Research. An apparently benign eight-letter word that seems to have a habit of representing a multitude of sins for many nurses, myself included. After wading through paradigms, ontologies and epistemologies during my pre-registration training and having lived to tell the tale, I found myself ready to box up my lecture notes and immerse myself in the challenging, glorious world of direct clinical care.
I suspect that, deep down, I knew then, as I know now, that nursing is not that simple. Research is the engine that drives us to improve the care we provide for patients, for families and for ourselves. It cannot simply be put back into its box, nor should we seek to keep it there. It seems to me that the challenge lies in bringing it to life by making it relevant and making it real. Lord Willis's Shape of Caring review recognised this and presented a call to action: ‘Employers need to recognise that there is powerful evidence regarding the benefits and return on investment of registered nurse leaders who successfully combine practical clinical and academic work’ (Health Education England, 2015:57).
Fortunately, I find myself employed by an organisation that has heeded this call through the creation of a community nursing research fellowship by our trust lead for nursing, midwifery and allied health professionals (NMAHP) research and our district nursing (DN) service manager. This has given me the time and space to take a step back from the bustle of my busy clinical role to consider what a research-active DN service might look like. I now find myself on a journey to familiarise myself with a research landscape that, previously, felt like something out of a parallel universe. If I can bring some of my colleagues on this journey with me, I know I will have succeeded.
Despite the untold challenges that all community nursing services have faced in the shadow of the COVID-19 pandemic, I am amazed by the energy and ideas presented by our DN staff on a daily basis. Rather than being a time to put research on the back burner, it is clear that we are now learning and adapting better than ever before. Capturing the challenges inherent in the complex nature of district nursing seems a perfect fit for a research-centric approach. By defining real problems for patients and staff, we can develop real solutions. Here is just one small example: one of the many impacts of COVID-19 on our DN service has been an increased level of demand, in terms of both the complexity and the number of our visits. As you might expect, we complete a structured nursing assessment with patients when we first meet and document their information electronically. In doing so, my own rudimentary analysis revealed that we click around 122 times and fill 28 text boxes when assessing an independent person with no complex clinical or social needs. Providing some hands-on nursing care, referring them on to other specialist services or booking follow-up visits all increase these numbers significantly.
In the digital age, this data matters. It matters to patients because the questions we ask shape their care, and we should be asking ‘What matters to you?’ as the starting point for our conversations (NHS England, 2020). It matters to nurses because every extra click or duplicated text box costs us time that could be better spent caring, teaching or recovering. Every one of my 122 clicks might be essential, but there is only one way to know for sure: deploy the ‘R-’ word. Research is our safest bet for better health and patient care in 2021.