"Promoting a research culture in emergency medicine is essential”: Meet Mary Dawood, consultant nurse emergency medicine
To mark the launch of the second series of Channel 4's Emergency, we are publishing a series of Q&As with key staff involved in our major trauma centre.
Emergency care is a vital part of what we do at Imperial College Healthcare, through both our emergency department and major trauma centre. Here, Mary explains the importance of research to this and the joy she feels supporting our emergency nurses and advanced practitioners to develop their careers.
Tell us about your role – what do you love most about it and how does it link with the Major Trauma Centre?
I am a consultant nurse in the emergency directorate and have been in post since 2002. I love my role as it allows me to do what I most enjoy: looking after patients, research activity, promoting the specialty and supporting our emergency nurses and advanced practitioners to develop their careers. It is such a privilege to be a very senior nurse while also being hands on with patients and sharing expertise with more junior staff, helping them ensure patients are getting the best possible care.
Identifying learning needs and developing appropriate learning programmes, which includes trauma training, is central to this role. We currently lead on the specialist emergency nurse training for the Integrated Care System (ICS) for north west London, running two courses per year. I am also a co-author/editor of the Oxford Handbook of Emergency Nursing which dedicates a whole chapter to trauma nursing and is currently in its third edition.
Additionally, alongside my consultant nurse colleague, I lead a team of 21 emergency practitioners (EP) in the Urgent Treatment Centre (UTC) at Charing Cross Hospital. This is part of the emergency directorate where we care for on average 90-100 walk-in patients per day. In recent years we have developed a very successful bespoke EP training programme, which is a collaboration between Imperial College Healthcare and King’s College London. We’ll be running this training programme from September, and we have offered training places to our neighbouring trusts in the ICS who also need to recruit and train emergency practitioners. We also provide professional support to the advanced clinical practitioners in same day emergency care (SDEC) across Charing Cross and St Mary’s hospitals.
Why is research so important within emergency medicine?
Emergency medicine is a relatively new specialty so developing and building research is essential to validate our practices. I believe promoting a research culture in the emergency directorate is essential if we are to maintain our reputation as an academic health science centre. Emergency care can be pressurised and time dependent, and this means that research activity can be easily jeopardised. Motivating staff and presenting research as something we all do in everyday practice by asking searching questions is a great starting point. Clinical staff can be put off by perceptions of research as a focus on methodology, statistics and study design but these skills can be learnt. Leadership and communication skills are equally important in research activity.
What type of research projects have you and your team been involved in?
Many of our staff are keen to advance their practice and as a result have become more involved in research. In the past couple of years seven of our staff have achieved a post-graduate MSc degree and submitted a thesis of their own research of which they are rightly proud. The projects included systematic reviews about achilles tendon injuries and patients’ perception of frailty. It's wonderful that four more members of staff are currently on the MSc pathway.
Some of our research projects are QIPs which are focused on improving patient experience and outcomes. For example, one project focused on making sure patients who need an x-ray have one requested immediately on arrival; this has enhanced patient satisfaction and reduced time in the department.
Our research projects have also improved the experience for patients, for instance by allowing nurses to give pain relief at triage and request x-rays for the patient as needed. Other projects looked at the importance of identifying frailty early in the patient pathway – this is important as we increasingly see older frail patients who will benefit from timely referral to the frailty team.
I’m very proud that our staff will be presenting their research at the Global Emergency Nursing and Trauma Conference in Gothenburg this November. We have also had six publications in nursing/medical journals by our nursing staff in the past three years and two more papers are in the process of being written up.
Are there opportunities for NHS staff to get involved in research, how can they do this?
Staff have the opportunity to get involved in more national research projects, such as Rapid 1 where Imperial College Healthcare is designated as a participating site. This is a blind randomised controlled trial which investigates the effectiveness of the drug Infliximab on patients with acute pancreatitis.
Staff are also encouraged to get involved with the neuro-emergencies trauma (NET) research team who promote and manage neuroscience, injuries and emergency studies at the Trust.
Imperial College Healthcare hosts large research trials and it’s important for staff to be aware of these trials and why they’re running. Research nurses will usually run teaching sessions for staff prior to the start of a study. A current example of this is the ASPIRED Study, a randomised controlled trial around patients with unexplained syncope (fainting, or sudden loss of consciousness). Potential participants will be identified from ED and highlighted to the research team. The research team rely on the ED staff to highlight suitable participants and in order to do this staff need to understand the study.
You're also associate editor of the Emergency Medicine Journal (EMJ) – tell us about this.
I have been an associate editor of the EMJ for the past ten years. It’s an exciting but time consuming role as I constantly have research papers in my inbox that need to be thoroughly read, as well as the comments of the reviewers and statistician, before I make a recommendation to the editor in chief .The advantage is that I get to read original research before it’s published which ultimately benefits my team. As an associate editor, I have learnt much and gained significant skills in identifying what is good research and what is likely to get published and what will not meet the mark. Through this role, I also come in contact with many well-established researchers in emergency medicine which can be inspirational. As an associate editor, I have to write the Primary Survey (Editorial) twice a year and on occasions I write commentary pieces about some of the papers that are being published. This keeps my knowledge of the latest research and writing skills finely tuned and up to date!
What’s been your proudest moment in your career to-date?
I’ve had many proud moments in my career and at many different hospitals. But I always feel proud and happy when our clinical staff get involved in research and achieve their MSc degree, especially when they doubted themselves in the first place – this is always a great moment and worth celebrating. I am also very proud of the UTC we set up at Charing Cross and the 48 practitioners we have trained to date. The UTC is the first point of access where walk in patients are assessed – they may be treated and discharged by the emergency practitioner or referred to the emergency department for further investigation. The UTC treats and discharges between 80 and 100 patients a day. Our patients in the UTC are safe, well looked after and our work impacts positively on the emergency department.
What’s your biggest inspiration at work?
My greatest inspiration is the professionalism and kindness of colleagues, despite pressures, and my motivation is the very great need to improve our NHS.
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