- Email: [email protected]
Susan MacLean, RN, PhD, Director, ENA research services
Susan MacLean,RN, PhD, Director, ENAResearchServices
hree years ago the ENA Board of Directors voted to create the Research Services Department. Susan MacLean, RN, PhD, was hired as director. In 3 short years, Dr. MacLean has catapulted ENA into the age of research. Under the leadership of Dr. MacLean, the ENA Research Services Department has come to be known and respected as a leader in the national nursing community and beyond. Jane Koziol-McLain, Journal Research Column section editor, recently interviewed Dr. MacLean to learn more about the accomplishments and the future direction of the Research Services Department. JEN: How would you describe the ENA Research Services Department? Susan MacLean: Having an ENA department dedicated to research means that there are more ENA resources available for conducting research, supporting research, mentoring, and other activities. Much of the last 3 years has been spent developing new projects. Also, we have become a center for information. The Research Department receives a lot of phone calls from members, emergency departments, other organizations, and federal facilities. They request information about w h a t is h a p p e n i n g in e m e r g e n c y departments today, so in 1995 we started conducting the annual National Emergency Department Database Survey The survey results provide the data to answer some of the questions we receive. A lot of information exchange goes on through the office; if we do not have the information, we try to connect people with someone who does, maybe the Nursing Practice chairperson or the Managers Committee chairperson, someone who might have resources for them. We are also finding websites that we can refer people to. It has been fun. There have been lots of new opportunities to create, to develop, and to work with some really neat people. Lots of projects have "taken off" and we stay very busy.
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J Emerg Nurs 1998;24:90-4. Copyright © 1998by the EmergencyNurses Association. 0099-1767/98 $5.00 + 0 18/1/87122
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JEN: I often hear from ENA Departments and Committees that you are highly valued as an expert research consultant. You are a valuable liaison between the Research Committee and the Journal, and have published Editorials and Research Columns that support research. How would you summarize your many activities? Susan MacLean: There are really two kinds of activities: c o n d u c t i n g research and facilitating research. I do not think that the ENA members are aware of how m u c h research goes on at the national office. We have a Demographic Survey of our members that is c o n d u c t e d by the Membership Department and a Purchasing Survey conducted by Meeting Services. The Marketing Department does a Needs Assessment. The Government Affairs Committee is conducting a Violence in the Workplace Survey. Within the national office, I do a lot of consulting. I provide feedback on survey methods and on tools that other committees or departments develop that need the expertise of a researcher. The majority of the research effort in this department is helping facilitate research for emergency nurses. Facilitating research is primarily done through the Research Committee. They focus on activities that will mentor emergency nurses. The two multisite studies, Learning and Using New Approaches to Research I (LUNAR I) and LUNAR II, which is starting now, are both large, multisite studies designed to help emergency nurses learn about research while actually participating in the study. As Director of Research Services, I have facilitated the processing of these two large multisite studies. JEN: Program evaluation is an important process when conducting large multisite studies. I understand you coordinated a LUNAR I program evaluation. Susan MacLean: Yes, we did an evaluation of LUNAR I participants after the completion of the s t u d y - - t h e y were very positive. The respondents were excited about being able to participate in a study that somebody else designed because they did
JOUKNAL OF EMERGENCYNURSING
n o t have the e x p e r i e n c e or the k n o w l e d g e to write a proposal, get the proposal t h r o u g h a n i n s t i t u t i o n a l review board, c o n d u c t the study, a n d analyze the data. The o p p o r t u n i t y to p a r t i c i p a t e a n d g a i n skills w i t h o u t carrying t h e responsibility for the overall s t u d y w a s i m p o r t a n t for m a n y nurses. People said, "I w a s too a n x i o u s to do r e s e a r c h on m y o w n a n d yet I always w a n t e d to b e involved." It w a s e x c i t i n g to hear from a d m i n i s t r a t o r s of the site coordinators as well. T h e y w e r e very e n t h u s i a s t i c a n d supportive of h a v i n g n u r s e s involved in r e s e a r c h at their institution.
in my :study examining tnaoe d.ecision m a k i n g , m y c o i n v e s t i g a t o r s w e r e al! emergency nurses. They did n o t h a v e to d e s i g n t h e s t u d y or g e t t h e f u n d i n g , b u t t h e y h a d t h e c l i n i c a l e x p e r t i s e to help me collect the data and to h e l p i n t e r p r e t w h a t w e !(:ound in our q u a l i t a t i v e !.nterviews.
We also l e a r n e d s o m e t h i n g s from n u r s e s w h o p a r t i c i p a t e d i n LUNAR I t h a t w e are n o w able to apply to LUNAR II. We heard, after LUNAR I, t h a t the project involved c o n s i d e r a b l e work for a single p e r s o n and m a n y wished they had a team working with t h e m . For LUNAR II, w e h a v e d e v e l o p e d a s e c t i o n in t h e t r a i n i n g m a n u a l on h o w to recruit a n d train a team. We also tried to work on clearer i n s t r u c t i o n s so e v e r y b o d y w o u l d code or fill out d a t a collection forms correctly; r e v i e w i n g more t h a n 12,000 LUNAR I forms w a s very t i m e - c o n s u m i n g . Overall, t h e e v a l u a t i o n s w e r e very strongly in favor of d o i n g a n o t h e r study. The Board of Directors a n d t h e R e s e a r c h C o m m i t t e e also w a n t e d LUNAR to c o n t i n u e . T h e y t h o u g h t it w a s a great e x p e r i e n c e for e v e r y o n e involved. JEN: You m e n t i o n e d o n e w a y for a clinical n u r s e to b e c o m e involved i n r e s e a r c h is to p a r t i c i p a t e in t h e E N A LUNAR Projects. How else m i g h t n u r s e s b r i n g r e s e a r c h into their p r a c t i c e ? Susan MacLean." O n e w a y to b r i n g r e s e a r c h into practice is b y p a r t i c i p a t i n g in r e s e a r c h at your institution. I k n o w at Rush University, in m y s t u d y e x a m i n -
Dr. MacLean (far right) works with committees to design new models for research innovations.
m g triage d e c i s i o n making, m y coinvestigators were all e m e r g e n c y nurses. They did not have to d e s i g n the s t u d y or get the funding, b u t they h a d the clinical expertise to help m e collect the data a n d to help interpret w h a t w e found in our qualitative interviews. I could not have done the s t u d y w i t h o u t them, a n d t h e y were n o t able to do the s t u d y w i t h o u t me. I w a s very fortunate to h a v e h a d clinical n u r s e s w h o w a n t e d to b e involved a n d to work closely w i t h me. I k n o w that ENA's Research C o m m i t t e e m e m b e r s also like to work with clinicians. The joint expertise of the researcher a n d clinician c o n t r i b u t e to a really strong study. A s e c o n d w a y to b r i n g r e s e a r c h into p r a c t i c e is to work w i t h a mentor. I s o m e t i m e s h a v e s t u d e n t s work w i t h m e on projects here at the n a t i o n a l office. I a m fortunate there are m a n y u n i v e r s i t i e s in Chicago a n d m a n y e m e r g e n c y n u r s i n g s t u d e n t s who n e e d res e a r c h experience, although, in this electronic age, you do n o t always have to b e in the s a m e building, or e v e n in the s a m e city to work together. Several gradu a t e s t u d e n t s have c o m e here to work on projects. T h e y have h e l p e d w i t h d a t a analysis, for i n s t a n c e . I w o u l d also love to have a r e s e a r c h intern. I t h i n k a n e x c i t i n g e x p e r i e n c e for a p e r s o n w o u l d b e to c o m e to the n a t i o n a l office to do a n i n t e r n s h i p in r e s e a r c h a n d t h e n r e t u r n to his or her o w n i n s t i t u t i o n a n d help facilitate r e s e a r c h in the e m e r g e n c y d e p a r t m e n t . U s i n g available data to a n s w e r a q u e s t i o n is a n o t h e r w a y to b r i n g r e s e a r c h into practice. There is a n e n o r m o u s a m o u n t of d a t a already available in e m e r g e n c y d e p a r t m e n t s . I a m surprised t h a t there is n o t more r e s e a r c h related to trauma, g i v e n the a b u n d a n c e of t r a u m a injury d a t a already available in databases. O n e of the r e a s o n s w e could do the LUNAR s t u d i e s is b e c a u s e all t h a t d a t a already exist. M a n y
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Committee chairperson Linda Scheetz (center) and ENA Board member Sherri-Lynne Almeida (left) plan a new Outcomes Research project with Dr. MacLean.
