When nursing is the topic of conversation, terms such as expert clinical knowledge, authentic compassion, keen observation, organized patient management, complex care coordination and passionate advocacy flow easily.
Outside of the nursing community, however, when I talk about nursing science – nursing research – I often get blank looks and questions like: Why are nurses doing research? What distinguishes nursing science from medical research?
Given our powerful, but often unsung, impact on the quality of countless patients’ lives, it disturbs me that people don’t understand what we do. So allow me to try to explain.
Put simply, nurse scientists generate questions geared toward improving how clinicians and patients administer care and manage conditions. Such questions emerge from a unique nursing lens, which is always focused on detecting, understanding and responding to signs and symptoms that our patients experience. In a health care world moving toward – and certainly benefiting from – diagnosis and treatment that relies increasingly on sophisticated technology, it’s absolutely essential we not lose sight of the patient experience. It’s what provides health care’s critical balance.
Let’s take an example. In most intensive care units, a cacophony of alarms, whooshing and clicking sounds assaults the senses of the nurses monitoring and caring for the patients. Nurses know these alarms make it difficult for patients to sleep. We witness the distress alarms cause for family and other visitors. Worse, the constant noise, some of it unnecessary, can inure the nurse so that he or she misses an important event. Known as “alarm fatigue,” this phenomenon can make intensive care an unsettling and, at times, unsafe experience.
Nurse scientists such as UCSF’s Barbara Drew have insisted that we can engineer a safer nursing care environment. She and newly recruited faculty member and bioengineer Xiao Hu are collecting millions of data points and deriving algorithms so alarms can better predict clinical events. If Drew and Hu’s early results are validated, it will help some remarkable technology achieve its original purpose of providing precisely targeted advanced warning without all the unnecessary noise.
The point is that it is nurse scientists whose experience positions them to raise such questions, assemble the team to address the need, put methods together to gather the data and bring their lens to an analysis that is most likely to uncover the right answers for both nurses and patients.
Similarly, consider symptom assessment and management, something nurses have been studying for decades – and something that has a deep and lasting effect on patients. Some of the most impressive work in this area has been on the pain, nausea and fatigue associated with cancer and chemotherapy. During the past decade, nurse scientist Chris Miaskowski and geneticist Brad Aouizerat from our faculty have gone beyond measuring self-reported symptoms to uncover genetic markers for pain associated with cancer chemotherapy. The hope is that adding genetic information to data from self-reports and physical signs can help us improve how we anticipate and effectively manage pain. While colleagues in other fields study genetic markers and mechanisms for diagnosis and treatment, nursing science focuses on symptoms because patient experience tells us that pain associated with cancer chemotherapy remains an unmet challenge.
One more example: At the University of Pennsylvania School of Nursing, Mary Naylor has clearly defined best practices for transitional care from hospitals to community. Such work is especially important today, as the health care reform movement has identified transitional care as an essential component in people maintaining and improving their health after a hospital stay. We are delighted to have Mary Naylor join us this year as a Presidential Chair, so we can learn from her work and generate our own.
There are, of course, thousands of other examples, both big and small, where nurse scientists’ unique lens helps build the science that is improving both individual and population health. So at a time when everyone in health care is trying to achieve the elusive balance between high-tech and high-touch care, it is high time for people to fully recognize nurse scientists’ critical contribution to the discussion.