Research challenge sparks CIHR-funded study of cardiac care innovation

25 March 2013

Why are frail, elderly patients willing to travel long distances and submit to a battery of tests in order to access a new heart valve replacement procedure?

This question, posed by St. Paul’s Hospital front-line nurse Leslie Achtem, has evolved from a point of curiosity into a CIHR-funded research project due in large part to research capacity supported by MSFHR’s Nursing Research Facilitator (NRF) program.

Seeking to understand the factors that motivate patients to undergo transcatheter aortic valve implantation, an innovative cardiovascular intervention, a clinical team from the St. Paul’s Hospital Transcatheter Heart Valve Program submitted a proposal based on Achtem’s question to the 2011 Providence Health Care Research Challenge.

Coordinated by Aggie Black, one of seven MSFHR-funded nursing research facilitators, the research challenge provides an opportunity for nurses to take part in research by applying for small grants to answer questions related to their clinical practice. This mechanism directly supports the NRF program’s mandate of building research capacity among nurses and other front-line staff.

Transcatheter aortic valve implantation is a potentially revolutionary procedure pioneered at St. Paul's Hospital that allows heart valves to be replaced without invasive open-heart surgery.

 

A replacement valve can be inserted through a small incision in the groin and guided to the heart with the aid of a catheter, offering a life-saving option to patients unable to receive conventional treatments.

On the strength of their proposal, the St. Paul’s team received a $5,000 grant to investigate their question. With this support, they completed a 12-month qualitative study in which interviews with prospective patients helped inform an understanding of patient expectations and educational needs.

“We found that patients do not really care so much about how long they live, but they want to feel better,” says Dr. Sandra Lauck, clinical nurse specialist of the Transcatheter Heart Valve Program, who served as the team’s research mentor. “So the risk as we see it of undergoing this procedure is really balanced by the fact that they just want to breathe better, feel less faint, have less chest pain.”

The study also revealed that patients were well educated about their options and well supported by family and caregivers. Many had previous experience with surgery at St. Paul’s and were motivated to undergo the procedure by trust of the physicians and clinical staff.

Since the study’s completion, its findings have helped inform patient education materials as well as clinical interactions between the program’s nurse coordinator and prospective patients. An abstract based on the project was presented at the 2012 Canadian Cardiovascular Society meeting.

Staying ahead of the curve

The results of this survey were used by Lauck and Dr. Jennifer Baumbusch (2011 MSFHR Scholar) to develop a proposal for a CIHR Catalyst Grant. The proposal was successful and the team was recently awarded more than $98,000 to carry out a follow-up study.

With the support of the CIHR grant, Lauck and Baumbusch will study the unique needs of patients undergoing the procedure at all stages of the continuum of care – at referral, time of decision, pre-admission, admission, and post-operation recovery. They will seek to better understand the patient experience as well as the health services that are required to support access to innovations in care.

“I think one of the things we can do with this catalyst grant is minimize the delay between innovation and research so that we can continue to keep pace with what’s going on and ensure that patients are staying ahead of the curve,” says Lauck.

Lauck believes the research challenge concept plays an important role in amplifying potential research questions drawn from clinical practice.

“One of the big wins of these research competitions is that the question a front-line nurse poses can lead to a bigger question. The possibilities are endless with that kind of a spark.”

It’s just this type of spark that MSFHR’s nursing research facilitators are hoping to ignite in other nurses and front-line care givers around the province to encourage the questions that will improve patient outcomes and patient experience.

The second Providence Health Care Research Challenge was staged in 2012. Fraser Health has held its own challenge, and a new competition was recently launched in Vancouver Coastal Health. Each health authority’s challenge is coordinated by its MSFHR-funded nursing research facilitator. Learn more about the Nursing Research Facilitator program.

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