How do I research
August 11, 2017 2:57 PM   Subscribe

I'm a nurse in a public hospital. I have an idea for a research study that I think would be relatively easy. But I know nothing about research and maybe more importantly, about the human relations part of how to raise this proposal with the relevant clinic, our research department, etc. Advice?

My study idea is to try a specific nursing intervention (counseling not clinically based) on a randomized sample of a specific clinic population, and, when compared to the non intervention group, see if a specific measurable health marker improves with the intervention.

In my favor: I work for a pretty flexible, non-corporate institution, where certain stuff can be tried that might not be elsewhere and where hierarchies aren't very rigid. I also think my studied intervention would be seen as a plus for the clinic, rather than a burden (I'd be making follow up calls to patients they don't have time to follow up with).

I don't really know where to start, who to approach, how to write this up. I have an Associates degree - no experience with formal research.

I know there is someone at my hospital whose job is like, approving research ideas... maybe I should just ask that person to lunch first? Or maybe I should approach the clinic manager or medical director? Or write a one page proposal and share it with all these people? There's also my boss to talk to about using my time this way...

Basically, a sort of to-do list of what to think about would be super helpful.

Thank you!
posted by latkes to Human Relations (15 answers total) 3 users marked this as a favorite
 
I think you should coordinate with someone in your hospital who is already doing research. Research like this involving human subjects requires a LOT of training and approval processes. You'll want someone who has been through it before and can be the PI (Principal Investigator) for the study -- most places I have ever worked, people need a specific degree/position to be allowed to lead a research study that involves human subjects. If you know others who have run research studies before in your clinic, that's who I would invite out to coffee to pick their brain and see if they are interested in a collaboration.

For context, my "human subjects" research involves having people take surveys online -- so extremely low/no risk, no physical or medical intervention whatsoever, etc. -- and still required hours of training + lots of writing proposals and filling out forms to get approved. So, even a "simple" study is not so simple. There has been a lot of abuse in the past, so that's why they are so strict these days.
posted by rainbowbrite at 3:26 PM on August 11 [9 favorites]


I would start first with someone who had a research background in this area. Someone with a PhD or MD/PhD would be ideal, but otherwise just a research-minded doctor or nurse. This person is going to have a better idea how to best construct your sample groups, know the relevant statistics, and know how to put together a proposal such that the various approvals can happen; not to mention the ability to search the literature for similar studies that can inform your experimental design. If there isn't a research wing to your institution, it'd be good to find collaborators at another institution close to you who are doing research.
posted by Betelgeuse at 3:26 PM on August 11 [1 favorite]


I think the advice to find an experienced collaborator is very good. Research, even if you have done it before, is a lot of work, and that's not even taking into account all the pre-approval work that will need to be done.

To give you an idea: I recently completed the pre-project documentation for a low-risk study involving human subjects that I'll be doing with a colleague. This consisted of

-an eight page proposal including a review of the current literature, to see what kind of research, if any, has already been done in this area
-a 15 page application for approval by our research ethics board
-development of our information and consent forms
-development of our research instruments (in our case, open-ended written response questions)

I have also previously completed a mandatory 6-hour online course on research ethics. Also, this is all before we actually complete the research and write up the results.

I think it couldn't hurt to meet with the person in charge of research at your institution--they may have suggestions on experienced researchers you could approach to be collaborators.
posted by hurdy gurdy girl at 3:38 PM on August 11


Do you have a library in your facility, or network? Medical libs are a fantastic resource.
posted by haunted by Leonard Cohen at 3:44 PM on August 11 [2 favorites]


My study idea is to try a specific nursing intervention (counseling not clinically based) on a randomized sample of a specific clinic population, and, when compared to the non intervention group, see if a specific measurable health marker improves with the intervention.

This is an extremely good start. But you have a long way to go. Here are some concrete steps for you to take:

(1) Find out all you can about research in this general area. Before you approach anyone, do your homework! If you're thinking of doing a behavioral intervention to improve postoperative outcomes after organ transplantation, search for reviews about postoperative outcomes after organ transplantation. Do some searches on Google Scholar and PubMed. Check out what the Cochrane Collaboration has to say in this are. Consult a medical librarian if you need help. The more you know about research in this area, the better you will be able to advocate on your own behalf.

(2) Find out if anyone has done any research in this exact area already. Do some searches on Google Scholar and PubMed. Consult a medical librarian if you need help. There is no need to do this research if it the exact same study has already been done before (unless you want to do a replication study, but that is another matter). If a similar study has already been done (maybe on a different population, or with a slightly different intervention, or in a different location) you can still do yours but it would be good to know what has already been done. Also, this can give you helpful ideas for how to conduct your own study.

(3) Now you are in a position to approach someone to help you with your research. Because you will need help doing a ton of things, including: designing a research protocol; getting ethics approval for human subjects research; recruiting participants; identifying a setting in which you can conduct research; securing funding to support the research, including payments to participants if necessary; collecting and analyzing data; writing it up and publishing it.

