Providing hands-on experiences in health care research to mentor new research scholars.
AIM This article describes the benefits of integrating students into a National Institutes of Health-funded research project.
BACKGROUND Research is important in all academic disciplines for increasing knowledge and determining the effectiveness of currently used interventions. Educating nursing students to read, evaluate, and use research in practice is essential for solving complex health care challenges and achieving better patient outcomes
METHOD The students were involved at all levels of the research process: project development, site acquisition, recruitment of participants, data collection and analysis, and manuscript development. Interviews of the student researchers were conducted to understand the students' experience of participation in the research study.
RESULTS Three themes were identified: creating new knowledge is worthwhile, research is interesting and meaningful, and research can shape practice.
CONCLUSION Promoting knowledge and experience by involving students in research projects can create a bridge to the development of evidence-based practice.
KEYWORDS Education Strategies--Mentoring--Health Care Research--Nurse Scholarship--Interdisciplinary Education
Research is important in all academic disciplines for increasing knowledge and determining the effectiveness of currently used interventions (Birtey & Moreland, 2013). Educating nursing students to effectively read, evaluate, and use research in practice is essential for solving complex health care challenges and achieving better patient outcomes (Hall, Feng, Moser, Stokols, & Taylor, 2008). For students in doctoral programs in nursing, attention must be paid in educating potential scholars to participate in research teams that focus on diverse patient populations that include older adults (Sanchez et al., 2011).
This article describes the benefits of integrating students into a research project funded by the National Institutes of Health Academic Research Enhancement Award (R15) mechanism. Focus groups involving the student researchers were used to obtain information regarding the experience of participation in the research study.
MENTORING RESEARCH SCHOLARS
Although mentoring students to comprehend the many aspects of research is an important characteristic of the education for all health care providers (Buddeberg-Fischer & Herta, 2CXD6; Hall et al., 2008), it is estimated that only 10 percent of health care providers consistently Implement evidence-based knowledge into practice (Krugman, 2012). According to Krugman, it often takes decades before research findings are translated into practice. One of the many reasons that research findings lag In implementation is that health care providers do not feel competent to read, understand, or embrace research findings.
Although almost all students understand the clinical roles for which they are educated, many do not understand the importance of research and evidence as a basis for practice (Birley & Moreland, 2013; Moch & Lonsdorf, 2014). Students often feel detached from research, believing that it is limited to those who seek academic careers. Educators, researchers, providers, and funding agencies have called for increased exposure to research in clinical education as well as mentoring and support to increase students' awareness and understanding of the relevance of evidence-based practice (Sanchez et al., 2011; Stewart et al., 2010).
In an effort to support the education of research scholars, students were recruited for all aspects of this research process and participated fully in the research project. The funding mechanism for the grant was an Academic Research Enhancement award from the National Institutes of Health (NIH). This award, originally introduced in 1985, is an NIH-wide program designed to provide up to 3 years of renewable funding of meritorious research at less research-intensive institutions. Today, eligible institutions and colleges within those institutions must not receive more than $6 million per year in total costs in four or more of the most recent seven years.
The AREA award program has three primary goals: a) support meritorious research, b) expose students to research, and c) strengthen the research environment of the institution. NIH has clearly delineated that the AREA program is a research award and not a training or fellowship award. It is intended that a) investigators will benefit from the opportunity to conduct independent research, b) the grantee institution will benefit from a research environment strengthened by participation in the diverse extramural programs of the NIH, and c) students at recipient institutions will benefit from exposure to and participation in scientific research in the biomedical and behavioral sciences.
Engaging students in meaningful research is recognized as a powerful instructional tool (Guertin, 2014; National Science Foundation, 1989; Winters & Echeverri, 2012) and is associated with improved academic performance and sustained interest in biomedical research careers (NIH Office of Strategic Coordlnation-The Common Fund, 2014). Such engagement provides students with interest in learning and advancing foundational skills that they can apply to real life/world problems. Students report benefiting from the personal relationships they develop with their mentors, scholarly writing and publishing (Wood, 2006), and exposure to professional meetings and conferences. Finally, it has been noted that the exposure to research experiences can sustain student interest in a science career, providing an opportunity to work collaboratively with colleagues while making novel contributions to the health and well-being of the community.
