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As the national voice for America's
university and four-year college nursing education programs,
the American Association of Colleges of Nursing (AACN) is
dedicated to the improvement of the public's health by furthering
nursing education, research, and clinical practice. Via its
membership, AACN facilitates the conduct of research as well
as the utilization of research findings through the education
of professional nurses and nurse scientists.
This statement focuses on the research mission
of schools of nursing and outlines AACN's position on the
focus, culture, and infrastructure required to meet the research
mission of the academic nursing community.
Nursing Research: Vital to the Health of
the Public
The United States provides unprecedented global
leadership in biotechnology, science, and research. Over the
past few decades, the record of biomedical discovery, technologic
innovation, and medical therapeutics has been spectacular.
The nation also commands research leadership in the humanities,
social sciences, communications, and educational methods.
Moreover, the manner by which individuals and populations
learn, live, develop, adapt, and measure the quality of life
has been advanced. Research conducted by nurses and research
about nurses and nursing has been a part of these major advances
in the past few decades; and there has been a dramatic increase
in the quantity and quality of nursing research.
The essence of a discipline is its body of
scientific knowledge, its system of values and ethics, and
its societal worth. In a practice discipline such as nursing,
there is the added dimension of the thoughtful and discriminating
application of knowledge from many fields of human endeavor.
It is this complex relationship between the building of a
body of science, the utilization of knowledge from other disciplines,
and the application to practice that poses opportunities and
challenges for scholarship within the academic nursing community.
Nursing Research: A Vital Partner in the
Development of the Health-Related Research Spectrum
Although many nurses conduct autonomous biomedical
research in a variety of fields and work collaboratively as
part of interdisciplinary research teams, nurse researchers
make unique, independent contributions to the public's health.
Nursing takes an expanded view of health by emphasizing health
promotion, restoration, and rehabilitation, as well as a commitment
to caring and comfort. Nursing research, for example, frequently
focuses on fostering healthy lifestyles and improving health
outcomes for individuals, families, and communities. Particular
attention is given to vulnerable groups such as the elderly
and their caregivers, preterm and low-birthweight infants,
abused children, rural and urban youth, pregnant teenagers,
victims of violence, the depressed, and the critically ill.
Nurse researchers study how to assist individuals and groups
as they respond to health and illness experiences (e.g., reducing
side effects of illness and treatment); and address social
and behavioral aspects of illness and quality of life components.
Nursing research also focuses on health systems
and outcomes in order to identify ways in which the organization
and delivery of health care influences quality, cost, and
the experience of patients and their families. While research
on such topics is not exclusive to any single discipline,
nurses have a particular focus that brings important balance
to the health/biomedical research agenda for the nation. The
nursing research priorities identified by the American Nurses
Association's position paper, Direction for Nursing Research:
Toward the Twenty-First Century, illustrate the vital
contributions of nurse scientists.(1)
The focus of biomedical science on the discovery
of disease causation and cure is essential but not sufficient
alone to improve health. Despite the dramatic successes of
improved diagnostic and therapeutic modalities, the overall
impact on the health of the public still requires more attention.
Less dramatic strides have been made in disease prevention;
the equitable, efficient and humane delivery of care; and
improvements in societal indicators of health, such as infant
mortality and life expectancy rates. Some diseases are better
prevented than treated, others simply cannot be cured, and
suffering and irreversible changes such as aging are part
of the human experience. Indeed, health can be far better
maintained when it is viewed in the broader context of lifestyle,
culture, and socio-economics.
As an additional component of the broader continuum
of health-related research, health services research is particularly
concerned with issues of organization, delivery, financing,
quality, patient and provider behavior, effectiveness, cost,
and outcomes. It evaluates both clinical services and systematic
structures in which those services are delivered. Both basic
and applied research questions are addressed. Biomedical and
health services research comprise the health-related research
continuum and have overlapping boundaries that reduce the
risk of gaps and support the relationship between the different
areas of research focus.(2)
As the health care environment continues to
change rapidly, the consolidation of health plans and the
movement of patients and providers into managed care settings
continues. The containment of costs, continued problems with
access, and efforts to develop quality care have increased
the demand for nurse researchers to broaden their understanding
of the research continuum to include the development of knowledge
and skills in health services research.
Scholarly environments require the integration
of various approaches to inquiry. Faculty, in concert with
the mission of their institution, need to approach their work
as scientists with rigorous inquiry and reflective thought.
Many faculty will concentrate on the advancement of the knowledge
domain of the discipline, which will enhance the practice
of nursing. Other faculty will focus on advancing knowledge
of how students learn in the clinical discipline of nursing,
which requires the systematic assessment of the teaching-learning
process using rigorous research strategies. Collaborative
inquiry into both domains can result not only in a better
understanding of and coherence in the entire discipline, but
also in an understanding of how knowledge from one conceptual
area complements and extends learning in another. While research
in both domains is important, the purpose of this paper is
to describe the essential elements required to ensure that
the contributions of nursing research to the health of the
public are made.
