Kate E. Klein, MS, ACNP-BC, RN, CCRN is an acute care nurse practitioner in the neurological intensive care unit (ICU) at Cleveland Clinic’s main campus. She won the Zielony Nursing Institute’s 2015 Nancy Albert Nursing Research Award. Her research focus is ameliorating the impact of critical illness and care received in the ICU and improving outcomes of patients with neurological injury. Klein was the principal investigator for a delirium screening tool validation study and also conducted research on the impact of an early progressive mobility program for patients with neurological injury. She also is co-chair to the development, implementation and impact analysis of Cleveland Clinic’s Mobility and Safe Patient Handling Care Path.
Q: When did you first begin conducting research?
A: It all started about six months into my practice at Cleveland Clinic in 2009. Two patient care needs in our neurological ICU became evident – delirium management and early progressive mobility. Throughout my career as a bedside nurse, I had seen firsthand that those two things improved care. However, I wasn’t sure if either was feasible, safe or of benefit to patients critically ill with neurological injury. So I approached a physician in the ICU and asked if there was something about patients with neuro injuries I wasn’t understanding. Why didn’t we screen for delirium? He said, ‘That’s a really great question, and I think you should find out why and if we can.’ So started my research career!
Q: That sounds like a big undertaking. How did you begin?
A: It was. I had all kinds of questions that made it a little daunting – actually, a lot daunting – but very exciting! I went to the literature and looked for delirium screening and neurological injury. There wasn’t a single study that looked into whether you could even test neuro patients for delirium, and there had never been a tool validated for this population. I was not sure where to begin, so I sought out Nancy Albert. [Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FAAN, is Associate Chief Nursing Officer of Research and Innovation at Cleveland Clinic.] She encouraged me to figure out what’s been done in other ICUs and perhaps develop a similar protocol.
We developed a delirium tool validation protocol to test if delirium screening was feasible and if a tool could be validated for this population. While conducting this research, our neuro ICU team also was testing the impact of a nurse-driven early progressive mobility protocol on patients with neurological injury. Various circumstances landed me as principal investigator for this study as well. Because of my work with these two investigations, I truly found my passion for early neurological rehabilitation.
Q: Why do you think it’s important for nurses to participate in research?
A: Nurses can have a tremendous influence on bedside practice. They are on the frontline of care and have first-hand experience with what can help – and cause risk – to patients and caregivers. So many nurses have great ideas for research, and that research could impact our current and future nursing practice. Every time nurses have a clinical or practice question, I encourage them to ask, ‘Could we do this better?’ Then I recommend that they search the literature to see what’s already been answered and what has not been answered.
Q: Some nurses may be intimidated to participate in research. Do you have any advice for them?
A: Don’t be afraid of the process. A lot of nurses see research as overwhelming, and it can be. But it’s also very rewarding. You have the chance to influence and change practice – to do things differently that will change the outcomes of not only our patients, but of our caregivers, too. Nursing research is the means to discovering not only how to improve the care of patients and optimize outcomes, but improve the processes of nursing practice. Doing the research is the first step. Test your questions, discover the answer, and then translate your findings into practice, when applicable. Conducting research is time and labor intensive, but it’s a road to finding one’s passion and truly making a difference for patients and caregivers.
Q: In your studies, how did research and translation into practice go hand-in-hand?
A: When you do research, it opens up a Pandora’s box of other questions. In our research, we found mobilizing our patients in the neurological ICU was a best practice and improved outcomes. This was wonderful news, but then a very important question about the needs of our caregivers surfaced. How do we mobilize patients in a way that keeps our caregivers safe? In the neuro ICU we didn’t have safe patient handling equipment, which challenged our nurses’ desire to do what’s best for patients while compromising their own safety.
I’ve learned a tremendous amount from our Safety Director, Jeff Hildreth, about the importance of safe patient handling equipment. Together we advocated for and drew up a proposal for ceiling lifts for each ICU room. With the Neurological Institute’s commitment to patient and caregiver safety, our proposal was accepted and ceiling lifts were installed. Additionally, a multidisciplinary team developed a Mobility and Safe Patient Handling Care Path, which we are currently piloting in the Neurological Institute. This project has become a wonderful example of how patient and caregiver needs were identified, studied and translated into practice to improve safety of nursing practice and patient outcomes.
Q: What does winning the Nancy Albert Research Award mean to you?
A: Nancy is a model of true commitment to the development of nurses and nursing practice. With tremendous dedication, knowledge and passion, she has generously mentored hundreds of nurses through nursing research. I am deeply honored to receive this award for all Nancy represents. The award speaks volumes to how important nursing research is to Cleveland Clinic. Such dedication gives me confidence we will continue to lead the way with evidence-based improvements in patient care, nursing practice and the environment in which we all serve.