The exposure of students to research through AREA (R15) awards provides unique opportunities to build a strong foundation in the research process. For students, the experience is often their first exposure to research. Although the value of engaging students, particularly undergraduates, in research has been well reported (Anagnopoulos, 2006; Laskowltz, Drucker, Parsonnet, Cross, & Gesundheit, 2010; Weiss, 2009), published outcomes for student research experiences through NIH-funded AREA (R15) awards are limited in number.
STUDENT INVOLVEMENT IN THE RESEARCH STUDY
The two-year research study (2013-2015) that created the opportunity for this research mentoring project was a randomized controlled clinical trial entitled "The Effect of Sit 'N' Fit Chair Yoga on Community-Dwelling Older Adults with Osteoarthritis." Students were recruited for involvement in all aspects of planning, implementation, and evaluation.
Two principal investigators from the same university in South Florida were responsible for the study, one from the college of nursing (CON) and one from the school of social work (SSW); other coinvestigators from medicine and physical therapy were also involved in this interdisciplinary effort. The two sites used for the research project were a senior center that operated five days per week and a senior housing facility for low-income seniors. The senior center had a fulltime RN who assisted with recruitment and room reservation; a fulltime social worker in the housing facility assisted in meeting the needs of residents, including recreation.
The target population was adults over 65 years of age diagnosed with osteoarthritis and unable to participate in standing exercise. One hundred twenty participants (60 at each site) were recruited and randomized to either the Sit 'N' Fit Chair Yoga intervention or a Health Education Program (HEP) attention control group. Each cohort participated in an eight-week intervention; data were collected five times: prior to the intervention, after four weeks, after eight weeks, and one month and three months after the intervention.
The primary objective of the research project was to determine the feasibility of recruiting, randomizing, and intervening with older adult participants with osteoarthritis by adherence to the Sit 'N' Fit Chair Yoga program and the HEP. Secondary objectives were to determine the effects of both interventions on pan, balance, gait speed, walking, fatigue, depression, social activity, and life satisfaction.
Sit 'N' Fit Chair Yoga is a program created by Kristine Lee, a certified yoga instructor with more than 20 years of experience in yoga; Lee trains all instructors and completes fidelity monitoring for classes to ensure adherence to the program. Eight weeks of twice weekly 45-minute sessions (total of 16 sessions) were held at each of the project sites. Each yoga session began with breath work, then continued with movement (asana) work, and concluded with a period of meditation.
The HEP also met twice weekly for 45-minute sessions for 8 weeks. Discussions involved health-related topics: healthy living, exercise, diet, medication, alternative and complementary therapies, and stress reduction. Students from related health care disciplines including medicine, social work, and exercise science were involved in identifying content areas for the HEP sessions and assisted in creating the presentations. Nursing students developed the physical health sessions (e.g., use of herbs and vitamins, healthy diet for older adults); social work students developed psychosocial health sessions (e.g., psychosocial aspects of chronic pain, stress management).
Twelve students from the CON and SSW were recruited to participate in this project; six students from nursing or social work were hired as paid student research assistants, and six fulfilled course requirements by serving as volunteers. One student had been part of a research team previously, and one had served aging populations in field practice; the rest had no practice experience with older adults. One student was in the CON PhD program; five were from a master's program in holistic health in the CON; four were nursing undergraduates; and two were in the SSW in the master's program and as an undergraduate. The students became full members of the research team and were Involved at all levels of the research process: the application for university institutional review board (IRB) approval, project development, site acquisition, recruitment of participants, and data collection and analysis. Participation was deemed appropriate for clinical hours by the CON and the SSW for master's-level students, as students were exposed to a stringent protocol used to measure the effectiveness of the interventions and gain an understanding of working with aging populations. The goal for student participation in the research was to expose them to hands-on research experiences.
