1. Evidenced Based Nursing Practice: Conducting Research
Robin Sheeran RN, CRRN, WCC
Theresa Sherman RN, BA, CRRN
[Moderator introduces
Robin Sheeran and
Theresa Sherman]

2. Bryn Mawr Rehab Hospital, Malvern, PA
Evidenced Based Nursing Practice: Conducting Research
Bryn Mawr Rehab Hospital, Malvern, PA

3. Describe the study results and integration of findings
Evidenced Based Nursing Practice: Conducting Research
Objectives
Describe the process and experience of a team of nurses conducting research at an acute care rehab hospital
Describe the study results and integration of findings

4. Nursing Research Fellowship
Evidenced Based Nursing Practice: Conducting Research
Nursing Research Fellowship
Two week intensive educational program
Teaches staff nurses the IOWA model
Nursing experts and mentors to assist nurses in the conduct of a nursing research project

5. Problem Focused Trigger
Evidenced Based Nursing Practice: Conducting Research
Problem Focused Trigger
Can a nursing practice or outcome be improved?
To improve the discharge process for patients admitted to our stroke unit
Increase patient education materials
To better prepare the patient for discharge to home
To improve patient satisfaction with education
Measured by Press Ganey – Nurses instruction re: homecare and medications

6. PICO Patient or Problem : stroke patients at an acute rehab hospital
Evidenced Based Nursing Practice: Conducting Research
PICO
Patient or Problem : stroke patients at an acute rehab hospital
Intervention: enhanced patient and family education
Comparison intervention: existing education
Outcomes: increased patient satisfaction with instructions regarding home care and medications

7. Is this topic a priority for the organization?
Evidenced Based Nursing Practice: Conducting Research
Is this topic a priority for the organization?
Meetings with nursing expert and mentor to:
Review articles
Develop question
Determine feasibility of study
Obtain approval for research question

8. Forming a Research Team
Evidenced Based Nursing Practice: Conducting Research
Forming a Research Team
Nursing Research Fellows:
Robin Sheeran RN, CRRN, WCC – Principle Investigator
Terry Sherman RN, BA, CRRN
Nurse Researcher: Roger Jones RN, BSN
Nurse Mentor: Catherine A. Harmer RN, MPH, CCRN, CRRN, MSN(c)
Nurse Research Expert: Sara J. Reeder PhD, RN

9. Assembling Relevant Research and Literature
Evidenced Based Nursing Practice: Conducting Research
Assembling Relevant Research and Literature
Define search terms
Request literature review
Review listing of articles
Select articles
Filter the articles by relevance
Focus on those closest to topic

10. Synthesizing the Research
Evidenced Based Nursing Practice: Conducting Research
Synthesizing the Research
Two articles found to be most relevant
Evidence showed:
that the information patients need to care for themselves post stroke is inadequate
patients require more education
Evidence showing a disconnect between what patients perceive as a learning need and what nurses think the need is
A tool to measure self-care needs

11. Is there a Sufficient Research Base?
Evidenced Based Nursing Practice: Conducting Research
Is there a Sufficient Research Base?
Decision to conduct research
Many articles about self care needs of populations of patients as compared to nurse perceptions of needs, fewer in the stroke population
Several older articles on rehab units
No articles capturing the perceived learning needs of stroke patients, as compared with caregivers and nurse caregivers
Therefore, an opportunity to study all three groups

12. Defining Study Limits Population Members: Consent:
Evidenced Based Nursing Practice: Conducting Research
Defining Study Limits
Population Members:
Hospitalized stroke patients, their caregivers, and nurses who care for stroke patients in an acute rehab hospital
Demographic information collected on all groups
Consent:
Required for patients, their caregivers and nurses
Inclusion criteria: patients and caregivers
FIM score above 4 (patients only)
Patient within 2-3 weeks of discharge (has some education exposure)
At least one caregiver will render assistance on discharge
No evidence of aphasia (receptive or expressive)
Less than 90 years of age
Inclusion criteria: nurses
> 1 year of experience taking care of stroke patients

13. Evidenced Based Nursing Practice: Conducting Research
Submission to the IRB
IRB Proposal and documentation completed for the study
Expedited review of IRB Proposal
Approval in June of 2010
Official study title:
Perceived Learning Needs: A Comparison Between the Stroke Patient, Caregiver, Nurse Caregiver

14. Consenting and the Needs Survey Process
Evidenced Based Nursing Practice: Conducting Research
Consenting and the Needs Survey Process
Introduction and Description of the Research
Obtain Consent
Patient Form (permit access to medical records)
Demographic Survey Form
Learning Needs Survey Form
47 learning need topics
Study subjects asked to identify their top 12 learning needs (check off box) and then to prioritize the 5 most important to them (circle the response)

15. Collecting Survey Data
Evidenced Based Nursing Practice: Conducting Research
Collecting Survey Data
Census fluctuations and longer length of stays reduces target population
Consenting:
Patient – scheduling conversation around therapy
Caregiver – most not available during the day
Additional Research Investigator added to study
To assist with caregiver consenting
Required an addendum to the original IRB proposal
Study Subjects
40 Patients, 34 Caregivers
39 Nurses (RN and LPN)

