From Intuition to Evidence: Interdisciplinary Inquiry into Nursing's Role in Improving Patient Care

    • April 30, 2012


In April, the Journal of the American Medical Association (JAMA) published a study examining whether hospitals that had been recognized for nursing excellence had better outcomes for very low birthweight (VLBW) infants. While the study found that VLBW infants have better outcomes in hospitals that have received Recognition for Nursing Excellence (RNE) from the American Nurses Credentialing Center, it’s the fact that it was conducted by an interdisciplinary team comprised of nurses, economists, and a pediatrician that makes the study stand out. It is one of 40 studies funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI), a program of the Robert Wood Johnson Foundation (RWJF).

On April 26 and 27, INQRI held a national conference in Washington, D.C. to review its work over the last seven years and to celebrate the contributions made by the interdisciplinary research teams INQRI has funded. At the conference, members of those teams and others who have worked with the program discussed how far interdisciplinary research has come since INQRI began and the benefits of this approach for health care research, for health professionals, and for patients.

Nurses represent the single largest group of health professionals who deliver hospital care. They also are the health professionals who provide the most direct, hands-on care to patients. But before INQRI began, little was known about nurses’ contributions to saving lives and keeping patients safer and healthier.

INQRI supports rigorous interdisciplinary science to identify the contributions nurses make to improving health and health care. In addition to being the first national research effort to demonstrate the connection between nursing care and patient outcomes, INQRI was the first to fund only interdisciplinary teams that would bring the perspectives and methodological techniques of diverse disciplines to their research.

“We did not start this program on the assumption that we had all the answers about nursing and had to tell them to someone else,” said Mary Naylor, PhD, RN, FAAN, INQRI program director. “It was that we could uncover opportunities to get to better care delivered by nurses as we made the case through rigorous evidence that nurses are central to delivering high value, high quality care.”

A nationally-recognized nurse and health services researcher who has, since 1989, led an interdisciplinary program of research aimed at improving outcomes and reducing costs of care for vulnerable seniors in community-based health care, Naylor was a logical choice to lead INQRI. RWJF established the program in 2005 to address the significant gaps in knowledge about what nurses do to ensure that care is safe, beneficial, patient-centered, timely, efficient, and equitable. Naylor’s background in interdisciplinary and nursing research was perfect for the program.

Mark Pauly, PhD, a health care economist and professor at the University of Pennsylvania, co-directs the program with Naylor. Pauly is the author of numerous publications about health care costs and quality. The third member of INQRI’s leadership team is a health researcher and also a labor economist, Lori Melichar, PhD, RWJF director.

INQRI awarded its first round of grants in 2006 and since that time, has funded interdisciplinary research teams across the country that are building a body of knowledge about nurses’ impact on the quality of patient care, while advancing interdisciplinary research.

“Knowledge is critically important,” Pauly said. “We are building the right evidence through rigorous science. And this is what multiple disciplines force each other to do, to be the most rigorous that they can, because with rigor, you get to make the case. But we’ve done more than make the case. We’ve shown how to implement change. INQRI has paid as much attention to how it is that we get to new knowledge as it has to how we can make knowledge have an impact in the real world.”

Sessions at the two-day conference addressed the dissemination and implementation of evidence-based practices, trends in interdisciplinary collaboration, methodology in implementation science, the challenges of and future direction for research into nurses’ contribution to quality of care, the business case for changes in nursing to improve quality, and more. The event also included a focus on the ways INQRI is supporting The Future of Nursing: Campaign for Action, a national initiative led by AARP, the AARP Foundation and RWJF to build on the recommendations of the landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. The papers discussed at the conference will be part of a special edition of the journal Medical Care, planned for later this year.

Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing programs at RWJF, discussed the links between INQRI and the Campaign for Action. “The point of the Campaign for Action is to get the IOM recommendations adopted,” Hassmiller said. “But you can’t do that with nurses alone. That’s also true of improving quality of care, and that’s something INQRI recognizes. In both cases, it’s about interprofessional collaboration to improve health care.”

Ezekiel Emanuel, MD, vice provost for global initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, gave the keynote speech at the gathering of more than 150 health professionals, health care researchers, and others. He focused on health care reform and his strong belief that the nation will continue to move toward improved care. “Health care reform was a world historical event,” Emanuel said. “The road ahead will be bumpy, but by 2020 the U.S. will have better health care.”

A highlight of the conference was the screening of a short film about INQRI, featuring several INQRI research teams.

The team whose work was published in the recent issue of JAMA was led by Eileen Lake, PhD, RN, FAAN, nursing professor and associate director of the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania and Jeannette Rogowski, PhD, university professor in health economics at the School of Public Health at the University of Medicine and Dentistry of New Jersey. It found that despite having more risk factors than VLBW infants in non-RNE hospitals, babies in the RNE hospitals had lower rates of death, hemorrhage, and infection.

“Nurses working with these high-risk babies, usually in the neonatal ICU, must constantly be on their toes to monitor their patients for subtle changes or signs of distress that could signal cardiac, respiratory, or neurologic problems,” Lake said. “They also have to maintain a scrupulously hygienic environment, especially where catheters are concerned. Hospitals that receive RNE designation are evaluated for many of the attributes associated with nursing excellence, including exemplary professional practice and implementing new knowledge, innovations, and improvements.”

The INQRI program will continue to support the research teams as the last cohorts complete their studies and publish their findings. The program will host regular webinars on issues related to nursing’s contributions to quality of care and interdisciplinary research, and maintain the INQRI website, blog, and Twitter account. As Melichar said at the closing session, “although we are ending a chapter, the INQRI handbook is not over.”