CNCC nursing students share research, suggest changes
Several student projects consider ways to reduce pain during various treatments
March 12, 2016
Craig — Nursing students on the cusp of starting their careers talked about their fresh research projects to medical professionals at The Memorial Hospital in Craig on Monday. The students are slated to graduate this year from Colorado Northwestern Community College.
A key task was to find evidence for nursing practices that are in place — or for practices students think should be in place.
"We often talk about how our practice is evidence-based," said Julie Alkema, nursing faculty member at CNCC. "We do things for a reason."
The students performed the research — and created striking visual displays to convey it — as part of a class in advanced medical surgical nursing, taught by Alkema and Melissa Greene-Walzak, also on the college's nursing faculty.
Past student research, Alkema said, has led to some nursing practice changes in the area.
The research on display Monday spanned a range of topics that touched the nursing profession and the patients who rely on it. The research included exploration about the best ways to handle consumption of food before childbirth, skin-to-skin contact between infants and adults, laundry practices in hospitals, communication methods between patients and nurses, ways to preserve delicate hospital equipment and several projects that touched methods to limit patients' pain or discomfort, sometimes focusing on equipment such as catheters.
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Nursing student Paulo Fernandez explored the effects of widely used 12-hour nursing shifts. Fernandez cited written sources that presented evidence for a greater likelihood of medical errors when nurses work these shifts.
Fernandez also drew material from a survey of nurses he conducted with other students.
"A little bit over 50 percent of the staff was satisfied with their shifts," he said. "The other people wanted 10- or eight-hour shifts."
Fernandez noted some of the comments about 12-hour shifts that people left on the surveys.
"A lot of them reported tired(ness) and exhaustion," he said. "They said when they would stay late, they would notice more errors in their charting. One even said that they feel like they're on autopilot."
As students crafted their projects, they drew from their experience as nursing students and as patients. Ashley Moon proposed consistent use of lidocaine — a numbing agent — when performing procedures with nasogastric tubes.
Nasogastric tubes extend from the nasal passages into the stomach.
"In the last two years, I've had several NG tubes placed myself," Moon said. "They're very painful, and in one study, they were rated as one of the most painful procedures done in a hospital setting."
Moon said she's had nasogastric tubes placed with and without lidocaine, and the pain she noticed without the lidocaine helped to launch her research. She not only discovered patients report less pain with lidocaine, but also that the procedure progressed more smoothly when lidocaine was used.
"With lidocaine spray, the rate of failed insertions was 10 percent, and with the placebo group, the rate of failed insertions was 85 percent," she said.
A failed insertion, she said, was defined as an insertion that took two or more attempts.
Without lidocaine, she said, patients, "had more coughs, shortness of breath, chest pains and dizziness" — all things that can disrupt the procedure.
Moon proposed a consistent practice using lidocaine with nasogastric tubes.
"What I'd like to see is that, with every NG tube that's ordered, lidocaine automatically gets ordered with it, as long as the patient's not allergic so there are no contraindications," she said, noting that the cost for multiple doses of lidocaine falls below $10.
About 12 students presented their work at TMH on Monday, and more were scheduled to give presentations at the Yampa Valley Medical Center in Steamboat Springs later in the week.
Alkema commended the students for presenting feasible solutions to the problems they uncovered.
"Several of (the projects) focus on decreasing pain with the patients," Alkema said. "And they're such easy fixes."
The college is scheduled to graduate 23 nursing students this year.