To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at http://evolve. elsevier.com/Black/professional.

The word “science” comes from the Latin word scire “to know” and refers to knowledge gained by systematic study, that is, research. Although science and research can be imposing concepts, they actually form the base of the discipline and profession of nursing. The purpose of this chapter is to help you understand nursing’s scientific base—the science of nursing—and the links between nursing practice, research, and science. Many of you who are studying this chapter are working toward completion of a bachelor”s degree of science in nursing (BSN); each of you are using nursing science to shape your practice.

Chapter opening photo from istockphoto.com.

Mature professions have a strong scientific base, which both defines and is defined by the purposes of a profession. Florence Nightingale, whose work is detailed in Chapter 2, advanced the practice of nursing by both defining it clearly and providing scientific evidence of the outcomes of excellent nursing care in the Crimea. Figure 11-1 shows her careful documentation of the improvement in morbidity and mortality among soldiers in Bulgaria and the Crimea over a course of a year. In the mid-twentieth century, scholars and researchers realized that nursing could achieve a high level of professional status only to the extent that the discipline was based on a scientific body of knowledge unique to nursing. As a result, nursing researchers began developing knowledge unique to nursing, and nursing theorists began developing theories and testing them. Theory and research are the foundations of scientifically based nursing practice.

At the same time, nurses realized that professionalization of patient care practices was also needed. Until that time, nurses relied on traditional techniques to manage common patient problems. More unusual problems were often managed by trial and error or intuition. However, these were no longer acceptable ways to care for patients. The impetus toward evidenced-based practice was emerging, which required nurses to base their care and activities on research-based knowledge. This necessitates a strong link between the work of nurse researchers and nurses in practice. The development of the nursing process became a means of adapting a scientific framework to the management of patient care so that nurses were no longer depending on hit-or-miss techniques but were shaping care in direct response to the individual needs of the patient. The nursing process is presented in depth in Chapter 8.

Furthermore, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program, described in Chapters 3 and 10, includes in its Magnet Model a component “New Knowledge, Innovation, and Improvements” (www.nursecredentialing.org/MagnetModel.aspx). Inclusion of this requirement for hospitals seeking to attain Magnet status underscores the importance for nursing to be responsible for the development, maintenance, and application of its own professional scientific knowledge base. The Magnet Model requires that initiatives and leadership for nursing research reside with clinical nurses, not nurse managers or others in administrative positions.

Science and the scientific method

Science is research based on one or more past scientific achievements or accomplishments that are acknowledged by the scientific (academic) community as providing a foundation for further study or practice (Kuhn, 1970). Good science—that which contributes to the knowledge bases of a discipline—requires that research be based on the previous work of others in the same academic discipline or be related to work of others from other disciplines. This is a safeguard that ensures that knowledge development is based on sound principles and theory rather than simply the product of a creative idea that is not based on any known science. Sound science and creativity are not mutually exclusive; creativity has led to many interesting and useful research developments that in turn guide nursing practice.

Science has three distinct divisions: natural, social, and formal sciences. Natural sciences include disciplines such as biology, chemistry, and physics. Social sciences such as economics, sociology, anthropology, and history are focused on aspects of the human experience. Formal sciences include logic, systems theory, statistics, and mathematics and are concerned with formal systems—sets of axioms, definitions, and rules—to create knowledge.

Each academic discipline has its own specific scientific community, meaning that nurse researchers and scholars acknowledge and judge scientific developments in nursing. Common to research in all disciplines, however, is the use of an orderly, systematic way of thinking about and solving problems. This systematic way of thinking is traditionally known as the scientific method, used by scientists for centuries to discover and test facts and principles. The history of the development of the scientific method is complex; however, Sir Francis Bacon (1561–1626) is widely considered the father of today’s scientific method.

