Transcript Document

Evidenced Based Nursing
Practice: Conducting Research
Robin Sheeran RN, CRRN, WCC
Theresa Sherman RN, BA, CRRN
Evidenced Based Nursing Practice: Conducting Research
Bryn Mawr Rehab Hospital, Malvern, PA
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Evidenced Based Nursing Practice: Conducting Research
Objectives
• Describe the process and experience of a team of nurses
conducting research at an acute care rehab hospital
• Describe the study results and integration of findings
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Evidenced Based Nursing Practice: Conducting Research
Nursing Research Fellowship
• Two week intensive educational program
• Teaches staff nurses the IOWA model
• Nursing experts and mentors to assist nurses in the conduct
of a nursing research project
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Evidenced Based Nursing Practice: Conducting Research
Problem Focused Trigger
• Can a nursing practice or outcome be improved?
– To improve the discharge process for patients admitted to our
stroke unit
• Increase patient education materials
• To better prepare the patient for discharge to home
– To improve patient satisfaction with education
• Measured by Press Ganey – Nurses instruction re: homecare and
medications
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Evidenced Based Nursing Practice: Conducting Research
PICO
• Patient or Problem : stroke patients at an acute rehab hospital
• Intervention: enhanced patient and family education
• Comparison intervention: existing education
• Outcomes: increased patient satisfaction with instructions
regarding home care and medications
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Evidenced Based Nursing Practice: Conducting Research
Is this topic a priority for the organization?
• Meetings with nursing expert and mentor to:
– Review articles
– Develop question
– Determine feasibility of study
• Obtain approval for research question
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Evidenced Based Nursing Practice: Conducting Research
Forming a Research Team
• Nursing Research Fellows:
– Robin Sheeran RN, CRRN, WCC – Principle Investigator
– Terry Sherman RN, BA, CRRN
• Nurse Researcher: Roger Jones RN, BSN
• Nurse Mentor: Catherine A. Harmer RN, MPH, CCRN, CRRN, MSN(c)
• Nurse Research Expert: Sara J. Reeder PhD, RN
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Evidenced Based Nursing Practice: Conducting Research
Assembling Relevant Research and Literature
• Define search terms
• Request literature review
• Review listing of articles
• Select articles
• Filter the articles by relevance
• Focus on those closest to topic
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Evidenced Based Nursing Practice: Conducting Research
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Synthesizing the Research
• Two articles found to be most
relevant
• Evidence showed:
– that the information
patients need to care for
themselves post stroke is
inadequate
– patients require more
education
• Evidence showing a disconnect
between what patients perceive
as a learning need and what
nurses think the need is
• A tool to measure self-care
needs
Evidenced Based Nursing Practice: Conducting Research
Is there a Sufficient Research Base?
• Decision to conduct research
– Many articles about self care needs of populations of patients as
compared to nurse perceptions of needs, fewer in the stroke
population
– Several older articles on rehab units
– No articles capturing the perceived learning needs of stroke patients,
as compared with caregivers and nurse caregivers
– Therefore, an opportunity to study all three groups
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Evidenced Based Nursing Practice: Conducting Research
Defining Study Limits
• Population Members:
– Hospitalized stroke patients, their caregivers, and nurses who care for stroke
patients in an acute rehab hospital
– Demographic information collected on all groups
• Consent:
– Required for patients, their caregivers and nurses
• Inclusion criteria: patients and caregivers
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–
–
–
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FIM score above 4 (patients only)
Patient within 2-3 weeks of discharge (has some education exposure)
At least one caregiver will render assistance on discharge
No evidence of aphasia (receptive or expressive)
Less than 90 years of age
• Inclusion criteria: nurses
– > 1 year of experience taking care of stroke patients
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Evidenced Based Nursing Practice: Conducting Research
Submission to the IRB
• IRB Proposal and documentation completed for the study
• Expedited review of IRB Proposal
• Approval in June of 2010
• Official study title:
Perceived Learning Needs: A Comparison Between
the Stroke Patient, Caregiver, Nurse Caregiver
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Evidenced Based Nursing Practice: Conducting Research
Consenting and the Needs Survey Process
• Introduction and Description of the Research
• Obtain Consent
– Patient Form (permit access to medical records)
• Demographic Survey Form
• Learning Needs Survey Form
– 47 learning need topics
– Study subjects asked to identify their top 12 learning needs
(check off box) and then to prioritize the 5 most important to
them (circle the response)
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Evidenced Based Nursing Practice: Conducting Research
Collecting Survey Data
• Census fluctuations and longer length of stays
reduces target population
• Consenting:
– Patient – scheduling conversation around therapy
– Caregiver – most not available during
• the day
– Additional Research Investigator added to study
• To assist with caregiver consenting
• Required an addendum to the original IRB proposal
