Chapter 06: An Invention and Advancing Nursing Research

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Chapter 06: An Invention and Advancing Nursing Research

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Ms. Alt begins this chapter by talking about what she enjoyed about her role as Director of Nursing. Next she talks her invention of the Patient Manifold (see left), explaining the work she did with the IV Team to develop the device and perfect its use in a clinical setting. She notes that she traveled around the country to teach other institutions about the use of the Manifold to reduce infections. Next she talks about promoting Pat Taylor to Chair for Nursing Research and to sit on the institutional research committee, the first time in MD Anderson’s history (in the early 80s) that a nurse participated in this committee.

Identifier

Alt,J_01_20180529_S06

Publication Date

5-29-2018

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution Discovery and Success; Healing, Hope, and the Promise of Research; MD Anderson Product Development and IP; The Researcher; Building the Institution; Building/Transforming the Institution

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Chapter 06: An Invention and Advancing Nursing ResearchB: Building the Institution;CodesC: Discovery and Success;C: Healing, Hope, and the Promise of Research;B: MD Anderson Product Development and IP;A: The Researcher;B: Building the Institution;B: Building/Transforming the Institution;

Tacey A. Rosolowski, Ph.D:

It sounds like you liked this job, the director job.J

Joyce Alt, RN, MS:

I did, I really did.

Tacey A. Rosolowski, Ph.D:

What was it that really jazzed you about it?J

Joyce Alt, RN, MS:

Seeing the improvements, the increase in job satisfaction, putting in systems that I knew would improve patient care. [ ] [Employees being excited about it. Sponsoring a surprise party for me to say, Thank you, because things were better. On top of this, I was awarded a patent.]

Tacey A. Rosolowski, Ph.D:

Tell me.J

Joyce Alt, RN, MS:

The IV Administration Set. Patients would have [ ] probably 25-feet or more of IV tubing, from the bottle to them, and then it was all wound around, and the nurse would have to go and found out where the inlet is, to give him.

Tacey A. Rosolowski, Ph.D:

And these were all the different—what were those tubes representing?J

Joyce Alt, RN, MS:

For the IV, but it still didn’t take care of the blood, so they had to stick them again.

Tacey A. Rosolowski, Ph.D:

But if they had 25 tubes sticking out their arms.J

Joyce Alt, RN, MS:

No, I mean 25-foot, I mean it just went on forever and you couldn’t—the way it was, there’s no way you could retain a sterile environment. So I went to Pat, who was head of our Department of Nursing Research and Quality Assurance, and I said, “Can I get some people to help me? I want to try this.” I got this image in my head, went to pharmacy and Roger said we’re going to try, I think we’ve got something here. So then he called Quest, it’s a medical supply company, and told them we wanted to do some research. So, I built it and it had filters in that would take—they call it dirt and it isn’t dirt, but IVs, medication, chemotherapy, have a lot of trash in it and it clogs filters, so we put filters in of a certain microsystems and I would take out the trash and the patient would get the IV. We made ports different, so that the patient wouldn’t have to be stuck again to give blood.

Tacey A. Rosolowski, Ph.D:

Oh, wow, yeah.J

Joyce Alt, RN, MS:

And so it just, I mean this took a lot of nursing research and training of people to be very objective about this, tell us what’s good about it, what’s bad, and we got it, and that took a long time.

Tacey A. Rosolowski, Ph.D:

And this came to be known as the Patient Manifold, right?J

Joyce Alt, RN, MS:

Uh-huh.

Tacey A. Rosolowski, Ph.D:

And that was patented in 1984, but when did it actually go into use? How long was it in development?J

Joyce Alt, RN, MS:

About a year and a half.

Tacey A. Rosolowski, Ph.D:

Oh wow, okay.J

Joyce Alt, RN, MS:

Yeah, it was about a year and a half, to get our attorneys onboard. Roger was very good, Roger Anderson, who was head of pharmacy, and he knew the problems we were causing the patients. Not intentionally, but it was just the nature of the beast, and the patients loved it. Some of the wives would come down and tell me. So it was things like that, that kept me going, I enjoyed that kind of thing. Now, I don’t know, I was told it was the most—I’m sure that’s changed now, but it brought it more money to the institution than any other patent.

Tacey A. Rosolowski, Ph.D:

When this was—I didn’t note down when the—because I found an article about that. There was an article in the Conquest, written about patents at MD Anderson and it had a section. They even have a little picture of it, which I will put in your transcript, so anybody who looks at your transcript can see your Patient Manifold. And at the time that that article was written, it was still making the most money for MD Anderson, so it’s kind of interesting to see.J

Joyce Alt, RN, MS:

I remember one of the other financial officers, we always had a patent party once a year, and he’d always introduce me as making the most money. I thought, “Honey, you missed the whole [point]…” (both laugh) And then we established an IV Team, because these patients’ veins are so brittle, and they get stuck so many times, and they hate to even see you coming because it hurts so much. Some people are very good at it and some people aren’t, and their whole goal, and they grew and grew and grew, around the clock, they started IVs and they put in the long-dwell catheters and physicians would call them because they could do it better.

