Wednesday, October 31, 2007

Research Interview

First of all I would like to thank all the nurses who have been interviewed for allowing us to showcase their projects. Secondly I would like to wish Happy Holidays to everyone!
We are now coming to the end of an exciting year in evidence-based practice and research here at St. Joseph Hospital with many new projects to come in 2008. As you have seen from the other articles our nurses are busy! This issue I would like to introduce you to Kathleen Close, the Colorectal Nurse Navigator here at St. Joseph Hospital and her study is called “Gum Chewing for Post-Colorectal Surgery Patients.”

Q. What is your study about?
A. “My study is about determining ways to prevent ileus following colorectal surgery. We need to know if providing patients with gum after colorectal surgery decreases their incidence of time to flatus and bowel movements and if this leads to a decrease in ileus.”

Q. Is it an EBP/ResearchProject?
A. “This is retrospective pre/post comparative study.”

Q. What made you interested in this project?
A. “As the Nurse Navigator for colorectal patients I am responsible to identify and follow-up on any patients who have been newly diagnosed with any type of colorectal disease. I follow them from the time of diagnosis, through surgery, and then post surgery. I am available to them 24 hours, 7 days a week until they are home and comfortable. Our colorectal cancer patients I keep in touch with on an ongoing basis because I help coordinate our support group. Due to this role I really decided to look in to the research and see if there was any information on decreasing ileus to help these patients after their surgeries. As the Colorectal Nurse Navigator I love my role and I love my patients, therefore I want to decrease any complications they might have if I can.
My daughter heard an article being discussed on the radio one morning from JAMA as a possible health program and told me about it. I had our library pull all the current articles regarding this study and the Japanese study was among the articles I received which is called, “Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy”, (Asao, T. et al. 2002). These researchers found patients undergoing laparoscopic colectomy for colorectal cancer who chewed sugarless gum three times per day passed flatus and defecated sooner than did patients who did not with good significance (p<. 01). I thought this is great! Especially since the amount of literature on this subject is very limited.”

Q. How did you go about doing your research?
A. “After reading this article and a few others, my daughter and I decided I should try to replicate this study. So I presented the idea to the three physicians I work with and we decided this would be a great idea. I then brought the idea to Dana Rutledge in the Nursing Research Department and we worked on the logistics as far as what type of study I should do, how many charts, and what information we should be looking at. We used the other studies I looked at as a basis for data collection. We developed a tool to audit my charts. I then went to the IRB and presented my project. Once approved, I was on my way. Since then I have been working with you to collect my data. We will soon be analyzing the data.”

Q. What are your expected outcomes?
A. “Well initially, I was really hoping we would see a difference with gum chewing, but at this point after collecting the data I noticed there was not a decrease in ileuses. One study actually said that gum chewing might be a safe way to provide benefits of stimulation without the same complications of feeding (Asao, T. et al) but I’m not sure if the data we found actually has the same results. Since we don’t have statistical analysis yet, I do not know statistically what we have actually found. It is so hard to know what your research will lead you too.”
Q. Have you done research before? If so what did you learn?
A. “ Yes, I was involved in drug research with Bristol Meyers on a drug many years ago. The drug was to help with diagnosis and prevention of early Alzheimer’s but the medication never made it to the market. I never actually found out what the results were. I thought the medication actually made a difference but the patients may have done better because we gave them a lot of attention, so it could have been a placebo effect.”
Q. Will you do an EBP/research project again?
A. “Yes. I enjoy doing research. My results may help other people regardless of positive or negative outcomes. Research also helps find new and exciting questions and answers. I don’t really find research to be that difficult once you start. The biggest problem has been getting other people excited initially about the project. But once I got everyone on board, it took off. Working with you made data collection easier since we had a great system worked out for getting the charts from medical records. Once I got a system with auditing the charts, it actually went fast! I am looking forward to our analysis.


Asao, T. et al. (2002). Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. Journal of the American College of Surgeons, 195, 30-32.

