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Home > RNJ > 2005 > July/August > Rehabilitation Nurses Working as Collaborative Research Teams

Rehabilitation Nurses Working as Collaborative Research Teams
Linda L. Pierce, PhD RN CNS CRRN FAHA

Rehabilitation nurses conducting research would benefit from working within collaborative research teams. The development of intradisciplinary (one discipline) and interdisciplinary (many disciplines) research teams is described in this article. A research team is defined as more than a single person in the role of the researcher while studying the same topic of interest in a joint or collaborative manner. Strategies to ensure successful research team collaboration are described. Exemplars of developing and maintaining a team at one site, which consists of members of the same discipline, as well as another team that consists of multiple professional disciplines, are shared. Collaboration among research team members in practice, administration, and education settings transcends degrees and roles to make substantial contributions to professional practice.

Rehabilitation nurses conducting research as solo investigators may assume a sense of freedom to be creative. However, numerous unforeseen challenges can arise during the research process that can challenge this freedom. Support from colleagues can provide guidance through these challenges (Norwood, 2000). Sound research rarely happens in isolation and a “good study has enough glory to share with all…and a poor study is a heavy burden to bear alone” (Martin, 1998, p. 92).

Sometimes research teams are defined as the dyad between researcher and participant or informant in qualitative studies. More broadly, the research team is defined as two or more researchers studying the same topic in a joint or collaborative manner (Gates & Hinds, 2000). Intradisciplinary (one discipline) and interdisciplinary (many disciplines) collaborative research is a growing trend for several reasons. Many issues in health care are so complex that they warrant a team approach to investigation as well as care delivery (Brown & McWilliam, 1993; NIH, 2003). Collaborative research can promote cooperative approaches to care delivery (Sprague-McRae, 1988) and supports nursing’s philosophy of working with others to meet the needs of individuals and families (Norwood, 2000).

Strategies for Successful Collaboration

Schlotfeldt (1974) identified several individual characteristics necessary for research success: intellectual curiosity, conceptual ability, competency, creativity, and caution. One researcher may not possess all of these needed characteristics. Collaborative processes among discipline-specific individuals, as well as people from multiple disciplines, help to ensure that these essential characteristics are incorporated into the project. Building on Schlotfeld’s earlier work, Lancaster (1985) described six Cs of collaborative research (contribution, communication, commitment, compatibility, consensus, and credit) and Govoni and Pierce (1997) added a seventh C—cohesion.

Contribution

Seasoned researchers contribute knowledge of research methodology as initiators and facilitators of research. Other members of the research team may or may not have this knowledge, but they bring enthusiasm and energy to the project that helps to motivate the team. The work of the project is divided according to each person’s skill and ability (Lancaster, 1985). Collaborative research promotes mutual professional respect and fosters positive working relationships. In addition, it enables all members of the team to pool talent and resources to meet mutual goals that may affect care, validate practice, and hone research skills. The background that each member of the research team brings to a research problem provides a unique filter for critically evaluating issues from a number of perspectives that ensures a more sound and credible study with more comprehensive and possibly more widely applicable findings (Norwood, 2000).

Communication

Throughout the research process, communication is crucial for successful collaboration and outcomes to occur. The team members must accept one another enough to work together. Group dynamics influence communication throughout the project (Lancaster, 1985). For example, the principal investigator has skill in overall research design. However, different leaders may emerge as the project moves from design to data collection. A software engineer is the expert in designing Internet-based forms of data collection, while the statistical manipulation of data often requires a specialist in data analysis techniques. Individual team members must feel comfortable with one another so that control can be relinquished by one person and established or reestablished by another team member as the project moves through the various phases of the research process.

Commitment

Physical and emotional commitment of time, energy, and resources to the project from all team members is needed. Such commitment may be difficult to realize as many individuals struggle to divide their time and energy among many activities, such as practice, administration, education, and research endeavors. Managing time and dealing with scheduling constraints, as well as administrative support, are issues that must be resolved if the research project is to come to fruition. Commitment often is influenced by factors outside the researchers’ control (Lancaster, 1985). For example, increased client workload for any researcher can adversely affect any project. When unexpected occurrences happen, research responsibilities usually can be temporarily or permanently renegotiated, reducing tension among the team members.

