NursingExcellenceP r i d e i n P r o f e s s i o n a l P r a c t i c e

Baptist Health South Florida

Spring 2013

In this issue:Pathway to Excellence

Research CollaborationFoundations for Nursing Research

7

10

11

Nursing Research Supporting an Evidence-based Practice Environment

Nursing is widely considereda science and an art. The education nurses obtain and the knowledge they gain with

research are the scientific componentsof nursing. A nurse’s ability to apply thisknowledge into practice is an art.

Nursing research ensures accounta-bility for nursing practices and fostersoptimum patient- and family-centeredcare. An Institute of Medicine report,The Future of Nursing: LeadingChange, Advancing Health, identifiesresearch priorities for transformingnursing practice through models ofcare, residency programs and innovativesolutions, including technology. Usingdata to change the way nursing is prac-ticed is essential to nursing’s future.

The Center for Research & Grantsacts as a hub for research at BaptistHealth. The Center empowers health-care practitioners to identify and conduct research studies that build ascientific foundation for clinical practice

that produces positive patient outcomes.The Research Fellowship Programbegan in 2007 and is designed to assistindividuals in improving the quality ofpatient care delivered through the utilization of evidence-based principlesat the bedside. There are currently ninefellows in the program.

Nursing research has evolved overthe years, changing from a focus on education and administration to an emphasis on scientific foundation forclinical practice. Nurses in clinicalpractice are in a prime position to guidea research agenda that promotes qualityhealth outcomes for individuals, families,communities and healthcare systems.Nurses at the bedside are in the best position to challenge practices that havealways been done the same way.

Baptist Health nurses are taking aleadership role in creating a culture ofquality and clinical excellence throughevidence-based practice. Doctors Hospital nurses studied patient outcomes

of an ultrasound-assisted peripheral IV insertion; and at Baptist Hospital,nurses are investigating the use of per-sonal alarms to decrease patient falls.The effect of a hyperglycemic protocolon glycemic control among medical-surgical patients is under investigationat South Miami Hospital.

Homestead Hospital recently com-pleted a study on the effects of a culturallysensitive community intervention imple-mented to reduce health risk factors in alow socioeconomic population. MarinersHospital studied a rural hospital’s under-standing of shared governance, and WestKendall Baptist Hospital is evaluatinghow nurse satisfaction and patient safetyare impacted by medication cabinetsplaced in patient rooms.

There are currently 57 active IRB-approved nursing research studies beingconducted throughout Baptist Health.Nine manuscripts have been acceptedfor publication in various journals and 58studies have been accepted for nationaland international conference presentations.

As a science and an art, the nursingprofession is challenged with keeping“the care” in nursing. Practice-orientednursing research must continue to shapeour future. This issue of Nursing Excellence highlights Baptist Healthprocesses in place that support and advance nursing research at the bedside.You will discover numerous examplesof how the care nurses provide each dayis underscored by scientifically validfindings.

Research at the Bedside Elevates the Practice of Nursing

Message from Corporate Vice President and Chief Nursing OfficerDeborah S. Mulvihill, R.N.

Deborah S. Mulvihill, R.N.

2 I NursingExcellence

Spring 2013 I 3

The new science of genomicsis the next nursing competency.Genomics is the study of all genes in the human genome,

including interactions with each otherand the environment. Nine of the top 10 causes of death have a genetic component.

The future of healthcare changedwhen the sequencing of the humangenome was completed in 2003. Theapplication of genomic knowledge isresulting in more personalized health-care. Now, a patient’s genes can beused to improve outcomes through earlier diagnosis of disease and morerational management of illnesses.

Nursing has responded by imple-menting a number of projects that address the challenging issues createdby genetic and genomic advances. In2006, the American Nurses Association

published Essentials of Genetic andGenomic Nursing: Competencies andCurricula Guidelines. These Essentials,established by a large consensus panel,are endorsed by more than 50 profes-sional nursing organizations, includingthe American Nurses Association, National League for Nursing and American Academy of Nursing. Thisbody of work aims to standardize basicnursing education genomic curriculaand introduce nursing genomics as acompetency for practicing nurses.

How will practicing nurses learnabout genomics? A national researchproject is under way to answer thisquestion. The goal of the study, whichoriginated at West Virginia Universityin January 2012, is to boost nursingprofessionals’ awareness of genetics’role in patient care. The study is fundedby the National Council of State Boards

of Nursing and supported by the National Institutes for Health and theNational Cancer Institute.

The research process recruited 22Magnet-designated hospitals, includingBaptist Hospital, as participant sites. The study process assesses the genomiclearning needs of direct care nurses byadministering a pre-survey, offering genomic education and administering apost-survey to reassess nurses’ genomicknowledge.

Results of this large-scale study areexpected in fall 2013, and will assistnurses and healthcare providers in apply-ing genomics knowledge in direct care atBaptist Health and across the country.

Baptist Hospital

Message from Chief Nursing Officer Becky Montesino, R.N.

Becky Montesino, R.N.

Study Supports Family PresenceFamily presence during resuscitation (FPDR) provides an

opportunity for families to remain in visual or physical contact with their loved one during resuscitation efforts. The practice remains highlycontroversial for healthcare professionals.

Suzanne Balbosa-Saunders, MSN, is the principal investigator of astudy that assesses nurses’ and physicians’ perceptions of risks and benefitsof FPDR in the Emergency Department at Baptist Hospital. The goal ofthe study is to provide clinicians with a standardized, evidence-basedpractice that improves outcomes and satisfaction for patients, familiesand healthcare professionals, a standard at Magnet hospitals.

