Nursing and Health Care Research

Collette Clifford, Stephen Gough

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317904090
• Edition: 2
• Topic: Medicine
• Subtopic: Health Care Delivery

First published in 1997. This volume is part of the Prentice Hall series- a series of comprehensive textbooks and reference manuals for nurses and other health care professionals. The development of a number of sections in the second edition of this book serves perhaps as an indication of the changes that have occurred in health care education and research over recent years. The emphasis of this text, as in the first edition, is to trace the research process from the initial idea through to dissemination and implementation of findings as appropriate. In so doing, a number of sections have been enlarged and updated. This includes a greater emphasis on some of the 'planning' issues in research seen as particularly important given the increased opportunity available for practitioners to take part in funded research projects. From this perspective increased emphasis has been given to acquiring funding for research and working with established systems of ethical approval.

1 Research for health care

The interest in research in health care has grown rapidly in recent years to the extent that all health care professionals are now encouraged to ensure that their practices reflect knowledge based on research rather than practices determined by tradition.

In this chapter three aspects of research are explored:

1. Research for health care practitioners.

2. Why research is required in health care.

3. Who can be involved in research in health care.

What is research in health care?

As the interest in research in health care has grown, the number of definitions and explorations of the topic has increased. Most definitions of research follow a similar theme with the search for knowledge being emphasised as a fundamental reason for undertaking research studies. There is a general consensus that this search must follow a ‘logical planned format’ for it to be classed as a research study. This logical planned process distinguishes research from other types of project that may be undertaken for the purpose of enquiry.

This is important in health care for there are many different formats that may be used when undertaking enquiries. For example a new health care student may undertake a project to determine the health education facilities available in his or her district. At the early stage of a course it would not be normally expected for this student to have an extensive knowledge of the research process or techniques of data collection. Consequently the means by which the student collects information will be left very much to his or her own initiative and so the teacher may expect a variety of approaches to be used by students.

Further analysis of a number of definitions of research show similar themes emerging through all of them. The emphasis in each varies but, in general terms, there is some note made of research reflecting a scientific process. The word ‘scientific’ perhaps serves to make research appear to be somewhat distant from some aspects of health care practice. The associations with science may be seen as something more common to those used to working in laboratories rather than to people working with others in a health care setting.

The scientific approach to research indicates a situation in which there is ‘control’ over the factors that are being studied. By exerting this control, the researcher is attempting to predict what will happen following a planned sequence of activities. In using such an approach the researcher is in fact using the principle of an experimental research design, which we will return to later in this text.

Although the notion of doing an experiment is familiar to many of us, it does represent quite a complex approach to research. This can easily be illustrated in relation to our own experiences. In a laboratory setting in our school days we may have done experiments by mixing a little of substance ‘A’ with a little of substance ‘B’ and produced substance ‘C’. If this was done on ten occasions, and if each occasion produced the same result, then we would feel fairly confident that on the eleventh occasion the same result would occur. In other words we would be predicting the outcome based on the findings of our experiment.

If using an experimental approach to health care research the researcher will approach the study in a similar controlled way. The goal of the research would be to predict the outcome of a given situation based on the findings of the experimental study. All factors should be monitored closely and the pattern of events analysed to determine the outcome on each occasion.

There are very practical uses for this type of research in health care but, when studying people, it is not so easy to have control over all of the variables involved in the experiment in the same way as it is in the laboratory when working with chemical substances.

For example, the nurse searching for the perfect technique to enhance healing of the infected wound may choose to carry out an experimental study to determine which is the most effective wound dressing to use in this situation. She would need to consider a large number of variables including factors such as age, wound site, causative organisms, other underlying diseases and so on. The benefits of such research are that a nurse might then be able to predict with some confidence that a particular dressing was the one most likely to promote a quick recovery in her patients with wound infection.

In experimental studies such as this there are specific requirements in terms of being able to ‘manipulate’ the substance being studied (in this case the wound dressing) and therefore to control the situation being studied. Because of the complexity of this there is not a long tradition of experimental research in some branches of health care including nursing and other health care workers such as physiotherapists, midwives, occupational therapists and so on. This contrasts with medical research which relies heavily on the experimental approach to determine the effectiveness of new treatment particularly, for example, for new drug therapies. Consequently alternative approaches to research, which do not seek to predict outcomes, have been more commonly utilised by a wide range of health workers. Rather than attempting to exert control in an experimental situation, for example, the researcher may analyse the relationship between observed events in an approach to research known as correlational research design, may compare two sets of results – comparative research design – or may simply observe and describe what is happening – descriptive research. We will look at these different designs in more detail later in the text.

