Ever wonder why nurses do things a certain way? Ever think about the science behind established practices or policies?
Nurses frequently raise questions about patient care, but at Inova Health System in Virginia, research projects led by staff nurses are uncovering answers, expanding nursing knowledge, and ultimately changing practice to improve care.
“I really enjoyed it, and think it has been very beneficial,” says Maggie Spinelli, RN-BC, a staff nurse with a diploma degree participating in the Nurse Research Internship Program at Inova Fairfax Hospital, Falls Church. “It makes me think about my work.”
Spinelli investigated whether educating nurses in self-care techniques developed from Jean Watson’s human caring theory, such as breathing and centering exercises, and Charles Figley’s compassion fatigue research, including managing home and work transitions, could promote hardiness and enable nurses to better handle day-to-day stress associated with caregiving.
Spinelli continues to collect post-intervention data. She worked with Gwen Kinney, RN-C, MSN, education coordinator at Inova Fairfax, on the project, and appreciated the opportunity to share ideas.
“The surprising thing was how much fun this has been, and I never thought I would say that about research,” Kinney says.
Jean Moore, RN, PhD, CPN, a professor and assistant dean of nursing research development at George Mason University School of Nursing, Fairfax, Va., and a doctoral nurse scientist at Inova Health, considers teamwork a key component for successful nursing research.
“Nurses who participate with a team and most of them do are very successful,” Moore says.
Gina Harrison, RN, BS, CPEN, CEN, advises peers not to fear research. As a staff nurse in the pediatric ED at Inova Loudoun Hospital, Leesburg, Va., Harrison conducted a study comparing the quality of blood specimens drawn by emergency medical services personnel with blood collected by ED staff.
“We found, on the whole, there were few statistical differences between the groups,” says Harrison, a management coordinator. “The redraw rate was lower for the EMS group than the ED group.”
Reasons for EMS redraws included tubes that were only partially filled or the physician adding a test that couldn’t be drawn in the field. On the other hand, the majority of redraws of ED-collected specimens occurred because of hemolysis of the original blood. Harrison attributed that to the hospital using smaller needles than EMS. The study also found turnaround time was 17 minutes shorter for patients arriving with blood drawn by EMS.
Inova’s Nurse Research Internship Program gave Harrison the guidance and support to formulate a research question, receive institutional review board approval, collect and analyze the data, and disseminate the results, as well as time away from the bedside to complete the tasks.
“There were so many steps,” Harrison says. “Everything felt like a mountain. But as soon as I climbed to the top of it, there was a feeling of satisfaction.”
Karen Gabel Speroni, RN, PhD, director of nursing research and chair of the research council at Inova Loudoun and Inova Fair Oaks hospitals, developed the research internship program in 2004, the year before the 155-bed Loudoun Hospital Center joined the Inova system. The internships expanded systemwide in 2007.
“Our job is to get the infrastructure in place so staff nurses can conduct research, because that’s where the clinical questions come from,” says Kathy Chappell, RN, MSN, director of nursing clinical development and nursing research for Inova Health.
Actively practicing nurses with a study idea competitively apply for an internship. In addition to their own study, Loudoun interns assist with other research projects to gain experience with a wider variety of investigations.
Past and current studies have focused on clinical practices and human caring. Nurses have explored the cost effectiveness of standard vs. endotracheal tubes with continuous subglottic suctioning in the reduction of ventilator pneumonia, new mothers’ reasons for discontinuing breastfeeding, the effectiveness of inpatient diabetes self-management on glycemic control, whether music therapy decreases pain scores in women receiving a Caesarean section, the effect of incentive spirometry on post-op respiratory complications, the success of femoral nerve blockades for pain control after total knee arthroplasty, and whether intentional caring behaviors alter patients’ perceptions.
“There are always nurses in any organization who have great ideas about how they can improve nursing practice,” Speroni says. Inova nurses have presented their findings at various professional meetings and published them in journals and books. Twenty-one nurses have participated in Inova’s Nurse Research Internship Program to date. The health system plans to offer 10 more internships early this year. It also provides nursing research workshops and an annual research conference.
“Now I look at things differently,” Harrison says. “It’s made me grow and realize there is a lot more to bedside nursing. More people should get involved and go through this. They will look at nursing from a different perspective.”
For information about Inova’s research program, contact Chappell at 703-205-2141 or Speroni at 571-333-9278.
Debra Anscombe Wood, RN, is a freelance writer.
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