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. Author manuscript; available in PMC: 2022 Oct 1.
Published in final edited form as: Teach Learn Nurs. 2021 Jun 5;16(4):423–428. doi: 10.1016/j.teln.2021.05.001

Mentoring Undergraduate Nursing Students in Palliative Home Care Research

Ubolrat Piamjariyakul 1, Tina Antill Keener 1,*, Angel Smothers 1, Stephanie Young 1, Saima Shafique 2, Serenity McDill 1, Karissa Keech 1, Trisha Petitte 1, Cinthia Pacheco 3
PMCID: PMC8553230  NIHMSID: NIHMS1702357  PMID: 34720774

Introduction

Research is an important part of nursing education (Polit & Beck, 2017), as is the understanding of end-of-life and palliative care (Li et al., 2019; Smothers et al., 2019). The World Health Organization recognized the importance of palliative care and urged reforms of policies, resources, and education to improve palliative care access to enhance the quality of life of persons with life-threatening illnesses. (World Health Organization, 2020). Furthermore, the American Association of Colleges of Nursing (AACN) developed competencies and recommendations to address the urgent need to better educate nursing students to provide high-quality, evidence-based, end-of-life and palliative care (AACN, 2016).

Nursing research is a systematic inquiry into nursing practice, nursing education, and nursing administration challenges (Polit & Beck, 2017). Research plays a critical role in innovating and implementing better nursing practices and healthcare standards by promoting evidence-based practice. Nursing students must understand research to systematically find relevant information and critically appraise evidence to address patient problems (Melnyk & Fineout-Overholt, 2015). This knowledge is specifically essential when providing nursing care in sensitive end-of-life palliative care (EOLPC) situations for underserved, isolated populations (AACN, 2016).

Introducing nursing students to research early in their education can promote inquiry and critical thinking skills. The educational process of including students in ongoing research is often intimidating for students and challenging for the faculty researcher. Many students feel unprepared and lack confidence or interest in participating in research (Wuetherick & McLaughlin, 2011). Few students are aware of the study topics available within their university, and many feel apprehensive about particular topics such as palliative care (Warkentin et al., 2014). Further, the traditional didactic approach to teaching research was reported not to improve student attitudes towards research (Ramsey et al., 2020). Having students engage in experiential learning through hands-on research involvement at an early stage in the undergraduate curriculum may help dispel such issues.

To engage undergraduate students in research, the West Virginia University (WVU) established the Research Apprenticeship Program (RAP) in 2017. The program is a multidisciplinary undergraduate research experience that allows students with limited research experience to serve as apprentices for faculty members conducting research at the University. In addition to the research, RAP students enroll in an accompanying Introduction to Research course for two academic semesters. The main goal of this course is to provide basic research knowledge and support students’ research endeavors. The course curriculum focuses on developing students’ oral and written communication skills, strengthening their connection with their mentors, and establishing an environment where they can interact with peers and discuss research. At the end of their two-semester experience in RAP, students present their projects at one of the University’s culminating end-of-semester research symposia.

The primary mission of the RAP is to enhance academic excellence through undergraduate research endeavors. The program also expands opportunities for students, introduces the concept of scholarship, and facilitates learning the scholarly methods in their field (WVU Office of Undergraduate Research, 2020). The RAP’s mission aligns with the WVU School of Nursing’s mission and goals to prepare students to learn the processes of research and recognize its impact in promoting evidence-informed practices (WVU School of Nursing, 2020). The University provides comprehensive academic, research, and clinical practice environments, including four campuses and multiple clinical sites. As an R1 Institution classified by the Carnegie Classification of Institutions of Higher Education, WVU engages in the highest research activity levels (WVU Research Office, 2021), including a 10-year continuous Clinical Translational Science Institute (WVCTSI, 2021). Therefore, there are numerous research projects available for undergraduate students to participate.

Purpose

The purpose of this paper is to describe the experience of engaging undergraduate students participating in the RAP with a multidisciplinary palliative care research team at WVU School of Nursing. Two students engaged in a National Institutes of Health (NIH) funded research project that aims to improve home end-of-life palliative care for patients with advanced heart failure and their family caregivers (Piamjariyakul et al., 2019). These two students also worked with faculty on the team who has led the nation in developing the translatable advance directives in palliative care (Constantine et al., 2018; Smothers et al., 2019). One student worked with a faculty member in a mixed-method study, evaluating compassionate nursing care perceptions among patients with substance use disorder hospitalized for extended medical treatment.

