From the viewpoint of a Nurse Practitioner (NP), Laura Istanboulian has gained a deep understanding of not only the gaps in health care, but also the mechanisms that sustain and perpetuate them.
This perspective inspired her to pursue a program of research that focused on nursing interventions for critically ill patients in the ICU.
During her PhD at the Lawrence Bloomberg Faculty of Nursing, Istanboulian created a bundled communication toolkit for patients requiring ventilators in the ICU. Now, she returns to the Faculty as an Assistant Professor (Tenure Stream), with an evolving research portfolio that aims to promote safe and equitable access to care for patients across the critical care continuum.
Istanboulian officially begins her new role on July 1.
“I’m excited to be joining Bloomberg Nursing and work with the visionary leadership at the Faculty. I believe U of T has the research infrastructure that I need to do this program of research justice, including a platform for international collaborations to scale up and implement changes more effectively,” says Istanboulian.
As part of her international research approach, Istanboulian is currently involved in a research group led by leading Australian and UK researchers, that is exploring global priorities related to communication research in the ICU, including the needs of patients, family caregivers, and healthcare providers.
“Right now, we don’t train critical care healthcare providers in communication techniques, and so many of them feel ill-equipped to address barriers in their practice,” says Istanboulian.
To sustain interventions – particularly in complex care units such as the ICU – they need to be properly implemented. Istanboulian found that focusing on just a single intervention, such as the communication toolkit, was not enough. In addition to reframing patient communication in the ICU as a safety issue, Istanboulian has shifted the framing of her research focus to include communication interventions across the care continuum – before ICU admission and post-discharge.
“When people are unable to effectively communicate their needs, not only do we make them vulnerable to physical harm, such as short and long-term pain, but they become at risk of psychological harm that can last well beyond discharge from hospital,” says Istanboulian.
In addition to focusing on patient needs, Istanboulian involves families and caregivers in her research, co-designing and evaluating family engagements strategies that go beyond a single intervention and encompass policies and structural change across the entire care continuum.
“Embedding family engagement in the structure of ICU care is not only humane, it is also about providing equitable care,” says Istanboulian.
Aligned with her expanding research program, Istanboulian is also a Clinician Nurse Scientist for the Provincial Centre for Excellence in Prolonged Ventilation at Michael Garron Hospital. Here, her patient-oriented research includes exploring and evaluating ways to promote health and accessibility to care by creating integrated care pathways across the critical care continuum.
As she begins her journey as a faculty member, Istanboulian is looking forward to progressing this research and also mentoring students.
“Having the opportunity to guide someone in their PhD in the same way I was mentored at Bloomberg Nursing, and to collaborate with new graduate students is something I am really looking forward to,” says Istanboulian.