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• To recognise the importance of nurses understanding research and applying research evidence in their clinical practice
• To understand the motivations and barriers to engaging with research
• To consider opportunities for increasing your engagement with research
Nurses at every level can reflect on their active engagement with clinical research. This article aims to support nurses to understand how they can facilitate and lead research. It provides practical advice to support the integration of research evidence into care delivery and increase the opportunities for patients to participate in clinical research. This is important because patients can benefit from nurses who are knowledgeable, confident and supported in applying research evidence. Furthermore, nurses can support and inform patient choice through increased confidence and competence in engaging with research and implementing research findings. Organisational culture and leadership are also important elements in fostering environments where evidence and research are promoted throughout the nursing workforce.
Nursing Standard. doi: 10.7748/ns.2022.e11738
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestBoth authors are National Institute for Health Research (NIHR) 70@70 Senior Nurse and Midwife Research Leaders. The views expressed in this article are those of the authors and not necessarily those of the NIHR
Hare N, Whitehouse CL (2022) Engaging with research: practical advice for nurses at every level. Nursing Standard. doi: 10.7748/ns.2022.e11738
AcknowledgementsThe authors would like to thank Tracey Gibbs, clinical nurse specialist (oncology) at Norfolk and Norwich University Hospital, and Heather Rostron, senior research nurse and NIHR 70@70 senior nurse research leader at Leeds Children’s Hospital, for reviewing this article and providing constructive feedback before submission
Published online: 04 January 2022
Understanding research and evidence can significantly enhance the provision of optimal care to patients. As the coronavirus disease 2019 (COVID-19) pandemic has demonstrated, research is crucial to providing evidence that vaccines, medicines and any treatment or care interventions are safe and effective (Omary et al 2020) or, conversely, to understand why these are not effective or do not produce the desired outcome.
The COVID-19 pandemic has brought increased attention to healthcare research, demonstrating its value in improving health-related outcomes through the generation of knowledge and development of treatments (Isles-Smith et al 2020). The fundamental aims and components of research have not changed, but its visibility has increased rapidly since the start of the pandemic, with clinical research nurses at the forefront (Jones et al 2020). Since the pandemic has prompted many services to restructure and reconsider their ways of working, it also provides an opportunity to increase nurses’ engagement with research.
Knowledge drawn from research is fundamental to all aspects of nursing practice. Nurses need a robust evidence base to identify optimal care for patients, address knowledge gaps and develop new ways of working. Since nurses closely interact with patients, families and carers, they are well placed to provide insights into people’s care needs and into unanswered research questions (Scala et al 2016, Bridges 2019, Broom et al 2021). The nursing profession is central to gathering, contributing and using research data, as well as applying and disseminating research knowledge (Gibbs and Lowton 2012).
Nurses need to be able to understand research and apply research evidence in their daily practice, but they do not always know how to develop the skills or access the appropriate training to enable them to do so.
This article describes how nurses at every level – regardless of their workplace, role or experience – can reflect on their active engagement with clinical research, what this engagement might entail, and activities they can undertake to ensure that it forms part of their practice.
• Integrating research into nursing practice can contribute to the provision of high-quality care and lead to improved patient outcomes
• Nursing and Midwifery Council registrants are expected to practise in line with the best available evidence and be able to analyse and apply research findings
• Nurses need a robust evidence base to identify the optimal care for patients and develop new ways of working
• Nurses may engage with research for various reasons, including to improve patient care, develop professionally, support organisational goals and/or advance nursing globally
• Research activities can count towards continuing professional development and revalidation, and becoming increasingly research active enables nurses to develop their competence and confidence
The potential benefits of clinical research include: the development of new treatments; healthcare improvements; the minimisation of health inequalities; and economic growth (Health Research Authority 2017, Wellcome Trust 2018, NHS England 2019). In England, national policy puts clinical research at the core of NHS business and emphasises that it is a crucial element of clinical care provision (NHS England 2017, 2019). One of the five key lines of enquiry of the Care Quality Commission (CQC) is to determine whether a healthcare organisation is well led, and participation in research projects is one of the criteria used by the CQC to assess this, as shown in the ‘Trust-Wide Well-Led’ inspection framework (CQC 2018).
