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Enabling the Best Possible Care: Q&A with Elizabeth Froh, PhD, RN
Editor’s Note: With the World Health Organization (WHO)’s designation of 2020 as “Year of the Nurse and the Midwife,” we are taking this special opportunity to recognize the community of nurse scientists at Children’s Hospital of Philadelphia. Throughout the year, we will feature nurse researchers in a series of Q&As that touch on everything from their research projects to the unique perspective of nurse scientists. This Q&A with Elizabeth Froh, PhD, RN, nurse scientist in the Center for Pediatric Nursing Research and Evidence-Based Practice at CHOP, is the third in the series. We are proud to share the valuable work and wisdom of our CHOP nurse scientists!
When did you start to integrate research into your career as a nurse, and why?
In my first nursing role as a clinical nurse in Georgetown University Hospital’s neonatal intensive care unit (NICU), I had truly wonderful preceptors, mentors, and multi-professional colleagues. My clinical questions were welcomed, and following the completion of my orientation, I joined our unit’s research and evidence-based practice committee. My first experience in clinical research was a quasi-experimental study in which we evaluated two different methods for securing nasogastric or orogastric feeding tubes in the neonatal intensive care unit population.
How long have you been at CHOP?
I just passed my 12th anniversary. I came to CHOP in August of 2008 as a clinical nurse in the neonatal/infant intensive care unit (N/IICU). In 2013, I was hired into a newly created position as the clinical supervisor for the Lactation Program and Human Milk Management Center. And in January of 2018, I transitioned to a full-time nurse scientist role with the Center for Pediatric Nursing Research & Evidence-Based Practice.
Why did you choose neonatal intensive care and human milk and breastfeeding as your areas of focus?
Through my work on the nasogastric/orogastric feeding tube securement study, I became extremely interested in enteral feeding among infants with congenital diaphragmatic hernia and other surgical anomalies. When I searched the literature, I found the work of Diane Spatz, PhD, RN-BC, FAAN, and the teams at CHOP and the University of Pennsylvania.
Serendipitous timing of a graduate open house at the University of Pennsylvania School of Nursing gave me the opportunity to meet Dr. Spatz in person, and I asked her my question: Among infants with congenital diaphragmatic hernia, do we know if breastfeeding and the provision of human milk has implications for both short and long-term health outcomes? And I’m laughing now because I truly thought I would return to Georgetown University Hospital with an evidence-based answer — but rather, this one question became the driver of my program of research.
Has clinical practice, or your clinical experience, influenced your nursing research, and vice versa?
Absolutely. For me, it was my unanswered questions as a new-to-practice nurse that inspired me to pursue my doctorate. Before I applied to the MS/PhD Program at the University of Pennsylvania School of Nursing, I worked full time in CHOP’s N/IICU on the surgical team so that I could learn more about the care of these vulnerable infants and their families. And throughout my graduate studies, I remained a per diem nurse in the N/IICU. My bedside nursing practice was essential to the development of my program of research and was an integral element in understanding how to best translate my research into practice.
What excites you the most about being a nurse scientist?
My excitement is, and always has been, grounded in enabling, through research, the best care possible for our patients.
Tell me about some of your current research projects, or research that you’re eager to work on?
At the moment, I have a few studies running, but I can share a bit about a qualitative research study that is currently underway. We have known for many years that the challenges of physical and emotional separation of new mothers from their infants has consequences on maternal milk supply and breastfeeding. Here at CHOP, we are very fortunate to have cameras at all of the bedsides in our N/IICU that allow families to “look in” on their infants when they are not able to be physically present.
We wanted to know, what are the implications of that virtual connectivity to a person’s lactation experiences? But first, we need to understand if there is even a relationship — we need to describe the experiences of new lactating mothers who use this technology as an element of their lactation journey. I am partnering with my colleagues to interview our CHOP N/IICU mothers as a first step in exploring this line of inquiry.
Why do you think the unique perspective of nurse scientists is so integral to pediatrics and pediatric research? What unique approach do nurse scientists bring?
In nursing, we are trained to understand how our practice impacts not only the immediate disease process, but the entirety of the person. In pediatrics, this conceptualization of the person always includes the family. So, a nurse scientist is perfectly positioned to see that whole picture and to research areas that have yet to be described and understood.
In my case as a new graduate nurse, we would reach the point in care when the infant was ready for enteral feeding, but in some cases, as it was weeks after the birth, the mothers would not have an adequate milk supply. So in that instance, all members of the healthcare team have done everything possible to provide the best care for the infant, our patient, but we couldn’t offer the known best form of enteral nutrition: maternal milk. This is of course a simplified version of the story, but I think it illustrates the challenges we face in the care of pediatric patients. With those challenges, again, come great opportunities.
What’s in store for you in terms of future research? What do you hope to accomplish?
Here at CHOP, I have seen the great benefits of what happens when we drive our nursing practice grounded in research, particularly the research of our team of nurse scientists. I know that my teams and I will continue to pursue these clinical unknowns in human milk science and the implications among our most vulnerable infant populations.
Almost daily we hear the experiences of not just clinicians, but families, across the country who are facing numerous challenges in the provision of human milk in the hospital setting. But what we have found through our research is that many of these obstacles can be overcome if clinicians, not just nurses, are educated and empowered to provide evidence-based lactation care and support from the prenatal period through discharge.
I hope in the future that our work will grow, and we will continue to prioritize our efforts in advocacy, access, and policy. We have generations of human milk science, but in their study designs, researchers purposely excluded any mother-infant dyads if the infant had a congenital anomaly. So, we are really still in the emerging phases of understanding the context and implications of human lactation and outcomes among critically ill infants. It is my hope that in building out this program of research, we can give voice and representation to these families and provide the evidence needed to best support their nutrition and health.