Evidenced Based Nursing Practice: Conducting Research Robin Sheeran RN, CRRN, WCC Theresa Sherman...

Evidenced Based Nursing Practice: Conducting Research

Robin Sheeran RN, CRRN, WCC

Theresa Sherman RN, BA, CRRN

2Evidenced Based Nursing Practice: Conducting Research

Bryn Mawr Rehab Hospital, Malvern, PA

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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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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



• 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

Problem Focused Trigger

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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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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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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



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


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


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


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– 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


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


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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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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Patient Caregiver

No. of Subjects 40 34

Sex

Female 44 65

Male 56 35

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

Ethnicity:

Black 19 23

White 81 77

Level of Education:

High School 47 35

College 31 46

Graduate 19 19

Demographics: Patient and Caregiver


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Demographics: Nurse

Nurse

Subjects: 39

Sex, %:

Female 86 Male 14

Age in years, %: 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 20



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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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



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


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

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

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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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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



Questions?

Evidenced Based Nursing Practice: Conducting Research Robin Sheeran RN, CRRN, WCC Theresa Sherman...

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