- Email: [email protected]
Benefits to ED Nurses Participating in Interdisciplinary Research
UNDERSTANDING RESEARCH
BENEFITS TO ED NURSES PARTICIPATING INTERDISCIPLINARY RESEARCH
IN
Authors: Kathleen E. Zavotsky, MS, RN, CEN, ACNS-BC, CCRN, Lisa A. Wolf, PhD, RN, CEN, FAEN, Kathy M. Baker, PhD, RN, NE-BC, Margaret J. Carman, DNP, ACNP-BC, CEN, Paul R. Clark, PhD, MA, RN, Kevin Langkeit, MSN, RN, Gail Lenehan, EdD, MSN, FAEN, FAAN, and Michael Moon, PhD, MSN, RN, CEN, CNS-CC, FAEN, New Brunswick, NJ, Des Plaines, IL, Richmond, VA, Durham, NC, Louisville, KY, Bountiful, UT, Boston, MA, and San Antonio, TX Section Editors: Lisa A. Wolf, PhD, RN, CEN, FAEN
E
NA has taken the position since 1989 that, The exchange of ideas and shared learning among disciplines may improve interdisciplinary collegiality and increase the legitimacy of the research. Research collaboration among nurses, physicians, pharmacists, social workers, mental health specialists, and other health care disciplines will continue to be an important focus in the development of safe and effective solutions to our health care system’s most pressing problems. 1
Interdisciplinary research has been defined as “two or more investigators holding different professional degrees who are actively engaged in the design, implementation, and analysis of clinical or health services research.” 2 Broadly defined, interdisciplinary research is work that involves researchers working jointly, but from the perspective of their own specialty areas, to address a common problem. Kathleen E. Zavotsky, Member, West Central New Jersey Chapter, is Director, Nursing Research, Advanced Practice and Education, Robert Wood Johnson University Hospital, New Brunswick, NJ. Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL. Kathy M. Baker, Member, Central Virginia Chapter, is Nursing Director, VCU Health System, Richmond, VA. Margaret J. Carman, Member, Cardinal Chapter, is Assistant Professor, Duke University School of Nursing, Durham, NC. Paul R. Clark, Member, Kentuckiana Chapter, is System Educator, Norton Healthcare Institute for Nursing, Louisville, KY. Kevin Langkeit, Member, Timpanogos Chapter, is Emergency Department Director, Intermountain Medical Center, Bountiful, UT. Gail Lenehan, Member, Mayflower Chapter, is Clinical Nurse Specialist, Massachusetts General Hospital, Boston, MA. Michael Moon, Member, San Antonio Chapter, is Associate Professor, University of the Incarnate Word, School of Nursing, San Antonio, TX. For correspondence, write: Lisa A. Wolf, PhD, RN, CEN, FAEN, 915 Lee Street 110 Middle Street, Des Plaines, IL 60016; E-mail: [email protected]. J Emerg Nurs 2014;40:512-4. 0099-1767 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2014.06.008
512
JOURNAL OF EMERGENCY NURSING
This problem can address a specific population (geriatrics, pediatrics, perinatal, etc…) or a process (STEMI management, stroke teams, sepsis protocols). In the geriatric context, as described by Shulte et al. 2, “an interdisciplinary approach across a range of problems has demonstrated the capacity of this type of research to enhance the effectiveness of interventions, thereby improving health outcomes and the quality of life of individuals”. As in all aspects of health care, collaboration with multiple disciplines is vitally important to help ensure both safe practice and care daily. Nurses practicing in emergency departments collaborate with other disciplines including physicians, physician assistants and nurse practitioners in order to be able to help meet the patient’s most immediate needs. Collaborating with other disciplines allows emergency nurses to make sound clinical decisions that will ultimately affect patient outcomes. In addition to medical providers, emergency nurses partner with multiple disciplines such as social workers, chaplains, physical therapists, child life specialists and nurses from various specialties outside of the emergency department in order to be able to meet the needs of their patients. Given the potential to advance excellent emergency care of individuals and families, multidisciplinary studies should be considered if appropriate for emergency nursing research. Overall, building interdisciplinary research capabilities takes time, attention, and support. 2 When developing research protocols, involving collaborative disciplines that could give perspective on the problem can increase the usefulness of the study findings for overall emergency care. The purpose of this article is to describe the best approach to and the potential benefits of interdisciplinary nursing research in an emergency department. Benefits
Once a research question/problem has been identified and the literature has been initially reviewed, it is important that the researcher determine the key stakeholders and if any interdisciplinary partners would be able to help add value to the study; potential contribution may include expertise in methodological approaches or financial/economic support. An example of this may be if a nurse researcher is developing a
