The impact of COVID-19 on clinical research at Australian and New Zealand universities: A qualitative study

BackgroundThe COVID-19 pandemic resulted in the implementation of social distancing measures, travel restrictions, and infection control measures that introduced a myriad of disruptions in the conduct of clinical research worldwide. As a result, many aspects of clinical research were variably impacted.AimTo explore the impact of the first 18 months of the COVID-19 pandemic on clinical research across accredited nursing, pharmacy, and medicine program providers in Australian and New Zealand universities.MethodsRepresentatives from all program providers across Australian and New Zealand universities, with publicly available contact information, were invited to participate in this qualitative study, whereby semi-structured interviews were completed with participants who held senior research or leadership positions within their institution. Interviews were transcribed verbatim and inductively analysed using thematic content analysis.FindingsInterviews were conducted with 16 participants between August and October 2021. Two major themes were identified (Immediate Research Impact and Broader Research Impact) with six subthemes: Prioritisation, Continuation, and Dissemination of Research; Modifications to Research; Funding and Changes to Research Focus; Collaboration; Research Workforce; Context-specific Impacts.DiscussionThe impact on clinical research in Australian and New Zealand universities included changes to data collection methods, a perceived decreased quality of research, changes to collaboration, neglect of basic disease research, and loss of the research workforce.ConclusionThis study highlights the impact of the COVID-19 pandemic on clinical research within the Australian and New Zealand university context. Implications of these impacts should be considered to ensure long-term sustainability of research and preparedness for future disruptions.     

Building a program of research

This article provides highlights of a talk titled, "Building a Program of Research," given at the Japan Academy of Nursing Science's 28th annual meeting, Fukuoka, Japan, on 13 December 2008. A program of research is defined as a coherent expression of a researcher's area of interest that has public health significance, builds from the published research literature in the field, has relevance for clinical nursing practice, and captures the passion and commitment of the researcher. The Outcomes Model for Health Care Research is proposed as a framework for how to develop and articulate a program of research. Eight steps are proposed to help a new researcher to think about how to build a program of research.     

The impact of research governance in healthcare and higher education organizations

AIM: This paper reports a study exploring the impact and implementation of research governance in the North West region of England. BACKGROUND: In 2001, the UK Government launched a framework to ensure the governance of research within the National Health Service. Whilst this framework was undoubtedly geared towards improving the standards and practice of research, concerns have been raised in the academic literature about the potentially negative impact on future research. METHODS: A mixed method approach, using questionnaires (n = 350), semi-structured interviews and focus groups with a volunteer sample, was used to explore research staff perspectives about research governance. Survey data were analysed using Microsoft Excel, and a thematic analysis was used to elicit themes from the semi-structured interviews. The study lasted for 12 months and used a range of study sites, giving insight into potentially different experiences or approaches to implementing the research governance framework. FINDINGS: Questionnaire data revealed a good level of awareness about the Research Governance Framework. However, a range of concerns was also raised, such as the increased workload associated with the research governance application process and lack of transparency about the process. Five themes emerged from the focus groups: control, epistemology, organizational issues, impact on teaching and learning, and ambiguity in the definitions of research and audit. CONCLUSIONS: Recommendations emerging from the study include the promotion of transparent research governance guidelines for practitioners, and the need for staff education about governance processes and greater parity between organizations in research governance processes.     

Nurses' experiences of research utilization within the framework of an educational programme

This paper explores nurses' reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants' wards. Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. Organizational and leadership issues, nurses' interest in research, nurses' reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts.     

Barriers to paediatric nurses' research utilization

BACKGROUND: A number of studies have investigated barriers to research utilization among nurses in various countries, and standardized scales have been validated to study this. Reported barriers have been categorized as individual, organizational and environmental, with organizational characteristics generally accounting for more variance. However, information about research utilization among paediatric nurses is lacking. AIM: The objective of the research reported here was to investigate barriers to research utilization and relationships between those barriers and participation in research, self-reported research utilization and education among paediatric nurses. DESIGN: A survey of all nurses in a paediatric teaching hospital; 176 nurses (33.3%) responded. Two standardized measures were used, the Barriers Scale and the Edmonton Research Orientation Scale. RESULTS: Lack of time to read research was the most frequently cited barrier to using research and administrators not allowing implementation was the least frequently cited. Characteristics of the communication and of the setting were more likely to be cited as barriers to research use than were characteristics of the nurse. Nurses who reported higher levels of actual research use were slightly less likely to see characteristics within themselves as barriers. Those who had taken a course about reading or using research were more likely to see the organization as a barrier. Barriers to research use were not associated with self-reported understanding of research. CONCLUSIONS: These results are congruent with previous findings that implementing research in practice is a complex process. They indicate that individual nurses' knowledge about research may not be as important as the process by which organizations implement research. However, the Barriers Scale measures general perceptions about barriers to research utilization and not nurses' specific experiences with barriers to implementing particular research.     

