UCL Nursing (UoA 11)
BACKGROUND AND STRUCTURE
This is the first submission by University College London (UCL) to the nursing and midwifery unit of assessment. Its purpose is to establish the quality credentials of UCL research that relates to nursing and midwifery and which underpins the recent development of the new flagship nurse-led centre for Patient Care Research and Innovation (PCRI). UCL and its NHS partners now comprise one of the largest biomedical research campuses in Europe. Within this structure there are at present four full-time academic nurse scientists and three affiliated nursing and allied health researchers. Their outputs, grants and indicators of esteem featured in this
submission demonstrate a strong track record of high quality original research that has significantly contributed, nationally and internationally, to knowledge, practice and health policy affecting adults and children.
University context: The UCL School of Medical and Life Sciences (SMLS) consists of two divisions, the Faculty of Life Sciences (FLS) and the Faculty of Biomedical Sciences (FBS), which includes five recently incorporated research institutes, of which four were separately submitted to RAE 2001. The FBS comprises 13 thematically-based research divisions, which are aligned, where appropriate, with partner NHS Trusts. This submission benefits from and contributes to the
interdisciplinary and collaborative environment under the SMLS. The
Comprehensive and Specialist Biomedical Research Centre status awarded in 2007 by the NIHR to UCL/University College London Hospital (UCLH) and to UCL Institute of Child Health/Great Ormond Street Hospital (GOSH), respectively, now enables UCL and its partners to provide new resources to build on the present foundation of nursing scholarship and to ensure sustainability of a new leading-edge research centre. Accordingly, during 2006-07, the PCRI was formed to bring together academic nursing research across UCL.
PCRI sits within UCL’s FBS and multidisciplinary research groupings at the ICH, Institute for Women’s Health and Division of Population Health. Staff hold joint appointments with NHS partners (e.g., UCLH, GOSH, Camden Primary Care Trust, North Central London Research Network). These collaborations provide unparalleled access to clinical research facilities, equipment and expertise. PCRI research
focuses on the experience of individuals in health and illness across the lifespan, leading investigation on symptom management, health-related quality of life (HRQL) and the role of caregivers (self, family, and professionals) in health promotion and disease management. We provide research training and career development for nurses and allied health professionals. Future plans for the Centre are to build on existing expertise and resources within UCL and lead internationally excellent patient care research in collaboration with researchers from other clinical disciplines and basic sciences and, with NHS partners, to achieve more rapid translation of clinical research into innovations in patient care delivery.
RESEARCH ACHIEVEMENTS
With over 150 data-based publications and 15 research reviews during 2001-07, our research has made significant contributions to patient care knowledge, practice and health policy for two main population groupings: (1) children, young people and their parents; and (2) adults with cancer, genitourinary conditions and nicotine
dependence. Our research emphasises the importance of the dual perspective of service users and service providers and has focused on two main themes: (1) assessment of symptoms and outcomes; and (2) understanding and improving patient care services.
Assessment of symptoms and outcomes: Research to improve understanding of symptoms and outcomes of important health problems affecting children and young people has been led by four of our researchers (Franck, Gibson, Sell, Wray) in four areas of paediatric care: pain, cancer, speech difficulties and psychological health after cardiac transplant. Major achievements in pain research include: the first quantitative evidence of long-term somatosensory function in children a decade after neonatal surgery (Franck 1); the first validation of an assessment tool for detecting iatrogenic opioid and benzodiazepine withdrawal in critically ill infants and children (Franck 2); the first description of parents’ concerns about neonatal pain and the associated parental stress (Franck 3); and the first multidimensional assessment of pain across healthcare settings in children and young people with sickle cell disease (Franck 4). These outputs are primary points of reference in the field and have influenced national and international guidelines, professional curricula, and standards for research relating to paediatric pain management. Major achievements in cancer research include exploration of cancer-related fatigue in young people during and after (Gibson 1,2,3) treatment, demonstrating the dominance and persistence of fatigue; the first description of the views on follow-up care services and healthcare needs of childhood cancer survivors (Gibson 3); and the first validation of an oral health assessment tool for oral mucositis, a major side effect of treatment affecting children’s quality of life (Gibson 4). Research in speech assessment produced key findings on outcomes of surgical repair for children with cleft palate (Sell 1, 2) and prosthetic appliances for children with velopharyngeal dysfunction (Sell 3). A randomised clinical trial (RCT) found no improvement in feeding or growth with the controversial use of presurgical orthopaedics (Sell 4). These findings have strongly influenced UK and international standards of care for children with craniofacial anomalies. Psychological health research on the vulnerabilities (Wray 1) and short and long-term outcomes (Wray 2,3) of children undergoing cardiac transplantation has highlighted similarities and differences between children with cardiac and other chronic conditions and revealed unmet psychological needs in families of children with heart disease (Wray 4). Following on from the Bristol and Brompton reports, these studies have influenced the development of children’s cardiac liaison nursing and psychological support services.
