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Bridging clinical practice and research in the hospital setting: Exploring the endless possibilities Lauck, Sandra 2009-04-30

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From thesis to bedside: Bridging research and clinical practice in the hospital setting Sandra Lauck MSN, RN, CCN(C)Nexus Doctoral TraineeResearch possibilities in the hospital settingPatients and their familiesNew technologyNew evidenceNew policiesNew budgetary directionsNew concernsNew treatmentoptionsNew staffing modelsFrom thesis to bedside: Changing PCI carePeople undergoingpercutaneous coronary interventions(PCI)PCI: Coronary angioplasty and stenting PCI: Pre and PostPeople undergoing PCINew evidence:Same-day discharge11Webb et al. Am J Card 2002;90:425-7New technology:Coronary stentNew treatment option:Rapid vascular access removalNew budgetary directions:Same-day proceduresNew staffing models:Critical care nursesNew policies/standard:Same-day discharge for all elective patientsNew concerns:How are our patientscoping?Same-day discharge PCI• Research questions:– What are the self-care recovery behaviours in the 2 to 5 days following same-day discharge (SDD) PCI?– What are the relationships between patient and procedural characteristics and self-care agency (SCA) and cardiac self- efficacy (CSE)?• Research team:– MSN committee: Drs. Joy Johnson and Pam Ratner, Martha Mackay– Cardiac short stay unit nurses and clerical staff – Regular updates to cath lab care teamSame-day discharge PCI: Findings• Health care behaviour:– High degree of adherence to discharge guidelines• Chronic disease management:– 50% did not know what lifestyle changes were required to alter the course of their heart disease – 43% stated that their did not understand the causes of their heart disease at all or very well – Low levels of referral to cardiac rehabilitation programs• Predictors of self-care agency and cardiac self-efficacy:– Marital status: no partner– Perceived lack of social support– Psycho-emotional distressLauck et al. (2009) Eur J Cardiovasc NursSame-day discharge PCI: Knowledge exchange• Presentation at staff meeting and care team• Publication of findings• Nursing committee:– Examine implications for practice– Develop recommendations– Implement change Same-day discharge PCI: Changes in practiceScreening for social support1: – Do you live alone?– When you need help, can you count on anyone to help with daily tasks like grocery shopping, cooking, giving you a ride?– Do you have regular contact with friends or relatives?– Have you lost your life partner within the last few years?– Can you count on anyone to provide you with emotional support?Screening for psychoemotional distress2:Over the past 2 weeks, how much have you been bothered by:– Feeling sad, down or uninterested in life?– Feeling anxious or nervous?– Feeling stressed?– Feeling angry?1Linden W. et al. Health Qual Life Outcomes, 2005;3:542Young QR et al. Can J Cardiovasc Nurs, 2007; 22:525-34Interventions• Development of draft nursing protocol• Education initiatives to improve capacity to intervene in collaboration with social worker and psychologist• Development of a telephone intervention for people at high risk for low level of SCA and CSE• Referral systemNeed for rapid KESurvivors of sudden cardiac deathDevelopment of clinical practice guidelinesWhat are the experiences of patients and their family in accessing and utilizing hospital and community resourcesfollowing survival from sudden cardiac death?Research team: Carol Galte MSN, NP(F) and Paul Galdas PhD, RNNeed for rapid KEFrail elderly undergoing innovative approach to aortic valve replacement Development of transcatheter valve replacement  programWhat are the changes in neurocognition and activities of daily living following transcatheter aortic valve replacement? Research team: Carol Galte MSN, NP(F), John Webb MD and Rob Boone MDNeed for rapid KEPeople with implantable cardioverter-defibrillatorsDevelopment of decision-making tooland ICD coping groupWhat are the changes in quality of life and other patient-reported outcomes following ICD implantation?  Research team: Pam Ratner PhD, RN, Joy Johnson PhD, RN and Rick Sawatzky PhD, RNHospital-based research and rapid KE: What works? • Proximity:– To the questions– To the patients– To the clinical stakeholders• “Inside” knowledge:– Of the programs and systems– Of the registries and documentation– Of existing protocols • Clinical leadership:– Able to “sell” the idea– Able to justify change– Able to implement change• Program support:– Support from administration– Collaboration with physicians– Critical mass of APNsHospital-based research and rapid KE: What we need• Research capacity:– CNS PhD?– Clinical nurse scientist?– Collaboration with non-hospital based researchers• Peer-review scrutiny:– Quality improvement vs. research  – Choice of publications– Access to transdisciplinary research groups • Capacity to attract funding and hold research grants


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