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These days, it is theoretical research that is outside the norm. The government and other sources of funds have moved toward favoring outcomes-based research in nursing schools, Jacobson said.

The change in emphasis stems partly from a realization that quality of care could be measured, said Patricia Rowell, Ph.D., RN, a senior policy fellow in the department of Nursing Practice and Policy at the American Nurses Association.

It started in the late '80s and early '90s, when the Agency for Health Care Policy and Research-at that time a center within the Department of Health and Human Services-started looking at the effects of managed care and capped reimbursement costs.

Researchers realized the primary product delivered in hospitals, nursing homes and home health services is nursing care, Rowell said, and soon they set their sights on studying health services. The center grew into an agency, which issued clinical practice guidelines about 10 years ago.

Still, more research is needed, Rowell said. "Some people estimate that just 20 percent of nursing practice has been proven to do less harm than good," she said.

National groups and associations have placed greater emphasis on following such national guidelines based on outcomes-based research, said Marianne Chulay, DNSc, RN, FAAN.

The American Association of Critical-Care Nurses, for example, decided to publish the "Protocols for Practice" series, easy-to-read articles that summarize the latest research and best practices in critical care nursing.

"One to two are published every year in a format that is easy for a clinician to see the critical recommendations and incorporate the research," Chulay said.

Still, getting the growing amount of practical research into the hands of clinicians is a problem, she said.

Incorporating research

Until the late '90s, Winslow and Jacobson addressed this problem by writing a column in the American Journal of Nursing called "Working Smart." The column was inspired by a complaint among nurses that research is often too dry and highbrow to read.

Many of Winslow's studies, including some topics for the column, come out of comments made by nurses on the nursing research committee that Winslow chairs at Presbyterian Hospital. Petroleum jelly, which for years had been used to moisturize the dry lips and noses of patients, had been banned, and the nurses found other moisturizers ineffective. They wanted to know why they couldn't use the product.

Winslow tries to demystify rituals and traditions by looking at research, but she is not deterred if none is available.

"The first thing I usually do is go to the literature," she said. She found that petroleum-based Vaseline was deemed potentially flammable and therefore banned, but she could not find any reports of actual harm from the product.

Winslow then consulted colleagues and, in this case, found that some hospitals still used Vaseline.
She consulted the national group responsible for writing fire protection manuals for hospitals. She learned the original standard that called for the ban didn't apply to use on lips and noses.

Finally, Winslow wrote a paper on the subject that was evaluated by an independent researcher. A year later, the hospital switched back to Vaseline. Winslow publishes her findings in a variety of nursing and medical journals, but she no longer publishes the column with Jacobson.

That's in part because nursing has come a long way, Jacobson said.

"We no longer edit that column, I'm happy to say," she said. "AJN felt its readership no longer needed to be handheld in applying research findings."

Some, like Chulay, wish the column were still around. "They wrote in a conversational style," she said. "I believe that's really missing in our nursing literature."