Clinical Appraisal

What it takes to be a nurse scientist-in-training and a practicing clinician at the bedside requires a level of emotional maturity I think is likely entirely unique. I have immense respect for your work, and no one should ever make you feel as if you are a lesser researcher or scholar because of your clinical practice. Relationships with patients is why we do what we do.

Dr. Briere's recent publication can be read, here: https://www.mdpi.com/2072-6643/16/3/362

Don't become an evangelist for Capital S- Science. Instead, be open to the idea that you may not know what you think you know based on singular studies that have never been replicated, and may have results which actually fail the false discovery test.

How often should you expect the clinical research in your field to change your practice? If we assume Price's Law holds in health research regarding the validity of non-Null findings, we should expect a small fraction of published research to provide 'true' results. And amongst them, a smaller and smaller number will harbor all the 'large' effects.

Jackie Nikpour joins the podcast to discuss her crucial work in the space of primary healthcare and share her thoughts on what it means for RNs to work at the top of their license in primary healthcare in the U.S.

Dr. Pamela J. Grace joins the podcast for an episode dedicated to a discussion about how nurses can 'do right' by their patients.

Don't devalue new nurses' experiences and assume that, just because you've been in practice a long time it means your practice patterns are based on truisms. The way you've learned to do something and the fact that it's 'worked for you,' doesn't mean it's inherently true. Oftentimes, when studied, we learn what we thought we knew was true... isn't.

The burden of proof to demonstrate efficacy of biomedical tools (namely, drugs or surgery) is on biomedical scientists and physician-investigators. We are too quick, as a society, to assume their science is particularly good, just because it's popular, they're confident in what they do, and what they do appears impressive. Eminence is trumped by evidence every time, and some things that were hitherto dearly held beliefs by medical scientists as true have been crumbling down around them over the last fifteen years. Some biomedical findings are true and stand the test of time. Most don't.

It is easier to differentiate nursing from other health disciplines when you realize that the framework from which you're practicing not only implies unique processes but leads to distinct, if overlapping, outcomes, and that it's not all about tactics and techniques. Techniques and tactics, while similar, are grounded and applied from distinct frameworks of knowing and unique strategies, in service of often different goals.

I've recently made the case that I don't believe the NP is practicing nursing anymore, but that they're now medical providers. This is my attempt to buttress the opposing argument, rather that they are simply extending nursing thinking into a legislatively expansive domain of care provision.

Nursing is unique and we mustn't forget all the ways in which this is true. Medicine is almost always treated as 'the standard' against which other disciplines of healthcare are measured. But why should that be? What right has it earned to maintain that position beyond historical power hierarchies? Certainly contemporary evidence doesn't support that stance. You are an expert nurse. You are not a lower order version of medicine's implementation arm without prescriptive or diagnostic authority. And you're certainly not the punching bag for a medically-centered hospital system. You are an autonomous professional. Embody that and remember who you are and from where you came.

"Don't quantify your qualitative data." Except when you do it without realizing it... Also, sidebar, yay for 100 episodes of the pod.

While qualitative research has challenges, quantitative methodology faces numerous challenges of its own. In the end, what can we really learn about human experience from either form of research? Only that which lies either on the margins, or that which can be captured in an overly simplified model.

In this episode, I speak with a well-respected PICU colleague of mine and bedside nursing expert, Michelle Boivin, BSN, RN, about how she has managed to maintain her bedside practice for over 20 years.

