The Primary Health Care Research Evaluation and Development strategy provides financial support for the development of early to mid career researchers through its Research Capacity Building Initiative and Research Development Program. Practice nurses can provide valuable contributions to research practices undertaking research projects.
This article documents the experiences of three practice nurses involved in an independently funded cardiovascular research project and how the experience helped to enhance their role in their general practice.
The combination of general practitioner and practice nurse working together is an important component of primary care research. The development of research skills is an exciting option for practice nurses wishing to expand and develop their careers.
ISSN: 0300-849

Arnold-Reed, Diane

Brett, Tom

Manea-Walley, Wendy

Mora, Noelene

Young, Julie

English

ResearchOnline@ND

The University of Notre Dame Australia ResearchOnline@ND Medical Papers and Journal Articles School of Medicine 2008 Practice nurses and research: The Fremantle Primary Prevention Study Julie Young Wendy Manea-Walley Noelene Mora Diane Arnold-Reed University of Notre Dame Australia, darnold-reed@nd.edu.au Tom Brett University of Notre Dame Australia, tom.brett@nd.edu.au Follow this and additional works at: https://researchonline.nd.edu.au/med_article  Part of the Medicine and Health Sciences Commons  This article was originally published as: Young, J., Manea-Walley, W., Mora, N., Arnold-Reed, D., & Brett, T. (2008). Practice nurses and research: The Fremantle Primary Prevention Study. Australian Family Physician, 37 (6), 464-466. This article is posted on ResearchOnline@ND at https://researchonline.nd.edu.au/med_article/4. For more information, please contact researchonline@nd.edu.au.  professional practice noelene MoraEN, is a practice nurse, Mandurah, Western Australia.Julie Young RN, is a practice nurse, Mosman Park, Western Australia. Wendy Manea-Walley RN, is a practice nurse, Greenwood, Western Australia.practice nurses and researchThe Fremantle Primary Prevention studyBackgroundThe Primary Health Care Research Evaluation and Development strategy provides financial support for the development of early to mid career researchers through its Research Capacity Building Initiative and Research Development Program. Practice nurses can provide valuable contributions to research practices undertaking research projects.objectiveThis article documents the experiences of three practice nurses involved in an independently funded cardiovascular research project and how the experience helped to enhance their role in their general practice.DiscussionThe combination of general practitioner and practice nurse working together is an important component of primary care research. The development of research skills is an exciting option for practice nurses wishing to expand and develop their careers.the role of practice nurses (pns) as essential members of australian general practice teams continues to evolve and develop.1 to date, the primary focus has been activities such as immunisation, wound management, chronic disease management, care plans, and health assessments for the elderly. More recently, additional australian Government funding covering specific Medicare items has expanded the pn role. the primary Health care research evaluation and Development (pHcreD) strategy, through its research Development program (rDp) and research capacity Building initiatives, offers pns the opportunity to gain skills and experience in primary care research.2As part of its Primary Care Research Program, Notre Dame Fremantle PHCRED places a high emphasis on encouraging and supporting clinical practices undertaking primary care research. The Fremantle Primary Prevention study (FPPS) is a general practice based research project into risk factor modification for cardiovascular disease. Practice nurses from each of the three general practices involved in the research project (Mandurah, Greenwood and Mosman Park) were awarded RDP fellowships for their contribution to the study. The study recruited 400 men and women aged 40–80 years from each of the three practices (1200 in total). Recruited patients were randomised to either an intensive arm with 3 monthly PN and/or general practitioner follow up, or to a regular treatment arm with their usual practice attendances and a final follow up consultation after 12 months.the role of pn researchers in the studyPractice nurses provided the essential coordinating role between individual patients, the medical practice and the study investigators. Critical research roles undertaken by the PNs included: •	identifying	suitable	target	patients	for	the	study•	assisting	with	randomisation464  reprinted from australian faMilY pHYsician Vol. 37, No. 6, June 2008tom Brett MA, MD, MRCGP, FRACGP, is Associate Professor and Director, PHCRED Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia. tbrett@nd.edu.auDiane arnold-reedPhD, is Program Co-ordinator, PHCRED Unit, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia.