Catholic Health World

Humility of Mary nurses pursue clinical research ideas

Beth Ghioldi, a nurse at St. Elizabeth Health Center in Youngstown, Ohio, was chatting with Dr. Elena Rossi about admissions to the special care nursery. Dr. Rossi, a neonatologist, said she was seeing fewer newborns from induced births.

Ghioldi mentioned the new, uniform protocol that the obstetrics unit was using to administer oxytocin in labor inductions. Perhaps it made things better for the babies, they told each other.

Some years ago, an observation like that might have ended with the passing conversation. But Ghioldi, a clinical educator, brought the subject to

St. Elizabeth's annual Nursing Research Idea Fair. She and Julie Follmeyer, a clinical educator at a sister hospital, St. Joseph Health Center in nearby Warren, Ohio, proposed to undertake a study of the well-being of newborns delivered through induced labor.

The women are in their second year of research, working under the supervision of their hospital system's Nursing Research Council. They intend to publish their findings.

And they already have a greater sense of a nurse's potential to advance health care knowledge. "This has made research seem so much less untouchable," Ghioldi said. "It shows us that our thoughts are important."

That's music to the ears of Mary Ann Turjanica, chair of the Nursing Research Council for St. Elizabeth, St. Joseph and St. Elizabeth Boardman Health Center, the three Humility of Mary Health Partners hospitals in the Youngstown area. In 2007, the council established the Nursing Research Idea Fair to encourage nurses to follow up on their valuable frontline insights.

"Nurses are at the bedside watching trends every day," Turjanica said. "But most don't have a lot of training in research. They see that as something for the PhDs. We want our nurses to be comfortable coming forward and saying, 'Hey, I have an idea.' We want them to see the connection between their own research and better patient care."

Ghioldi has worked most of her career in and near obstetrics units. Until 2006, she said, the unit at St. Elizabeth had four protocols for administering oxytocin to pregnant women to induce labor. And one of the protocols, she said, was doctors' discretion.

Nationally, researchers were identifying and publishing best practices in the use of oxytocin. In 2006, St. Elizabeth adopted a single protocol for dose standardization for oxytocin based on established science that set forth timed, incremental increases in the drug. The protocol calls for increasing dosage in two milliunit increments, usually at 30-minute intervals, up to a maximum of 20 milliunits, she said. Ghioldi and Follmeyer are studying the charts of 150 births to determine whether the new protocol has led to fewer cesarean births and reduced stress on the babies.

Ghioldi said some research by others has led them to expect that finding. She said her work so far suggests the uniform protocol is an improvement over the old system of multiple protocols.

"If true, that would be good for mom and baby," she said.

The Ghioldi-Follmeyer project is among four under way by nurses at the Humility of Mary hospitals. Each year, nurses offer ideas at the annual fairs held at each of the hospitals. The Research Council reviews them for merit and feasibility and picks one formal study to support. Ghioldi's and Follmeyer's proposal was chosen in 2008.

Idea spark
This October, Humility of Mary nurses will describe the idea fair in a one-hour presentation at the annual National Magnet Conference of the American Nurses Credentialing Center, to be held in Phoenix. The credentialing center, an arm of the American Nurses Association, designates as "Magnets" hospitals that promote excellence in nursing.

St. Elizabeth and St. Joseph achieved Magnet status in 2002, and they were the first hospitals in Ohio to win that distinction. Nationwide, 370 health institutions in 45 states and the District of Columbia are Magnets.

Nancy Siefert, a nursing director and Magnet program director for Humility of Mary, said the idea fairs are an important part of maintaining the goals of Magnet status. Siefert is in the thick of preparing the system's application to renew the designation for St. Elizabeth and St. Joseph, and to extend it to Humility of Mary's new hospital, St. Elizabeth Boardman Health Center, which opened two years ago in suburban Boardman, south of Youngstown.

"We believe Magnet is the gold standard in nursing," Siefert said. "In nursing, it's important to engage in practices founded in evidence-based research. It keeps nurses thinking in a professional, progressive way, so they don't become stale in their methods."

Siefert said programs such as the idea fair "give nurses that spark to think about finding new ways to produce better outcomes for their patients."

For instance, Lynn Clark, a nurse at St. Elizabeth, noticed that some patients developed sores on their ears where nasal oxygen tubing wrapped around their heads. She proposed to study the problem, and her project was green lighted in 2007, the inaugural year for the fair.

Clark found that more than one third of patients with oxygen tubing developed skin ulcers on their ears. To address this, the hospital bought soft pads for use as buffers between the tubes and ears. Turjanica said that since then, no patients have developed skin ulcers of the ears.

Clark presented her work to her colleagues at the 2008 Nursing Research Idea Fair and will publish her findings this fall in MEDSURG Nursing: The Journal of Adult Health.

Yellow brick road
The Research Council organizes the annual fairs around an entertaining theme. This year, it was "Follow the Yellow Brick Road to Research," with Wizard of Oz-inspired costumes and decorations.

Humility of Mary held its 2010 fairs at St. Elizabeth and St. Joseph in March and at St. Elizabeth Boardman in April. The daylong events were informal, and nurses visited during their breaks, or before or after their shifts. Students from Youngstown-area nursing schools mingled with staff nurses. Nurse-researchers were on hand to answer questions about their projects.

"We want to get the nurses engaged in the idea of research," Turjanica said. "And we want them to get together for a little fun."

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