The Nursing INQUIRY Triad · ANA Code of Ethics for Nurses Provision 7 • “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry,

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The Nursing INQUIRY Triad: Quality Improvement, Evidence-Based

Practice, and ResearchKaren Gabel Speroni, PhD, BSN, MHSA, RN

Nursing Research Consultant

Leesburg, Virginia

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What Is Your Best Practice Idea?

• Please complete the QuERY card provided at registration.

QuERY:Quality Improvement, Evidence-Based Practice, Research & You

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Objectives

• Review background of quality standards and measures as they apply to research priorities

• Review inquiry methodologies for conducting quality improvement (QI) activities, evidence-based practice (EBP) projects, and nursing research studies

• Review nursing research studies published following the processes and their translation of findings

iQuERY: Quality Improvement, Innovation, Evidence-Based Practice, Research & You

iQuERY fuels the spirit of inquiry!

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Inquiry

• Defined [Merriam-Webster]• A request for information• An official effort to collect and examine information

about something

• Systematic inquiry• Designed to develop knowledge about issues of

importance• Practice• Education• Administration• Informatics

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The Inquiry Triad of QI, EBP & Research: Each Informs the Other

• QI Activities• Improves processes of

care / system focused

• EBP Projects• Uses new knowledge to

change practice

• NR Studies• Generate new

knowledge

QI

NR EBP

iQuERYfuels the spirit of inquiry!

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Why is Inquiry Important?

• Advance the practice of nursing• Nursing related quality standards and measures

• Nurse sensitive indicator measures and national databases

• American Nurses Association (ANA)• Institute of Medicine (IOM) / National Academies of

Science (NAS)• The Joint Commission Standards (TJC) National Patient

Safety Goals• Patient Protection and Affordable Care Act (ACA) quality

related outcome requirements• Other ………………………………

• Alignment with organizational and nursing strategic goals• Funding

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ANA Scope & Standards of PracticeStandard 13: Research

• 17 national standards of practice and performance that define the who, what, where, when, why and how of nursing practice

• Standard 13: Research: • RNs utilize best available evidence, including research

findings to guide practice decisions• RNs actively participate in research activities at levels

appropriate to education and position

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ANA Scope & Standards of PracticeStandard 13: Research (continued)

• RNs actively participate in research activities at levels appropriate to education and position, including activities of:

• Identification of clinical problems specific to nursing research (patient care and nursing practice)

• Participate in data collection• Participate in a formal committee / program• Share research activities / findings with peers / others• Conduct research • Critically analyze and interpret research for practice

application• Use research findings to develop policies, procedures,

and standards of practice• Incorporate research as a learning basis

iQuERY card

Nursing Research Council or inquiry Council

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ANA Scope & Standards of PracticeStandard 13: Research (continued)

• Advanced Practice Registered Nurse• Contribute to nursing knowledge by conduct or synthesis

of research, to discover, examine, and evaluate knowledge, theories, criteria, and creative approaches to improve healthcare practice

• Nursing role specialty• Contribute to nursing knowledge by conduct or synthesis

of research, to discover, examine, and evaluate knowledge, theories, criteria, and creative approaches to improve healthcare practice

• Formal dissemination of research findings through activities, such as presentation, publication, consultation and journal clubs

Nursing Scope and Standards of Practice: A detailed and practical discussion of competent levels of nursing

practice and professional performance

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ANA Code of Ethics for NursesProvision 7

• “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standard development, and the generation of both nursing and health policy.”

• Evidence-informed practice

ANA Code of Ethics for Nurses with Interpretive Statements, 2015

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ANA Code of Ethics for NursesProvision 7• Knowledge base for nursing practice

“Nurses use theoretical and evidence-basedknowledge…to assess, plan, implement, and evaluate care. Nursing interventions are intended to produce beneficial effects and contribute to quality outcomes. Nurses evaluate the effectiveness of their care in relation to identified outcomes and use evidence to improve care.”

ANA Nursing‘s Social Policy Statement

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The Joint Commission

• 2018 National Patient Safety Goals• Purpose: Improve patient safety• Focus: Problems in health care safety

and how to solve them• Quality and evidence driven

Where is an inquiry method needed or

innovation?

