Promoting excellence in care through R&D · responsibilities.R&D should be seen as an essential and...

Promoting excellence in carethrough research and developmentan RCN position statement

“..while compassionate care is

important, compassionate but

ill-informed care may be harmful”.Royal College of Nursing, 2003

Professor Veronica Bishop, Editor, Nursing TimesResearch, London

Professor Steve Campbell, Professor of NursingPractice, Northumbria University, Head of NursingResearch and Practice, City Hospitals SunderlandNHS Trust, Sunderland

Dr Ann Caress, Lecturer, School of Nursing,Midwifery & Health Visiting, University ofManchester, Manchester

Sue Hinchliff, Director, Accreditation Unit, RoyalCollege of Nursing Institute, London

Claire Johnston, Director of Nursing & Performance,Camden & Islington Mental Health & Social CareNHS Trust, London

Ann McMahon, RCN Research & DevelopmentAdviser, RCN R&D Co-ordinating Centre, School ofNursing, Midwifery & Health Visiting, University ofManchester, Manchester

Colin Rees, Project Leader, All Wales NM & HVResearch, The Welsh Assembly, Cardiff

Professor Sydney Salmon, Director of Nursing &Primary Care, Ulster Community and HospitalsH&SS Trust, Belfast

Theresa Shaw, Chief Executive, Foundation ofNursing Studies, London

Margaret Smith, Director of Nursing, North GlasgowUniversity Hospitals NHS Trust, Glasgow

Professor Heather Waterman, Professor of Nursingand Ophthalmology, School of Nursing, Midwifery &Health Visiting, University of Manchester,Manchester

Val Woodward, Senior Lecturer, Institute of HealthStudies, University of Plymouth, Plymouth

Promoting ExcellenceWorking Party

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Promoting excellence in care

Contents

1. Introduction 2

2. Action 2

3. Position statement 3

4. Conclusion and recommendations 6

References 7

Appendix 1: Working party membership 8

Appendix 2: Good practice examples 8

Promoting excellence in carethrough research and development:an RCN position statement


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Introduction

Excellence in patient care is dependent on bothresearch and development (R&D). Without R&D,health care practitioners would not be able to buildthe sound evidence base needed to underpinpractice. This applies equally to the knowledge andskills necessary to develop their practice and newknowledge and understanding.

The nursing professions1 make up almost 80% of thehealth care workforce (UK Parliament, 1999), buttheir potential to deliver excellence in care has beenthwarted by:

✦ shortcomings in the body of professionalknowledge

✦ limited research and development capacity andcapability in nursing throughout the UK (HigherEducation Funding Council for England, 2001 andScottish Executive Health Department, 2002)

✦ a nursing culture that does not universally valueresearch and development.

This situation led a group of nurses from across theUK to form a working party to consider how toexpand the nursing knowledge base and R&Dcapacity, and importantly how to create a culture inthe profession that promotes these values.

Action

The working party of nurses from across the UKconsidered how to:

✦ expand the knowledge base on which nursingdraws

✦ extend the research and development capacity andcapability in nursing

✦ identify and develop a culture that values,promotes, sustains and rewards research anddevelopment in nursing.

As a result of their discussions, the working partypublished a draft position statement for consultation(McMahon, 2003) which encouraged nurses toparticipate in the debate, to feedback on initialproposals and to provide examples of good practice.

The responses to that draft have shaped the followingstatement in this document. It outlines the beliefs andvalues of nurses on the role of R&D in nursing, andhow this agenda could be progressed and by whom.Examples of good practice are included in theAppendix to facilitate professional networking and tohighlight the potential of investment in R&D innursing.

1 Nurses, midwives and health visitors.

1 2

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2 The Code of professional conduct for nurses exists toprotect the public through professional standards(Nursing and Midwifery Council, 2002). It clearlyasserts: “As a registered nurse, midwife or healthvisitor, you are personally accountable for yourpractice.” The code also specifically states that as aprofessional nurse, midwife or health visitor “you havea responsibility to deliver care based on currentevidence, best practice and, where applicable,validated research when it is available”. One of theways to achieve this is through the maintenance of up-to-date professional knowledge and competence.

Position statement

The following statement highlights how research anddevelopment are essential in the delivery ofexcellence in patient care.

Statement

If the public is to be properly served through systemsthat ensure that nurses are both accountable andknowledgeable, there must be a commitment to theidentification of gaps in nursing knowledge, to thegeneration of new knowledge and application ofknowledge in practice.

Although some robust nursing research is available toinform practice, there is a shortfall of nursingresearch available in relation to many nursingactivities. Further, there is much good practice, whichis not examined and disseminated widely enough tobenefit the larger population (see, for example, Kitsonand Currie, 1996).

Nursing needs its own unique knowledge base andmust take responsibility for developing this, ratherthan drawing on knowledge from other disciplines,relying on other professional groups and a genericR&D agenda. The standard of R&D in nursing shouldbe equal to that expected of any health professionalgroup, and should conform to statutory requirementsfor each of the four UK countries.

To deliver evidence-based practice, in line with theclinical governance agenda (Currie, Morrell, &Scrivener, 2003), research and development must berecognised to have equal importance and value.Nurses and nursing cannot advance their contributionto effective health care without both (see Departmentof Health, 2002; Department of Health Social Servicesand Public Safety, 2002; Welsh Health Circular, 2003;and The Scottish Office NHS Scotland, 2003).

Nursing needs to embrace a philosophy of practicethat sees participation in R&D as a legitimate nursingactivity. Additionally, it is essential that there is asupportive culture in nursing and health care, withthe appropriate infrastructure. Achieving thisrequires the commitment of a range of health carestakeholders (see Figure 1).

While the commitment of all health carestakeholders, identified in Figure 1, is key to thisagenda, individual nurses, health care providers(HCPs) and higher education institutions (HEIs) arealso pivotal to this process.

Promoting excellence in R&D in nursing will developknowledgeable and accountable practitioners2 whowill advance the quality of their nursing practice as aresult.

Figure 1: Stakeholders

Excellencein care

Foundationof Nursing

Studies

RoyalCollege

of Nursing

Funders ofhealth care

education anddevelopment

HighereducationinstitutionFunders of

health careR&D

Healthcare

provider

Nursing &Midwifery

Council

Nurse

3


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Table 1: Requirements of the individual nurse

a) Can identify gaps in knowledge and pressingclinical needs to inform priority setting.

b) Understands the dynamic relationship betweenR&D and clinical effectiveness.

c) Can be questioning, reflexive and a criticalthinker (can “think outside the box”).

d) Demonstrates how R&D is an integral part oftheir professional development portfolio andnursing career pathway.

e) Builds R&D into their personal developmentplan/appraisal.

f) Can identify and appropriately utilise R&Dleadership and support structures in theirorganisation.

g) Can identify and appropriately utiliselibrary/IT/web resources in their organisation.

h) Contributes to the recording of R&D activitywithin corporate R&D databases and returnsas appropriate.

i) Contributes to the reporting and disseminationof R&D activity as appropriate.

j) Demonstrates a commitment to using researchin practice and sharing knowledge.

k) Actively contributes to/supports initiativesdesigned to link/bridge R&D and clinicalpractice (for example, shared governance).

l) Understands the importance/relevance of linkswith HEIs* for R&D.

m) Endeavours to bring a nursing perspective intoother disciplines’ R&D activity.