Understanding and improving patient care services: The research theme led by three PCRI staff (Lanceley, McEwen, Miles) has focused on: (1) support services for patients; and 2) the effectiveness of health professionals’ roles and ways of working. Major achievements include insights into the decision-making processes within multidisciplinary teams caring for women with gynaecological cancer
(Lanceley 1); a novel RCT of specialist nurse-led care for women with genitourinary conditions (Miles 1); identification of cancer information and support needs of
minority ethnic communities (Lanceley 2), identification of challenges faced by young people with HIV transitioning from paediatric to adult services (Miles 4), and
attitudinal and practice barriers to effective health service delivery for pregnant women with nicotine addiction (McEwen 1). Further seminal RCTs of novel
supportive smoking cessation interventions and evaluations of behavioural support (McEwen 2,3,4) have provided important new evidence for this priority public health issue, whilst descriptive research has provided new methods for quality assessment and evaluation of user-driven changes for NHS patient advice and liaison services (Lanceley 3,4), sexual health clinics and HIV care (Miles 2,3). Linkages between the two research themes are evident in the work of Gibson, Wray, Miles.
Contributions to scholarship, policy, and practice: Research led by PCRI staff has contributed new knowledge regarding research methods crucial to the conduct of patient-focused research, including development and validation of symptom
refinement of participatory research methods (Gibson 2,3; Lanceley 2,3; Miles 4). Examples of the influence of our research on health policy, practices and patient care provision nationally and internationally include:
• Children’s National Service Framework (England) standards on paediatric pain and acute hospital family-centred care (Franck, Gibson, McDonald)
• International Association for the Study of Pain paediatric pain curriculum and research standards (Franck)
• Consultation to the European Agency for the Evaluation of Medicinal Products (Franck)
• National guidelines on mouth care for children and young people with cancer (Gibson)
• NHS consensus statement on involving children and young people in health services (Gibson)
• National guidelines on ethical decision making in fetal and neonatal critical care (Franck)
• DH/NHS (England) guidelines on research governance and paediatric consent for research (Franck)
• Consultation to commercial companies on children’s pain and fatigue measurement and management (Franck, Gibson).
• DH (England) universal reporting parameters for speech of individuals with Cleft Palate and UK and Ireland craniofacial audit (Sell)
• Development of NHS psychosocial services in paediatric cardiothoracic transplantation (Wray)
• Neale Inquiry, Patient Advice and Liaison Services (Lanceley)
• Smoking cessation guidance for community pharmacists and for dental teams (McEwen)
• Consultation to governments of The Netherlands, Japan and Thailand on national stop smoking services (McEwen)
• DH (England) Sexual Health Strategy implementation team (Miles)
• National Sexual Health Policy and NHS nurse-led sexual health clinics (Miles). • DH (England) Modernising nursing careers: health visitor role, education and
preparation for nursing in the community (Drennan)
• DH (England) Advisory panel for supplementary prescribing research (Drennan) • UK Quality Outcomes Framework, research evidence review for the General
Medical Services Contract (Drennan)
RESEARCH ENVIRONMENT
Research income: Funding for research has been achieved through rigorous, peer-reviewed competition at national, regional and local levels. The most significant sources of funding were UK-based charities and prestigious awards from MRC (Franck), DH (Drennan), and NHS (Drennan). Income administered through UCL during 2001-07 was £950k. A further £271k in research funding was recently competitively awarded to PCRI staff but not yet expended by the census date. In addition, staff were lead investigators for research income of £650k awarded or administered by partner agencies (e.g., NHS Trusts). Staff were active
co-investigators for £1.1 million where the principal investigator (PI) was from another UCL department, £1.5 million in research grants where the PI was from another UK institution, and £624k in internationally held research grants. Partner NHS Trusts have provided salary support in the form of clinical nursing secondments to PCRI for which we have provided research mentorship and supervision to develop skills of nursing professionals in patient-focused research. Our funded research projects often form the basis for Masters degree research projects for clinical staff.