VOLUME 40 • ISSUE 5
September 2014
Zavotsky et al/UNDERSTANDING RESEARCH
study to analyze secondary data from a large data set of all patients who have fallen in an emergency department over a period of 10 years. An appropriate collaborator might be someone from physical therapy or medicine, or even pharmacy, to think about possible research questions. The wider perspective that an interdisciplinary group can provide can broaden the scope of the project in a way that benefits patients, both in structuring the research question, and examining implications. In this same example, the number of cases to be reviewed is large (600 or more) and requires extensive data analysis. In order to help offset the cost of the data analysis the nurse researcher may reach out to a local university to find a faculty member who has expertise in statistical analysis with large data sets and offer to work jointly with them. This faculty member may also have students who can assist the project by entering data into software analysis programs. Seeking additional professional resources such as expert faculty will provide the bedside nurse researcher with the necessary resources to complete the study and develop a partnership for future studies. Including other colleagues in the initial discussion of the research problem may yield a fuller understanding of the problem, which is important as the research questions are developed and the methods used to answer those questions are decided upon. For example, if a nurse researcher would like to explore the emergency nurses’ perception of the effects of palliative care in the emergency department on the patient and the family, collaborating with members of a palliative care team may help to make the study more robust and meaningful across the disciplines. People who have expertise in specific practice areas generally have a passion for their specialty and can be willing to partner with other disciplines in order to improve the care of patients. For emergency nurses who work in academically affiliated emergency departments, there may be opportunities to work with interdisciplinary team members, whose career advancement is dependent upon being involved in research and other scholarly activities, increasing both the number of opportunities and the variety of disciplines with which to collaborate. The final phases of any research study are the dissemination of the results, findings and implications for practice. The final phase of a research project involves developing and submitting abstracts for posters and oral presentations at national conferences as well as submitting manuscripts to peer-reviewed journals. This process can be time consuming and oftentimes would benefit from writers who have previous experience in this process. Professionals who work in academic settings welcome partners from other specialties, and professional organizations value
September 2014
VOLUME 40 • ISSUE 5
projects that are multidisciplinary and therefore make scholarly work more appealing. Special Considerations
When nurses collaborate with other disciplines it is critical that professionalism and the basic principles of ethical research be followed. If the emergency nurse researcher believes that a research study would benefit from an interdisciplinary approach, the appropriate professionals should be invited to discuss the study and be invited to be part of the design, data collection, and data analysis processes. When a team approach is being used in a study, decisions need to be made before the study is initiated to help eliminate any conflict at the end of the process. These decisions include which researcher is going to be the principal investigator (PI) or the one primarily responsibility for the study, the number and type of coinvestigators, and who will be the first author, second author, etc. for any publications. Each investigator should be given a role and responsibility throughout the study, such as: data collection, obtaining consent, and recruitment, etc. If there is any question about the responsibility of any research team member, minutes can be taken during meetings and a formal contract or a memorandum of agreement should be considered. This is also true when other disciplines invite emergency nurses to assist with research. For the most part this invitation should be taken as a compliment and should be viewed as a wonderful scholarly opportunity. Emergency nurses bring value and expertise to a research project and can help provide depth and breadth to any study that involves patient care. Conclusion
