Guest Editorial: Scholarship, interdisciplinarity and academic identity
A recently published nationwide study among nurses and midwives in Ireland identified and established priorities for nursing and midwifery research in each of three broad areas: clinical, managerial and educational (Meehan et al. 2005). Within the Irish context, the study is significant in that its findings provide a clear rationale for programmes and projects of research that can enhance nursing and midwifery care by developing standards of best practice based on empirical evidence. Already the report has led to a call for tenders for major programmes of nursing and midwifery research. For nursing and midwifery in Ireland, the identification of research priorities is, in itself, something of a milestone in the development of the professional and academic disciplines. The process of conducting the national research priorities study implicitly proclaimed the distinctive identities of nursing and midwifery in health care; the product of the study challenged the disciplines to secure the necessary funding, including infrastructural funding, to conduct the research that they themselves prioritized.
In this editorial, we do not wish to comment on the situation in Ireland per se but rather to raise some wider concerns regarding the relationship between research content and output, and nursing's identity as an academic discipline, which the current developments in Ireland bring to our attention. These issues are important as they are ultimately concerned with the ability of nursing to build its research capacity and to advance its scholarship for practice. In particular, we wish to comment on the relationship between scholarship, academic identity and interdisciplinary collaboration.
Research focus and academic legitimacy
In addressing the question, ‘what do nursing professors profess?’, Thompson and Watson (2006) take some nursing academics to task for the ways in which they have sought to distance themselves from their identity as nursing scholars, electing instead to identify themselves with other academic disciplines and to deny their ‘nursing roots’. Thompson and Watson implicitly invoke the concept of academic or ideological drift whereby the pursuits of academics become ever more irrelevant to their occupational base of origin, thereby creating strong boundaries between the professional and academic disciplines. In challenging nursing academics to guard nursing's disciplinary identity and academic integrity, Thompson and Watson raise fundamental questions for the discipline that have a bearing not just on the position of nursing in the academy – which from time to time can seem somewhat tenuous – but also on the future success of nursing in securing research grants.
Perhaps another way of asking the question ‘what do nursing professors profess?’ is to ask ‘what do nursing academics research?’ In a bibliometric analysis of published UK research, Traynor et al. (2001) refer to the apparent valuing within nursing – but notably not amongst funding bodies – of ‘endogenous’ research, i.e. research that emphasizes problems and issues to do with nursing as a profession, over ‘exogenous’ research, i.e. research that emphasizes the nursing of patients. Endogenous research refers to studies of professional issues and the education of nurses, while exogenous research is concerned with topics such as care of older people and quality of life. Accordingly, nursing research tends to be inward looking, focussing on practitioners themselves and on the characteristics of nursing, as opposed to the practices and the outcomes of nursing. Moreover, it also tends to be short term and small scale and less likely to meet the gold standards of quality – characteristic of, for example, biomedical research (Traynor et al. 2001) such as multiple authorship, international and interprofessional collaboration and frequent citations and, therefore, of the type that is much less likely to secure research funding. This trend can be explained by factors such as nursing's stage of disciplinary development and its, perhaps understandable, need for introspection, self-understanding and self-definition, as well as by the need of individual nurse academics to get published. Another explanation is that small-scale scholarship, as opposed to large-scale evaluations of clinical interventions, is more feasible for nursing academics submerged with teaching and administration (Meerabeau 2006).
