Undertaking research in the Clinical setting: reflections from Downunder

 

In March, this year I was excited because two projects that I had put years of work into were coming to fruition. The projects had much in common: theclinicians clinical problem was delirium; were being undertaken in hospitals; and were a partnership between academics and clinicians. My clinical partners were senior nursing staff who I had spent years developing a relationship with and were very invested in reducing delirium in their respective hospitals. Project planning had considered the demands of undertaking research in the clinical setting, yet we still underestimated the speed humps that would slow us down.
In Australia undertaking research in their clinical setting is an expectation of advanced practice nurses and midwives. This research ranges from undertaking and disseminating local projects to initiating and coordinating larger multi-site projects. Completing projects can be difficult given common barriers including inadequate research skills, lack of management and executive support, and most commonly time and money. Partnering with academics can help to overcome some of these, with the academic nurses and midwives bringing their skills to the table, while the advanced practice nurses and midwives provide the clinical expertise and credibility.
I had worked in a senior state-wide role before I became an academic. In this role I was asking senior nurses from multiple speciality units to undertake work that benefitted the whole of the State, not just one specialist unit or local health district. I learnt some hard lessons in this role, and I have some advice for academic nurses who are seeking to undertake research in the clinical setting.

  • Ensure you develop a true partnership with these nurses. Senior nurses have a full roster of commitments and are frequently called upon to step into other duties with little warning. Your relationship will be enhanced when you clearly show you understand this. They will be more likely to persist with the research work where their expertise and contributions are highly valued.
  • Establish effective communication channels so you can provide advice and moral support. Sometimes your partners may need to simple debrief and reassure themselves that you understand their situation.
  • Do not underestimate the need for line management support and executive sponsorship. It is vital that the full extent of the research work is understood and supported. This ensures these nurses have defined channels to use when problems arise. This is especially where senior management may need to step in. You also need to clearly demonstrate that your project has significant multiple benefits for the clinical setting. I found that simply reducing length of stay is not enough. Consider looking at key performance indicators for hospitals, especially quality and safety standards and accreditation processes.

Unfortunately project progress was protracted. Despite holding events around delirium, survey completion was sluggish. Roll up to education events was limited and audit completion was drawn out due to increasing patient acuity. However, this is not a story with an unhappy ending. My clinical partners persisted despite the challenges that sought to derail our careful planning. Practice audits were completed and interventions delivered. The response rate to the survey gradually climbed. The commitment of these nurses to improving the care of their patients is inspiring and makes me hopeful for the future.

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