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.