•	providing	logistical	support	for	data	collection•	contributing	 to	 assessing	 and	 recording	 clinical	 information	 on	modifiable risk factors•	ensuring	data	sets	on	individual	patients	are	complete•	following	up	on	missing	data•	providing	ongoing	supportive	counselling	to	participants•	timely,	efficient	information	transfer	to	the	study	research	officer.initial learning curveThe FPPS was the first major research experience for all three PNs, and the early phase of the study proved to be especially difficult as each attempted to integrate research demands with practice work.  Practice nurse #1 (PN1) reported that personal reading and research into cardiovascular risk factors resulted in greater confidence and knowledge when talking to patients about the study. This was particularly useful explaining the rationale behind setting specific targets such as the global risk score. By encouraging patients to modify specific risk factors being targeted, PN1 could point to the impact such improvements would have on their global risk score at subsequent visits and on their overall cardiovascular health in the long term. Similarly, PN2 reported having to devise marketing skills to help with recruitment and to encourage practice doctors to become involved. Her initial difficulties were compounded by an already busy workload and limited physical practice space. These demands meant that at times recruitment had to be deferred and a more opportune time negotiated for the patient to return and complete the process. The initial targeting and recruitment of 400 patients also proved difficult for PN3. Her larger practice meant that she had to reorganise her work schedule to accommodate peak demand times and still allow dedicated time for undertaking research activities. Independent research funding provided 1 day per week of nurse contribution to the study. For PN3, the practice arranged a dedicated day for research work, whereas in the other two practices, the PNs contributed to the study alongside their normal work.effect on other practice staffAll three PNs commented on the additional workload placed on reception staff, especially in the early phase of the study. The situation became more acute during busy periods when the study was relegated to secondary importance. Not all GPs were as interested in the study as the key doctors and PN. Potential recruits were often overlooked in such circumstances. Busy practice workloads placed extra pressure on recruitment.  The timeframe of 3 monthly follow up visits for the intensive arm had less relevance for some, often younger, patients. The added duty of reminder calls inevitably increased the PNs' workload.effects of participationOver time, the study was viewed as an asset to the practice, and most staff felt empowered by being part of the process. Practice nurse #1 felt that the research process worked better in the small to medium sized practice where there was still an element of personal recognition and where patients generally attended their ‘own’ doctor. The PNs provided a valuable role in being able to recognise patients attending the practice for other reasons and opportunistically enquiring about their progress in the study, how they were coping with reaching target goals and providing encouragement. Positive effects are summarised in Table 1, negative effects in Table 2.DiscussionPractice nurses in clinical research practices receive practical, hands-on experience – a process widely regarded as the best means to enhance proficiency (and interest) in the research process.3 The PNs involved in the FPPS were enthusiastic about this aspect of their research experience.  