Angeline Price is an Advanced Clinical Practitioner and PhD student with a project exploring the impact of emergency laparotomy for older people living with frailty. She’s blogged about her experiences developing her research career.
My experience of research seemed to come from nowhere and suddenly went from 0-60 mph!
After qualifying as a nurse in 2009 I worked in purely clinical roles and had been relatively unfamiliar with the research process, or how I might contribute. This changed when I moved into Ageing and Complex Medicine in 2016 to train as an advanced clinical practitioner (ACP). Becoming an ACP meant I was required to demonstrate competence across the four pillars of advanced practice: clinical, education, leadership and research.
My journey into research began while I was completing the MSc in Advanced Clinical Practice programme. I became involved in a local service evaluation project that reviewed the outcomes of older people living with frailty who had undergone an emergency abdominal surgery (emergency laparotomy). Part of my clinical role included reviewing this group of patients on the surgical wards post-operatively. Large scale research has shown that 30-day mortality and hospital re-admission rates are significantly higher for these patients than for those who are younger, and our local project found that the risk of death was even higher at 12 months.
The project was published in a peer reviewed journal, with me as a co-author. But it was also submitted to geriatric medicine conferences to be presented as a poster. Thanks to a nurse’s study grant from the British Geriatrics Society I could attend some of these conferences, answer questions about the poster and meet clinicians who were also interested in this area, gaining insight into what work was occurring nationally.
I started to become more engaged with work on a national level – applying for committee positions within the British Geriatrics Society and Royal College of Nursing, writing blogs and newsletter pieces about my role, along with CPD articles for nursing journals. This led to me being invited to speak at conferences about my role as an ACP in frailty and emergency laparotomy and contribute to the development of national guidelines on the perioperative care of people living with frailty.
When the covid-19 pandemic came along, it brought with it the opportunity for me to develop my skills in formal research. I was invited to contribute to an observational study into the influence of frailty on outcomes for older people admitted to hospital with covid-19.
I was responsible for screening patients locally to identify those who were eligible for inclusion, collecting data and entering it into the study database. Building on the skills and confidence I gained from this, I acted as the site Principal Investigator for Salford for another covid-19 related observational study. I put together a team of collaborators, including my ACP colleagues and junior doctors, and we were able to capture data on 200 patients.
Through the networks I had developed through the research and my national work, I was then invited to join the steering group of a surgical study, exploring outcomes for older people who required but did not undergo an emergency laparotomy. I led on advertisement of the study, site recruitment and obtaining ethical approvals, and then troubleshooting for sites throughout the patient recruitment period. It was a steep learning curve!
Patient and public involvement
Reflecting on all the experience I had gained made me wonder what I might want to achieve through my own research, and what problems in my clinical practice I wanted to address. The high risk of adverse outcomes for older people living with frailty was something I wanted to explore further, to understand what might be done to better support recovery.
I applied for funding from the NIHR Research Design Service to undertake Patient and Public Involvement work with older people who had undergone emergency laparotomy. They told me overwhelmingly that they felt there should be more focus on the experience of having surgery and what life is like afterwards. I used this insight to develop a research proposal, with a project exploring the impact of emergency laparotomy for older people living with frailty.
I applied successfully for a NIHR Clinical Doctoral Research Fellowship, which involves a PhD through The University of Manchester, and I began this in April 2022. The funding enables me to study full-time and complete courses and training relevant to my project. It is such a fantastic opportunity, and I would highly recommend it to anyone. I never would have imagined this is where I would end up, but now I wouldn’t change it for anything!
My advice to anyone who is interested in taking the first steps into research would be to start small and build up skills and confidence along the way. Each different experience will bring new knowledge and opportunity. Don’t be afraid of knocking on doors and asking to get involved in projects in your area, who knows what it might lead to…