Clinical Nurse-Led Projects

Oral versus Axillary Temperature Measurement in the Ventilated PICU Patient

Danielle Wood, BSN, RN, CCRN, C-NPT; Mary Heitschmidt, PhD, APN, CCRN

After years of working with the Pediatric Intensive Care patients, Danielle Wood, a PICU RN 2, often wondered: do heated gases through ventilators affect oral temperature readings? She reached out to Mary Heitschmidt, PhD, RN, Director of Clinical Research, to help find the evidence to answer her question.

Using the Iowa Model of Evidence-Based Practice to Promote Quality Care (Critical Care Nursing Clinics of North America, 13(4), 407-509), they determined there was a paucity of literature related to this subject and decided to move forward, with the support of the PICU leadership team, to develop a research study that would generate new knowledge in this area.

Dr. Heitschmidt mentored Danielle in the processes necessary to develop, conduct, and complete the clinical research in the PICU by the spring of 2017. Danielle, the principal investigator of the study, and Dr. Heitschmidt, co-investigator, would like to recognize the following PICU RN data collectors who were instrumental during the course of the study: Michelle O’Connor, Ana Rodriguez, Valerie Steele, and Brittany Lawler, as well as Dr. Joanna Kuppy, our PICU physician collaborator. Statistical data analysis is pending.

Piloting a Picture of Pain in the PICU

Denielle Anderson, BSN, RN; Mary Heitschmidt, PhD, APN, CCRN

With many gaps in the literature, pain continues to be not well understood in pediatric intensive care units (PICU). During a meeting of the National Pediatric Nurse Scientist Collaborative: A Research Network, committee members were asked about participating in the multi-site research study: Piloting a Picture of Pain in the PICU.

One of the purposes of the study was to provide preliminary data regarding the occurrence of pain in the PICU, the pain assessments conducted, and the pain interventions provided. After this meeting, Mary Heitschmidt, PhD, APN, CCRN, Director of Clinical Research, contacted the PICU leadership team and Denielle Anderson, BSN, RN, a clinical nurse in the PICU was identified.

Prior to starting the study at Rush and throughout the course of the study, Denielle regularly met with Dr. Heitschmidt, the RUMC principal investigator, while completing her Rush research training and specific study training activities. For this study, Dr. Heitschmidt received funding from a sub award from the University of Iowa, supported by the Mayday Fund. The study was approved by the Rush IRB and the Rush PICU participated in the one-day, multi-site pain prevalence study on Aug. 31, 2016.

Patient records were reviewed and nurses were surveyed by the study team during the 24-hour time period. Initial study results were received in March 2017. Included in this part of the study were 211 patients from 13 sites. Out of these, 10 patients were from RUMC.

Most study patients (88 percent) experienced at least one painful procedure with an average of 10, in 24 hours. Over 11 different pain scales were used to assess pain in the PICUs and 83 percent of all PICU patients received pharmacological intervention for pain. The results from this study are being used by the Rush PICU leadership team to structure future PICU patient pain educational activities.

The final study results are pending. It is hoped that our participation in this study will enhance future national research collaborations and lead to positive patient outcomes for PICU patients.

Results provided are from the multi-site study Piloting a Picture of Pain in the PICU, Principal investigators C. LaFond, K. Hanrahan, and A. McCarthy with support from the Mayday Fund, University of Iowa, and the Pain and Associated Symptoms: Nurse Research Training Grant [NINR/NIH, T32 NR011147]

Impact of Mediterranean Diet Education on Cancer Patients and Nursing Staff

Nurse Led Poster Presentation

Cathleen Maidlow, MSN, RN, CNL; Karine Otten, MSN, RN, APN-BC, Marisa Mozer, MS, RD, CSO, CNSC; Beth Staffileno, PhD, FAHA

Nurses on the oncology unit (Maidlow and Otten) questioned current practice concerning the Oncology Safe Handling Diet and wondered why the Mediterranean diet wasn’t being promoted for patients. These two nurses consulted the Center for Clinical Research & Scholarship (CCRS). A PhD faculty (Staffileno) assisted with proposal development, IRB submission, data management, and dissemination. Funding for this project was granted from the Racine Family Award.

A formal literature search was conducted. While the health benefits of the Mediterranean diet are well-documented, little is known about oncology patient and nursing staff knowledge concerning the Mediterranean diet.

A multidisciplinary team was formed consisting of two oncology nurses (Maidlow and Otten), a dietician (Mozer), a PhD faculty (CCRS, Staffileno), and consultation with a PhD Nutrition Researcher (Dr. C. Tangney).

A proposal was developed and the quality initiative aimed to: 1) identify oncology patients and nursing staff knowledge concerning the Mediterranean diet; and 2) teach them about the health benefits and ways to easily incorporate more fruits and vegetables into their daily diets. IRB requirements were considered and the PhD faculty (Staffileno) assisted with the 118 Form.

An education module was developed, and patients and nursing staff completed a pre and post education survey. Survey Monkey was used to collect survey responses and manage the data. Descriptive statistics and weighted averages were calculated.

