Features

A new vision for research

18 March 2022

Louise Wolstenholme, Jo Cooke, Lisa Manlove and Tracey Long discuss sharing good practice when developing a 0 to 19 research network.

In November 2021, the chief nursing officer (CNO) for England launched the first strategic plan for nursing research with a vision ‘to create a people-centred research environment that empowers nurses to lead, participate in and deliver research, where research is fully embedded in practice and professional decision-making’ (NHS England and NHS Improvement, 2021). This vision builds on that of the National Institute for Health Research (NIHR) which has a ‘mission to improve the health and wealth of the nation through research’ (NIHR, 2021).

There is a growing body of evidence that demonstrates research conducted alongside practice improves the quality of care provided. For example, a study reviewing embedded research practitioner positions describes the benefits of increased research activity and collaborations, service improvements and workforce skills development and an enhanced research culture (Wenke et al, 2017). Boaz et al (2015) suggest that having research as part of organisational structures contributes to improved healthcare performance and describes this as a ‘by-product’ of the research itself.

This paper describes a research network developed over eight years that resonates and reflects such a vision in practice for 0 to 19 practitioners. In most instances, specialist community public health nurses (SCPHNs) have undertaken a postgraduate qualification and are well placed to participate in research, but we often lack confidence to do this. Developing a research network can be a good first step. It supports a collective approach that brings interested people together and enables research capacity.

Our ambition was to support research ‘close to practice’ in four ways:

  • First, by using research in practice.
  • Second, by delivering research in practice through recruiting children and families into ongoing research. It can also include delivering intervention projects, where practitioners learn new skills and evaluate impact on families.
  • Third, by developing and leading research. This is ideally done within practice, academic posts and partnerships.
  • And finally, through co-production and priority setting where practitioners help identify research priorities and participate in the design of the research from inception onwards.

Background to the network

The 0-19 Research Network Yorkshire and the Humber (Y&H) is a pioneering initiative aimed at public health professionals working within 0 to 19 services. Health visitors and school nurses are our key audience.

Formerly known as the North of England Health Visitor Research Network, it was created in 2013 by academics from Sheffield Hallam University and the University of Central Lancashire. At its outset it postulated that a facilitative approach could support research capacity-building, provide learning opportunities and start to inspire knowledge generation.

In 2016, a collaboration with the Y&H NIHR Clinical Research Network (CRN) was established, which supported further meetings, networking and increased reach whereby membership included others with an interest in 0 to 19 public health research, such as school nurses, public health practitioners, commissioners and managers. The objectives then included research delivery as an additional function.

In December 2020, the 0-19 Research Network was relaunched and became hosted by 0 to 19 services at Sheffield Children’s NHS Foundation Trust. It is run by a practitioner project group following the retirement of its founding member. The network includes members from most NHS trusts/local authorities. Our aims are:

  • To increase research engagement and capacity of public health professionals working with the 0 to 19 age group (building research capacity and engagement).
  • To support and increase the participation and recruitment of children and families in health services and public health research (research delivery).

 

our experience is that Developing a research network supports a collective approach that brings interested people together and enables research capacity

Capacity for Impact

The network has been guided by the research ‘Capacity for Impact’ framework (Cooke, 2021; 2005) shown in Figure 1, which includes seven principles that aim to guide and evaluate research capacity interventions like a research network. Many of the examples of achievements, challenges and interventions are influenced by several of the seven principles, demonstrating the interconnectedness and complexity of research capacity development. It also serves to identify gaps and future planning while recognising achievement.

Skills and confidence building

Our network has helped to build research skills and confidence in practitioners. We host an email-sharing platform and run virtual events for members where practitioners, researchers, academics, managers and commissioners have an opportunity to get together and share ideas and research. We disseminate research training opportunities and promote our online learning events. Members have gained personal research internships and PhD opportunities (see Table 1), and we believe the network itself is a learning environment that ‘brings research within reach’ to practice. Table 2 highlights topics presented at meetings.