The successful promotion and development of research practices depends on the motivation of key personnel.4 The GP-PN axis is the main driving force behind the research agenda. Their complementary roles can highlight the relevance of primary care research and be sufficient inducement for practices to be involved in research.5,6  Major obstacles for PNs in research practices include ever increasing workloads, lack of support from medical colleagues and competing demands on their time.7 Compensation for time spent on research activities is usually nonexistent; inadequate funding is a constant barrier.5 The fact that research does not usually generate income can be a significant disincentive to some practices. Some GP comments about lack of time may be veiled references to lack of payment.6 This study sought to address these obstacles by providing some independent funding for PN contributions. The absence of research infrastructure8 in most practices may call for some ingenuity on the part of PNs and GPs. An important strategy for primary care research is to produce key data in areas of relevance to the practice and to feed this evidence back to patient management.9 A sound, evidence based approach can be a powerful motivating factor to achieve change. reprinted from australian faMilY pHYsician Vol. 37, No. 6, June 2008  465practice nurses and research – the fremantle primary prevention studyprofessional practice5. Askew DA, Clavarino AM, Glasziou PP, Del Mar CB. General practice research: attitudes and involvement of Queensland general practitioners. Med J Aust 2002;177:74–7.6. Salmon P, Peters S, Rogers A, et al. Peering through the barriers in GPs’ explanations for declining to participate in research: the role of professional autonomy and the economy of time. Fam Pract 2007;24:269–75.7. Davies J, Heyman B, Bryar R, et al. The research potential of practice nurses. Health Soc Care Community 2002;10:370–81.8. Nutting PA. Practice-based research networks: building the infrastructure of primary care research. J Fam Pract 1996;42:199–203.9. Zwar NA, Weller DP, McCloughan L, Traynor VJ. Supporting research in primary care: are practice-based research networks the missing link? Med J Aust 2006;185:110–3. The coordinating role of the PNs in the FPPS was essential to helping the study achieve its goals. Patients readily accept PNs fulfilling such a role. It is a role that deserves promotion as a key element of research capacity building in primary care. The next logical step is for PNs to become involved in data analysis and dissemination of findings.Conflict of interest: none declared.acknowledgmentsPractice nurses Julie Young, Wendy Manea-Walley and Noelene Mora received RDP Fellowships and Diane Arnold-Reed and Tom Brett received part support under the Commonwealth PHCRED Strategy. The Fremantle Primary Prevention Study is funded by Pfizer (IIR No: AUS-Non Drug CVS-06-001).references1. Walker L. Practice nurses – working smarter in general practice. Aust Fam Physician 2006;35:20–2.2. Australian Government Department of Health and Ageing. Primary Health Care Research, Evaluation and Development Strategy: Phase 2 (2006–2009) strategic plan, December 2005. Available at www.phcris.org.au/phcred/strategic_plan.php [Accessed September 2007]. 3. Hiramanek N, Bridges-Webb C. How to undertake research in general practice: tips for the novice researcher. Aust Fam Physician 2004;33:766–8. 4. de Wit NJ, Quartero AO, Zuithoff AP, Numans ME. Participation and successful patient recruitment in primary care. J Fam Pract 2001;50:976.Table 2. Negative effects of research participation•	Busy	practice	workloads	meant	research	was	often	deferred	•	Research	is	not	income	generating –  GPs and practice managers may view research as costing the practice money •	Not	all	GPs	and	PNs	have	the	same	interest	in	research	 – a few carry most of the load •	Reception	staff	and	practice	manager	received	no	additional	funding despite contributing to the study •	Physical	capacity	of	practices	can	be	stretched	if	consulting	room used for research purposes Table 1. Positive effects for PNs and practices•	Research	project	was	seen	as	highly	relevant	to	the	practices	•	Independent	research	funding	allowed	practices	to	employ	PNs	for	equivalent	of	1	day	per	week	on	research	($13	000	per	practice)	•	RDP	fellowships	awarded	to	PNs	involved	in	research	project	($6000	each)	•	Hands-on	research	skills	training	and	professional	development	provided	•	Mini	primary	care	research	network	developed	between	the	three	practices	(PNs	compared	experiences	and	strategies)	•	Encouraged	collegiality	between	practices	through	attendances	at	Notre	Dame	PHCRED	clinical	research	meetings	and	attendances	at	and presentations to national and state PHCRED conferences •	Gained	better	understanding	of	individual	patient's	health	and	social	circumstances	•	Preventive	medicine	and	evidence	based	medicine	became	part	of	every	day	practice	•	Encouraged	reflective	approach	to	primary	care	and	adherence	to	best	practice	guidelines	CORRESPONDENCE afp@racgp.org.au466  reprinted from australian faMilY pHYsician Vol. 37, No. 6, June 2008

Practice nurses and research: The Fremantle Primary Prevention Study

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Practice nurses and research: The Fremantle Primary Prevention Study

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