Research Reflection: Nurse practitioner engagement in research

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INTRODUCTION

N

urse practitioners (NPs) are rec- ognized as having distinct knowledge and skills including their role in NP-led and NP-involved research. Nurse practitioners are registered nurses who have completed additional education, often at the Master’s level, and are able to work in an expanded scope of practice (Donald et al., 2010; Kaasalainen et al., 2010). This includes the ability to diagnose, write prescriptions, order laboratory tests, and refer patients to specialists (Sangster-Gormley, 2016).

Over the past 40 years, research has demonstrated that NPs provide safe and effective care (Horrocks, Anderson,

& Salisbury, 2002; Mundinger, Kane, Lenz, & Trial, 2009; Sackett et al., 1974;

Sangster-Gormley, Frisch, & Schreiber, 2013).

To date, a large focus of NP research in Canada has been in primary care (Burgess & Purkis, 2010; Heale, 2012;

Roots & MacDonald, 2014; Russell et al., 2009; Sangster-Gormley, Martin- Misener, & Burge, 2013; Way, Jones, Baskerville, & Busing, 2001). Nurse practitioners, however, are increasingly working in highly specialized areas including acute and community oncology settings (Stahlke Wall & Rawson, 2016). The move towards specialized areas of practice has created new and exciting opportunities for NP research in Canada and emphasizes the impor- tance of recognizing the unique voice of NPs in healthcare. The purpose of this paper is to explore opportunities for NPs to engage in research, with a focus

on NPs practising in oncology care, and to provide a brief discussion of knowledge dissemination activities.

NURSE PRACTITIONER ENGAGEMENT IN RESEARCH

As advanced practice nurses (APNs), NPs are uniquely positioned to lead and participate in research that is meaningful to their complex practice environments. Nurse practitioners are required to engage in evidence-based practice (EBP) and maintain clinical competency, which in Canada is regulated provincially and territorially (Wong &

Farrally, 2013). Nurse practitioners also maintain competency through reading and incorporating evidence-based publications into practice; attending professional conferences; and participating in journal clubs and formal organizations such as communities of practice and professional associations. In speaking with colleagues, we know that NPs are interested in contributing to research in meaningful ways. However, there is some uncertainty for NPs in know- ing where to start and how to negotiate involvement in research that extends beyond the activities required to meet continued practice competency (e.g.

incorporating evidence into clinical practice). Nurse practitioners may also experience difficulty reconciling how to initiate a research project with limited time and resources available to support such efforts. It is, therefore, important for NPs to identify how to engage

in research in ways that are accessible while working in busy clinical practices.

WHERE TO START IN GETTING INVOLVED WITH RESEARCH

Identifying an issue of clinical rel- evance that stems from practice experience and observation is one way to begin the research process. Real-world clinical observations may give rise to innovative research questions or new ways of looking at a phenomenon of interest. Planning a research project and determining an appropriate strategy of inquiry, however, can be challeng- ing for busy clinicians, and this is where the interdisciplinary environment of oncology care can be invaluable. Nurse practitioners should be cognizant of opportunities to collaborate with interdisciplinary partners (e.g., oncologists, registered nurses, and pharmacists) who can add important perspectives to a research project. A helpful resource on how to partner and collaborate in research is the Guide to Researcher and Knowledge-User Collaboration in Health Research developed by the Participatory Research at McGill group (Parry, Salsberg, & Macaulay, 2009).

This comprehensive learning mod- ule uses everyday language, including several examples and case studies, to illustrate how to identify and develop research partnerships.

Looking for ‘in-house’ research opportunities within an NP’s practice organization may be another way to begin the research process. Most NPs in Canada work for health authori- ties or provincial organizations, where their salaries are paid for by govern- ment funding (Kaasalainen et al., 2010;

Wong & Farrally, 2013). This includes NPs who work in specialized areas such as oncology care. There may be unique opportunities within these organizations that NPs are unaware of, including assisting on established research

RESEARCH REFLECTION

Nurse practitioner engagement in research

by Leah K. Lambert and Laura M. Housden

ABOUT THE AUTHORS

Leah K. Lambert, RN, PhD(c), School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5

Laura M. Housden, RN, NP, PhD(c), School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5

Author for correspondence: Leah K. Lambert Email: LLambert@alumni.ubc.ca

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Table 1: Research strategies

Strategy Description Resources

Structured literature review

A structured literature review is a means of analyzing existing knowledge of what is known about a phenomenon to provide a more comprehensive understanding of a subject of interest (Whittemore & Knafl, 2005). There are various methods available for conducting structured reviews including integrative, systematic, and qualitative reviews, and meta-analyses.