* Higher education institution (HEI).

Table 1 shows the requirements needed in theindividual nurse, dependent on their roles andresponsibilities. R&D should be seen as an essentialand integral part of nursing practice. Therefore, allnurses should be given the opportunity to participatein R&D activities at an appropriate level to theirroles, experience and qualifications.

Table 2: Requirements of the health care provider

a) Works in partnership with HEIs and localpeople to develop a strategy, with clearlydefined priorities for nursing research and thedevelopment of practice.

b) Understands HEIs’ funding arrangements andstrategic/operational imperatives.

c) Works in partnership with HEIs in knowledgegeneration and in effective, sustained change inpractice.

d) Can demonstrate links between R&D strategyand clinical governance and modernisationagendas.

e) Can demonstrate how commitment to R&Dhas impacted on organisation-wideperformance through performance assessmentsuch as accreditation/benchmarking etc.

f) R&D skillmix is known ie, numbers of nurseswith Bachelors, Masters, M.Phil / PhD, otherresearch training – completed and in progress.

g) Has R&D skills development plan with targetsand resources.

h) Has clearly defined research career pathway(s).

i) Has a clearly defined and appropriatelyqualified R&D leadership position with clearlines of influence in both the HCP and an HEI.

j) Provides nursing staff with access tolibrary/IT/Web resources in the workplace andinformation literacy skills developmentopportunities.

k) Recognises that R&D activities are an integralpart of professional development and providesdevelopment opportunities and support forR&D and innovation in nursing.

In order to develop leaders in R&D throughout healthcare settings, a viable clinical and academic careerpathway should be pursued by a section of the nursingworkforce. If health care providers are to ensurestandards of practice and value for money, there mustbe a commitment to the development of staff who canboth participate in and lead R&D activities (see therequirements of HCPs outlined in Table 2 ).

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l) Provides nursing staff with access to researchsupport structures (for example, for puttingtogether research bids, research supervision).

m) Can identify capacity building intent withinR&D in progress.

n) Has knowledge of nursing involvement inTrust R&D activity with details of sources offunding.

o) R&D activity in nursing can be identified asintegral part of corporate / business plans.

p) Can demonstrate outputs from nurses involvedin research in last five years throughpublications, conference presentation and localpress.

q) Can demonstrate links with other HCPs forNursing R&D mentorship purposes.

r) Can demonstrate how nursing R&Dstrategy/development plan does or willintegrate with its overall organisational R&Dstrategy.

s) Works with HEIs to develop and sustainintegrated career pathways, with appraisal.

t) Expects engagement of its research staff withHEIs.

Finally, the partnership between HCPs and highereducation is vital to ensuring the success of R&D innursing. It is assumed that knowledge derived fromhigher education has academic rigour. Genuinepartnerships must ensure that they generateknowledge that makes a difference to patient care,and a commitment to supporting both research anddevelopment in nursing practice (see therequirements of HEIs outlined in Table 3).

Table 3: Requirements of the higher educationinstitution

a) Works in partnership with HCPs* to developR&D priorities.

b) Understands HCPs’ governance arrangementsand strategic/operational imperatives.

c) Provides development opportunities andsupport for R&D and innovation in nursing.

d) Can articulate how research makes adifference to the HCPs it works with.

e) Provides research training and supportscapacity building for HCPs.

f) Works with HCPs to develop and sustainintegrated career pathways, with appraisal.

g) Supports provision of R&D leads for HCPs.

h) Encourages engagement of its research staffwith HCPs.

i) Supports development of information literacyin nurses.

j) Provides flexible opportunities for nurses tointegrate R&D into their professionaldevelopment.

k) Facilitates provision of research supportstructures within HCPs.

l) Ensures that all R&D activity involving HCPsis appropriately reported/logged.

m) Facilitates/supports use of research inpractice and sharing of knowledge.

n) Works in partnership with those leading thegeneral nursing agenda.

* Health care providers (HCP)


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Conclusion andrecommendations

One way to increase the number of nursesparticipating in, and leading R&D activities is todevelop national R&D standards and guidelines inclinical practice for NHS trusts and other HCPs. Thiscould be used as part of a dynamic, developmentalsystem of acknowledging excellence in care throughR&D.

It is fundamental that there should be access to, andmaintenance of, the whole range of R&D skillsrequired to contribute to the development andintegration of evidence into practice.

There are a number of clinically-based professorialpositions and nurse consultant posts in R&Dthroughout the UK. These senior nurses should beidentified and promoted as leaders dedicated to thedevelopment and maintenance of an R&Dinfrastructure and culture. At a minimum theyshould have well established and clearly defined linksbetween their HCP and HEIs. In some cases the postsare joint appointments, and the R&D strategies ofboth the HCP and HEI are fully integrated. Examplesof R&D leadership and good practice are provided inthe Appendix.

Leaders with the necessary skills to fulfil thesecomplex roles should be equipped throughinnovative curricula including, for example,professional doctorate programmes. R&D leadershiproles should be promoted across the UK, andunderpinned by nurses engaged in integrated clinicalacademic career pathways.

3 Increasingly Government funding for R&D isdependent on demonstrable benefits to the economyand to society. It is therefore incumbent on highereducation institutions to demonstrate that they aregenerating knowledge that is making a difference.

Identifying and benchmarking best practice wouldlead to the establishment of standards and a dynamicand developmental system. This would acknowledgeand promote good practice and excellence in R&D. Awide range of stakeholders would benefit from this.For example:

✦ public and patient groups that wantimprovements in public health, and patients’experiences and outcomes

✦ HCPs responsible for clinical governance that wantto improve external assessments of their qualityperformance

✦ HEIs involved in academic, industrial, or publicservice partnerships that want to demonstratethat they are generating knowledge that will makea difference3.

The commitment of all of the stakeholders (seeFigure 1) is an essential condition to promoteexcellence in nursing care through R&D.

For further information, visit www.man.ac.uk/rcn/promotingexcellence

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References

Currie L, Morrell C J, & Scrivener R (2003) Clinicalgovernance: an RCN resource guide. London: RCN.Publication code 002 036.

Department of Health (2002) Improvement, expansionand reform: the next three years priorities and planningframework 2003 – 2006.www.dh.gov.uk/publicationsAndStatistics/publications(and search policy and guidance)

Department of Health Social Services and Public Safety(2002) Developing a regional strategy for the health andpersonal social services 2002 – 2022: a consultationdocument. Belfast: DHSSPS.

Higher Education Funding Council for England (2001)Promoting research in nursing and the allied healthprofessions. London: HEFCE. Research report 01/64.www.hefce.ac.uk/Pubs/hefce/2001/01_64.htm

Kitson A, Currie L (1996) Clinical practice developmentand research activities in four district healthauthorities. Journal of Clinical Nursing, vol. 5, no. 1. pp41-51.

McMahon A (2003) Promoting excellence in research.Nursing Standard, vol. 17, no. 32, pp. 38-41.