Methods

Students Enrollment

The RAP is widely advertised throughout the University, particularly to incoming students. To participate in the program, the student must contact the RAP director or coordinator and submit their resume and research expectations. Based on the student’s profile, the RAP staff connects the student with a faculty member whose research projects align with the student’s interests. To facilitate this process, each semester, the program asks researchers across the University to send a synopsis to RAP of their ongoing research projects, including study timelines and lists of research-learning opportunities for undergraduate students.

School of Nursing Undergraduate Student Mentoring Activities

Following the student’s referral by the RAP, the principal investigator (PI) faculty mentor schedules an in-person meeting to learn the student’s research interests, ambitions, school schedule and discuss a mentor-mentee agreement. The agreement includes the RAP training goals and the scope of the students’ work within the ongoing research project. Upon acceptance to work on the research project, specific communication flow, work assignments, and meeting schedules are determined. Throughout the meeting, students are encouraged to ask questions about the research and their expected role as research team members.

Students Engagement

Upon acceptance, the PI faculty mentor introduces the student to the other faculty researchers and graduate student research assistants on the study team. Each undergraduate RAP student is provided a designated cubicle workspace in the school of nursing research office. Students must notify the PI faculty mentor and RAP at least one week in advance if there are changes in their schedule. As WVU participates in the Federal Work Study (FWS) Program, eligible students can use FWS funds to pay for their research activities through RAP. Students who are not eligible to be paid through FWS enroll in the RAP as course credit students. Instead of being paid for their research hours course credit students get one extra academic credit for their research hours. All students, regardless of being course credit or paid by FWS, get one credit for the Introduction to Research course. Therefore, at the end of each semester, students receiving course credit get two academic credits, and FWS students get one academic credit for their participation in RAP. The program requires students to work a minimum of four to six hours per week on the research projects and provides students a flexible work schedule to accommodate coursework and testing schedules.

Specific Research Training Procedures

The School of Nursing training augments the RAP accompanying course topics, which include Responsible Conduct of Research, Research Communications, and Literature. Two sophomore nursing students participating in the RAP program were engaged in an NIH NINR pilot clinical trial, funded by the National Institute of Nursing Research and National Institute of General Medical Sciences (R15NR018547). The first student participated during the 2019 spring and summer semesters. The second student participated during the spring and fall semesters of 2020. The primary aim of this research trial is to test whether the nurse coaching intervention of supportive discussions will improve home end-of-life palliative care for patients with advanced heart failure and their family caregivers (Piamjariyakul, et al., 2019). This research study is conducted in an underserved rural Appalachian region.

A third student was a freshman nursing student enrolled with the RAP during the fall and spring semester of 2020-2021. This student worked with a PI faculty mentor on a study to improve the compassionate nursing care of patients with substance use disorder requiring complex medical treatment and care. West Virginia is the state most affected by the opioid epidemic and has the country’s highest mortality rate (National Institute on Drug Abuse, 2020). Improving the interactions between nurses and individuals with substance use disorder provides opportunity for helping patients receive the palliative care they need. The following section includes research-based activities undertaken by each student.

Conducting Responsible Research

Prior to involvement in the conduct of the research study, each student completed two mandatory Collaborative Institutional Training Initiative (CITI) modules (CITI Program, 2020). These were Social and Behavioral Research Investigators and Social and Behavioral Responsible Conduct of Research. Students who participated in the randomized controlled trial study were required to complete another CITI training on Good Clinical Practice (GCP). The short GCP course includes overviews of the Federal Drug Administration regulations, investigator obligations, adverse events, and monitoring clinical trials. The CITI training focuses on knowledge and protection of human subjects in research. Modules include discussions of ethics, informed consent, patient confidentiality, data safety, federal regulations, and good clinical practice guidelines. After completing these modules, the students were given an abstract describing the study they were assigned. Further, each student read short articles on topics related to palliative care and advanced directives.

