Development Capacity Building Program
5.2 Working with Research and Development Capacity Building Within a University Hospital
reminder of how to document and measure the work. In this context, development capacity is added to the centre of the model, and the six principles cover the activ- ity level well.
5.2 Working with Research and Development Capacity
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research should be participatory, applied and clinically relevant [16] and should have the support and attention of the hospital management.
By including the concepts constructive, creative, inclusive and visible, it was possible to signal:
• Constructive, which refers to a collaborative approach that acknowledges the exiting and ongoing projects, ideas and initiatives within the nursing and allied health professions.
• Creative, which refers to a broad understanding of what counts as relevant evi- dence [17, 18] and an acknowledgement that new knowledge can be developed by different methods and approaches [19].
• Inclusive, which refers to an attitude that welcomed new ideas and initiates across the hospital and disciplines.
• Visible, which refer to the importance of being visible and present in all parts and levels of the hospital but also outside, national and international, including physical presence at research and practice-focused conferences, workshops, seminars and network meetings and by writing papers in scientific and other journals.
5.2.2 Concrete Initiatives
With a strategy and infrastructure that were supported at many important levels in the organization, including the director of nursing, head nurses and clinical nurse specialists, and acknowledgement from the medical director and medical head of research, several initiatives were taken. The underlying approach was that the initia- tives should be clinically relevant and participatory. Examples of initiatives were:
• Development of academic career pathways from newly educated bachelor in nursing to professor. This included articulation of the ambition of having doctoral nursing or allied health students and postdoctoral nursing or allied health- care staff at department levels.
Development
Basis level Management level
Research Culture Fig. 5.2 Research culture
capacity model: Bottom up, top down and don’t forget the middle
5 Pioneers in an Old Culture. Developing and Leading a Research and Development…
• Establishment of a new intra-organizational network of RNs and allied health professional responsible for education, development and research.
• Initiation of an article writing course for nurses and other health-care profession- als, in order to secure documentation of the many undocumented research and development projects [20].
• Initiation of a journal club facilitation course, targeted at clinical specialists [12].
• Surveys among RNs in order to understand barriers for continuing education and for participating in research [21].
• Initiation of research courses targeted at managers at ward and unit levels [22].
• Initiation of an intensive research course for RNs and allied health professionals [23].
If possible, the capacity building initiatives were documented in peer-reviewed publications or in practice journal articles and book chapters depending on relevance.
By doing so, it was signalled that it was necessary to walk our own talk (be critically reflective and document new initiatives) and simultaneously demonstrate that research and development in capacity building is not something that falls from the sky, but is based on professional, complex and theoretically based academic compe- tencies that include perspectives coming from the humanities and social sciences.
One example of such publications is the free online book series (in Danish) Research and Development Culture. The first book Research and Development Culture—In Clinical Practice [24] consisted of 12 chapters written by RNs and allied health professionals at different levels in the organization, sharing their reflec- tions and experiences with the first steps of building research and development capacity. The book was followed the next year by another free online book, Research and Development Culture—From Idea to Publication [25]. Here, several articles developed through the article writing course were gathered and presented together.
The third book Research and Development Culture—Researchers in Clinical Practice was published in September 2018 [26]. Here, a group of researchers with nursing and allied health background, employed at the hospital, described their experiences and reflections regarding these new positions in clinical practice.
Knowing that both reading a foreign language and book prices can be barriers to accessing and reading professional literature, the books are in Danish and free of charge. The idea behind the book series is to raise attention to the strategy and share the experiences with developing the culture as easily as possible with as many col- leagues possible. It is also a way to ensure that all possible publications written within the organization, on this topic, are published. The contributions in the books are very different; some required a lot of editing and mentoring and others hardly any, but the aim was that the nurses and health-care professionals published together, and that is a strong symbol of working together with a common purpose.
5.2.3 Educating and Recruiting Researchers
Having worked at all levels of the organization, to establish the best possible foun- dation for a research and developmental culture which “only” needed researchers
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may seem to be easy to do—but this was by no means a simple process. Even though many doctoral students with medical background were employed at the hos- pital, no single head nurse was willing to take the economic risk and become the first department to establish a doctoral nursing student scholarship. This barrier was addressed in the Research and Development Council, and at nurse management meetings, resulting in two initiatives.