Traynor et al. (2001) suggest that one of the reasons that endogenous research has tended to be valued by nurse academics and journal editors is that it provides nursing with ‘a perceived entry token to the academy’ (p. 220) by setting out its theoretical foundations. We sometimes reflect on the position of nursing academics in the academy given that others often question whether we are, in fact, of it. Nurse academics are expected to display their academic credibility – through research and publications – as generators (and not just recontextualizers) of knowledge, while at the same time they encounter scepticism about the academic legitimacy of the discipline both from within and outside the academy. They often find themselves represented in professional and popular discourse as a doubly profane presence in academia: profane by virtue of our origins in an occupation which is concerned with the intimate bodily care of patients and profane in the sense that our academic ambitions are depicted as vain and self-serving, directed at the pursuit of status and material reward rather than knowledge to improve nursing practice (Fealy & McNamara 2006, McNamara 2006). Indeed, some would argue that the esoteric theorizing and narcissistic navel-gazing that characterize much academic nursing has corroded the sacred essence of nursing as a practical noble calling (Bradshaw 2001a,b) while academic nursing itself lacks a sacred core in the sense of a distinct body of disinterested knowledge: a bounded substance and syntax. Allen (2004) suggests that much of the discourse of academic nursing is based on a romantic and idealized conception of nursing practice as concerned with holistic emotion work on patients within one-to-one therapeutic relationships. These representations of nursing practice are so at odds with the empirical reality of most nurses’ work as to be pathological, resulting in poor morale and chronic dissatisfaction, which in turn lead to problems of retention.
If nursing's academic identity and legitimacy are called into question in this way, how can nursing hope to succeed in the future in its engagement with the tendering process for research grants and in building its research capacity and, ultimately, its knowledge for practice? As identity is a function of how we see and express ourselves and how others see and talk about us, then clearly academic identity will be constituted in and through language as we interact, qua nursing academics, with other academics and with our clinical nursing colleagues. How might we affirm our academic identity and establish our academic legitimacy and, in the process, ultimately secure our place in the academy? While participating in the work of university committees and contributing to national policy iteration on nursing and health care are essential, the content and the output of our research and scholarship remain the most important vehicles for achieving academic legitimacy.
In seeking research funding to conduct clinical research, nursing academics can expect to encounter strong competition for finite funds from other disciplines. This has been the experience of nursing to date in the various UK research assessment exercises (RAEs) and the evidence suggests that nursing has not fared well in the face of such competition. The pursuit of research grants is not an end in itself as research is ultimately concerned with the dissemination of knowledge; nor does the output of funded research constitute all of nursing scholarship (El-Masri & Fox-Wasylyshyn 2006). However, an analysis and evaluation of publication trends and patterns, authorship, funding sources and citation can reveal much about the extent and character of scholarship (Rafferty & Traynor 2006) and about the character of the discipline itself. Initiatives to build research capacity in both the UK (Rafferty & Traynor 2006) and in Ireland (Department of Health and Children (DoHC) 2003) point to the possibility of increased output and improved quality in the future. While data on UK nursing research output has indicated increases in both quantity and quality with a greater focus on priority areas such as mental health, care of older people, cancer, heart disease, palliative care, pain management and maternity care, and with examples of genuine cross-disciplinary collaboration, a number of areas of concern persist (Bond 2001). These include an over reliance on research funding from a single source, the NHS, a virtual absence of programme-level research funding in nursing departments, underdevelopment of interdisciplinary research and collaboration, insufficient clinical research and a virtual absence of laboratory research (Bond 2001). Thus, while there has been much growth in nursing research activity and output, nursing continues to perform poorly in procuring research funding compared with other academic disciplines. In the 2001 UK RAE, nursing was ranked lowest among the academic disciplines (Cecil et al. 2006). The position in which nursing finds itself with regard to research funding is compounded by policy and political discourse on nursing that emphasizes manpower planning and education while research funding for nursing remains a mere fraction of that available to medicine. This places nursing scholars in the position of marginalized researchers seeking to enter the mainstream of research funding (Meerabeau 2006).
