Upload
bryan-craig
View
213
Download
0
Tags:
Embed Size (px)
Citation preview
Promoting research by practitioners:the National Council perspective.
Sarah CondellSandra Delamare
Maura Lavery
Highlights 2003-2008
19 of 21 recommendations achieved, 12 ongoing.HRB Funding €1m in 5yr programme grants, €2m in 3
yr project grants, €5m in Fellowship awards.HRB 48 individual awards to nurses and midwives.
NCNM Mission & Function
The National Council for the Professional Development of Nursing and Midwifery exists to promote and develop the professional role of nurses and midwives in order to ensure the delivery of quality nursing and midwifery care to patients and clients in a changing healthcare environment
Statutory Agency established in 2001
Core Concepts of Developed Roles (National Council)
CNS/CMSClinical focusPatient advocateEducation & TrainingAudit & ResearchConsultant
ANP/AMPAutonomy in clinical practiceProfessional & clinical leadershipExpert PractitionerResearcher
Key nursing and midwifery roles for practitioner research
ANP/AMP Posts Approved/ Meet Standards & Criteria
ANP/AMPsAccredited / Meet Standards & Criteria
154 95
CNS/CMS Posts Approved/ Meet Standards & Criteria
CNS/CMS Postholders Approved/ Standards & Criteria
2235 1744
Evaluation 1: Preliminary evaluation of the AN/MP role (NCNM 2005)
Findings:“Fulfilling clinical leadership and research aspects of
the role is proving problematic due to time constraints and the growing clinical need for ANP services.” (p43)
Research master-classes for AN/MPs.For example:Directors of Research in Academic Schools presented Research Strategies/Themes
Junior Clinician Scientist for Nursing and Midwifery 2006-2009
Strengths & Weaknesses:• Limited funding - €30,000 pa
for max 3 years towards protected time, €5,000 towards fees/consumables.
? completion• Local negotiation of
structuring.
4 awards – 1 ANP & 3 CNSs for 3 PhD & 1 MSc by Research.
RheumatologyMotor Neurone DiseaseMental HealthFalls
Lists peer-review publications by 8 ANPs in mainly international journals.
Findings from mixed methodology study (including focus groups, Delphi survey, case study observation and interviews. Data collected 2009-2010.
Very strong evidence that AP are conducting research (and strong evidence of audits, especially by CSs).
Study concludes “research skill and motivation present but is in its infancy and occurring against all the odds with little support.”
Evaluation 2: Forthcoming SCAPE report (TCD & NUIG, 2010)
Innovative Research Development Initiative (IRDI) 2010 only- 5 awards totalling €70,000
Awards based on fulfilling criteria and VFM
1. HSE South Cork/Kerry (UCC&ITT) – Masterclass series2. NUIG & HSE West – elearning and support programme.3. DCU & Beaumont/Connolly Hospitals – mentorship type
programme4. TCD & St James – mentorship type programme
Award 5 = RCSI – Research roundtable for CNS Forensic nursing
•Dr. Susan Miner, Rape Crisis Network Ireland (RCNI) •Dr. Maeve Eogan, National Medical Director, Sexual Assault Treatment Units •CNSs (Sexual Assault Forensic examination) and HDip students•RCSI staff
Key research issues identified:
Is current service meeting the needs of patients/clients? How can improvements could be made? Impact of the sexual assault treatment units on patient/client outcomes?How to raise awareness of sexual assault and of the 6 sexual assault treatment units?
Promoting research by practitioners:the National Council perspective.
Sandra Delamare,ANP sexual health, St James Hospital.
Who is going to Gain?• Nursing Profession• Patients
Worst Case Scenario• Solitary Academics reading theories & practice
that is maybe 10years old• Not engaging in practical setting• Professional nurses – whiz, whiz, whiz• Not engaging in research
Best Case Scenario• Dialogue progression• Patient focus• Publication
Usefulness of Collaboration
Partnership approach, contributing to strengths and weaknesses of each other
Independent Researcher• A prospective Study, to compare the satisfaction of patients attending the
Advanced Nurse Practitioner (ANP ) and the Senior House Officer (SHO ), for sexual health screening in the GUIDE Clinic
• 2005
• This initial assessment of patient satisfaction attending the sexual health clinic has shown patients to be equally satisfied with the care provided by the ANP as they are with the SHO
• It also demonstrates the acceptability of the ANP as a first-line care provider in the Irish Health services. This further strengthens the need for the development of the role of the ANP in the future of health care in Ireland
Multidisciplinary Research
Outdoor Music Festival Lots of young people – 80,000 !! July 6,7,8 2007 Lots of rain, beer, etc…
Research Team
Research Participants
Data Collection
Results – Chlamydia testing 947 tested for Chlamydia Positive rate of only 2.1% Why so low????
