Nurses Improve Clinical Practice with Their Research
By Lindy Keane Carter
Tradition and opinion still drive many practices in medicine, sometimes because of a lack of evidence, sometimes despite the evidence. In today’s health care environment, in which all members of the medical team are expected to accept responsibility for outcomes, registered nurses have an increasingly important role in questioning the methods and processes they encounter. To empower MUSC Health nurses to develop best practices, nursing administrators are enhancing resources and support for the bedside nurse.
The Nurse Alliance (NA) at MUSC Health, co-chaired by Katie Steidle, MSN, RN-BC and Heather Sodee, MSN, MHA, RN, is the hospitals’ nursing governance structure. The NA committee charged with implementing research activities (the Evidence-Based Practice and Research Council) is co-chaired by Heather Craven, RN, Nursing Quality Data Lead, and Teresa Atz, Ph.D., RN, Assistant Professor in the College of Nursing. Together with Andrea Coyle, MSN, MHA, RN, Professional Excellence Manager, and other colleagues, these leaders are strengthening the research culture at MUSC Health. Such efforts have been a major part of the hospitals’ application to the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program. A site visit is scheduled for July 2015.
“For the Magnet Recognition Program, we have to outperform in quality measures, nurse engagement, and patient satisfaction. Of course, these are MUSC Health’s goals as well, so we want to put all the things in place that will enable us to meet those goals,” says Coyle.
To support registered nurses in their investigations and build a strong research culture, NA leaders have launched several initiatives. In 2013, Coyle established a partnership with MUSC Health’s Center for Evidence-Based Practice, resulting in a workshop for nurses in research methodology. An advanced course is now being planned. Their collaboration continued with the first offering of the MUSC Health Evidence-Based Practice and Nursing Research Conference in May 2015.
The NA has also launched a “research challenge,” which is an invitation to hospital units to create a team that identifies an area of inquiry, attends a research workshop, and presents a proposal that may eventually be submitted to the Institutional Review Board for approval and implementation.
In addition, the Council has announced the contest, “Digging for Dinosaurs,” designed to prompt nurses to identify practices that are outmoded or without an evidence base. The entries will build a research agenda for nursing leadership.
The importance of nurses as scientist-researchers who generate new knowledge about health, wellness, and disease has been recognized for nearly 60 years. The federal government first supported nursing research in 1946 with the establishment of the Division of Nursing within the Office of the Surgeon General, Public Health Service. In 1955, the National Institutes of Health (NIH) established a section within the Division of Research Grants to review the growing number of applications. Thirty years later, the National Center for Nursing Research at NIH (now the National Institute of Nursing Research) was created in response to a 1983 federal study that recommended that nursing research be included in the mainstream of biomedical and behavioral science and included in a 1984 NIH Task Force study.
Today, professionals and students must understand the fundamentals of research. Health care trends are driving health systems to focus not only on patient safety, quality, and cost-effectiveness, but also encouraging ownership on the part of the whole care team.
Bedside Nursing Research
Coyle and Jessica Koenig, MSN, RN, Meduflex Assistant Nurse Manager, recently concluded a study funded by the Beryl Institute Patient Experience Grant Program on whether the availability of seating for health care providers improves the patient’s perception of effective listening and creates an environment for patient-centered care. For three months, folding chairs were put in patient rooms in two units to enable nurses and physicians to sit when speaking to the patient in the bed. The goal was to measure change in the patient experience (i.e., how often physicians and nurses listened carefully to him or her) by comparing Hospital Consumer Assessment of Healthcare Providers and Systems scores before and after chair placement. In addition, the staff in those two units were surveyed regarding the use of the chairs. “Current literature shows that there is a link between physicians sitting at the bedside to talk and a decrease in health care costs and litigations. We’re still compiling our results, but hope to see that these chairs have made it easier for staff to sit down and build a relationship. It’s a simple, inexpensive tool, but could have a big impact on patient satisfaction scores,” says Coyle.
