Is it safe to leave a patient’s IV tube in during daily chemotherapy treatments? Does stopping tube feeding while turning a patient raise the risk of aspiration? How can we improve our post-operative discharge phone calls? Could nurses have more effective conversations with patients who have received “bad news”?
These are among the questions that Clinical Associate Professor and nurse scientist Susan DeSanto-Madeya is helping fellow nurses at Beth Israel Deaconess Medical Center (BIDMC) in Boston answer—with research. Whether she’s mentoring colleagues at the bedside or teaching students in the classroom at the Connell School of Nursing (CSON), DeSanto-Madeya wants current and future nurses to pay closer attention to nursing science, to turn their hunches into questions and investigations, and to gather evidence that enhances nursing practice.
“Nursing research is about making sure patients and families are receiving care that enhances their quality of life, despite illness,” says DeSanto-Madeya, who has a joint appointment as the Beth Israel Hospital Nurses’ Alumnae Association Endowed Nurse Scientist at BIDMC. “It’s about advancing our knowledge. Nurses bring unique qualities and knowledge to the patient care area.”
While many CSON faculty pursue their research interests at health-care organizations, DeSanto-Madeya is one of a half-dozen scholars, mentors, and teachers working in formal collaborations between the Connell School and some of greater Boston’s most renowned hospitals. Bridging the gap between bedside and classroom, they help hospital nurses design, execute, and document studies; produce results that demonstrably affect care; and share what they’ve learned.
“They can come back to campus and give ‘Yesterday, when I was in the hospital’ examples to students,” says CSON Dean Susan Gennaro. “And to the hospital nurses they can say, ‘One of my students brought in this article on the same topic that we’re interested in.’ It goes both ways.”
“They’re in these hospitals,” Gennaro adds, “because we are all committed to improving health care in the United States.”
More than 15 years of growth
The Connell School’s oldest and largest nursing research partnership is with Massachusetts General Hospital (MGH), where Professor of Adult Health Nursing Dorothy (“Dottie”) Jones directs the Yvonne L. Munn Center for Nursing Research.
Jones has advised nurse scientists at Mass General since the late 1980s, when she was brought in to confer with staff about perioperative procedures and the patient experience. Her position has evolved significantly. In 2007, she was named the first director of the Munn Center, which supports nursing science and research that promotes quality, cost-effective patient care. “Today, we have more than 45 doctorally prepared nurses at MGH, about 80 percent of them from the Connell School,” she says. “Many have led research initiatives affecting patient care delivery.”
The Munn Center’s seven-person staff fosters research in areas such as symptom management, elder care, ethics, and work environments for nurses. In one evidence-based project, for example, clinical nurse specialist and CSON doctoral student Lillian Ananian has collaborated with MGH physician Paul Currier to create an educational program to help clinicians lead family meetings in the medical intensive care unit (ICU).
Although nursing research is on the rise, many hospitals have only one or two nurse scientists on board, according to Jones. Funding is often a challenge. When she meets with visitors or colleagues from other parts of the country, “I tell people that what we’ve accomplished at Mass General has taken over 15 years to develop and has advanced because of organizational support and visionary nursing leadership.”
Conducting research is energizing, Jones observes. It reminds nurses why they chose the profession: to make a palpable difference in the lives of patients and families.
What do you notice?
Connell School faculty are jump-starting research among the nursing staff at other Boston-area hospitals as well.
“We’re at the beginning stages,” reports DeSanto-Madeya, one of two part-time nurse scientists at Beth Israel Deaconess Medical Center. Since joining the teaching hospital in 2011, she has sought to demystify research by offering “how-to” classes, presentations, and educational displays, and by striking up conversations with nurses in which she asks, “Are there things you question or notice in your daily practice that you’d like to explore or change?”
“It’s about meeting the nursing staff where they’re comfortable,” DeSanto-Madeya says. “There’s still mystery and fear behind conducting research, but there are many ways to use research to inform practice.”
