The Challenges of Clinical Nursing Research
The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses’ experiences in doing clinical research. The main challenges of doing clinical research arise from a culture that prioritizes practice where nursing work is core business. There is a need to address immediate and short-term goals. There are also problems with using research language amongst clinical nurses and ambiguity concerning research role expectations. Lack of support and resources for doing research and keeping up the momentum for a research project also poses significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence-based.
The need for research in practice is well documented and accepted within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. For many nurses, undertaking clinical research is challenging for many reasons. It requires an understanding of research processes, commitment, resilience, and much time above and beyond regular working hours. In this paper, we explore nurses’ experiences who, despite the difficulties, have undertaken clinically based research. The challenges faced by the nurses in conducting clinical research are as follows;
Is nursing work a core business?
How is inadequate support and resources for doing research a challenge?
How is language a problem in clinical research?
How do cultural practices as a priority affect the nurses conducting clinical research?
What are the role expectations of nurses in conducting clinical research?
During the clinical research by the nurses, what are the short-term goals?
Is Nursing work a core business?
An ongoing debate amongst clinical nurses in the
workplace focuses on what is essential and what is
not in terms of nursing work and core business.
The core business for clinical nurses in the provision
of patient care in an environment that involves
a rapid turnover of patients with complex care
needs. In all clinical settings
An ongoing debate amongst clinical nurses in the
workplace focuses on what is essential and what is
not in terms of nursing work and core business.
The core business for clinical nurses in the provision
of patient care in an environment that involves
a rapid turnover of patients with complex care
needs. In all clinical settings
An ongoing debate amongst clinical nurses in the
workplace focuses on what is essential and what is
not in terms of nursing work and core business.
The core business for clinical nurses in the provision
of patient care in an environment that involves
a rapid turnover of patients with complex care
needs. In all clinical settings
An ongoing debate amongst clinical nurses in the
workplace focuses on what is essential and what is
not in terms of nursing work and core business.
The core business for clinical nurses in the provision
of patient care in an environment that involves
a rapid turnover of patients with complex care
needs. In all clinical settings
An ongoing debate amongst clinical nurses in the workplace focuses on what is essential and what is not in terms of nursing work and core business. The core business for clinical nurses in providing patient care in an environment that involves a rapid turnover of patients with complex care needs. In all clinical settings, nurses are forced to prioritize the increasing demands for patient care and associated workloads. On a day-to-day basis participating in research is not a priority because of the imperative to meet the needs of patients, clients, and their families and provide hands-on care. Unlike a research meeting or co-operating with researchers to recruit potential research participants, clinical workloads and patient/client care demand immediate or imminent response. The best intentions of clinical nurses to participate and or support research can be thwarted by patient care and workload demands. As one discussion group member said,
Working with hands-on clinicians is like a double-edged sword: you need their engagement to proceed with clinical research and implement any subsequent change, yet the clinician’s focus is firmly set on the day-to-day business of health care providers so that research-related tasks will be relegated to a low priority rating or ignored.
This means that research is something that gets tacked on to the end of the working day. This makes timelines impossible to keep and puts clinicians under stress.
Nurse researchers believe that many nursing colleagues don’t engage in research because the prevailing culture does not support it. One group member lamented it is ‘like [getting] blood from a stone. There is so much information that clinical staff members constantly process that non-essential information is not considered. Indeed, clinical nurses seem to ‘carry the mantra that we are doing the important work don’t interfere or waste our time’. The perception is that doing research is an ‘imposition on clinical nursing staff, that it is not ‘real nursing work’; rather, it is a ‘luxury.’ When invited by nurse researchers to participate in research activities, clinical nurses often say ‘I don’t have time for this, and the general attitude is ‘we’ll think about it, ‘if I have time, or ‘tell us about the result.’
What are the role expectations of nurses in conducting clinical research?
While there are expectations for professional nurses to engage with research in one form or another, some nurses experience tensions when meeting the requirements of their roles. For example, one Clinical Nurse Consultant (CNC) noted that the ‘Expectations outlined in my job description and articulated at performance appraisal includes research but minimal support for this.
That research is not ‘core business’ coupled with nurse managers wanting quick outcomes is a barrier to some CNCs fulfilling the research component of their role. Some ask:
Is it realistic to expect that researchers undertake research with already full roles? With the ever-increasing demands of juggling total workloads and the challenges [concerning funding], it is surprising it happens at all.
Lack of respect for the efforts of nurse researchers from other health professionals leaves some feeling demeaned, undervalued, and doubting the worth of their work. For example, concerning one clinical research project:
Medical staff felt they could make suggestions and expected these suggestions would be adopted about changes to the research project, specifically the research questionnaire and interview questions. [This was] after ethics approval and a research grant [for the study had been] obtained.
In another study conducted by a group member, the medical staff was invited to participate in focus groups. Their response was of general surprise at being asked to participate as the study was nurse-led. They were happy to be informed about the project but did not believe they should be participants as ‘nurses led the study.’
On the other hand, university graduates seem to be more amenable to research participation. They are open to the idea of research when approached about possible studies and are generally supportive when it comes to playing a role. They see the inherent value of research and share the excitement and enthusiasm of their colleagues doing research. Participating in research may be less familiar to other nurses who tend to be skeptical and cautious in their responses. Indeed, in some instances, there is a perception amongst discussion group members that projects are undermined through gate-keeping behavior and lack of support by the ‘skeptics.’ For university graduates, research is an integral part of their curriculum. Therefore, future clinical nurses may see research as an integral part of their role and day-to-day practice. For both the university graduate and other nurses, patient care priorities overtake their ability to participate in research. The challenge for clinical researchers is to engage clinicians appropriately and show how research contributes to positive patient care outcomes.
