Posts Tagged ‘nursing research’

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‘My Professor Said to Submit My Paper’ (We Hope They Also Told You This)

February 22, 2013

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

When we get a manuscript submission, I always read the cover letter first to learn about the author and why the article was written. Often, the first sentence goes something like this: “I am a student and I’m submitting my capstone paper as required by my professor.” Or the letter may say, “My professor encouraged me to submit this paper, my capstone work.”

The paper is usually the very paper the student wrote and submitted to the professor. And that almost always means it’s not suitable for a professional journal.

The problem is not that we won’t consider manuscripts written by students—we sometimes welcome them, especially papers written by nurses who are experienced clinicians and working toward a graduate degree. The problem with the submissions I’m talking about here is inherent in the purpose of the papers themselves. Student papers are written primarily to demonstrate what the student knows about a subject; these papers tend to be expansive, cover the topic in a superficial way, and include a long list of references of books, articles, and Web sites (or, conversely, they may only have a few references, mostly Web sites, plus perhaps one much-cited textbook—thankfully, few are citing Wikipedia).

Student papers that describe themselves as “literature reviews” often have no information about the search strategy—and little synthesis. Instead, they contain a long list of various studies related to the topic, with no real discussion of key findings or filtering of the information for relevance. Student  papers tend to cover what most nurses in practice already know. Writing them may help a student get a good overview of what’s known about a specific clinical topic or issue, but this doesn’t mean the papers should necessarily be published.

Articles written for professional journals have a different purpose. These articles, properly done, should be written with the reader in mind, presenting new information the reader needs to know or that provokes the reader to think about something in a different way. The reader should come away with new knowledge or a new perspective.

There are many good reasons that faculty should encourage students to write. For one, we need nurses at all levels to write about their work, and not enough of them do so. And the responsibility for nursing’s scholarly work cannot rest solely with academics and researchers; clinicians have the firsthand knowledge about care processes and outcomes, and they need to document their work. They need to communicate to the public about what it is that they do so that nurses’ work becomes more visible; they need to communicate to colleagues about what works and what doesn’t so that we can replicate successful quality improvement initiatives.

But in encouraging students to write, faculty members need to give the correct messages.

Here’s what faculty might tell students:

  1. Go to the journal’s Web site and review several articles similar to what you want to write. Note the tone, level of detail, sourcing. Search the journal to see if it recently published articles on a topic similar to what you want to write. Send a query letter to determine whether your topic is of interest.
  2. Review the submission guidelines. Pay special attention to the instructions for authors and to how to format the paper and the references. This isn’t just an academic exercise, but is necessary so that references appear correctly and are verifiable in online databases. Also keep in mind that many journals run software to detect plagiarism, and the results can be inaccurate if the software reads the references as part of the body of the manuscript because they are improperly formatted.
  3. Write the manuscript using the information you learned when preparing your capstone paper or thesis as a starting point. All information is not equal. Be selective. Perhaps include a case study, and focus on what’s new or important for nurses to know. In addition, write to the audience that makes up the readership of the journal. Use active voice; avoid jargon. If there’s a word limit, honor it.
  4. Be sure to use primary sources when providing citations to support facts. Ask the librarian to help you find the correct sources.
  5. Spell-check your article before you send it. Read it aloud. Ask a colleague to read it.

We often suggest that new authors invite a colleague or faculty member who has published in a peer-reviewed journal to be a coauthor. And perhaps faculty should rethink requiring all students to submit papers and instead only encourage those students whose papers go beyond competence and add to our knowledge or understanding of a topic. We want students to want to write, and their first experience with publishing shouldn’t be one in which they have little chance of success.

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Nursing Research: Alive and Well

September 17, 2012

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Last week I spent two-and-a-half days in Washington, DC, where there are LOTS of campaign collectibles. My favorite: coffee mugs proclaiming “Friends Don’t Let Friends Vote [insert Democratic or Republican).” Also noteworthy: “Hot for Mitt” and “Hot for Barack” hot sauce (see photos). I was there attending the meeting of the Council for the Advancement of Nursing Science (CANS), where close to 1,000 nursing researchers met to share their work. It wasn’t too long ago that one would have been hard-pressed to find that many nurses doing research. The National Institute of Nursing Research (NINR) only celebrated its 25th anniversary in 2010 (see our 2010 article about their many accomplishments).