During the first phase of the study, a 64-question survey was distributed to 158 Baptist Hospital Emergency Department nurses andphysicians. This same survey administered following the implementationof the FPDR policy will gauge staff’s perceptions of the policy.

The 70 nurses and 18 physicians who participated in the initial survey agreed that family members should be given theoption to be present during patient resuscitation efforts.

The research team includes (back row): Andrea Prentiss,ARNP, Vivian Fuentes, MSN, Suzanne Balbosa-Saun-ders, MSN, Teresa Mancuso, R.N., Eve Butler, Ph.D.,R.N., Monika Tano, R.N.; (front row): Marcia Gibson,MSN, Raquel Putulin, R.N., Joanne Masongsong, R.N.,Paula Barass, R.N.

The spirit of clinical inquiry isingrained in nursing practice atSouth Miami Hospital and always has been. The hospital’s

first research study in 1995 conductedby Pat Collins, MSN, examined the perception of pain with IV catheter insertion using Lidocaine, buffered Lidocaine and benzyl alcohol. Today,the research program at South MiamiHospital is conducted with three mainobjectives in mind: improve patient out-comes; use resources more effectively;and use resources more efficiently.

A study currently being conductedby Lee Streater, MSN, and her team isevaluating the impact of an educationalprogram to improve nurses’ abilities toapply the Braden Scale risk assessment.Appropriate patient risk assessmentleads to proper intervention that preventsthe formation of pressure ulcers. Thisstudy aims to improve patient outcomesby ensuring nurses make appropriaterisk assessments during the first stage ofpatient care.

Having all of the necessary resources to practice at the bedside is an important component to providingoutstanding patient care. However, effectively utilizing those resources is alsoessential. Bedside nurses are uniquelypositioned to conduct effectiveness-evaluation studies. A striking example ofsuch a study is one being conducted byTracy Penar, R.N., and her team in Cardiac Rehabilitation. Despite the factthat cardiac rehabilitation is a class IArecommendation by the American HeartAssociation –– indicating there is strongevidence for this treatment –– less than30 percent of patients with qualifying diagnoses enroll in the program.

South Miami Hospital

Message from Chief Nursing Officer Kathy Sparger, R.N.

Kathy Sparger, R.N.

Ms. Penar’s study is focusing onidentifying barriers to enrolling in cardiacrehabilitation that may exist while a patient is in the hospital and at sixmonths post-discharge. The result of thisstudy will assist the Cardiac Rehabilita-tion program in targeting resources to effectively overcome perceived barriersby qualifying patients. As a result, re-sources will also be used more efficiently.

These are just a few examples of themany innovative nursing questions thatare being answered through research.South Miami Hospital nurse researchers

4 I NursingExcellence

are working to find new knowledge and testinterventions based on what they havefound.

Research at the bedside is a crucial el-ement of South Miami Hospital’s strategicplan –– a plan that promotes a researchagenda to meet current and future health-care needs and anticipate future healthcarechallenges and priorities.

Improving NICU Breast-feeding OutcomesThe World Health Organization has deemed breast-feeding the optimal

mode of nutrition for infants. However, the South Miami Hospital NICU breast-feeding initiation rates were below the national recommendation of 81.9 percentand the estimated average of 35 percent among NICUs nationwide. One majorbarrier existed — a lack of breast-feeding education among nurses.

Research specialist Shakira Henderson, R.N., received national and inter-national recognition for her role as principal investigator in a research studythat evaluated the impact of a strategic intervention on breast-feeding outcomes. The research team was composed of seven NICU nurses who hadobtained breast-feeding counselor certification. The intervention, intimatelynamed “The Breastaurant,” included the following components: one-on-one

counseling to mothers; monthly staff and parent in-services; monthly internalnewsletters; and electronic tracking anddocumentation of breast-feeding outcomes.

“The Breastaurant” successfullychanged the culture of breast-feeding support on the unit. Patient satisfactionrose from the 70th percentile to the 90thpercentile. The percentage of motherswho breast-fed their infants and pumpedmilk quadrupled as a result of the intervention.

Spring 2013 I 5

Q uality care is not possiblewithout continual clinical investigation and application of the new knowledge. Research studies performed

by Doctors Hospital bedside nursesfocus on improving patient care. Nurseand staff research efforts are facilitatedby Research Specialist Carolyn Lindgren,Ph.D., R.N., who helps foster a strongculture of evidence-based practice at our hospital.

Doctors Hospital has been a restraint-free facility since 2007. TheCare of the Older Adult program instituted by the nursing departmentprovides formalized training for theclinical partners who provide sitter service and daily stimulation for elderlypatients. This important service helpsensure patient safety and maintain theirfunctional and cognitive capabilities.

Because this service is widely used,

the research study Development of aTool for Identifying Patients Eligiblefor Care of the Older Adult Sitter Services in an Acute Care Hospital waslaunched. Cheryl Brown, R.N., BarbaraFlorence, R.N., and Ms. Lindgren werethe investigators. The findings from thistwo-year study were used to develop anadmission and discharge criteria toolfor the sitter program. The new toolwill be subject to evaluation for its effectiveness and need for updating.

Other research studies at DoctorsHospital have also enhanced patientcare. To improve the patient dischargeprocess, Esther Thomasos, MSN, andEdwina Forges, MSN, are conductingthe study Discharge Process and Patient Satisfaction on a TelemetryUnit. To address a critical care need,ICU nurse Ricardo Ramirez, R.N., conducted the study Characteristics of Patients and Outcomes of

Doctors Hospital

Message from Chief Nursing Officer Sandy Hyatt, R.N.

Sandy Hyatt, R.N.

