Article Content

I am honored to be here before all of you this morning as I begin my year as INS president. I joined INS in the 1980s when I left critical care to become a home healthcare nurse. As I look back over the years, this was one of the best decisions in my career, leading me to this moment. Homecare was growing tremendously, and providing intravenous therapy in the home was a fast-growing practice. I applied for and was given the position in my agency to develop a home infusion therapy program. Thus began my involvement in INS. I joined and began to familiarize myself with the INS Standards of Practice and used them to guide development of my program and policies and procedures. I became active in our local chapter, serving as program and newsletter chairs, treasurer, and president. The ability to network with other infusion nurses was invaluable in my own professional growth. I was given great opportunities to participate in INS at the national level, including participation in the National Council on Education and Standards of Practice Committee. And finally today, I am very excited to begin my INS presidential term.

Figure. Lisa Gorski,... - Click to enlarge in new windowFigure.

The presidential theme I have selected is "Advancing the Science of Infusion Therapy." Science is derived from the Latin term scientia, meaning knowledge. Science refers to a system of acquiring knowledge through scientific methods such as research. Science includes the increasing use of technology. Think about 25 years ago and back to today-the advances in computerized infusion pumps, the technology built into catheters and catheter valves to reduce blood reflux, the information systems that improve clinical communication and can decrease medication errors.


The INS mission includes "advancing best practice through evidence-based research," and that is where I would like to focus my message. The term evidence-based practice has become familiar to all of us-evidence-based practice is, in fact, the standard of excellence in nursing practice. Research is required to provide the evidence on which we base our interventions and structure our programs. Through all of the efforts to promote evidence-based practice at a national level, at the nursing organization level, and in your institutions, we are making great strides in implementing better interventions that lead to improved clinical outcomes for our patients. Catheter-related bloodstream infections are being significantly reduced in acute care organizations across the country. The evidence is clear that hand washing, use of maximum sterile barrier precautions during catheter insertion, and use of chlorhexidine in site preparation all contribute to reduced risk of infection. Research has demonstrated the effectiveness of IV specialists and teams. Success at bedside PICC placement through the use of science-driven visualization technology has resulted in increased nursing referrals, contributing not only to improved quality but also to more cost-effective care. Yet we have many unanswered questions about clinical practice that must be addressed in the research.


Members of the most recent Standards of Practice Committee reviewed all pertinent literature to support each standard. It is clear that over the years, there is increasing evidence to support certain standards, yet there is a dearth of evidence regarding others. For example, what is the best flush solution to maintain vascular access devices? How often should they be flushed? This is a common procedure for which there is a lack of clear evidence to guide consistency in practice, and now there is emerging research that may challenge the use of traditional heparin flushes. Over the last year, a number of INS members volunteered to work on a committee, and a white paper summarizing their work and the current state of research in this area is forthcoming.


Although increasing numbers of patients with vascular access devices are being cared for in outpatient clinics, physician offices, and homecare settings, there is even less research to guide optimal practice in these alternate sites. I believe that existing studies clearly support less risk of infection in general, but how does this information translate into simplifying and optimizing procedures when patients and their family members become the primary caregivers? Outpatient settings often have fewer clinical resources and are more likely to lack infusion therapy policies and procedures. While the INS Standards do guide infusion practice in all settings, there may be a complete unawareness of the existence of our standards and not a CRNI(R) to be found.


So how can each of us "Advance the Science of Infusion Therapy"? It does not mean that every nurse must conduct or even participate in research; not everyone has the same desire to contribute at that level. But you are likely to have ideas of what is important to research and can share those ideas. At your local chapter meetings, take one meeting and devote it to presentation of a recently published infusion therapy research study. Or take a few minutes at every chapter meeting to highlight a research article that your members might like to read. As infusion nurses, each of us can and must strive to educate clinicians, both in and outside of our specialty, about the INS Standards and about the science that supports the rationale for our clinical interventions. The fact is, much infusion therapy is provided by nurses and other healthcare providers who are not specialists in infusion therapy and who are not familiar with our specialty or the Infusion Nursing Standards of Practice. We protect the patients we care for when we take the responsibility to share and promote our standards.


Although I have practiced in this specialty for more than 20 years, I continue to be surprised that so many clinicians lack basic knowledge about infusion therapy procedures. We can and must address this lack of knowledge. You are contributing to "Advancing the Science of Infusion Therapy" when you work with student nurses or new graduates and teach them not only how to apply a securement device but also explain the rationale for its use and how such devices contribute to improved outcomes. You teach your patient or a family member about the importance of scrubbing the injection valve before flushing a catheter but take the time to explain the importance of this procedure in reducing the risk of introducing bacteria into a catheter.


We are "Advancing the Science" by contributing to our own Gardner Foundation. The Foundation strives to enhance the infusion specialty practice by funding infusion nursing research and education. I would ask all of you to consider making at least a $10 donation to the Gardner Foundation when you renew your annual membership.


What else can we do in "Advancing the Science of Infusion Therapy"? I believe that we are at a critical point in continuing INS' professional development. During my presidency, it is my desire and goal that we identify research priorities for INS. The identification of research priorities represents yet another step in the growth of INS as a specialty nursing organization. It is a landmark year in that we are celebrating the 30th year of the Journal of Infusion Nursing. We will be celebrating our 35th year as a specialty nursing organization in 2008. We are the leaders in establishing Infusion Nursing Standards of Practice, beginning in 1977, and subsequently revised in 1982, 1990, 1998, 2000, and 2006. We have a strong certification program through the Infusion Nurses Certification Corporation, which was accredited by American Board of Nursing Specialties last year. This was yet another tremendous achievement. We have well-designed and well-attended meetings. Now we must identify our priorities for research. Why should we do this? We need to identify the research topics of the greatest importance to infusion therapy and to INS. By doing this, we provide the direction for future research, a research agenda guiding and "Advancing the Science of Infusion Therapy." We can use our research priorities to focus our financial resources on the topics of greatest need. We can work with and encourage researchers to use our INS research priorities as they design and implement research projects. You will be hearing more about this process over the next year. It is a process in which you, the INS members, will have the opportunity to participate.


I would like to close my remarks with a quotation from Florence Nightingale, the incredible nurse leader and role model who advanced the science of nursing by collecting data and using statistics to promote and support interventions that controlled the spread of infection and decreased the rate of death: "For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back."


I ask you to think about how you will make progress in "Advancing the Science of Infusion Therapy" over the next year. Thank you so much for being here this morning. Enjoy the final day of this excellent meeting and I hope to see you back again next year.