Nursing and Midwifery Council (2002) Code ofprofessional conduct. London: NMC.

Royal College of Nursing (2003) Defining nursing.London: RCN. Publication code 001 998.

Scottish Executive Health Department (2002) Choicesand challenges. The strategy for research anddevelopment in nursing and midwifery in Scotland.Edinburgh: SCHD.

The Scottish Office NHS Scotland (2003) Partnership forcare. Scotland’s health white paper. Edinburgh: TheStationery Office.

United Kingdom Parliament (1999) Memorandum bythe RCN of the UK. London: The Stationery Office.www.parliament.the-stationery-office.co.uk/pa/cm199899/cmselect/cmhealth/38/8121016.htm

Welsh Health Circular (2003) Annual priorities andplanning guidance for the service and financialframework and health improvement programmes 2003-04. Cardiff: NHS Wales, WHC .


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Appendix 2:Good practice examples

1. Hull & East Riding Community NHSTrust

Name of trust: Hull & East Riding Community NHSTrust

Name of contact: Allyson Kent

Phone: 01482 343 125

Email: [email protected]

Description of trust

The trust provides a range of health and social careservices to people across Hull and the East Riding ofYorkshire, a population of approximately 575,000.Over 2,500 people work for the trust to deliverservices in people’s own homes, in local clinics,health centres, local authority premises and schoolsto provide convenient care near to where people live.

Services include: children’s services; dental; learningdisability services; mental health; sexual health;specialist substance misuse; therapy services; alliedhealth professionals; chaplaincy; continence service;psychology; and services to aid independent livingand stroke services.

Infrastructure to support R&D

The trust has an R&D strategy and an effectivenessstrategy.

The trust has established and supported a NursingResearch Support Unit (NRSU) in partnership withthe University of Hull. Two research nurses wereinitially employed and the NRSU produced aconsultation report and action plan. Due to costpressures this was reduced to one post and the workof the NRSU is currently being evaluated.

The trust also has established a multi-disciplinarypostgraduate researchers’ support network for thosestaff undertaking or intending to undertake researchdegrees. There are currently six nurse members ofthis network.

Appendix 1:Working party membership

Professor Veronica Bishop, Editor, Nursing TimesResearch, London

Professor Steve Campbell, Professor of NursingPractice, Northumbria University, Head of NursingResearch and Practice, City Hospitals SunderlandNHS Trust, Sunderland

Dr Ann Caress, Lecturer, School of Nursing,Midwifery & Health Visiting, University ofManchester, Manchester

Sue Hinchliff, Director, Accreditation Unit, RoyalCollege of Nursing Institute, London

Claire Johnston, Director of Nursing & Performance,Camden & Islington Mental Health & Social CareNHS Trust, London

Ann McMahon, RCN Research & DevelopmentAdviser, RCN R&D Co-ordinating Centre, School ofNursing, Midwifery & Health Visiting, University ofManchester, Manchester

Colin Rees, Project Leader, All Wales NM & HVResearch, The Welsh Assembly, Cardiff

Professor Sydney Salmon, Director of Nursing &Primary Care, Ulster Community and HospitalsH&SS Trust, Belfast

Theresa Shaw, Deputy Director, Foundation ofNursing Studies, London

Margaret Smith, Director of Nursing, North GlasgowUniversity Hospitals NHS Trust, Glasgow

Professor Heather Waterman, Professor of Nursingand Ophthalmology, School of Nursing, Midwifery &Health Visiting, University of Manchester,Manchester

Val Woodward, Senior Lecturer, Institute of HealthStudies, University of Plymouth, Plymouth

Appendices

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Examples of clinically-based research anddevelopment projects/activity that havemade a difference to patients’experience/outcomes

The trust produces an annual directory ofinnovations and good practice projects, many ofwhich are clinically-based, nurse-led and make adifference to patients.

Some examples from this year’s directory are:

✦ coping Skills Enhancement Circuit

✦ implementation of 65+ screening programme forpreviously referred and assessed clients withorganic difficulties

✦ evaluation of ongoing medication managementclinic

✦ coping with voices education group

✦ client perception of staff morale

✦ crisis management and co-ordination

✦ non-clinical fatigue and pain management inoccupational health

✦ evidence-based patient information

✦ carer’s group evaluation

✦ total bowel management.

Any Internet links

Not yet, but potentially.

Contact Allyson Kent for more information.

2 Barnsley District General Hospital NHS Trust

Name of trust: Barnsley District General HospitalNHS Trust

Name of contact: Jeff Bailey

Phone: 01226 730000 X 2096 Bleep 242



The trust serves a population of 240,000. Servicesoffered to the public include: medical; surgical; andwomen’s and children’s specialties. There are 771(690.80 wte) nurses and midwives, and 290 (235.36wte) health care assistants and auxiliaries.


The trust has used part of its allocation of R&Dfunding to employ two research nurses to act in ageneric role supporting multi-disciplinary researchactivity. The trust has also built up close links withthe University of Sheffield through the Trent Institutefor Health Services Research (TIHSR). These nursesare supported by more experienced researchers fromSheffield University seconded to the trust part-timethrough the TIHSR. After three years thisarrangement is being formalised through a jointtrust and TIHSR appointment, who will continue tosupport the research nurses.

The research nurses have gained confidence inresearch and IT skills, have undertaken master’sdegrees, and have enabled the trust to increase itsresearch output. The availability of nurses in thetrust with research skills has also been enhanced bysecondment to various small projects (see below),some of which have also been enabled by trust R&Dfunding.


Here are some examples:

1. Barriers to using research in nursing project

As part of the strategy to promote clinical nursingresearch, a project was devised to assess barriersto using research in nursing at BDGH, and tomeasure research skills in nurses. The project was


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conducted by a clinical nurse, seconded part-time,funded by the trust R&D department, andsupported by researchers from SheffieldUniversity. Outputs include increased skills andconfidence for the nurse researcher, a possiblepublication, and evidence on which to basesubsequent nursing research development work.

2. Evaluation of the heart manual for cardiacrehabilitation

This project was funded by the local Health ActionZone to promote better access to cardiacrehabilitation. A health visitor was seconded to theproject full-time for ten months, and completedthe project under supervision of a researcher fromSheffield University. Acting on the results, cardiacrehabilitation policy is being reviewed and theheart manual introduced for all AMI patients. Thehealth visitor who carried out the research isundergoing further research training. The resultshave been disseminated at local and nationalconferences, and a publication is in preparation.

3. The FED Project

This project was funded by PPP Healthcare topromote a better nutritional understanding forelderly patients following a medical incident. Theinterim results show a need for better nutrition forthe elderly. This long running project has formedan increased awareness of research among clinicalnurses because of recruitment practices on allmedical wards and departments

4. SURUSS

This nurse-led project has now been completedand has led to a nationally used series of methodsfor determining antenatal Downs Syndrome. Theresults have been presented nationally andinternationally.

5. Corneal Donation

This small study has led to a nurse practitioneridentifying a potential for retrieving corneas andhas since become the trust’s corneal retrievalnurse. The study was part of the New ResearcherTraining Programme that the trust joined as partof a Trent Institute initiative

6. Domestic Violence against Pregnant Women

This nurse-led project initiated in the trust has led

to increased awareness, and highlighted a need foraction in this problem area.