Hospital• Identify patients correctly

• Improve staff communication

• Use medicines safely

• Use alarms safely

• Prevent infection

• Identify patient safety risks

• Prevent mistakes in surgery

Ambulatory• Identify patients correctly

• Use medicines safely

• Prevent infection

• Prevent mistakes in surgery

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ACA

• Charged with driving QI in health care • 2011 ACA National Quality Strategy priorities to

achieve better care, healthy people / healthy communities, and affordable care for Medicare, Medicaid, and Children’s’ Health Insurance Program

1. Make care safer by reducing harm in the deliver of care2. Ensure each person and family are engaged as partners in

their care3. Promote effective communication and care coordination4. Promote most effective prevention and treatment practices

for leading causes of mortality5. Work with communities to promote wide

use of best practices to enable healthy living

6. Make quality care affordable through new health-care delivery models


innovation?

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Centers for Medicare & Medicaid Services

• Quality measures• Tools that measure / quantify healthcare processes,

outcomes, patient perceptions, and organizational structure and/or systems associated with the ability to provide high-quality health care and/or that relate to one or more quality health care goals:

• Effective• Safe• Efficient• Patient-centered• Equitable• Timely care

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html


innovation?

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Focus systematically on the parts of each of the processes to

understand the whole picture

“If you can't see the small picture, you miss the big picture”.

James Speroni, 2016

QI

Research

EBP

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Nurses are Innovators

Innovation Defined: “Innovation is the application of creativity or problem solving that results in a widely adopted strategy, product, or service that meets a need in a new and different way. Innovations are about improvement in quality, cost effectiveness, or efficiency”. (Kaya et al 2015, 1674)

2019 Magnet Application Manual, ANCC

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Nurses are Innovators (cont)

Innovation• Application of better solutions to meet [new]

requirements for existing needs• Accomplished with more effective product,

processes, services or technologies• Something new, original and/or an environmental

improvement

Innovation versus improvement• Innovation doing something different• Improvement doing something better

Where something does not exist

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The INQUIRY TRIAD and the QuERY Model

QuERY: Quality Improvement, Evidence-Based Practice, Research & You• Document idea on QuERY card• Conduct literature review to determine inquiry process to follow based on

evidence findings• Schedule discussion of idea with Nursing Research Council (NRC) to review

inquiry processes

If idea is an EVIDENCE-BASED PRACTICE PROJECT

follow Johns Hopkins EBP Model Guides and Tools

If idea is a QUALITY IMPROVEMENT ACTIVITY

follow Focus PDSA Process

Improvement Action Plan template

If idea is a NURSING RESEARCH STUDY follow

Nursing Research Study Process Steps

Evidence TranslationPractice

Question

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Definition: Quality Improvement

Quality Improvement Defined: “Consists of systematic and continuous actions that lead to measurable improvements in healthcare services and the health status of targeted patient groups.”

(US Department of Health and Human Services Health Resources and Services Administration 2011, 1)


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Quality Improvement Processes

• Identify quality improvement• Collect data• Analyze data• Generate recommendations• Implement process changes

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QI Improvement Processes/Models

FOCUS/PDSA• FOCUS: Do once

• Find process to improve• Organize team• Clarify current knowledge• Understand variation• Select process changes / improvement

interventions

• PDSA: Cyclical and ongoing• Plan the changes• Do [implement the change]• Study the effects of the changes• Act on what your analysis reveals

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QI Improvement Processes/Models (cont.)

• Lean Model• Defines value by what a customer (i.e., patient) wants • Maps how value flows to the customer (i.e., patient)• Ensures the competency of the process by making it cost-

effective and time-efficient

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

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• Six Sigma:• Measurement-based strategy for process

improvement and problem reduction• Completed through the application of the

QI project

http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/part3.html

Define Measure Analyze Improve Control

Problem or opportunity

Data before Discuss, explore, investigate, flow, interview

Test change

Data afterPrevent practice drift

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• Two Six Sigma models: • DMAIC (define, measure, analyze, improve, control)

• Designed to examine existing processes

• DMADV (define, measure, analyze, design, verify) • Used to develop new processes

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Quality Improvement Balance

• Access versus cost• Cost versus quality• Quality versus access

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SQUIRE Guidelines

Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines• Title and abstract• Introduction: product description, available knowledge,

rationale, specific aims• Methods: context, interventions, study of the

interventions, measures, analysis , and ethical considerations

• Results • Discussion: summary, interpretation, limitations,

conclusions • Other information: funding

WWW.SQUIRE-STATEMENT.ORG

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The Inquiry TriadQI, EBP & Research

• QI Activities• EBP Projects• NR Studies


QI

NR EBP

NURSING EXCELLENCE

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Definition: Evidence-Based Practice

EPB Defined: “A problem-solving approach to clinical decision making within a health-care organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of evidence to care of the individual patient, patient population, or system.” (Newhouse et al. 2005, 3-4)