Structured reviews can be used to inform research and policy initiatives and integrate new knowledge into practice (Whittemore & Knafl, 2005).

A structured review of the literature can also highlight gaps in existing knowledge and identify areas requiring further research. For a discussion of review methods, including issues specific to combining nursing research studies, see Whittemore (2005). For a comprehensive guide to knowledge synthesis (e.g., a structured review that is reproducible such as a systematic review) including a discussion of the purpose of conducting a knowledge synthesis, the steps involved in this process, and an in-depth discussion of synthesis methods see Grimshaw (n.d.).

Example: Nichol, K., Stacey, D., Kuziemsky, C., & Gifford, W.

(2016). Cancer symptom management in the home: A scoping review. Canadian Oncology Nursing Journal, 26(1), 4–10.

Resources

Garrard, J. (2016). Health sciences literature review made easy:

The matrix method (5th ed.). Burlington, MA: Jones & Bartlett Learning.

Whittemore, R. (2005). Combining evidence in nursing research: Methods and implications. Nursing Research, 54(1), 56–62.

Grimshaw, J. (n.d.). A guide to knowledge synthesis: A knowledge synthesis chapter. Retrieved from http://www.cihr- irsc.gc.ca/e/41382.html

Qualitative

study NP practice environments involve complex phenomena and qualitative methodologies can guide the exploration of these complexities. For example, Stahlke Wall and Rawson (2016) conducted a qualitative study to explore characteristics of the NP role in cancer care and identify the unique value of NP-provided care. Small qualitative studies can sometimes be conducted with little financial resources yet yield important findings, making qualitative work more accessible to investigators with limited funding. Qualitative data collection methods include, but are not limited to, participant interviews, focus groups, participant observation, open- ended surveys, and textual analyses (e.g., health records and policy documents) (Polit & Beck, 2012).

Example: Stahlke Wall, S., & Rawson, K. (2016). The nurse practitioner role in oncology: Advancing patient care. Oncology Nursing Forum, 43(4), 489–496.

Resources

Thorne, S. (2016). Interpretive description: Qualitative research for applied practice (2nd ed.). New York, NY:

Routledge.

Thorne, S., Stephens, J., & Truant, T. (2016). Building qualitative study design using nursing’s disciplinary

epistemology. Journal of Advanced Nursing, 72(2), 451–460.

Needs

Assessment A needs assessment is a systematic process of identifying unmet needs and priorities of a sample population. It involves the use of qualitative and/

or quantitative research methods to collect data. A needs assessment can be used to identify: 1) the specific needs of a population, 2) gaps in patient care, and 3) patient preferences. For example, Fitch and Maamoun (2016) conducted a needs assessment for the purposes of informing program development, in which they assessed the unmet supportive care needs of cancer patients undergoing radiation treatment and their desire for assistance in meeting those needs.

Example: Fitch, M.I., & Maamoun, J. (2016). Unmet supportive care needs and desire for assistance in patients receiving radiation treatment: Implications for oncology nursing.

Canadian Oncology Nursing Journal, 26(1), 53–59.

Resource

Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed).

Philadelphia: Lippincott Williams & Wilkins.

Pilot Study A pilot study is a smaller version of a proposed study that can inform the design and development of a larger study (Arain, 2010). Pilot studies can be used to test procedures, determine the validity of clinical tools, and help define the methods and parameters needed to conduct a larger study. For example, Ozier and Cashman (2016) conducted a pilot study to investigate the impact of a one-to-one peer support intervention on quality of life in newly diagnosed primary brain tumour patients.

Example: Ozier, D., & Cashman, R. (2016). A mixed method study of a peer support intervention for newly diagnosed primary brain tumour patients. Canadian Oncology Nursing Journal, 26(2), 104–111.

