Pivoting Nursing Research and Scholarship during the COVID-19 Pandemic

Abstract

Background:

The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health.

Objective:

The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic.

Methods:

Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research due to the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale.

Results:

Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline due to additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic.

Discussion:

Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.

The novel coronavirus pandemic (COVID-19) is having devastating effects on public health and healthcare across the world. As of November 19^th 2020, more than 55 million people worldwide have tested positive for the virus and more than 1.3 million have died due to viral complications (World Health Organization, 2020). In the United States (US), the Centers and Disease Control and Prevention report that approximately 11.3 million people have tested positive for the virus that causes COVID-19 (SARS-CoV-2) and more than 247,000 have died (Centers for Disease Control and Prevention, 2020). Many states continue to see high case volumes, and hindsight will reveal that some pandemic projections were woefully underestimated (Stubinger & Schneider, 2020).

In nursing and other healthcare disciplines, the COVID-19 pandemic has not only had substantial effects on direct patient care but has also severely disrupted research and scholarship. Funding agencies such as the National Institutes of Health (NIH) have recommended limiting study visits, conducting virtual study visits, canceling large gatherings, and limiting or suspending unnecessary travel to promote the safety of researchers, staff, and participants (National Institutes of Health, 2020). Similar recommendations have been made by hospitals and academic institutions that are both research sites and employment settings for researchers. Challenges to conducting research involving human subjects (e.g., patients, community participants, etc.) are likely to have affected researchers from other disciplines including delays in enrolling participants, delivering interventions, and collecting data (Marcum et al., 2020). While funding agencies are being flexible and sensitive to the challenges of conducting research during the pandemic (National Institutes of Health, 2020), many investigators are experiencing stress and frustration as they navigate the new reality of altering their research plans and protocols while balancing new professional and personal responsibilities. Additionally, many investigators are experiencing decreased scholarly productivity due to increased personal responsibilities and the psychological distress accompanying the pandemic. Decreased scholarly productivity is particularly concerning for women in academia (Gabster et al. 2020), and predominantly female professions such as nursing are likely to experience substantial disruptions to their research progress.

Despite the challenges of conducting research and maintaining scholarly productivity during this unprecedented crisis, investigators and institutions must make many necessary changes to minimize disruptions and help ensure continued scientific progress. Strategies for overcoming challenges in conducting research are also imperative for ensuring that nurse scientists can address some of the most pressing priorities for nursing science in the COVID-19 era (Pickler et al., 2020). In this article, we present how the University of South Carolina (UofSC) College of Nursing (CON) and its faculty have been affected by and responded to the challenges of conducting research during the COVID-19 pandemic (Figure). We believe that our experiences and lessons learned may be helpful to other institutions and researchers who are facing similar challenges during this pandemic.

Figure.

Pivoting Nursing Research and Scholarship during the COVID-19 Pandemic

The UofSC CON is centrally located in the capital city of Columbia, South Carolina in the southeast US. The University is designated a very high research doctoral university by the Carnegie Classification of Institutions of Higher Education (2018), and in 2019 the CON ranked 36^th nationally among all schools of nursing for NIH funding. Many faculty members also have substantial funding from non-federal sources, diversifying the CON’s research portfolio. The CON employs 62 full-time faculty members with approximately 98% of those holding a doctoral degree. Approximately 1,750 students are currently enrolled across the CON’s undergraduate and graduate programs that include the Bachelor of Science in Nursing (BSN), Master’s and Certificate Programs, the Doctor of Nursing Practice (DNP), and the Doctor of Philosophy in Nursing Science (PhD). The CON has recently experienced substantial growth in its research and scholarship as a result of several strategic initiatives and strong leadership (Andrews et al., 2019; Pinto et al., 2020).

