Promoting research by practitioners: the National Council perspective.

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Promoting research by practitionersthe National
Council perspective.

• Sarah Condell
• Sandra Delamare
• Maura Lavery

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Highlights 2003-2008

• 19 of 21 recommendations achieved, 12 ongoing.
• HRB Funding 1m in 5yr programme grants, 2m in 3
  yr project grants, 5m in Fellowship awards.
• HRB 48 individual awards to nurses and midwives.

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NCNM Mission Function
Statutory Agency established in 2001
The National Council for the Professional
Development of Nursing and Midwifery exists to
promote and develop the professional role of
nurses and midwives in order to ensure the
delivery of quality nursing and midwifery care to
patients and clients in a changing healthcare
environment
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Core Concepts of Developed Roles (National
Council)
ANP/AMP Autonomy in clinical practice Professional
clinical leadership Expert Practitioner Researc
her
CNS/CMS Clinical focus Patient advocate Education
Training Audit Research Consultant
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Key nursing and midwifery roles for practitioner
research
CNS/CMS Posts Approved/ Meet Standards Criteria CNS/CMS Postholders Approved/ Standards Criteria
2235 1744
ANP/AMP Posts Approved/ Meet Standards Criteria ANP/AMPs Accredited / Meet Standards Criteria
154 95
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Evaluation 1 Preliminary evaluation of the AN/MP
role (NCNM 2005)

• Findings
• Fulfilling clinical leadership and research
  aspects of the role is proving problematic due to
  time constraints and the growing clinical need
  for ANP services. (p43)

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Research master-classes for AN/MPs.

• For example
• Directors of Research in Academic Schools
  presented Research Strategies/Themes

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Junior Clinician Scientist for Nursing and
Midwifery 2006-2009

• 4 awards
• 1 ANP 3 CNSs for 3 PhD 1 MSc by Research.
• Rheumatology
• Motor Neurone Disease
• Mental Health
• Falls

• Strengths Weaknesses
• Limited funding - 30,000 pa for max 3 years
  towards protected time, 5,000 towards
  fees/consumables.
• ? completion
• Local negotiation of structuring.

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• Lists peer-review publications by 8 ANPs in
  mainly international journals.

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Evaluation 2 Forthcoming SCAPE report (TCD
NUIG, 2010)

• Findings from mixed methodology study (including
  focus groups, Delphi survey, case study
  observation and interviews. Data collected
  2009-2010.
• Very strong evidence that AP are conducting
  research (and strong evidence of audits,
  especially by CSs).
• Study concludes research skill and motivation
  present but is in its infancy and occurring
  against all the odds with little support.

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Innovative Research Development Initiative
(IRDI) 2010 only- 5 awards totalling 70,000

• Awards based on fulfilling criteria and VFM
• HSE South Cork/Kerry (UCCITT) Masterclass
  series
• NUIG HSE West elearning and support
  programme.
• DCU Beaumont/Connolly Hospitals mentorship
  type programme
• TCD St James mentorship type programme

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Award 5 RCSI Research roundtable for CNS
Forensic nursing
Key research issues identified Is current
service meeting the needs of patients/clients?
How can improvements could be made? Impact of
the sexual assault treatment units on
patient/client outcomes? How to raise awareness
of sexual assault and of the 6 sexual assault
treatment units?

• Dr. Susan Miner, Rape Crisis Network Ireland
  (RCNI)
• Dr. Maeve Eogan, National Medical Director,
  Sexual Assault Treatment Units
• CNSs (Sexual Assault Forensic examination) and
  HDip students
• RCSI staff

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Promoting research by practitionersthe National
Council perspective.

• Sandra Delamare,
• ANP sexual health,
• St James Hospital.

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Who is going to Gain?

• Nursing Profession
• Patients

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Worst Case Scenario

• Solitary Academics reading theories practice
  that is maybe 10years old
• Not engaging in practical setting
• Professional nurses whiz, whiz, whiz
• Not engaging in research

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Best Case Scenario

• Dialogue progression
• Patient focus
• Publication

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Usefulness of Collaboration

• Partnership approach, contributing to strengths
  and weaknesses of each other

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Independent Researcher

• A prospective Study, to compare the satisfaction
  of patients attending the Advanced Nurse
  Practitioner (ANP ) and the Senior House Officer
  (SHO ), for sexual health screening in the GUIDE
  Clinic
• 2005
• This initial assessment of patient satisfaction
  attending the sexual health clinic has shown
  patients to be equally satisfied with the care
  provided by the ANP as they are with the SHO
• It also demonstrates the acceptability of the ANP
  as a first-line care provider in the Irish Health
  services. This further strengthens the need for
  the development of the role of the ANP in the
  future of health care in Ireland

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Multidisciplinary Research
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• Outdoor Music Festival
• Lots of young people 80,000 !!
• July 6,7,8 2007
• Lots of rain, beer, etc