The traditional form of “doing science” requires standardized experimental designs with hypotheses, measurable variables and outcomes, and statistical analyses. This form of inquiry is often referred to as quantitative research, because variables are measurable (quantifiable). Quantitative research is sometimes referred to as “hard science” because of the reliance on research designs that are used to minimize subjectivity and bias. Bias refers to the systematic distortion of a finding from the data, often resulting from a problem with the sample, that is, the persons being studied. For instance, if you wanted to test an intervention focusing on the benefits of early mobility after abdominal surgery, your sample should include a wide age range of patients. If you included only young patients who by benefit of age are likely to be in better health and thus are likely to get out of bed soon after surgery, your results may be biased; that is, they show more benefit than the intervention actually delivers because your sample is narrowly confined to younger patients.

Because nursing is interested in human phenomena (events or circumstances) that might not be best studied using traditional quantitative research techniques, a significant number of noted researchers in nursing use a different approach to explore human responses in health and illness. This approach is known as qualitative research, because there are no variables being manipulated; rather, qualities of the human experience are described and interpreted. Sometimes qualitative methods are referred to as “soft science,” meaning that manipulation of variables is not a goal in this type of research. “Soft” does not refer to the level of difficulty that is required to do excellent qualitative research.

Qualitative research, also known as naturalistic inquiry or interpretivism, relies on data collection techniques such as narrative interviews and participant observation, among others. These techniques are known as “field work,” where the researcher spends much time in the setting where the phenomenon occurs. Examples of phenomena studied by qualitative researchers include women’s responses to intimate partner violence, fatigue related to human immunodeficiency virus, couples’ experiences of pregnancy when the fetus has a been diagnosed with a serious defect, and the adjustment by elders to living in a skilled nursing facility. Qualitative methods are commonly used in the social sciences, where measurement of phenomena may not be possible or even acceptable in terms of understanding the human experience. Several types of inquiry are commonly identified with naturalistic inquiry; ethnography, phenomenology, and grounded theory are the most familiar.

A combination of quantitative and qualitative methodologies is known as mixed methods research, a means of examining phenomena of interest using a variety of data collection techniques and analyses. Regardless of type of methods, all good research has a theoretical basis and is carried out in a systematic, disciplined way that furthers the development of a discipline’s knowledge base.

Basic, clinical, and translational science

Traditionally, scientists divided scientific knowledge into two categories: pure and applied. Pure science or pure research, sometimes referred to as bench science, summarizes and explains the universe without regard for whether the information is immediately useful. When Joseph Priestley discovered oxygen in 1774, he did not have an immediate use for that information. Therefore that discovery could be classified as pure science, that is, information gathered solely for the sake of obtaining new knowledge. Applied science is the practical application of scientific theory and laws. Applied science is usually referred to as clinical science now—taking to the patient’s bedside those findings that may be useful in curing, managing, or preventing diseases or managing symptoms. For instance, when Priestly discovered oxygen almost 240 years ago, he had no idea that one day this elemental substance would be used as a therapy under pressure (as hyperbaric oxygen therapy) in the treatment of air emboli, decompression sickness, myonecrosis (gangrene), and other wounds.

More recently, however, scientists have recognized the importance of a third type of research—translational research—that serves as a conduit between the “bench and the bedside.” Translational research takes the findings in the laboratories and develops them for use at the bedside. In turn, translational research takes the findings from clinical research done at the bedside to ask new questions and to direct new research at the bench level.

In 2006, the National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services and the largest source of public funding for health-related research, launched a new initiative known as the NIH Common Fund. The Common Fund supports collaboration across two or more of the 27 institutes and centers, each with a specific scientific agenda, that make up the NIH.

The Common Fund has supported a series of high-impact programs across the NIH, known collectively as the NIH Roadmap for Medical Research. The purpose of the Roadmap effort is to enhance the way that American biomedical research is conducted, making it more streamlined and flexible in responding to the health needs of society, while still maintaining the high standards required of excellent scholarship and science. One of the key innovations of the Roadmap effort has been to enhance translational science by funding the Clinical and Translational Science Awards (CTSA) initiative. The CTSA initiative holds great promise in advancing interdisciplinary research, shortening the time from “bench to bedside” and enhancing patient care in a multitude of ways.