Resources

Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L.P., … Berlin, J. (2010). A tutorial on pilot studies: The what, why and how. BMC Medical Research Methodology, 10(1), 1.

Arain, M., Campbell, M.J., Cooper, C.L., Lancaster, G.A., Arnold, D., Burns, K., … Petticrew, M. (2010). What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Medical Research Methodology, 10(1), 67.

Survey Surveys or questionnaires are used to elicit information about the prevalence and interrelationship of variables from a sample population (Polit & Beck, 2012). There are a variety of standardized questionnaires available that NPs can use in their research endeavours. While these questionnaires are primarily quantitative in nature, some may also include a qualitative component. The APN chair program established a toolkit of data collection tools for use in APN research (CHSRF/CIHR Chair Program in Advanced Practice Nursing, n.d.). These tools are organized according to role development, role implementation, and role evaluation. The toolkit also includes questionnaires to examine patient outcomes. Nurse practitioners who are interested in using a standardized questionnaire are encouraged to explore this site for previously established and tested data collection tools.

Example: Macartney, G., Stacey, D., Carley, M., & Harrison, M.B. (2012). Priorities, barriers and facilitators for remote support of cancer symptoms: A survey of Canadian oncology nurses. Canadian Oncology Nursing Journal, 22(4), 235–47.

Resources

CHSRF/CIHR Chair Program in Advanced Practice Nursing (n.d.). Data Collection Tools. Retrieved from: http://apntoolkit.mcmaster.ca/index.

php?option=com_content&view=article&id=243&Itemid=2

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projects or helping the leadership team to answer important practice questions.

Organizations may also be able to assist NPs with funding and research support throughout the course of a project. For these reasons, it is important that NPs reach out to organizational leaders when interested in engaging in research.

RESEARCH STRATEGIES

There is a wide range of research methodologies available for use in knowledge development including quantitative and qualitative methods. Some methods are extensive and require significant time and expertise (e.g., randomized control trials), and other methods may be more manage- able for novice researchers. A few of the ways NPs might engage in research include conducting a structured literature review, undertaking a small qualitative study or pilot project, completing a needs assessment, or administering a standardized survey. In Table 1, we have outlined these suggestions and offered examples for each research strategy along with a list of resources for NPs to consider. While this is by no means a comprehensive list of strategies available, these suggestions may be useful for NPs in thinking about how to negotiate a greater involvement in research.

KNOWLEDGE DISSEMINATION

An important aspect of any research project includes knowledge dissemination activities.

A range of knowledge dissemination approaches exist, some more accessible and less time intensive than others.

In determining how to share knowledge, researchers need to consider the intended audience and identify the best way to effectively communicate

their findings. A common way of com- municating research results is to publish findings in peer-reviewed journals.

While publishing may seem like a daunting task, writing resources may be available through universities, professional associations, or organizational affiliations. Nurse practitioners may also use partnerships established in the research process to collaborate on writing projects.

Publications, however, need not only be limited to research results. Nurse Practitioners can also reflect on experiences they had during the research process or in clinical practice by publishing these experiences in a reflection column. A research or practice reflection is a way for NPs to describe and analyze their experiences. Nurse practitioners can use their voice to articulate concerns and experiences that arise in the course of their work that may also represent commonalities across practice disciplines. Practice reflections that draw on experiential knowledge and make these aspects of practice explic- itly known to others can be valuable in advancing NP dialogue on important matters. For example, a practice reflection could highlight the barriers and facilitators encountered by a new NP in transitioning to an oncology practice setting.

In terms of where to publish, NPs could consider organizational publications (e.g., health authority or regional newsletters), as well as peer-reviewed journals. Many journals welcome sub- missions by new researchers and can provide valuable feedback during the peer-review process. Editors will often respond to publication queries, and NPs can contact the editor in advance to dis- cuss the appropriateness of the article for the journal. While NP-focused journals may be a familiar resource, NPs

ought to consider the value of making research visible to broader audiences by publishing in interdisciplinary journals.

