Developing a Research Idea Madeline Gervase RN,MSN,CCRN,FNP Advanced Practice Nurse

Identifying Questions………. Where can we identify answers to questions that arise on a regular basis in the clinical setting? Where can we identify answers to questions that arise on a regular basis in the clinical setting? What sort of questions ? What sort of questions ? What are we looking for? What are we looking for?

What kind of questions? Important to our patients….. Important to our patients….. >Affect ability to give quality patient care to our patients. >Affect ability to give quality patient care to our patients. >Questions that may arise in the course of clinical pathway development. >Questions that may arise in the course of clinical pathway development.

Questions and Ideas……… DO ANY OF THE FOLLOWING SCENARIOS SEEM FAMILIAR…………

Telemetry Electrodes……… Which can monitor patients for the longest period of time with optimal conductivity and without causing skin irritation or poor adherance in patients with oily skin or after bathing or diaphoresis? Which can monitor patients for the longest period of time with optimal conductivity and without causing skin irritation or poor adherance in patients with oily skin or after bathing or diaphoresis?

Tympanic Thermometers…… Are they as accurate as our current product? Do they really cut down on nosocomial infections transmitted via thermometers? Can we justify the added expense of the new technology?

Optimizing the CABG Patient and Length of Stay Some hospitals are using “Fast Tracking” for early extubation. Some hospitals are using “Fast Tracking” for early extubation. Should we try this? Should we try this? Would this change our CABG outcomes? Would this change our CABG outcomes? Would this change our LOS and respiratory outcomes? Would this change our LOS and respiratory outcomes?

Let’s think……… What examples have you encountered…… even this week……that might give rise to questions like………… What examples have you encountered…… even this week……that might give rise to questions like………… What do we do? Why do we do it? Is there a better way to do it?

“Stick em up method” Can Can capture clinical questions as they occur in the midst of a dynamic patient care setting. The The clinical arena is the most interactive place to identify new devices, technologies and ideas.

The bedside………… The bedside is an excellent forum for research, question and new idea generation…….

Question Evaluation and Grouping Based upon: 1. Policy Issues 2. Staff Development 3. Administrative Issues 4. Clinical Practice

Evaluation of Questions Based on Clinical Importance How can we do this? How can we do this? Informal discussion with staff, educators and clinicians. Informal discussion with staff, educators and clinicians. Any questions or issues that are not considered of high importance should be eliminated or placed on a waiting list from the research category. (Prioritize) Any questions or issues that are not considered of high importance should be eliminated or placed on a waiting list from the research category. (Prioritize)

Prioritize Ideas and Questions Once questions of high clinical importance are identified, they need to be further evaluated based on high clinical importance. The core of the problem and impact on patient care needs to be taken into consideration when be prioritized by investigators.

Examples of Prioritizing Clinical Issues and Sample Questions Based on the Following Categories: Policy Issues Policy Issues Administrative Issues Administrative Issues Educational Issues Educational Issues Research Issues Research Issues

Policy Issues…….Questions….. 1. Do we really need AVO2 differences done every 4 hours? Should we change our policy? 1. Do we really need AVO2 differences done every 4 hours? Should we change our policy? 2. Can RBC’s effectively run on a pump or under pressure? 2. Can RBC’s effectively run on a pump or under pressure? 3. Can more than one unit of blood be given through a filter? 3. Can more than one unit of blood be given through a filter?

Administrative Issues….??????? What should the level of care be for patient’s that are on continuous Cardizem and inotropic drips? What should the level of care be for patient’s that are on continuous Cardizem and inotropic drips? Do we need to change our policy and investigate other institutions with the same level of care? Do we need to change our policy and investigate other institutions with the same level of care?

Educational Issues…..???????? Can bolus infusions be given properly through the PA port of a Swan Ganz catheter? Can bolus infusions be given properly through the PA port of a Swan Ganz catheter? What is the need for nutritional maintenance in long term ventilator patients following extubation? What is the need for nutritional maintenance in long term ventilator patients following extubation? Which is the best method in caring for chest tubes…….is stripping avoided in all instances? Which is the best method in caring for chest tubes…….is stripping avoided in all instances?

Four Steps to Gather Ideas 1. Brainstorming session on your unit. 1. Brainstorming session on your unit. 2. High volume patient population with common needs and problems. 2. High volume patient population with common needs and problems. 3. Frequent nursing interventions 3. Frequent nursing interventions 4. Common technologies 4. Common technologies

Brainstorming Session Identify common patient problems What needs and nursing interventions are employed to address these needs or problems?

High Volume Patient Populations With Common Problems Patient demographics….. Age, race,… Patient demographics….. Age, race,… Medical Diagnosis Medical Diagnosis Surgical Diagnosis Surgical Diagnosis Nursing Diagnosis Nursing Diagnosis Symptoms Symptoms Problems…Needs…Other…. Problems…Needs…Other….

Frequent Nursing Interventions Catheter management Catheter management Education…..Discharge teaching… Education…..Discharge teaching… Symptom management Symptom management Drug administration Drug administration Psychosocial support Psychosocial support Family support Family support

Common Technologies Infusion pumps Cerner system Monitoring devices Bedside lab testing

Care Paths and Examining Variances Clinical Pathways are designed to reflect “Best Practice” in that they represent guidelines for patient management based on the results of carefully reviewed research.

Pathway variances related to expected outcomes Clinical paths meet the needs of: Clinical paths meet the needs of: > 70 – 80% of the patients in a diagnostic group will follow a path without deviating. > 70 – 80% of the patients in a diagnostic group will follow a path without deviating. >20% or more may experience complications and may deviate from normal expectations. >20% or more may experience complications and may deviate from normal expectations. Deviation = Variance Deviation = Variance

Investigative Variances Identify changes in practice which may emerge from variances. Identify changes in practice which may emerge from variances. Ie. Same Day Angioplasty Pathway Ie. Same Day Angioplasty Pathway LOS – 36hrs : 50% of pts. LOS – 36hrs : 50% of pts. What factors cause prolonged LOS What factors cause prolonged LOS > Variables: Patients inability to perform groin incision care > Variables: Patients inability to perform groin incision care

Research Ideas Generation 100% of patients following post cath path meet the expectation of ambulation six hours after sheath removal. 100% of patients following post cath path meet the expectation of ambulation six hours after sheath removal. Question: Question: Can early ambulation, three hours, after sheath removal be done safely without an increase in bleeding complications? Can early ambulation, three hours, after sheath removal be done safely without an increase in bleeding complications?

Variances Trigger Clinical Questions: “Why did this deviation or complication from this outcome occur?” “Why did this deviation or complication from this outcome occur?”

Compiling Research Ideas Review articles on topics that are common to your unit. Review articles on topics that are common to your unit. Authors are experts in areas of research…..and often suggest areas for future research. Authors are experts in areas of research…..and often suggest areas for future research.

Suggestions for future research… Identify problems with how the past studies were carried out. These are known as “Holes” in research or new areas for research based on existing work. Identify problems with how the past studies were carried out. These are known as “Holes” in research or new areas for research based on existing work. End of research studies, can identify additional areas of research. End of research studies, can identify additional areas of research. Authors will routinely list areas for recommended future research based on the findings of their study. Authors will routinely list areas for recommended future research based on the findings of their study.

In Review: Where can I find clinical questions and ideas? Problems or issues on my unit Problems or issues on my unit Focus group investigators Focus group investigators Clinical pathways Clinical pathways Review articles in the literature Review articles in the literature Prioritizing problems and lists Prioritizing problems and lists

Research……… Take Take the path to success………