#IamMGHresearch tells the stories of our researchers. Meet Dr. Laura Istanboulian, Nurse Practitioner (NP) and Clinician Scientist at our Provincial Prolonged-Ventilation Weaning Centre of Excellence (PWC).
“I've been working as a Nurse Practitioner (NP) for the Provincial Centre for Excellence for Prolonged-Ventilation Weaning at Michael Garron Hospital (MGH) since 2012. I started my nursing career in multi-organ transplant, and then the Intensive Care Unit (ICU). In 2012, I completed my Master of Nursing and extended class nursing license and started my NP role here at MGH working with patients and families dealing with complex and chronic respiratory diseases, including prolonged and long-term ventilation.
I was inspired to focus my research on communication vulnerabilities among patients with prolonged and long-term ventilation because of my time working in the ICU. There, I witnessed firsthand the challenges patients face in communication due to issues such as hearing or vision impairments, limited health literacy, language barriers, and the loss of their ability to speak due to medical equipment.
These communication difficulties were beyond frustrating for patients and impacted their ability to participate in care and care decisions, as well as their safety. This realization sparked my interest in addressing these issues through patient- and family-oriented research. In 2018, I started my PhD in nursing at the University of Toronto and graduated in June of 2023.
My doctoral thesis focused on co-creating and evaluating an intervention to improve communication in critical care that emphasized principles of complex intervention design and implementation science. My supervisory team and I published multiple studies exploring the barriers to and facilitators for supporting communication with and for patients treated with invasive mechanical ventilation in the ICU during the COVID-19 pandemic. We also explored the use of virtual technologies in studies using co-design methodologies.
We will be rolling out this communication intervention in areas at MGH where we provide care for patients who need mechanical ventilation. We plan to continue evaluating its impact on communication and clinical practice.
Currently, I'm excited to be working on shifting the conversation around communication vulnerability in critical care to highlight its safety implications. In collaboration with Dr. Kelly Smith, Chief Scientific Officer at MGH, and leading critical disability researchers at Toronto Metropolitan University, I have completed a series of studies to further explore patient safety and communication vulnerabilities during and post-critical illness. It's a thrilling shift in our approach to a longstanding problem, and I hope it leads to positive changes in patient care.
Balancing clinical work and research can be demanding, and sometimes, the changes we want to make take time to implement. However, I feel the benefits of my work outweigh the challenges. The most rewarding part always comes down to connecting with patients and their families. When I have the chance to interview them for a study or discuss their experiences, I learn so much. Understanding a patient’s and family’s needs and perspectives can impact their care positively. Building those connections makes patients feel cared for and part of our healthcare community.
Nursing clinical research is invaluable, given the proximity of nursing work to patients and their families. I'm proud that MGH supports nursing research and is dedicated to creating roles that allow nurses like me to balance clinical and academic work and facilitate patient- and family-centered improvements for our community.”