Building a Program of Research & Post-Doctoral Considerations Nursing Research Field Advisory Committee Office of Nursing Services

VETERANS HEALTH ADMINISTRATION Program of Research Definition: Cohesive approach to sequencing a series of studies to efficiently and effectively build new knowledge Topic Area: Fits with organizational goals, broad enough to be cross cutting, narrow enough to be manageable, addresses a gap or gaps, and is fundable 1

VETERANS HEALTH ADMINISTRATION Selecting a research focus is an important first step in building a program of research The focus of a program of research will depend on the organization's strategic plan and mission; being mindful of the organization’s needs is important. If your organization has a research center, such as a GRECC or COIN, consider a research fit with the program and collaboration with that team. If your VA does not have a research center, consider collaboration with another VA Research Center (pending approvals). In some instances, your focus may change or the focus of a research center may change. Stay connected with other researchers and stay in touch with research centers. 2

VETERANS HEALTH ADMINISTRATION Practical considerations for a research focus On a practical level, a research focus will drive many decisions such as collaborators, funding sources, professional contacts, and base of support. – For example, if your program of research is in technology for safe mobility in older adults, you might seek collaborators from academic affiliations in aging studies programs and engineering. Professionally, you would want to align with gerontology and ergonomic organizations. Choosing a focus allows you to leverage resources and efficiently build the science in a given area. – For example, laboratories you might build to support safe mobility research could be used by students, fellows, and others who are building science in the same area 3

VETERANS HEALTH ADMINISTRATION Identifying a Program of Research Lifetime commitment! Establish area of expertise through a track record with a common thread (publications & funding) Authorship on publications should reflect ongoing work with collaborators Available on-site resources and collaborations – Expertise for a team – Labs / Space – Support: administrative and clinical areas

VETERANS HEALTH ADMINISTRATION Breadth of Research Programs Junior researchers – More focused, narrower program of research, avoid hopping around with a series of disjointed studies Mid-level researchers – Broaden research, refine focus – May have to reframe or ‘re-invent’ focus due to circumstances, opportunity, or other reasons Senior level – Larger research focus with depth in some areas, such as more patient groups or settings

VETERANS HEALTH ADMINISTRATION Examples of Research Programs and Gaining Focus Too narrow – Intermittent catheterization in SCI patients Too broad – Chronic care – Patient outcomes On target: – Safe patient mobility – Safe transitions from hospital to home – Prevention of pressure ulcers in SCI

VETERANS HEALTH ADMINISTRATION Selecting a Research Focus Investigators select a research focus for a variety of reasons: – An intrinsic curiosity about a certain topic – Aptitude for a particular method – Available funding opportunities – Organizational support – Personal experience with a health condition. Because we are located in a service organization, the impact of our research is valued very highly. Results of our research need to have a clear impact on improving VA healthcare delivery and Veterans’ health and well-being. 7

VETERANS HEALTH ADMINISTRATION Selecting a Research Focus – con’t It makes sense to think about the local resources when settling on a research focus. Think about the expertise at your local VA facility and your local academic affiliation. Draw on existing resources and leverage those resources to secure others. For example, if your local facility has a strong mental health service with providers who are interested in research, and your local university has a nationally recognized department in clinical psychology, think about how you can collaborate with both of them to achieve mutually satisfying goals. 8

Clinical Research  Produces new evidence, innovation  Directly involves a particular person or group of people, or that uses materials from humans, such as their behavior or samples of their tissue (NIH). Implementation Research  Study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice to improve the quality and effectiveness of health services.  Study of influences on healthcare professional and organizational behavior. Eccles and Mittman, 2006

Clinical research vs. Implementation research Study type Study feature Clinical research Implementation research Aim: evaluate a / an … clinical intervention implementation strategy Typical intervention drug, procedure, therapy clinician, organizational practice change Typical outcomes symptoms, health outcomes, patient behavior adoption, adherence, fidelity Typical unit of analysis, randomization patient clinician, team, facility Courtesy of Brian S. Mittman, PhD Center for Implementation Practice and Research Support, VA Dept of Research and Evaluation, Kaiser Permanente Southern California School of Medicine, University of California at Los Angeles 9/7/14

Research Pipeline Basic Science Pre-Clinical/ Translational Research Type 2 Translation Implementation Research Clinical Research Type 1 Translation Improved Health Processes, & Outcomes for Veterans Clinical & Implementation Research Clinical efficacy research Clinical effectiveness research Health behavior research Health services research Epidemiology Guidelines, Evidence Syntheses Adapted from Brian S. Mittman, PhD 9/7/14