Staffing policy
The first aim was to recruit expert leadership (Franck) and new researchers with expertise in patient-focused research (Lanceley, McEwen). A second aim was to develop individuals with outstanding research potential from within UCL and its partners through provision of opportunities for research with mentorship from PCRI, bringing together academic and peer support and shared nursing and allied health perspectives. The success of this strategy is evidenced by the progression of clinical staff from PhD training to academic appointment and promotion (Gibson, McDonald, Main - now in UoA4) and the successful recruitment of Category B staff to prestigious posts at other universities (Drennan; McDonald). The third was to enable expert clinicians (Sell, Wray, Miles) to increase their research activity and share their research expertise with NHS nursing and allied health staff.
Interdisciplinary collaboration
Staff have developed extensive and effective cross-faculty collaborations within UCL and with NHS partners, service users and international researchers. We have been creative in the use of joint appointments at other HEIs and partnership posts to enable staff to work in interdisciplinary groups with multiple institutions. UK
collaborators include Universities of Stirling, Leicester, De Montfort, City, and King’s College London (KCL). International collaborators include universities and healthcare organizations in North America (e.g. Universities of California, Pennsylvania and Toronto), Australia, China, Sweden, France, and Mozambique. Over 80% of our research output is co-authored with collaborators from other disciplines and/or institutions. Research partnerships with industry have led to two public awareness campaigns on parental support after premature birth (with Fairy Non-Bio) and young children’s verbal communication when they have pain (with Calpol), research funding and public engagement in research (Franck).
PCRI has made a major contribution to a vital research culture within UCL and its NHS partners that is sustainable and growing. This is achieved through research facilitation activities (e.g., seminars, study days, small group and individual consultation with clinical staff); research utilisation activities (e.g., consultation to NHS clinical practice committees, evidence-based practice guidance, quality
improvement and audit, professional strategy); and research supervision (e.g., formal academic supervision, clinical project consultation, informal advice and consultation services).
Patient and public involvement in research
We have provided leadership for UCL and the nursing profession in the area of patient and public involvement in research, particularly in the challenging area of children, young people and their families, where our expertise is sought nationally and internationally. Franck chaired the first NHS research governance committee to involve lay members and organised the first national conference on involving children and young people in research in 2005. Research on the readability of written
information for potential research participants (Franck) led to improved written information for children and families about participation in research. We involved parents in design of clinical trials of pain education (Franck), seating systems for disabled children (McDonald) and developed new methods to engage children and young people in research about their cancer treatment and follow up (Gibson). Gibson and Drennan were members of research ethics committees (GOSH and UCLH, respectively) during 2001-07.
PCRI staff provide research education in a multiprofessional and multi-institution context. Research training and academic supervision is often in collaboration with other universities (e.g., KCL, University of Sheffield); PCRI staff are regularly appointed as external examiners for MPhil-PhD conversions and PhD and Masters thesis examinations at universities nationally and internationally. PCRI staff provide consultation, mentorship and career guidance to clinical staff within NHS partners. We are a key research resource for GOSH- and UCLH-funded research nurses (approximately 60) and nurse consultants. Our students are encouraged to attend PCRI seminars, joint teaching sessions with NHS partners, and UCL workshops and courses on experimental design, statistics, evidence-based practice, research ethics, intellectual property rights, project planning and supervision. UCL offers outstanding library (print and electronic) services, statistical support and research methodology expertise. Student mentorship is both formal and informal, with regular meetings between students and supervisors. Student progress is jointly documented and monitored by student and supervisor using an electronic student log.
