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.