Clinical Research
Clinical Nursing Research An Overview
Clinical nursing research is both broadly and narrowly defined. Broadly, it denotes any research of relevance to nursing practice that is focused on care recipients, their problems and needs. This broad definition stems from the 1960s, when a major change occurred in nursing science.
Prior to the 1960s the research of nurses had focused on nurses and the profession of nursing including major questions of interest related to nursing education and the way in which nurses practiced within care delivery structures (ie, hospitals).
The reasons for
these foci are many, but for the most part they stem from the dearth of nurses
with advanced degrees at that time and the fact that nurses with advanced
degrees were educated in other disciplines (eg, education).
Nursing Research Nursing Leaders
In the late 1950s and 1960s a major shift occurred, driven by three factors. First, leaders in nursing successfully lobbied for the in situation of the nurse scientist program through the federal government, which provided financial support for nurses to be educated in the sciences (eg, physiology, biology, anthropology, psychology).
Second, nurse theorists such as Faye Abdellah, Virginia Henderson, Imogene King, Ida Orlando, Hildegard Peplau, and Martha Rogers began to formulate conceptual models to direct nursing practice, and attention was focused on designing research that more or less was guided by those models (or at least the substantive areas circumscribed by the models).
Third, as more nurses attained advanced degrees, doctoral education with a major in nursing finally became a reality, and the focus of nursing research shifted more firmly away from nurses and nursing education to the practice of clinical nursing.
The broad definition of clinical nursing research, then, was
originally formulated to differentiate between the research conducted by nurses
prior to the 1960s, which focused on nurses, to the major shift in focus on
practice.
Nursing Research Centre
Strongly influenced by the establishment of the Center for Nursing Research (at present the National Institute of Nursing Research) in the National Institutes of Health (NIH), clinical nursing research has recently taken on a narrower definition, modeled after the definition of clinical Trials (large-scale experiments designed to test the efficacy of treatment on human subjects) used at NIH.
This narrow definition limits clinical nursing research to only those
studies that focus on testing the effects of nursing interventions on clinical
or "nurse sensitive" outcomes.
Evolution in Clinical Nursing Research
In addition to an evolution in definition, clinical nursing research also has changed in form and complexity over time. Early clinical nursing research was characterized by a focus on circumscribed areas of inquiry using experimental and quasi-experimental methodologies.
Investigators were few and tended to work in isolation. Prompted by meta theorists such as Dick off, James, and Wiedenbach (1968) and methodologists such as Abdellah and Levine (1965) and Mabel Wandt (1970), nurse scientists were advised to derive questions directly from problems encountered in their clinical practice and to strive to develop and test interventions to solve these problems.
Often an investigator conducted single studies on different problems rather than series of studies focused on different aspects of the same problem. As a result, study results tended to be context-bound and limited in generalizability to other settings, samples, or problems.
The relationship between theory development and research was discussed abstractly but not explicitly operationalized, and a philosophy of knowledge building, rather than problem solving, had not yet developed. The next stage in the evolution occurred with the realization that little was known about many of the phenomena of concern to nurses.
This heralded a period during which emphasis shifted away from experimental methods to exploratory/descriptive methods, such as grounded theory.
Guided by the meta-paradigm of nursing
(person, nursing, health, environment), nurse scientists began focusing on
discovering and naming the concepts of relevance for study in nursing,
delineating the structure of these concepts, and hypothesizing about the
relationships of these concepts in theoretical systems.
Clinical Research Cumulative
More recently, clinical nursing research has become clearly defined as a cumulative, evolutionary process. Investigators are still advised to derive questions from clinical problems, but the focus is on knowledge generation, specifically the generation and testing of middle-range theory (a theory that explains a class of human responses)
For example, self-help responses , symptom experience and management, and family responses to caregiving. Because knowledge is viewed as cumulative, investigators usually study various aspects of one particular concept or response; studies build on one another, and each study adds a new dimension of understanding about the concept of interest.
This approach to clinical nursing research requires investigators to use multiple methodologies in their programs of research, including:
(a) inductive techniques to discover knowledge from data.
(b) deductive techniques to test hypotheses that are either induced or deduced.
(c) instrumentation to increase the sensitivity,
reliability, and validity of the measurement system designed for the concept.
Methodologies In Clinical Nursing Research
The methodologies being used include qualitative methods such as ethnomethodology, grounded theory, and phenomenology and quantitative methods ranging from traditional experimental methods and designs to less traditional methods, such as path analysis and latent variable modeling.
Because human responses change over time based on contextual factors or treatments (independent variables) applied by the nurse investigator and because understanding the nature of change often is at the crux of the theory building, skills in measuring change also may be required.
This has resulted in the need for many investigators to
incorporate techniques such as time series analysis and individual regression
into their research.
Clinical Research As Cellular Process
Understanding the human responses of concern to nurses can also require an understanding of cellular mechanisms that are best studied in animal models and a coupling of biological techniques such as radioimmunoassay and electron microscopy, with psychosocial techniques such as neurocognitive assessment or self report of psychological states.
In addition, measurement of different units of analysis (eg, individual, family, organization) may be required, along with strategies for understanding the effect of care contexts (eg, social, physical, organizational environments) on the human response of concern .
Needless to
say, single investigators rarely have all the skills needed to advance the
understanding of a particular concept. As a consequence, single investigators
are becoming more and more a thing of the past as teams of scientists, including
nurses and individuals from other disciplines, collabo rate in the
knowledge-building endeavor.
Human Response to Clinical Nursing Research
Nursing is concerned with human responses and is based on the assumption that humans are holistic and embedded in history and various environments. Clinical nursing research is about generating a body of knowledge on which nurses can base practice.
It is about assuring the efficacy and safer of nursing actions, substantiating the effect of nursing actions on patient outcomes, and conserving resources (costs, time, and effort) while effecting the best possible results.
It is about identifying strategies for improving the health of the population and promoting humanization within a health care environment. that has a natural tendency to be mechanistic, compartmentalized, and focused on short-term rather than long-term gain. It is about client advocacy, client protection, and client empowerment.
The challenge of clinical nursing research
is to develop an understanding of human response through theory generation and
testing while developing measurement systems and using research methods that
capture the holism of the client and the holistic nature of the health care
experience.
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