Compatibility

Research teams need to fit together to make an effective whole. Development of trust, mutual understanding, and respect among members is important, along with development of confidence in team members’ abilities (Brown & McWilliam, 1993; Sangster & Grace, 1993). Team members need to find ways to recognize and appreciate one another’s differences and similarities. The team needs to find ways to harmonize different members’ styles so that mutual respect is maintained and optimal performance is encouraged. In this way, potential liabilities are turned into assets (Lancaster, 1985).

Consensus

As team members evaluate their degree of compatibility, they will also recognize whether consensus is possible. Consensus is an unending process of communication, compromise, and negotiation. Collaborative research guards against vested interests. As team members with different values, beliefs, and backgrounds collaborate, biases may be countered by making vested interests known and negotiating until a middle ground is found (Lancaster, 1985). Ground rules need to be established for attending meetings, adhering to deadlines, and handling disagreements, as well as authorship issues, before the study commences (Brown & McWilliam, 1993; Sangster & Grace, 1993).

Credit

Credit may become an issue. The research team must agree upon ownership of group efforts. To decrease sources of disagreement, decisions such as order author names in publications and presentations are best made at the beginning of the project when all members of the team are present. Decisions should be put in writing either in meeting minutes or in a separate written agreement (Lancaster, 1985). All those involved need to be given recognition for their work on a project. Sometimes team members receive publication authorship when they participate in writing reports; nonauthor team members often are given an acknowledgment in the publication for their contributions to the work.

Cohesion

Like and unlike individuals develop cohesion when they are united in working together toward a common goal. The size of the team is central to effective cohesion. Usually six to eight core members are best to ensure project completion. Larger groups may place high demands on the principal investigator, lessen group participation, and decrease group unity. If additional research expertise is needed, consultants or ad hoc members can be added to the team (Govoni & Pierce, 1997). Cohesion can be built and maintained by celebrating small successes throughout the project.

Intradisciplinary Research Team: A Case Study

For advanced practice nurses in clinical practice at a large metropolitan teaching hospital and rehabilitation center in northeastern Ohio, teamwork became a way of life, and inherent in that life were multiple research endeavors. A research component was part of all nurses’ job descriptions and one of the steps in the clinical advancement program for staff nurses. Administrators sanctioned these research projects as being important to the institution and the profession, and work time was committed to them. This arrangement was a win-win situation for all involved, because the findings of these projects affected clinical practice decisions and care outcomes.

Exemplar

Clinical nursing judgment related to reducing the incidence of falls by elderly clients (Turkoski et al., 1997) was a collaborative qualitative study based on a body of nursing research suggesting that expert clinical judgment is the guide for discretionary nursing behaviors that result in quality nursing care (Benner, 1984; Corcoran, 1986; del Bueno, 1983). Interviews were completed with 14 female nurses between the ages of 24 and 55 years working on a geriatric rehabilitation unit in northeastern Ohio. Staff nurses identified variables as influencing their clinical decision-making and the nursing behaviors associated with preventing client falls. Four themes emerged from these data: (a) the reasons for client falls, (b) identification of clients who are likely to fall, (c) prevention of falls, and (d) nurses’ feelings when clients fall.

This collaborative research team involved a staff nurse, two nursing managers, three clinical nurse specialists (CNSs), and a doctoral-prepared university nursing professor. These seven rehabilitation nurse collaborators became a cohesive group in which all members could make their unique contributions.

The original problem was identified by the staff nurse and the nursing managers, and they worked with the CNSs to design the research project. The CNSs found the nursing professor in the Association of Rehabilitation Nurses (ARN) membership directory. She had expertise not only in rehabilitation nursing but also in qualitative research methods and data analyses. The nursing professor joined the team and took part in the participant interview processes and data analyses.

Communication was enhanced by weekly or monthly meetings with all members of the team during which the researchers got to know one another and divided up the work of the project. Because the six members of the research team had varying levels of experience with data content analysis, the entire team spent time over a 4-month period in informal classes led by the nursing professor. These sessions included the rationale for content analysis, different approaches to content analysis and coding, and several hours of practice with data analysis. These sessions represented a large commitment of time and energy by the entire team, but desire to complete the project kept the members motivated.

The members were compatible; they worked well together and brought out the best in each other. Consensus was obtained throughout the project. For example, as the four themes emerged from these data during data analysis, consensus not only helped establish the themes but also determined how the data could be used in practice. The aspects of clinical decision-making found to be successful in preventing falls were incorporated into staff orientation and education programs by the managers and CNS and into falls-prevention protocols by the staff nurse and CNSs.

