Vol. 7 Issue 23
Passion, scholarship and communication are a winning combination for a nurse set on improving patient care
Three years ago, Harriet came to see me because she wanted guidance in developing a nursing research study.
She had read a study in the American Journal of Nursing about preop fasting and was determined to develop a better practice for her patients. As a preadmission-testing nurse, Harriet was concerned about her patients being NPO too long, having seen children and elderly patients in the summer with 4 p.m. OR dates. She worried about them and others suffering from prolonged fasting.
When we met, I told Harriet she was going to need to decide whether she wanted to do a performance improvement project or a research study. Like many nurses who ask for help in developing a research proposal, Harriet had an ax to grind. I could see it frustrated her to set her opinions to the side to be objective. But in the end, she took off her "clinician's hat" and put on her "researcher's hat."
She and her clinical nurse specialist (now a nurse manager) developed a research proposal and had it approved by the Institutional Review Board. They collected and analyzed data, completed the manuscript and submitted it for publication, which was recently accepted.
"Preoperative Fasting: A Trilogy of Attitudes," set to be published in the AORN Journal, is a qualitative study on the perceptions of perioperative nurses, anesthesia providers and patients.
Getting published is quite an accomplishment, but it wasn't enough to satiate Harriet. Remember, she wanted to prevent excessive preop fasting. So she set off to meet with the anesthesiology department. Here, Harriet presented her study, discussed the relevant literature, reviewed the American Society of Anesthesia guidelines for preop fasting and asked for a change in policy based on those documents.
Anesthesiologists listened, debated and challenged Harriet's proposal to make the guidelines more liberal in the interest of patient comfort. They were respectful; they were concerned about patient safety too; and they insisted on their autonomy as clinicians in making patient care decisions. The discussion lasted an hour.
In the end, Harriet closed the sale. The updated policy will allow patients to have clear liquids up to 4 hours before their scheduled surgery time. Once out of the conference room, Harriet turned to me with an infectious smile and shot me a high five.
Harriet's passion for patients, her willingness to do the hard scholarship, and her ability to present a compelling argument for a change in anesthesia policy demonstrates to nurses what such a winning combination can accomplish.
Kathleen Beyerman is director of nursing staff development at the Community Health Institute at Winchester Hospital, Winchester, MA.