Nurse Researcher
Lessons learned from conducting qualitative research in a hospital Cite this article as: Woith WM, Jenkins SH, Astroth KS, Kennedy JA (2014) Lessons learned from conducting qualitative research in a hospital. Nurse Researcher. 22, 2, 40-43. Date of submission: September 9 2013. Date of acceptance: October 12 2013. Correspondence [email protected] Wendy Mann Woith PhD, RN, FAAN is an associate professor at the Mennonite College of Nursing Sheryl Henry Jenkins PhD, ACNP, RN is an associate professor at the Mennonite College of Nursing Kim Schafer Astroth PhD, RN is an assistant professor at the Mennonite College of Nursing Julie A Kennedy MSN, RN is a PhD student All at Illinois State University, Normal, llinois, US Peer review This article has been subject to double-blind review and checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Abstract Aim To examine unexpected barriers to the conduct of hospital research during a study of nurses’ activation of rapid response teams. Background We interviewed hospital nurses regarding their decisions to activate rapid response teams and encountered unexpected barriers to the conduct of this study in the hospital setting. Data sources Experience of conducting qualitative research with bedside nurses in a community hospital. Review methods Review of the reports of others who have conducted hospital research. Discussion Barriers related to administrative support, environmental distractors, constraints on nurses’ time, apparent lack of investment in research by staff and a cumbersome recruitment process are identified. Recommendations on study site selection, timing of research, gaining access to nurses, scheduling and conducting interviews, and transcribing recorded data are made.
Introduction Nurses are expected to use evidence to support their practice and provide safe, high-quality care (Jamerson and Vermeersch 2012, Syme and Stiles 2012). It is therefore important that nurses understand and participate in research. This participation involves conducting research, and also serving as participants to broaden understanding of the experiences and perceptions of nurses (Shaha et al 2011, Silka et al 2012). We recently interviewed hospital nurses regarding their decisions to activate ‘rapid response teams’ (Astroth et al 2013) and encountered unexpected barriers to the conduct of this study in a hospital. 40 November 2014 | Volume 22 | Number 2
Conclusion As evidence is necessary to deliver safe, quality care, it is important that nurses understand and participate in research. This participation involves not only conducting research, but also serving as subjects. Given the importance of bedside nurses’ willingness to engage in research, it is crucial to understand factors that impede or assist their participation. Implications for research/practice We offer several recommendations to nurses conducting research in hospitals, including: ■ Seek hospitals that are supportive of research, yet not over-invested in the process. ■ Build extra time into data collection schedules to maximize flexibility and accommodate work-place demands. ■ Emphasise the relevance and benefits of the research to nurses. Keywords Hospital research, nurses, barriers to research, recruitment, qualitative research Rapid response teams are typically comprised of an intensive care nurse, a respiratory therapist, and possibly a third clinical expert, who respond to the bedside of patients experiencing clinical deterioration (Astroth et al 2013). These teams provide early intervention in an attempt to prevent cardiopulmonary arrest (Astroth et al 2013). The purpose of this paper is to explore the barriers we encountered while conducting research at a 155-bed, faith-based, community hospital.
