SPHERE Fellowship: a career catalyst

A SPHERE Fellowship was the stepping stone needed to boost the research careers of these two past SPHERE Fellowship recipients.

Dr Laurel Mimmo

A gentle nudge from one of her PhD supervisors had Laurel Mimmo apply for the 2019 SPHERE Fellowship which has not only helped propel her career but also brought attention to the importance of building paediatric nurse-led research.

The start of a career in research

Laurel was always interested in the care of children with intellectual disabilities. However, in her role as a paediatric nurse she wasn’t sure how she could make a difference outside of her nursing duties.

Whilst doing a dual Masters of Public Health/Health Management at UNSW, Laurel realised that looking at health services research more broadly was a way of potentially improving the quality of healthcare for this group.

She recalls a lecture by the late Professor Joanne Travaglia who talked about the vulnerabilities of women with intellectual disability in hospital.

“I wasn’t comfortable knowing that people with intellectual disability, who should have felt safe in hospital, had such negative experiences.

“This led me to turn my attention to the quality and safety of children with intellectual disabilities in hospitals.”

SPHERE Fellowship research

Laurel’s PhD looked at the population of children with intellectual disabilities who were admitted into the Sydney Children’s Hospital Network (SCHN). Laurel discovered that these children account for 4.5 per cent of the child population yet make up 14 per cent of the hospital admissions.

“Children with intellectual disabilities have high healthcare utilisation. They have a longer length of stay in hospital and are more likely to have a clinical incident reported during their admission,” explains Laurel.

“Realising there is a clear inequity in quality and safety outcomes for these children, I looked at the evidence exploring the experiences of the parents of hospitalised children with intellectual disability to help develop a conceptual model of what good care looks like.”

However, there is little published evidence of the experience of children with intellectual disability from the children themselves. So, with additional funding from the Disability Innovation Institute UNSW, with her PhD supervisors, A/Prof Reema Harrison, A/Prof Sue Woolfenden and Prof Jo Travaglia, and under the guidance of Prof Iva Strnadová, Laurel worked with two young people with intellectual disabilities, conducting coresearcher training workshops to learn about inclusive research approaches.

“The workshops were important; in order for me to understand the needs and experiences of children and young people with intellectual disabilities. I needed to involve them in my research and learn accessible interview techniques.”

Over the course of six workshops, Laurel introduced the two coresearchers to research and together they learnt the research techniques needed to facilitate a person with intellectual disabilities to give their perspectives and experiences of hospitals. This experience not only provided the two co-researchers with invaluable information but also provided Laurel with her own lessons.

“I had my assumptions challenged during this time. I needed to be flexible in my approach to give the two young people a platform and a voice to participate in research.”

The workshops resulted in a co-authored paper with the coresearchers and their parents.

With COVID lockdowns limiting non-essential access and preventing Laurel from entering wards to interview patients, Laurel organised zoom focus groups with paediatric nurses from across SCHN. This study explored the perceptions of good care from paediatric nurses with experience caring for children and young people with intellectual disability in hospitals. The findings from this research have been used to expand and enrich Laurel’s theoretical framework regarding the provision of safe and high quality healthcare for children and young people who have intellectual disabilities. This framework revolves around the child, emphasising their care journey while prioritising a good quality and safety experience.

“The enhancements to the model acknowledges the joy and job satisfaction for paediatric nurses when they are able to give specialised inpatient care for these children and young people.”

The paper arising from that study was published in 2022:

https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15256

Moving into a new research position

Laurel is steadfast in her belief that the SPHERE Fellowship was the catalyst for her successful transition to Senior Research Fellow in the Nursing Research Unit at the Sydney Children’s Hospital Network.

“The SPHERE Fellowship gave me the opportunity to advance my research skills and expertise for this position which keeps me specifically looking at paediatric health services research,” Laurel explains.

“I wanted to continue in a paediatric healthcare focussed role after completing my PhD. Through my fellowship I found that paediatric nurses have unique insights into healthcare delivery that we need to harness. I believe it’s important to encourage paediatric nurseled research to improve care and access for children with intellectual disabilities, and for all children, when they come to our hospitals.”

Laurel is also busy promoting and supporting nurses to understand, use and conduct research across the SCHN.

And when she’s not doing that, Laurel sits on many research committees, presents at conferences the most recent being at the European Society for Paediatric and Neonatal Intensive Care in Athens, and is working together with other researchers both locally and internationally on funded projects.

“The SPHERE Fellowship has expanded my research to a lot more people. It has helped highlight the challenges children with intellectual disability face just coming into hospital, and the experiences that health services do well. Children with intellectual disability are made vulnerable by our systems and structures. By understanding their experiences health services are ideally positioned to ensure equitable, safe, high quality healthcare delivery.”

Dr Bernadette Brady

Bernadette (Bernie) Brady was just wrapping up her PhD when she decided to apply for SPHERE’s Fellowship program. Unfortunately, her application was unsuccessful. While disappointed, it gave Bernie the opportunity to reassess what she really wanted to do post-PhD.