In an effort to justify its position in the RAE process, nursing frequently invokes the claim that its relative youth as an academic discipline leaves it in a position of always playing catch-up, and the cries-de-coeur from nursing academics is that research into such matters as patients’ experiences of illness, coping with illness, and caring is always likely to lose out to the randomised controlled trial that holds the promise of a better treatment for specific diseases. Whatever the truth of this claim, nursing can no longer rely upon it to account for its poor showing in the competition for research funding. While nursing can and has successfully lobbied for the ring-fencing of some funding, it cannot expect all its funding to be secured in this way. The challenge is to bid successfully for research grants in the face of competition from more established disciplines that have the history and tradition of scholarship and a proven track record in securing funding and in publishing. This challenge may be met in two complementary ways. Firstly, nursing academics can develop research questions that focus more on patients and on practice and less on nurses. This, as Kitson (2006) points out, will require an infrastructure that establishes and sustains a virtuous cycle of scholarship, action and innovation involving academics, clinicians and, that as yet rare creature, clinical nursing academics. Secondly, they can collaborate with academics from other disciplines.
Research focus and collaboration
As already observed, research in nursing has tended to be inward looking and of the type that is much less likely to secure research funding (Traynor et al. 2001). Notwithstanding methodological and translational issues, such as ‘the utility question’ in relation to qualitative research (Sandelowski 2004), shifting the focus of research from nurses to nursing care would now seem to be what nursing demands; the Irish research priorities study identified ‘outcomes of care delivery’ as the highest ranked research priority for nursing (Meehan et al. 2005). Moreover, it is by respecting and researching nursing practice and those aspects of health systems and structures that impinge directly and indirectly on patient care that nursing will derive its disciplinary identity. To do this, nursing academics must establish a real dialogue with clinical innovators and with nursing champions and nursing entrepreneurs (Kitson 2006). This will, in turn, serve to reconnect the often abstracted, distracted and distant academic domain with the clinical domain and reduce the sort of academic drift that has left many nursing academics at a distance from their professional base resulting in them professing almost everything except nursing (Thompson & Watson 2006). Regarding the methods of research, nursing will remain in a relatively marginalized position vis-à-vis other academics if it continues to eschew quantitative and experimental research in favour of qualitative research that can often be based on misunderstandings of the theory–method relationship (Bonnell 1999, McNamara 2005).
The other strategy is to collaborate with other disciplines to generate research questions that affirm and take account of the interdependent and complementary nature of interdisciplinary healthcare delivery. Long-standing evidence of the effects of interdisciplinary collaboration between nurses and physicians demonstrates a powerful association between better patient outcomes and nurse–physician collaboration in the practicum (Brooten et al. 2005). The extension of such collaboration into clinical research would seem intuitively the right thing to do, particularly where many funding bodies now seek information on the translational aspects of a research proposal. In the conclusion to her book the Politics of Nursing Knowledge, Rafferty (1996, p. 188) writes:
Nursing's future as a discipline may depend upon the extent to which it can create space to manoeuvre in clinical and academic environments. Thus nursing's freedom to expand intellectually and, I would argue, politically hinges upon its power relations with kindred disciplines, such as medicine and social work, as well as wider social attitudes towards class, gender and mind/manual labour.
Luker (1992) argued that single discipline research should remain as a necessary ‘interim activity’ until nursing developed its own research capacity through the training of researchers. Almost 15 years later, there is evidence of initiatives to build research capacity in both the UK (Rafferty & Traynor 2006) and in Ireland (Department of Health and Children (DoHC) 2003), and many nurses are successfully collaborating with other healthcare professionals in ‘health services research’ (Luker 2006). Collaborative health services research involves research of which nursing research can be an integrated component; health services research and nursing research should not be seen as mutually exclusive activities. Interdisciplinary collaboration should contribute to and not take from the identity and the development of each collaborator and should ultimately provide relevant knowledge for all the contributing disciplines.
Academics in other disciplines collaborate with others as a matter of course and without any apparent loss of identity on the part of any one discipline. However, unlike nursing, disciplines such as medicine, pharmacy and management are self-assured in their disciplinary identity and relatively secure in their perceived and actual academic credibility; this remains a significant challenge for nursing (Kitson 2006, McNamara 2006).