Each student who applied to participate in the project was interviewed by the Pis to discuss aspects of the research process and student roles. Selected students completed the Web-based Collaborative Institutional Training Initiative (www.citiprogram.org) and an eight-hour class on research ethics, data collection, and safety (see Table 1). Upon completion of the training, the students used volunteer sham participants from the CON health center to demonstrate their ability to enroll participants, complete Inclusion and exclusion evaluation, and collect data. In addition, the student participants watched a two-hour video on body mechanics specifically created for the study, including instructions on how to safely work on physical movements with older adults.
Following the training, the students reviewed the study protocol and attended an 8-hour extensive study protocol review by an outside evaluator representing the National Centers for Complementary and Alternative Medicine (NCCAM). During that meeting, the discussion of requirements, changes, and implementation of the study protocol included input from the students. Changes recommended by the outside evaluator and NCCAM, including changes to reporting documents, were made by the students and investigators working together. Once approved by NCCAM and the IRB of the participating university, the study was submitted and placed in ClinicarTrials.Gov, where the students reviewed the final clinical protocol.
After approvals were secured, the students were integrally involved in all aspects of implementation of the protocol. They assisted with the evaluation and enrollment of participants, the evaluation of inclusion and exclusion criteria, the recording of participant information, data collection, and the identification of adverse events and serious adverse events. They were involved In leading the HEP sessions provided to the attention control group for the project.
All study personnel, including students, participated in monthly team meetings, which were seen as opportunities for students to understand the rigor involved In research endeavors. Topics discussed at these meetings included the retention of participants, data collection, adverse and serious adverse events, timing of the next cohort, and recruitment. The students provided excellent Information and suggestions to assist with the overall resolution of issues.
Students participated in fidelity monitoring by listening to tapes of the Intervention sessions and using a checklist to document fidelity of the interventions according to the study protocol. They participated in data entry in the statistical analysis software (double entry was used for all data). Once all data were entered and cleaned, the students attended data analysis sessions with the research team and participated in the dissemination of findings.
FOCUS GROUPS ON THE EFFECTS OF PARTICIPATION
To determine the effects of student participation in research, focus group interviews were conducted with participating students. The IRB approval for this aspect of the study was included in the original IRB application for the study and approved by the university.
Two focus groups were conducted, one at each of the two research sites. The two Pis, as group leaders, developed a set of open-ended questions to elicit the participants' views of the experience. Each of the 12 students responded to the following questions:
1. Tell me about your Involvement In the research project.
2. In what ways did the research project assist your understanding of research and how research and evidence are used in practice?
3. How do you feel about research and evidence as a basis for practice and advancing knowledge?
Each Interview was tape recorded and transcribed. Both Pls reviewed the transcripts and conducted theme-based content analysis of descriptions of experiences reported by the focus group participants. Recurrent Information and thematic material were extracted from the transcribed data.
Trustworthiness of the analysis of interview data was assessed In three ways. First, each PI read and reread transcripts of the focus group discussions; the Pis then met to discuss individual findings, reach consensus regarding the meaning of the content, and extract themes. Second, an outside qualitative researcher reviewed the transcriptions and the Pis' selected themes; the researcher agreed that the themes were consistent with comments in the interview data. Third, the student participants reviewed the themes to determine whether they were an accurate reflection of the focus group sessions.
All 12 students participated in the focus group discussions. Analysis of the data from the focus group discussions yielded three themes regarding the students' experience in participating in the research process and their perceptions of research as a basis for practice and advancing knowledge: Creating new knowledge is worthwhile, research is interesting and meaningful, and research can shape practice. The PhD and master's students were primarily responsible for statements leading to the first theme. All students made statements that led to the second and third themes. Table 2 lists statements made during interviews that affirm the themes; the level of the student participant who made each comment Is identified.