Ultrasound-assisted Peripheral IV Insertion. As a result of the study con-ducted by Ms. Forges, Clinical Partners’Perceptions of Patient Assignments According to Acuity Level, a tool wasdeveloped to assign acuity levels to patients that led to a more effectivemethod of assigning clinical partners.

The culture of research at DoctorsHospital is consistently fostered by educational and research discussions atvarious luncheons, meetings and train-ing sessions. The integration of researchinto nursing practice is an essential partof providing quality patient care –– andour Magnet journey.

Frontline Nurses Engage in Quality ImprovementWhile performing their duties, nurses experience everyday challenges such as communication breakdowns, medication

supply problems, equipment failures, personnel issues and unit structure hindrances. Doctors Hospital nurses recentlyparticipated in a 15-hospital-network national study centered on these daily challenges.

The study, entitled Small Troubles Adaptive Responses (STAR-2): Frontline Nurse Engagement in Quality Improve-ment, was sponsored by the Improvement Science Research Network of the Academic Center for Evidence-based Practice at the University of Texas Health Science Center at San Antonio School of Nursing.

The Doctors Hospital research team included principal investigator Carolyn Lindgren, Ph.D., R.N., and membersCheryl Brown, R.N., Edwina Forges, MSN, Susan Dingler, MSN, Barbara Florence, R.N., and clinical researchers Ignacio Danta and Josette Elysee.

For three weeks, the 22 nurse participants recorded on pocket cards the small troubles they encountered during theirshifts. They completed a survey addressing the unit environment of safety and care quality, and the data was electronicallyrecorded on the study’s web-based data site.

Study findings for Doctors Hospital are being compared to the national findings. The results will provide evidence ofproblematic areas to be addressed, which will improve the quality of nursing care at Doctors Hospital.

Research at the bedside is a critical factor for Magnet status. When Homestead Hospital began the journey to

achieve Magnet status four years ago, ournurses were not familiar with the researchprocess.

We had a lot of work to do to becomeMagnet material. We began educatingour nurses and nurse leaders. We hired aresearch specialist to help guide researchactivities and create an Evidence-basedPractice Research Council as part of theshared governance model.

Since then, four studies have beencompleted: ■ Efficacy of Early Intervention Bundles

in Patients Identified With Severe Sepsis or Shock, studied by Ana Cabrera, DNP.

■ The Effects of a Culturally SensitiveCommunity Intervention in ReducingHealth Risk Factors in Low Socioeco-nomic Groups, studied by Ann MarieAllen, R.N., and Ana Cabrera, DNP.

■ Efficacy of the Diabetes-

Homestead Hospital

Message from Chief Nursing Officer Gail Gordon, R.N.

Gail Gordon, R.N.

Hyperglycemic Management Protocolfor Subcutaneous Insulin Orders forMedical-Surgical Patients in a Community Hospital, conducted byIngrid Hassani, DNP.

■ The Effects of Nursing Activities onthe Ultraabdominal Pressure of Patients at Risk for UltraabdominalHypertension, studied by RosemaryLee, DNP. We continue to encourage, educate

and guide nurses doing research. Activestudies include:■ Measuring Unit Practice Council

Functionality: A Pilot Study, conducted by Maria Ojeda, MSN.

■ Scale-Skin Changes at Life’s End, Educational Intervention for CriticalCare Registered Nurses and MedicalSurgical Nurses, conducted by RosaFilomeno, R.N., and SophiaBoudreau, R.N.

■ The Effects of Educational Interven-tion Based on Visual Cues and Buddy System on the Incidence and Preva-lence of Pressure Ulcers, conducted

6 I NursingExcellence

Cue Turn Project –– A Research Success StoryApproximately 2.5 million patients are treated for pressure ulcers in acute care facilities in the U.S., and approximately

60,000 die each year. The cost for care is estimated at $8.5 billion annually. Turning patients every two hours can prevent the incidence of pressure ulcers. The Cue Turn research project spear-

headed by Rosa Filomeno, R.N., and a team of Homestead Hospital nurses introduced an educational intervention to reduce the incidence and prevalence of unit-acquired pressure ulcers.

Using a visual tool to identify time and positioning of the patient, a standardized turning system was implemented. A“buddy system” between clinical partners was established to ensure compliance.

A quasi-experimental, pre- and post-intervention design was used to determine changes in pressure ulcer rates over athree-month period. In addition, an open-ended question survey was administered to direct patient care staff to identifybarriers and current practices used in the prevention of pressure ulcers.

The findings showed the Cue Turn intervention was effective in reducing the unit-acquired pressure ulcer rates. Theoccurrence of pressure ulcers among patients fell from 16 to two –– an estimated improvement rate of 80 percent.

by Rosa Filomeno, R.N., Shelly AnnCommock, R.N., Adriana Garay, R.N.,and Gloria Rueda, R.N.

■ Development of a Perinatal Acuity Scoring Tool (PAST), conducted by Jan Weatherspoon, R.N., KatherineAdamson, R.N., and Maria Ojeda, MSN.Another study, Examining the Perceived

Value of Certification and BSN AttainmentAmong Registered Nurses at a CommunityHospital, will soon be presented to the IRB.

At Homestead Hospital’s annual bestpractice fair last year, there were nineposter presentations and 11 podiumpresentations. One poster was subsequentlypresented at a national Versant seminar.

Through continuing education, nursesbecome aware of the research on whichtheir interventions are based. Research conducted by practicing nurses educatesother nurses and ultimately improves patient outcomes.

Spring 2013 I 7

researched the characteristics of Path-way to Excellence-designated hospitalsand conducted a gap analysis beforeapplying for the designation.

Our document demonstrating thepresence of the 12 Standards of Practicewas submitted to the ANCC on April 1,2012. The standards support the

Mariners Hospital

Message from Chief Nursing Officer Cheryl Cottrell, R.N.

