Nurse Research: the qualitative research circle

1 July 2012

Principal researcher VALERIE NORTON and novice research nurse LEANNE WALDEN reflect on how their respective roles in a palliative care research study flowed on to influence their nursing and research practice.

We met during a Te Omanga Hospice study into patients’ and caregivers’ experiences of using a medication syringe driver to control symptoms.

The study included training palliative care nurses to carry out some of the research interviews.

In the end, the constraints of time (the window of opportunity to complete the interview was short) and conflict of interest (it was inappropriate for the patient’s own nurse to carry out the research interview) meant fewer nurses could take part and fewer patient/caregiver interviews were able to be completed (a total of 27 people were interviewed for the study, which can be found on the Te Omanga website www.teomanga.org.nz).

For us – the novice research nurse interviewer and the principal researcher – the study also provided insight into how research practice can impact on your nursing practice and nursing practice on your research.

From research to nursing practice (Leanne’s perspective)

As an undergraduate nursing student, I was captivated by learning about qualitative research and its ability to inform nursing practice.

I can remember a patient with a chest drain at Wellington Hospital. I found a research paper about patients’ lived experiences with a chest drain that night, and my understanding of the patient’s holistic experience was instantly enhanced.

The next day, I was able to ask questions regarding comfort from the point of view of the patient using the identified knowledge regarding the experience of other patients. As an inexperienced nurse, this knowledge is gold! It is like stepping into a patient’s shoes, acknowledging, of course, that all patients’ experiences are unique.

As an inpatient unit new graduate nurse at Mary Potter Hospice, I was quick to take up the opportunity to be involved with the Te Omanga syringe driver study. It involved an interview training workshop, which added depth to my understanding of qualitative research studies.

It was, however, spending two hours with a patient and his wife in their home, listening as they responded to the study questions, which transformed my understanding of the total impact of living with a syringe driver in place.

It has changed the way I provide new information to patients when a new syringe driver is to be started in the unit by informing the things that are important from a patient’s view and not the things that are relevant from a nursing perspective.

I now talk about aspects of care that were identified in the interview, including “tips” for comfort (like adjusting straps and suggesting site placement), what to do about the (syringe) beeping, the impact of site infections and importance of the early recognition of infection.

From nursing practice to research practice (Val’s perspective)

Hearing from Leanne late last year that doing her research interviews had changed her nursing practice sits in my kete of sacred moments.

For me, being a nurse means I do research differently. I listen in a different way because of my nursing knowledge and experiences.

Long ago in the 1970s, I wrote that, as a nurse, I listened with my whole body. I ‘listened’ with my eyes and ‘saw’ with my ears. This was part of my way of ensuring I was fully present with the person’s experience. It meant that I could stay silent for quite a long time as they found the words – and the trust in me to use the words – confident they would not be judged. I noticed all the detail of what was going on.

I wrote about that again as part of the methodology for my master’s thesis and once again when preparing the interview training notes for the syringe driver study. In the same way that “nurses are the tool of nursing”, so is the interviewer “the tool of the research interview”.

I told the interview trainees that the integrity of the study is dependent on the information provided in the patient and caregiver interviews, with the information elicited without asking too many direct or leading questions. To many casual observers, research interviewing does not seem to require a great deal of skill: “It’s so easy. Just having a chat”.

The skill of the interviewer is demonstrated when they make it look easy. The substantial work is invisible in the moment and is a consequence of sound planning and preparation, underpinned by respect for and sensitivity to the person’s dignity and humanity.

Nursing and research practice together (Leanne’s perspective)

I had been rather nervous at the start of my interviews with the couple. But afterwards, I returned to my car smiling quietly to myself with a newfound confidence and satisfaction. I had not only gained knowledge for the study, but I had also provided a therapeutic environment for both the patient and their carer to discuss the impact of using a syringe driver to provide medication to relieve nausea, vomiting, and pain.

I still need to gain more experience as a nurse, but I’m now confident that being a part of research studies will always be an important aspect of the nurse I will become.

They say “a picture paints a thousand words“. For me, this single interview allowed me to step inside a patient’s unique frame through spoken words and experience the holistic picture of their syringe driver experience – an insight like no other I had as a new graduate nurse.

We believe even if nurses are not directly participating in research, the benefits of reading and exploring ideas as we reflect on our work widens the scope of our practice enormously.

We also believe that nursing research has an important role in fostering a sense of curiosity about their practice for all nurses – so the cycle of nursing practice influencing research and research influencing nursing practice can keep on going round again and again.

Leanne Walden began work as new graduate palliative care RN at Mary Potter Hospice in 2011 under the NETP scheme and is starting on her Master of Nursing pathway this year.

Valerie Norton RN, M.A. says it felt like coming home when she returned to nursing practice at Te Omanga Hospice after several decades as a health researcher. She was awarded a Te Omanga Murray Bond Research Fellowship to carry out the syringe driver study.