Any Internet links

We are developing a website initially for useinternally to be followed by an external link.

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3. Southern Derbyshire Acute HospitalsNHS Trust

Name of trust Southern Derbyshire Acute Hospitals NHS Trust

Name of contact: Judith Tanner

Phone: 01332 340131 X 6725


Description of trust The Southern Derbyshire Acute Hospitals NHS Trustincorporates the Derbyshire Royal Infirmary, DerbyCity General Hospital, Derbyshire Children'sHospital, Derby Chest Clinic and the Grove Hospital.

We have been rated a three-star acute trust by theDepartment of Health for the past three years andprovide a wide range of services including: generalmedical; surgical; maternity; rehabilitation care; andaccident and emergency services. We have a total of1,235 beds and serve a population of over half amillion people throughout Southern Derbyshire.

The trust employs over 6,500 staff from doctors andnurses to housekeepers and porters, with an annualbudget of around £200 million. This year the trustwill see and treat over 600,000 people as inpatients,outpatients, emergency patients and day cases.


Research posts

The trust employs a lead for nursing research whosesalary is funded by charitable trust funds. The trustalso employs a lead for midwifery research whosesalary is funded by the NHS R&D Levy. The lead fornursing research is managerially responsible to theR&D Manager and reports to the director of nursing.This post holder also sits on the Nurses andMidwives Advisory Council, which is the trust’smonthly strategic meeting for its most senior nurses.By sitting in both departments, nursing research isfirmly embedded in both nursing and the R&Ddepartments. The research lead is skilled inundertaking research, supervising research anddisseminating research studies.

We are currently negotiating the possibility ofimplementing nursing researcher/practitioner posts.These posts will allow staff to combine working inclinical practice with undertaking practice-based

research. They will enable us to develop newresearchers and form part of a career pathway forstaff. These post holders will be supported toundertake research qualifications.

Research strategy

Nursing research is addressed in two complementarystrategies: the Nurses, Midwives and TherapistsResearch and Practice Development Strategy; and theTrust’s Research and Development Strategy.

Nursing has teamed up with Midwifery, Therapy andPractice Development to present a combined Nurses,Midwives and Therapists Research and PracticeDevelopment Strategy. The overall purpose of thisstrategy is to deliver evidence-based patient-centredcare.

While the trust promotes a multi-professionalapproach in the trust’s R&D strategy, nursingresearch is highlighted as requiring specific attentionto promote capacity building activities.

Initiatives to support research in the trust

We run a number of initiatives in the trust to supportnursing research. These include:

✦ Research and Practice Development SupportScheme

This scheme is designed to help nurses, midwivesand therapists undertake a piece of research andimplement their findings in practice. Nurses who areundertaking the scheme are given two hours perweek for a year to undertake a research project andalso allowed to attend four training workshops. Thetraining workshops focus on practical skills such asgaining ethical approval, writing for publication,designing PowerPoint presentations, and how to getresearch findings into practice. All the nurses on thisscheme have two supervisors: a research lead; and apractice development nurse. The practicedevelopment nurses assist with implementing theirfindings into practice. At the end of the scheme thenurses present their research at the trust’s annualResearch and Practice Development Conference.

✦ Nurses, Midwives and Therapists Research andPractice Development Conference

This conference is held annually and presents around25 speakers. The speakers are nurses, midwives andtherapists who have undertaken some researchactivities in the past year.

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✦ Research Interest Group

This is an electronic newsletter, which is compiled bythe Lead for Nursing Research and is distributedevery two weeks to over 100 research-interestednurses, midwives and therapists throughout thetrust. The newsletter provides research-relatedinformation such as funding and trainingopportunities relevant to trust staff. The first sectionin the newsletter provides information on nurseswho have, for example, had an article published,given a conference paper or received funding.

✦ Recognition for research achievements

We endeavour to recognise research achievementssuch as changes in practice resulting from researchstudies, publications, conference papers and fundingawards. Each nurse who achieves one of thesesuccesses receives a letter from the Director ofNursing congratulating them on their achievement.This recognition does not cost much but can havequite an impact on the recipients. Some nurses whohave received these letters keep them in theirpersonal portfolios and in one of our paediatricwards they are displayed in the sister’s office.

In addition, nurses who are undertaking someresearch activity are featured in the hospitalmagazine and the electronic research newsletter.

Research is one of the headings on the nursing staffappraisal form. This shows that research is valued bythe trust and considered to be part of the nurse’s role.

Research outcomes

Changed or informed practice is the most importantoutcome for a research project. By focusing onchanges in practice we emphasize the relationshipbetween research and practice development andstress that research is about improving patient careand not merely an academic exercise. Some examplesof our research projects are given in the followingsection.

We also expect all nurses who are undertakingresearch to disseminate their findings throughpublications and conference papers and we providesupport to enable them to do so. In the past year(2002-2003) we have had over 30 articles acceptedfor publication.

Being awarded funding is another indicator of our

research activity. In the past year (2002-2003) fourstudies were awarded external funding and one studywas awarded internal funding.

Links

Internal

To provide a co-ordinated approach to research-based practice we have found it important to closelylink research and practice development. We holdjoint meetings between research staff and practicedevelopment staff to ensure that research feeds intopractice development and that practice developmentfeeds into research.

Like many other trusts, staff find it difficult todifferentiate between research, audit and serviceevaluation. We have found it helpful, therefore, tohave close links with the Audit Committee andService Evaluation to pick up projects which havebeen submitted to the wrong department. Tofacilitate this the lead for Nursing Research also sitson the Audit Committee and the Service EvaluationPanel.

External

We have links with our local universities, primarycare and acute trusts. For example, representatives ofboth our local universities attend regular Researchand Practice Development Steering Group meetings.We also have regular formal meetings withrepresentatives from the primary care trusts inSouthern Derbyshire and are in contact with theresearch leads at the other acute trusts inNottinghamshire and Derbyshire.

Joint appointments

We are currently discussing the possibility of havingjoint research appointments with one of our localuniversities.


Ideally all nursing research projects conducted in thetrust focus on improving patient care and meetinglocal or national needs. The following five studiesprovide examples of projects that have changed, orwill change, our clinical practice.


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✦ Temperature measurement in paediatrics

Contrary to the nurse’s initial impression, the studyfound children preferred tympanic measurement.

✦ Pre-operative shaving

When the study is completed the trust will be able toimplement a research-based pre-operative shavingpolicy and the review will be published in theCochrane Library.

✦ Bladder spasm in patients undergoing trans-urethral surgery

Preliminary statistical analysis suggests that bladderspasm is linked to length of surgery, insertion of acatheter and is most effectively treated by Buscopan.The findings will be used to develop a protocol tomanage pain relief for patients undergoing trans-urethral surgery.

✦ Surgical hand scrubs prior to surgery

A surgical sister is undertaking a systematic reviewof hand scrubbing and use this review to develop atrust policy.