Inductive and deductive reasoning

Research requires the use of one of two kinds of logic: inductive reasoning or deductive reasoning. In inductive reasoning, the process begins with a particular experience and proceeds to generalizations. Repeated observations of an experiment or event enable the observer to draw general conclusions. For example, a researcher may be interested in the experiences of women who participated in centering, a form of group prenatal care. After interviewing 25 women who had this form of care and finding a generally positive response, inductive reasoning may lead the researcher to infer that this is an effective intervention, based on the responses from this small sample of women. This type of inferential reasoning leads to the development of probabilities but not certainties, unless every single woman who received centering prenatal care was included in the research—a study that would be impossible to conduct.

One of the important uses of research that uses an inductive approach is that inferences are made that leads to further research. For instance, the researcher studying centering prenatal care finds that most women experienced this form of care as acceptable, but also that several mentioned that they would appreciate some one-to-one time with a provider to discuss more personal matters. From the findings from the original study, the researcher can develop an intervention and test it against the usual standards of care. In this case, three different forms of care could be tested: centering only, centering with provider time (based on the responses of several women in the original qualitative study), and usual care as typically provided in the clinical setting.

Scientists also use deductive reasoning, a process through which conclusions are drawn by logical inference from given premises. Deductive reasoning proceeds from the general case to the specific. For example, if the premises “All pregnant women benefit from centering prenatal care” and “Ms. Foster is a pregnant woman” are accepted, the conclusion “Ms. Foster will benefit from centering prenatal care” can be drawn. It may be entirely possible, however, that Ms. Foster, although pregnant and needing prenatal care, may have specific needs not amenable to centering care and will not benefit from receiving care in a group setting. In deductive reasoning, the premises used must be correct or the conclusions will not be. The faulty premise in this example is that “All pregnant women will benefit from centering prenatal care.”

Conclusions drawn through deductive processes are called valid rather than true. “Valid” is a term meaning “soundly founded,” whereas “true” means “in accordance with the fact or reality” (Flexner, Stein, Su, 1980). It is possible for a conclusion to be solidly founded without being true for everyone. There is a subtle but real difference between the words “valid” and “true.” For example, the premise that women benefit from centering care may be valid; this is soundly founded in the original findings of the researcher who interviewed 25 women. What is not true, however, is that all women benefit from centering care. The premise is valid but not true in all cases.

As seen by these examples, neither inductive nor deductive processes alone are adequate. If scientists used only deductive logic, experience would be ignored. If they used only inductive logic, relationships between facts and principles could be overlooked. A combination of both types of reasoning processes in science unifies the theoretical and the practical, which is the basis for the scientific method and research.

Limitations of the strict definition of scientific method in nursing

The traditional scientific method used by quantitative researchers has considerable value, and it has been used by nurse researchers to address a wide range of nursing problems (Polit and Beck, 2004). However, the scientific method as implemented exclusively with quantitative techniques has limitations when applied to phenomena of interest to nursing.

The first and most obvious drawback is that health care settings are not comparable with laboratories. Certain phenomena of interest to nurses are not amenable to study in a laboratory setting and in fact are not amenable to study in tightly controlled circumstances. For instance, in the discussion of inductive/deductive logic regarding centering prenatal care, measurement of women’s experiences and reactions to this method of care is not possible in the laboratory setting by conventional measures. The phenomenon of pregnancy care may be of great interest to perinatal nurses; the systematic examination of this intervention and the measurement of outcomes may not be a particularly good fit with the laboratory setting. Women’s reaction to this form of care is a human response that occurs in real-world settings. Research techniques generic to qualitative research may be more appropriate to the aims of this research. Note that the term “naturalistic inquiry” is a term that is often used in place of qualitative research to refer to the examination of phenomena that occur in the “real world” as opposed to the laboratory setting or in research where variables are controlled.

