Future Directions in Knowledge Development
The knowledge base to guide nursing practice and healthcare has expanded dramatically in the past two decades in a number of regions of the world. As a critical mass of doctorly prepared nurses has built major research programs focused on priority nursing and health problems in their countries, substantiated bodies of knowledge are evolving that enhance the quality of life for multiple populations and improve the healthcare provided to the public.
This expansion of knowledge has been facilitated in a number of countries by nurse scientists’ access to growing resources for conducting research. For example, Canadian nurse scholars are now highly successful competitors for federal research monies within most of the government’s funding agencies for health and cancer research. In the Canadian health services research arena, there are targeted federal monies for nursing studies
There is a symbiotic relationship between the expansion of knowledge in a discipline and its doctoral programs; That is, as the cadre of doctorly prepared graduates grows, the research expands the knowledge base for the discipline and its practice, which in turn stimulates additional interest in doctoral education to acquire the competence and skills to further the science. Thus, the expansion of knowledge influences doctoral education while such education also impacts on the directions of knowledge development.
The development of knowledge through scientific inquiry is embedded in the context of the culture of the investigator’s country (Ketefian and Redman, 1997). The research questions that are posed reflect the particular perspective and basic values of the researcher’s cultural background. For example, in the USA, the nursing profession has a strong commitment to promoting the health of the public as well as ameliorating the consequences of illness.
This orientation is evident in the research programs developed by nursing scientists. The knowledge developed reflects the Western value for individualism and for promoting health through self-care and self-management behavioral strategies. In countries where infectious diseases are prominent in large populations there may be more focus on the immediate need to control the various illnesses.
Knowledge development within the nursing discipline is also greatly influenced by several factors within the country of the researchers. These factors include social issues, economic status, political events, demographic profiles of the populations and health/healthcare trends. For example, in a number of the countries with more developed economic and healthcare structures individuals are living longer.
This has resulted in a growing cadre of older adults who are more prone to multiple chronic illnesses. These types of conditions require increased care within the community rather than acute care settings, a situation that changes the pattern of delivery of healthcare (Callahan, 1985).
In the USA, the PhD or Doctor of Philosophy degree is the culturally accepted preparation for research careers and is now being ‘re-envisioned’ by many disciplines. The intent of the examination of this degree is to consider whether its orientation remains relevant given the numerous changes in the cultural, social and economic context of the country.
The development of knowledge through the research programs of nursing researchers will reflect both their cultural values and context as well as the current social, economic , political, demographic and health trends within their countries as stated above.
In this chapter, two Western perspectives on building knowledge and developing doctoral programs will be discussed and the major trends within the countries that shape the research questions and the evolving science will be considered. The two global regions/countries that will be examined are Europe, in particular Finland, and North America, in particular the USA.
Knowledge Development and Doctoral Education: Nursing Scholarship in Europe and Finland
The continent of Europe has many countries. The European Union (EU, www.europa.eu.int; accessed on 18.8.2003), founded in 1993, is a union of 15 independent states. The EU was founded to enhance political, economic and social cooperation between the countries of Europe.
Finland joined the EU in 1995, and at present the other members are: Austria, Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and United Kingdom of Great Britain and Northern Ireland (UK). Ten more countries joined the European Union in 2004: Cyprus (Greek section), the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia.
The educational context for doctoral education in nursing in the EU includes the growth of education generally, research and development of the countries and the emerging issues for doctoral education. During the course of the 1990s the number of people in tertiary level education increased. In the EU, 16% of people over 15 years of age go for third level education. In proportion to the population, Finland has the highest number of people who have third level education—by 2001, nearly a quarter of people aged 15 and over. This is more than 50% higher than the average in the rest of the EU.
In 2002, the countries of the EU agreed the target of raising research and development (R&D) investment to 3% of the gross national product (GDP) by the year 2010. The aim was to make the EU, by 2010, the most competitive and dynamic knowledge-based economy in the world. At the time of writing, only Finland and Sweden have exceeded the 3% target level (Academy of Finland, 2003).
Doctoral degrees have been an essential part of higher education in Europe for over eight centuries. In 1987, the Organization for Economic Cooperation and Development (OECD) (Noble, 1994; Blume, 1995) identified the emerging problems of growing postgraduate education, drawing attention to the long duration of postgraduate studies. In the 1990s, the OECD (1991, 1995) recommended that postdoctoral positions should be increased, and graduate school model should be implemented. At present, there still is a need for developing more systematic information on European postgraduate education (Fijdal and Bartelse , 1999).