Preliminary data suggests that knowledge of the Mediterranean meal plan is low among cancer patients and nursing staff, with patients currently reporting consumption of fruits and vegetables well-below the recommended daily guidelines. Importantly, this initiative is changing food options and the hospital menu offerings for oncology patients.

These findings were presented at the Oncology Nursing Society 42nd Congress in Denver and the Golden Lamp Society Luncheon in Chicago in May 2017.

Evaluation of Nursing Shared Governance at Rush

Angela Geschrey, MSN, RN, CMSRN; Kelsey Schmitt, BSN, RN, CPN; Lauren Robertson, BSN, RN, CGRN; Melissa Browning, DNP, APRN, CCNS; Rachel Start, MSN, RN, NE-BC

Angela Geschrey, MSN, RN, CMSRN; Kelsey Schmitt, BSN, RN, CPN; Lauren Robertson, BSN, RN, CGRN; Melissa Browning, DNP, APRN, CCNS; Rachel Start, MSN, RN, NE-BC

Because RUMC’s nursing shared governance model has been in place around 34 years and health care settings have become dynamic and ever-changing, the PNS officers felt it would be beneficial to evaluate the model to assess strengths and find opportunities for improvement.

The Index of Professional Nursing Governance (IPNG) has been found to be the most reliable and valid tool to measure the degree of shared governance. Rush University Medical Center (RUMC) and Rush Oak Park Hospital (ROPH) used the IPNG survey to assess our shared governance structures. Interventions were implemented to increase awareness and use of shared governance. The post survey will be conducted in June 2018.

A descriptive research design was used for this study and it was IRB approved. The Index of Professional Governance (IPG) by Dr. Bob Hess is a validated tool used to survey the nurses at both hospitals. At RUMC, the survey was distributed to all members and chairs of the PNS committees, the PNS executive team, which includes officers and representatives from each department, nursing senior leaders, and to all members of each DAC (departmental level of PNS). ROPH surveyed all nurses. Surveys were completed anonymously online through Survey Monkey.

Descriptive statistics were used to analyze data from RUMC. A total of 72 nurses responded and 53 percent were clinical nurses. The overall score of professional governance (PG) for the organization was 172.5 (173-257 is primarily management/administration with some staff input). Clinical nurses scored PG 167.36 while managers, educators, and senior leaders all scored PG>180. Of the six IPG subscales, personnel, information, and participation were the lowest scoring while the subscales of practice, resources, and goals scored the highest. A retreat was held in September 2016 where small groups of leaders and staff created action plans for each subscale. RUMC and ROPH will resurvey in June 2018.

Measuring Nurses’ Beliefs and Confidence to Implement Evidence-Based Practices

Davena J Beal, DNP, RN; Melissa Browning, DNP, APRN, CCNS; Mary Carol Racelis, MSN, APN, ACNS-BC

The aim of this project was to measure nurses’ beliefs in an academic medical center about the value of evidence-based practice (EBP) and their confidence to implement it into practice. This occurred as a baseline measure and a reassessment two years after organization-wide initiatives were implemented.

EBP in health care involves using results from controlled, replicated research studies in conjunction with the clinician’s knowledge base and the patient’s preferences to make the best clinical decisions for each patient.

Use of EBP in clinical decision-making improves patient outcomes and reduces health care costs. However, nurses across the nation do not consistently use EBP in patient care, and report that health care organizational cultures do not support nurses’ use of EBP.

This was a descriptive study using survey research. A convenience sample included 647 nurses pre-intervention and 486 nurses post-intervention. The EBP Beliefs Scale (Melnyk, 2012) was used to obtain a baseline measure and a reassessment 24 months after implementing organization-wide initiatives.

Initiatives began with revamping the EBP committee to include one to two clinical nurses from each department. In an effort to improve knowledge about the EBP process, two algorithms were created: one for nurses interested in leading a project and the other for clinical nurse specialists who served as project mentors. Additionally, four department-sponsored nurse-led projects were implemented and an online journal club was created.

Demographic data for the pre and post survey include 74 percent (pre) and 73 percent (post) clinical nurse responders and 7 percent for advanced practice nurse responders pre and post. Highest nursing degree listed as BSN or higher was 93 percent (pre) and 95 percent (post).

From the 16 questions (Likert scale rating), six had a statistically significant improvement post interventions. These questions included: "I believe that critically appraising evidence is an important step in the EBP process" (p .01 pre and post), "I believe the care I deliver is evidence based" (p .036 pre and post), "I know how to implement EBP sufficiently enough to make practice changes" (p.050 pre and p.048 post) and "I believe EBP is difficult" (p .028 pre and 0.029 post).

Interventions impacted nurses’ understanding of EBP process. Results indicate that with increase in knowledge, nurses feel EBP remains challenging to implement. Further resources will be established to support nurses applying EBP to practice. Additional measurements are planned to identify strategies impacting nurses’ confidence to implement EBP. Funding for this project from the Center for Clinical Research & Scholarship at Rush University College of Nursing is gratefully acknowledged.