Tuesday October 22nd 2019

The findings are in

Nursing research makes a difference for colleagues, patients, the public

If there is a good idea to be had — and particularly one that can make a difference in the lives of patients, communities or other nurses — there most likely is a nurse researcher behind it.

Since its founding in 1955, the American Nurses Foundation (ANF), the charitable and philanthropic arm of the American Nurses Association, has supported more than 950 novice and experienced nurse researchers through its Nursing Research Grant (NRG) program as they’ve tackled a wide range of topics. The National Institute for Nursing Research and the Agency for Healthcare Quality and Research also are key movers of nursing research.

“When I started conducting nursing research, there was one journal,” said Norma Lang, PhD, RN, FAAN, FRCN, a world-renowned nurse researcher and Wisconsin Nurses Association member who has been instrumental in building the foundation’s NRG program. “Now I can’t keep up with the dozens of journals that come out every month.”

And that is a good thing.

“The breadth of research that has been done by nurses and what is being done by nurses is incredible,” said Lang, an expert in quality measurement and past ANF president. They’ve addressed pain, safety and quality, technology and women’s health, to name some examples. (For more on the breadth of nursing research, see the related story below.)

What follows is an example of the issues that three NRG awardees are currently exploring: workplace bullying, loneliness, and the effects of a neighborhood’s walkability on health.

Changing bad behavior

When Ohio Nurses Association member Peggy Ann Berry, MSN, RN, COHN-S, SPHR, returned to school in 2006 to advance her education, she had not yet settled on a research topic.

Peggy Ann Berry

Then, while working in her job as a clinical instructor, she had what she describes as an “a ha” moment.

“A charge nurse was verbally berating one of my students,” said Berry, who had been an occupational health nurse and case manager for the previous 15 years. “I got in between them, and told the charge nurse that that was not the way to talk to — or teach — someone. And then she said to me, ‘How else are [potential nurses] going to learn?’”

That nurse subsequently did not speak to Berry or any of her students during the rest of the clinical rotation on her unit. Since that day, Berry has been exploring workplace bullying as she’s moved through her master’s degree and toward her PhD. She received a two-year NRG grant in 2011 to specifically study the coping strategies of novice nurses after workplace bullying.

“As nurses we treat our patients well, but we don’t always treat other nurses or student nurses as well,” she said.

In her previous research from 2010, Berry found that more than 70 percent of novice nurses are exposed to workplace bullying — with the majority being the target of that bullying. Additionally, the novice nurses — who were largely bullied by their nurse colleagues — were at high risk for developing anxiety and stress and becoming less productive as a result.

Berry now is analyzing the data in her current project, which looks at the same cohort of new nurses from Ohio, Indiana and Kentucky, to determine which coping strategies, such as having the support of outside peers and family or just changing work units, were most effective in stopping workplace bullying.

While delving into this important workplace topic, Berry has encountered some surprises. For one, she believes that nurses don’t interpret workplace bullying the same, in part, because it is referred to in varied terms, such as horizontal violence, workplace violence and abuse. Her definition of workplace bullying takes into account factors such as the nature of the bullying, balance of power, and the frequency, duration and intentionality of the bullying.

She also discovered that new nurses — based on how they were raised or their inherent traits — can sometimes misinterpret the communication styles or facial expressions of their stressed-out colleagues as bullying. Additionally, the workplace culture may be built upon incivility, which can further exacerbate problems for new nurses who often feel powerless.

That said, Berry added, “If you think you are being bullied, you are. And you need to get help.” (See ANA’s resources on bullying at nursingworld.org.)

Berry hopes that through her current research, she can develop effective interventions to protect new nurses against workplace bullying. Those interventions, in turn, can lead to a safer patient environment and fewer nurses leaving their workplaces or the profession.

Employers need to address incivility and bullying in the workplace, as well as workload and other issues that create unhealthy work environments, she added. Nursing schools need to talk with student nurses about successful coping strategies, resiliency and reporting up the chain of command.

“And we all need to look at our behaviors and work on this together,” Berry said.

Intervening in loneliness

Certain workplace behaviors also sparked West Virginia Nurses Association member Laurie Theeke, PhD, FNP-BC, GCNS-BC, down an intriguing research path: what can be done about loneliness.

Laurie Theeke

“I’m a family nurse practitioner and clinical nurse specialist in gerontological nursing,” Theeke said. “At the clinic where I work, I heard some medical students say that there is nothing they can do for some of the older patients who come in — that they are just lonely or they just want to talk.

“What we know about loneliness is that it exists, but we don’t do anything about it,” she said. “Yet it can affect everyone across their lifetime, generally around transitions, such as losing a spouse or becoming a new mother.”

Historically, researchers looked at loneliness as a social problem, and then they focused on its link to depression. A 2012 study, however, showed that loneliness can lead to functional decline and mortality, according to Theeke.