Creativity and innovation. Kathi Mooney, PhD, RN, FAAN, from the University of Utah College of Nursing, gave the keynote—and it was perfectly suited to this group, many of whose members are immersed in analytical thought and scientific methodology. Mooney talked about the importance of creativity and innovation in moving research forward—yes, applying scientific rigor to identifying knowledge gaps and building on known research is critical, but she urged attendees to step back occasionally and be open to other ways of thinking.

To do that, she said, one must create time for reflection and thinking. She also encouraged deans and faculty to foster environments that support creativity, where there’s freedom to explore non-mainstream thinking, risk taking is encouraged, and there’s time for social interaction and informal encounters.

Posters and symposiums and podium presentations filled the rest of the schedule. The presentations were akin to speed dating—researchers had less than 15 minutes to present the highlights of their work. I’m sure for those presenting and those involved in the particular area of research, it might have been frustrating, but for someone like me seeking what’s new and compelling across many areas, it was an ideal format. As one presenter said, “It’s like being a detective on Dragnet, that old TV show, where the lead detective would say, ‘Just give me the facts, please.’”

Some takeaways for me:

Creative thinking involves reframing problems and tasks (one example from Mooney: does the stone cutter see his job as cutting large chunks of stone, or as being part of a team that’s building a cathedral).

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Legacy of the Living Legends: Slackers Need Not Apply

October 27, 2011

By Shawn Kennedy, editor-in-chief

Earlier this month, I attended the American Academy of Nursing 38th Annual Meeting and Conference. With e-mails flooding my inbox and a full meeting agenda over the next few days, I was thinking of skipping the 2011 Living Legends event that took place on the first evening. Thankfully, an old friend, nurse historian Sandy Lewinson, talked me into going—it was one of the more memorable nursing events I’ve attended.

The academy honors “Living Legends” in recognition of the multiple contributions these nurses have made to the profession and the impact these contributions have made on health care in the United States and abroad. This year’s honorees are shown in the photo, from left: May L. Wykle, Meridean L. Maas, Ada Sue Hinshaw, Suzanne Lee Feetham, and Patricia E. Benner.

Credited with such achievements as creating a nursing taxonomy on nursing error, building the science of pediatric nursing in the context of the family, conducting ground-breaking nursing research, developing and implementing professional nurse governance in employing organizations, promoting policy change, and addressing the nursing shortage, these nurses join 77 other nursing notables who’ve been so honored since the first class was named in 1994. Read the rest of this entry ?

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Toward a Less Painful Death: ICD Deactivation at End of Life

October 14, 2011

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

Lightning by snowpeak, via Flickr

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So it’s essential for providers and patients to talk about the possibility of deactivation, well in advance of such crises.

Russo, the coordinator of the pacemaker clinic at the Department of Veterans Affairs Medical Center in New York City, wanted to better understand why providers and patients weren’t discussing this possibility and to find ways to promote more timely discussions. Read the rest of this entry ?

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Killing Traditional Nursing Duties #3 – NPO after Midnight

October 11, 2011
fasting Buddha/ via Wikipedia Commons

By Shawn Kennedy, editor-in-chief

In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post called “Killing Traditional Nursing Duties #1.” We did another post on the answers to our second question, “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)?” This also got many comments in response.

Our last question was this:Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Here’s some of the comments we received on the blog:

My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before?

…most of the younger anesthesiologists/CRNA’s allowed BLACK COFFEE to be drunk right up until time  of surgery. No dairy or sugar in it, obviously.

The facility that I work for does routinely follow ‘nothing by mouth’ after midnight guidelines. If the patient  is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable and will change the orders, writing NPO after midnight with the exception of clear liquids.

Responses on Facebook, however, showed a stricter adherence to the traditional no eating or drinking after midnight before surgery; it was fairly unanimous that institutions still follow this ancient practice (though one person did ask, “What’s npo?”!).

Well, it’s clear that this month’s CE article by Jeannette Crenshaw is sorely needed. “Preoperative Fasting: Will the Evidence Ever Be Put into Practice?” addresses the fact that despite 25 years of evidence and standards showing that NPO after midnight is not good practice, it is still used in most hospitals and preoperative practices. The evidence support clear liquids up to a few hours before surgery, and many groups have endorsed carbohydrate-rich beverages along with clear liquids up to a few hours before surgery.

