Meet the Interdisciplinary Nursing Quality Research Initiative
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.
A team led by Susan Letvak, PhD, RN, associate professor at the University of North Carolina at Greensboro School of Nursing, and Christopher Ruhm, PhD, professor at the Bryan School of Business at the University of North Carolina at Greensboro, investigated the impact of nurses’ “presenteeism” on productivity and patient care. They found that when nurses come to work sick or otherwise impaired (for instance, suffering from a chronic condition or an injury) it negatively affects their productivity and efficiency, their interactions with patients and coworkers, their memory, their ability to properly document, their reaction time, and their physical ability to provide care.
Linda L. Costa, PhD, RN, NEA-BC, a nurse researcher at The Johns Hopkins Hospital and assistant professor at Johns Hopkins University School of Nursing, and Robert Feroli, PharmD, FASHP, medication safety officer for The Johns Hopkins Hospital, led a team that conducted a pilot study to help patients manage their medication during the transition from hospital to home. They found that when registered nurses oversaw medication management during the transition, they were able to detect medication discrepancies and help correct them, and encourage patients to fill and take their prescribed medications in the correct dosages. The study also revealed that nurses could facilitate transferring information to primary care providers.
A research team led by Robin Newhouse, PhD, RN, assistant dean for the Doctor of Nursing Practice Program and associate professor in the Department of Organizations Systems and Adult Health at the University of Maryland School of Nursing, and Laura Morlock, PhD, professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, examined how nurses’ confidence in their smoking cessation counseling skills affected the likelihood that they would engage in cessation counseling. While roughly two-thirds of the nurses surveyed reported that they assessed all patients’ tobacco use “all the time,” and nearly as many reported advising tobacco users to quit “all the time,” far fewer “always” provided counseling, such as advising patients to set a quit date or explaining that drinking alcohol is strongly associated with relapse. Those omissions were due to nurses’ low confidence in their counseling skills.
RWJF established INQRI in 2005 to address the sizeable gaps in evidence-based knowledge about the impact of nurses’ roles in and contributions to improving patient care. INQRI’s program office is also interdisciplinary. The co-directors are a leading nurse scholar, Mary Naylor, PhD, RN, FAAN, and a leading health economist, Mark Pauly, PhD.
By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the initiative also ensures that diverse perspectives are brought to bear in research. This diversity has helped ensure a more rigorous approach to research and has given the teams important insights into nursing care and the nursing workforce, on which they can build further research efforts.
In April, the journal Medical Care will publish a special supplement highlighting the cross-cutting issues addressed by the program and discussing the implications of INQRI-funded studies on: advances in the science of nursing’s contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing.