Integrating Nursing Research into Practice: Whats Needed for a Practical Transition

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Integrating Nursing Research into
PracticeWhats Needed for a Practical
Transition

• Bernice L. Coleman Ph.D., ACNP-BC, FAHA
• Nurse Practitioner, Comprehensive Heart Failure
  and
• Heart Transplant Programs, Cedars Sinai Medical
  Center,
• Los Angeles Ca.

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Background Fundamentals Tenets for Prudent
Patient Care

• ..That individualized patient care based upon the
  best evidence, supports good outcomes.
• That ideally, research should be analyzed and
  used based upon levels of evidence.
• .That often the evidence needed to make clinical
  decisions is still evolving!

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Background Definition of Evidence Based Nursing
(EBN)

• EBN
• Involves the ability of access, summarize and
  apply literature in response to the need to
  manage day-to-day clinical problems. This process
  provides the background for holistic care and
  treatment that incorporates patient preferences
  and the impact of cost.
• Kessenich CR, 1997, Nurse Educator, 22(6), 25-29.

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Background What's the Expected Nursing, Scope of
Practice Today?

• Florence Nightingale, 1860
• No man even a doctor ever gives another
  definition of what a nurse should be other than
  this Devoted and Obedient. This definition may
  do well for a porter. It might even do for a
  horse. But not a policeman

• Provide empathic culturally sensitive care
• Identify and plan interventions for patients
  actual and potential health problems
• Develop research based strategies to prevent,
  ameliorate and comfort patients
• Undertake work historically done by MDs
• Empathic communicators
• Highly educated critical thinkers
• Master technology
• Actively practice within the context of
  interdisciplinary teams
• Dicenso A et al, EBN, 1998, Apr. 138-40,
• Ellis et al(2005), WorldViews on Evidence based
  Nursing 2(2), 84-93

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Supply and Demand

• Average age of a nurse is 43 years old
• 30 years ago, 26 of the workforce was under age
  30.
• Today lt10 are under age 30
• African American Nurses enter the field at an
  older age
• NLN report gt147,000 students were rejected from
  entering nursing school due to lack of adequate
  faculty numbers
• RN workforce saves lives,
• J Health Affairs, 2006

• Cost of health care continues to rise for all
  hospitalized patients
• Health disparities persist!
• gt40 million persons are uninsured and without
  adequate health care
• African Americans continue to disproportionably
  be affected by chronic diseases of HTN, renal
  failure, HD, DM and HIV

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Barriers to EBN

• Pravikoff et al, 2005 conducted a descriptive
  study to determine barriers to EBN
• Demographics
• Female 91 Caucasian 86
• Age 30-49 52 African American 4
• BSN or Assoc 73 Graduated lt1984 41
• Lack of time / computer access (hospitals 250
  beds or less)
• Inadequate search skills of electronic databases
  (rather ask colleague or search web)
• Lack of access to skill librarians (Dee
  Stanley, 2005 Journal of Hospital Librarianship,
  5(2), 1-12)
• Lack of authority to bring about change (Malone
  et al Issues in Clinical Nursing, 2004, 13
  913-924

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Strategies to Support EBN

• Nursing Administration
• Creation of an empowering work environment that
  supports nursing participation in quality care
  outcomes.
• Support strategies to increase electronic access
  at the unit level.
• Provide recognition excellent patient outcomes
  driven by research utilization.
• Expect excellent and strive for high goal
• Commitment to Advance Practice Nursing

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Strategies to Support EBN

• Academic Institutions
• Continue to integrate nursing students into the
  unit cultures fostering curious practice
  questions.
• Provide nursing students projects that require
  library database searches as part of a clinical
  rotation.
• Utilize advance practice nurses as both clinical
  and teaching faculty.
• Partner with hospital sites to assist in
  providing programs that promote staff nurse
  competence in EBN.

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Strategies to Support EBN

• Advance Practice Nurses
• Establish and utilizing hospital based nursing
  research committee structure to promote EBN /
  research development.
• Establish a collaborative between Nursing and the
  Librarian in your the hospital.
• Assure needed nursing journal access in the
  library or team up with local universities.
• Support quality inquirygtdevelop researchable
  questions gt publish results.

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NURSING RESEARCH TOOLBOX
Join the Advanced Practice Nurses for a look
inside a
How to Choose a Question/ Topic?

• Session 1- Getting Excited about Research
• Wednesday, January 18th 230- 330 pm in HM Room
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• Speakers Bonnie De Los Santos, RN, MN, CNS
• Linda Gorman, RN, MN, CNS
• Ann Mijares, RN, MSN, CNS
• Session 2- How to do a Literature Search
• Wednesday, January 25th 2-3 pm in HM Room 6
• Speakers Irene Lovas Dede Leshy Medical
  Librarians
• Session 3- What to Do after your Search???
• Wednesday, February 1st 2-3 pm in HM Room 3
• Speaker Ellen Mack, RN, MN, CNS
• Please Contact Nichele Garrett to RSVP
• Email - GarrettN_at_cshs.org

How Nurses use Research Daily
QI vs Research whats the difference???
Learn MEDLINE PUBMED!
Putting Knowledge to Practice!
How Can Advanced Practice Nurses Help You?
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Staff Nurse Generated Questions

• Improvement in care often starts with causal
  questions
• What? I didn't get that in report! How do we
  insure information handoff between shift?
• Why are you crushing that pill? How much is to
  much residual when infusing tube feedings?
• No restrains? Then what is the best way to
  prevent injury in confused patients?

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The Problem

• Our team was interested in assessing what nurses
  knew about crushing medications, checking
  residuals and administering NG tube medications
• Additionally, we were concerned given the volume
  of medications administered to our patients
  populations, that the potential for medication
  error could be great.

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Interdisciplinary Research Team

• Project Co-Chairs
• Ann Trank MSN CN III
• Debbie Saks-Morgan CN III

• Paula Williams RN CN III
• Sunee Vong RN CN IV
• Jed Carces RN CN II
• Peggie Huges RN CN II
• Louis Guitron RN CN II
• Boris Brand RN CN I
• Robert Fellin Pharm.D
• Berni Coleman Ph.D ACNP

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Methodology

• Revised a 20 item test to determine nurses
  knowledge of
• a) Medications that can be crushed
• b) Safety of medications administered via
  NG tube
• c) Checking residual
• Determined Face Validity of the test items
  (Unit Pharmacist / APN)

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Calculating Tube Feeding Residuals

• If tube feeding is running at 75cc/Hr X4 hours
  (300cc) and the residual is 140cc after four
  hours, should the tube feeding be stopped?

Percent correct
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Crushing Medications

• Oxycondone --gt Never be rushed
• Sublinguals --gt Never be crushed
• Procar --gt Unsafe for
  pregnant women to crush
• Vasotec --gt Can be crushed

Percent correct
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Paradigm Shift
Education
EBN
Consummate Patient Care
Experience