Promoting Nursing Research: Strategies for Success

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Promoting Nursing Research Strategies for
Success

• Ruth M. Kleinpell PhD RN FAAN
• Martha Curley PhD RN FAAN

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Objectives

• Review essential components to consider when
  planning conducting research
• Discuss strategies for integrating research in
  clinical practice
• Highlight examples of using research in clinical
  nursing practice

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Research

• Important to clinical practice
• Serves as the basis for evidence based practice
• Reality it is often difficult to devote time to
  interpreting, conducting and using research in
  practice
• Daily demands of practice often take precedence

4
Research Reality

• Despite the acknowledged benefits of research,
  many barriers to clinical nursing research have
  been identified including
• Lack of knowledge about nursing research
• The results of research are not reported in terms
  that can be easily understood by clinicians

Hodge M et al Am J Crit Care 200312361-366
Chulay, M 200617253-265.
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Research Reality

• Clinicians do not readily know how to apply
  research findings to clinical practice
• Lack of time for clinicians to conduct research
• Lack of administrative support
• Limited research findings that are directly
  applicable to nursing practice
• Negative attitudes about nursing research

Hedges C. AACN Adv Crit Care. 200617(2)226-229
Smith P Nurs Manag. 200714(5)28-31.
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Strategies for Implementing Research in Clinical
Practice

• Promoting the use of research
• Increase awareness of research
• Provide access to resources
• Implement research initiatives

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Research

• Examples of research that improve nursing care
  and patient outcomes
• Patient rounding to address patient care needs
• Fall prevention measures to decrease the risk of
  falls
• Use of chlorhexidine skin preparation and maximum
  barrier precautions during insertion of central
  venous catheters to prevent catheter-related
  infections

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Nursing Research Example

• ? Impact of nurse led protocol development to
  address central line infections
• Components
• Protocol development
• Staff Nurse education
• Impact of protocol reinforcements

Harrigan S. et al. Developing and Implementing
quality initiatives in the ICU. Critical Care
Nursing Clinics 2006 18469-479
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Catheter-Related BSI Rates

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Strategies for Implementing Research in Clinical
Practice

• May need to educate staff about the importance of
  research and the research process
• Attitudes and interest of the nursing staff are
  the most crucial variables to conducting and
  using research in practice

Pallen Timmins 2002. Nurse Education in
Practice 99-108
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Fostering Skills to Interpret Research

• Variety of resources are available
• Articles/books on interpreting research
• Formal on-line tutorials
• Journal Clubs
• Role of APN
• Role of Research Committee

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Access to Resources

• Provision of relevant user-friendly information
• Bulletin board article postings
• Research Briefs
• Bathroom Reviews

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Strategies for implementing Research

• Identifying, developing, and implementing
  projects
• Identify current initiatives that can be
  formulated into research projects
• Develop research projects that target established
  indicators

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Identifying Research Projects

• Quality Indicators NDNQI

• Patient Falls
• Pressure Ulcers
• Nurse Satisfaction
• Nursing Hours Per Patient Day
• Staff Mix
• Agency staff

http//www.nursingworld.org/quality/database.htm
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Clinical ExampleRush University Medical Center

• Wound Care Project

Started as QI project to promote nursing
assessment skills for wound care Evolved to
research project to assess the impact of a
nursing educational intervention on skin and
wound assessment
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Clinical Example Wound Care Project

• A descriptive study design with pre and post
  tests was used to assess the impact of a 4 hour
  skin and wound care workshop
• Follow up was conducted at 1 to 3 months after
  the workshop to assess use of the educational
  information in clinical practice
• Addresses the National Database of Nursing
  Quality Indicators priority area of preventing
  skin breakdown for hospitalized patients

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Strategies

• Garner administrative support for nursing time
  allocation to research activities
• Create formal project protocols and submit for
  institutional review board approval
• Designate project leaders and unit based
  champions

Kleinpell R. AACN Adv Crit Care 2008
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Strategies

• Showcase research projects to promote interest in
  conducting additional projects
• Nursing Grand Rounds
• Formal Programs/continuing education forums
• Institutional newsletter updates
• Poster presentations
• Participation in institutional research day
  forums

Kleinpell R. AACN Adv Crit Care 2008
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Breakfast Bar Research Study
Research Fall Forum 2009
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How would you rate Bar A in regards to its
texture

• Excellent
• Pretty good
• Not bad
• Bad
• Very bad

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How would you rate Bar A in regards to its
texture

