Research in Nursing is no longer new in this era of evidence- based practice. Although research in nursing has developed slowly, giant strides have been made by nurses and nursing as a profession in keeping abreast of the world trend in research. This paper, through literature search, looks at the evolution of nursing research, the goals and contributions of research to nursing; the benefits and limitations of nursing research were outlined as well as the role of the nurse in conducting research.
Keywords: Nursing, Research, Evolution, Roles.
Nursing today, is no longer intuition and experience- based. As the status of the profession has emerged emphasis is on evidence based care which focuses on what was done, how it was done, when and where it was done, why such action was taken as well as the implication of such action on client outcomes.
One of the factors that has enhanced professionalism in nursing is research. Nursing has also contributed to the field of research and this is evident from the developments and reformations observable in nursing today.
It is becoming very glaring how much nurses have engaged in research and how much research in nursing has changed hence this paper focuses on the evolution of nursing research, goals, and contribution of research to nursing, advantages and limitation of research as well as the roles of nurses in research.
Definition of Key Terms
Nursing was defined by Virginia Henderson as having the unique function of assisting the individual, sick or well in the performance of those activities leading to health, its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible (Smeltzer, Bare, Hinkle & Cheevers, 2010).
Uzoagulu (2012) defined research as a logical and systematic process of finding solution to a problem. As such research affects the identification and solution of problem areas and challenges facing nursing as a profession.
Evolution means gradual development of something; hence evolution of nursing research implies the gradual development of research in nursing over the years amidst multiple challenges of those years.
Roles are the function or position that something has or is expected to have in an organization, in society or in relationship. In the context of this paper, role of the nurses in research refers to the extent to which the nurses can be involved in research and the influence or effect she has on it through her activities. Nurses' role in research is therefore a conscious activity.
Evolution of Nursing Research
The origin of nursing research has been traced to the mother of modern nursing Florence Nightingale, during the Crimean war of 1850s. Moules and Goodman (2008) stated that Nightingale identified research questions in her nursing practice and undertook a systematic collection of data to try to find answers to the problem. Applying her knowledge of statistics, she analyzed the data and this led to changes in the environment for sick soldiers in form of cleanness, ventilation, clean water and adequate diet these subsequently reduced morbidity and mortality from 40% to 2%.
Although Nightingale's work illustrated the power of statistics to reform nursing, her insistence that nurses undertook clinical research was ignored by the school administrators for well over 100 years (University of Maryland, 2012).
By the early 1900s, there was rapid expansion of hospital training schools which revealed an alarming problem of lack of standards in practice and education. Nursing leaders began investigations and observed that the demands of maintaining efficient nursing services gave little or no time for students to ask questions hence, important surveys, studies and reports that documented the need for a change and value for nursing research, were sponsored by nursing organizations. However, only a small nursing number of pioneering nurses like Majorie Simpson who were educated were conducting research on nurses and nursing.
By 1902, Lavina Dock reported a school nurses “experiment” and by 1906, Adelaide Nutting conducted the survey of the status of nursing education. By 1909, the first university based nursing programme was established at the University of Minnesota.
The University of Maryland further stated that through research, nursing challenges its image as a traditional bound, hands on vocation and built a distinctive base of nursing knowledge.
Irrespective of the growing interest and commitment to research, the practice of nursing was still not a patient oriented science until around 1952, when the Journal of nursing research was published. Berman and Snyder (2012) asserted that other research Journals were subsequently produced and research conferences were held. Nursing research began to be communicated.
Moules and Goodman (2008) noted that many factors affected the growth of nursing research such as: Lack of resources and finding; slow development of research training; capacity and capability building and; the low status of nurses relative to other health professionals particularly medicine.
However, by 1970s, serious considerations of nursing research in the UK came with the publication of the Brigg's Report that recommended nursing should become a research based profession. This is often seen as a turning point in the context of nursing research and as something that is badly needed for professional status.
A standard for clinical practice was developed and the first nursing diagnosis conference was held which influenced nursing research and practice. Initial nursing research focused qualitative research; the argument ensued that nurses did not read and understand research, did not know how and were not able to use it in practice, did not believe research, and that nurse researcher did not communicate well.
Eliot (2011) stated that by 1986, the National Centre for Nursing Research (NCNR) was established under the directorship of Dr. Ada Sue Henshaw; and NCNR started awards and grants to support nursing research and training, and research finding priorities was issued for 2000 2004 exceeding $100million.
