CHAPTER TWELVE Leading research to enhance nursing practice
INTRODUCTION
A major development in the history of nursing research was the establishment in 1986 of a National Center for Nursing Research within the National Institutes of Health in the United States. In 1993 the Center was redesignated the National Institute of Nursing Research; its mission to facilitate national programs of nursing research and promote excellence in the knowledge base for the profession (Hinshaw 1999). No such initiative exists elsewhere in the world and there are arguments as to whether nursing should adopt such a model or take a broader health perspective.
Whatever approach is used, there are a number of issues that need to be addressed including the development of thematic programs (ideally, multi-centred) of nursing research as opposed to small-scale, short-term projects that are unreplicated and ungeneralisable; the identification and securing of research funding; and the building and strengthening of research capacity (Thompson 2000a). In addition, there is a real need for economic evaluations in nursing practice (Jenkins-Clarke 1999).
RESEARCH AND PRACTICE
Practice, the raison d’etre of nursing, is, or should be, the hotbed for generating good research questions. However, although research is being used increasingly by practitioners and more of them are engaging in research, there is little evidence that this is closing the theory–practice gap. If the theory base of practice and the practice base of research are to be strengthened, it is vital that clinical nurses undertake research and nurse-researchers investigate areas that are perceived to be relevant to practice (Thompson 2000b).
While nursing knowledge and research have expanded rapidly over the past few decades, much of it driven by the development of systematically generated knowledge to inform and guide nursing practice, research is not always recognised, even by nurses (including nurse academics), as a legitimate area of science and health care. Nurse researchers often lack the confidence and political acumen to persuade others of the potential important contribution that they can make. Although nursing needs to generate and extend its own body of knowledge through research, it is important that nursing research is seen as part of the broader scientific community. However, there are tensions that relate to what is considered to be quality research in nursing and what is considered to be the role of nurses in a multidisciplinary research agenda (Luker 1999). Nurses rarely participate in research collaborations as equal partners, nor do they participate as equals in identifying worthwhile research questions.
ESTABLISHING A RESEARCH CULTURE IN THE CLINICAL AREA
Research is a human activity and invariably a team effort. The ideal is to be able to assemble a team of individuals sufficiently different to complement each other. The hallmark of a good research team is that it has an ethos of openness, creativity, flexibility, healthy scepticism and a willingness to question the status quo or accepted conventions (Thompson 1998a). As well as an air of trust and collegiality, a sense of fun is also helpful, even if only to counteract the frequent frustrations and disappointments that most researchers encounter.
In order to maximise expertise to improve patient care, a sensible and pragmatic approach is to develop a collaborative partnership between clinicians and researchers. This also has the added advantage of bringing together health care settings and universities. Kitson et al. (1996) identify an organisational framework for promoting research-based practice that includes:
acknowledgement of the importance and inter-relationship of the research implementation and practice development models;
These principles have been used in formulating a strategy for developing research in practice in local settings (Knight et al. 1997). The aim has been to further develop the spirit of inquiry and inculcate a culture of research-based practice, to provide opportunities for nurses to develop their understanding of research, to actively promote the utilisation of research and to contribute, where possible, to the design and conduct of research. Achievements from such an initiative include not only heightened research awareness and research involvement but tangible outputs such as research publications (Martin et al. 1998).
In order to lead and manage research and to foster a climate of intellectual curiosity and creativity, there is a need for regular briefings and intellectual stimulation and interaction, as well as to formulate strategy and project management. There is a need to respect epistemiological and methodological diversity, and through this understanding, ensure that the research methods chosen are appropriate, rigorous and sensitive to the problem. In essence, there is a need to value diversity and plurality in nursing philosophy, science, research methods and practice (Jacox et al. 1999).
Staff education and training
Short courses can play a very important part in enabling continuing education for those employed in research. These can often include specific research methods (such as qualitative interviewing, the design of a longitudinal survey or the management and conduct of a clinical trial), methods of analysis, computing and statistics, writing proposals and presentation skills.
There has been a move towards increasing the role of patients and carers in health care decision-making and policy. Consumer involvement is important because there is a clear mismatch between the interventions that are researched, and those regularly used and prioritised by patients (Tallon et al. 2000). Consumer involvement is likely to improve the way in which research is commissioned, conducted and disseminated. Thus, there is the notion of training and supporting consumers to become involved in research. Consumers can help to ensure that issues important to them, and therefore to the health system as a whole, are identified and prioritised. They can also help to ensure that research does not just measure outcomes that are identified and considered important by health care professionals. They should be involved in all stages of the research process and there should be recognition that there are education and training needs associated with the implementation of this principle.
Nurses need to have adequate time, space, resources and intellectual support, with strong mentorship and supervision. However, they also have to work with many other community members. Increasing emphasis is being placed on multidisciplinary proposals and collaboration. There is a danger that, either through ignorance, naivety or nursing imperialism, nurses may alienate themselves from their closest clinical colleagues. This may result not only in nurses being excluded from collaborative ventures, but also in a possible lack of recognition being given to their own unique and valuable contribution (Thompson 1998b). Thus, there is good reason to offer research training and support programs for a variety of staff, representing a range of disciplines and which teach students not only about the relative merits of the different research methods and approaches but to constantly develop the theoretical framework within which nursing and other research is carried out. This is likely to generate more mutually respectful and harmonious working relationships.
Novice researchers must not only immerse themselves in the literature but must begin to serve an apprenticeship to learn the ways in which research is done. This involves much more than acquiring necessary techniques, whether they be observational or experimental; it also requires the attitudes of commitment and relentless curiosity. These come from seeing how other, more experienced and wiser researchers pursue their investigations. Helping and supervising the novice researcher requires careful judgement, sensitivity and tact (Thompson 1998a). Research degrees (i.e. MSc(Hons), MPhil/PhD) are, of course, important, as is the need for nurse leaders to create opportunities for nurses to be supported to undertake these research training opportunities.
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