VETERANS HEALTH ADMINISTRATION Value-Added Benefits of a Research Program Benefits Personal Value-Added – Increase chances of getting funded – Focused expertise (evidence of knowledge depth) Professional Value-Added – Contribute to Science of Nursing – Contribute to Nursing Practice Organizational Value-Added – Contribute to Nursing Service – Contribute to Organization Mission – Quality of Care Outcomes Personal – Funded studies – Consultations Professional – Academic affiliation – Publications Organizational – Leadership team/governance – Serve as reviewer on scientific program panels for research proposals

VETERANS HEALTH ADMINISTRATION Identify Goals: Short-term / Long-term Types and # of studies to participate as PI, Co-I Grants to be submitted Types and numbers of publications planned Organizational participation planned Gantt chart timeline for goals is useful How do your goals fit in the organization’s vision/mission?

VETERANS HEALTH ADMINISTRATION Considerations for Productivity Consider pilot study so that preliminary data is available for proposal applications -Apply for internal funding for pilot study or small grants program How many grant proposals should be submitted per year? How many studies can one researcher work on at a time? How do you figure out your % of time on each study? Should you or should you not seek a CDA? Why or why not (pros vs cons)?

VETERANS HEALTH ADMINISTRATION For newer researchers… One mistake novice researchers may make is taking on too many projects because the projects are interesting for a variety of reasons. In building a research career, it is probably not wise to spread yourself too thinly or you risk not becoming proficient and credible in any one area. Any researcher should be able to state a program of research in a few sentences in a way that is clearly understood by experts as well as those who are less familiar with the topic. 15

VETERANS HEALTH ADMINISTRATION Milestones of Success 1.Well-funded program of research 2.Proposals build upon each other to systematically contribute to science and health and well-being of Veterans 3.Research findings provide solutions to problems that are important 4.The research transcends a single discipline 5.Scholarly contributions, with high quality/quantity of manuscripts in high impact journals – Articles are cited frequently by others 16

VETERANS HEALTH ADMINISTRATION Milestones of Success - con’t 6.Evidence of research findings changing the way people think or practice 7.Creativity in using research to change practice 8.Scope of impact of research findings on Veterans’ health care. 9.Highly visible nationally (leadership roles, research presentations, press); nationally known in their field of study 10.Instrumental in training new generation of researchers 17

VETERANS HEALTH ADMINISTRATION Time Management – Research time (study activities, travel, planning) – Scientific reading & grant writing – Continuing education & mentoring – Administrative time – Collaboration & meetings not directly related to your study Self Management – learn to say “no” – Avoid over committing Chase, JD et al. (2013). Time Management Strategies for Research Productivity. Western Journal of Nursing Research, 35(2),

VETERANS HEALTH ADMINISTRATION Typical Postdoctoral Program Goals Build on dissertation work toward research program Continue to build knowledge and skills – Research methods (e.g., design, measurement, analysis) – Networking – Interdisciplinary collaboration – Leadership – Grants administration, budgeting, personnel supervision – Research dissemination and translation Move toward greater independence and complexity in research

VETERANS HEALTH ADMINISTRATION Seeking a CDA (Career Development Award)? Why or why not? PROs A feather in your cap & for Center Significant amount of protected time for research and academic study Salary support not dependent on continual competitive grant awards Formal mentor support Availability of grant development administrative support to launch your program CONs Research may be under- resourced (administrative support) Research operational duties can intrude on time & development as PI Have to nurture relationship with clinical partners (not ready made) 20

VETERANS HEALTH ADMINISTRATION Centers & Offices for Information Office of Research and Development (ORD) Biomedical Laboratory Research & Development Service (BLR&D) Biomedical Laboratory Research & Development Service (BLR&D) Clinical Science Research and Development Service (CSR&D) Health Services Research and Development Service (HSR&D) Rehabilitation Research & Development Service (RR&D) VA Nursing Research website:

VETERANS HEALTH ADMINISTRATION Contributors to Content All members over the years from the Nursing Research Field Advisory Committee (formerly Nursing Research Advisory Group) Audrey Nelson, PhD, RN, FAAN Gail Powell-Cope, PhD, ARNP, FAAN

VETERANS HEALTH ADMINISTRATION VHA ONS Points of Contact Beverly Priefer, PhD, RN – Acting Director, Research & Evidence-Based Practice – Roberta K. Oka, PhD, RNP – Acting Associate Director, Research & Evidence Based Practice – 23