Nursing Research A Historical View
Nursing Research
The first public health policy act was signed on July 16, 1798, by President John Adams. A public health service organization, later named the US Public Health Service (USPHS), would operate hospitals and rest homes for sick merchant seamen.
The act was expanded in 1877 as a result of a yellow fever epidemic in
New Orleans that required the passage of the Quarantine Act of 1878.
Monitoring and Regulations
In 1879 a national Board of Health was established to monitor public health regularly, especially in the area of sanitation. A weekly report that later became the Public Health Reports was published. The board had the authority to intervene in case of an epidemic.
In the late 19th century, Robert Koch and
Louis Pasteur made important discoveries about the nature of infectious diseases
that explained the transmission of such diseases and aided in controlling their
spread. In this control, government had a significant role.
Statistical Use in Worlds War II Nursing Data and Role of Florence Nightingale
Although the role of the federal government became significant in 1938 through grants-in-aid to universities under a research grants program, it is generally held that nursing research began after World War II, even though the work of Florence Nightingale (1820- 1910) introduced the use of statistics in analyzing nursing data.
Beginning in 1920, the Goldmark study was the first of the landmark studies of nursing.Research developed into nursing education, time studies, salaries, supply and demand, employment conditions, costs, status of nurses, job satisfaction, needs, and resources.
In 1955 the Nursing Research Grants and Fellowship Program of the Division of Nursing, USPHS, was established; it awarded grants for nursing research projects, nursing research fellowships, and nurse scientist graduate training.
In 1978 the Division of Manpower Analysis was established within the Division of Nursing in the Bureau of Health Manpower to conduct research on manpower.
Statistical Data to Analysis of Nursing Data
In the 19th century, Florence Nightingale, a founder of modern nursing, was the first nurse to do research in connection with nursing, when she used statistics in the analysis of her data. She was the first Bio Statistician in nursing, Nightingale did her work alone and not until after World War II was there an organized, continuing effort to conduct further nursing research.
Nursing care research is defined as research directed to understanding the nursing care of individuals and groups and the biological, physiological, social, behavioral, and environmental mechanisms influencing health and disease that are relevant to nursing care.
Nursing research develops knowledge about health and the promotion of health over the life span, care of persons with health problems and disabilities, and nursing actions that enhance the ability of individuals to respond effectively to actual or potential health problems.
The following is a summary of major hallmarks in the history of nursing research:
- 1920. Josephine Goldmark, under the direction of Haven Emerson, conducted a comprehensive survey that identified the inadequacies of housing and instructional facilities for nursing students 1922. In a time , study of institutional nursing, the New York Academy of Medicine, showed wide discrepancies in the costs of nursing education and services. 1923. The Committee for the Study of Nursing Education conducted the first comprehensive study of nursing schools and public health agencies. The final report was published as Nursing and Nursing Education the United States. 1924. The first nursing doctoral program was established at Teacher's College, Columbia University. 1926. May Ayres Burgess was commissioned by the Committee on the Grading of Nursing Schools to ensure that nursing service provided adequate patient care. The result was the classic report, Nurses, Patients, and Pocketbooks 1934. The second project of the Committee on the Grading of Nursing Schools was a job analysis reported in An Activity Analysis of Nursing. The grading of nursing schools was not realized until the establishment of the National Nursing Accrediting Service in 1950.
- 1935. The American Nurses Association (ANA) published Some Facts About Nursing: A Handbook for Speakers and Others, which contained yearly compilations of statistical data about registered nurses.
- 1936. The ANA scrutinized the economic situation of nurses by studying incomes, salaries, and employment conditions; it excluded public health nurses.
- 1940. Pfeffer Korn and Rovetta compiled basic data on the costs of nursing service and nursing education,
- 1941. The United States Public Health Service (USPHS) conducted a national census on nursing resources in cooperation with state nursing associations as World War II loomed.
- 1943. The National Organization of Public Health Nursing surveyed needs and resources for home care in 16 communities. The work was reported in Public Health Nursing Care of the Sick.
