Delineating the Role of a Cohort of Clinical Research Nurses in a Pediatric Cooperative Clinical Trials Group

Clarifying the role of clinical research nurses working in Sweden, using the Clinical Trial Nursing Questionnaire - Swedish version

Aim

To explore the role of CRNs in Sweden and differences in competences and tasks, using the Clinical Trial Nursing Questionnaire – Swedish version (CTNQ‐SWE).

Design

A cross‐sectional survey.

Methods

Participants were identified through strategic sampling. Data were analysed by descriptive and comparative statistics.

Results

The respondents were experienced nurses who felt proficient in their role, they felt more acceptance by the principal investigators than by nursing colleagues. A majority of CRNs are involved in all procedures specified in the CTNQ‐SWE. The most often performed tasks, also rated as the most important by the CRNs, concerned informed consent and management of investigational products. The education was often informal: with a lack of job descriptions and professional development plans. Need of formal specialist education was expressed.

Conclusions

Knowledge about the role description can be used by clinical research enterprise internationally and healthcare organizations aiming to support CRNs in their role.

Duality of practice in clinical research nursing

Background

International evidence suggests that Clinical Research Nurses (CRN) can have a dual role incorporating both clinical care and research responsibilities. This duality of role often assists in meeting the clinical care and research needs of the participants and can contribute to the credibility of the CRN role. Conversely, it can also lead to feelings of confusion and role conflict as CRN's time is divided.

Aim

To identify and explore experiences of clinical and research roles among CRNs. This emerged as a theme in a wider research project exploring CRNs' experiences of working with clinical nurses.

Methods

Following an Interpretative Phenomenological Analysis approach, 10 CRNs participated in face-to-face semi-structured interviews. Transcribed data were analysed and a number of themes emerged. Duality of role was one of these.

Findings

Findings indicated that if CRNs fulfil a dual role, this can assist in care provision, research delivery and in building positive relationships with clinical nurses. However, there were also instances when a dual role led to clinical nurses questioning the value of research and to issues with competing demands of clinical care and research. These experiences had an important impact on some of the CRNs and led to reflection on the value of their role.

Conclusions

This study identifies new understandings of a dual role of the CRN. The findings will inform the preparation and practice of this group of nurses, whilst also leading to a deeper understanding of the CRN's role in care and research delivery. It will also contribute to a wider appreciation of organisational factors and social interactions that impact on health care research.

Infirmière de recherche clinique en oncologie : revue exploratoire

En ce 21e siècle, le cancer est une maladie qui suscite particulièrement l’attention en raison de sa complexité ainsi que des impacts physiques, émotionnels et financiers sur notre vie. L’attention portée à la recherche et les investissements dans le traitement contre le cancer en font la maladie la plus étudiée dans les essais cliniques à l’échelle mondiale. Les infirmières de recherche clinique font partie de l’équipe de recherche en oncologie et sont un élément fondamental de réussite des essais. Leurs relations directes avec les participants d’une étude de recherche sont essentielles pour les activités des essais cliniques en première ligne. De façon générale, l’afflux et la complexité des essais cliniques en oncologie ont transformé la pratique infirmière en oncologie et ont mené à la création de la sous-spécialité unique qu’est l’infirmière de recherche clinique en oncologie. La présente revue exploratoire s’est penchée sur le rôle et la pratique futurs de l’infirmière de recherche clinique.

Oncology clinical trials nursing: A scoping review

In the 21st century, cancer is a disease that captures much of our attention for its complexity, and its physical, emotional, and financial impacts on one's life. Research attention and investment in cancer management has made it the most studied disease in clinical trials globally. Clinical trials nurses are part of the oncology research team and a fundamental factor in trial success. Their direct relationship with research subjects is the key connection in the operation of clinical trials at the front line. The influx and complexity of oncology clinical trials has transformed both oncology nursing practice in general and led to the development of the unique subspecialty of the oncology clinical trials nurse. This scoping review investigated the role and future practice of the clinical trials nurse.