Engaging in Multidisciplinary Research Team Meetings

The PI faculty mentor and graduate research assistants provided students a detailed overview and orientation of the research. The research program assistant shared information about the office operations and work environment. Initially, the research team worked with the student to discuss the overall areas and definitions of research. There were weekly meetings between the PI faculty mentor and student to review research assignments and expected learning outcomes. Questions and research challenges (i.e., mid-term testing, writing an abstract for poster presentation) were resolved during individual meetings with the PI faculty mentor.

The two students engaged in the NIH NINR pilot clinical trial attended bi-weekly and ad hoc research team meetings on the study’s progress (before the unprecedented COVID-19). Students were exposed to the coaching intervention training sessions. They read the published study protocol (Piamjariyakul et al., 2019), IRB-approved standard intervention script, and observed how the interventionist delivered the intervention. During these meetings, the team members discussed and resolved the common research challenges such as recruitment, enrollment, or missing data. In the meeting, students were introduced to each team member and observed the function of team science. Interaction with professionals from various fields provided networking opportunities for the students. The team discussed the need and importance of translating nursing research to practice through developing evidence-based nursing interventions. The student also worked under the supervision of doctoral students working on the project, one a graduate student from the Department of Epidemiology and the other from the WVU School of Nursing. One graduate student assisted in data collection and data entry. The other was trained to complete the intervention fidelity checklist to ensure the intervention was delivered as planned and as written in the intervention manual (Piamjariyakul, et al., 2019; Piamjariyakul et al., 2020).

The RAP student participating in research related to compassionate care of patients with substance use disorder met with the PI faculty mentor weekly by ZOOM (telecommunication system) to discuss the study’s progress and discuss the next steps in the research process. The RAP student had the opportunity to work with the PI faculty mentor, biostatistician, and serve on this project’s research team consisting of nurse leaders from WVU Hospital.

Searching and summarizing literature

The PI faculty mentor taught the RAP students to search peer-reviewed data-based articles in the PubMed Database on topics related to this study (e.g., impact of health literacy on chronic illnesses management, cultural specific care, evaluating psychometric properties of study measures, and current statewide policies on palliative care). Each student presented a table summarizing the findings from their literature search at team meetings. The students reported the importance of health literacy to nursing care and patient education through their literature reviews. The scarce resources that influenced people’s end-of-life palliative care in the rural region of this study were reported by a student in a poster shared at a statewide venue. The intervention research nurse discussed strategies, included in the intervention manual, to enhance cultural awareness when providing interventions for patients and families within rural Appalachia. Students observed the intervention research nurse on the use of coaching and teach-back mechanisms to ensure participants in the study understood the delivered content. This process enhanced students’ learning as it relates to the evidence-based literature used in the research intervention.

Similarly, the RAP student working on compassionate care of substance use disorder study was taught how to identify reliable online resources and search Cumulative Index of Nursing and Allied health Literature (CINAHL) and PubMed. The student was introduced to using a search log and synthesis table. The RAP student converted these documents into Google Docs to improve team efficiency and allowing the RAP student and PI faculty mentor to collaborate in real-time. Additionally, the PI faculty mentor assigned reading literature to enhance the RAP student’s knowledge of substance use disorder and the concept of compassion in nursing.

Collecting, entering, and analyzing data

The RAP students working with the NIH project observed the doctoral student to establish a database in REDCap, the secure online data entry platform. Students learned how to set up data parameters and to test mocked up data before launching the final data collection survey. The students entered the de-identified data into the REDCap under the supervision of the graduate nursing student. Students indicated they had learned the basic elements of the research process and models for applying evidence to clinical practice in their didactic evidence-based practice and research class. Students also observed how these basic concepts were used in this research study.

The RAP student working on the compassionate care of substance use disorder study spent a great deal of time immersed in the process of qualitative data analysis. Resources were provided, and detailed instructions were given to the student throughout the process. The student met with her PI faculty mentor weekly to review the progress and discuss the next steps. Additionally, the RAP student transferred quantitative data from the Qualtrics survey to an Excel spreadsheet and learned about data cleaning and analysis.