Interdisciplinary teams that include clinicians benefit from these kinds of collaborative research experiences, in that novice nurse researchers experience first-hand the process of hands-on study design, data collection, data analysis, and dissemination of findings. Through this collaborative process, nurses better understand the procedure for designing methods to answer clinical inquiry questions. When the nurse is an experienced researcher, he or she brings a disciplinary focus to the work, whether he or she is functioning as the Principle Investigator or a co-researcher. Involving different disciplines provides a wider perspective of a clinical problem, thus interdisciplinary research benefits practicing nurses through a multifaceted process of clinical inquiry. The emergency nurse researcher may decide that a study can be developed, implemented and analyzed without any input from any other discipline; this decision should be based on knowledge of the research process. However, as a novice researcher it may be
WWW.JENONLINE.ORG
513
UNDERSTANDING RESEARCH/Zavotsky et al
prudent to have a mentor to help provide guidance throughout the study. The mentor-mentee relationship needs to be clear and it may include a nurse or another member of the interdisciplinary team. As in care delivery, there is tremendous benefit in having a multidisciplinary approach to emergency nursing research projects. In order to ensure that roles and responsibility are clearly understood by the research team, professionalism and mutual respect for what each discipline will contribute must be the underpinnings for a successful study. An interdisciplinary approach may make any nursing research study more robust and applicable to the patient population under study, while at the same time the process of conducting research with a team of healthcare profes-
514
JOURNAL OF EMERGENCY NURSING
sionals can help to establish better inter-professional relationships. These relationships can have lasting positive effects on patient outcomes and help to advance the science of emergency nursing practice. REFERENCES 1. Emergency Nurses Association Position Statement on Collaborative and Interdisciplinary Research. http://www.ena.org/SiteCollectionDocuments/ Position%20Statements/CollaborativeandInterdisciplinaryResearch.pdf. Accessed May 1, 2014. 2. Schultz D, Keyser D, Pincus HA. Developing Interdisciplinary Centers in Aging: Learning From the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers Initiative. Acad Med. 2011;86 (10):1318-24.
VOLUME 40 • ISSUE 5
September 2014
BENEFITS TO ED NURSES PARTICIPATING INTERDISCIPLINARY RESEARCH
IN
Authors: Kathleen E. Zavotsky, MS, RN, CEN, ACNS-BC, CCRN, Lisa A. Wolf, PhD, RN, CEN, FAEN, Kathy M. Baker, PhD, RN, NE-BC, Margaret J. Carman, DNP, ACNP-BC, CEN, Paul R. Clark, PhD, MA, RN, Kevin Langkeit, MSN, RN, Gail Lenehan, EdD, MSN, FAEN, FAAN, and Michael Moon, PhD, MSN, RN, CEN, CNS-CC, FAEN, New Brunswick, NJ, Des Plaines, IL, Richmond, VA, Durham, NC, Louisville, KY, Bountiful, UT, Boston, MA, and San Antonio, TX Section Editors: Lisa A. Wolf, PhD, RN, CEN, FAEN
E
NA has taken the position since 1989 that, The exchange of ideas and shared learning among disciplines may improve interdisciplinary collegiality and increase the legitimacy of the research. Research collaboration among nurses, physicians, pharmacists, social workers, mental health specialists, and other health care disciplines will continue to be an important focus in the development of safe and effective solutions to our health care system’s most pressing problems. 1
Interdisciplinary research has been defined as “two or more investigators holding different professional degrees who are actively engaged in the design, implementation, and analysis of clinical or health services research.” 2 Broadly defined, interdisciplinary research is work that involves researchers working jointly, but from the perspective of their own specialty areas, to address a common problem. Kathleen E. Zavotsky, Member, West Central New Jersey Chapter, is Director, Nursing Research, Advanced Practice and Education, Robert Wood Johnson University Hospital, New Brunswick, NJ. Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL. Kathy M. Baker, Member, Central Virginia Chapter, is Nursing Director, VCU Health System, Richmond, VA. Margaret J. Carman, Member, Cardinal Chapter, is Assistant Professor, Duke University School of Nursing, Durham, NC. Paul R. Clark, Member, Kentuckiana Chapter, is System Educator, Norton Healthcare Institute for Nursing, Louisville, KY. Kevin Langkeit, Member, Timpanogos Chapter, is Emergency Department Director, Intermountain Medical Center, Bountiful, UT. Gail Lenehan, Member, Mayflower Chapter, is Clinical Nurse Specialist, Massachusetts General Hospital, Boston, MA. Michael Moon, Member, San Antonio Chapter, is Associate Professor, University of the Incarnate Word, School of Nursing, San Antonio, TX. For correspondence, write: Lisa A. Wolf, PhD, RN, CEN, FAEN, 915 Lee Street 110 Middle Street, Des Plaines, IL 60016; E-mail: [email protected]. J Emerg Nurs 2014;40:512-4. 0099-1767 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2014.06.008