✦ Patients, visitors and staff preferences for hospitalvisiting times

The main finding showed that neither patients,visitors or nursing staff considered open visiting tobe their first preference for a visiting policy.

Any Internet links

The nursing research strategy is not currentlyavailable online but the lead for Nursing Researchwill be pleased to discuss any aspect of nursingresearch at Southern Derbyshire Acute HospitalsNHS Trust.

4. Royal Hospitals Trust, Belfast

Name of trust: Royal Hospitals Trust, Belfast

Name of contact: Prof Brendan McCormack

Phone: 028 9063 5332

Email:[email protected]


The Royal Hospitals is Northern Ireland’s biggest andbest known hospitals complex. Almost two-thirds ofthe Northern Ireland population live within 40minutes travel from the 70 acre site, which is situatedonly a few minutes drive from Belfast city centre.Made up of four linked hospitals - the Royal Victoria,Royal Jubilee Maternity Service, Royal BelfastHospital for Sick Children and the Dental Hospital -the Royal treats more than half a million peopleevery year and has a worldwide reputation forexcellence. Almost all the regional, medical, surgicaland dental specialty services for Northern Irelandare provided by the Royal hospitals. The Royal hasmore than a fifth of all acute beds in NorthernIreland. We have a staff of some 6,000 including aquarter of all hospital doctors in the province and2,500 registered nurses and midwives.


In 2000 the Royal appointed a Professor/Director ofNursing Research and Practice Development (PD) asa joint appointment with the School of Nursing,University of Ulster. The post is set at ADNS leveland has authority to lead nursing development andresearch in the trust. A strategy for nursing R&D hasbeen developed as an integrated approach toresearch, practice development and clinicaleducation. A team of 22 people has been recruited tofacilitate this, working across all specialties in thetrust. The Royal has led the development of theResearch Governance Framework for R&D inNorthern Ireland, and nursing research is an integralcomponent of this. The Director of Nursing Research& PD works collaboratively with the trust’s Directorof Research. Four jointly appointed researchassociate posts have been created between the Royaland the University of Ulster. Two other joint posts(fixed-term) have been created between the trustand the Royal College of Nursing (RCN) andNorthern Ireland Practice and Education Council

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(NIPEC). In addition, in 2003 the Royal invested inexcess of £100,000 in developing a NursingDevelopment Centre in the trust from where theNursing Development Team work: Director ofNursing Research & PD; Head of Clinical Education;Practice Development Co-ordinator; NursingDevelopment Facilitators (11); researchassociates/project officers (5); consultant nurses (2);and administrative support (2). R&D grants inexcess of £600,000 have been secured forprogrammes of work in the trust in the last twoyears. The strategy is being evaluated on an ongoingbasis and as a part of the trusts accountabilityframework.


For example, some projects include:

1. Person-centred nursing project

This is a quasi-experimental design with a PDintervention. The project is in its second year andis due for completion in 2005 (jointtrust/university funding)

2. Development of person-centred practice inperioperative nursing

This is an emancipatory practice developmentproject (trust funded). The project started in2002 and is a five-year programme of work.

3. Development of person-centred rehabilitationpractices in services for older people(trust/university funding)

This is a three-year emancipatory practicedevelopment programme. The programme hassecured two external competitive grants forparticular strands of work:

✦ BUPA Foundation: development of amethodology for the collection of usernarratives as an indicator of care quality witholder people (£80,000)

✦ R&D office NI/HRB Republic of Ireland (jointlywith University College, Cork): identification ofthe contextual indicators that inhibit the use ofevidence among nurses in the promotion ofcontinence with older people (£160,000).

4. Development of a Clinical Careers Framework forNurses (the REACH Programme) (DHSSPS &joint post with the RCN – £120,000):

An integrated realistic evaluation programme andaccreditation framework.

5. Development of person-centred nursing insurgical settings (joint project with Belfast CityHospital) (DHSSPS funding £150,000):

A two-year programme of emancipatory practicedevelopment and research work with 60 clinicalleaders across eight surgical specialties. Thisproject started in 2003.

Any Internet links

Trust strategy documents are not placed online.However, copies are available by contacting ProfessorBrendan McCormack.

5. Epsom and St Helier NHS Trust, St George’s Healthcare NHS Trust, Joint Faculty of Health and Social CareSciences, and Kingston University/StGeorge’s Medical School

Name of trust:Epsom and St Helier NHS TrustSt George’s Healthcare NHS TrustJoint Faculty of Health and Social Care Sciences, andKingston University/St George’s Medical School

Name of contact: Sharon Hamilton, Head of NursingResearch

Phone: 020 8296 2870



Epsom and St Helier were formed from the merger oftwo district general hospitals and associated cottagehospitals. St Helier hospital is located on the edge ofsouth London, while Epsom hospital is locatedapproximately ten miles away in Surrey. The trusthas approximately 900 beds and 1,800 nurses.

St George’s hospital is a large teaching hospital inTooting, south London with a medical school andfaculty of health and social care sciences on campus.It has approximately 900 beds and 1,500 nurses.


Each trust and the university have active R&D

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committees, each of which have senior nursemembers. The Head of Nursing Research is amember of the Sutton/ Merton/ Epsom/ Kingstonand Richmond ethics committee.

In 1997, St. Helier hospital appointed a seniorlecturer in nursing research in collaboration withKingston University to undertake a PhD and leadnursing research. The R&D committee funded thepost following a competitive bidding process.

In 2002, Epsom and St Helier NHS Trust/St George’sHealthcare NHS Trust and the Joint Faculty of Healthand Social Care Sciences collaboratively appointed aHead of Nursing Research to develop theinfrastructure across the organisations to supportnursing research. The Head of Nursing Researchchairs a Joint Nursing and Midwifery ResearchDevelopment Group, which has 22 members acrossthe organisations and the primary care trusts.Members include all nurse consultants and clinicalspecialist nurses actively involved in leading theirown research. Each member of the group isresponsible for leading and developing research intheir area and reports back to the group. The longerterm aim of this group is to expand to become anursing research network across south west London.

St George’s Health Care NHS Trust has appointed apart-time senior nurse (R&D) to support the work ofthe Head of Nursing Research.

The Head of Nursing Research will be publishing anursing research strategy.

The Head of Nursing Research leads a Priorities andNeeds programme of research in nursinginterventions.

Infrastructure such as dictaphones, transcriptionmachines and SPSSPC have been purchased for thespecific use of nurses in their research.

Examples of clinically based research anddevelopment projects/activity that havemade a difference to patients’experience/outcomes

Example of work include:

Hamilton, S. The management of change: anevaluation of the use of a multifaceted strategy toimplement best practice in stroke assessment. PhDstudy, research-based at St Helier hospital. Improved

the completeness of the nursing assessment from 9%pre-implementation of guidelines to 74% post-implementation.

Brooks, W., Whittet, A. An evaluation of a moving andhandling teaching programme for nurses on a strokeunit. Study to improve the moving and handlingskills of all nurses (including health care assistants)on a stroke unit. Outcomes being evaluated.

Farnell, S. A study to compare the accuracy andreliability of non-invasive methods of measuringtemperature in critically ill adults. Study based in theintensive care unit at St George’s hospital.

