New Knowledge, Innovations, and Research
As an academic medical center and Magnet organization, we embrace new knowledge, innovation, and research – each of which plays a vital role in the current and future state of nursing and patient care. UT Southwestern nurses at all levels seek new knowledge and current evidence to frame their practice in leadership, clinical education, advanced practice, and direct patient care. Structures and processes have been developed and implemented to involve more nurses in the research process, and new nursing knowledge gained through research efforts and contributions is regularly disseminated.
UT Southwestern’s Nursing Research Program has two strong components supporting nursing research throughout our organization, along with a variety of resources to help support integration of current evidence into practice. The UT Southwestern Library provides electronic, web, and personnel resources to assist with searching and acquiring relevant evidence to guide and transform our professional nursing practice.
Innovation and Research
The Neuroscience Nursing Research Center (NNRC) at UT Southwestern is dedicated to ensuring that nurses at all levels are able to provide vital research contributions to the science of caring for patients with neurological illness. In 2020, the Center reached a milestone when it worked with its 200th RN, and it has now surpassed that number as it continues its mission to develop nurse researchers. The NNRC’s year saw 33 new projects, 30 new scientific abstract presentations, and 20 new peer-reviewed publications, which included, in the spring, the Center’s landmark 100th peer-reviewed manuscript published since the NNRC opened in 2013. In the fall of 2020, the Center saw more growth when it admitted six new NNRC Nursing Research Fellows.
The NNRC continues to develop an international presence. In addition to hosting the annual International Neuroscience Nursing Research Symposium, the Center also hosted nursing research visiting scholars from Hong Kong, Colombia, the Philippines, and Australia. In December, the Center received data from one of its collaborative sites in Tokyo, which officially made the NNRC an international clinical research organization. This global nursing research leadership will continue in 2021 when the Center will receive data from a collaborative site in Germany and NNRC leadership will submit a grant application to host visiting nurses from Kenya – all of which is part of the NNRC’s vision of truly being a world leader in promoting neuroscience nursing research.
The 2020 Neuroscience Nursing Research Center Fellows
In the fall of each year, the NNRC selects six Fellows to participate in the UT Southwestern NNRC Fellowship. The UTSW nurses chosen for the 2020 Nurse Fellowship program, along with their areas of research, were:
Tomas Armendariz, B.S.N., RN, CMSRN
Rebecca Cooley, B.S.N., RN, CCRN
Payton Link, B.S.N., RN
Shelley Speed, M.S.N., APRN, ACNP-BC, FNP-BC
Tiffany Trent, D.N.P., APRN, AGACNP-BC
Michelle White, B.S.N., RN
Nursing research at UT Southwestern took a giant step forward in 2017 when Linda Denke, Ph.D., RN, CCRC (pictured), joined UTSW in the Office of Nursing Excellence and was named both Director of Nursing Research and Director and facilitator of the Nursing Research and Evidence-Based Practice Shared Governance Council. Since then, the council has grown to include an assistant manager, a data analyst, a senior administrative assistant, and a statistician. With leadership’s vision, this growth supports nurses pursuing Doctorates of Nursing Practice (DNPs), as well as generally those interested in research, with guidance and resources that help them achieve the successful completion of research impacting nursing practice and contributing to better patient outcomes. Nursing research output at UT Southwestern has quadrupled since induction of the council, which now has overseen more than 50 nursing research studies and dozens of conference podium and poster presentations disseminating nurse-led research. The council and its members, together with the nursing research leadership, provide the research training and guidance to cultivate the next generation of nurse researchers. Over the past year, its members have assisted in 41 journal reviews. 41 literature [RR1] [ML2] reviews, and 25 population/intervention/control/outcomes (PICOs) questions.
In collaboration with the Office of Nursing Excellence, the council convenes a Research Day. In 2020, Research Day was held virtually over the course of three days that highlighted nursing-led research studies. Two hundred seventy nurses “attended” the event, which included presentations from four principal investigators discussing their studies. In addition, short videos were designed and presented based on the research needs assessment from 2019, covering topics such as music therapy for pain management and anxiety in cardiac surgery, peripherally inserted central catheter (PICC) line management during chemotherapy, research study compliance and audits, and other information for nurses and the interdisciplinary staff wanting to know more on how research is conducted.
Other areas supporting research on campus or serving as venues for completed studies include the Institutional Review Board (IRB), the UTSW Health Sciences Digital Library and Learning Center, TCU Fellows poster presentations, Magnet, and access to the annual research needs assessment. In September 2020, with the changes brought on by COVID-19, the Nursing Research leadership launched Research Today, an electronic newsletter distributed quarterly and designed to share information on current research studies, provide new and existing resources, and share general campus updates.
Nursing-Led Research in 2020
Throughout 2020, UT Southwestern nurses were involved in nursing research and evidence-based practice initiatives in specific areas. Many either published their research or presented their findings in poster and/or podium presentations at professional conferences across the country – most often virtually after the advent of COVID-19.
Publications in 2020: 39
Nurse Presentations and Posters
As evidence of our organizational commitment to professional development, UT Southwestern supports attendance (virtual or otherwise) at local, regional, and national conferences. Financial support for continuing education is aligned with organizational priorities and initiatives. Full or partial funding is awarded based on the nurse presenting a poster or delivering a presentation at the (virtual) podium. Over the past nine years, we have taken an increasingly forward-looking approach to supporting our nurses in participating in key conferences through poster and podium presentations. This approach supports our leadership’s strategic goal of positively impacting the nursing profession at UT Southwestern and beyond.
Number of Podium Presentations by UT Southwestern Nurses in 2020: 19
Number of Poster Presentations by UT Southwestern Nurses in 2020: 34
Innovation and Improvements
Going ‘Surgical Smoke Free’ in the Zale Operating Rooms
Members of the Zale Lipshy OR Surgical Services unit-based council (UBC) developed an initiative to promote a smoke-free environment in the Zale ORs. To achieve this goal, the interprofessional Zale Lipshy OR Surgical Services UBC members completed a gap analysis to measure the current percentage of surgical procedures in which smoke is evacuated through the use of smoke-evacuation devices. The team then provided a cost analysis and assessment of the current smoke-evacuation cautery options available and revised the Electrosurgical Unit (ESU) safety policy to address surgical smoke in the OR. Emily Holmes, RN, created an interprofessional education presentation on the risks of surgical smoke based on the Association of periOperative Registered Nurses’ (AORN’s) recommendations and surgical smoke safety guidelines. In addition, Anna Zita Alayon, RN, created an educational bulletin board in the Zale Lipshy OR breakroom for staff members to review.
Certified surgical technologists Paul Dodge and Sabrina Perry identified suction cautery pencils as worthy of trial. Throughout each trial, Mr. Dodge and Ms. Perry presented data to physicians at UBC meetings about each of the various suction cautery pencils being tested. The UBC scheduled in-service meetings with each of the device manufacturers to ensure staff could safely use the new equipment during the trials. Over several months, surgeons trialed the smoke-evacuation cautery options approved by the hospital and came to a consensus on which option would be adopted. The practice change was implemented, based on the AORN practice guidelines. As a result of this change, the Zale Lipshy OR successfully applied for the Go Clear program and was awarded the Go Clear Gold Level award, an achievement signifying 100% compliance in surgical smoke education and the utilization of smoke evacuators.
Increasing Staff Responsiveness to ‘Top Box’ Scores on 9 Green
Clinical nurses’ involvement in the adoption of technology using Responder 5 – an innovative, high-end, multiple nurse call system – was initiated with the goal of improving all units’ staff responsiveness domain at Clements University Hospital. Using a weighted average of each unit’s contribution to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Responsiveness domain, which includes asking the patient if they received call light help and toileting help as soon as they wanted, it was possible to identify an internal benchmark, which was 6 Green. The project was piloted by Nurse Manager Amber Ulate, M.S.N., RN, who led a staff responsiveness workgroup with members of her nursing team on 9 Green, including nurses Elizabeth Masteropiero, B.S.N., RN, and Asha Gene, M.S.N., RN. The workgroup observed the Lean Six Sigma practices on 9 Green that they believed would result in improved staff responsiveness and HCAHPS “Top Box” scores.
The 9 Green unit adopted the Responder 5 nurse call system, which integrates cellphones, pagers, enterprise-wide reporting systems, electronic staff assignments, and real-time staff locations. Implementing innovative processes of the purposeful “5 Ps” (potty, pain, position, possessions, and peaceful environment) of hourly rounding, the health care unit coordinator (HUC) five-minute call back, and leadership rounding real-time feedback to staff resulted in improved patient perception of staff responsiveness.
The above three strategies, and adoption of the Responder 5 technology, provided real-time feedback for staff, and the implementation of this technology and strategies was shared throughout CUH and Zale Lipshy Pavilion over the next 12-18 months via classroom-style presentations and high-reliability simulations. All activities took place to facilitate the adoption of technology while improving measurable response time when patients reached out for help.
Radiation Oncology Rapid Response Workflow Redesign
The Radiation Oncology unit-based council (UBC) formed a task force to create a set of guidelines for rapid response equipment needs based on location and to provide staff direction for rapid response calls on the units.
Staff members completed a rapid response survey that gauged their level of comfort using rapid response equipment and supplies and carrying out rapid response protocols and skills. Nurses and medical office assistants (MOAs) worked together to create guidelines and floor plans that instructed staff on what equipment to bring to any given location within Radiation Oncology’s three-story building. To address the staff’s level of comfort in responding to rapid response calls, the team launched monthly rapid response-focused initiatives aimed at educating and refreshing staff on navigating rapid response equipment and supplies.
New Staffing Matrix Yields Satisfaction Score Improvements
A prospective pilot study evaluating implementation of a new matrix staffing grid (MSG) focused in part on how well the tool improved nurse satisfaction. The study was conducted at a 20-bed inpatient rehabilitation unit and occurred in five phases: 1) development, 2) baseline, 3) run-in, 4) implementation, and 5) sustainability. Data were collected during phases 2-5.
One hundred thirty satisfaction surveys were completed by nurses during the study phases: baseline (21), run-in (34), implementation (60), and sustainability (15). Of these, 128 satisfaction surveys completed by 21 consented nurses were analyzed. There was a statistically significant improvement in mean survey over time (p < .05), supporting nursing satisfaction score improvements with the use of the matrix tool.
Led by Yahaddy Riley, RN, and Nneka Ifejika, M.D., M.P.H. (pictured, left to right), the study used a phased approach to implementation of the MSG, which proved to be feasible and also appropriate for measuring nurse satisfaction. In fact, the MSG showed to increase nurse satisfaction significantly. Results suggest it would be beneficial to implement the MSG in other rehabilitation settings and inpatient units as a way of improving generalizability of the MSG.
Simmons Comprehensive Cancer Center Launches Advanced Practice Provider Acute Care Initiative
Simmons Acute Care (SAC), located in UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center (SCCC), opened Aug. 4, 2020, and represents an innovative process redesign utilizing advanced practice registered nurses (APRNs) and physician assistants (PAs) to provide outpatient care for the treatment of acute illnesses to established SCCC patients. Research has demonstrated patients receiving chemotherapy have higher emergency department (ED) utilization and admission rates than other patients. The scope of SAC is to focus on acute medical problems related to cancer and/or cancer treatment. APRNs and PAs provide health care services to patients who are receiving treatment for their cancer or who have completed treatment in the past three months. The goal of SAC is to reduce avoidable ED visits and to deliver high-quality care to SCCC patients.
Data on the volume of ED visits by SCCC patients at Clements University Hospital (CUH) were reviewed to clearly define the opportunity for improvement. SCCC patients were utilizing CUH ED at risk-standardized rates higher than those at similar cancer centers. A multidisciplinary team including advanced practice providers (APPs), nurses, pharmacists, faculty physicians, and SCCC leadership was formed to investigate options to better serve patients and reduce avoidable ED visits. One element of the plan was developing clinical guidelines to manage the most commonly reported symptoms oncology patients experience during treatment. SAC Clinical Guidelines were developed based on existing UT Southwestern protocols and evidence-based care found in the literature.
From Aug. 4 to Oct. 31, 2020, 89 patient visits were completed in SAC, with 84 ED visits avoided and 73 patients discharged home. Patient satisfaction was expressed verbally, with some patients and/or family members sending cards after patients were discharged home.
Fuel Gauge: An Innovative Well-Being Assessment System
The COVID-19 pandemic brought new and unprecedented challenges for UT Southwestern clinical nurses who were coping with the unknown while providing patient care during a pandemic. With the rising surge in COVID-19 patients, the clinical nurses caring for them regularly noted that they had less time or resources for self-care. Due to the restrictions in place with the pandemic, they felt they could not “refuel” – not only physically but, at times, mentally, emotionally, and spiritually, as well. In order to meet the needs of the clinical staff members impacted by COVID-19, nursing leadership responded by forming an initiative that directly addressed these challenges. The goal was to a) quickly bring nurses together, b) identify and monitor their mental health, and c) bring resources to the nurses on the front lines quickly and regularly to sustain them during the COVID-19 pandemic.
“The Well-Being Fuel Gauge” initiative was thus conceived and implemented to create options for nurses to check in using the weekly Fuel Gauge surveys. The UTSW Department of Psychiatry partnered with the Office of Faculty Wellness to identify nurses who were deemed to have “low fuel gauges” and to reach out to those who requested contact by a behavioral health provider for follow-up. A list of organizational resources was created and sent to nurses for virtual yoga, meditation, Pilates, and other classes, along with the names of community partners that provide child care, discounts, donations, meals, and more.
In May and June 2020, more than 170 nurses responded to The Well-Being Fuel Gauge survey. The first week in May, the average fuel-gauge score was 57 out of 100, and 85 nurses responded to the survey requesting a “check-in.” Nursing leadership is committed to this well-being initiative and is planning to continue providing the resources and maintaining the infrastructure to sustain this innovative program for nurses and staff.