By 1990s focus was on outcomes research and the report of the task group on the strategy for research in Nursing, Midwifery and Health visiting and published (DOH, 1993); which sought to address many deficiencies noted earlier about nursing becoming a research based profession. The report recommended that all nurse should become research literate as an essential skill for knowledge led nursing practice.
With the move of nurse education into higher education institutions in the 1990s, research was fully integrated into pre-registration curricula especially in the UK. By 2001 there was a research assessment exercise (RAE) in the UK, an audit of research quality and volume.
Nursing departments came 3A and 3B in the exercise and received a finding through the research capability fund.
By 2007, the UK clinical research collaboration (UKCRC) reported on developing the best research professional who are qualified graduate nurses. DOH, (2006) further opined that the report was part of the agenda to modernize nursing careers, developing and preparing nurses to lead in modernized health care systems. The University of Mary Land School of Nursing 2012 noted that with the birth of nursing organization such as the Royal College of Nursing in the UK, nursing research further developed and by the 1st decade of the 21st century, the foundation of scientific enquiry in the area of scholarship and fellowship was strengthened by the provision of an environment rich in specialized expertise with opportunity for integration of education/practice and mentorship of new scholars.
In Nigeria, research development was rather slow but is currently growing. Asika (2009) observed that great strides have however been made in some functional areas of management. He further noted that the Federal government's research recognition and emphasis was on all types of research especially in firms to the growth and development of Nigerian industries.
A lot of individuals and groups in Nigeria today are engaging in research in various areas so as to advance nursing practice, education and management. Many research Journals are also being produced such as the Nigeria Journal of Nursing, West African Journal of Nursing, International Professional Nursing Journal, the Nursing and Midwifery Council of Nigeria Research Journal, etc. All these Journals are produced in a bid to further advance research in nursing and to change the face of practice, education and management in nursing.
Goals of Research in Nursing
The University of Mary Land School of Nursing identified for main goals of research as follows:
(1) Promotion of evidence based practice
(2) Ensuring credibility of the nursing profession
(3) Providing accountability for Nursing practice
(4) Documenting the cost effectiveness of nursing care
(i) Promotion of evidence based nursing practice
Moules and Goodman (2005) opined that evidence based practice implies making decision about the type of nursing care to give to patients and clients.
In other words, decision about care should be explicit and based on current best evidence as well as using the practitioner's own expertise. Moules and Goodman (2005) further opined that in making an “evidence-based” decision about client care, the nurse should employ three key components thus: to search for and use the best available evidence; consider the requirements, values, circumstances and preference of the patient; integrating their own professional judgments.
Research utilizes the five steps of evidence based practice as follows:
· Identify a problem from practice and turn it specific questions
· Find the best available evidence that relates to the specific question, usually through a thorough and systematic literature search.
· Critically appraise the evidence for its validity, usefulness practical application and methodology rigour.
· Identify and use current best evidence with patient's preferences and the practitioner's expertise, skill, and experience and apply it to the situation.
· Evaluate the outcome and reflect on the process (nurses performance)
(ii) Ensuring credibility of Nursing profession
In the past, nursing lacked credibility as the public felt that nurses had no contribution to the public. With research, nursing developed her body of knowledge and has emerged as a profession that can boldly say what they do, how and why they do them.
Gain (2009) recorded that as at August 2005, nurses were ranked highest in honesty and ethical standards when compared with other professionals; and have continued to prove the worth of their services to the public.
(iii) Providing Accountability for Nursing practice
As a result of the autonomy in nursing profession, there is growing independence which brings with it the duty of being accountable to the recipients of our care. It therefore becomes the responsibility of the nurses to improve their knowledge base regarding healthcare. Gain (2009) further opined that to be accountable for their practice, nurses must have sound rationale for their actions based on the knowledge that is gained through scientific research. The goal of research in nursing is therefore to provide needed knowledge base including the skill for the expected practice.
(iv) To develop Theory in Nursing
Burns and Grove (2005) indentified that one of the goals of research is to develop theory in nursing. Ofi, Kujore and Olubiyi (2007) stated that theoretical models serve as a framework for nursing curricula and clinical practice. Education, they said, promotes research and facilitates the development of new knowledge and modes of nursing practice. Nwankwo (2013) stated that nursing research is needed to generate knowledge about nursing education, administration, health services, etc. The findings of the study have influenced nursing practice and added to a body of knowledge.