Review of the literature Several barriers to the conduct of hospital research have been reported. A review of the literature © RCN PUBLISHING / NURSE RESEARCHER
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Barriers revealed these barriers fall primarily into two categories: systems barriers and barriers related to nurses. Systems barriers Although healthcare institutions in the US and elsewhere may have systems to promote research, historically this has involved doctors rather than nurses (Syme and Stiles 2012, Paterson Kelly et al 2013). Given the importance of including nurses in research (Shaha et al 2011, Silka et al 2012, Syme and Stiles 2012), the American Nurses Credentialing Center (ANCC) in the US developed a plan for a ‘Magnet’ designation to recognise institutions characterised by nursing excellence, improve patient outcomes and promote programmes of nursing research (ANCC 2013, Paterson Kelly et al 2013). Magnet facilities use expert nurse researchers, nurse research committees and other structures to support nurses’ involvement in these activities (ANCC 2013). Regardless of whether hospitals have achieved Magnet designation or not, barriers exist to nursing research in clinical settings (Shaha et al 2011, Akerjordet et al 2012, Syme and Stiles 2012). Hospitals tend to have hierarchical structures. To access nurses, researchers must identify key players, and gain the approval and support of gatekeepers (Gordon et al 2005, Shaha et al 2011). These gatekeepers may not understand the research process, for example, Gordon et al (2005) described a hospital study in which supervisors tried to select participants, ordered employees to participate in interviews and attempted to remain during participant interviews. Supervisors are also charged with being cognisant of demands on nurses’ time; with the current emphasis on nurse-led research, organisations may be so involved with internal research that nurses have little time to participate in external studies (Fischer et al 2012). Nevertheless, the support of leaders is essential for nurses to participate in research (Shaha et al 2011, Akerjordet et al 2012, Jamerson and Vermeersch 2012, Paterson Kelly et al 2013). Barriers related to nurses Nurses’ time Time is an important barrier to nurses leading research and participating in studies (Roxburgh 2006, Shaha et al 2011, Akerjordet et al 2012, Syme and Stiles 2012). According to a study of hospice nurses carried out in the US, the amount of time nurses are willing to spend on the conduct of research varies: 25% of hospice nurses said they had no time for research and 34% said they were willing to spend no more than ten minutes per patient visit on the process (Kirsh et al 2004); by contrast, © RCN PUBLISHING / NURSE RESEARCHER
in a British study, nurses said they would devote one half day to one day a week on research activities (Roxburgh 2006). Gordon et al (2005) described hospital research as time-consuming and difficult to schedule. Since hospitals operate around the clock, researchers must be available when participants are working, including nights and weekends (Gordon et al 2005, Shaha et al 2011). Even when researchers are present, the number of hospitalised patients for a given institution, the severity of their illnesses and the amount of nursing care required make it difficult to predict staff availability (Gordon et al 2005). Furthermore, nurses may not wish to leave their patients in the care of co-workers who have their own responsibilities (Roxburgh 2006, Shaha et al 2011). Patient care is the highest priority for nurses (Paterson Kelly et al 2013) and providing quality care when there is inadequate staffing and patients with increasingly complex needs takes precedence over other professional activities, such as research (Shaha et al 2011). Incentives for nurses Given these barriers (Shaha et al 2011, Akerjordet et al 2012), providing incentives may encourage nurses to participate in research (Roxburgh 2006, Kleinpell 2008, Astroth et al 2013). Education may serve as an important internal motivator: researchers have noted that nurses with advanced degrees are more likely to conduct hospital research (Paterson Kelly et al 2013), support research and participate in studies (Roxburgh 2006, Silka et al 2012). Relevance of the research may be an important internal motivator; nurses are more likely to participate if they believe a study will affect nursing practice (Roxburgh 2006, Paterson Kelly et al 2013). The emphasis on evidence-based practice should encourage nurses to seek interventions that have been demonstrated to promote safety and quality care (Jamerson and Vermeersch 2012). If nurses do not value the research or see its importance, they are less willing to become involved (Shaha et al 2011, Akerjordet et al 2012, Paterson Kelly et al 2013). When potential participants realise that the researchers are also nurses, they may view a study as more credible and of greater importance to the profession (Shaha et al 2011). Even when institutional motivators are in place, researchers may find it helpful to offer incentives to participants, in countries where this is allowed. Nurses have described being asked to work harder without a concomitant increase in compensation (Roxburgh 2006); therefore, modest financial compensation (Astroth et al 2013) or some other November 2014 | Volume 22 | Number 2 41
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Art & science | acute care Nurse Researcher form of reward may serve as an inducement for engaging in research (Roxburgh 2006).
