Starting a career in research nursing during a global pandemic.

In the spring of 2020, two nurses (KR and AJ) commenced their research nurse careers amid the SARS-Cov-2 (COVID-19) global pandemic. This reflective article discusses their experiences of beginning a clinical research nursing career, presented as a case study of their learning journey, rather than detailing the randomised controlled trial they delivered via GP practices. The main study compared standard care to nurse-led management of irritable bowel syndrome, the details of which will be published separately. The article identifies three overarching concepts: 'Green as grass, keen as mustard', 'Spires and steeples', and 'Down the rabbit hole'. The article offers insight from the two nurses for other professionals contemplating a career in research.

Development and Implementation of an Oncology Clinical Research Nursing Residency Program for Newly Licensed Nurses.

ABSTRACT: A paucity of nurses trained in clinical research prompted the development and implementation of a newly licensed nurse residency program in oncology research. The components of the program, funding, curriculum development, preceptor model, and partnerships, are described. Formal evaluation to quantify success in creating a pipeline for the future, increasing retention, and reducing costs is underway and will be reported in a future publication.

How clinical research nursing is shaping the future of urology trials.

Nursing research has been developing, particularly over the past 15 years. The role of the clinical research nurse (CRN) is vital because of nurses' high level of patient contact. They are therefore involved in the identification of suitable study participants, initial contacts, enrolment, monitoring and follow-up. The COVID-19 pandemic has emphasised the importance of research to government, the NHS and patients. In this article, the author describes three research studies in which she has taken part and emphasises the importance of research and the role of CRNs in bringing together nursing, medicine and science through the CRN's specialist knowledge and how this particular career choice in nursing is now gaining greater attention and momentum.

Research utilisation in clinical practice: the experience of nurses and midwives working in public hospitals.

BACKGROUND: Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, limited support for research utilisation and barriers of research utilisation hamper to utilise up-to-date research findings in clinical practice. Therefore, this study aimed to explore nurses' and midwives' experience of research utilisation in public hospitals. METHODS: A qualitative descriptive approach was conducted to explore nurses' and midwives' experience of research utilisation in clinical practice within South Gondar Zone public hospitals from January 3 to June 28, 2020. A total of 20 interviewees, 40 participants of FGDs, and 8 observations were considered in the study. Data from the interview, FGD, and observation were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. RESULTS: Nurses' and midwives' experience of using research findings in clinical decision-making emerged as "the non-intentional research utilisation" the main theme. Data analysis produced as "the belief towards research utilisation", "the limited support for nurses and midwives", and, "the perceived barriers of research utilisation" as the three themes. Participants believed that the non-use of the primary research was recommended due to fear of accountability for client harm. The limited support for nurses' and midwives' experience of research utilisation decrease nurses' and midwives' confidence to utilise research in clinical practice. Knowledge, attitude, time mismanagement, and the lack of motivation were perceived barriers to research utilisation. The lack of training and access to systematic review and meta-analysis research findings limited the research utilisation in clinical practice. CONCLUSIONS: The experience of research utilisation indicated that there was limited support for nurses and midwives to utilise research. Nurses and midwives did not utilise research in their clinical practice intentionally. This study identified that knowledge, negative attitude towards research utilisation, lack of training; time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory. Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, the limited support for research utilisation and barriers of research utilisation hamper the utilisation of up-to-date research in clinical practice. Therefore, this study aimed to explore nurses' and midwives' experience of using the knowledge obtained from research findings in clinical and healthcare decision-making practice within public hospitals. The experience of research utilisation among nurses and midwives working in public hospitals was studied. There was limited support for nurses' and midwives' experience of research utilisation. Nurses and midwives did not utilise research in their clinical practice intentionally. The knowledge, negative attitude towards research utilisation, lack of training, time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory.

Redeployment during the first wave of the COVID-19 pandemic: implications for a clinical research workforce.

BACKGROUND: Health professionals are considered a group vulnerable to developing mental health symptoms during a pandemic, with redeployment being a risk factor. However, previous literature suggests workplace communication can be a protective element. AIMS: An audit aimed to evaluate NHS research staff's experiences of redeployment in order to provide suggestions for future improvements in the process. METHODS: A questionnaire was disseminated to all staff in the clinical research directorate of an NHS trust. Responses were analysed using thematic analysis. FINDINGS: Over half the redeployed staff experienced perceived negative psychological outcomes. The main reported contributor to this was perceived lack of communication. CONCLUSION: Communication needs to be improved in future redeployments. Future research should consider a larger cohort and more input from team members who remained on the pre-COVID-19 studies in order to improve the transition back from redeployment.

Clinical research nurses' expectations and realities of their role: A qualitative evidence synthesis.