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Where Does Evidence Come From?• Practice based evidence

• Clinician expertise

• Research-based evidence• Research

• Patient values and preferences

• Patient experiences

• Guidelines• Case studies• Performance data• Organizational• Regulatory

NEEDED: Evidence-Informed Practice

Many traditions have been embedded in our nursing culture and as such their validity has not been adequately

evaluated

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Always Ask Three Questions

1. Are the results valid?2. What are the results? 3. Will the results help me care for my patient?

• Best research evidence• Clinical expertise• Patient values and preferences

Patient Values & Preferences

Best Research Evidence

Clinical Expertise

EBP

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Evidence Cycle: Five A’s of EBP

• Assess: Clinical evaluation• Ask: Develop the clinical question

• PICO (patient population, intervention, comparison, outcome; t – time)

• Acquire: Search the evidence• Appraise: Critically appraise the evidence• Apply: Apply it to the patient and reevaluate

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Translating New Knowledge into Practice: EBP Models

(Stetler, 2001)

(Rossworm & Larabee, 1999)

(Stevens, 2004)

(Titler, et al., 2001)

(Newhouse, 2007)

Stetler Model

Rossworm & Larabee

ACESTAR

IOWA Model

Johns Hopkins Nursing Model

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Johns Hopkins Nursing EBP Model [2017]

19 Step ProcessSteps 1-6: Practice questionSteps 7-11: Evidence steps Steps 12-19: Translation

# of Steps658

©The Johns Hopkins Hospital / Johns Hopkins University School of Nursing

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Practice Question Steps (Steps 1-6)

• Step 1: Recruit interprofessional team

• Step 2: Define the problem

• Step 3: Develop and refine the EBP question

• Step 4: Identify stakeholders

• Step 5: Determine responsibility for project leadership

• Step 6: Schedule team meetings

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Evidence Steps (Steps 7-11)

• Step 7: Conduct internal and external search for evidence

• Step 8: Appraise the level and quality of each piece of evidence

• Step 9: Summarize the individual evidence

• Step 10: Synthesize overall strength and quality of evidence

• Step 11: Develop recommendations for change based on evidence synthesis

• Strong, compelling evidence, consistent results. • Good evidence, consistent results• Good evidence, conflicting results• Insufficient or absent evidence

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Translation (Steps 12-19)

• Step 12: Determine fit, feasibility, and appropriateness of recommendation(s) for translation path

• Step 13: Create action plan

• Step 14: Secure support and resources to implement action plan

• Step 15: Implement action plan

• Step 16: Evaluate outcomes

• Step 17: Report outcomes to stakeholders

• Step 18: Identify next steps

• Step 19: Disseminate findings

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Follow the Steps and USE THE FORMSAPPENDIX FORM • Appendix A: Project Management Guide• Appendix B: Question Development Tool• Appendix C: Stakeholder Analysis Tool• Appendix D: Evidence Level and Quality Guide• Appendix E: Research Evidence and Appraisal Tool• Appendix F: Non-Research Evidence Appraisal Tool• Appendix G: Individual Evidence Summary Tool• Appendix H: Synthesis Process and Recommendations Tool• Appendix I: Action Planning Tool• Appendix J: Dissemination Tool

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Use of EBP

• When

• Where

• Integrate best research evidence with clinical expertise and patient values (Sackett et al., 2000)

• Process for developing guidelines• Guideline for practice decisions• Integration of multiple findings and ideas

What do we need do EBP

on?

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The Inquiry TriadQI, EBP & Research

• QI Activities• EBP Projects• NR Studies


QI

NR EBP

NURSING EXCELLENCE

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Nursing Research

Nursing Research Defined: “Nursing research provides the scientific basis for the practice of the profession. Using multiple philosophical and theory-based approaches as well as diverse methodologies, nursing research focuses on “understanding the symptoms of illness; preventing and slowing disease or disability; finding effective approaches to achieving optimal health; and improving clinical settings where care is provided (American Association of Colleges of Nursing 2006, 1). For Magnet® purposes, nursing research may encompass studies of work environment, professional development, organizational supports, and other factors that influence nurse and nursing outcomes.”


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Speroni’s Research Steps

20 Steps: From Nursing Research

Study Idea Inception to

Translating Findings into Practice

Work with a mentor for each of these steps

• McLaughlin, Speroni, Kelly…, JONA 2013;

• Kelly, Turner, Speroni…., JONA, 2013.

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Speroni’s Research Steps (cont.)