Linkages and collaborations

Our network helps to share knowledge between professionals and researchers, and between research-interested practitioners. We also explore experience and options for current and future postgraduate study. Importantly, we share ideas and vision for future service development, evaluation and research, and help practitioners get involved with small studies.


Table 1: Personal awards as a direct result of the 0-19 Network

  • Six members have achieved Health Education England-NIHR integrated clinical academic internships, and one member has achieved a Collaboration for Leadership in Applied Health Research and Care research internship (impact examples: establishing a dental health intervention, evaluating Pregnancy, Birth and Beyond© programme, undertaking a systematic review of dietary interventions, and developing a local community of research practice).
  • One member on the NIHR [email protected] Senior Nurse Research programme (three-year funded secondment with a focus on building research capacity within 0 to 19 services).
  • One member secured funding for a part-time PhD, alongside a change of role focus to that of building research capacity.
  • One member on the NIHR/CRN First Steps into Research programme.

During the pandemic we have moved to virtual meetings, which has enhanced opportunities to engage with researchers regionally and nationally. The Institute of Health Visiting (iHV) and the School and Public Health Nurses Association (SAPHNA) have both endorsed the network, and their respective chief executives have presented on research priorities (Table 3).

We have worked collaboratively with researchers and other key stakeholders (for example, the iHV) on research projects that improved service delivery. These ‘close to practice’ intervention projects have a short route to impact and research benefit is felt quickly by services. This promotes and maintains enthusiasm and interest in the workforce, which can positively impact on staff retention.

Actionable dissemination

Projects that improve services and promote action stimulate motivation and capacity to do more. Intervention studies provide opportunities to promote impact and action. But unfortunately, such studies for HV practice are minimal. We also recognise that if practitioners are involved from the outset including identifying research needs, and influencing design, there is an increased likelihood for developing relevant findings and actionable recommendations and research outputs (Greenhalgh et al, 2016). We therefore promote further collaboration between practitioners and academics to work together co-productively. We are also undertaking research priority setting to shape work, for example engaging with other research/researchers.

We share ideas and vision for future service development, evaluation and research, and help practitioners get involved with small studies

Ownership and responsibilities

Three smaller geographically dispersed communities of research practice (CoRPs) have developed with the support of our network promoting ownership and responsibility to research at an organisational level. These groups have a recognised lead and meet regularly in their host organisation and we have shared how to set these up and adapt terms of reference. They have an overarching aim to increase research capacity at an organisational level through supporting delivery of externally funded research projects; developing and conducting research, service evaluation and audit; participating in and delivering training; implementing research findings into practice; discussing innovative practices; networking and supporting staff development; and offering postgraduate peer support.

Sustainability and leadership

Building research capacity is challenging when research is not seen as core business within services. We have experienced that staff that have completed the NIHR/Health Education England ICA internships then leave practice for academia because this offers research career progression.

Such roles and research career pathways in 0 to 19 services hardly exist and need managerial support.

Embedding research as a core business within services requires a shift in culture and a drive from leadership to transform services. Our network advocates for this to happen, as we recognise this as a block in getting research close to practice. While we welcome the financial support from the CRN, applying for this annually is also a challenge for sustainability of our network.

Co-production

We see this is where the greatest progress could be made. Our experiences have shown that 0 to 19 services are approached as potential sites once the research project has been written and funded. This is too late. Moving forward, we hope to strengthen collaborations with academics and be considered earlier in the research process and be funded as clinical collaborators to make this happen.

Infrastructure

Infrastructure spans a variety of organisational systems. The CRN supports and funds our network, providing administrative support, leadership time, room bookings, travel, materials and media costs. In return, our network helps to deliver research. We have also developed an infrastructure at an organisational level through the CoRPs. These enhance access to organisational infrastructure, including R&D departments, library services and service improvement departments. Infrastructure is vital as it provides the space to meet, collaborate and innovate.

