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SUE SENDELBACH, PhD, RN, CCNS, FAHA, began her career in nursing as a staff nurse in a progressive care unit. She's currently the director of nursing research and a critical care clinical nurse specialist at Abbott Northwestern Hospital in Minneapolis, Minn. Dr. Sendelbach is the past president of the National Association of Clinical Nurse Specialists. Her current research focuses on cognitive function following cardiovascular events, including open-heart surgery and therapeutic hypothermia post-cardiac arrest. A nursing student, Hannah Wichterman Peller, interviewed her to gain further insight into nursing research beyond academia.
This interview focuses on the progression of nursing research in the clinical setting. The nursing perspective in research has uniquely contributed to the improvement of patient outcomes. This is exemplified in Dr. Sendelbach's work through her bedside knowledge, collaborative investigations, and individual aspiration to improve the comfort and quality of the patient experience.
What really changed my perception of research was a study I was involved in at Abbott Northwestern Hospital in the early 1990s. We looked at the use of 10-pound sandbags on a patient's groin after femoral sheath removal. I thought the sandbag was put on the patient's groin to stop bleeding.
The physician said, "No, all it does is reminds the patient to keep the affected leg straight."
And we nurses said, "There must be a more comfortable way to remind a patient to keep the leg straight."
We randomized patients to one of three interventions: using the sandbag, reminding the patient to keep his or her leg straight, or wrapping a sheet around the patient to help keep the leg straight. We found that using a sandbag or wrapping a sheet were both equally effective in preventing bleeding and more effective than the reminder.
What became exciting to me was changing nursing practice. Patients were more comfortable. I thought, "We're advancing nursing science!"
I believe all disciplines look at patients holistically, but each of us brings our own science to the research team. Nursing has conducted a lot of both qualitative and quantitative research. The qualitative research helps to bring into focus the patients' experience. In my first research study (sandbags following femoral sheath removal), we were not only interested in how to best prevent the site from bleeding (the physiologic response), but we were also interested in the patient's comfort.
I think we're at an exciting time in nursing research. When I started my practice, we never talked about nursing research. It used to be that when you conducted research at Abbott Northwestern Hospital, you needed a physician cosponsor for the institutional review board. Now that's changed. Even though I have physician co-investigators, they don't have to be cosponsors; they're part of the team.
I think research is becoming more integral to nursing practice, partly because the research is more relevant to clinical nurses. For example, evidence supports the idea that thigh-high graduated compression stockings (GCS) are no more beneficial than knee-high GCS, and our practice changed from thigh- to knee-high GCS based on the literature.
Nurses thanked me, saying, "Finally, something that makes sense to practice."
I think we have a really good collaboration. In a hospital setting, research must be interprofessional. Everything we do around the patient is so intertwined. Even when physicians conduct medical interventions such as giving a drug, nurses administer that drug, knowing adverse reactions and monitoring the patient response.
I also believe we need to conduct research that captures how nurses impact patient outcomes-this is our science, and we need to understand which nursing intervention achieves the best patient outcome.
Nursing interventions are under-researched. I was recently asked this clinical question: "How frequently should nurses conduct nighttime assessments on patients in a medical-surgical area?" We found very few studies in the literature.
In one study of bone marrow transplant patients, nurses avoided nighttime assessments between 0100 and 0600 hours so that these patients could sleep.1 The authors cited research that demonstrated the benefits of sleep and the detrimental effects of sleep deprivation. This is an example of the kind of interventional studies needed in nursing because of a lack of science to inform practice. Conducting intervention research is complex and challenging.
I don't want to diminish any of the contributions of associate-degree or diploma nurses. In fact, I'm a diploma graduate, and some of the best nurses I know have this level of education. But I believe that a BSN should now be the level of entry. Nurses with 2 years of education are missing 2 years of school, including a course in research. The patients we take care of in telemetry units are as complex as those I took care of in critical care units 30 years ago. The patients are much sicker than they used to be.
Any time you teach a subject, you should incorporate the evidence to support the practice. When I say something, I want people to be able to go back to the literature and review the article also. We should integrate the evidence into how we work so that it becomes a natural part of our practice. We should collaborate with schools of nursing on evidence-based practice projects and with the students who conduct clinicals in our hospitals.
Our practice is based on science. We need science to help us answer clinical questions, and I believe it can. We have plenty of opportunities to conduct research. Sometimes we must rely on the expertise of clinicians and do things the way we've always done them; at times, that's the right approach because there aren't any studies to answer the question. But for the question of "How frequently should I assess my patients on night shift?" and many other questions, it's not enough. I think research is integral to our practice. It advances our science, and our patients deserve it.
1. Sharda S, Carter J, Wingard JR, Mehta P. Monitoring vital signs in a bone marrow transplant unit: are they needed in the middle of the night? Bone Marrow Transplant. 2001;27(11):1197-1200 [Context Link]
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