- 1948. The publication of the Brown Report identified issues facing nursing education and nursing services for the first half of the century. The recommendations led to much research during the next 10 years, for example: studies on nursing functions, nursing teams, practical nurses, role and attitude studies, nurse technicians, and nurse-patient relationships. Other studies rooted in the Brown report were on the hospital environment and economic security as well as the report Nursing Schools at Mid-Century, from the National Committee for the Improvement of Nursing Services. The Division of Nursing Resources (now the Division of Nursing) of the USPHS conducted statewide surveys and developed manuals and tools for nursing research. Major breakthroughs in nursing research were made by such studies as: (a) patient satisfaction, (b) patient classification studies, (c) problem-oriented record. These studies laid the ground-work for nursing research for the next 2 decades.
- 1949. The ANA conducted its first national inventory of Professional Registered Nurses in the United States and Puerto Rico. An Interim Classification of Schools of Nursing Offering Basic Programs was prepared with classifications I, II, and III according to specific criteria.
- 1950. The National Nursing Accrediting Service, established a system for accrediting schools of nursing.
- 1952. The journal Nursing Research was published in June 1952. It was the ANA's first official journal for reporting nursing and health research.
- 1953. Leo Simmons and Virginia Henderson published a survey and assessment of nursing research which classified and evaluated research in nursing during the precious decade. Teachers College, Columbia University, established the Institute of Research and Service in Nursing Education under Helen Bunge.
- 1954. The ANA established a Committee on Research and Studies to plan, promote, and guide research and studies relating to the functions of the ANA (1968 published) ANA Guidelines in Ethical Values.
- 1955. The ANA established the American Nurses' Foundation (ANF), a center for research to receive and administer funds and grants for nursing research. The foundation conducts its own programs of research and provides consultation to nursing students, research facilities, and others engaged in nursing research. Twenty Thousand Nurses Tell Their Story was published. The Nursing Research Grants and Fellowship Programs of the Division of Nursing, USPHS, were established to stimulate and provide financial support for research investigators and nursing research education.
- 1956. The study of Patient Care and Patient Satisfaction in 60 Hospitals was published.
- 1957. The Department of Nursing, established at Walter Reed Army Institute of Research, provided opportunities for growth in military nursing research. The Western Interstate Commission for Higher Education (WICHE) sponsored the Western Interstate Council on Higher Education for Nursing (WICHEN) to improve the quality of higher education for nursing in the western US, focus on preparing nurses for research, and develop new scientific knowledge and communicate research findings. Other such groups were the Southern Regional Education Board (SREB), New England Board of Higher Education (NEBHE), Midwest Alliance in Nursing (MAIN), and Mid-Atlantic Regional Nurses Association (MAR NA).
- 1959. The National League for Nursing (NLN) Research and Studies (later the Division of Research) was established to conduct research, provide consultations to NLN staff, and maintain information about NLN research products.
- 1960, Faye Abdellah developed the first federally tested Coronary Care Unit and published Patient Centered Approaches to Nursing, which altered nursing the ory and practice.
- 1963. The Surgeon General's Consultant Group on Nursing reported on the nursing situation in the US and recommended increased federal support for nursing research and education of researchers. Nursing Studies Index, Volume IV, 1957-1959, was completed as a guide to analytical and historical literature on nursing in English from 1900-1959. Volume I, 1900-1929, was published in 1972; Volume II, 1930-1949, was published in 1970; and Volume III, 1950-1956, was published in 1966.
- 1964. Nursing Research: A Survey and Assessment provided a review and assessment of research in areas of occupational health, career dynamics, and nursing care.
- 1965. ANA Nursing Research Conferences (1965 through the 1980s) provided a forum for critiquing nursing research and opportunities for nurse researchers to examine critical issues.
- 1966, International Nursing Index was published. One of the first textbooks on nursing research was published by Abdellah and Levine: Better Patient Care Through Nursing Research.
