EDITORIAL

Nursing in Critical Care 2003 • Vol 8 No 5 185

Critical care research Leslie Gelling

In recent years, there has been a con-siderable investment in the provisionof critical care services in the NationalHealth Service. As a result, there areconsiderably more beds available nowthan 5 years ago. This financial invest-ment has also been accompanied by arethink in the way critical care servicesare delivered with an emphasis on thebreaking down of traditional physicaland professional barriers. Outreach teamshave flourished in many hospitals withnurse consultants taking a leading role.There has also been a move to establishcritical care outpatient clinics to beattended by former patients. As a resultof these and other initiatives, criticalcare without walls has become a reality.

Despite the revolution in critical careprovision, this has not been accompan-ied by a similar increase in the volumeof critical care nursing research. Theprinciple reason for this is that, on thewhole, research is still not consideredan integral component of the nurses'role, and this is no different in ICUthan any other clinical setting. All toooften research is considered to be anactivity only to be undertaken whenclinical commitments permit. A numberof reasons can be cited to partly explainthis, including the lack of funding andinsufficient protected research time, butthe overriding reason is that an appro-priate research culture is still not fos-tered amongst nurses.

The Royal College of NursingResearch Society has long argued that‘research is every nurses business’ andshould not be an activity restricted tofull-time researchers or academics. Thecontinuing drive for evidence-basedpractice means that critical care practi-tioners are no longer able to ignore theimportant role that research plays intheir everyday practice. This does notmean that all nurses should be under-

taking original research but it doesmean that all nurses should be able tocritically review the available literature.In instances where current literatureis inadequate, nurses should considerundertaking original research. Unfortu-nately, the volume of original researchbeing undertaken in critical care unitsby nurses is limited.

The potential research topics to bestudied in critical care are endless but,like critical care itself, research shouldnot be restricted to the physical bound-aries of the ICU or acute hospitals. Crit-ical Care Outreach teams have been thefirst in taking ICU outside the trad-itional physical boundaries, and someresearch is being undertaken into theeffectiveness of these teams. A numberof outpatient clinics have been estab-lished for former ICU patients, whichhave, for the first time, taken criticalcare services into the community. Thefocus of these clinics has been to iden-tify some of the potential long-termclinical consequences of a period ofadmission to an ICU. The potential toresearch the long-term impact of crit-ical care has yet to be realized.

Such research would necessitate newcollaborations between acute care teamsand community teams. Research under-taken in such novel partnerships wouldhave the potential to offer much to thedelivery of care in all stages of the crit-ical illness. It is only recently that it hasbeen broadly accepted that critical ill-ness does not end when the individualis transferred from the confines of thecritical care unit. It would not be a steptoo far to suggest that critical care alsodoes not come to an end on dischargefrom hospital.

If a research culture is to be betterdeveloped in critical care nursing, thereare four fundamental changes needed.First, research should be seen as an

everyday part of the nurses' role andnot a luxurious add-on undertakenwhen clinical commitments allow. Thiswill require careful manpower plan-ning, including ensuring that sufficientnurses are available to allow the perusalof research activities. In addition, pro-tected research time should be madeavailable to all nurses. Unfortunately,this issue is too often dependent on theattitude of managers who do not alwayssee the importance of research whenwrestling with staffing budgets.

Second, supervision and supportshould be available to those undertak-ing research activities. Nursing hasbeen plagued by poor quality research,which adds little to existing knowledgeand understanding. The prime reasonfor this is the lack of academic supportwith the result that clinicians haveendeavoured to fit research intomethods of which they have experi-ence. Unfortunately, there still exists anoutdated argument that nursing has abetter fit to qualitative researchmethods and medicine has a better fitin quantitative methods. This argumentshould now be considered redundantwith the most appropriate method, oreven mixed methods, being adopted toanswer the research question. However,without adequate support, cliniciansmay be unwilling to adopt methods ofwhich they have little or no experience.Some critical care units have devel-oped strong links with academic insti-tutions but many more have not.

Third, clinically based critical carenurses should not be shy in applyingfor the research funding that is availa-ble. It is true that funding opportun-ities are becoming increasingly difficultto secure but funding is available. Forexample, the British Association ofCritical Care Nursing offers annualsmall research awards. It is vital that

Editorial

Nursing in Critical Care 2003 • Vol 8 No 5186

clinicians are encouraged to seekresearch funding, but this can be intimi-dating in the highly competitive fund-ing market. With well thought out andprepared submissions, using appropri-ate methods and with sufficient scien-tific rigour, there is no reason whynurses should not compete for researchfunding.

Fourth, it was envisaged that one ofthe nurse consultants' roles would beto undertake research and, in doing so,to play a principle role in developing aresearch culture amongst nurses. Formany in such positions, this compon-

ent of their role has yet to be realized.Again, the principle reason for this isthat consultants have insufficient timeto focus on anything but clinicalcommitments. Again, this requires achange in attitude with the importanceof research to practice being realized.

If critical care nursing is to adopt amore effective research culture, to thebenefit of patients and the nursing pro-fession, all critical care nurses shouldbegin to think of research as anotherimportant tool in their armoury. Crit-ical care nurses have already been atthe forefront of revolutionizing the

way in which critical care has beendelivered for many years. It is nowtime that the same commitment wasextended to making critical care nurs-ing a branch of the profession trulyembedded in a research culture.

Leslie GellingResearch Officer

School of Community Health andSocial Studies

Anglia Polytechnic UniversityCambridge

England, UKE-mail: l.gelling@apu.ac.uk