PICU nurse practitioner stresses family integration in care and research around critically ill children

For someone who said, upon completion of her Masters/Nurse Practitioner (NP) program from the University of Toronto, that she had no interest in doing research, Laurie Lee has landed in a role that completely validates the interconnection of bedside nursing and nursing research.

Lee, the director of the PICU Research Program at Alberta Children’s Hospital (ACH), and the upcoming UCalgary Nursing Food for Thought Breakfast lecturer [Thursday, March 2], has worked diligently with her team in the past two years to almost double the number of studies underway and grow research staff to one of the largest PICU research programs in the country. 

We asked Lee, who is also an adjunct clinical associate at UCalgary Nursing and an assistant professor in the Department of Paediatrics at the Cumming School of Medicine, to give us a little insight into her career and her research. 

How did your career progress in paediatrics?  
"My entire nursing career has been dedicated to critically ill children. I was fortunate enough to have a paediatrics rotation in my third year of undergraduate nursing which I loved and led me to complete my final practicum in the PICU at the Stollery Children's Hospital [Edmonton]. I was hired into their PICU as a 'new grad' and embarked on my nursing career. During that time, I was exposed to a few NPs in Neurosurgery and ENT and the role piqued my interest.  

Life and a desire for adventure took me to San Francisco, Bermuda and the UK and I consistently worked in PICU roles as a bedside RN, unit manager and educator. Finally, while completing my MN/NP program, my husband and I decided to head back home and moved to Calgary. Our timing was impeccable because the PICU at ACH had just decided they wanted to start an NP program; my colleague Kim Menzies and I were hired to develop the NP role."  

You weren’t interested in research in the beginning: what changed your mind? 
"A desire to study the potential benefits of modes of care provided to our patients led me to an additional and remote position as the international project manager for a PICU clinical research study run by Dr. Martha Curely, a nurse scientist out of the University of Pennsylvania.

Following completion of this project, I began to initiate my own program of research with the mentorship of our research director, Dr. Elaine Gilfoyle. When Dr. Gilfoyle left ACH for SickKids, I became director of the research program, the first nurse in Canada in such a role."  

What is the most rewarding part of work for you?  What is the most challenging? 
"By far the most rewarding part of my clinical practice is engaging with children and their families. They typically come to us on the worst day of their lives and being able to help and support them as we care for them is incredibly rewarding. The challenge of the clinical work, other than the night shifts, is that many of the cases we see can be truly heartbreaking and seeing children and families suffer takes a significant toll.  

My research is rewarding in a very different way. Working clinically at the bedside can feel stifling and frustrating as larger scale change often seems daunting and impossible.

Through my research work, I am able to ask important nursing-driven questions that, through rigorous study, has the potential to improve the care of many children. As a nurse, the questions I ask are informed and imbedded in my clinical practice and therefore are greatly informed by my interactions with patients and their families.

In this way, I can feel empowered to investigate and improve the care of these children." 

What has been a career high for you so far? 
"There have honestly been so many, but I think currently one of the contributions I have been most proud of has been elevating the recognition of nursing knowledge at a national level. In many ways, and especially in critical care, nursing knowledge can be under-valued and considered "less than" physician knowledge.

Through my research and quality improvement work, I have begun to become recognized as a national expert in pain, agitation and delirium in paediatric critical care. This led to being invited faculty at the Critical Care Canada Forum this year to give a scientific tract lecture and run a working group session on this topic.

Historically, this conference has only invited physician speakers: this year, I was one of few non-physician health-care professionals. Having the opportunity to share the breadth of nursing knowledge at a national level and challenge traditional medical ways of thinking about how we engage patients and families in comfort care was a true career high." 

What would you tell students interested in this area of nursing? 
"When I was in nursing school, I was always under the impression that you were either a researcher or a clinical nurse. I think this is what kept me away from research for so long.

But being able to engage in research as a bedside nurse is incredibly rewarding. Not only is it essential that bedside nurses become more engaged in research to ensure we ask and answer questions that can truly impact ways we provide nursing care, but by becoming involved in research, nurses can feel autonomous in their ability to change care.

We are the foundation of health care: our questions are essential to informing the best practices. Furthermore, I believe that nurses are incredibly well-equipped and situated to best engage families in designing, conducting and implementing research. The relationship nurses develop with families is deep and broad and our ability to engage with families is incredibly advantageous from a research perspective."  

Can you give a little taste of what guests will learn at your breakfast talk on 2 March? 
"I will focus on family engagement in care and research. I have co-led a national study understanding the impacts of restricted visitation during the COVID-19 pandemic and will review some of these results. I will highlight the literature surrounding the benefits of family engagement in care and research and then, as an example, discuss how this has worked in two of our studies.

One is underway: the FAM-CAPD study exploring the validity and acceptability of family assessment of PICU delirium; and one in development called the CHiCKs study. This discussion will focus on the benefits of family engagement as well as some ‘how-tos’ and pitfalls along the way."