p e o p l e call s a y i n g , "I n e e d to justify staffing (or a cert a i n intervention)," "What c a n I do," a n d "Do y o u k n o w w h e r e t h e i n f o r m a t i o n is?" S o m e t i m e s t h e i n f o r m a t i o n is r i g h t t h e r e in their e m e r g e n c y d e p a r t m e n t . I c a n s u g g e s t h o w t h e y c a n "think like a researcher," m a k i n g s u r e t h a t w h a t t h e y collect is a c c u r a t e a n d t h a t t h e r e are e n o u g h data. Collecting e n o u g h a c c u r a t e information, o r g a n i z i n g t h e information, a n d p r e s e n t i n g it so t h a t y o u h a v e m a d e your c a s e a r e r e s e a r c h e r skills. R e s e a r c h to m e is m o r e t h a n j u s t a h u g e c o m p l e x s t u d y t h a t you d e s i g n , cond u c t , p r e s e n t , a n d publish. T h e r e are so m a n y p i e c e s of r e s e a r c h t h a t I t h i n k clinical n u r s e s s h o u l d b e d o i n g a n d could b e doing, b u t just do n o t b e l i e v e t h e y h a v e t h e skills to do. R e s e a r c h is really g e t t i n g t h e d a t a y o u n e e d so t h a t y o u c a n u s e t h e m , u s e t h e i n f o r m a t i o n in your institution. JEN: W e h a v e all h e a r d t h a t it is i m p o r t a n t t h a t emergency nursing be research based. What exactly does that mean? Susan MacLean: Well, t h e r e are t w o p e r s p e c tives. T h e s c i e n t i f i c b a s i s of n u r s i n g p r a c t i c e m e a n s that when we make decisions, when we implement t r e a t m e n t s , t h e r e is s c i e n t i f i c e v i d e n c e for w h a t w e do. P r a c t i c e often evolved o u t of b e i n g t h e r e a n d d o i n g it, a "trial-and-error" m e t h o d , w i t h o u t t h e d o c u m e n t a t i o n or control to really s e e w h e t h e r one w a y w a s b e t t e r t h a n another. Overall, t h e r e is a v e r y s t r o n g s e n s e t h a t t h e r e m u s t b e s c i e n t i f i c d a t a to s u p p o r t w h a t w e are doing, to c r e a t e n e w w a y s of d o i n g t h i n g s , a n d to b e able to m e a s u r e t h e s u c c e s s of t h a t n e w innovation. D e v e l o p i n g t h e t h e o r y a n d t h e scie n c e of p r a c t i c e , t h e g r a n d r e s e a r c h of nursing, is usually done by researchers who have research edu-
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c a t i o n a n d e x p e r i e n c e . We n e e d to k e e p c o n d u c t i n g scientific studies. T h e s e c o n d p e r s p e c t i v e f o c u s e s on t h e e v e r y d a y s i t u a t i o n s of t h e e m e r g e n c y nurse. E v e r y t i m e you are w o r k i n g w i t h a p a t i e n t or a n o t h e r staff m e m b e r a n d y o u are t h i n k i n g a b o u t w h a t y o u a r e doing, you n e e d timely, a c c u r a t e information. T h e r e a r e m a n y s o u r c e s of i n f o r m a t i o n on w h i c h to b a s e your p r a c t i c e . It m a y b e t h a t it r e q u i r e s a p h o n e call to a r e s e a r c h e r or ENA, or to t h e N a t i o n a l I n s t i t u t e s of Health, t h e C e n t e r s for D i s e a s e Control a n d Prevention, or s o m e organization that has data that you can use and bring b a c k to your situation. You q u e s t i o n , "Why a m I d o i n g this? Is this t h e b e s t w a y to do i t ? " - - t h e n you go g e t the information you need. Research utilization involves a s k i n g t h e q u e s t i o n s a n d g o i n g after t h e i n f o r m a t i o n on a daffy b a s i s , t h a t is t h e p r a c t i c a l u s e of r e s e a r c h . In t o d a y ' s h e a l t h c a r e e n v i r o n m e n t , y o u really n e e d to h a v e t h e d a t a to s u p p o r t w h a t you are doing. You really m u s t k n o w h o w to g e t t h e i n f o r m a t i o n y o u n e e d . In t h i s a g e of e l e c t r o n i c c o m m u n i c a t i o n , t h e r e are so m a n y p l a c e s t h a t y o u c a n a c c e s s d a t a q u i c k l y to g e t t h e i n f o r m a t i o n y o u n e e d . So r e s e a r c h - b a s e d p r a c t i c e is t h e daily i n t e g r a t i o n of r e s e a r c h at t h e p r a c t i c e level. A n d t h e n in t h e g r a n d s c h e m e , w e c a n c o n d u c t t h e b i g s c i e n t i f i c s t u d i e s b e c a u s e w e also n e e d to do that. JEN: You a r e a n a c c o m p l i s h e d r e s e a r c h e r in t h e a r e a of n u r s e s ' clinical d e c i s i o n m a k i n g . Could y o u tell m e a b o u t your w o r k in t h a t a r e a ? Susan MacLean: S i n c e t h e early 1980s I h a v e been studying how nurses make decisions and what i n f l u e n c e s t h a t d e c i s i o n m a k i n g so t h a t w e c a n cons t a n t l y i m p r o v e h o w w e m a k e clinical d e c i s i o n s . In m y m a s t e r ' s t h e s i s e n t i t l e d , "The A m o u n t s a n d R e l e v a n c e of P a t i e n t D a t a G a t h e r e d b y N u r s i n g S t u d e n t s , ''~ I m e a s u r e d c h a n g e s in clinical d e c i s i o n m a k i n g over t h e c o u r s e of n u r s i n g s t u d e n t s ' e d u c a t i o n a l p r o g r a m . In m y d i s s e r t a t i o n e n t i t l e d , " D e s c r i p t i o n of C u e s N u r s e s U s e for D i a g n o s i n g A c t i v i t y I n t o l e r a n c e , ''2 I i d e n t i f i e d t h e c u e s t h a t e x p e r t n u r s e s u s e d to m a k e d e c i s i o n s a b o u t a c t i v i t y limits for c a r d i a c p a t i e n t s . M o r e recently, a t R u s h U n i v e r s i t y in C h i c a g o , m y r e s e a r c h h a s e x a m i n e d t r i a g e d e c i s i o n m a k i n g of e m e r g e n c y n u r s e s to develop a m o d e l of clinical d e c i s i o n m a k i n g . In t h e t r i a g e study, it w a s e x c i t i n g to o b s e r v e a n d validate excellent decision making by emergency nurses. I u s e t h e t e r m critical thinking to c a p t u r e w h a t I found, w h i c h s u p p o r t s n u r s e s ' " s c i e n c e of p r a c t i c e . " Critical t h i n k e r s are v e r y c u r i o u s p e r s o n s , t h e y are a l w a y s q u e s t i o n i n g , "Why, . . . . H o w c a n I i m p r o v e p r a c t i c e , " a n d "Is t h e r e a b e t t e r w a y ? " Life