- 1968. The ANA Blueprint for Research in Nursing and The Nurse in Research, ANA guidelines in ethical values were published.
- 1970, ANA Commission on Nursing Research was established and prepared position papers on human rights in research. Papers included: Human rights guidelines for nurses in clinical and other research (1974), Research in nursing: Toward a science of health care (1976), Preparation of nurses for participation in research (1976), and Priorities for nursing research (1976) . An abstract for action made recommendations for changes in nursing such as increased practice research, improved education, role clarification and practice, and increased financial support for nursing. Overview of Nursing was supported by the Department of Health, Education, and Welfare, 1955-1968, to assess nursing research, knowledge, gaps, and future needs. 1971. The ANA Council of Nurse Researchers was established by the ANA Commission on Nursing Research to advance research activities and published issues in research: Social, Professional, and Methodology (1973). The Secretary's Commission, Department of Health, Education and Welfare (DHEW) published Extending the Scope of Nursing Practice as a position of the health professions to support the expansion of the functions and responsibilities of nurse practitioners.
- 1973. The American Academy of Nursing was founded with 36 charter fellows to advance new concepts in nursing and health care, to explore issues in health care, the profession and society as directed by nursing, to examine dynamics of nursing, and to propose resolutions for issues and problems in nursing and health.
- 1977. Nursing Research became the first nursing journal to be included in Medline, the computerized information retrieval service.
- 1979. Healthy People, the Surgeon General's report on health promotion and disease prevention, was published. Clinical content of nursing proceedings Forum on Doctoral Education in Nursing de fined the content of nursing research at the doctoral level.
- 1980. Promoting Health, Preventing Disease: Objectives for the Nation was published. ANA published a social policy statement, which defined the nature and scope of nursing practice and characteristics of specialization in nursing.
- 1981. Strategies for Promoting Health for Specific Populations was published by the Department of Health and Human Services (formerly Department of Health, Education, and Welfare). DRGs (Diagnostic Related Groups) were mandated by the Health Care Financing Administration for Medicare regarding reimbursement. This stimulated the importance of evidence-based practical nursing. 1983. The 1981 White House conference on aging: Executive summary of technical committee on health maintenance and health promotion and Report of the mini conference on long-term care: Report of the technical committee on health services: Nursing and nurse education-Public policies and private actions. Report of the Institute of Medicine, National Academy of Sciences defined nursing research and outlined its direction. Magnet Hospitals: Attraction and Retention of Professional Nurses was published by the American Academy of Nursing. Report of the Task Force on Nursing Practice in Hospitals. New legislation established reimbursement policies for hospitals based on prospective payment of Diagnosis Related Groups (DRGs) the determined amount paid for Medicare patients.
- 1983. The first volume of the Annual Review of Nursing Research series was published by Springer Publishing Company.
- 1984. The ANA formed the ANA Council on Computer Applications in Nursing to focus on computer technology relevant to nursing practice, education, administration, and research. The ANA Cabinet on Nursing Research published Directions for Nursing Research: Toward the Twenty First Century.
- 1985. The National Center for Nursing Research (NCNR) was established in the PHS. Programs would work to enlarge scientific knowledge underlying nursing services, administration, and education. The Center was initially located in the Division of Nursing, Bureau of Health Manpower, Health Resources, and Services Administration, but in 1986 it became part of the National Institutes of Health (NIH). In 1993, the NCNR was renamed the National Institute of Nursing Research.
- 1988. The Agency for Health Care Policy and Research (AHCPR) within the Department of Health and Human Services (DHHS) was established to focus on the development of clinical practice guidelines, outcome measures, and effectiveness research. (The name was changed to Agency for Health Care Research and Quality).
Role of National Center for Nursing Research (NCNR)
Thirty years after the idea was first proposed by the National Institute of Health's National Advisory Council, the National Center for Nursing Research (NCNR) was established in 1986.
Its mandate was "to advance science to strengthen nursing practice and health care that promotes health, prevents disease, and ameliorates the effects of illness and disability."