Monday, October 22, 2007

Oct 3 2007 Nursing Research Council KEY POINTS

We will now post a "key points" summary of each of our monthly Nursing Research Councils:

October 3, 2007 Nursing Research Council – KEY POINTS

The Research Reflection prompted the Council to discuss a possible new project for blood pressure screening in the ED.

There are now two RN members of the IRB Committee and nursing projects are beginning to receive expedited reviews.

There were reports on the progress of all ongoing projects.

Education was provided on EBP nursing competencies. Dana Rutledge and Vickie Morrison will incorporate these competencies into next year’s EBP classes.

Eleanor Jamieson, Carmen Ferrell and Dana Rutledge have an article accepted for publication in Med Surg Nursing. The topic is outcomes from the MET Team.

The Nursing Research Blog Committee will meet in December for an update and additional training.

The Council will continue to invite new members and talk about EBP on their units.

There will be a special EBP presentation at Nursing Grand Rounds on November 19. Breakfast will be served.

Wednesday, October 10, 2007

Do patients coming in to the emergency department for minor injury display psychiatric comorbidities?

Research Abstract with Commentary

Abstract: Psychiatric disorders in patients presenting to the Emergency Department for minor injury

BACKGROUND: Thirty-five percent of all Emergency Department (ED) visits are for physical injury.
OBJECTIVES: To examine the proportion of patients presenting to an ED for physical injury with a history of or current Axis I/II psychiatric disorders and to compare patients with a positive psychiatric history, a negative psychiatric history, and a current psychiatric disorder. METHODS: A total of 275 individuals were selected randomly from adults presenting to the ED with a documented anatomic injury but with normal physiology. Exclusion criteria were: injury in the previous 2 years or from medical illness or domestic violence; or reported treatment for major depression or psychoses. Psychiatric history and current disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual Disorders, 4th edition (DSM-IV), a structured psychiatric interview. Three groups (positive psychiatric history, negative psychiatric history, current psychiatric disorder) were compared using Chi-square and analysis of variance.
RESULTS: The sample was composed of men (51.6%) and women (48.4%), with 57.1% Black and 39.6% White. Out of this sample, 103 patients (44.7%) met DSM-IV criteria for a positive psychiatric history (n = 80) or a current psychiatric disorder (n = 43). A past history of depression (24%) exceeded the frequency of a history of other disorders (anxiety, 6%; alcohol use/abuse, 14%; drug use/abuse, 15%; adjustment, 23%; conduct disorders, 14%). Current mood disorders (47%) also exceeded other current diagnoses (anxiety, 9%; alcohol, 16%; drug, 7%; adjustment, 7%; personality disorders, 12%). Those with a current diagnosis were more likely to be unemployed (p <.001) at the time of injury. CONCLUSIONS: Psychiatric comorbid disorders or a positive psychiatric history was found frequently in individuals with minor injury. An unplanned contact with the healthcare system (specifically an ED) for treatment of physical injury offers an opportunity for nurses to identify patients with psychiatric morbidity and to refer patients for appropriate therapy. Richmond, T.S., Hollander, J.E., Ackerson, T.H., Robinson, K., Gracias, V., Shults, J., Amsterdam, J. (2007). Psychiatric disorders in patients presenting to the Emergency Department for minor injury. Nursing Research, 56, 275-82.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

The framework for the study – which is not described in the abstract – indicates that when psychiatric disorders occur along with traumatic injury, the potential for disability is substantial. What is remarkable about the findings of this descriptive study is the high numbers of patients with psychiatric conditions, despite the fact that those with major depression and psychoses were excluded. Also impressive is the fact that persons with the fewest resources available to them (those with lower levels of education, the unemployed) were the most likely to have comorbid psychiatric disorders.

Do these patients resemble those seen in the SJH ED for minor injury? Maybe not… there were 57% black patients, which does not reflect an Orange County population. However, the other demographic variables may be more in line with our patients.

What the study did not do was ask what resulted from knowledge of the psychiatric disorder in terms of referrals, or work up in the ED. These aims were beyond the purpose of this study, but are important to consider in thinking about the implications of these findings for SJH nurses. I believe this study points to the potential screening/referral role of nurses in the ED for multiple conditions, such as those described in this article (psychiatric disorders).