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t o d a y is p u s h i n g u s to find b e t t e r w a y s of p r a c t i c i n g . S o m e o n e w h o is critical w i t h h e r or his t h o u g h t s a n d o p e n to n e w i d e a s will s e e k n e w w a y s to do t h i n g s . L a c k of critical t h i n k i n g k e e p s u s d o i n g t h i n g s t h e s a m e w a y b e c a u s e w e t h i n k it is easier, familiar, or habit. You c a n g e t c o m f o r t a b l e d o i n g t h i n g s t h e s a m e w a y all t h e time. N o b o d y w a n t s m o r e a n x i e t y in t h e w o r k e n v i r o n m e n t , b u t t h e critical t h i n k e r is t h e pers o n w h o c a n t o l e r a t e u n c e r t a i n t y a little better. W h e n s o m e o n e says, "Let's c h a n g e , " critical t h i n k e r s do n o t go into shock. T h e y are t h e first o n e s to say, "Well, tell m e a b o u t this c h a n g e , " a n d t h e y will a n a l y z e t h e c h a n g e . It is t h a t curiosity, t h a t o p e n - m i n d e d n e s s , t h a t q u e s t i o n i n g t h a t are c h a r a c t e r i s t i c s of inventors, r e s e a r c h e r s , a n d hopefully, t o d a y ' s nurses. I am always shocked when someone thinks
The ENA Foundation has ~ u n d e d 29 s t u d i e s . researchers are these uptight, boring people who are h e r m i t s in s o m e office a n d w h o only g e t a thrill b y w o r k i n g w i t h n u m b e r s . I w o u l d h a v e to g e t into a n e w c a r e e r p a t h if t h a t w e r e true. R e s e a r c h e r s are c u r i o u s a b o u t e v e r y t h i n g , a n d y o u c a n n o t b e c u r i o u s a n d live in a n ivory tower. You j u s t c a n ' t do g o o d r e s e a r c h isol a t e d from t h e world. It t a k e s a lot of c r e a t i v i t y to d e s i g n s t u d i e s , to t h i n k in t h e future, to a n t i c i p a t e . A t t h e s a m e time, r e s e a r c h e r s m u s t b e e x t r e m e l y d e t a i l oriented. I s e e a r e s e a r c h e r a s a p e r s o n w i t h a crea t i v e s i d e a n d a d e t a i l side. N u r s e s are p e o p l e oriente d a n d are u s u a l l y t r y i n g to find t h e b e s t w a y to do s o m e t h i n g . I t h i n k t h e y h a v e t h e p o t e n t i a l to b e v e r y good researchers. JEN: W h a t future c h a l l e n g e s do y o u s e e for develo p i n g our e m e r g e n c y n u r s i n g k n o w l e d g e b a s e ? Susan MacLean: I w o u l d s a y t h a t it is s t u d y i n g h o w h e a l t h e c o n o m i c s is d r i v i n g our p r a c t i c e . T h a t is a n i m p o r t a n t c h a l l e n g e for our future. N u r s e s are looki n g at staffing m o d e l s a n d r e l a t i n g t h a t to o u t c o m e s ; t h a t is t h e drive. N u r s e s are looking at b e n c h m a r k i n g , s e t t i n g "gold s t a n d a r d s . " We m u s t s h o w t h a t our h i g h quality p a t i e n t c a r e is p r o d u c i n g a better, or t h e best, o u t c o m e . T h a t is v e r y c o m p l e x r e s e a r c h to do, b u t it is d e s p e r a t e l y n e e d e d , n e e d e d in all a r e a s of nursing, i n c l u d i n g e m e r g e n c y nursing. A t ENA, w e h a v e a n O u t c o m e s R e s e a r c h Task F o r c e w o r k i n g on a r e s o u r c e d o c u m e n t r e l a t e d to w a y s to m e a s u r e o u t c o m e s a n d actually d e s c r i b i n g a n d c r i t i q u i n g i n s t r u m e n t s , so t h a t p e o p l e w h o w a n t to m e a s u r e o u t c o m e s c a n u s e
Dr. MacLean provides research expertise by meeting with groups such as the Outcomes Research Task Force.
this r e s o u r c e to help t h e m k n o w h o w to do that. U s i n g t e c h n o l o g y is a n o t h e r c h a l l e n g e for t h e future of e m e r g e n c y n u r s i n g r e s e a r c h . E m e r g e n c y d e p a r t m e n t s are u s i n g c o m p u t e r t e c h n o l o g y for regi s t r a t i o n a n d billing, b u t few actually t r a c k p a t i e n t s , r e c o r d i n g r e a l - t i m e clinical d a t a a b o u t p a t i e n t s . T h e
Data Elements for E m e r g e n c y Department S y s t e m s d o c u m e n t w a s r e c e n t l y d e v e l o p e d b y t h e C e n t e r s for D i s e a s e Control a n d Prevention, w i t h E N A a p a r t i c i p a t i n g g r o u p , to s t a n d a r d i z e d a t a c o l l e c t i o n on p a t i e n t s , s T h e t e c h n o l o g y is also available, b u t g e t t i n g i n s t i t u t i o n s to c o m m i t to u s i n g t h e t e c h n o l o g y h a s y e t to b e done. O n c e t h a t occurs, t h a t will b e v e r y helpful to e m e r g e n c y n u r s e s in d o c u m e n t i n g w h a t t h e y do. Right n o w w h e n s o m e b o d y says, "Let's g e t rid of staff," t h e only p l a c e to go to find w r i t t e n d o c u m e n t a t i o n is t h e m e d i c a l record. A n d often, n u r s e s ' d e c i s i o n m a k i n g , i n t e r v e n t i o n s , a n d o u t c o m e s do n o t s h o w u p in p a p e r records. I t h i n k t h e w h o l e world of t e c h n o l o g y is just w a i t i n g to arrive at e m e r g e n c y d e p a r t m e n t s , to g e t p e o p l e really i n t e r e s t e d in inform a t i o n s y s t e m s a n d b e a b l e to d o c u m e n t t h a t e m e r g e n c y n u r s i n g p r a c t i c e r e s u l t s in g o o d o u t c o m e s . T h a t is a n i m p o r t a n t challenge. JEN_: Susan, you w e r e t h e first r e c i p i e n t of t h e E N A F o u n d a t i o n r e s e a r c h g r a n t a w a r d in 1991. You h a v e w i t n e s s e d , a n d a c t i v e l y c o n t r i b u t e d to, t h e d e v e l o p m e n t of t h e e m e r g e n c y n u r s i n g k n o w l e d g e b a s e . W h a t w o u l d you i d e n t i f y as h i g h l i g h t s of e m e r gency nursing's knowledge base? Susan MacLean: In a c h a p t e r I r e c e n t l y w r o t e for a b o o k e n t i t l e d Encyclopedia of Nursing Research e d i t e d b y J o y c e F i t z p a t r i c k 4 at C a s e W e s t e r n R e s e r v e University, I w r o t e a b o u t t h e s t a t e of clinical r e s e a r c h
