Bedside to bench: re‐thinking nursing research

There is very little clarity or agreement in the nursing profession on the best way to teach and examine students on research understanding, let alone develop and appraise nursing research application to patient care. Nursing research, in the curriculum, is a patchwork of interpretation, and in application it is delivered with varied levels of complexity across schools of Nursing and Midwifery, often with disregard to distinguishing undergraduate from postgraduate research teaching. This is not uncommon in health professions education, as this lack of clarity on teaching research also extends to medical schools. Throughout many years of external examining and institutional review, I have observed an indifference and uncertainty among academics towards research, which leads me to conclude that research all too often is viewed as an academic exercise. Such observations are supported through failings in research application to patient care activities. In nursing education, we need a fundamental review of nursing research from its conception to its application, incorporating how best to teach, examine and apply nursing research in undergraduate and post graduate education. Realistic learning outcomes with incremental building of research teaching content from research appreciation to advanced research methods is key to a successful approach. The determination of appropriate methods of student assessment will require profiling of content with progression from understanding nomenclature, to interpretation and systematic reviewing of literature (undergraduate), to critiquing and undertaking pilot study research work (post graduate), to the competencies of the commanding role of Principal Investigator. It should also be mandatory that all nursing research activity in whatever form should have meaningful links with clinical nursing and patient care. In health professions, the foundations for research were established during the formalization of structured education and professional regulation. The application of science into medical and nursing health services research is manifest in a model which aimed to improve the diffusion of knowledge from the basic sciences into patient care. Later, translational research was projected as a gateway which was supposed to fill a gap between knowledge produced at the university laboratory bench and its use at the bedside. The Canadian Institute for Health Research (2004) stated that translation research ‘encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society’ (p. 3). However, over a decade later, we have very little evidence to suggest that this model has been successful and there is little clarity on how such resource investment has been used for the benefit of patients. Contopoulos-loannidis et al. (2003) identified that less than 25% of highly promising biomedical discoveries resulted in a published randomized clinical trial and less than 10% were established in clinical practice within 20 years. The foundations of translational research, in principle, espoused a dual process: ‘Bench to Bedside’ and ‘Bedside to Bench’. The evidence suggests that the Bench to Bedside paradigm has dominated and Bedside to Bench efforts have been limited. One suggestion could be that the scientific aspects of research are poorly understood by clinicians and the difficulties of accessing and managing patients are poorly appreciated by academics. Therefore, the profession of nursing and indeed the medical profession are caught in a schism and are conflicted in trying to ensure the application of research to practice within the established biomedical research model of bench to bedside. The NIH funded nearly $15 billion of basic science research in 2009 and it may be argued that the level of investment in the Bench to Bedside model has not resulted in a commensurate level of sustained activity in evidence-based practice. Such concerns are expressed by Grol (2001) who suggests that in health care 30–40% of patients do not receive treatments based on proven effectiveness and up to 25% of patients receive unnecessary care or care that is potentially harmful. One of the many examples is, Hydrogen Peroxide (H2O2) which is still being used for wound cleaning, primarily as an antiseptic agent. However, it has no direct benefit as an antiseptic, but is associated with significant risk (Reid et al. 2011). It is now time for the health professions, including the nursing profession, to focus its efforts on developing the Bedside to Bench model. The interpretation and application of the Bedside to Bench model has limited discourse in the published literature. This may be related to Marincola's (2003) claim, that prestigious journals, appear more fascinated with the mythology of transgenic and knock-out mice than the humble reality of human disease. The advantages of the Bedside to Bench model are that the research is embedded in patient care and the process and outcomes have a direct bearing on improving care provided to patients. A methodological dominance of an interventional and outcomes research approach in the Bedside to Bench approach is consistent with models of nursing theory and the nursing process. In recent times, I have been focusing my research efforts on the application of the Bedside to Bench approach in my selection and supervision of post graduate students and also through the agreement of a nursing research strategy with one of our associated large teaching hospitals in Bahrain. Through the determination and adoption of a basic Bedside to Bench research model, post graduate students at MSc and PhD level have completed studies on topics which have resulted in change to patient care policy and clinical practice. Such topics include: patient compliance with Diskus inhalers, (Mac Hale et al. 2014); 30-degree tilt for pressure ulcer prevention (Moore et al. 2013); Changing analgesia and sedation management in the Paediatric Intensive Care Unit (Magner et al. 2016); and my most recent postgraduate student topic Improving Health Outcomes in Type 2 Diabetes (T2 DM), in Bahrain, through a Nurse-led patient and family intervention. Evidence-based practice sets out to addresses the growing body of healthcare knowledge supported by different levels of evidence for best practice; however, the fundamental challenge remains, of how to most effectively close the gap between what is known and what is practiced. One of the qualities of the Bedside to Bench research approach is that it is embedded in practice and, therefore, it places a clinical value on any proposed research and supports the process of finding solutions to problems in uncertain, complex healthcare environments.

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