Reflection on moving research forward during COVID-19: Strategies to continue, conclude and commence

Abstract

The COVID-19 pandemic required oncology nursing researchers to immediately and drastically adjust their research activities. During the 33rd Annual CANO/ ACIO Conference Roundtable Workshop October 2021 – Moving Research Forward During COVID-19, oncology nurses gathered to share and discuss strategies they will continue, conclude, and commence when leading research during and beyond the pandemic. Workshop participants identified the use of low technology, such as telephone and virtual calls without video, as a valuable data collection strategy they will continue for individual interviews. In contrast, attendees expressed their desire to stop conducting virtual focus groups when public health measures are lifted. Oncology nurses indicated an interest in beginning to use a hybrid in-person/virtual data collection approach and incorporate some technological features, such as QR codes, for recruiting participants. Workshop attendees also reflected on the impact of COVID-19 on oncology nursing practice and education, highlighting future research priorities and considerations.

BACKGROUND

The nursing profession has faced unprecedented challenges during the COVID-19 pandemic. In addition to their pivotal role in responding to the clinical burden of this public health crisis (Paterson et al., 2020), oncology nurses also have worked diligently and creatively to move important research forward during pandemic times. Urgent public health measures to decrease viral transmission, such as physical distancing, directly impacted research conduct across all fields, including cancer care (Waterhouse et al., 2020). With necessary restrictions in place, research ethics board reviews and amendments faced delays, data collection procedures were put on hold, and travel was temporarily suspended (Spagnolo et al., 2020). Oncology nurses adapted old and adopted new strategies to continue moving research forward during COVID-19, including the use of new technologies to aid in virtual recruitment and data collection, as well as innovations to support remote team collaboration (Maheu et al., 2021).

During the 33rd Annual CANO/ ACIO Conference Roundtable Workshop – Moving Research Forward During COVID-19, oncology nurses gathered to share their experiences with conducting research in the context of COVID-19, reflect on insights gained, and discuss key lessons learned. The reflection publication by Maheu and colleagues (2021) served as a starting point for discussion and information sharing. The aim of the workshop was for participants to share and acquire knowledge of new tools and strategies they could integrate into their own research. The workshop was conducted in an interactive, virtual format where participants could discuss the strategies oncology nurses will continue, conclude, and commence when leading research during and after the pandemic. Workshop attendees also reflected on the impact of COVID-19 on oncology nursing practice and education, highlighting future research priorities and considerations. This reflection column will highlight key insights from the workshop discussions and potentially useful strategies to support nurses leading research in the context of COVID-19.

CONTINUE

The COVID-19 pandemic illuminated several strategies that proved useful when in-person research was immediately disrupted. The primary strategy that participants expressed they would continue to implement beyond the pandemic was the use of low technology, such as telephone or virtual calls (with or without the use of video features) for individual interviews. These approaches were described as valuable, allowing researchers to collect rich, high-quality data while decreasing the time and travel burden on participants. In contrast to the primarily in-person data collection procedures used before COVID-19, low technology allows research participants to schedule interviews at more convenient times and reduces the need to travel, which were highlighted during the workshop discussion as particularly important considerations for patients and families living with cancer. This approach also allows nurse researchers to overcome geographical barriers, recruit without space boundaries, and ensure the representation of diverse samples in a cost-effective manner while minimizing time and travel commitments for themselves. Workshop attendees highlighted that low technology can be particularly beneficial when speaking about potentially sensitive topics, as this method of data collection empowers study participants to control whether they wish to be seen or observed. Providing participants with the choice of enabling video during virtual calls was described as a potentially useful strategy to address the power imbalance that sometimes exists between researchers and study participants. While the benefits of virtual methods depend on participants’ access to these technologies, which is a potential limitation, this approach was seen as an important option to supplement in-person data collection approaches moving forward.

