HLG Nursing Bulletin Vol 32 (3/4)
Kathleen Irvine
Subject Librarian
Highland Health Science Library,
Old Perth Road,
Inverness.
IV2 3JH
k.y.irvine@stir.ac.uk
Abstract
This article describes the issues involved in a collaborative research effort between a health librarian and midwifery professionals working in academia and clinical settings. The collaborative process is described and the advantages and challenges of such collaboration are highlighted. The project described illustrates how collaboration between team members can integrate skills, theory, research and practice.
It might be argued that research is the health librarian’s stock in trade. Information professionals working with nurses and other health practitioners encourage them to appreciate the value of research in their daily decision making (Schulte and Sherwill- Navarro 2009). LIS professionals have roles as trainers, educators, consultants, disseminators of information, supporters of research and champions of evidence-based practice. The health librarian’s specialist skills in information retrieval and knowledge management are much valued by healthcare researchers and their advanced research-related skills in health informatics and critical appraisal are increasingly in demand (Urquhart et al. 2005). Librarians are used to team working and working in multidisciplinary teams and in clinical settings is becoming much more common.
Health librarians are not only supporters of research but are increasingly conducting their own studies. Within the LIS profession there is a long tradition of practitioner research, often focusing on the evaluation of library services. Since the turn of the millennium there has been an emphasis on providing an evidence base to inform approaches to practice and today, in these straightened economic times, the need to conduct research to produce evidence to justify spending on developing and maintaining services has become vital (Raven 2011).
Given such complementary skills and shared interests in research, it is surprising to discover that examples of librarians and nurses or midwives working collaboratively as researchers are conspicuously rare. This paper reports on one such project and argues that inter-professional research has distinct advantages for both the LIS professional and the health professional colleagues.
Review of the literature
Jones et al. (1998) noted the rarity of research collaboration between university-based researchers and clinicians. Often, particularly in earlier days, where collaboration was claimed it was common for nurses to be involved as data collectors while university researchers were the ‘number crunchers’ handling the data and drawing conclusions. Nowadays such partnerships are likely to be more equal.
Health librarians (often, but not exclusively, in university settings) are having an increasing involvement in systematic reviews and are more frequently co-authoring such papers. However, a review of the library and nursing literature found only one example (Kirkwood, Wales and Wilson 2003) of nurses and librarians working as co-researchers in primary research.
The literature on collaborative research (being defined as university and clinical researchers working together on particular projects) notes a numerous advantages and a few disadvantages of this approach.
Advantages of collaborative research
Many healthcare practitioners now have a specific remit to undertake research but often lack the skills, knowledge or time to do justice to this aspect of their work. Collaborative research is an appropriate way for these professionals to improve their research skills and make a tangible contribution to developing the evidence base for practice (Fitzgerald et al. 2003). It has been noted that nurse participation in research projects may be increased by partnerships with academic staff (Balakas 2011)
Involvement of health practitioners in research may be expected to reap benefits in the incorporation of research into practice, extending the knowledge of the practitioner-researcher and benefiting the clinical setting (Jones et al. 1998; McCloughen and O’Brien 2006).
Clinician input increases the likelihood that research questions are concrete, relevant to practice and pertinent (Booth 2008; Jones et al. 1998)
In these metrics-informed times, collaboration has the potential to increase a researcher’s impact and supports the development of early career researchers (Kahn and Greenblatt 2009). It is widely accepted that collaborative research more readily attracts funding (McCloughen and O’Brien 2006).
Disadvantages of collaborative research
While most authors stress the advantages of collaboration, Jones et al. (1998) note that there can be some drawbacks. In particular, conflicts between clinical priorities and research interests including time spent collecting data. In addition, Gaskill et al. (2003) noted the mistrust and suspicion of clinical staff not engaged in research.
The study context
A University- employed Librarian attached to a School of Nursing and Midwifery with an additional remit for NHS
Highland staff worked in collaboration with a lecturer in Midwifery and a hospital-based Staff Midwife on a Delphi study of the research priorities of NHS Highland midwives. The Librarian was the principal investigator (PI) and the project arose out of her successful grant application to the Library and Information Research Group. The team comprised two novice researchers (the PI and the staff midwife) and one (the midwifery lecturer) with considerable experience. The study was modelled on research conducted by Kirkwood, Wales and Wilson (2003) with Glasgow nurses that used the Delphi technique to attempt to achieve a consensus on future research priorities. The researcher team in that study were two health librarians and a retired nurse.
The aim of the Highland Midwives STORY (HMS) was to identify the research priorities of midwives practising in the NHS Highland area and to examine the current evidence base underpinning their questions to determine the most important areas for focusing research efforts and areas where dissemination of evidence may be required.
