Developing a Research Idea

Madeline Gervase RN,MSN,CCRN,FNPMadeline Gervase RN,MSN,CCRN,FNP

Advanced Practice NurseAdvanced Practice Nurse

Identifying Questions……….

Where can we identify answers to questions Where can we identify answers to questions that arise on a regular basis in the clinical that arise on a regular basis in the clinical setting?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 >Affect ability to give quality patient care to our patients.our patients.

>Questions that may arise in the course of >Questions that may arise in the course of clinical pathway development.clinical pathway development.

Questions and Ideas………

DO ANY OF THE FOLLOWING SCENARIOS DO ANY OF THE FOLLOWING SCENARIOS SEEM FAMILIAR…………SEEM FAMILIAR…………

Telemetry Electrodes………

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

Tympanic Thermometers……

Are they as accurate as Are they as accurate as our current product?our current product?

Do they really cut Do they really cut down on nosocomial down on nosocomial infections transmitted infections transmitted via thermometers?via thermometers?

Can we justify the Can we justify the added expense of the added expense of the new technology?new technology?

Optimizing the CABG Patient and Length of Stay

Some hospitals are Some hospitals are using “Fast Tracking” using “Fast Tracking” for early extubation.for early extubation.

Should we try this?Should we try this? Would this change our Would this change our

CABG outcomes?CABG outcomes? Would this change our Would this change our

LOS and respiratory LOS and respiratory outcomes?outcomes?

Let’s think………

What examples have What examples have you encountered…… you encountered…… even this week……even this week……that might give rise to that might give rise to questions questions like…………like…………

What do we do?What do we do? Why do we do it?Why do we do it? Is there a better way to Is there a better way to

do it?do it?

“Stick em up method”

Can capture clinical Can capture clinical questions as they questions as they occur in the midst of a occur in the midst of a dynamic patient care dynamic patient care setting.setting.

The clinical arena is The clinical arena is the most interactive the most interactive place to identify new place to identify new devices, technologies devices, technologies and ideas.and ideas.

The bedside…………

The bedside is an The bedside is an excellent forum for excellent forum for research, question research, question

and new idea and new idea generation…….generation…….

Question Evaluation and GroupingBased upon:Based upon:

1.1. Policy IssuesPolicy Issues

2.2. Staff DevelopmentStaff Development

3.3. Administrative IssuesAdministrative Issues

4.4. Clinical PracticeClinical Practice

Evaluation of Questions Based on Clinical Importance How can we do this?How can we do this? Informal discussion with staff, educators Informal discussion with staff, educators

and clinicians.and clinicians. Any questions or issues that are not Any questions or issues that are not

considered of high importance should be considered of high importance should be eliminated or placed on a waiting list from eliminated or placed on a waiting list from the research category. (Prioritize)the research category. (Prioritize)

Prioritize Ideas and Questions

Once questions of high clinical importance are Once questions of high clinical importance are identified, they need to be further evaluated based identified, they need to be further evaluated based on high clinical importance.on high clinical importance.

The core of the problem and impact on patient The core of the problem and impact on patient care needs to be taken into consideration when be care needs to be taken into consideration when be prioritized by investigators.prioritized by investigators.

Examples of Prioritizing Clinical Issues and Sample Questions Based on the Following Categories:

Policy IssuesPolicy Issues Administrative IssuesAdministrative Issues Educational IssuesEducational Issues Research IssuesResearch Issues

Policy Issues…….Questions….. 1. Do we really need AVO2 differences 1. Do we really need AVO2 differences

done every 4 hours? Should we change our done every 4 hours? Should we change our policy?policy?

2. Can RBC’s effectively run on a pump or 2. Can RBC’s effectively run on a pump or under pressure?under pressure?

3. Can more than one unit of blood be given 3. Can more than one unit of blood be given through a filter? through a filter?

Administrative Issues….???????

What should the level of care be for What should the level of care be for patient’s that are on continuous Cardizem patient’s that are on continuous Cardizem and inotropic drips?and inotropic drips?

Do we need to change our policy and Do we need to change our policy and investigate other institutions with the same investigate other institutions with the same level of care?level of care?