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Research Team
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Research Participants
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Data Collection
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Results Chlamydia testing

• 947 tested for Chlamydia
• Positive rate of only 2.1
• Why so low????
• Samples very very dilute
• Many samples far from adequate
• Many samples NOT urine
• Many girls messing in the loos
• Alcohol effect

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Interdisciplinary Research
Syphilis Outbreak
Europe 2000 - 2002
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Syphillis outbreak
Infection rates in BT
Infection rate in SJH GMHP
Meeting with NDSC ID consultants
Outbreak team formed
H/A appointed
2 special clinics
innovation
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Innovation
Reg. Meetings with outbreak team Public health
Sauna owners
On-site testing
Gay bars/clubs
Saunas
Gay pride
Media campaigns
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Dublin Outbreak

• Contacts
• 30 2-5 contacts in past yr
• 50 5-40 contacts in past yr
• 20 gt40 contacts in past yr
• Amongst those with early syphilis..
• 139 attended saunas regularly
• 121 attended gay bars/clubs to meet partners
• 14 used internet chat sites
• 11 found partners in local parks
• 20 had sex in UK/Europe in the previous 6mths

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Positive aspects

• Academic support
• Improved patient care
• Research awareness
• Dedicated time

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Negative Aspects

• No funding
• Time

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The Future

• Unprecedented changes
• Emerging research focussed and research aware
  nurses
• Profession of nursing has changed forever

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Promoting research by practitionersthe National
Council perspective.

• Maura Lavery,
• CMS Lactation,
• Rotunda Hospital.

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• Research is a vital role in a Clinical Midwife
  Specialists job.
• As an educator the Clinical Midwife Specialist
  must ensure that breastfeeding information given
  to staff and mothers needs to be up to date and
  evidence based. This will ensure delivery of a
  high standard of care for our mothers and babies.

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Research/Audits I have been involved with in the
last 2 years

• 1.Rotunda Hospital Breastfeeding Policy Regular
  audits of this policy which incorporates the 10
  steps to successful breastfeeding.
• It is a requirement to maintain Baby Friendly
  Hospital Initiative accreditation that these
  steps are audited regularly.

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• 2.Baby Friendly Hospital Advisory Committee
• A National Audit of the maternity
  hospitals/units to determine the methods used to
  sterilize breast pump attachments.

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• 3.Food Safety Authority Ireland
• Measurement of dioxins in breastmilk
• 2010.
• Involved in the recruitment of
• breastfeeding mothers to the study and
• the collection of the milk samples.

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Research/Audits

• 4.Lactrack 2010
• Pilot Programme in the Rotunda Hospital Neonatal
  Unit in the 7th month.
• 1st hospital in Europe to use this system.
• Barcode system to track expressed breast milk
  from expression by the mother to baby.
• Regular audits performed in the Neonatal Unit.

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• 5.MEEP Study
• Use of Manual Expression (hand expressing) as
  compared to using Electric Pump in the 1st 72hrs
  for mothers of premature babies.

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Aim

• Review of the amount of colostrum/ breastmilk
  obtained by mothers for premature or sick babies
  in the Neonatal Unit.

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MEEP Study - Neonatal Unit Rotunda Hospital

• Team
• CMS in lactation
• Advanced Nurse Practitioner
• Ward Midwives/Nurses
• Consultant Neonatologist
• Pediatric Registrar

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Obstacles to Research/Audit

• 1.Time
• Reviewing research information
• Planning
• Proposal for ethics committee
• MEEP study takes approx 2 hrs to recruit
• mothers

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• 2.Lack of admin support
• Preparing paperwork
• Info and consent sheets
• Photocopying
• Information management e.g. database and reports

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• 3.Staffing Level
• 2009
• 1 wte to 8912 deliveries
• Breastfeeding initiation 64.82
• Breastfeeding at discharge 60.63

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• 4.Clinical Patient Care
• Ante natal support
• We offer one-to-one support to mothers that have
  experienced past difficulties breastfeeding their
  babies.
• We also offer one-to-one support to mothers
  expecting high risk babies.

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• Postnatal support
• Support for mothers at ward level
• Babies who refuse the breast
• Babies who have difficulty attaching to the
  breast due to a difficult or medicated delivery
• Babies who have excessive weight loss
• When necessary individual consultations for
  mothers
• Phone line support
• Weekly support group
• Neo natal support groups

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• 5.Education
• Tutorials for midwifery and medical staff
• 20 hr breastfeeding training programme
• Refresher courses
• Sessions at all induction programmes
• Lactation Specialist. Person .Team

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Conclusion

• Time
• Staff

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Promoting research by practitionersConclusion.

• Nurses and midwives can contribute to health
  research in services.
• Best placed to do so are those in CS and AP
  roles.
• Much of the current CS or AP activity would
  benefit by increased support and resources.
• CS and AP should be members of clinical academic
  networks.