One requirement of The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates (Nursing and Midwifery Council (NMC) 2018a) is that registrants must assess people’s needs and deliver or advise on treatment ‘on the basis of best available evidence’. To ‘always practise in line with the best available evidence’, registrants must ‘make sure that any information or advice given is evidence-based including information relating to using any health and care products or services’ (NMC 2018a).
The Standards of Proficiency for Registered Nurses (NMC 2018b) stipulate that all registered nurses have a vital role in providing, leading and coordinating care that is evidence-based – as well as compassionate and person-centred. Providing evidence-based care involves ‘looking at what research has shown to be most effective’ when providing care and treatment to people (NMC 2018b). Therefore, nurses need to demonstrate ‘an understanding of research methods, ethics and governance’ so that they are able to ‘critically analyse, safely use, share and apply research findings’ (NMC 2018b). This in turn requires confidence in understanding and applying research evidence, as well as a workplace culture and leadership that promote an evidence-based approach to care (NHS England and NHS Improvement 2020).
Alongside fulfilling the professional requirements set by the NMC (2018a, 2018b), nurses may have various motivations for participating in research activities and applying research evidence. Examples of these motivations include:
• Improving patient care – a desire to improve the quality of care for the benefit of patients and families (Dimova et al 2018).
• Developing professionally and personally – an aspiration to progress in one’s role and career, the need to fulfil continuing professional development and revalidation requirements, and/or personal interest (Rahman et al 2011, French and Stavropoulou 2016).
• Supporting organisational goals and national strategies – a desire to assist in redesigning or expanding services, fulfil CQC inspection criteria and/or contribute to the work on research priorities detailed in national healthcare agendas (Boaz et al 2015, Harding et al 2017, Afolabi et al 2018, CQC 2018).
• Contributing to nursing globally – a desire to advance nursing and nursing care globally, for example by collaborating in international research projects related to COVID-19 (Coster et al 2018, Calvert et al 2021).
Despite these potential motivations, there are many recognised barriers that prevent nurses from integrating research into their clinical practice. These include: an increasing and sometimes overwhelming demand for services; operational pressures, such as low staffing levels and high patient acuity; and an ever-growing amount of research literature, which can present a seemingly unmanageable array of evidence when time is limited (Al Khalaileh 2016, Aljezawi et al 2019, Moore and Tierney 2019). Further barriers cited by nurses include a lack of knowledge of the research process, a lack of critical appraisal skills, the lack of an academic degree, low confidence in using research evidence, and a lack of support, opportunities and role models in the clinical environment (Kajermo et al 2008, Bahadori et al 2016, Peckham et al 2021). As a consequence, research activities and knowledge may still be viewed by some as an ‘add-on’ and not prioritised as fundamental to routine care delivery.
In its 2017 research plan, NHS England (2017) described how the NHS would focus its research efforts on three areas:
• Supporting the use of evidence in decision-making and translating research into practice.
• Contributing to an NHS environment that fosters research and innovation.
• Driving the direction of research.
Based on these focus areas, the authors of this article propose three corresponding levels of engagement at which nurses can become research active:
• Level 1: awareness – developing one’s research awareness and applying research evidence in clinical practice.
• Level 2: facilitation – facilitating and contributing to clinical research.
• Level 3: leadership – undertaking and leading clinical research, and promoting a positive research culture.
Table 1 provides examples of activities that nurses can undertake to engage with research at each of these three levels. Individual nurses will be able to identify which activities are suitable for them according to their area of practice, role, experience and capacity, as well as the resources available to them.
Focus area from the NHS England (2017) research plan | Level of engagement | Role of nurses | Examples of activities |
---|---|---|---|
Supporting the use of evidence in decision-making and translating research into practice | Level 1: awareness | Developing one’s research awareness and applying research evidence in clinical practice |
|
Contributing to an NHS environment that fosters research and innovation | Level 2: facilitation | Facilitating and contributing to clinical research |
|
Driving the direction of research | Level 3: leadership | Undertaking and leading clinical research and promoting a positive research culture |
|
Nurses’ use of research evidence and participation in research is essential because the quality of patient care cannot be improved solely by research nurses and nurse researchers; it requires the sustained production and application of research evidence by all nurses, teams, departments and healthcare organisations. Patient outcomes can be enhanced by ensuring that existing research findings are applied in practice and by determining what the knowledge gaps are so that further research can be conducted to address these areas (Claxton et al 2015).
