Research Rooted in Strength

The first National Teaching Institute (NTI) was held by the American Association of Critical-Care Nurses (AACN) in 1974.¹  Critical care nurses gather annually at the event, which features celebrations of the critical care nursing community and its members, continuing education, and research presentations. Each year, NTI feeds both the minds and the spirits of critical care nurses. Although the 2021 virtual format was new for NTI, the goal of educating, reinvigorating, and energizing nurses was fully achieved.

One of our favorite NTI events each year is the unveiling of the new AACN President’s theme. On several recent occasions, the September AJCC editorial has reflected on the relationship of the theme to AJCC’s core mission of publishing research that grounds clinical practice. The power of the theme to inspire excellence is always impressive.

In the president-elect’s keynote address at NTI on May 22, 2021, Beth Wathen spoke eloquently about both her own personal experiences with grief and the larger context of grief and loss that nurses as individuals and as a profession have borne in the context of the COVID-19 pandemic.²  The theme that emerged, “Rooted in Strength,” not only holds great potential to inform our personal and professional growth but also has application to the relationships between clinical research and nursing excellence in caring for critically ill patients.

Of the strength that emerges from difficult experiences, Wathen said, “It’s a strength rooted in our connections with our patients and their families, and partnerships with our teammates and colleagues.”²  Like the nursing profession, clinical research is also rooted in the strength of our connections to patients and families. The deep understanding of the patient and family perspective that underpins nursing also guides and informs research at the bedside. Clinically based nursing research questions focus on patient and family needs and seek to improve outcomes that are meaningful to them. Outcomes that are important to patients transcend those associated solely with cure or treatment of diseases and may encompass symptom management, palliative care, spiritual and emotional well-being, finding meaning in the experience of critical illness, prevention of complications, recovery, and other concerns. Rooting research in the strength of connections to our patients and their families enables us to advance knowledge for practice.

The intensive care unit is a rich environment for collaboration, and partnerships with teammates and colleagues are as crucial to research as they are to patient care. The perspectives, capabilities, and insights that can result from collaboration among disciplines provide strong roots for discovery of new knowledge to improve patient and family outcomes. We believe that knowledge for nursing practice arises both from discipline-specific nursing research conducted with our nursing teammates and from interdisciplinary research conducted with our colleagues. At AJCC, we encourage interdisciplinary research submissions and seek to promote collaborative practice solutions that value and incorporate nursing’s optimal contributions to care. Partnerships with teammates and colleagues strengthen the roots for clinical research.

The 2 Distinguished Research Lectures that were presented at the 2021 NTI illustrate the importance of patients, families, teammates, and colleagues as roots for research strength. One Distinguished Research Lecture is traditionally presented orally at each annual NTI. Having 2 Distinguished Research Lectures presented at the same NTI was novel! Why did it happen? The 2020 NTI was cancelled because of the COVID-19 pandemic, so that both the 2020 Distinguished Research Lecture by Dr Karen Giuliano and the 2021 Distinguished Research Lecture by Dr Mary Beth Happ were presented at the 2021 NTI. (The sequence of presentation and publication was also altered for the 2020 Distinguished Research Lecture. The Distinguished Research Lecture abstract is customarily published in the May issue of AJCC, and the full paper is then published in the July issue of AJCC following the oral presentation at NTI. Giuliano’s paper was published in July 2020,³  in advance of the rescheduled oral presentation at the 2021 NTI. Happ’s paper⁴  was published after the oral NTI presentation as is usually done.)

Both Giuliano and Happ have rooted their research excellence in their connections with patients and families and in a collaborative approach that involves colleagues from nursing and multiple disciplines in problem-solving. Both began their careers as bedside critical care nurses, and both have maintained a strong patient-centered nursing perspective. Giuliano built her program of research around designing and developing technology to improve patient care. Happ’s research career has focused on improving communication for critically ill patients.

Giuliano describes her research program as the “responsible use and development of technology.”^3(p255) Her framework begins with a respect for the critically ill patient first as a person, incorporates a view of technology as a means to contribute to the physical and emotional well-being of patients at the point of care, and acknowledges the importance of scientific inquiry to support and inform evidence-based care. Her research trajectory has involved employment in clinical settings, industry, and academia. In reflecting about her career, she noted,

At the end of her Distinguished Research Lecture, Giuliano offers lessons learned that illustrate how her work is rooted in strength; among her suggestions are, “make patient care and end-user needs a center-point of your work,” and “work with groups, be interdisciplinary and collaborative.”^3(p259)

Over time, Happ’s research has led to a body of evidence about the problems that critically ill patients encounter in attempting to communicate, to the development and testing of augmentative and alternative communication (AAC) interventions, and to dissemination of resources for best practice in optimizing communication for nonvocal critically ill patients.⁴  Her work is rooted in a deep connection to patients and an understanding of the patient and family experience. Like Giuliano’s, Happ’s trajectory has involved other nurses and interdisciplinary colleagues. Happ’s research dispels some common myths about communication between nonvocal patients and registered nurses in the intensive care unit (see Table 2 in Happ’s Distinguished Research Lecture⁴ ). As an example, one myth she identifies is the belief that nurses and family members can accurately anticipate what the nonvocal critically ill patient wants to express; her research demonstrates otherwise. This expectation bias leads to frustration for the patient, family, and nurse and truncates the full range of concerns and emotions that patients wish to convey. It can lead to serious gaps in quality of care and patient safety, including underrecognition of pain and other patient problems. Happ has developed and tested multiple AAC strategies to improve nurse-patient communication and that reflect patients’ needs and capabilities. The SPEACS intervention (Study of Patient-Nurse Effectiveness with Assistive Communication Strategies) improved nurse-patient communication through training nurses in assessment, in appropriate use of AAC, and in consulting with a speech language pathologist.

The perspective of nurses is unique. Both Giuliano and Happ have devoted their research to applying the unique nursing lens to improve care of critically ill patients. They have done so by focusing on patient needs and the work of nurses to meet those needs. Their accomplishments, and those of many other nurse scientists and expert clinicians, are built on a foundation of their connection to patients and families. Their success is amplified by their collaborative partnerships with colleagues in nursing and other disciplines. These roots—connection to patients and families, and collaborative teamwork—are crucially important to research and to the application of research findings to practice as well. Rooted in Strength, we can make our optimal contribution to patients.