Lessons learned During the conduct of an Institutional Review Board (IRB)-approved qualitative study, we encountered several barriers to research. Consistent with our review of the literature, we found barriers related to systems and nurses; we also found barriers related to the research process that have not yet been described in the literature. Systems Support from hospital leaders Leaders at the study hospital had demonstrated support of professional nursing practice by attaining Magnet status. They had promoted nursing research through a nurse-led, multidisciplinary research council and a requirement that nurses participate in research if they want to advance their careers. The literature suggests that these activities are important in assisting nursing research (Kleinpell 2008, Shaha et al 2011, Akerjordet et al 2012, Jamerson and Vermeersch 2012, Silka et al 2012). At the time of our study, the study hospital had seven ongoing studies and while administrators were supportive of research, the institution may have over-invested. We had difficulty recruiting nurse participants, with unit leaders suggesting that the staff may have had ‘research fatigue’. This has been described in nursing (Fischer et al 2012) and other disciplines (Clark 2008) to the extent that organisations have refused to participate in research because they were already involved in multiple studies (Clark 2008, Fischer et al 2012). Facilities Hospitals are challenging settings for conducting research (Gordon et al 2005, Roxburgh 2006, Shaha et al 2011). Our interviews were interrupted when nurses who were off-duty were called by their co-workers to answer questions or even asked to report to their units when extra help was needed. Ambient noise was also a problem: for example, we found it difficult to conduct interviews in hospital conference rooms wired to receive announcements. Nurses Flexibility Researchers have suggested that flexibility is important when conducting research with nurses (Shaha et al 2011). In our study, registered nurses participated in semi-structured interviews. We developed a flexible interview schedule so that researchers were able to meet participants when they were available. Our interviews were conducted 42 November 2014 | Volume 22 | Number 2
on-site to make it easier and more convenient for participants. Since conducting hospital research immediately before or after assigned shifts encourages participation (Shaha et al 2011), we scheduled our interviews accordingly. Despite this approach, we had difficulty recruiting the desired number of nurses. Time The literature supports the notion that time constraints impede nurses’ participation in research (Shaha et al 2011, Akerjordet et al 2012, Silka et al 2012, Syme and Stiles 2012, Paterson Kelly et al 2013); this barrier also affected our research at several points. We started recruiting at staff meetings, which were already tightly scheduled. Although nothing was overtly stated, we perceived that we were imposing on the staff – the nurses were busy and we were asking them to devote an additional half hour to our study. During our interviews, it was evident that nurses felt compelled to respond when co-workers called for help. Relevance of research topic Nurses are more likely to participate in research they believe to be relevant (Akerjordet et al 2012, Silka et al 2012, Syme and Stiles 2012, Paterson Kelly et al 2013). Our study involved nurses describing their experiences with rapid response teams. These teams are well-established at the study site, and most participants expressed confidence in the system and their ability to navigate it. However, they recognised that there were problems: for example, they acknowledged that education for rapid response was sporadic, that some nurses did not understand their roles, and that team members were sometimes condescending to staff nurses who called for help. It would then seem likely that nurses would view rapid response research as valuable. Furthermore, the study hospital is a Magnet facility and nurses’ promotions are tied to their involvement in research; this could be expected to be a motivator for participation (Kleinpell 2008). Participation in our study offered nurses two potential benefits: stronger rapid response systems and personal career advancement. Nevertheless, most were reluctant to participate. Research process Our review of the literature described barriers to the conduct of hospital research related to systems and nurses. However, we also found that some of the logistics associated with our research design impeded our work. For example, our recruitment process was cumbersome. Shaha et al (2011) found that staff meetings provided excellent opportunities for recruitment, but we began our study during the summer when these meetings are poorly attended. We had intended to complete enrolment in © RCN PUBLISHING / NURSE RESEARCHER
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Barriers one month, but to contact most of the nurses, we had to extend recruitment to a second month. Because rapid-response activation can be a sensitive topic, we took extra measures to ensure confidentiality. After describing the study’s purpose and procedure during recruitment, we gave each nurse a form and asked them to check one of two boxes: ‘Yes, I am interested, contact me’ and ‘No, I am not interested.’ Nurses who were interested were also asked to add their contact information to their forms so a researcher could call to set up interviews. Extra forms were left in staff lounges for those who were not present at meetings. This involved multiple return trips to the nursing units to retrieve completed forms. To explore factors that discouraged nurses from calling for help, we initially planned to include ten nurses who had not activated the rapid response team and ten who had. However, only nurses who had activated rapid response contacted us. To obtain this information by another means, we added the following question to our interview guide: ‘Can you tell me about a time when you believe you could have activated the rapid response team, but chose not to?’ This required revision of the research protocol and modification of the IRB proposals for the study site and the researchers’ academic institution. Recorded interviews allowed us to capture nurses’ perspectives in rich detail but deciphering recordings could be difficult: ■ Fluctuations in the volumes of voices and extensive background noise sometimes made conversations hard to understand. ■ Fire-alarm testing occurred during one interview and although we were able to continue, the conversation was intermittently inaudible. Fortunately, we were able to reconstruct
that portion of the interview using the researcher’s field notes. ■ One participant brought her sleeping infant to the interview, requiring the conversation to be carried out in whispers.