Her PhD research focused on cultural adaptation, specifically how to modify pain management interventions to be culturally appropriate. Knowing she wanted to continue working with CALD communities, Bernie successfully applied for two seed grants which allowed her to continue her research into this space.

However, it became increasingly obvious that while she was seeing some success with local Arabic, Assyrian and Vietnamese communities within the SWSLHD Pain Clinic, her ongoing research raised some challenging questions about scalability.

“I started to ask myself, how we could possibly do this on a large scale when we have 200+ cultures in Australia,” said Bernie.

“Is it feasible to expect the health workforce to be able to adapt their interventions for every culture?”

It was at this point that she had an idea that would become the focus of her second (and this time, successful) SPHERE Fellowship application. The idea was to develop a partnership model that could be implemented in any clinic treating patients with chronic pain or musculoskeletal conditions and for different communities. The proposal sought to match volunteers, who identify with culturally and linguistically diverse (CALD) background and who have lived experience of a pain condition, to work with the healthcare team to adapt their interventions, at an individual patient level, to better support patients.

“It was basically peer support for CALD patients,” explains Bernie.

“There’s good evidence for peer support but where it was lacking was embedding that peer support into formal health services, such as our hospital outpatient clinics.”

She postulated that the partnership model would have a three-fold benefit.

“Our theory was that firstly, the model would support the patient by matching them to a peer/mentor they could relate to. Secondly, it would improve the credibility of our messages because it was coming from someone who had a lived experience of the condition and not just a health care worker. Lastly, we believed that this project would also be beneficial to the health service because by working with these mentors, the service would become more aware of the importance of cultural adaptation for their CALD patients.”

We designed the fellowship application not only around the proof of concept and feasibility but also the logistics of setting up a training program, onboarding people and then evaluating this concept of peer support for people with chronic musculoskeletal conditions,

The Fellowship was the springboard that Bernie needed to propel her research and her career.

“The Fellowship was a gamechanger. It gave me protected time for three years to focus on this project whilst at the same time allowing me to get involved, collaborate and network with people in the Musculoskeletal Clinical Academic Group (MSK CAG) and beyond.”

Successfully completing the pilot study across three clinics in South West Sydney: Liverpool Hospital Pain clinic, Fairfield Hospital Hip and Knee service and Fairfield Hospital Physiotherapy Department, Bernie was able to demonstrate proof that the concept of peer support embedded in a health service worked.

“In our preliminary evidence, we looked at what mechanisms of action the mentors were having on the patients. Specifically, we looked at how a patient’s knowledge, skills and attitudes towards self-management changed amongst those with or without a mentor. In our usual care arm, that is, those who didn’t have a peer mentor, pain outcomes improved but their attitudes didn’t really change. This suggests that when treatment is complete, they won’t sustain the changes they made.

“In contrast, people who had mentors had a 10-point improvement in activation. This is a significant improvement when a minimal clinically important difference is a four-point change. It made us realise that we were definitely onto something.”

Off the back of the pilot study, the results of which were published in this year’s BMC Musculoskeletal Disorders (https://rdcu.be/dh89x), Bernie started working on her next plan, specifically how to scale up the program. After forming a new team, they decided the concept wasn’t specific to pain but could be translated to chronic disease management. This shift to include patients with chronic disease received widespread interest across clinics in SWS including diabetes clinic, cardiac rehab, respiratory, rehab services and rheumatology.

Pilot study spawns more funding

Armed with the success of the pilot project and with a clear direction and interest from various clinics, Bernie was up for success in her next application for funding from the Ministry of Health (MOH).

“The $232K from MOH allowed us to make plans to do this on a larger scale. We were able to employ Golsa Saberi, a Multicultural Health Officer who is revising the training program, formalising the recruitment process, and networking with the communities.”

Formalising links with Multicultural Health through Golsa’s employment has allowed Bernie to develop a proposal for a Hybrid Type 1

Implementation-Effectiveness

Cluster Randomised Controlled Trial which looks at how to evaluate the effectiveness of the model and then how to embed it more widely.

The successful MOH funding spurred the team to submit for a Medical Research Future Fund grant early this year.

“I really do believe that because we had all that preliminary work completed, thanks to the time I was given whilst on my SPHERE fellowship, we had everything set up to be successful.”

Not only was Bernie’s own application for scaling the Natural Helper Project successful, she is also a CI or AI on two other NHMRC applications this year with funding exceeding $3 million, a significant achievement for an early-career researcher.

“This opportunity allows me to gain experience leading a large team to embed our research not only in our health district but to expand to similar health settings such as the health district we are bringing on board in Victoria. We’re in the thick of taking our model and seeing if it translates to other settings and other communities.”

“If I was just working clinically, I would have had limited opportunities to do research, but the SPHERE Fellowship gave me the time outside of my clinical work to collaborate, be mentored and provided me with opportunities for career development. It was the catalyst for all the success I’ve had since.”

Dr Bernadette Brady