(v) To Develop Nurse Researchers
The need for nursing research gives birth to the need for nurse researchers and as more nursing researches are conducted, there is continue improvement in practice and more nurses get involve in identifying problems in clinical practice, and search for answers using scientific method, thus getting more developed in the area of research.
Contributions of Research to Nursing
Research has contributed to nursing in many ways:
- In the science of practice
- In the artistry of practice
- In the structure needed for optimal delivery of care
- The methodologies needed for measurement and evaluation
Science of Practice
Research provides scientific enquiry which has led to knowledge advancement. Scientific enquiry is a process of involving systematic and rationale for actions, thus with application of scientific principle to nursing actions, the science of practice is established.
Art of Practice
Gortner, Block and Philips (2006) stated that art of practice is about the design and beauty of nursing practice. With research, better and more beautiful ways of practice are adopted in nursing. The artistry of nursing practice is about the competence required in nursing which Schon (1988) in Hird (2005) described as professional art involving the skills, attitudes, knowledge and abilities to deliver excellent care to patients. Professionally nurses integrate all elements of competence at an advanced level and make nursing appear easy and effortless. Nursing process, a guide to competency, was made possible as a result of researches by various nursing researchers and theorists.
Structure Needed For Optimal Health Care Delivery
The structure is about the setting in which care is delivered and includes the environment; buildings and infrastructure; the management and policies; nursing system and staff, including state of licensure, accreditation, and certification; the equipment/materials. The structure of health care has been immensely influenced by technology especially in the area of buildings/infrastructure but including machines and monitoring gadgets such as pulse oximeters, cardiac monitors, central patient monitoring systems etc.
Methodology Needed For Measurement And Evaluation
Research is a process in which measurements are taken of individuals or organization and the data subjected to analysis and interpretation. Pion and Codray (2003) stated that in doing this, a variety of methodologies and procedures are employed some of which include survey, observation correlation, experiment, quasi-experiment, secondary and meta analysis etc.
When measurements have been established, evaluation is employed to check the effectiveness of the tools and the result of the tests, hence in nursing, intervention and actions are weighed against standards to ensure congruency.
Other Contribution of Research to Nursing include:
Description of nursing through nursing theories and nursing process, collaborative management of patients; Nurses have collaborated with other professionals in advancing biomedical research with numerous benefits such as:-
i. prevention and control of heart attacks and strokes due to advancing research in area of drugs nutrition, stress etc.
ii. Improving quality of life of people with different types of cancer.
Benefits of Nursing Research
Numerous benefits accrue from nursing research among which are:
Ø Helps in developing scientific knowledge which helps in improving nursing care, patient outcomes, and health care delivery system
Ø Generation of knowledge about nursing education and administration, health service, characteristics of nurses and nursing roles.
Ø Enhances critical skills in communication, independent thinking, creativity and problems solving.
Ø Develops one-on-one mentoring relationship between students and research supervisors.
Ø Enhances the use of ethical consideration in nursing hence protecting the vulnerable public.
Ø It helps in creating a multidisciplinary work environment, as it pulls other professional together during nursing practice.
Ø Encourages qualitative assessment of care by peers
Ø It helps to understand the impact of policy on practice.
Ø Enables triangulation for better results which may be data, investigator, theory and methodological triangulation.
Ø Provides satisfaction for helping others by contributing to medical knowledge or helping to identify possible new treatment
Ø Helps in building capacity and capabilities in nursing.
Ø It helps in the development and evaluation of new types of care delivery (Moules of Goodman 2008) etc.
Ø Provides the opportunity to learn more about an illness and how to take care of it.
Ø Allows treatment to be renewed by many people, including other nurses, doctors and researchers.
Limitations of Research
Although research in nursing has many benefits, it is not without limitations. Some of the limitations of nursing research include:
· Lack of materials/poorly functioning materials which give rise to false results.
· Lack of research knowledge makes it difficult to embark on and sustain nursing research study.
· The rigors of getting ethical clearance especially for researches involving human subjects.
· Lack of value for research makes researchers in specific area to be discouraged thus, no research.
· Time limitation: According to Osuala (2009) agencies and institutions usually prescribe the time for duration for studies, especially sponsored and student researches.
· Lack of literature makes some researchers not to embark on or to abandon many studies.
· Financial Obstacles: Research requires financial commitment depending on the type and duration
· Complexity of human psychology makes it difficult to ascertain responses etc.
