MANAGEMENT BRIEF

Number 20 Overviews of Health Care Topics for VA Senior Managers May 2001

Nursing Research

“Nurses are a vital part of any health care organization.

The unique perspective they bring to research is valuable to the

system as a whole and, particularly, to the patients.”

John G. Demakis, MD

Director, Health Services Research and Development Service

What makes nursing research unique?

Nursing is the largest health care profession, and they

are the single biggest operational cost in any health care system.1 Their effect and contribution to the daily operation of

any health care organization is thus of great importance.

Nurses bring a special perspective to research because they

have a unique relationship to patients, having more direct

contact with patients than any other health care professionals.

Nursing research, that is research conducted by nurse investigators, is aimed at high-priority health issues for veterans.

The Nursing Research Initiative (NRI) was initiated by the

Under Secretary for Health and was implemented by the

Office of Research & Development, in collaboration with the

Nursing Strategic Health Care Group. Managed by HSR&D,

the NRI program encourages the development of nurse investigators to conduct independent research.

What kinds of issues are nurse

investigators researching?

The NRI program invites study proposals from nurse

investigators in health services, medical and rehabilitation

research that address a wide range of issues pertaining to

patient-centered care. Nursing research projects focus on a

variety of health care issues, such as dementia, congestive

heart failure, cancer pain management, spinal cord injury, and

improving adherence to antiretroviral therapy in HIV-infected

veterans. Twelve new NRI projects were funded in FY 2001,

including studies on preventing home injury to veterans with

Alzheimer’s disease, care giving for stroke recovery patients

after hospital discharge, and an intervention study for veterans with chronic pulmonary disease.

Below is a brief discussion of some of the

exciting HSR&D nursing studies.

Nurses to take more active role in

pain management for cancer patients

Pain is considered a fifth vital sign for VHA, which makes

this study of particular importance. Estimates of pain in hospitalized patients with cancer are as high as 73 percent, yet

research suggests that nurses may lack the knowledge to adequately manage pain and may harbor attitudes that interfere

with successful pain management. An HSR&D study has

educated 12 registered nurses in pain assessment and management. These specially trained Pain Resource Nurses have

been working over the past year in VA facilities in Tampa and

Bay Pines, Florida to provide pain management education

and consultation to the staff nurses, so that they can decrease

patient pain and increase functional status among hospitalized veterans with cancer. This study has demonstrated a

significant improvement in attitude among participating

nurses, and may provide an intervention to improve pain

management for cancer patients and other veteran patients

with painful diseases or conditions.

McMillan S, Hagan S, Tittle M, et al.. Knowledge and

attitudes of nurses in veteran hospitals about pain management in patients with cancer. Oncology Nursing Forum;

27(9):1415-23, 2000.

McMillan S, Tittle M, Hagan S, Laughlin J. Management

of pain and pain-related symptoms in hospitalized veterans

with cancer. Cancer Nursing; 3(5):327-335, 2000.

HSR&D study NRI 95-042. Principal Investigator:

Susan Hagan, MSN.

VA HSR&D Management Brief May 2001 Page 1 of 2
VA HSR&D Management Brief Number 20, May 2001 Page 2 of 2

Nurse counseling increases physical

activity in elderly patients

Many elderly patients are at high risk for health complications and functional impairment due to low levels of physical

activity. This study sought to determine if nurse telephone

counseling could assist elderly patients in establishing and

maintaining a regular walking program. In this randomized

clinical trial, sixty to eighty year-old patients were referred to

a walking program by their primary care providers. Over one

year, all participants received one of the following interventions: 20 calls initiated by a nurse, 10 calls initiated by a

nurse and 10 by an automated telephone message delivery

system, or no follow-up calls. Results of the study showed

that more than half of the study participants began a walking

program, and that during the maintenance phase (7 to 10

months), both phone contact groups walked more than

controls with no phone contacts. Findings also suggest that

nurse counseling not only increases walking, it also produces

significant improvements in measures associated with disease/disability risk.

Dubbert PM, Meydrech EF, Kirchner KA, Cooper KM,

Bilbrew DE. Exercise counseling and walking for exercise

among elderly VA primary care patients. Federal

Practitioner. In press for July 2001 issue.

HSR&D study NRM 95-022. Principal Investigator:

Patricia Dubbert, PhD.

Redesigning patient handling to

reduce nursing injuries

Nurses are an invaluable asset to a health care organization

and are becoming increasingly difficult to acquire and retain.

One reason for nursing shortages may be that they have one

of the highest incidences of work-related back injuries of any

profession. Over the past 20 years, efforts to reduce these

types of injuries have been largely unsuccessful. The goal of

this HSR&D study is to reduce the incidence and severity of

nursing back injuries through the redesign of stressful patient

handling tasks. These tasks were evaluated on many levels,

including biomechanical, ergonomic, and quantitative. Techniques used to perform tasks were then redesigned to reduce

the risk of musculoskeletal injury, and laboratory-based

assessments were conducted to assess the benefit of the proposed intervention strategies. Back injury for those nurses

performing the redesigned tasks were then compared to those

who performed tasks using traditional techniques. This evaluation showed that nurses who used the redesigned techniques

had significant improvement in several areas. Study recommendations include the use of friction reducing devices for

lateral transfers, ceiling mounted patient lifts, and bed

adjustments for height. Building on this project, a new

program initiative – “VISN-Wide Deployment of a Back

Injury Prevention Program for Nurses: Safe Patient

Handling and Movement” – was funded for $2.2 million.

Nelson A, Tiesman H, Lloyd J. Safe patient transfer and

activity. Nursing Management; 31(12):47, 2000.

HSR&D study NRI 95-150. Principal Investigator:

Audrey Nelson, RN, PhD.

References:

1. Kizer, K. Promoting innovative nursing practice during

radical health system change. Nursing Clinics of North

America; 35(2):429-440, June, 2000.

MANAGEMENT BRIEF is produced by the Management

Decision and Research Center, a program within VA’s Office

of Research & Development, Health Services Research &

Development Service. The purpose of the MANAGEMENT BRIEF

is to provide VA senior management with a concise and

timely overview of a specific health care topic that includes

topic definition, benefits, VA research activities, and resources for further information.

For more information about this issue of

MANAGEMENT BRIEF please contact:

Geraldine McGlynn, M.Ed., Manager, Information

Dissemination Program, MDRC (152-M), VA Boston

Healthcare System, 150 S. Huntington Avenue, Boston, MA

02130. Phone: 617-278-4433. Fax: 617-278-4438.

To access back issues of MANAGEMENT BRIEF and/or additional MDRC publications and reports, visit the Research and

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