How is inadequate support and resources for doing research a challenge?
Another issue discussed by the group was the perceived lack of support and resources for doing their research. One group member said, ‘It was often difficult to get support to undertake the process.
Management is more than happy to support research initiatives in principle; however, [they are] usually unable to provide [this] support as they have incredibly tight budgets and other clinical management demands.
There are often difficulties associated with obtaining adequate funds to undertake a project, and, once awarded, securing and accessing funds is not easy. There is a risk of underestimating the budget for research so that there may be insufficient infrastructure available to support the project entirely.
As with most competitively funded research projects, the budget sought for the research is not consistently awarded. When this occurs with small-scale projects, the challenge is how to reconceptualize the project to suit the budget allocated.
This results in the project leader/s doing the lion’s share of the workfrom printing questionnaires and chasing expenditure details to writing and submitting ethics and grant applications and ethics variations.
Being a sole researcher on a time-limited research project.and managing to hold together all other aspects of the work is a dilemma.
The time taken to do research is often underestimated, and considerable time and effort are often put into preparing a grant application which ultimately may not be successful. Focusing on meeting deadlines and the progress of a project means that less attention can be given to other aspects of work roles. Ultimately, doing research without adequate support or funding becomes a constant juggle.
Head nurse.
A head nurse is an individual who oversees nursing operations at your healthcare employer’s place of business. Whether you’re located in a hospital, outpatient clinic, or another medical setting, you will lead teams of nurses in providing effective, high-quality care for all patients. As a specialized position, the role of a head nurse is best filled by an individual with both an undergraduate and master’s degree in nursing. In addition, head nurses are often characterized by years of experience in specific nursing fields. Head nurses also face challenges in conducting clinical research, and they are as follows;
What adjustment do they make when there are fluctuating staff and patient Volumes?
How do they balance the patient care demands with research?
What skill/knowledge do they have as head nurses in their roles?
What is the hardness of working conditions?
What support do they get from their colleagues in conducting their clinical research?
What adjustment do they make when their are fluctuating staff and patient Volumes?
Along with high patient acuity, fluctuations in nurse staffing patterns created an additional challenge for nurse involvement in the research process. Staffing patterns in clinical settings require that direct care nurses may be unpredictability assigned on a daily basis to work in different in-patient care units to accommodate changes in daily patient census patterns and acuity. For instance, nurses familiar with the study, who knew how to integrate study activities into patients’ care plans, were often reassigned to work in other in-patient care units when the HCST patient census was lower. Conversely, in times of high HCST patient census patterns, direct care nurses that were not familiar with the research study may be reassigned to provide patient care to AYA in the HSCT units where the study was being conducted. The number of study-eligible patients would also fluctuate; for example, there were times when study approved clinical sites had multiple patients simultaneously enrolled in the study and other time periods in which no eligible patients could be recruited to the study. After periods of prolonged study inactivity, direct care nurses often felt less prepared to support the research protocol because they lacked recent experience integrating study procedures into routine clinical care. For example, obtaining physiological data regarding aspects of the patients’ status (e.g., pain and mucositis) to provide to the study interveners and coordinating patient care (e.g., timing of pain medication delivery in relation to scheduled intervention sessions) was less intuitive after periods of study inactivity. It became evident that fluctuations in nursing staff and study participant volumes were affecting the direct care nurses’ enthusiasm and focused commitment to be actively engaged in recommended recruitment activities (e.g., offering a study brochure to eligible patients) and that the nurses would require a booster training plan for ongoing support and education.
How do they balance the patient care demands with research?
The targeted population, AYA undergoing an SCT, had high acuity and experienced multiple distressing physical symptoms including pain, mouth sores, nausea and vomiting, diarrhea, and fatigue. Sometimes, limited time and complex patient care needs made it difficult for nurses to accomplish necessary direct care while also supporting the research process. This experience is consistent with literature indicating that nurses’ primary concern is delivery of timely, competent care and being an advocate for patients; hence, anything perceived as not in the patients’ best interest, such as involvement in research, will likely be abandoned [9]. To remain involved, the direct care nurses needed guidance in how to find ways to balance the provision of quality patient care along with adherence to the correct delivery of the study protocol. In order to address this concern and sustain involvement of the direct care nurses, our research team realized that we would need to develop and implement ongoing booster training to introduce strategies to assist the nurses in how to adhere to the research protocol while also remaining sensitive and responsive to the ever-changing needs of the high acuity patient population.
What support do they get from their colleagues in conducting their clinical research?
Coordinating Interdisciplinary Clinical and Study Personnel. Coordination of clinical and study personnel was a primary challenge encountered during SMART study implementation. Study personnel included HSCT coordinators who identified study-eligible patients, project managers who obtained informed consent and scheduled study activities, clinical research coordinators who administered study measures, and board-certified music therapists who delivered the study intervention sessions. Some study team members were not familiar with HSCT patients’ usual clinical pattern and the nature of their changing needs. Therefore, some of our study team members often needed to consult with the direct care nurses about the current health care status of enrolled patients and explore ways to integrate intervention sessions and measurement times into the daily flow of the patients’ plans of care. Consistent and effective communication among the direct care nurses and study team members fostered successful scheduling and execution of the study sessions and activities during delivery of the enrolled patients’ HSCT treatments.
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