Good examples

Increasing number of nurses with PhDs – crucial for tomorrow’s health and medical care

Eva Hellström Lindberg

Initiatives are being taken throughout the country to ensure nurses with PhDs can continue to carry out research and at the same time keep on their work in patient-proximate nursing. For Susanna Ågren, a specialist intensive care nurse who has a PhD, the position as “university nurse” in Linköping means that she can strengthen the position of nursing research and function as a bridge between clinical work and academia.

Since August 2017, Susanna Ågren has had a “clinical research position”, which corresponds to “university nurse”. The position means that – for three years, with an option to extend for a further three years – she has time for research and teaching in parallel with working as a nurse at the thoracic intensive care clinic (THIVA) at Linköping University Hospital.

– This gives me the opportunity to influence and strengthen nursing research at the clinic, which in turn can improve the quality of medical care and general care of patients, as well as support for their relatives. This feels both important and meaningful, says Susanna Ågren.

Family support during cardiac disease

More than 30 years have passed since she trained as a nurse in Kristianstad. After a couple of years working at medical wards, Susanna became interested in emergency healthcare, and applied to do intensive care training in Linköping.

– It as tough to begin with, and lots to learn, but also very exciting. After a while, I was offered a position at THIVA, where I have now worked for many years.

It was only in 1982 that nurse training in Sweden became university-based, with an academic first-cycle degree programme (Bachelor level). Susanna supplemented her nursing training, and once she had returned to the clinic, she became interested in research.

– I was particularly interested in family support. As an intensive care nurse, I often meet relatives of seriously ill patients who have received treatment for heart disease. I saw a need for support to the relatives, and I wanted to understand the situation for the families in conjunction with heart disease and intensive care.

Susanna started her PhD in nursing in 2005, and completed it in 2010 at Linköping University.

Her thesis concerned the need for psycho-social support forpatients with cardiac insufficiency (chronic or as a result of a heart operation), and their families, following the hospital care. With ever-shorter in-patient stays, greater demands for post-operative nursing are being placed on relatives. For many, this entails a strain that risks impacting on both mental health and social life.

– The clearest problem was social isolation, with limited time and energy to meet other people. Interviews showed that partners need recognition, security and opportunities for recovery to build up inner strength. When we made an intervention, with training and psycho-social support for patients and partners, the patients’ control of their life situations improved.

Increasing number of nurses with PhDs

After her PhD, Susanna got a combination position as lecturer at the thoracic-vascular clinic in Linköping. Half her working time is spent teaching at the university, and the other half working clinically and on nursing development.

– For a while, I was responsible for the specialist training course in intensive care. Now I have handed over this responsibility to a colleague, and am instead an examiner for nursing science on the same course.

In August 2017, the opportunity arose to apply for the position as university nurse (which is known as “clinical research position” at Linköping). Today, Susanna works clinically during 20% of the week, and the rest of her working time she spends on research, nursing development and teaching.

– I have more time left over for research, and havealso been appointed as docent, which is so nice.

The word “docent” (English: reader/associate professor) comes from Latin, and means to teach or educate. To be appointed a docent, you have to have achieved high scientific and educational skills in your subject, and as a docent, you have to be of benefit to research and education.

The actual number of nurses with PhDs in Sweden is unclear. For many years, the Swedish Society of Nursing has tried to map the number, and estimates that around 1 200 theses have been published by nurses.

More and more nurses are choosing to do PhDs, but for many years it has been difficult to combine research with developing the clinical operation following the PhD award. In several locations in Sweden, various models for career and competence development are now being introduced, to ensure nurses want to stay and develop as clinicians and researchers, but also to utilise the knowledge and competence that academically educated nurses can bring to day-to-day nursing.

– It is important that we have nurses with PhDs on our wards, who can inspire and capture the ideas of colleagues, and work systematically to drive development projects, both through research, but also through various improvements.

– As a nurse with a PhD, your chances also increase of receiving research funding for projects that can reinforce the importance of nursing in the healthcare chain, for patients and their relatives.

The importance of a “clinical eye”

Today, Susanna is running various research projects and supervises a PhD student, and has two further PhD students planned. One of the projects is about identifying and developing evidence-based measures to discover infection early in critically ill patients within intensive care.

– In short, it concerns investigating how nurses think and act in order to discover infections. This “clinical eye” that many have is important. We want to try to understand what it consists of, and how important it is to really see the patient, and not just to focus on the medical apparatus.

Another project is about developing and evaluating a model for health-promoting family discussions, a kind of conversation methodology aimed at capturing the experiences of the patient and the family, and to strengthen their function and well-being.

– The project aims to evaluate and measure whether these conversations can influence and improve the function, and in which way.

A third project is about describing the importance of participation by relatives in conjunction with thoracic surgery.

– We want to take a closer look at the impact of family on post-operative recovery based on a family-centred care perspective. What is needed to involve the family and create greater participation?

Susanna also works in a larger, interprofessional project to evaluate an interactive website for relative carers of persons with cardiac insufficiency, with the aim of providing support to the elderly person with cardiac insufficiency to stay living at home for longer, with support from the family.

Another project being planned concerns offering survivors of heart failure internet-based cognitive behaviour therapy.

Susanna is also a member of Swedish, Nordic and international networks within research into intensive care, family-centred care and coronary healthcare.

– Among other things, I am a member of a national network for intensive care nurses. We exchange knowledge and experiences, and can also establish research collaborations that may include several different clinics around the country. The network is also aimed at PhD students, who have opportunities to get feedback and to present their research to a broader audience within intensive care.

Although there are many challenges in today’s healthcare reality, with shortages of specialist nurses and difficulties in recruiting and retaining nurses, Susanna is happy with her situation and her choice of profession. Being able to work clinically and combining this with research, teaching, supervision and healthcare development is both satisfying and meaningful, she considers.

– After so many years as a nurse, I really appreciate the opportunity to do different things. Another strong driver is to make colleagues interested in research and teaching, and together develop and improve the care of our patients and their relatives.