This article, the fourth in a series on the lifecycle of a research project, looks at the various ways in which the findings of a single study can help change practice
On their own, the outcomes of a single study rarely lead to significant changes to practice but there are ways in which they can help improve care. This article, the fourth in a six-part series on the lifecycle of a research project, uses the example of the Creating Learning Environments for Compassionate Care (CLECC) study to explore these ways. Researchers need to place their study in the context of the literature in the field, include their study in a wider programme of research, disseminate findings to the right audiences, and take their research through the next steps following on from their original findings.
Citation: Bridges J (2019) Lifecycle of a research project 4: taking the research project further. Nursing Times [online]; 115: 4, 42-43.
Author: Jackie Bridges is professor of older people’s care, University of Southampton.
I am a registered nurse and the principal researcher on the Creating Learning Environments for Compassionate Care (CLECC) study (Box 1). I am passionate about high-quality healthcare for older people and conduct research because I believe it can make a difference to care. It is rare for the findings of a single study to lead to significant and widespread changes to practice, but there are ways in which they can help improve care. This article uses the example of the CLECC study to explore these ways.
This is the fourth article in a six-part series on the lifecycle of a research project. In part 3, we briefly presented the CLECC study findings. These suggested the intervention is promising but we cannot say it definitely makes care more compassionate.
Box 1. The CLECC study
Creating Learning Environments for Compassionate Care (CLECC) is a practice development programme for nursing teams that aims to build a culture in which team members feel able to practise compassionately (Bridges and Fuller, 2015). A mixed-methods research study – Bridges et al (2018) – was undertaken to determine whether the programme could be made to work in acute hospitals and whether we would be able to measure its impact using an experimental design.
Wider research context
One way to increase the influence of a single study is to include it in a wider programme of research and use its results to support the thinking about, and delivery of, other studies. Researchers need to be clear how their work adds to the existing body of knowledge – that is, findings from other studies carried out by other research teams in other settings. Their findings might confirm the results of other studies or make a new contribution to the field, developing people’s understanding and providing a new platform from which to work.
To support our thinking in the CLECC study, we carried out two other pieces of research:
- A systematic review – Blomberg et al (2016) – looking at published research on the effectiveness of compassionate nursing care interventions;
- A small study – McLean et al (2017) – developing the Quality of Interactions Schedule (QuIS) for use in the acute hospital setting.
Having worked with researchers from two Swedish universities and completed the review, which comprised 24 studies, we concluded that research into compassionate care interventions needed more robust assessment of effectiveness, moving from simple before-and-after measures of outcomes towards experimental designs such as randomised controlled trials (RCTs) (see part 2) (Blomberg et al, 2016). We also reviewed the qualitative research on compassionate care interventions and found robust contributions about enablers and barriers, but concluded more research was needed on implementation into practice.
We needed to find a way of measuring the impact of the CLECC programme by rating the quality of interactions between staff and patients, so we took an existing measure – the QuIS (Dean et al, 1993) – and developed it for use in the acute hospital setting (McLean et al, 2017) (see part 2). Originally developed for use in long-term care settings, its accompanying guidance had to be revised to make sure researchers using it in hospital settings would rate accurately and consistently. This was done in a small study before the CLECC study started. We also tested the relationship between researchers’ QuIS ratings and patients’ ratings of their experiences.
A key part of changing practice through research is making sure the results reach the right audiences. One common technique is to publish these in journals. We have published the results of the systematic review and QuIS development study. From the CLECC study, we published the qualitative results (Bridges et al, 2017) and the RCT results (Gould et al, 2018), in addition to a report on the whole study (Bridges et al, 2018). We also used study data to:
- Investigate how best to calculate QuIS rating consistency between researchers (Mesa-Eguiagaray et al, 2016);
- Analyse the quality and quantity of staff–patient interactions in hospital (Barker et al, 2016);
- Look at the connections between the quality of interaction, staffing levels and skill mix.
Beyond dissemination in journals, we have presented the study findings at conferences – as a small team, we have to choose carefully which ones to attend. We were also fortunate as the results were selected to feature in a National Institute for Health Research (NIHR, 2017) review on hospital care for older people living with frailty, which opened our work to a wider audience.
