Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.
Six months into a PhD to research the concept of volunteers in dementia and acute hospital wards, it has become apparent to me that there are a number of ways this area can be explored. Should I do a case study and examine the directorate as a whole? Or would ethnography be better to allow me an understanding of the organisational culture? Maybe a phenomenology study to understand the lived experience of those involved? How about a biographical account of a volunteer or maybe grounded theory to discover emerging theory?
The possibilities are endless and endlessly fascinating.
Having grappled with philosophy and emerging unscathed with a realisation that interpretivism would serve me well, I now see that things are not as straightforward as choosing an ‘off the peg’ epistemology, ontology and methodology. In fact, the whole business of designing a research proposal appears to be like that of trying to solve a Rubik’s cube; when it seems that all the pieces are in place, the novice researcher sits back with a sigh of relief only to discover one glaringly obvious piece which simply does not fit and the whole process begins again.
Similarly, healthcare of the older person can be just as enigmatic. While there is an emerging trend for HCOP advanced nurse practitioners there continue to be calls for a specialist registered older person nurse. The specialism is increasingly recognised for its complexities and the need for sensitive and intelligent juggling of multiple comorbidities as frail older people near the end of their life. In the face of improving technology, and increased number of drugs, lifesaving equipment and techniques, the urge for careful untangling of the puzzle of old age and illness is increasingly becoming more urgent.
Research is slow, time consuming and difficult. It is also exciting, exhilarating, and highly effective. A well put together systematic review will save many more lives than my lifetime spent at the bedside delivering care. I remember many years ago having the debate on whether or not we should give patients with catheters cranberry juice. We were told that it would ‘teflon coat’ bacteria to prevent it from multiplying. A meta analysis revealed it was not as effective as originally believed and that in some patients, as in the case of warfarin, could be positively harmful.
Good research can save vast amounts of money while improving quality; yet experienced, compassionate, skilled and knowledgeable nurses at the bedside are crucial too. A clinical academic pathway can strike a balance between clinical duties and academic work to support the delivery of evidence based nursing care.
While I puzzle my way through the enigmatic world of research design, I will remember that good quality research is the stuff of the future. Quantitative researchers continue to statistically analyse their data, while qualitative researchers shine a light in previously unexplored areas, and mixed methods researchers hint at the promise of the best of both worlds.
Older person care has the potential for new challenges and new frontiers as we continue to pursue the answers we need through research. Whichever methods we choose to pursue knowledge to help our patients, we merely hold the baton of excellence for future generations to carry on the work as healthcare improves through time.