Chapter 10: The NIH and an Opportunity to Support Research Nurses
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Description
In this Chapter, Dr. Summers explains that she was recruited for NIH Clinical Services to develop cancer nursing research programs for research nurses. Dr. Summers explains Jean Watson’s care theory in greater detail and talks about its connections with transformational leadership. She then goes on to talk about her role at the NCI (where she arrived “knowing zip”): she developed a program to support research nurses proposing their own research projects.
Dr. Summers gives an example of a project proposed by a nurse on drawing blood. This demonstrates how a nurse brings a unique perspective to care situations and the issues/questions they raise can be quantified to improve care for all patients.
Dr. Summers next observes that she was a member of the Institutional Review Board at the NIH and learned a great deal about clinical research.
Identifier
SummersB_01_20140123_C10
Publication Date
1-23-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, January 23, 2014
Topics Covered
The Interview Subject's Story - The ResearcherThe Researcher The Leader The Professional at Work The History of Health Care, Patient Care Patients Patients, Treatment, Survivors
Creative Commons 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
Tacey Ann Rosolowski, PhD:
Sure. Why don’t we do that. Yeah, because I did want to ask you next about your activities at NIH. What was the—
Barbara Summers, PhD:
Oh, that was a great experience. You know, it’s interesting, because when people say, “Who were your mentors?” I say I didn’t really have any, but as I’m talking to you, I had lots of them.
Tacey Ann Rosolowski, PhD:
You’ve mentioned a few, yeah.
Barbara Summers, PhD:
You know, as I finished my dissertation—well, let’s talk before the dissertation. So I was again uprooted from an organization where I worked for ten years. I knew everybody. I knew my networks. I knew how to get stuff done. And I came to NIH and I didn’t know where the bathrooms were, I didn’t know zip. And I’m like, “Oh, my god, they hired me to develop a research program, and I know nothing about science. What am I going to do?” (Rosolowski laughs.) But luckily, there was a very seasoned scientist who was employed at the Clinical Center and who had developed a wonderful model that supported staff nurses in conducting research, and so my job was to apply that model within my division with the nurses. So I was greatly relieved, and she was able to be a resource to me.
Tacey Ann Rosolowski, PhD:
So what was the project and what were its goals?
Barbara Summers, PhD:
The project? Well, the intention of my role was to have bedside nurse-driven clinical research, to have nurses identify research questions and then to work with them so that they actually went through the entire process of flushing out their research question, going to the library, doing a literature review, summarizing the gaps in the literature, identifying hypotheses if they were appropriate, then talking about, okay, what were the methods going to be, who were the subjects going to be, what kind of data did we need, how are we going to analyze the data. So through weekly meetings with staff who were interested, we would identify a topic, start to have some initial questions. The staff would go through the literature review. I had a librarian who would work with me. We’d pull papers. I’d divvy them out to the staff. They would review them. We’d come back, we’d talk about it. We’d develop our final hypotheses. Then we would, as a group, talk about the rest of it, and as a group we would write the protocol.
Tacey Ann Rosolowski, PhD:
How long had this been going on at NIH?
Barbara Summers, PhD:
A year before I got there.
Tacey Ann Rosolowski, PhD:
Okay. So it was relatively new. Because I’m thinking it seems like this is part and parcel of the rising prominence of nurses having their own sphere of influence.
Barbara Summers, PhD:
Yes, yes.
Tacey Ann Rosolowski, PhD:
So the NIH is supporting that.
Barbara Summers, PhD:
Very much so.
Tacey Ann Rosolowski, PhD:
Great.
