Examining what’s best for the patient

Nurses perform research to answer the question: What’s best for the patient?

BY EMMA V. CHAMBERS

Advanced education programs and training have allowed nurses to create new niches for themselves in research as well as patient care.

Over the last five years, nurses at The Methodist Hospital began conducting formal research. A number of projects currently are under way with the goal of improving patient care and outcomes such as an ambulatory cancer pain management study, which explores the feasibility of collecting pain and other symptom data in outpatient centers across multiple institutions in the Texas Medical Center (TMC). The study examines the prevalence and severity of cancer-related pain and identifies other commonly reported symptoms in the outpatient setting.

Methodist nurse practitioner Anne Bross, MSN, RN, FNP-BC, who serves as a co-investigator, has worked for two years with area hospital nurses to lay the groundwork for this multi-institutionalstudy conducted simultaneously at The Methodist Hospital, Baylor Breast Care Center, M.D. Anderson Cancer Center, Michael E. DeBakey VA Medical Center and Memorial Hermann Hospital.

Over a 12-month period, nurse researchers are asking patients with breast, lung, colorectal and prostate cancer in the outpatient area to participate in the study. Patients who agree to participate are given a questionnaire that asks a series of questions related to the severity of pain, symptoms and how it affects their activities over the course of 24 hours. “This information will be used to narrow the knowledge gap regarding pain and pain management,” Bross said. “It will help us develop improved interventions and patient education.”

This is only the second time TMC institutions have joined forces on a study of this nature, she said. “There has not been a lot of collaboration in the past among nurses but it’s gaining momentum,” she said. “Networking and sharing best practices is for the betterment of the patient. We are patient advocates. This is where nursing is going.”

Evidence of nurses conducting research goes as far back as the 19th century when Florence Nightingale, the iconic nurse who lived and worked in the late 1800s, documented sickness and mortality data in European military hospitals. Armed with factual data, she was able

Beverly Lamoth, RN Anne Bross, MSN, RN, FNP-BC

to institute a number of health care reforms that dramatically improved hospital sanitation practices and lowered mortality rates.

“Florence Nightingale was the prototype for the nurse scientist,” Ann Scanlon McGinity, PhD, RN, said. “She observed that patients had fewer infections if caregivers washed their hands. This helped create clean environments.” Scanlon McGinity, who is a Methodist vice president and chief nursing executive, said the level of sophistication and advancement of nursing research as a science has expanded greatly. She points to a cultural shift as the impetus for the wealth of research being conducted by nurses. “Nursing research is a joint effort between academia and clinicians,” she said. “The context is that we must look at quality and patient safety. It is the responsibility of nursing to look at and provide the latest in proven patient care protocols. “Curiosity leads us to ask questions,” she said. “We raise questions and then study them. ‘Why are we doing this? Is it the best course of action for the patient or are we doing this because it’s the way we’ve always done it?’ The shift is to evaluate what’s best for patients through broad evidence-based practice.”

She used one common practice to illustrate her point. She said patients are advised not to eat or drink from midnight on the day of anesthetization (NPO) prior to undergoing surgery. However, people who have been involved in serious accidents are immediately taken into surgery and given anesthesia. She said there is no compelling evidence that shows that the problem of keeping patients NPO is necessary in all situations. This would be a study worth pursuing, as many surgical cases are cancelled because the patient drank a cup of coffee. unding for nursing research, like that of other disciplines, comes from a variety of sources in the public and private sectors. In 2005, Methodist nurses led nine studies, supported by $765,000 in funding. Bross’ study is funded by the Houston chapter of the Oncology Nursing Society.

Governmental support dates back to the mid-1940s when the Division of Nursing was established within the Office of the Surgeon General. Federal involvement continued over the next two decades. By the mid-1960s, many academic institutions across the nation began to establish predoctoral and postdoctoral fellowship programs to train independent nurse investigators.

The National Institutes of Health established the National Institute of Nursing Research in the mid-1980s to support comprehensive research training and career development programs to prepare nurses with the requisite skills to conduct nursing research in an interdisciplinary setting. When it was founded in 1986, its annual budget was $16 million. Today, the budget is a robust $138 million.

Advanced nursing education and training is critical to nursing research. The number of nurses obtaining masters and doctorate degrees has doubled over the past two decades. Bross, who has been a nurse for more than 30 years, first obtained an associate nursing degree. She later returned to school to obtain bachelor’s and master’s degrees.

She echoed Scanlon McGinity’s enthusiasm for evidence-based practice. “We need to base nursing on scientific evidence. We use critical thinking skills. I recommend bachelor’s degree programs to those who are considering nursing as a career because there is a lot you just don’t receive in basic two and three-year programs,” she said.

Although nurses are conducting their own research, it is not performed in a vacuum. “We must form interdisciplinary teams to evaluate what’s best for patients,” Scanlon McGinity said.

A nursing research committee has been established to leverage expertise from The Methodist Hospital Research Institute and the Center for Nursing Excellence. The committee will formulate developmental and operational plans to expand and further nursing research at Methodist. The ultimate goal is to advance the hospital’s nursing research on a national level.

“Nursing, medicine, physical therapy, respiratory therapy and others must be included to provide insight from that discipline’s point of view. That’s the only way we can determine what makes sense,” Scanlon McGinity said.