Theeke’s ANF grant, along with funding from the Robert Wood Johnson Foundation, is allowing her to specifically explore which emotions are attached to loneliness by interviewing older adults living with chronic illness in Appalachia who have scored high on a loneliness index she administered. Like many other nurse researchers, it is a topic that allows her to investigate the mind-body connection and to look at the whole person — a perspective that Theeke believes nurses are uniquely positioned to provide.

What Theeke has learned so far from her interviews with older adults is that loneliness is equated with stigma, sadness, anxiety, depression, anger toward themselves and others, and to some degree, fear about their situation. Associated behaviors also can vary, from crying to smiling.

“I’d like to help people process the way they think about themselves so they can move forward,” Theeke said. Her next goal is to test targeted interventions that can address the specific components of loneliness.

She also believes that researchers need to determine whether functional decline leads to people isolating themselves, or whether it generally happens the other way around.

“Nurses and other health care providers need to really listen to their patients, because patients know when you are not being attentive,” Theeke said. “[Health care professionals] also need to take on loneliness as a health care issue, assess people for it and then determine ways to change people’s response to loneliness.  It might save a life.”

Challenges of a neighborhood walk

Walking has been a huge and enjoyable part of Pamela DeGuzman’s daily routine since childhood.

Pamela DeGuzman

“I grew up in a suburb of Boston that was very walkable,” said DeGuzman, PhD, MBA, RN, a Virginia Nurses Association member. “And I’ve always tried to live within walking distance from where I worked.”

Given her background in community health nursing, she also saw walking as a potential public health strategy. As DeGuzman began reviewing the literature for her research project, she saw that there were many studies that linked walking with better physical, emotional and mental health.

“But I noticed a pattern,” DeGuzman said. “In nursing, we are particularly focused on vulnerable populations. And there was very weak or nonexistent data on walkability and the health of vulnerable populations in the literature I reviewed.”

So with NRG funding, DeGuzman focused her research into how pedestrian-friendly neighborhoods may influence health outcomes of low-income residents using data from three select cities. To see whether neighborhood features also played a role in health disparities among racial and ethnic minorities, she further parsed the data to see whether neighborhood features affected poor, African-American women differently than poor women from other racial backgrounds.

Looking at her findings, she saw that one-third of the women in these low-income neighborhoods rated their health status as fair or poor. A significant portion also reported having a body mass index that was on the cusp of overweight and obese.

She ultimately discovered that the walkability of a neighborhood, such as the availability of sidewalks, did not seem to influence the health of low-income women from African-American or other racial backgrounds. Rather it was other factors, such as the actual or perceived safety of the neighborhood, that were associated with mental and physical health risks.

“As nurses, we need to look closely at where people are living,” DeGuzman said. “Sometimes we tell people they need to walk to lose weight or to get healthier. Maybe it’s not about them being unmotivated, but rather that they don’t feel safe in their neighborhood. So we need to look at those factors and work collaboratively with our patients and community residents.”

Given her research findings, DeGuzman said she and other nurses need to start working with urban planners to determine which changes can be made in neighborhoods to improve safety, and ultimately, residents’ health.

“Maybe it’s not about putting in sidewalks, but eliminating vacant lots,” she said.

— Susan Trossman is the senior reporter for The American Nurse.

The wide world of nursing research

Nursing research has always been deep and broad, inclusive and cutting edge. Part of its richness is related to the variety of settings and roles that nurses work in, from community health centers to nursing informatics to acute care clinicians. Another factor is that professional nurses have an inherent ability to see a need and want to address it.

World-renowned nurse researcher and Wisconsin Nurses Association member Norma Lang, PhD, RN, FAAN, FRCN, recently outlined several broad areas of study where nurse researchers have made their mark. (See related story, page 1.) They include examining:

• Specific clinical conditions, practices and problems, such as pain, depression, falls and smoking.

• Workplace issues, including back injuries, factors that create a safe workplace to deliver care, and psychosocial factors.

• How care is organized, such as acute care, primary care and transitional care.

• Care coordination and patient-centric care.

• Credentialing and regulations around nursing practice.

• Safety and quality, including developing and measuring quality, and using the American Nurses Association’s database, the National Database of Nursing Quality Indicators® (NDNQI®) to benchmark and compare care.

• Informatics, including looking at how to make health data more useful for nurses, administrators and for policymaking.

• Care and needs of specific populations, such as older adults, pediatric patients and women.

• Ethics, including end-of-life care and moral distress.

• Development of nursing theories to guide practice.

Resources to help nurses get started

ANA’s research agenda and research toolkit: www.nursingworld.org/EspeciallyForYou/Nurse-Researchers.

NDNQI: www.nursingquality.org.

American Nurses Foundation National Research Grants: www.anfonline.org.

Federally funded research:

National Institute for Nursing Research: www.ninr.nih.gov.

Agency for Healthcare Quality and Research: www.ahrq.gov.

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