Guest editorial: Maximizing value from clinical research

Authors

  • Amanda Henderson

    1. Nursing Director – Education, Nursing Practice Development Unit, Princess Alexandra Hospital & District Health Service, Woolloongabba, Qld, Australia
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Nurses are progressively demonstrating the value of their practice through clinical research. JCN provides an excellent forum for nurses to contribute to clinical practice knowledge by reporting the research undertaken in their practice. For this reason, it is increasingly popular as a ‘useful’ journal for informing ‘hands-on’ practice. I believe that the value of JCN is achieved through the willingness of JCN to recognize the importance of exploratory work that can provide insights into the complexity of contexts of ‘everyday’ phenomena in nursing and also through the acceptance of a range of emerging assessment and evaluation strategies in the study of the process and content of nursing practice. It is important to note that this is achieved through both quantitative and qualitative methods (Watson 2006).

Efforts of JCN to report on this broad base of ‘nursing work’ make a significant contribution in assisting the further explanation and development of nursing practice. Clinical work is complex, with the vast number of patients and their individual requests that need to be addressed by large bureaucracies that have competing demands of cost and efficiency. As highlighted in the editorial by Thompson and Watson (2005), nursing clinical practice, despite being the raison d'etre for nursing is comparatively devalued compared with bureaucratic responsibilities. Given this anomaly, nurses themselves demonstrate a continued interest in trying to achieve the best possible outcomes for their patients and, accordingly, show a willingness to investigate the impact of their practice on the individual. Through exploration and analysis of clinical practice, nurses attempt to develop and communicate knowledge, awareness and understanding of the patient and practices that can best meet patients’ needs.

In reviewing papers and reading JCN, it is inspiring to see the breadth of the concerns and interests that nurses recognize as important to patient well-being; for example, patients’ information needs, patients’ experiences of nursing practice, the uptake of evidence-based practice and the exploration of nursing roles and models of service provision. What I notice when reviewing papers is that nurses’ enthusiasm and passion for what they are exploring, often coupled with the demand by bureaucracies for tangible outcomes, can result in some ‘haste’ with particular components of the research process. For example, nurses may quickly gather data prior to the implementation of an initiative to ascertain a baseline measure. These data, gathered in haste prior to the project are often limited in their usefulness. Unfortunately, assessing the value of the initiative can be constrained because of the rigour of the data obtained prior to the initiative.

Furthermore, nursing work is multifaceted. Nurses routinely undertake many interrelated aspects of practice simultaneously. The difficulty for nurses is ‘breaking-off’ aspects of their clinical work into manageable research projects. Separating practices into specific areas or component parts is invaluable as it means that each specific area or component part of the practice can be separately argued and debated within its relevant knowledge domain. This is essential if nurses are to quantify the impact of their practice.

Powerful studies are those successful in ‘taking apart’ the dynamic processes that has become almost ‘automatic’ in nursing practice. While particular actions as part of an intervention make intuitive sense it is important to recognize these as ‘part of the research’ because their neutrality cannot be assumed.

It is important if nurses are to justify their contribution to practice that the component parts of their practice are clearly recognized. Assumptions are often inherent in research work because many of the problems that nurses solve in their everyday practice are taken-for-granted and not recognized as part of their contribution to practice. Nurses need to be vigilant in their description of complex processes, so nursing activity can be clearly articulated to lay people and other health professionals.

I commend the work of so many nurses who strive to assess and evaluate rigorously the less tangible aspects of nursing care. While it can be argued that these assessments do not produce ‘new knowledge’, i.e. a practice not known previously to nurses, it does provide much needed feedback to direct future practice. In a world where nurses have to justify the worth of their clinical practice increasingly, this research that clearly articulates the worth of particular activities has significant potential to inform how future health care is provided.

Through the exploration of nursing practice, articulation of what makes a difference to patients, and evaluation of nursing practices, JCN makes a significant contribution to inform nurses about strategies that may be useful to incorporate into their own practice. It is essential that nurses coherently unravel these complexities within their research. The implementation and evaluation of compound processes, as part of a research project, are tempting, as these compound processes are representative of our practice. However, it is important that, as nurses, we carefully differentiate, what it is that we want to achieve, what are the particular components around this phenomena, what are the best methods to address this and, in the situation of intervention studies, that the intervention is clearly explicated, to ensure that our findings are rigorous and can be argued to the broader population that we aim to assist.

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