Nurse scientist Linda Chlan, Ph.D., joined Mayo Clinic last year as the health care organization’s first associate dean for nursing research and as director of Mayo Clinic’s Nursing Research Division. Here, Chlan answers questions about the role of nurse-led research and nurse scientist initiatives underway at Mayo Clinic.
What’s your take on the state of nurse-led research in the U.S.?
Nursing research is growing and is now more diverse than ever. Nurses are involved in bench science as well as behavioral science. We look at the patient’s function and their responses to illness and health as well as the ways the patient and their families cope. Nurse scientists have a natural focus on prevention and are delving into multi-cultural research and underserved populations of many kinds.
Yet, nurse-led research represents a fraction of total research done. A few nursing schools and universities excel at securing NIH grants for nurse-led research, which typically focuses on holistic ways to improve the health and well-being of patients, families and communities. There is limitless potential for this type of inquiry. I’d like to see much more happening.
What’s the difference between physician-led research and nurse-led research?
Nursing is about caring; nursing research is focused on generating new knowledge to improve the health and well-being of persons across the life-span. We’re looking for ways to create an immediate benefit for our patients at all stages of life.
For example, my clinical nursing experience and research are focused on patients in the intensive care unit (ICU). While other researchers look for cures, I’m not trying to fix the illness or injury that brings patients to the ICU. Rather, I’m looking to test and implement scientifically based interventions to better manage patients’ symptoms― such as anxiety ― while they are in the ICU.
Of course, nurse-led research doesn’t involve only nurses. We care for patients in a multidisciplinary environment and conduct our research that way, too.
What’s needed to grow nurse-led research?
Nurse scientists across the country need funding to do more great work, and that means NIH and other extramural grants. I encourage nurse researchers to seek out collaborators, perhaps outside their home institutions. Challenge yourself. Volunteer to lead and be a member of multidisciplinary teams. Consider publishing or presenting in venues that reach broad audiences. These are tangible ways to build visibility for your work and expand your network.
What’s limiting nurse-led research?
Right now, a finite number of Ph.D.-prepared nurse scientists are available to do the research. Second, securing extramural funding is very competitive. Nurse scientists need to actively seek coaching and mentoring to help them be competitive in securing funding.
How do nurse researchers build the case for funding?
Nurse researchers need to be tenacious and persistent in pursuing grant funding and tell the stories about why this research is important. Nurses bring a very different perspective to research. Our focus on patient-centered care can directly challenge the usual way of managing care.
For example, I was just awarded an National Institutes of Health grant for $2.4 million to test a novel concept that diverges from the past 40 years of managing ICU patients. We will test what happens when ICU patients on ventilators self-administer sedative medication to reduce their anxiety.
What other nursing research is going on at Mayo Clinic?
We’re focusing on several areas including studies on advance care planning, care transition across care settings, palliative care, and symptom management for patients with atrial fibrillation.
Three recent research projects:
Patient Anxiety in ICU
Linda Chlan, Ph.D., R.N., F.A.A.N., associate dean for nursing research at Mayo Clinic, studies symptom management for critically ill patients receiving mechanical ventilatory support. These patients are subject to high stress and anxiety levels, which can have adverse effects on the patient’s health. While most research in this area focuses on pharmacological treatment, Dr. Chlan researches adjunctive methods to reduce anxiety, in addition to the medical plan of care. Chlan’s research was the first to show that music can be used to reduce patient anxiety and lower the use of sedative medications. The studies were also the first to show that patients on mechanical ventilator support can engage in self-management of anxiety, both with alternative music listening intervention and self-administration of sedative medication. Dr. Chlan’s work led the American Association of Critical-Care Nurses to name her their 2016 Distinguished Research Lecturer.
Development and Validation of a Screen for Specialized Discharge Planning Services
Diane Holland, Ph.D., R.N., nurse scientist at Mayo Clinic, developed a process that streamlines discharge for certain patients needing specialized services. The process uses clinical admission data to identify patients that need specialized discharged planning services. This planning is a critical first step in the discharge planning process that will help engage specialized services in a timelier manner. This study is among the first to assess the use of early identification for specialized discharged planning services. The process has shown to reduce average length-of-stay by 20 percent for certain patients. The Early Screen for Discharge Planning (ESDP) is used widely, both nationally and internationally.
Feasibility Testing of the Alert for AFib Intervention
Pamela McCabe, Ph.D., R.N., nurse scientist at Mayo Clinic, developed a program to educate patients at risk for developing atrial fibrillation (AF) to recognize signs and symptoms of AF. Improvement in early detection and treatment of AF is critical. If gone untreated, AF is an important contributor to embolic strokes, heart failure and can worsen existing cardiac conditions. Investigators used a 33-item Knowledge, Attitudes, and Beliefs about Atrial Fibrillation Survey (KABAFS) to test the effect of the intervention. Participants who received the Alert for AFib education had greater knowledge about AF and improved confidence for recognizing and seeking treatment for AF signs and symptoms comparted to participants who did not receive the Alert for AFib education. All patients that participated were able to identify and self-monitor signs and symptoms of AF and seek treatment earlier if needed.
What’s new in nursing research at Mayo Clinic?
My goal as associate dean for nursing research is to expand this multidisciplinary approach to research by hiring and growing our own Ph.D.-nurse scientists. Mayo Clinic has recognized the potential of this work and plans to increase nursing research across campuses in Rochester, Arizona, Florida and in the Mayo Clinic Health System.
We’re looking for people who are persistent and have a burning passion to answer pressing clinical questions surrounding patient care. That’s how I got my start in research. As an ICU nurse, I was incredibly frustrated with the tools to help manage patient anxiety. They were limited and ineffective. I’ve always been a curious and questioning person. That led me to a Ph.D. in nursing and a post-doctoral research fellowship on nursing interventions, outcomes and effectiveness. I have been doing research in this area for more than 15 years.
What counsel would you offer to nurses interested in research?
Be bold, be curious and follow your passions! If there are complex clinical questions that seem to defy answers, find the answers. It’s of paramount importance that we take every opportunity to improve how we meet patients’ needs.