Creating New Knowledge Is Worthwhile
This theme grew out of discussions about first-hand observations that students made of both the intervention and the research processes. The students agreed that participation in a well-designed, federally funded research project helped them understand the research method from first-hand experience and the reasons for research procedures. They also agreed that innovative research and best evidence from the research would help patients.
Research Is Interesting and Meaningful
The second theme emerged from discussions regarding students' feelings about being integral to the research process. The students stated that they enjoyed being "real members" of the research team and that the openness of the research team to their shared ideas made the research project and their experiences more meaningful. Some reported that the research experience had led them to change their career plans, including pursuit of a doctorate.
Research Can Shape Practice
The third theme came from the understanding that findings from research have validity and can make a difference when disseminated through presentations and manuscripts, so that many can benefit from the findings. The students expressed that they were eager to share their new knowledge concerning project findings so that the benefits identified in the study could be shared with other older adults.
One limitation of this focus group evaluation was that some of the students were either paid or received credit for their work. This limitation was modified by the fact that all grades were submitted and payments made prior to the focus group discussions.
Nursing and social work students at different levels in their education were able to work together and appreciate each other during the research process. They participated in all aspects of the research process, including proposal development, design development, participant recruitment and retention, the randomization and blinding process, data collection, data analysis, and dissemination of findings. The students were integral members of the research team and were encouraged to share ideas and concerns about the research process.
Although research methods and the evaluation of research findings are often taught in classrooms, making the experience an academic exercise, actual participation in research can be an effective way to instill research knowledge and encourage students to embrace research as an important aspect of evidence-based practice. In this example, students were either pad for their work in the research process or received course credit. In either case, they felt compelled to participate fully and become active members of the research team. They worked together and shared their knowledge and experience to move the research process forward.
Developing and mentoring students in health care professions who are capable of designing and completing research studies, translating research knowledge into appropriate action in the clinical setting, and using research in clinical practice is essential to the future of health care (Sullivan, Furner, & Cramer, 2014) and a requirement for obtaining hospital Magnet status. Although translating research into practice is an essential component of nursing and all health care disciplines, implementation continues to lag (Morris, Wooding, & Grant, 2012; Wood, 2006). Creating opportunities for students to be part of a research team enhances interest and promotes the idea of using research findings in practice.
Nurses and social workers, as patient-centered care providers, are often the best health care workers to describe barriers and problems in care delivery and outcomes. Preparing nurses and social workers to embrace the idea of research as important and meaningful in practice can promote their willingness to participate in research projects in the work setting. As nurses and social workers are challenged to propose innovative solutions in the complex health care system, understanding and embracing research findings are essential.
The Institute of Medicine (IOM) has described important steps in the future of nursing. One statement by the IOM (2011) proposes that nurses be full partners, with physicians and other health professionals, in redesigning health care. The foundation of most health care disciplines is research and evidence; however, nursing and social work have lagged, focusing instead on tradition and usual practice (May, Sibley, & Hunt, 2014). Promoting knowledge and experience by involving students in research projects can create a bridge to working in health care teams and bring nurses and social workers into the discussion of creating evidence-based practice.
The goal of this qualitative study was to understand the effect of participation in all aspects of an NIH R15 funded research project on students at all levels of nursing and social work education. Twelve students were included in this project over the 2-year period. Focus group sessions with the student were recorded and transcribed. Three themes emerged from the data: creating new knowledge is worthwhile, research is interesting and meaningful, and research can shape practice. Implications for nursing and social work practice include increasing the translation of research into practice and preparing nurses and social workers to be active and equal members of the health care team.
Ruth G. McCaffrey, DNP, FNP-BC, GNP-BC, FAAN, is a professor at Georgia Baptist College of Nursing at Mercer University, Atlanta. Linda Weglicki, PhD, RN, is the associate dean for research at Florida Atlantic University Christine E. Lynn College of Nursing. Juyoung Park, PhD, is associate professor in social work at Florida Atlantic University Department of Social Work. Jacinto Garrido, DNP, FAAN, FAANP, is adjunct faculty at Florida Atlantic University Christine E. Lynn College of Nursing. The authors are grateful to the National Institutes of Health, Office of Extramural Research for the 2013 Academic Research Enhancement Award (Parent R15), PA-13-313, described in this article (http://grants.nih.gov/grants/guide/pa-files/PA-13-313.html).