A public health nursing research agenda

Public health nurses (PHNs) use many interventions to prevent illness and promote the health of populations. Unfortunately, generating evidence regarding PHN practice is not explicitly identified as a research priority area of the major national funding agencies. Nor has PHN, as a profession, had a strong enough research agenda to drive practice improvement on a population-level and to drive funding to support such areas of research. To further advance the science needed to guide PHN practice, a national conference to set the research agenda was held in October 2010 with grant support from the Agency for Healthcare Research and Quality. The conference was part of a multimethod, participatory, multistage approach taken to generate the final research priority themes and corresponding priority research questions. The process yielded four high priority PHN research themes: PHN intervention models, Quality of population-focused PHN practice, Metrics of/for PHN, and comparative effectiveness and PHN outcomes. As the agenda is adopted by funding agencies, researchers, and practice-based partners, a more focused program of research will produce evidence that can guide population-focused PHN practice.     

基于渥太华研究应用模式的妊娠期糖尿病临床护理实践指南应用方案的构建

目的构建妊娠期糖尿病临床护理实践指南应用方案。方法以渥太华研究应用模式为指导,建立指南应用方案构建小组和咨询小组,采用专家咨询法,根据前期确定的障碍因素,从证据、采纳者及实践环境三面面构建指南应用方案。结果在证据方面,制定了针对护理人员的“妊娠期糖尿病护理管理最佳实践手册”;在实践者方面,构建了护理人员培训方案;在患者方面,构建了“妊娠期糖尿病孕妇自我管理手册”、体验门诊、基于微信平台的健康教育;在实践环境方面,构建了护理操作规范和管理流程、患者血糖管理档案、以妊娠期糖尿病专科护士为主导、病区责任护士参与的专科护理团队、多途径、多形式的妊娠期糖尿病健康教育方案、GDM专科护士与医生的双向转诊流程。结论在渥太华研究应用模式的指导下,本研究构建了基于指南的可操作性强的综合干预策略,获取领导力支持、推动干预策略的实施,是下一步研究的重点。     

Developing nursing research

Following an information-giving workshop to senior nurses within the hospital by the Research Nurse Group, a research-practice gap was identified. To ascertain the extent of this, a survey with an explanatory letter was distributed to all qualified nurses within the Trust. Although initially the response rate was thought to be low, it compared favourably to other studies. Results showed that 45% of respondents did not feel confident to undertake a research project but more than 80% felt that research was a part of their clinical role and was relevant to nursing. Three-quarters of respondents also acknowledged that they had read a paper resulting in a change in their clinical practice. When asked about skills and resources, 29% did not know how to conduct a literature search and 39% were unable to critically appraise a paper. Furthermore, 62% did not know what resources were available when considering a research project of their own. It was concluded therefore, that the research-practice gap does exist and nurses need encouragement and support in the implementation of the research process. In view of these conclusions, an action plan was developed.     

Seeking evidence from medical research consumers as part of the medical research process could improve the uptake of research evidence

Concerns have been expressed about gaps between available medical research evidence and current medical practice. These gaps have been attributed to process problems with the implementation of evidence previously judged to be appropriate, rather than to problems with the appropriateness of the evidence provided for implementation. Two such 'appropriateness' problems are the applicability of research evidence to an individual patient, and the acceptability to an individual patient of a proposed treatment. Part of both these problems is due to the pre-eminence of the scientific paradigm within the medical research domain, and of the randomized controlled clinical trial within that domain. However, there is an opportunity beneficially to address both these problems by supporting reciprocal communication between medical research 'producers' and medical research 'consumers'– both practising clinicians and patients' representatives – in the setting of research priorities, selection of topics for research, development of research questions and study designs, in-progress reviewing, and final reporting of medical research projects. Such communication could allow researchers to understand, and respond to, clinicians' and patients' inputs concerning the applicability, utility and acceptability issues that will ultimately affect whether, and how, medical research findings can be applied. Such communication could also assist with some post-research implementation issues: integration of appropriate evidence into everyday practice; access to appropriate information sources; and a critical lack of necessary time.     

An action research approach for developing research and innovation in nursing and midwifery practice: building research capacity in one NHS foundation trust

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.     