Cheryl Cottrell, R.N.

organizational commitment to create awork environment in which nurses flour-ish as a result of professional growthand development, job satisfaction, respect and appreciation. More than 80percent of Mariners nurses completedan online survey to validate the presenceof the 12 Standards of Practice in theorganization. Our submitted documentreceived 12 exemplars.

Being a small rural hospital makesit challenging to meet the requirementsfor designation and certifications. ThePathway to Excellence designation is avalidation, on a national level, of ourefforts and accomplishments.

Follow-up Reduces Patient ReadmissionsApproximately 30-40 percent of patients with congestive heart failure

(CHF) are readmitted within six months of hospitalization. The average costof readmission per patient is $10,870.

Prior studies have revealed that effective discharge planning and patientfollow-up after hospital discharge reduces readmissions. For example, patientswho were called within 14 days of discharge had fewer readmissions.

The purpose of the Mariners Hospital CHF study was to determine theimpact of a nurse-led telephonic follow-up program on readmission rates forCHF patients. During the six-month study, 10 CHF patients were dischargedfrom the medical-surgical unit. In the first three months, five patients werecalled back using a computerized survey. One patient was readmitted twomonths after hospital discharge. In the second three months, six patients werecalled back using a zones survey. No patients were readmitted during the second three months.

This study demonstrates that effective discharge planning and follow-upphone calls decrease hospital readmissions among CHF patients by helpingthem manage their disease at home.

In July 2012, Mariners Hospital became the first hospital in Florida to receive the American Nurses Credentialing Center (ANCC)

Pathway to Excellence designation. ThePathway to Excellence program recog-nizes the essential elements of an idealnursing practice.

The path to this designation actuallybegan in 2008 as Mariners Hospitalbegan its Magnet journey. The first stepwas to establish a shared governancemodel, which was accomplished afterconsulting with Baptist and SouthMiami Hospitals. The next step was toresearch the nursing theorists and allowour direct patient care nurses to vote forthe nursing theorist who best repre-sented our nursing philosophy. Finally,we began conducting a gap analysis ofthe 14 Forces of Magnet.

During this process, Baptist Healthand Mariners representatives began ex-ploring the possibility of converting thehospital to a critical access hospital(CAH). The change, which requiredMariners Hospital to convert from a 42-bed to a 25-bed facility with an averagepatient stay of 96 hours, would have apositive financial impact. The decisionwas made to convert to a CAH, and theconversion was completed in 2010.

It became clear at this time thatMariners Hospital did not have the ability to meet the requirements of the14 Forces of Magnet. Our hospital possessed many attributes of a Magnetfacility, but not all. We were thereforeencouraged to consider pursuing thePathway to Excellence designation.Magnet Program Director DawnKressly, R.N., and the nursing leader-ship team reviewed the requirements,

8 I NursingExcellence

The hallmark of a profession and akey element of Magnet designa-tion is research. West KendallBaptist Hospital has embraced

the Magnet journey and established a culture based on our nursing mission andvision: “Our care will be provided from aframework of research and evidence-based leading practices.”

West Kendall Baptist Hospitalnurses are committed to our culture ofinquiry and evidence-based practice.Bedside nurses are leading the chargewith the support of two important coun-cils: Research Evidence-based Counciland the Professional Development Council –– home to the ProfessionalNursing Advancement Program.

West Kendall Baptist Hospital Message from Chief Nursing Officer Denise Harris, R.N.

Denise Harris, R.N.

Baptist Health entities are blessed tohave the infrastructure of the Center forResearch & Grants. The Center providesresearch support, expertise and resourcesfor each entity. Tanya Judkins-Cohn,MSN, West Kendall Baptist Hospital’sresearch specialist, co-chairs our interdis-ciplinary Research Evidence-basedCouncil and has provided coaching andenthusiastic mentorship to staff and leaders advancing research at our hospital. Additionally, the ProfessionalNursing Advancement Council providesa framework for clinical excellencethrough evidence-based practice and support for research efforts.

West Kendall Baptist Hospitalnurses are committed to excellence in

professional practice. In just 19 shortmonths, nine investigators have conductedfive IRB-approved research studies, listedbelow. In addition, our nurses have giventhree podium and five poster presentationsat national conferences and one podiumand two poster presentations internationally.

Investigations/inquiries at WestKendall Baptist Hospital include:■ Will Installation of Medication Cabinets

in Medical-Surgical Patients’ Rooms Increase Nurses’ Satisfaction of theMedication Administration SystemWithout Altering Charge Accuracy?

■ Shared Governance Equals Shared Decision: Does It or Does It Not? (Part 1and 2)

■ Exploration of Hispanic Women’sEmergency Room Chief Complaints andDiagnosis During a Myocardial Infarction.

■ The Experiences and Meaning of BeingCared for in the Emergency Room forHispanic Women Living With a ChronicDisease or Condition.

■ Effect of Nighttime Use of Earplugs onDelirium Onset and Sleep Perception inOlder ICU Patients: A RandomizedControlled Study.

West Kendall Baptist Hospital nursesembrace research and evidence-based practice not only to ensure that our hospitalachieves its mission and vision and attains its recognition of excellence by the ANCC and Magnet Recognition Center, but to stay true to the nursing profession. It is the responsibility of allnurses to be researchers; this is the hallmark of a profession.

Nurses Base Practice on Solid EvidenceResearch specialist Tanya Judkins-Cohn, MSN, conducts education sessions

at meetings of West Kendall Baptist Hospital’s Research Evidence-based Councilto engage direct patient care nurses in research and evidence-based practice. Thiscollaboration has prompted council members Mavel Arinal, R.N., and FatimaGarcia, R.N., to lead research studies and serve as mentors to other nurses.

