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https://infirmiere-canadienne.com/blogs/ic-contenu/2015/10/05/le-cote-pratique-de-la-recherche

The top people at three leading research groups talk about the uniqueness and importance of the research nurses are conducting and provide insight into how to build capacity, increase visibility and use research in everyday clinical practice

Oct 05, 2015

Nancy Edwards, RN, PhD, FCAHS
Scientific Director
Institute of Population and Public Health
Canadian Institutes of Health Research (CIHR)

Caroline Porr, BScN, RN, MN, PhD
President
Canadian Association for Nursing Research (CANR)
(with contributions from past president Caroline Park, PhD, M.Ed., RN, and past president Joanne Profetto-McGrath, PhD, RN)

Christine Rieck Buckley, RN, M.Sc.
Executive Director
Canadian Nurses Foundation (CNF)

What types of research do nurses usually focus on doing? How do they differ from other types of health research?

Edwards: Nurses tackle a wide range of research questions, with their nursing practice and policy perspectives influencing the types of questions they pose. Clinical research questions address clinical practices (e.g., what feeding, bathing and evening care practices would improve sleep and reduce agitation among long-term care residents living with dementia?). Health system research questions concern the organization of care and service delivery (e.g., do integrated care teams with nurse-initiated referrals improve timely access to home care and improve quality of life for patients living with chronic disease and for their caregivers?). Public health research tackles underlying determinants of health and interventions (both in health and in other sectors) that improve the health of populations (e.g., does the provision of adequate, low-cost housing reduce hospital readmission rates among those living with mental illness?). Much of the research undertaken involves interdisciplinary teams that bring the array of skills and experiences needed for challenging problems.

CANR: Nurses focus on research in all areas of health and illness care. They also conduct research to better prepare nursing students to meet the challenges of today’s complex health-care practice environments. Nurse researchers may also be addressing issues common to administration and leadership. Research done by nurses does not differ in methodologies from research done by other health professionals, but nurse researchers bring a nursing perspective, such as holistic, patient-centred care, to the many interdisciplinary health research teams. They focus on the voice and perspectives of patients, families and communities.

Rieck Buckley: Nurses focus their research on quality patient care and health outcomes including preventing the progression of disease, improving the patient experience and helping people manage better in their home communities — all critical for safe and quality health care. The focus is on health rather than illness and extends beyond the patient to the family and the communities in which they live.

Why is the research nurses conduct important to the profession and the average bedside nurse?

Edwards: Research is a critical means of advancing the quality of nursing care we provide for patients, whether in hospitals or communities. We are all potential users of research; nurses, patients, their families and caregivers, and society are beneficiaries. In all areas of nursing practice, research has shaped and shifted improvements in care and health outcomes. Illustrative examples include the treatment of pressure ulcers, the use of decision aids, counselling practices, neonatal care and access to health services for vulnerable populations.

Research needs to be critically appraised, contextualized and translated into practice. All health professionals may do this by keeping abreast of published research on topics of interest to them. Journal clubs, seminars and conferences provide a means to contribute and learn from others. Clinical practice guidelines involve systematic approaches to assemble the research evidence on specific practice issues. Systematic reviews provide a quality ascertainment of primary studies and conclusions reflecting the strength of evidence for the question of interest. The Cochrane and Campbell Collaborations regularly publish new reviews of interest to health-care providers. The Joanna Briggs Institute focuses on reviews pertinent to nursing. HealthEvidence.org provides an excellent source of systematic reviews, particularly in the area of health promotion and community health.

Nurses whose primary work is clinical practice may have opportunities to engage in research projects, providing a rich opportunity to inform the research and to consider the implications of research findings for their practice and those of their peers. Nurses may also facilitate the engagement of patients and caregivers in research. Citizen engagement strategies, such as those developed by CIHR, outline a myriad of ways in which clients and caregivers may contribute to research and improve its potential impact.

CANR: Given nursing’s unique role and responsibilities, there are facets of nursing work that benefit from uniquely nursing research. Nursing practice is evidence-informed so nurse researchers must uncover the best and most up-to-date ways for nurses to intervene to promote health and well-being. Moreover, with the focus on multidisciplinary teams within the health-care system, there is an increased need to explore the best ways to prepare all nurses with the interpersonal and management skills and knowledge to function well on teams.

