Content courtesy of South University.
For years, nurses with a passion for research have made strides that positively affected patient care, and that trend continued during the pandemic.
Early in the pandemic, nurses frequently confronted unknowns about how to best care for patients with COVID-19.
This uncertainty prompted Christine Wendt, MSN, RN, CEN, TCRN, a clinical specialist at Morristown Medical Center in New Jersey, to launch a study to find her own answers.
Wendt was eager to help patients with COVID-19 delay or avoid mechanical ventilation altogether because she’d seen too many people struggle to get off ventilators — and demand for these machines threatened to outstrip supply in many states.
To delay intubation, nurses throughout the country were experimenting with proning COVID-19 patients experiencing hypoxic respiratory distress, who were still awake and breathing on their own. This positioning strategy involved showing them how to lie face down and place one arm up over the head and the other down by their side.
“We did a literature review, and there was almost no data on proning patients who were not on a ventilator,” Wendt said.
To investigate whether the strategy was helping patients who had not been intubated, Wendt’s research team studied charts of patients who had COVID-19 and had been admitted through the emergency department between March 30, 2020, and April 30, 2020. They discovered that this method improved oxygen saturation and respiratory and heart rates for patients.
“This is a nurse-driven protocol that can easily be implemented,” said Wendt. The next step is exploring whether proning before intubation leads to decreased length of stay and better outcomes.
This study is just one example of how nurse research is shaping healthcare practices and policies throughout the nation.
“It’s critical for nurses to contribute to research because they can actively identify what needs to be improved when they are on the front lines caring for patients every day,” said researcher Jenna LoGiudice, PhD, RN, CNM, FACNM, an associate professor in the Egan School of Nursing and Health Studies at Fairfield University in Connecticut.
To support nurses interested in leveraging research to improve patient care, the work environment, or other aspects of the profession, hospitals are increasingly hiring nurse researchers or consultants who can help staff design and implement studies.
LoGiudice realized her expertise in trauma research could be applied to studying the experiences of nurses who were treating patients with COVID-19 during the pandemic. In the spring of 2020, she could find only two studies that had focused on this topic in China.
LoGiudice and her colleague, Susan Bartos, PhD, RN, CCRN, posted a request for participants on the American Association of Critical-Care Nurses website, and within two weeks, dozens of nurses responded.
“It was clear that they needed to be heard and process what they were going through,” LoGiudice said. Through quantitative and qualitative analysis, one of the themes that emerged was the heightened stress nurses felt because hospital protocols changed daily for patient care and the proper use and allocation of PPE.
In the study, one community hospital ICU nurse shared that staff “literally have no idea how to treat this, [and] each week is a guessing game as new data comes out showing what we did the week before made patients worse.”
Participants also shared how patients were depressed and fearful, and they smiled less without family members around. Some patients with COVID-19 asked nurses if they were going to die. One nurse said “the worst part was reassuring them ‘no’ but not being so sure yourself,” according to the paper.
Although these experiences took a toll on nurses, they also described the benefit of working during the pandemic, said LoGiudice.
“They were resoundingly proud of being nurses, and they highlighted how nurses pulled together in this difficult time,” she said.
LoGiudice hopes the study will validate the nurses’ experiences and motivate more hospitals to invest in wellness programs for staff.
Nurse Research Digs Into Staffing Ratios
The pandemic also highlighted the work of nurse researchers who have investigated the impact of nurse staffing ratios. A recent study showed significant variation in how many patients nurses were caring for in New York and Illinois — two states that are considering nurse staffing legislation. The ratios ranged from three to 10 patients per nurse, with the highest ratios in New York City.
“Our study found that before the pandemic, half of nurses working in hospitals were experiencing high levels of burnout,” said study author Karen Lasater, PhD, RN, an assistant professor in the University of Pennsylvania School of Nursing.
Half of the respondents gave their hospitals unfavorable safety grades, and two-thirds would definitely not recommend their hospitals. Nurses also were more likely to be dissatisfied with their jobs and intended to leave their employers if they worked in hospitals with higher-than-average staffing ratios.
Although better nurse staffing is associated with cost savings, if statewide staffing legislation is passed, the hospitals most in need of improved nurse staffing may also be the most financially constrained, said Rachel French, BSN, RN, one of the study’s authors and a predoctoral fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania.
“The next step will be finding creative solutions like grants to make better staffing ratios possible for all hospitals,” she said.
Studying Beliefs About Vaccines
Nurse researchers also are starting to investigate how to care for their communities as millions of people face decisions about whether or not to get the COVID-19 vaccines. Nancy Blake, PhD, RN, FAAN, an adjunct associate professor of nursing at University of California, Los Angeles and CNO at Harbor-UCLA Medical Center in Torrance, California, had noticed vaccine hesitancy among people of color at her hospital, and the majority of patients at the medical center were Hispanics, Blacks, or Asian Pacific Islanders.
To study why patients were declining vaccination opportunities, Blake applied for funding for a DAISY Health Equity Grant, a new program offered by the DAISY Foundation, an organization known for honoring nurses who demonstrate extraordinary compassion during their work.
Blake’s proposal was approved, and later in the spring, she will use the grant funding to explore how social determinants of health and other factors influence vaccine choices. “There may be an aunt, grandfather, or other relative who makes the decision for the entire family, but those choices may be based on fear,” Blake said.
The goal of the study is to develop interventions aimed at answering questions people may have about the vaccines. For Blake, studies like this highlight the powerful influence nurse researchers can have on their communities.
“We saw hundreds of people of color die of COVID-19 at our facility, and many of their loved ones shared that they hadn’t heard about the risks of large gatherings during the pandemic,” Blake said. “We hope to publish and disseminate our findings to improve outcomes for people of color.”