Ms. Garcia, co-chair of the ResearchEvidence-based Council, is not only the hos-pital’s first research fellow, she is leading atwo-hospital collaborative study about theeffects of ear plugs on ICU delirium andsleep quality.

Ms. Arinal led the first direct care nurseresearch team at West Kendall Baptist Hospital. She has disseminated her findingsabout the implementation of medicationcabinets on medical-surgical units at national and international conferences. Currently, Ms. Arinal is working on a manuscript and mentoring nurses conduct-ing an interdisciplinary research study.

Leading the way in nursing research areFatima Garcia, R.N., (left) and MavelArinal, R.N.

Baptist Outpatient Services provided over 53,000 patients with mammograms last year. More than 1,700 of those

patients had abnormal results. The Baptist Health Breast Center

sees approximately 45-50 patients eachmonth with newly diagnosed breastcancer or a high-risk lesion. A breastcancer diagnosis can be a life-changingexperience for patients and their families and caregivers. The process ofgathering and understanding breast cancer information and resources andnavigating the complex healthcare mazecan be overwhelming and exhausting.

Research has shown that patientnavigation programs improve the quality of healthcare among cancer patients, especially those diagnosedwith breast cancer. As a result, morepatient navigation programs have been

Baptist Outpatient ServicesMessage from Chief Nursing Officer Tina Jones, R.N.

adopted throughout the U.S. The CareCoach program at Baptist

Health Breast Center was launched in2009 and is supported solely throughcharitable donations. The program provides patients with assistance innavigating the complicated breast cancer journey, so they can focus theirenergies on healing.

CareCoach Tania Silva-Santos, R.N.,explained. “The CareCoach programcreates a one-on-one relationship between patients and our trained Care-Coaches, who provide information,support, resources and personal guidance throughout the patient’s journey,” she said. “We want patients,their families and caregivers to knowthat they're not alone.”

Evidence-based research supportsthe need for patient navigator programsin cancer care. This has led cancer

program accrediting bodies to add patient navigation as a required standard.The National Accreditation Programsfor Breast Centers (NAPBC) has had apatient navigation standard in placesince it was instituted in 2009, and theAmerican College of Surgeons Commission on Cancer added patientnavigation standards in 2012.

“The Baptist Health Breast Center iscommitted to providing the best possiblecare to patients with diseases of thebreast,” said Nancy Batista-Rodriguez,vice president. “Our goal is to seek accreditation through NAPBC prior tothe transition of the Breast Center to thenew Baptist Health Cancer Institute.”

Spring 2013 I 9

Tina Jones, R.N.

Evidence Guides Patient Care at Breast CenterWomen visiting Baptist Health Breast Center may be treated by nurse

practitioner Dora Escobedo, ARNP, who follows evidence-based practiceguidelines within her scope to provide quality care to patients.

Patients with various benign breast conditions are evaluated, assessed,screened, diagnosed and treated according to the National ComprehensiveCancer Network (NCCN) guidelines, which has developed practice guidelines for most cancers. These algorithms guide Ms. Escobedo as shecollaborates with the Center’s team of physicians to determine the best preventive, diagnostic, treatment and supportive services for each patient.

To ensure best practice, the network is continuously updating recom-mendations according to newly published and supportive data.

Dora Escobedo, ARNP, specializes in breast health and uses a comprehensive approach to treat and care for each patient.

10 I NursingExcellence

Baptist Health’s six entity-based research specialistsare “helping nurses get over the ‘R’ word,” says Andrea Prentiss, ARNP, Baptist Hospital Women’s and Children’s Research Specialist. “For many

nurses, the word research is terrifying,” she explained. But itneed not be. Working with the Center for Research & Grants,the team of seasoned nurses fosters a culture of nursing re-search and promotes evidence-based practice at Baptist Health.

“We mentor nurses at the grass-roots level and assist themthrough every step of the research process,” said Ms. Prentiss,who has more than 30 years of experience in pediatric andneonatal intensive care. She has been in her present role sinceApril 2011 and is currently obtaining her Ph.D. in nursing.

To encourage nursing involvement in data collection anddecision making in patient care –– an important element ofMagnet status –– Ms. Prentiss and Baptist Hospital ResearchSpecialist Eve Butler, Ph.D., R.N., have an open-door policy.The pair also assists entire teams, such as the hospital’s painteam, as they perform research studies.

Dr. Butler has cared for patients at Baptist Hospital for27 years, serving in various units including the NICU andPICU. Returning to school to obtain her Ph.D. ignited her interest in clinical research and helped prepare her for the research specialist role.

“Research is an integral part of nursing –– it shapes thecare we provide and creates better ways to do what we do,”Dr. Butler said. “Kudos to Baptist Health for providingnurses with such a tremendous research support system.”

Shakira Henderson, R.N., South Miami Hospital’s Research Specialist, is a second-career nurse who is passionateabout research and learning. After spending 10 years in biologyresearch, she yearned to do healthcare research. She joined Baptist Health in 2008 after simultaneously completing threedegrees –– a bachelor’s in nursing and master’s degrees inanatomy and public health. She served as a nurse clinician inSouth Miami Hospital’s NICU.

Ms. Henderson is currently earning two doctorate degrees–– DNP and Ph.D. Like her colleagues, she supports nursesconducting research and mentors those completing the evidence-based component of the Professional Nurse Advancement Program.

Throughout her 50-year nursing career, Doctors HospitalResearch Specialist Carolyn Lindgren, Ph.D., R.N., has mentored and educated nurses in Michigan, Texas, Ohio andFlorida. She received tenure while teaching at Wayne StateUniversity in Michigan. This year, Dr. Lindgren celebrates her five-year anniversary with Baptist Health.