Dee San, MBA, BSN, CSSBB, CPBN, Perioperative Services Program Manager at MUSC Health, is the Principal Investigator of a study titled, “Effect of Human Factors on Operating Room Traffic Control and Associated Hospital Acquired Infections.” Operating room (OR) traffic, particularly OR door openings, increases ambient bacteria counts, which have been correlated with increased surgical site infection (SSI) rates. Current efforts to reduce door openings are not highly effective. This study will introduce a real-time visual cueing device to monitor door openings during procedures. During case debriefings, surgical teams will review door opening occurrences, controllable factors, and opportunities to reduce frequency in subsequent cases. Research outcomes will determine whether the use of such human factor techniques affect OR physician and staff behavior and ultimately reduce SSI rates.
One of the pillars of MUSC’s College of Nursing’s mission is advancing knowledge about improving patient care. Thirteen faculty members are currently conducting 28 research projects (listed on the following pages). One example, funded by the National Institutes of Health/National Institute of Nursing Research, is led by Teresa Kelechi, Ph.D., RN, FAAN, Professor and David and Margaret Clare Endowed Chair. Kelechi is conducting a two-year study to examine the use of a natural homeopathic powder to provide a non-invasive treatment for chronic wounds in patients receiving palliative care (clinicaltrials.gov identifier NCT02008487).
The Magnet Journey
The ANCC Magnet Recognition Program expects to see evidence-based practice (EBP) embedded in the culture of the organization, as well as visionary leadership, nursing structure, professional practice, quality improvement, and outcomes.
“The ANCC looks for structures and processes that support nursing clinical inquiry,” says Craven. “We are working on several initiatives that will support that.”
To that end, the NA is reorganizing the nursing governance structure, developing an RN IV level that incorporates EBP, revising the review process for nursing proposed studies to include the NA as part of the IRB review, and other activities.
“At Magnet-designated hospitals, nurses need to feel empowered, to be able to say they need to do what’s best for their patients,” says Craven. “We are building a culture that empowers nurses to control their own practice.”
Principal Investigator: Acierno, Ronald E.
National Elder Mistreatment Study: 5 Year Follow Up of Victims and Matched Non-Victims (NIJ/Archstone Foundation)
In-Home Exposure Therapy for Veterans with PTSD (Sub with Veterans Medical Research Fdn)
Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy and Their Combination of OEF/OIF with PTSD (Sub with Veterans Education and Research Association of Michigan (VERAM))
Principal Investigator: Amella, Elaine
RWJF Future of Nursing (RWJF)
Principal Investigator: Cartmell, Kathleen
Principal Investigator: Kelechi, Teresa J.
Principal Investigator: Magwood, Gayenell
Principal Investigator: Mueller, Martina
Adequate Breast Milk for Improved Health of Very Low Birth Weight Preterm Infants (Sub with Univ. of Florida/NIH - R15)
Principal Investigator: Ruggiero, Kenneth J.
A Peer-Education Approach to Support the Behavioral Health Needs of Fire Service Professionals (Dept. of Homeland (FEMA))
Implementation of Prolonged Exposure in the Army: Is Consultation Necessary for Effective Dissemination? (University of Pennsylvania/DoD)
Principal Investigator: Smith, Gigi
Nurse Faculty Loan Program (HRSA)
Principal Investigator: Spruill, Ida J.
Principal Investigator: Stuart, Gail W.
Virtual Interprofessional (VIP) Education (Josiah Macy Jr. Foundation)
Principal Investigator: Treiber, Frank A.
Smart phone Med Adherence Stops Secondary Strokes (SMASSS) (MUSC Telehealth Program Development Award)
Smartphone Delivered Meditation for BP Control among Prehypertensives (NIH/NHLBI - R01)
Principal Investigator: Williams, Tiffany
Scholars in Residence Fellowship Program (AcademyHealth/Aetna Foundation)
Principal Investigator: Williamson, Deborah C.
Teen Health Advocate Leadership Program Planning Grant (Center for Public Service Community)