• Step 1: Conduct literature review• Identify gaps• Identify study team

• Step 2: Obtain approval to secure support of nursing research study idea

• Determine need for funding• Step 3: Develop nursing study

protocol following protocol templates

• Step 4: Develop data collection tool following template

• Surveys, Case Report Forms • Step 5: Develop study log(s)


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• Step 6: Develop table shells following templates

• Step 7: Develop database for data entry and following template and test

• Step 8: Consult with statistician prior to Institutional Review Board (IRB) submission

• Review protocol data analysis methods

• Sample Size• Database

• Step 9: Submit required study documents to IRB


Know where you are going before you start

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Speroni’s Research Steps (cont.)• Step 10: Create Study Initiation

Meeting (SIM) document following template

• Step 11: Hold SIM after IRB approval/review and initiate study

• Step 12: Conduct study with routine reporting to nurse research leader

• Step13: Conduct data analysis • Ensure quality assurance review of

data in databases prior to analyzing

• Step14: Draft manuscript• Peer-reviewed journal• Identify implications for practice


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• Step 15: Disseminate findings with nursing leadership approval (Manuscript, Abstract for poster, and Podium presentation)

• M• A• P

• Internal dissemination• Conference presentations and

posters• Newsletters• Annual reports

• Step 16: Archive study files

MAP

it out


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• Step 17: Provide implications for practice recommendations to nursing leaders / Shared Governance councils

• Change in policy / procedure• Change to care delivery • Change in work environment

• Step 18: Translate findings into practice

• Implementation strategies

• Step 19: Evaluate effect of change in practice


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• Step 20: REJOICE

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Speroni’s Research Steps

Summary• Its like a wheel, going

around and around again, doing the same steps for completely different ideas, generating the same outcome: translating findings into practice


• McLaughlin, Speroni, Kelly…, JONA 2013;

• Kelly, Turner, Speroni…., JONA, 2013.

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Nursing Research Study Published Examples

• Patient Anxiety in ED• Isolation Patients• Violence (workplace, lateral, family,

domestic)• MRSA• Emerging diseases• NICU• ICU• Hospital nursing research

infrastructure• BSN degree completion• Handoffs• Case management• Behavioral health• Near misses/safety violations• Occupational health

• Nurse tattoo / body piercings• Bariatrics• PICC lines• Hemolysis• Surgical services• Orthopedics• Ambulatory – Catheter Care

Clinic• Endoscopy• Obesity

• Nurses Living Fit• Kids Living Fit

• Shared governance• Annual review process• Interdisciplinary

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• Patient Anxiety in ED• Shapiro, M., Speroni, K.G., Edsall, R., & Daniel, M.G. What is the

relationship between ED patient anxiety level and patient sureness of medication history? Nursing2017; 47(10): 58-64.

• Improvement: EMR modification to verify medications in ED.

• Isolation Patients• Roderick, M., Speroni, K.G., Stafford, A., & Seibert, D.J. (2016). Pilot

Evaluation of Isolation Patients’ Perceptions on Ability to Identify Types of Health Care Workers When Wearing Isolation Gowns. AJIC.

• Improvement: Processes for isolation patients to identify health care worker type when worker gowned.

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Nursing Research Study Published Examples: Violence

• Workplace Violence• Speroni K.G., Fitch T., Dawson E., Dugan L., & Atherton M. (2014).

Incidence and Cost of Workplace Violence Perpetrated by Hospital Patients or Hospital Visitors. J Emerg Nurs. 1-11. doi:10.1016/j.jen.2013.05.014.

• Improvement: Awareness; processes for documenting; legislation.

• Lateral Violence/Bullying• Stagg, S., Sheridan, D., Jones, R., & Speroni, K.G. (2013). Survey Research

Evaluation of a Workplace Bullying Program. Workplace Health & Safety, 61(8), 333-338.

• Stagg, S., Sheridan, D., Jones, R. A., & Speroni, K. G. (2011). Evaluation of a Workplace Bullying Cognitive Rehearsal Program in a Hospital Setting. The Journal of Continuing Education in Nursing, 42(9), 395-403.

• Improvement: Harassment in workplace policy revisions.

