By Debra Wood, RN, contributor
March 11, 2011 - Across the health care spectrum—from pediatrics to palliative care—academic nurse researchers are investigating unanswered nursing care questions that will improve patient outcomes, relieve pain and enhance quality of care.
“The line of nursing science versus health science is blurring,” said Courtney H. Lyder, ND, GNP, dean of the UCLA School of Nursing in Los Angeles. “When a nurse asks, ‘How does biology affect health behavior?’ that’s nursing science.”
Courtney H. Lyder, RN, ND, expects nurses will play a greater role in expanding the body of knowledge to prevent disease and care for patients with a variety of health issues.
About one-third of UCLA’s 50 nursing faculty members are not nurses, but engineers, geneticists and people from other disciplines who can help advance nursing knowledge in a variety of areas. Deborah Koniak-Griffin, EdD, RNC, FAAN, is looking at ways to reduce the risk of teen pregnancy, while Angela L. Hudson, RN, Ph.D., FNP-C, studies adolescents in foster care, learning that the children are at higher risk for sexually transmitted diseases and testing interventions to prevent the problem. Other nurses are investigating the use of technology to determine patients’ pressure ulcer risk and stepping up turning those people who are more prone to skin breakdown.
“We want to prepare the leaders in nursing that will enhance health and quality of life—a wide perspective, from transitioning to the next life to making wise choices in food plans,” Lyder said. “Nurses are the new face of health care in the 21st century.”
Testing theories in animals
Many discoveries start with laboratory science, getting to the root of the problem by working on a cellular level or with animals. Nancy C. Tkacs, RN, Ph.D., associate professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia, is researching hypoglycemic unawareness, exploring the brain changes that occur after a severe hypoglycemic episode. She has collaborated with Penn’s veterinary school to measure sleep in rats.
Most people with diabetes are at greatest risk of hypoglycemia unawareness when they are sleeping. She has found hypoglycemic rats have much less REM (rapid eye movement) sleep, associated with dream time, and an increase in slow-wave sleep and time awake. She is trying to determine the affect of the sleep waveforms.
“When they are asleep and hypoglycemic, their sleep is a little deeper, which may be the reason why the perception of hypoglycemia is so much worse at night,” Tkacs said.
Tkacs is looking into whether sleep deprivation or irregular sleep patterns make hypoglycemia unawareness worse. With rats, she can set up a situation not possible with human subjects. She’s convinced the research will lead to applications in people with type 1 and type 2 diabetes.
“What nurses bring to bench science and biological measurements is a greater awareness of the whole person, not just their glucose,” Tkacs said. “Nurses who incorporate some element of bench science in their research are at the forefront of integrative research.”
Deborah McGuire, Ph.D., RN, FAAN, is co-developer of a new pain assessment tool for patients unable to communicate, which she hopes will improve patient care.
Patients whose condition has declined so much they cannot describe their pain remain a perplexing problem for nurses trying to ensure their comfort. Deborah McGuire, Ph.D., RN, FAAN, professor at the University of Maryland School of Nursing in Baltimore, and Karen Kaiser, Ph.D., RN-BC, AOCN, CHPN, a clinical practice coordinator at the University of Maryland Medical Center and an adjunct associate professor at the school, sought to resolve this problem by developing, testing and validating an observational pain assessment tool for patients unable to communicate.
“Someone had to address this population, and we wanted to do it,” McGuire said.
A nurse using the Multidimensional Objective Pain Assessment Tool (MOPAT) would watch for facial grimacing, restlessness, muscle tensing and vocalizations associated with pain. They piloted the tool, with funding from the National Institute of Nursing Research, in the hospice setting and found it was reliable, valid and clinically useful.
McGuire’s next step is incorporating the tool into a pain assessment and management algorithm with analgesic order sets and testing whether it helps critical care nurses assess pain and makes a difference in patients’ pain levels.
“We hope to see having an assessment tool for this challenging group of patients, coupled with order sets about what to do, will help their situation,” McGuire said.
McGuire considers symptom relief and palliative care an area of nursing ripe for additional research. The National Institutes of Health has designated the National Institute of Nursing Research the lead institute for end-of-life research. The University of Maryland School of Nursing created the Developing Center of Excellence in Palliative Care Research to address the critical need for more knowledge in this specialty.
Carla Hermann, Ph.D., RN, aims to improve quality of life as patients approach death through a greater understanding of their needs and ways nurses can alleviate their distress.
“There are lots of funding opportunities and needs for more research to better guide care,” McGuire said. “Pain is just one aspect of palliative care that needs research. Nurses always take a holistic approach to patient care, and that’s part of palliative care.”
Improving dying patients’ quality of life
Carla P. Hermann, Ph.D., RN, associate professor and director of the doctoral program at the school of nursing at the University of Louisville in Kentucky, has worked in critical care and oncology and realized that a limited body of knowledge existed to provide good direction to take care of patients’ needs at end of life. Therefore, she has focused her research endeavors on what determines quality of life as patients approach death.
Her recent study, funded by the National Institute of Nursing Research, involved interviews with 80 patients with stage IIIb or IV lung cancer. She found that the amount of distress was the biggest predictor of quality of life.
Knowing this, she suggested nurses conduct good patient assessments, including asking about sleep, depression and physical symptoms as well as psychosocial and spiritual concerns every time a patient comes in for treatment or is cared for at the hospital.
“I found there is a wide variety of symptoms that patients experience,” Hermann said. “One thing nurses could readily alleviate but we rarely ask about is dry mouth.”
When their pain and other symptoms are controlled, patients can deal with other concerns, such as spiritual needs. Hermann considers palliative care a good area for nursing research. She has found patients willing and able to participate.
“Our focus is not on curing the disease but caring for the patient as a whole—physical, psychological, spiritual needs—at end of life,” Hermann says. “And the body of knowledge is limited.”
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