In the first initiative, 16 leaders agreed to support the first doctoral nursing stu- dent to conduct a PhD study with a small amount each year, which covered the student’s salary for the 3 years it takes to complete a PhD in Denmark. This meant that it was needed to establish a study everybody found relevant. The solution was a study focusing on general palliative nursing care, conducted by a RN employed at the hospital. The RN had just completed her master’s thesis and was very interested in the subject. The conditions were not optimal, but on the other hand there was a tremendous interest and support to the nurse researcher and the theme, and by the completion of the study [27], it had gained substantial external funding, for instance, from the Novo Nordisk Foundation for nursing research, with some co-funding from the departments.
The other initiative was the announcement from the director of nursing of fund- ing of 1-year salary to another PhD student within nursing and allied health. This, together with the positive funding experiences from the first study, resulted in sev- eral applications and initiations of studies.
As it became increasingly apparent that educated researchers were needed in clinical practice to support the research and development culture and capacity build- ing, it became possible to gain further support from the hospital management, which resulted in five 50% postdoctoral positions financed by the hospital management and the other 50% of the position co-financed by the departments. Currently there are 22 RNs and allied health professionals working in junior research functions, like doctoral nursing students, or in senior research functions, like postdoctoral nurses, assistant professors, associate professor and professor.
It is important to note that not all RNs or allied health professionals who have gained a PhD degree wish to or, for different reasons, can continue with academic careers at university level. From the experiences so far, it is clear that some postdoc- toral nurses, rather than aiming for personal academic careers at the universities, prefer to use their research background in positions, where they focus on practice development and research at the hospital [28].
5.2.4 Establishing Professorships and Nursing Research Program
As an important part of the newly gained university hospital status, nursing and allied health is now part of the official professor plan. The hospital’s ambition is to have five professors in nursing or allied health before 2021. The hospital pri- marily collaborates with the University of Copenhagen, but most academic nurses and allied health professionals are associated with the University of
5 Pioneers in an Old Culture. Developing and Leading a Research and Development…
Southern Denmark, as this has specific master’s programmes in nursing, physio- therapy, midwifery and occupational therapy. Others are associated with Aarhus University, Roskilde University and some with Lund University in Sweden. Now, three nursing professors are associated to the hospital: a professor of clinical nursing who is also the director of nursing/allied health research and two inter- national visiting professors. There is no doubt that professors can act as research frontrunners, but the art is to keep a sharp focus on the balance between the dif- ferent capacity levels [8, 13–15] and respect that change of culture takes time.
There is a need of professors in clinical practice but also a need of assistant and associate professor positions, and they need to be established in close collabora- tion with the specific department in order to secure that mutual expectations are clarified and adjusted [28].
The last initiative is the establishment of a 5-year research programme CAPAN (capacity building in clinical nursing). The PARIHS framework has inspired us in setting up the programme because it focuses on interactions between evidence, con- text and facilitation [17, 29]. Further, the approach to nursing practice is inspired by the person-centred framework [30]. Both frameworks are reflected in the vision and strategy for nursing and allied health at the hospital.
The overall purpose of CAPAN is to facilitate the generation, dissemination and absorption of a development and research culture that is constructive, creative, inclusive and visible at all levels. This means that the programme builds on the pre- vious work and includes producing and transferring knowledge to, from and between nurses, patients and collaborators (researchers and non-researchers) in clinical practice. The specific components of the first year have been:
• Establishing a programme database.
• Validating and translating the Context Assessment Index [31] used in a nurse survey [32].
• Preparing and distributing a nurse survey to all nurses in the region.
• Developing a department specific survey feedback strategy.
• Developing and testing a generic reflection tool.
• Developing a supervision programme for head nurses.
• Establishing a network regarding nurse-led clinics at the hospital.
• Developing a collaborative research training programme for researchers/
non-researchers.
• Establishing a closed Facebook group for all nurses at the hospital.
• Linking international visiting professors to the programme.
The degree of implementation of the CAPAN programme components over time and across different clinical settings is continuously being documented. This includes focus on contextual factors, development of new action-driven initiatives and reports on how participants engage in and respond to the programme compo- nents. The framework for evaluating research (and development) capacity building [8] (Fig. 5.1) is a helpful inspiration and reminder of how complex and important the task is.
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