The importance of dedicated supportive research infrastructure in the hospital setting to support clinical nursing research and evidence-based practice.

Abstract

The last two decades have witnessed unprecedented developments and advancements in nursing research globally. Contributions to this include the evidence-based practice (EBP) movement, the professionalization of nursing, the advancement of nursing education within the higher education sector and the requirement to keep up with scientific and technological advancements. The pace with which the nursing profession has expanded and responded to this general movement varies internationally, with many European countries, including Italy, lagging in terms of both professionalization and the advancement of nursing research and EBP (Sasso et al., 2019). However, despite the perceived delays, there are important initiatives underway in Italy that we would like to showcase within this editorial that could provide important examples for international nurses and nurse researchers. Importantly, the benefits of having a local interdisciplinary research infrastructure in the clinical healthcare setting. A research infrastructure is defined as an ‘organisational structure dedicated to facilitating or conducting research, providing scientific equipment, data, or services for use in basic or applied research’ (OECD, 2019), which ultimately promotes a culture of research within the hospital setting. Indeed, promoting a research culture is critical for the development of EBP, and a dedicated organizational structure can contribute greatly to this. The organization of such a research infrastructure is based mainly on an operational framework, resourced by the hospital, that is composed of diverse range of research support facilities and activities. This framework ultimately keeps patients at the centre of its activity and strategic goals, with an overall aim to improve patient care and support excellence in healthcare delivery. It can consolidate multidisciplinary skills and knowledge within an interdisciplinary team, to transfer research results into the healthcare system, within hospital and tertiary settings. It employs trained and dedicated staff as well as cutting-edge technology to foster and support various types of research (preclinical, clinical, translational, population, nursing and organizational). Its mission is to define a research programme, monitor its progress, enable the evaluation of the obtained results, against those hypothesized, and optimize as well as disseminate the findings. While this type of organization is common in university settings, it is less common in hospitals and healthcare sites. The concept of establishing a research infrastructure in a hospital setting can provide an innovative solution to overcome the most common barriers to conducting clinical research, such as lack of expertise, time, resources by providing support and assistance from experienced and trained personnel (Henshall et al., 2022). The strategic goal of a research infrastructure is to involve clinical professionals in the research process. Knowledge co-production (Schutte et al., 2022) is a collaborative approach motivated by the need to engage with those who will implement the generated knowledge in care practice. The specific goal is to improve the relevance and applicability of research findings to the context of care. Research leadership is crucial to assess healthcare workers' level of competence to involve them in research activities, innovations and engagement plans through education and facilitation. This strategy may be the key to engaging more clinical nurses who can begin to see research as the solution to the critical issues that they and their patients have identified. Another aspect to consider is that clinical nurses play a strategic role in engaging patients and carers in the research process. They are essential for sharing research with the community as consumers of hospital healthcare services. A collaborative multidisciplinary research environment, promoted and supported by a clinical research infrastructure, can indeed facilitate, and accelerate the timely introduction of evidence into clinical practise, thereby reducing the research-practice gap (Bartos & Kris, 2020). Ultimately, this formalized research support infrastructure enables the implementation of evidence in clinical practice, by involving clinical nurses at every stage of the research with an educational approach and monitored by research nursing leadership. In particular, when bottom-up approaches are used, clinical professionals can identify precise research problems and then, with expert support can translate these into clinically relevant research problems, that can drive solution-focused research leading to high-quality studies. A dedicated research infrastructure within the clinical setting is a valuable strategy for developing a culture of research and improving clinical outcomes. The benefits of a hospital-organized structure include nurses' active participation in research, improved resources for clinical research, fostering innovation in patient care and a faster application of scientific evidence. The presence of a research infrastructure is therefore to be considered as a facilitator, that can support a healthcare facility to optimize clinical research. These authors1–7 work within such an organization that provides this formalized infrastructural support. As such scientific activities are centralized under a nursing leadership within a dedicated organizational research infrastructure, providing guidance and support to all clinical professionals at all stages of a research study and/or at translational stages of research. These authors1–7 form part of what