CAMH nurse researchers hope to make positive changes

By Patrick Callan, Communications Coordinator

Nurses are the backbone of a hospital. 

They are known for providing hands-on care, getting to know their patients and helping them manage and cope with their illness, administering medication, as well as serving as a vital liaison between patients, doctors, families and the health care team.

A lesser-known fact about these passionate professionals is many return to school to pursue a master’s degree or PhD to deepen their knowledge about specific populations to find a solution to a problem they’ve encountered working in direct care.

Dr. Gillian Strudwick, a Registered Nurse and an Independent Scientist at CAMH, says nurses providing direct care see firsthand what’s working well and where there’s room to make improvements for patients and staff. 

“That’s often the catalyst for people going back to school to formally study a problem and identify a solution,” says Dr. Strudwick. “We hope it’s a cycle of nurses identifying important clinical issues at CAMH, doing the research at CAMH, and now applying the findings at the organization. That’s how nurses can make a difference in a different way.”

And that’s exactly what two of CAMH’s Advanced Practice Clinical Leaders (APCL) are hoping to do.

Meet Remar and Sara

“One of my goals as a nurse is to make our workspace safe, so I’m dedicating my career trajectory and research around that area,” says Remar Mangaoil, an APCL at CAMH and PhD Candidate at the University of Toronto supervised by Dr. Kristin Cleverley, CAMH Chair in Mental Health Nursing Research at CAMH.

Remar started his career as a Personal Support Worker working closely with nurses. That experience inspired him to become a nurse. Before arriving at CAMH in 2013, he was a crisis nurse in the emergency department at hospitals in Hamilton and Kitchener.

“I was in a violent situation and didn’t know what to do. Afterwards, it was really hard for me to continue work and provide patient care,” he says. “I kind of knew about risk assessment, but risk management or violence support for staff was unknown to me, so I started reading the literature and got interested in some of the ways we can support nurses after seclusion or restraint events.”

Remar’s interest in this topic grew at CAMH, especially as he noticed that in the aftermath of a violent situation it was very hard for some nurses to resume patient care. “It kind of validated my interest and I knew this was something we really needed to look at, so I decided to pursue a PhD with a similar topic,” says Remar, who is now in the third year of PhD studies and preparing to defend his thesis proposal. 

Remar is looking into what factors influence nurses’ decision to either participate or not participate in immediate staff debriefing that takes place following a seclusion or restraint event. “It could be the amount of documentation they have to do or maybe they’re too stressed to debrief right away,” he says. 

Remar says the two biggest challenges he expects to find in his research will be getting enough nurses to participate in his study and then asking them to share their experiences.

“The use of debriefing after seclusion or restraint use is a sensitive topic and can be anxiety-provoking,” he says. “I hope nurses can support other nurses by participating in research, so we can improve how immediate staff debriefing is delivered at CAMH.”

Nurses helping nurses

Supporting nurses is one of the things Sara Ling enjoys most about her current roles as an APCL at CAMH and PhD student at the University of Toronto also supervised by Dr. Kristin Cleverley, CAMH Chair in Mental Health Nursing Research at CAMH. “I’ve really enjoyed giving guest lectures at the University of Toronto and the mentorship aspect of the Barford Scholarship program. It’s a pleasure to connect and mentor,” she says.

The Barford Advanced Practice Nursing Scholarship is available for registered nurses at CAMH who are interested in pursuing a master’s degree in nursing, health administration or another field. The prestigious scholarship annually supports one full-time student for a maximum of two years, and two part-time students for a maximum of four years.

Sara, who started at CAMH in 2010 as a new graduate Registered Nurse on unit 2-2, was one of the first-ever Barford scholars in 2012. After completing a Barford Internship, Sara began working as an APCL in the Medical Withdrawal Service. She says her experience as an APCL and interest in research inspired her to return to school in 2017 to pursue a PhD.

“I’ve seen many patients leave care early and always wondered what happened to them and if they share any characteristics. For my PhD, I’m looking at if there are predictors of patients leaving and what their experiences in the hospital were,” she says. “I’m trying to understand if there’s something we can be doing differently to help engage these patients to prevent them from leaving care early.”

Sara is using the rest of this year to develop her research proposal and hopes to start conducting her research in 2020 after defending her proposal. Like Remar, one of the obstacles she expects to encounter is recruiting enough participants for her research study. 

In addition to the challenges of finding enough willing participants, the larger systemic issues nurse researchers face are recognition and opportunity, explains Dr. Strudwick. 

“There’s not a common understanding that nurses are equally able to contribute to research as their colleagues, such as physicians,” she says. “There also is very limited nursing-specific research funding, which makes it very hard to pay participants and hire research analysts.”

Nonetheless, Dr. Strudwick is grateful for the opportunity to have independence and autonomy to look for solutions to problems that exist in the system and at CAMH. “To have the ability to think about different ways of addressing them and then get some funding and a team together to actually try to tackle them is awesome—especially if the solutions are truly impactful,” she says.