THROUGHOUT THE AGES, research has been used to advance the profession of nursing. For instance, Florence Nightingale was involved in clinical research when she kept systematic records of patient outcomes. The importance of engaging clinical nurses in research is becoming more apparent. When nurses directly experience research, they may become more acutely aware of the need for evidence-based practice (EBP).
Research makes nurses agents of positive change. The whole process builds nurses' confidence and stirs up something deep inside them to question current practices and seek out new challenges. New information discovered in the research process becomes the source of changes to EBP. Participating in research is a gratifying experience because nurses can witness how an idea is implemented and can see the changes that result. The research process summons professional growth, lifelong learning, and confidence to move up the clinical ladder.1
We used a research study about managing post-op nausea to engage clinical nurses in research on a cardiovascular step-down unit. (For a full description of this study, see “Inhaled Peppermint Oil for Postop Nausea in Patients Undergoing Cardiac Surgery” in the July issue of Nursing2016.2) For many, this was their first involvement in conducting nursing research. This article focuses on the strategies employed to engage nurses in clinical research.
An initiative to study the use of peppermint oil inhalers to decrease post-op nausea began with a poster critiquing Anderson and Gross's research article “Aromatherapy with Peppermint, Isopropyl Alcohol, or Placebo Is Equally Effective in Relieving Postoperative Nausea.”3 The poster was entered into a contest during Nurses Week, and then posted on the cardiovascular critical care complex (CVCCC), which is our open-heart surgery ICU and the open-heart surgery step-down unit, to provide an example of how to critique a research article. It also informed nurses about the use of peppermint oil for post-op nausea. This drew the interest of nurses in the step-down section of CVCCC, and they began asking if this approach would be appropriate for their patients undergoing open-heart surgery.
Due to the interest generated, a team of step-down unit nurses formed to study the effect of peppermint oil on nausea in post-op cardiac surgery patients. The intent of the research team was to develop a straightforward research project that would be exciting and could involve the entire nursing staff. The research team realized this was a golden opportunity to mentor nursing staff new to research and purposefully designed the study with this in mind.
Past research experiences had shown that complex protocols are difficult to implement. Knowing this, the research protocol algorithm was structured to be user-friendly. This approach decreased everyone's apprehension about research and encouraged greater staff participation in implementing the study. A quantitative approach was purposefully chosen over a qualitative approach because more staff could be involved in both data collection and analysis. The protocol for the study was similar to that of Anderson and Gross except that inhalers were used instead of gauze soaked with peppermint oil.3 A literature review found that no research studies on using peppermint oil to combat nausea in the cardiac surgical population had been published. The study was approved by the institutional review board (IRB).
In dynamic nursing environments such as ours, nurses need to generate evidence to guide an ever-changing practice. Patient outcomes can be greatly improved with evidence of superior quality. Having nurses involved in a current research project engages them to take ownership of the project.
Choosing a topic that's meaningful to nurses enhances their desire to be involved. When nurses see immediate results, this encourages them to be active participants. Designing a straightforward research protocol lets nurses integrate the study into their daily workflow, ensuring easy application and completion of the study. This also makes the research study less intimidating, and nurses are more inclined to understand and want to participate.1
The first step for clinical nurses in the research process was to complete the necessary human subject education. This education about the use of human subjects in research is required by the IRB. It includes the history of the ethical treatment of subjects, the right of potential subjects to refuse to participate in research or withdraw without penalty, informed consent, and requirements for vulnerable populations (older adults, prisoners, children, and those who are mentally ill).
The education often takes 8 hours to complete. Anyone taking the education must score 80% on each unit. For this study, 40% of our staff successfully completed the education. The research investigators maintained constant communication with all stakeholders, including clinical nurses, physicians, and management. Our management team was included from the beginning.
Everyone received weekly updates about the number of patients enrolled and how the study was progressing. This helped generate more enthusiasm, increasing the momentum, excitement, and engagement in the research project.
Participating in this clinical research study empowered both nurses and patients. One nurse said, “I felt empowered because the peppermint inhaler gave me one more option to offer the patient suffering from nausea. It also felt good when the patient got relief with the peppermint inhaler.” The peppermint inhaler gave patients more control because they could choose to use medication, the peppermint inhaler, or both to manage their nausea.
