Professional Factors Influencing Knowledge Development
Several professional factors have strengthened the development of knowledge to guide nursing practice in the USA and Canada. These include building strong multidisciplinary networks for developing knowledge and developing a tradition for postdoctoral study with senior nurses and multidisciplinary researchers. One factor has limited knowledge development in the discipline; this has to do with the late career stage of doctoral students and graduates, and the building of research programs.
A related factor, particularly for the near future is the anticipated shortage of nursing faculty for academic positions and roles. Knowledge development in nursing has incorporated a strong multidisciplinary component from its early roots. The richness of the orientation of multiple disciplines, integrated and creatively used within the nursing perspective has strengthened the knowledge that can be used to guide nursing practice.
In addition to enriching the knowledge base for nursing practice, interaction with other disciplines brings a new and creative scientific perspective to other non nurse colleagues. For doctoral programs, the strong multidisciplinary network has opened many opportunities for students and postdoctoral fellows to study with individuals from numerous fields. They are both influenced and influential in this learning process.
The development of a tradition for postdoctoral study in nursing has enhanced knowledge development in the discipline (Hinshaw and Ketefian , 1996, Hinshaw, et al, 1999). Nursing as a discipline has been late in developing this tradition. The number of postdoctoral fellows studying one to two years following their earned doctoral programs has increased since the late 1980s in the USA and Canada.
The opportunity for postdoctoral study came with the establishment of the NINR and the increase in funding for research and research training in the USA. The Canadians have been successful in competing for postdoctoral fellowships through the multiple federal agencies and foundations.
A number of nurse researchers have been chosen to concentrate on building their independent research programs with postdoctoral study. Balancing the tripartite mission of academic roles, i.e. teaching, research and service, is difficult for new faculty. Establishing the early phase of research programs through postdoctoral work with senior nursing and multidisciplinary mentors enhances success in new academic roles and in forming strong research programs for knowledge development.
One major problem has delayed knowledge development in the nursing discipline (Hinshaw and Ketefian , 1996; Anderson, 2000; Hinshaw, 2001). Nurses have a unique career pattern for acquiring doctoral preparation, entering quite late into doctoral programs. The average age of the doctoral nurse student is in the late thirties and beginning assistant professors are on average 50 years of age (AACN, 2003).
The demographics for Canadian nurses and scholars are similar (CNA, 1997, 2001). Since doctoral preparation provides the knowledge and skills for building research programs and information for the discipline, this pattern of late entry into doctoral study severely limits knowledge development.
Most research and knowledge development occurs within the university and state college systems in North America. Starting a research career in the late forties or early fifties means that the scientist has approximately 15 years before retirement to build a research program, contribute to the knowledge of the discipline, develop a reputation in healthcare based on research, and participate in health policy discussions as a leader in his or her knowledge field (Hinshaw and Ketefian , 2001).
Two funded research studies, usually four years in length per study, are about all that is possible in this limited timeframe. The contribution to knowledge is thus limited. One strategy for countering the late career issue is the establishment of rapid progression doctoral programs that recruit students early following their baccalaureate or Master’s programs into doctoral study.
Approximately 20–25 doctoral programs in the USA are offering a baccalaureate- to doctoral -degree program which allows for rapid progression through the undergraduate and graduate programs. Because clinical experience is highly valued for the critical base provided for raising relevant nursing research questions, a number of these programs include clinical experience in some planned form.
The rapid-progression career pattern would provide doctorly prepared graduates with approximately 30–35 years of productivity as nurse investigators. Recall, the Canadian CASN objective for ‘fast-tracking’ faculty as well (CASN/ACESI, 2003). The transition to this pattern will be critical in terms of the discipline’s ability to develop knowledge to guide nursing practice and provide leadership from the nursing perspective for health policy at all levels.
A future limiting factor in North America will be the shortage of nursing faculty for academic positions. The shortage is expected to intensify in the next five to ten years due to the ‘greying of the professoriate.’ This situation is discussed in detail elsewhere in this volume.
From a knowledge development perspective, the faculty shortage is likely to limit the research programs due to a need to teach and cover more courses and advise more students. Maintaining a strong focus and commitment of academic resources on the importance of knowledge development for the discipline and nursing research in the next decade will be critical.
Similarities and Differences in Knowledge Development and Doctoral Education in the Two Western Regions of the Globe
Knowledge development and doctoral education in the two Western, developed regions of the globe are remarkably similar in their evolution in terms of research and research training. There are also several differences based on the values and contextual factors shaping the nursing discipline’s scholarship base.
