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Nursing Research Sets Patient Care Standards

Monday September 24, 2007
<B>Patricia A. Grady, RN, PhD, FAAN, director of the National Institute of Nursing Research at the National Institutes of Health, Bethesda, Md. </B>
Patricia A. Grady, RN, PhD, FAAN, director of the National Institute of Nursing Research at the National Institutes of Health, Bethesda, Md.
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Tired of doing things the same way just because it's policy? Do you have better ideas to increase efficiency and safety? Do you want your voice to be heard? Then consider nursing research.

"Staff nurses are the ones at the bedside, making the observations that lead to asking questions and starting research studies," says Patricia A. Grady, RN, PhD, FAAN, director of the National Institute of Nursing Research (NINR) at the National Institutes of Health. "Research is the best way to create better patient care. It ties you to something bigger and provides a basis for other people to learn from. Nurses should think about research as an investment in the future."

Administrators, managers, physicians, and other nurses stand up and take notice when you can show them the evidence that proves your ideas, Grady says. "Developing evidence-based practice is an important way to get your ideas implemented, improve the health of the American people, and move the profession forward in the 21st century."

Important forays into research can include participating in surveys about equipment, forms, or quality improvement projects within your department, or volunteering to help compile the data from them. "Nurses are already trained to make important observations, which is essentially what researchers do — any nurse is trained to do research at some level," says Grady.

When nurses feel like they are burning the candle at both ends, that is the time they raise the most important questions about processes, procedures, and nursing practice that need to be studied and addressed. Staff participation in research projects can lead to such innovations as streamlined handoffs, better patient flow, less paperwork, and more direct-care time.

"There is more to nursing than just being a data collector for physicians. In order to give really good care, we have to understand why we are doing things. Nursing science is what informs our practice," says Barbara Medoff-Cooper, RN, PhD, CRNP, FAAN, the Ruth M. Colket Chair in Pediatric Nursing at Children's Hospital of Philadelphia. She is also the director of the Center for Biobehavioral Research at the University of Pennsylvania School of Nursing. As an instructor, Medoff-Cooper teaches research methods that emphasize the importance of integrating research into clinical practice.

Local nurse studies CAM treatments

Maureen George, RN, PhD, AE-C, assistant professor at the Johns Hopkins University School of Nursing in Baltimore, was the principal investigator in a study that was published as the cover article in the December 2006 issue of the Journal of General Internal Medicine — a physician's journal. In her study, George investigated the use of conventional prescription drugs and complementary and alternative medicine (CAM) in low-income African-American adults with severe asthma.

The journal's editorial in the same issue discussed the influential implications of George's research.

George and co-researchers found 100% of study participants used at least one form of CAM for asthma. While most participants did trust prescription medications, there was a preference for integrating CAM with conventional prescription asthma treatment. In addition, 63% of participants were found to be non-adherent to conventional therapies in the two weeks before the study interview.

George says she chose this topic to research partly because she wanted a deeper understanding of why compliance with prescription asthma medication is low in this population and the factors that go into a patient's decision-making process. "In order for us to develop partnerships with patients, we need to be open to multiple ways of managing symptoms, health, wellness, and illness," says George.

One important finding was the need for a sense of control in patients who must live with chronic diseases. CAM, chosen and administered by patients themselves, might give patients more of a sense of empowerment than conventional medicine, says George. One of the most commonly used CAM treatments was prayer.

"Prayer gives people a sense of control and peace, and there can't be anything wrong about that when you are having asthma symptoms," says George.

Although the vast majority of CAM used by study participants appeared to be safe, George and co-researchers did identify potentially dangerous CAM practices, including the ingestion of camphor-based or mentholated topical salves.

"To meet the needs of the changing demographic population of the U.S. and to provide the best public and global health care, nurses and healthcare providers are going to have to know about CAM and be culturally competent in treating all groups," says George.