We're fortunate because our institution is committed to research that encourages and supports nurses' involvement. At our facility, we have an active research council and many experienced nurses who can help with the development and implementation of research. We have doctorate-prepared research nurses guiding the staff in their research projects. They not only help the principal investigator with the human subjects' application but are also readily available for any questions that may arise.
Within the institution, different aspects of the research process can be explored. The annual Critiquing a Research Article: Tell It in a Poster workshop introduces nurses to the process of carefully critiquing a research article. Nurses can also create a professional poster. The Nursing Journal Watch, another resource, gives nurses current research article recommendations of particular relevance for our organization.
The nursing research council (NRC), part of our shared governance structure, provides feedback for nurses who want to conduct research. The NRC also promotes research that aligns with the annual operating goals of the organization. This gives nurses guidance in choosing clinically relevant research areas. The NRC cosponsors an annual nursing research/EBP conference with several other institutions. Nurses can develop abstracts for either podium or poster presentations, have the abstracts peer-reviewed, and, if they're accepted, present their studies.
The research findings were first shared with the research team and then presented as a poster at the Ninth Annual Nursing Research Conference at Christiana Care Health System. The conference is sponsored by several hospitals and universities in the area. This exposure sparked an interest in the local medical and teaching community, including our own facility.
Because mentoring nurses in research was one goal of this study, the research investigators used the poster as another mentoring opportunity. Two of the nurses who'd excelled in recruiting patients into the study were asked if they'd like to participate in creating and presenting a poster highlighting the study and findings. This was these nurses' first opportunity to present a poster. They were very enthusiastic about presenting the poster and sharing the results of the study not only with our institution but also with other clinical and educational institutions. Mentoring continued with a presentation at nursing grand rounds.
Implications of the study generated a great deal of interest within our hospital, and more departments very quickly became interested in duplicating the study with their own patient populations. Nurses in the post-op acute care unit, joint replacement unit, heart and vascular interventional services, spinal surgery unit, and antenatal/high-risk unit expressed interest in replicating the study. Our research team wanted to not only share the results of the study, but also use the research findings as a springboard to incorporate a policy change within the institution. We wanted to include the peppermint inhaler as an option for the patients on our cardiac unit initially and eventually systemwide within our organization.
The findings were presented to our management and surgical teams. They determined that the peppermint oil inhaler would be considered a nurse-driven initiative and not a medication within our institution. Our presentation was given to the systemwide EBP council for its approval to create a new nursing procedure for the peppermint inhaler.
Not only have we been able to change procedure within the hospital, we've presented the information at a national conference, National Teaching Institute & Critical Care Exposition, sponsored by the American Association of Critical Care Nurses in May 2016 in New Orleans. Our first article about the study was published in Nursing2016.2
Peppermint twists practice
The peppermint inhaler research study was designed to mentor clinical nurses in research. Systematically, the investigators laid a pathway to circumvent or overcome common barriers to research, encouraging participation and taking the fear out of research. The results were very positive. Most clinical nurses in the unit participated in the research project. The nurses received instant gratification when they saw immediate results. This encouraged ownership of the research study and continued engagement in the project.
Both nurses and patients were empowered. The study started as a research initiative and became nurse driven, and finally patient driven as patients began asking to be enrolled in the study so that they'd have the option of using the peppermint inhaler. The nurses were able to witness the entire research process, from the conception of an idea through implementation and then dissemination. The findings from the study were so positive that other units asked permission to replicate the study with their patient population. This gave everyone involved in the study a sense of satisfaction and a job well done.
As a result of this study, our surgical director suggested that we explore applications for other aromatherapy in our patient population. From an institutional perspective, the implications are huge. The doorway for us to explore holistic complements to our traditional medical approach just swung open. Before this study, this particular doorway had been closed. This suggestion and support generated enthusiasm among the staff for the next research project. The focus of the next project will be lavender to enhance sleep in sleep-deprived surgical patients.
The icing on the “research cake” was the opportunity for the research team to change procedure: The nausea protocol now includes using a peppermint inhaler as an alternative for managing nausea. This change initially occurred on the unit, but it then rippled out to become a systemwide change through our systemwide EBP council.
Seeing the ramifications of this straightforward research study has inspired many other nurses within our facility to join the ranks of the clinical research nurses for the first time. This is truly a cause for celebration.