MRC/CSO Social and Public Health Sciences Unit

Published on: 25th January 2019

Nicola Smith is a paediatric research nurse who has been working with the Trial for Healthy Relationship Initiatives for the Very Early Years (THRIVE) at the MRC/CSO Social and Public Health Sciences Unit for the past three years. In this blog, she shares her experiences of the research process.

As a paediatric nurse, I spent several years with the health visiting service in one of Glasgow’s most deprived areas. I regularly saw the challenges that faced some of the most vulnerable families in Scotland. It felt like all that was possible was to ‘fire fight’ in situations that existed throughout generations so I was always very interested in addressing the wider causes of inequality facing children and families. 

During a team meeting, a researcher from THRIVE came to talk to us about how the trial hoped to help mums and babies by comparing parenting groups that looked to address some of the issues facing parents and aimed to build better relationships between mums and babies. I was delighted to secure a job on the trial, which seemed to fit with so many of my values and experiences.

The role of the research nurse

Being a research nurse has been such a wide and varied role.  The trial required us, now a team of nine nurses from varying backgrounds, to help recruit 500 pregnant women from across the health boards of Glasgow and Ayrshire. The criteria was strict to focus on the most vulnerable women who were between 12 and 27 weeks pregnant. They also needed to fulfil one or more of the following criteria:

• Experienced significant or current mental health difficulties, or have a family history of serious mental health issues
• Experienced homelessness, drug or alcohol addiction
• Been looked after in the care system
• Current or previously identified child protection issues
• Learning difficulties
• Involvement (or partner involvement) in the criminal justice system
• HIV+
• Asylum seeker or refugee
• Young mum

The challenge of recruitment

We attended antenatal clinics in both community and hospital settings.  We particularly focussed on clinics for women with ‘Special needs in Pregnancy’ (SNIPS) and consultant clinics, which provide specific support for vulnerable mums-to-be. With such tight recruitment criteria, we often had to decline women who were interested in taking part. We found that women who may have been interested initially faced challenges such as childcare and work issues, or anxiety about being part of a group or sharing information with us. Spending time talking to women in the clinic environment meant that we were able to support them in taking part in the trial.  Often, women we met in the clinic requested that the person who spoke to them complete all of their study measures. This was great as it helped build relationships and encourage women to remain part of the trial.

To help with recruitment, we also built relationships with midwives and support staff to help us to identify women suitable for the study. By having a regular presence at clinics, we were able to keep the trial fresh in the minds of midwifery staff, who could also refer women directly to the study team.  Despite busy clinics, the midwives were generally supportive and pleased to see us - especially as our presence helped to relieve some of the pressure upon them identifying participants for the trial!  We also worked with people from the third sector, education and social care to recruit those who may have benefitted from extra support.

Home visits

Once recruited, we would visit the women at home to complete study assessments. Depending on the information available, we would risk assess whether we visited alone or with a colleague. Home visits could last between one and four hours and we could attend two planned visits in a day. 

Carrying out baseline questionnaires in their homes gave us a greater insight into the issues people faced. The listening and observation skills that we acquired as nurses gave us a means of supporting participants though the completion of the questionnaire.  Sometimes the women became upset as the sensitive nature of the questions brought up issues they may not have considered since their own childhood. Our observation and communication skills as nurses also helped us to compile rich data by writing detailed ethnographic notes about the women and their experiences. 

As a nurse, it was often challenging to hear stories where additional support and follow-up would be helpful, but knowing we could only provide the minimum amount of signposting. If we were concerned that the participant or child may have been at immediate risk of harm of course we would contact their GP, health visitor or midwife. However, as nurses we were aware that although we might have liked to help, it was important that we did not provide additional support unless we were seriously concerned about the mother or child’s safety, as this could have affected the results of the trial.  This was because the trial was testing whether providing additional support during pregnancy improved the mental health of new mums and helped them to form positive and secure bonds with their babies. 

We went back to visit participants when the babies were 6 months old to complete follow-up questionnaires. The women are usually happy to share their experiences with us and keen to show off their babies, which we loved too!  As part of data collection, we ask that the mums to let us film the interaction with their babies during short episodes of care and play.  The filming has produced interesting results, not least the nurses’ camera skills!

Throughout the process, we were always supported by the THRIVE research team and able to discuss and reflect on our time with participants. Some of the stories we heard could be particularly harrowing and unless on a joint visit, we rarely saw the other research nurses to discuss our experiences. Team meetings were arranged for us several times a year to address any issues that may have arisen, share stories and reflect, which was valuable to us as part of our own professional development.

I have learned so much about the research process during THRIVE. I have been able to become more involved as the trial has progressed and I am now excited to see the results this summer. Hopefully, all the hard work will translate into better outcomes for some of the most vulnerable mums and babies.

Disclaimer: The views expressed in this blog are those of the author.

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First published: 25 January 2019