• Samples very very dilute• Many samples far from adequate• Many samples NOT urine• Many girls messing in the loo’s• Alcohol effect+++++++++++
Interdisciplinary Research
Syphilis Outbreak
Europe 2000 - 2002
Paris88 cases90% MSMs50% HIV +
Peterborough & Nth Cambridge.13 casesAll MSMs, all primary/secondary
Oslo27 casesAll MSMsAll primary/secondary
Antwerp51 cases7 HIV +31 MSMs
London109 cases92 MSMs, all primary/secondary
Dublin458 cases
Syphillis outbreak
Infection rates in BT
Infection rate in SJH & GMHP
Meeting with NDSC + ID consultants
Outbreak team formed
2 special clinics H/A appointed
innovation
Innovation
Reg. Meetings with outbreak team + Public health +Sauna owners
On-site testing
Gay bars/clubs Saunas Gay pride
Media campaigns
Dublin OutbreakDublin Outbreak
Contacts30% 2-5 contacts in past yr50% 5-40 contacts in past yr20% >40 contacts in past yr
Amongst those with early syphilis..139 attended saunas regularly121 attended gay bars/clubs to meet partners14 used internet chat sites11 found partners in local parks20% had sex in UK/Europe in the previous 6mths
Positive aspects
• Academic support
• Improved patient care
• Research awareness
• Dedicated time
Negative Aspects• No funding
• Time
The Future• Unprecedented changes• Emerging research focussed and research
aware nurses• Profession of nursing has changed forever
Promoting research by practitioners:the National Council perspective.
Maura Lavery,CMS Lactation,
Rotunda Hospital.
35
36
• Research is a vital role in a Clinical Midwife Specialists job.
• As an educator the Clinical Midwife Specialist must ensure that breastfeeding information given to staff and mothers needs to be up to date and evidence based. This will ensure delivery of a high standard of care for our mothers and babies.
37
Research/Audits I have been involved with in the last 2 years
1.Rotunda Hospital Breastfeeding Policy Regular audits of this policy which incorporates the 10 steps to successful breastfeeding.
It is a requirement to maintain Baby Friendly Hospital Initiative accreditation that these steps are audited regularly.
38
2.Baby Friendly Hospital Advisory Committee A National Audit of the maternity hospitals/units to
determine the methods used to sterilize breast pump attachments.
39
3.Food Safety Authority Ireland• Measurement of dioxins in breastmilk 2010.• Involved in the recruitment of breastfeeding mothers to the study and
the collection of the milk samples.
40
Research/Audits
4.Lactrack – 2010 • Pilot Programme in the Rotunda Hospital
Neonatal Unit in the 7th month.• 1st hospital in Europe to use this system.• Barcode system to track expressed breast milk
from expression by the mother to baby.• Regular audits performed in the Neonatal Unit.
41
5.MEEP Study• Use of Manual Expression (hand expressing) as
compared to using Electric Pump in the 1st 72hrs for mothers of premature babies.
42
Aim
• Review of the amount of colostrum/ breastmilk obtained by mothers for premature or sick babies in the Neonatal Unit.
43
Team • CMS in lactation • Advanced Nurse Practitioner• Ward Midwives/Nurses• Consultant Neonatologist • Pediatric Registrar
MEEP Study - Neonatal Unit Rotunda Hospital
44
Obstacles to Research/Audit
1.Time • Reviewing research information• Planning • Proposal for ethics committee• MEEP study takes approx 2 hrs to recruit mothers
45
2.Lack of admin support• Preparing paperwork• Info and consent sheets• Photocopying• Information management e.g. database and reports
46
3.Staffing Level
2009:1 wte to 8912 deliveries
Breastfeeding initiation 64.82%Breastfeeding at discharge 60.63%
47
4.Clinical Patient Care Ante natal support• We offer one-to-one support to mothers that have
experienced past difficulties breastfeeding their babies.
• We also offer one-to-one support to mothers expecting high risk babies.
48
Postnatal support• Support for mothers at ward level • Babies who refuse the breast• Babies who have difficulty attaching to the breast
due to a difficult or medicated delivery• Babies who have excessive weight loss • When necessary individual consultations for
mothers• Phone line support• Weekly support group• Neo natal support groups
49
5.Education • Tutorials for midwifery and medical staff• 20 hr breastfeeding training programme• Refresher courses• Sessions at all induction programmes
Lactation Specialist…. Person .…Team
50
Conclusion
• Time• Staff
51
Nurses and midwives can contribute to health research in services.
Best placed to do so are those in CS and AP roles.
Much of the current CS or AP activity would benefit by increased support and resources.
CS and AP should be members of clinical academic networks.
Promoting research by practitioners:Conclusion.