https://about.me/ianlane/ https://youtube.com/@clinicalappraisal

https://about.me/ianlane/ https://youtube.com/@clinicalappraisal

https://about.me/ianlane/ https://youtube.com/@clinicalappraisal

According to the fan-favorite 30-year celebratory piece she wrote in Nursing Science Quarterly in 2017, Dr. Jacqueline Fawcett, Ph.D., RN, FAAN implies that: because the 'medical model' doesn't exist as a conceptual model (from what Dr. Fawcett could find from a brief, non-systematic review), medicine, per se, does not have discipline-specific knowledge and, therefore, isn't a discipline but rather is a 'trade.' Ergo, "medical model" doesn't really exist at all. This is all predicated on faulty reasoning, illogical leaps and poor empirical and philosophical work on the part of Dr. Fawcett. The fact that no one on the Editorial side of this publication didn't reject this just speaks to the fact that because Dr. Fawcett is a 'Living Legend," no one wishes to challenge her. This needed to be challenged, and is one of the sorts of pieces that does more harm to our profession publicly than it helps. This serves merely to alienate us from the rest of contemporary healthcare, at a time when our field continues to dwindle and our resources follow suit. https://youtube.com/@clinicalappraisal https://about.me/ianlane/

An interesting RCT examining nasogastric tube securement devices versus standard taping methods on accidental dislodgment. https://about.me/ianlane/ https://youtube.com/@clinicalappraisal

What else is there to say. https://about.me/ianlane/ https://www.youtube.com/@clinicalappraisal/videos https://www.buymeacoffee.com/ianalaneRN https://www.paypal.com/paypalme/clinicalappraisal

An excellent nurse-led RCT of an organizational-level nursing intervention for specialty wound care clinics. (Sili et al., 2023) https://about.me/ianlane/ https://www.youtube.com/@clinicalappraisal/videos https://www.buymeacoffee.com/ianalaneRN https://www.paypal.com/paypalme/clinicalappraisal

A review of Lydia E. Hall's seminal 1963 work: "Nursing - What is it?" An important addition to the Clinical Appraisal Nursing Theory podcast series and the inaugural YouTube video podcast upload. Watch on YouTube: https://www.youtube.com/@clinicalappraisal

Struggling with imposter syndrome? In academics, this feeling never goes away. And there's no magical threshold that comes with taking more and more classes to makes you 'ready' to write that first grant or paper. It's time, now, to push yourself to new heights. Watch on YouTube: https://www.youtube.com/@clinicalappraisal

A discussion with Nurse Theorist and Scientist, Dr. Bernie Garrett, from UBC School of Nursing, on the problem of New Age Spiritualism in Nursing.

A brief discussion of the challenges and biases that arise when interpreting qualitative research, as well as the pivotal role of clinical insights in advancing evidence-based practice in health sciences.

This episodes discusses the philosophical importance of skepticism in scientific pursuits.

In this episode, Ian speaks with his grandmother, Dianne Lane, a masters-prepared psychiatric nurse and nurse researcher who is now 90 years old. In it, she describes what life was like as a psychiatric nurse pre-psychotropic drugs.

What is an advanced nurse? Is prescription authority synonymous with APRN practice? What constitutes an APN? These are issues dealt with in this episode of the podcast.

In this episode, Ian speaks with National Association of Clinical Nurse Specialists (NACNS) President, Dr. Phyllis Whitehead, PhD, APRN/CNS, FAAN, about how she conceptualizes the unique contributions to patient care of CNS trained nurses and how one might differentiate the roles of CNS practitioners from nurse practitioners.

In this conversation, Ian talks with Dr. Stephanie Griggs, PhD, RN, FAAN, a sleep self-management expert in pediatrics, focused on young adult health. Stephanie is an assistant professor of nursing at Case Western Reserve University and an up-and-coming force to be reckoned with in academic sleep and diabetes self-management research. Specifically, Ian and Stephanie talk about her academic trajectory and how she came to be using a novel time series modeling technique known as cosinor models to better understand the nuances of individuals' patterns and biological rhythms.

In this episode, Ian discusses the importance of understanding research design and analysis to accurately determine the efficacy of research findings, as well as the frequency with which most research findings are demonstrably proven 'false' over time, according to researchers at Stanford. Additionally, he discusses the impact of clinical scholars understanding how to piece together methodological designs while reading wide swaths of clinical literature and how it makes their critical appraisal skills better.

In this episode, Ian details his journey through quantitative health science and how he originally became interested in statistical methods as applied to research on human health.