The Oncology Clinical Research Nurse Study Co-Ordinator: Past, Present, and Future

Clinical research nursing is a specialty practice that has evolved over the past century. Clinical research nurses (CRNs) work directly (e.g., direct care provider and advance clinician) or indirectly (e.g., manager, educator, and study co-ordinator) to support clinic research. For more than 50 years, oncology nurses have contributed to the body of evidence describing and validating the responsibilities and importance of the nurse in clinical research, especially the study co-ordinator role. This article will focus on the CRN study co-ordinator role in oncology clinical trials highlighting the historical evolution of the role, the contributions of dedicated members of the Oncology Nursing Society, and the future landscape of clinical research nursing through the International Association of CRNs.

CE: Original Research: The Clinical Research Nurse: Exploring Self-Perceptions About the Value of the Role

: Background: Clinical research nursing is an emerging specialty practice. Clinical research nurses (CRNs) work to make protocol-related care safe for the research subjects while simultaneously maintaining protocol fidelity. They must continuously balance the needs of the research subjects and the study requirements.

PURPOSE

The purpose of this qualitative study was to describe CRNs' perceptions of the value of their role.

METHODS

Two focus groups were conducted with a purposive sample of 18 CRNs. An interview guide consisting of eight open-ended items was used. Data analysis used critical elements from Krueger's systematic steps for analyzing focus group data.

RESULTS

Five major themes emerged from 168 coded statements contained within the focus group transcripts: comprehensive nursing care of research subjects, training and education of research subjects and staff, contributions to clinical science, unique combination of clinical and critical thinking skills, and CRN practice attributes. Subcategories were also identified. In general, participants felt strongly about the value they added.Clinical research nursing requires the use of a variety of abilities and skills, including critical thinking and problem solving, as well as clinical and research knowledge. The CRNs in this study described incorporating these and other elements into their practice, which they associated with their specialized role. The five themes that emerged help elucidate the importance and utility of including CRNs on research teams.

CONCLUSIONS

The unique combination of applied research knowledge and expert clinical skills sets the specialty of clinical research nursing apart. The study findings, in particular the five themes, provide an evidence-based framework that will be useful in the development of competencies for CRN specialty practice. In helping to bring research findings to bear on clinical care, the impact of CRNs' practice extends beyond the individual patient to larger patient populations.

[Nurses' participation in clinical research projects: a cross-sectional study in five hospitals]

The number of hospital-based clinical trials is resulting in the growing involvement of nurses. A cross-sectional study in five hospitals involving 60 nurses assessed the clinical research activities, the time allocated and the training level. The results suggest that identifying specific nursing time devoted to clinical research may influence the activities carried out. Improving the definition of these activities could facilitate their integration into nursing practice.

Ward-Based Nurses' Knowledge and Attitudes Toward Clinical Trials: A Survey Study in Taiwan

PURPOSES

Clinical trial education has not been extensively integrated into nursing education systems. Acute care nurses may lack sufficient knowledge when caring for admitted trial patients, which may negatively influence their attitudes toward clinical trials. The aim of this study was to explore ward-based nurses' knowledge and attitudes toward clinical trials.

DESIGN AND METHODS

Ward-based nurses working in medical, surgical, and intensive care units in a medical center in Taiwan were approached to complete a questionnaire. The questionnaire was developed by the research team and included four parts: demographics, experience with clinical trials, clinical trial knowledge, and attitudes toward clinical trials.

FINDINGS

A total of 161 nurses responded. Nearly 90% of the nurses accessed trial information in their workplace. Nearly 80% of the respondents had experience with caring for trial patients, but the mean score of clinical trial knowledge was 4.5 out of a possible score of 10. For attitudes toward clinical trials, the mean score for positive beliefs was 39.7, and the mean score for negative expectations was 42.5, both out of a possible score of 55. The results indicated that respondents typically tended to hold a negative attitude toward clinical trials, especially in regard to the side effects of study drugs and communication with investigators.

CONCLUSIONS

Knowledge deficits of ward-based nurses concerning trial participation is apparent. Continuing education for ward-based nurses is necessary to promote implementation of clinical trials and reduce negative expectations related to clinical trials.

