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Pioneering ‘Wet’ Lab Sets Research
Agenda for Nurses
Critical Care Laboratory will allow training, research and testing of new protocols
before bedside clinical trials
A $500,000 grant will enable The University of Texas School of Nursing at Houston to establish a first-ofits- kind “wet” lab, which is expected to attract top researchers and graduate students to revolutionize critical care nursing education.
Sandra K. Hanneman, Ph.D.,
director of the Center for Nursing
Research at the UT School of
Nursing at Houston, conceived
of the Pre-clinical Critical
Care Laboratory to test research
ideas before taking them to the
ICU.
Photo by Marc Morrison
Funded by The University of Texas System through its Enrich Nursing Through Exceptional Recruitment (ENTER) program, the innovative new Pre-clinical Critical Care Laboratory (PCCL) will complement the School of Nursing’s current research laboratories.
Scheduled to open in Spring 2007, the new lab will prepare nursing students at all levels with superior assessment skills and an understanding of the range of patient responses to illness, injury and treatment. The lab will not only facilitate basic and translational research, but will also make it possible to test new protocols prior to bedside clinical trials and to train interdisciplinary teams in advanced clinical care.
One of the first items on the new laboratory’s research agenda will be to examine and research some of the current protocols being used in intensive care units (ICUs).
Since 1996, Sandra K. Hanneman, Ph.D., the Jerold B. Katz Distinguished Professor for Nursing Research and director of the Center for Nursing Research at the UT School of Nursing, has researched ICU patients and methods for removing them from respirators more rapidly in an effort to decrease morbidity, mortality and costs.
“In doing that research, I had looked at what other researchers had found and realized, in the past 30 years, little progress had been made,” Hanneman said, “so the next question had to be, ‘What were we missing?’”
ICU and Circadian Rhythms
One factor – circadian rhythms – posed one of the larger unknowns. Circadian rhythms – first identified in the 1700s – are driven by an internal biological clock in every organism. The clock runs on an approximate 24-hour cycle, depending on environmental cues, such as light and dark. The study of circadian rhythms is called chronobiology.
Searching the literature, Hanneman traced early chronobiological research to the 1960s, when British researchers took away normal social/behavioral and environmental cues, including light and dark cycles, and studied subjects in caves. Without routine schedules, researchers learned, while the biological clock continued to tick without cues, the circadian rhythms became longer and longer.
“It’s possible the ICU environment could cause biological clock drifts in patients,” Hanneman said, “and when the clock drifts, things start to fall apart. So, if you’ve been exposed to a virus and your circadian rhythms are abnormal, you may be more apt to get sick.”
That concept led her to consider this: If the ICU environment could be controlled to the point that patients’ circadian rhythms were not disrupted, or minimally disrupted, it may be possible to get people off respirators faster. She also wanted to determine if the convergence of the ICU’s environmental factors and the patient’s illness could interrupt circadian rhythms and if the rhythms return over time in the ICU.
“That’s when it occurred to me that a pre-clinical model would have to be developed before we took the results to ICU patients,” Hanneman explained, “and that would require a lab where illness and environment could be controlled.”
In 1997, she applied to the National Institutes of Health to underwrite a feasibility study to see if an adult ICU model could be developed. Beginning her research in 1998 in borrowed facilities at Texas Heart Institute’s Cardiovascular Research Laboratory, Hanneman published three articles, two in Comparative Medicine, the leading English-language publication in the field of comparative and experimental medicine.
The feasibility study confirmed that circadian rhythms are obliterated when subjects are in ICU. “When we proceed with our research, we’ll test how we can get circadian rhythms to return. We hope to rewrite some textbooks, but we have a lot of work to do,” Hanneman said.
Turning ICU Patients
“We will also be doing pilot work with St. Luke’s Episcopal Hospital and The Methodist Hospital on turning patients in ICU,” Hanneman said. The standard of care since the 1960s has been to turn a patient every two hours to prevent pulmonary complications, promote circulation and prevent pressure ulcers.
“In the new lab, we will be testing the best protocol for turning patients, including the optimal time period between turns,” she continued, “with funding for that trial and a larger study in ICU patients. Once we test the new turning protocols in a controlled lab setting, we will refine the intervention before it is taken to the clinical environment.”
The new lab is being built in the School of Nursing and Student Community Center and will house an operating room, a procedure room, a two-bed ICU and a pathology suite, as well as a nurse’s station, shower and small lounge. Because the new lab will replicate protocols, supplies and equipment in the clinical setting, the PCCL provides a superior training and research model in which students can practice assessment, treatment and prevention skills without risk to patient safety.
To run the model will cost $1 million a year and will include a full ICU staff of nurses, surgeons, biomedical engineers, physicists, clinical pharmacists, pathologists and veterinarians.
Another purpose for the new lab is a collaborative effort in the Texas Medical Center among Magnet Hospitals (hospitals judged by the American Nurses Association Credentialing Center to have strong and excellent nursing care) to send teams to develop patient care protocols and test them in the pre-clinical ICU before using these protocols in the clinical ICU.
Besides maximizing the learning experience, training across disciplines and translation of research to practice, this lab setting – which Hanneman calls “the first of its kind” – will draw stellar academic and clinical personnel to Houston.
“It will require a lot of hard work and resources, but the yield from this lab will definitely be high,” Hanneman said. “Ultimately, the new lab reflects UT’s research legacy, which is rooted in unique areas and methods of inquiry.”
The UT System started the ENTER program in October 2005 to address the continuing shortage of nurses in the state by funding infrastructure projects that might attract more students to apply for nursing education.
By Alice Adams