512
JOURNAL OF EMERGENCY NURSING
This problem can address a specific population (geriatrics, pediatrics, perinatal, etc…) or a process (STEMI management, stroke teams, sepsis protocols). In the geriatric context, as described by Shulte et al. 2, “an interdisciplinary approach across a range of problems has demonstrated the capacity of this type of research to enhance the effectiveness of interventions, thereby improving health outcomes and the quality of life of individuals”. As in all aspects of health care, collaboration with multiple disciplines is vitally important to help ensure both safe practice and care daily. Nurses practicing in emergency departments collaborate with other disciplines including physicians, physician assistants and nurse practitioners in order to be able to help meet the patient’s most immediate needs. Collaborating with other disciplines allows emergency nurses to make sound clinical decisions that will ultimately affect patient outcomes. In addition to medical providers, emergency nurses partner with multiple disciplines such as social workers, chaplains, physical therapists, child life specialists and nurses from various specialties outside of the emergency department in order to be able to meet the needs of their patients. Given the potential to advance excellent emergency care of individuals and families, multidisciplinary studies should be considered if appropriate for emergency nursing research. Overall, building interdisciplinary research capabilities takes time, attention, and support. 2 When developing research protocols, involving collaborative disciplines that could give perspective on the problem can increase the usefulness of the study findings for overall emergency care. The purpose of this article is to describe the best approach to and the potential benefits of interdisciplinary nursing research in an emergency department. Benefits
Once a research question/problem has been identified and the literature has been initially reviewed, it is important that the researcher determine the key stakeholders and if any interdisciplinary partners would be able to help add value to the study; potential contribution may include expertise in methodological approaches or financial/economic support. An example of this may be if a nurse researcher is developing a
VOLUME 40 • ISSUE 5
September 2014
Zavotsky et al/UNDERSTANDING RESEARCH
study to analyze secondary data from a large data set of all patients who have fallen in an emergency department over a period of 10 years. An appropriate collaborator might be someone from physical therapy or medicine, or even pharmacy, to think about possible research questions. The wider perspective that an interdisciplinary group can provide can broaden the scope of the project in a way that benefits patients, both in structuring the research question, and examining implications. In this same example, the number of cases to be reviewed is large (600 or more) and requires extensive data analysis. In order to help offset the cost of the data analysis the nurse researcher may reach out to a local university to find a faculty member who has expertise in statistical analysis with large data sets and offer to work jointly with them. This faculty member may also have students who can assist the project by entering data into software analysis programs. Seeking additional professional resources such as expert faculty will provide the bedside nurse researcher with the necessary resources to complete the study and develop a partnership for future studies. Including other colleagues in the initial discussion of the research problem may yield a fuller understanding of the problem, which is important as the research questions are developed and the methods used to answer those questions are decided upon. For example, if a nurse researcher would like to explore the emergency nurses’ perception of the effects of palliative care in the emergency department on the patient and the family, collaborating with members of a palliative care team may help to make the study more robust and meaningful across the disciplines. People who have expertise in specific practice areas generally have a passion for their specialty and can be willing to partner with other disciplines in order to improve the care of patients. For emergency nurses who work in academically affiliated emergency departments, there may be opportunities to work with interdisciplinary team members, whose career advancement is dependent upon being involved in research and other scholarly activities, increasing both the number of opportunities and the variety of disciplines with which to collaborate. The final phases of any research study are the dissemination of the results, findings and implications for practice. The final phase of a research project involves developing and submitting abstracts for posters and oral presentations at national conferences as well as submitting manuscripts to peer-reviewed journals. This process can be time consuming and oftentimes would benefit from writers who have previous experience in this process. Professionals who work in academic settings welcome partners from other specialties, and professional organizations value