Roles of Nurses in Research
Gain (2009) listed the major research roles of the nurse as follows:
· Principal Investigator
· Member of a research team
· Identifier of a re-searchable problem
· Research Consumer
· Evaluator of research findings
· Patient/Client advocate during studies
· Subject/participant in studies
The nurse acts as the number one person who is spearheading research studies, as such the nurse should be adequately knowledgeable and prepared. This is the essence of research inculcation into nursing curriculum at all levels.
Member of Research team
The nurse collaborates with other health personnel in collecting data or administering experimental interventions of the study, hence bed-side nurses validate the impact of nursing on patient outcomes and health care system in general.
Identifier of Re-searchable Problems
Nurses stay with patients 24 hours a day, hence they are able to live up to the responsibility of identifying problems in daily practice. By doing this, they become more familiar with the current state of knowledge in the problem areas.
Nurses read current literature and get current by reading current research reports in their areas of practice and general nursing.
Evaluator of Research findings
Nurses read and critique research reports and this enables them to elicit adequate quality studies for practical applicability.
Patient/Client advocate during studies
Nurses assume the responsibility of protecting their Clients/Patients rights by ensuring the use of ethical considerations. Habel (2005) in Henderson (2012) noted that nurses can serve as valuable resources for information about clinical trials both in the community and health care setting.
Subject/Participant in studies
Nurses are also used as researcher subjects, hence are also exposed to all this risks involved in the conduct of studies and should also be advocated for
Other roles of nurses in Nursing research include: Managing subject recruitment and enrolment; supporting study implementation even when she is not a participant, investigator or member of research team within the context of care delivery setting and; delivery of “hands on” care including administration of investigational drugs or intervention.
It is evidence that though nursing result has evolved slowly, it is now spreading like mid fire touching all aspects of nursing education, clinical administration, etc. The numerous benefits and contributions of research to nursing cannot be over stressed. It is however pertinent that all nurses support and carry out research in their specific areas so as to keep the banner of nursing soaring high in this era of evidence based practice
Asika, N. (2009). Research Methodology in the Behavioural Science Lagos: Longman Nigeria PLC.
Berman, A. & Snyder, S. (2012). Kozier of Erb's Fundamental of Nursing: concepts, process and practice (Ninth Edition). New Jersey: Pearson Education Inc.
Burns, N. & Grove, S. K. (2005). What is the Purpose of Nursing Research? Accessed 18/02/13 from allnurses.com
Department of Health (2006). Modernizing Nursing Careers: Setting the direction. London: Department of Health.
Eliot, J. (2011). Nursing Research History. Accessed 18/03/13 from http: //www.health.uoltana.ca/nursing/history.
Gain, S. I (2009). Introduction to Nursing Research reviewer. Accessed 18/02/13 from http://nursingcrib.com
Gortner, S.R; Block, O. & Philips, T.D. (2006). Contribution of Nursing Research to patient care. Accessed 18/02/13 from http: //onlinelibrary.willey.com/doi/o.iii/j.1365-2648
Henderson, K.J. (2012). Roles of Nurses in Nursing Research. Accessed 02/03/13 from http//www.ehow.com>ehow>careers
Hird, V. (2005). Nursing Competences: The artistry of Nursing. accessed 02/03/13 from http://sio.cu/galerias/pdf/situos/info
Moules, A. & Goodman (2008). Research in Nursing. Accessed 15/02/13 from http://moule&Goodman3814-ch-01qxp11/11/2008.
Nwankwo, N. (2003). Unpublished Lecture Notes in Advanced Research Methods. Nnamdi Azikiwe University, Nnewi Campus.
Ofi, B.; Kujore, O.O. & Olubiyi, K.S. (2007). NSS 301: Nature of Nursing. Lagos: National Open University of Nigeria.
Osuala, E.O. (2006). Research Statistics in Nursing and Related fields. Nimo: Rex Charles and Patrick's.
Pion, G.M. & Codray, D.S. (2013). Research Methods qualitative and ethnographic, school and program evaluation, verbal protocols overview. Accessed 02/03/13 from http://education.state university.com/pages /2364/researchmethods.html.
Smeltzer, S.C; Bare, B.G; Hinkle, J. L. & Cheever, K.H. (2010). Brunner & Suddarth's Textbook of Medical Surgical Nursing (12th Edition). Philadelphia: Lippincot Williams & Willkins Uzoagulu, A.E. (2012). Practical Guide to Writing Research Projects Report in Tertiary Institutions. Enugu: John Jacob's Classic publishers ltd.