Commentary: Priorities for research during the Coronavirus SARS-CoV-2 (COVID-19) pandemic and beyond: a survey of nurses, midwives and health visitors in the United Kingdom

The coronavirus disease 2019 (COVID-19) pandemic has been the greatest single health challenge of my working life. The total number of people infected in the United Kingdom (UK) is unknown as community testing was suspended for much of 2020, but over 4.5 million people have tested positive (DHSC 2021). There have been over 460,000 hospital admissions (DHSC 2021) and around 500,000 people in the UK reporting Long Covid symptoms that last for more than 6 months (ONS 2021). Nurses are at the forefront of meeting the challenges around this disease and should be equal partners in setting the emergent research and policy agendas.

Early research efforts assumed that Covid19 would follow a known trajectory of previous respiratory infections and yet we have come to learn over the past year that it is a multisystem disease in both the acute and chronic phases. The enduring symptoms can leave people unable to work, to undertake activities of daily living independently and to care for dependents (NIHR CED 2021). Enduring symptoms may be tipping people with frailty into care dependency, with profound implications for health and social care services making this a major public health issue.

This paper describes a cross sectional survey of 1296 nurses and midwives, undertaken at an early stage of the pandemic (May 2020). The self-selected sample of predominantly female, registered nurses of white British ethnicity, located in England and working for acute care providers will likely reflect nurses’ experiences of caring for hospitalised patients in the first wave in the UK. However, given the at least a tenfold difference in the number of people who contracted COVID-19 and stayed in the community and those admitted to hospital, this is at best a partial view and a survey of community and social care nurses would probably identify different priorities.

Whilst supra ordinate themes have been identified by the authors, there appears to have been little consensus amongst respondents about priorities, with 3444 research priority recommendations from 1296 people with each of the subthemes mentioned by between 1% and 22%, suggesting a lack of common priorities within the respondents. Conducting this enquiry as a rolling Delphi study (Allan et al. 2020) to rank order the suggestions and to dynamically update them as our understanding of the condition evolves may have been more reflective of changing assumptions about research needs.

The authors note that the nursing voice has been absent from policy and research priority settings, although the respondents to this survey raised many concerns that have been raised by other professions as well patient groups, managers and policy makers. Whilst nursing and midwifery have unique perspectives, COVID-19 is complex and cannot be solved by a uniprofessional approach. The paper does not attempt to situate the themes within the already commissioned and published research on COVID-19 and its sequelae, nor the wider COVID-19 research priority setting, and it is unclear how the themes will be used to influence multiagency research commissioners.

This raises the age-old question, should nurses be contributing to research in general and exploring the nursing contribution to healthcare as part of much larger studies or should there be ‘nursing research’ that stands alone and not integrated into the wider research economy? Larger studies with multiple arms attract more funding and have wider impact on policy makers. If these studies do not currently have nursing sensitive objectives it behoves nurses to engage with their colleagues more not less.

Nursing brings a different lens and must absolutely play a leading role in research and research commissioning. But nursing alone is not sufficient to address the research questions raised by COVID-19 and nursing must take its seat at the multi professional research table to ensure a ‘gestalt’ where the sum of research activities is more than the total of the individual parts.

Biography

Elaine Maxwell is Scientific Advisor to the National Institute for Health Research. She is the author of the two NIHR reviews of Long Covid.