I had a great day today with a group of community nurses who are passionate about research. Their energy and commitment to helping to find out what really works was inspiring and despite the many challenges we discussed, I came away feeling hopeful and re-energised.
For many years I have been involved in the VenUS leg ulcer trials at York University which have been funded by the NHS to investigate the relative effectiveness of all sorts of interventions related to venous leg ulceration. Today was a meeting of the trial nurses from across the country. Most are very experienced community tissue viability nurses who are passionate about using and producing good quality research to improve community nursing care.
To date, the Venus trials have discovered that: • Four-layer bandaging is better than short stretch bandaging for healing (VenUS I) • Larvae (maggots) debride sloughy ulcers more quickly but do not speed up healing (VenUS II), and • Ultrasound does not help ulcers heal faster (VenUS III).
The current trial (VenUS IV) is investigating whether the new compression hosiery kits are as good as four-layer bandaging. It is a large 'pragmatic' randomised, controlled trial which means it is recruiting a wide range of patients with venous leg ulceration (mainly from district nurse caseloads and GP practices) and randomly allocating them to receive either four layer bandaging or compression stockings. If at the end of the trial we find that there is a difference in the healing rate between the two groups, we can be reasonably sure that this is due to the treatments rather than anything else.
All the research questions above are very relevant to community nursing but recruiting patients from the community is really hard work. Most practice nurses and district nurses work in relatively small teams so anyone who is trying to find patients for a trial has to have brilliant networking skills to keep contacts with all these little teams. They also need to be extremely good at persuading very busy nurses on the ground that it is worth making that little bit of extra effort that is involved in collecting patient data. The last thing that any of us needs is more work!
However, there are so many benefits in getting involved in good quality research studies. There is the obvious one that the trial should produce useful information that will help patients and enable us to use healthcare resources as wisely as possible. However, there are also some more surprising benefits to both patients and nurses.
Patients who are enrolled in a study tend to do better on average than those who are not in a study regardless of whether or not they receive the 'new' treatment or the comparative treatment. It is not clear why this is so but being in a good quality trial appears to be good for your health! There are also advantages for clinicians. 'Research' can be a scary topic but one of the best and easiest ways of learning about research is through being involved in some.
So next time one of those pesky research-obsessed nurses approaches you to see if you have any patients who might be recruited to a study, check the credentials of the study, but if looks good, please find the extra five minutes to help that nurse. Research needs you!