Supporting Clinical Nurses Through a Research Fellowship.

After reviewing the literature, nurses at the bedside seeking answers to clinical questions may find their inquiries remain unanswered. This article describes the yearlong Research Fellows Program in which candidates, funded for 12 hours per month of research release time, answered formal research questions in a curriculum designed to provide the skills to complete their study. Five have completed their studies; 1 has received a grant to continue. Two are in process of submitting manuscripts to journals.

Promoting Bedside Nurse-Led Research Through a Dedicated Neuroscience Nursing Research Fellowship.

OBJECTIVE: We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research. BACKGROUND: The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research. METHODS: The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation. RESULTS: Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses. CONCLUSIONS: The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.

A team approach to recruitment in hospice research: engaging patients, close people and health professionals.

Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting.

Evaluation of the impact of support for nursing research on scientific productivity in seven Italian hospitals: A multiple interrupted time series study.

BACKGROUND: Nursing research is not well-developed in Italy, and knowledge of the methodologies for conducting research is lacking. In several hospitals, including those in which this study was conducted, a research center has been established to support and educate nurses on how to conduct clinical research. AIMS AND OBJECTIVES: In this observational study, we sought to assess whether establishing a support center for nursing research has resulted in an increase in scientific production in terms of the numbers of protocols approved (primary outcome), articles published and nurse authors involved in the publications (secondary outcomes). DESIGN: Multiple interrupted time series. METHODS: Data from 2002 to 2012 were collected in seven hospitals. Research centers have been established at various times in only four of these hospitals. RESULTS: A statistically significant increase in the primary outcome (the number of protocols approved by the Research Ethics Committee in which the principal investigator was a nurse) was observed in two hospitals approximately 2years after establishing a research center. The number of nursing research articles published in scientific journals with an impact factor increased but was not statistically significant. Finally, the number of nurse authors increased significantly in two hospitals with support units. Definitive conclusions could not be reached for the other two experimental hospitals because notably few post-intervention data were available. In the control hospitals, the scientific production outcomes did not change. CONCLUSIONS: This study shows that establishing a support center for nursing research inside hospitals can facilitate the production of research.

Original Research: Implementation of an Early Mobility Program in an ICU.

OBJECTIVE: Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care. METHODS: We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups. The mobility team screened patients Monday through Friday using a mobility algorithm to determine eligibility for participation in each early mobility session. Based on their strength, balance, hemodynamic stability, and ability to participate in early mobility activities, patients advanced through four progressively difficult phases of mobility. Data were collected and analyzed after patients were discharged from the hospital. RESULTS: The 66 patients who received the mobility intervention had significantly fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs than the 66 patients in the routine care group. The mobility group also had lower hospital costs, fewer delirium days, lower sedation levels, and improved functional independence compared with the routine care group. Patients in the mobility group got out of bed on 2.5 more days than patients in the routine care group. There were also no adverse events in the mobility group. CONCLUSIONS: It is feasible for a community hospital to create and implement a dedicated ICU mobility team. Early mobilization of ICU patients contributed to fewer delirium days and improved patient outcomes, sedation levels, and functional status.

Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.

Clinical research potential in Victorian hospitals: the Victorian clinician researcher needs analysis survey.

BACKGROUND: The 2012 McKeon Review highlighted the role of clinician researchers in patient based research and the need to foster this capacity. While anecdotal evidence suggests that clinician researchers are under threat and underfunded, Australian data on barriers and enablers of clinician-led research are scant. AIMS: To describe (i) characteristics of clinician researchers; (ii) for research-active clinicians: areas of research, barriers/enablers of research and factors associated with funding success; and (iii) for research-inactive clinicians: enablers of future research. METHODS: An online survey distributed through the Bio21 Cluster to clinicians (doctors, nurses, allied health professionals) in 15 Victorian hospitals between November 2011 and January 2012. RESULTS: Seven hundred and seventy of 1027 (75%) of respondents were research-active and were more likely to be male, medical doctors, aged 45-54 years, to work full-time and have a higher degree (all P < 0.01). Of clinicians with a higher degree, 28% were research-inactive. Clinicians identified protected research time (50%), designated research space (42%), clinical trial coordinators (35%), institutional funding (34%) and mentoring (33%) as critical enablers of research. Research-inactive clinicians identified protected research time as the key enabler of future research. CONCLUSIONS: To realise recommendations in the McKeon Review, hospitals and research bodies will need to protect research time and provide space and funding. Engaging research-inactive clinicians will build research capacity.

Another link to improving the working environment in acute care hospitals: registered nurses' spirit at work.

Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.

Research on nursing handoffs for medical and surgical settings: an integrative review.

AIMS: To synthesize outcomes from research on handoffs to guide future computerization of the process on medical and surgical units. BACKGROUND: Handoffs can create important information gaps, omissions and errors in patient care. Authors call for the computerization of handoffs; however, a synthesis of the literature is not yet available that might guide computerization. DATA SOURCES: PubMed, CINAHL, Cochrane, PsycINFO, Scopus and a handoff database from Cohen and Hilligoss. DESIGN: Integrative literature review. REVIEW METHODS: This integrative review included studies from 1980-March 2011 in peer-reviewed journals. Exclusions were studies outside medical and surgical units, handoff education and nurses' perceptions. RESULTS: The search strategy yielded a total of 247 references; 81 were retrieved, read and rated for relevance and research quality. A set of 30 articles met relevance criteria. CONCLUSION: Studies about handoff functions and rituals are saturated topics. Verbal handoffs serve important functions beyond information transfer and should be retained. Greater consideration is needed on analysing handoffs from a patient-centred perspective. Handoff methods should be highly tailored to nurses and their contextual needs. The current preference for bedside handoffs is not supported by available evidence. The specific handoff structure for all units may be less important than having a structure for contextually based handoffs. Research on pertinent information content for contextually based handoffs is an urgent need. Without it, handoff computerization is not likely to be successful. Researchers need to use more sophisticated experimental research designs, control for individual and unit differences and improve sampling frames.

Challenges and costs related to recruitment of female adolescents for clinical research.

Addressing health issues in adolescents is a national priority. However, recruitment of adolescents into research studies can be challenging and costly. The purpose of this article was to compare procedures, costs, and challenges in recruiting female adolescents from two hospitals and two high schools in an urban area of the southern United States. Three studies will be described. The findings indicate that the choice of recruitment procedures and sites has major implications for study budget in terms of personnel time as well as for the timeline of the study.