Liehr Class

Frameworks for Research
      Patricia Liehr and Mary Jane Smith
From Practice to Research
      To be introduced to frameworks for research, put yourself in the shoes of Kate and thoughtfully listen to her story by attending to the message it brings for the practicing nurse wishing to critique, understand and do research. Kate works in a coronary care unit (CCU). She has worked in this unit for nearly three years, since she graduated with a baccalaureate degree in nursing. She has grown more comfortable over time and now believes that she can readily manage whatever comes her way with the complexities of patient care in the CCU. Recently, she has been observing the pattern of blood pressure (BP) change when healthcare providers enter a patient’s room. This observation began when Kate noticed that one of her patients a 62 year old African-American woman who had continuous arterial monitoring, had dramatic increases in BP, as much as 100%, each time the healthcare team made rounds in the CCU. Furthermore, this elevated BP persisted after the team left her room and slowly decreased to reach pre-round levels within the following hour. Conversely, the same patient, when visited by the nurse manager on her usual daily rounds, engaged calmly in conversation and was often left with lower BP when the nurse-manager moved on to the next patient. Kate thought about what was happening and adjusted her work so that she could closely observe the details of this phenomenon over several days.
      Team rounds were led by the attending cardiologist and included nurses, pharmacists, social workers, medical students and nursing students. The nurse-manager’s visit occurred one-on-one. During team rounds the patient was discussed and occasionally, she was asked to respond to a question about her history of heart disease or her current experience of chest discomfort. Participants took turns listening to her heart and students responded to questions related to her case. During the... [continues]

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