DeSanto-Madeya has guided individuals and teams working on quality improvement, evidence-based practice, and full-fledged research projects. In one project, nurses explored whether cancer patients undergoing daily chemotherapy treatments could continue using one plastic intravenous tube instead of getting “stuck” each time. “There was no evidence to support leaving the IV in or taking it out in the outpatient setting,” DeSanto-Madeya points out. “A lot of nursing practice is based on the nurse’s past experience and how ‘it has always been done’ within an institution.” In this case, the team surveyed other organizations and spoke with their own patients before developing a standard of care they are testing now. They send patients home with educational materials, and with their tubes capped and taped securely to their arms.
Advancing nursing practice
On a July morning, two dozen nurse managers gathered for a research methodology workshop at Newton-Wellesley Hospital—part of a new collaboration between CSON and the hospital. Professor Ann Wolbert Burgess, a psychiatric and forensic nurse scientist who has published extensively, was leading a six-part educational series on nursing research with Eileen Searle, a CSON doctoral degree student, and June Andrews Horowitz, a Connell professor with expertise in postpartum depression.
The participants identified research questions on topics like simulation training, safe medication practice, patients’ cell phone use, and thermometry. Burgess and Searle helped clarify their projects: “What’s your aim? What are the assumptions? Can you reframe the question? What does the literature report? Focus groups can provide strong pilot data.”
“We’re trying to make nursing research an integrated part of their practice,” Burgess says. “It’s really about making sure the nurses are asking, ‘What’s the evidence and best practice for improving patient care?’”
Publishing in peer-reviewed journals is the brass ring of research, and CSON faculty have had success guiding their hospital-based mentees toward that goal. Assistant Professor Melissa Sutherland, for one, helped nurses at McLean Hospital in Belmont design and execute a study management of patients with (or at risk for) metabolic syndrome, a weight-related condition that raises the risk for diabetes and heart disease and is associated with some antipsychotic drugs. The paper, coauthored by Paula Bolton, M.S. ’83 among others, appeared in the Journal of Psychosocial Nursing and Mental Health Services in March 2012.
Nursing scholarship has also moved forward at Brigham and Women’s Hospital (BWH), where Associate Professor Katherine Gregory and Assistant Professor Lichuan Ye serve as Haley Nurse Scientists, a partnership between the hospital and CSON that fosters clinical nursing research. Ye, who studies sleep disorders, is collaborating with BWH nurses to better understand sleep patterns among hospitalized patients and to spread the word internally about the importance of shut-eye.
Gregory, meanwhile, coauthored two papers this year based on nursing science investigations she helped lead at Brigham and Women’s. One, titled “Tub Bathing Improves Thermoregulation of the Late Preterm Infant” and published in the Journal of Obstetric, Gynecologic & Neonatal Nursing in March/April 2012, reported on nursing research showing that late preterm infants washed in hospital tubs had warmer and more stable body temperatures than those who were sponged off.
“This is one of the first studies tailored to nursing care for this patient population [born between 34 and 37 weeks of gestation], and it now guides practice here at Brigham and Women’s Hospital,” says Gregory, a former neonatal ICU nurse who studies gastrointestinal health in premature infants.
In a second project, Gregory urged BWH neonatal nurse Jo Ann Morey to study a class she has taught for years to prepare women who are expecting to have a baby cared for in the neonatal intensive care unit. The results were published in the American Journal of Maternal Child Nursing in May/June 2012. “I walked her through the process of developing a study, like finding the right things to measure and how to measure them,” Gregory notes. “And lo and behold, her class does make a difference.”
As Dean Gennaro sees it, the faculty are continuing a tradition of nursing science that goes back to Florence Nightingale, accelerated during the 1980s, and is now woven into the fabric of the nursing profession. Gennaro, who serves on the National Advisory Council for Nursing Research, (see article on page 6) expects the demand for evidence-based practice will grow in the United States. “We know that nursing research contributes to patient satisfaction and cost savings and improved outcomes,” she says. “It’s an exciting time to be a nurse and a nurse scientist.”