Facilitators and challenges to conducting interdisciplinary research

Professional development outcomes associated with interdisciplinary research: An integrative review

BACKGROUND

Interdisciplinary research among health care professionals has gained importance over the last 20 years, but little is known about its impact on career development.

PURPOSE

This study examined professional development outcomes associated with interdisciplinary research.

METHODS

An integrative review was conducted using Whittmore and Knafl's framework. PubMed, Embase, PsycInfo, Web of Science, and CINAHL were searched to identify studies.

FINDINGS

Thirteen studies were included. The majority used bibliometric analyses, finding that moderate level of interdisciplinary collaboration was associated with a greater amount and higher quality of publications. Interdisciplinary publications allocated more credit (i.e., had more authors). Interdisciplinary research proposals had less funding success than single discipline proposals. Important cultural and personal aspects of interdisciplinary research (e.g., work and communication styles, research goals) have not been assessed to date.

DISCUSSION

Rigorous qualitative studies are needed to characterize benefits and challenges of interdisciplinary research to scholars and to institutions.

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization.

RESULTS

Baseline characteristics of participants (n=141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P=0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P=0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP, hemoglobin, phosphorus, or parathyroid hormone.

CONCLUSIONS

Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home.

Enhanced New Mothers Network Cell Phone Application Intervention: Interdisciplinary Team Development and Lessons Learned

Single, low-income, African American mothers experience challenges caring for themselves and their infants. Nurse researchers, providing creative and theoretically based approaches for complex client health care, are increasingly becoming interdisciplinary leaders on research teams. The first purpose of this article was to describe this interdisciplinary team's development of a cellular (cell) phone application (app), the Enhanced New Mothers Network (ENMN). The second purpose of this article was to describe lessons learned by nursing members of the interdisciplinary team members about developing a cell phone app for delivery of the ENMN intervention. Interdisciplinary research is beneficial where providing interventions to assist patients to achieve optimal health outcomes is rarely dependent on the work of one profession.

Preserving Self: Medication-Taking Practices and Preferences of Older Adults With Multiple Chronic Medical Conditions

PURPOSE

To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen.

DESIGN

A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes.

METHODS

In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively.

FINDINGS

Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, "preserving self," was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health.

CONCLUSIONS

A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties.

CLINICAL RELEVANCE

The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients' voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern.

A research capacity strengthening project for infectious diseases in Honduras: experience and lessons learned

Background

In Honduras, research capacity strengthening (RCS) has not received sufficient attention, but an increase in research competencies would enable local scientists to advance knowledge and contribute to national priorities, including the Millennium Development Goals (MDGs).

Objective

This project aimed at strengthening research capacity in infectious diseases in Honduras, focusing on the School of Microbiology of the National Autonomous University of Honduras (UNAH). The primary objective was the creation of a research-based graduate program for the continued training of researchers. Parallel objectives included institutional strengthening and the facilitation of partnerships and networks.

Methods

Based on a multi-stakeholder consultation, an RCS workplan was designed and undertaken from 2007 to 2012. Due to unexpected adverse circumstances, the first 2 years were heavily dedicated to implementing the project's flagship, an MSc program in infectious and zoonotic diseases (MEIZ). In addition, infrastructure improvements and demand-driven continuing education opportunities were facilitated; biosafety and research ethics knowledge and practices were enhanced, and networks fostering collaborative work were created or expanded.

Results

The project coincided with the peak of UNAH's radical administrative reform and an unprecedented constitutional crisis. Challenges notwithstanding, in September 2009, MEIZ admitted the first cohort of students, all of whom undertook MDG-related projects graduating successfully by 2012. Importantly, MEIZ has been helpful in expanding the School of Microbiology's traditional etiology-based, disciplinary model to infectious disease teaching and research. By fulfilling its objectives, the project contributed to a stronger research culture upholding safety and ethical values at the university.

Conclusions

The resources and strategic vision afforded by the project enhanced UNAH's overall research capacity and its potential contribution to the MDGs. Furthermore, increased research activity and the ensuing improvement in performance indicators at the prime Honduran research institution invoke the need for a national research system in Honduras.

Introduction: the Interdisciplinary Nursing Quality Research Initiative

BACKGROUND

The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative.

METHODS

INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing.

RESULTS

A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing.

DISCUSSION

This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.