The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department

The Trent Regional Health Authority funded a study in 1995 to train nurses in an accident and emergency (A&E) department to screen all adult attendees for alcohol problems with a view to identifying a sample of problem drinke rs to participate in a randomised controlled trial (RCT). In the RCT identi fied drinkers were to be assigned either to health education plus brief cou nselling intervention or, as controls, to health education alone. Despite 1 6 654 attendance's at A&E during the recruitment phase of the study only 20 % of attendees were screened of whom a further 19% were identified as probl em drinkers by the CAGE screening questionnaire. Less than half of the prob lem drinkers were however, provided with feedback by the nurses, leaving a small group of 264 eligible for entry to the RCT. The great majority of thi s subgroup refused an initial appointment at the specialist clinic and so t he trial was abandoned. A number of in-depth interviews were undertaken wit h the nurses in an attempt to understand ways in which the overall conduct of the study might have been improved. This paper outlines in some detail s ome of the reasons for the lack of success with the study which include; ge neral environmental factors that undoubtedly led to stress and poor morale amongst the nursing team, the differences in perception between managers an d clinical nurses concerning the value of research and the inadequacy of th e initial training programme. The paper concludes that there are problems i n the NHS which do not provide a helpful backcloth to the successful conduc t of health services research. (C) 1999 Elsevier Science Ltd. All rights re served.