Nursing minds

More than 2,000 strong, nurses make up the largest professional group providing clinical care at The Royal Children’s Hospital (RCH).

Through the generosity of Victorians, the reach and profound impact of nurses is being extended. Under the stewardship of Professor Fiona Newall, funded as the Donald Ratcliffe and Phyllis McLeod Director of Nursing Research, a Nursing Research team was established in 2011 to focus on academic nursing leadership.

Nurses are the eyes and ears on the wards. The research team supports them to think critically about their bedside observation of patients, to ask questions of practice, gather evidence as a complement to their clinical expertise, then pinpoint achievable improvements. The ultimate goal is transforming evidence-backed research into improved practice.
Fiona described it as a “grassroots enabling” of nurses.

“That starts with nurses standing alongside patients and identifying a problem,” she said. “That problem isn’t abstract but something causing the child or family pain, discomfort or distress.”

Eight RCH nurses each year are accepted into the Building Evidence with Support to Transform (BEST) Practice program to break down their identified problem and work towards a solution over six months.

Supervised by Fiona and other members of the Nursing Research team, the nurses write a project brief.

“We’re careful to select projects that have a feasible solution,” she continued. “Is the identified problem a systems issue? Will it be possible to implement a clinical change? We take a personalised approach through a series of workshops and study days. We give them an understanding of research principles such as how data can lead change, but also support them to work with stakeholders or seek ethics approval.”

So far 84 nursing clinical guidelines have been developed to improve clinical outcomes for RCH patients and their families. In the last financial year, these web-based nursing guidelines have garnered 2.25 million hits, the majority accessed internationally.

The Nursing Research team has a strong partnership with the Department of Nursing at the University of Melbourne, supporting student nurses to complete clinical research projects at the RCH in the light of contemporary practice. In addition, the research team supports RCH nurses across the continuum of academic development from post-graduate certificates to PhD studies.

There are now six PhD-prepared nurses on campus, eight nurses completing PhDs and 178 nurses with Masters-level qualifications. All these research studies are informed by clinical questions identified by nurses in practice.

Fiona is a role model of this integration of practice and research, maintaining her clinical practice one day a week in the Clinical Haematology department as a Clinical Nurse Consultant in Anticoagulation.

The vision of the Nursing Research team is to further grow the nursing network and encourage broader research collaboration and service evaluation across the campus. The program raises the profile of nurses as subject matter experts while underpinning that knowledge with research methodology.

Also supported each year under Fiona’s broad umbrella is the Dame Elisabeth Murdoch Scholarship recipient (page 39). The 2018 recipient Tania Ramos was provided with dynamic mentoring which will lead to the collation of her findings on emergence delirium, experienced by some children as they emerge from the operating theatre.

“Underlying all of this is helping the hospital achieve excellence through delivering great patient care,” continued Fiona. “Nurses aspire to advance themselves, but their clinical issues also place them in exact alignment with the hospital’s aspirations: timely access to quality care and doing no harm.

“We seek to establish nurses as agents of change. It’s quite something to see the look of determination in an empowered nurse’s eyes when they can see a solution up ahead and they are a part of that solution.”