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r e l a t e d to e m e r g e n c y nursing. I will g i v e t h e R e s e a r c h C o m m i t t e e k u d o s on t h i s subject, b e c a u s e s e v e r a l years ago they collected and classified the research t h a t h a d b e e n p u b l i s h e d b y e m e r g e n c y n u r s e s or pres e n t e d at our c o n f e r e n c e s (Scientific A s s e m b l y a n d Leadership Symposium). I updated that information to g e t a s e n s e of h o w t h e r e s e a r c h d u r i n g t h e last 5 y e a r s r e l a t e d to t h e E N A r e s e a r c h i n i t i a t i v e s a n d t h e t y p e of r e s e a r c h t h a t h a d b e e n u s e d . T h e m o s t c o m m o n a r e a of r e s e a r c h r e l a t e s to effective a n d efficient o u t c o m e s of e m e r g e n c y n u r s i n g care. W h e n t h e y talk a b o u t o u t c o m e s in t h i s early s e r i e s of s t u d i e s , t h e y w e r e n o t e x a c t l y t a l k i n g a b o u t t h e s a m e k i n d s of o u t c o m e s t h a t w e m e a s u r e now. T h e focus w a s m o r e on i n t e r v e n t i o n s t h a n a c t u a l l y m e a s u r i n g t h e c h a n g e . T h e n e x t l a r g e s t g r o u p of p a p e r s w a s r e l a t e d to factors affecting e m e r g e n c y n u r s i n g p r a c t i c e . A n d to a l e s s e r extent, to n u r s i n g c a r e d e l i v e r y s y s t e m s , h e a l t h p r o m o t i o n a n d injury p r e v e n t i o n , a n d t h e n h e a l t h c a r e technology. In t h e c h a p t e r I also p r e s e n t e d m y p e r s p e c t i v e on d e v e l o p i n g a n " e m e r g e n c y n u r s i n g r e s e a r c h culture." We n e e d to h a v e r e s e a r c h s c i e n t i s t s w i t h i n t h e s p e ciality of e m e r g e n c y n u r s i n g in order to do that. A c c o r d i n g to our D e m o g r a p h i c Survey, w e h a v e v e r y well-educated ENA members. One sample reflected 41% w i t h b a c c a l a u r e a t e d e g r e e s , 14% w i t h m a s t e r ' s d e g r e e s , 6% w i t h d o c t o r a l d e g r e e s , a n d 31% w h o a r e f u r t h e r i n g t h e i r e d u c a t i o n . A n d w h e t h e r it is in b a c c a l a u r e a t e , m a s t e r ' s , or d o c t o r a l e d u c a t i o n , you are a l w a y s e x p o s e d to r e s e a r c h . F u n d i n g is also g r o w i n g . W h e n you w a n t to do e v e n a small p r o j e c t properly, y o u n e e d m o n e y to do it. T h e E N A F o u n d a t i o n b e g a n in 1991 w i t h a $1500 grant. M o v i n g to t h e p r e s e n t , in 1997, t h e F o u n d a t i o n h a d $33,000 in g r a n t o p p o r t u n i t i e s . I t h i n k t h a t helps. T h e E N A F o u n d a t i o n h a s f u n d e d 29 s t u d i e s . JEN: H o w d i d y o u b e c o m e involved in r e s e a r c h ? Susan MacLean: I p r a c t i c e d for a b o u t 15 y e a r s as a clinical nurse. D u r i n g t h o s e y e a r s I really liked to teach--it was what gave me the most satisfaction. I w o r k e d in a n i n t e n s i v e c a r e u n i t for o p e n - h e a r t surgery patients and what I loved was teaching p a t i e n t s preoperatively. I k n e w to b e a b l e to t e a c h I h a d to r e t u r n to school. I r e c e i v e d m y b a c c a l a u r e a t e d e g r e e in 1980, a n d s t a r t e d g r a d u a t e school i m m e d i ately. I do n o t t h i n k w e h a d f i n i s h e d o n e s e m e s t e r of our p r o g r a m before t h e faculty said, "To t e a c h y o u n e e d a d o c t o r a l d e g r e e a n d y o u n e e d to b e d o i n g r e s e a r c h . " I n e v e r s e e m e d to h a v e t h e r i g h t d e g r e e ! In t h a t first y e a r of m y m a s t e r ' s p r o g r a m at t h e College of Nursing, U n i v e r s i t y of Illinois C h i c a g o , I s t a r t e d to t a k e r e s e a r c h a n d t h o u g h t , "This is really i n t e r e s t ing!" I loved t h e r e s e a r c h c l a s s e s a n d t h e c h a l l e n g e
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t h a t r e s e a r c h g a v e me: B e s i d e s m y c o m p r e h e n s i v e m a s t e r ' s a n d d o c t o r a l r e s e a r c h , I w o r k e d on a n u m b e r of s t u d i e s as a r e s e a r c h a s s i s t a n t . By t h e t i m e I g r a d u a t e d in 1987, I k n e w h o w to identify really g o o d r e s e a r c h , h o w to i d e n t i f y flaws, a n d h o w to a v o i d pitfalls in r e s e a r c h . I h a v e s i n c e s e r v e d on t h e t h e s i s c o m m i t t e e of n u m e r o u s g r a d u a t e s t u d e n t s . Fortunately, I h a v e b e e n a b l e to c o n t i n u e m y faculty a p p o i n t m e n t at R u s h U n i v e r s i t y College of N u r s i n g in C h i c a g o . It h a s b e e n v e r y n i c e to m a i n t a i n t h e a c a d e m i c role, w o r k i n g w i t h s t u d e n t s , a n d now, w i t h ENA, to w o r k w i t h 25,000 m e m b e r s a n d o t h e r o r g a n i zations and associations. JEN: Do y o u h a v e a n y l a s t c o m m e n t s ? Susan MacLean: I g u e s s m y overall s e n s e of r e s e a r c h o u t s i d e t h e c l a s s r o o m is t h a t it c a n b e exciting, i n t e r e s t i n g , a n d v e r y useful to t h e e m e r g e n c y nurse. R e s e a r c h d e a l s w i t h f i n d i n g timely, a c c u r a t e i n f o r m a t i o n t h a t c a n b e u s e d in p r a c t i c e , for p o l i c y m a k i n g , a n d in a d m i n i s t r a t i o n . T h e r e are differing levels of i n v o l v e m e n t in r e s e a r c h , of w a y s to u s e information. Critical t h i n k i n g a n d b e i n g o p e n - m i n d e d a r e i m p o r t a n t . I w o u l d like to s e e m o r e e m e r g e n c y n u r s es involved w i t h r e s e a r c h at s o m e level. I t h i n k t h a t t h e y h a v e t h e ability to do this. R e s e a r c h h a s p r a c t i cal value. E m e r g e n c y n u r s e s n e e d s o u n d d a t a in their p r a c t i c e . R e s e a r c h is c h a l l e n g i n g , b u t e m e r g e n c y n u r s e s c a n b e involved, a n d it is i m p o r t a n t for u s to b e i n v o l v e d now. References 1. MacLean S. The amounts and relevance of patient data gathered by nursing students [thesis]. Chicago (IL): University of Illinois at Chicago Health Science Center; 1983. 2. MacLean S. Description of cues nurses use for diagnosing activity intolerance [dissertation]. Chicago (IL): University of Illinois at Chicago; 1987. 3. DEEDS Writing Committee. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): a summary report. J Emerg Nurs 1998;24:35-44. 4. MacLean S. Emergency nursing research. In: Fitzpatrick J J, editor. Encyclopedia of nursing research. New York: Springer. In press.
