As we all know, nurses make a difference in patients lives every day.
But some nurses also impact their colleagues lives by giving them the knowledge and tools they need to improve nursing practice.
The four nurses interviewed in this story made changes in their own practices that, because of their ingenuity, eventually influenced nursing practice across the nation and beyond. These RNs are inspirations to any nurse who thinks there might be a better way to care for patients and that they know what it is.
The right tool for the jobBarbara J. Braden, RN, PhD, FAAN
Early in her career as a researcher, Barbara J. Braden, RN, PhD, FAAN, realized pressure ulcers were an unending challenge for acute care and long-term healthcare facilities and there was a need for better prevention and treatment.
In 1984, while researching the link between poor nutrition and pressure ulcers as the project director of the Creighton University (Omaha, Neb.) Teaching Nursing Home Project which was funded by the Robert Wood Johnson Foundation Braden developed the Braden Scale.
The scale provides better validity and reliability than other pressure-ulcer risk tools and calculates the risk for pressure ulcers using indicators such as sensory perception, moisture, activity, mobility, nutrition, and friction.
Braden initially believed her new scale would only be used as a screening tool for her own research. But within five years of her research being published in 1987, it was adopted by U.S. hospitals and long-term care facilities and went international.
It has since been translated into about 20 languages. Its use has spread wildly beyond my expectations, says Braden, who is dean of the University College and Summer Sessions at Creighton.
The Braden Scale also has been widely studied in tertiary care hospitals, Veterans Administration medical centers, and skilled nursing facilities by domestic and international researchers. Its success is tied with its ability to provide more consistent assessment of the risk level for pressure ulcers and, therefore, helps nurses determine patients turning schedules and other details of care.
Most studies report anywhere from a 60% to an 80% decrease in facility-acquired pressure ulcers [after implementation of the Braden Scale], says Braden.
Bradens current goal is to raise awareness and decrease the risk for the early development of pressure ulcers in settings including the ED and OR, where patients who are immobile can lie on hard or minimally padded surfaces or gurneys for long periods of time.
I believe many problems start in the ED, she says. For example, patients should be cleared from backboards within 20 minutes.
She also is pushing for better skin assessments in the ED as well as the OR. If the patient is in the ED or OR for more than two hours, staff should perform a Braden Scale and decide if they need to transfer the person to another surface, she says.
Braden also would like to expand the scale to include other factors that are more difficult to measure, such as age, that contribute to the risk for pressure ulcers.
A social healthcare movementRuth Watson Lubic, RN, CNM, EdD, FAAN, FACNM, with patients Tameka and Cole Murphy.
The concept that infant mortality is a direct consequence of social injustices is a driving force in the career of Ruth Watson Lubic, RN, CNM, EdD, FAAN, FACNM, founder of the Washington, D.C., Developing Families Center (DFC) and the Family Health and Birth Center (FHBC).
In 2000, the DFC/FHBC opened in the nations Capitol, which had the highest infant mortality rate in the country. Im here because of the health disparities it was bearing heavily on my conscience, says Lubic.
The birth center serves an underserved African-American population and provides cost-effective and comprehensive maternal services by nurse-midwives in conjunction with hospital-based obstetrical care.
FHBC has broken new ground in the freestanding birth center model by developing what Lubic dubs a social healthcare movement.
Through the DFC, prenatal care, deliveries, health education, and well-woman and NP well-child health care are integrated with social and educational services. Through its partner, the Healthy Babies Project, the center provides social support. A third partner, the United Planning Organization, provides infant and child development services in the same building.
Many women in the community have low self-esteem, and there is no better place to break that cycle than in the birthing process, says Lubic. Were showing that if you spend time with women, listen to them, and make relationships with them, they can overcome a lot of their challenges through giving birth rather than being delivered [by someone else].
Lubic proved she was right. After 5 1/2 years of operation, FHBCs cesarean section, preterm birth, and low birth-weight rates were lower than the rates of those of the African-American population in D.C., of all D.C. births, and the overall U.S. African-American rates, according to data from the University of North Carolina School of Public Health.
Because of the low rates of these complications, the FHBC saved more than $1.1 million in 2005 for the healthcare system, a figure greater than its 2005 operating budget, Lubic says.
Lubic is currently spearheading an effort with staffers in both the U.S. Senate and House of Represenatives to get an administrative ruling to award a Medicaid facility fee across the board for the nations birth centers, 42 of which serve 50% or greater of medically underserved populations in 19 states.
Many centers do not get any reimbursement from Medicaid.
Nursing Research Comes of AgeAda Sue Hinshaw, RN, PhD, FAAN
In the early 1990s, nursing research was ready to come into its own, led by Ada Sue Hinshaw, RN, PhD, FAAN, the first permanent director of the National Center of Nursing Research.
In 1993, the center was elevated into the National Institute of Nursing Research (NINR) at the National Institutes of Health, a huge coup for the nursing profession.
Nursing research advanced rapidly because of its legitimacy and credibility, stable funding, and the sense that nursing is a science that the NIH [designation] gave it, says Hinshaw, who is the recently appointed dean of the Uniformed Services University of the Health Sciences Graduate School of Nursing in Bethesda, Md.
Today, the NINR collaborates with other NIH institutes and centers in investigations to improve the nations health. In this endeavor, nurses have an important contribution to make because they bring both clinical and research expertise to the research table, Hinshaw says.
The whole discovery process is exciting because there is an outcome and a contribution to make at the end, says Hinshaw.
NINR-funded scientists are currently impacting nursing practice and promoting good health through studying how to prevent and control high blood pressure in young African-American men, helping youth to control their diabetes, and assisting Spanish speakers in self-management of chronic diseases.
They also are involved in researching symptom management, including improving quality of life after organ transplantation, determining the role of gender in easing pain, supporting family caregivers, and reducing end-of-life symptoms and stresses.
She advises nurses who have an idea or topic they would like to investigate, but who do not have research experience or a doctoral education, to contact local schools of nursing and ask to partner with a nurse researcher.
Its through staff nurses who work with nurse researchers that we gain strong research programs because they know the issues at the bedside and ask the questions that are important to patients and families, she says.
Driving Genetics Studies ForwardPatricia A. Grady, RN, PhD, FAAN
Under the leadership of the current NINR director, Patricia A. Grady, RN, PhD, FAAN, the NINR has more than doubled the institutes budget and significantly increased the number of nursing research and training grants awarded.
Grady has supported several major NINR initiatives, including pain management, end-of-life care, self-management of chronic illness, and caregiving or bedside research.
Grady, an internationally recognized researcher on stroke prevention, also has supported the development of research and training opportunities, including the NINR Summer Genetics Institute (SGI).
This hands-on program helps foster interest in genetics and related research for nursing faculty, graduate students, and advanced practice nurses and helps get nurses in on the ground floor of genetics research, which will become the foundation for personalized medicine in the future, Grady says.
Genetics is a new, exploding field thats important in identifying genetic predispositions for conditions, she says. Nursing is at the cross-roads of becoming the most important force in driving this forward. We are getting in there early, and the students that finish this course are putting the information to work and are having a high success rate at getting research funding.
Grady also is dedicated to the goal of making the research process understandable and within the reach of nurses of all educational levels and backgrounds.
Then it becomes less mysterious and more attainable and becomes more a part of you and your practice, she says.