Research is more costly and labor-intensive than you might realize. Great ideas abound; translating them into actual research takes an immense amount of time and effort. No one is going to help you unless you can demonstrate that it will be worth their time to do so. If you really believe in this idea, you need to be able to make the best possible case for it. Do your homework, and then approach someone to help you.
posted by googly at 4:30 PM on August 11 [4 favorites]


This is what I would if I would suggest doing if I were in your shoes. To be honest, I think that there is likely to be a lot of upfront work before even determining if this is viable, but:

  • Go to clinicaltrials.gov and run the name of your institution and nearby institutions. You might already find registered clinical trials (even noninvasive ones) and often, the Primary Investigator of the study is listed. What would be great is if you can find people who already participate in trials now and your facility or a nearby place to have a one-on-one conversation if possible.

  • I would also run a search for your particular idea as another search on clinicaltrials.gov because...its not uncommon to find ongoing simiilar trials or an initial pilot study ready to expand, etc. If you find a similar idea that is ready to go to a multicenter study, it might be a better way to become involved.

  • if you find a study on clinicaltrials.gov similar to what you want to do - look closely at the institution and any collaborators because often times there is additional funding and/or support (and maybe you can find out more about these companies to see if they would want to collaborate)

  • I would do a bit of a lit search. Not a crazy 10000 articles lit search, but focused on...gaps in the area (really, plop in gaps + therapeutic area + intervention into pubmed and googlscholar) - this will give you the ammunition and rationale as to why it is important when you have conversations with other pple. I would also look closely at ...what is the primary, secondary, etc. outcomes or endpoints of these studies? Because this is what you are likely to also need to demonstrate for efficacy. But this way, when you have a conversation with people ...you can say...here is my idea....here is why it is needed....here is one way we could study it...here are the suggested endpoints.

  • When you do your search, you might already find that your idea is part of a study that demonstrated efficacy, or even part of guidelines. If you find this, then the next step would be to make someone aware of it and try to implement it at your institution. You'd be surprised how many studies are even part of guidelines and no one implements them because of time or money.

    That's how I'd start. YMMV.

    Good luck.

    Augh! Googly just posted something similar when I was typing..I will let this stand instead of deleting my answer because it gives you one or more places to search. But nthing googly.




  • posted by Wolfster at 4:35 PM on August 11 [3 favorites]


    Fellow nurse here. Do you have quality improvement people where you work? Gather some background information as suggested above, then talk with your manager and see if the two of you can meet with the quality person. Rather than doing a formal research study you might just want to do a pilot intervention.
    posted by SyraCarol at 4:40 PM on August 11 [6 favorites]


    The group you are looking for, for ethical approval, is the Institutional Review Board. If your research study involves humans, it needs to be approved, or deemed exempt, by an IRB. They don't comment on the scientific merit of your proposal, just whether the ethical principles of whether harm (physical and psychological) vs. benefit (to the patient, to society, to Medical Knowledge). I am only familiar with large university-based hospitals, where the IRBs can feel a little impersonal, but if you are able to identify an IRB member at your institution, by all means, chat with them and see what you need to do. They probably have a template you can use for your submission.

    In terms of the actual planning of a study, think about your desired effect size (how much of a difference in this health marker is a relevant outcome) and therefore what your sample size will need to be. If you recruit, say, 10 people in each arm of the study, you will need a big effect size to be sure that any difference between the groups is not simply by chance. If you recruit, say, 10,000 people in each arm, you may be able to detect a tiny difference between groups, but is that clinically meaningful? Thinking about this stuff can help you talk to someone about study design, recruitment techniques, etc.
    posted by basalganglia at 5:01 PM on August 11


    I think SyraCarol is on the right track. There's a ton of work to be done prior to pursuing any project/study, which would be difficult for anyone whether or not they have a background in research.

    Projects involving chart reviews alone, or unit-based projects can typically be done without IRB approval so long as there's no deviation from standard of care. In a community hospital without ties to an academic institution, your best bet would be to approach a nursing administrator or nurse executive. The hospital should have have some sort of committee for research (whether or not it's very active or functional is something I can't answer). From there, you may find a connection to a larger entity/institution.

    So yeah, I'd ask "upward." If you don't seem to get a lot of support, I'd keep asking around. Collaboration is fun, especially if you are able to find colleagues who are just as excited about your study and goals as you are! Good luck!

    I work/have worked in community and academic/teaching hospitals as an attending.
    posted by herrdoktor at 8:23 PM on August 11 [1 favorite]


    Whoops, forgot to paste this from notes, which are some things you can prep ahead of time for discussions you may have with the folks you speak with:

    - Draft proposal, be brief, ensure your name and all contact info is on it
    - Single-line statement of purpose: WHAT you'd like to do
    - Very brief WHY you'd like to do it (eg: find any changes in outcome X or metric Y)
    - Estimated time/week, any potential impact to your work/duties
    - Any projected costs re: time/money.