Research Specialists: Partners in Research and Evidence-based Practice

“Nurses often have questions and know there is a betterway. They are the practice experts,” said Dr. Lindgren. “It is a joy for me to work with nurses on research that addresses the practice issues. Together, we are building evidence and elevatingthe quality of nursing practice.”

Homestead and Mariners Hospital Research SpecialistMaria M. Ojeda, MSN, has been involved in the world of research for 20 years. As a certified family nurse practitioner,Ms. Ojeda’s clinical background is in primary care, geriatricsand occupational and employee health. She also holds a master’s degree in public health with a specialty in epidemiology and a certificate in data mining. Ms. Ojeda iscurrently obtaining her DNP and Ph.D.

“Research touches so many aspects of what we do inhealthcare every day. Seeing that practitioner have an ‘aha!’ moment and becoming a true believer in research is ab-solutely thrilling,” she said.

West Kendall Baptist Hospital Research Specialist TanyaJudkins-Cohn, MSN, is a second-career nurse with experienceworking in medical-surgical and surgical-trauma ICU. Beforeobtaining her master’s degree in nursing, her first career rolewas as a mentor and counselor for at-risk children. Ms. Judkins-Cohn has been a research nurse with Baptist Healthfor four years and a research specialist for three. The motherof 4-year-old twins is currently obtaining her Ph.D.

“It’s very rewarding to work in a system where the leaderssupport and celebrate nursing research,” Ms. Judkins-Cohn said.

Profile of Success

Nursing Notes

Supporting a Culture of Research

Nursing research helps build the scientific foundation for clinical practice,prevention and improved patient outcomes.The Center for Research & Grants is dedicated to fostering a culture of researchat Baptist Health, and provides resources,expertise, education and opportunities fordissemination of research findings.

“Who better than the bedside nurse toknow what procedural changes should bemade to improve patient care, safety andoutcomes?” said Michelle Kirgan, MSN,director of Research & Clinical Trials Operations.

Research specialists working at Baptist Health entities mentor nurses andallied health professionals in research andevidence-based practice. The specialistsassist nurses throughout the entire researchcycle –– from identifying, designing andcarrying out the research study to analyz-ing and publishing the results.

Research specialists also serve asmentors to nurses enrolled in the NurseScholar Program and those working on theevidence-based practice component of theProfessional Nurse Advancement Program.

Susan Golembeski, Ph.D., assistantvice president, Center for Research &Grants, was Baptist Health’s first researchspecialist in this model for research sup-port. Her work supporting the Magnet ef-forts at Baptist and South Miami Hospitalswas originally funded by the Center forExcellence in Nursing. Demand for research services grew systemwide and research grants were increasingly awarded.As a result, the Center for Research &Grants was formed in 2006.

“We have grown quickly –– from oneresearch specialist to six. We have morethan 40 employees dedicated to supportingall aspects of research, some of which isfunded by grants,” said Dr. Golembeski.

The Center’s Grants Support teamprovides a customer-centered approach toidentify grant opportunities, submit appli-cations and manage awards. Doctoral-prepared administrators assist physicianswith protocol development and clinical trials. Research Compliance ensures

Spring 2013 I 11

adherence to federal regulations. LibraryServices provides nurses with invaluableresearch resources. Training and Educationoffers lunch-and-learn sessions, onlineeducation, research rounds, conferencesand a Research Fellowship Program.

Promoting Growth and DevelopmentThe Center’s Research Fellowship

Program is designed to guide BaptistHealth nurses and allied healthcare pro-fessionals to identify clinical problemsand seek the best evidence to supportchanges in practice. The two-year pro-gram aims to foster networks of mutualsharing, prepare participants for research

and provide opportunities for professionalgrowth and development. Participantsearn CE credits and qualify for a bonus ofup to $2,000. The fellowship is open tofull-time or part-time employees in clinical positions who have been em-ployed at Baptist Health for six months.

Presenting an Educational Opportunity

The Center will host its Eighth AnnualBaptist Health South Florida ResearchConference in April. Attendees earn CEcredits at the day-long event, which includes a keynote speaker and educationalbreak-out sessions. The conference is open

to all nurses and alliedhealth professionals, andis free for Baptist Healthemployees.

___________

For more informationabout the Center’s programs, go to the intranet, click Depart-ments and Directories,then choose Center forResearch & Grants.

Lifelong Learning Motivates ClinicalEducators

“As a nurse, I’ve always had questions,” said Kathy Tryon, R.N., ClinicalLearning Educator II. To help answer some of those questions, the 31-year nurseveteran applied and was selected to participate in the Research Fellowship Program offered by the Center for Research & Grants.

Ms. Tryon created the Tryon Hula Hoop Axis Tool –– an abstract training tool inthe form of a badge buddy that helps nurses and healthcare providers identify the ven-tricular axis on a 12-lead electrocardiogram. The tool’s creation inspired two researchprojects. In addition, Ms. Tryon has given two podium and two poster presentations in2012, and will present her evidence-based project several more times in 2013.

“The process has been very rewarding, and has empowered me,” Ms. Tryonsaid. “I have encouraged others to apply for the Research Fellowship Program.Lifelong learning is essential to keep us young, motivated and focused.”

In his research project, “The Influence of a Critical Care Educational ProgramUsing a Human Patient Simulator in Developing Skills of Students in Crisis Resources Management,” Specialty Practice Clinical Learning Educator II, JoseGuitian, Ph.D., ARNP, provided evidence of the advantages of simulation in nurse education.