Barbara Summers, PhD:
It was great, because you had the opportunity to allow nurses to really exercise their intellectual curiosity. So I worked with a number of teams of nurses, you know, looking—I worked with a group of pediatric nurses, and they were fascinating. They were interested in—the typical pattern for administering a particular drug was to take the patient’s vital signs every fifteen minutes in case the patient had an adverse reaction to the drug. But when the nurses reviewed the literature, there was nothing to substantiate the need for every-fifteen-minute vital signs. It had become like the pattern and the habit everybody did, every hospital. It was just like that’s the way it was. And then when the nurses began looking at the incidence of what we call hypersensitivity reactions, the incidents were low in the literature and in their clinical experience they were low. And then the nurses began looking at hypersensitivity reactions and the literature about hypersensitivity reactions, identification of hypersensitivity reactions never happens because of vital signs ever, ever, ever, ever. It always happens because of patient expression of symptoms. So here we have nurses dutifully performing every-fifteen-minute vital signs in futility, because if the patient is going to have a reaction, it’s not going to show up in their vital signs. By the time it shows up in their vital signs, the patient will be purple. So the nurses designed a lovely study where they randomized patients to every-fifteen-minute vital signs, which was the standard, and then the intervention group, they did vital signs every thirty minutes. And they found absolutely no difference in their ability to check hypersensitivity reactions. So that was great because that was taking control over their practice. Then we had another group that was very interested in the detrimental impact for cancer patients of having to have a lot of blood tests done. And most of these patients have something called a central venous catheter in place that remains in place, and you can draw blood samples from that. But when you draw the blood samples, you have to take about 5 milliliters first and discard that because it has Heparin flush solution in it. So every time a patient had their blood drawn, we were throwing away 5 milliliters, and then we were taking 5 or 10 milliliters for the blood tests. And so you start adding that up, no wonder we had to transfuse patients, because we were, you know, phlebotomizing them. So the nurses asked the question, “Well, could we withdraw the discard but then reinfuse it instead of throwing it way?” So we thought we could do that because we could put a stopcock on and we could just draw it out and then do the thing and push it back. And I said, “Not so fast. We need to study this, because what if we have contamination of the blood? Or what if during the time that the blood is sitting in the syringe, you get clots?” So we talked to the Infectious Disease folks, and they didn’t think as long as it was a closed system there was a high risk of contamination, but there was a great potential for developing blood clots. So we devised an experiment where we studied discard blood for the presence of clots, and we worked with a physician, hematologist, in the lab. And it was great because the nurses actually learned that routinely reinfusing discard blood is not a good practice, because there was a substantial percentage of patients whose blood would develop some amount of clotting, so you would be pushing that clot back into the patient. But that was great fun, too, because, I mean, that had a little bit of a laboratory component because we would have to take the blood and immediately put it through a filter to see if there were any clots in there. So that was great. They got that published too. So we just had great fun. And the nurses felt very strongly that they were influencing practice using science.
Tacey Ann Rosolowski, PhD:
Yeah. I mean, they’re taking all of the things observed at the bedside but then turning it into evidence with proof. Very, very neat.
Barbara Summers, PhD:
And then I was also very fortunate because I was a member of the Institutional Review Board, the IRB, at the National Cancer Institute, and, you know, that was like the Who’s Who in cancer research, who would come and submit their protocols for review by the IRB. And so I learned more about research, about clinical research, serving as a member of the IRB than I learned about research in my doctoral program, because your doctoral program teaches you the tenets of conducting research, but not clinical research, not clinical trials. So I just viewed that as a really great opportunity to learn more about clinical research, but I also learned about the way that scientists should comport themselves. When you have to appear before an IRB, you don’t go in there with guns blazing; you go in there with a sense of humility and appreciation for the feedback you’re going to get from the IRB, not defensiveness, etc.
Tacey Ann Rosolowski, PhD:
It sounds like you learned a lot through negative example there. (laughs)
Barbara Summers, PhD:
You know, I did, but I also learned by looking at some people who were very famous in cancer research and who could be quite flamboyant when they were not in front of the IRB, but they would come into the IRB, they were like little puppies, they were so well behaved. I was shocked it was the same person.
Tacey Ann Rosolowski, PhD:
And do you think it was genuine?
Barbara Summers, PhD:
I think it was learned behavior, that they knew that if they went in and they behaved badly, that they would be punished and their protocol wouldn’t be approved, so, you know. (laughs)
Tacey Ann Rosolowski, PhD:
Right. Just learning to play the game.
Barbara Summers, PhD:
It was a conditioned response.
Tacey Ann Rosolowski, PhD:
Right, right. Interesting.
Barbara Summers, PhD:
But I learned it’s possible not to get defensive when people are asking you questions or giving you feedback. It’s just that they don’t understand your perspective. And so, number one, you should accept the feedback for what it is, which is feedback, and, number two, respond thoughtfully and with appreciation. And they may not be correct, but they’re not trying to play gotcha. So that was great.
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 10: The NIH and an Opportunity to Support Research Nurses" (2014). Interview Chapters. 1247.
https://openworks.mdanderson.org/mchv_interviewchapters/1247
Conditions Governing Access
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