Responding to the Challenges in Conducting Research

Contacting Funders and Regulatory Bodies

On April 8, 2020, the Office for Human Subjects and Research Protections published guidance on COVID-19 encouraging the research community to prioritize public health and safety. The guidance focused on four major categories: Public Health and Clinical Activities, Research Changes to Eliminate Apparent Immediate Risks, Proposing and Removing Study Changes, and Whether Suspensions of Research Must be Reported. Consistent with this guidance, several CON faculty members contacted funding organizations to discuss necessary changes to research protocols to help ensure participant safety. Some funders held COVID-19 investigator forums where investigators discussed the effects of the pandemic on targeted communities, necessary protocol changes, and the effect of the pandemic on study outcomes. In addition to communicating desired or necessary changes to funding agencies, CON investigators contacted and worked with their institutional review boards (IRBs) to ensure their study protocols optimized patient safety while maintaining scientific integrity. The UofSC IRB was prompt in responding to faculty questions and in processing amendments to study protocols.

Recruitment and Enrollment

Many studies required new approaches for participant recruitment and enrollment due to fears about virus exposure and the effects of social distancing and shelter-in-place orders. Some investigators had originally been attending community events to engage with potential participants about their research. For example, one investigator had attended farmers’ markets, local fairs, and church fellowship gatherings to recruit participants into a study addressing obesity among African American men living in the rural South. Many of these events were cancelled due to COVID-19, which required increasing virtual outreach through social media and presenting to community groups having virtual meetings. In another study, recruiting adult survivors with lung cancer and their family members (often with health histories that include co-morbidities) to a 12-week home-based multiple behavior change intervention study needed minor modifications to the enrollment process. Two in-person visits were required for enrollment and orientation, and two more visits were required at the end of the study. After a 3-month recruitment pause the process was restarted in June 2020. With IRB approval, the protocol was amended to protect participants and the research team involving the following changes: (1) in-person visits are limited to one visit, (2) face coverings are required (masks and shields will be offered to participants), (3) a private room (somewhat isolated) in the cancer center that allows 6 feet distancing is being used, (4) consent forms are mailed to participants prior to the visit, (5) questionnaires and outcome measures are administered at the visit, and (6) all study equipment is distributed at the visit and returned by mail using pre-paid packaging that is given to participants. During the pandemic surge in July 2020, the process was modified again to maximize the use of mail and telephone and the single in-person visit was dropped.

Alternative Consenting Processes

Obtaining consent from participants during the COVID-19 pandemic presents a unique situation as the process is typically handled in-person. Due to limitations with in-person interactions, researchers require creative options for obtaining consent from participants. One option our faculty has used for written informed consent involves the secure Research Electronic Data Capture (REDCap) web application. It offers a framework for collecting electronic consents (eConsent) and securely storing the completed consents. REDCap eConsent offers a variety of design options such as branching logic, in-line descriptive pop-ups, avatars, and embedded videos (Lawrence et al., 2020). Potential participants are sent a secure link to access the eConsent, which allows them to review, complete, and submit the consent. Once the participant submits the consent, the participants receive a PDF copy of the completed consent while researchers have a secure repository of completed consents.

Data Collection, Storage, and Analysis

There are many methodological challenges related to collecting, storing, and analyzing data during a pandemic. Due to safety issues with COVID-19, faculty at the UofSC CON turned to alternative data collection methods such as phone, online meetings, email, text, social media, or online surveys to help protect participants and researchers. Collecting, cleaning, and merging data from off-site locations also presented unique challenges and required complex data management to ensure privacy and data security. For example, researchers must be attentive to potential privacy and security breaches when using current technological platforms. One solution is using Privacy by Design principles, Privacy Impact Assessments, or other guidelines to identify potential risks or gaps in privacy (Bender et al., 2017; Benton et al., 2017). Research teams had to develop proactive strategies for preventing data breaches, restricting data access, data encryption, as well as deleting unused data, only collecting essential data, using different passwords, and testing vulnerabilities at every level of the system. Researchers working from home needed to adhere to maintaining confidentiality of data including storage of paper documents such as consent forms, contact sheets, and incentive receipts that contain personal identifying information. As required by the IRB, documents were stored securely in a safe or locked file cabinet.

