Nurses play a crucial role in patient care at Massachusetts General Hospital, often spending more time with patients than any other member of the care team.
They are frequently the first to identify opportunities to enhance care, improve work processes, make patients safer and more comfortable during their hospital stays and reduce readmission rates.
Their unique points of view spark valuable insights into research that improves patient care.
The Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital holds Nursing Research Day each year to showcase and celebrate the impactful and innovative research conducted by Mass General nurses.
Below are short summaries of the winning abstracts from the 2020 Nursing Research Day.
Nutritional Status is Associated with New-Onset Delirium in Elderly, Acute Care, Orthopedic Trauma Patients
INVESTIGATORS: Susan Maher, PhD, CRNA, Esteban Franco Garcia, MD, Carmen Zhou, MD, Marilyn Heng, MD, Maria Van Pelt, PhD, CRNA, Oluwaseun Akeju, MD, PhD, Sadeq Quraishi, MD, PhD
Almost half of the emergency room visits by elderly individuals are due to injury or unintentional fall. When the fall results in major orthopedic trauma, up to 60% of individuals develop delirium—a state of confusion, disorientation and an inability to think clearly.
In a retrospective study of 471 patients aged 65+ hospitalized for major fractures, we found that malnourished patients—those with a score of 0-7 on the the Mini Nutritional Assessment-Short Form (MNA-SF)— were twice as likely to develop New Onset Dementia than non-malnourished patients (MNA-SF scores of 8-14). Each unit of decrement on the MNA-SF scale was associated with a 14% increase in NOD risk.
This suggests nutritional status may be a modifiable risk factor for NOD in elderly, orthopedic trauma patients.
Skin Care Guidelines: What is the Evidence Regarding Topical Agents on Skin During Radiation Treatment?
INVESTIGATORS: Janet Umphlett, RN; Cyndi Bowes, CNP; V. Capasso, PhD, APRN; Franchesca Carducci, RN BSN; Gregory Conklin, RN ND; L. Philpotts
Restrictions on the use of topical agents (creams, lotions and ointments) in adult patients undergoing radiation treatments were instituted in the 1970s without scientific evidence. These restrictions can increase the risk of skin breakdown, discomfort and infection and cause anxiety in patients.
We conducted a literature search for peer reviewed studies from (1997 to 2019) regarding radiation dermatitis and the effect of topical agents during radiation delivery. Five studies were eligible for inclusion. The agents tested included aqueous cream, zinc oxide, metallic deodorant and silver sulfadiazine 1% in various levels of thickness.
No significant increase in skin dosing was seen in any of these studies except with a 3mm layer of zinc oxide.
These studies show strong evidence there is no significant increase in skin dosing with moderate application of TAs (under 3mm) and that restrictions on the types and timing of applications of skin care products to the treated area should be omitted.
Comparison of Salivary Biomarkers with Infant Driven Feeding (IDF®) Scores
INVESTIGATORS: Margaret Settle PhD, RN, NE-BC, Kim Francis PHD, RN, PHCNS- BC, Elizabeth Farland BS, Sergei Roumiantsev MD, PhD, Paul Lerou, MD
Many preterm infants face oral eating disorders later in life, possibly due to poorly timed initiation of the transition from tube feeding to independent oral feeding.
The Infant-Driven Feeding® (IDF) program is a rating scale used by clinicians to assess a preterm infant’s readiness to feed (RTF). A recent research study also identified five biological markers in infant saliva that are correlated to RTF.
Our team investigated whether using a combination of biomarkers and IDF ratings could validate both approaches and approve RTF assessments.
We collected 19 salivary samples from seven infants and compared the levels of gene expression for these five biomarkers to the IDF scores from the infants’ electronic medical records.
We found that two of the biomarkers were positively expressed in all saliva samples and that infants with higher expression of these biomarkers displayed higher RTF scores and progressed to independent oral feeding sooner.
This suggests correlating AMPK and NPHP4 expression with IDF scores can improve assessment of feeding readiness and better inform the progression to independent oral feeding.