“Nurses learn clinical skills in nursing school, but they don’t learn nontechnicalskills such as leadership, communication and teamwork –– all crucial skills to beeffective during a crisis,” said Dr. Guitian. “Practicing critical situations in a simulation lab can reduce anxiety, resulting in better performance when it counts.”

The Baptist Health South Florida Research Conference gives health-care providers the tools and strategies they need to integrate researchand evidence-based practices into their professional lives.

Nursing Achievements

6855 Red Road ■ Coral Gables, FL 33143-3632

NON-PROFITORGANIZATIONU.S. POSTAGE

PAIDPermit No. 2655

Miami, FL

Nursing Excellence is guided by the Editorial Advisory Board, which includes DeDe Austin, R.N., Doctors Hospital; Rosalina Butao, R.N., West Kendall Baptist Hospital; Sandy Jones, R.N., Homestead Hospital; MarySue Lloyd, R.N., Baptist Hospital, Baptist Children’s Hospital; Deborah S. Mulvihill, R.N., Baptist Health South Florida; Maria Olmeda, R.N., Baptist Outpatient Services; Melanie O’Neill, R.N., Mariners Hospital; Jan Brodnax, R.N., South Miami Hospital. Editor: Georgina Gonzalez-Robiou, APR. Editorial Coordinator: Nancy Eagleton. Art Director: Denise Winston. Copyright ©2013 Baptist Health South Florida. All rights reserved. None of the contents of this publication may be reproduced or transmitted without the priorwritten permission of the publisher.

Publications, Presentations andResearchPoster presentations:Joanne Aberilla, R.N., Olivia Cocabo, R.N., Delia Hipos,R.N. XIII Pan American Nursing Research Colloquium, Miami,2012. Early Mobilization Therapy for Ventilated Patients. Patricia Alcoser, R.N. Florida AWHONN Conference, Clearwater, 2012. Mavel Arinal, R.N., Carmen Avila-Quintana, R.N. XIII PanAmerican Nursing Research Colloquium, Miami, 2012. Will Installation of Medication Cabinets in Medical-Surgical Patient’sRoom Increase Staff Nurses’ Satisfaction of Medication Adminis-tration System as Measured by MAS-NAS Without Altering Medication Charge Accuracy?Fatima Garcia, R.N. XIII Pan American Nursing Research Colloquium, Miami, 2012. Virtual Journey Club: An InnovativeWay of Bringing Evidence-based Practice and Research toNurses in Their Workplace.Diane Kramer, R.N. Eighth Annual Versant Client Conference,Positioning Nursing for the Future: Demonstrating CollaborationThrough the Versant RN Residencies, San Antonio, 2012. TheClinical Practice Collaborative Support Model: On-boardingUsing a Team Approach; and Collaboration on the Continuum ofCare: Ensuring Successful Transition of the Scholar Nurse to Professional Registered Nurse. Mari Seidu, R.N., Lisa Trainor-Robinson, R.N. FloridaNurses Association Conference, Davie, 2012. Mari Seidu, R.N. Baptist Hospital Research Conference, NorthMiami Beach; and XIII Pan American Nursing Research Colloquium, Miami, 2012. Podium presentations: Ana Cabrera, DNP. XIII Pan American Nursing Research Collo-quium, Miami, 2012. Efficacy of Early Intervention Bundles inICU Patients With Severe Sepsis and Septic Shock. Denise Harris, R.N. South Florida Nursing Consortium,Miami, 2012. Fostering Clinical Practice Leadership. Andrea Lavallee, MSN. American Society for Quality, Miami,2012. Creating a Culture of Excellence. Publications: High, C., Kramer, D., Lindgren, C., Ocon, S., Sanchez, R.(July 2012) The Clinical Practice Collaborative Support Modelfor the Graduate Nurse. Journal of Continuing Education in Nurs-ing, 43(7): 315-323.Arocha, M., Benitez, J., Diaz, N., Gil, W., Gow, H., Harrison, L., McClure, P., Ortiz, C., Padron, A., Sikora, G.,Trujillo, S. Open Heart Lab Process Improvement. Compendium Book of Abstracts.

Printed on recycled and mixed-source paper using vegetable-based inks.Please recycle.

