Apr 01, 2014
By Agnes Black, RN, MPH , Lynda Balneaves, RN, PhD , Candy Garossino, RN, MSN

The Practice-based Research Challenge at Providence Health Care

Promoting evidence-informed practice, enhancing employee engagement and improving knowledge of research methods

Aggie Black
Teckles Photography Inc.Aggie Black debriefs with a Research Challenge team following a presentation.

Staff nurses at Providence Health Care (PHC) in Vancouver are engaging in a novel research initiative. In 2011, PHC, motivated by a desire to improve patient care through the promotion of evidence-informed practice, combined with a belief in the importance of staff nurses’ contribution to research, initiated the Practice-based Research Challenge. Developed in partnership with the University of British Columbia (UBC) school of nursing, the Research Challengehas involved 200 point-of-care nurses and other health-care professionals since 2011. Thirty-four research teams have been funded in the past three years; 16 were led by nurses. Eighteen groups, nine of which are led by nurses, are competing for funding in 2014.

Lack of organizational support to conduct research and insufficient time to implement new ideas are recognized as barriers to research utilization (Squires, Estabrooks, Gustavsson, & Wallin, 2011). The Practice-based Research Challenge (modelled on a similar program at Toronto’s University Health Network) is removing these barriers by engaging point-of-care nurses in the creation of new evidence and funding teams of health-care professionals to conduct small-scale research projects in their practice settings. The organizers of the initiative wanted to involve those who had previously had limited opportunity to conduct research and clinicians who did not have “conduct research” in their job descriptions.

PHC’s nursing research facilitator, one of six nursing research facilitators in British Columbia, brought together clinical and academic leaders to form an advisory committee to lead the Research Challenge, and she continues to act as its coordinator.

When the call went out for applications for the initial Research Challenge, 89 nurses and other health-care professionals responded. The teams, many of which were multidisciplinary in structure, were enthusiastic about the opportunity to learn about research and explore research questions that in some cases had been forming in the minds of practitioners for years.

THE PROCESS
The Research Challenge is promoted widely across PHC through newsletters and presentations and by word of mouth.

Team applicants submit a short letter of intent describing the question or issue they want to research. The advisory committee assesses submissions for feasibility and significance of the proposed project. At least one member of each team must be a point-of-care practitioner, defined as a clinician who maintains a clinical practice and is not in a purely managerial or educational role. The team leader must have been an employee of PHC for a minimum of one year.

All applicants attend a series of educational workshops, put on by the advisory committee, in which they review the process for conducting a literature search, are given an overview of research methods and discuss the design of an ethical research study. Teams are paired with experienced research mentors, generally either clinical nurse specialists or academics, who help them prepare the funding proposal. Criteria for funding decisions include significance of the proposed research to patient care improvements, coherence of the proposal and soundness of the research method chosen. Funding has been provided by a variety of sources, including PHC’s chief nursing officer and office of professional practice, the PHC Research Institute, the British Columbia Nurses’ Union and the UBC school of nursing. The awards from BCNU and the school of nursing are given to teams led by nurses.

Most of the proposals have been accepted. Once funding is awarded (in amounts ranging from $2,000 to $4,000), the teams have one year to conduct their projects. They are supported through the process of submitting an ethics application, hiring research assistants and finalizing their budget. When the projects are completed, teams are required to write a report on their findings and present at an interprofessional conference coordinated by PHC.

Knowledge translation is a key component of the Research Challenge. Teams are asked to prepare a KT plan as part of their proposal. The activities submitted to date include conference abstracts, grand rounds lectures, peer presentations and manuscript development.

LESSONS LEARNED
Informal conversations with nurse participants, their managers and their Research Challenge mentors indicate overwhelming support. Nurse participants are pleased with the improvements in their practice. Some have been inspired to enrol in graduate school or apply for additional grant funding from external agencies. We have received messages of appreciation from managers, noting that staff nurses are no longer intimidated by the idea of conducting research. Mentors have indicated that their involvement has helped increase awareness of practice issues for nurses at the point of care. These anecdotal reports are encouraging. The Research Challenge is also undergoing a rigorous mixed-methods evaluation. We are conducting surveys of participants at three points in the process (i.e., on acceptance, after the proposal is submitted, on completion of the project), focus groups for participants and semi-structured interviews with managers.

In the first three cohorts of the Research Challenge, several teams withdrew before funding decisions were announced, because of changes in employment and parental leaves. Other teams struggled to find sufficient time to develop the funding proposals. We have had difficulties securing appropriate mentors with the expertise and substantive knowledge needed to support teams. These challenges highlight the importance of research team building and cohesion, of ongoing commitment from clinical and community organizations, and of strong partnerships with academic institutions that can offer mentorship from faculty and advanced graduate students.

This initiative is raising the visibility of nurses as researchers and building excitement in the workplace. We believe that involving nurses in creating knowledge through research improves their ability to see the links between research evidence and excellence in clinical practice and strengthens academic-practice partnerships.

The structure of the Practice-based Research Challenge at PHC — providing support that begins at the idea stage and continues right through to knowledge translation — can be adapted for use in other health-care organizations seeking to enhance evidence-informed practice and engage point-of-care nurses in the creation and implementation of new evidence.

Reference

Squires, J. E., Estabrooks, C. A., Gustavsson, P., & Wallin, L. (2011). Individual determinants of research utilization by nurses: A systematic review update. Implementation Science, 6(1):1-20.


Examples of nurse-led projects that received funding in 2011

Practice changes resulting from project findings

Issues, barriers and themes associated with the implementation of the mild therapeutic hypothermia protocol

An order set developed by the team leader resulted in patients with cardiac arrest spending significantly less time awaiting the protocol in the St. Paul’s Hospital emergency department. The team leader is expanding this work and developing practice standards for hypothermia protocol initiation that will be shared across the province.

An exploratory study of the decision-making, reasons and motivation of older people with severe heart disease to be assessed for transcatheter aortic valve implantation

The findings have led to the modification of patient education resources on the treatment of severe aortic stenosis, informed nurses in supporting patients’ decision-making and consent, and prompted the integration of a palliative approach in the trajectory of care. The mentors for this team were awarded a CIHR Catalyst Grant to expand this research.

Evaluation of an intervention to enhance in-centre hemodialysis patients’ self-care abilities

The team designed a formal orientation for patients, then assessed its effectiveness by measuring self-care abilities before and after the intervention, using the validated Self-Care for Adults on Dialysis tool. Thirteen per cent of the patients moved on to more independent forms of dialysis. Patients are now more involved in day-to-day aspects of care. The team leader plans to expand this training to other areas in the renal program.

Agnes Black, RN, MPH, is the Nursing Research Facilitator for Providence Health Care and Vancouver Coastal Health.
Lynda Balneaves, RN, PhD, is an Associate Professor, UBC School of Nursing. She holds a CIHR New Investigator Award.
Candy Garossino, RN, MSN, is Director, Professional Practice and Nursing, Providence Health Care and a Member of the Research Challenge Advisory Committee.
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