Research and development in nursing revisited: nursing science as the basis for evidence-based practice
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30th Anniversary Invited Editorial reflecting on Luker K.A. (1990) Research and development in nursing. Journal of Advanced Nursing 17, 1151–1152
In 1992, Karen Luker's Journal of Advanced Nursing Editorial focused on why nursing research had not had the expected impact on nursing practice, and expressed a concern that the emphasis on research utilization had obscured the priority to fundamental research. Has this situation changed in the ensuing 15 years? Is research informing practice in nursing and the health professions more effectively than was perceived a decade and a half ago? Is nursing research achieving an impact on the health of people throughout the world? What barriers still stand in the way?
Research informing practice
I believe that the rapid embracing of ‘evidence-based practice’ throughout the health professions over the past decade indicates that not only nursing, but also medicine, health administration, social work and other health service providers have taken seriously the need to base an increasing proportion of current practice on sound evidence, and especially on evidence from research. Indeed, the most recent statement on nursing research of the American Association of Colleges of Nursing reflects this worldwide commitment to sound evidence from rigorous scientific inquiry (AACN 2006). The worldwide vision for nursing research as a basis for evidence-based practice is contained in this quotation from the International Council of Nurses:
Nursing research is needed to generate new knowledge, evaluate existing practice and services, and provide evidence that will inform nursing education, practice, research and management. (ICN 1999)
The evidence-based practice movement was more prominent in former Commonwealth countries [United Kingdom (UK), Canada, New Zealand, Australia] than in the United States until the mid- to late-1990s. Now, one finds references to evidence-based nursing or evidence-based practice throughout the world (Dunbar-Jacob 2005). Many of these references are true to the earliest formulations of evidence-based practice that indicated research was only one part of a three-legged stool upon which to base practice, clinical expertise and patient preferences or values being the other two legs (Sackett et al. 2000). Thus, choices among treatment options should take all of these factors into account, including – but not limited to – the research base supporting (or not) the therapeutic option.
There continue to be surveys that indicate many practising nurses are unaware of the concept of evidence-based practice; do not feel skilled in finding or evaluating evidence; or do not understand how to practice from an evidence base (e.g. Egerod & Hansen 2005, Pravikoff et al. 2005). Nevertheless, there is growing evidence of innovative academic–practice partnerships throughout the world that are making evidence-based practice a part of everyday clinical practice, and of nursing curricula at all levels. I believe there is strong evidence that we have moved beyond simple ‘research utilization’ to make ‘evidence-based practice’ part of our educational and practice norms in countries that have a strong history of nursing research and nursing education within higher education (Burke et al. 2005, Henderson et al. 2005, Mohide & Coker 2005, Parkin & Bullock 2005). This surely represents great progress over the relatively short period since the publication in 1992 of Luker's Editorial in JAN.
Impact of nursing research
The growing centrality of evidence-based practice would imply an impact of nursing research on people's health through nursing practice. Others would contend that nursing is still not a high-impact science, either in terms of the citations of our research work in the larger scientific community or in terms of financial support of nursing research by national and international funding sources (Tilden & Potempa 2003). While there is no question that international journals, such as JAN, that publish nursing research are ascending in the scientific index impact ratings, as a group these journals are somewhat lower in status than medical and interdisciplinary journals publishing largely ‘hard science’ and biomedical research. Several editors suggest caution in relying only on journal impact factors to judge the overall impact of science developed by nurse scientists, recommending instead a multifaceted evaluation of impact (Lewison 2002, Broome 2005). Perceived impact on the public's health is evident in a growing number of worldwide press notices about articles in nursing journals that capture the public's interest. For example, studies published recently in JAN about tai chi and fall reduction, stress factors for new mothers, and use of compression stockings to prevent deep vein thrombosis in air travel have received international press coverage through this journal's innovative Media Outreach programme (see the Press Room on JAN’s website: http://www.journalofadvancednursing.com). And many websites for funding or health agencies provide numerous examples of nursing research studies that are making a substantial contribution to improving the quality of life and health for people worldwide (see http://ninr.nih.gov/ninr/news-info/pressrelease.html or the WHO evidence network: http://www.euro.who.int/HEN).
Barriers to nursing research development
I believe we have come quite a distance in developing research that underlies nursing science, and in turn underpins nursing practice, thus making a visible impact on the health of people around the world. Nonetheless, there are still numerous barriers to realizing the full potential of research in the science and practice of nursing. The issue of research capacity is still with us, although many nations have advanced preparation of nurses and nurse scientists into higher education (Cooke & Green 2000). The PhD is rapidly becoming the essential degree for faculty positions in premier universities and colleges worldwide. But the adjustment of workload for these newly doctorally prepared nursing faculty is not as uniformly accomplished. Greenwood and Gray (1998) discussed the establishment of clinical research Chairs as necessary to providing a research culture in nursing faculties. Yet, we still see our colleagues with newly minted PhDs return to extraordinarily heavy teaching and clinical supervision loads, with little time to develop and manage the research careers for which they have been educated (Lee 2003). This is certainly true in many colleges in the United States, prompting Potempa and Tilden (2004) to recommend that Deans of Nursing take responsibility for establishing a research track that supports the research career development of faculty members with significant research activity or potential. The same barriers are holding back nursing research in universities around the world. And, in practice settings, clinical nurses who have undertaken research training, even those with a PhD, are not being adequately supported as research-active practitioners. The lack of organizational supports, lack of time, and mentorship for practising clinicians to learn and use evidence-based practices also remains a substantial barrier (Fink et al. 2005). However, as the many examples earlier attest, these barriers can and are being overcome. What remains is a significant commitment to international collaboration to speed these efforts across our countries in order to increase research activity and impact across all fields of nursing.