is known as ‘the Health Professions Research Unit ‘(URPS). This is a formalized Research, Training and Innovation Infrastructure (IRFI) based at one hospital in Alessandria, Italy. The Department works to identify and promote scientific research that supports healthcare activities. The primary goal is to improve healthcare delivery and patient outcomes. The major purpose of URPS is to improve the practice and safety of patient care, by integrating the most recent innovations and research perspectives into practice across all fields of healthcare, but also by supporting local research initiatives. The URPS is multidisciplinary consisting of four nurses, all with research expertise and experience, but also of various scientists. URPS also leads a corporate network of research nurses, which consists of 11 department nurse researchers and 67 nurses across the hospital site, who, while remaining within their hospital unit, commit some of their time to research activities. There is also a Centre for Health. Professions Research Studies (CSRPS) which is an extension of the IRFI of the Hospital. It reports to the Department Integrated Activities Research and Innovation. In accordance with the CSRPS's interdisciplinarity and integration ideals, professionals and professors from many national and international universities and agencies participate in its activities. The major goal of the Centre is to advance research in the Health Professions to encourage its use in daily clinical practise. The Study Centre has established several multidisciplinary research themes in the areas of chronicity and frailty, artificial intelligence and person-centred wellness. It has had success with multiple projects and international publications. We believe this localized multidisciplinary hospital-based research infrastructure, which is not provided for consistently internationally, despite great advances in research, creates a rich platform for EBP and research activity. One particular strength is the multidisciplinary approach which allows for multi-perspective research solutions to arise from identified patient-centred research problems. An additional asset is that this research unit is embedded within the hospital infrastructure and its support and capacity stretches beyond the centre staff to support nurses and other healthcare workers with advancing the research agenda. The employment of research nurses is key to this organization's success. They make their scientific-methodological knowledge available to more effectively reframe research in the specialty field of the clinical professionals who seek support from the unit. These special-purpose, skilled research nurses work very closely with various multidisciplinary groups across the hospital and service as a vital knowledgeable and skilled resource for health professionals, who can flourish from this support (Lönn et al., 2022). As specialized competencies in research methodology are required for the implementation of healthcare research projects across the organization, it is essential that the hospital infrastructure promotes extensive training in the hospital setting through continued education, training trials and mentoring. A structured infrastructure with established resources and strategies also enables the growth of international networks, which have become vital to this team's experience of improving the quality of research studies. This also enables sharing of results within the international scientific community. Developing the necessary competencies to encourage research and assistance is critical for developing an ecosystem capable of promoting change and innovation. A dedicated research unit, such as that outlined above, can have a very beneficial effect on developing these competencies locally. An effective strategic approach to fostering improved clinical practice is based on key elements such as cultural and scientific/technological growth, as well as increased professional participation. Healthcare facilities that use organizational strategies, such as this to support clinical research activities can potentially improve both patient health outcomes, professional well-being as well as nurses and patient satisfaction. Furthermore, despite the availability of EBP recommendations, there is a global gap between available evidence and clinical practice. Educational and communication strategies directed by a dedicated research infrastructure, such as we outline, can serve to promote the sharing of knowledge and resources, encouraging the promotion of a research culture. This can be particularly helpful in countries where the professionalization of nursing is not yet complete, or where there has not been full advancement into the university sector. The localized research infrastructure organizations can serve to accelerate research learning and implementation. This is essential to motivate nurses to stay current and to raise awareness of how research contributes to the improvement of care and treatment. A hospital-based infrastructure can generate and foster a research culture through scientific activities that are based on the needs identified by clinical nurses who are constantly working alongside patients. This is a viable strategy for increasing interest in and commitment to the immediate application of evidence in practice, particularly in the absence of more developed national approaches to research support. All authors have been involved in drafting the manuscript or revising it critically for important intellectual content, given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated. The authors received no financial support for the research, authorship, and publication of this article. The authors declare that there is no conflict of interest.