Journal of Nursing Education

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Education in Research for Nurses*

Jeannette R Folta; Leonard Schatzman

Abstract

The academic marketplace has become increasingly like a competitive arena, with academicians being pressured to compete for professional status by means of publication. College and university administrators vie with each other for "top people" in the various fields, persons who are well known, if not preeminent, through their accomplishments in research and/or publication. Evaluations of professional competence, decisions on salary and promotion, and academic survival itself depend progressively more on publication and less on teaching ability or on abilities in the clinical application of knowledge. As with other professions, so too with nursing. This phenomenon has become conditional to the attainment of professional recognition and status. Of course, this trend would pose no problem if the nursing profession were content to hold an exclusively clinical position in the world of health work or if, by some quirk, it was somehow exempt from the research and publications race. Such is not the case, however. The nursing profession has joined the research movement and has sought no special privileges from academic institutions.

If what we are saying is correct, then problems are posed for nursing regarding the preparation and training of students to meet the requirements of scientific research-oriented careers. Compared to social work, and certainly to clinical psychology, nursing has focused less upon basic research and more upon clinical practice. But for a very few training centers, there is very little research orientation in nursing. Undoubtedly part of the problem is that nursing has failed to attract significant numbers of research-oriented persons -a phenomenon probably characteristic of all the health professions, but particularly of nursing. Even when basic research is or becomes an interest, it is usually of a secondary nature. The question then is: how well prepared is nursing to move along at a relatively rapid pace toward its proper place in the world of science, research, and publication?

Research funds are becoming increasingly available to nursing, and nursing journals are growing in size and number, providing the means, models, and media for research expression. In this sense the stage is set. But the pace is relatively slow and will not quicken until a number of obstacles are overcoma One such obstacle is that nursing, including its faculties, is relatively unprepared to conduct research and to instruct others in research technology. For years, the discipline has been tied not only to clinical practice, but to educational practices as well. Nurses as teachers seem to have shifted their concern from patients to students, "regarding" one as they would the other. Thus the nursing instructor's energy is absorbed into teaching, supervision, and curriculum development. Much of this is due to the traditional tie between nursing and departments of schools of education- a tie which has done relatively little toward developing researchmindedness. It has, we believe, reinforced the clinical bias rather than enhanced the broader scientific perspective. When research is taught and attempted, it is focused largely upon problems in teaching-learning and problems in comparative clinical studies, and in both cases highly stylized techniques are utilized. As a result, many of the best-educated nurses view research, even scientific thinking itself, as a highly organized set of procedures and processes different from clinical practice and content but still relatively fixed and routine. In the meantime, and for these reasons, much of the research on nursing and the training of nurses in research is being conducted by social scientists and psychologists, usually from outside of schools of nursing. This is a growing development and provides one way of ultimately producing a core of nurses who will be able to carry on with the work of…

The academic marketplace has become increasingly like a competitive arena, with academicians being pressured to compete for professional status by means of publication. College and university administrators vie with each other for "top people" in the various fields, persons who are well known, if not preeminent, through their accomplishments in research and/or publication. Evaluations of professional competence, decisions on salary and promotion, and academic survival itself depend progressively more on publication and less on teaching ability or on abilities in the clinical application of knowledge. As with other professions, so too with nursing. This phenomenon has become conditional to the attainment of professional recognition and status. Of course, this trend would pose no problem if the nursing profession were content to hold an exclusively clinical position in the world of health work or if, by some quirk, it was somehow exempt from the research and publications race. Such is not the case, however. The nursing profession has joined the research movement and has sought no special privileges from academic institutions.

If what we are saying is correct, then problems are posed for nursing regarding the preparation and training of students to meet the requirements of scientific research-oriented careers. Compared to social work, and certainly to clinical psychology, nursing has focused less upon basic research and more upon clinical practice. But for a very few training centers, there is very little research orientation in nursing. Undoubtedly part of the problem is that nursing has failed to attract significant numbers of research-oriented persons -a phenomenon probably characteristic of all the health professions, but particularly of nursing. Even when basic research is or becomes an interest, it is usually of a secondary nature. The question then is: how well prepared is nursing to move along at a relatively rapid pace toward its proper place in the world of science, research, and publication?

