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Local nurses engage in research to improve outcomes

Monday October 22, 2012
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Saint Barnabas Health nurse leaders who are part of the system-wide research council, from left, are Roxana Gonzalez, RN, critical care nurse educator; Anne Macaluso RN, director psychiatric education; Judith J. Mundie, RN, vice president, patient care services-nursing education; and MaryAnn Kaufmann, RN, director, nursing quality and cardiac rehab.
(Photo courtesy of Roxana Gonzalez, RN)
The nursing research studies underway at North Shore-LIJ Health System in New York and Barnabas Health in New Jersey are a testament to the fact scientific inquiry and nursing research spring directly out of practice questions. Their study results offer real proof that nursing research changes practice and improves patient outcomes.

"The spirit of inquiry is essential to optimize nursing research and evidence-based practice, and we need to continue to stimulate the curiosity of clinicians to ask vital questions regarding care delivery and build a culture that facilitates the inquiry," said Lily Thomas, RN, PhD, vice president, system nursing research, North Shore-LIJís Institute for Nursing.

With 19 facilities within the North Shore-LIJ system and 10 in the Barnabas system, itís been no small endeavor to educate and engage staff and guide them in the research process.

But thatís what Thomas and Judith J. Mundie, RN-BC, MEd, MA, vice president, patient care services-nursing education, Barnabas Health, are accomplishing in partnership with frontline staff, members of the system-wide and local research councils and their leadership teams.

"Once we demystify the process and educate our nurses, they are energized to create or replicate studies that have meaning and relevance to their practice," said Mundie, who emphasizes the need for nurses to have the time and support to get involved in research.

After a routine patient assessment, Nancy Weitzman, RN, BSN, CHPN, staff nurse, North Shore University Hospital, Manhasset, N.Y., observed deep tissue changes that looked like tissue injury, but she reported its sudden and unusual appearance to Kathy Trombley, RN, BS, CHPN, nurse manager, palliative care unit.

Trombley, Thomas, Myriam Kline, RN, PhD, biostatistician, Feinstein Institute, and Mary R. Brennan, RN, MBA, CWON, FACCWS, assistant director, wound and ostomy care and the principal investigator, conducted an institutional review board-approved study in which they described skin changes seen at the end of life in 80 patients on the palliative care unit and identified the relationship between these skin changes and time of death. Based on findings, the nurse researchers hypothesized the presentation of terminal tissue injuries is an unavoidable occurrence that is related to organ failure at the end of life.


Nurse leaders from the system-wide research council meet to discuss the research at North Shore-LIJ system at a recent Nurse.com roundtable.
(Photo by Janice Petrella Lynch, RN)
"We hope to change end-of-life assessment and care, build scientific knowledge and change public policy, so that nurses arenít blamed for wound changes that occur prior to death," Brennan said. The findings were published in the American Journal of Hospice and Palliative Medicine in January, and Trombley and Brennan have presented their results at national conventions. "We have almost 200 patientsí findings in our database, and we continue to spread the word throughout the system," Brennan said.

At the Barnabas Health Behavioral Health Center in Toms River, N.J., RNs partnered with pharmacists to change treatment protocols for mental health patients who suffer from alcohol withdrawal. After a literature review, the team decided to use the Clinical Institute Withdrawal Assessment for Alcohol-revised scale to evaluate patientsí symptoms, even though there was no evidence of use in a psychiatric hospital.

"Based on our assessment results, we successfully managed patientsí symptoms and lowered the dose of benzodiazepines, which translated to improved patient outcomes and shorter lengths of stay," said Anne Macaluso, APRN-BC, MSN, director, psychiatric education and RN principal investigator of the study. This practice change has been implemented in the facility and provides RNs with the autonomy to administer the scale and use clinical judgment to treat patients more consistently, according to Macaluso.

Maternal child nurses at Kimball Medical Center, a Barnabas facility in Lakewood Township, N.J., changed practice in the care of newborns during circumcision. The data for the quantitative research proposal, "Impact of Pain Relief Measures During the Circumcision of the Newborn Male" was collected, analyzed and presented to the nursing research council and the IRB.

"The results indicated that during the procedure the infants given the Sweet Ease pacifier, which consists of a purified water and sucrose solution, and the dorsal penile nerve block, scored less pain overall using the neonatal infant pain scale, and that they experienced prolonged pain relief after the procedure," said MaryAnn Kaufmann, RN, MSN, director, nursing quality and cardiac rehab, and chairperson, nursing research council, who is also spearheading a research study on workplace bullying at KMC.

When Clara Maass Medical Center telemetry staff nurses and their manager learned about the theory of human caring, they decided to create a staff tranquility room. Under the mentorship of MaryEllen Clyne, RN, PhD, NEA-BC, executive director, the nurses completed a 15-week qualitative study, based on grounded theory, that included three caring perspective questions. The results showed RNs taking as little as 10 minutes in the room improved mind, body and spirit perspectives toward the care of self and others.

Two other units have created their own rooms, with more being planned throughout the Belleville, N.J. facility, according to Roxana Gonzalez, RN, MSN, CCRN, critical care nurse educator and nursing research council facilitator.

Debora Riccardi, RN, DNP, CPNP, Cohen Childrenís Medical Center, New Hyde Park, N.Y., conducted and completed a randomized control study in the NICU in 2011 with 140 mothers to examine whether understanding inconsolable crying increases recognition and provides appropriate interventions.

The control and intervention groups both received current standard of care for discharge, with the study group also receiving the Period of PURPLE (Peak of crying; Unexpected; Resists soothing; Pain-like face; Long-lasting; Evening) Crying program, developed by the National Center on Shaken Baby Syndrome.

"We now have a formalized program that provides discharge education to families regarding child abuse prevention and it provides families with tools to use should they find themselves in a situation with an inconsolable crying infant," Riccardi said.

Riccardi received a grant to purchase the Period of PURPLE videos that staff distributed during the study. They will continue to distribute the video in the NICU, as well as make the information part of discharge education throughout the hospital.

The purpose of an IRB-approved nursing research study at Huntington (N.Y.) Hospital, was to describe cesarean section mothersí perceptions of benefits associated with skin-to-skin contact with their newborns immediately after birth.

"We now perform skin-to-skin contact as a standard of practice among the majority of women delivering babies at Huntington, regardless of the method of delivery," said Judith Ann Moran-Peters, RN, DNSc, NE-BC, assistant vice president for nursing, critical care services, who was one of the principal investigators with five RNs as part of the research team.

Through their research efforts, RNs at North Shore and Barnabas Health show that clinical expertise and proximity to patients support their ability to build a distinct set of knowledge. "Nurses are uniquely positioned at the center of patient care where they can continuously refine knowledge as they witness the results of their interventions and the effects on nursing practice and patient care outcomes," said Patricia C. Dykes, RN, DNSc, FACMI, FAAN, senior nurse scientist, Brigham and Womenís Hospital, Boston.

Janice Petrella Lynch, RN, MSN, is a regional nurse executive.


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