Reality testing is needed to assess the validity of your abstract constructs, and if it cannot be shown to hold outside of your mental ideals... I am sorry, but it's wrong. We need to go back to the drawing board, in some sense.

In this episode, Ian concludes his arguments from the last year as to why we need a track for the DNP-prepared clinical researcher, separable from PhD-typical training pathways, for nurse scientists at the applied or practice-based setting, by teasing apart many of the usual rebukes of this idea that come from traditionally prepared scientists and skeptics. Rebutting many of these positions, Ian points out many logical flaws and inconsistencies in the argument that we ought not prepare a small cadre of DNP clinical experts in translational and clinical research, in an effort to help people understand that there is value in this position, and that other fields are already pursuing it, successfully.

In this episode, Ian discusses the science of labor and delivery with Melissa Anne Dubois, a seasoned L&D nurse and soon-to-be Nursing PhD student. They passionately discuss all things maternal health, in the context of what we can learn from the trials that currently exist and where they tend to fall apart from a nursing perspective and potentially fail millions of women and infants. A dynamic guest, Melissa Anne does a great job of being charitable to the medicalization of the birth process where it's warranted but is perfectly willing to shed light on the areas that are in desperate need of improvement for the sake of women's health.

In this episode, Ian speaks with Dr. Anne Marie Rafferty, a nurse, scholar, educator and historian from the UK, about a 1996 book she published entitled "The Politics of Nursing Knowledge," which was largely predicated on her doctoral dissertation work in medical sociology and modern history. They discuss how the book has shaped her career, her thinking, and where some of the big problems are in need of tackling in the field, and traverse elements of the historical context that undergirds many of these contemporary nursing and health policy issues.

In this episode, Ian interviews a Living Legend in Nursing, Dr. Jacqueline Fawcett, PhD, RN, FAAN. Jacqueline is internationally recognized for her work in meta-theoretical underpinnings of nursing science and practice, and has been credited as revivifying a term from the 1970s, "Nursology", as being most appropriate for our discipline, to distinguish it as a discipline similar to biology or psychology or sociology. Ian was able to ask Jacqueline why she prefers the term and where it originated, how she envisions the linkages between theory and practice in nursing, and how and whether it is possible or necessary to develop a theory-driven nursing science. Enjoy! http://nursology.net

In this episode, Ian responds to a listener question about how he reconciles the apparent contradiction in his recent claims about how most nurses eschew nursing theory so we need to make it more pragmatically relevant to practicing nurses, with the idea that he still finds Nursing Theory to be relevant and important and worth embracing and taking seriously.

In this episode, Ian discusses the importance of clinical trade offs and the implications of the multiplicity problem in terms of real world effects of our overly simplistic theories.

In this episode, Ian details his methodology for reviewing intervention studies, particularly randomized controlled clinical trials (RCT) and other human subjects experiments in the biomedical or biobehavioral sciences. This is merely the method that has worked for him over the years, and provides the most bang for his buck. Others' mileage may vary of course. But these are the pieces at least to be on the lookout for, when reading intervention research in biomedicine.

In this episode, Ian speaks with Dr. Rosemary Taylor, PhD, RN, CNL, an experienced nurse and academic scholar with a wealth of knowledge and an interest in studying interpersonal violence, bullying and other noxious behaviors in the health care environment, particularly amongst nurses. Nurse on nurse "horizontal violence" as she has termed in in her dissertation defense and beyond is a construct which has been notoriously difficult to measure and evaluate in the research on this topic, and Dr. Taylor's life's work is to help tease apart these issues in an effort to disentangle the structural barriers to intervening and improving the work environment for individual nurses. In particular, Ian and Rosemary talk about her three 'subtypes' of nursing bully, as elucidated by her PhD thesis.

In this episode, Ian revisits the notion of number needed to treat (NNT) and absolute risk ratio (ARR) from a few episodes ago, in light of some new claims made about mAb therapies for the treatment of COVID-19 patients, given some of the public support for their early use. As always, the approach taken is a methodological one, and the focus is not on COVID-19 per se.