The true volume of our students is not reflected in RA3 because many are registered at other schools of nursing or allied health but received their primary research
supervision by PCRI staff (see table below). Our supervision of MSc students’ empirical research projects and theses is noteworthy as all our students are experienced health professionals who conduct primary research with patients or caregivers on questions highly important to clinical practice.
The success of this collaborative model is evident in prestigious funding achieved for students we supervised or co-supervised. We were awarded funding for the first (and only) nursing studentship in paediatric pain (WellChild Charity), which supported 1 MSc research thesis, 1 PhD (current) and 1 postdoctoral student during the RAE period. Our staff co-sponsored successful PhD studentships in nutrition (DH), primary care (DH and NHS), gynaecological cancer (MRC), smoking cessation (Cancer Research UK). One of our co-supervised doctoral students won the RCN Marjorie Simpson New Researcher Award (2006). All students present their work at relevant conferences and PCRI staff have co-authored with students over 25 papers in peer-reviewed journals related to PhD and Masters research.
Staff (Category)
UCL Students supervised (1st, 2nd, completed)
Other Universities Students supervised (1st, 2nd, completed) PhD Masters clinical research theses PhD Masters clinical research theses Franck (A) 1 (1st) 1 (2nd) Postdoctoral: fellowship: 1 (completed) 2 (1 completed) 1 (2nd) 3 (completed: 2001 (2nd); 2002 (2nd); 2007 (1st)) 1 International sabbatical research 2 (12 completed)
Gibson (A) 1 (completed:
2007 (2nd)) International visitor: 1
2 (7 completed)
Lanceley (A) 1 (2nd) 1 (2nd)
McEwen (A) 1 (2nd) 1 (completed) 1 (2nd) 2 (completed) Sell (C) 1 (1st) 1 (2nd, completed) Postdoctoral
fellowship: 2 (completed)
Wray (C) 2 (completed) Miles (C) 5 (completed) Drennan (B) 1 (1st) 2 (completed) 1 (2nd) 1 (completed) McDonald (B) 1 (2nd) 3 (completed) RESEARCH STRATEGY
Over the next five years, UCL will strengthen the infrastructure for advanced nursing research training and build research capacity to enable world-leading, nurse-led patient care research.
1. Expansion of research capacity: Planned expansion started with a bid to the UCL Comprehensive Biomedical Research Centre, which has received first-stage approval for 2 new academic posts to replace the Category B staff and 6 pre- and postdoctoral studentships. The new posts will be based in PCRI and link with UCL FBS themes in anaesthetics and critical care, cardiovascular disease and long-term conditions. Our objectives are to increase:
• Clinical research funding from NIHR funding streams, research councils and charities
• Research that directly benefits NHS patients (e.g., reduction of morbidity, better symptom management/HRQL) and improve healthcare services (e.g., more effective nursing care)
• Capacity to provide patient care research expertise to research collaborators and clinical staff within UCL and NHS partners
• International recognition through excellence in research and research training 2. Expansion of research training: As part of the UCL academic strategy we will increase our capacity to provide research training. Key objectives are to gain:
• Funding from the UKCRC and others for research and clinical/academic career training
• Research studentships (e.g., from research councils) and recruitment of high-calibre students
• Income generation from new post-graduate courses for research nurses and clinical nurses interested in research (e.g., MRes in clinical trials)
3. Innovations in patient care delivery: Working with NHS partners, other healthcare providers, and directly with the public, we will enable rapid translation of research into innovations in patient care delivery. Key objectives include:
• Investigating new ways of engaging clinical staff in collaborative nurse-led research
• Evaluation of innovations in patient/public involvement in research
• Development of better metrics to evaluate patient and health service benefits resulting from research led by or in collaboration with nurse researchers 4. Expansion of research programme: The £271k in recent awards enables continuation of current research. Plans are underway to increase the depth and breadth of our research, moving from two research themes to three research programmes:
Symptom management: Funded and planned studies will test interventions through RCTs and other designs suited to complex interventions to provide the necessary level of evidence to guide and improve clinical practice. For example, pilot trials are underway (Franck, £139k) or planned (Franck, Wray) to evaluate novel education and coping interventions for parents of critically ill children and those requiring
cardiac transplant. Mobile phones are being tested as a means of improving symptom assessment in young people with cancer (Gibson, 112k). Assessment methods developed by staff (Franck, Gibson, Sell, 30k) will be implemented in national and international research and evaluated in clinical practice.
