Richard James has held the position of Nursing Liaison Librarian at the Biomedical Library for the last four years. “My main job is to support undergraduate School of Nursing (SON) students,” says James, which entails teaching students how to find and assess research literature.
“This isn’t only an essential skill in academic and research contexts,” he explains. “The quality of real-world patient outcomes is significantly improved by a healthcare professional’s ability to find, interpret, and apply the best available clinical evidence.”
Beyond undergraduate instruction, James’ charge includes providing research support and author services to SON faculty and staff; building the Biomedical Library’s nursing collections; and coordinating with other librarians throughout the University of Pennsylvania Health System (plus CHOP) to promote what services the Biomedical Library has to offer.
James is also working toward his Master of Bioethics at the Perelman School of Medicine, so serves as the liaison to the Medical Ethics and Health Policy Department — “opportunistically,” he jokes.
Though James has held a number of health sciences-related library positions, his roots are in nursing. “Right out of college, I attended nursing school in England and worked for several years in the National Health Service,” he explains, “so I immediately felt comfortable with SON school and faculty.”
Recently, James’ efforts have been directed toward helping nurses and other medical professionals meet the extraordinary demands of global health crises. These efforts include an ongoing collaboration with the City of Philadelphia Department of Public Health and the delivery of a Massive Online Open Course (MOOC) developed by the World Health Organization.
We spoke with James about COVID-19, his involvement in public health projects, and his perspective on the emergent field of implementation research.
What were the early days of the pandemic like for you as a medical librarian?
In the context of such overwhelming loss and dislocation as a result of the pandemic, it seems fairly petty and privileged to center my own — but I’ve always loved being on campus and in campus life as a service- and relationship-oriented librarian. Personal connections are central to my professional practice, and I’ve always spent as much time in and around the School of Nursing as in my own office.
I’m involved with supporting public health programs in my local Delawarean community as a medical reservist. Though, in the early weeks of lockdown, I was able to participate in community screening programs and other responses at home, I felt like I’d abandoned my campus community.
By April, then, I was regularly consulting with students in our Master’s programs — who were working nurses at some of the hardest hit hospitals in New York and Boston — and with our remarkable PhD students as they helped create the framework for Philly’s public health response, in the absence of any meaningful work by the federal government.
Describe your COVID-related public health work.
At some point in the late spring, the University of Pennsylvania Health System (UPHS) and Perelman School of Medicine (PSOM) created StepUP, a platform for recruiting volunteers for a variety of COVID-related research opportunities. It enabled me to see the spectrum of programs and projects that were being created and where I might contribute my skills and expertise.
As a librarian with experience in health literacy, I’ve been part of the Penn Public Health COVID Response Team, a health communications team which includes medical and nursing students. In the spring, we worked to develop a variety of public health messaging resources based on consumer health best practices and our best available evidence around social distancing and mask-wearing. Then, during the summer, we produced a variety of infographics and visual resources in multiple languages that were used by Philadelphia’s Department of Public Health in social media campaigns. We were also part of the review team for the Department’s public-facing website; we were tasked with making sure that the information was accessible and responsive to the multiple needs of various communities in the City.
At about the same time, it had become obvious to public health professionals that contact tracing was going to make a big difference in pandemic spread, and that the city and the Commonwealth weren’t going to be able to meet this need in a timely manner. Penn volunteers are currently still running a robust contact tracing program developed by UPHS. Volunteers reach out to people who have had an exposure to someone with a positive COVID-19 result and help them strategize how best to protect themselves, their loved ones, and their community through isolation, testing, hygiene, and other measures. The goal is to prevent community spread.
The volunteers work from an FAQ of research-influenced best practices from the Centers for Disease Control and Prevention, the World Health Organization (WHO), and City and Commonwealth agencies. My continuing role has been to make sure the FAQ that screeners are using to advise people who have been exposed to a positive COVID case is accurate and up to date as new research and guidelines emerge.
One of your pedagogical priorities has been implementation research. What is implementation research, and why is it important from a public health perspective?
Peter Drucker’s famous quote, “Culture eats strategy for breakfast,” applies in healthcare, too. Solutions derived under theoretical circumstances often fail to stick. in rickety, complex, and familiar “real world” environments. The actual, on-the-ground implementation of evidence-based research continues to be a wicked problem.
The field of Implementation Research — which is often used interchangeably with Implementation Science — focuses on identifying, analyzing, and overcoming institutional, logistical, cultural, and other systems-level barriers to translating evidence into routine practice.
Implementation Research thus provides a framework for addressing a “last mile” problem in evidence-based health care, particularly in public health, global health, and, increasingly, within highly-developed health systems. In many areas, rigorous research leads to effective solutions and “answers” to clinical questions. Research synthesis through systematic reviews and meta-analyses (of the kind that our own Biomedical Library supports) can take that evidence further into the establishment of rigorous guidelines and best practices that are potentially transformative.
In August and September, you led a MOOC developed by the WHO’s Special Programme for Research and Training in Tropical Diseases (TDR). What was the scope of that course? Did you learn anything new in leading it?
School of Nursing Dean Antonia Villarruel expressed interest in implementation science at a number of faculty town halls in 2019 and 2020. I responded by making an intentional effort to develop additional resources to support the implementation science community in the School of Nursing and at PSOM. Both schools have a number of experts in the field, including Rinad Beidas, a thought- and practice-leader in the discipline.
In the process of identifying implementation science materials for the Libraries’ collection, I came across the TDR MOOC. The scope of the course is fundamentals-oriented, with a focus on global diseases of poverty; I thought it would deepen my own understanding of the state of implementation science. I was especially interested in becoming better informed, given the discipline’s emerging profile among the community that I serve at Penn.
I also saw the course as an opportunity for Nursing students to engage with health professionals from all kinds of global settings in a way that COVID has made more challenging since the cessation of study abroad programs.
The MOOC was a tremendous success. It delivered a high-quality learning experience to the 130 people who completed it and received a certificate; there were several dozen others who participated in the course but opted not to complete the final assessment project, which was pretty rigorous.
The reception was immediately and overwhelmingly positive. One Wharton faculty member who had taken the course stated that he had already found that what he had learned was influencing his existing projects in supporting African health education. And a student from Tanzania was able to submit the certificate from the MOOC as supporting documentation for a grant proposal.
It was also an incredible partnership opportunity between the School of Nursing, the PSOM Center for Global Health, and Penn’s Implementation Science Center, which is part of the very influential and very inter-professional Leonard Davis Institute of Health Economics. These centers gave us contacts and networks to promote the program offering, which is why we had an amazing global representation of learners from more than 30 countries on every continent — other than Antarctica, that is. Maybe next time.