In this episode, Ian speaks with Dr. Patricia M. Delgado, DNP, APRN, DCNP. Patricia is a DNP-prepared principal investigator with extensive training in adult-gerontological primary care and subspecialty training in dermatology about her journey into clinical research, what hurdles she overcame to be afforded the opportunity to be a PI, and her perspective on the viability of this path for others with similar training. Her interests in the intersection of psychiatric and dermatological research was also discussed, from the perspective of there being unique and important questions to answer from her vantage point as a DNP-prepared clinical researcher.

In this episode, Ian reviews some literature and some questions surrounding the idea of whether quality improvement (QI) projects are just "research lite" or whether they have valid standing in and of themselves apart from research. Many people have written on whether QI is just 'research which doesn't require IRB approval and can't be gneralized,' while others are staunch proponents of the immediacy and primacy of QI initiatives, for various reasons, some of which will be explored in this episode. Ian discusses three primary components of this problem which are interesting to him: 1. QI and research may only differ on the front end regarding human subjects and ethics committees, 2. QI and traditional clinical investigations might be bridged by leveraging implementation science, and 3. generalizability and statistical inference may be the Achille's heel of the QI proponent.

In this episode, Ian discusses some methodological challenges in properly interpreting emerging data from the COVID-19 pandemic, specifically surrounding the Delta variant of concern (VOC).

In this episode, Ian takes a more esoteric thought-ride through the bramble of lived experience and shared health-illness experiences to arrive at a tentative conclusion that perhaps the development of a methodology to evaluate the ontological legitimacy of an externally valid measure of shared health-illness experiences is perhaps tenable after all... (then again, this is all just interesting pontificating at this point).

In this episode, Ian speaks with physical therapist and hip pain researcher extraordinaire, Dr. Marcie Harris-Hayes, PT, DPT, MSCI. Dr. Harris-Hayes is on the faculty at Washington University School of Medicine in St. Louis, where she advises trainees interested in clinical research and conducts her own independent program of research focused on arthritic and pre-arthritic hip conditions. She has been an independently funded scientist translating the work of her colleagues from the bench to the bedside for a number of years, and joins the podcast today to speak with Ian about what the path looks like for an MSCI-prepared clinical investigator with a practice-doctorate, as opposed to the more traditional PhD pathway for those who learned later on that they were interested in a career in clinical research.

In this episode, Ian speaks with Dr. Yvette P. Conley, Ph.D., FAAN of University of Pittsburgh School of Nursing about her experience as a human molecular geneticist working in Nursing Science, to untangle the complexities of symptom development and about nursing research using omics techniques more broadly.

In this episode, Ian speaks with Dr. Angela Starkweather, professor of Nursing at UConn School of Nursing and NINR-funded translational pain scientist, about biobehavioral mechanisms of pain and symptom self-management. They also talk at length about maintaining clinical competence as a clinical researcher in nursing science and balancing one's career aspirations across domains.

In this episode, Ian speaks with Dr. Theresa Koleck from University of Pittsburg School of Nursing about her expertise in omics and biomedical informatics. Dr. Koleck recently published a fascinating first-author paper in Nursing Research focused on the use of natural language processing (NLP) in the study of five deliberately selected symptoms. This project was a methodologically-focused feasibility pilot of the use of NLP and the NimbleMiner R-Studio Shiny package, created by one of her nurse scientist colleagues at Columbia University (Dr. Max Topaz). Additionally, they discuss Dr. Koleck's broader interests in symptoms and symptom burden.

In this episode, Ian speaks with NIH Lasker Clinical Scholar, Dr. Paule V. Joseph, about her experiences as a nurse scientist focused on the translation of basic science questions into practice. Her work specifically concentrates on chemosensory (taste and smell) dysfunction arising from metabolic conditions(i.e., obesity) , but she has a wealth of experience in every facet of clinical investigation, and simultaneously continues to practice as an advanced practice nurse, board certified in family practice. As she has become an impromptu mentor for Ian, he was extremely grateful to have the opportunity to interview her on the podcast. Please enjoy this invaluable episode.