Several presentations at local and national meetings and two publications resulted from this project. Credit was divided among the researchers. The nursing professor took the lead in writing the results of the project (Turkoski et al., 1997) and a nurse manager (see Table 1) took first-author responsibility for writing the manuscript that precipitated this research (Brady et al., 1993). All members of the team are listed in the authorship of both manuscripts, because all participated in writing sections of the papers.

Interdisciplinary Research Team: A Case Study

In 1999, a colleague at a medical college in northwestern Ohio brought together two doctoral-prepared researchers, one a rehabilitation nurse and the other a developmental psychologist with similar interests in caregivers and caregiving outcomes. The nurse had a strong background in caring, stroke, and caregivers, and had facilitated a face-to-face support group for caregivers of persons with stroke and their families for several years (Pierce & Salter, 1988). The psychologist had worked with geriatric populations, completed research in health behaviors and with caregivers of persons with dementia, and is considered an expert in Intranet applications. Both researchers used Internet-based applications in their teaching assignments. As they began to work together on a research project, each made their own contributions based on their past experiences and current ability. Roles intrinsic in university life are research and scholarship, as well as teaching and service. Working with individuals from different disciplines within the university setting is important and fosters research processes.

Exemplar

A cohesive bond was formed between these two researchers. Together, they developed an Internet-based intervention of education and support for caregivers of persons with stroke called Caring~Web© (Steiner & Pierce, 2002). Once caregivers gain access to Caring~Web©, they can link to and/or participate in: a customized educational caregiving tip that changes on a monthly basis; a consultation with a nurse specialist and rehabilitation team called Ask the Nurse; an e-mail discussion group, Caretalk, with other caregivers and the nurse specialist; and links to educational information from reliable sources (Steiner & Pierce).

This Web site was designed in consultation with software engineer and student Web-page designers at the college. The need for the caregiving tips was identified and much of the content was written by two graduate students as their scholarly projects (Pierce, Finn, & Steiner, 2004; Pierce, Rupp, Hicks, & Steiner, 2003). Another graduate student’s project evaluated the quality of the Caring~Web© design (Steiner, Pierce, & Herceg, 2004). A coinvestigator and nursing professor from another university in northeastern Ohio who is a CNS with a solid background in home care as well as psychiatric and rehabilitative experience manages the Ask the Nurse component of the intervention. As a back-up for this nurse specialist, a multidisciplinary rehabilitation team helps her answer caregivers’ questions. This rehabilitation team is composed of a physician, occupational and physical therapists, dietitian, pharmacist, speech therapist, and social worker (Govoni, Pierce, & Steiner, 2003; Pierce, Steiner & Govoni, 2002; Pierce et al., 2004).

This intervention is used in research endeavors with caregivers of persons with stroke; the medical college is the primary performance site. Caring~Web© has been tested in pilot studies and found easy to use and valuable by the caregiver participants (Govoni et al., 2003; Pierce et al., 2002; Pierce et al., 2004). Current research with the Caring~Web© intervention is underway [National Institutes of Health/National Institute of Nursing Research RO1 NR07650] by a collaborative research team that (a) examines caregivers’ well-being and use of healthcare services between Web users and non-users and (b) examines the caregivers’ experience of caring by identifying problems and successes in caring.

In addition to the initial three investigators and graduate students, a larger collaborative team of researchers came together to participate in these accomplishments. Less-seasoned members were enthusiastic and motivated to participate, while the more experienced researchers spearheaded the project. Individuals contributed in their own way. The team consisted of nurses in the role of recruiters; medical care workers, nurses, and social workers in the role of interviewers; a computer technician that connected caregivers’ equipment to the Internet and trained them in the use of the intervention; a software engineer that maintained the Web site; and several consultants for qualitative and quantitative analyses of data and overseeing the theoretical components of the project.

Communication among team members was critical with such a large collaborative group and occurred in three formal ways. First, monthly meetings were held. One meeting was held for the interviewers, the software engineer, and the investigators to talk specifically about their issues with data collection. Another monthly meeting was held with the investigators, recruiters, the computer technician, and software engineer to discuss recruitment and subject maintenance. All members could attend both meetings, if desired, and oftentimes they did, as issues cut across all members of the team. At times, they could not attend any of the monthly meetings, and e-mail served as the vehicle to keep all team members up-to-date.