Recommendations Considering the challenges we encountered in conducting hospital research, we offer the following recommendations: ■ Consider choosing hospitals in which leaders have demonstrated a commitment to nursing research. ■ Acknowledge any ongoing research when choosing study sites and developing project timelines. ■ Schedule interviews in quiet locations. ■ Build extra time into the data collection schedule to accommodate workplace demands. ■ Emphasise the need for participants to schedule interviews when they have no other commitments. ■ Emphasise the relevance and benefits of the research to nurses. ■ Obtain access to staff using email, staff meetings and posted materials to make recruitment less cumbersome. ■ Be cognisant of the timing of the study; summer months and holidays in general may be problematic. ■ Invest in good recording equipment when feasible. ■ Maintain detailed field notes to help interpret recorded interviews.
Conclusion Bedside nurses are experts in providing safe, excellent care and can provide a wealth of information. Consequently, their participation in research is vital so researchers need to be proficient at conducting hospital research. This entails having a realistic understanding of potential barriers.
Online archive For related information, visit our online archive and search using the keywords
Conflict of interest None declared
References Akerjordet K, Lode K, Severinsson E (2012) Clinical nurses’ attitudes towards research, management and organisational resources in a university hospital: Part 1. Journal of Nursing Management. 20, 6, 814-823. American Nurses Credentialing Center (ANCC) (2013) ANCC Magnet Recognition Program www.nursecredentialing.org/Magnet.aspx (Last accessed: September 12 2014.) Astroth KS, Woith WM, Stapleton SJ et al (2013) Qualitative exploration of nurses’ decisions to activate rapid response teams. Journal of Clinical Nursing. 22, 19–20, 2876-2882.
Clark T (2008) ‘We’re over-researched here!’: exploring accounts of research fatigue within qualitative research engagements. Sociology. 42, 5, 953-970.
Jamerson PA, Vermeersch P (2012) The role of the nurse research facilitator in building research capacity in the clinical setting. Journal of Nursing Administration. 42, 1, 21-27.
Roxburgh M (2006) An exploration of factors which constrain nurses from research participation. Journal of Clinical Nursing. 15, 5, 535-545.
Fischer DJ, Burgener SC, Kavanaugh K et al (2012) Conducting research with end-of-life populations: overcoming recruitment challenges when working with clinical agencies. Applied Nursing Research. 25, 4, 258-263.
Kirsh KL, Walker R, Snider S et al (2004) Hospice staff members’ views on conducting end-of-life research. Palliative and Supportive Care. 2, 3, 273-282.
Shaha M, Wenzel J, Hill EE (2011) Planning and conducting focus group research with nurses. Nurse Researcher. 18, 2, 77-87.
Gordon DR, Ames GM, Yen IH et al (2005) Integrating qualitative research into occupational health: a case study among hospital workers. Journal of Occupational and Environmental Medicine. 47, 4, 399-409.