Another concern is access to a secure and encrypted server to store and back up data while providing remote access. Researchers at the UofSC CON increasingly rely on cloud computing that offers remote data access using encryption and security measures. The security measures include verification methods for authorized users in the research team such as two or three factor authentication (Priya & Gunasundari, 2017). Additionally, encryption in the cloud computing adds another layer of security by using a statistical algorithm to encode data into cipher text. Further, cloud computing allows data analysis of identified data in a secure environment. This prevents the unintentional release of identifying information while allowing proper and advanced statistical modeling to minimize study bias. Faculty worked closely with data managers and statisticians to ensure that safeguards were in place.

Timeline Implications

The COVID-19 pandemic and its associated disruptions to the research process have had substantial effects on study timelines. Many studies were temporarily halted as researchers attempted to navigate the changing academic landscape and adhere to shelter-in-place orders. Most healthcare facilities prohibited human subjects research that was nonessential for patient health, and community organizations closed their doors to activities involving in-person interactions. Key informants and other members of targeted populations began to express concern about participating in research requiring in-person activities, whereas others were suffering from economic hardship and struggling with the health effects of the pandemic. These factors diminished enthusiasm for participating in research, even after remote alternatives were implemented. Consequently, some investigators fell behind schedule and will need to expedite research activities within existing timelines or request extensions from funding organizations. Fortunately, many funding organizations including the National Science Foundation and the NIH have been sensitive to the effect that COVID-19 is having on project timelines and are being flexible with project extensions, costs, and deadlines for some applications and reports. Some PhD nursing students have also experienced challenges that may negatively affect their dissertation and graduation timelines. One student who was assessing hospital food environments encountered barriers entering certain facilities and therefore had to prolong data collection. The student experienced heightened pressure to write and defend her dissertation to graduate on time. Similarly, an undergraduate student who received funding from the Office of Undergraduate Research had planned a project that required home visits to older adults. He had to entirely change his research topic and he will be on a tight timeline to complete the project prior to his December 2020 graduation.

Dissemination

Scholarly productivity has been both positively and negatively affected by the COVID-19 pandemic. Faculty members whose research has slowed due to recruitment challenges or the inability to conduct research have had more time to allocate for writing. Some faculty members have been able to finalize and submit manuscripts that have been lingering, whereas others have used the extra writing time to develop new manuscripts that would have otherwise never been drafted. Some faculty have been writing manuscripts including literature reviews, commentaries, and letters to the editor that do not require an existing data source. Others have been able to use existing data or publicly available data to generate and disseminate original, empirical research. Some faculty members, though, have experienced delays in the peer-review process and have been informed by editors that securing peer reviewers has been a challenge.

While some faculty members have increased their scholarly productivity during the pandemic, others have experienced a substantial decline. Those with young children experienced challenges balancing their careers with increased childcare responsibilities. Many parents spent more time at home facilitating their children’s education, whereas some who relied on daycare no longer had this resource. These challenges to maintaining productivity have been particularly felt among the female faculty, which is consistent with reports that women’s academic careers are disproportionately disrupted by the pandemic (Gabster et al., 2020). Other faculty members have assumed increasing caregiving responsibility for parents or other family members during the pandemic. Balancing these increasing responsibilities have been especially challenging for faculty with partners who are also working from home and experience similar caregiving responsibilities. The pandemic has also adversely affected the psychological well-being of faculty, particularly African American and faculty of color who simultaneously suffer from the effects of racism while being disproportionately affected by COVID-19 (Stokes et al., 2020).

The COVID-19 pandemic has also affected whether and how faculty have been able to disseminate their research at professional conferences. Many conferences were cancelled or offered virtually for 2020, and others have already planned for virtual offerings in 2021. While some UofSC CON faculty have been able to present their research at virtual conferences, others have been unable to present due to conference cancellations. Experiences presenting at virtual conferences has varied, with some faculty members being unable to interact with attendees due to pre-recording their presentations and others having a more traditional experience presenting to a live audience with engagement opportunities. Due to the increased volume of virtual meetings and events, many faculty members are now experiencing “virtual meeting fatigue,” and some are opting to not attend conferences that they have historically attended.