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Nursing Research Study Published Examples: Violence

• Family Violence• Durham-Pressley, C., Speroni, K.G., Kingan, M.J., MacDougall P., & Williams,

M. (2018). Nurse Perceptions of the Family Violence Screening Process and Education Program in a Rural Healthcare System. Nursing2017; 48(1): 56-63. http://journals.lww.com/nursing/Citation/2018/01000/Nurse_perceptions_of_the_family_violence_screening.15.aspx

• Improvement: Modification of family violence documentation questions/requirements

• Domestic Violence• Trinkley, D., Bryan, S., Speroni, K. Gabel, Jones, R.A., & Allen, H. (2012)

Evaluation of Domestic Violence Screening and Positive Screen Rates in Rural Hospital Emergency Departments. Online Journal of Rural Nursing and Health Care; 12(1):78-82. http://rnojournal.binghamton.edu/index.php/RNO

• Improvement: ED domestic violence screening processes expanded.

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• MRSA• Seibert, D., Speroni, K.G., Oh, K.M., Devoe, M., & Jacobsen, K. (2014).

Preventing Transmission of MRSA: A Qualitative Study of Healthcare Workers' Attitudes and Suggestions. American Journal of Infection Control

• Seibert, D., Speroni, K.G., Oh, K.M., Devoe, M.C., & Jacobsen, K.H. (2014). Knowledge, Perceptions, and Practices of Methicillin-Resistant Staphylococcus aureus Transmission Prevention among Acute Care Setting Healthcare Workers. American Journal of Infection Control.

• Improvement: Handwashing by health care workers (HCW)

• Emerging Diseases• Speroni, K.G., Seibert, D., & Mallinson, R.K. (2015). Nurses'

Perceptions on Ebola Care in the United States, Part 2. Journal of Nursing Administration, 45(11): 544-550.

• Speroni, K.G., Seibert, D., & Mallinson, R.K. (2015). US Nurses' Perceptions Regarding Caring for Suspected, Probable and Confirmed Ebola Virus Disease Patients, Part 1. Journal of Nursing Administration, 45(10): 477-484.

• Improvement: Improve processes for managing HCW and patient safety for emerging diseases

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• NICU• Crouch, L., Speroni, K.G., Jones, R.A., MacDougall, E.P., and

Daniel, M.G. (2016). Timing of Newborn Pulse Oximetry Screenings for Critical Congenital Heart Defect Rates Before Discharge. Journal of Obstetric, Gynecologic & Neonatal Nursing; 45, (1): 39–44. http://dx.doi.org/10.1016/j.jogn.2015.10.007 http://jognn.org

• Improvement: Confirmed current POS timing acceptable; no change required.

• ICU• Bounds, M., Kram, S., Speroni, K.G., Brice, K., Luschinski, M.A., Harte,

S., & Daniel, M.G. (2016). Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients. Am J Crit Care; 25(6): 535-544. doi: 10.4037/ajcc2016209

• Improvement: Decrease delirium in ICU patients• Speroni, K.G., Lucas, J., Dugan, L., O’Meara-Lett, M., Putman, M.,

Daniel, M. & Atherton, M. (2011). Comparative Effectiveness of Standard Endotracheal Tubes versus Endotracheal Tubes with Continuous Subglottic Suctioning on Ventilator-Associated Pneumonia Rates Journal of Nursing Economic$, 29(1), 15-21.

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• Hospital Nursing Research Infrastructure• McLaughlin, M., Speroni, K.G., Kelly, K.P, Guzzetta, C., & Desale, S. (2013).

National Survey of Hospital Nursing Research, Part 1. Research Requirements and Outcomes. Journal of Nursing Administration, 43(1), 10-17.

• Kelly, K.P., Turner, A., Speroni, K. G., McLaughlin, M., and Guzzetta, G. (2013). National Survey of Hospital Nursing Research, Part 2. Facilitators and Hindrances. Journal of Nursing Administration, 43(1), 18-23.

• Improvement: Facilitation of nursing research infrastructure for nursing research conduct.

• BSN Degree Completion• Duffy, M.T., Friesen, M.A., Speroni, K.G., Swengros, D.A., Shanks, L., Waiter,

P. & Sheridan, M.J. (2014). Bachelor of Science in Nursing Degree Completion Barriers, Challenges, Incentives and Strategies. Journal of Nursing Administration. 44(4), 232-236.

• Improvement: Facilitation of meeting Institute of Medicine report recommendation of 80% of RNs have BSN.

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• Handoffs• Herbst, A.M., Friesen, M.A., Speroni, K.G. (2013). Caring, connecting, and

communicating: reflections on developing a patient-centered bedside handoff. International Journal of Human Caring, 17(2), 16-22.

• Friesen, M.A., Herbst, A., Turner, J.W., Speroni, K.G. & Robinson, J. (2013). Developing a Patient-Centered ISHAPED Handoff With Patient/Family and Parent Advisory Councils. Journal of Nursing Care Quality, (28)3, 208-216.