The placement of NCNR at the National Institute of Health (NIH) moved nursing research into a broader based biomedical research environment and facilitated the collaboration between nursing and other research disciplines.
On June 9, 1993, the NCNR was renamed
and became the National Institute of Nursing Research, which placed nursing on
an equal footing with other NIH institutes.
Role of National Institute of Nursing Research (NINR)
The National Institute of Nursing Research (NINR) is the key organ for funding nursing research grants and contracts and has approved priority areas for research as determined by its National Advisory Council for Nursing Research.
NINR provides a scientific base for patient care and is used by many disciplines among health care professionals- especially by the nation's 2.5 million nurses.
NINR-supported research spans both health and illness and deals with individuals of all age groups. Nursing research addresses the issues that examine the core of patients' and families' personal encounters with illness, disability, treatment, and disease prevention.
In addition, nursing research
addresses issues with a community or public health focus. NINR's primary
activity is clinical research, and most of the studies directly involve
patients. The basic science is linked to patient problems.
Role of USPHS
The nursing programs of the USPHS stimulated the postwar expansion of nursing services through pilot studies, nursing research, and community health services.
The Division of Nursing Resources, with a modest budget of $95,000 and a small staff, was able to undertake a number of landmark studies to find solutions to postwar nursing problems in hospitals and health agencies.
During
the years 1949 to 1955, a number of state surveys of nursing needs and
resources were conducted in almost all states.
In 1954, among the many studies and tools developed by the USPHS Division of Nursing Resources. (Now the Division of Nursing) was a cooperative study carried out with the Commission on Nursing of Cleveland, Ohio, to discover the reasons for the understaffing of nursing departments.
A by product of the study was that it produced the outcome measure satisfaction study. Another study involved the use of disease classification for nursing planning. The diagnoses were then coded and classified into 58 groups representing discrete nursing problems.
A similar methodological approach was followed in the development of
the problem-oriented medical record more than a decade later and in the
development of Diagnostic Related Groups. In 1955, Congress earmarked $625,000
for nursing research and fellowships that were awarded directly to
universities, hospitals, health agencies, and professional associations.
Military Nursing Research
The
Army Nurse Corps initiated nursing research in the military and has been a
major contributor to the evolution of both military and civilian nursing
research. The army developed a program designed to concentrate on clinical
nursing research in addition to fostering participation in the collaborative
studies of other disciplines.
The history of nursing research in the navy (primarily unpublished master's theses) covers research topics that are broad and focus on various aspects of the organization and administration of nursing service.
Further work to incorporate
nursing research into the Navy Nurse Corps became prominent in 1987, when the
navy conducted a review of billets and identified the need for doctorly
prepared nurses.
The history of nursing research in the air force is found primarily through the review of unpublished mimeographed documents covering research at the School of Aerospace Medicine at Brooks Air Force Base, Texas.
Among the research topics reported are the development of equipment for aeromedical evacuation (such as examination lamps, oxygen and humidity apparatus, hand disinfection devices, patient monitoring and blood pressure measurement, litter lift, and transportable airborne stations).
Physiological and psychological changes
experienced by air force nurses associated with flying duty on jet and
propeller aircraft and ways to evaluate patient care in flight are other areas
of research.
In the Fall of 1990, representatives from the army, navy, and air force met to discuss collaborative research among the services. This group formed the Federal Nursing Research Interest Group, which later became the Tri Service Nursing Research Group (TSNR Group).
The TSNR Group was made responsible for finding ways to promote military nursing research both collectively and individually, within and across the services.
The initial appropriation for the TSNR program under SR 102-154 was $1 million for fiscal year (FY) 1992 and it increased to $5 million in FY 1996, $6 million thereafter, authorizing the TSNR program as part of the Department of Defense Health Care Program , administered by the TSNR Group and established at the Uniformed Services University of the Health Sciences.
In 2000, the Council for the Advancement of Nursing Science
(CANS) created the research policy and facilitation arm of the American Academy
of Nursing.
Best Comprehensiveness of Research Types
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