Health-related quality of life (HRQL): This topic will become a specific research theme over the next year. Planned studies will investigate the impact of critical care, long-term conditions and end-of-life patient care on HRQL of patients and families (Franck, Wray). New research collaborations within UCL, nationally and
internationally are currently being developed (e.g., an international HRQL database and a national long-term follow-up study of all paediatric cardiothoracic transplant patients into adulthood (Wray, £100k) and a European project to investigate HRQL in women with endometrial cancer (Lanceley, 20k).
The role of caregivers in health promotion and disease management: New research will explore the roles of caregivers, particularly regarding vulnerable patient groups and where health disparities exist. For example, creating choices and
evaluating responsiveness of nurse-led models of follow-up care for women with gynaecological cancer and exploring the interaction between health beliefs of
patients and practitioners in women’s health care (Lanceley). Research is planned to evaluate the cost-effectiveness and nursing contribution to patient-centred multi-professional teams, particularly in relation to transitional care services (Lanceley, McEwen, Miles, Gibson). Innovations in patient care delivery include a novel nicotine delivery device, for which initial laboratory studies are complete and user satisfaction studies are planned, and the Smoking Cessation Research Network is being developed for clinical research on patient outcomes (McEwen). Funding bids have been submitted for the use of technology for the management of patients with sexual health needs (Miles) and cancer symptoms (Gibson).
Individual indicators of esteem: Further evidence of the high regard for the research quality and expertise of staff is shown in the following table:
Staff (Category) Indicators of esteem during assessment period
Franck (A) Visiting Professor, Perinatal Society of Australia and New Zealand; BLISS Premature Baby Charity Research Team Award;
Distinguished Leader in Neonatal Nursing (USA); Fellow, American Academy of Nursing; Fellow, Royal College of Paediatrics and Child Health; Fellow, European Academy of Nursing Science; European Science Foundation Scientific Network Group on Research in Early Developmental Care; MRC Clinical Trials for Tomorrow: Design and Delivery Steering Group; Royal College of Nursing Consent for Research Expert Panel Member; Over 40 plenary research papers at international conferences (12 keynotes); Editorial boards: 6 journals (e.g., JAN, IJNS).
Gibson (A) Fellow, Royal College of Nursing, Member, National Cancer Research Institute Teenagers/Young Adults Clinical Studies Group; Panel Member, Quality Review, Uppsala University Sweden; RCN Expert Group on User Involvement in Research by Nurses; Plenary papers at major international conferences (5 keynotes); Editorial boards: 3 journals (Assoc. Ed. J Onc Nurs).
Lanceley (A) Member, Nursing Strategy Group, Marie Curie Cancer Care; Executive Committee Member, British Psychosocial Oncology Society; Research presentations at international conferences. McEwen (A) Plenary presentations at international conferences (2 keynote);
Sell (C) OBE for Services to Health; Distinguished Visiting Fellow, University of Latrobe, Melbourne, AU; 16 plenary presentations at international conferences (3 keynote). Invited presenter, NIH workshop on Deafness and Other Communication Disorders, USA; UK representative,
Eurocran Collaboration on Craniofacial Anomalies; Editorial boards 2 journals; Invited user representative of RAE 2008 UoA12 subpanel. Wray (C) Research presentations at international conferences (1 keynote).
Committee Member, International Pediatric Transplant Association. Miles (C) Steering Group, national competency framework for sexual health
nursing (RCN, BASHH, GUNA, NANCSH, FFPRHC, FPA); Research presentations at international conferences; Invited speaker,
Westminster briefing.
Drennan (B) Council Member, Geriatrics and Gerontology Section, Royal Society of Medicine; Member, Research Group Royal College of General Practitioners; National Convenor for UK Network for Primary Care Nursing Research; Research presentations at international
conferences; Editorial boards: 2 journals (e.g., JAN).
McDonald (B) Chair and Executive Committee (research), National Association of Paediatric Occupational Therapists; Research presentations at international conferences Editorial board: 1 journal.