Contributions for this column can be sent toJane Koziol-McLain, RN, PhD(c), 7360 S. Tamarac Court, Englewood, CO 80112; (303) 721-1723; E-mail: [email protected] orRuth Malone, RN, PhD, CEN, 3906 Midvale Ave., Oakland, CA 94602; (415) 874-8010; E-maik rmalone@itsa. ucsf.edu
hree years ago the ENA Board of Directors voted to create the Research Services Department. Susan MacLean, RN, PhD, was hired as director. In 3 short years, Dr. MacLean has catapulted ENA into the age of research. Under the leadership of Dr. MacLean, the ENA Research Services Department has come to be known and respected as a leader in the national nursing community and beyond. Jane Koziol-McLain, Journal Research Column section editor, recently interviewed Dr. MacLean to learn more about the accomplishments and the future direction of the Research Services Department. JEN: How would you describe the ENA Research Services Department? Susan MacLean: Having an ENA department dedicated to research means that there are more ENA resources available for conducting research, supporting research, mentoring, and other activities. Much of the last 3 years has been spent developing new projects. Also, we have become a center for information. The Research Department receives a lot of phone calls from members, emergency departments, other organizations, and federal facilities. They request information about w h a t is h a p p e n i n g in e m e r g e n c y departments today, so in 1995 we started conducting the annual National Emergency Department Database Survey The survey results provide the data to answer some of the questions we receive. A lot of information exchange goes on through the office; if we do not have the information, we try to connect people with someone who does, maybe the Nursing Practice chairperson or the Managers Committee chairperson, someone who might have resources for them. We are also finding websites that we can refer people to. It has been fun. There have been lots of new opportunities to create, to develop, and to work with some really neat people. Lots of projects have "taken off" and we stay very busy.
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J Emerg Nurs 1998;24:90-4. Copyright © 1998by the EmergencyNurses Association. 0099-1767/98 $5.00 + 0 18/1/87122
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JEN: I often hear from ENA Departments and Committees that you are highly valued as an expert research consultant. You are a valuable liaison between the Research Committee and the Journal, and have published Editorials and Research Columns that support research. How would you summarize your many activities? Susan MacLean: There are really two kinds of activities: c o n d u c t i n g research and facilitating research. I do not think that the ENA members are aware of how m u c h research goes on at the national office. We have a Demographic Survey of our members that is c o n d u c t e d by the Membership Department and a Purchasing Survey conducted by Meeting Services. The Marketing Department does a Needs Assessment. The Government Affairs Committee is conducting a Violence in the Workplace Survey. Within the national office, I do a lot of consulting. I provide feedback on survey methods and on tools that other committees or departments develop that need the expertise of a researcher. The majority of the research effort in this department is helping facilitate research for emergency nurses. Facilitating research is primarily done through the Research Committee. They focus on activities that will mentor emergency nurses. The two multisite studies, Learning and Using New Approaches to Research I (LUNAR I) and LUNAR II, which is starting now, are both large, multisite studies designed to help emergency nurses learn about research while actually participating in the study. As Director of Research Services, I have facilitated the processing of these two large multisite studies. JEN: Program evaluation is an important process when conducting large multisite studies. I understand you coordinated a LUNAR I program evaluation. Susan MacLean: Yes, we did an evaluation of LUNAR I participants after the completion of the s t u d y - - t h e y were very positive. The respondents were excited about being able to participate in a study that somebody else designed because they did
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n o t have the e x p e r i e n c e or the k n o w l e d g e to write a proposal, get the proposal t h r o u g h a n i n s t i t u t i o n a l review board, c o n d u c t the study, a n d analyze the data. The o p p o r t u n i t y to p a r t i c i p a t e a n d g a i n skills w i t h o u t carrying t h e responsibility for the overall s t u d y w a s i m p o r t a n t for m a n y nurses. People said, "I w a s too a n x i o u s to do r e s e a r c h on m y o w n a n d yet I always w a n t e d to b e involved." It w a s e x c i t i n g to hear from a d m i n i s t r a t o r s of the site coordinators as well. T h e y w e r e very e n t h u s i a s t i c a n d supportive of h a v i n g n u r s e s involved in r e s e a r c h at their institution.
in my :study examining tnaoe d.ecision m a k i n g , m y c o i n v e s t i g a t o r s w e r e al! emergency nurses. They did n o t h a v e to d e s i g n t h e s t u d y or g e t t h e f u n d i n g , b u t t h e y h a d t h e c l i n i c a l e x p e r t i s e to help me collect the data and to h e l p i n t e r p r e t w h a t w e !(:ound in our q u a l i t a t i v e !.nterviews.
We also l e a r n e d s o m e t h i n g s from n u r s e s w h o p a r t i c i p a t e d i n LUNAR I t h a t w e are n o w able to apply to LUNAR II. We heard, after LUNAR I, t h a t the project involved c o n s i d e r a b l e work for a single p e r s o n and m a n y wished they had a team working with t h e m . For LUNAR II, w e h a v e d e v e l o p e d a s e c t i o n in t h e t r a i n i n g m a n u a l on h o w to recruit a n d train a team. We also tried to work on clearer i n s t r u c t i o n s so e v e r y b o d y w o u l d code or fill out d a t a collection forms correctly; r e v i e w i n g more t h a n 12,000 LUNAR I forms w a s very t i m e - c o n s u m i n g . Overall, t h e e v a l u a t i o n s w e r e very strongly in favor of d o i n g a n o t h e r study. The Board of Directors a n d t h e R e s e a r c h C o m m i t t e e also w a n t e d LUNAR to c o n t i n u e . T h e y t h o u g h t it w a s a great e x p e r i e n c e for e v e r y o n e involved. JEN: You m e n t i o n e d o n e w a y for a clinical n u r s e to b e c o m e involved i n r e s e a r c h is to p a r t i c i p a t e in t h e E N A LUNAR Projects. How else m i g h t n u r s e s b r i n g r e s e a r c h into their p r a c t i c e ? Susan MacLean." O n e w a y to b r i n g r e s e a r c h into practice is b y p a r t i c i p a t i n g in r e s e a r c h at your institution. I k n o w at Rush University, in m y s t u d y e x a m i n -
Dr. MacLean (far right) works with committees to design new models for research innovations.
m g triage d e c i s i o n making, m y coinvestigators were all e m e r g e n c y nurses. They did not have to d e s i g n the s t u d y or get the funding, b u t they h a d the clinical expertise to help m e collect the data a n d to help interpret w h a t w e found in our qualitative interviews. I could not have done the s t u d y w i t h o u t them, a n d t h e y were n o t able to do the s t u d y w i t h o u t me. I w a s very fortunate to h a v e h a d clinical n u r s e s w h o w a n t e d to b e involved a n d to work closely w i t h me. I k n o w that ENA's Research C o m m i t t e e m e m b e r s also like to work with clinicians. The joint expertise of the researcher a n d clinician c o n t r i b u t e to a really strong study. A s e c o n d w a y to b r i n g r e s e a r c h into p r a c t i c e is to work w i t h a mentor. I s o m e t i m e s h a v e s t u d e n t s work w i t h m e on projects here at the n a t i o n a l office. I a m fortunate there are m a n y u n i v e r s i t i e s in Chicago a n d m a n y e m e r g e n c y n u r s i n g s t u d e n t s who n e e d res e a r c h experience, although, in this electronic age, you do n o t always have to b e in the s a m e building, or e v e n in the s a m e city to work together. Several gradu a t e s t u d e n t s have c o m e here to work on projects. T h e y have h e l p e d w i t h d a t a analysis, for i n s t a n c e . I w o u l d also love to have a r e s e a r c h intern. I t h i n k a n e x c i t i n g e x p e r i e n c e for a p e r s o n w o u l d b e to c o m e to the n a t i o n a l office to do a n i n t e r n s h i p in r e s e a r c h a n d t h e n r e t u r n to his or her o w n i n s t i t u t i o n a n d help facilitate r e s e a r c h in the e m e r g e n c y d e p a r t m e n t . U s i n g available data to a n s w e r a q u e s t i o n is a n o t h e r w a y to b r i n g r e s e a r c h into practice. There is a n e n o r m o u s a m o u n t of d a t a already available in e m e r g e n c y d e p a r t m e n t s . I a m surprised t h a t there is n o t more r e s e a r c h related to trauma, g i v e n the a b u n d a n c e of t r a u m a injury d a t a already available in databases. O n e of the r e a s o n s w e could do the LUNAR s t u d i e s is b e c a u s e all t h a t d a t a already exist. M a n y
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Committee chairperson Linda Scheetz (center) and ENA Board member Sherri-Lynne Almeida (left) plan a new Outcomes Research project with Dr. MacLean.
