Time to open-up nursing research

The core question discussed here relates to the definition of what is nursing research. An implicit criterion used to set the boundaries of this research field – and which seems in surprisingly broad currency – relates to the training of who is doing the research. According to this view, nursing research is research conducted by people trained in nursing. This definition is well rooted both historically and sociologically and we will come back to those roots later on. However, the point we would like to make here is that an open debate about the definition of nursing research would be timely and useful.

Nursing has undergone seismic changes in a relatively short period of time. Finally, having emerged as an autonomous profession, we can’t seem to shake the image of the handmaiden. In the sociology of professions literature, nursing remains often used as the prototype of a subordinate profession and Abbott forcefully makes the point:

‘Since there is a system of professions, however, there are only so many full jurisdictions to go around. Some have been claimed from time immemorial. […] To develop themselves, professions may have to accept limited mobility within this circumscribed environment. A variety of alternatives to full jurisdiction provide the limited settlements that make this possible. The most familiar of these limited settlements is subordination. Nursing is the classic case.’ (Abbott 1988 p.71) [1]

From this standpoint, the autonomization of nursing from medicine and it’s efforts to fend-off boundary pressures from other subordinate professions (respiratory therapy, nutrition, etc.) provide an essential historical backdrop to analyze the importance self-definition has for the nursing profession. The capacity to autonomously define what constitutes nursing practice, to successfully defend those definitions in order to have them embedded in regulated exclusive rights of practice and to implement those definitions in day-to-day workplace practices are all vitally important endeavours for the nursing profession.

It may be that the valorization of autonomy and self-definition explains a great deal of the highly « disciplinary » definition of nursing research. But, notwithstanding its simplicity, such a definition has many important shortcomings both logically and practically.

One of these shortcomings is that we’ve been working harder on the structure of nursing science– where and by whom it is done –than on its content. This too often paved the way for a counterproductive insolation from other related or relevant disciplines. Researchers trained in nursing conducted research in nursing schools and faculties and published in nursing journal, read – almost exclusively – by nurses. Such a closure surely strengthens intra-disciplinary cohesion but can hardly be seen as positive from the broader perspective of science as a human endeavour focused on understanding the world. No scientific discipline, notwithstanding how mature and relevant it may be, can pretend to develop itself in isolation from other disciplinary fields.

An often heard, counter argument is that most of nursing research focuses on nursing interventions and clinical practices and that mastering those practices through personal clinical experience is an obvious asset to conduct high-quality research in the field.

But this functionalist argument has two weaknesses. Firstly, contrarily to the situation of Medicine, because of the funding rules most faculty members in nursing schools don’t have significant clinical practice once they get appointed. This situation creates its own set of tension as « clinically active » nurses sometime criticize academic nursing as disconnected from clinical experience. Secondly, the argument doesn’t have the same validity throughout what constitutes nursing research. Take for example the growing interest in organizational and system-level research focused on nurse-based care delivery models, the scope of nursing practices, etc. There are plenty of research questions with a tremendous potential impact for nurses and nursing that are outside of direct care or clinical interventions. And the scope of those is anything but trivial as such a research focus is mostly what the third key message of the Institute of Medicine (2011) report on the Future of Nursing rests on:

‘Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.’ (IoM 2011 p.4) [2]

Then a core question is to know whether a clinical training in nursing – and the right to add R.N. after one’s name – is indeed an indisputable asset to conduct that kind of organizational and system-level research from a nursing perspective? Or would the crux be that the research is conducted from a nursing standpoint? The answer to those questions may be argued in one way or the other but will escape any definitive answer.

But in our view, one cannot negate that much can be learned from other disciplines (organizational theory, health administration, management, sociology, political science, only to name a few). Some will suggest trained RNs should get additional training in those fields, which indeed appears an excellent idea. But then why wouldn’t the opposite also be a great option? Physicians, sociologists, psychologists and any other researcher of health or social sciences could learn from and contribute to nursing science.

In our view, the practical disciplinary definition of nursing research should be research focused on a phenomenon – nursing care – that has a direct and significant implication for human health and the societies we live in. This should be the criterion upon which the boundaries of the field of nursing research are defined. According to such a definition, a nurse may do research outside of the field, in the same way a sociologist could conduct nursing research. And, in the end, research validity or relevance usually isn’t – and should not be – assessed on the basis of who is conducting it.

Professional boundaries are defended in multiple arenas (legal, social perceptions, workplace practices) (Abbott 1988) but academia maintains a central place in professionalization processes and professional struggles. A profession’s ability to establish an autonomous basis of academic knowledge is central in its capacity to gain ground in all those arenas and defends its professional autonomy. Historically the nursing profession harnessed very efficiently the legitimacy of academia in its professionalization process and the current text is no critique of the past as much as a plea for evolution.

[1] Abbott, A. (1988). The system of Professions. Chicago: The University of Chicago Press.

[2] IoM. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC : Committee on Quality of Health Care in America, Institute of Medicine, National Academy Press.

Une réflexion au sujet de « Time to open-up nursing research »

  1. No pressure to disclose (either publicly or in an email), but who wrote this? The reason I ask is because, if this is a theme the writer explores in other pieces, I would love to read more of their work.

    I am a nurse and budding nurse scientist (Masters student) who wants to do stellar nursing research (though I’m not sure what that is; I need to read and reflect a lot more to figure out what stellar nursing research means to me). Thoughts about this, some of which are reflected in this piece, swim in my mind very often.

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