CVMC’s Research and Evidence-Based Practice Program seeks to advance clinical decision making through research and EBP, and to aid in transforming the practice environment to improve patient outcomes. Highlights from 2009 are described below.
Three rapid response team (RRT) calls occurred in a single month on the Ortho/Neuro unit triggering an EBP initiative led by Rose Cook, BSN, RN, ONC and Kelly Yang, BSN, RN. The result? A standard order set for knee and hip replacement patients receiving intraoperative cocktail injections (synthetic narcotic and anesthetic mixture). Formation of a multidisciplinary team including a physician, pharmacist, and nurses from Ortho/Neuro and PACU was key to the success of this EBP initiative. In five of the six months following implementation, no RRT calls occurred. The improvement in patient outcomes can be attributed to the standard order set, which heightens awareness of potential problems and specifies interventions. Cook and Yang presented the evidence-based practice initiative at the 4th Annual Forsyth Nursing Research Symposium on November 13, 2009. Other CVMC staff presenting EBP or research posters and/or talks at this symposium included: Beth Rudisill, MSN, RN-BC, Betty Easter, RN, CPAN, Carolyn Starnes, MSN, RN, CNM, CPAN, Gail Settlemyre, BSN, RN, CPAN, Kimberly Yates, MSN/MHA, RN-BC, Ann Moore, MSN, RN-BC, CEN and Rebecca Tart, PhD.
Nurses undertook evidence-based practice initiatives in several other units or departments during 2009. In the Level III Nursery, clinical evidence regarding feeding cues or feeding readiness practice was brought to staff attention with a hospital-sponsored conference. “The evidence presented confirmed my beliefs and what I was seeing in my practice,” Chris Bowman, RN, BSN, NIC states. The feeding practice in the nursery at the time was not evidence-based practice. After implementation, seeing babies tolerate feedings with less spitting up and faster increase in weight encouraged nurses, who were less willing to accept the EBP change initially, get on board. The Feeding Readiness EBP initiative resulted in bringing the CVMC feeding readiness practice in line with best clinical evidence.
In an effort to increase patient satisfaction, improve nurse to patient communication, and to provide diversional activity, psychiatry nurses created a library for patients. The nurses received a grant from the Catawba Medical Foundation to purchase books, and CVMC employees also donated books. A rolling library cart is now wheeled around the department in the afternoons providing psychiatric patients an opportunity to read in their free time. Book check-out and check-in is handled by psychiatric nurses, thus increasing nurse to patient interaction and communication.
Anita Herman, BSN, RN, CEN led an Emergency Department Journal Club topic on the use of capnography during moderate sedation. The lively discussion made Herman and other ED nurses wonder why their department was not using the monitoring tool when evidence in the literature supported its use. Soon thereafter an EBP initiative was begun. The Directors of Respiratory Therapy and Anesthesia joined with ED nurses to design a pilot study to evaluate capnography use with ED patients undergoing moderate sedation. This EBP initiative is continuing in 2010, and may soon be the standard of care for this patient population.
The Department for Research and Evidence-Based Practice encourages and supports knowledge dissemination both internally and externally. External dissemination of research findings in national and regional venues allows other facilities to benefit from what nurse researchers at CVMC have learned. Kimberly Yates, MSN/MHA, RN-BC was recognized at the 16th National Evidence-Based Practice Conference in Iowa, held April 2009, as winner of the Marita Titler Conduct of Research Award for her poster presentation entitled “Post-Implementation Analysis of a Revised Fall Prevention Program at a Magnet Community Hospital.” A manuscript describing this research was submitted to Applied Nursing Research in October 2009 and is undergoing peer review.
A Suicide Prevention Team was formed to address care of failed suicide-attempt patients. The team developed a protocol that addresses specific needs of this patient population while undergoing treatment in a department other than the psychiatric department. Susan Bumgarner, MSN, RN-BC, NEA-BC and Van Haygood, MSN, RN, NE-BC wrote an article describing the protocol, “Suicide Prevention Outside the Psychiatry Department: A Bundled Approach,” which was published in the September/October 2009 issue of Patient Safety & Quality Healthcare1. Greg Billings, RN, presented a poster on this subject at the 23rd American Psychiatric Nurse Association Annual Conference in Charleston, SC, October 2009. The poster focused on the role of the Psychiatric Resource Nurse in suicide prevention.
Granger & Chulay2 developed the point-of-care team approach to nursing research, which is being utilized at Catawba Valley Medical Center to involve staff nurses in clinical research relevant to their practice. An advanced practice nurse with research experience or an accomplished researcher mentors a team. This ‘learn by doing’ approach allows nurses to get involved in research within the safety of a group.
The PACU Nursing Research Team, which completed their research in 2008, disseminated their findings in 2009. First, at the 28th Annual American Society of PeriAnesthesia Nurses in Washington DC, where Betty Easter, RN, CPAN met the co-editor of the Journal of PeriAnesthesia Nurses (JOPAN). As a result of this encounter Easter was asked to write a guest article, which was recently published (Easter B. Community grants for research projects. JOPAN 2009;24(5):330-331.) A manuscript describing the research entitled “The Impact of Music on the PACU Patient’s Perception of Discomfort” was submitted to JOPAN and is under review.
