Janice M. Morse
4
INCORPORATING THEORY INTO PRACTICE RESEARCH
Repression as the theory of neurosis served as the ground for which a number of revolutionary movements to gain freedom originated. The Victorian outlook on manners and the self-containment of past decades have not become expressionism at any cost. But while we all believe that more people are not mentally healthier because they “express” themselves, this has yet to be proven.
—Burton (1974, p. 14)
The biologist an d Nobel Laureate, Szent-Györgyi (1972), once said that in order to be a great researcher, one must think of a groundbreaking approach to familiar problems that everyone sees. In nursing, this begins with an understanding of the theory–practice–research link, or relationship between theory, research, and practice. The theory–practice–research link was discussed in detail by nurse researchers and theorists in the early 1980s. As a result of these discussions, several landmark articles were written. These acclaimed articles are still in use in doctoral theory courses, and are often unquestioned and unchallenged. Since then, we have grown evolved, and developed as a profession, and we should now reconsider our approach to this vital and foundational topic, as the process of deciding what to research, and which perspective to adopt, and how to re-explore the topic, is of paramount importance (Beck, 2016). Here, I examine the relationships between how we perceive clinical problems, or what I call theoretical perspectives considered pertinent to those problems; ensuing research methods; and the influence of various research products as they are applied to nursing practice. This article is based on a plenary address I prepared for a summit intended to discuss new directions for the research agenda in the area of urinary incontinence. This article illustrates how theoretical frameworks may be applied to that substantive area, through various lenses, but I believe that the points made here may be applicable to nursing research’s agenda as a whole.
We should be cognizant of these sometimes conflicting perspectives in our daily interactions, especially as they relate to determining what research will or will not be funded. These conflicts prioritize which problems are considered important and are subsequently researched. By prioritizing one problem over another, conflicts may arise during patient care, in the classroom, and in private meetings of granting agencies. Newspapers may also cover these conflicts, and they may be brought to light during government allocation meetings and in response to special interest groups and lobbyists.
In nursing, our subdiscipline drives what we identify as meaningful research topics, and what we consider as standard modes of inquiry, as data, and as realistic outcomes. Perspectives on such matters are diverse within our profession and vary based on what our view of nursing is, what theories we have been taught, and the role we believe the political agenda should play in resolving these clinical problems. Even though we believe in holism, we fractionate our profession into subdisciplines. Subdisciplines enable us to care for the entire person, but simultaneously our bio-psycho-socio mandate makes nursing one of the most eclectic of all the medical disciplines. For instance, a nurse administrator will likely have different research interests than a home health nurse or a nurse who specializes in women’s health. Similarly, the research interests of a nurse with pathophysiological interests will likely differ from a qualitative nurse researcher concerned with experience and perception, and so on. It is important we study these diverse perspectives from the theories that emanate from them and make them part of our awareness and our consideration.
SCENARIO
To help us better understand these perspectives, let us create a scenario upon which to focus our discussion. In this scenario, Hagar is an elderly woman with deteriorating health. A few months prior to this exchange, Hagar moved in with her son, Marvin, and his wife, Doris. Doris is the primary caregiver who is struggling to continue caring for Hagar in their home. Because Hagar’s health continues to decline, Marvin and Doris decide they must place her in a nursing home:
He [Marvin] stands there awkwardly, his hands held out. Doris sidles up to him, nudges his ribs with a brown rayon elbow.
“Go on now, Marv. You promised.”
Marvin clears his throat, swallows, but fails to speak.
“Stop fidgeting, Marvin, for heaven’s sake. I can’t bear people who fidget. What is it?”
“Doris and me, we’ve been thinking—“ His voice peters out, goes thin as shadows, vanishes. Then, in a gunfire burst of words, “She can’t look after you any longer, Mother. She’s not been well herself. The lifting—it’s too much. She just can’t do it—”
“Not to mention the disturbed nights—“ Doris prompts.
