1. Peller, Hannah Wichterman BSN, RN
  2. Sandau, Kristin E. PhD, RN

Article Content

KIMBERLY STEPHENS, PhD, MPH, RN, majored in biochemistry as an undergraduate. She then pursued a nursing degree and became a critical care nurse and nursing research project specialist. She completed her PhD in nursing at the University of California, San Francisco (UCSF). (See Focusing on research education.) During her PhD program, she worked as a research associate for the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial, a 5-year multisite randomized clinical trial that evaluated current use of American Heart Association (AHA) Practice Standards for ECG monitoring and nurses' knowledge and skills in ECG monitoring. Dr. Stephens and another PULSE research associate gathered baseline data at 17 hospitals. They evaluated cardiac electrode placement on each monitored patient. They also reviewed medical records of current patients to determine if ST-segment, QTc, and dysrhythmia monitoring were being performedaccording to the AHA Practice Standards. Nurses' knowledge was assessed via online testing. The intervention was online education with the aim of improving nurses' knowledge and skills as well as patient outcomes. Final results are currently being analyzed.1


Dr. Stephens is currently a postdoctoral fellow in the Interdisciplinary Training Program in Biobehavioral Pain Research at Johns Hopkins University. The following interview with Dr. Stephens was conducted by a nursing student (Hannah Wichterman Peller) during her undergraduate studies so she could learn about the various backgrounds and applications of nursing research.


Your career path has been far from standard. You started in biochemistry, right? How did you become interested in nursing?

Yes, after I finished my degree in biochemistry, I worked in an environmental toxicology lab at the University of California, Davis. The projects that I worked on involved collaborations between our lab and faculty from various departments, many of whom were clinicians who studied associations between inhaled particles and the development of disease. During college, I worked as a nursing assistant. I loved working in a lab, but I also wanted to continue to work in a professional capacity with patients who'd been affected by environmental exposures.


What was your perception of nursing research during your BSN program at Johns Hopkins University?

I was taught as an undergraduate to be aware of the evidence, or lack of evidence, that supported the interventions I planned for my patients. I was surprised by the lack of research to support many nursing interventions. In addition, I worked in a research lab in the school of nursing as an undergraduate. I was able to participate in preclinical research and gain some understanding of how these preclinical studies may impact nursing practice in the future.


You were a research associate for the PULSE Trial. What did that involve?

A total of 17 sites were involved in the study. I was responsible for data collection at seven of these sites, which involved traveling to each of these hospitals three times during the 5-year study. I worked with the site investigators to coordinate my visits for data collection, supported them as they implemented different phases of the study, and helped with other administrative issues such as institutional review board applications and renewals.


During your data collection visits, you assessed all available patients requiring cardiac monitoring to determine if their monitoring electrodes were placed correctly. Were staff and patients receptive to your visit?

The staff members at all the sites were very helpful during my visits. Many asked questions about the study and nursing research in general; they seemed very curious and interested. The patients were also curious about the study. This aspect of data collection took the longest because the patients wanted to ask questions or share their experiences with cardiac monitoring. At times, I found it difficult to leave patients' rooms.


How did your work as a nursing research project specialist prepare you for your present work?

Prior to this position, my research experience had been with animals. In this position, I was introduced to clinical research involving human subjects. I was responsible for managing protocols with the institutional review board, obtaining informed consent, recruiting and retaining patients, and managing data for various nursing research studies. There are many differences between research involving humans versus animals. I feel fortunate to have had this unique opportunity.


You recently completed your PhD. Tell us about your studies.

I finished the doctoral program at UCSF in June 2013. In my dissertation research, I studied the associations between genetic and epigenetic variation in cytokine genes and the intensity of persistent pain after breast cancer surgery.


Ultimately, we'd like to understand why some people experience pain differently than others and to learn more about the underlying biological mechanisms. If we learn why some patients experience pain more intensely than others, we may be able to predict and possibly affect the development of pain and other associated symptoms.


That sounds like the type of study that would involve more than just nursing science. What sort of collaboration is needed for this kind of research?

Collaboration is essential because most research requires the combined efforts of practitioners from different specialties. Each discipline brings a unique expertise and perspective, and I think this combination makes research more successful.


What unique qualities does the nurse bring as part of the research team?

Nurses spend a lot of time with patients. We can individualize or provide context for a specific intervention or outcome being measured. I think we look at signs and symptoms, quality of care, and quality of life, and we're probably less focused on absolute outcomes, such as mortality. Every member of the team has his or her unique perspective and specific purpose for participating.


What do you see for the future of nursing research?

Nursing practices continually change with improved understanding of disease, emerging treatments and technologies, and new findings from research studies. Even an area that's been well studied evolves over time. Ideally, as one area of nursing is studied, future studies will incorporate these findings to extend our understanding.


What advice do you have for nurses interested in pursuing research?

Some hospitals employ an individual to conduct or assist with nursing research. These positions would be a good place to start. If a university is nearby, nurses can learn about the faculty's programs of research on the school's website. In addition, nurses can read about research projects in journals and contact those who are studying areas of interest to them. Most researchers really enjoy talking about their work.


Focusing on research education


* What's the difference between a research-focused doctorate and a clinical doctorate?


Research-focused doctoral programs include degrees such as doctor of philosophy (PhD) or doctor of nursing science (DNS or DNSc). In academic settings, the PhD is the most commonly offered research-focused degree, but in clinical settings, doctorates such as the doctorate of nursing practice (DNP) are becoming more common.


* Why is the DNP currently receiving so much attention?



The American Association of Colleges of Nursing (AACN) accredits baccalaureate and higher nursing programs. The AACN has recommended that by 2015, initial advanced practice nurses (clinical nurse specialists, nurse anesthetists, nurse midwives, and NPs) should hold a DNP.


* How does graduate school differ for PhD and DNP programs?



Research-focused doctoral students take research courses designed to prepare them to generate new knowledge and conduct independent research. Although clinical doctorates such as the DNP also require coursework in research, the intent of these doctoral programs is to prepare the graduate to focus on advanced practice roles and applied research.


* How popular are doctoral degrees for nurses?



Both DNP and research-focused doctoral programs in nursing have grown over the years. An exciting surge in DNP programs occurred during a 6-year period from 2006 to 2011: The number of DNP programs rose from 20 in 2006 to 184 in 2011. In addition, from 2003 to 2011, research-focused doctoral programs increased by 52%.2 Doctoral-level nursing education continues to grow today.3




1. Funk M, Winkler CG, May JL, et al. Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use of the Latest Standards for Electrocardiography trial. J Electrocardiol. 2010;43(6):542-54l. [Context Link]


2. American Association of Colleges of Nursing. New AACN data show an enrollment surge in baccalaureate and graduate programs amid calls for more highly educated nurses. 2012. [Context Link]


3. American Association of Colleges of Nursing. DNP fact sheet. 2014. [Context Link]