CLINICAL RELEVANCE

One way to improve nurses' knowledge is to integrate clinical trial education into nursing education systems, which will provide more channels through which nurses can understand how a trial works, including the risks, benefits, and participant protection. Through such educational initiatives, ward-based nurses may develop more positive beliefs regarding clinical trials and provide higher quality clinical trial care to participants.

Translation and validation of the Clinical Trial Nursing Questionnaire in Swedish-A first step to clarify the clinical research nurse role in Sweden

AIM AND OBJECTIVES

To translate the Clinical Trial Nursing Questionnaire (CTNQ) into Swedish and test it for face and content validity as well as internal consistency and reproducibility using test-retest procedures.

INTRODUCTION/BACKGROUND

In many countries, as in Sweden, a registered nurse can be involved in research by becoming a clinical research nurse. The clinical research nurse plays a pivotal role in clinical studies as a part of the research team. Scales have been developed and used with the objective to clarify the role of clinical research nurses: one of them is the CTNQ.

METHODS

A quantitative cross-sectional design with a test-retest procedure was applied to validate the translated questionnaire. By using a snowball sampling method, relevant participants were identified and 49 registered nurses working in the field of research as clinical research nurses answered the questionnaire on two occasions. An expert panel of three clinical research nurses evaluated the questionnaire for face and content validity. The STROBE checklist for observational research has been followed for presenting the research (see File S1).

RESULTS

Face and content validity was agreed upon in the expert panel group. Tests for internal consistency of the CTNQ was calculated and showed a high Cronbach's alpha for both the frequency and importance subscales. The test-retest correlation analysis (reproducibility) also revealed a high correlation coefficient for both subscales.

CONCLUSION

The CTNQ-SWE is a valid and robust instrument in a Swedish version. The instrument can be of importance in assessing the role of clinical research nurses in Sweden in future studies.

RELEVANCE TO CLINICAL PRACTICE

Use of the CTNQ-SWE in future research can be of value for clarification and professional development of the clinical research nurse role in Sweden. The further use of the CTNQ in Sweden can be of value in understanding the process where licensed nurses make a transition into becoming a clinical research nurse, and to identify needs for customised education.

Research nurses in New Zealand intensive care units: A qualitative descriptive study

BACKGROUND

This study explored the role of the research nurse in New Zealand (NZ) Level III intensive care units (ICU). Little was known about this role in NZ prior to this study.

OBJECTIVES

To describe the role and responsibilities of NZ ICU research nurses.

METHODOLOGY

A qualitative, descriptive approach, using semi structured interviews was used.

RESULTS

The study was conducted in six Level III ICUs throughout NZ that employed a research nurse. Interviews were conducted with research nurses (n = 11), principal investigators (n = 6) and nurse managers (n = 6), and the findings were triangulated. The views across all ICUs and stakeholders were generally similar, with differences only being in some operational areas. This study found that the primary role of the research nurse was trial management, where they coordinated all elements of trial conduct. Almost half of the research nurses were involved in trial design through their positions on management committees. Research nurses also played a vital role in patient and trial advocacy, and they bridged the knowledge gap by bringing research to staff nurses, patients and their families. The majority of research nurses reported to a nursing line manager, and had an informal accountability to the PI.

CONCLUSION

The role of NZ ICU research nurses is similar to their international counterparts. This study provides clarity about the research nurse role and showcases their key contribution in ensuring that NZ ICUs undertake high quality research, thus contributing to potential improvements for future patients' outcomes.

Professional identity and the Clinical Research Nurse: A qualitative study exploring issues having an impact on participant recruitment in research

AIMS

The aim of this study was to explore the experiences of Clinical Research Nurses, with an emphasis on factors that may have an impact on successful study delivery.