Developing dissemination skills

Disseminating research findings is another essential scholarly process. The RAP requires students to present their research experiences at the WVU Undergraduate Symposium during the spring and fall semesters. Each student selected a specific interest in palliative care and heart failure, and the PI faculty mentor helped students develop a professional poster presentation. One of the RAP students presented a poster related to palliative care policy, “Insight into the Decision of Palliative Care” at the Perspectives on Caring: Sociopolitical Engagement to Guide Action to Care Poster Gallery Walk, WVU School of Nursing, and at Political Action Day at the State Capitol in Charleston, West Virginia in 2019. Students learned how research influences policies to improve patients’ healthcare through presenting the posters and engaging with policymakers. Students underscored the following policy recommendations through their professional posters: (a) Funding mechanisms should be created to support palliative care research in order to improve health care in West Virginia; (b) Health care institutions should continue to emphasize the expansion of palliative care services within their organizations; and (3) Health professions educational institutions should assure that palliative care content is included in their educational programs. This student was invited to give an oral presentation to potential WVU students and their parents on WVU Decide Day in Fall 2019. This student shared personal experiences of engaging in research mentorship and highlighted research opportunities available to WVU undergraduate students.

The other student presented the ongoing research activities “Undergraduate Students Engaging in Coaching Palliative Home Care for Family Caregivers of Heart Failure Patients” at the WVU Spring and Fall Symposium in 2020. All students gave an oral presentation to fellow honor college classmates using the scientific method, including study background, hypotheses, methods, results of the study to date, and students’ research activities.

Encountering challenges and discovering opportunities for research during a global pandemic

The coronavirus disease 2019 (COVID-19) and the subsequent social distancing guidelines created a disruptive impact on our research activities since early March 2019. We were unable to enroll patients (in person) within the hospital and clinics due to COVID-19 restrictions to protect patients, healthcare professionals, and the rural Appalachian communities. The unprecedented pandemic has shifted all classes online, including the RAP accompanying course, and required students to return and stay at home (AACN, 2020; Carolan et al., 2020; Pickier et al., 2020). Recently, all undergraduate and graduate students working with our research team transitioned to remote work. The research team used an online scheduling application (i.e., Doodle polls) to check availability, scheduled meetings via ZOOM, streamlined research activities requests via the PI faculty mentor to monitor student’s workload and priority, used clear email communication and provided timely email responses to avoid disruption in the research process.

Discovering and integrating research

One RAP student described research as an “exhilarating field” in which discoveries could improve the quality of life of patients and their families and noted the application of the research to experiences in clinical courses. Our undergraduate researchers discussed the RAP experience helped to connect theory from their evidence-based practice and research course to the team’s research study.

Lesson Learned from Students ‘ Perspectives

Students described their goals, which were evaluated during the bi-weekly meetings with the PI faculty mentor. The PI faculty mentor also requested students to write an anecdotal note to reflect their learning experience in bi-weekly research activities logs. Content analysis was used to analyze students’ anecdotal notes. Content analysis is a method used to categorize the words or phrases of written narrative data. This type of analysis can identify the meaning and relationships of words or concepts (Krippendorf, 2004). Responses were reviewed for similar content and grouped under emerging topics. The PI (UP) and another faculty mentor (TAK) coded the data independently, met to discuss the codes, and achieved 100% agreement that each topic label was reached and free from biases (Brod et al., 2009).

Sample quotes of students’ learning experiences aligned with research training topics and procedures are shown in Table 1.

Table 1:

