2009 Distinguished Research Lecturer: Mary Jo Grap

Mary Jo Grap, PhD, RN, FAAN

2009 Distinguished Research Lecturer

Mary Jo Grap, RN, PhD, FAAN

Mary Jo Grap is a professor of nursing in the Adult Health and Nursing Systems department at Virginia Commonwealth University in Richmond, Virginia.

Her program of research is focused on optimizing pulmonary function in critically ill adults undergoing mechanically ventilation. Her studies have focused on airway management, prevention of ventilator-associated pneumonia (VAP) and recently on sedation evaluation during mechanical ventilation.

Her funded work — through the National Institutes of Health, the American Nurses Foundation and AACN — has consistently investigated clinical issues that have had a direct impact on nursing care of patients on mechanical ventilation.

Specifically, Dr. Grap's long history of research in mechanically ventilated patients includes studies examining nurses' suctioning practices, effects of suctioning procedures in lung injury on ventilation and oxygenation, the incidence of unplanned endotracheal extubation and the incidence of endotracheal tube narrowing in closed suction systems.

More recently her team has focused on reducing VAP through oral care interventions. They first described backrest elevation and oral care practices and frequency in a variety of ICU settings finding little consistency and few standards in either case.

In a National Institutes of Nursing Research (NINR) funded study (R15 NR04730), they found that subjects spent the majority of time at backrest elevations lower than the CDC recommendation (> 30 degrees), and although low backrest elevation was not directly related to VAP, the combination of early, low backrest elevation and increasing severity of illness did increase the incidence of VAP.

As a coinvestigator with Dr. Cindy Munro (PI, R01 NR07652), a 7-day oral care protocol to reduce VAP was tested and results showed that chlorhexidine significantly reduced the incidence of VAP, but no VAP reduction was found with tooth brushing.

Dr. Grap's team is presently testing a single peri-intubation oral care intervention to evaluate its effect on VAP (TSNRP MDA-905-03-1-TS02). In addition, because inappropriate levels of sedation may increase duration of mechanical ventilation, her team is evaluating sedation effects in mechanically ventilated patients to determine the ability of sedation to meet sedation goals of physiologic stability, ventilator dysynchrony and comfort.

This NINR-funded study (NR R01 NR009506) was developed on the basis of extensive pilot data (measurement of continuous physiologic data, actigraphy, processed electroencephalography) and will provide important information about sedation effectiveness in critically ill adults.

Dr. Grap participated in the development and testing of a sedation evaluation tool, the Richmond Agitation Sedation Scale, which has been used across the nation, and is considered to be the first of an improved, "second generation" sedation scale. In addition, her team was among the first to evaluate the use of actigraphy as a means to assess agitation in critically ill patients.

Dr. Grap has published more than 50 articles, including an AACN Practice Alert on Oral Care, and is a contributing author on pulse oximetry for AACN Protocols for Practice: Noninvasive Monitoring. She serves as the associate editor for the American Journal of Critical Care (AJCC), and has presented at more than 50 international, national and local conferences.

She has served as a research consultant and mentor for staff nurses, graduate students and faculty in a variety of intensive care settings to improve critical care nursing practice. She has been recognized for Excellence in Critical Care Nursing by the US Army Surgeon General for officers who have obtained national prominence in his or her field."

Her interdisciplinary research team includes respiratory therapists, physicians, biomedical engineers, basic scientists, physical therapists and developers of critical care equipment; the team has advanced the visibility and impact of critical care nursing research to a wide audience.

Kent University, Kent, Ohio; BSN, 1972; major: nursing
University of Colorado, Denver; MS, 1977; major: medical-surgical nursing
Georgia State University, Atlanta; PhD, 1986; major: higher education/educational administration

Please direct inquiries to: research@aacn.org