CONCLUDE

Although the pandemic highlighted potentially valuable approaches for oncology nursing researchers, not all strategies they applied during this period of time were seen as effective. In contrast to the benefits described above regarding remote individual interviews, workshop participants expressed their intention to no longer conduct virtual focus groups when public health measures are lifted. When compared to in-person focus groups, workshop attendees identified that online platforms may lead to decreased participant interaction. Attendees perceived that some virtual focus group participants may feel uneasy discussing divergent perspectives because of varying comfort levels with the platform, challenges with interpreting body language, and the ability of more dominant participants to occupy voice space in the virtual setting. While in-person focus groups usually allow for informal time before, during, and after data collection to promote participant interaction, attendees discussed that focus group facilitators may require different skills to effectively establish group cohesion in virtual settings, where it can be more difficult to engage in organic conversations. The use of two or more moderators has been identified as a potentially beneficial strategy to facilitate group discussion, probing, monitoring, and troubleshooting during virtual focus groups (Tran et al., 2021). Workshop participants expressed a desire to return once again to using informal strategies, such as providing breaks with refreshments, to increase comfort levels and facilitate group dialogue.

COMMENCE

During the workshop, oncology nurses conducting research in the context of COVID-19 had the opportunity to learn various strategies from fellow participants and collectively discuss emerging research approaches they might initiate moving forward. As public health measures are lightened, several attendees highlighted their intention to start using hybrid data collection approaches, incorporating the merits of both in-person and virtual methods described above. The workshop also provided an opportunity to share tips and tactics for maximizing the use of newly adopted technologies. Attendees expressed they would consider adopting technological features, such as QR codes and online programs (e.g., Qualtrics, REDCap) to enhance study recruitment, obtain informed consent, and promote higher response rates. While many were using online surveys, the use of QR codes to facilitate participant access to surveys was another new strategy for some.

DISCUSSION AND RESEARCH PRIORITIES

Workshop participants, many of whom were graduate students or held academic positions at Canadian universities, also discussed the impacts of COVID-19 on nursing students. Dialogue among participants highlighted that graduate student research has been particularly impacted by the pandemic, with repercussions being highly dependent on the stage of the research study, the methodology being used, local sanctions on research activities, and frequent research ethics board amendments required to address evolving public health measures. Workshop participants also acknowledged that pandemic-related demands on the healthcare system resulted in many graduate nursing students facing challenges when balancing their studies with their increased clinical work hours. Nursing workforce shortages and redeployment have inevitably had an impact not only on nurses’ mental health and wellbeing, but also on their ability to progress in their studies and move graduate research forward during COVID-19. Some of the new research strategies discussed during the workshop (e.g., hybrid data collection) are now being built into student projects to facilitate resilience against future disruptions.

Participants also discussed the impacts of COVID-19 on their ability to conduct research focused on the practice of oncology nursing. Oncology nurses engaging in participatory research approaches and those conducting research at the point of care articulated the ethical dilemma of burdening an already heavily encumbered workforce with requests to participate in research. This was identified as especially challenging, despite research being necessary to inform nursing practice, policy, and education both during and after the pandemic. In line with established research priorities for oncology nurses in the context of COVID-19 (Zanville et al., 2021), workshop participants articulated the pressing need to evaluate emerging care delivery models (e.g., team-based nursing, virtual care) on patient and workforce outcomes. Research in this area is essential to guide current and future healthcare delivery. Top of mind for oncology nursing attendees was also the urgent demand for innovative approaches to prepare qualified nurses and fill growing workforce vacancies. Workshop participants echoed the need for such innovations to be firmly rooted in evidence, calling for research to understand the effectiveness and optimal delivery of virtual and simulation-based nursing education.

CONCLUSION

Despite posing extraordinary challenges, the COVID-19 pandemic has illuminated new perspectives, strategies, and priorities for oncology nursing research. The CANO/ACIO Roundtable Research Workshop provided a supportive platform for oncology nurses to reflect on research practices they may continue, conclude, and commence, as they lead research initiatives both during and beyond the pandemic. This workshop highlighted that oncology nurses are and will continue to be leaders in scholarship, research, and cancer care.