p e o p l e call s a y i n g , "I n e e d to justify staffing (or a cert a i n intervention)," "What c a n I do," a n d "Do y o u k n o w w h e r e t h e i n f o r m a t i o n is?" S o m e t i m e s t h e i n f o r m a t i o n is r i g h t t h e r e in their e m e r g e n c y d e p a r t m e n t . I c a n s u g g e s t h o w t h e y c a n "think like a researcher," m a k i n g s u r e t h a t w h a t t h e y collect is a c c u r a t e a n d t h a t t h e r e are e n o u g h data. Collecting e n o u g h a c c u r a t e information, o r g a n i z i n g t h e information, a n d p r e s e n t i n g it so t h a t y o u h a v e m a d e your c a s e a r e r e s e a r c h e r skills. R e s e a r c h to m e is m o r e t h a n j u s t a h u g e c o m p l e x s t u d y t h a t you d e s i g n , cond u c t , p r e s e n t , a n d publish. T h e r e are so m a n y p i e c e s of r e s e a r c h t h a t I t h i n k clinical n u r s e s s h o u l d b e d o i n g a n d could b e doing, b u t just do n o t b e l i e v e t h e y h a v e t h e skills to do. R e s e a r c h is really g e t t i n g t h e d a t a y o u n e e d so t h a t y o u c a n u s e t h e m , u s e t h e i n f o r m a t i o n in your institution. JEN: W e h a v e all h e a r d t h a t it is i m p o r t a n t t h a t emergency nursing be research based. What exactly does that mean? Susan MacLean: Well, t h e r e are t w o p e r s p e c tives. T h e s c i e n t i f i c b a s i s of n u r s i n g p r a c t i c e m e a n s that when we make decisions, when we implement t r e a t m e n t s , t h e r e is s c i e n t i f i c e v i d e n c e for w h a t w e do. P r a c t i c e often evolved o u t of b e i n g t h e r e a n d d o i n g it, a "trial-and-error" m e t h o d , w i t h o u t t h e d o c u m e n t a t i o n or control to really s e e w h e t h e r one w a y w a s b e t t e r t h a n another. Overall, t h e r e is a v e r y s t r o n g s e n s e t h a t t h e r e m u s t b e s c i e n t i f i c d a t a to s u p p o r t w h a t w e are doing, to c r e a t e n e w w a y s of d o i n g t h i n g s , a n d to b e able to m e a s u r e t h e s u c c e s s of t h a t n e w innovation. D e v e l o p i n g t h e t h e o r y a n d t h e scie n c e of p r a c t i c e , t h e g r a n d r e s e a r c h of nursing, is usually done by researchers who have research edu-
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c a t i o n a n d e x p e r i e n c e . We n e e d to k e e p c o n d u c t i n g scientific studies. T h e s e c o n d p e r s p e c t i v e f o c u s e s on t h e e v e r y d a y s i t u a t i o n s of t h e e m e r g e n c y nurse. E v e r y t i m e you are w o r k i n g w i t h a p a t i e n t or a n o t h e r staff m e m b e r a n d y o u are t h i n k i n g a b o u t w h a t y o u a r e doing, you n e e d timely, a c c u r a t e information. T h e r e a r e m a n y s o u r c e s of i n f o r m a t i o n on w h i c h to b a s e your p r a c t i c e . It m a y b e t h a t it r e q u i r e s a p h o n e call to a r e s e a r c h e r or ENA, or to t h e N a t i o n a l I n s t i t u t e s of Health, t h e C e n t e r s for D i s e a s e Control a n d Prevention, or s o m e organization that has data that you can use and bring b a c k to your situation. You q u e s t i o n , "Why a m I d o i n g this? Is this t h e b e s t w a y to do i t ? " - - t h e n you go g e t the information you need. Research utilization involves a s k i n g t h e q u e s t i o n s a n d g o i n g after t h e i n f o r m a t i o n on a daffy b a s i s , t h a t is t h e p r a c t i c a l u s e of r e s e a r c h . In t o d a y ' s h e a l t h c a r e e n v i r o n m e n t , y o u really n e e d to h a v e t h e d a t a to s u p p o r t w h a t you are doing. You really m u s t k n o w h o w to g e t t h e i n f o r m a t i o n y o u n e e d . In t h i s a g e of e l e c t r o n i c c o m m u n i c a t i o n , t h e r e are so m a n y p l a c e s t h a t y o u c a n a c c e s s d a t a q u i c k l y to g e t t h e i n f o r m a t i o n y o u n e e d . So r e s e a r c h - b a s e d p r a c t i c e is t h e daily i n t e g r a t i o n of r e s e a r c h at t h e p r a c t i c e level. A n d t h e n in t h e g r a n d s c h e m e , w e c a n c o n d u c t t h e b i g s c i e n t i f i c s t u d i e s b e c a u s e w e also n e e d to do that. JEN: You a r e a n a c c o m p l i s h e d r e s e a r c h e r in t h e a r e a of n u r s e s ' clinical d e c i s i o n m a k i n g . Could y o u tell m e a b o u t your w o r k in t h a t a r e a ? Susan MacLean: S i n c e t h e early 1980s I h a v e been studying how nurses make decisions and what i n f l u e n c e s t h a t d e c i s i o n m a k i n g so t h a t w e c a n cons t a n t l y i m p r o v e h o w w e m a k e clinical d e c i s i o n s . In m y m a s t e r ' s t h e s i s e n t i t l e d , "The A m o u n t s a n d R e l e v a n c e of P a t i e n t D a t a G a t h e r e d b y N u r s i n g S t u d e n t s , ''~ I m e a s u r e d c h a n g e s in clinical d e c i s i o n m a k i n g over t h e c o u r s e of n u r s i n g s t u d e n t s ' e d u c a t i o n a l p r o g r a m . In m y d i s s e r t a t i o n e n t i t l e d , " D e s c r i p t i o n of C u e s N u r s e s U s e for D i a g n o s i n g A c t i v i t y I n t o l e r a n c e , ''2 I i d e n t i f i e d t h e c u e s t h a t e x p e r t n u r s e s u s e d to m a k e d e c i s i o n s a b o u t a c t i v i t y limits for c a r d i a c p a t i e n t s . M o r e recently, a t R u s h U n i v e r s i t y in C h i c a g o , m y r e s e a r c h h a s e x a m i n e d t r i a g e d e c i s i o n m a k i n g of e m e r g e n c y n u r s e s to develop a m o d e l of clinical d e c i s i o n m a k i n g . In t h e t r i a g e study, it w a s e x c i t i n g to o b s e r v e a n d validate excellent decision making by emergency nurses. I u s e t h e t e r m critical thinking to c a p t u r e w h a t I found, w h i c h s u p p o r t s n u r s e s ' " s c i e n c e of p r a c t i c e . " Critical t h i n k e r s are v e r y c u r i o u s p e r s o n s , t h e y are a l w a y s q u e s t i o n i n g , "Why, . . . . H o w c a n I i m p r o v e p r a c t i c e , " a n d "Is t h e r e a b e t t e r w a y ? " Life
JOURNAL OF EMERGENCY NURSING