AIMS: To synthesise the available body of qualitative studies relating to clinical research nurses' experiences of their role. METHODS: A systematic search of the literature in five databases was undertaken: CINAHL, MEDLINE, EMBASE, PubMed and ProQuest. Thomas and Harden's three-stage approach to thematic analysis was followed using the ENTREQ statement for reporting. RESULTS: Nineteen studies reported in 20 papers (with a total of 232 nurses) were included in the synthesis. Three analytical themes with six subthemes were identified as follows: "identity"; "meeting targets"; and "patient advocate." CONCLUSIONS: Clinical research nurses experience isolation, and contributing to this is their perception of nonresearch nurses' lack of understanding for their role. This can result in difficulties when recruiting study participants. Clinical research nurses can experience internal conflict between being a patient advocate and adhering to a trial protocol. RELEVANCE TO CLINICAL PRACTICE: Training is needed to help research nurses develop skills to face challenges in order to ensure safe and ethical care is provided to research participants while also ensuring high-quality data collected for the study.

Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study.

AIMS AND OBJECTIVES: To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues. BACKGROUND: Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention. DESIGN: Ethnographic methodology was used. METHODS: Fieldwork methods were participant observation and semi-structured interviews. Participants were ANPs (n = 9) and nursing colleagues (n = 5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ. RESULTS: Three themes were identified which indicated how intra-professional relationships were conducted: Conciliating Nursing, where ANPs took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined ANPs, who themselves behaved similarly towards other nurses; and Lateral Othering, where ANPs undermined other ANPs. Vertical Discounting and Lateral Othering destabilised advanced practice. CONCLUSION: Intra-professional relationships, and the broader nursing profession, shape advanced practice. We theorise this is underpinned by threats to professional identity, while weak professional identity amongst even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra-professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice. RELEVANCE TO CLINICAL PRACTICE: As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on health care will likely increase and the importance of strong advanced practice identity will become increasingly relevant.

Gender as a principle of the organization of clinical sleep research.

In 2014 the National Institutes of Health required researchers to examine sex as a biological variable. While this approach is necessary to ensure adequate and appropriate female inclusion in research studies, it puts researchers at high risk for attributing their findings to biological sex differences when instead they may be more appropriately attributed to the influence and expectations of gender. In this paper, we specify how gender works as a principle of the social organization of symptoms, experiences, research, and clinical practice using obstructive sleep apnea symptomology to illustrate these patterns. We draw from psychologist Sandra Bem's account differentiating three specific mechanisms of gender: gender polarization, androcentrism, and biological essentialism.

Action research: A mechanism for active engagement of clinical nurses in a program of research.

This study aimed to explore the outcomes of active participation in an action research project on building the research capacity of clinical nurses. In this qualitative research study, six registered nurses volunteered to participate in the action research team. None of the nurses reported having any prior research experience. This study was part of a larger three-phase project. The nurses were required to reflect on the data about their medication practice of phase 1, develop and implement a bundle of interventions in phase 2 to improve medication safety, and evaluate the effectiveness of these interventions in phase 3. We report the nurses' participation in Action Research during phase 2. Meeting minutes and six semistructured interviews were thematically analyzed. The results showed that after receiving support to enhance their research skills from the research team, the nurses were empowered to perform and lead clinical nursing research project. Nurses were able to take ownership of the research process and outcomes and were then able to translate their new research knowledge and skills into their clinical practice by building their own research capacity.

Systematic and integrative reviews: synthesising evidence for community nursing practice.

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.

Participation in nursing research: We can do better.

This article discusses the potential drivers and barriers to clinical nurse research participation. Here, the author describes a research exemplar that highlights how understanding the link between research and practice can influence participation.

Linking to Improve Nursing Care and Knowledge: Evaluation of an Initiative to Provide Research Support to Clinical Nurses.

OBJECTIVES: The aim of this study is to describe and evaluate the impact of the Linking to Improve Nursing Care and Knowledge (LINK) project on increasing nurse-led clinical research. BACKGROUND: Nurse-generated research is the cornerstone of evidence-based practice and continues to be a marker of nursing excellence. However, the dearth of PhD-prepared nurses creates a challenge for creating an environment to promote clinical nursing research. We evaluated the LINK project, an academic-clinical partnership, to assess its impact and feasibility, for fostering nurse-led clinical research. METHODS: The LINK project created a formal command and control structure bringing together existing academic resources, including a PhD-prepared nurse researcher, a biostatistician, and a development of a formal research consultation request process. Measures tracked over a 12-month period included average response time, request volume, client satisfaction, institutional review board (IRB)-submitted protocols, and work products. RESULTS: All measures exceeded expectations with an average 1-day request response time, 35 requests, 98% client satisfaction, a 367% increase in nurse-led IRB approved protocols from the previous 12-month period, and 2 publications in peer-reviewed journals. CONCLUSIONS: The process and outcome measures indicate that the LINK project is feasible, sustainable, and reproducible. We were able to meet and, in many cases, exceed measurement goals. In addition, implementation science literature indicates that the most valid measure of a successful project rollout is user satisfaction and usefulness. The LINK project received consistently positive feedback.

