The main concourse at the University Hospital of Wales in Cardiff is busy on a Monday morning; people are arriving for outpatient appointments or sitting in the café area drinking coffee, while they take a break from visiting a relative on the ward.
Standing by the information desk, I’m on the look-out for one of Health and Care Research Wales’ leading research nurses – Jade Cole. Dressed in her blue uniform, Jade greets me with a warm smile and takes me to the third floor in block A, where she shares a small office with the research team.
Jade specialises in critical care research; the type of studies that are helping to improve the care of the most vulnerable patients here in the hospital.
We joke about this being like a Mastermind appearance for Jade as she sits in her office chair but there is no need to worry, critical care research is definitely her specialist subject.
As a starter for 10 points, we chat about Jade’s first steps into the world of research.
“I got into research almost by accident if I’m honest,” Jade recalled. “I had worked in critical care for about seven years and absolutely loved it. I knew I had found my niche and I didn’t want to go anywhere else.
“However, I was aware that we didn’t really do any research here. There was the odd study involving one or two patients but that was it. I knew that research was how we improved care for patients and I started saying to people ‘we’re a massive ITU, why aren’t we doing any research?’”
In 2010, the attitude towards research began to change. Consultant Matt Wise, who had joined the critical care research department in Cardiff a few years before, started to fulfil his vision of building a research team.
“By this time, people were used to me asking why we didn’t do any research, so it was suggested that myself and a colleague applied for the critical care research specialist nurse roles in Matt’s new team.
“We started off really small with just the three of us working part time. Having someone like Matt saying ‘we really should be doing this in Wales because we’re letting our patients down’ was a big inspiration for me.
“I absolutely loved it, which was a shock to me as I’m very clinical and very hands on so I never thought that I would go into research. But this area of research is so clinical that you’re still with patients and relatives, and you’re still making clinical decisions and keeping up your clinical skills. I love that – it’s the best of both worlds.”
Jade is really passionate about her work – and she talks animatedly about why she does it.
“It’s all about the patients and the relatives,” Jade explained. “We can only make things better for them by doing research.
“It’s about something as simple as doing a study that helps us to take a patient off a ventilator sooner. If we get them off a ventilator sooner, they don’t have complications, like delirium or infections, and their chances of surviving and actually making a really decent recovery are better.”
The intensive care unit is just across the corridor from where we are sitting. On the other side of the double doors, families are with their loved ones going through what Jade describes as an ‘awful time’ as they try to take in all the information they’re being given about their relative’s condition.
“The first question is always ‘how are you, are you ok?’”, Jade explained. “It’s not just about finding out that their husband or daughter is really ill and being told what the treatment plan is, it’s also do they remember where they can go and get a drink or where they can stay overnight.”
It is undoubtedly a challenging environment to carry out research and it is one that requires a 24/7 approach, rather than Monday to Friday, 9 to 5.
“You can’t predict when someone is going to be critically ill,” Jade continued. “You have no idea when a person is going to meet the criteria for a study so we don’t have the luxury of saying ‘I’m going to meet you in an out-patients clinic on a particular day.’”
A different model of consent is also used in critical care research: deferred consent. Where a patient is unable to give consent themselves, which is usually the case when someone is critically ill, then consent is deferred to a family member to make a decision based on what they believe their relative would want to do.
“We approach the family as soon as possible but always at an appropriate time. To ask them to make an informed decision when they first arrive is an extra burden they don’t need. Also, you don’t want them to agree to things that they wouldn’t if they had time and space to think about it.”
Jade’s face brightens when she talks about the reaction from families and relatives who have taken part in research.
“They are always so pleased that they were able to do something when they were at their most vulnerable. They always say ‘I’m so glad I was able to do something to help someone else’ or ‘if it means somebody else isn’t as ill as I was, isn’t that great’.”
Time is up for now on Jade’s specialist subject but her critical care research journey will continue. She hopes to inspire others to follow in her footsteps, which have taken her from part time research nurse to critical care team lead, working on global research studies.
“I would like us to be able to offer formal training posts for people. To be able to say here is an all-Wales critical care training package for any research nurse who wants to get started in Wales. I would love that.”
In true Mastermind style, Jade has started so she’ll finish.
“I might have entered into this almost by accident but now I couldn’t imagine doing anything else!”