Research funds are becoming increasingly available to nursing, and nursing journals are growing in size and number, providing the means, models, and media for research expression. In this sense the stage is set. But the pace is relatively slow and will not quicken until a number of obstacles are overcoma One such obstacle is that nursing, including its faculties, is relatively unprepared to conduct research and to instruct others in research technology. For years, the discipline has been tied not only to clinical practice, but to educational practices as well. Nurses as teachers seem to have shifted their concern from patients to students, "regarding" one as they would the other. Thus the nursing instructor's energy is absorbed into teaching, supervision, and curriculum development. Much of this is due to the traditional tie between nursing and departments of schools of education- a tie which has done relatively little toward developing researchmindedness. It has, we believe, reinforced the clinical bias rather than enhanced the broader scientific perspective. When research is taught and attempted, it is focused largely upon problems in teaching-learning and problems in comparative clinical studies, and in both cases highly stylized techniques are utilized. As a result, many of the best-educated nurses view research, even scientific thinking itself, as a highly organized set of procedures and processes different from clinical practice and content but still relatively fixed and routine. In the meantime, and for these reasons, much of the research on nursing and the training of nurses in research is being conducted by social scientists and psychologists, usually from outside of schools of nursing. This is a growing development and provides one way of ultimately producing a core of nurses who will be able to carry on with the work of developing a research orientation within the profession. Yet, unless the research is carefully designed in terms of the special background needs of nurses, the results are not likely to meet the accepted standards of research competence or the needs of the nursing profession.

Many nurses in the higher levels of education are taking or have taken courses in research methodology. This might appear to be the desirable way to achieve sophistication in research, except that the average course, however rich it might be in technical procedure, rarely deals adequately with the logic underlying the operations taught. Under these conditions, independent research is rarely attempted, simply because the researcher does not quite know what he is doing. Unless the data fit a classroom model precisely, action is either blocked or directed toward a search for data that will fit the model. At best, research becomes a series of routine impersonal techniques without much creativity, adventure, or discovery. At worst, the "course work" approach produces boredom and disenchantment with research.

Other avenues are open to nurses in search of an education in research. One of these is the route leading to the doctorate, most usually in the social sciences. This route requires considerable energy, fortitude, and a major reorientation in ways of living and thinking. It is a time-consuming program, not only because of its essential nature, but also because many nurses require additional courses, either as formal prerequisites or because they lack sufficient background. In addition, nurses are not always welcome into such a program. For these and other reasons, the doctorate is attractive mainly to nurses who are relatively young, bright, and highly motivated, and probably somewhat rebellious or disappointed with their lot. The profession must, of course, expect that some of these nurses will not return to nursing, or even to any of the health disciplines.

Still others see possibilities of learning research through on-the-job apprenticeship. This method seems to be unsatisfactory simply because the directors of the various research projects are not likely to offer the nurse a true colleagueship nor undertake to educate her. They are much more likely to use her as a data gatherer or data processor. Even under the best of circumstances, the nurse will rarely witness, much less help with, research design and analysis and writing. Nor does a mere briefing on these procedures constitute an education in research. Consequently, a research career via this route may well prove illusory as well as inconclusive and unsatisfactory. Despite the shortcomings in the apprenticeship mode of acquiring research skills, nurses will doubtless continue to use it. It may be all that is available, or given limitations of time and money, all that nurses can afford. We believe, however, that there is another way, one which is feasible and realistic in terms of the needs of both nursing and the health professions generally. This other way is a special program for interested and capable nurses to acquire research skills, a program which can be instituted in most larger schools of nursing. It would be a special program suited to the probable or assumed intellectual strengths and weaknesses of nurses generally. We propose a two-( prefer ably three-) year program designed as an education in science and research. Our emphasis here is on a "program" instead of on "courses," and on an "education" instead of on "training." The program would capitalize upon skills already acquired by the student in conjunction with her clinical area of specialization. Students would be selected according to capability, imagination, and motivation, and would be taught and guided on a tutorial level.