t o d a y is p u s h i n g u s to find b e t t e r w a y s of p r a c t i c i n g . S o m e o n e w h o is critical w i t h h e r or his t h o u g h t s a n d o p e n to n e w i d e a s will s e e k n e w w a y s to do t h i n g s . L a c k of critical t h i n k i n g k e e p s u s d o i n g t h i n g s t h e s a m e w a y b e c a u s e w e t h i n k it is easier, familiar, or habit. You c a n g e t c o m f o r t a b l e d o i n g t h i n g s t h e s a m e w a y all t h e time. N o b o d y w a n t s m o r e a n x i e t y in t h e w o r k e n v i r o n m e n t , b u t t h e critical t h i n k e r is t h e pers o n w h o c a n t o l e r a t e u n c e r t a i n t y a little better. W h e n s o m e o n e says, "Let's c h a n g e , " critical t h i n k e r s do n o t go into shock. T h e y are t h e first o n e s to say, "Well, tell m e a b o u t this c h a n g e , " a n d t h e y will a n a l y z e t h e c h a n g e . It is t h a t curiosity, t h a t o p e n - m i n d e d n e s s , t h a t q u e s t i o n i n g t h a t are c h a r a c t e r i s t i c s of inventors, r e s e a r c h e r s , a n d hopefully, t o d a y ' s nurses. I am always shocked when someone thinks
The ENA Foundation has ~ u n d e d 29 s t u d i e s . researchers are these uptight, boring people who are h e r m i t s in s o m e office a n d w h o only g e t a thrill b y w o r k i n g w i t h n u m b e r s . I w o u l d h a v e to g e t into a n e w c a r e e r p a t h if t h a t w e r e true. R e s e a r c h e r s are c u r i o u s a b o u t e v e r y t h i n g , a n d y o u c a n n o t b e c u r i o u s a n d live in a n ivory tower. You j u s t c a n ' t do g o o d r e s e a r c h isol a t e d from t h e world. It t a k e s a lot of c r e a t i v i t y to d e s i g n s t u d i e s , to t h i n k in t h e future, to a n t i c i p a t e . A t t h e s a m e time, r e s e a r c h e r s m u s t b e e x t r e m e l y d e t a i l oriented. I s e e a r e s e a r c h e r a s a p e r s o n w i t h a crea t i v e s i d e a n d a d e t a i l side. N u r s e s are p e o p l e oriente d a n d are u s u a l l y t r y i n g to find t h e b e s t w a y to do s o m e t h i n g . I t h i n k t h e y h a v e t h e p o t e n t i a l to b e v e r y good researchers. JEN: W h a t future c h a l l e n g e s do y o u s e e for develo p i n g our e m e r g e n c y n u r s i n g k n o w l e d g e b a s e ? Susan MacLean: I w o u l d s a y t h a t it is s t u d y i n g h o w h e a l t h e c o n o m i c s is d r i v i n g our p r a c t i c e . T h a t is a n i m p o r t a n t c h a l l e n g e for our future. N u r s e s are looki n g at staffing m o d e l s a n d r e l a t i n g t h a t to o u t c o m e s ; t h a t is t h e drive. N u r s e s are looking at b e n c h m a r k i n g , s e t t i n g "gold s t a n d a r d s . " We m u s t s h o w t h a t our h i g h quality p a t i e n t c a r e is p r o d u c i n g a better, or t h e best, o u t c o m e . T h a t is v e r y c o m p l e x r e s e a r c h to do, b u t it is d e s p e r a t e l y n e e d e d , n e e d e d in all a r e a s of nursing, i n c l u d i n g e m e r g e n c y nursing. A t ENA, w e h a v e a n O u t c o m e s R e s e a r c h Task F o r c e w o r k i n g on a r e s o u r c e d o c u m e n t r e l a t e d to w a y s to m e a s u r e o u t c o m e s a n d actually d e s c r i b i n g a n d c r i t i q u i n g i n s t r u m e n t s , so t h a t p e o p l e w h o w a n t to m e a s u r e o u t c o m e s c a n u s e
Dr. MacLean provides research expertise by meeting with groups such as the Outcomes Research Task Force.
this r e s o u r c e to help t h e m k n o w h o w to do that. U s i n g t e c h n o l o g y is a n o t h e r c h a l l e n g e for t h e future of e m e r g e n c y n u r s i n g r e s e a r c h . E m e r g e n c y d e p a r t m e n t s are u s i n g c o m p u t e r t e c h n o l o g y for regi s t r a t i o n a n d billing, b u t few actually t r a c k p a t i e n t s , r e c o r d i n g r e a l - t i m e clinical d a t a a b o u t p a t i e n t s . T h e
Data Elements for E m e r g e n c y Department S y s t e m s d o c u m e n t w a s r e c e n t l y d e v e l o p e d b y t h e C e n t e r s for D i s e a s e Control a n d Prevention, w i t h E N A a p a r t i c i p a t i n g g r o u p , to s t a n d a r d i z e d a t a c o l l e c t i o n on p a t i e n t s , s T h e t e c h n o l o g y is also available, b u t g e t t i n g i n s t i t u t i o n s to c o m m i t to u s i n g t h e t e c h n o l o g y h a s y e t to b e done. O n c e t h a t occurs, t h a t will b e v e r y helpful to e m e r g e n c y n u r s e s in d o c u m e n t i n g w h a t t h e y do. Right n o w w h e n s o m e b o d y says, "Let's g e t rid of staff," t h e only p l a c e to go to find w r i t t e n d o c u m e n t a t i o n is t h e m e d i c a l record. A n d often, n u r s e s ' d e c i s i o n m a k i n g , i n t e r v e n t i o n s , a n d o u t c o m e s do n o t s h o w u p in p a p e r records. I t h i n k t h e w h o l e world of t e c h n o l o g y is just w a i t i n g to arrive at e m e r g e n c y d e p a r t m e n t s , to g e t p e o p l e really i n t e r e s t e d in inform a t i o n s y s t e m s a n d b e a b l e to d o c u m e n t t h a t e m e r g e n c y n u r s i n g p r a c t i c e r e s u l t s in g o o d o u t c o m e s . T h a t is a n i m p o r t a n t challenge. JEN_: Susan, you w e r e t h e first r e c i p i e n t of t h e E N A F o u n d a t i o n r e s e a r c h g r a n t a w a r d in 1991. You h a v e w i t n e s s e d , a n d a c t i v e l y c o n t r i b u t e d to, t h e d e v e l o p m e n t of t h e e m e r g e n c y n u r s i n g k n o w l e d g e b a s e . W h a t w o u l d you i d e n t i f y as h i g h l i g h t s of e m e r gency nursing's knowledge base? Susan MacLean: In a c h a p t e r I r e c e n t l y w r o t e for a b o o k e n t i t l e d Encyclopedia of Nursing Research e d i t e d b y J o y c e F i t z p a t r i c k 4 at C a s e W e s t e r n R e s e r v e University, I w r o t e a b o u t t h e s t a t e of clinical r e s e a r c h
February 1998 93
