Research Nurses in Orthopaedics

Gayle Walley BSc(Nurs)
Orthopaedic Surgical Trial Unit
Departrment of Trauma and Orthopaedic Surgery
Keele University School of Medicine
Thornburrow Drive
Harsthill, Stoke on Trent ST4 8FB Staffs
ENGLAND
Tel:  + 44 1782 55 48 46
Fax: + 44 1782 41 22 36

Nursing research is complex, and relatively little nursing research has been undertaken (Bassett and Hopkins 2001).  The role of research nurse in trauma and orthopaedics is vast and multi-faceted, and can vary considerably (Williams and Gumbrell 1990), but can be extremely important to the successful implementation and completion of clinical studies.  The research nurse is involved in all aspects of the research process, including assisting in the initial writing of the protocol.  Successful coordination of multidisciplinary, collaborative research relies heavily on the qualities that constitute the "art" of nursing, especially those of interpersonal communication skills (Martin 1994).  Whilst having an in-depth knowledge of the research process is fundamental to the research nurse role, past experience will also determine the feasibility of a planned project (Dunn 1991).  The role involves the education of clinicians and nurses about the study protocols, and strengthening the links between clinicians and researchers can help to enhance this process.

The research nurse can enroll patients into studies, administer study interventions, and record data, acting as the link between the study subjects and the investigative team (Pranulis 1997).  Conflict between roles as caregiver versus researcher can occur (Hagle, Barbour, Flynn, Kelley, Trippon, Braun, Beschorner, Boxler, Hange, McGuire, Bressler and Kirchhoff 1987), and therefore attempts should be made to minimise such conflicts (McGuire et al 2000).  The nurse has to balance patient advocacy and responsibilities to the study and the study contributors (Stanfield and Simon 1991) to ensure that the role is carried out proficiently.

Scientists often tend to function under the illusion that, when a research study is planned, patients will respond like "experimental subjects" (Gross and Fogg 2001).  In our setting, the research nurse is responsible for the screening of all potential study patients according to the eligibility criteria central to the study.  This is often time consuming, especially in the constraints of clinics when patients have to see so many members of the multi-disciplinary team, and regular hospital staff have many other duties that compete for their attention (Friedman et al 1998). 

The research nurse should use strategies to ensure adherence by informing the patient in as much detail as possible on what the trial involved and what was expected from them: a truly informed participant is a better adherer (Becker 1990 and Green 1979).  The provision of an information sheet to take away also reinforces what has already been discussed.  Good communication skills and a more thorough delivery of the intervention are vital in ensuring that all members adhere to the protocol to ensure the trial runs smoothly and the results may be generalized.                    

The research nurse must ensure that the patient is given all the necessary information to make an informed choice, and must promote the interests of the patient (UKCC 1992).  The patient must be given the opportunity to think over the information, thereby offering the patient a choice as to whether to participate in the study (O'Brien 1997).

The research nurse's sensitivity to the moral implication of the research, and firm adherence to a professional code of practice, ensures sound foundations for the security and well being of all who participate in the research or contribute to the process in any way.  Patients' perception of quality and satisfaction with care appear to be strongly connected with impressions of practitioner interpersonal and clinical competence, and the nature and significance of the relationships cultivated between the nurse and the patient (French 1981; Kitson 1986 and Cleverley 1990).  Providing an honest but approachable relationship with the patient/client can help to ensure patients feel both comfortable in entering research studies and also feel satisfied with the process.      

Although the roles and responsibilities of research nurses involved in clinical trials and studies have been described (Crowley, Somelofski, Hill, Smith and Buchwald 1988; Engelking 1991; Melink and Whitacre 1991; Seguin 1990; Stewart 1990 and White-Hersey and Nevidjon 1990), published nursing research on the clinical research nurse role is lacking.  A multidisciplinary team approach to research helps to disperse the traditional boundaries between health professionals, between doctor and patient, and between managers and clinicians.  This enables a no-blame culture, excellent leadership and an ethos of staff that feel valued and supported (Halligan and Donaldson 2001).  Involving a wide range of stakeholders in uncovering the best available evidence, and ascertaining the priorities and benefits from the facts, leads to a sense of ownership and involvement (Kitson, McMahon, Rafferty and Scott 1997).  It allows for a culture more receptive to research and the changes associated with it, and it emphasizes the importance in ensuring evidence-based quality patient care.

The research nurse can help to establish dedicated research clinics.  This ensures that patients are followed up and reviewed according to the protocol, and allows for continuity of patients involved in the clinical studies.  The research clinics allow for time to follow-up patients without any interruptions, although follow-up can be scheduled as much as possible to coincide with appointments with the medical staff so as to inconvenience the patient as little as possible.

In conclusion, the role of the research nurse in clinical research can be challenging.  Conflict and animosity can be prominent features initially; as staff may feel the role impinges on systems already in place and may interfere with already overburdened job roles. The research nurse role carries a considerable amount of clinical autonomy (Johnson 1986 and Xanthos et al 1998), and yet much experience can be gained by the whole research team while properly interacting in a constructive fashion. 

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