• Study Subjects
– 40 Patients, 34 Caregivers
– 39 Nurses (RN and LPN)
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Evidenced Based Nursing Practice: Conducting Research
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Demographics: Patient and Caregiver
Patient
No. of Subjects
Caregiver
40
34
Female
44
65
Male
56
35
Sex
Age in years, %
21-30
0
0
31-40
0
0
41-50
6
6
51– 60
9
32
61-70
21.5
15
71-80
21.5
23
81-90
43
23
Black
19
23
White
81
77
Ethnicity:
Level of Education:
High School
47
35
College
31
46
Graduate
19
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Evidenced Based Nursing Practice: Conducting Research
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Demographics: Nurse
Nurse
Subjects:
39
Sex, %:
Female
86
Age in years, %:
Male
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Years of experience in
Rehab Nursing, %:
21-30
14
1-10
31
31-40
17
11-20
26
41-50
27
21-30
31
51– 60
40
31-40
11
61-70
2
71-80
0
81-90
0
Ethnicity, %:
Skill Mix:
Black
4
RN
80
White
96
LPN
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Evidenced Based Nursing Practice: Conducting Research
Collation & Analysis of Survey Data
• All Patient, Caregiver and Nurse data was entered
into an Excel database
• PI verified the accuracy of data entry
• Data sent to statistician for statistical analysis in late
August
• Analysis received in early September
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Evidenced Based Nursing Practice: Conducting Research
Statistical Analysis
• Analyze the data provided by stroke patients, caregivers and nurses
– All respondents were asked to identify the top 12 learning needs and then
prioritize that list to the top 5 learning needs
– 3 X 3 contingency tables were constructed to reflect top 12 learning needs,
top 5 learning needs and those considered not to be top learning needs
– Fisher’s exact test conditioning was calculated using the SAS Version 9.2
– 11 topics – highly significant findings
• 6–perceived patient and caregiver learning needs, not nurse
• 4 –nurse perceived patient learning needs, not patients and caregivers
• 1 – perceived patient learning need
– 6 topics – statistically significant findings
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Evidenced Based Nursing Practice: Conducting Research
Study Results
• Data from patients, caregivers and nurses was compared among the groups
• Grouping highly and significantly statically findings:
– 9/17 topics – patients and caregivers are in agreement about learning need
• monitoring blood pressure, understanding the stroke process
– 2/17 topics – nurse, patient and caregivers are in agreement about learning need
• finding day care, managing stress
– 3/17 topics – nurse perceives learning need, not patients or caregivers
• Dealing with body image, preventing swallowing problems,
– 1/17 topic – patient learning need, not nurse or caregiver
• preventing constipation
– 2/17 topics – nurse and patient or nurse and caregiver in agreement
• Managing swelling of the hands and feet, dealing with emotion
• Identify topics that patients and families agree are important learning needs
– Develop educational programs and informational materials on topics for use by
stroke patients, families and nursing staff
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Evidenced Based Nursing Practice: Conducting Research
Integration of Findings
• Education program was initiated based on
topics patients and caregivers rated as
important
– Patient Family Education Program Series
was developed in January 2011
• 10 topics from stroke research (2 added
topics)
• Topics offered by a multidisciplinary team
• Weekly education session, with rotation of
topics
• Monitoring outcomes of program with pre-,
post- tests, and evaluation
• Development of additional patient/family
education materials
– Available for stroke patients and other
patient populations
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Topics
Presenters
Managing Swelling of
Hands and Feet
Nursing
Monitoring B/P
Nursing
Understanding the
Stroke Process
Nursing
Presenting
Constipation/Managing
Incontinence
Nursing
Preventing Falls
Therapy
Household Safety
Strategies
Therapy
Demonstrating Transfers
Therapy
Dealing with Emotion,
Managing Stress
Psychology
Coping with Life
Psychology
Learning Activities for
Memory and Dexterity
Speech Therapy
& Occupational
Therapy
Evidenced Based Nursing Practice: Conducting Research
Implications for Practice
• Evaluate the effectiveness of the multidisciplinary Patient
Family Education Program Series
– Does it increase patient satisfaction scores?
– What additional programs should be added or deleted?
– Is this method of providing education effective?
• Sharing the survey results with staff nurses
– Integration of study findings into practice
– Increased availability of patient and family educational
materials
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Evidenced Based Nursing Practice: Conducting Research
Conclusions and Recommendations for Future Work
• Analysis of the results was consistent with evidence reviewed
– There appears to be greater synchrony between patients and caregivers about
perceived learning needs than with nurses
• The difference in perception offers additional opportunities for investigation
– Nurses perceived “managing anticoagulation therapy” as important
– Patients and caregivers did not perceive “managing blood thinning medications”
as important
– Why the discrepancy?
• How many of patients were on blood thinners?
• Already giving education on topic, therefore, satisfied with education?
• Future Research
– Repeat the study in the brain injury or spinal cord patient populations
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Evidenced Based Nursing Practice: Conducting Research
Questions?
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