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Clinical Investigators Contributing to Research in Nursing: Dr. Miriam Bender and Dr. Alison Holman

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UCI’s Institute for Clinical and Translational Science welcomed Dr. Miriam Bender, the Associate Dean for Academic and Student Affairs in the Sue and Bill Gross School of Nursing, and Dr. Alison Holman, a professor for the Sue and Bill Gross School of Nursing, for a virtual seminar on research implementation in the disciplines of nursing, during a seminar on March 1. 

Throughout the hour-long seminar, both guest speakers discussed their research interests in nursing and the ways in which their work could further develop nursing within medicine. It was the sixth seminar in the Physician Scientist and Clinical Investigator Enhancement Lecture Series, which aims to further develop particular research exchange mechanisms for research and education purposes among clinical investigators across areas within the health sciences.

Dr. Frank Meyskens, a professor for the College of Health Sciences at the UCI School and Medicine, was the host for the seminar and began by introducing Bender as the first speaker of the evening. She started her presentation by introducing the complexity of care delivery and the progress of nursing as a health care intervention. 

“In 2013, the Agency for Healthcare Research and Quality had reported that nursing does not have a lot of evidence-based interventions that show . . . effectiveness in regards to making healthcare safer,” Bender said. “Areas like registered nursing have been identified as possible strategies for reducing factors like mortality, but mixed evidence with impacts of nursing on morbidity for instance has not been able to improve healthcare delivery.”

As this is evaluated, the number of nursing interventions and nurses available can’t immediately be used to blame the lack of more positive outcomes. Interventions are being used to train nurses on the essential skills required in this profession. Thereafter, it is the nurse’s job to apply these skills into their own practice. A nurse’s ability to organize their knowledge into viable practice outcomes is the key to making a real difference. To achieve this, Bender described conducting research in the area of nursing in order to consider nursing as an organized system and not as an intervention. This, however, can be challenging to accomplish.

“There is a lot of evidence out there for a multidisciplinary approach towards thinking about healthcare, public healthcare, and care delivery through the lens of an organized system,” Bender said. “Although we don’t know how to study the organization of complexity, I believe that this approach could aid us in moving past binary questions of efficacy, using methodologies that can access complexity and heterogenous relationality, and engaging context.” 

To carry out this methodology, Bender has organized her research through a stakeholder-engaged framework that involves professionals from research, policy, education and practice sectors. 

Working towards synthesizing existing knowledge, developing pragmatic research strategies, and conducting research at a national level, her goal was to go into the care delivery world to make a difference in care quality and patient safety. In doing so, she found that existing practices in care delivery interventions could be modified to yield better outcomes since current projects do work.

“We are showing that these methods work and are able to capture what is going on in health care systems. Although intervention clusters will be different depending on the healthcare setting, they are still able to capture things that are occurring and make a difference in positive outcome achievement,” Bender said. 

After  Bender’s presentation, Meyskens introduced Holman, who opened her discussion by describing the aspect of collective trauma. In the last two years, she emphasized the presence of varying stressors in our world that have induced such collective trauma. 

“2020 was uniquely characterized by a series of collective traumas. We had the coronavirus, an economic recession, climate change predicaments and social reckoning around racial conflict. When all these stressors came down on us together, which have been like nothing we have ever experienced before, we were forced to cope with them in some way,” Holman stated. 

Described as the prime stressor during this time, COVID-19 was a concerning and silent threat that had implications at the local and global level. As it touched and restricted many parts of our own lives, many individuals found themselves feeling hopeless and unmotivated without a purpose. 

Due to this significant impact, Holman conducted a study to understand how individuals in the U.S. were dealing with this period of uncertainty. 

“Using data from the AmeriSpeak panel of the National Opinion Research Center (NORC), my colleagues and I were able to collect data on more than 65,000 Americans who provided data on their mental and physical health prior to the start of the pandemic,” Holman said. 

In the middle of March 2020, Holman and her team randomly selected a sample of participants that were divided into three 10 day cohorts that lasted until April 2020. Asking them about their stress and other aspects of their mental health through various waves of surveys, Holman found that overexposure to the media and individual exposures to COVID-19 drastically and negatively affected an individual’s mental health. 

In this process however, she believed that a certain population of individuals were being overlooked: healthcare workers. She concluded the seminar by describing the impact of the silent stressor on these individuals, and what can  be done in the future to aid them.

“Over 36,000 healthcare workers died during the pandemic. Those who passed involved more nurses and support staff than doctors, where a lack of personal protective equipment (PPE), COVID-19 tests and a contraction probability played a significant role,” Holman said. “With the rise of burn out cases that led to increased depersonalization, a lack of compassion and empathy in medical care had also resulted. It is a red flag that we need to pay attention to, which could be addressed with more research on the impact of the pandemic on the mental and physical health of healthcare personnel.” 

To read more about both Bender and Holman’s work in nursing, implementations in healthcare and their other medical practices, visit the UCI Sue and Bill Gross School of Nursing’s website

Korintia Espinoza is a STEM Staff Writer. She can be reached at korintie@uci.edu.