From nursing to clinical research: interview with Professor Haleema Shakur-Still
On International Nurses’ Day, 12 May, the I’M WOMAN Trial team highlight the importance of nursing in clinical research to improve maternal health outcomes worldwide.
In this interview, Professor Haleema Shakur-Still, Emeritus Professor of Global Health Clinical Trials and Co-Principal Investigator of the WOMAN-2 Trial, reflects on her nursing experiences and how it has influenced her career in clinical trials.
Haleema began training as a nurse aged 17 at the former St. Vincent’s Orthopaedic Hospital in Pinner, Middlesex – the only nursing course which accepted young trainees. She later completed general training alongside a nursing degree to become a registered nurse in Hillingdon and Harefield hospitals, then as a cardiothoracic nurse specialist, a respiratory nurse specialist before joining the London School of Hygiene & Tropical Medicine (LSHTM) in 2002 to work in clinical trials.
What made you want to pursue nursing at such a young age?
I never wanted to be a nurse as a kid. I wanted to be an air traffic controller instead, but I was encouraged by my father to pursue nursing.
Nursing is a career where you’re able to help somebody in the worst moments of their lives.
What was the highlight of your nursing career?
I loved every moment of being a nurse. I was lucky enough to work in different areas of nursing, from psychiatric nursing to obstetrics to gynaecology and paediatrics. I cannot think of another job like nursing because there are so many different areas in a hospital to specialise in.
The person who spends the most time with a patient is a nurse. If there’s an emergency, it’s the nurse who responds initially while a doctor is called.
I experienced caring for people from conception all the way through to death. When you have a patient at the end of their life, for example, when medical care is no longer appropriate, nursing is what is required. You get to see the person, not just an illness.
And in nursing, you never know the impact you can have on somebody’s life. I’ve had patients diagnosed with cancer contact me several years later to say thank you.
Did you ever respond to obstetric emergencies when you were a nurse?
I saw a postpartum haemorrhage (PPH) for the first time as a student nurse.
I didn’t know what it was, because you’re told all women bleed, but when does it become a problem? I took one look at this woman, and she was pale and clammy. I lifted the sheet and there was blood everywhere. I knew something was not right.
As a student nurse, all you can do is call for help at that stage, because you have no knowledge on how to intervene. Of course, I know now that PPH is highly preventable.
Did this experience influence you to work on a clinical trial?
I became a ward sister in my 20s and I can remember wishing I could do more to make a difference to my patients. So, I began a Master’s degree in biomedical sciences to further understand and treat diseases. I quickly learned that lab research does not always transfer to making an impact on people’s lives.
I started to see the impact of clinical trials as a research nurse at the Royal Postgraduate Medical School. Then I came to work at LSHTM and discovered epidemiology. For the first time, I really understood how clinical trials could make a difference to people. Epidemiology teaches you how to design a clinical trial properly, identify the size and how to target the right population to create a trial that matters to people.
What was it like to work on your first clinical trial?
The first trial I worked on was on a standard treatment for brain injury, corticosteroid. However, it showed that the treatment was doing more harm than good. The upside is that it changed that area of practice around the world. So, clinical trials can really impact global health in this way.
A clinical trial can take between five and 10 years to get a result. The impact you would see on patients from working as a nurse is different in clinical trials because the results affect people you will never see or meet in your lifetime.
How did you bring your nursing experience to the WOMAN Trials?
My experience as a nurse and witnessing a PPH all led to working on the WOMAN Trials. I was working on the CRASH-clinical trial at the time testing tranexamic acid on bleeding from traumatic injury.
I remember once being in the emergency room when a woman arrived having given birth outside the hospital. She came in extremely unwell, and we could hear resuscitation behind the curtains, then there was this wailing, and we learned this woman had died from PPH. When I spoke to the doctor, they said they needed more treatments for women with PPH and asked why women in this situation were not being tested. If she had received TXA, she would have had a good chance of surviving.
We know from the WOMAN Trials, tranexamic acid reduces the risk of a woman bleeding to death by about a third. I believe the WOMAN Trials have made a difference to women worldwide.
Learn more about how the WOMAN-2 Trial and how the WOMAN Trials are researching ways to reduce global maternal deaths.