Dawson, D., Farnell, S. A study to explore nurses’experiences during their first six months of working incritical care.

A number of research secondment opportunities areavailable for nurses at the trusts. An E grade nursefrom the stroke unit is currently on secondment toundertake data collection in a research project. An Hgrade nurse is taking up a secondment with theuniversity.

The Head of Nursing Research is collaborating onresearch projects with colleagues internal andexternal to the organisations. For example, a projectis underway to describe convention physiotherapy instroke rehabilitation with the Professor ofRehabilitation at St George’s Medical School.

All members of the Joint Nursing and MidwiferyResearch Development Group are encouraged tosubmit abstracts of their research for conferences,particularly the RCN Research Society conference.

Any Internet links

A web page is being developed at each trust.

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6 East Kent Hospitals NHS Trust

Name of trust: East Kent Hospitals NHS Trust

Name of contact: Vicki May

Phone: 01227 766877 ex 73695



East Kent Hospitals provides acute hospital servicesat three main hospitals, but has approximately 1,634beds over five hospital sites (William HarveyHospital, Ashford; Queen Elizabeth Queen MotherHospital, Margate; Kent & Canterbury Hospital,Canterbury; Royal Victoria Hospital, Folkestone; andBuckland Hospital, Dover). The geographical areacovers approximately 50 miles, representing bothrural and town communities.

The trust serves a population of 600,000 andemploys approximately 8, 000 employees, of which3,500 are in nursing.

There are approximately 150 clinical areas that arecurrently in 15 directorates (although restructuringis imminent).

We have a one star rating.


In July 2002 under the umbrella of ‘sharedgovernance’, the Nursing & Quality Directorate set upits first Nursing & Midwifery Research &Development Forum. Approximately 15 to 20members come from a wide range of clinical areasand represent a mixture of nursing and midwiferygrades. The forum also has members fromsupporting areas such as the local university, thelibrary services, audit and the trust R&Ddepartment. The forum exists to promote nursingand midwifery research activity and change clinicalpractice. The forum does this by:

✦ informing people about research appraisalworkshops and accessing clinical researchdatabases

✦ providing support and supervision to thoseundertaking a research project

✦ helping people write high quality researchproposals in line with national and localpriorities.

✦ peer review research proposals

✦ putting people in touch with possible fundingsources

✦ facilitating the pathway through the trust R&Ddepartment and Ethics Committee processes

✦ helping and promoting the dissemination ofresearch findings via presentations at nationalconferences and journal publications.

Managerial support for attending these meetings hasbeen secured by all members.

In addition to the forum, the trust has a small R&Ddepartment (1 manager, 1 secretary and a part-timeclinical director). They oversee all governance issuesand have a national perspective on all NHS research.They support multi-professional research, althoughmedical research still predominates.

All trust employees have access to the intranet, Emailand the Internet. However, clinical staff rarely havetime to access this. Additionally, all staff can gainaccess to excellent library resources.

In the trust there is also a small central NursingPractice Development Team, consisting of five WTE.They support all nursing staff in a variety of ways,leading on trust-wide initiatives such as essence ofcare benchmarking, which have strong links to thedevelopment aspects of R&D and changing practice.The trust also supports several practice developmentnurses working in some directorates/specialties, anda few joint appointments with the local university inthe way of lecturer/practitioner posts.


The forum has only been in existence for one year,but its achievement levels are high, at this stage notnecessarily resulting in differences to patientexperiences but in producing foundation blocks tobuild on, as no central co-ordination of nursingresearch existed previously.

Work initially started with establishing a strategyand action plan.

We then had to let people know that the forumexisted. This was achieved as part of the widerlaunch of ‘shared governance’, and, additionally, we

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produced an information leaflet.

We then had to look at simplifying the researchprocess as too many people were confused and didnot know how to access the right help at the righttime. We produced a flow chart and this is sent outwhen a nurse makes enquiries to the trust R&Ddepartment, and by all members if approached forhelp. Additionally this is available on the forum’s webpage on the intranet.

We have set about increasing the number of nursesavailable to peer review research projects that comethough the trust R&D department from three tonine, and this course will be offered bi-yearly. Thiscourse has also formally established criteria for bothwhat peer reviewers need in terms ofqualifications/experience and what is looked for bythem in a project. This reviewing criteria has alsobeen made available to those writing projects so theycan set about achieving the criteria in a fair and openmanner.

We are establishing a database of all research anddevelopment activity. This has, however, been verydifficult over such a large area, battling with a cultureof not to share information and people notrecognising that what they are doing is research ordevelopment. It is anticipated that this will get easieras the forum’s presence becomes more established.

Additional achievements have been tofacilitate/mediate two separate projects at the ethicsstage.

The forum’s final achievement is being part oforganising a nursing and midwifery conference forthe trust. The philosophies of dissemination arebeing shared through 40 poster and 16 verbalpresentations of development initiatives andchanging practice that have occurred over the pasttwo years. Many of the presenters are first-timers,and the conference is free to 250 nurses andmidwives of all grades from A to H+. This will be anexcellent example of sharing practice and willhopefully show some people that changing practiceis achievable in challenging times and thatdissemination has to be part of any research anddevelopment process to prevent the wheel forumbeing reinvented

Any Internet links

All our information is available on the trust intranet,so it is not available outside of the trust. If peoplecontact me I will be more than happy to passinformation on electronically and we, as a forum,will need to address this in the future.

[email protected]

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7. Barts and the London NHS Trust

Name of trust: Barts and the London NHS Trust

Name of contact: Dr Angela Grange

Phone: 020 7882 7275



Barts and the London NHS Trust is one of the largestemployers in east London with over 6,600 staffproviding services to more than half a millionpatients each year. There are nearly 1,000 doctorsand dentists, 1,948 qualified nurses, 107 qualifiedmidwives and 197 qualified allied health professions(AHPs) working with patients at: The Royal London;St Bartholomew’s; and the London Chest Hospitals.The trust provides the capital’s largest traumaservice, and is one of five cancer centres servingLondon and the home counties. The renal service isthe largest in Europe, and the trust is a nationalcentre for specialties such as retinoblastoma andcolo-rectal surgery. There are seven clinicaldirectorates with over 40 medical, surgical andemergency specialties, many of which are at theleading edge.


A draft nursing and midwifery strategy has beenwritten and is awaiting approval by the trust NursingPolicy and Maternity Governance Boards (a systemof nursing and midwifery shared governance is inoperation in the trust). It is hoped that this strategywill be combined with the therapy R&D strategy inthe near future to form a joint strategy as the aimsand objectives are similar. Collaborative workingbetween nursing, midwifery and AHPs is alreadyunderway to develop a joint strategy.

An inter-professional research team has beenapproved by the Nursing Policy Board and TherapyEvidence-Based Practice Group, to support theimplementation of the R&D strategy. Approval forthis is being sought from the Maternity GovernanceBoard. The inter-professional team will comprisenursing, midwifery and AHP representation as wellas research experts and academics from partnerinstitutions. It will be key to putting aspects of theR&D strategy into operation.

