Evidenced Based Nursing Practice: Conducting Research

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• Evidenced Based Nursing Practice Conducting
  Research

Robin Sheeran RN, CRRN, WCC Theresa Sherman RN,
BA, CRRN
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Evidenced Based Nursing Practice Conducting
Research
Bryn Mawr Rehab Hospital, Malvern, PA
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Objectives
Evidenced Based Nursing Practice Conducting
Research

• 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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Nursing Research Fellowship
Evidenced Based Nursing Practice Conducting
Research

• 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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Problem Focused Trigger
Evidenced Based Nursing Practice Conducting
Research

• 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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PICO
Evidenced Based Nursing Practice Conducting
Research

• 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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Is this topic a priority for the organization?
Evidenced Based Nursing Practice Conducting
Research

• Meetings with nursing expert and mentor to
• Review articles
• Develop question
• Determine feasibility of study
• Obtain approval for research question

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Forming a Research Team
Evidenced Based Nursing Practice Conducting
Research

• 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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Assembling Relevant Research and Literature
Evidenced Based Nursing Practice Conducting
Research

• 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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Synthesizing the Research
Evidenced Based Nursing Practice Conducting
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

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Is there a Sufficient Research Base?
Evidenced Based Nursing Practice Conducting
Research

• 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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Defining Study Limits
Evidenced Based Nursing Practice Conducting
Research

• 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
• 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
• gt 1 year of experience taking care of stroke
  patients

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Submission to the IRB
Evidenced Based Nursing Practice Conducting
Research

• 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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Consenting and the Needs Survey Process
Evidenced Based Nursing Practice Conducting
Research

• 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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Collecting Survey Data
Evidenced Based Nursing Practice Conducting
Research

• 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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Demographics Patient and Caregiver
Evidenced Based Nursing Practice Conducting
Research
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Demographics Nurse
Evidenced Based Nursing Practice Conducting
Research

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Collation Analysis of Survey Data
Evidenced Based Nursing Practice Conducting
Research

• 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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Statistical Analysis
Evidenced Based Nursing Practice Conducting
Research

• 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
• Fishers exact test conditioning was calculated
  using the SAS Version 9.2
• 11 topics highly significant findings
• 6perceived 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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Study Results
Evidenced Based Nursing Practice Conducting
Research

• 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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Integration of Findings
Evidenced Based Nursing Practice Conducting
Research

• 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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Implications for Practice
Evidenced Based Nursing Practice Conducting
Research

• 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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Conclusions and Recommendations for Future Work
Evidenced Based Nursing Practice Conducting
Research

• 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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Questions?
Evidenced Based Nursing Practice Conducting
Research