• Improvement: Standardized process for shift to shift reporting.

• Case Management• Stagg, S., Speroni, K.G., Daniel, M.G., Eigenbrode, M., & Geisler, L. (2017).

Evaluation of Text Messaging Effects on Health Goal Adherence in the Management of Participants with Chronic Diseases. Professional Case Management Journal; 22(3):126-135.

• Improvement: Utilize text messaging as a platform to manage chronic patients after discharge

• Behavioral Health Unit• Van Dyke, D., Singley, B., Speroni, K.G., & Daniel, M. (2014). Comparative Study

Evaluation of Fall Risk Assessment Tools for Psychiatric Patient Fall Prevention: A Comparative Study. Journal of Psychosocial Nursing and Mental Health Services. 52 (12):30-5.

• Weston, J., Ellis, T., Speroni, K.G., and Daniel, M. (2012). The Effect of Menstruation on Psychiatric Hospitalization. Journal of Psychosocial Nursing and Mental Health Services, 50(7), 39-43.

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• Near Misses / Safety Violations• Speroni K.G., Fisher J., Dennis M., & Daniel M. (2014). What causes

near misses and how are they mitigated? Plast Surg Nurs. Jul-Sep;34(3):114-9. Reprinted from: Nursing 2013, 43(4), 19-24.

• O’Neil, S., Speroni, K.G., Dugan, L, & Daniel, M. (2010). A Two-tier Study of Direct Care Providers Assessing the Effectiveness of the Red Rule Education Project and Precipitating Factors Surrounding Red Rule Violations. Journal of Quality Management in Health Care, 19:3, 1-6.

• Occupational Health• Dawson, E., Speroni, K.G., Salisbury, M., & Atherton, M. (2010).

Effect of the Workforce Initiatives Safe Handling Minimal Lift Program on Patient Care Provider Injuries, Attributable Costs, and Satisfaction. Journal of the Association of Occupational Health Professionals, 3, 22-26.

• Speroni K.G, Dawson E., Atherton, M., & Corriher J. (2005). Influenza vaccination, incidence of symptoms and resulting absenteeism in hospital employees. American Association of Occupational Health Nurses Journal, 53 (11), 477-483.

• Nurse Tattoos and Body Piercings• Westerfield, H.V., Stafford A.B., Speroni, K.G., & Daniel, M.G. (2012)

Survey Research of Patients' Perceptions of Patient Care Providers with Tattoos and/or Body Piercings. Journal of Nursing Administration; 42(3),160-164.

AHRQ Patient Safety

Network

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Nursing Research Study Published Examples• Bariatrics

• Suchicital, L.G., Gujral, H., Speroni, K.G., Eldridge, D. & Atherton, M. (2011). Prospective, Randomized, Pilot Study Evaluating the Effect of Ice Chip Administration versus None on the Bitterness of Crushed Medications in Post Operative Bariatric Patients. Journal of Bariatric Nursing and Surgical Patient Care, 6(1), 15-20.

• PICC Lines• Bowers L., Speroni K.G., Jones L., & Atherton M. (2008).

Comparison of Occlusion Rates by Flushing Solutions for Peripherally Inserted Central Catheters with Positive Pressure Luer-Activated Devices. Journal of Infusion Nursing, 31(1), 22-27.

• Hemolysis• Harrison, G., Speroni, K.G., Dugan, L., & Daniel, M.G. (2010). A

comparison of the quality of blood specimens drawn in the field by Emergency Medical Services verses specimens obtained in the Emergency Department. Journal of Emergency Nursing, 36(1), 16-20.

• Dugan L., Leech L., Speroni K.G., & Corriher J. (2005). Factors affecting hemolysis rates in blood samples from newly placed IV sites in the Emergency Department. Journal of Emergency Nursing, 31(4), 338-345.

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• Surgical Services• Ganter-Ritz, V., Speroni, K.G., & Atherton, M. (2012). A Randomized Double

Blind Study Comparing Intradermal Anesthetic Tolerability, Efficacy, and Cost-Effectiveness of Lidocaine, Buffered Lidocaine and Bacteriostatic Normal Saline for Peripheral Intravenous Insertion. Journal of Infusion Nursing; 35(2): 93-99.

• Improvement: Modified policy so that local anesthesia can be offered as a choice to patients during vascular access cannulation.

• Leonard Y., Speroni K.G, Atherton M. & Corriher J. (2006) Evaluating use of flash sterilization in the OR with regard to postoperative infections. Journal of the Association of peri-Operating Room Nurses, 83(3), 672-680.