A research facilitator for nurses, midwives and AHPs

was appointed by City University in September 2003,based in the trust R&D Department. The main aimof the research facilitator project is to build researchcapacity within nursing, midwifery and AHPs. Thisis being approached by developing a caseload ofnurses, midwives and AHPs to support in threeareas: 1) getting started in research; 2) acquiringfunding for research; and 3) disseminating researchresults. An inter-professional researcher network isalso being established in the trust to support noviceresearchers.

There are four consultant nurses and one consultantmidwife in the trust. There are several lecturerpractitioner posts and newly emerging researchpractitioner posts. These posts are jointappointments with City University.

Access to IT needs improving, but all wards have aPC for staff to access evidence. There are goodtraining facilities provided by the Medical andDental Library and School of Nursing Libraries insearching for evidence. An Electronic InformationLiaison Officer has been in post for ten months tosupport staff at the London Chest Hospital to findevidence to support their practice.

There are many clinical nurse specialists andpractice development nurses in the trust and thesenurses work closely with the Senior Nurse forPractice Development, and the Clinical EffectivenessUnit to evaluate outcomes of their care. The essenceof care benchmarks have been implemented trust-wide, and are being continuously monitored via thePractice Development Unit (PDU). The PDU hasclose links with the RCN, which is involved in theimplementation of the PD strategy in the trust, andthe RCN Leadership programme is well established.

The trust has close links with the WorkforceDevelopment Confederation in developing trainingprogrammes and career pathways.


There is a strong research culture in nursing in a fewtrust departments, for example, renal, cardiac, cancerand infection and immunity. Nurses working inthese directorates regularly present their research atnational and international conferences. There are

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many nurses working with medical colleagues onclinical trials research. The trust has its own ClinicalResearch Centre.

Rather than list all projects recently conducted bynurses, we will highlight some specific projects ledby nurses that have impacted on/or have thepotential to impact on clinical practice:

✦ a research project was conducted in conjunctionwith City University, which explored the care ofolder people in relation to reasons for delayeddischarges. The results of this research led to theimplementation of a new role – care co-ordinator,with improved length of stay outcomes

✦ a research study piloted the introduction of a newway of working within medical teams on generalmedical wards, from medical firms visiting wardsto ward-based medical teams. Improvements incommunication and co-ordination of carebetween medical and other colleagues wereobserved

✦ a research study investigating cardiovasculardisease risk has the potential to challenge thebasis of the CHD National Service Framework.Preliminary results suggest that the current policyon the use of lipid lowering drugs for patientswith, or at risk from, heart disease needs to bereviewed if expensive drug treatment is to bemost appropriately targeted

✦ an evaluation of the mental health services inA&E revealed a whole series of problems faced bytrust staff caring for people with complex physicaland mental health needs. This resulted in thedevelopment of a further research proposalfocusing on the mental health needs of generalmedical patients. The project also mapped out thetraining needs of staff involved in liaison nursing,and an MSc course has been validated by CityUniversity to meet these needs

✦ a research study investigated the conditions,human and environmental, that make drug errorsmore likely to occur, and the checking proceduresthat are most effective in preventing errors. Theresults led to the implementation of a MedicinesNurses Forum, which meets monthly and isattended by ward nurses to discuss problems andidentify solutions. A nurse is also working withthe Clinical Physics Department to establish anequipment library

✦ a research study to compare hospital and home IVantibiotic therapy in adults with cystic fibrosis.

Any Internet links

R&D information is accessible via the trust intranetpages with information on: funding and trainingopportunities; research ethics application process;research governance issues; dissemination; finance;and research support for nurses, midwives andAHPs.

Information on the research facilitator project fornurses, midwives and AHPs is available via the trustintranet and City University websitewww.city.ac.uk/barts/research/depts/hcru/researchers/grange_a.htm

Once approved the nursing and midwifery R&Dstrategy will be available on the trust intranet pages.Unfortunately the trust R&D department does nothave an external web address to advertise thestrategy, but it will be freely supplied on request.

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8. City Hospitals Sunderland NHS Trust

Name of trust: City Hospitals Sunderland NHSTrust

Name of contact: Prof Steve Campbell

Phone: 0191-565-6256 Ext. 42692



The trust is an acute-based organisation with a fullrange of medical and surgical specialties for a largegeneral hospital, with some community paediatricservices and child psychiatry. The trust is the secondlargest organisation in the north east of England, andhas a reputation for high quality services. It has hada three star evaluation for the last three years, andimpending foundation status. On the various sites(largely now at Sunderland Royal Hospital), there are975 acute beds and 18 ITU/HDU beds. The trust hadan income of £167.7 million in 2002/03. There are4,600 staff of whom approximately 1,300 areregistered nurses, with a further 600 auxiliarynurses/HCAs. The trust cared for:58,179 inpatients;259,265 outpatients;36,073 day cases;234,498 AHP contacts;and had 106,238 A&E attendances.This is well above the national average for thepopulation served.


Systems to support R&D are complex and have beenestablished over a number of years. Central in thesesystems is the Nursing Practice Research Centre(NPRC), led by the Professor of Nursing Practice,who is also the Head of Nursing Research andDevelopment in the Trust. The NPRC is part of theDirectorate of Nursing and Quality in the trust, andthe Head of Nursing R&D, partnered with the Headof Nursing/Chief Matron, are the two senior supportposts to the Executive Director of Nursing andQuality.

The staffing in the NPRC comprises: the Head ofNursing R&D, who is a joint appointment (50:50)with Northumbria University; and a principallecturer (vacant 20:80) again with NorthumbriaUniversity (earlier in the development this post was

at SL level and with University of Sunderland).Currently Dr Helen Hancock is a research associateworking on a variety of projects with a particularfocus of clinical decision-making.

Other joint appointments exist in the trust. Forexample, there are two lecturer practitioners withNorthumbria University, one in cancer care, and theother in ICCU, who has a largely teaching function.There are five nurse consultants in the trust, who areprofessionally accountable to the Director of Nursingvia the Head of Nursing R&D. All of these aredeveloping or are established researchers.

The NPRC has strong insider relationships with anumber of integral services with the trust, theseinclude: Organisational Development andModernisation (OD&M); Clinical Governance; andResearch and Development. The NPRC complementsit partners, such as conducting a number of researchprojects that could be termed modernisation, withOD&M, providing qualitative input with clinicalgovernance, as well as providing qualitative expertisein partnership with R&D, and for governancepurposes.

The Head of Nursing R&D sits on a number of keycommittees in the trust and outside: the R&DStrategy Group; the Scientific Review Committee; theEducation and Training Steering Group; the LREC;the Steering Group of the TPCT; the ResearchConscious Workforce sub-group of the TPCT; theSHA Nurse Consultant Review Committee; theModernisation Team; and not least the StrategicNursing and Midwifery Forum, which from time-to-time he chairs on behalf of the Director of Nursing.

While being an integral part of City Hospitals, theNPRC is also allied with Northumbria University’sNursing, Midwifery, and Allied Health Professions(NMAHP) R&D unit. Members of the NPRC havemembership of NMAHP. This relationship provides adegree of wider academic community, and hasafforded secondments into projects, and access topatients and staff at CHS for research purposes.

