FEBRUARY 2010 • ON THE JOB

“Undergraduates need to be passionate about critical inquiry,” says Barbara Paterson, a Canadian Institutes of Health Research Tier 1 Canada Research Chair and a professor and director of the University of New Brunswick Chronic Illness Research Institute. “That means making sense of the research that’s out there so that they know what is relevant to their practice.”

Research is a requirement in most nursing programs, says Paterson. Usually, it’s taught by giving students all the different research designs, giving them a research utilization model to use and having them critique research reports. “When I teach it,” she says, “we don’t talk about design until the course is two-thirds over. We talk about why it is that nurses don’t embrace research. Then I introduce all kinds of people and experiences that help them to understand that appreciating and using research is critical to good nursing.”

Unfortunately, she says, research studies are often presented using language that is unclear and confusing, especially for those who don’t have time to sit down and decipher it. “We often don’t write our research in ways that are really engaging or accessible,” says Paterson. “We forget that nurses have to do things on the fly.”

Theresa Hurd, a nurse educator in Toronto and an advanced practice nurse specializing in wound care, agrees that the way research results are communicated can sometimes keep nurses from applying them on the job. But in wound care in particular, she says, it isn’t just that the information isn’t easily accessible; many nurses got little or no exposure to statistics or to nursing research when they were in school. “In the wound care world, the majority of nurses are not applying numbers and evidence,” she says. “And the younger nurses are so swamped with what they have to do that when you throw research and statistics at them they are completely overwhelmed.”

Hurd says that wound care is driven by protocols, so the notion of “best practice” isn’t as relevant as it is in other specialties. Nonetheless, a practical gap exists. “Nurses know what best practice means, but they don’t know what the best practice is,” explains Hurd. “They haven’t integrated it into their day-to-day work.”

She adds that nurses are not necessarily motivated to do things in a new way. “That’s hard for anyone, not just nurses” says Hurd. “In health-care education today, when we ask people to do something differently —think differently, analyze differently or make decisions differently — they have to be able to demonstrate a competency in the actual practice.”
Standing at the front of the class and just lecturing isn’t enough, says Hurd. “If research is nothing but numbers and statistics, students won’t do anything with them. It doesn’t help that we’re teaching them far from the bedside where they could actually integrate the theoretical knowledge into practice.” With nurses becoming more educated and as their clinical scope of practice increases, they are doing more, but “to really understand research, they have to ask themselves, ‘what’s practical for me?’ That takes thinking.”

Paterson says many undergrads are unaware of the research that’s going on across the country and believe that researchers would not be good at the bedside. “When I tell them I looked after patients before I took the research chair position, they are floored,” she says. Researchers are partly to blame. “We sometimes don’t do the best job of showing that the questions we explore come very much from our being nurses,” she says. “I ask very different questions about diabetes, for example, than would, say, a physician or a sociologist. Research has to be relevant to my practice as a nurse.” Paterson prefers to refer to research as “critical inquiry” and reminds students that the critical thinking skills they used to evaluate and choose an academic program are similar to those they will use to decide whether research evidence is credible.

She invites researchers to come in and talk to her undergrads. An aboriginal nurse, who as an undergrad, disliked research, tells students how she became involved in one of Paterson’s community-based projects and saw how research made a real difference to her community. That kind of enthusiasm rubs off. “She convinces them in ways that I wouldn’t be able to,” says Paterson.

Students get to meet and interview an academic or clinical-based researcher, look at the researcher’s proposals that received funding (or not), and present a professional poster about the researcher to the class. “This ‘adopt the researcher’ assignment has been so successful,” says Paterson. “It’s fun for students to explore different projects and to see the impact they have made on policy and in practice. They become great public relations people for nursing research after that experience.”

Paterson likes to walk students through her current research project: developing an online support intervention for parents of adolescents with diabetes. She explains that she discovered the need for such an intervention in talking to a colleague who had a teenage daughter with the disease. She talked to other parents, who agreed there is a great need for support. Then she wrote a proposal with several colleagues, and they received funding. “My great love is nursing,” Paterson says. “Students are often surprised by that. They think that researchers are boring and only interested in studying things and getting grants. I show them that research makes a difference.”