Promoting research by practitioners:the National Council perspective.

Sarah CondellSandra Delamare

Maura Lavery

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.

NCNM Mission & Function

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

Statutory Agency established in 2001

Core Concepts of Developed Roles (National Council)

CNS/CMSClinical focusPatient advocateEducation & TrainingAudit & ResearchConsultant

ANP/AMPAutonomy in clinical practiceProfessional & clinical leadershipExpert PractitionerResearcher

Key nursing and midwifery roles for practitioner research

ANP/AMP Posts Approved/ Meet Standards & Criteria

ANP/AMPsAccredited / Meet Standards & Criteria

154 95

CNS/CMS Posts Approved/ Meet Standards & Criteria

CNS/CMS Postholders Approved/ Standards & Criteria

2235 1744

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)

Research master-classes for AN/MPs.For example:Directors of Research in Academic Schools presented Research Strategies/Themes

Junior Clinician Scientist for Nursing and Midwifery 2006-2009

Strengths & Weaknesses:• Limited funding - €30,000 pa

for max 3 years towards protected time, €5,000 towards fees/consumables.

? completion• Local negotiation of

structuring.

4 awards – 1 ANP & 3 CNSs for 3 PhD & 1 MSc by Research.

RheumatologyMotor Neurone DiseaseMental HealthFalls

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

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.”

Evaluation 2: Forthcoming SCAPE report (TCD & NUIG, 2010)

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

Awards based on fulfilling criteria and VFM

1. HSE South Cork/Kerry (UCC&ITT) – Masterclass series2. NUIG & HSE West – elearning and support programme.3. DCU & Beaumont/Connolly Hospitals – mentorship type

programme4. TCD & St James – mentorship type programme

Award 5 = RCSI – Research roundtable for CNS Forensic nursing

•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

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?

Promoting research by practitioners:the National Council perspective.

Sandra Delamare,ANP sexual health, St James Hospital.

Who is going to Gain?• Nursing Profession• Patients

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

Best Case Scenario• Dialogue progression• Patient focus• Publication

Usefulness of Collaboration

Partnership approach, contributing to strengths and weaknesses of each other

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

Multidisciplinary Research

Outdoor Music Festival Lots of young people – 80,000 !! July 6,7,8 2007 Lots of rain, beer, etc…

Research Team

Research Participants

Data Collection

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 loo’s• Alcohol effect+++++++++++

Interdisciplinary Research

Syphilis Outbreak

Europe 2000 - 2002

Paris88 cases90% MSMs50% HIV +

Peterborough & Nth Cambridge.13 casesAll MSMs, all primary/secondary

Oslo27 casesAll MSMsAll primary/secondary

Antwerp51 cases7 HIV +31 MSMs

London109 cases92 MSMs, all primary/secondary

Dublin458 cases

Syphillis outbreak

Infection rates in BT

Infection rate in SJH & GMHP

Meeting with NDSC + ID consultants

Outbreak team formed

2 special clinics H/A appointed

innovation

Innovation

Reg. Meetings with outbreak team + Public health +Sauna owners

On-site testing

Gay bars/clubs Saunas Gay pride

Media campaigns

Dublin OutbreakDublin Outbreak

Contacts30% 2-5 contacts in past yr50% 5-40 contacts in past yr20% >40 contacts in past yr

Amongst those with early syphilis..139 attended saunas regularly121 attended gay bars/clubs to meet partners14 used internet chat sites11 found partners in local parks20% had sex in UK/Europe in the previous 6mths

Positive aspects

• Academic support

• Improved patient care

• Research awareness

• Dedicated time

Negative Aspects• No funding

• Time

The Future• Unprecedented changes• Emerging research focussed and research

aware nurses• Profession of nursing has changed forever

Promoting research by practitioners:the National Council perspective.

Maura Lavery,CMS Lactation,

Rotunda Hospital.

35

36

• 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.

37

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.

38

2.Baby Friendly Hospital Advisory Committee A National Audit of the maternity hospitals/units to

determine the methods used to sterilize breast pump attachments.

39

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.

40

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.

41

5.MEEP Study• Use of Manual Expression (hand expressing) as

compared to using Electric Pump in the 1st 72hrs for mothers of premature babies.

42

Aim

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

43

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

MEEP Study - Neonatal Unit Rotunda Hospital

44

Obstacles to Research/Audit

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

45

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

46

3.Staffing Level

2009:1 wte to 8912 deliveries

Breastfeeding initiation 64.82%Breastfeeding at discharge 60.63%

47

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.

48

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

49

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

Lactation Specialist…. Person .…Team

50

Conclusion

• Time• Staff

51

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.

Promoting research by practitioners:Conclusion.