Second, human beings are far more than collections of parts that can be dissected and subjected to examination or experimentation. A criticism of methodology that relies solely on measuring attributes of people is that it is “reductionistic,” that is, the richness of human experience is reduced to variables that can be measured. Conversely, a strength of nursing is its holistic view of patients. Because humans are complex organisms with interrelated parts and systems, the scientific method loses much of its usefulness in the examination of complex human phenomena.

A third limitation of the scientific method as the only approach to solving patient problems is its claim to objectivity (freedom from bias); it fails to consider the meaning of patients’ own experiences, that is, their subjective view of reality. Nurses are keenly aware, however, that patients’ perceptions of their experiences (subjective data) are just as important as objective data and may have significant effects on their health behaviors. Again referring to the centering prenatal care example, let us assume that a well-designed, reliable, and valid instrument (such as a questionnaire) can measure Ms. Foster’s satisfaction with this form of care. One month after delivery, her satisfaction scores are higher than they were when she was pregnant, thus it appears that she is satisfied from the centering care. However, this approach fails to take into consideration the complex changes one undergoes when becoming a mother, and Ms. Foster’s higher scores may represent something completely different from her satisfaction with her care—her happiness in being a new mother or her relief that she is not pregnant anymore. There may be many reasons she is now scoring higher on satisfaction with this form of prenatal care. The questionnaire by itself may not capture in its entirety or the nuances of the experience of Ms. Foster’s centering prenatal care in light of her new motherhood.

What is nursing research?

If you are a college or university student, you may have been introduced to research through your basic psychology or sociology courses, in which you may have been required to participate in some way in your professor’s research project. Although sometimes these projects involve interesting experiments, in some cases, the only type of research to which you may have been exposed used surveys or questionnaires to collect data. This kind of introduction to research may lead you to wonder what research has to do with your ability to care for patients.

The rest of this chapter describes some basic concepts of nursing research. The purpose is to introduce nursing research, demonstrate its merit, and provide a basic vocabulary. The ultimate goal is for nurses to participate in the research process and apply research findings to clinical practice. This is a key component to what is known as evidence-based practice (EBP).

Nursing research is the systematic investigation of phenomena related to improving patient care. Ideas for nursing research often arise from nurses’ clinical observations. Although a research topic may be new and innovative, much can be gained from choosing research problems that are connected to work already done, thereby building the body of knowledge of nursing. A problem may be amenable to being addressed by research if these criteria are met:

1. A conceptual framework exists or can be constructed from research that already has been done; that is, the researcher’s ideas about the problem fit logically and align with what is already known about the topic.

2. The proposed research project is based on related research findings published in professional peer-reviewed journals or is supported by similar ongoing research in other settings or disciplines, thereby building nursing knowledge.

3. The proposed research is carefully designed so that the results will be applicable in similar situations or will generate hypotheses for further research and testing.

In addition to building nursing knowledge, studies that build on previous work are more likely to receive financial support. Research can be expensive and sometimes requires funding beyond what one nurse, hospital, or university can supply. Small projects such as survey research may not be prohibitively expensive, especially if the sample (the persons in the study) is not large or if the persons being studied can be recruited nearby. Many hospitals and professional nursing organizations have funds available for small projects to encourage nurses in practice to do research.

Nurses who want to do large, expensive research studies will find it necessary to obtain outside funding or compete with other aspiring researchers for limited internal (from within the agency) funding. Therefore to receive funding, nurses must do research that interests others, has demonstrated significance, and has support from reviewers who examine the proposed research for the specific funding agency and make recommendations about whether to fund it or not.

Furthermore, research that is not based on or is not related to previous foundational work may have inadvertent violations of human participants’ rights. In other words, it is hard to justify asking people to participate in research if there is no real connection to previous work or theory that supports the idea that an intervention works or a problem is significant. Researching or testing an intervention in humans just to see whether it works or that seemed like a “good idea” ignores potential shortcomings or may fail to anticipate problems if adequate foundational work is not done before instituting the research. In fact, such research will not receive approval from a federal human participants’ review board if significant linkages with previous research are not demonstrated. This review board (commonly known as the institutional review board [IRB]) approval must occur before any research involving humans is undertaken.

