Partnership works to transform nursing practice and research
by: Kathy Quirk
 Norma Lang (seated) and Sally Lundeen
Will providing that information improve the outcome for a patient?
A dynamic, one-of-a-kind collaboration among UWM’s College of Nursing, Aurora Health Care and the Cerner Corporation is trying to answer those questions.
“There is nothing else like this project in the world,” says Norma Lang, Wisconsin Regent Distinguished Professor and Aurora Distinguished Professor of Healthcare Quality and Informatics, who leads the project.
“What we’re doing is bringing together the university, a premier health care system and a huge health information technology company to discover and synthesize the best nursing knowledge and get it to the nurse right at the point of care.”
Called the Knowledge-Based Nursing Initiative (KBNI), the health informatics research project brings together academic researchers, computer engineers, staff nurses and information technology experts to better apply informatics – computer tools applied to health care – to the work that nurses do.
A natural partnership
<!--Improving the standardized “discharge instructions” to help lower readmission rates and enhance patients’ quality of life is a shared goal of the project partners, who are already making major contributions to improving public health in southeastern Wisconsin.
--> With its expertise in community health care, UWM’s College of Nursing is developing ways to help nurses educate patients before and after they leave medical facilities. Aurora already has a strong community health and teleservices program to support patients as they leave its medical facilities.
Finally, the Cerner Corporation has valuable technological reources to help gather and synthesize the data needed to create a “nursing knowledge repository,” one of KBNI’s key objectives.
Nurses on the front lines
Nurses are on the front lines of medical care, assessing patients, observing and monitoring their condition, and educating them and their families, says Lang. So “translational research” – moving the best nursing scientific research into practice – is vital.
For example, if a patient seems confused following surgery, a nurse may explore whether the problem is related to anesthesia or medication, delirium from dehydration or fever, dementia or depression, or possibly a combination of those factors. Each requires different interventions, family and patient education and instructions for care.
“This research is complex because people are complex,” notes Lang.
Designing a system to provide such information and decision-making support is daunting. Terms and definitions have to be standardized so they can be coded into an electronic system. Clinical knowledge must be evidence-based and easy for nurses to access, understand and act on.
And this is where the “nursing knowledge repository” becomes necessary. The database integrates scientific publications, research reports, national guidelines, professional organizations’ practice standards and expert opinions. This information is then translated into “actionable knowledge” and embedded into the Cerner and Aurora electronic information system.
The repository will eventually include information summarizing the best nursing science on hundreds of conditions – falls after surgery, potential complications from anesthesia, hip replacement aftercare and myriad others.
Using the system in real-time practice
The project team has also begun using the system in real-time practice, extracting and analyzing data, then using that information to make recommendations for improvements both to nursing practice and the information-gathering process.
Working with Aurora’s staff of more than 7,000 nurses allows researchers to see how the information is used in different patient-care settings. As patients move from doctor’s office to emergency room to hospital to home care, the nursing care provided will be documented.
Documentation is important because it provides knowledge that will help continually improve nursing practices. For example, nurses may follow recommended best practices and document the care in the KBNI system. Researchers can then evaluate the patient outcome. If the recommended best practices don’t result in improvement for all patients, researchers can figure out what’s not working, why it’s not working and make recommendations for improvements.
“Nursing is knowledge work, but much of the work that nurses do isn’t captured in current patient records systems,” says Sally Lundeen, dean of UWM’s College of Nursing and co-principal investigator on the project. “By developing ways of better capturing information on what nurses are doing, researchers can make links between the work of nurses and the outcomes of patients.”
‘A huge step forward in nursing’
“We are working to transform both practice and research,” says Susan Ela, Senior Vice President/President Aurora Healthcare Metro Region. “Working in partnership with UWM and Cerner Corporation has enabled us to take a huge step forward in nursing.”
UWM, Cerner and Aurora are jointly developing new content for the system for specific diseases and care settings, and customizing the information for the Aurora nurses’ work-flows.
Caring for a patient with congestive heart failure, for example, may involve multiple Aurora medical staff and facilities. Gathering information on what nurses are doing through Cerner’s system allows the UWM researchers to analyze data and determine what nursing actions are having the most positive impact. Aurora can then make these “best practices” standard for congestive heart failure patients.
“We need to identify evidence-based knowledge, transform it for use in everyday practice and embed it in an electronic information system,” says Lang. “That’s how we will recognize and measure the value of nursing care as it impacts patient outcomes. By exploiting nursing science, and information science and technology, we will have simultaneously transformed practice and research.”
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