Sample Quotes of Students’ Learning Experiences

Research Training Topics and Procedures Students’ Sample Quotes
1. Conducting Responsible Research “This week I attended the virtual research workshop and sent my mentor notes I took on it. During the workshop I learned a lot about how to avoid plagiarism.” [S1]
“I completed CITI-Behavioral Responsible Conduct of Research and Good Clinical Practice…. I learned standard guidelines to protect human subjects in research.” [S2]
2. Engaging in Multidisciplinary Research Team “It was the first time I had ever worked with a large research team. I found it extremely helpful to learn by being immersed into the research.” [S1]
“I was given a deeper understanding into what my role will be within the research team and the role that the nurses play.” [S2]
3. Collecting, entering, and analyzing data “Data entry requires significant attention to detail. Students learned about the data collection, accurate and precise data entry, data storage, and safety and protection of human subject data.” [S2]
“Being taught how to use standard database such as REDCap was a great experience because I learned about data structure, parameter…it felt as if I was truly making a difference and fully part of the project!” [S1]
“This week I was rereading some of the interviews to look at whether or not our categories could be expanded in any way. I also learned how to use excel in order to do some data organization.” [S3]
4. Searching and summarizing literature “I assisted in summarizing aspects of our most recent study with heart failure.” [S2]
“This assignment helped me understand the importance of the data collections tool, its validity and reliability, and the details of the search process including copyrights status.” [S2]
“I looked for literature that would complement our study and looked for more interview quotes to include in our codes.” [S3]
5. Developing dissemination skills “I am very proud of being able to learn how to use PowerPoint for presentations and share my research experiences at the state capitol and other student colleagues. I learned how to write a scientific abstract and the standard presentation guidelines which I never did it before. I will apply this skill for my other nursing courses.” [S1]
“… editing research papers is obviously beneficial because it prepares me for if I have to start one of my own (paper) in the future.” [S2]
6. Encountering challenges and discovering opportunities for research during a global pandemic “There have been many challenges presented due to the limitations the COVID pandemic has set as far as working cohesively with a team. It was stressful to do everything online!! Team meetings would regularly be held in person where we could all get together and discuss issues/ tasks face to face, but now gatherings are to be avoided or kept at a distance as much as possible. We have had to get more creative with communication, i.e., via ZOOM meeting.” [S1]
“Gain new experience in virtual presentation.” [S1]
7. Discovering and integrating research “Being a nursing student, I care a lot about the holistic care and health of patients, so I felt a sense of pride being able to work with a project implementing palliative home care.” [S1]
“Being from rural West Virginia (WV), I could relate this literature to my personal experience and clinical nursing practices.” [S1]
“Research is an “exhilarating field” the discoveries will improve the quality of life of patients with heart failure and their families. [S2]
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*

S1 = student 1, S2 = student 2, and S3 = student 3

The opportunity to interact in the team meetings with multidisciplinary research team members (including cardiologist, palliative medicine, nurse interventionist, mental health specialist, clinical trial consultant, biostatisticians, and graduate student from the School of Public Health) was noted as an inspirational experience preparing undergraduate researchers to understand how each discipline contributes to solving pressing healthcare issues (Tingen et al., 2009). Further, the students also observed the dynamic of team communication, flexibility, and data monitoring throughout the project, which are essential to team science.

Students shared a sense of pride in participating in a project potentially benefiting patients with advanced chronic illness and their families. The students were proud to be a part of the research team and contribute to implementing the evidence-based practice they learned theoretically in their undergraduate evidence-based nursing course.

Discussion

Research is a key element of nursing education (Polit & Beck, 2017). Involving undergraduate students in research is an effective way to increase students’ interest in research, strengthen the quality of learning, and reduce misconceptions. Participation in the research process provided students with hands-on research experience, a chance to develop a new set of collaborative skills, and the opportunity to share research findings and experiences with fellow undergraduate students to encourage them to become involved in research.

Developing and implementing teaching strategies for research in undergraduate nursing classrooms is challenging. One effective method is the involvement of undergraduate nursing students in the faculty’s ongoing research projects. This method improves student perception about research, cultivates future nurse researchers, and supports the collaboration between students and faculty (Hickey et al., 2019). The following student supported learning through the mentorship process, “It was the first time I had ever worked with a large research team. I found it extremely helpful to learn by being immersed into the research.” During research mentorship, the students could relate their classroom learning to what they experienced in the research environment. One student stated that “Being from rural West Virginia (WV), I could relate this literature to my personal experience and clinical nursing practices. [S1]”

Evidence-based practice is the conscientious use of current evidence in making informed decisions about patient care (Hall & Roussel, 2014). Implementation science involves integrating the best research evidence and clinical expertise to achieve patient goals. It is essential for nurses to understand logical reasoning in research development to generate a high quality of evidence that informs clinical decisions. One student mentioned that “Research is an “exhilarating field” the discoveries will improve the quality of life of patients with heart failure and their families. [S2]”