Thus although nursing research may be broadly defined as anything that interests nurses and helps them provide better care, controversy exists over what can legitimately be included. When considering a research question, the wise nurse researcher considers the practical issues of background and financial support. An important source of funding and support for nursing research is the NIH’s National Institute for Nursing Research (NINR), created in 1992 from what had previously been known as the National Center for Nursing Research. NINR states its goal is to “advance nursing science by supporting research on the science of health, which focuses on the promotion of health and quality of life” (NINR, 2011). To advance the science of health, NINR has identified five strategic areas in which it will invest. These areas, in addition to NINR’s mission statement, are included in Box 11-1.

BOX 11-1   NATIONAL INSTITUTE OF NURSING RESEARCH: MISSION, GOAL, AND INVESTMENT IN THE SCIENCE OF HEALTH

The mission of NINR is to promote and improve the health of individuals, families, communities, and populations. The Institute supports and conducts clinical and basic research and research training on health and illness across the lifespan to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and improve palliative and end-of-life care.

NINR’s goal is to enhance nursing science and health care by integrating the biological and behavioral sciences, applying new technologies, promoting health equity, and developing scientists of the future.

To advance the science of health, NINR will invest in research to:

• Enhance health promotion and disease prevention

• Improve quality of life by managing symptoms of acute and chronic illness

• Improve palliative and end-of-life care

• Enhance innovation in science and practice

• Develop the next generation of nurse scientists

National Institute of Nursing Research (NINR): Bringing science to life: NINR strategic plan, Bethesda, MD, National Institutes of Health (NIH), 2011 (website). Available at www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan.

Research is different from problem solving. Problem solving is specific to a given situation and is designed for immediate action, whereas research is generalizable or transferable to other situations and deals with long-term solutions rather than immediate ones. For example, Mrs. Abney is an elderly patient who is often found wandering in the halls of the nursing home, unable to find her way back to her room. This is distressing to her and time-consuming for the nursing staff that help her find her way “home.” A nurse notices that Mrs. Abney has no difficulty recognizing her daughter, so she tapes a photograph of the daughter to Mrs. Abney’s door. Now Mrs. Abney can find her room easily. She is less agitated, and the nursing staff time can be spent elsewhere.

Mrs. Abney’s case is an example of problem solving, an effective intervention in one set of circumstances that has immediate application. However, the solution that worked for Mrs. Abney may not work for all confused patients. In fact, it may not continue to work for Mrs. Abney if her cognitive abilities decline further. Remember that nursing research was developed in response to the professional and scientific mandate that nursing care be based in evidence and not simply on trial and error. Occasionally, creative problem solving such as that of Mrs. Abney’s nurse is required on a per-case, situational basis. But this sort of trial-and-error problem-solving approach is not adequate to base one’s professional practice in a substantial and sustained way. Table 11-1 contrasts research and problem solving.

TABLE 11-1

COMPARISON OF RESEARCH AND PROBLEM SOLVING

CHARACTERISTIC	RESEARCH	PROBLEM SOLVING
Type of problems addressed	Significant number of people affected or significant impact on smaller number of people	Situation-specific
Conceptual basis	Theoretical framework; keys to researching the problem found in previous research	Often none; trial and error
Knowledge base needed	Extensive review of literature to determine latest thinking and research	Practical knowledge, common sense, and experience
Scope of application	Generalizable or transferable to similar situations	Useful in immediate situation; may or may not be useful in other situations

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Critical thinking, the nursing process, and clinical judgment
2. The education of nurses: On the leading edge of transformation
3. Illness, culture, and caring: Impact on patients, families, and nurses
4. Health care in the United States

Stay updated, free articles. Join our Telegram channel

Join