The Delphi technique is a well-established methodology that aims gain consensus among a panel of experts. All practising midwives in NHS Highland (n=280) were invited to participate as they were expected to have expert knowledge of the midwifery issues that might be addressed through research. A three- round Delphi was employed. In Round 1 midwives were asked to list up to five topics/issues/questions of importance to midwifery practice. Their open-ended responses were then themed by the research team. In round 2 participants were asked to score the themes on a five-point Likert scale. Analysis using descriptive statistics identified those themes where a consensus on their importance had been reached. In round 3, participants were asked to reconsider their rating of the remaining non-consensus themes in the light of their colleagues’ opinions. Further analysis was undertaken and additional consensus themes were identified.
The thematic analysis of the open-ended responses to the round 1 questionnaire involved each response being presented on a slip of paper and the research team grouping these into themes. 20 main themes were identified. A questionnaire was drawn up listing the 20 themes and was sent to all respondents from round 1 for scoring. The scores were analysed.
Consensus on priority status was deemed to have been achieved, effectively, when 70% of respondents rated the theme ‘important’ or ‘very important’. Consensus was reached on four themes: workforce issues, second stage of labour, obesity in pregnancy and women’s expectations. After round 3 a further two topics reached consensus: breastfeeding and place of birth.
The evidence base surrounding the six themes was then examined. A protocol was drawn up and literature searches were conducted at sub-theme or, where more appropriate, question level. The research team examined the literature to determine which of these were worthy of further research and which had a sufficient evidence base for them to be treated as dissemination topics. For a fuller explanation of the study methodology see Irvine, Jessiman and Felce (2012)
Research collaboration issues
The skills of the team were complementary and each member was able to contribute more fully to different aspects of the project. The more experienced researcher was able to offer valuable suggestions regarding obtaining ethical approval, questionnaire design and recruitment of subjects. The staff midwife’s very presence on the team facilitated ‘buy-in’ from her peers and her knowledge of the local administrative structure, communication channels and the key personnel were invaluable in ensuring all midwives were invited and encouraged to participate.
Analysis of the round 1 questionnaires required considerable clinical knowledge that the PI lacked, but all three researchers contributed to the discussion and debate about the emergent themes. The librarian drew up the search protocol and template and advised members on searching the literature. She handled the ‘trickier’ searches such as those where evidence was absent or the evidence question was qualitative.
Both the staff midwife and librarian gained valuable new skills in conducting research. The former was able to attend the Royal College of Midwives’ annual conference to present a poster on the research project and the PI presented on the study at Umbrella and the Evidence-Based Librarianship Conference in Salford 2011. All three team members have new publications to add to their CV.
Both midwifery professionals have been made aware of midwives’ opinions on the areas requiring further research and of the evidence base surrounding the questions identified as priorities by midwives. This may lead either or both of these to further studies or changes to their professional practice.
The status of the librarian and the library service have been enhanced by the involvement as part of a team with clinicians. Midwifery professionals are now more aware of the librarian’s potential role and are more likely to use library services; the PI has recently contributed to the updating of the local midwifery guidelines, for example.
The potential disadvantage of a conflict over time spent on the project or the study taking away from clinical responsibilities as suggested by Jones (1998) did not occur as all three team members worked on the study ‘out of hours’. However, this has meant that the dissemination phase of the study has fallen behind schedule. The suspicion and resentment noted by Gaskill et al. (2003) was not observed, possibly because all midwives had been invited to participate in the study.
Conclusion
The experience of collaboration on HMS was entirely positive. It benefitted the team members, their services and the wider midwifery community in NHS Highland. Cohen et al. (2011) note the value of “a research-intensive environment [to] facilitate the ability of investigators to discuss their methods, struggles, and findings”. The two University-employed members of the team work in such an environment in The Centre for Health Science in Inverness and the staff midwife is employed in the adjacent Raigmore Maternity Unit. This proximity to a body of research expertise was indeed supportive and valued by the team.
The knowledge and skills of the team members were complementary and the benefits to team members (learning new skills, improving professional competence and enhancing CV’s) were shared across the team. Each member has a better understanding of theory, research and midwifery practice as a result of participating in this study.
The midwifery service should become more evidence based and research aware as a result of this study. The library service has gained a higher profile and the librarian’s status as ‘researcher’ has led to other clinicians seeking her advice and involvement in their research projects. The School of Nursing and Midwifery have gained valuable insight into the issues in midwifery practice of importance to practitioners, something that may inform future research efforts.
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