Rieck Buckley: Their expertise and care reaches into homes, shelters and care facilities, as well as urban and rural/remote settings. They provide 24/7 oversight in tertiary and long-term care and, as part of health teams, they are instrumental in understanding and providing for the needs of people across the full continuum of care — in areas of health promotion; disease prevention; and acute, chronic, long-term and palliative care. Their capacity for inquiry and their expert insights into understanding and introducing improved approaches to care is critical to cost-effective, quality care. For example, a master’s award recipient is studying critical care nursing resilience in adverse working environments to develop a theoretical framework to help nurses thrive in their workplaces and cope in stressful work environments.

How do nurses build research capacity?

Edwards: Building capacity to both do research and use research is required for a robust system of knowledge production and to be able to use that informs improvements in nursing care. Building research capacity continues throughout one’s career. Nurses should consider their continuing learning objectives in relation to research, taking advantage of both formal and informal learning approaches. Nurses study the fundamentals of research in undergraduate programs as they learn how to review and interpret research. Some nurses choose to further their research skills in graduate programs. Building one’s research skills can include reading journals, contributing to the development and implementation of practice guidelines, using online resources, participating in peer review and getting involved in research projects. Professional journals can play an important role in communicating research findings to nurses and raising practice and policy concerns that need to be addressed through research.

CANR: Building capacity begins at the baccalaureate level where students complete courses relevant to nursing research. Summer studentship, research assistant opportunities and various programs further engage nursing students in research. With more nurses obtaining master’s degrees and PhDs, capacity is increasing. Graduate-level research-intensive nursing programs are contributing to building capacity. So too are research funding agenies’ calls for research synthesis grant applications that stipulate collaboration with patients, communities and other knowledge users such as front-line nurses. Funding through CIHR, CNF and other bodies assists nurses in building capacity.

Do funding agencies put different values on the type of research nurses do, compared with other types of health research?

Edwards: Funding agencies outline similar criteria to assess research proposals. A call for applications usually includes evaluation criteria used to assess the quality of proposals. As is the case for all professional disciplines, any nurse submitting a grant application as a principal investigator needs to convince peer reviewers that the research issue is relevant, the team has the necessary skills and experience to undertake the research, and the methods proposed are sound. Researchers submitting applications to CIHR may propose qualitative, quantitative or mixed methods. The proposed research methods need to match the research question(s). The funding agency will identify peer reviewers who have the necessary expertise (methods and content) to review grant proposals.

CANR: It depends upon the agency and its mission. Obviously, CNF funds nurses exclusively.

Rieck Buckley: CNF funds clinical nurse research that builds research capacity and improves patient care and outcomes. We work to enhance knowledge and research capacity; to support evidence-informed policy; and to support the development and dissemination of methods that influence best practice to improve health care. Grant applications must reflect that research is practice-based and has broadly applicable new knowledge. A dissemination plan that will reach practising nurses and research team members who are in a position to influence clinical practice are also important. Through its funding of master’s and PhD scholarships, CNF is able to support nursing research on an ongoing basis. This year alone, CNF was able to support 30 nurses in their pursuit of advanced education or research, totalling nearly $250,000. In addition, CNF partners with other organizations to provide single and multi-year funding grants to nurses studying a broad range of health issues from seniors care to adolescents living with mental illness.

What can be done to make nursing research more visible?

CANR: Nurses disseminate their research findings in a variety of ways, such as publications in peer-reviewed journals, textbooks and conferences. Nurses are members of numerous organizations, boards and committees at the local, provincial, national and international levels and, through these roles, they share research evidence to inform these particular groups. Through these venues and their daily practice, nurses need to continue to advocate for evidence-informed practice and to work with a variety of stakeholders, including governments, to share research findings that inform policy.

Rieck Buckley: CNF encourages nurse researchers to collaborate with community organizations, hospitals and allied health organizations to increase awareness of nursing’s contributions to health care. Nurses linking with decision-makers and policy-makers facilitates the visibility and usability of research.

What needs to be done to ensure research findings are used in practice?

CANR: Implementation science has been part of research curricula, with graduate students exploring how best to improve knowledge utilization — the uptake of research findings in practice. The purpose of CANR is to foster research-based nursing practice and practice-based nursing research.

Rieck Buckley: CNF supports world-class Canadian health care through the advancement of knowledge and research-informed innovative practices to support quality patient care and health outcomes. Through strategic partnerships, as illustrated by one of CNF’s PhD awards, an examination of gaps in the quality of care for cancer patients with local, national and international health leaders was launched. Discussions included the role of nurses in promoting health equity and the opportunities and challenges they face. Findings were integrated into the strategic plan of the Canadian Association of Nurses in Oncology. Developing and scaling up cost-effective, quality practice solutions through collaborative partnerships and community-based approaches will improve access to care and quality of health outcomes for all Canadians and their communities.