Asking Nursing Questions
The research of Debra Ridling, a clinical nurse specialist on the Intensive Care Unit, established a best practice for checking blood flow to a child's organs.
At 7:15 a.m. on the Medical Unit, a young patient's nurse meets with other members of his care team, including the physician, a respiratory therapist and the boy's mother.
After the group discusses his plan of care, the nurse sits with the mom to make sure she fully understands a procedure scheduled later that day for her son.
It's a much different scenario than Linda Latta, PhD, recalls from her days as a staff nurse at a large hospital in the 1970s.
One of her morning duties was ushering parents off the ward before doctors began patient rounds.
"Including parents on the care team is a big evolution in patient care," explains Latta, who now leads Nursing Professional Development at Children's. "Often, it's the curiosity of bedside nurses that starts the process of exploring patient care improvements like this."
There's an art to nursing, but its most basic skills — observing, listening and asking questions — are also the foundation of scientific inquiry.
Using research to look critically at the "way things have always been done" is an expected role for nurses at Children's. Throughout the hospital, staff nurses are asking research questions aimed at finding care practices that support the best outcomes for children, teens and families.
Evolving the status quo
Take the question asked by clinical nurse specialist Debra Ridling, a 10-year veteran on the Intensive Care Unit (ICU), who wondered if the accepted method for checking blood flow to a child's organs — touching the feet to assess warmth — was truly the best indicator.
Our nurses' spirit of inquiry helps us to continually improve patient care and reduce errors at the bedside.
Susan Heath
Children's nurse executive
She also questioned whether the blood flow reading on a little-used bedside monitor was truly accurate.
She searched the clinical literature to see if other clinicians had evidence about the accuracy of the bedside monitor.
When Ridling's search turned up nothing, she led her own study to compare the effectiveness of three different ways of measuring blood flow.
In the end, her data showed that neither the hand method touted as standard clinical practice in the nursing literature nor the bedside monitor readout recommended by the equipment manufacturer were nearly as effective as putting a thermometer against a child's feet.
Ridling's finding, an example of Children's evidence-based approach to nursing practices, is helping ICU nurses and doctors monitor critically ill children more effectively.
And, when published, her study will contribute to improving clinical practice for nurses across the country.
Meeting unmet needs
Karen Wilkinson, pictured with childhood cancer survivor Jeanna Dance, developed a comfort kit to ease the anxiety and fear experienced by children during painful procedures.
Karen Wilkinson, ARNP, an oncology nurse practitioner, repeatedly heard parents wish they could do something for their children during painful procedures.
She also saw the anxiety experienced by children anticipating lab visits and treatments.
So she developed a comfort kit for parents and clinicians to use with children who were experiencing fear.
To evaluate the usefulness of this new tool, Wilkinson studied patients and families before and after using the kit. Nurses at Children's Clinical Research Center, experts in obtaining consent and collecting research data, helped her.
Patients and parents overwhelmingly rated the distraction props in the comfort kit — pinwheels, bubbles, squish balls, imagery cards and various types of puzzles — as very effective.
Based on these results, Children's now uses these kits throughout the hospital. Wilkinson presented her study at the March conference of the American Society for Pain Management Nursing.
"Our best nursing moments are when curiosity, creativity and rock-solid evidence come together to improve the gold standard of care that changes the lives of children and their families for the better," says Susan Heath, Children's nurse executive.
"Our nurses' spirit of inquiry helps us to continually improve patient care and reduce errors at the bedside."