Nursing research and patient care: A case for the bedside rather than the bench

Field: Nursing (Health Sciences)

In the nursing profession, there is very little agreement on how to develop nursing research in the clinical practice setting. This is unfortunate as the ultimate measure of any nursing development is its application to patient care. It is difficult to understand this indifference and uncertainty amongst nurses towards research, as all university schools of nursing offer teaching and examination on modules of nursing research at undergraduate and postgraduate education levels. Therefore, it should be the case that nurses have knowledge of research. Progress has been made; however, the challenge to the profession of nursing is, as it has always been, why is nursing research not more impactful, and why is it not integral to our patient care activities. Is this a failing in our approach to university teaching of research, or is it the case that health service employers do not place a value on nursing research and therefore our nursing managers have not adopted nursing research as a modus operandi. Almost 150 years ago, Nightingale reminded us that the first requirement in a hospital is that it should do the sick no harm. The Nightingale mantra is even more important in todays health care environment of accountability and litigation, where it is the individual responsibility of each nurse to provide the most up to day care practices to each patient. A prevalent debate for many decades, which has influenced research developments, has been the bench to bedside debate. In a previous publication (Cowman, 2017), I suggested a bedside to bench approach to research is more appropriate for nursing research rather than the predominant model of bench to bedside. I argued that for nursing research to be meaningful to clinical nurses and their managers, the bedside location must be the main stimulus for research questions. In recent years, the central tenets of translational research set out to bridge a gap between knowledge produced at the university lab bench and its use at the bedside. However, over a decade later we have very little evidence to suggest that this model has been successful and there is little clarity on how such resource investment has been used for the benefit of patients. Interestingly, what was published over fifteen years ago, may reflect the situation today, is that less than 10% of promising laboratory research and Randomized Controlled Trials become established in clinical practice within 20 years (Contopoulos-loannidis, Ntzani, & Ioannidis, 2003). Also, the major component of research funding is allocated to bench research, rather than bedside and clinical research. Perhaps, the imbalance in funding relates to a perception that health services research is of less value that than bench research. However in health services, this is difficult to justify given that Grol (2001) suggested that in health care, 30%–40% of patients do not receive treatments based on proven effectiveness and up to 25% of patients receive unnecessary care or care that is potentially harmful. For clinical nurses and their nurse's managers, this must be of concern and provides a powerful argument for clinical nursing research as a platform for evidence-based practice. In my current role as a Professor of Nursing, I recognize the potential in bedside nursing research where the process and outcomes have a direct bearing on improving patient care. I also accept that the development of bedside nursing research will present many challenges and must be done collaboratively between faculty from university schools of nursing & midwifery and clinically based nurses. In recent years, my efforts to enhance clinically based nursing research have been targeted in a number of directions. Firstly, selecting and supervising postgraduate students at MSc and PhD, most often clinically based nurses whose research topics are focused on change to patient care policy and clinical practice. (Cowman, 2017) Most recently, I have promoted a collaborative clinical research development model engaging academic faculty from the university school and clinical nursing and management staff from our linked partner teaching hospital. This collaborative faculty clinical nursing model involved a number of formal stages, which very importantly must be managed. Firstly, a nursing research strategy was prepared and agreed, by senior nursing faculty from the university and senior nursing management staff from the hospital. A nursing research strategy is pivotal to ensuring that developments take place with an informed and coordinated approach. Integral to the success of the strategy is the development of an embedded culture of nursing research underpinned by capacity building, capability and increased research outputs and identifying nursing research priorities at the hospital. The main thrust of this strategy, therefore, is to help build a clinical nursing environment, where research and clinical practice are all interconnected, and equally valued. The second stage in managing the strategy was to gain approval from both the executive and academic board of the university and the hospital and to promote its significance. The third stage was to establish a Nursing Research Council, which was set out in the strategy. The council was jointly chaired by the Head of the School of Nursing & Midwifery and the Director and Nursing from the hospital, with equal committee membership from school faculty and nursing staff from the hospital. The fourth stage was to implement a hospital-based nursing research priorities study, which was agreed at the first meeting of the Nursing Research Council. The identification of nursing research priorities provided direction and targeting of resources to ensure maximum efficiencies in the use of human and financial capital at hospital and the university. Determining the research, priorities was an objective approach supporting the hospitals strategic goal of pursuing excellence in patient care, and also, the universities approach of working collaboratively with hospital partners in advancing nursing practice through the professional scholarship of nurses. In determining the priorities, a two round eDelphi survey design was conducted. Data were collected from the population of registered nurses at the hospital (N = 716). The respondents from round 1 suggested a total of 1,419 research priority areas, and following analysis of round 2, the top ten nursing research priorities at the hospital were determined. During the fifth stage, the Nursing Research Council identified opportunities to facilitate the development of nursing research projects. It was agreed by the Council that all nursing staff research projects and student sponsored postgraduate students should be guided by the 10 research priority areas. To date, a number of projects are underway, and a project on patient falls is complete and the results will be presented, at an international conference and a paper is in draft form for publication. In conclusion, the nursing profession strives for an evidence-based practice approach, and the way forward is to embed in clinical nursing practice the value of the research approach in finding solutions to problems in uncertain and complex health care environments. The bedside nursing research approach outlined above can provide a successful working model engaging a university and the clinical nursing services of a hospital, in developing a collaborative approach to clinical nursing research.