Sparked from discussions held during a journal club regarding temperature assessment in children in their practice environment, the Emergency Department Nursing Research Team was formed in 2008. Following IRB approval of their research proposal in November of the same year, data collection began. Currently, the rectal versus temporal artery thermometry project is in the final phase of data collection. In mid-January 2010, the team submitted an abstract of their preliminary results for presentation at the 2010 Emergency Nurses Association Annual Conference to be held in San Antonio. They await news from the abstract review process.
CVMC’s third point-of-care nursing research team was formed in early 2009. Day Surgery nurses developed a research proposal in collaboration with CRNA’s and PACU nurses. This team received IRB approval for their proposal entitled “Comparison of Controlled Breathing With and Without Peppermint Aromatherapy for the Relief of Postoperative Nausea and/or Vomiting” in September of this year. Presently, staff education on the research protocol is underway and data collection is planned for the first quarter of 2010.
ED Nursing Research Team
Day Surgery Nursing Research Team
The Birthing Center Unit-Based Nursing Research Team formed from the unit’s Shared Governance Council late in 2009. Team members are completing their review of the literature, and soon will begin the preliminary phases of study design. Coping strategies for pain experienced by laboring women is the team’s research interest.
In efforts to enculturate evidence-based nursing practice at CVMC, the Research & Evidence-Based Practice Council of 10 members expanded its efforts to educate nurses about the process of evidence-based practice. During the last week of April 2009, the Council sponsored a variety of EBP activities during the first CVMC EBP Week. Staff could learn something about evidence-based practice or demonstrate their EBP knowledge playing ‘spin the wheel’ in the cafeteria and on floor rounds. A poster session included presentations from Lenior-Rhyne University Senior Nursing Students CVMC researchers. Multiple sessions of our educational courses were offered, ‘Let’s Get Cooking with EBP,’ and two advanced topics – ‘Searching the Literature’ and Appraising the Literature.’ A new course, ‘Grading the Evidence,” is slated for its first offering in February 2010 when the Council sponsors a Research & EBP Saturday Morning Clinic.
EBP 101 was launched on HealthStream in October 2009. Accessible via the Intranet, the educational module addresses the components of EBP and the importance of evidence-based nursing practice. A follow-up course, EBP 201, is currently under design. The Council is seeking to reach more nurses with EBP education with these computer courses, which can be taken at a time convenient for each nurse.
Fourteen entries were submitted in our Evidence-Based Practice Logo Contest. With the assistance of CVMC’s former Graphics Analyst, the Council chose the images judged to best convey the meaning of evidence-based practice that would also conform well to different types of media presentation. For a week, four finalist images were on display outside the cafeteria for house wide voting. Hospital staff cast 408 ballots in the contest, and the image submitted by Robyn Ison, CRNA became the EBP Logo by popular choice.
September brought our 2nd Annual Research Theatre. Due to the popularity of the 2008 Research Dinner Theatre, two sessions were provided in 2009. Staff who attended enjoyed good food, while taking in research presentations by CVMC nurses. Over 100 nurses and nursing assistants participated in the Morning and Dinner Research Theatres. The success of this endeavor can be judged by these comments received in response to an anonymous electronic survey question – ‘What did you like most about the Research Theatre?’
- “The enthusiasm the nurses had for the changes taking place and their ability to be a part of it.”
- “It gives direct care nurses an opportunity to shine with their achievements.”
- ” Interesting to see what research is going on. Inspired me to want to participate in research.”
- “Seeing fellow CVMC employees do their own research start to finish.”
- “The atmosphere, the presentation [of] interesting information, and the special treatment you received as well.”
- “I am interested in doing a research project and was excited about seeing fellow nurses who have completed research and who will soon be able to publish the information. It motivated me to look for a topic of interest to research.”
- “Peers presenting the information.”
- “Fun way to learn and also enjoy time with my coworkers.”
- “The material was presented in a very professional manner by people that we work with everyday. It made it more personal.”
- “The enthusiasm for making improvements in care.”
What will 2010 bring? The members of the Research and Evidence-Based Practice Council are excited and energized about promoting research and EBP throughout the hospital. Also their community outreach in providing EBP education to nursing students enrolled in area college and university nursing programs will continue. New endeavors include staff nurse participation in monthly Council meetings, regularly scheduled literature searching help sessions with Council members in the library, development of an online quick reference guide, and a pamphlet for new hires. The Research & EBP Program at CVMC is striving to move to the next level while holding our gains of the last three years.
1. Bumgarner S, Haygood V. Suicide prevention outside the psychiatry department: a bundled approach. Patient Safety & Quality Healthcare. 2009;Sept/Oct:34-40.
2. Granger BB, Chulay M. Research Strategies for Clinicians. East Norwalk, CN: Appleton & Lange; 1999.