10 things I learnt about research in 2016
In the role of a nurse, it is an integral part of our training and continuing professional development to reflect on our practice, and is now part of revalidation. I therefore want to share with you 10 things I learnt about clinical research in 2016 (in no particular order).
1.Be dynamic in your approach to consent and research delivery. A big lesson I have learnt working in the EMERGING research team is the dynamicity of the clinical environments where we deliver research. Patients become unwell and are unable to take on information. There is fluctuating clinical condition and capacity. Doctors get tied up in their other roles and responsibilities, when we need their assistance with consent procedures and physical examinations. But that’s the dynamic environment we work in, and we must adopt flexibility to aid research delivery and not to interfere with routine clinical care.
2.Engagement in the clinical area is key for the success of any clinical research study. My greatest challenge this year has been integrating myself into a new team and a variety of clinical areas, covering the ED and CCU. I have made a conscious effort to get to know people I am working with and encountering every day, both inside and outside of the clinical context; regardless of if their patient is taking part in clinical research. This has really helped to build professional relationships, and assist multi-disciplinary working and research delivery.
3.Most people are happy to be asked about taking part in clinical research. Due to the area we work in we have no choice but to approach patients about clinical research when they are at their sickest. This is to ensure we develop best methods to care for and treat our sickest patients coming through the ED and CCU. I have been surprised to learn that most patients are willing to be asked about taking part in clinical research when they are able to and adopt an altruistic approach to helping others. Similarly, families of acutely and critically ill relatives often welcome being approached about research. Despite having experience working as a critical care nurse, and having difficult conversations with families of the acutely and critically unwell, I was apprehensive about approaching them about clinical research. I didn’t want to burden them at this difficult time and feared they wouldn’t want to be approached about participating in clinical research. Over the past year, I have encountered some willing relatives who not only advise on whether or not their loved one would want to take part should they have capacity, and are mostly supportive, but they see the importance for future patients outcomes and the NHS.
4.Proper Preparation Prevents Poor Performance (5 P’s). As CRNs we are expected to plan, prioritise and manage our own workload and clinical research studies. Having previously worked as CRN, I had developed my time management and organisation skills. Having clinical experience, I am able to envisage potential problems and barriers in practice regarding research delivery. However, despite thinking I had planned for every eventuality, things happen that challenge your planning and thinking. This is particularly apparent working in the ED and CCU. Therefore, I have learnt the importance of reflecting on these challenges, being flexible and making necessary modifications to working practices to ensure safe and effective research delivery.
5.There are no failures or mistakes – just learning. A recent project was my first experience of the Trust being a sponsor for a clinical research study. This gave the team a great opportunity to design and implement the research delivery. We designed procedures for delegated professionals to be autonomous with randomisation and recruitment procedures. However, we soon learnt that out-of-hours recruitment was challenging and affecting the quality of research without research team members’ oversight. We therefore revised our procedures and continued to recruit well to the study.
6.There’s still a lot we don’t know. Is it better to give smaller or larger volumes of albumin? Do we protect the lungs if we remove co2 from the blood? Can we diagnose ventilator acquired chest infections from patient breath samples? Can delivering stem cells help repair lungs in critically ill patients? How do we treat people who have taken ‘legal highs’? What I love about research is the opportunity for discovery and innovation.
7.Be your own hero. A successful CRN must be their own hero. You must be internally driven and motivated. Screening for participants can be very time consuming and a fruitless task. Research participants will not come and ring the office doorbell. We must be relentless in our efforts in screening and clinical engagement to identify and offer patients the opportunity to benefit and be a part of clinical research and innovation in the NHS.
8.Transferable skills are great. Time management, organisation and prioritisation are skills nurses become proficient in very quickly, which are also very useful skills as a CRN. At any one time in clinical care we could be obtaining clinical observations, completing documentation, attending to an alarming IV pump or ventilator, helping a patient to eat and drink or be delivering medication, and we must prioritise these tasks. Developing these skills has really helped me prioritise my workload this year as a CRN, particularly covering two clinical environments (ED and CCU), and helped me get stuck in and support the clinical teams with routine care delivery and recruitment to clinical research studies.
9.Team work makes the dream work. Without supporting each other on clinical research studies we wouldn’t recruit and deliver research to the high standard that we do. This is not just the immediate EMERGING research team, but the multi-disciplinary team and supporting services such as the labs. Their expertise and willingness to help contributes to our success. Our clinical colleagues play a huge part in the identification of research participants, taking samples and recording observations out of hours. Thank you!
10.What doesn’t challenge you, doesn’t change you. I previously worked as a CRN in a Clinical Research Facility, a very clinical and controlled environment where patients participating in clinical research studies turn up to pre-arranged appointments. Compared to now where I deliver research to acutely and critically unwell patients, this has challenged me and changed my practice for the better. I have learnt to overcome the challenges of working with patients without capacity and how to best involve them in research, and learn new approaches to consent. I have also gained valuable experience working with relatives, as part of clinical research. Working in a city centre hospital has given me exposure to a diverse group of people, which has brought new challenges of language, education, cultures and beliefs. We continue to work well as a team to challenge these potential barriers and be inclusive to all in clinical research.