History of Nursing Nursing Research: A Historical View
Nursing research has played a crucial role in the development of health care services, significantly advancing the quality of patient care, nursing practices, and health policy. This article traces the historical evolution of nursing research, from its early beginnings in the 19th century to the more structured and organized efforts of the 20th century. Through the contributions of pioneering figures like Florence Nightingale, the establishment of regulatory bodies, and the support of organizations such as the U.S. Public Health Service (USPHS) and the National Institute of Nursing Research (NINR), nursing research has grown to encompass a wide range of studies that focus on the care of patients and the development of health care services.
Nursing Research
The foundations of public health policy in the United States can be traced back to July 16, 1798, when President John Adams signed the first public health policy act. This act established an organization, later named the U.S. Public Health Service (USPHS), that would operate hospitals and rest homes for sick merchant seamen. The initial focus of this act was on safeguarding the health of those who worked in the maritime industry, recognizing the importance of keeping essential workers healthy.
In 1877, a yellow fever epidemic in New Orleans necessitated the expansion of public health policy with the passage of the Quarantine Act of 1878. This act gave the government more power to prevent and control the spread of contagious diseases, marking an important early step in the development of a national health care infrastructure. It was during these early years that nursing began to emerge as a recognized profession, with nurses playing an essential role in the provision of care during epidemics and other public health crises.
Monitoring and Regulations
As the role of nursing in health care expanded, so did the need for regulation and oversight. In 1879, the national Board of Health was established to monitor public health, with a particular focus on sanitation. One of the board’s key responsibilities was publishing a weekly report on health conditions across the country, a publication that would later become known as the Public Health Reports. The board also had the authority to intervene in cases of epidemics, highlighting the growing recognition of the importance of public health as a matter of national concern.
The discoveries of Robert Koch and Louis Pasteur in the late 19th century significantly advanced the understanding of infectious diseases, providing important insights into how diseases were transmitted and how they could be controlled. These scientific breakthroughs laid the groundwork for modern public health practices, including the development of vaccines and other preventive measures. The government’s role in controlling the spread of infectious diseases became more pronounced, with nurses often at the forefront of efforts to contain outbreaks and provide care to affected populations.
Statistical Use in World War II Nursing Data and the Role of Florence Nightingale
Although nursing research became more prominent after World War II, the foundation of modern nursing research can be traced back to the work of Florence Nightingale (1820–1910). Nightingale is often regarded as the first nurse to apply statistical analysis to nursing data, a revolutionary approach at the time. Her meticulous collection and analysis of data during the Crimean War allowed her to demonstrate how improved sanitation and hospital practices could significantly reduce mortality rates. Nightingale’s use of statistics to advocate for better health care practices marked the beginning of nursing as an evidence-based profession.
The role of the federal government in nursing research began to take shape in 1938, with the introduction of grants-in-aid to universities for research purposes. However, it was only after World War II that nursing research began to develop as a formal discipline. The war highlighted the need for research in various aspects of nursing, including nursing education, workforce planning, job satisfaction, and employment conditions.
One of the first landmark studies in nursing was the 1920 Goldmark study, which examined nursing education, working conditions, and the supply and demand for nurses. This study paved the way for further research into the economic aspects of nursing, including studies on salaries, employment conditions, and the costs of nursing services. The findings of these early studies were critical in shaping nursing education and health care policy in the mid-20th century.
Statistical Data to Analysis of Nursing Data
Florence Nightingale’s use of statistics in the analysis of nursing data was groundbreaking, and she is widely recognized as the first biostatistician in the nursing field. Her work set the stage for future nursing research by demonstrating the power of data in improving health care practices. Despite her contributions, it was not until after World War II that nursing research became an organized, systematic effort.
Nursing research is now defined as research aimed at understanding the nursing care of individuals and groups, as well as the biological, physiological, social, behavioral, and environmental mechanisms that influence health and disease. This broad definition reflects the diverse areas of inquiry within nursing research, which seeks to develop knowledge about health across the lifespan, the care of people with health problems and disabilities, and nursing interventions that improve patient outcomes.