Creating a Research Culture and Workforce
for Nursing
Any research enterprise can thrive only when
there are certain prerequisites, including a supportive culture,
strong mentoring, educational programs to ensure a research
workforce, and an infrastructure and funding mechanisms to
support the research.
The culture for research generally develops
within academic institutions, in which knowledge development,
discourse, and debate are expected and encouraged. Schools
of nursing that offer baccalaureate, master's, doctoral, or
postdoctoral education build a knowledge base for the discipline
and produce professionals who are able to use that knowledge
in professional practice.
University and four-year-college-based schools
of nursing prepare professional nurses capable of using scientific
knowledge in their practice and contributing to new knowledge.
Health-related research, whether biomedical, clinical, health
care services, public health or health care policy, is an
integral part of all nursing curricula. All baccalaureate
nursing programs are committed to teaching and integrating
nursing's research base into curricula. Teaching from such
a research base results in professional graduates who provide
evidence-based practice. Master's programs in nursing build
on the baccalaureate base of critical thinking to advance
the depth and competence of graduates. Doctoral and postdoctoral
programs provide the strong research preparation required
to generate knowledge relevant to nursing practice and advance
the profession's contribution to enhancing the health and
health care of individuals, families, and communities. The
research expectations and outcomes of the graduates at each
level of nursing education are described below:
- Baccalaureate programs prepare nurses
with a basic understanding of the processes of research.
The goal is that the graduate is able to review and use
research findings from nursing and other disciplines that
can be applied in their clinical practice. These graduates
may be involved in teams with nurse scientists or other
researchers to plan and implement changes in the organization
or delivery of care based on research, or they may serve
as data collectors and research assistants.
- Master's programs prepare nurses
to critique research and to implement changes in practice
based on research data. Their leadership skills enable them
to form teams of professionals, and to initiate and evaluate
new practice policies and programs within their agencies
and professional groups. They identify practice and systems
problems that need to be studied and collaborate with other
scientists to generate new studies based on their expertise.
- Doctoral programs prepare nurse scientists
for the beginning researcher role. These individuals are
able to conduct nursing research independently, preferably
with a senior researcher in the early years as they establish
their funded research program(s). These nurse investigators
also are able to facilitate teams of clinicians and researchers
in planning and conducting studies.
- Postdoctoral programs provide nurse
scientists not only with a period of time devoted fully
to developing research skills, but also a research program
with the mentorship of a senior investigator. Nurse scientists
conduct the early phases of a research program and plan
for ensuing phases. Postdoctoral fellows are generally expected
to submit an initial application for funding for the next
phase of their research program. Establishing nurse scientists
in postdoctoral study ensures that research is firmly started
before these individuals assume the multiple roles expected
in an academic, clinical, or administrative position.
Formal academic programs are embedded in a
long-term commitment to continuing scholarship and updating
of knowledge and expertise required to conduct cutting-edge
research. Future nurse researchers need to be in schools where
the administration is strongly committed to research, faculty
are active investigators with funded research, and the environment
is rich in collaboration and inquisitive spirit. These are
the types of schools that must take the lead in the preparation
of nurse scientists. This research-intensive environment takes
years to develop and must be protected to ensure a continued
legacy of strong, relevant research.
The Indicators of Quality in Doctoral Programs
in Nursing, adopted by AACN in 1993, outlines the major
educational components required for nurse scientist preparation,
including faculty with appropriate expertise, programs of
study, resources, students, and research characteristics.(3)
The quality of doctoral programs has been correlated to the
future graduates' productivity as nurse researchers.(4)
An effective research culture to prepare excellent
nurse scientists is characterized by:
- faculty with long-term commitment and productivity
as nurse scientists and educators, including the availability
of senior investigators and mentors;
- opportunities for postdoctoral study;
- interdisciplinary research and educational
experiences for nurse investigators; and
- a strong research environment.
Providing a Research Infrastructure and
Funding
To generate the science base for nursing practice
and educate future generations of nurse scientists, the requisite
infrastructure must be strong. Support for research must be
present within departments and schools, in the larger academic
institution, and at the national level.
The importance placed on the research mission
by the larger institution has a major impact on the nursing
school's research environment. In research-intensive environments,
support is evident in the hiring and retention packages provided
for investigators, in the peer and administrative review mechanisms
used for appointments and promotions, and in the availability
of start-up research funds available to faculty. It is in
this kind of university environment that nurse scientists
participate and in which they lead interdisciplinary research
activities. Interdisciplinary work provides the opportunity
to understand the complex nature of many scientific problems
and to exchange views and collaborate in teams of committed
scientists. In this setting, research permeates the entire
academic enterprise.
Schools of nursing must provide the training
ground for the next generation of nurse scientists. The infrastructure
may include an office or center for research, concentrated
centers or areas of research excellence, formative and summative
mock reviews of grant applications and manuscripts, informal
or formal mentorship programs, visiting scholars, and external
consultants. The research productivity of the faculty, including
grants obtained and manuscripts published, the number of doctorally
prepared graduate faculty, and the successes of graduates
of doctoral programs are indicators that the environment is
one in which faculty research will flourish.
