Research by Nurses for Nursing and Care Improvement: A funder’s view

8 November 2018

In two new blogs, Professor David Richards, Professor of Mental Health Services Research and Head of Nursing at the University of Exeter, and Professor Jo Rycroft-Malone, Director, National Institute for Health Research Health Services & Delivery Programme and Pro-Vice Chancellor for Research & Impact at Bangor University, provide two perspectives on the impact of nursing research. Jo describes a range of excellent nursing research studies and their contribution to improving quality, accessibility and organisations of health and care. Summarising two new systematic reviews of nursing research in Europe, David argues that there is a lack of high-quality experimental studies in nursing research that would contribute to a strong evidence base. Both blogs emphasise the need for building the profession’s capability and capacity to contribute impactful research to more evidence-based care.  

For the past few years I have been the Programme Director for the National Institute for Health Research’s (NIHR) Health Services and Delivery Research (HS&DR) programme. The programme’s aim is to produce evidence to improve the quality, accessibility and organisation of health and care. In this role I have the privilege and pleasure of reading many funding applications, recommend to the Department of Health and Social Care the projects that our funding committee believes will, if funded, have the greatest potential impact on health and care, and in seeing the outcomes and impact of the research. As an NIHR Programme Director with a nursing background I am particularly sensitised to the research that comes through the programme that is of direct relevance to nurses, and the organisation and delivery of nursing and care. I also take a keen interest in the make-up of investigator teams, particularly of those Chief Investigators who are nurses. There’s a good news story in the fact that there are many excellent examples, which as a community perhaps we should be better at showcasing.

Given the plethora of examples to choose from, the research projects highlighted here focus on some of the key challenges facing today’s health and care system where nursing and the improvement of people’s care can have the greatest impact. Without doubt one of the greatest challenges concerns how we care for people living within care homes. In on-going research different types of staffing models within care homes are being investigated to uncover whether they are related to resident outcomes, including hygiene and social participation. This study will provide evidence about what configurations lead to better outcomes for people. In a different study focussed on care homes researchers showed the importance of shared learning and cohesion in multi-disciplinary team working, where this was working well, it led to better and more timely support and care for frail older people and those who were dying. Nurse staffing is not only a politically hot topic, it is also receiving attention through research. On-going and completed studies explore use of staffing tools, and the links between staffing and safe and effective care, including missed care and opportunities to act where a patient is deteriorating, and how this links to patient outcomes such as mortality. A number of studies have also drawn attention to the role and contribution of nurses and midwives to particular national policy and practice developments such as protocol-based care and chronic disease management. These studies show how nurses are increasing their impact on direct patient outcomes through leadership and more autonomous roles. Finally, a number of projects have been completed in which innovations relevant to nursing have been evaluated, such as in hospital redesign to single room accommodation and Schwartz Centre Rounds®.

These examples only reflect one part of the health research funding landscape in the United Kingdom, and only one of the NIHR’s research programmes. Looking to the NIHR Health Technology Assessment programme for example, there is a pioneering suite of studies in leg ulcer care and treatment Venous Ulcer Studies (VenUS), and some highly influential studies in pressure ulcer prevention and care.

Whilst the handful of examples highlighted here show the relevance and quality of research being undertaken by and for nurses, there is of course still much to do to build capacity and capability. We need to do more to embed nursing research into our systems including in education provision and funding. The newly launched NIHR Academy recognises the need to build research capacity in professional groups where it is low, specifically naming nurses. This is an important development, but one which needs to go hand in hand with the work of other agencies and influential bodies such as the Council of Deans for Health. However,  if we are to make a step change in ensuring the discipline’s capacity for leading and contributing to high quality research of relevance to nursing and patient care there also needs to be better and more joined up thinking and action across the clinical-academic interface. Collaborative and collective action across the various parts of the system will not only ensure an increased volume of high quality research, but will facilitate the provision of better quality and evidence informed care for patients and the public – which of course is the end goal for us all.

Guest blog by Prof Jo Rycroft-Malone, RN, BSc(Hons), MSc, PhD
Director, National Institute for Health Research Health Services & Delivery Programme
Pro-Vice Chancellor for Research & Impact, Bangor University

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