Clinical practice fueled my passion for research

By Therese S. Richmond | 12/11/2018

The author shares six important lessons she learned.

Therese S. Richmond

Caring for the injured raised questions. To find answers, she became a nurse researcher and co-founded an interdisciplinary center that is helping the injured find healing.

I am a nurse researcher and injury scientist. As one of a small cadre of nurse researchers who focus on injury, I was thrilled to be inducted into the International Nurse Researcher Hall of Fame in 2013 and am thankful to Antonia Villarruel, Leanne Aitken, and C. William Schwab for nominating me. My induction provided a platform for highlighting injury science, which is important because injury and violence are global public health problems that need high-priority attention.

At Sigma’s 44th Biennial Convention in 2017, I received Baxter International Foundation’s Episteme Award for my research on preventing injury and violence and improving outcomes after serious injury. Charles Branas, Leanne Aitken, and Pamela Mitchell nominated me as Episteme Laureate, for which I am also grateful. My nominators for the two awards represent a cross-disciplinary mix of nursing, trauma surgery, and epidemiology, reflecting my commitment to work across disciplines to solve challenging societal problems.

Why I am a researcher
Injury and violence touch all segments of society but disproportionately affect minority populations and those living in low-resource and marginalized communities. I was drawn to the injured as a young nurse in the late 1970s when I was part of a resuscitation team in a trauma intensive care unit (ICU). At that time, trauma centers and trauma systems were just developing, and it was an exciting time to enter the field. As a primary nurse and, subsequently, a clinical nurse specialist, I practiced in a trauma center that was among 139 North American hospitals participating in the Major Trauma Outcome Study. I witnessed firsthand the importance of data and rigorous research in providing evidence that trauma centers save lives.

Two clinical experiences in particular drove my passion to become an injury scientist. The first, which occurred in my practice in Washington, D.C., USA, profoundly influenced that decision. One of my patients sustained a close-range shotgun wound to his abdomen during a robbery in a corner store. He survived what, in most cases, would have been a lethal injury, and we cared for him for months in our ICU. When he was finally discharged to home, we congratulated ourselves for saving his life—truly a “high-five” moment.

Our congratulatory bubble was burst weeks later, however, when this patient came back—very irate—saying, “You saved my life, but I am not healed.” He stated further that he had changed, and no one in his life understood what he had gone through or was currently confronted with. At that moment, I realized I had never really thought about what happened to my patients after they went home, let alone after they left the ICU. In an era when research focused almost entirely on decreasing mortality rates, that experience was a wake-up call for me. What happened to survivors?           

The second experience occurred after I moved to Philadelphia in the 1980s. I was a clinical nurse specialist in a neurological ICU that had a large population of acute spinal cord injury (SCI) patients. I had the good fortune, in partnership with a valued colleague, to receive two small research grants, one from my chapter of the American Association of Critical-Care Nurses, the other from my hospital’s chief nursing officer. Our study examined nursing care needs and diagnoses of SCI patients.

During one interview, an older woman with quadriplegia who was constrained in a halo immobilizer shared an event that had happened the night before. Her dentures had become dislodged and pushed back into her throat. Unable to reach the special call light available to her, she was sure she would die—suffocate—from her own dentures. Her story caused us to question what it must be like to feel and be so powerless. We subsequently examined in depth the phenomenon of powerlessness and published two papers on the topic. Situations like this piqued my curiosity.           

More tools needed
In these and other ways, my clinical practice molded my interest and fueled my passion for research. I desperately wanted to understand how to keep people from being injured, how to reduce gun violence, how people recover from serious injury, and what happens psychologically after a serious injury. My first small research grants also showed me that I did not have the toolbox needed to rigorously answer the millions of questions I had.

I came to understand that strong science is a product of insatiable curiosity and rigor. I had the curiosity but, at that point, didn’t have the rigor, so I pursued my PhD. Completing my PhD was an essential step in my journey. It was frightening to move from expert clinician to novice scholar, but it was the best decision I could have made.

I committed to a research program focused on injury and violence—­not exactly mainstream in nursing science—that brought unique challenges. It’s difficult to obtain funding to study firearm violence, and it’s a highly polarizing topic in the United States. I had the good fortune to work with stellar colleagues at the University of Pennsylvania. In 1995, my colleague Bill Schwab and I co-founded the Firearm & Injury Center at Penn (FICAP), a vibrant interdisciplinary research center. The center provided me with multiple lenses for viewing a very difficult societal problem and helped move my own research forward. At that time, I was focusing on getting communities engaged in using data to understand their local firearm violence and to use that data in driving action.

FICAP evolved into the University of Penn Injury Science Center, funded by the Centers for Disease Control and Prevention. The center’s robust research portfolio focuses on mitigating violence and firearm violence, preventing motor vehicle crashes, reducing risk of concussions, addressing opioid use disorder, evaluating policy, and improving recovery when injury does occur.

My own research grew as well. My current focus, which has been funded by several of the institutes that make up the National Institutes of Health, is improving health after serious injury. This line of research took me down a path I did not expect—acquiring better understanding of the psychological consequences of injury and their impact on recovery. My work has shown that a major driver of suboptimal outcome is post-injury depression and post-traumatic stress disorder (PTSD), both of which must be addressed if we are to optimize recovery. To provide resources to those with the greatest need, my team has systematically examined factors that contribute to these psychological consequences and has developed a short clinical screener that helps predict development of post-injury depression and PTSD.           

Six important lessons
Over the decades of my research, I have learned much. Here are the most important lessons I’ve learned:

  1. Complex social problems require complex solutions best sought by a scientific team that represents a broad array of disciplines.
  2. Always stay true to your passion, regardless of the ebb and flow of funding streams or what are currently the most popular research topics.
  3. Always be willing to play with new ideas and look at problems from new perspectives. One rule I have for myself is to peruse electronic journals from outside my field on a weekly basis until I land on a paper that piques my interest. I then read that paper deeply.
  4. Be optimistic and tenacious. Not all grant submissions will be successful. But you’re in it for the long term, so stay with it.
  5. Commit to developing the next generation of researchers—no matter the discipline.
  6. Remember, you are not doing this work to be inducted in the International Nurse Researcher Hall of Fame or to be named an Episteme Laureate. These awards are wonderful recognition of one’s contributions and are highly valued by those who receive them, but we do this rigorous research to improve health and well-being of individual people, communities, and society.

That’s why I continue to move forward with my own research program and help advance the programs of my mentees. In 2017, the National Academy of Medicine (NAM) honored me with election to the academy. Recently, I served on the planning committee for a two-day workshop NAM gave on the role health systems play in reducing firearm injury and death. Click here to view my presentation—based on my research—about the psychological and social consequences of firearm violence. I hope to make many more research contributions to our knowledge of injury and violence. RNL

Therese S. Richmond, PhD, CRNP, FAAN, is Andrea B. Laporte professor of nursing and associate dean for research and innovation at University of Pennsylvania School of Nursing in Philadelphia, Pennsylvania, USA.

Editor’s note: The International Nurse Researcher Hall of Fame award, first presented in 2010 by Sigma Theta Tau International Honor Society of Nursing (Sigma), honors nurse researchers who have achieved significant and sustained national and/or international recognition for their work and whose research has influenced the profession and the people it serves. The induction ceremony during the 30th International Nursing Research Congress, 25-29 July 2019, in Calgary, Alberta, Canada, will mark the 10th presentation of the award.

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