Grant Writing and Funding Opportunities

The global magnitude of the COVID-19 pandemic on health and healthcare prompted funding sources from local (e.g., College, University, community foundations) to national and international (e.g. NIH, Agency for Healthcare Research and Quality [AHRQ], Pfizer’s Competitive Grants Program, Bristol Myers Squibb Foundation) to release new funding opportunities, expand existing opportunities, and/or support existing programs to include COVID-19-related research or research affected by the pandemic. NIH began devoting some of its regularly appropriated funds to COVID-19-related research activities and received over $1.75 billion emergency funding for COVID-19 research as early as April 2020 (Lauer, 2020). Available COVID-19 funding poses both opportunities and challenges for researchers. Faculty must decide if and how such funding may fit into their larger programs of research. If funded, the research may complement existing inquiry while extending knowledge. However, if not funded, the time and energy expended might detract from their overall productivity and slow progress on their current trajectory. Another consideration in weighing the risk and benefit of initiating COVID-19-related research is whether funding for non-COVID-19 research will be even more scarce and more competitive in the future. Some funding organizations, particularly those that receive public funding, may be able to sustain or increase their research budgets (Stoye, 2020), while others, such as non-profit organizations, may need to reduce research expenditures (Stoye, 2020; Webster, 2020). Finally, many COVID-19-related requests for proposals, whether local or national/international, have very short submission timelines requiring research teams to divert much of their time and resources to meet deadlines while grappling with other demands of the pandemic in both their personal and professional lives. Thus, in our experience, applying for such funding has been dependent on individual programs of research as well as faculty members’ personal situations.

Career Implications

The “career shock” of COVID-19 (Akkermans et al., 2020) and other current events surrounding social injustice has been felt among all faculty at the UofSC CON and across the world. Many pre-tenured faculty members who have not met their unit’s criteria for promotion and tenure have felt added pressure to publish and obtain grant funding as a result of decreasing productivity during this time of crisis. Conference cancellations have also led to some faculty members being unable to disseminate their research, while others have had the opportunity to present at conferences that were offered virtually. Concerns about the career ramifications of conference cancellations may be eased, to some extent, with organizations recommending that peer-reviewed and accepted presentations for cancelled conferences be included on curriculum vitas (American Psychological Association, 2020). In addition to the career implications of research disruptions, faculty members have expressed concern about receiving negative course evaluations as courses transitioned from an in-person to an online format. Organizations such as the American Federation of Teachers and the American Association of University Professors (2020) have published principles pertaining to higher education’s response to COVID-19 and argue that faculty should be protected against negative actions arising from poor teaching evaluations. Our University allowed student evaluations from the 2020 spring semester to be omitted from tenure portfolios. In addition, the added stress of achieving tenure metrics may have been mitigated to some extent as our University automatically extended all tenure-track faculty members’ probationary periods by one year. Many other universities across the US and in other countries have adopted similar practices to delay or extend tenure clocks due to disruptions caused by the COVID-19 pandemic. Despite these efforts, many pre-tenured faculty members will experience an increase in stress as they work to overcome the numerous challenges of conducting research and teaching during the pandemic. These challenges are likely to be most felt by female faculty, and some have advocated for additional resources including flexible work schedules, workload modifications, and increased access to child or family care to better support women during this time of crisis (Woitowich et al., 2020).

Tenured faculty members are experiencing a different set of challenges than those of their pre-tenured colleagues. Many of the tenured faculty members at the UofSC CON were affected by the University furlough that applied to 9-month faculty earning at least $118,000. The University adopted a tiered approach in which faculty earning between $118,000-$199,999 are scheduled to be furloughed for 10 days for the 2020-2021 academic year whereas those earning at least $200,000 are scheduled to be furloughed for 20 days. Many tenured faculty members, particularly those serving in leadership positions, have also seen an increase in the number of meetings they must attend to ensure the CON runs effectively during this time. These additional meetings have taken up faculty time that could have otherwise been spent on pursuing scholarly activities.