• Excellent Like mom makes it
• Pretty good a good safeway bar
• Not bad like Dad makes it
• Bad a bad safeway bar
• Very bad I would not feed it to my dog

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Strategies

• Seek funding for clinical pilot studies
• Link participation in research to incentives such
  as clinical ladder advancement/promotion
• Publish and present research projects

Kleinpell R. AACN Adv Crit Care 2008
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Critical Care and Cardiovascular Nursing Program
for Clinical Inquiry
Martha A.Q. Curley, RN, PhD, FAAN Nurse Scientist
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Program for Clinical Inquiry

• Yr 2000 Professional advancement program
  restructured to include the Synergy Model
• Clinical Inquiry the process of questioning and
  evaluating practice, providing informed practice
  based upon available data, and innovating
  practice though research.

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Program for Clinical Inquiry

• Shaped by staff nurses, clinical nurse
  specialist, nurse scientists and clinical leaders
• Core Values
• Primacy of patient and family
• Spirit of inquiry
• Innovation

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Program for Clinical Inquiry

• Our Mission
• To use, develop and/or test innovative,
  cost-effective practices and models of care
  delivery for children and families.
• To conduct clinically-based nursing research to
  support the science of critical care and
  cardiovascular nursing.

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Program for Clinical Inquiry

• Best Practices
• Ensure that care is evidenced-based and that
  changes in care delivery systems are data driven
  and systematically evaluated.
• Focus on the critically ill and cardiovascular
  patient and family.
• Clinical Scholarship
• Includes clinical inquiry
• Ensure the relevance of our clinical research,
  the mentoring of our staff in research methods,
  and the growth of our science within our
  subspecialty.

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Structure

• Nurse Scientists (total 1.0 FTE)
• Research Project Coordinator (1.0 FTE)
• Project Managers (6.0 FTEs)
• Cardiology Clinical Research and Regulatory Group
  (CCRRG)
• General Clinical Research Center (GCRC budget
  development, statisticians)
• Research computing
• Research librarian

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Nurse Scientists

• 3 individuals 1.0 FTE
• Critical care and cardiovascular nursing
• Health services research
• Neonatal critical care nursing

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Ongoing Processes

• Nightingale metrics
• Evidence based journal club
• Clinical practice council
• Educator and CNS strategic planning group
• Scientific review committee

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Ongoing Training

• Workshop Evidence base practice
• Clinical research methods course
• GCRC 3-day investigator course 1-day project
  management program
• Education and Quality Improvement Program (EQuIP)

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Nurse Scientists - Leadership

• Parent Presence during invasive procedures and
  resuscitation
• Parent Facilitator Training DVD distributed
  nationally by Fanlight Productions
• Donation after cardiac death
• Effective communication (SBAR)
• Healthy work environment

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Mentorship

• Research questions
• Research design
• Funding
• Implementation
• Data collection
• Data analysis
• Abstracts submission
• Research presentations
• Manuscript submission

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Mentorship (examples)

• Paw prints program (pet visitation)
• Nursing continuity in care
• Parent presence on rounds in the NICU
• Parents participation in a prenatal tour in the
  CICU
• Measuring patient needs (MSICU, CVICU, NICU)
• Occipital pressure ulcers
• Using simulation to augment CRRT training

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Research Project Managers

• 9 individuals 6.0 FTEs
• Member of the research team (physicians, nurses,
  research assistants, data managers,
  statisticians, and research finance managers)
• Screen for study candidates
• Obtain informed consent
• Complete case report forms
• Ensure compliance with study protocols
• Liaison with in-patient and outpatient services
• Provide support to parents
• Communicate with referring physicians
• Consider nursing questions

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OutcomesKnowledge Dissemination(Examples)

• Local Nurses week
• National and International
• Abstracts (oral and poster)
• 5th World Congress Pediatric Critical Care,
  Geneva
• National Teaching Institute 2007, 2008
• CHOP Cardiology Update 2007, 2008
• Publications
• Experiencing the PICU Perspective from parents
  of children with severe antecedent disabilities.
• Enteral feeding algorithm for infants with
  hypoplastic left heart syndrome post stage I
  palliation.

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Questions

• What are the strengths and limitations of this
  model?
• What are the potential barriers and the
  solutions?

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Summary

• Integrating evidence based practice and research
  can impact patient outcomes and promote best
  nursing care practices
• Research is important to clinical practice
• A variety of strategies exist which can be used
  to facilitate clinical research