Nurses Embrace Cleveland Clinic's Nursing Research Plan
By Debra Wood, RN, contributor
Nursing research forms the foundation for improved practice, yet pressed for time and lacking investigational expertise, few staff nurses conduct their own studies. The Cleveland Clinic Foundation aims to change that with a special department to support nurses in their scientific inquiries.
“Having a department with infrastructure helps focus us to achieve goals and the diverse benefits of research for the hospital, division of nursing and the patients we serve,” said Nancy Albert, RN, MSN, CCNS, CCRN, CNA, director of nursing research for the Cleveland Clinic Foundation, Ohio. “This is a concerted effort to not just wait for people to come to us, but for us to proactively go to them and create research projects.”
Although nurses have long been involved in Cleveland Clinic studies, in the past, experienced researchers coached individual nurses, but support was limited. The new department will help nurses define their research question and write proposals and grant applications to secure funding, in some cases from external sources.
The internal, privately supported Cleveland Clinic Nursing Research Fund awards up to $15,000 annually to help defray research-associated costs. The money may be used for equipment or supplies or to pay a per diem nurse to cover the researcher’s shift, allowing the nurse uninterrupted time to work on the study.
Albert also will assist with development of an abstract or manuscript for publication and will promote practice changes based on the results. She has extensive experience conducting research studies, publishing her findings and helping incorporate them into practice.
“My philosophy is a study is not done until we have looked at the nursing implications and acted on them if necessary,” Albert said. “We will take everything back to the staff nurse level, because that is the way they will realize this is important. You need to make that association.”
As soon as the hospital announced the new program, nurses came forward with proposals for studies that could answer questions related to patient care and processes. Many investigations launched in the second half of 2004, with at least one study under way in every major area of the hospital.
“It is important to demonstrate evidence for why we do what we do,” said Lucia Wocial, Ph.D., RN, CCNS, a neonatal clinical nurse specialist who is conducting a NICU transitional screening study. “We must change how we think about our practice and change how we care for patients—one nurse at a time.”
Wocial developed a screening tool for newborns. Nurses will use it after the initial APGAR and during the first hour of life. Wocial will measure outcomes to assess whether a baby scoring high can safely spend time bonding with the mother, before being taken to the nursery.
In the medical intensive care unit, staff nurses Deb O’Meara, RN, and Fran Frame, RN, suspected that patients may not receive their optimal daily caloric input, because enteral tube feedings are stopped when patients leave the floor for diagnostic workups and or are positioned flat. So they decided to study how often tube feedings are turned off and how many calories patients miss.
“We are concerned about our patients’ nutrition in light of the high metabolic demands critical illness places on often-compromised, medically fragile patients,” O’Meara said. “We have made a number of observations over time that patients fed early and at goal usually do better than those who don’t. Our plan is to document and evaluate our current practice and hopefully devise new standards for our practice.”
In the cardiothoracic surgery unit, nurse clinician Carol Zacharias, BSN, RN, hopes to prove that by improving preoperative nutritional status of open-heart surgery patients with low preoperative albumin levels, patients will go home sooner and experience fewer respiratory complications and enhanced wound healing.
“I believe that many of my hunches as a practitioner hold merit based on many years of experience,” Zacharias said. “Nurses need to evolve and support their practice, so that it can be improved.”
Jane Hartman, BSN, RN, a staff nurse, began conducting research as part of her graduate school education. However, she plans to continue and will develop an education program for pediatric patients, 7-to-12-years old, undergoing radiological procedures. She aims to determine whether her program decreases children’s anxiety about undergoing an MRI by conducting surveys before and after implementing the teaching tool.
“Evidenced-based practice is the only way change can occur and new interventions can be incorporated into patient care,” Hartman said.
On a geriatric unit, nurses have initiated a study to determine the validity of a bedside swallowing screening test performed by nurses compared to formal swallowing tests by a speech pathologist.
“If the correlation is positive and very strong, it may be we change practices on medical floors and have every patient go through a bedside swallowing screen to be sure somebody is not going to get into trouble with complications,” Albert said.
Nurses also are assessing ways they can improve patient and family satisfaction and will measure whether actions they take to improve communication and education will result in increased approval ratings.
“Many of the studies are things that historically have been associated with good or bad nursing care,” Albert said. “We’ll see a lot of benefits from results traditionally associated with nursing, but also we can impact evidence-based practice.”
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