Directorate of Nursing, Rehabilitation and Quality Assurance
Location: Royal Marsden
Section: NHS Clinical Research Programme
Chief Nurse/Deputy Chief Executive: Dr D Weir-Hughes OStJ EdD MA RN FRSH
Introduction
The Directorate of Nursing, Rehabilitation and Quality Assurance is committed to constantly improving the care experience and outcomes for patients, their families and staff. In 2006 studies have led to improved outcomes for patients, families and staff at the trust but increasingly across the wider health community with studies in primary care and across several health care providers. Steve Scholtes (Charge Nurse BC ward) as part of his MSc, conducted a study investigating differences in knowledge about testicular cancer and testicular self-examination between different socio-economic groups. A questionnaire was distributed to more than 200 men attending sporting clubs in the London area. Shelley Dolan (Nurse Consultant Cancer: Critical Care & Head of Nursing Research) has also been working with a group of nurses and patients in the South-West London Cancer Network and Kingston University devising a three-year study that will look at the impact of culture on care and will result in a national tool that can be used across the NHS. Barry Quinn (Lecturer/ Practitioner Haemato-oncology School of Cancer Nursing and Rehabilitation) has been undertaking his doctoral study using phenomenology to explore how people with cancer try to make sense of their experience, specifically using the work of two principle writers Martin Heidegger and Viktor Frankl. The findings will help in critically examining our approach to cancer care and to address some of societies’ concerns around cancer as a sickness.
Natalie Pattison (Nurse Researcher Critical Care nursing) is leading a trust wide study looking at the impact of a critical care outreach service on critically ill cancer patients. The aims of the study are to establish referral patterns for acutely ill cancer patients and the characteristics of the cancer patients’ critical illness episodes. The outcomes of the study will be increased knowledge about what makes nurses and doctors refer critically ill cancer patients to outreach, the identification of any educational needs and resource implications.
Research in the Psychological Medicine Service of the Department of Pastoral and Psychological Care has covered a diverse range of areas in both adults and children. The last year has seen the department, led by Maggie Watson (Consultant Clinical Psychologist) obtain major funding to run a Phase II trial of psychological therapy delivered via the telephone with a health economics analysis to determine the cost-benefits and cost offsets of this provision. In paediatrics, studies have included the development of guidelines for schools teachers of children who have been treated with a brain tumour led by Samantha Peacock (Clinical Psychologist) and the start of a study collaborating with physiotherapy and dietetics to research into hypothalamic obesity due to childhood cancer (Lesley Edwards, Clinical Psychologist). The department also collaborates with the UK Leukaemia trials group acting as consultants for quality of life assessment in a number of multi-centre trials.
Symptom management investigation
Camilla McGough, Linda Wedlake (Research Dietitians) and Dr Jervoise Andreyev (Consultant Gastroenterologist) have continued to lead research on gastrointestinal symptoms during radiotherapy treatment and the influence of modifying dietary intake of fat may have on these symptoms and markers of gut damage. This research will influence the management of both the short- and long- term effects of radiotherapy on the gastrointestinal tract. Jeannie Dyer (Complementary Therapy Team Leader) is currently carrying out a randomised control study on two different sprays, one including hydrolats of peppermint and neroli, for the amelioration of hot flushes experienced by women with breast cancer.
Research as part of an MSc programme has been undertaken by AHPs within the Trust. Deborah Hill (Dietitian) explored healthcare professionals’ experience and understanding of providing ‘supportive care’ to adults with head and neck cancer by using a qualitative study taking an interpretative phenomenological approach. Diz Hackman (Physiotherapist) has undertaken an ethnographic qualitative study exploring the purpose of rehabilitation for patients with primary brain tumours. This study aims to give an insight into patient’s perceptions of the role that physiotherapy treatment provides in their holistic management.
Educational research
A key part of the Directorate’s strategy is the growth of educational research. Sara Lister (Assistant Chief Nurse/Head of School), Clair Sadler (Programme Leader School of Cancer Nursing & Rehabilitation) and Chris McNamara (Teaching Charge Nurse) led a study in collaboration with Dr Daniel Kelly (Reader in Cancer & Palliative Care, Middlesex University) to evaluate the effectiveness of a three-day educational programme aimed at nurses and allied health professionals caring for people with cancer in general (non-specialist) settings. The educational programme which was designed and facilitated by the Royal Marsden School of Cancer Nursing and Rehabilitation and taught by local staff was accessed by more than 300 health care professionals in and across London and was consistently well evaluated. The evaluation demonstrated that patient involvement was effective and successful, and that this approach to education was useful in providing opportunities for whole teams to explore the reality of cancer care in general settings.
Relevance to the NHS Research and Development Programme
The key impact areas such as ascertaining clients' needs, evaluation of care, and cost benefits of health care have remained the main themes of research activity with several interventional studies aiming to explore and then improve the experience of cancer treatment. Shelley Dolan, Natalie Pattison (Nurse Researcher Critical Care Nursing) and Geraldine O’Gara (CCU Clinical Audit Nurse) completed a national multi-centre randomised controlled study to evaluate an advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity. Colorectal, lung and breast cancer patients undergoing a new course of chemotherapy were randomised to receive with standard care or standard care + the ASyMS handset, a mobile XDA device. Having established a baseline at each cycle via a written questionnaire for all patients, those patients in the intervention group additionally answered questions regarding the following symptoms: nausea and vomiting, hand-foot syndrome, diarrhoea, fatigue, mucositis and temperature on the ASyMS handset. The ASyMS handset then generated alerts if the symptoms were deemed by a computer programme to be cumulatively worrying or if above a certain trigger threshold. These alerts were received by a senior nurse in the hospital who could give specialised advice. In addition to this, the handset gave patients tailored evidence-based advice according to the symptom alert. This meant that patients could deal with problems in real-time and that patients would be prompted to contact the hospital, and the hospital to contact the patient in the event of symptoms problems. Semi-structured qualitative interviews and questionnaires were carried out with staff and patients participating in the research. Final analysis of the national data is expected in Summer 2008.
Growing research capacity
A priority in 2006 has been the growth of our research capacity with a particular emphasis on building confidence and knowledge. To this end we have provided monthly coaching sessions which have been attended by more than 300 nurses and allied health professionals. The sessions have covered all aspects of research methodologies, aspects of epistemology, quantitative and qualitative analysis techniques and the peer review and ethics approval process. The Directorate has identified 10 Principal Investigators who are all research experienced and have attended Good Clinical Practice training. The directorate also continues the support of individuals undertaking postgraduate study with nurses and AHPs registered for Masters programmes. In 2006 the Trust had six nurses registered on PhD programmes with two likely to complete in the first quarter of 2007.
This year the Royal Marsden School of Nursing and Rehabilitation saw the highest intake of BSc students since the course began in 2004.The MSc in Advanced Practice also commenced in September 2006 and increases opportunities to translate research findings into practice. All programmes are evidence-based and assessment strategies reflect the need to demonstrate this approach to care in practice. The postgraduate diploma for AHPs has seen the first AHP graduates.
Future Aims
During the coming year there are plans to bid for monies from the health services research funding from the Department of Health to develop and implement a directorate research structure and strategy that will coordinate the nursing and rehabilitation research strategy across the Trust. The overall aims of our work during the next three years are fourfold:
- To increase the capacity and output of good quality clinical research
- To ensure the implementation of clinical research
- To support novice and current nursing and AHP researchers
- To increase the publication of good quality health services research in peer reviewed journals
In the NHS Clinical Research Programme