The findings of this paper were consistent with previous literature showing students had many misconceptions about research before participating in the research process (Wuetherick & McLaughlin, 2011). The students not only thought the research process was intimidating and repetitive but felt excluded from research activities due to the lack of opportunities. One student said, “I had never attended a research workshop before, and honestly, I thought it would be boring at first, but quickly gained interest and was very grateful my mentor showed me it. [S1]”

Mentored research experiences prepare students to enter graduate programs which will benefit nursing research workforce and promote research scholarship in the future (Kessler & Alverson, 2014). A student noted that “I attended the research workshop, the topics talked about how to better (advance) research beyond undergraduate levels, so since I want to go to graduate school I also found that beneficial to me. [S1]” Increasing faculty awareness of research training opportunities such as the RAP in our university will promote research programs’ visibility and diminish misconceptions and challenges in learning nursing research. However, mentoring undergraduate students requires PI faculty mentor time and accountability of research activities, especially when the research involves human subjects.

Although faculty members might have concerns about working with undergraduate students, it has been shown that this partnership can benefit the students and increase faculty research productivity (Morales et al., 2017a). Mentors play a critical role in the successful outcomes of structured undergraduate research programs such as RAP, and studies have tried to understand what motivates faculty to mentor undergraduate students (Morales et al., 2017b). It is important universities, including the schools of nursing, find ways to recognize, motivate, and award faculty who serve as mentors to undergraduate students. Notably, student research mentorship is one of the criteria for the annual review of tenure-track faculty for retention, promotion, and tenure as specified by West Virginia University School of Nursing. Further, RAP is one of the Office of Undergraduate Research programs at WVU. Since 2016, the office sponsors the Faculty Award for Distinction in Mentoring Undergraduates in Research. The award serves to recognize, reward, and encourage faculty members who mentor undergraduate students in research and creative endeavors. The recipients are recognized with a monetary award for continued support of their undergraduate researchers.

The coronavirus disease 2019 (COVID-19) and the subsequent social distancing guidelines created a disruptive impact on research activities and student learning. A recent study conducted during the COVID-19 pandemic reported students feeling unprepared for online education, experiencing psychological distress and having poor resilience (Keener et al., 2020). These findings reinforced the need for PI faculty mentors to support, maintain open communication, and offer flexibility during these unprecedented times. PI faculty mentors must role model and assist students in caring for themselves, balancing competing demands, and prioritizing and achieving academic goals while learning research skills. Thus, research faculty must provide mentorship with empathy, help students to prioritize school assignments and home care responsibility, and allow flexibility to ease stressful circumstances and make students feel cared for (Keener et al., 2020, 2021; Taylor et al., 2020).

Although the COVTD-19 pandemic disrupted our personal, professional, and academic lives, we must acknowledge potential learning opportunities. Communication was tested when guidelines to mitigate the disease prevented us from meeting in person. Through technology, such as conference calls, we stayed connected and resolved schedule conflicts. Our student researchers adapted well to these changes and were able to follow directions and continue their important work. Lesson learned about conducting research during the COVID-19 pandemic can be used to adapt mentoring plans for students in the future without abandoning the important scientific work to improve health outcomes (Pickler, 2020).

Conclusion

This paper describes the research experience of undergraduate students who participated in an institutional structured undergraduate research program at a School of Nursing, with research faculty conducting an NIH-funded project and research related to national priority areas. Skills and experiences gained included completing NIH modules on responsible conduct of research, engaging in multidisciplinary research team meetings, collecting data, entering data, searching and understanding literature, gaining dissemination skills, and learning how the research influenced the policy to improve patients’ healthcare. Students also shared the benefits and challenges of research. The lessons learned, which are reported in this paper can be used to adapt mentoring plans for students in the future.

Acknowledgments:

We appreciate Dr. Carol Smith, PhD, RN, FAAN for her exemplar of research mentorship. We also appreciate the Office of Undergraduate Research at the West Virginia University for collaboration and fostering the undergraduate students’ research training. We recognize Miss Briana Hines for her participation in the RAP program and for sharing her learning experience.

Funding:

This work was supported by the National Institute of Health [Grant Number: R15NR018547-1, 2019]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

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Declarations of interest: none

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