Research infrastructure at the national level
is also critical. Journals providing peer review of manuscripts
and regional and national conferences in which peer-reviewed
research presentations are included provide opportunity for
nurse scientists to present their work for scrutiny and consideration
by colleagues. The National Institute for Nursing Research
(NINR) at the National Institutes of Health (NIH), as well
as other NIH institutes, provide federal funding for nursing
research as well as support for research training for pre-
and post-doctoral students, new investigators, and mid-career
researchers. The Agency for Health Care Policy and Research
(AHCPR), the lead agency for research on the outcomes, effectiveness,
and quality of health care focuses on the delivery of health
care services in daily practice. AHCPR provides research funding
conducted by all health professionals (including nursing).
Professional, public, and private organizations also offer
competitive research funding and training support.
Despite a documented need for more doctorally
prepared research faculty and postdoctoral training, the quality
of training will be compromised if the research environment
is not supported adequately. Building the research infrastructure
is vital to strengthening the impact that nursing research
has on the public's health and health care outcomes; thus
increasing the funding base is critical. Doctoral education
must occur in schools of nursing that have sufficient numbers
of research-productive faculty, and students must be exposed
to researchers in a variety of related disciplines. In addition,
access to statistical and technologic support are other components
essential to the infrastructure for nurse scientists and students.
Challenges to the Research Mission
Nursing research faces a number of challenges
stemming from rapid growth and diminishing resources. These
challenges include:
- Schools of nursing and affiliated health
organizations are under major financial pressures to deliver
educational and health services more competitively. This
creates competing demands across academic institutions in
general, and specifically, within the nursing education,
research, and practice missions that require deliberate
decisions on the value of research and maintaining the research
infrastructure.
- The management of large population-based
data sets from multi-site and interdisciplinary studies
mandates that nurse researchers are experienced in managing
teams of researchers and collaborative projects. Many studies
to date (in all disciplines, including nursing) have been
conducted at single sites or with investigators of a single
discipline.
- Advancing nursing research requires more
senior, experienced research team leaders who can develop
centers of excellence in important fields of inquiry. This
will require additional post-doctoral training opportunities,
funding for research training, and enhanced research-intensive
environments.
- The growing opportunities for research partnerships
with private and public industries create the need for schools
of nursing to maintain vigilance over research integrity,
conflicts of interest, and academic freedom.
- Funding increases throughout the NIH, especially
the NINR (the major source for nursing research support),
have not kept pace with the growth of doctoral programs
and the number of new doctorally prepared researchers, as
well as the growth in senior nursing researchers who have
major programs of research.4 Increased access to professional,
public, and private funding sources also is needed.
- Fostering evidence-based nursing practice
and innovation will require a long-term commitment to developing
more health services research studies to examine the impact
of nursing processes and structures on the health care outcomes
of patients and populations. Additionally, nursing education
must develop nurses with basic and advanced degrees with
the ability to use these research findings skillfully in
their practice.
Nursing research has grown dramatically in
the past few decades and has had a vital impact on the public's
health and well-being. Given continued university and school
support, as well as the necessary public support and funding,
nursing schools and researchers will continue to make contributions
to the health of people around the world. In order to ensure
an effective research enterprise, four essential elements
-- a research culture, quality education to prepare a workforce
of nurse scientists, a sound research infrastructure, and
sufficient funding -- must be supported vigorously and allowed
to flourish.
Task Force on the Revision of the Position
Statement on Nursing Research:
Members
Ada Sue Hinshaw, PhD, Task Force Chair
Dean, School of Nursing
University of Michigan
Elaine L. Larson, PhD
Dean, School of Nursing
Gerogetown University (DC)
Ada M. Lindsey, PhD
Dean, College of Nursing
University of Nebraska Medical Center
Norma M. Lang, PhD
Dean, School of Nursing
University of Pennsylvania
Linda E. Berlin, DrPH
Director of Research and Data Services
AACN Staff Liaison Liaison
lberlin@aacn.nche.edu
Liasons from the Board of Directors
Carolyn Williams, PhD
Dean, College of Nursing
University of Kentucky
Ellen Beam Rudy, PhD
Dean, School of Nursing
University of Pittsburgh (PA)
References
- American Nurses Association (1997). Directions
for Nursing Research: Toward the Twenty-First Century.
Washington, DC: American Nurses Publishing.
- Eisenberg, J. (1998). Health services research
in a market-oriented health care system. Health Affairs,
17 (1), 98-108.
- American Association of Colleges of Nursing
(1993). Indicators of Quality in Doctoral Programs in
Nursing. Washington, DC: American Association of Colleges
of Nursing.
- Farren, E.A. (1991). Doctoral preparation
and research productivity. Nursing Outlook, 39 (1).
- Hinshaw, A.S. and Berlin, L.E. (1997) The
Future for Quality Doctoral Nursing Programs: Are the Resources
There? Sanibel Island, FL: Paper presented at the American
Association of Colleges of Nursing 1997 Doctoral Conference.
(Approved by AACN Membership: October
26, 1998)
(Revised: March 15, 1999)
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