Both pre-tenured and tenured faculty members have experienced other time demands and constraints that have affected their ability to fulfill their regular academic obligations. Faculty members serving on the CON’s Diversity, Equity, and Inclusivity Committee have increased their meeting frequency and outreach in response to issues surrounding racial injustice. Other faculty members have expended substantial time and effort as they transition their courses from in-person to online delivery. In addition, faculty have spent significant time learning about and navigating different technology platforms that have been used to enhance communications during the pandemic. Meetings both internal and external to the University have been held using Microsoft Teams, Zoom, Blackboard Collaborate, Skype for Business, Adobe Connect, and GoToMeeting. Faculty members with international collaborators have felt the effects resulting from variations in how countries have responded to the COVID-19 pandemic. For example, Melbourne Australia implemented a second lockdown prohibiting residents from leaving their homes for six weeks for nonessential reasons (BBC News, 2020). This has affected the timeline of multiple co-authored manuscript submissions between faculty members at the UofSC CON and the Swinburne University of Technology.

Communication during the COVID-19 Pandemic

Communicating with Mentors, Peers, and Research Team Members

Clear and frequent communication is required to conduct high quality, rigorous research. Communication is necessary between team members, among mentors and mentees (students and junior faculty), and among colleagues who are sharing perspectives, findings, and learning from one another. Traditionally, most communication has been through in-person dialogue, although in more recent years it is often supplemented by video or voice communication. The COVID-19 pandemic halted in-person meetings in March 2020, and as of November 2020 in-person meetings remain an exception. This change has resulted in many doctoral students feeling isolated from their faculty mentors, particularly highly engaged students who often had more frequent in-person interactions due to being directly involved in assisting faculty with their research. In response, faculty members have been more deliberative about offering virtual meetings more frequently to help mitigate the sense of isolation that has emerged due to decreased in-person student interactions.

Establishing and maintaining relationships and trust is essential for effective research teams and mentoring relationships. While it is often tempting to get right to the agenda of a meeting, it has been important for us to check in with team members, colleagues, and mentees as the start of each meeting to engage in informal relationship-building conversation (e.g., How are you doing? What are you doing in your time off during the pandemic? How was your weekend?). These types of conversation often happen informally in hallways or directly before and after meetings and serve to promote trust and cohesiveness between team members and among colleagues. In a virtual environment we need to purposefully build this into our interaction/meeting time. Other challenges to virtual meetings include connectivity problems, interruptions created by working from home (e.g., family demands, barking dogs), and waiting for everyone to join the meeting. Navigating differing videoconferencing platforms from multiple vendors may reduce meeting efficiency and effectiveness. Finally, we found that email communication has become increasingly necessary. Appropriate email etiquette is especially critical as we contend with the pandemic and the heightened awareness of racism and social injustice.

College and University-Level Communication

At the senior leadership level of the CON, the Associate Dean for Research (ADR) first launched an FAQs in the weekly Office of Research e-newsletter to keep faculty informed on the latest developments that support research within the university (e.g., sponsored awards management), and at funding agencies regarding grant due dates, policies concerning on-going research disrupted by the pandemic, as well as effects on grant supported staff, among others. The FAQs were updated each week. They were replaced by a “drop in” Zoom meeting that the ADR hosted once a week called “Resilience in Research.” This meeting was open to all faculty and staff who could no longer “drop in” to the ADRs’ office with research-related questions. The one-hour meeting was also used as a venue for presentation on tools needed to continue human subjects’ research (e.g., the IT director presented on using Microsoft Teams) and monitoring post-award grant budgets and expenses. Attendance varied at these weekly meetings (range 2-8 attendees per meeting). The meetings were offered particularly for junior faculty who may not have been part of well-established research teams to learn from each other about current challenges in conducting their research (e.g., replacing focus groups with individuals interviews conducted via videoconferencing or by phone; assessments via regular mail or by phone) and problem solving as a group.

