Volume 11│Issue 3│Fall 2020 Carilion Medical Center, 1906 Bel leview Ave, Roanoke, VA 24014 https://www.insidecarilion.org/hub/nursing -research-evidence-based-practice nursingresearch@carilionclinic.org (540)266 -6216
Necessity is the mother of invention (Old English proverb. Author unknown) Deirdre Rea, DNP, MSN, RN-BC - Department of Psychiatry and Behavioral Medicine
In the June issue of Within REACH, Dr. Kim Carter focused her editorial on some of the impacts of COVID19 on both our work and personal lives. With an eye toward resources available for best practice, she included links to multiple agencies providing information and assistance with everything from epidemiology to practice and to travel. Now, eight months into the pandemic, enough time has passed for us to begin to look back at our response to the crisis and understand what we have learned. At the forefront, healthcare systems, and nurses specifically, have demonstrated resilience, nimbleness, and an ability to turn on a dime when the CDC or WHO changed recommendations, or when problems or delays arose with equipment and testing and innovative thinking was required. Because the virus was novel, there was little evidence to guide our responses. We were creating our own evidence in real-time. Prior, Delac, Laux and Melone (2020) described their hospital’s multiple approaches to the challenges COVID-19 presented. One was a method of managing just-in-time learning needs with each new, emerging piece of information about the virus. Their hospital system chose to consolidate nursing care to reduce COVID exposure time despite no literature or evidence on the efficacy of such an approach. They created new guidelines and tried it anyway. Resuscitation and intubation procedures had to change to maintain staff safety. Each step had to be assessed and modified and modified again. Sixty to seventy percent of their over-1000 member nursing staff were trained on the changes in six days. The rate of the education was impressive and we might learn from their dissemination practices. But what were the staff and patient outcomes from the new initiatives? Did they have any clinical impact? That might be the next step in the research process. Minissian, Ballad-Hernandez, Coleman, …& Marshall (2020) looked at pre-and post-COVID learning environments and the use of a multispecialty nursing team in improving care. They described using this team to rapidly educate nurses from various areas to re-deploy them to the front lines of COVID care. It demonstrated the flexibility of nurses and their ability to rise to the patient need. But they also introduced other concepts including the use of ‘innovative techniques’ in screening, diagnosis and treatment and the idea that work culture had to change. What a hard concept that was for many nurses to accept. Ultimately the article only reported findings on the reduction of learning time, leaving the efficacy of the ‘innovative techniques’ or the lived experience of the culture change and its impact on nurses and patients completely unaddressed- but ripe for exploration. The pandemic may be on-going, but we have already, whether we realize it or not, learned much. It is time to take stock of our creative experiments and initiatives and begin to test our hypotheses on these new practices. Areas for exploration and study are limitless - staffing models, how education was done, changes in the timing of patient rounding, methods of managing PPE supplies, prone versus supine placement, patient satisfaction, family experience, nursing attitudes and moral distress to name a few. Carilion nurses have been challenged and have prevailed. It is time to begin studying, testing, creating and disseminating the evidence that is needed both now and in the future for unprecedented illnesses like COVID-19. Carilion Clinic Roanoke Campus
~ Deirdre References on page 5