© RCN PUBLISHING / NURSE RESEARCHER
Kleinpell RM (2008) Promoting research in clinical practice: strategies for implementing research initiatives. AACN Advanced Critical Care. 19, 2, 155-161. Patterson Kelly K, Turner A, Gabel Speroni K et al (2013) National survey of hospital nursing research, part 2: facilitators and hindrances. Journal of Nursing Administration. 43, 10Suppl., S36-S41.
Silka CR, Stombaugh HA, Horton J et al (2012) Nursing research in a nonacademic health system: measuring knowledge, attitudes, and behaviors. The Journal of Nursing Administration. 42, 7/8, 386-392. Syme R, Stiles C (2012) Promoting nursing research and innovation by staff nurses. Applied Nursing Research. 25, 1, 17-24.
November 2014 | Volume 22 | Number 2 43
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Lessons learned from conducting qualitative research in a hospital Cite this article as: Woith WM, Jenkins SH, Astroth KS, Kennedy JA (2014) Lessons learned from conducting qualitative research in a hospital. Nurse Researcher. 22, 2, 40-43. Date of submission: September 9 2013. Date of acceptance: October 12 2013. Correspondence [email protected] Wendy Mann Woith PhD, RN, FAAN is an associate professor at the Mennonite College of Nursing Sheryl Henry Jenkins PhD, ACNP, RN is an associate professor at the Mennonite College of Nursing Kim Schafer Astroth PhD, RN is an assistant professor at the Mennonite College of Nursing Julie A Kennedy MSN, RN is a PhD student All at Illinois State University, Normal, llinois, US Peer review This article has been subject to double-blind review and checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Abstract Aim To examine unexpected barriers to the conduct of hospital research during a study of nurses’ activation of rapid response teams. Background We interviewed hospital nurses regarding their decisions to activate rapid response teams and encountered unexpected barriers to the conduct of this study in the hospital setting. Data sources Experience of conducting qualitative research with bedside nurses in a community hospital. Review methods Review of the reports of others who have conducted hospital research. Discussion Barriers related to administrative support, environmental distractors, constraints on nurses’ time, apparent lack of investment in research by staff and a cumbersome recruitment process are identified. Recommendations on study site selection, timing of research, gaining access to nurses, scheduling and conducting interviews, and transcribing recorded data are made.
Introduction Nurses are expected to use evidence to support their practice and provide safe, high-quality care (Jamerson and Vermeersch 2012, Syme and Stiles 2012). It is therefore important that nurses understand and participate in research. This participation involves conducting research, and also serving as participants to broaden understanding of the experiences and perceptions of nurses (Shaha et al 2011, Silka et al 2012). We recently interviewed hospital nurses regarding their decisions to activate ‘rapid response teams’ (Astroth et al 2013) and encountered unexpected barriers to the conduct of this study in a hospital. 40 November 2014 | Volume 22 | Number 2
Conclusion As evidence is necessary to deliver safe, quality care, it is important that nurses understand and participate in research. This participation involves not only conducting research, but also serving as subjects. Given the importance of bedside nurses’ willingness to engage in research, it is crucial to understand factors that impede or assist their participation. Implications for research/practice We offer several recommendations to nurses conducting research in hospitals, including: ■ Seek hospitals that are supportive of research, yet not over-invested in the process. ■ Build extra time into data collection schedules to maximize flexibility and accommodate work-place demands. ■ Emphasise the relevance and benefits of the research to nurses. Keywords Hospital research, nurses, barriers to research, recruitment, qualitative research Rapid response teams are typically comprised of an intensive care nurse, a respiratory therapist, and possibly a third clinical expert, who respond to the bedside of patients experiencing clinical deterioration (Astroth et al 2013). These teams provide early intervention in an attempt to prevent cardiopulmonary arrest (Astroth et al 2013). The purpose of this paper is to explore the barriers we encountered while conducting research at a 155-bed, faith-based, community hospital.