Barriers to and facilitators of research utilization, as perceived by a group of registered nurses in Sweden

A survey was conducted to describe registered nurses' ( n =237), perceptions of the barriers to and the facilitators of research utilization at two hospitals in Sweden. A questionnaire, Barriers and Facilitators to Using Research in Practice developed by Funk et al. , was used to collect the data. The major barriers to research utilization were that the research is not readily available along with inadequate facilities for implementation of research findings, lack of competent colleagues with whom to discuss research, lack of time for reading and implementing research findings and the nurses lack of authority in the organization. The nurses who had studied research methods in their basic nursing education, seemed to perceive fewer barriers than those who had not. The facilitating factors most frequently suggested by the nurses were diverse models of education to increase their knowledge of research methods and to develop skills in evaluating research findings. The allocation of resources for education and implementation of research findings in clinical practice, in addition to special positions in clinical practice for nurses with scientific qualifications, were also suggested.     

Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review

AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation. BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes. METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis. RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation. CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.     

Piloting a Nationally Disseminated,Interactive Human Subjects Protection Program for Community Partners: Unexpected Lessons Learned from the Field

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers of the program and the collaborators who participated in the pilot across the United States describe 10 important lessons learned that align with four major themes: The distribution of the program, the implementation of the program, the involvement of community engagement in the program, and finally lessons regarding the content of the program. These lessons are relevant to anyone who anticipates developing or improving a training program that is developed in a central location and intended for local implementation.     

Approaches used to implement research findings into nursing practice: Report of a study tour to Australia and New Zealand

The focus of the study tour to several research and nursing units in Australia and New Zealand (NZ) was to investigate what has influenced the way nurses implement research into practice. The key areas examined were strategic policy influences, activities within leading academic units and responses in practice areas. The main themes to emerge were that the strategies developed by health policy makers in Australia and New Zealand have been profoundly influenced by the global clinical effectiveness and evidence-based practice movements. Nursing needs to position itself firmly in the centre of such developments and leading nursing initiatives need to be mainstreamed into the wider evidence-based movement. While activity around clinical/practice guideline development moves on, more work needs to be done to understand how best to actually implement research in practice. Issues of organizational context, ownership, practice, culture and identifying local champions are emerging as key challenges for the next stage of implementation. Much can be learnt from ongoing dialogue.     

Driving towards an improved research and development culture

BACKGROUND: This study examined the research and development culture and capacity within one NHS Trust in Northern Ireland. Strengths and challenges were identified and opportunities for further research and development expansion were sought. METHODS: This is a two-stage project incorporating a baseline survey (n = 379) followed by consultation with key stakeholders across the Trust (n = 11). FINDINGS: In the survey, over half of the respondents (n = 194) stated they had participated in a research project and a significant number (n = 313) read health care journals. Identification of barriers to research resulted in findings similar to other published work. Staff responded positively about using research in practice (n = 328) and that practice should be influenced by research (n = 312). Nurse Managers indicated support for research and development activity. CONCLUSION: The study provides a starting point from which to develop a positive research and development culture within this Trust. IMPLICATIONS FOR NURSING MANAGEMENT: After establishing a baseline of research and development activity across a large acute Trust, the strengths and weaknesses of such activity were identified with a view to informing a strategy to develop this aspect of professional activity. A change in an organizational culture cannot be made without full support of both the clinicians and their managers.     

组织实施护理PBL教学查房的行动研究

目的探讨在护理学生毕业实习中实施PBL教学查房的方法,在内科、外科、妇产科、儿科中开展教学方法改革。方法在为期10个月的毕业实习中开展16次PBL教学查房,采用Lewin的行动研究框架,以计划、行动、观察、反思4个步骤进行螺旋式循环实践,评价方案实施的效果,采用PBL学习体验评估量表调查学生PBL教学环境体验,反思PBL教学查房中值得注意的问题。结果通过培训、集体备课、观摩、访谈和查房等4轮循环完善了实施方案,44名学生的PBL学习体验评估量表总分为（81．83±10．42）分。本科生PBL学习体验评分为（89．45±8．47）分,高于专科生的（78．93±9．70）分,差异有统计学意义（t=3．165,P=0．003）。结论制定的PBL教学查房步骤经过行动研究实践的修改和完善,在内科、外科、妇产科、儿科中实施效果良好,实现了PBL教学方法的改革。     

National EMS Research Agenda: Proceedings of the Implementation Symposium

The National EMS Research Agenda identified eight recommendations for improving the conduct of emergency medical services (EMS) research in the United States. EMS leaders from across the country attended a two-day symposium to discuss implementation of the Research Agenda recommendations. The participants suggested specific methods to move the recommendations forward. These included improving training opportunities for EMS researchers, stimulating increases in available funding sources, facilitating the integration of research into practice, and crafting alterations within the regulatory environment. Participants felt that EMS must be more broadly integrated into the public health continuum. Federal agencies, states, local governments, charitable foundations, and corporations are asked to examine their practices to increase opportunities for participation in EMS research programs at all stages of the process.