VOL: 97, ISSUE: 19, PAGE NO: 37
Charlotte Clarke, PhD, MSc, BA, RN, PGCE, is professor of nursing practice development research, University of Northumbria at Newcastle
Vince Ramprogus, PhD, MSc, BA, RGN, RMN, RNT, is head of the school of nursing studies, University of Northumbria at NewcastleThe values of the current quality-led NHS are underpinned by evidence-based care (Department of Health, 1997). However, the extent to which professional groups use and develop knowledge on which to base their practice is compromised by an underdeveloped research and development capacity in the NHS.
The values of the current quality-led NHS are underpinned by evidence-based care (Department of Health, 1997). However, the extent to which professional groups use and develop knowledge on which to base their practice is compromised by an underdeveloped research and development capacity in the NHS.
Despite the opportunities for collaborative development of patient care, partnerships between universities and health care providers can be difficult. Some of the concerns about partnership centre on:
- The ability to meet both academic and practice demands;
- The capacity of organisations to accommodate different criteria of achievement. For example, an academic researcher may not value the applied research of the health care provider;
- The demands and pace of change in clinical practice.
Models of exchange
There are two dominant models of exchange between universities and service providers - inreach and outreach models. Both have their own strengths and weaknesses.
Inreach models, for example the appointment of a practitioner/lecturer, are currently favoured by professional bodies such as the English National Board.
For universities, this model has the advantage of bringing clinical expertise and a political awareness of service providers to teaching, curriculum development and research. For the NHS, it broadens the skills base of specific people, which may in turn permeate through the organisation.
Outreach models support the university through the development of academic links with clinical areas that involve students. The results are varied and tend to focus on educational support rather than research and development. This model has also been adopted for research and development, with academic staff committing time to practice in identified clinical areas.
For universities, this model broadens the clinical knowledge and skills base of academic staff. For the NHS, it offers opportunities for research knowledge and skills to be integrated into clinical areas and passed on to other practitioners. However, the number of university staff available to carry out outreach work is limited.
This model limits the number of clinical areas that could be linked, resulting in a lack of continuity that may not be to patients' advantage.
The Northumbria Strategic Alliances
The Northumbria Strategic Alliances for Research and Development (N-SARD) are based on a third model, which builds on links between organisations to support research at the University of Northumbria at Newcastle and in health care settings.
This model recognises the limited capacity and resources of both the higher education sector and the NHS. It builds on the skills of staff in both organisations while not developing individuals as all-rounders. It also recognises the symbiotic relationship that can develop by acknowledging the equal but different knowledge and skills of researchers and practitioners.
The model is based on research that analysed the processes of developing health care practice (Clarke et al, 1998; Clarke and Procter, 1999). It provides explicit avenues for collaboration in research.
N-SARD uses a hub-and-spoke structure (Fig 1) to involve a number of organisations, maximising the use of research resources and creating a learning environment in which the use of research in patient care can be developed. The N-SARD model has a number of core values:
- Enhancing sustainable development in practice through research and development;
- Integrating education, practice and research, allowing the involvement of a range of staff from both organisations;
- Moving patient care forward within a facilitative framework to promote learning for practitioners and researchers;
- Enhancing research and development in both settings.
Each spoke in the N-SARD wheel is specific to the health care provider. However, as a whole, the work contributes to a distinct research programme, focusing on the ways in which practitioners use knowledge to develop patient care. The spokes of N-SARD are evolutionary, responding to the requirements of the health care provider.
Some current N-SARD links include:
- The nursing practice research centre in City Hospitals Sunderland NHS Trust - a collaboration between the trust, the University of Northumbria at Newcastle and the University of Sunderland which aims to enhance the research and development capability of nurses in the trust;
- Projects that aim to build up the research and development capacity of nursing and allied health professions at Northgate and Prudhoe NHS Trust and Gateshead Health NHS Trust;
- Research development at Priority Healthcare Wearside NHS Trust, with a team of nurses who each contribute to generic practice development support in the trust and lead in specific clinical areas, such as person-centred care for older age psychiatry;
- A number of specific research projects that help practitioners to conceptualise patient care, for example, using participatory action research to explore continence care for older people with a mental illnesses at Newcastle City Health NHS Trust.
In addition, the practice development research programme at the university sustains a wider network of learning in the NHS and independent sector through frameworks of research, including:
- The developing health care practice programme, which sets up collaborative peer-learning groups among practitioners;
- The clinical practice development accreditation scheme, which supports the development of patient-focused care;
- Client-specific research and development forums, such as the dementia care forum which will disseminate research and innovative practice across north-east England.
A closer look
Closer examination of two of the links that contribute to N-SARD reveals the core values of the model.
The Firm Foundations project at Northgate and Prudhoe NHS Trust, a specialist trust for people with learning difficulties, is a three-year project designed to increase research capacity and enhance services.
The research and development plan for 1999-2001 highlighted the need to widen participation in research by staff, carers, family members and service users. The project, set up in July 1999, includes a number of research workshops and the development of four multidisciplinary research themes that involve about 35 practitioners from the trust and several university staff members. The project is being evaluated to assess its impact on services and outcomes.
The second link, the Nursing Practice Research Centre at City Hospitals Sunderland NHS Trust, was launched in December 1998 to develop nursing research and development capabilities in the trust, which provides general secondary care to the local community.
Its five-layered approach includes:
- Educational workshops;
- Developments in patient-focused care, for example, developing the care of older people with mental health needs in acute medical care settings;
- A research agenda of partnerships in care;
- Developing the centre's relationship with other corporate activities;
- Individual research profiles.
Increasingly, the centre and its work is making connections with professional leaders in the trust and university staff who want to develop their clinical liaison role in research and development.
The N-SARD is one response to the challenges of collaborative research between higher education and the NHS. By allowing each organisation to retain its own structure and distinctiveness while becoming part of wider learning, research and patient-care development, this model shows that the sum can be greater than its parts.
The Practice Development Research Programme website is at: http://online.unn.ac.uk/faculties/hswe/research/PDRP/NorthumbriaRD.htm