For the EU and the North American countries, several basic elements provide the foundation for nursing research and research training: the placement of nursing as an educational and scholarly discipline in the university and collegiate systems of the countries, the development of nursing faculty research programs, the development of doctoral programs, and the evolution of funding sources for nursing research and research training. For both regions, the opening of funding resources for research and research training has been a precursor to a dramatic explosion of knowledge for the practice of nursing and for doctoral and postdoctoral study.
Similar Contextual Factors
A series of contextual factors are similar across the two regions. These factors have shaped the nursing research priorities and programs. Nurses in many of the countries in the two regions have focused their research on critical health problems and concerns of the public that nursing, as a profession and discipline, can influence for optimal health and well-being. The contextual factors that are similar include:
- The Western, developed countries are all showing an ‘aging’ population and thus dealing with an increasing incidence of chronic illness.
- The increasing costs of healthcare, more in the USA than in either Canada or the EU, are emphasizing health promotion and self-management of health and illness in the community settings.
- Health disparities and inequalities (by ethnicity, socioeconomic levels and gender) are evident in all the countries even though the healthcare systems are quite different. Nursing’s focus on vulnerable populations makes this a clear target for nursing research.
- A pending or increasing problem with a shortage of health professionals, especially nursing, is evident in both Western regions and requires attention to
A major difference in the two Western regions is the amount of international collaboration. The structure and nature of the EU, including funding incentives and other resources, facilitates more international collaboration than between the North American countries.
For Canada, and especially the USA, there are examples of international work but the structural and resource incentives are more difficult to access even though many of the research programs focus on similar healthcare interests, such as women’s health, palliative care at end-of-life. life and health promotion intervention studies.
The priorities for nursing research are similar across the two Western regions with several differences in terms of emphasis. For most of the countries represented, the priorities are not unlike those evident in the 2000 survey of international priorities (Hinshaw, 2000). These included health promotion across the life span, care of elderly people, shaping healthcare systems, management of symptoms secondary to illness or treatment, and quality of care outcomes balanced with cost. The survey included a number of the countries in the EU and North America.
Priorities Responding to Contextual Factors
In the past three years, a number of new priorities have evolved, responding to contextual factors and to new knowledge breakthroughs. These priorities involve:
- genetic explosion of knowledge for screening, symptom management and therapies
- multiple chronic illnesses being managed by individuals and families in the community
- palliative care and ethical issues involved with the end-of-life care
- health promotion for better lifestyles
- health disparities from multiple sources
- advanced information technology as a method for extending health and healthcare.
Several priorities are emphasized more in some countries than in others due to particular critical health needs. Studying family issues and context is a major focus in the EU and Finland, while shaping healthcare systems has been stronger in Canada due to economic and shortage of nurses’ concerns. Additional research funds have targeted human resource issues in Canada and thus provide incentive for this research.
Research in the USA has heavily focused on clinical research to guide nursing practice with the bulk of the funding resources in these areas of study. In the USA, an emphasis has been placed on intervention studies, while in the EU such studies are less evident but highly valued. Since intervention studies are expensive, the funding available in the USA has allowed for the increased development of these studies.
Hindrances Regarding Infrastructure
From a professional perspective, both these Western regions have similar concerns with the development of research training and the advancement of funding programs for nursing research. Several issues and concerns about the infrastructure are evident:
- development of doctoral programs with a special emphasis on the need for funded, senior researchers to serve as mentors and faculty
- evolution of postdoctoral study with strong nursing scientists to develop independent, funded research programs prior to entering academic positions
- advancement of the numbers of research-prepared faculty for schools of nursing through the research training programs
- provision of additional funding sources for nursing research and research programs
- development of ‘fast-track’ doctoral programs and other funding incentives to move nurses into doctoral programs at a younger stage in their career.
The regions share the problem of ‘greying,’ older faculty who are in short supply. This has a similar impact in all the countries; a shortage of faculty compounded with a limited career in research, the ability to provide national healthcare leadership and be able to be involved in health policy decisions.
Knowledge development and doctoral education in the EU, especially Finland, and in North America, and the USA specifically, have grown dramatically in the past two decades.
With the establishment of nursing doctoral and postdoctoral programs in universities and collegiate systems, the development of strong funding sources for nursing research and research training, and the identification of priorities for nursing research, the generation of knowledge to guide nursing practice and influence the healthcare issues of the various countries has exploded.
The development of nursing research programs underlying the knowledge base is interactive with the advancement of doctoral and postdoctoral education in each country, just as the preparation of new nursing scientists feeds the development of more research and continues to advance the knowledge base.
Given the identified priorities of these two developed, Western regions, the knowledge development and generation of doctoral and postdoctoral education should be even more exciting and challenging in the next decade.