With colleagues from clinical governance, and R&D,the NPRC provides support to the nurses in the trustfor a variety of research projects, whether fordegrees, clinical need, or academic interest. TheNPRC leads the Research Appreciation course for thetrust with support from colleagues. This provides

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insight into methods and access and governanceissues – a study has been carried out into itseffectiveness and alternative forms of delivery.


Each year the trust holds a nursing conference inpartnership with the Royal College of Nursing andthe University of Sunderland. This gives locally-based researchers the opportunity to present theirwork in preparation for national and internationalconferences.

✦ Patient journey project

Part of the modernisation work, 12 services haveparticipated ranging from Acute CoronarySyndrome, COPD to the last 72 hours of life oflung cancer patients. Resulted in more patient-focused services

✦ Essence of care

The NPRC leads this project with one of thematrons, and is a good example of collaborationwith the Practice Development Nurse team

✦ Health care assistants

Are they prepared to take on a wider role, andthose that have undertaken more training – whatimpact are they making with their colleagues andpatients? £17,500 from Culyer funds

✦ LEO – impact study

Similar methodology, about whether LEO makes adifference to colleagues working with the G gradenurses. £17, 500 from WDC funds

✦ Nurse Practitioner training and evaluation

A study into the development of nursepractitioners to cover junior doctors’ hoursreductions on nights, development of the training,as well as evaluation of impact. £42,000 fromDepartment of Health (via CHS)

✦ Strategy enmeshed into the Modern Nursingproject, and into the R&D strategy

Where the NPRC leads the Delivery of Careprogramme.

Any Internet links

Contact Steve Campbell for details of the projectslisted above.

9. Christie Hospital NHS Trust

Name of trust: Christie Hospital NHS Trust

Name of contact: Linda Scott, Senior Nurse,Professional Development

Phone: 0161 446 3006



The Christie Hospital is the largest single-site cancercentre in Europe. It provides care for people withcancer and their families across the GreaterManchester and Cheshire Cancer Network, thelargest of the UK’s Cancer Networks. As well asspecialist clinical provision, the trust incorporatesthe Paterson Institute for Cancer Research. The trustis a recognised world leader in cancer care andresearch. Services provided include chemotherapy,radiotherapy and surgery, as well as rehabilitativeservices, such as physiotherapy, occupationaltherapy, and supportive & palliative care. The trusthas some innovative services, including art therapyand a range of complementary therapies.


The trust has a research strategy, which highlightsthe links between research and excellence in clinicalcare and which also recognises the need for supportfor nursing and the allied health professions (AHP),as fledgling research disciplines in the trust. Theresearch strategy has been produced within a tri-partite framework of clinical governance, educationand research strategy development.

Nurse and AHP-led research activity in the trust hasbeen recognised through incorporation into one ofthe trust’s named research programmes – Improvingthe Patient Experience. The nursing element of thisprogramme includes eight trust nurses who areworking towards research degrees (MPhil andabove), a nurse consultant who has a Macmillanresearch scholarship and a £0.25 million CommunityFund research grant, joint with a local hospice (StAnn’s) and two local higher education institutions(HEI), the universities of Manchester and Salford, to

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explore complementary therapy service provision inthree cancer centres.

The trust has a Nurse Learning and DevelopmentUnit, headed by the Senior Nurse for ProfessionalDevelopment. The NLDU includes support forclinical practice (pre and post-registration),professional development and researchcapacity/capability building. We have a well-established shared governance programme, withthree councils (Human Resources, Education &Research and Practice Development), as well as anover-arching Co-ordinating Council. Sharedgovernance activity is multi-professional andincludes representation from a local HEI (theUniversity of Manchester). Our clinical oncologyservices are currently working towards accreditationas a Practice Development Unit. There are more than30 research nurses working in the trust, some ofwhom are under-taking nurse-led research as well assupporting others’ research.

The trust has excellent links and collaborations withthe Manchester-based Macmillan Research andDevelopment Unit (formerly Macmillan PracticeDevelopment Unit). Activities include secondment oftrust nurses to unit research projects, facilitatingresearch capacity and capability building, andinvolvement of unit staff in the supervision of higherdegrees by research.

Four years ago, a joint post was established betweenthe School of Nursing, Midwifery and Health Visitingat the University of Manchester and the trust. Thishalf-time post, involving secondment of a post-doctoral researcher from the university, wasspecifically for facilitation and promotion of nursingR&D in the trust. Appointment at this level ofresearch experience, and good links with the HEIhave been central to the success of the role. The remitof the post has expanded considerably since itsinception and includes individual support (eg fornurses wishing to apply for/undertaking a higherdegree, individuals wishing to undertake serviceevaluation); supporting and promotion productionof public output (papers, conference submissions,applications for R&D awards); facilitation of sharedgovernance projects; promotion of research andevidence-based practice (eg through criticalappraisal skills teaching, workshops on writing for

publication and submitting conference abstracts);and development of research proposals. The post-holder has also had a strategic role, leading ondevelopment of trust nursing research strategy andcontributing to the education strategy and researchgovernance initiatives, particularly regarding userinvolvement in research. In recognition of theimportance of multi-professional working, the post-holder, although mainly focusing on nurses, alsoprovides support for allied health professionals andjunior medical colleagues. The recent appointment ofa Reader in Cancer and Supportive Care at theUniversity of Manchester has provided an excitingopportunity to review the role and we hope that asubstantial programme of externally funded nursingresearch will develop over the next couple of years.

Examples of clinically based research anddevelopment projects/activity that havemade a difference to patients’experiences/outcomes

There are numerous shared governance projects thathave influenced patient care, including: developmentof care pathways (eg for patients experiencing spinalcord compression and those with brain tumours);evidence-based care plans (eg oral care); anevidence-based cancer-specific wound careformulary. One multi-professional sharedgovernance project, an evaluation of the use of ozonetreatment for radiotherapy skin reactions, hasresulted in a publication and is being developed as aproposal for external funding. The trust has a veryactive clinical benchmarking group, undertakingwork connected with the essence of care initiative,and the team recently won a Nursing Times award fortheir work regarding nutrition. A trust nurse isundertaking ground-breaking work exploring use ofaromatherapy massage in patients receiving highdose chemotherapy. A multi-professional group,including three trust nurses, recently secured £0.25million to undertake a multi-centre evaluation ofcomplementary therapy service provision. Two trustnurses are central to work on exploring late effects ofcancer treatment. There are a number of audit andservice evaluation projects being led by nurses,including: an audit of cardiopulmonary resuscitationdocumentation, which has led to a review of trustCPR guidelines; an evaluation of a chair massageservice for carers; and an evaluation of a nurse-led

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telephone follow-up service, which has recently beenaccepted for publication.

Any Internet links

The research strategy is available to Christie staff viathe trust intranet. We have R&D pages on the trust’sweb site, which are accessible to individuals outsidethe trust.

Quality education for quality care

May 2004

Published by the Royal College of Nursing 20 Cavendish SquareLondon W1G 0RN

020 7409 3333

Publication code 002 279

The RCN represents nurses andnursing, promotes excellence inpractice and shapes health policies.

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