Research Based Changes in Nursing Practice Improve the Profession

By Rene Jackson, RN, BSN

Nursing research is an academic process confirming and refining existing knowledge. It generates new knowledge and affects nursing practice in all areas, including administration, research, clinical and education.

Used to guide nursing practice, improve patient care and outcomes, as well as the whole healthcare system, the knowledge is generated by research in a systematic, credible, and ethical way.

Research encompasses the aspects of health care integral to nursing: disease and injury prevention, health promotion, and supportive care, as well as education, policy and nursing services and the nursing profession. All nurses should be involved in the research process, and their roles will differ based on their level of education, competence, roles and responsibilities. The knowledge gleaned though research is an integral part of evidence-based nursing practice.

Lily Thomas, Ph.D., RN, chairperson of the North Shore-LIJ Health System’s Nursing Research Committee and Director of Nursing Education at North Shore University Hospital in Manhasset, New York, said she finds transferring research findings to routine practice, complex and multifaceted.

"The goal is to make decisions based on the best possible evidence," Thomas said. "Much of the research is generated at academic institutions, but the need to answer questions generated in practice is propelling our quest for evidence in clinical practice further."

Thomas said that the goal is to identify the best available research evidence and implement it in practice for best patient outcomes, rather than rely on tradition, authority, or ritual as we did in our past.

It is challenging ever evolving and there are numerous steps required. Committed nursing leadership, integration, implementation and information are essential for clinical change strategies to occur, Thomas said.

Nursing administrators, as well as staff nurses, play a vital role in creating a culture that encourages clinical debate and review, as well as encouraging improved communications to overcome problems that may occur while analyzing the effectiveness of the information gathered. Implementing research into practice is the responsibility of not only the individual nurse, but of the entire healthcare organization. The individual nurse should be continuously striving to improve his/her practice because that is what will provoke significant change.

For nursing practitioners to actually utilize evidence, a problem needs to be recognized for which the evidence is appropriate and must also be seen as relevant. Though research investigates and analyzes a particular issue or problem, it does not always provide an immediate solution.

Nursing has made great strides in clinical practice research. However, issues such as the nursing shortage, and the changing healthcare market, have promoted concentration on areas such as mortality of patients with increased nursing caseloads, implementation of differentiated nursing practice models, interdisciplinary collaboration, nursing empowerment, and technological advancement in clinical care.

The Association of Women’s Health Obstetric and Neonatal Nurses (AWHONN), has a Research-Based Practice (RBP) Program that was created to provide a systematic, participative approach to the design, implementation and evaluation of evidenced-based clinical practice guidelines, said Anna Santa-Donato, RNC, MSN, and AWHONN’s associate director of Childbearing and Newborn Programs.

One of the programs resulting in changes in nursing practice is Continence for Women, a project that was implemented in 37 ambulatory care sites around the United States during a one-year period. The goal was to evaluate a research-based practice protocol in daily practice and measure the effect on women’s urinary continence.

Implementation of the researched-based guideline in clinical practice resulted in a greater awareness among nurses of the nature and scope of the problem of urinary incontinence and the importance of research-based practice. Project outcomes include increased screening by nurses for the presence of urinary incontinence, a decrease in the frequency of incontinent episodes among the women participating in the project, and overall improvement of the quality of life of women treated for this condition.

A pediatric nurse practitioner at Children’s Memorial Hospital in Chicago, Illinois, Lisa Kohr was part of an evaluation of the Pediatric Nurse Practitioner (PNP) Program by staff nurses, physicians, and nurse practitioners.

The PNP Program for Cardiovascular Surgery was set up in response to decreased residency coverage. Recognizing the need for an alternative method for health care delivery, the program was begun in 1995. Financial impact of the program was determined, and based on the findings, support for the pediatric nurse practitioner role was garnered and increased education for staff nurses was attained, as well as enhanced communication with physicians.

Thomas has been involved in a multitude of research-based changes in practice at North Shore University Hospital.

An example is the fall prevention strategy for hospitalized elderly patients. Falls are the leading cause of accidental death in older adults and one out of seven falls result in fracture. The use of low beds in the acute care setting was piloted, and a three-month follow-up showed elimination of vest restraints and positive feedback from staff, patients, and family.

The recommendations from the study include either renting or purchasing these beds in the acute care setting. The study is ongoing.