Another communication method involved semiannual 2-day meetings between the consultants and the team. The qualitative data and the theoretical consultants were nursing professors from Michigan and Florida, respectively. Agendas for all meetings were essential to keep focused and move the work forward. The meeting days were long and filled with content items that often extended into the evening. E-mail communication occurred throughout the year on a weekly basis, depending upon the needs of the team members. For example, the researchers and the nursing consultants discussed how the data and the theory were connected as they continued to work on a coding rubric for these data. Each consultant contributed expertise in the form of content analysis, theoretical framework, and overall knowledge of the research process.

The third communication method involved biannual meetings between the researchers and the seven discipline-specific rehabilitation team members, including the nurse specialist that ran the Ask the Nurse portion of the intervention. Each of these members contributed their professional expertise in answering e-mail questions the subjects asked. Rehabilitation team members demonstrated compatibility in their e-mail messages to one another. For example, therapists might not know the answer to caregivers’ questions about diabetes, but the nurse specialist, physician, and dietitian did. Each respected the other and said so in their e-mails to one another; they learned from one another. Meeting in person brought the group together and increased their unity. They came together in other ways, too. Many rehabilitation team members wrote and reviewed educational tips for the Web pages. They also wrote descriptions of the rehabilitation team for posting on the Web site intervention. In addition, the social worker took the lead as first author in a publication effort, with consensus on credit for authorship of the team members. Together, most members wrote and submitted a manuscript for publication on the role of the rehabilitation team with the investigators. All in all, the entire collaborative team members were committed, both physically and emotionally, to this project, and open communication helped all members become comfortable with each other and the activities of the project.

Discussion and Implications

Meshing research into professional roles continues to elude many individuals. Networking with others at meetings or conferences is one way for staff and advanced practice rehabilitation nurses to begin to identify other professionals with similar interests and initiatives for collaboration. Another way that rehabilitation nurses can find research partners is to contact doctoral-prepared university professors to discuss similar interests. While this access may be easier for advanced practice nurses because these professors may be their former advisors, anyone can contact a university’s research department for information about collaborative research endeavors. However, it also is not uncommon for university professors to contact nurses in daily practice for assistance and collaboration with research projects.

Collaborative projects result in relevant research that not only increases the scientific knowledge base for professions that may improve professional practice, but also makes research work manageable and attainable. In different phases of these projects, distinct team members took the lead. No matter what the team members’ roles were, commitment and clear communication was essential in ensuring successful working relationships, as well as favorable outcomes for the projects. Differing levels of commitment and poor communication can hinder any team. Communication was the responsibility of all research team members. Open discussion and feedback contributed to team cohesion and compatibility, and facilitated consensus in decision-making processes. Using these strategies prevented power struggles from occurring. Everyone contributed his or her expertise to the projects. For example, when one member wanted to push ahead without thinking through all aspects of the process, another was cautious and insisted that the collaborators look at alternatives, allowing all research collaborators to come to consensus on the major aspects of the projects. Order and credit for publications and presentations were established early in the projects. In describing entire projects, it was either the principal or coprincipal investigators who took responsibility and first authorship for manuscripts. Other times, different members of the team took first authorship responsibilities in publications and presentations depending upon manuscript content and presentation audience.

Summary

This article discussed researcher characteristics and explored issues for successful research team collaboration among rehabilitation nurses at all levels of practice and in several settings. In today’s complex world of healthcare practice, research team collaboration is a necessity. Team members came together through professional networking opportunities and mutual research interests. Through regular opportunities to discuss and revise their own and other team members’ ideas, rehabilitation nurses as researchers working in collaborative teams formed personal friendships, developed a mutual mindset, and grew in ability to function interdependently and learn from one another. As a result, team members provided mentoring and support to each other. Members also benefited from shared labor. Similar to other teams, members of collaborative research teams have an enlarged information system and expanded contacts for research and other scholarly activities. With highly motivated and committed members, research teams can make substantial contributions to healthcare initiatives in practice and education settings.

Acknowledgments

The author acknowledges the collaborative research work of many colleagues. Victoria Steiner, PhD, assistant professor at the Medical College of Ohio, and Amy Govoni, MSN RN CS, associate professor at Cleveland State University, are thanked for their review of this manuscript.

The research undertaken in the exemplar of the interdiscipline collaborative research team is supported by grant RO1 NR07650, National Institutes of Health/National Institute of Nursing Research.

About the Author

Linda L. Pierce, PhD RN CNS CRRN FAHA, is a professor at the Medical College of Ohio School of Nursing in Toledo, Toledo, OH. Address correspondence to her at 3015 Arlington Ave., Toledo, OH 43614, or by e-mail to lpierce@mco.edu.

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