Using a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management.

OBJECTIVE: The aim of this study was to identify clinical nursing research priorities among nurse managers (NMs). BACKGROUND: Determining research priorities is the 1st step toward building a solid evidence base for clinical practice. NMs are well poised to identify research priorities, and yet, a literature review revealed a dearth of research priorities as determined by clinical NMs. METHODS: Using a Delphi survey, 38 NMs were queried at a large, urban hospital regarding critical priorities for nursing research. RESULTS: Critical priorities for clinical nursing research included nursing workforce/nursing workflow and communication (categorized as critical by 68% and 53% of NMs, respectively). Other important priorities focused on falls/patient safety/hospital-acquired infections, patient/family satisfaction, emergency preparedness, patient outcomes, and collaboration/interdisciplinary research. CONCLUSIONS: Because NMs are positioned to direct clinical research agendas, the results provide a critical guide for policy development surrounding nursing research. Directing research toward these identified topics will help build a solid evidence base for nurses and ultimately improve patient outcomes.

Intensive care nurses' perceptions of various ethics concerns affecting clinical research.

BACKGROUND: Intensive-care unit (ICU) nurses have an important role in the recruitment of patients for scientific research and in the performance of clinical research. AIM: A study was conducted to examine ICU nurses' perceptions of ethics-related aspects of ICU-based research. The study focused on nurse attitudes and knowledge related to clinical research, with special emphasis on perceptions of the informed-consent process in ICU research. METHOD: The study applied a descriptive qualitative approach, involving semi-structured group interviews and theme-based inductive content analysis. Subjects were ICU nurses (n = 28) at a university hospital ICU who had experience with research protocols applied in that unit. FINDINGS: The nurses had mainly positive perceptions of clinical studies. They found research beneficial for future patients and for society. The nurses considered the information given to them about the studies inadequate. They were concerned about the fact that the consent for research is almost always obtained at the beginning of the ICU care, when patients and relatives are still in the crisis period. This limits the possibility of understanding and assimilating the information provided on the study. CONCLUSIONS: The role of ICU nurses in clinical studies should be more prominent and taken into account in the planning of ICU studies.

Engaging Clinical Nurses in Research: Nurses' Experiences Delivering a Communication Intervention in a Behavioral Oncology Clinical Trial.

Despite the recognized need for clinical nurses to engage in the conduct of research, little is known about their research experiences. This article describes the experiences of nurses who delivered the communication intervention in a behavioral oncology clinical trial for parents of adolescents and young adults (AYAs) with cancer. A qualitative thematic analysis was conducted of nurse interveners' (NIs') reflections on their experiences delivering the communication intervention. Ten data-generating questions were developed to guide NIs' reflections. Twelve NIs responded via verbal discussions. Six of these also provided written responses. Overall, nurses' experiences as interveners were powerful and positive, and included time and space to be fully present with patients and families. Nurse interveners identified barriers to their involvement in research related to time constraints, administrative support, physical space to privately conduct the intervention, and difficulties maintaining expertise with the intervention. The importance of ongoing collaboration between nurses, unit staff, leaders, and study teams was corroborated. An unexpected finding was the importance of reflective clinical research.

Holistic nursing competence scale: Turkish translation and psychometric testing.

AIM: This study aimed to culturally adapt and evaluate the reliability and validity of the Holistic Nursing Competence Scale for application in the Turkish context. BACKGROUND: Nurses are expected to assess well-being of individuals by considering physical, social, psychological, cultural and spiritual dimensions to enhance adaptation to diseases. In Turkey, no tools have been developed to date for the evaluation of competencies in holistic nursing in the country. METHODS: The study was conducted with 288 nurses working in two hospitals in Ankara equipped with over 500 beds. A confirmatory factor analysis was performed in order to identify whether the items and the sub-dimensions of the adapted scale complied with the original structure comprising 36 items and five sub-scales, namely 'general aptitude', 'staff education and management', 'ethically oriented practice', 'nursing care in a team' and 'professional development'. Cronbach's alpha value was used as an estimate for reliability analysis. RESULTS: Opinions of 11 experts were obtained for content validation of the scale, and the content validity index was 0.90. The adaptation was observed to be acceptable on the basis of structural equation model fit indices in confirmatory factor analysis. Cronbach's alpha value was estimated to be 0.97 and 0.90, respectively, for the complete scale. CONCLUSION: The study identified the Turkish version of Holistic Nursing Competence Scale as a valid and reliable tool for the evaluation of competence in holistic nursing among nurses. IMPLICATIONS FOR NURSING AND NURSING POLICY: The instrument may now be utilized as a tool of measurement in nursing practice, as well as in education and research, for identifying the level of competence in the holistic nursing practices among the nurses in Turkey.

