Trust blog

"Nurses are perfectly placed to take part in research." Meet Niamh Bohnacker, senior clinical research nurse 6 Sep 2024

To mark the third series of Channel 4’s Emergency documentary, we’re highlighting the work of some of the people who work in or alongside our major trauma centre.   

Niamh Bohnacker is a senior clinical research nurse at Imperial College Healthcare NHS Trust, and leads the Neurosurgery, Emergency and Trauma (NET) research team. Niamh tells us about the vital role nurses play in research and why her biggest inspiration is her patients and colleagues. 

Tell us about your role and work with the major trauma centre.

I’m a senior clinical research nurse, and lead the Neurosurgery, Emergency and Trauma (NET) research team. Our small team of six nurses is responsible for delivering clinical research studies in these specialities at the Trust, including across the major trauma pathway. We’re from predominantly emergency and intensive care nursing backgrounds and have a rolling portfolio of 15-20 clinical studies open at any one time.

We help decide which studies the Trust can best support, set studies up, and then provide end-to-end coordination of each active study. For us, it’s ultimately about offering patients or their families the opportunity to get involved in high-quality research and supporting them to reach an informed decision about whether to take part or not.

Research is an additional option for patients. It builds on the high-quality care that they already receive, to try and further improve quality of life and propel evidence-based advancements in clinical care.

Trauma patients can be extremely vulnerable, both physically and emotionally, and it’s therefore important to have a dedicated team who are adept at managing research within a trauma environment. This protects patients, maintains strong ethical standards and produces reliable data which could inform and improve future care.

Trauma research has its own unique challenges, including potential fluctuations in mental capacity of patients due to their injury or due to being sedated and ventilated, and the delivery of time critical care. In such cases, the team are responsible for meeting and proving the threshold for use of emergency waiver of consent and auto-enrolment onto a study. There are ethical approvals in place for this and, in these cases, we always follow-up with the patient to seek their consent retrospectively.

I am always proud of how the team manage these often highly emotional and sensitive situations with skill and compassion. We provide time and space for patients to ask questions and fill in gaps that they can’t remember. When their lives have been upturned and taken out of their hands, participating in research can give them a sense of empowerment.  

Do you have a typical working day?

Our NET research service runs from 08.00-20.00, Monday to Friday. The day starts with the team attending the Emergency Department (ED) handover and screening the overnight trauma list, ED bedboard, ward and clinic lists for patients that could be eligible for any of our studies.

Throughout the day, we attend trauma calls to screen patients in the resuscitation area of ED – and confirm eligibility with the multi-disciplinary team responsible for each patient’s care, as well as senior consultants.

We have consenting rounds twice a day. This is where we first approach patients or next of kin to inform them about a study, follow up on any questions they might have, or to seek consent. If a patient consents, we start study procedures, which could include computer-randomisation, delivery of the intervention, safety monitoring of the patient, blood-sampling, or data collection.

We also review patients already on studies every morning for safety monitoring, and spend a significant part of each day performing trial management and study training. No two days are the same and, due to the nature of trauma, no day is predictable.

In addition to overseeing the team, I help to decide which studies we support, how we are going to do it, and who needs to be involved. Alongside the research and development team and the lead nurse for neuroscience research, I support the completion of feasibility and contracts, governance and stakeholder engagement.

A big part of the role is integrating research into clinical practice and trying to bring about that culture change – not so easy when you know that your colleagues are already working under extreme pressure and you’re asking them to do something differently. I advocate for research, my clinical colleagues and patients. It’s a fine balance and demands clinical and research knowledge, as well as the ability to lead, negotiate and collaborate. If done well, research should fit smoothly into clinical care.

Why is research so important in neurosurgery, emergency and trauma? 

It’s known that research-active hospitals have better patient outcomes. It goes without saying that all research must be based on a proven intended benefit to the patient. Even if patients don’t benefit from the study themselves in the immediate term, research can question the status quo and generate debate, discussion, collaboration and innovation. All this can ultimately lead to medical breakthroughs which have the power to improve and even save people’s lives.  

Whilst it’s an option for patients, research should be a staple for healthcare professionals. The alternative is to stagnate, and that shouldn’t really be an option. Research will also lead to a more efficient and sustainable NHS. Major trauma remains a leading cause of death globally and there is still much to investigate. The creation of the major trauma network in London has improved outcomes by linking up systems and ensuring that all the clinicians you need are in one place. It’s an optimal context for trauma research and it’s important to harness this opportunity at St Mary’s Hospital, as a major trauma and research centre. 

What type of studies do you tend to get involved in? 

Most of the studies we work on are interventional, randomised control trials, that introduce and trial a medicinal product or surgical technique into a patient’s care. Some recent examples are:  

• a study comparing triple immobilisation with movement minimisation in suspected spinal injuries (SIS).
• the MaST study, which investigates the efficacy of anti-seizure medications in traumatic brain injuries.
• a major haemorrhage study (SWIFT) that compares pre-hospital use of whole blood versus standard blood components.
• a study (CoMiTED) where the intervention is conservative management –  not inserting a chest drain – in the management of traumatic pneumothoraces. 
• a surgical interventional study investigating the use of duroplasty in addition to laminectomy for patients who have suffered a traumatic spinal cord injury (DISCUS).  

Are you excited about any upcoming trials?   

There are always fascinating trials ongoing and upcoming. One that’s particularly exciting is the follow-up to the CRASH3 study, which showed that administration of tranexamic acid within three hours following a traumatic brain injury reduced head-injury related death. We’ll soon be recruiting to the CRASH4 study, which investigates the intramuscular administration of tranexamic acid in patients who have suffered a mild to moderate head injury.  

Your background is nursing – how did you first get into nursing and then research? 

Becoming a nurse is one of the best things I’ve ever done, but it certainly wasn’t the plan. Nor was working as a nurse in clinical research. But, I’m really glad it’s now a part of my career.  

I actually completed a degree in history and worked in fine art before I decided to become a nurse. I’ve now been qualified for 11 years and my background is in intensive care nursing, which I loved. I joined NET in 2021 and became lead of the team in 2022. I start a master’s degree in neuroscience in the autumn.  

As an ICU nurse, you’re responsible for delivering some of the most supportive care to the most unwell patients. I’ve lived and worked abroad in different healthcare systems. I started to wonder about differences in healthcare, what the evidence base was for what I was doing and what else could be done for patients. 

What do you love most about your job?

I love the variety of clinical questions we investigate, how dynamic it is, and also getting to work with so many different and talented people at the Trust and beyond.  

Research is demanding. It requires perseverance and some courage, especially when you’re going against the grain and trying to take others along with you. It also connects you to some of the best of human nature: curiosity, endeavour and progress. Getting to play a very small part in that, in a profession I love, is what motivates me in my current role.  

My biggest inspiration is the people I work with, both patients and colleagues. Patients who are confronted with, and have to overcome, so much, yet still get involved in research. None of it happens without their participation and we’ll all have them to thank when we have research breakthroughs in the future.  

I’m always impressed by the clinical expertise of the clinicians I work with and am consistently struck by the depth of their compassion and empathy. I feel very lucky to be part of an organisation full of people who come to work, day in and day out, to collectively alleviate suffering. Everyone in the hospital plays a role in doing that. That’s incredibly special.  

Find out how to join Imperial College Healthcare NHS Trust.  

Watch Emergency series 3 on Channel 4 in August 2024.