One study cannot give a definitive answer – research is a journey, a process of building knowledge, and answering one question can result in more questions. We have identified next steps, post the CLECC study, some of which are under way.
We needed to further develop the CLECC intervention – in particular to include ways in which managers could support teams to use it. As such, we developed new activities and tried out the newer version of CLECC in two wards in a district general hospital, using qualitative interviews to understand the views of the teams.
We revisited the wards from the original CLECC feasibility study, conducting qualitative interviews to see whether staff were still using CLECC. We offered a CLECC ‘boost’ to two of these wards to help them revisit CLECC. We are using the QuIS to help evaluate impact on the new and original wards, and are planning to test how well QuIS ratings match the experiences of people living with dementia. This phase of the work is funded by the Burdett Trust for Nursing through its nurse retention programme.
CLECC has also been used as part of an intervention aimed at improving patient involvement in their hospital care; this is being evaluated by a research team (of which I am part) funded through the NIHR. It is exciting to see CLECC ideas being adapted and used in other ways in practice.
Our next planned study stems from our finding that there were differences between wards regarding whether staff carried on with CLECC after the initial four-month facilitated period (see part 3). We want to better understand what makes a trust or team receptive to something like CLECC and, if they are not, what can be done to remedy this. To test it, we will need to run the intervention in many more wards than in the original feasibility study. We hope the findings will help us define the conditions needed for nursing teams to deliver high-quality care – which would constitute important learning for the NHS and beyond.
Whether or not the findings of a research study bring about a change in practice is largely beyond the control of the research team. It relies on individual practitioners accessing the findings and working out how they can use them in their own practice. It also relies on managers and policy makers creating the conditions in which change is possible. Part 5 and part 6 in this series will examine these issues.
- Research is a process of building knowledge
- One study cannot give definitive answers and answering one question may result in more questions
- Researchers need to be clear about how their work adds to the existing body of knowledge
- Disseminating study results to the right audiences is key
- The team behind the Creating Learning Environments for Compassionate Care (CLECC) study is continuing its research journey
Also in this series
- Lifecycle of a research project 1: why research into care matters
- Lifecycle of a research project 2: designing and planning the study
- Lifecycle of a research project 3: reading research findings
- Lifecycle of a research project 5: using results to shape clinical practice
- Lifecycle of a research project 6: how research might guide policy
- Acknowledgements – The author would like to thank her fellow CLECC study investigators and all patients, research nurses and staff in the participating hospitals.
- Funding – The CLECC study was funded by the National Institute for Health Research (NIHR) (Health Services and Delivery Research programme, project number 13/07/48). The views and opinions expressed in this article are those of the author and do not necessarily reflect those of the Health Services and Delivery Research programme, NIHR, NHS or Department of Health and Social Care.
Barker HR et al (2016) Quantity and quality of interaction between staff and older patients in UK hospital wards: a descriptive study. International Journal of Nursing Studies; 62, 100-107.
Blomberg K et al (2016) Interventions for compassionate nursing care: a systematic review. International Journal of Nursing Studies; 62, 137-155.
Bridges J et al (2018) Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study. Health Services and Delivery Research; 6: 33.
Bridges J et al (2017) Optimising impact and sustainability: a qualitative process evaluation of a complex intervention targeted at compassionate care. BMJ Quality and Safety; 26: 12, 970-977.
Bridges J, Fuller A (2015) Creating learning environments for compassionate care: a programme to promote compassionate care by health and social care teams. International Journal of Older People Nursing; 10: 1, 48-58.
Dean R et al (1993) The Quality of Interactions Schedule (QUIS): development, reliability and use in the evaluation of two domus units. International Journal of Geriatric Psychiatry; 8: 10, 819-826.
Gould LJ et al (2018) Compassionate care intervention for hospital nursing teams caring for older people: a pilot cluster randomised controlled trial; BMJ Open; 8: 2, e018563.
McLean C et al (2017) Reliability, feasibility, and validity of the Quality of Interactions Schedule (QuIS) in acute hospital care: an observational study. BMC Health Services Research; 17: 380.
Mesa-Eguiagaray I et al (2016) Inter-rater reliability of the QuIS as an assessment of the quality of staff-patient interactions. BMC Medical Research Methodology; 16: 171.
National Institute for Health Research (2017) Comprehensive Care: Older People living with Frailty in Hospitals.