Oral or poster presentations are also an excellent way of sharing new knowledge. In the oncology setting there are often many local opportunities to present. For instance, NPs might present their work at organizational level meet- ings and conferences, tumour board groups, grand rounds, guest lectures in academic programs, and through online webcasts offered by professional associations. National and international conferences, such as the Canadian Association of Nurses in Oncology annual conference, offer presentation opportunities for NPs to ensure their research reaches relevant audiences.

Conferences can also help to connect NPs with a community of researchers and clinicians. There may also be additional, creative ways for NPs to dissem- inate knowledge in their specialized areas of practice that are not included here. Identifying key stakeholders and clearly defining relevant messages will help to clarify the best way to share knowledge with target audiences.

CONCLUSION

Nurse practitioners have a unique voice and perspective on the healthcare system and patient care that high- lights the important contribution NPs can make to research. While there may be limited time and resources for NPs to embark on research endeavours, this process does not have to be too compli- cated. A range of opportunities exist for NPs to engage with research and knowledge dissemination in meaningful, yet accessible ways. We have suggested strategies for NPs to consider in thinking about leading and participating in research projects, and in planning the dissemination of new knowledge.

REFERENCES

Arain, M., Campbell, M.J., Cooper, C.L., Lancaster, G.A., Arnold, D., Burns, K.,

… Petticrew, M. (2010). What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Medical Research Methodology, 10(1), 67.

http://doi.org/10.1186/1471-2288-10-67

Burgess, J., & Purkis, M.E. (2010). The power and politics of collaboration in nurse practitioner role development.

Nursing Inquiry, 17(4), 297–308. http://doi.

org/10.1111/j.1440-1800.2010.00505.x CHSRF/CIHR Chair Program in Advanced

Practice Nursing (n.d.). Data Collection

Tools. Retrieved from: http://apntoolkit.

mcmaster.ca/index.php?option=com_

content&view=article&id=243&Itemid=2 Donald, F., Martin-Misener, R., Bryant-

Lukosius, D., Kilpatrick, K., Kaasalainen, S., Carter, N., … DiCenso, A. (2010). The primary healthcare nurse practitioner

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FEA TUR ES /R U bR iq UE S

role in Canada. Nursing Leadership, 23(Special Issue), 88–113. http://doi.

org/10.12927/cjnl.2013.22271

Fitch, M.I., & Maamoun, J. (2016). Unmet supportive care needs and desire for assistance in patients receiving radiation treatment: Implications for oncology nursing. Canadian Oncology Nursing Journal / Revue Canadienne de Soins Infirmiers en Oncologie, 26(1), 53–59.

http://doi.org/10.5737/236880762615359 Garrard, J. (2016). Health sciences literature

review made easy: The matrix method (5th ed.). Burlington, MA: Jones & Bartlett Learning.

Grimshaw, J. (n.d.). A guide to knowledge synthesis: A knowledge synthesis chapter.

Retrieved from http://www.cihr-irsc.

gc.ca/e/41382.html

Heale, R. (2012). Overcoming barriers to practice: A nurse practitioner-led model.

Journal of the American Academy of Nurse Practitioners, 24(6), 358–363. http://doi.

org/10.1111/j.1745-7599.2012.00737.x Horrocks, S., Anderson, E., & Salisbury, C.

(2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal (Clinical Research Ed.), 324, 819–823. https://doi.

org/10.1136/bmj.324.7341.819

Kaasalainen, S., Martin-Misener, R., Kilpatrick, K., Bryant-Lukosius, D., Donald, F., Carter, N., & DiCenso, A. (2010). A historical overview of development of advanced practice nursing roles in Canada. Nursing Leadership, 23(Special Issue), 35–60.

https://doi.org/10.12927/cjnl.2010.22268 Macartney, G., Stacey, D., Carley, M., &

Harrison, M.B. (2012). Priorities, barriers and facilitators for remote support of cancer symptoms: A survey of Canadian oncology nurses.