• Improvement: Purchases equipment trays and decrease flashing

• Orthopedic Unit• Hanlon, L., Punzo, A., Jones, R.A., & Speroni, K. G. (2011). Cardiopulmonary

Complication Rates in Patients Undergoing Total Knee Arthroplasty and Reinfusion of Shed Blood. Journal of Orthopaedic Nursing. 30 (5): 307-311.

• Improvement: Nursing stopped usage of reinfusion devices• Bergin, C., Speroni, K.G., Travis, T., Kacoyanis, K, Bergin, J., Sheridan, M, Kelly,

K, & Daniel, M. (2014). Effect of Preoperative Incentive Spirometry Education Nursing Intervention on Knee and Hip Joint Patient Outcomes. Journal of PeriAnesthesia Nursing, 29(1):20-27. doi: 10.1016/j.jopan.2013.01.009 [Included in Cochrane systematic review on psychological preparation for surgery: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008646.pub2/full]

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• Ambulatory – Catheter Care Clinic• Ganter Ritz, V., Speroni, K.G., & Waldbridge, D. (2016). Reducing

Complications and Hospitalizations Through an Innovative Catheter Care Clinic for Percutaneous Nephrostomy Catheter Patients. Journal of Radiology Nursing; 35: 275-280.

• Endoscopy• Groton, M. Fisher, M, Stranahan, K, Higley, M, Speroni, KG, & Daniel, M.

(2015). A Prospective, Randomized, Single-Blind Study Evaluating the Effectiveness, Tolerability and Cost of Colonoscopy Bowel Preparations. Gastroenterology Nursing. 38(1): 31-41.

• Improvement: Patient bowel preparation instructions standardized the use of Miralax for routine use based on the findings (least expensive for patients and most tolerable for consumption). Additional Bisacodyl was added to the prep in consultation with the Endo physicians; continues to be used and effective. Preparation instructions standardized with use of Miralax with GI physicians.

• Speroni K.G., Hannah, J., Corriher, J., & Atherton, M. (2005). Evaluation of demographic, behavioral, and procedural factors on pain perception by patients undergoing colonoscopy and moderate sedation. Gastroenterology Nursing Journal, 28(6), 502-508.

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• Nurses Living Fit / Adult Obesity• Speroni, K.G. (2017). Goals and actions for a healthy lifestyle. American Nurse Today; 12(5).

https://www.americannursetoday.com/goals-actions-healthy-lifestyle/• Speroni, K. G. (2014). Designing Exercise and Nutrition Programs to Promote Normal

Weight Maintenance for Nurses. Online Journal of Issues in Nursing, 19(3). http://nas.sagepub.com/content/29/3/140.full

• Speroni, K.G. (2014). School Nurse Facilitated Programs for Families Living Fit. National Association of School Nurse. 29(3), 140-144.

• Speroni, K.G., Williams, D.A., Seibert, D.J., Gibbons, M., & Earley, C. (2013). Helping Nurses Care for Self, Family and Patients through the Nurses Living Fit™ Intervention. Nursing Administration Quarterly, 37(4), 286-294.

• Speroni, K.G., Earley, C., Seibert, D., Kassem, M., Shorter, G., Ware, C., Kosak, E. & Atherton, M. (2012). Effect of Nurses Living Fit™ Exercise and Nutrition Intervention on Body Mass Index in Nurses. Journal of Nursing Administration, 42(4), 231-238.

• Kids Living Fit / Childhood Obesity• Speroni, K.G. (2014). School Nurse Facilitated Programs for Families Living Fit. National

Association of School Nurse. 29(3), 140-144.• Speroni, K.G., Tea, C., Earley, C., Niehoff, V., & Atherton, M. (2008). Evaluation of a Pilot

Hospital-Based Community Program Implementing Fitness and Nutritional Education for Overweight Children. Journal for Specialists in Pediatric Nursing, 13(3), 144-153.

• Speroni K.G., Earley, C., & Atherton, M. (2007). Evaluating the Effectiveness of the Kids Living Fit™ Program: A Comparative Study. Journal of School Nursing, 23(6), 329-336

AHRQ Health Care Innovations Exchange

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Nursing Research Study Published Examples• Shared Governance

• Wilson, J., Speroni, K.G., Jones, R.A. & Daniel, M.G. (2014). Exploring How Nurses and Managers Perceive Shared Governance. Nursing2014, 22: 19-22. www.Nursing2014.com

• Annual Review Process• Durcho, J., Speroni, K.G., Jones, R.A., Daniels, M.B., Beemer, C., & Daniel, M.G.

