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Finding the Evidence

Cindy Brockway, MSN, RN, CCRP

Whenever perioperative care nurse Kathy Hubbard, MSN, RN, CPAN, witnessed a patient experiencing nausea and vomiting after surgery, she thought, “There must be a way we can prevent this.” Digging a little deeper, Hubbard found that about 23 percent of patients at Chester County Hospital’s Ambulatory Care Center were experiencing this common side-effect of anesthesia — lower than the national average, but still too high, she and her colleagues felt. Hubbard looked into best practices for preventing nausea after surgery and discovered the Apfel risk assessment scale, which estimates a person’s risk using factors such as gender (women are at higher risk), history of motion sickness and/or past postoperative vomiting, and whether they were prescribed opioids after surgery. Seeing an opportunity to help care providers recognize and take preventive steps – such as giving anti-nausea medications to high-risk patients – Hubbard led an effort to make this screening tool part of pre-surgical care.

The result? After three months, the rate of post-operative nausea and vomiting decreased to just 7.5 percent.

As recently as a year and a half ago, Hubbard’s project likely would have remained just a good idea. Although Chester County Hospital has had an active research program since the 1980s, it has focused mainly on helping oncologists bring trials of new treatments to their patients. Five years ago, when the hospital achieved Magnet® recognition from the American Nurses Credentialing Center — the highest mark of excellence for nursing quality — the review team made one major recommendation: Get nurses more involved in research.

Cheryl Monturo, PhD

As frontline caregivers interacting closely with patients and families, nurses are uniquely positioned to ask questions that might improve processes or lead to even better care. And for nurses who are pursuing advanced degrees, as many Chester County Hospital nurses do, a research project is often required. But nurses can only do research if they are encouraged to ask questions and given the tools to find the answers.

“We wanted nursing-initiated research,” says Cindy Brockway, MSN, RN, CCRP, director of Research and Disease Management, adding that the hospital decided to focus on research related to evidence-based practice. “Think about how physicians no longer recommend that everyone take an aspirin a day to lower heart disease risk,” she says. “Unless you’re at high risk for heart disease, the risk of internal bleeding from a daily aspirin is now known to be greater. And that evidence is based on research.”

Brockway enlisted the help of Cheryl Monturo, PhD, a professor of Nursing at West Chester University and a senior nurse scientist at Chester County Hospital, to create a structure that would encourage nurses to develop and pursue research projects aimed at making sure that patient care always reflects the latest medical evidence — and to create that evidence if it doesn’t already exist. Together they attended trainings at The Ohio State University’s renowned Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare. Using what they learned, Brockway and Monturo start the hospital’s Evidence-Based Practice Research Council in early 2018.

“Some hospitals don’t empower nurses to ask questions. They have a more traditional attitude: “Don’t ask; just do it,” Monturo says. “Well, we want nurses and others to ask ‘why, why, why?’ We are cultivating a culture of inquiry and normalizing questions such as ‘Why do we do this?’

“Often, people are afraid of research, so our job is to make it more accessible,” she adds. “[Our attitude is] ‘You know best, you are at the bedside. Come to us with your ideas. If the evidence is already out there, put it into practice and see if it makes a difference to your patients. If not, we want you to do the research and publish your findings.’”

Although nursing research is often siloed away in other institutions, Brockway and Monturo intentionally designed the new Council to include people from across all professions, such as nurses, physicians, clinical managers, pharmacists, statisticians, quality and patient safety officers, and respiratory therapists, among others. The initial focus is on nurse-led projects, but the ultimate goal is that any provider with an idea for an evidence-based research project could bring it to the Council, who can then help with critical next steps such as securing approvals from the hospital’s Institutional Review Board, designing and conducting the project, and sharing the results system-wide through poster presentations and symposium talks.

Brockway and Monturo incorporated technology to make the posters more interactive by adding a  QR code that would allow any viewer with a smartphone to access a video of the researcher talking about the project. Clinicians then have the option to answer a few quick questions to earn continuing education credits.  

“One of the big challenges with nursing research is that the results often don’t get disseminated, but I often say ‘It’s not done until it is disseminated,” Monturo says. The end goal is always publication in a journal to reach an even wider audience — a step she is working on right now with Chester County Hospital’s Jill Doyle, RN, BSN, CEN, an Interventional Radiology nurse who recently completed a study on whether lavender-based aromatherapy can reduce anxiety for people who are about to undergo biopsy. The project combined Doyle’s personal interest in aromatherapy with a desire to lessen patients’ anxiety over a possible bad outcome. When she couldn’t find anything conclusive in the medical literature, she designed her own study and enrolled 90 participants.

Although the Evidence-Based Practice and Research Council exists primarily to support aspiring researchers from within Chester County Hospital, it’s also paving the way for outside researchers to bring their projects here. For example, researchers from Penn State Nursing are studying whether specific interventions might help older adults with early-stage dementia avoid readmission after spending time in the hospital — a common occurrence, given that hospitalization is known to accelerate dementia. Nurses on some units are learning strategies for working with caregivers to keep routines consistent with how they were at home, from mealtimes and food choices to taking medications. Another team from Penn Nursing is planning to study how Chester Country Hospital’s heart patients fare after completing cardiac rehabilitation: Do they follow through on the advice they received, and does their environment hurt or help their progress? The team has a special interest in the local Latino population, given its higher-than-average risk of heart disease and contributing conditions such as obesity and diabetes. A third project led by a kinesiology student from West Chester University investigated whether supervised exercise within 72 hours of a chemotherapy session could benefit cancer patients.

“We’ve had a positive response from staff across the board because we are always asking, ‘What is best for our patients?’” Monturo says. Even as these projects promise to improve patient care, they also benefit her nursing students at West Chester University, some of whom work at Chester County Hospital. They also benefit nurses and other care providers who see that they are expected to question current practice and make it better.

Brockway says the Council will be key to overcoming the tendency to do something “because it has always been done that way,” and encourages patients to play a role, too. “Patients absolutely can ask, ‘What is the evidence behind this screening or treatment that you are recommending?’”




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