Educational Issues…..????????

Can bolus infusions be given properly Can bolus infusions be given properly through the PA port of a Swan Ganz through the PA port of a Swan Ganz catheter?catheter?

What is the need for nutritional What is the need for nutritional maintenance in long term ventilator patients maintenance in long term ventilator patients following extubation?following extubation?

Which is the best method in caring for chest Which is the best method in caring for chest tubes…….is stripping avoided in all tubes…….is stripping avoided in all instances?instances?

Four Steps to Gather Ideas

1. Brainstorming session on your unit.1. Brainstorming session on your unit. 2. High volume patient population with 2. High volume patient population with

common needs and problems.common needs and problems. 3. Frequent nursing interventions3. Frequent nursing interventions 4. Common technologies4. Common technologies

Brainstorming Session

Identify common Identify common patient problemspatient problems

What needs and What needs and nursing interventions nursing interventions are employed to are employed to address these needs or address these needs or problems?problems?

High Volume Patient Populations With Common Problems

Patient demographics….. Age, race,…Patient demographics….. Age, race,… Medical DiagnosisMedical Diagnosis Surgical DiagnosisSurgical Diagnosis Nursing DiagnosisNursing Diagnosis SymptomsSymptoms Problems…Needs…Other….Problems…Needs…Other….

Frequent Nursing Interventions

Catheter managementCatheter management Education…..Discharge teaching…Education…..Discharge teaching… Symptom managementSymptom management Drug administrationDrug administration Psychosocial supportPsychosocial support Family supportFamily support

Common Technologies

Infusion pumpsInfusion pumps Cerner systemCerner system Monitoring devicesMonitoring devices Bedside lab testingBedside lab testing

Care Paths and Examining Variances

Clinical Pathways are designed to reflect “Best Clinical Pathways are designed to reflect “Best Practice” in that they represent guidelines for Practice” in that they represent guidelines for patient management based on the results of patient management based on the results of carefully reviewed research.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 > 70 – 80% of the patients in a diagnostic group will follow a path without deviating.group will follow a path without deviating.

>20% or more may experience >20% or more may experience complications and may deviate from normal complications and may deviate from normal expectations.expectations.

Deviation = VarianceDeviation = Variance

Investigative Variances Identify changes in Identify changes in

practice which may practice which may emerge from variances.emerge from variances.

Ie. Same Day Angioplasty Ie. Same Day Angioplasty PathwayPathway

LOS – 36hrs : 50% of pts.LOS – 36hrs : 50% of pts. What factors cause What factors cause

prolonged LOSprolonged LOS > Variables: Patients > Variables: Patients

inability to perform groin inability to perform groin incision careincision care

Research Ideas Generation

100% of patients following post cath path 100% of patients following post cath path meet the expectation of ambulation six meet the expectation of ambulation six hours after sheath removal.hours after sheath removal.

Question:Question: Can early ambulation, three hours, after Can early ambulation, three hours, after

sheath removal be done safely without an sheath removal be done safely without an increase in bleeding complications?increase in bleeding complications?

Variances Trigger Clinical Questions:

““Why did this Why did this deviation or deviation or complication from this complication from this outcome occur?”outcome occur?”

Compiling Research Ideas

Review articles on Review articles on topics that are topics that are common to your unit.common to your unit.

Authors are experts in Authors are experts in areas of areas of research…..and often research…..and often suggest areas for suggest areas for future research.future research.

Suggestions for future research…

Identify problems with how the past studies were Identify problems with how the past studies were carried out. These are known as “Holes” in carried out. These are known as “Holes” in research or new areas for research based on research or new areas for research based on existing work.existing work.

End of research studies, can identify additional End of research studies, can identify additional areas of research.areas of research.

Authors will routinely list areas for recommended Authors will routinely list areas for recommended future research based on the findings of their future research based on the findings of their study.study.

In Review:Where can I find clinical questions and ideas?

Problems or issues on my unitProblems or issues on my unit Focus group investigatorsFocus group investigators Clinical pathwaysClinical pathways Review articles in the literatureReview articles in the literature Prioritizing problems and listsPrioritizing problems and lists

Research………

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