Ambition

Families are now being invited to take part in research in Y&H that has the potential to impact on their health outcomes, and practitioners are gaining new knowledge and skills through research which positively affects the care they give.


Table 2: Topics presented at meetings

  • Building a research network – Louise Wolstenholme
  • How and where the 0-19 Research Network might work – Professor Jo Cooke
  • Research readiness and clinical academic careers: a personal account – Tracey Long

This achievement is all the greater for having been delivered at a regional level, enabling practitioners who often work in local silos to share best practice and learn from one another in a way that has never previously happened. However, we have described some difficulties and issues, particularly in relation to embedded research practitioner roles and funding to support sustainability.

There is a momentum behind SCPHN research, and there are policy drivers to make it happen through the CNO for England’s strategic plan (NHS England and NHS Improvement, 2021), the Care Quality Commission Strategy encouraging research and innovation (CQC, 2021) and the draft Standards of proficiency for specialist community public health nurses (NMC, 2021).


Table 3: Collaborators’ research priorities

  • Reporting the findings from the iHV State of Health Visiting survey and future research priorities – Alison Morton, iHV director
  • A call to arms for research by SAPHNA – Sharon White OBE, CEO, SAPHNA

The CNO’s vision of an empowering research environment for nurses could include running journal clubs, undertaking research projects, completing a service evaluation and evidence-based improvements, contributing to a paper, supporting individuals as clinical academics and creating research roles in practice.

We have described how a network can enable this. Ours was initially created by academics but is now led by practitioners demonstrating how close to practice research can happen. It has been pivotal in providing research successes within our region. We believe this approach can be mirrored elsewhere and would contribute to the CNO research vision. 

Louise Wolstenholme is 0 to 19 services research lead and health visitor, Sheffield Children’s NHS Foundation Trust, and NIHR [email protected] senior nurse research leader; Jo Cooke is professor of research capacity building at the Health Sciences School, University of Sheffield; Lisa Manlove is 0 to 19 services team leader and health visitor, Sheffield Children’s NHS Foundation Trust; Tracey Long is community practice educator and PhD researcher, Children’s Care Group, Rotherham Doncaster and South Humber NHS Foundation Trust.


References

Boaz A, Hanney S, Jones T et al. (2015) Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 5(12): e009415.

Cooke J. (2021) Building research capacity for impact in applied health services research partnerships comment on ‘experience of health leadership in partnering with university-based researchers in Canada - a call to “re-imagine” research’. International Journal of Health Policy and Management 10(2): 93-7.

Cooke J. (2005) A framework to evaluate research capacity building in health care. BMC Family Practice 6: 44.

Care Quality Commission. (2021) A new strategy for the changing world of health social care: our strategy from 2021. See: www.cqc.org.uk/sites/default/files/Our_strategy_from_2021.pdf (accessed 7 February 2022).

Greenhalgh T, Jackson C, Shaw S et al. (2016) Achieving research impact through co-creation in community-based health services: literature review and case study. Milbank Quarterly 94(2): 392-429. 

NHS England. (2021) Making research matter: chief nursing officer for England’s strategic plan for research. See: www.england.nhs.uk/wp-content/uploads/2021/11/B0880-cno-for-englands-strategic-plan-fo-research.pdf (accessed 7 February 2022).

National Institute for Health Research. (2021) Best research for best health: the next chapter. See: www.nihr.ac.uk/documents/about-us/best-research-for-best-health-the-next-chapter.pdf (accessed 7 February 2022).

NMC. (2021) Standards of proficiency for specialist community public health nursing. https://www.nmc.org.uk/globalassets/sitedocuments/post-registration/final-documents/standards-of-proficiency-for-specialist-community-public-health-nursing-.pdf (accessed 2 March 2022).

Wenke RJ, Ward EC, Hickman I et al. (2017) Allied health research positions: a qualitative evaluation of their impact. Health Research Policy and Systems 15(1): 6.

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