September 2014
VOLUME 40 • ISSUE 5
projects that are multidisciplinary and therefore make scholarly work more appealing. Special Considerations
When nurses collaborate with other disciplines it is critical that professionalism and the basic principles of ethical research be followed. If the emergency nurse researcher believes that a research study would benefit from an interdisciplinary approach, the appropriate professionals should be invited to discuss the study and be invited to be part of the design, data collection, and data analysis processes. When a team approach is being used in a study, decisions need to be made before the study is initiated to help eliminate any conflict at the end of the process. These decisions include which researcher is going to be the principal investigator (PI) or the one primarily responsibility for the study, the number and type of coinvestigators, and who will be the first author, second author, etc. for any publications. Each investigator should be given a role and responsibility throughout the study, such as: data collection, obtaining consent, and recruitment, etc. If there is any question about the responsibility of any research team member, minutes can be taken during meetings and a formal contract or a memorandum of agreement should be considered. This is also true when other disciplines invite emergency nurses to assist with research. For the most part this invitation should be taken as a compliment and should be viewed as a wonderful scholarly opportunity. Emergency nurses bring value and expertise to a research project and can help provide depth and breadth to any study that involves patient care. Conclusion
Interdisciplinary teams that include clinicians benefit from these kinds of collaborative research experiences, in that novice nurse researchers experience first-hand the process of hands-on study design, data collection, data analysis, and dissemination of findings. Through this collaborative process, nurses better understand the procedure for designing methods to answer clinical inquiry questions. When the nurse is an experienced researcher, he or she brings a disciplinary focus to the work, whether he or she is functioning as the Principle Investigator or a co-researcher. Involving different disciplines provides a wider perspective of a clinical problem, thus interdisciplinary research benefits practicing nurses through a multifaceted process of clinical inquiry. The emergency nurse researcher may decide that a study can be developed, implemented and analyzed without any input from any other discipline; this decision should be based on knowledge of the research process. However, as a novice researcher it may be
WWW.JENONLINE.ORG
513
UNDERSTANDING RESEARCH/Zavotsky et al
prudent to have a mentor to help provide guidance throughout the study. The mentor-mentee relationship needs to be clear and it may include a nurse or another member of the interdisciplinary team. As in care delivery, there is tremendous benefit in having a multidisciplinary approach to emergency nursing research projects. In order to ensure that roles and responsibility are clearly understood by the research team, professionalism and mutual respect for what each discipline will contribute must be the underpinnings for a successful study. An interdisciplinary approach may make any nursing research study more robust and applicable to the patient population under study, while at the same time the process of conducting research with a team of healthcare profes-
514
JOURNAL OF EMERGENCY NURSING
sionals can help to establish better inter-professional relationships. These relationships can have lasting positive effects on patient outcomes and help to advance the science of emergency nursing practice. REFERENCES 1. Emergency Nurses Association Position Statement on Collaborative and Interdisciplinary Research. http://www.ena.org/SiteCollectionDocuments/ Position%20Statements/CollaborativeandInterdisciplinaryResearch.pdf. Accessed May 1, 2014. 2. Schultz D, Keyser D, Pincus HA. Developing Interdisciplinary Centers in Aging: Learning From the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers Initiative. Acad Med. 2011;86 (10):1318-24.
VOLUME 40 • ISSUE 5
September 2014