Education and CertificationsBSN ■ Katherine Adamson, R.N., Ron Burke, R.N., SaraCastaneda, R.N., Raydene Christian, R.N., Grace KittelleCintas, R.N., Claire Croswell, R.N., Kelly Delgado, R.N.,Adriana Diaz, R.N., Ileana Fernandez-Traveria, R.N.,Monique Hayez, R.N., John Mompremier, R.N., SandraMontalvan, R.N., Nicole Parr, R.N., Emily Ramos, R.N.,Zayra Reilly, R.N., Sherry Stathers, R.N.MSN ■ Agnes Alexander, MSN, Suzanne Balbosa-Saunders, MSN, Demi Barbeito, MSN, Obed Bello, MSN,Raul Botana, MSN, Paula Fonte, MSN, Anthony Gonzalez,MSN, Erika Gonzalez, MSN, Ronye Kreiner, MSN, AnnLevering, MSN, Marjorie Lima, MSN, Tamara Naar,MSN,Lourdes Pastoriza-Posada, MSN, Mariana Povea, MSN,Maday Rafuls, MSN, Elizabeth Ramos, MSN, Regina Russell, MSN, Vanessa Vigo, MSN.APRN: ■ Indiana Alcala, APRN.ARNP ■ Rebecca Adam, ARNP, Allison Allard, ARNP, Jennifer Leal Beltran, ARNP, Amy Chu, ARNP, Marli DeLeon,ARNP, Barbara Gonzalez, ARNP, Michelle Houellemont,ARNP, Vanessa Leal, ARNP, Kyra Sherburne, ARNP. MBA ■ Griselle Diaz, R.N., Julia Velazquez, R.N.DNP ■ Becky Montesino, DNP. Ph.D. ■ Nada Wakim, Ph.D., R.N. Certified ■ International Board-certified Lactation Consultant(IBCLC), Laura Houwers, R.N.; Certified Critical Care Registered Nurse (CCRN), Sister Maria Sochima Mgbokwere,MSN; Medical-Surgical Registered Nurse (MSRN), PricillaMolas, R.N.; Certified Pediatric Nurse (CPN), Nari Muci, R.N.;Certified Lactation Consultant (CLC), Binay Reynolds, R.N.;Certified Nurse Manager Leader (CNML), Linda Simpson, R.N.Certified Cardiovascular Nurse (CCVN) ■ David Goins, R.N.,Michael Robbins, R.N., Melanie Stoia, R.N.Certified Critical Care Registered Nurse (CCRN) ■ Ana Barrera,R.N., Irene Dominguez-Prendes, R.N., Hector Gordillo,R.N., Shamma Legrand, R.N., Catalina Mendoza, R.N.,Sister Maria Sochima Mgbokwere, MSN, Roberto Rodriguez, R.N., Suhail Sanchez, R.N., RosemarieSchwitzer, R.N., Marc Smith, R.N., Elisa Sperling, R.N.,Brittney Taylor, R.N. Certified Emergency Nurse (CEN) ■ Kim Estes, R.N., MichelleKozak, R.N, Tara Loughlin, R.N., Camille Rosatto, R.N. Certified Family Nurse Practitioner (FNP-BC) ■ JacquelineGavin, MSN, Jessica Henry, MSN. Certified Medical-Surgical (CMSRN) ■ Sheila Alabastro,R.N., Sergio Arce, R.N., Carmen Avila Quintana, R.N.,Sandra Bastidas, R.N., Vanessa Benavides, R.N., ArianBethencourt, R.N., Ariadne Borroto, R.N., Sarah Cano,R.N., Shelly-Ann Commock, R.N., Karen Doucette, R.N.,Alvaro Forero , R.N., Lillian Giras, R.N., Aylen Gordillo,R.N., Jeannette Hansen, R.N., Valerie Harvey, R.N., Evelyn Jonusas, R.N., Christina Jordan, R.N., Courtney

Kelly, R.N., Kim Kyong Mi, R.N., Kenia Lazos, R.N., KileyMartinez, R.N., Lilly Moctezuma, R.N., Blessing Nwonu,R.N., Dhanya Paul, R.N., Armelle Prosper, R.N., AileenReganit, R.N., Carina Reyes, R.N., Mariela Rivas, R.N.,Roberto Roman, R.N., Michelle Santana, R.N., LauraSaoud, R.N., Maria Tamayo, R.N., Melinda Watson, R.N.Certified Nurse, Operating Room (CNOR) ■ Faria Idoe, R.N.,Maria Northerner, R.N., Ruth Ann Osborne, R.N.Orthopedic Nurse Certified (ONC) ■ Merly Fernandez, R.N.,Monica Pavlova, R.N., Farrah Saint Louis, R.N.Certified Pediatric Emergency Nurse (CPEN) ■ RusetteArends, R.N., Lizette Rivera, R.N.Certified Post-anesthesia Nurse (CPAN) ■ Terri Mitchell,R.N., Georgina Perez-Campa, R.N., Blanca Talavera, R.N.Certified Rehabilitation Registered Nurse (CRRN) ■ AgnesAlexander, R.N., Chiara Salomon, R.N. Oncology Certified Nurse (OCN) ■ Lily Basadre, ARNP, KatieBukolt, ARNP, Peggy Bullard, R.N., Yamile Jimenez,R.N., Lisa Nickerson, R.N., Johnny Pallango, R.N.,Monique Peddle, R.N., Jennyfer Simpson, R.N.Pediatric Nurse Practitioner-Board Certified (PNP-BC) ■ DemiBarbeito, MSN, Vanessa Vigo, MSN. Progressive Care Certified Nurse (PCCN) ■ Marigold Arco,R.N., Dianne Henriques, R.N. Registered Nurse, Board Certified (RN-BC) ■ Daisy Ayala,R.N., Kristine Enobal, R.N., Ludin Escobar, R.N., MelissaGomez, R.N., Manuel Longoria, R.N., Myla Malto, R.N.,Eusebio Marrero, R.N., Pilar Moreno Paico, R.N.,Murielle Pariente, R.N.Registered Nurse, Certified Neonatal Intensive Care (RNC-NIC)■ Diane Baijoo, R.N., Karla Norori, R.N.

Professional Awards/RecognitionKatherine Adamson, R.N., Odalys Bancroft, R.N., Natalia Flores, R.N., Anne Keane, R.N., Karla Norori,R.N., Lillian Romero, R.N., Jean Jacques Rousseau, R.N.,Jan Weatherspoon, MSN, named 2012 March of DimesNurse of the Year finalists. Vanessa Benavides, R.N., Anelise Berish, R.N., KrisMacalino, R.N., Nancy Vihlen, R.N., received DAISY Award. Andrea Lavallee, MSN, appointed to Florida Sterling CouncilBoard, September 2012.Ann Levering, R.N., received University of Miami AcademicExcellence Award. Priscilla Molas, R.N., recognized as Outstanding Alumna forExcellence in Clinical Practice by Far Eastern University. Rhonda Rodriguez, R.N., named Baptist Children’s HospitalPreceptor of the Year.Pam Sabatino-Holmes, R.N., named president, local Intra-venous Nursing Society Chapter, 2012-2013.

As of December 2012