Princeton, N.J.– A review of research studies funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) shows that the program helped improve the rigor of research methodology, built a solid base of evidence showing links between nursing care and patient outcomes, and helped increase interdisciplinary research and practice. It also identified significant challenges for researchers exploring the ways nursing contributes to improved care.
Over the last seven years, INQRI has funded 40 studies conducted by interdisciplinary research teams to investigate how nurses contribute to and can improve patient care quality. A special supplement of Medical Care published online this month focuses on INQRI-funded research and discusses the implications of that research 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. It also provides recommendations for improving research and areas to address in the future.
“It’s safe to say that INQRI has accomplished more than we ever hoped,” said Mary Naylor, PhD, FAAN, RN, Marian S. Ware professor in Gerontology at the University of Pennsylvania School of Nursing and co-director of the INQRI program. “The program was established to address the gaps in knowledge about the relationship between nursing and health care quality through interdisciplinary research; raising the bar and bringing important diverse perspectives to the studies. We have done those things, but we have also identified successful strategies for and challenges associated with implementation, measurement, and dissemination. I believe we have contributed not only to health care and nursing but to increasing the methodological rigor and the quality of health care research.”
Each article was written by a team of INQRI researchers and reviews the methodology, findings, and recommendations of several INQRI studies. Overall, the articles find that:
- There has been a significant increase in the amount and quality of research evidence linking nursing and quality of care since RWJF launched INQRI.
- INQRI has increased and enhanced the set of research measures that can be used to identify and quantify nurses’ contributions to improving acute patient care.
- Interdisciplinary research can facilitate the redesign of health systems and health policies to improve care, but health care organizations need to make infrastructure changes that facilitate translating the study findings into practice.
- Implementation research lacks set standards and guidelines. To improve implementation science, researchers need to generate: a core set of implementation concepts and metrics; standards for implementation methods; and reporting standards for implementation studies.
- Successful implementation research strategies include: educating staff and leaders who have a stake in or will be affected by the study; regular interaction with sites; implementation tools; and raising the visibility of the project. The primary challenges associated with implementation studies are the time it takes to get institutional review board (IRB) approval which leaves less time for implementation.
- It is difficult to establish a business case for investing in nursing because those investments tend to improve patient outcomes, reducing readmissions and the need for additional care, and result in reduced income for health care organizations. Research that examines reductions in health care costs and is replicable could help support a business case for nursing.
“We hope that this series of articles will provide other researchers with the information and insights they need to build on INQRI’s work,” said Mark Pauly, PhD, Bendheim Professor and professor of health care management and business economics and public policy at the Wharton School at the University of Pennsylvania, and co-director of INQRI. “Not only have we contributed to the set of research measures, but we have also identified where more research needs to be done, the nature of that research and barriers that need to be addressed to further enhance our knowledge about nursing’s impact on quality of care.”
INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s (IOM) landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. 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 increases the methodological rigor of the research conducted.
“Over the last seven years we have learned a lot about what it takes to foster successful interprofessional research and how to ensure that research helps drive improvements in care,” said Lori Melichar, PhD, a director at RWJF. “INQRI has provided important evidence to support investing in nurses to improve care and that evidence is helping nurses and other professionals around the country advance the recommendations of the IOM report.”
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter (www.rwjf.org/twitter) or Facebook (www.rwjf.org/facebook).