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Hello. My name is Dr. Susan Hamer.
I am the Director of Nursing,
Learning and Organizational Development
at the National Institute
for Health Research,
and I am based
at the University of Leeds.
What I am going to talk to you about
is The Nurse's Contribution
to Clinical Research
and Evidence-Based Practice.
Because it is such an enormous area,
I think it's fair to say
what I am going to try and do
is present an overview
of the key concepts
and perhaps wet your appetite to go
and explore a bit more,
and I felt the best way in was to start
by sharing a story with you
from my own personal experience
as a practitioner
which has and did ignite my lifelong
interest in this field of enquiry.
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So when I was very young,
before the grey hair emerged,
and a very new researcher,
I was working in a surgical ward,
and when I was part of my practice,
we used to regularly fast patients
before surgery.
And I was very curious about how long
we prevent people eating and drinking.
It was very arbitrary,
so if somebody came in
as an emergency surgical patient,
they weren't fasted at all,
but it wasn't uncommon for somebody
to be on the afternoon list for surgery
to have been fasting from midnight,
and so they were often very dehydrated,
very uncomfortable,
and quite rightly asked me the question,
"Well, surely I could
just have a sip of water."
But as a junior staff nurse
at that time,
I was very much about the rule
and the rule was nil by mouth
and, indeed, there was a large sign
over their bed that said just that.
So my first bit of research
was to look at this ritual,
somebody had done it before,
and it was a very classic piece
of research,
and I looked and used
the same methodology
and found that even 10 years later
from the original piece of research,
we were doing exactly the same.
But when I talked to anesthetists,
actually a couple of them
laughed out loud and they said,
"Oh, my goodness,
you're not still doing that, are you?"
Back from when we used
to have chloroform-induced anesthetics,
and there was a real risk
of vomiting
and, of course, new drugs meant that
that was a very low risk, indeed,
and their view was actually,
"You don't need to do that."
Oh, great, I thought,
I have got the answer,
we'll just change that.
So hotfooted it back to my ward and said,
"We don't need to be doing this.
This is just a ritual.
And why don't we just change practice?"
Well, suffice it to say,
nothing changed.
And that was the beginning
of a painful lesson to me
about actually having the evidence
isn't enough,
and having compelling evidence
and quite a high level
of patient discomfort isn't enough,
that actually when it comes
to evidence-based practice,
the picture is much more complicated.
And it might seem that
that is a simple local story,
but what I'm hoping to persuade you
is that that behavior, that difficulty,
is translated across the entire system
and that's my starting point.
