Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 2, 1993 TAG: 9304280448
SECTION: NURSES PAGE: 8 EDITION: METRO
SOURCE: By SARAH COX
DATELINE: LENGTH: Long
Take Lorna Facteau, for instance. Before she became director of nursing education and research at Fairfax Hospital, she was simply the nurse researcher there. Facteau, the current president of the Virginia Nurses Association, said researching was her entire job.
"It's all about identifying clinical problems - trying to solve them with a research methodology," she said.
Facteau said coming from a nursing background helps identify the problems; she takes those problems and tries to develop more effective and efficient care to meet the patients' needs. She said her type of research is different from that of her medical colleagues, who look at cures for a variety of diseases.
"We look at how best to assist patients to manage, and how to help patients respond to illness. We really come at patients' problems from very different perspectives," she said.
One of her research studies involves pain. There is the biomedical approach to pain relief - what drugs to use, when to use them and where to use them. Nursing, she said, looks at it in a broader context.
For instance, what does the patient need to know that might help alleviate pain? If the situation is unfamiliar and the patient becomes anxious, the perception of pain might be heightened.
"We look at not just pain, but the whole response," she said.
Facteau has found, through pain research, that certain things make patients recover more successfully, and one of these things is being educated.
Patients will take less pain medication if they are less anxious. And they are less anxious if, prior to surgery, they know what to expect.
"Through very good scientific research done by nurses, we have found out about how to teach patients to deep breath and cough before surgery, so they can prevent pneumonia after surgery," she explained.
Facteau said nurses' pre- and post-surgery connections with patients give them a good perspective on cause and effects.
Another research project she has been involved in is premature birth recovery rates. "We have found that very sick newborns are out of the hospital earlier if certain nursing interventions are started in the hospital and followed through at home. That has to do with nurses teaching the mothers," she said.
Facteau said more and more home health effects are being studied, a trend in health care. The impact of the home and what the patient's positions are in the family all need to be considered, she said.
Another trend in research, according to Facteau, is a changed in who is being tested by researchers.
"We have had doctorally prepared nurses for 60 or 70 years, but up until 15 years ago most of the research was conducted on student nurses and ourselves. Now, we've started looking at patient-centered research. Before, we relied on very traditional medical models that were disease and care focused. Nursing has a rich tradition of looking at the whole person. We need to celebrate that in our research," she said.
Although Facteau admits that nursing research is just one component of scientific medical study, it's a unique and necessary angle. "The best research will be done when doctors and nurses collaborate," she said. Most of the best pain research has resulted from such a collaboration, Facteau said. She predicts more of that kind of research in the future.
Facteau is one of the few nurse researchers in a hospital setting. She said that although there are fewer than 250 clinical nurse researchers in the country, many nurses are involved in research as a component of their jobs - whether that job is in a clinical or university setting.
Her research roots began long before she put questions to paper. Her specialty in pediatric nursing, in both clinical and educational settings, made her realize that education and practice work well together.
"Research uncovers knowledge, and knowledge starts at what is needed at bedside," she said.
While she cared for children, Facteau said she was struck by how vulnerable the child and his or her family is in a hospital. Her doctoral work was based on family and parent roles, and the turmoil a family is struck with because they are so poorly prepared to handle certain situations. She began an investigation of parental response, and an offshoot of that became how parents actually become, or transform into, parents.
Facteau said currently they are involved in a couple of projects at Fairfax Hospital. She is identifying nursing prevention measures to assist patients with managing their pain. And she is involved in patient education toward that end as well.
Because patients are sent home from hospitals so much earlier now, a nurse must decide essential information and pack it into a fewer number of days. In addition to that, patients are not usually well enough to pay attention to the plethora of information they need to absorb. She has also found that with new mothers, "in less than 24 hours we are still trying to teach the same amount of content that used to be taught in five to six days."
Facteau sees the research role as a natural extension of her profession because nursing has always been involved in education.
According to a 1992 American Association of Colleges of Nursing study, Facteau said, " we've gone from 600 nurse researchers 15 years ago to more than 6,000 today. Most of those 6,000 are on faculties." That is opposed to what Facteau and the less than 250 other nurse researchers in the country do, which is conduct research on a full-time basis in a hospital setting.
At Roanoke Memorial Hospital, Carolyn Rogers and Rachel Huddleston have worked together on research projects, but this is just one component of their nursing jobs.
Huddleston is a staff nurse on the neurotrauma unit, and Rogers is a Clinical Nurse Specialist in Neuroscience. Rogers says research is a continuous way of validating and measuring her practice, and to that end she endeavors to get a number of nurses involved in it.
First, she tries to get them to keep up to date on current nursing research through periodicals, and "wherever appropriate, to incorporate findings into their practice." This, she said, ensures RMH patients will be receiving nationally accepted standards of practice.
Secondly, she conducts research or assists other disciplines in conducting research. For instance, she collaborated to look at nutritional aspects of oncology patients.
And she also assists in collecting data for others' research projects. The neurologists at RMH, she said, are part of a multi-institutional study looking at new medications for ischemic strokes, and she is helping collect information for that.
One study she is involved in is examining how nurses have identified and met the needs of critically ill patients' families.
Staff nurses interviewed 60 patient family members, asking what their needs were and if nurses were meeting them. It became a "sort of report card on how we were doing," said Rogers. She also said the research was based on the hypothesis that if families were given adequate support, they in turn would give the patients more support and therefore render a more conducive healing atmosphere.
With the findings from this study, Rogers conducted a regional workshop, "Family Issues and Critical Care," which included staff nurses in critical care, volunteers and a variety of other disciplines such as patient representatives, social workers and chaplains.
She said that based on her findings, they are currently supplying more informative printed materials, allowing more flexible visiting hours and making the telephone more accessible.
"We can't show a direct correlation [between family and patient well-being], but we are interested in better family outcomes. We can look at how we were doing before, and how we're doing after."
In addition, Rogers and Huddleston are involved in a quality management program they use as a form of monitoring.
"It puts us in a research mode because we are using a scientific process of problem solving," said Rogers. One of the aspects of this quality management program is looking at ways to make patients as pain-free as possible.
Huddleston, who is the transport nurse for the adult special care unit, is examining whether or not their transport system gives patients the same quality of care outside the unit by taking along emergency equipment.
"I'm definitely going to keep my hands on research," said Huddleston, "but the clinical area is what I like best. This is an adjunct to that."
Rogers said staff nurses such as Huddleston are becoming more interested in research partly because it is becoming more incorporated into their education.
"They expect to be able to monitor themselves. One of the things we as nurses look at is reducing the complication rate, reducing length of stay, and that's important to the consumer with the cost of health care rising."
by CNB