forum to collaborate, share their work and seek mentorship. “It’s a great way to seek guidance on the paper writing process, a presentation or a poster,” said Patricia Dykes, PhD, RN, FAAN, FACMI, senior nurse scientist and program director in the Center for Patient Safety Research and Practice and the Center for Nursing Excellence at BWH. “Networking is critical for lifelong learning.”
Nurse-Lead Research Impacts Care
With the right amount of mentorship and support, nurses at BWH have studied countless research questions, and in turn have validated current practice and enhanced patient care. Below are just a few examples of how research led by both nurse scientists and clinical nurses has made a difference at BWH and beyond.
In 2008, Rita Patnode, MSN, PNP, clinical nurse educator in the NICU and Karen Griswold, MBS, RN, lead patient safety consultant, developed specific criteria to guide nurses and other clinicians on when to call for a newborn rapid response team. They conducted a retrospective analysis of charts and noted factors that most commonly were followed by a call for an urgent NICU assessment or an adverse event, such as low or high respiratory rate, difficulty breathing, low oxygen, a home birth or a recent fall or seizure. This work is novel because no other such criteria exist in the literature. Patnode and Griswold presented at the 2013 Council of International Neonatal Nurses (COINN) conference.
Inspired to help infants receive the nutrition they need, Tina Steele, RN, IBCLC, clinical nurse and lactation consultant in the NICU, established BWH’s first human donor milk program in 2010 and conducted studies to better understand the nutritional needs of babies. When comparing the benefits of donor milk, mother’s milk and formula, she found that mother’s milk and donor milk improved outcomes for premature newborns, including days to full feeding attainment, less IV days, and fewer parenteral nutrition days.
In 2011, Dee Lynch, MSN, NP, and Karen Meyers, MSN, RN, CCRN, both nurses-in-charge in the medical intensive care unit (MICU), researched the role of family meetings. When they audited 90 charts, they found that in most cases, family meetings had not taken place within five days after a patient’s admission. They implemented a program whereby the care team met with each patient and their family within three days of admission. In a later audit, they found improved patient outcomes and shorter lengths of stay. “Family meetings not only improve a patient’s quality of life, but they facilitate communication and keep everyone on the same page,” said Meyers.
In 2011, after BWH performed several face transplant procedures, Linda Evans, PhD, RN, program director in the Center for Nursing Excellence, was interested in learning more about the perceptions of caregivers who participate in ethically complex procedures such as face transplants. She conducted a qualitative study involving interviews with 26 members of the inter-professionalcare team. Her findings were overwhelmingly positive, showing that they felt a strong sense of purpose and teamwork when involved in facial transplantation cases. Evans’ findings were published in the journal Nursing Research.
Current Studies and Looking to the Future
Exciting new nursing research is underway at BWH. In various stages, these studies have great potential to add to the current nursing knowledge.
When Sharon Levine, BSN, RN, clinical nurse in the Cardiac Intensive Care Unit (Cardiac ICU), learned that certain patients experience PTSD for years after staying in the Cardiac ICU, she was curious as to why. In 2014, Levine began a study to evaluate whether diary use could decrease anxiety, depression and PTSD. Now, as part of the study, nurses and family members keep a record of ICU patients’ daily activities and experiences for the duration of their stay. Once discharged, patients bring home the diary, which helps them recall their time in the ICU. Levine is hopeful that her research will show decreased PTSD and mental sequellae following ICU stays.
In 2014, Stephanie Shine, BSN, RN, clinical nurse in the NICU, was inspired to find a way for new mothers to connect with their babies during a NICU admission after her son was born prematurely. Shine experienced firsthand the stress caused by separation. Upon returning to work, she researched Google Glass, a wearable technology that streams live video and is using an adapted version of the technology for a NICU study she is leading called “Love at First Sight.” The study, which investigates the influence of video conferencing on maternal stress, uses the technology to allow mothers to see and hear their babies through their partners’ “eyes” in real time while they are physically separated.
Lee recently completed a research study to measure caring and civility among clinical nurses. “How we treat each other affects the entire environment of care,” said Lee. “Our care delivery model, relationship-based care, includes the relationship with patients, families, ourselves, and our colleagues,” said Lee. “We have an obligation to care for and support our coworkers in order to create a caring and healing environment for everyone.”
Mulloy is in the early stages of planning a new research study for which she has just received IRB approval. This research will evaluate a trans-intravenous access device (TIVA) that will allow for blood samples to be drawn from peripheral IV lines. This device has the potential to have a major impact on reducing the number of venapunctures for a patient leading to increased patient comfort and satisfaction.
“Now more than ever, nurses across the organization are engaging in evidence-based practice,” said Nicholas, who for the past 10 years, has reviewed all protocols submitted to the IRB. “Evidence-based practice is vital to advancing the nursing profession because it allows us to continually improve our practice as we deliver compassionate care.”
For a listing of Department of Nursing opportunities that support nursing research, visit PikeNotes.