Beyond the bedside: Nurses improve patients' lives through research

December 22, 1999

Puppets, rocking chairs and coloring books don't exactly spring to mind as the latest tools that researchers have developed for improving our health. Health-care technology for the new millennium might conjure up images of super scanners that zero in on ever-smaller tumors in our bodies, or DNA tests that provide a laundry list of the major diseases that will threaten us.

But sometimes, even a puppet, in the hands of a nurse who has done the proper research, can work wonders to make a patient feel better.

In their bid to improve the quality of lives of their own patients, as well as millions of patients they've never met, nurses at the University of Rochester's School of Nursing frequently turn to research to develop new ways to improve the lives of their patients. The school has created three new research centers where nurses will do studies to enrich the lives of children and the elderly, and evaluate the impact of new medical devices on the lives of patients.

"Research is how we improve patient care; it's how we impact national health policy," says Bernadette Melnyk, R.N., Ph.D., the school's associate dean for research. "It improves the ability of nurses to deliver care to their patients, and it makes it possible for us to improve the lives of patients we'll never even meet."

Most nursing research is a long way from large technology-filled laboratories where discoveries are years away from having an impact on human health. Since nurses are often the health-care professionals who deal most directly with patients, their research almost always addresses an immediate patient concern. School of Nursing faculty members and students are trying to improve treatment of a variety of conditions that affect tens of millions of people in the United States alone.

Among the topics in the Center for High-Risk Children and Youth: improving the ability of growing numbers of children to manage asthma effectively, reducing the prevalence of HIV and sexually transmitted diseases, and teaching parenting skills to teen parents. To help children and families cope with illness and divorce, nurses recently developed a set of children's books and videos, which are now used in hospitals around the country.

At the other end of life, nursing researchers at the Center for Clinical Research on Aging are addressing a variety of concerns that appear as people age. Nurses have found that puppets help youngsters communicate with loved ones who have dementia. To calm agitated nursing home residents with Alzheimer's disease, nurses have found that the use of humor and rocking chairs helps. Among the other studies: looking at the role of friendship and a strong spiritual life in elders as they age, helping family members care for hospitalized elderly family members, treating urinary incontinence in older women, and keeping patients comfortable in the last days of life.

"A nurse is the first person to monitor a patient's status, identify symptoms, and assess people's response to treatment," says Nancy Watson, R.N., Ph.D., director of the center on aging. "We're the eyes and ears of the health-care system. Because we generally spend a lot of time with patients and family members, we know what problems to address.

"Research helps nursing students realize that there is always new information coming along that can improve the way they practice. It shows them the scientific basis for what they do, and it makes them better critical thinkers. That helps patient care."

Knowing how a research study should be designed, evaluating results, understanding statistics, checking references to test the validity of new ideas - all are topics covered in more than a dozen classes devoted to research at the School of Nursing.

"If you have not taught students how to be independent learners, you have not taught them how to be more updated than they are the day they graduate. They're essentially frozen in time," says Jeanne Grace, Ph.D., RN-C., associate professor of clinical nursing.

Understanding which new ideas are valid is vital. To illustrate the point, Grace says, consider the widespread belief that skin-to-skin contact between newborn and mother is vital immediately after birth for long-term bonding. The original 1970s study was tiny, with just a couple dozen women, and the results were never fully replicated by other researchers. But nurses, doctors and parents seized on this scant evidence to demand changes in birth practices, and bonding became "the be-all and end-all of post-partum care," she says. While Grace says the emphasis on togetherness has been pleasing to many familes, some parents who didn't have immediate post-birth contact feared that their "unbonded' babies might be warped for life. The childbearing community could have easily relieved those concerns if they had understood research a bit more, she says. Since the stakes are so high, Grace spends much of her time training nurses how to understand research articles. "I tell them that reading research is like reading poetry: every word counts."

Part of the school's strategic plan is to show nurses how beneficial research can be both for their own education and for their patients' well-being. "Oftentimes there's a disconnect between nursing researchers and practicing nurses," says Melnyk, herself a pediatric nurse practitioner. "But research really is relevant to their lives and the lives of their patients. We plan to bridge the gap through extensive outreach, to show nurses the richness and value of research."

University of Rochester

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