The Operations unit at the CON also acted swiftly with the assistance of the ADR to address data storage. The requirement to work remotely created urgency for faculty to access and analyze data stored on the HIPAA-complaint server hosted by the University’s Department of Information Technology. Guidelines for accessing these data for off-site analyses were developed, faculty input was solicited, and the guidelines were then reviewed and approved by the HIPAA Compliance Officer at the University. In the same manner, staff in post-award management alerted faculty to plan and implement any needed reductions in grant-funded support for themselves and research staff since face-to-face recruitment, data collection and intervention delivery were no longer feasible.

In May 2020, the ADR along with a volunteer group of faculty (Research Taskforce convened in response to the Dean’s request) developed a short survey to understand faculty needs, plans to return to campus, and resources needed to mitigate risk. The Research Taskforce used these data to develop recommendations for resuming research on-site and off-site with risk mitigation. The ADR presented these recommendations to all faculty and staff via videoconferencing in late May. The ADR also provided seed funds to support a college-wide initiative headed by three faculty to develop an app for COVID-19 symptom tracking and referral for the first group of nursing students to return to attend on-site classes in June 2020.

At the university level, the Vice-President of Research’s (VPR) office initiated a process for requesting permission to continue specific research activities on campus that were deemed essential. These exceptions were required when the SC Governor issued a “stay and shelter” directive. The faculty and staff at the CON were able to continue their research efforts while working remotely and did not request “essential” service designation. The VPR’s office began providing a weekly e-memo outlining latest news from funding agencies, FAQs and university-specific resources. This weekly memo was included in the OR weekly e-newsletter. In April, the President of the University set up several groups to plan for the resumption/re-opening of the university, academic units and all ancillary services that support the tripartite missions (teaching, research and service) of the university. One group was charged with determining “How to plan and deliver world-class academics & research in the safest and most practical environment.” An ad-hoc subcommittee was set up on May 6, 2020 to concentrate on research-specific issues and serve in an advisory capacity to help ensure that the research enterprise maintained or grew momentum despite the challenges raised by the pandemic. This goal was consistent with the University’s Carnegie R1 classification (i.e., doctoral university of “very high research activity”). The subcommittee included the ADRs of several colleges (including the CON’s ADR) and other stakeholders, led by the Director of Sponsored Awards Management and Research Compliance and the Vice President of Research. This subcommittee discussed and provided guidance on how to resume research operations (for the spectrum of research ranging from basic to community-based research activities) and mitigate risk. The guidelines addressing “how to” resume research activities were released on June 2, 2020 to all faculty and staff at the university.

Maintaining Morale and Well-being

The COVID-19 pandemic has negatively affected the mental health of populations across the world (Chen et al., 2020; Rees & Fisher, 2020). At the UofSC CON, faculty and staff have felt the mental fatigue of living through the pandemic and have struggled with reduced collegial connections during a time in which such support is highly needed. Despite having fewer opportunities for in-person interactions due to home confinement, faculty members have adopted several practices to maintain morale and promote well-being during this challenging time. Faculty members have organized multiple virtual lunch meetings, after-work social gatherings, and celebratory events, which have helped maintain collegiality and positive morale. Some faculty members have designated work and off-work hours to preserve a sense of normalcy and to establish necessary boundaries for maintaining work-life balance. Self-care strategies that have been adopted by our faculty include counseling and therapy, increasing physical activity through activities such as walking, running, and cycling, and decreasing social media consumption, and meditation.

Conclusion

The novel COVID-19 pandemic has significantly disrupted the research and careers of nurse and other health profession scientists across the world. Without effective strategies to overcome the challenges posed by COVID-19, the critical scientific progress and advancements needed to improve health may stall and not reach its full potential. Faculty members at the UofSC CON have adopted several key strategies to minimize the extent to which their research, scholarly productivity, careers, and morale are negatively affected by the COVID-19 pandemic. Individual-level adaptions have been supplemented by multiple University- and College-level strategic initiatives to support the research enterprise. Our experiences in pivoting research during the COVID-19 pandemic can serve as a helpful exemplar for the nursing research community as it attempts to respond to the challenges brought forth by this unprecedented crisis.