Nursing research continues to develop knowledge about health promotion, disease prevention, and the enhancement of individuals’ abilities to respond to actual or potential health problems. Research in this field is critical for improving the quality of nursing care and ensuring that health care services meet the needs of patients and their families.
Role of National Center for Nursing Research (NCNR)
Thirty years after the idea of a national nursing research center was first proposed, the National Center for Nursing Research (NCNR) was established in 1986. The center’s mandate was to advance the science of nursing practice and health care, with the goal of promoting health, preventing disease, and mitigating the effects of illness and disability. The establishment of the NCNR at the National Institutes of Health (NIH) signified a major milestone for nursing research, as it placed nursing within the broader biomedical research environment and facilitated collaboration with other scientific disciplines.
The NCNR’s role in advancing nursing research was critical in elevating the status of nursing as a scientific discipline. Its placement at the NIH also enabled nursing researchers to access federal funding for research projects, which helped to expand the scope and impact of nursing research across the country. On June 9, 1993, the NCNR was renamed the National Institute of Nursing Research (NINR), giving nursing research equal standing with other NIH institutes.
Role of National Institute of Nursing Research (NINR)
The National Institute of Nursing Research (NINR) is the primary federal agency responsible for funding nursing research in the United States. NINR’s mission is to provide a scientific foundation for patient care, focusing on the core issues that shape patients’ and families’ experiences with illness, treatment, and care. NINR-funded research spans the entire spectrum of health and illness, from disease prevention and health promotion to the management of chronic conditions and end-of-life care.
NINR’s primary focus is clinical research, and many of the studies it funds involve direct interaction with patients. These studies are aimed at improving patient outcomes, developing new nursing interventions, and advancing knowledge about the factors that influence health and illness. By providing a scientific basis for nursing practice, NINR plays a crucial role in improving the quality of care provided to patients across the country.
Role of USPHS
The U.S. Public Health Service (USPHS) has been instrumental in the development of nursing research since the early 20th century. During the post-World War II period, USPHS nursing programs played a significant role in expanding nursing services and conducting pilot studies that shaped the future of nursing research. These studies focused on addressing the challenges faced by the nursing profession in the aftermath of the war, including the understaffing of hospitals, the need for better workforce planning, and the development of new health care services.
One of the landmark studies conducted by the USPHS Division of Nursing Resources was a cooperative study with the Commission on Nursing in Cleveland, Ohio. This study aimed to identify the reasons for understaffing in nursing departments and led to the development of new tools and methodologies for evaluating nursing care. The USPHS also pioneered the use of disease classification systems for nursing planning, a methodological approach that would later be used in the development of diagnostic-related groups (DRGs) for hospital reimbursement.
Military Nursing Research
The history of military nursing research dates back to the establishment of the Army Nurse Corps. Over the years, military nursing research has made significant contributions to both military and civilian nursing, particularly in the areas of clinical nursing and health care services. The Army Nurse Corps developed a research program focused on clinical nursing research, with the goal of improving the quality of care provided to service members and their families.
Navy and Air Force nursing research programs have also played important roles in advancing military nursing. The Navy Nurse Corps focused on research related to the organization and administration of nursing services, while the Air Force conducted research on the development of equipment for aeromedical evacuation and the physiological and psychological changes experienced by air force nurses during flying duty.
In 1990, representatives from the Army, Navy, and Air Force formed the Federal Nursing Research Interest Group, which later became the Tri-Service Nursing Research Group (TSNR Group). This group was tasked with promoting collaborative research among the military services, with the goal of advancing military nursing research. The TSNR Group received federal funding to support its research initiatives, and by 1996, its budget had grown to $6 million annually.
Conclusion
Nursing research has evolved significantly since the time of Florence Nightingale, who laid the foundation for evidence-based nursing practices with her use of statistical analysis during the Crimean War. The establishment of the NCNR and later the NINR marked important milestones in the recognition of nursing research as a scientific discipline. Today, nursing research continues to play a critical role in advancing health care, improving patient outcomes, and addressing the challenges faced by health care systems around the world. With ongoing support from organizations such as the NINR and USPHS, nursing research will continue to evolve and contribute to the improvement of health care services for future generations.