Nursing Research

An Introduction

Pam Moule, Helen Aveyard, Margaret Goodman

• Publisher: SAGE Publications Ltd
• Year: 2016
• ISBN:
  9781473998469
• Edition: 3
• Topic: Médecine
• Subtopic: Soins infirmiers

This book answers all your students? questions on the nursing research process. Restructured to follow their progress from being a novice nurse researcher to an experienced one, it gives them theknowledge to understand evidence-based practice and critical appraisal and to succeed intheir own projects. Key features of the book are:

• Updated practical coverage of key methodssuch as conducting a survey and a section on the Research Excellence Framework
• International research examples in action
• Reflective exercises
• A companion websiteincludingaccess tojournal articles and flashcards.

It is essential reading for nursing undergraduates, postgraduates and all new researchers.

Part 1 Appraising Research

1 Research in Nursing

Learning outcomes

This chapter will enable you to:

• Understand the nature and historical context of nursing research
• Define research in nursing
• Understand evidence-based practice
• Reflect on how to involve the public in research
• Appreciate the relationship between research and nurse education

The care provided by nurses must be based on up-to-date knowledge and research that supports the delivery of the highest standards of practice possible. Nurses are developing their own professional knowledge base with strong foundations built on research and evidence. Nurses have a responsibility in some way to contribute to the development of the profession’s knowledge through research.

The term ‘research literate’ or ‘research aware’ is used by many to describe the way that nurses should be in the twenty-first century. This means:

• having the capacity for critical thought
• possessing analytical skills
• having the skills to gain access to relevant research and evidence
• having a critical understanding of research processes
• being able to read and critically appraise research and other types of evidence
• having an awareness of ethical issues related to research.

By possessing these skills and being ‘research literate’, nurses should be able to assess the appropriateness of using specific types of evidence in their daily practice. It should be a natural activity for nurses to keep up to date and use research findings and evidence in their work, and being ‘research literate’ is one of the basic skills.

In this chapter, we consider the historical context of nursing research, the nature of nursing research, including different definitions, and the development of evidence-based practice.

Historical and Current Context

Florence Nightingale is often seen as the very first nurse researcher. Her research in the 1850s focused on soldiers’ morbidity and mortality during the Crimean War. Nightingale identified ‘research’ questions in practice and undertook a systematic collection of data to try to find answers to the problems. Her ‘research’ eventually led to changes in the environment for sick people, including cleanliness, ventilation, clean water and adequate diet. However, Nightingale’s contribution has been described as atypical with Kirby (2004) pointing out that the development of nursing research in the United Kingdom really only started with the inception of the National Health Service (NHS) – now the world’s largest publicly funded health service – in the late 1940s. Prior to this, the development of nursing research had relied on a few highly determined individuals and was bound up with the professionalisation of nursing, the demands for suitable nurses, and the raising of educational standards for nurses (Kirby, 2004). Furthermore, in the 1950s, sociologists and psychologists were more likely to be undertaking research into nursing and nurses; only a small number of pioneering nurses were researching nursing and nurses themselves, one being Marjorie Simpson, who started the first self-help group for nurse researchers in 1959 called the Research Discussion Group (Hopps, 1994). This went on to become the Royal College of Nursing Research Society, which continues today. The Royal College of Nursing is a body in the UK that represents nurses and nursing, promotes excellence in practice and shapes health policies.

Tierney (1998) presented a picture of the development of nursing research across Europe. She identified the UK, Finland and Denmark as having developed in a similar way over the past 30 years, with Estonia, Lithuania and Slovenia only developing in the last 15 years. Growth was particularly evident in the 1980s and 1990s. It can be seen that, although overall growth has been slow, it has been more rapid in developed European countries. Many factors have affected this growth, such as the lack of resources and funding to support research, slow development of research training, capacity and capability building, and the low status of nurses relative to other health professions, particularly medicine. Tierney pointed out that there are four elements that support development: ‘bottom-up’ initiatives by forward looking individuals; ‘top-down’ initiatives through government support; growth of a research infrastructure as seen through universities; and a strategic approach rather than ad hoc initiatives.

In the 1970s, serious consideration of nursing research in the UK came with the publication of the Briggs report (Committee on Nursing, 1972), which recommended nursing should become a ‘research-based’ profession. This is often seen as a turning point in the historical context of nursing research, and as something that was badly needed for professional status. However, in the decades following the publication of the Briggs report, many suggested that nursing had not become ‘research based’, nor had research made an impact on the daily practice of nurses (Hunt, 1981; Thomas, 1985; Webb and Mackenzie, 1993). Specifically, the arguments were that nurses did not read or understand research, nurses did not know how to use research in practice, nurses did not believe research, nurses were not able to use research to change practice, and nurse researchers did not communicate well. It is interesting to think about the current position: Do nurses read research? Do they understand research? Is research impacting on practice?

In 1993 the Report of the Taskforce on the Strategy for Research in Nursing, Midwifery and Health Visiting (DH, 1993) was published. It sought to address many of the deficiencies noted earlier about nursing becoming a ‘research-based’ profession. It was suggested that nurse education, support and research infrastructure needed to be developed to support progress. The report did not suggest that all nurses should be undertaking research; rather it recommended that all nurses should become research literate, an essential skill for knowledge-led nursing practice. It became much clearer that all nurses needed to become equipped with the skills of understanding the research process, and an ability to retrieve and critically assess research findings, increasing capacity, with only a few nurses needing to be prepared to undertake research, increasing capability.

The impetus to develop evidence-based practice in order to achieve best care delivery has influenced nurse education. It was recognised that nurses needed to be able to critically read and understand research in order to support its use in practice. In addition, it was suggested that some nurses would need to develop greater research capability in order to lead research and contribute to the existing evidence base. This led to a number of changes, such as the funding initiatives by the Higher Education Funding Council for England (2001) and innovations in the delivery of nurse education. Research was fully integrated into the pre-registration curricula in the 1980s (UKCC, 1986) and introduced to post-registration provision shortly after (UKCC, 1994). The move of nurse education into higher education institutions in the 1990s supported ongoing academic development. In 2009, 30 per cent of nurses qualified at degree level or above (Ball and Pike, 2009) and increased numbers studied at Master’s and doctoral level. Now all entrants to the profession follow an undergraduate degree level programme (Commission on Nursing and Midwifery, 2010).

The Higher Education Funding Council – a body that promotes and funds high-quality, cost-effective teaching and research in higher education in England (HEFCE, 2001) – provided capability building for both nursing and allied health professionals following the 2001 Research Assessment Exercise (RAE). A further RAE in 2008 also saw some universities secure monies to support capacity building, some of which will have benefitted nurse researchers. The RAE was an audit of research volume and quality used to allocate research funding to higher education institutions based on the quality of research activity. Nursing departments scoring 3a and 3b in the 2001 RAE received funding through the Research Capability Fund. The results of the 2008 RAE showed 36 institutions entered 641 full time equivalent (fte) staff. These results showed a positive impact on patients, families and communities with nursing rising from the bottom to the middle of the table. Of the research, 19 per cent was ranked world leading in terms of originality, significance and rigour (Council of Deans, 2009). The Research Excellence Framework (REF) exercise submitted in 2013 superseded the RAE. This submission saw nursing and midwifery as part of a larger Unit of Assessment (UoA3), which included other disciplines such as pharmacy and allied health professions. The submissions were judged on research outputs including publications, the research environment, which included doctoral complications, and the impact of the research in a range of areas such as practice, policy and economics. Only the highest levels of quality research received funding, deemed as world lea...