16. Demographics: Patient and Caregiver
Evidenced Based Nursing Practice: Conducting Research
Demographics: Patient and Caregiver
Patient
Caregiver
No. of Subjects 40 34
Sex
Female 44 65
Male 56 35
Age in years, %
21-30
31-40
41-50 6
51– 60 9 32
61-70
21.5 15
71-80 23
81-90 43
Ethnicity:
Black 19
White 81 77
Level of Education:
High School 47
College 31 46
Graduate

17. Years of experience in Rehab Nursing, %:
Evidenced Based Nursing Practice: Conducting Research
Demographics: Nurse
Nurse
Subjects: 39
Sex, %:
Female 86
Male 14
Age in years, %:
Years of experience in Rehab Nursing, %:
21-30
1-10 31
31-40 17
11-20 26
41-50 27
51– 60 40 11
61-70 2
71-80
81-90
Ethnicity, %:
Skill Mix:
Black 4 RN 80
White 96
LPN 20

18. Collation & Analysis of Survey Data
Evidenced Based Nursing Practice: Conducting Research
Collation & Analysis of Survey Data
All Patient, Caregiver and Nurse data was entered into an Excel database
PI verified the accuracy of data entry
Data sent to statistician for statistical analysis in late August
Analysis received in early September

19. Evidenced Based Nursing Practice: Conducting Research
Statistical Analysis
Analyze the data provided by stroke patients, caregivers and nurses
All respondents were asked to identify the top 12 learning needs and then prioritize that list to the top 5 learning needs
3 X 3 contingency tables were constructed to reflect top 12 learning needs, top 5 learning needs and those considered not to be top learning needs
Fisher’s exact test conditioning was calculated using the SAS Version 9.2
11 topics – highly significant findings
6–perceived patient and caregiver learning needs, not nurse
4 –nurse perceived patient learning needs, not patients and caregivers
1 – perceived patient learning need
6 topics – statistically significant findings

20. Evidenced Based Nursing Practice: Conducting Research
Study Results
Data from patients, caregivers and nurses was compared among the groups
Grouping highly and significantly statically findings:
9/17 topics – patients and caregivers are in agreement about learning need
monitoring blood pressure, understanding the stroke process
2/17 topics – nurse, patient and caregivers are in agreement about learning need
finding day care, managing stress
3/17 topics – nurse perceives learning need, not patients or caregivers
Dealing with body image, preventing swallowing problems,
1/17 topic – patient learning need, not nurse or caregiver
preventing constipation
2/17 topics – nurse and patient or nurse and caregiver in agreement
Managing swelling of the hands and feet, dealing with emotion
Identify topics that patients and families agree are important learning needs
Develop educational programs and informational materials on topics for use by stroke patients, families and nursing staff

21. Integration of Findings
Evidenced Based Nursing Practice: Conducting Research
Integration of Findings
Topics
Presenters
Managing Swelling of Hands and Feet
Nursing
Monitoring B/P
Understanding the Stroke Process
Presenting Constipation/Managing Incontinence
Preventing Falls
Therapy
Household Safety Strategies
Demonstrating Transfers
Dealing with Emotion, Managing Stress
Psychology
Coping with Life
Learning Activities for Memory and Dexterity
Speech Therapy & Occupational Therapy
Education program was initiated based on topics patients and caregivers rated as important
Patient Family Education Program Series was developed in January 2011
10 topics from stroke research (2 added topics)
Topics offered by a multidisciplinary team
Weekly education session, with rotation of topics
Monitoring outcomes of program with pre-, post- tests, and evaluation
Development of additional patient/family education materials
Available for stroke patients and other patient populations
[Script must be developed for this slide.]

22. Implications for Practice
Evidenced Based Nursing Practice: Conducting Research
Implications for Practice
Evaluate the effectiveness of the multidisciplinary Patient Family Education Program Series
Does it increase patient satisfaction scores?
What additional programs should be added or deleted?
Is this method of providing education effective?
Sharing the survey results with staff nurses
Integration of study findings into practice
Increased availability of patient and family educational materials

23. Conclusions and Recommendations for Future Work
Evidenced Based Nursing Practice: Conducting Research
Conclusions and Recommendations for Future Work
Analysis of the results was consistent with evidence reviewed
There appears to be greater synchrony between patients and caregivers about perceived learning needs than with nurses
The difference in perception offers additional opportunities for investigation
Nurses perceived “managing anticoagulation therapy” as important
Patients and caregivers did not perceive “managing blood thinning medications” as important
Why the discrepancy?
How many of patients were on blood thinners?
Already giving education on topic, therefore, satisfied with education?
Future Research
Repeat the study in the brain injury or spinal cord patient populations

24. Questions? Questions & Answers
Evidenced Based Nursing Practice: Conducting Research
Questions?
Questions & Answers