Q&A: Research on the wards
We know that clinical research relies on doctors and willing patients, but what about nurses? Chris Lerpiniere is a Senior Research Nurse on the MRC-funded RUSH, ‘Research to Understand Stroke due to Haemorrhage’ project at the University of Edinburgh. Here she tells Hazel Lambert about her work, and the route she took from clinical nursing to research.
How did you become a research nurse?
My nursing experience has been within neurosciences, critical care and tissue donation for transplant. Research has always been something I have had an interest in, particularly when you see the benefits and improvement to patient care brought about by research. However my career had followed a more clinical-based route until I saw the advert for the RUSH research nurse post and realised it was an opportunity to branch out into research.
What is the RUSH study aiming to do?
There are two types of stroke: one is caused by blockages in the blood supply to the brain (ischaemic), and the other is caused by bleeding in the brain (haemorrhagic). RUSH looks at what causes haemorrhagic strokes and the best way of treating them. I work on a part of the programme called the LINCHPIN (Lothian study of INtraCerebral Haemorrhage, Pathology, Imaging and Neurological outcome). What does LINCHPIN entail?
Patients consent to any of the four parts of the LINCHPIN. With consent from the patient or their next of kin, I gather a background history to look at why the patient may have had a haemorrhagic stroke. I take a blood sample for DNA extraction, which we share with the International Stroke Genetics Consortium. If patients are able, I organise a brain MRI scan three months after their stroke, which wouldn’t happen in routine clinical practice. This may show an underlying cause for the haemorrhagic stroke and if there are any small deposits of blood known as ‘microbleeds’. These microbleeds could indicate the presence of amyloid protein in the blood vessels of the brain, and LINCHPIN is trying to establish the role of this protein in causing strokes. Lastly, the most valuable and generous contribution that patients can make in the event of their death is to allow samples of their brain tissue to be taken post-mortem, which will tell us for sure whether amyloid caused their haemorrhagic stroke.
What do you collect in the post-mortem?
A neuropathologist and technician take one centimetre cubed samples from many areas of the brain according to a standard protocol. These tissue samples are frozen and embedded in paraffin, and stored in the MRC-funded Edinburgh Brain Bank. The rest of the brain is returned to the deceased’s body.
How much of your time is spent talking to families and patients?
About 80 per cent. I visit the patient and their family on the stroke unit to give them information about haemorrhagic stroke and the option to enrol in RUSH. They need a lot of support and information. Before even getting to discuss the research, I often need to supplement the information provided in routine clinical practice.
What do you enjoy about your job?
It’s a privilege that people allow me into their lives at a very distressing time. I help patients and their families by giving them more detailed information about haemorrhagic stroke and about what the likely outcome will be. By increasing our knowledge of the cause of haemorrhagic stroke we may be able to influence prevention and improve outcome in the future.
Are you under pressure to publish?
No, but my boss ― MRC senior clinical fellow, Professor Rustam Al-Shahi Salman ― is! Publishing new knowledge about haemorrhagic stroke is the goal. Personally I’m interested in other research questions too, for example why some individuals will say yes to post-mortem and others decline, and whether our approach as researchers influences that decision-making.
What is a typical working day like?
I work as part of a team but have autonomy over my day-to-day work. I start by finding out about new admissions with haemorrhagic stroke. If a patient comes in overnight who has had a major haemorrhage and death is inevitable, then that patient becomes my priority. I will visit the clinical area and assess whether it is appropriate to approach the family about research participation. We have excellent relations with the clinical staff in the stroke units who are supportive of the research, so that makes my role easier. The rest of my time is taken up with data collection, entering information into the database, arranging MRI scans and clinics, taking blood, sending letters to families and arranging post-mortems.
What would you say to anyone working as a clinical nurse who would like to make the switch?
Keep your eyes open because there are jobs coming up all the time. Edinburgh University has just started an MSc in clinical nurse research so that nurses who’ve finished their initial training can specialise in research straightaway. It’s an interesting role and has different challenges to those in the clinical area.
Where can you go next with a research nurse role?
Working within the area of brain banking has highlighted to me that the patients and their families are not averse to agreeing to post-mortem. Being able to examine brain tissue damaged through disease is essential to advance the treatment and care for individuals after haemorrhagic stroke. I love this job so much that I would like to continue within this role and promote further research requiring brain tissue donation.