by Dr. Rebecca Tart
Director Department for Research & Evidence-Based Practice
Albert Szent-Györgyi on discovery …
“Discovery consists of seeing what everybody else has seen and thinking what nobody has thought.”
There is a bit of discovery in evidence-based practice (EBP). How … you say? The first step of the EBP process is to assess a problem/issue or why it is you do what you do in everyday practice. It is seeing what you and all your colleagues see every day, but stopping to think – why? To ask is there a better way? What does the best evidence say?
And this is where research first comes in to play. Using a well-designed clinical question, research evidence is acquired from the literature. Appraising the evidence found allows you to either conduct an EBP pilot project or a research study. When strong evidence supports a practice change, that evidence can be applied in an EBP pilot. When your appraisal yields insufficient or inconclusive evidence, you have to decide to either conduct a research study or wait until further research is published. If the outcome is to conduct research, then more than a bit of discovery lies ahead.
Your colleagues that asked ‘Why’ last year are actively engaged in three point-of-care projects that have advanced along the trajectory of the EBP or research process path.
- Postsurgical Pain Management Education Program EBP Project – nurses completed design of the DVD script detailing what patients should expect following surgery in regards to pain and traditional and alternative ways to manage it, and they received grant funding for production of the DVD
- Psychiatry Exercise Research Team – nurses developed the patient exercise program in collaboration with Marcus Osborne, CVMC FitnessPlus Director, and purchased equipment to use with patients who choose to participate in low impact exercise as means to reduce anxiety
- No Interruption Zone Research Team – members recruited nurse subjects to participate in this observational study, which evaluates interruptions that occur during medication administration, and completed their pre-NIZ implementation data collection
2013 is sure to hold new discoveries for all three nursing point-of-care teams!
Nurses, allied health providers and physicians are involved in research studies and EBP projects at CVMC. Fourteen proposals received Institutional Review Board approval in 2012 – 7 undergraduate and 4 postgraduate in addition to the 3 point-of-care teams mentioned above. Five research studies begun in prior years remain active.
Generating new knowledge through research and EBP projects is invaluable to patients, organizations, and you – the healthcare professional. However, when these discoveries are shared externally more patients and facilities benefit, thereby, improving healthcare at large. CVMC nurses disseminated their findings via two abstracts that were accepted for presentation – one to a national meeting and the other to a statewide symposium. Moreover, the principle investigator of the interdisciplinary research team evaluating the use of aromatherapy for postoperative nausea and/or vomiting (PONV) was invited as a panelist for the 2012 North Carolina Organization of Nurse Leaders Research Symposium in Raleigh.
You have a great example to follow when it comes to research and setting stretch goals for yourself. None other than your Chief Nursing Officer and CVMC’s Senior Vice-President for Patient Care Services completed his research dissertation mid-year. If you followed his blog, you learned about the ‘discoveries’ he made while earning his Doctorate of Nursing Practice degree. Check out “Hooked on Research” to hear Eddie Beard, DNP, RN, NEA-BC and other research and EBP investigators share their experiences (insert link).
2012 saw notable advances in the EBP education program co-sponsored by the Department for Research and Evidence-Based Practice and the Research & EBP Council. Building on core course offerings, a program of intensive research and EBP education was developed – EBP&U. This intensive program follows an academic curricular model of required and elective courses. In designing the EBP&U curriculum, 2 new courses – Levels of Evidence and Stats101 – and a capstone project were developed. Kim Bumgarner, BSN, RN and Freda Glenn, RN, members of the charter class are set to ‘graduate’ in 2013. Growing EBP superusers, planted in all departments, is how we envision embedding EBP in the organizational culture. EBP&U is a means of growing those superusers. Will you be a 2013-2014 EBP&U applicant?
What opportunities existed for you to grow your research and/or EBP knowledge? Council members facilitated courses, journal clubs, EBP mini-sessions, nursing student outreach education and the program’s signature events. Were you among the 115 individuals who earned contact hours by participating in our courses or journal clubs? Mini-EBP sessions familiarized staff with EBP patient education and internet resources as well as levels of evidence and online research and EBP toolkits. Ninety-five persons viewed quality improvement, EBP or research presentations by CVMC staff and undergraduate nursing students, while 215 CVMC employees volunteered as subjects in the Salsa Tasting mock ‘research’ study conducted during our annual EBP Week. We hope you were active participant in EBP Week’s informal learning activities.
Resources provided on the Department for Research and Evidence-Based Practice intranet site were expanded this year, and a new internet website was developed for Human Subjects Research (HSR) http://irb.catawbavalleymedical.org/. This site places information and forms required for conducting research at CVMC at investigators fingertips. Potential subjects can learn what is involved in being a human research subject and their rights as research subjects here as well. IRB members access a secure portal of the HSR site to carry out their responsibilities as reviewers. This site’s for you when you decide to embark on your research journey.
2012 has made its way into the history books, but its discoveries continue to influence practice at CVMC. Take the aromatherapy research study for instance. The research revealed that even though peppermint aromatherapy (experimental) and controlled breathing (control) were both effective and efficacious for PONV, controlled breathing was more effective and efficacious. This randomized control trial demonstrated that a bedside intervention, which can be demonstrated immediately upon a patient’s first compliant of PONV, is effective in alleviating symptoms in more than 50% of patients. If it fails, aromatherapy is another alternative therapy that may provide relief without the need for antiemetic medication. The initial intervention of controlled breathing, now an implemented practice change, was a discovery Day Surgery nurses were not expecting at the outset. Such may be the case for your research or EBP project.