Evidenced Based Nursing Practice: Conducting Research

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

2. Evidenced Based Nursing Practice: Conducting Research Bryn Mawr Rehab Hospital, Malvern, PA

3. Evidenced Based Nursing Practice: Conducting Research 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

4. Evidenced Based Nursing Practice: Conducting Research 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

5. Evidenced Based Nursing Practice: Conducting Research Problem Focused Trigger • 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

6. Evidenced Based Nursing Practice: Conducting Research 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

7. Evidenced Based Nursing Practice: Conducting Research 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

8. Evidenced Based NursingPractice: Conducting Research 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

9. Evidenced Based Nursing Practice: Conducting Research 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

10. Evidenced Based Nursing Practice: Conducting Research 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

11. Evidenced Based Nursing Practice: Conducting Research 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

12. Evidenced Based Nursing Practice: Conducting Research 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

13. Evidenced Based Nursing Practice: Conducting Research 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

14. Evidenced Based Nursing Practice: Conducting Research 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)

15. Evidenced Based Nursing Practice: Conducting Research 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)

16. Evidenced Based Nursing Practice: Conducting Research Demographics: Patient and Caregiver

17. Evidenced Based Nursing Practice: Conducting Research Demographics: Nurse

18. Evidenced Based Nursing Practice: Conducting Research 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

19. Evidenced Based Nursing Practice: Conducting Research 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

20. Evidenced Based Nursing Practice: Conducting Research 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

21. Evidenced Based Nursing Practice: Conducting Research 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

22. Evidenced Based Nursing Practice: Conducting Research 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

23. Evidenced Based Nursing Practice: Conducting Research 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

24. Evidenced Based Nursing Practice: Conducting Research Questions?