Canadian Oncology Nursing Journal / Revue Canadienne de Soins Infirmiers en Oncologie, 22(4), 235–240. http://doi.

org/10.5737/1181912x224235240

Mundinger, M.O., Kane, R.L., Lenz, E.R., &

Trial, A.R. (2009). Primary care outcomes in patients treated by nurse practitioners or physicians. Journal of the American Medical Association, 61(3), 332–351.

https://doi.org/10.1001/jama.283.1.59

Nichol, K., Stacey, D., Kuziemsky, C., &

Gifford, W. (2016). Cancer symptom management in the home: A scoping review. Canadian Oncology Nursing Journal / Revue Canadienne de Soins Infirmiers En Oncologie, 26(1), 4–10. http://

doi.org/10.5737/23688076261411

Ozier, D., & Cashman, R. (2016). A mixed method study of a peer support intervention for newly diagnosed primary brain tumour patients.

Canadian Oncology Nursing Journal / Revue Canadienne de Soins Infirmiers en Oncologie, 26(2), 104–111. http://doi.

org/10.5737/23688076262104111

Parry, D., Salsberg, J., & Macaulay, A.C.

(2009). Guide to researcher and knowledge- user collaboration in health research.

Retrieved from http://www.cihr-irsc.

gc.ca/e/44954.html

Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed). Philadelphia:

Lippincott Williams & Wilkins.

Roots, A., & MacDonald, M. (2014).

Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: A mixed methods study. Human Resources for Health, 12(69), 1–11. https://doi.

org/10.1186/1478-4491-12-69

Russell, G. M., Dabrouge, S., Hogg, W., Geneau, R., Muldoon, L., & Tuna, M.

(2009). Managing chronic disease in Ontario primary care: The impact of organizational factors. Annals of Family Medicine, 7(4), 309–318. https://doi.

org/10.1370/afm.982.

Sackett, D.L., Spitzer, W.O., Gent, M., Roberts, R.S., Hay, W.I.A.N., LeFroy, G.M., … McAuley, R.G. (1974). The Burlington randomized trial of the nurse practitioner: Health outcomes of patients. Annals of Internal Medicine, 80(2), 137–142. http://dx.doi.

org/10.7326/0003-4819-80-2-137

Sangster-Gormley, E. (2016). Prescribing patterns of nurse practitioners in Canada.

Canadian Medical Association Journal, 188(3), 173–174. https://doi.org/10.1503/

cmaj.150913

Sangster-Gormley, E., Frisch, N., & Schreiber, R. (2013). Articulating new outcomes

of nurse practitioner practice. Journal of the American Association of Nurse Practitioners, 25(12), 653–8. https://doi.

org/10.1002/2327-6924.12040

Sangster-Gormley, E., Martin-Misener, R., &

Burge, F. (2013). A case study of nurse practitioner role implementation in primary care: What happens when new roles are introduced? BMC Nursing, 12(1), 1. https://doi.org/10.1186/1472-6955-12-1 Stahlke Wall, S., & Rawson, K. (2016). The

nurse practitioner role in oncology:

Advancing patient care. Oncology Nursing Forum, 43(4), 489–496. http://doi.

org/10.1188/16.ONF.489-496

Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L.P., … Berlin, J.

(2010). A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology, 10(1), 1. http://doi.

org/10.1186/1471-2288-10-1

Thorne, S. (2016). Interpretive description:

Qualitative research for applied practice (2nd ed.). New York, NY: Routledge.

Thorne, S., Stephens, J., & Truant, T. (2016).

Building qualitative study design using nursing’s disciplinary epistemology.

Journal of Advanced Nursing, 72(2), 451–

460. http://doi.org/10.1111/jan.12822 Way, D., Jones, L., Baskerville, B., &

Busing, N. (2001). Primary health care services provided by nurse practitioners and family physicians in shared practice. Canadian Medical Association Journal, 165(9), 1210–4. Retrieved from http://www.pubmedcentral.nih.gov/

articlerender.fcgi?artid=81583&tool=

pmcentrez&rendertype=abstract

Whittemore, R. (2005). Combining evidence in nursing research: Methods and implications. Nursing Research, 54(1), 56–62.

Whittemore, R., & Knafl, K. (2005).

The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–53. http://doi.

org/10.1111/j.1365-2648.2005.03621.x Wong, S.T., & Farrally, V. (2013). The

utilization of nurse practitioners and physician assistants: A research synthesis.

Retrieved from http://www.msfhr.org/

utilization-nurse-practitioners-and- physician-assistants