This article, the fifth in a six-part series on the lifecycle of a research project, looks at how the outcomes of a research project can be used by a director of nursing to shape practice
Directors of nursing have a central role in helping to shape clinical practice, with the ultimate aim of providing the best possible care to patients. In this article, a director of nursing explains how she can use research findings to make decisions and influence trust board members’ decisions, using the example of the Creating Learning Environments for Compassionate Care study. The study shows how interventions to make care more compassionate can improve staff satisfaction and patient outcomes. It therefore provides food for thought and evidence to support a case for change. This is the fifth article in a six-part series on the lifecycle of a research project.
Citation: Tunney J (2019) Lifecycle of a research project 5: using results to shape clinical practice. Nursing Times [online]; 115: 5, 43-44.
Author: Julie Tunney is director of nursing, Mid Cheshire Hospitals Foundation Trust.
In NHS trusts, the director of nursing is responsible for providing clear direction to nursing and midwifery staff, and for improving care and services for patients. The role also involves developing relationships and coordinating health services across organisational partnerships. Certain skills and attributes are essential, including the ability to provide leadership and coordinate safe and effective patient care.
Delivering services with the best possible outcomes for patients requires directors of nursing to regularly refresh the way they undertake their role. Part of this process is keeping up to date with the best available evidence to support practice and argue for service developments. It is, therefore, vital to be research aware.
The Creating Learning Environments for Compassionate Care (CLECC) study (Box 1) is an example of research that has practical implications for nurses (see part 2, part 3 and part 4). In this article, I use it to explain how I use research to shape practice.
Box 1. The CLECC study
Creating Learning Environments for Compassionate Care (CLECC) aims to build a culture, in which nursing teams feel able to practise compassionately (Bridges and Fuller, 2015). A mixed-methods research study was carried out to determine whether the CLECC programme could work in acute hospitals and its impact be measured
(Bridges et al, 2018)
I would consider using a study such as CLECC in four ways:
- To influence the trust board;
- To improve care quality and safety;
- To spread best practice;
- To increase clinical engagement.
Influencing the trust board
The trust board plays a pivotal role in shaping the strategy, vision and purpose of the organisation. It directs operational staff, and holds them to account for delivering the strategy and ensuring value for money. Board members need to understand how their strategic decision making affects the quality and safety of patient care; the director of nursing can help them achieve this by using research evidence.
Directors of nursing need to be able to analyse qualitative and quantitative data, and present them in a way non-clinicians and fellow board members can understand. This helps the board to apply research evidence to its decision making. A practical example of this is research on human factors – which seeks to optimise human performance through better understanding individuals’ behaviour and their interactions with each other and their environment (NHS England, 2013) – and their role in reducing patient harm. When an organisational risk that has the potential to increase patient harm has been identified, research can be used to support a plan aimed at mitigating that risk. Frontline staff can also use research evidence to explain what this means in practice and how the plan can be used to improve care quality and safety.
Using research can foster discussions among trust board members, and therefore, influence their decisions. It can encourage thinking and enable conversations between executive and non-executive colleagues. This is especially evident when linking research back to the core purpose of the organisation. The CLECC study demonstrates the importance of looking at the care provided, rather than just the financial cost of care.
Improving care quality and safety
The CLECC study looked beyond the individual nurse at how organisations can create environments conducive to compassionate care. It found that time to undertake relational (compassionate) care is not factored into calculations of safe staffing requirements and that establishments should not be based on patient clinical acuity alone. I will consider this evidence when completing my bi-annual mandatory acuity/staffing reviews required by the National Quality Board.
Where the CLECC intervention was successfully implemented, there was an increase in staff morale and wellbeing. This has the potential to improve nurse retention and satisfaction; retention is crucial in addressing the nursing shortage and previous studies have found an association between staff satisfaction and patient outcomes (NHS England, 2018; West and Dawson, 2012). While the trust board might perceive promoting compassionate care as a subjective measure, the CLECC outcomes could support the case for change.
The study looked at the culture of compassion among nursing teams and offered nurses a framework to consider how this can be achieved in practice. Some wards in the study managed to sustain a culture of compassionate care while others were less successful. I am interested in why this happens, as nurse leaders have put in place strategies to measure compassion in the past but lacked an evidence base.
The CLECC study provides a framework to look at best practice. In my organisation, we have used it to think about clinical leadership and how we reward compassion. It can facilitate a discussion on the value of compassionate leadership in improving patient care. This requires a dialogue with frontline staff, who also need to be research aware.
Spreading best practice
Engaging with research findings can help shape practice and save time. Nurses often start a process of change from scratch using ‘plan-do-study-act’ cycles, which can be lengthy and time consuming. Large research studies such as CLECC provide a useful evidence base for best practice that has been tested at scale. Often a piece of research can help me decide whether to adopt something new.
Increasing clinical engagement
Promoting debate and inquiry can be key to developing clinical services. Using research evidence can facilitate this, providing a powerful way for senior nurses to engage clinical staff and help them to understand problems.
Engaging frontline staff is critical in implementing policy agreed at senior levels; the CLECC programme provides useful examples of how to do this. The original research paper (Bridges et al, 2018) outlines that, despite a real focus on compassion in healthcare, agreement on how best to promote and sustain it is still lacking. It discusses whose job it is, and whether people have the capacity to be compassionate. Bridges et al (2018) present the different methods that have been used to examine and evaluate this question, including study sessions, questionnaires, pilots and reflection. The study explains the interventions that can be used to try to make care more compassionate. It presents a blended view of approaches to achieving compassionate care and examples of how the research has tried to come to conclusions.
There is, however, less evidence on purely nursing practice. This can lead to decisions being made on personal experience or assumptions about what works. Robust research, such as the CLECC study, gives insight into the complexity of providing compassionate care, as well as into the actions directors of nursing need to take to ensure all patients receive this fundamental entitlement. We need more high-quality research into the conditions that enable nurses to practise well.
In recent years, I have built my ability to critically appraise research. There is much evidence that assists me with aspects of my role – particularly around clinical procedures and patient safety. That evidence, when used, has improved services. Supporting my work with evidence has given me more gravitas and enabled me to be more successful in shaping our services.
Perhaps the most important aspect of being research aware is that it helps me to discover new ways of doing things, and even challenges my views about what is best for patients and for organisations. By constantly reviewing the evidence on what works, rather than sticking with what I already know, I am contributing to the improvement and success of my organisation. On a personal level, being research aware and questioning the status quo has a positive impact on how I am perceived by others, and ultimately how successful and credible I am.
- Directors of nursing need to be research aware so they can help shape practice
- Nurses can use research-based evidence to argue for service developments
- The Creating Learning Environments for Compassionate Care study has implications for nurses
- The interventions studied can improve nurse satisfaction and, in turn, patient outcomes
- The study gives directors of nursing insight into what can be done so all patients receive compassionate care
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 4: taking the research project further
- Lifecycle of a research project 6: how research might guide policy
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, 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.
NHS England (2013) Human Factors in Healthcare: A Concordat from the National Quality Board.
West MA, Dawson JF (2012) Employee Engagement and NHS Performance.