By Matthew Cyr
Martha Curley, RN, PhD, FAAN
A nurse researcher on in the Medical/Surgical ICU
How did you end up as a nurse researcher?
When I was a staff nurse and a clinical nurse specialist, I was
constantly challenged with what was the best way to provide nursing
care. I felt it was important to get a PhD in nursing research in
order to systematically answer those questions.
But if someone told me when I started nursing 30 years ago that
I would have my PhD and would be a nursing scientist at Children’s,
I would have said you’re totally out of your mind because
that wasn’t in the cards for me at all. The only reason I
went into nursing was because my father told me I couldn’t
marry my husband unless I made something of myself, and I could
finish a nursing program in three years rather than go to a university
for four. We got married a week after I graduated from nursing school
and we’re still together 30 years later. All I wanted to do
was get married, but my father wanted me to be self-sufficient.
It was good advice.
How do you go from helping individual patients to asking
questions that affect all patients?
Once you become proficient in bedside patient care you realize that
there are parents around and they need as much help from nursing
as the patients. They come to the intensive care unit and it’s
a strange environment and a strange experience to see their child
critically ill. The nurse is the singular person with those parents
eight or 12 hours a day who can help them understand what they’re
feeling and show them how best to help their child. As nurses we
help them succeed as “good” parents in that situation.
We may not be able to influence the outcome of every child who comes
here, but we can influence how a family experiences their child’s
illness.
Early on, I developed the Nursing Mutual Care Participation Model
of Care, and one of my initial studies was how nurses work with
families on how to parent a critically ill child. We found that
the care model significantly reduced parent stress in regard to
the intensive care environment. And once we started showing that
nursing intervention makes a huge difference to parents, I got hooked
on how to take care of patients better.
How does your research differ from that of physician
researchers?
The science of nursing is separate from other disciplines. The American
Nurse Association talks about nursing practice as caring relationships
that facilitate healing, so we look at both the subjective and objective
experience of illness. For example, we look at what it’s like
to be the parent of a sick child, but also study how to position
patients with acute respiratory failure so they heal the best. The
best outcomes happen when you have the best medicine, surgery, radiology,
nursing, physical therapy and social work.
What does your current research focus on?
Right now I’m doing a multi-site research study on the effect
of prone positioning in patients with acute lung injury. Many patients
come into the ICU in respiratory failure, and by tradition nurses
have cared for them in the supine position, which is on their backs.
We did a phase one trial and found that about 80 percent of children
had an improved level of oxygenation when placed on their stomachs.
We then asked whether that level of oxygenation improves the clinical
outcome. Is it worth turning someone who is heavily instrumented
on their stomachs for 20 hours a day? To find out I’m enrolling
180 patients in more than 12 sites around the country to determine
whether the clinical outcomes are better when treating children
in the prone position.
In this kind of work, one thing feeds into another. When patients
are kept prone for 20 hours a day they are more likely to get pressure
ulcers. So in order to learn how to best prevent those, I worked
with my colleague Sandy Quigley to predict, manage and prevent them.
On top of all that, in order to assure patient comfort we had to
consistently evaluate and manage their sedation, so we developed
the nurse-implemented sedation algorithm. You ask one question and
it gets bigger.
Do you miss direct patient care?
There’s still a lot of the clinical nurse specialist in me,
and for me being a researcher has everything to do with being a
nurse. Most doctorally prepared nurses work in an academic setting
and don’t have the clinical connection that I do. My office
is here on the ICU and I wouldn’t give that up for anything.
I can walk out of my office, touch a human life, then walk back
in here and crunch the numbers.
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To support
nursing at Children’s, contact Cindy Zilch in the Children’s
Hospital Trust at (617) 355-2416 or cindy.zilch@chtrust.org.
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