Nurses are trained to give patients the best care possible. Sometimes that means saying "no." Sometimes it means taking the initiative to find out if the answer could be "yes."

"The greatest complaint that nurses hear from patients after heart surgery is that they are thirsty," said Nancy Hutchison, RN, CCRN, MS, staff nurse at St. Joseph's Hospital in Atlanta.

Barry Williams/Special (ENLARGE)

Nancy Hutchison is one of eight nurses at St. Joseph's Hospital who conducted research about the benefits of giving more fluids to patients after surgery.

That's not surprising. Before surgery, patients are given a drug to dry up their saliva. They aren't dehydrated after surgery, but their mouths are very dry.

The complaint is so common that nurses had joked about making a loudspeaker recording to play every 15 minutes for patients recovering from open-heart surgery. It would say, "No, you can't have any more fluids."

A recording is no longer necessary. Not finding any published data on the subject, a team of nurses at St. Joseph's decided to conduct a research study to address the issue. Because of the results, the hospital's cardiac patients can now safely receive up to four times more fluids after surgery.

Because of the risk of vomiting, the practice had been to give patients 30 cc's of ice chips after extubation and then to advance their diet as they can tolerate it.

"If we overload the patient's digestive track before it is ready, then the patient can vomit, and that puts a lot of pressure on the fresh incision," said Hutchison. "In the worst-case scenario, the coronary bypass grafts to the heart can detach, causing excessive bleeding, leading to tamponade [a buildup of blood around the heart], which can lead to cardiac arrest."

"For nurses, the protocol was a huge safety issue, but to patients the thirst was a big comfort issue," Hutchison said. "You ask any cardiovascular nurse about what they hear from patients post-op, and it's 'I'm thirsty.' We hear more complaints about that than we do pain."

Because loudspeaker recordings would not meet St. Joseph's standards of nursing care — or solve the problem — and because no published data could be found on the subject, a team of heart nurses at St. Joseph's decided to do some bedside research.

Hutchison and seven other nurses — Megan Brunson, Ann Marie Madden, Joyce Crook, Fang Fang Jiang, Rebecca Reese, Tina Taylor and Cheryl Bittel — established stringent criteria and proposed the study to the hospital's Nursing Research Council. It took nine months for the internal review board to approve the study.

The nurses gave four groups of randomly selected patients who met the study's criteria either 30 cc's of ice chips, 120 cc's of ice water, 120 cc's of room-temperature water or 120 cc's of Sprite Zero after surgery.

"We do approximately 1,500 heart surgeries (per year) at St. Joseph's, but it took us a long time to collect the data, because the patients had to be stable and not have other issues," Hutchison said. "It had to be a straightforward surgery, and the patients couldn't be on any assist devices afterward. There could be no reason that we couldn't give them fluids."

It took six months to collect the data, which then had to be sent off for statistical analysis.

"This was real bedside research and a huge team effort," Hutchison said. "There was no grant money and no secretarial assistance. Megan Brunson took on that role."

The nurses collected and wrote pages of data on vital signs, blood-glucose levels, types of anesthesia and postoperative narcotics, often on their own time. Hutchison said that the group got good advice about organizing the study from Diana Meeks-Sjostrom, director of the Center for Nursing Excellence at St. Joseph's.

"One way nurses develop standards of care is through research undertaken at the bedside," said Meeks-Sjostrom, Ph.D., RN, MSN. "The results of this study showed that oral hydration had no measurable effect on nausea or vomiting but did positively affect the patient's comfort and satisfaction. Those are important findings for our nurses and help them provide the most compassionate care."

The results of the study prompted nurses at St. Joseph's to change their postsugery hydration practices in July.

"This issue is important to what staff nurses do every day, and it's extremely gratifying to have collected the data, analyzed it and know that we are able to give patients more fluid," Hutchison said.

Hutchison received first place for her presentation at the Toolbox for Bedside Research Nursing Conference — sponsored by Emory Healthcare, WellStar Health System and St. Joseph's Hospital — in the fall.

"We're hoping to present it to the National Teaching Institute in May," Hutchison said. "It's a small study but addresses a common post-op issue . . . so this helps both patients and nurses."