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Kathy Schell
School of Nursing

What are your general research interests?

I am primarily a clinical researcher. My research focuses on accuracy of blood pressure measurement and assessment of cardiovascular patients to promote patient safety and quality care. I also recently finished a study about postoperative care in the hospital setting. In addition, I have conducted studies focused on innovative teaching in higher education.

What are your current projects and how are they funded? Who are your collaborators on these projects?

In fall 2011, we completed a project assessing the effects of gum chewing on postoperative recovery after colorectal surgery. Funded by Christiana Care Health System Nurse Research Apprentice program, we compared bowel recovery time and length of hospital stay in post-operative bowel surgery patients who chew gum and those that do not. Subjects in the experimental group were asked to chew a piece of sugar-free gum for 30 minutes three times a day. Both groups were allowed ice chips and hard candy. Post-surgery progression of diet, time to first bowel gurgles (sounds), first passage of gas, and first bowel movement were not different between the two groups, and we found no statistically significant differences in length of stay in the hospital. We concluded that gum chewing is not an effective intervention in promoting post-operative bowel recovery of patients having elective bowel surgery. However, there were no obvious negative effects of gum chewing so, as long as the surgeon approves, patients can chew gum to increase their comfort after surgery. My collaborators were Elizabeth Haley (Christiana Hospital) and Julie Waterhouse (UD School of Nursing).

Kathy Schell, SON

In a second study, I am part of a team that is assessing the anatomical determinants of forearm–upper arm blood pressure differences. Funded by a University of Delaware Research Foundation grant, we are trying to find out why forearm (lower arm) blood pressures and upper arm blood pressures measured by an automatic blood pressure machine are different in some people but not others. We know there are differences, but the size of these differences is not predictable. We want blood pressure machines to be accurate regardless of where we put the blood pressure cuff, so we need to look at factors like size and depth of the vessel in that part of the arm, amount of fatty tissue, and shape and size of the waveforms to see if we can develop a better machine design. We also are comparing arm waveforms to waveforms in the aorta, the main vessel from the heart, to provide more insights into blood pressure measurement and cardiovascular risks. Data collection is ongoing in this project, which I am doing in collaboration with William Rose (UD Department of Kinesiology and Applied Physiology) and Dr. Michael Stillabower, Dr. William Hopkins, and Angela DiSabatino (Christiana Hospital Department of Cardiovascular Research).

In a project supported by Bayhealth Medical Center Department of Nursing, we are trying to find out the number of minor and major bleeding events in patients who have a heart attack or unstable angina (Chest pain) who receive blood thinners while in the hospital. Our goal is to determine whether nurses and doctors can detect minor bleeding before it becomes a major bleed, as major bleeding events require more treatment and increase length of hospital stay. We believe that the results of this study will help us to develop best practice for detecting and preventing bleeding. Data collection for this completed in January 2012,

In my fourth project, also supported by Bayhealth, we are evaluating the need for post-study nursing assessments and cardiovascular monitoring of patients undergoing coronary computed tomography angiography (CCTA). CCTA is an imaging test that can be used to detect early risk factors for heart disease and rule out heart attack. These tests can be done on outpatients who are then immediately sent home. Most patients undergoing CCTA are given medications that slow down the heart and dilate the vessels so a “good” picture can be taken. These medications can cause the heart rate and blood pressure to become too low and the patient to become dizzy or weak. Sending patients home right after the test may not be advisable, but currently there is a lack of research to suggest the length of time patients should be monitored and assessed. We are exploring the relationship between the medications and post-study symptoms or significant changes in vital signs. Data collection for this project—which is being done in collaboration with Bayhealth nurse Kim Ford, who is also a master’s student in our nurse practitioner program, was completed in February 2012.

Kathy Schell, SON

What are the likely “next steps” in your work?

The gum study needs to be published and presented in professional circles. The remaining studies have small sample size, so if findings lean toward statistical significance, our plan is to fine tune the data collection procedures and then consider conducting larger studies, possibly with multiple hospital sites. We will seek National Institute of Nursing Research and/or foundation grants to support this work.

How would you describe your work’s importance to an interested lay audience?

GI gum study: Although gum chewing did not change how fast the bowels recovered and/or time spent in the hospital, we determined that it is okay to chew gum after elective bowel surgery. But be certain to have your surgeon’s permission!

BP study: Appropriate assessment and treatment of patients is dependent on accurate blood pressure (BP) measurement. If BP is measured inaccurately, misdiagnosis and over- or under-treatment may result. We would like to help develop blood pressure machines that are more accurate.

Bleeding study: Detecting minor bleeding prior to a major bleed would facilitate earlier intervention and possible prevention of the major bleed. The results will help provide research support for existing bleeding precaution protocols used by nurses in the hospital. We are focused on patient safety.

CCTA post-assessment study: This study also promotes patient safety. We are trying to determine if there should be a standard amount of time during which patients are assessed following CCTA. If we detect prolonged side effects from drugs given during the test, we can prevent complications by monitoring patients more closely before sending them home. If, after conducting additional studies, we find no significant problems after the CCTA, we can save patient/nurse time and healthcare dollars by discharging patients and omitting unnecessary monitoring.

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