Private sector another alternative

The private sector also offers many unique opportunities for nurses to work in research. For example, the SNBL Clinical Pharmacology Center in Baltimore offers clinical research nurse positions in which a BSN is preferred, but not required.

SNBL Clinical Pharmacology Center collaborates with the University of Maryland in Baltimore to focus on Phase I/IIa complex clinical pharmacology research. The company is located in the University of Maryland biopark, where clinical research nurses monitor patient status and safety, ensure established trial protocols are implemented and followed, and collect and prepare clinical research data. They also perform study-related tests and procedures and are expected to play a significant role in the education of other clinical staff and clinical trial participants.

Thuy Anderson, RN, BSN, manager of clinical operations, broke into the research field without any prior experience as a study coordinator at a physician's office.

Anderson oversees the recruitment of participants for studies and manages the clinical aspects of new-drug research. She studies medications for diabetes, hypertension, osteoarthritis, chronic pain, muscle relaxation, and sleep maintenance. "I'm at the cutting edge of new medications that are coming out, and I can use my nursing knowledge and experience to help cure diseases and prolong and improve the quality of life," she says.

Anderson works on trials with healthy volunteers (phase I trials, first in-human studies) and patients with specific medical conditions (phase III trials). "Someone might come in with a lot of pain from arthritis, and I get to see him or her improving," she says.

This type of research environment allows nurses to contribute to the development of new drugs while staying "hands-on" with patients, she says. A critical-care background is not always required, but strong clinical skills are a must.

"In some trials, medications are being used for the first time in humans, and they can experience any type of reaction, including anaphylaxis," she says. "We have to be prepared and have very strong assessment skills."

Catherine Spader, RN, is a freelance writer and frequent contributor to Nursing Spectrum and NurseWeek. To comment on this story, e-mail pmeredith@gannetthg.com.

Development of NINR

The National Institute of Nursing Research (NINR), National Institutes of Health (NIH), U.S. Department of Health and Human Services, supports and conducts research and research training on health and illness across the life span.

A 1983 report by the Institute of Medicine recommended that nursing research be included in the mainstream of biomedical and behavioral science, and a 1984 NIH task force study found nursing research activities to be relevant to the NIH mission.

NINR began in 1986 as the National Center for Nursing Research at the NIH. In 1993 the center was elevated to the status of an NIH institute and changed its name.

Through NINR research funding, nurses are on the front lines of studying and developing better treatments and processes to prevent, delay the onset of, and slow the progression of disease and disability. NINR-sponsored research includes programs designed to reduce health disparities, promote optimal end-of-life care, and help patients develop skills to achieve healthier lifestyles and prevent and better manage chronic diseases.

One example of an NINR-funded study was led by Martha Hill, RN, PhD, FAAN, dean of the Johns Hopkins University School of Nursing in Baltimore. She led a research group that developed a three-year program to provide care for inner-city black men with high blood pressure.

The program created a multidisciplinary team approach to provide free antihypertensive medications and follow-up care, ongoing assessments, home visits, and referrals to social services and job training. The men who received this intervention showed a significant decrease in systolic and diastolic pressures, with 44% lowering their blood pressure to within the normal range. They also showed fewer signs of heart and kidney damage and reported more regular use of healthcare services and antihypertension medications than the control group, which received referrals to community healthcare sources for ongoing care.

Another NINR-funded study researched a program developed to help diabetic teens better cope and control their diabetes. Titled, "Coping Skills Training," the program was developed by Margaret Grey, RN, DrPhD, FAAN, dean, and Annie Goodrich, RN, professor at the Yale School of Nursing in New Haven, Conn.

The program teaches coping and communication skills, healthy behaviors, and conflict resolution in conjunction with routine diabetes management. Study results found the teens enrolled in the program maintained better metabolic control, with a significant improvement in long-term blood sugar levels than those in the control group. They also experienced a decrease in depressive symptoms and reported a better quality of life.

For more information about NINR, visit the website at www.ninr.nih.gov.