Promoting research by practitioners: the National Council perspective. Sarah Condell Sandra 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 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 Core Concepts of Developed Roles (National Council) CNS/CMS Clinical focus Patient advocate Education & Training Audit & Research Consultant ANP/AMP Autonomy in clinical practice Professional & clinical leadership Expert Practitioner Researcher 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 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 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. Lists peer-review publications by 8 ANPs in mainly international journals. 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.” Innovative Research Development Initiative (IRDI) 2010 only5 awards totalling €70,000 Awards based on fulfilling criteria and VFM 1. HSE South Cork/Kerry (UCC&ITT) – Masterclass series 2. NUIG & HSE West – elearning and support programme. 3. DCU & Beaumont/Connolly Hospitals – mentorship type programme 4. TCD & St James – mentorship type programme 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 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 Dublin 458 cases Antwerp 51 cases 7 HIV + 31 MSMs Oslo 27 cases All MSMs All primary/secondary Peterborough & Nth Cambridge . 13 cases All MSMs, all primary/secondary Paris 88 cases 90% MSMs 50% HIV + London 109 cases 92 MSMs, all primary/secondary 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 Innovation Reg. Meetings with outbreak team + Public health + Sauna owners On-site testing Gay bars/clubs Saunas Gay pride Media campaigns Dublin Outbreak Contacts 30% 2-5 contacts in past yr 50% 5-40 contacts in past yr 20% >40 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 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 • 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. 36 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. 37 2.Baby Friendly Hospital Advisory Committee A National Audit of the maternity hospitals/units to determine the methods used to sterilize breast pump attachments. 38 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. 39 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. 40 5.MEEP Study • Use of Manual Expression (hand expressing) as compared to using Electric Pump in the 1st 72hrs for mothers of premature babies. 41 Aim • Review of the amount of colostrum/ breastmilk obtained by mothers for premature or sick babies in the Neonatal Unit. 42 MEEP Study - Neonatal Unit Rotunda Hospital Team • • • • • CMS in lactation Advanced Nurse Practitioner Ward Midwives/Nurses Consultant Neonatologist Pediatric Registrar 43 Obstacles to Research/Audit 1.Time • • • • Reviewing research information Planning Proposal for ethics committee MEEP study takes approx 2 hrs to recruit mothers 44 2.Lack of admin support • • • • Preparing paperwork Info and consent sheets Photocopying Information management e.g. database and reports 45 3.Staffing Level 2009: 1 wte to 8912 deliveries Breastfeeding initiation 64.82% Breastfeeding at discharge 60.63% 46 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. 47 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 48 5.Education • • • • Tutorials for midwifery and medical staff 20 hr breastfeeding training programme Refresher courses Sessions at all induction programmes Lactation Specialist…. Person .…Team 49 Conclusion • Time • Staff 50 51 Promoting research by practitioners: Conclusion. 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.