Category Archives: Interprofessional collaboration
Promoting Rigorous Interdisciplinary Research and Building an Evidence Base to Inform Health Care Learning, Practice, and Policy
By Mary D. Naylor, PhD, RN, FAAN, Marian S. Ware Professor in Gerontology, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing, and co-director of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative. This commentary originally appeared on the Institute of Medicine website.
The Institute of Medicine (IOM) established the Roundtable on Value & Science-Driven Health Care to accelerate the advancement and application of science to achieve the best possible health and health care outcomes and value for Americans. The work of the roundtable is predicated on the notion that our health care system must continuously learn from rigorous evidence in order to innovate and improve. To that end, it acknowledges and promotes the importance of identifying best practices in health and health care, developing and testing innovations, and—most importantly— promoting collaborative efforts.
This vision for improving health and health care is shared by the Robert Wood Johnson Foundation, which funds an innovative and unique initiative to improve patient care by examining the role nurses play in improving care quality: the Interdisciplinary Nursing Quality Research Initiative (INQRI). Mark Pauly of the University of Pennsylvania and I have had the great privilege of serving as co-directors of this program since its inception in 2005.
Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.
You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.
Tracey L. Yap, PhD, RN, CNE, WCC, is an assistant professor at the Duke University School of Nursing, a John A. Hartford Foundation Claire M. Fagin Fellow, and a senior fellow at the Duke University Center for Aging and Human Development. With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), Yap and her co-investigators developed a cost-effective, nurse-led intervention that aimed to reduce the prevalence of pressure ulcers in long-term care facilities by increasing resident mobility through a musical prompting system specifically tailored to each facility. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
It started with a boombox and the Byrds.
Those are hardly the first things that come to mind when you think about pressure ulcers, also referred to as bed sores—the wounds that are caused by continuous, unrelieved pressure on the skin and that often develop in people who have impaired mobility. Yet that’s just how my husband, a physician who has a large population of patients in long-term care, inspired this research by suggesting that I pursue a grant related to this serious issue.
At one long-term care facility, my husband had a maintenance person use a boombox over the public address system to play “Turn, Turn, Turn” at two-hour intervals. It was a creative, simple, and fun way to remind staff to move patients, and it appeared to be effective in preventing pressure ulcers.
We were in Kentucky at the time, and I was teaching at the University of Cincinnati College of Nursing. When I took my husband’s suggestion and applied for an INQRI grant, it radically changed my life—and the lives of many long-term care residents—for good. In my PhD studies, I’d focused on occupational health, and the INQRI grant helped me apply that knowledge in a new way and ultimately led to my current work at Duke University.
This is part of the April 2013 issue of Sharing Nursing's Knowledge.
“A nurse practitioner may be in your future — if he or she is not already in your present. This is a kind of super-nurse, who’s gone through four years of nursing school plus at least two more years of training in diagnosing and treating disease. Nurse practitioners may specialize in women’s health, pediatrics or cardiac care ... I went to a superb nurse practitioner for years... When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call. Her accessibility was a big plus... Cutting health-care costs—and making health-care services more convenient for consumers—demands moving basic medical services away from hospitals and, in many cases, doctors’ offices. Sometimes we need a doctor; sometimes we don’t. A well-trained nurse practitioner can help point us in the right direction.”
-- Froma Harrop, Nurse Practitioners Can Help Save Big Health-Care Dollars, Columbus Dispatch, March 30, 2013
“I have watched my daughter, Sam, in action several times. She has volunteered for several years during the flu shot clinics at the health department. But her finest moments were the ones taking care of her dad while he was dying. The tenderness and careful attention she gave him was indescribable ... I imagine she gives that kind of care to all her patients. She has sat with families while they waited on their loved one to pass. She has encouraged dying people to go with confidence and poise. Going through it with her dad has given her a special love for helping the dying to die peacefully. Going the extra mile is important in any professional field. In the nursing field, it is the difference between being a nurse and being a great nurse. It just doesn’t hurt to do everything you can for a patient. And it could be the difference between life and death. Appreciate those hard working nurses. They have tough jobs.”
-- Anita Goza, Those Hardworking Nurses, Waurika News-Democrat, March 27, 2013
The impact and influence of INQRI’s work is explored in a special supplement of the journal Medical Care which published online this month. A blog carnival related to the supplement is now on the INQRI blog.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
A deceptively simple intervention has dramatically reduced the incidence of painful pressure ulcers among nursing home residents in Signature Healthcare facilities in Kentucky. Every two hours, music is played throughout the nursing homes, prompting staff to go and check on residents and either ensure that they move or help them to move. This effective and easy intervention is the result of a study funded by the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI), which has provided funding to 40 interdisciplinary teams of researchers to investigate the link between nursing and the quality of patient care.
INQRI is the first effort of this size and scope to identify both the ways in which nurses improve the quality of patient care and keep patients safe, and the contributions nurses make to saving lives and keeping patients safer and healthier. INQRI research teams have examined such issues as: depression in nurses; the impact of nurse-to-patient staffing ratios on infection rates and on patient mortality; children’s assessments of hospital nursing care; fall prevention; differences in patient outcomes between Magnet and non-Magnet hospitals; and more. Each team includes a nurse researcher and at least one researcher from another field, such as business, economics, medicine, social work, pharmacy, and psychiatry.
The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) will present the next webinar in its “Translating Research into Practice” series on March 12.
INQRI grantees Marita Titler, PhD, RN, FAAN, and Paul Conlon, PharmD, JD, will present their research on reducing falls in hospitals by implementing a risk specific fall prevention bundle. Titler and Conlon’s 18-month study implemented fall prevention interventions targeted to patient risk factors, and evaluated the use and impact of these practices.
The webinar will take place from 4-5 p.m. EST.
The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) will host the next webinar in its “Translating Research Into Practice” series on February 14, 2013.
INQRI investigators Linda Flynn, PhD, RN, FAAN, and Joel Cantor, ScD, will discuss their research and the intervention they designed to increase patient safety by enhancing the leadership and team building skills of nurse managers.
The webinar will be held from 3-4 p.m. EST.
The Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) will host a webinar on January 31, 2013 as part of a series featuring all of the INQRI's grantee teams focused on translating research into practice. The webinar will feature INQRI Investigators Susan Beck, PhD, APRN, FAAN, and Nancy Dunton, PhD, FAAN, discussing their research on dissemination and implementation of evidence-based methods to measure and improve pain outcomes.
The webinar will be held from 2-3 p.m. EST.