So read Crenshaw’s article and disseminate it to your colleagues and clinical practice committees—practice changes should be based on evidence, and for this, the evidence is clear.

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So What? An Invitation to Nurses To Tell Us How They’re Translating Research into Practice

June 17, 2011

By Inge B. Corless, PhD, RN, FAAN, professor at the MGH Institute of Health Professions, Boston, and Brian Goodroad, DNP, RN, AACRN, nurse practitioner and associate professor at Metropolitan State University in Minneapolis–St. Paul, Minnesota

by centralasian/via Flickr

Crossing the Quality Chasm, an Institute of Medicine report from 2001, bemoans the chasm between our current research knowledge and the current state of care. Back in 2003, Don Berwick, now the Administrator of the Centers for Medicare and Medicaid Services, provided the following pithy codification of the problem in a JAMA article called “Disseminating Innovations in Health Care” (subscription required; click here for the abstract): “Failing to use available science is costly and harmful; it leads to overuse of unhelpful care, underuse of effective care, and errors in execution.” Berwick pondered the slow pace of innovation adoption and attributed it to three factors:

  • the characteristics of the innovation
  • the characteristics of the potential adopters
  • contextual factors

Berwick also made this observation about innovations that do get adopted: “Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all.”

Given these obstacles, what can be done to facilitate the integration of research findings into practice? What can be done to change this situation, and what would this entail?

One step is to share our knowledge and our successes in making changes, along with the obstacles to doing so. We invite nurses to identify research that has changed or somehow influenced their practice and to share their experiences with us for potential publication on this blog. We’re not asking for formal academic work here; what’s we’d like is simple, brief (one to five paragraphs) summary description in your own voice. Briefly describe the study and its findings, as you understand them—and then describe how the findings were integrated into practice and any outcomes (whether they were formally measured or anecdotally reported). Read the rest of this entry ?

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Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

June 7, 2011

By Sylvia Foley, AJN senior editor

In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.

Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?

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What Is the Role of the Staff Nurse on a Medical Emergency Team?

May 25, 2011

By Sylvia Foley, AJN senior editor

There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)

But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.

The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:

  • Nearly three-quarters of the respondents had participated in a MET call.
  • The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
  • But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?
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‘A True Art’: Strategies for Feeding Patients with Dementia

April 1, 2011

By Sylvia Foley, AJN senior editor

The fork and the spoon, by Jordan Fischer via Flickr

Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:

People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.

In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. Read the rest of this entry ?

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Entering the Mainstream? Nursing Research at 25 Years

October 4, 2010
Logo of the United States National Institute o...

Image via Wikipedia

By Shawn Kennedy, AJN interim editor-in-chief

Last Thursday the National Institute of Nursing Research (NINR) held its kick-off event to celebrate its 25th anniversary—and what could be more appropriate than holding a research symposium at the National Institutes of Health (NIH)? Scientists and researchers (nurses as well as others) whose work is supported by the NINR presented highlights of their research. (See here for synopses.)

Why it matters to all nurses. All nurses, researchers or not, should celebrate the growth and accomplishments of the NINR—its establishment provided tangible recognition of the value of the substantial body of research conducted by and/or about the nursing profession. As practitioners, where would we be without research to provide the evidence underlying care interventions or the processes of delivering that care? With the October issue, AJN highlights the NINR’s silver anniversary: on the cover, with a guest editorial by NINR director Patricia Grady, and with a timeline highlighting key milestones and landmark research supported by the NINR (click through to the PDF version to read this article). To give you an idea why nursing research matters, here’s just one entry on the timeline, from 1998:

Nancy Bergstrom, PhD, RN, FAAN, in a multisite study, tests the Braden Scale for Predicting Pressure Sore Risk and finds its predictive capability accurate. The scale is now widely used in nursing homes and hospitals.

AJN’s role in dissemination. What’s critical, though is that the outcomes of research get disseminated to those at the point of care. Researchers tend to publish in research journals, but how many nurses in clinical practice read those journals? As a general nursing journal with a wide readership, AJN covers the “broad view” of what’s important for most nurses regardless of practice setting or role. It’s our mission “to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research . . . .”

So on this 25th anniversary of the NINR, my hope for the next decade (we can’t wait another 25 years) is that nursing research will move more and more into mainstream clinical journals.

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