BACKGROUND

The Clinical Research Nurse workforce is pivotal to improving health outcomes through supporting research-active health economies. Investment in research infrastructure has led to nurses and midwives increasingly undertaking extended roles to deliver clinical research. Despite such opportunities, the recruitment of sufficient participants into research studies remains problematic. A growing body of literature is exploring barriers to successful study delivery, indicating the emergence of a caring-recruiting dichotomy in clinical research staff.

DESIGN

This qualitative study investigates the experiences of Clinical Research Nurses delivering research in the United Kingdom National Health Service.

METHODS

Four Focus groups (total 19 participants) were conducted in a large North East National Health Service Foundation Trust from November 2015 - February 2016.

FINDINGS

Thematic analysis identified perceptions of the role in the wider context of professional identity. Role transition, altered relationships and workload complexity, affected participants' practice, leading to inconsistency between core clinical values and perceived identities as research delivery staff. A duty of care as patient advocates contrasted elements of the work reflecting that of salespeople. The emotional labour of approaching patients and unease regarding peer perceptions of the Clinical Research Nurse role, affected the positive aspects of research delivery.

CONCLUSION

Professional-identity and self-concept appear to have an impact on practice in a research delivery role. Further research should explore these issues further, to enlighten the basis on which such feelings are positioned and to work towards practical solutions.

Clinical research education: perspectives of nurses, employers, and educators

The aim of this study was to understand the current environment around clinical research relating to nursing education and practice. This descriptive study analyzed data from 33 in-depth interviews with faculty members, nurse executives, staff development directors, and practicing nurses, as well as an online interactive brainstorming session with 28 deans of schools of nursing (or their designee). Patterns and themes that emerged within each group were identified and analyzed in relation to study objectives. Central themes emerged around participants' knowledge and attitudes about clinical research education for baccalaureate nursing students, factors enhancing or inhibiting inclusion of clinical research content in baccalaureate nursing programs, and professional roles nursing students could expect to assume after graduation. Although the participants agreed that mastery of clinical research knowledge and related skills is important, there was no agreement whether nurses should receive this education and training in baccalaureate programs or in staff development.

Researching in the community: the value and contribution of nurses to community based or primary health care research

AIM

To describe the role, contribution and value of research nurses in New Zealand community-based or primary health care research.

BACKGROUND

Research nurses are increasingly recognised as having a key role in undertaking successful research in hospitals and clinical trial units however only limited work has been undertaken to examine their role in community-based research. Undertaking health research in the community has unique challenges particularly in relation to research design and recruitment and retention of participants.

METHODS

We describe four community-based research projects involving research nurses, each with particular recruitment, retention and logistical problems. Vignettes are used to illustrate the role, contribution and value of research nurses in a diverse range of community research projects.

FINDINGS

The knowledge and skills used by research nurses in these projects included familiarity with communities, cultural competence, health care systems and practice philosophies and in particular with vulnerable populations. Their research actions and activities include competence with a broad range of research methodologies, organisational efficiency, family-centred approach, along with advocacy and flexibility. These are underpinned by nursing knowledge and clinical expertise contributing to an ability to work autonomously. These four projects demonstrate that research nurses in community-based research possess specific attributes which facilitate successful study development, implementation and outcome.

Examining occupational stress, sources of stress and stress management strategies through the eyes of management consultants: a multiple correspondence analysis for latent constructs

To date, little research has yet focused in broad assessment for management consultancy professionals. This investigation aims to analyse management consultants' self-perceptions of occupational stress (SPoOS), sources of stress (SoS) and stress management strategies (SMS) and to find latent constructs that can work as major determinants in consultants' conceptualization of SPoOS, SoS and SMS. Measures were completed, including demographics and interviews. Complete data were available for 39 management consultants, 53.8% male and aged between 23 and 56 years (M = 38.0; SD = 9.2). The data were subjected to content analysis. Representation of the associations and latent constructs were analysed by a multiple correspondence analysis. Results indicated that 'intellectual disturber' (31.4%) was the most referred SPoOS, 'high workload' (15.1%) was identified as the most prevalent perceived SoS and 'coaching' (19.0%) was the most mentioned SMS. No significant differences between the two gender groups were found regarding the three total scores. SPoOS was explained by a two-factor model: 'organization-oriented' and 'person-oriented'. A three-dimension model formed by 'job concerns', 'organizational constraints' and 'career expectations' was indicated as a best-fit solution for SoS, and SMS was best explained in a three-dimension model by 'group dynamics strategies', 'organizational culture strategies' and 'individual support strategies'. This research makes a unique contribution for a better understanding of what defines SPoOS, SoS and SMS for management consultants.