Preliminary piloting and validation of a questionnaire identifying basic clinical skills practised by research nurses.

Clinical research nurses (CRNs) need to be competent in both clinical and research skills. In the past 10 years there has been increasing focus on developing the research competencies of CRNs. Employers, however, use the nurses' registered status as a proxy measure of clinical competence to perform their duties. The true extent of what clinical skills are practised by CRNs in a large NHS trust is unclear and there is a lack of validated measures to obtain this information. By using a mixed-methods approach of questionnaire and semi-structured interview, we aimed to pilot and validate a questionnaire to identify CRNs' self-reported confidence with clinical skills.

Emerging Trends in Clinical Research: With Implications for Population Health and Health Policy.

Policy Points: Significant advances in clinical medicine that have broader societal relevance may be less accessible to population health researchers and policymakers because of increased specialization within fields. We describe important recent clinical advances and discuss their broader societal impact. These advances include more expansive strategies for disease prevention, the rise of precision medicine, applications of human microbiome research, and new and highly successful treatments for hepatitis C infection. These recent developments in clinical research raise important issues surrounding health care costs and equitable resource allocation that necessitate an ongoing dialogue among the fields of clinical medicine, population health, and health policy. CONTEXT: Developments in clinical medicine have important implications for population health, and there is a need for interdisciplinary engagement among clinical medicine, the social sciences, and public health research. The aim of this article is to help bridge the divide between these fields by exploring major recent advances in clinical medicine that have important implications for population health. METHODS: We reviewed the most cited articles published from 2010 to 2015 in 5 high-impact clinical journals and selected 5 randomized controlled trials and 2 related clinical practice guidelines that are broadly relevant to population health and policy. FINDINGS: We discuss the following themes: (1) expanding indications for drug therapy and the inherent medicalization of the population as highlighted by studies and clinical guidelines supporting lower blood pressure targets or widespread statin use; (2) the tension in nutritional research between quantifying the impact of isolated nutrients and studying specific foods and dietary patterns, for example, the role of the Mediterranean diet in the primary prevention of cardiovascular disease; (3) the issue of high medication costs and the challenge of providing equitable access raised by the development of new and effective treatments for hepatitis C infection; (4) emerging clinical applications of research on the human microbiome as illustrated by fecal transplant to treat Clostridium difficile infections; and (5) the promise and limitations of precision medicine as demonstrated by the rise of novel targeted therapies in oncology. CONCLUSIONS: These developments in clinical science hold promise for improving individual and population health and raise important questions about resource allocation, the role of prevention, and health disparities.

Professional identity and the Clinical Research Nurse: A qualitative study exploring issues having an impact on participant recruitment in research.

AIMS: The aim of this study was to explore the experiences of Clinical Research Nurses, with an emphasis on factors that may have an impact on successful study delivery. BACKGROUND: The Clinical Research Nurse workforce is pivotal to improving health outcomes through supporting research-active health economies. Investment in research infrastructure has led to nurses and midwives increasingly undertaking extended roles to deliver clinical research. Despite such opportunities, the recruitment of sufficient participants into research studies remains problematic. A growing body of literature is exploring barriers to successful study delivery, indicating the emergence of a caring-recruiting dichotomy in clinical research staff. DESIGN: This qualitative study investigates the experiences of Clinical Research Nurses delivering research in the United Kingdom National Health Service. METHODS: Four Focus groups (total 19 participants) were conducted in a large North East National Health Service Foundation Trust from November 2015 - February 2016. FINDINGS: Thematic analysis identified perceptions of the role in the wider context of professional identity. Role transition, altered relationships and workload complexity, affected participants' practice, leading to inconsistency between core clinical values and perceived identities as research delivery staff. A duty of care as patient advocates contrasted elements of the work reflecting that of salespeople. The emotional labour of approaching patients and unease regarding peer perceptions of the Clinical Research Nurse role, affected the positive aspects of research delivery. CONCLUSION: Professional-identity and self-concept appear to have an impact on practice in a research delivery role. Further research should explore these issues further, to enlighten the basis on which such feelings are positioned and to work towards practical solutions.