(2016). A subjective view: Nurse satisfaction and the review process. Journal of Nursing Management, 47(2): 40-46.

• Improvement: Confirmed current annual review process; no change required.

• Interdisciplinary• Kolman, J., Parker, H., Dorn, M.H., Speroni, K.G., Friesen, M., & Phillips, S.

(2016). A Balanced Approach: Analyzing the Effect of Exercise and Communication Sessions for People with Parkinson’s Disease. ADVANCE for Physical Therapy & Rehab Medicine. June 6, 2016: 23-24. Retrieved from: http://physical-therapy.advanceweb.com/ebook/magazine.aspx?EBK=PT060616

• Miles, S., Massengill, J., Gruber, D., Speroni, K.G., & Gaynor-Krupnick, D. (2013). Does Glycopyrrolate at Anesthesia Induction Increase Temporary Postoperative Urinary Retention after Midurethral Sling? Journal of Clinical Anesthesia, 25, 572–577.

• Healy, M.F., Speroni, K.G., Eugenio, K. R., & Murphy, P.M. (2012). Adjusting eptifibatide doses for renal impairment: A model of dosing agreement among various methods of estimating creatinine clearance. Annals of Pharmacotherapy, 46, 1-7.

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Scholarly Dissemination

• Leadership• Continued need to enhance writing skills of nurses• Writing workshops with follow-up mentoring have

demonstrated success• Emphasis needed on the value of dissemination to

positively change nursing organizational cultureRivera, 2016. Nurse Leader

• Transforming practice through publication• Provision of resources• Models to guide conduct of research and nursing

leadership to encourage and support research activitiesBrockopp, 2016. JONA

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Nurses and InquiryResearch Scientists

• Innovators Do something different• Improvement Do something better

EVIDENCE-BASED PRACTICE &

EVIDENCE- INFORMED PRACTICE

TRANSLATE SCIENCE

QuERY: Quality Improvement, Evidence-Based Practice, Research & YouiQuERY fuels the spirit of inquiry!

Where something does not exist

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Summary

• Multiple standards and measures drive the need for nursing inquiry methods of QI, EBP and research

• Use the appropriate process / methodology for inquiry methods

• QI activities: QI process model • EBP projects: EBP model• Nursing research studies: Nursing research process steps

• Inquiry methods advance the practice of nursing to improve

• Hospital/nursing policy/procedures• Standard of care/care delivery• Patient outcomes• Work environment

• Translate science: Spread and sustainiQuERY: Innovation, Quality Improvement, Evidence-Based

Practice, Research & YouQuERY fuels the spirit of inquiry!

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References

• American Nurses Association. 2017. 2019 Magnet® Application Manual. Silver Spring, MD: American Nurses Association.

• American Nurses Association. 2015. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association.

• American Nurses Association. 2015. Nursing Scope and Standards of Practice, 3rd. Silver Spring, MD: American Nurses Association.

• American Nurses Association. 2003. Nursing’s Social Policy Statement, 2nd. Silver Spring, MD: American Nurses Association.

• Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, 2015.

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References (cont.)

• Brockoff, D., Hill, K., Moe, K., & Wright, L. (2016). Transforming Practice Through Publication. Journal of Nursing Administration, 46(1): 38-42.

• Kelly, K.P., Turner, A., Speroni, K. G., McLaughlin, M., and Guzzetta, G. (2013). National Survey of Hospital Nursing Research, Part 2. Facilitators and Hindrances. Journal of Nursing Administration, 43(1), 18-23.

• McLaughlin, M., Speroni, K.G., Kelly, K.P, Guzzetta, C., & Desale, S. (2013). National Survey of Hospital Nursing Research, Part 1. Research Requirements and Outcomes. Journal of Nursing Administration, 43(1), 10-17.

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References (cont.)

• Melnyk, B.M., Fineout-Overhalt, E., Stilwell, S.B., & Williamson, K.M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice. Am J Nurs, 110(1), 51-3.

• Mick, J. (2016). Addition of a decision point in evidence-based practice Process Steps to Distinguish EBP, Research and Quality Improvement Methodologies. STTI: 179-181.

• Quality Improvement. (April, 2011). U.S. Department of Health and Human Services Health Resources and Services Administration. Retrieved from: https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

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Speaker Contact Information

Karen Gabel Speroni, PhD, BSN, MHSA, RNNursing Research ConsultantLeesburg, [email protected]

Documents

The Nursing INQUIRY Triad · ANA Code of Ethics for Nurses Provision 7 • “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry,