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 medicine 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 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 three strong departments supporting nursing research throughout our organization, along with a variety of resources to help support integration of current evidence into practice. The UT Southwestern Health Sciences Digital Library and Learning Center provides electronic, web, and personnel resources to assist with searching and acquiring relevant evidence to guide and transform our professional nursing practice.

Neuroscience Nursing Research Center

The Neuroscience Nursing Research Center (NNRC) opened in 2013 and is dedicated to ensuring that nurses at all levels can provide vital research contributions to caring for patients with a neurological illness. Under the leadership of Director DaiWai M. Olson, Ph.D., RN, FNCS, the NNRC provides guidance to nurses who are interested in engaging in research by leveraging and coordinating existing research-related resources.

In 2023, NNRC nurses participated in 52 publications (including 12 chapters in five textbooks), 30 scientific abstracts, and 33 platform presentations at conferences in nine U.S. states and eight foreign countries (Japan, Iceland, India, Colombia, Poland, Kenya, Ireland, and the Philippines). Also, during 2023, the NNRC hosted a three-month international visiting nurse from Kenya as part of a neuroscience nurse training program with the Moi Teaching and Referral Hospital in Eldoret, Kenya.

In spring 2023, the Magnet Program and Nursing Research Department collaborated with the Office of Quality, Safety, and Outcomes Education to develop a six-month Nursing Quality Improvement (QI) Fellowship. The fellowship comprised a one-week QI Bootcamp in June that included lectures, discussions, and applications of QI and systems engineering (SE) methodologies, and project activities in group settings. Following the QI Bootcamp, fellows were tasked with developing and implementing a department, unit, or organizational project leading to new processes of patient care delivery and enhanced outcomes. The fellows’ final projects will be showcased internally at the UTSW Celebration of Excellence and possibly published in academic journals or presented at industry conferences. Graduation from the fellowship will be held during Nurses Week in May 2024.

As research interests and skills populate throughout clinical settings at UTSW, the Magnet Program and Nursing Research Department continues to grow as a center of research-intensive activities and to provide the skills and capacity for nurses to pay it forward by mentoring and inspiring more nurses to think differently, ask the right questions, and pursue research.

UT Southwestern’s Nursing Research Fellowship program was established in 2021 to prepare nursing professionals from multiple specialties for nursing research. Fellows are immersed in the nursing research process, from the clinical question to the study initiation, including regulatory and compliance components. The goal is for clinical nurses to understand that evidence is essential to nursing practice and that every nursing specialty can apply research to improve an agreed-upon department/unit-level/organizational goal to enhance patient care and clinical practice and build the nursing body of science. UT Southwestern’s four Nursing Research fellows and their mentors in 2023 were:

Nursing-Led Research in 2023

Throughout 2023, UT Southwestern nurses were involved in research and evidence-based practice initiatives in specialized areas. As in recent years, our nursing research output increased exponentially. Nursing research leaders review the annual research needs assessment and all nurses’ submissions and recommend research mentors, when appropriate, to cultivate the next generation of nurse researchers.

Disseminations of Research in 2023

The Neuroscience Nursing Research Center, Office of Advanced Practice Providers, and Magnet Program and Nursing Research Department lead and support multiple research studies and projects. Accomplishments include various disseminations and collaborations of research in peer-reviewed journals and podium and poster presentations.

Number of poster presentations by and/or including UT Southwestern nurses in 2023: 48

Number of podium presentations by and/or including UT Southwestern nurses in 2023: 82

Number of publications by and/or including UT Southwestern nurses in 2023: 100

Improved Processes Keep Therapy on Track

The day a patient is admitted to the Inpatient Rehabilitation Unit at Zale Lipshy Pavilion can be hectic. Sometimes the patient’s transfer is delayed or the patient is too tired to participate in therapy. Inpatient Rehabilitation (IPR) has specific requirements, which include that a patient experiences 180 therapy minutes in five out of seven days. When a patient is not seen on the first day, his or her care can be deferred, which stalls overall progress from a therapy perspective. In 2022, IPR managers noted that such deferments were happening far too often and that part of the reason was because the unit had no clearly defined process to ensure that patients admitted earlier in the day were evaluated by therapy on that day. Instead, an email blast went out notifying the team that a new patient had arrived and that if “anyone has time, please evaluate.”  That lack of process resulted in only 30% of patients being seen on the day of admission.

The IPR developed a plan to change that. The initiative aimed to increase the percentage of patients seen by therapy services on the day they were admitted to IPR. The new, clearly defined process included having a core team of therapists with a later shift start time (and later shift end time) to see patients on the day of their admission if they were accepted before 3 p.m. This core group of therapists left an open timeslot in their schedule for the end of the day to complete this task. The entire team, including nurses and physicians, was educated on this initiative, and the results showed dramatic improvement.