Review of the literature Several barriers to the conduct of hospital research have been reported. A review of the literature © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 07, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Barriers revealed these barriers fall primarily into two categories: systems barriers and barriers related to nurses. Systems barriers Although healthcare institutions in the US and elsewhere may have systems to promote research, historically this has involved doctors rather than nurses (Syme and Stiles 2012, Paterson Kelly et al 2013). Given the importance of including nurses in research (Shaha et al 2011, Silka et al 2012, Syme and Stiles 2012), the American Nurses Credentialing Center (ANCC) in the US developed a plan for a ‘Magnet’ designation to recognise institutions characterised by nursing excellence, improve patient outcomes and promote programmes of nursing research (ANCC 2013, Paterson Kelly et al 2013). Magnet facilities use expert nurse researchers, nurse research committees and other structures to support nurses’ involvement in these activities (ANCC 2013). Regardless of whether hospitals have achieved Magnet designation or not, barriers exist to nursing research in clinical settings (Shaha et al 2011, Akerjordet et al 2012, Syme and Stiles 2012). Hospitals tend to have hierarchical structures. To access nurses, researchers must identify key players, and gain the approval and support of gatekeepers (Gordon et al 2005, Shaha et al 2011). These gatekeepers may not understand the research process, for example, Gordon et al (2005) described a hospital study in which supervisors tried to select participants, ordered employees to participate in interviews and attempted to remain during participant interviews. Supervisors are also charged with being cognisant of demands on nurses’ time; with the current emphasis on nurse-led research, organisations may be so involved with internal research that nurses have little time to participate in external studies (Fischer et al 2012). Nevertheless, the support of leaders is essential for nurses to participate in research (Shaha et al 2011, Akerjordet et al 2012, Jamerson and Vermeersch 2012, Paterson Kelly et al 2013). Barriers related to nurses Nurses’ time Time is an important barrier to nurses leading research and participating in studies (Roxburgh 2006, Shaha et al 2011, Akerjordet et al 2012, Syme and Stiles 2012). According to a study of hospice nurses carried out in the US, the amount of time nurses are willing to spend on the conduct of research varies: 25% of hospice nurses said they had no time for research and 34% said they were willing to spend no more than ten minutes per patient visit on the process (Kirsh et al 2004); by contrast, © RCN PUBLISHING / NURSE RESEARCHER
in a British study, nurses said they would devote one half day to one day a week on research activities (Roxburgh 2006). Gordon et al (2005) described hospital research as time-consuming and difficult to schedule. Since hospitals operate around the clock, researchers must be available when participants are working, including nights and weekends (Gordon et al 2005, Shaha et al 2011). Even when researchers are present, the number of hospitalised patients for a given institution, the severity of their illnesses and the amount of nursing care required make it difficult to predict staff availability (Gordon et al 2005). Furthermore, nurses may not wish to leave their patients in the care of co-workers who have their own responsibilities (Roxburgh 2006, Shaha et al 2011). Patient care is the highest priority for nurses (Paterson Kelly et al 2013) and providing quality care when there is inadequate staffing and patients with increasingly complex needs takes precedence over other professional activities, such as research (Shaha et al 2011). Incentives for nurses Given these barriers (Shaha et al 2011, Akerjordet et al 2012), providing incentives may encourage nurses to participate in research (Roxburgh 2006, Kleinpell 2008, Astroth et al 2013). Education may serve as an important internal motivator: researchers have noted that nurses with advanced degrees are more likely to conduct hospital research (Paterson Kelly et al 2013), support research and participate in studies (Roxburgh 2006, Silka et al 2012). Relevance of the research may be an important internal motivator; nurses are more likely to participate if they believe a study will affect nursing practice (Roxburgh 2006, Paterson Kelly et al 2013). The emphasis on evidence-based practice should encourage nurses to seek interventions that have been demonstrated to promote safety and quality care (Jamerson and Vermeersch 2012). If nurses do not value the research or see its importance, they are less willing to become involved (Shaha et al 2011, Akerjordet et al 2012, Paterson Kelly et al 2013). When potential participants realise that the researchers are also nurses, they may view a study as more credible and of greater importance to the profession (Shaha et al 2011). Even when institutional motivators are in place, researchers may find it helpful to offer incentives to participants, in countries where this is allowed. Nurses have described being asked to work harder without a concomitant increase in compensation (Roxburgh 2006); therefore, modest financial compensation (Astroth et al 2013) or some other November 2014 | Volume 22 | Number 2 41
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Art & science | acute care Nurse Researcher form of reward may serve as an inducement for engaging in research (Roxburgh 2006).
