When I reflect on my 50 years in nursing, I am awestruck at how research, with its discoveries, has changed the practice of medicine. Many improvements have occurred due to a variety of innovative findings and advancements in medical/surgical knowledge, from new equipment/therapies/testing methods to new pharmaceutical agents. Nursing practice has also changed and resulted in improvements in the delivery of patient care and updates to our standards of care.^1-3 Inquisitive nurses have questioned the status quo and challenged the current standards available at the time. They believed there was an improvement that could be made, and so these nurses began the process of validating their concerns or questions. Was this easy? Probably not, but their conviction to seek out a better method drove them to look, investigate, and validate their work. I would like to share a few stories of nurses who have changed our practice and hopefully inspire you to ask the question: Why are we doing this?

Infection Control

To illustrate the power of change, we must begin with Florence Nightingale. She challenged the lack of hand washing and hygiene practices at the time. The risk of infection was almost inevitable as little cleansing was done with equipment or even one’s own hands. She challenged this thinking by encouraging hygiene practices, thus saving lives and beginning to create the first standards in infection control.⁴

Neonatal Phototherapy for Jaundice

Another nurse, Sister Jean Ward, in 1950s England, cared for premature babies, some of whom experienced jaundice, a disease poorly understood at that time. On a sunny day, Sr. Ward thought she would take some of her charges into the fresh air and sunlight. By accident, a sheet covering one of the babies' feet was unnoticed. When she brought them back into the ward, the physician was there and upset she had taken the babies outside without his approval. When he moved the sheet to examine the baby, he noticed jaundice on the feet where the sheet was in place and not in the uncovered area. He also noted this in the other babies—that being in the sunlight reduced their jaundice. This inadvertent finding led to the beginning of neonatal phototherapy for jaundice.^5,6

Physical Therapy

Elizabeth Kenny was caring for young polio patients in Australia. The practice’s standard at that time was to place plaster casts on the patient’s extremities for long periods. Instead, she placed hot compresses on the extremities to comfort and address the spasms her young patients were experiencing and followed this treatment with passive range of motion exercises. These children benefitted from this therapy versus the restricted inactivity with immobility and were noted to maintain some muscle strength. It is thought this level of practice may have laid the foundation of our present-day physical therapy specialty.⁷

Further Nurse-Led Innovations

Other discoveries over the decades have included the following³:

• A crash cart that contains all the supplies one would need in an arrest
• Color coding IV lines to quickly differentiate each medication
• Ostomy pouches that contain the contents and odor of urine or stool
• A disposable liner for baby bottles to reduce the amount of air babies take in

Nurses piloted research into delaying the initial first bath with a newborn, finding that leaving the vernix in place for up to 24 hours may lead to a marked reduction in hypothermia and hypoglycemia among neonates.⁸ The above are just a few examples of wonderful additions that enhance the provision of care that bedside nurses developed by questioning their current practice.

Discussion: For Nurses

How did you begin? With the advent of search engines and widespread access to the Internet, anyone can search on any topic. First, form your question and then, using some keywords, search the literature to see what has been written, explored, or researched. Involve your colleagues in your quest. Nurses are inquisitive, always seeking a better way to deliver the best in care, and can be a supportive group when seeking answers that will help in patient care. Always remember that you see patients at all hours of the day and night and use all types of equipment or therapies. You are the prime audience to see issues or concerns and raise questions regarding routine practice.^1-3 You may believe there may be a path or process to improve the care. Always keep in mind that simply color-coding IV lines reduced errors and allowed nurses to complete assessments more effectively.³ The improvements to come will originate with the bedside nurses who see issues/challenges and begin with that spirit of inquiry. Change occurs because someone questions the norm and asks, "why."

References

1. Davis CR, Glasgow MES. An examination of nurse‐authored patents: Implications for nursing practice. Nurs Forum. 2020 Nov;55(4):772-781. doi: 10.1111/nuf.12495
2. Cioffi JM. Insight and discovery in clinical nursing practice. Collegian. 2015; 24(2):191-196. https://doi.org/10.1016/j.colegn.2015.10.004.
3. Hughes F. Nurses at the forefront of innovation. Int Nurs Rev. 2006;53(2): 94-101. https://doi.org/10.1111/j.1466-7657.2006.00463.x
4. Maetischang R, Peters A, Reart AN, Pittet D. The voice of nurses in hospital epidemiology and infection control: An example from the 19th century. Int J Infect Dis. 2020; 96:119-120. doi: 10.1016/j.ijid.2020.04.030
5. Maisels MJ. Sister Jean Ward, phototherapy, and jaundice: a unique human and photochemical interaction. J Perinatol. 2015;35(9):671-5. doi: 10.1038/jp.2015.56.
6. Stokowski LA. Fundamentals of Phototherapy for Neonatal Jaundice. Adv Neonatal Care. 2011; 11:10-21. doi: 10.1097/ANC.0b013e31822ee62c
7. Rogers N. The Polio Wars: Sister Kenny and the Golden Age of American Medicine. Oxford University Press; 2014. https://doi.org/10.1093/acprof:oso/9780195380590.002.0006
8. Warren S, Midodzi WK, Allwood Newhook LA, Murphy P, Twells L. Effects of Delayed Newborn Bathing on Breastfeeding, Hypothermia, and Hypoglycemia. J Obstet Gynecol Neonatal Nurs. 2020;49(2):181-189. doi: 10.1016/j.jogn.2019.12.004.

About The Author Mary Brennan is per diem at North Shore University Hospital and her work is now focused on writing and research studies. Currently, her and her team are waiting to hear if a NIH grant submission is approved to continue their work on the Trombley Brennan Terminal Tissue Injury. She serves on the Editorial Advisory Board of Advances in Skin and Wound Care and has presented posters, abstracts, and published on a variety of skin and wound care issues. She has been working on the terminal tissue injury phenomenon beginning with the initial patient observed with these skin changes in 2008. She has been a principle investigator and co-principle investigator on research studies including three involving the terminal tissue injury.