Pressure Injury Development, Mitigation, and Outcomes in Critical Care Patients Proned for ARDS Due to COVID-19
INVESTIGATORS: Virginia Capasso, PhD, CNP, ACNS, CWS, Colleen Snydeman, PhD, RN, Karen Miguel, MM-H, RN, Michelle Crocker, BSN, RN, Zachary Chornoby, BSN, RN, Mark Vangel, PhD, Mary Ann Walsh, BSN, RN, John Murphy, DNP, RN, Stephanie Qualls, MSN, RN, Xianghong Wang, MS.
Proning—placing ventilated patients on their stomachs—has been a powerful way to treat COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS).
However, pressure injuries (PIs) are a potential complication of proning and there’s a need to identify the best strategies to reduce them.
We conducted a retrospective chart review of 147 critical care patients proned at Mass General, looking at demographic, clinical, laboratory, treatment and outcome data. The patients were mostly male and Hispanic/Latino, and the median age was 61.
We found that facial pressure injuries dropped 70% by taping the endotracheal tube versus using a commercial tube holder, and that anterior pressure injuries decreased by 71% with the use of new pressure redistribution products.
Additionally, the patients who developed PIs tended to be heavier and on vasopressors (medicines that constrict blood vessels to increase blood pressure).
Our findings suggest that standardized methods for testing dressings and devices designed to reduce PIs are needed in order to inform and customize patient care.
Implementation of a Standardized Electronic Handoff Tool for Advance Practice Provider Patient Transfer
INVESTIGATORS: Christopher R. Curtis, APRN-BC; Laura K. Andrews, PhD, APRN, ANCP-BC.
Medical errors result in an estimated 210,000 to 255,000 deaths per year, and 80% are related to miscommunication by healthcare providers during patient transfer.
There is minimal literature on handoff tools for advance practice providers (APPs), and no formal handoff processes for patients transferring out of neurology intensive care units.
Our project was designed to increase the rate of documentation by APPs using a standard tool for patients being transferred to and from a neurology intensive care unit.
Of the 11 APPs who completed a pre-assessment, 65% said they were unsatisfied with the existing handoff process and 73% felt a standardized electronic tool would increase job satisfaction.
Based on these preassements, we created handoff tool that could be integrated into the electronic health record.
During the implementation period, the tool was used for 64 of 137 transfers (37%) involving 61% of all neurosurgery patients. Ten APPs completed the post-assessment and nine felt satisfied with the handoff tool due to perceived improvements in care processes.
More research is needed to see if the tool can reduce the number of medical errors related to patient transfers.
Nurse-Driven Implementation of Bubble CPAP in a Ugandan Nursery
INVESTIGATORS: Jennifer Duran RN, BS
Newborn respiratory complications are a leading cause of death in low resource settings.
Bubble Continuous Positive Airway Pressure (bCPAP)—a low cost method for delivering continuous airway pressure to infants in respiratory distress—has been identified as an effective intervention.
In a Ugandan nursery, 38 healthcare workers participated in bCPAP instruction. Clinical instruction included trainings on the pathophysiology of respiratory distress, the use of the Respiratory Severity Scale (RSS) for patient assessment, and bCPAP training. A post-lecture exam was used to evaluate participants’ understanding of these concepts.
Participants were then divided into small groups to assemble bCPAP devices using instructional materials. A skills checklist was used to assess the accuracy of each assembly.
Successful completion of both sessions enabled participants to identify patients who could benefit from bCPAP.
Educational impact was demonstrated by ongoing incorporation of the RSS and physical assessment skills when treating patients. Participants also recognized patients with contraindications to bCPAP and discontinued its use appropriately.
The results show that nurse-driven education can be used to implement lifesaving therapies in low resource settings. Further research is needed to assess the long-term sustainability of bCPAP training and its effect on patient outcomes.
About the Mass General Research Institute
Research at Massachusetts General Hospital is interwoven through more than 30 different departments, centers and institutes. Our research includes fundamental, lab-based science; clinical trials to test new drugs, devices and diagnostic tools; and community and population-based research to improve health outcomes across populations and eliminate disparities in care.
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