By Agnes Black, RN MPH, Nursing Research Facilitator for Vancouver Coastal Health and Providence Health Care
The cardiac ICU at VGH is a busy place. Machines whir, nurses bustle, stretchers are wheeled in and out, and several languages can be heard on any given day.
What happens when a nurse is assigned a post-cardiac surgery patient who doesn’t speak English? Does a non-English speaking patient take longer to recover from surgery, spend more days in the CSICU, more days away from home and more days in the costly environment of the acute care hospital? If so, how could nurses work more effectively with this group of patients and their families to improve recovery?
These are the questions that a group of nurses found themselves frequently discussing as they cared for post op cardiac surgery patients.
In 2012, this group of cardiac nurses, Erin Tang, Andrea Kwok, Jeremy Go and Bonnie Leung, were given the opportunity to formalize these questions and discussions into a funded research project. The VGH SON Alumni Association donated $5000 for nursing research, channeled through the VGH and UBC Hospital Foundation. At the same time, the VCH Professional Practice department, working with the VCH Research Institute, began advertising a program called the VCH Research Challenge. VCH Professional Practice leaders contacted the Foundation to ask if the VGH SON donation could be channeled through the Research Challenge to support a nurse-led team in acute care to conduct a research project. A match was made! The team was a successful applicant to participate in the first-ever VCH Research Challenge.
As part of the Research Challenge, teams were required to have a mentor. Priscilla Taipale was assigned to this group because she was very familiar with the VGH SON bursary – she won the award herself several years earlier and conducted her own research project in the cardiac ICU. Priscilla credits the VGH SON bursary and the project funded by this bursary with sparking her continued interest in research. Priscilla is currently working on her PhD in nursing at UBC School of Nursing and readily agreed to serve as a mentor.
The four-team members next conducted a literature review, which showed a gap in the literature regarding health care challenges for patients with “Limited English Proficiency” or LEP. This confirmed that the team had identified an important area of research that would fill a missing link for nurses caring for patients with LEP. The team learned how to conduct a formal chart review, which determined how they would categorize patients as LEP, and attended the Research Methods workshop organized by the Research Challenge. Next, the team drafted a five-page proposal outlining their research methods, explaining why the project was important, and describing what they would do with their findings. They also presented their research proposal in a very entertaining skit for VCH leadership and the Research Challenge organizers, with a memorable demonstration of what happens when a nurse addresses an LEP patient in English without realizing the patient does not understand the very important post-op instructions.
When the VCH Research Challenge funding was announced in June 2013, the team had reason to celebrate — they were awarded $5000 in Research Challenge funding donated by the VGH Alumni Association! The team got to work quickly, and received additional mentorship from Erin’s graduate school supervisor Dr Pam Ratner, a professor at the UBC School of Nursing.
When I met with the team in December 2013 they were finishing up their data analysis, having reviewed 712 medical charts (!), with plans to present their findings at the March 3, 2014 VCH Interprofessional Research Celebration, and plans to submit an abstract to the Canadian Cardiovascular Conference. They also hope to use their findings to identify LEP patients earlier in their journey at VCH, so that appropriate resources and assistance can be put in place to support these patients. As team member Bonnie noted, “In the CSICU, patient participation in their own recovery is huge, and when there are barriers like limited English, their recovery is slowed down.” With nurses like Andrea, Erin, Bonnie and Jeremy on the care team, LEP patients at VCH will have a better chance of a smoother recovery.
This team of nurses would like to say “thanks!” to the VGH Alumni Association. They note that without the support of the Research Challlenge and funding from the VCHAA, their project would not have materialized.