Nursing Research in Europe
In Europe, the history of nursing research goes back to 1950, starting in the UK (Tierney, 1997). In the Nordic countries, nursing research has been progressing since the end of 1960s (Hamrin, 1990; Lauri, 1990; Lerheim , 1990; Lorensen, 1990). The Nordic Academy of Nursing Science (NASV) was established in 1991. On a European level, the Workgroup of European Nurse Researchers was established in 1978 with the aim of building contacts between nurse researchers; This organization includes 25 European national nurses’ associations. It collects yearly information about nursing and nursing research in member countries.
In addition, the World Health Organization (WHO) Regional Office for Europe, the International Council of Nurses (ICN), and the International Council of Midwives launched a Europe-wide ‘Health21 Campaign’ aimed at strengthening the health impact of nurses and midwifes (WHO, 1999).
In 1996, the Council of Europe made five recommendations for nursing research in Europe. The recommendations proposed to develop:
(i) the structure and organization for nursing research.
(ii) the integration of research and practice.
(iii) education for nursing research.
(iv) funding for nursing research.
(v) national and international collaboration.
A year later, WENR (1997) surveyed the impact of the recommendations. Feedback was positive, but real impact was not so clear, especially on the governmental level. However, these Europe-wide recommendations became a landmark in the European history of nursing research. More recently, WENR (2003) published a Position Paper on nursing research in Europe. In this paper, WENR recommends that nursing research take into account the following: clinical outcomes, multidisciplinary work between all health and social care professionals and evidence-based practice.
All these documents and recommendations indicate the importance of nursing research in Europe. In some countries, these recommendations have already been realized. In some countries, they are being used politically to try to get support for the establishment of academic nursing education. In the Nordic countries a symposium was held in 1995, about priorities in nursing/caring science (Hamrin and Lorensen, 1997).
Some general recommendations for the future were made: promotion of health and wellbeing across the life-span of an individual, symptom management, care of the elderly, cost-effectiveness evaluation, restructuring healthcare systems, self-management of health and illness, and development of knowledge from theoretical/philosophical perspectives.
In 2001, in a symposium about knowledge development in nursing/caring arranged by NASV, nursing science was analyzed from the perspective of philosophy, ethics, social sciences, humanistic sciences and natural sciences. Based on the analysis, researchers in the Nordic countries were committed to the importance of nursing/caring sciences, and noted the high degree of multidisciplinary collaboration and strong interest for doctoral studies. More meta-analytic studies, concept analysis and theoretical studies were recommended.
In Finland, the Nursing Research Institute was established in 1966 and academic master’s and doctoral level education started in 1979 (Sinkkonen, 1988; Lauri, 1990). A review of licensure and doctoral studies (Leino- Kilpi and Suominen, 1998; Suominen and Leino- Kilpi , 1998), and articles published in the Finnish Yearbook of Nursing and in the Journal of Nursing Science from 1958 to 1995, pointed out that most of the research at that time was descriptive in nature with emphasis on quantitative methods and concentrated on the practice of nursing and primary healthcare. There was a lack of methodological research and concept analysis. This was also the case in Sweden (eg Segersten , 1993). International collaboration was challenged.
Today, nursing research has a strong position in Finnish society as part of health sciences. Research priorities (eg Eriksson, 1997; Hoitotiede-lehti , 1999; Academy of Finland, 2000) in the universities include theory construction, nursing philosophy and ethics, preventive nursing, family nursing, clinical nursing with different foci and also nursing education and health management science. Finnish researchers actively publish in international journals; for example, during 1997–2001 they collectively published more than 400 articles.
There is a national strategy for nursing and nursing research in Finland (Perälä, 1998). Several recommendations are included in this strategy such as a stronger role for nursing research, closer connections between research and practice, focusing the research on important areas of Finnish health policy, emphasis on the development of research skills, systematic funding for research and development of evaluative systems. In 2003 the Academy of Finland started an international evaluation of Finnish nursing research and the results of the evaluation will provide some recommendations for the future.
Recently, Evers (2003) described the developing nursing science in Europe. He emphasized the empirical nature of nursing science and the importance of clinically relevant problems related to nursing needs or nursing diagnosis of the people of Europe.
According to him, nurse researchers must combine theory and empirical evidence—and disseminate scientific nursing knowledge widely both to the public and to nurses themselves. The need for evidence-based nursing has been pointed out by many other authors in Europe as well. Evidence based nursing is still at an early stage of development, although it is growing steadily in many countries (WHO, 2002; Elomaa, 2003).
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