“Yes, the nights. She’s up and down a dozen times and never gets a decent sleep. You need professional care, Mother—a nurse who’ll see to everything. You’d be much happier, yourself, as well—”
“More comfortable,” Doris says. “We’ve been to Silverthreads Home, Mother, and it’s really cozy. You’d love it, once you got used to it.”
I can only gaze as though hypnotized. My fingers pleat my dress.
“A nurse—why should I need a nurse?”
Doris darts forward, her face not soft and flabby now, but peering earnestly. She gesticulates, as though she could convince me by this trembling of her hands.
“They’re young and strong, and it’s their business. They know how to lift a person. And all the other things—the beds—”
“What of the beds?” My voice is austere, but for some reason my hands are unsteady on the squeezed silk of the dress. Doris reddens, glances at Marvin. He shrugs, abandoning her to her own judgment.
“You’ve wet your sheets,” she says, “nearly every night these past few months. It makes a lot of laundry, and we haven’t been able to afford the automatic washer yet.”
Appalled, I search her face.
“That’s a lie. I never did any such thing. You are making it up. I know your ways. Just so you’ll have some reason for putting me away.”
She grimaces, an unappealing look, and I see that she is nearly in tears.
“I guess maybe I shouldn’t have told you,” she says. “It’s not a nice thing to be told. But we’re not blaming you. We never said it was your fault. You can’t help—”
“Please!”
My head is lowered, as I flee their scrutiny, but I cannot move, and now I see that in the entire house, mine, there is no concealment. How is it that all these years I fancied violation meant an attack upon the flesh?
How is it that I never knew about the sheets? How could I not have noticed?
“I’m sorry,” Doris mumbles, perhaps wanting to make it totally unendurable, or perhaps only blundering, having to wait another thirty years or so before she can know. (Laurence, 1966, pp. 73–74)
NURSING PERSPECTIVES
Let me introduce you to four of my fictional colleagues:
Emily
Emily primarily studies the epidemiology of incontinence in older adults. Most recently, she has undertaken a population study of types of incontinence. Her quantitative research is well published, and many of her articles have appeared in Applied Nursing Research and in The Gerontologist. She is considered by her colleagues to conduct meticulous research using complex models. Emily is most interested in identifying patterns of incontinence and occurrences of complications among older adults with diabetes. She completed her master’s in nursing in 1982 and her PhD in 1997.
Chelsea
Chelsea specializes in gerontological nursing, and her research of at-home caregiving for older adults has appeared in Qualitative Health Research (QHR) and Global Qualitative Nursing Research. Her most prominent study was an ethnography of at-home familial care of insulin-dependent older adults with incontinence. This study was funded by a grant from the university where she is on faculty. She has a PhD, and has a reputation with her peers to be an expert in qualitative methods. She has refined and published many of these innovative techniques because of the number of grants she has obtained using these methods.
Joanne
Joanne is a 55-year-old nurse clinician at a large metropolitan hospital. She graduated from the hospital school of nursing and has her diploma hanging in a prominent location in her office. A decade later, when her children were in high school, she completed her baccalaureate in nursing. She is passionate about patient home care, with a particular interest in patients with incontinence. She is respected by her peers and described as a methodical and clinical expert. The latter is largely due to her many years in the field and her efforts to stay abreast of new topics. She attends numerous conferences on aging, especially those related to patient care, and subscribes to the American Journal of Nursing.
Megan
As a nurse physiologist, Megan is primarily concerned with the neuromechanisms of bladder control in older adults with diabetes. She is a focused individual who earned her PhD in 2000 at the age of 27. Her research commonly involves rats, and she conducted most of her work during her postdoctoral program on diabetic kidney disease through the biomechanisms of bladder control. Her studies are typically well-funded by the National Institutes of Health, and she primarily publishes in Diabetes and the Journal of Physiological Nursing.
DIALOGUE
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