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Table 1: Outline of Research Preparation Class Objective: By the end of the 8-hour class the participant will be able to: 1. Discuss confidentiality and participants rights during research studies. 2. Support respect for the rights of all participants and each other during the research process. What can and should be shared. 3. Identify the primary and secondary objectives of the research grant and what data collection tools will be used to meet these objectives. 4. Describe the process for screening and consenting participants. 5. Discuss randomization and blinding procedure. 6. Feel confident in assisting participants to answer questions on data collection sheets. 7. Complete accurate collection of all information on data collection sheets. 8. Demonstrate the use of safety techniques when collecting physical data with older adult participants. 9. Demonstrate ability to communicate and discuss health issues with older adults. 10. Describe adverse events and serious adverse events and what to do should those occur during the research process. 11. Follow the appropriate chain of command for any problems or issues during participant time in the grant. 12. Discuss required reporting requirements and how they will be fulfilled in this grant. Table 2: Themes and Corroborating Interview Statements Theme Corroborating Statements Creating new I have really been too concerned with using evidence knowledge is from research in my practice but this experience has worthwhile. shown me how meaningful research can be and how it can lead us to more effective therapies. (Undergraduate nursing student) I am impressed with the careful and systematic way this research program has been done. It helps me to have more faith in other research 1 read about. (Master's social work student) This experience helped me to see how important research can be. 1 was surprised that so many chair yoga programs are provided without knowing if they are effective. After this project, we will know how the chair yoga affects older adults and just where it is most useful. (Undergraduate nursing student) The exciting part is to find out that there's many interventions and try to be innovative and individual with the client because it is their intervention so it is based on what their needs are so one size doesn't fit all so I think having to look through what the best available evidence is out there and the interventions that are working regardless of whether it's a large research population or not 1 think that's what is going to make me more effective and able to help more people. To treat each person as an individual and that each intervention you know is as unique as the person that you're working with. (Master's nursing student) Research is I have really learned to love research through this interesting project. I am not sure what population I would focus and on but I would like to make it a part of my career. meaningful. This has helped me decide to pursue my PhD so that I can be more involved in research. (Master's nursing student) I really, really, realty enjoyed it. I mean I never thought I'd be interested to conduct research until this experience so this has been actually sort of a life changer for me because now I am actually really considering doing the PhD, which before I didn't. I was actually excited and hopefully sometime next year I'll apply for a PhD. (Master's social work student) I really enjoyed being a part of this research team. I liked working with the participants and seeing how dedicated they were to this project. I am impressed with the whole research process and see it as so important to my growth as a health care provider. (Undergraduate social work student) Before this project, 1 never understood why research was important. When 1 read a research article, it seemed like a bunch of jargon but now I know firsthand what that "jargon" means and how it is used in a real life research setting. (Undergraduate nursing student) Research can I want to become a nursing educator and I see that shape research adds to nursing knowledge in a way that practice. helps us to be sure of what we do and the benefits research findings can bring. (Master's nursing student) I work with physicians as a nurse practitioner and I find that they are driven by research findings. After participating in this project 1 understand the value of evidence and using it in my practice as an NP. I think that we need to work together with physicians and speak the same language as they do. (Master's nursing student) The things I've learned in the research has definitely shaped what I think I want to do in the future because the great debate is do we work on a micro level or do we work on the macro level as social workers who affect change and 1 think research allows a social worker to actually help a broader group of people in their, the expanse of their career so I think research is definitely something I am interested in pursuing. (Doctoral nursing student)
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|Author:||McCaffrey, Ruth G.; Weglicki, Linda; Park, Juyoung; Garrido, Jacinto|
|Publication:||Nursing Education Perspectives|
|Date:||May 1, 2016|
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