Nurses Who Challenge Status Quo Will Improve the Status Quo
Elisa Jang, R.N., has a button that sums it all up. The words: “Because we’ve always done it that way!” have a red slash through them. Her message to NorthBay Healthcare nurses? Challenge the system.
No, Elisa is not spearheading an uprising, she’s following the path of Florence Nightingale, the founder of modern nursing, who is considered by many to be the pioneer of Evidence-Based Practice or EBP.
The practice encourages nurses and doctors to find ways to become more efficient and effective, using research to support change.
“EBP is a school of thought that rejects the ‘because we’ve always done it that way,’ argument,” Elisa explains. “Instead, you should be hearing people say ‘question your practice,’ or ‘challenge the status quo.'”
Why would an organization encourage its healthcare professionals to question their work practices?
“Because patients want their provider to use the best healing interventions, based on the highest quality research,” says Elisa, clinical practice manager for NorthBay’s EBP Program. “At NorthBay, we made a commitment to review current findings and incorporate them into our policies, procedures and, most importantly, into our bedside practices.”
When NorthBay decided in 2010 to work toward earning the Magnet designation of nursing excellence, nursing leadership created a formal EBP program.
“It’s not only good for patients,” Elisa notes, “but studies show long-term benefits, such as improved patient outcomes, avoidance of unnecessary procedures and reduction of complications.”
The first step was to form a council with representatives from each department (roughly 20) who were charged with teaching front line staff about EBP concepts and explaining how nurses could conduct scholarly research to prove or disprove concepts. A critical component was the creation of a fellowship program, which Elisa spent six months developing.
Since the fellowship program launched in January 2011, 14 nurses have undertaken 11 projects or research studies, and their findings have inspired changes, including the way NorthBay Healthcare nurses give inoculations to babies and how critical care patients are weaned off ventilators.
“Successes with our first several projects captured attention from professional organizations, and have fostered buy-in among our nursing staff,” Elisa says.
Each year, two to three nurses interested in scholarly and evidence-based practice research are recruited into the program. “Fellows bring an idea on how to improve quality and patient outcomes to their mentors,” explains Elisa. “The idea can either be an EBP project—which would provide already proven evidence for an intervention that could be incorporated into a work flow—or to conduct nursing research that would create new knowledge.”
Mentors offer advice, with the goal of developing the Fellows’ clinical, leadership, problem-solving and research skills.
Once completed, projects and research papers are submitted for presentation at professional conferences.
“One of the first projects to be completed through the NorthBay EBP program received ‘Best Research Award’ at a national conference, beating out 100 other competitors. It was a shining moment for us,” Elisa says.
It has also put the spotlight on Elisa, who has been asked to share her “EBP” Toolkit with other organizations such as the Mayo Clinic and Good Samaritan’s multi-hospital organization based in Cincinnati. NorthBay recently hosted a delegation from Hoag Orthopedic Institute in Southern California.
Elisa has been with NorthBay Healthcare since 2004, when she was hired as clinical practice manager for critical care services. Since then, she’s seen many changes implemented, based on EBP projects she’s undertaken. Among them, use of the simulation lab to help nurses improve their clinical competencies, creation of connection safety guidelines, and the creation of a Rapid Response Team. (see story on Page 18)
“I love EBP because it is a natural parallel to nursing—the inclusion of good science, paired with a holistic approach to patient care,” says Elisa. “I love nursing research, because I am a bookworm at heart. I love science, and I love to read!”
Although she misses being at the bedside of patients, she loves the challenge of sharing her passions and mentoring others to success.
“My goal is to make NorthBay a recognized leader in EBP and nursing research,” she says, “in Solano County and in Northern California.”
Changing Our System, One Study at a Time
Nearly a dozen NorthBay nurses have completed NorthBay’s Evidence-Based Practice Fellowships and their projects have already inspired changes in the system. Here are a couple of examples:
Mother’s Touch Eases Pain
NorthBay’s first original nursing research study, “The Impact of Kangaroo Care on Pain in Newborns,” was conducted by Labor & Delivery Nurses Autumn Thacker, R.N., and Barbara Abeling, R.N., in 2011. At the time, it was common practice for nurses to give newborns their routine injections—such as vitamin K or Hepatitis B—while they lay in warming bassinets.
The NorthBay nurses pointed to the lack of research that indicated untreated pain in newborns could have long-lasting, detrimental effects, and they wondered if they could prove that infants could handle pain better if they were held skin-to-skin in their mothers’ arms during these injections.
“This may seem obvious, but we use evidence to prove a new practice works,” Barbara says, “and our research evidence proved that babies held skin-to-skin experienced less pain overall, and they also appeared to recover from painful stimuli more quickly.” The study received ‘Best Research Award’ at a national conference, beating out 100 other competitors, and has led to a major philosophic shift in mother-baby care at NorthBay.
Healing Power of Music
Can music help patients relax when they are being weaned from mechanical ventilation? That was the question Maureen Allain, R.N., sought to answer in her evidence-based project undertaken in 2014.
Mechanical ventilation is one of the most frequently used treatments in the ICU, but despite its lifesaving nature, it is stressful and patients often need to be sedated while they are intubated. When it’s time to wean them from the ventilator, they are asked to perform breathing exercises, which can cause the patient anxiety and increase their respiratory rate and blood pressure.
Maureen’s project was to introduce soothing music through headphones—already proven to have a calming effect—during the weaning process.
Data collected during the study showed a significant decrease in patient’s blood pressure, heart rate and respiration, and an increase in the number of successful extubations in a group that was able to listen to music during the process.
The outcomes, Maureen’s study suggested, can lead to decreased ICU days, a decrease in ventilator-acquired pneumonia, and decreased costs.