    The idea being that you're trying to get some interest going and find support and direction. Reading up on related topics and any relevant studies, as well as checking to see if anything similar has already been done before, is necessary and will help with garnering support. If someone without a background in research were to approach me for an idea for a study, I would not expect a full proposal; I'd like to know, with some quickness, that the person is motivated, that there's a good reason to pursue the research, that it hasn't already been done, and that any time/money costs are nominal or can be mitigated. From there I'd try to connect the person to any relevant people.
    posted by herrdoktor at 8:35 PM on August 11 [1 favorite]


    I am a researcher and I got my PhD in a hospital environment and I also currently work in a hospital. We have many partnerships with clinical providers in order to do research studies. I have only personally worked with MDs but there's no reason you couldn't form a partnership with a research lab too. I would definitely suggest contacting a research group with aims similar to those you're interested in. You've gotten some great suggestions for how to pitch your idea. You should be prepared for some pushback/editing on the part of the researchers - from our perspective, clinicians sometimes don't think through study design in the most rigorous way, and it takes the combination of clinical knowledge AND research design experience to come up with a solid study design.

    Before you email anybody though, hop over to Google Scholar and see if you can find out if anybody has done something similar. Try multiple combinations of keywords. There is SO MUCH RESEARCH out there it's hard to come up with a new idea!! If somebody's done something similar or the same, don't give up, but try to think of ways in which your study might be unique. For example, is the population more diverse? Different age? Higher risk? Something like that. Replication of big new ideas is important too.

    Also, a reminder to discuss authorship of any potential publications ahead of time. If you're interested in being the first author on a research paper, there is likely a lot of work involved in analyzing the data with appropriate statistics, writing the paper (there are a TON of conventions in writing research papers that are not self-evident), etc.

    Two more big things to consider:
    1) You will need IRB (Institutional Review Board) approval for your study. This is a LONG and often difficult process. You will have to justify every thing you do, document everything and report deviations from protocol as small as a single missed test/appointment, and so on. Most journals won't publish work that wasn't done with IRB approval.
    2) Who will pay for your study? Perhaps it will be free/cheap and this isn't a big deal (I'm doing a clinical study like that myself right now) but if there are supplies involved, somebody's grant is going to be charged.
    posted by Cygnet at 7:45 AM on August 12


    Oh, I meant to add that you should try not to get too attached to your EXACT idea. When researchers think of study ideas, they usually go through about 10 iterations before they arrive at something that they think will work, is publishable, can get IRB approval, is affordable, and won't be too extremely difficult or time-consuming for the staff they have. It's hard! I know I often have a hard time letting go of ideas that won't work in favor of something related or even better that will work. It's human nature, but doing science right is difficult and you should be prepared for changes.
    posted by Cygnet at 7:52 AM on August 12


    There is great advice above, particularly on the exact steps required.

    SyraCarol and herrdoktor touched on this, but 'research' has a very specific meaning in this setting, particularly for human subjects. If your goal is to improve your program, you may choose to avoid that word to simplify your life.

    In my institution, something was research if it was a) novel, meaning that it had never been tried before, there were no published results, and we didn't actually know what was going to happen b) generalizable, meaning that we had to make sure that our methods were rigorous enough that we would be able to make a prediction about how the intervention would work in similar other settings and c) intended to be published for a wider audience. The bar for approval of human-subject research can be high because the expected benefit has to outweigh the expected cost. Cost, in this case, could be that some patients get worse care because the new protocol doesn't work, patient privacy is compromised, patients feel uncomfortable, etc, etc.

    Frequently, we could do activities that looked similar to research (from the outside) because we were implementing something that had been tried before somewhere else and simply monitoring our own results to make sure that the intervention was working. This was lumped in the more operational/ quality bucket and could be referred to as monitoring, testing, or piloting (but NEVER research). We couldn't publish these results, but we could use them to improve our programs.

    We still needed to submit these monitoring activities to the Institutional Review Board, to make sure that they agreed with our categorization, but the bar for approval was lower because we had a better idea of what the benefit would be.
    posted by oryelle at 8:08 AM on August 12


    nthing comments about the word 'research' I'm currently in the position to fund various workforce initiatives and something like you describe I would see written in UK language as a quality improvement pilot study, heavy emphasis on the QI aspects and patient's satisfaction. anything that emphasises they patients &/or their carers will be more satisfied as evidenced in the Patient reported outcomes measures (PROMS)

    I would be VERY clear of exactly what impacts you are expecting to see, so write up the outcomes in details before you even start to approach people to help. Bonus if it is easier for staff/more reassuring/makes them happier in their jobs, and even more bonus points if it turns out the additional time in doing it saves money down the road because XYZ...

    also nthing the med Librarian, they are aces! they will point you to all similar work in the area and can help with brainstorming as they work across all the different clinical environments and disciplines. I would think they will know exactly who you need to talk to.

    Finally, good for you!!!!
    adding this skill-set will make YOU happier and more productive and serve patients better in the long-run
    posted by Wilder at 7:46 AM on August 13


    This is really helpful everyone! This has been a sobering reality check on what research really is. I am thinking the advice to pitch this as a QI intervention is a great idea. All the specific steps folks were kind enough to list here are still really helpful and I'll use this thread as a guide as I try to present this project. I'll try to check back in on how it's going in a few months.
    posted by latkes at 11:39 AM on August 14


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