Wednesday, October 03, 2007

Interview with Pam Matten regarding her research on smoking cessation for healthcare professionals

Vickie’s Research Corner

Welcome again to my corner of the newsletter. It is so amazing to know that so many of our nurses are actually doing research. This issue, I would like to introduce you to Pam Matten, Nurse Navigator for the Lung Program here at St. Joseph Hospital, Orange, California. Her study is called “Assessment of community based smoking/tobacco cessation training program for healthcare professionals.”

Q. What is your study about?
A. “My study is educating nurses in the hospital setting to assess patients readiness to quit smoking. Some of our goals include equipping bedside nurses with the confidence and skills to talk to patients about smoking cessation and give a brief intervention. We follow up by providing access to free smoking cessation classes taught by SJH RNs.”

Q. Is it an EBP/ResearchProject?
A. “This is a quantitative research study.”

Q. What made you interested in this project?
A. “ Let me give a little background about my job first. As the Nurse Navigator for the Lung Program I am responsible to identify and follow up on any patients who have been newly diagnosed with lung cancer. I assist patients in navigating their way through chemotherapy, radiation therapy, etc. and link them to the necessary services and support. In addition, I provide patient education and support throughout their treatment.
I also facilitate a lung cancer support group. I am active in identifying patients for clinical trials and organizing the weekly patient management conference. I have a little bit of everything in my job (which keeps it interesting). I work with marketing and business development on "getting the word out" about the Lung Program by meeting with Primary Care Physicians. I also provide education to the community regarding lung cancer. I teach Smoking Cessation/ Readiness to Quit to the clinicians at SJH and I also teach outpatient smoking cessation classes to the community through a partnership with Santiago Canyon College. Just to add to my job, I facilitate a Journal Club for the physicians on lung cancer. I manage the CT Lung Cancer Screening program, which provides low-cost CT lung screening to at-risk-individuals in the community.
I got started in clinical research through Dr. Eunice Chung PharmD. She partnered me with an Oncology PharmD intern, Dr. Tim Chen. Together we developed the clinician education class I mentioned before. We had smoking cessation classes at outpatient sites but nothing for clinicians on the inpatient side. We wanted to design classes that were cohesively linked to our out-patient resources. The goal is to provide easy access to cessation services through our bedside nurses.”

Q. How did you go about doing your research?
A. “Dr. Wong suggested that we tie our education to a clinical trial. We contacted Dana Rutledge, the Nurse Research Facilitator, to see if she would like to be involved. She said yes and helped us develop the study and get us ready for IRB. We had subsequent meetings and began presenting our model and our preliminary data at conferences. Since this is a multi disciplinary effort our research has been presented at nursing conferences and pharmacy conferences, as well.”

Q. What are your expected outcomes?
A. “I am hoping that the nurses will use the materials they are taught to assess smoking practices for inpatients and point them towards the outpatient classes. I want the question of smoking cessation to be assessed easily and continually, like a vital sign. It takes people an average of 10.8 tries over 18 years before they quit for good. Continual assessment by a health care professional has been shown to increase a patient’s likelihood of quitting by 50%. ”

Q. Have you done research before? If so what did you learn?
A. “No, this is the first time I have ever done research. The IRB (Internal Review Board) felt a bit intimidating at first because they can potentially ask you anything about your study. I had two wonderful mentors; Dr. Dana Rutledge and Dr. Siu-Fung Wong who helped me every step of the way. I do think research is very fun, creative, and rewarding. I always thought only scholars or academics could perform research. I now know that any clinician with an interest in bringing about positive change for patients can participate.” I would encourage all clinicians to support evidence-based practice by participating in clinical research.”

Q. Will you do an EBP/research project again?
A. “Yes and I am always looking for opportunities. Once you start a research project it tends to snowball into additional projects. Recently, St. Joseph Hospital Cancer Center received a NCI grant that will focus on many issues including survivorship and health care disparities in the Oncology population. I am looking forward to pursuing clinical trials tied to those projects”.