The last decade has seen an increased emphasis on bringing more research-based care practices into U.S. hospitals. Much is at stake, as hospitals strive to control costs, improve quality of care and patient outcomes, and enhance their reputations and leadership status through rankings and recognition, such as the National Committee for Quality Assurance and Magnet Hospital designations.
At many of the top nursing schools, nurse researchers are at the forefront of this amazing race toward better care. Across the healthcare spectrum, nurse researchers are helping to lay the scientific foundation for breakthroughs in disease prevention, pain management, wound care, patient safety, quality of life, and many other areas that will improve patient outcomes and enhance quality of care.
But ensuring that patients receive actual care based on the best and latest scientific evidence is another story. Too often, clinically important research findings that could improve care practices never make it to the bedsides of our hospitalized patients. Despite their best intentions, the average clinician is just too overwhelmed with basic patient care to keep up with all of the latest evidence-based research or to engage staff in the complex process of instituting new evidence-based care into their daily practices.
A few years ago, administrators at the Ronald Reagan UCLA Medical Center decided to do something about this. In 2002, the hospital created a new position--director of evidence-based practice--to encourage and assist staff nurses and other clinicians to participate in an ongoing process of applying research findings to everyday practice situations to improve patient outcomes. By engaging and empowering nurses to be part of the process, the hospital was able to achieve more rapid adoption of new scientific knowledge, resulting in better care, enhanced patient outcomes, and cost containment.
Research on hospital-acquired pressure ulcers (PUs), conducted by myself and other faculty at the UCLA School of Nursing, has revealed key opportunities to prevent PUs in critically ill patients and residents in long-term care facilities. Hospital-acquired PUs are considered a medical error associated with substantial treatments costs (as much as $50,000 or more to manage a single ulcer, as well as potential monetary penalties, with related deaths occurring in 11.6 percent of stays with PUs as a secondary diagnosis). By implementing best practices discovered through the research, long-term care facilities are reducing costs, morbidity, and mortality.
In another instance, based on an analysis of the literature, staff nurses developed a standardized nursing shift report tool that resulted in more thorough shift reports, decreased frequency of missed information on shift changes, and fewer delays in shift starting times.
Across the country, many other research findings documented by nurse researchers have the potential to improve efficiencies and care at hospitals. But the key comes not just in discovery but also in implementing the research at the bedside where it can do the most good.
The recently released Robert Wood Johnson Foundation/Institute of Medicine document, "The Future of Nursing: Leading Change, Advancing Health," calls for new ways of conceptualizing the science and practice of nursing to meet the needs of an ever-changing healthcare system. Hospitals that embrace nurse research and empower their clinicians to adopt new best practices will set the standards for our industry that will ultimately result in better patient care, quality, and safety.
Dr. Courtney H. Lyder is dean and professor of the UCLA School of Nursing, professor of Medicine and Public Health as well as Executive Director of the UCLA Health System Patient Safety Institute and Assistant Director of the UCLA Health System.