At the first stage, the program would include readings, seminars, and didactic instruction in the logic and philosophies of science. There are several philosophical positions, each of which has a kind of world view which implicitly, at least, indicates a way of observing and understanding the world of things, people, and events. The things one looks at, how these are to be examined, and thoughts about mem have bearing upon the logic of these operations. The research educator owes it to his students to help them become familiar with these philosophical positions and the operations that logically follow, so that research techniques ultimately learned are related to the systems that produce them in die first place. This ability requires an exposure to a broad historical view of scientific activity in order to relate the various philosophies and the logic of science to the empirical world in which science is practiced. This exposure is necessary in order to avoid viewing philosophies and logical systems as entities unrelated to history. Typically, the "methods" course approach assumes implicitly or makes barely explicit the broader logic or rationale for specific techniques being taught, since the major focus is upon mastery of a technology. Research as it is generally now taught in schools of nursing does not involve any discussion of the history of science or the logic of its many techniques. We shall not concern ourselves here with die amount of time necessary for this stage of the program. Whatever period of time seems necessary- a month or more of fulltime work, perhaps - there should be a constant reiteration of the logical basis for all subsequent research operations in connection with the program. In other words, the attention to scientific logic and the philosophy of science is not a course in the program; rather, it is a continuing concern of the teacher so that it may eventually be a continuing concern of the student.

Unless the student works from a conceptual structure which is related to a body of knowledge, good scientific work cannot be done Research should begin with existing theory and result either in its modification or in the development of new theory, for the goal of science is the building of theory. A theory is not a set of facts; rather, it is a body of logically interrelated propositions that assert relations among the properties of the phenomena under study. By all means, the student must understand that learning theory is distinct from learning fact, for students tend to equate fact with theory. Furthermore, far from simply using theory to examine events, the learner (and researcher) must constantly subject a theory to examination in the fight of the events being examined. Clinicians frequently fail to examine or test a theory, but rather concern themselves solely with its application. Implicit here, and as a necessary condition to scientific research, is the development of a critical attitude. For, in fact, the quintessence of the research attitude is a willingness and the ability to modify existing theory or to develop new theory. This is quite different from a concern with the application of theory.

One of the characteristics of scientific work is the art of discovery, the ability to discover. It is necessary to be trained in readiness to perceive new phenomena for this ability to develop. To a certain extent, training and experience will enable a researcher to become aware of the discovery process. Such training will not produce genius, of course, but at least it will assure that the fledgling researcher will be better prepared to think and see creatively.

Education in research must include an abstract content so that the student might become familiar not only with the facts of the field but also with the major scientific problems contained therein. The techniques ultimately learned will be relevant not only to a content but to scientific research problems. Nursing education currently does not clearly distinguish between clinical and basic research, and it tends to lead the learner to a misapprehension of the meaning of research. "Problem solving" is not synonymous with scientific research. Clinical problems are concerned mainly with three modes of approach to any given phenomenon: (1) what needs to be done, (2) what is the best of several alternative actions, and (3) how best to implement the action chosen. These approaches are related to a peculiarity in American educational philosophy, which converts most phenomena into problems requiring solution. This calls for "research" on these solutions and for evaluating and testing. Hence, there arises an illusion that the person involved in this kind of work is in fact a scientist.

Having dealt with the logic of scientific method, with ways of handling theory, and with the character of scientific problems, the student must be introduced to the concept of design in research. The stock and trade of the researcher is his ability to design research whether or not he himself collects the data. Starting with a theoretical background which makes specific problems meaningful, the design is a way of identifying as well as of examining issues or questions that beset the researcher. Research design is a process which concerns itself with identifying a basic problem in any given area, with identifying the kind of problem that is researchable, with devising techniques that will shed light on this problem, and with determining when and how these techniques are to be applied at different stages in the development of the research.