Evaluation of internal peer-review to train nurses recruiting to a randomized controlled trial--Internal Peer-review for Recruitment Training in Trials (InterPReTiT)

AIM

A discussion and qualitative evaluation of the use of peer-review to train nurses and optimize recruitment practice in a randomized controlled trial.

BACKGROUND

Sound recruitment processes are critical to the success of randomized controlled trials. Nurses recruiting to trials must obtain consent for an intervention that is administered for reasons other than anticipated benefit to the patient. This requires not only patients' acquiescence but also evidence that they have weighed the relevant information in reaching their decision. How trial information is explained is vital, but communication and training can be inadequate.

DESIGN

A discussion of a new process to train nurses recruiting to a randomized controlled trial.

DATA SOURCES

Literature from 1999-2013 about consenting to trials is included. Over 3 months from 2009-2010, recruiting nurses reviewed recruitment interviews recorded during the pilot phase of a single-site randomized controlled trial and noted content, communication style and interactions. They discussed their findings during peer-review meetings, which were audio-recorded and analysed using qualitative methodology.

IMPLICATIONS FOR NURSING

Peer-review can enhance nurses' training in trial recruitment procedures by supporting development of the necessary communication skills, facilitating consistency in information provision and sharing best practice.

CONCLUSIONS

Nurse-led peer-review can provide a forum to share communication strategies that will elicit and address participant concerns and obtain evidence of participant understanding prior to consent. Comparing practice can improve consistency and accuracy of trial information and facilitate identification of recruitment issues. Internal peer-review was well accepted and promoted team cohesion. Further evaluation is needed.

Clinical trial recruitment--a complex intervention?

AIMS AND OBJECTIVES

To discuss the evidence of poor recruitment rates in randomised clinical trials and relate this to existing recruitment methodology before a novel approach to recruitment is suggested.

BACKGROUND

Recruitment is crucial to the success of research projects. Effective recruitment leads to effective retention, an increased pool of data and in-time completion of projects. Robust evidence indicates that recruitment remains a challenge in many clinical trials.

DESIGN

Discursive article.

METHODS

The complexity of recruitment is mandated based on the findings from a literature review that summarises common threats to successful recruitment. Nursing theories and models that incorporate recruitment are critically reviewed before recruiting, and its planning is related to existing complex intervention methodology.

CONCLUSION

Threats to sufficient recruitment are inherent in the planning of studies, the recruiting process and triadic relationships between institutions, recruiter and participants. Existing nursing theories and models address important recruitment issues but do not account for all aspects that jeopardise sufficient recruitment. Hence, available frameworks for complex intervention planning and evaluation are useful to guide recruitment and its planning as an umbrella methodology.

RELEVANCE TO CLINICAL PRACTICE

Using complex intervention methodology for recruitment and its planning enhances a nurse researcher's awareness of the challenges and pitfalls recruitment poses and may translate to improved recruitment rates and overall success of clinical trials.

The role of clinical trial nurses: an Australian perspective

Over the past two decades, the number of clinical trials conducted globally has increased thereby increasing demand for nurses working as Clinical Trial Nurses (CTNs), sometimes known as Clinical Research Nurses. The role and professional issues for these nurses in Australia has not been empirically formulated. Sixty-seven clinical trial nurses were surveyed nationally using a modified version of the Clinical Trials Nursing Questionnaire (CTNQ). Findings revealed the complex CTN role can include the coordination of the trials on one or more sites. This involves all domains listed in the questionnaire from protocol development, ethics approval applications, recruitment and consenting of participants in trials, to administering or assisting with treatments within the bounds of their practice code and the evaluation of protocols. Professional issues documented were: being undervalued in the nursing workforce, having no formal educational preparation for the role and minimal recognition in publications emanating from research in which they were involved. These nurses bring their practice knowledge to benefit research outcomes that may contribute to improving patient/client care.

