Newswise — In hospitals across the country, venous thromboembolisms (VTEs) pose a significant health risk, affecting more than 600,000 patients a year—despite effective prevention strategies such as blood thinners and compression stockings widely available to prevent these deadly clots.

At Johns Hopkins Hospital, Deb Hobson, RN, is part of a research team that is pushing to find out why. “I learned that 12 to 14 percent of our patients weren’t receiving the doses of heparin or other blood thinners that their doctors had ordered for them,” says Hobson. “As a nurse. I thought to myself, ‘Wow, that’s a lot!’ ”

With funding from the Patient Centered Outcomes Research Institute (PCORI), Hobson and nurse educator Dauryne Shaffer, MSN, RN, are developing training sessions for nurses aimed at ensuring more patients receive VTE-preventing medications. Their involvement is crucial to the overall success of the three-year VTE prevention project, notes principal investigator Elliott Haut, MD, PhD, a Johns Hopkins trauma surgeon.

“Without a multidisciplinary team, there’s no way you’re going to get buy-in from front line providers,” says Haut. “We all want to hear from our peers. Surgeons like to listen to surgeons. Nurses like to listen to nurses. When it comes to teaching and educating and giving advice, nurses want someone like them.”

Haut, who is also an associate professor of health policy and management at Johns Hopkins, says that over the past decade, he’s seen nurses become increasingly valued members of multidisciplinary research teams. “Science without collaboration doesn’t work,” he says bluntly. “If you try to do any [research] work in quality and patient safety without nurses having a voice, you’re dead in the water.”

Haut’s assessment appears to be shared by today’s grant funding organizations, from the National Institutes of Health, to PCORI, to the National Institute of Nursing Research.  Increasingly these agencies apportion their sought-after dollars to projects that cross disciplines and demand collaboration. “It has not been lost on funders and policy makers that involving nurses in research casts the spotlight on person-centered care and leverages the translation of evidence to practice,” says Patricia Davidson, PhD, MEd, RN, dean of the Hopkins School of Nursing.

Nurse researcher Deborah Gross, DNSc, RN, says it was precisely the potential for rich collaboration that drew her to Johns Hopkins back in 2008. And she hasn’t been disappointed.

“What makes Johns Hopkins such a great place to be as a scientist is how open people are to collaborating across school divisions,” says Gross, the Leonard and Helen Stulman Endowed Professor in Psychiatric and Mental Health Nursing. “I started doing this from the first day I arrived, working with people from the School of Public Health and the School of Medicine. If you’re doing good work, people want to know about it and be a part of it—whether you’re a nurse or a psychiatrist or a sociologist.”

Gross’s research focuses on promoting positive parent-child relationships and preventing behavior problems in preschool children from low-income neighborhoods. During her years at Rush University College of Nursing, she and colleagues launched the evidence-based Chicago Parent Program, which aims to strengthen parenting skills and prevent behavior problems in young children. The program is being used in early childhood programs across the country, including Head Start programs in Chicago and New York City.

Her research teams include a developmental pediatrician, psychologists, sociologists, social workers, psychiatrists, statisticians, and an economist. “It’s wonderful working across disciplines—they share perspectives that always make me think differently as a scientist,” says Gross.

While today’s nurses may be more and more in demand—as both collaborators and principal investigators—on scientific research teams, historically their importance to the team hasn’t been so readily recognized, says Christopher Chute, MD, MPH, DrPh, a newly appointed Bloomberg Distinguished Professor.

“Nurses have more direct day-to-day contact with patients than most other healthcare providers," Chute says. "They have a unique opportunity to contribute to what we know about patients in their activities of daily living—their sense of well-being, mood, disposition, attitude.”

From his years of experience in informatics, Chute has found again and again that these intangibles serve as “sentinel variables,” alerting healthcare providers to medical decline that might not otherwise manifest itself for weeks or months. “And yet historically, physicians, and for that matter the entire healthcare system, has diminished attention to what were regarded as these ‘softer’ variables, even though they are powerful predictors,” he says.

Show and Tell

In its research on why a significant number of patients at the hospital were refusing doctor-prescribed blood thinners, Deb Hobson and Dauryne Shaffer's team found some surprises. Among them: Some nurses believed that as long as their patients were ambulatory, the risk of blood clots was minimal, so they counseled patients against taking the prescribed medication. In other cases, nurses would make the decision to hold off on blood-thinning doses if patients were about to undergo a procedure (such as having a feeding tube inserted) out of concern that the medication could cause excessive bleeding.

While well intentioned, both courses of action had the potential to put patients at unnecessary risk of a deadly blood clot. Shaffer worked with other members on the research team to create several e-Learning modules. In addition, the team set up a technology-based system (tied to the electronic medical record) that alerts Shaffer or another nurse educator when a patient refuses a dose of prescribed preventive treatment. When she gets paged, Shaffer makes a visit to the patient’s bedside to talk through his or her concerns.

Based on what it learned by surveying patients, the VTE prevention team has come up with a one-page fact sheet (available in multiple languages) that is now given to many hospitalized patients. It also produced a short video in which patients who’ve suffered blood clots share their cautionary tales.

“We still have patients who will refuse [the blood-thinning] medication,” says Shaffer. “But at least it’s an educated refusal.”

Says Haut, “Without nurse representation in our group, it would have been impossible for us to work on any [of this]. When you’re doing quality and safety research on interventions for real patients on surgical floors, where nurses are an integral part of the care being delivered … it’s absolutely critical to have nurses on the team.”

Read the full article at magazine.nursing.jhu.edu

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