There are various benefits of integrating research into nursing practice. For example, there is evidence of an association between the integration of research into clinical practice and improved patient outcomes (Downing et al 2017, Nijjar et al 2017), even for patients who are not directly involved in a research study (Hanney et al 2013, Boaz et al 2015, Ozdemir et al 2015, Carrick-Sen and Moore 2019). It has also been identified that patients admitted to research-active hospitals express greater confidence in staff and report feeling better informed about their condition and treatment compared with those admitted to hospitals that are less research active (Jonker et al 2020). They are also more likely to be offered opportunities to participate in clinical trials. Furthermore, many patients recognise the value of research, since they want to benefit from improved treatments (Sacristán et al 2016, Sonpal et al 2019).
Faced with increasingly complex clinical situations, nurses need to be able to exercise accurate clinical judgement (NMC 2018a, Zieber and Sedgewick 2018). Research activities – such as those listed in Table 1 – can provide nurses at all levels with opportunities to develop this ability by generating mutual learning across professional boundaries and enhancing their understanding of diseases, care pathways and treatments (Shoghi et al 2019). Understanding research and applying research evidence in clinical practice can also assist in bridging the theory-practice gap (Whitehouse 2017).
Applying research evidence in clinical practice and participating in research enables nurses to develop their competence and confidence in:
• Understanding treatments and explaining treatment options to patients.
• Changing clinical practice and improving patient care.
• Engaging with their practice and career development.
• Understanding how research is funded, how it works and its place within healthcare policy.
Nurses can use research activities to count towards revalidation (Attenborough and Abbott 2019, Jackson 2019) and such activities do not have to be onerous or academic. Free training and resources are available through the National Institute for Health Research (NIHR) and other organisations, while local research and development teams can support nurses in their organisation. Regional and national fellowships and internships are available for those who want to take their engagement with research further.
Healthcare organisations can promote a positive research culture by offering and encouraging research activities. Providing staff with some ‘head space’ – that is, the capacity to think clearly without interference – can generate creativity and motivation (Baird et al 2012), which can subsequently improve individual and team performance, as well as staff retention (The Health Foundation 2012, Barrett and Robinson 2018).
To address the barriers that may prevent their staff from engaging with research, healthcare organisations can establish career pathways in research and give staff time to pursue such careers (Peckham et al 2021). Fostering a positive research culture in healthcare organisations can drive engagement and produce future research leaders (Hulcombe et al 2014, Barratt and Fulop 2016). Leaders acting as role models and research champions for a positive research culture could inspire newly registered nurses and nurses progressing in their careers to engage with research.
Having a research champion within the team, department or organisation is beneficial in that respect (Henshall et al 2021). Taking these steps can enable a workplace culture where research is the norm to emerge (Gibson 2019).
Knowledge drawn from research is fundamental to all aspects of clinical practice, and nurses may engage with research to improve patient care, develop professionally, support organisational goals and/or advance nursing globally. The NMC expects all nurses to have a minimum level of research proficiency, but some of them may be unsure about how to engage with research and may therefore find it challenging to be research active.
Nurses at all levels can undertake a range of activities to develop their research awareness, apply research evidence in their daily practice, contribute to clinical research or lead research projects. Their engagement with research also needs to be supported by a workplace culture and leadership that promote an evidence-based approach to care.
National Institute for Health Research – The Role of the Clinical Research Nurse
www.nihr.ac.uk/documents/the-role-of-the-clinical-research-nurse/11505
National Institute for Health Research – 70@70 Senior Nurse and Midwife Research Leader Programme
www.nihr.ac.uk/documents/7070-nihr-senior-nurse-and-midwife-research-leader-programme/22750
Health Research Authority – UK Policy Framework for Health and Social Care Research
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