Lessons learned During the conduct of an Institutional Review Board (IRB)-approved qualitative study, we encountered several barriers to research. Consistent with our review of the literature, we found barriers related to systems and nurses; we also found barriers related to the research process that have not yet been described in the literature. Systems Support from hospital leaders Leaders at the study hospital had demonstrated support of professional nursing practice by attaining Magnet status. They had promoted nursing research through a nurse-led, multidisciplinary research council and a requirement that nurses participate in research if they want to advance their careers. The literature suggests that these activities are important in assisting nursing research (Kleinpell 2008, Shaha et al 2011, Akerjordet et al 2012, Jamerson and Vermeersch 2012, Silka et al 2012). At the time of our study, the study hospital had seven ongoing studies and while administrators were supportive of research, the institution may have over-invested. We had difficulty recruiting nurse participants, with unit leaders suggesting that the staff may have had ‘research fatigue’. This has been described in nursing (Fischer et al 2012) and other disciplines (Clark 2008) to the extent that organisations have refused to participate in research because they were already involved in multiple studies (Clark 2008, Fischer et al 2012). Facilities Hospitals are challenging settings for conducting research (Gordon et al 2005, Roxburgh 2006, Shaha et al 2011). Our interviews were interrupted when nurses who were off-duty were called by their co-workers to answer questions or even asked to report to their units when extra help was needed. Ambient noise was also a problem: for example, we found it difficult to conduct interviews in hospital conference rooms wired to receive announcements. Nurses Flexibility Researchers have suggested that flexibility is important when conducting research with nurses (Shaha et al 2011). In our study, registered nurses participated in semi-structured interviews. We developed a flexible interview schedule so that researchers were able to meet participants when they were available. Our interviews were conducted 42 November 2014 | Volume 22 | Number 2
on-site to make it easier and more convenient for participants. Since conducting hospital research immediately before or after assigned shifts encourages participation (Shaha et al 2011), we scheduled our interviews accordingly. Despite this approach, we had difficulty recruiting the desired number of nurses. Time The literature supports the notion that time constraints impede nurses’ participation in research (Shaha et al 2011, Akerjordet et al 2012, Silka et al 2012, Syme and Stiles 2012, Paterson Kelly et al 2013); this barrier also affected our research at several points. We started recruiting at staff meetings, which were already tightly scheduled. Although nothing was overtly stated, we perceived that we were imposing on the staff – the nurses were busy and we were asking them to devote an additional half hour to our study. During our interviews, it was evident that nurses felt compelled to respond when co-workers called for help. Relevance of research topic Nurses are more likely to participate in research they believe to be relevant (Akerjordet et al 2012, Silka et al 2012, Syme and Stiles 2012, Paterson Kelly et al 2013). Our study involved nurses describing their experiences with rapid response teams. These teams are well-established at the study site, and most participants expressed confidence in the system and their ability to navigate it. However, they recognised that there were problems: for example, they acknowledged that education for rapid response was sporadic, that some nurses did not understand their roles, and that team members were sometimes condescending to staff nurses who called for help. It would then seem likely that nurses would view rapid response research as valuable. Furthermore, the study hospital is a Magnet facility and nurses’ promotions are tied to their involvement in research; this could be expected to be a motivator for participation (Kleinpell 2008). Participation in our study offered nurses two potential benefits: stronger rapid response systems and personal career advancement. Nevertheless, most were reluctant to participate. Research process Our review of the literature described barriers to the conduct of hospital research related to systems and nurses. However, we also found that some of the logistics associated with our research design impeded our work. For example, our recruitment process was cumbersome. Shaha et al (2011) found that staff meetings provided excellent opportunities for recruitment, but we began our study during the summer when these meetings are poorly attended. We had intended to complete enrolment in © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 07, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Barriers one month, but to contact most of the nurses, we had to extend recruitment to a second month. Because rapid-response activation can be a sensitive topic, we took extra measures to ensure confidentiality. After describing the study’s purpose and procedure during recruitment, we gave each nurse a form and asked them to check one of two boxes: ‘Yes, I am interested, contact me’ and ‘No, I am not interested.’ Nurses who were interested were also asked to add their contact information to their forms so a researcher could call to set up interviews. Extra forms were left in staff lounges for those who were not present at meetings. This involved multiple return trips to the nursing units to retrieve completed forms. To explore factors that discouraged nurses from calling for help, we initially planned to include ten nurses who had not activated the rapid response team and ten who had. However, only nurses who had activated rapid response contacted us. To obtain this information by another means, we added the following question to our interview guide: ‘Can you tell me about a time when you believe you could have activated the rapid response team, but chose not to?’ This required revision of the research protocol and modification of the IRB proposals for the study site and the researchers’ academic institution. Recorded interviews allowed us to capture nurses’ perspectives in rich detail but deciphering recordings could be difficult: ■ Fluctuations in the volumes of voices and extensive background noise sometimes made conversations hard to understand. ■ Fire-alarm testing occurred during one interview and although we were able to continue, the conversation was intermittently inaudible. Fortunately, we were able to reconstruct
that portion of the interview using the researcher’s field notes. ■ One participant brought her sleeping infant to the interview, requiring the conversation to be carried out in whispers.
Recommendations Considering the challenges we encountered in conducting hospital research, we offer the following recommendations: ■ Consider choosing hospitals in which leaders have demonstrated a commitment to nursing research. ■ Acknowledge any ongoing research when choosing study sites and developing project timelines. ■ Schedule interviews in quiet locations. ■ Build extra time into the data collection schedule to accommodate workplace demands. ■ Emphasise the need for participants to schedule interviews when they have no other commitments. ■ Emphasise the relevance and benefits of the research to nurses. ■ Obtain access to staff using email, staff meetings and posted materials to make recruitment less cumbersome. ■ Be cognisant of the timing of the study; summer months and holidays in general may be problematic. ■ Invest in good recording equipment when feasible. ■ Maintain detailed field notes to help interpret recorded interviews.
Conclusion Bedside nurses are experts in providing safe, excellent care and can provide a wealth of information. Consequently, their participation in research is vital so researchers need to be proficient at conducting hospital research. This entails having a realistic understanding of potential barriers.
Online archive For related information, visit our online archive and search using the keywords
Conflict of interest None declared
References Akerjordet K, Lode K, Severinsson E (2012) Clinical nurses’ attitudes towards research, management and organisational resources in a university hospital: Part 1. Journal of Nursing Management. 20, 6, 814-823. American Nurses Credentialing Center (ANCC) (2013) ANCC Magnet Recognition Program www.nursecredentialing.org/Magnet.aspx (Last accessed: September 12 2014.) Astroth KS, Woith WM, Stapleton SJ et al (2013) Qualitative exploration of nurses’ decisions to activate rapid response teams. Journal of Clinical Nursing. 22, 19–20, 2876-2882.
Clark T (2008) ‘We’re over-researched here!’: exploring accounts of research fatigue within qualitative research engagements. Sociology. 42, 5, 953-970.
Jamerson PA, Vermeersch P (2012) The role of the nurse research facilitator in building research capacity in the clinical setting. Journal of Nursing Administration. 42, 1, 21-27.
Roxburgh M (2006) An exploration of factors which constrain nurses from research participation. Journal of Clinical Nursing. 15, 5, 535-545.
Fischer DJ, Burgener SC, Kavanaugh K et al (2012) Conducting research with end-of-life populations: overcoming recruitment challenges when working with clinical agencies. Applied Nursing Research. 25, 4, 258-263.
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