Training in technology itself then comes into view. There are many different techniques, each of which is suitable to a specific range of problems. It is unfair to present to students one or more sets of techniques as suitable for any kind of problem, or to let them assume that phenomena not susceptible to these techniques do not pose problems. Education in techniques must flow logically from an education in problem formulation. The research problem should determine the technique, not vice-versa. In most research courses, the student typically learns a technique and then tries to find a problem to fit it in order to test the validity of the technique or to prove that he can use it. Doubtless, once a person becomes proficient in a set of techniques, he will characteristically select and deal with things in terms of these techniques. This approach is legitimate, provided the person is sufficiently sophisticated in research to recognize the nature of the selection.

The student must also be prepared to analyze data in order to develop theory. While it may be far too much to expect a student to create meory out of whole cloth, it is not too much to expect a student, in the course of his investigations and analysis, to create concepts out of research experiences and data. This may be difficult, even for the best of us, yet can we prepare for a research career with anything less in mind? One new concept can support an existing theory or give it a jolt; two or three new concepts neatly related have the makings of a conceptual structure. Techniques learned are simply tools for such purposes, not ends to be used as demonstrations of personal competence. Research design, patiently taught, yields conditions for concept development. Later, with the data sorted and tentatively examined, we have still other conditions for discovery. When additional data are received, we have opportunity again to examine them, not only in the light of the designed operation -which may yield new concepts- but also in the light of whatever additional perspective and operation becomes available to the intelligent mind. Reality is infinitely complex; therefore, the data must be seen by the student as holding potentially much more than was prepared or bargained for. Through such a program, the creative mind may be liberated. We hasten to add that a research training program must provide conditions in which the student can be comfortable with some error, ignorance, and confusion, and at times be able to express freely even the most outlandish ideas. Clearly, the education cannot be simply the mastery of specific technical processes; it must also provide training in thinking processes.

Finally, there is the matter of writing for publication. Research that is uncommunicated is of little value. As a researcher, one makes an implicit bargain to organize observations and to write them in some publicly acceptable form. Nurses do little writing for publication, and not necessarily because they have little to communicate to some special public. Rather, we suspect, ttiey are lacking in the mechanics and art of writing; thus they regard it as a disagreeable chore. A research training program, therefore, ought to provide some instruction in this aspect of a research career. Such instruction need not be focused upon grammar, but upon the orderly development of ideas relevant to the interest of specific audiences. The student then may be able to not only fulfill one of the requirements of scientific work but at the same time to provide an interested reading public with his findings. We are not certain exactly how this aspect of training can best be accomplished. We are, however, certain that a student must be provided time, encouragement, feedback, and any other condition which is demonstrably conducive to productive written expression.

We have deliberately expressed our views concerning a research training program in relatively abstract terms; consequently we have left implicit many of the specifics of the training we propose, including the acquisition of techniques necessary for careers in research. The program we recommend is built largely around field work techniques, including participant observation, interviewing, and qualitative analysis. Other aspects of research built into such a training program include sampling techniques, the construction, administration, and processing of questionnaires, and quantitative analysis. Rather than describe these features in detail here, we would rather emphasize one special aspect of the instructor-student relationship.

Just as the clinical instructor is thought necessarily to be a good clinician, so too the research instructor must be a good and constant researcher. Within a two- or three-year program there is ample time for both team and individual research. In this way, the tutorial system is reinforced and made effective. Also the student learns not only how to work in teams, but is witness and helper to every aspect of research from rough idea to finished writing. In the later stages of the program, the student is able to proceed on her own with a minimum of supervision.

Who should do research anyway? The authors argue that not every clinician, nor even every academician, need do research. For the broad spectrum of nurses, some discussion of scientific work and the logic and philosophy of qualitative and quantitative analysis is sufficient to make them intelligent consumers of research. To expect all nurses to conduct research is both unrealistic and exceedingly burdensome upon the profession, not to say for individual nurses. We would hope, minimally, that every nurse would be able to participate, if briefly, in some aspects of research and engage in an intelligent dialogue about it. Nurses who wish to be clinicians or teachers should be allowed to move in those directions. Nevertheless, if the profession as a whole is to "make its mark" in the scientific world, it must select for special training those few nurses with enough doubt, curiosity and motivation to become a different kind of nurse.

10.3928/0148-4834-19651101-08

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