Nursing must be alert to some inherent risks in interdisciplinary collaboration. With its historically lower position in the hierarchy of disciplines, nursing risks being viewed as the ‘junior partner’ in any collaborative enterprise. Accordingly, in the process of interdisciplinary collaboration, nursing must continue (collaboratively and independently) to research those aspects of patient care and health systems that are the particular responsibility of nurses. Crucially, when nurses collaborate with other academic disciplines, they must be mindful of what they qua nurses bring to the research. They must contribute to the framing of research questions in a way that only they as nurses can, drawing on their intimate knowledge of patients’ responses to ill-health and its diagnosis and treatment as well as of the day-to-day realities and exigencies of the environment of care at all levels. This requires close and continuous interaction with clinical colleagues. Nurses must identify and articulate their particular contributions to the design and conduct of interdisciplinary studies that contribute to the sort of interdisciplinary solutions that make health systems work more efficiently, effectively and humanely. Moreover, it is through the contribution of nursing-specific research questions and hypotheses in collaborative research studies that many academics can both assert their disciplinary identity and affirm their academic credibility. The articulation and enactment of this disciplinary identity requires the acquisition and elaboration of a distinct ‘social language’ (Gee 2005) through which nurses can articulate their particular contributions to healthcare delivery and research.
The issue of a distinctive language for both clinical and academic nursing is an important one; nurses often appear to be deficient in this regard, lacking a distinctive language to articulate their unique contributions to both health care and academia (Hyde et al. 2005, 2006, Meerabeau 2005, Butler et al. 2006, Irving et al. 2006). Whether this is a cause or a consequence of the difficulties attending the articulation of an agreed, credible and comprehensible academic nursing language with currency in both academic and clinical settings is unclear. In the absence of such a language, however, interdisciplinary collaboration poses threats to nursing's academic and disciplinary identity.
Cody (2001) cautions against the uncritical acceptance of ‘interdisciplinarity’ as a way forward for nursing education and research and observes that the term often serves as a rhetorical veneer masking the continuation of the status quo in academia and health care. Nursing, he warns, risks ‘being swallowed up’ by the interdisciplinary movement resulting in its ‘unique nascent knowledge disappearing’ (Cody 2001, p. 277). Standish (2002) argues for the maintenance of disciplinary borders insisting that we should cross them by all means ‘but this is not the same as to say that there must be a dissolution of disciplines in a confused interdisciplinarity’ (Standish 2002, p. 16). Interdisciplinary collaboration entails a new understanding of roles and relationships in health care (Kitson 2001) and mutual recognition of each participant's sphere of activity and responsibility (Lindeke & Block 1998). This requires of nursing clarity of thought regarding the precise contribution of a nursing sensitivity and perspective to programmes of healthcare research and the ability to articulate this forcefully and with conviction.
The agenda for research must include a focus on nursing and health care (in preference to a focus on nurses) and must involve multi-site/centre, international and interdisciplinary collaboration (Draper 2006). Interdisciplinary collaboration is by no means the panacea for assuring nursing's future as a research-active academic discipline. Nor is it in and of itself going to confer a greater academic legitimacy on the discipline. However, with well-formulated nursing research questions and hypotheses, and with well planned interdisciplinary and independent clinically-relevant research, nursing's identity can become clearer as nurses articulate their knowledge for practice and in the process create their own space in the academy and enhance their academic legitimacy.
As an intellectual and practical endeavour, scholarship is a concept that knows no disciplinary boundaries. The challenge for nursing is to ensure that the principles of scholarship inform both its research and practice. This is done by developing a relationship of equals with scholars in other disciplines, and crucially, by ensuring that its scholarship connects with its own practice and its own professional base.
Given the complexity of the relationship between the interdisciplinary and the intradisciplinary, we pose some further questions. These include: what should be the clinical research priorities for the next 5–10 years? With whom should nursing academics collaborate in addressing these priorities? How will collaborative health services research affect the content of nursing research? How will interdisciplinary collaboration influence intradisciplinary collaboration between nursing academics and nursing clinicians? How relevant will the outputs of collaborative research be for clinical nursing practice? Should certain funding bodies require research grant proposals in health services research to demonstrate evidence of the participation of stakeholder disciplines, such as nursing, as co-applicants?