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The rituals of hospital routine have come under increased scrutiny as nurses question why things are done a certain way and whether accepted methods make scientific sense.

Not many people want to study preoperative fasting or decipher doctors' handwriting samples, but Elizabeth Winslow, Ph.D., RN, FAAN, has made a life's work of questioning the efficacy of such elements of hospital rituals.

Take bedpans, for example. Winslow, a research consultant at Presbyterian Hospital of Dallas, first challenged the status quo when she examined the hospital's rule ordering postoperative heart attack patients to use a bedpan.

"They hate the bedpan," she said of patients. "It's very awkward to use."

Winslow measured oxygen consumption to compare the effort a patient exerted while using a bedpan, a bedside commode and a regular toilet. She found no difference.

"There is no reason why these patients couldn't get up and use the commode," she said. Patients not only preferred getting out of bed, but the movement also helped them to maintain their compensatory mechanisms for changing position.

Winslow published her findings in the American Journal of Nursing. Now, that particular bedpan tradition has gone the way of leeching blood not only in her hospital, but also in others around the country.

"There are so many rituals and traditions in nursing practice," Winslow said. "This is such fertile ground for research. We want our practice to be based on evidence."

The rituals of hospital routine have come under increased scrutiny as nurses like Winslow question why things are done a certain way and whether accepted methods make scientific sense.

The questioning has intensified in the last 20 years, coinciding with a tripling of the number of RNs whose highest level of preparation is either a master's degree or a doctorate. Furthermore, funding agencies and professional associations have turned away from theoretical research and toward outcomes-based research, which backs up or debunks practice with science.

Ann Jacobson, Ph.D., RN, who collaborated with Winslow on studies about intravenous needle insertion, has seen the gap between practicing nurses and nursing research close since the 1980s, when she attended Texas Woman's University to earn her Ph.D. Back then, nursing students favored developing theories about nursing and patients.

"The focus of study was to test a theory," she said. "It's not at a level of practice that's useful."

Now an associate professor at Kent State University's College of Nursing, Jacobson recalls battling professors and colleagues who resisted her pursuit of outcomes-based research. "They were not accustomed to students doing a dissertation on such clinical phenomena," she said.

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