Advancing the educational and career pathway for clinical trials nurses

Clinical trials nurses play a pivotal role in the conduct of clinical research, but the educational and career pathway for these nurses remains unclear. This article reports findings from a survey of nurses working in cancer clinical trials research in Australia. Most participants held postgraduate qualifications (42 of 61); however, clinical trials education was primarily attained through short professional development courses. Interest in pursuing trial-specific postgraduate education was high, but barriers were identified, including cost, time, and unclear benefit for career advancement. Job titles varied substantially, which is indicative of an unclear employment pathway. These findings suggest that initiatives to improve the educational and career pathway for clinical trials nurses are needed and should include the following: formal educational preparation, greater consistency in employment status, and clearer career progression. These strategies should be underpinned by broad professional recognition of the clinical trials nurse as a specialized nursing role.

Educating tomorrow's clinical researchers: a review of research preparation in undergraduate education

BACKGROUND

One large health region in England was experiencing difficulties in recruiting to clinical research posts which required registered nurse or allied health professional skills.

OBJECTIVES

Pre-registration preparation may influence practitioners' career choices and the study reviewed the research content in pre-registration nurse/AHP degree level programmes in the region to i) describe key features of the modules, and ii) determine the extent to which clinical research featured.

DESIGN AND SETTINGS

There are eight universities in the region. We reviewed and analysed 46 research and evidence-based practice module guides from relevant pre-registration degree level programmes. Documentary analysis was used and the findings were reviewed by the project group.

RESULTS

Modules aimed to produce practitioners who were aware of the principles of evidence based practice, and who could locate and evaluate research findings. There was some exposure to clinical research, though this was largely indirect, through considering research findings. Therapy students were more likely than nursing students to conduct a small clinical study for their final year assignment.

CONCLUSIONS

Pre-registration programmes focused on producing practitioners who were competent users of research evidence to inform practice, rather than clinical researchers, and this was inevitably the focus of the research modules. However, feasible opportunities for increasing students' exposure to clinical research were identified.

Oncology clinical trials nursing: developing competencies for the novice

Oncology clinical trials are important in the improvement of outcomes for people with or at risk for cancer. Because of the complexity of oncology clinical trials and the needs of patients with cancer, nurses play a crucial and unique role in the trial setting. However, great variability exists in how the role of the nurse on a research team is defined and implemented. An Oncology Nursing Society project team set out to identify the core competencies required of a novice oncology clinical trials nurse (CTN) across diverse settings. This article describes the process used to develop core competencies for the novice CTN, presents the final core competencies, and offers examples of how those competencies might be used in practice.

Defining clinical research nursing practice: results of a role delineation study

Clinical research nursing is a specialty nursing practice focused on the care of research subjects and implementation of clinical research. A five-dimensional model (Clinical Practice [CP], Study Management, Care Coordination and Continuity, Contributing to the Science [CS], Human Subjects Protection) has been validated nationally to represent the domain of clinical research nursing practice. The purpose of this study was to describe the frequency and importance of activities within each dimension as performed by nurses in clinical research and to describe differences between roles. One thousand and four nurses from the NIH Intramural Campus in Bethesda, Maryland, were invited to participate in an anonymous web-based survey. Participants (N = 412) were predominantly female (90%) with ≥11 years research experience (70%). Two hundred eighty-eight respondents (70%) identified themselves as clinical research nurses (CRNs) and 74 (18%) as research nurse coordinators (RNCs). CP activities were reported most frequent and important whereas CS activities were least frequent and important. CRN and RNC activity frequency differed across all dimensions (p < 0.001) with CRNs reporting significantly higher levels of CP activities and significantly lower levels in other dimensions. Delineating specialty activities and practice across roles enhances the understanding of nurses' role in clinical research and provides groundwork for role-based training.