Overall outcomes in self-care and mobility improved:

PEM 2022 (Program Evaluation Model)

• Change in self-care: 12.7 (up by 0.5 from the previous year)
• Change in mobility: 34.7 (up by 1.8 from last year)
• Overall PEM score: 91.4 (up by 2.4 from last year)

• Kasey Rehme, M.Ed., CCC-SLP, Assistant Therapy Manager
• Melinda Malone, M.S., CCC-SLP, Therapy Manager

Improving RN Skills in PH Medication Administration

Pulmonary hypertension (PH) is a complex and progressive disease characterized by the remodeling of small pulmonary vessels. Treatment includes administering lifelong potent intravenous medications in high concentrations and slow infusion rates. Because of the low frequency and substantial risk status of administering these medications, registered nurses (RNs) inexperienced with PH medication administration could experience a lack of confidence and compromise patient safety.

On the 8 Green Pulmonary Unit, the unit-based educator (UBE) noted a decreased confidence level in some nurses. Based on data, personal interviews, and direct observation of IV administration during PH care, the UBE identified potential gaps in knowledge, skill, and understanding of current nurse PH competencies. A pre-survey was conducted to assess nurses’ confidence level using a five-point Likert scale to measure the distribution of confidence levels from “No Confidence” (1) to "High Confidence" (5).

Pre-survey data collected in July 2023 showed only 35% of nurses indicated “Confidence” or “High Confidence” in administering PH medications, which was significantly less than half. Analysis of event reports from June 2022 to June 2023 related to medication errors on 8 Green revealed that 50% of those events were related to PH intravenous medication dose calculation.

To maintain safety of the PH patient population, a need was identified to provide further education of RNs on PH intravenous medication administration and dose calculation. The goal of this project was to improve the confidence level of RNs to administer PH intravenous medication and to reduce dose calculation errors related to PH medication. The project was aimed at RNs with less than two years of experience in PH patient care. Therefore, a sample of 25 RNs from 8 Green with less than two years of experience in PH patient care was selected for the project.

The quality improvement team led by UBE Rincey Daniel, B.S.N., RN, CMSRN, incorporated lean principles to identify areas for needed changes and process improvements. Through the team's collaborative efforts, a multimodal educational approach was developed to initiate practice changes. The team, composed of PH medical providers, clinical educators, pharmacy staff, and safety team members, gathered data and guided the interventions.

The team developed an educational toolkit to use during an interactive training program. A didactic course was offered with a PowerPoint presentation and hands-on learning. Attendees also received instruction via case scenarios and participated in simulation for medication pump programming setup and medication calculation. The team incorporated a detailed checklist outlining the PH medication administration steps into the toolkit and class.

A post-survey conducted in November 2023 to assess nurses’ confidence level demonstrated an improvement from 35% (pre-survey) to 76% (post-survey) of nurses having “Confidence” or “High Confidence” in administering PH medications. Data collected from event reports in November 2023 showed only one PH medication calculation error.

Data collection will continue into FY 24 to demonstrate further trends in reducing medication errors and increasing confidence levels.

Zen in 10

Nurses’ well-being was identified as a focus area for the oncology service line by input received from frontline nurses. Results from the October 2022 organizational-wide Glint employee engagement survey indicated that oncology nurses were concerned about their well-being, with oncology ranking much lower than the organization as a whole, scoring 62 versus 71, respectively, which reflected a decline organizationally by four points from the February 2022 survey. While the organization has launched several well-being initiatives, including support through the Employee Assistance Program, mindfulness exercises, and in-person counseling, bedside nurses are often unable to utilize the resources due to time constraints and the location of resources. With an unprecedented RN vacancy rate of 31% across the three inpatient oncology units, implementing sustainable, evidence-based strategies was critical to addressing the well-being of our bedside nurses. The Zen in 10 well-being initiative was implemented on 11 Orange with the support of the oncology service line leadership.

The Zen in 10 initiative aimed to improve nurses' anxiety and stress through a wellness bundle comprising a relaxation room, aromatherapy, mindfulness exercises and music, shared journaling, yoga, snacks, and restful lighting. The Office of Nursing Research assisted with developing a pre- and post-survey on wellness; the Music Therapy program created three mindfulness exercises; and the NOMAD clinical program coordinator provided yoga resources. The intervention was presented over several months during 11 Orange staff meetings, and an invite was sent to all staff to attend the official opening. The Zen in 10 relaxation room opened on Sept. 28, 2023, with the initial eight-week pilot phase ending November 25, 2023. Pre- and post-surveys on wellness were sent to all staff permanently assigned to 11 Orange.

The November 2023 staff satisfaction survey results indicated a unit well-being score of 75, up from the previous score of 71 and 12 points above the benchmark. In comparison, the two inpatient oncology units without the well-being intervention noted well-being scores of 57 and 62, with the combined oncology service line scoring 63.

It is expected that inpatient oncology nurses will experience improved psychological well-being by participating in this initiative. However, this will be validated after pre- and post-survey data analysis.

If the pilot is successful, the well-being initiative will be shared with the inpatient service line leaders and bedside staff during the oncology service line staff meeting. Additionally, the results of the Zen in 10 evidence-based practice project may be disseminated to nursing leadership, utilizing different internal organizational committees such as the Shared Governance Coordinating Council and Nursing Research Committee.