Tacey A. Rosolowski, Ph.D:

Wow. What is that catheter, what’s the name of that?J

Joyce Alt, RN, MS:

A long line.

Tacey A. Rosolowski, Ph.D:

A long line, okay.J

Joyce Alt, RN, MS:

Yeah. Milly Lawson was head of the team and she was traveling all around the United States. People were so impressed with how the manifold and their management of the IV lines reduced infection rates tremendously. And then JCAHO requirements included the dressing had to be changed minimally, every three days; that’s a lot. That’s fine, we got that in the computerized med record, they also could read. You had to document every bit of the dressing change of JCAHO would say you didn’t do it.

Tacey A. Rosolowski, Ph.D:

So what were some other changes that you instituted, because you were director for quite a while and you know, so there was an opportunity. I had a number of areas that there were changes in. I had the Career Ladder, but then there was this whole element Nursing and Research, because you had taken part in that yourself. So tell me about in the first part of your role as director, what were some of those—some other early problems that you were addressing in nursing at MD Anderson.J

Joyce Alt, RN, MS:

Well, turnover was impacting everything, everything, and so I really focused on retention. And then my chair for Nursing Research and Quality Assurance, Pat Tedder, she was a slugger, I mean she could get in with those researchers, because she was a researcher, and could hold her own. She got a nurse to sit on the Institutional Research Committee for the first time in [our] history.

Tacey A. Rosolowski, Ph.D:

Wow.J

Joyce Alt, RN, MS:

She came back with many a scar but it was important.

Tacey A. Rosolowski, Ph.D:

So what was the rationale for that, having a nurse sit on the Research Committee?J

Joyce Alt, RN, MS:

We could submit research, number one, and it was credentialed and that kind of thing. It just made an impact on universities, to see nursing sitting at the table.

Tacey A. Rosolowski, Ph.D:

What was around the timeframe in which she was able to get this to happen?J

Joyce Alt, RN, MS:

That was all this time. I mean, we’re talking two or three years.

Tacey A. Rosolowski, Ph.D:

So early ’80s?J

Joyce Alt, RN, MS:

Yeah.

Tacey A. Rosolowski, Ph.D:

Wow. So when you said she came back with many a scar, what would have been the reasons for that? What would have been the contentiousness?J

Joyce Alt, RN, MS:

She didn’t have a PhD. [ ] She hire a nursing researcher with a PhD, so they both became members. But, the neat thing was before the impact would hit the unit and the patient, we were ready for it. If you had to prepare for this, which you generally did, some of these terrific changes in protocols, we knew it was going to happen and we could prepare the staff, get the right supplies. So from that standpoint it was also good.

Tacey A. Rosolowski, Ph.D:

So are you talking about—because I’m not sure I’m understanding the situation you’re describing. Are you saying like based on research, there was a new procedure?J

Joyce Alt, RN, MS:

A new protocol.

Tacey A. Rosolowski, Ph.D:

A new protocol.J

Joyce Alt, RN, MS:

And most of this was medications. So if it was going to crash their red blood cells, be ready for it.

Tacey A. Rosolowski, Ph.D:

Right, okay. So the idea was that the procedure would be discussed on the Research Committee, the nursing representative would be part of this and know, and could kind of pass the information.J

Joyce Alt, RN, MS:

And [also vote to approve or disapprove] medical staff research.

Tacey A. Rosolowski, Ph.D:

Okay. Oh, okay, yeah.J

Joyce Alt, RN, MS:

Okay. I mean that was a biggie.

Tacey A. Rosolowski, Ph.D:

So what were some of the reasons why research would not be approved?J

Joyce Alt, RN, MS:

I’m just going to say the rationale was not sound [or, e.g. the provenance may not have been clear, they could not agree on the purpose or the procedure was not clear.][Redacted]

Tacey A. Rosolowski, Ph.D:

There was just so much conversation, because this is the time too, there’s a lot of discussion in the institution, you know the ethics of randomized versus non-randomized trials. How aggressive can you be? Can a patient really consent to something that’s incredibly aggressive if they are desperate? You know I mean all of these questions.J

Joyce Alt, RN, MS:

Oh, sure, they’re real.

Tacey A. Rosolowski, Ph.D:

They’re very real and so I’m interested to understand kind of what were the issues that, from a nursing perspective, were coming up.[Redacted]J

Joyce Alt, RN, MS:

It was a thing, nursing shouldn’t be approving medical research. You know it’s just the time, but it worked out. It worked out and some good brawls going on up there, that’s the way it should be, and respect was gained on both sides.

Tacey A. Rosolowski, Ph.D:

Oh, well that’s a positive for sure, because a lot of the discussions I have about the creation of these, what they’re now calling interprofessional teams, or multidisciplinary teams, where you’ve got people from different specialties, but also different services within the institution, who are coming together. Well that’s all well and good but it’s still very, very difficult for a person who is a nurse, to say to a doctor, “Hey wait a minute.”J

Joyce Alt, RN, MS:

Yes. That’s just the nature of the beast.

Tacey A. Rosolowski, Ph.D:

Right. So how do you create that environment in which there is enough respect where that can happen?

Chapter 06: An Invention and Advancing Nursing Research

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