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r e l a t e d to e m e r g e n c y nursing. I will g i v e t h e R e s e a r c h C o m m i t t e e k u d o s on t h i s subject, b e c a u s e s e v e r a l years ago they collected and classified the research t h a t h a d b e e n p u b l i s h e d b y e m e r g e n c y n u r s e s or pres e n t e d at our c o n f e r e n c e s (Scientific A s s e m b l y a n d Leadership Symposium). I updated that information to g e t a s e n s e of h o w t h e r e s e a r c h d u r i n g t h e last 5 y e a r s r e l a t e d to t h e E N A r e s e a r c h i n i t i a t i v e s a n d t h e t y p e of r e s e a r c h t h a t h a d b e e n u s e d . T h e m o s t c o m m o n a r e a of r e s e a r c h r e l a t e s to effective a n d efficient o u t c o m e s of e m e r g e n c y n u r s i n g care. W h e n t h e y talk a b o u t o u t c o m e s in t h i s early s e r i e s of s t u d i e s , t h e y w e r e n o t e x a c t l y t a l k i n g a b o u t t h e s a m e k i n d s of o u t c o m e s t h a t w e m e a s u r e now. T h e focus w a s m o r e on i n t e r v e n t i o n s t h a n a c t u a l l y m e a s u r i n g t h e c h a n g e . T h e n e x t l a r g e s t g r o u p of p a p e r s w a s r e l a t e d to factors affecting e m e r g e n c y n u r s i n g p r a c t i c e . A n d to a l e s s e r extent, to n u r s i n g c a r e d e l i v e r y s y s t e m s , h e a l t h p r o m o t i o n a n d injury p r e v e n t i o n , a n d t h e n h e a l t h c a r e technology. In t h e c h a p t e r I also p r e s e n t e d m y p e r s p e c t i v e on d e v e l o p i n g a n " e m e r g e n c y n u r s i n g r e s e a r c h culture." We n e e d to h a v e r e s e a r c h s c i e n t i s t s w i t h i n t h e s p e ciality of e m e r g e n c y n u r s i n g in order to do that. A c c o r d i n g to our D e m o g r a p h i c Survey, w e h a v e v e r y well-educated ENA members. One sample reflected 41% w i t h b a c c a l a u r e a t e d e g r e e s , 14% w i t h m a s t e r ' s d e g r e e s , 6% w i t h d o c t o r a l d e g r e e s , a n d 31% w h o a r e f u r t h e r i n g t h e i r e d u c a t i o n . A n d w h e t h e r it is in b a c c a l a u r e a t e , m a s t e r ' s , or d o c t o r a l e d u c a t i o n , you are a l w a y s e x p o s e d to r e s e a r c h . F u n d i n g is also g r o w i n g . W h e n you w a n t to do e v e n a small p r o j e c t properly, y o u n e e d m o n e y to do it. T h e E N A F o u n d a t i o n b e g a n in 1991 w i t h a $1500 grant. M o v i n g to t h e p r e s e n t , in 1997, t h e F o u n d a t i o n h a d $33,000 in g r a n t o p p o r t u n i t i e s . I t h i n k t h a t helps. T h e E N A F o u n d a t i o n h a s f u n d e d 29 s t u d i e s . JEN: H o w d i d y o u b e c o m e involved in r e s e a r c h ? Susan MacLean: I p r a c t i c e d for a b o u t 15 y e a r s as a clinical nurse. D u r i n g t h o s e y e a r s I really liked to teach--it was what gave me the most satisfaction. I w o r k e d in a n i n t e n s i v e c a r e u n i t for o p e n - h e a r t surgery patients and what I loved was teaching p a t i e n t s preoperatively. I k n e w to b e a b l e to t e a c h I h a d to r e t u r n to school. I r e c e i v e d m y b a c c a l a u r e a t e d e g r e e in 1980, a n d s t a r t e d g r a d u a t e school i m m e d i ately. I do n o t t h i n k w e h a d f i n i s h e d o n e s e m e s t e r of our p r o g r a m before t h e faculty said, "To t e a c h y o u n e e d a d o c t o r a l d e g r e e a n d y o u n e e d to b e d o i n g r e s e a r c h . " I n e v e r s e e m e d to h a v e t h e r i g h t d e g r e e ! In t h a t first y e a r of m y m a s t e r ' s p r o g r a m at t h e College of Nursing, U n i v e r s i t y of Illinois C h i c a g o , I s t a r t e d to t a k e r e s e a r c h a n d t h o u g h t , "This is really i n t e r e s t ing!" I loved t h e r e s e a r c h c l a s s e s a n d t h e c h a l l e n g e
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t h a t r e s e a r c h g a v e me: B e s i d e s m y c o m p r e h e n s i v e m a s t e r ' s a n d d o c t o r a l r e s e a r c h , I w o r k e d on a n u m b e r of s t u d i e s as a r e s e a r c h a s s i s t a n t . By t h e t i m e I g r a d u a t e d in 1987, I k n e w h o w to identify really g o o d r e s e a r c h , h o w to i d e n t i f y flaws, a n d h o w to a v o i d pitfalls in r e s e a r c h . I h a v e s i n c e s e r v e d on t h e t h e s i s c o m m i t t e e of n u m e r o u s g r a d u a t e s t u d e n t s . Fortunately, I h a v e b e e n a b l e to c o n t i n u e m y faculty a p p o i n t m e n t at R u s h U n i v e r s i t y College of N u r s i n g in C h i c a g o . It h a s b e e n v e r y n i c e to m a i n t a i n t h e a c a d e m i c role, w o r k i n g w i t h s t u d e n t s , a n d now, w i t h ENA, to w o r k w i t h 25,000 m e m b e r s a n d o t h e r o r g a n i zations and associations. JEN: Do y o u h a v e a n y l a s t c o m m e n t s ? Susan MacLean: I g u e s s m y overall s e n s e of r e s e a r c h o u t s i d e t h e c l a s s r o o m is t h a t it c a n b e exciting, i n t e r e s t i n g , a n d v e r y useful to t h e e m e r g e n c y nurse. R e s e a r c h d e a l s w i t h f i n d i n g timely, a c c u r a t e i n f o r m a t i o n t h a t c a n b e u s e d in p r a c t i c e , for p o l i c y m a k i n g , a n d in a d m i n i s t r a t i o n . T h e r e are differing levels of i n v o l v e m e n t in r e s e a r c h , of w a y s to u s e information. Critical t h i n k i n g a n d b e i n g o p e n - m i n d e d a r e i m p o r t a n t . I w o u l d like to s e e m o r e e m e r g e n c y n u r s es involved w i t h r e s e a r c h at s o m e level. I t h i n k t h a t t h e y h a v e t h e ability to do this. R e s e a r c h h a s p r a c t i cal value. E m e r g e n c y n u r s e s n e e d s o u n d d a t a in their p r a c t i c e . R e s e a r c h is c h a l l e n g i n g , b u t e m e r g e n c y n u r s e s c a n b e involved, a n d it is i m p o r t a n t for u s to b e i n v o l v e d now. References 1. MacLean S. The amounts and relevance of patient data gathered by nursing students [thesis]. Chicago (IL): University of Illinois at Chicago Health Science Center; 1983. 2. MacLean S. Description of cues nurses use for diagnosing activity intolerance [dissertation]. Chicago (IL): University of Illinois at Chicago; 1987. 3. DEEDS Writing Committee. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): a summary report. J Emerg Nurs 1998;24:35-44. 4. MacLean S. Emergency nursing research. In: Fitzpatrick J J, editor. Encyclopedia of nursing research. New York: Springer. In press.
Contributions for this column can be sent toJane Koziol-McLain, RN, PhD(c), 7360 S. Tamarac Court, Englewood, CO 80112; (303) 721-1723; E-mail: [email protected] orRuth Malone, RN, PhD, CEN, 3906 Midvale Ave., Oakland, CA 94602; (415) 874-8010; E-maik rmalone@itsa. ucsf.edu