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Your clinical research can be a game changer
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When you’re knee deep in patient care and find yourself asking a question about a process, procedure or outcome, you might be on the brink of a research project that’s pertinent to clinical nursing practice.
By Karen Schmidt, RN
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“Research questions should be derived from clinical practice,” said Margaret Barton-Burke, PhD, RN, FAAN, director of nursing research at Memorial Sloan Kettering Cancer Center in New York City. Barton-Burke shepherds clinical nurses through scholarly and research projects. Currently, her institution has about 108 Institutional Review Board-approved studies in process. Stephanie Jackson, MSN, RN, AOCNS, BMTCN, echoes the encouragement to step into bedside nursing research. “As we shift to patients being much more educated about their care and Magnet hospitals being reaccredited, clinical nurses should definitely be involved in research,” said Jackson, a clinical nurse specialist for the inpatient and outpatient hematology/stem cell transplantation units at Ronald Reagan UCLA Medical Center in Los Angeles. She tells her nurses it’s important to be curious and always ask, “Why do we do things this way?” After identifying a question about your clinical practice, Barton-Burke advises nurses to go to the literature to see the evidence that’s already been tested. If there’s nothing there, or if the evidence is limited, the nurse can develop a project that either demonstrates the evidence or tests the intervention already published.
Stephanie Jackson
MSN, RN
Research support and resources
Nurses at academic and Magnet healthcare centers have plenty of resources to help them plan and carry out a project, notes Elizabeth Bridges, PhD, RN, CCNS, FCCM, FAAN, a clinical nurse researcher at the University of Washington Medical Center in Seattle. Those who work in other settings should ask themselves, “What individuals in my community frequently look at outcomes?” Find a partner to sit down and evaluate your idea together. On a single page of paper, ask and answer: • What is our issue? • What are we currently doing? • What don’t we know? • What are we proposing to do to fill the gap? • How can we reach the intended outcome? Jackson recommends nurses contact key stakeholders in their institution or in that specialty as potential partners. As a nurse evaluates the literature, Jackson also suggests using mainly articles published within the last five years. One clinical nursing research example Barton-Burke shared was a quality improvement project. Two oncology nurses decided to evaluate the process of administering a drug known to cause hypersensitivity reactions. The nurses questioned the procedure of injecting the diluent for the medication into the IV tubing ahead of the drug, before slowly turning on the IV. Did this merely administer the diluent slowly then infuse the drug at full bore, which often resulted in hypersensitivity reactions? Barton-Burke said the nurses’ question led to a research project under the mentorship of experienced nurse scientists at their institution. The outcome has resulted in many nurses changing their practice. The nurses published their findings in the
Clinical Journal of Oncology
Nursing in August 2018. At UW Medical Center, post-anesthesia care unit nurses realized their practice of applying ice packs to the back of a patient’s neck to reduce post-anesthesia nausea was common. But this was not recognized as evidence-based practice. Bridges said one PACU nurse gathered others to work on a protocol, got IRB approval, launched a project, had the data analyzed and validated that the practice works. In addition, the nurse’s outcome also potentially reduced medications that patients might need and lowered cost. “It costs 41 cents for an ice pack vs. more expensive medication, and this was all the result of clinical nurses’ research,” Bridges said.
More tips for successful research
Validating or changing bedside practices that improve nursing care is exhilarating. But it’s not enough. “You have the responsibility to share your results,” Bridges said. This might be within your healthcare system, at a local or national conference, or via publication. Bridges recommends being systematic throughout, from your initial evaluation of the question to your plan and implementation. Don’t be overwhelmed, she advises, and stay focused. “Whatever initiative you’re working on, take it to your nurse manager,” she said. And, choose a project that is short term if you haven’t done this before. “You want to be up and running, able to evaluate your evidence, within three months,” she said. If needed, find help for your endeavor from nurses with PhDs and DNPs at local universities. Look to your own nursing school for a professor who might assist you or contact professional nursing organizations. Seek grant funding through a healthcare institution or your professional specialty organizations. The DAISY Foundation also offers
grants
and
valuable guidelines
for pursuing them. Why consider adding research to your clinical nursing role? Jackson said as laypeople are more educated when considering where to have treatment or elective surgery, they’re looking for the best institutions for their care. Simultaneously, nurses can optimize their practice, improving the profession while making care safer for patients.
About the Author
Karen Schmidt, RN, is a freelance writer.
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