Whichever approach is taken to research, the common themes to emerge in any definitions of research is that ‘research is a planned, logical process. Research may be undertaken for the purpose of analysing relationships between events, or for predicting outcomes.’

Research may be seen as a problem-solving process undertaken in the pursuit of knowledge. The ‘problem’ is the area that is the subject of the study whether that be the value of particular wound dressing in an experimental study or, in a correlational study or an account of what is observed in a descriptive study, the pattern of events in a food poisoning outbreak. In determining the problem area, the researcher would be very specific in stating the area of enquiry when planning a study.

Some types of research may not have a clearly defined ‘problem’ area at the outset. In the pursuit of knowledge the researcher may look for understanding, or meaning, in a given situation; for example, what it means to be a health care student. This approach does not identify a ‘problem’ for research, but rather seeks to add to the body of knowledge by taking an in-depth look at one particular situation, by trying to understand the meaning. We will discuss this later when we examine qualitative approaches to research.

In summary, research can be seen as a search for knowledge in which the format of the enquiry is logical and clearly defined. A variety of approaches to research can be identified, and each should be utilised appropriately in relation to the subject of enquiry.

Why research in health care?

An increasing number of health care professionals are resolving their own uncertainties about research by undertaking research appreciation courses in which their insight and knowledge of the subject can be increased. However, there are still many practitioners who see research as something new and consequently tend to view it with suspicion. It is recognised that this suspicion may come from uncertainty about what research means, and what the implications of using research are to health care practitioners. Although there is increasing knowledge about the subject among practitioners there remains an element of mystique associated with the research process and it is this that I hope to dispel in this book.

The reason for uncertainty about research lies in the history of the health care professions. From a nursing perspective it is interesting to note that Florence Nightingale is frequently given credit in many research texts for being the first nurse researcher. The statistical work she produced to support her arguments for the developing nursing workforce in the early days of organised nursing should be reviewed by any potential recruits to research. It was perhaps unfortunate that in her time Miss Nightingale did not identify the value of encouraging others to take such an analytic approach to their work, concentrating instead upon the practicalities of doing nursing. As the origins of the therapy professions can be traced back to the origins of nursing, many of the issues that influenced the evolution of these professions can be allied to nursing. Even those professions that have older roots than nursing, such as midwifery, were influenced by developments in nursing as they were allied to nursing for the purpose of regulation and control of professional development in the twentieth century.

A key factor to consider was the location of professional training in schools located in the UK National Health Service (NHS), unlike medical education which was developing in the university sector, the location of research activity. Professional education located in the NHS emphasised doing ‘the tasks’, whilst education in the university sector focused on the thought processes behind the ‘task’ and encouraged people to ask the question ‘why?’. As you will see later the word ‘why’ underpins research activity.

Over the years changes to the educational programmes for all health care professionals have resulted in the development of academic departments of health and nursing in the university sector in the United Kingdom. This means that all health care professional groups are now located in the university sector and are in a strong position to develop their educational base and thus research. These educational changes have been accompanied by many other changes at individual professional level. For example changes in the demographic distribution of members of health care groups have resulted in an increase in women entering the profession of medicine and men choosing nursing and other allied professions as their career. This will impact on research as some will suggest that the gender of researchers can influence the way in which research is developed. This may be reviewed further from the literature on feminist research.

The other major change that has, and will continue to have, a major influence on health care research is the major reorganisation of health care provision in the United Kingdom and the pressure from government to ensure that practices in health care are based on a sound knowledge base rather than ritualistic or traditional practices. In the United Kingdom in the 1990s the Department of Health (DoH) has established a major initiative to ensure that research for practice is well co-ordinated and developed to meet the needs of health care. The research and development (R&D) strategy for the NHS was established in 1991 and is now an integral part of health care management. The impact of this strategy can now be seen from the DoH level down to practice where the key question in health care is ‘what is the outcome of this treatment; is it effective?’. The responses generated by such questions have served to challenge health care practices developed over many years and to identify wide variation in approaches across the United Kingdom and wider. In the face of this challenge health care practitioners can no longer ignore the centrality of research in practice.

Who is involved in research in health care?

There are an increasing number of jobs in health care in which research is picked out as a key area of responsibility. Increasingly, however, a research component is being included in many job descriptions for professionals involved in health care.

In the light of the NHS R&D strategy the answer to the question of who can do research is any practitioner, at any level of practice. However, as you will see later in the book it may not be appropriate to talk of who can do research; rather we should be considering who might use research. Indeed a major thrust of the NHS R&D strategy is that of developing a system of review and dissemination to support practitioners who do not have the time or scope to do research.

Throughout this text applied examples will be related to many areas of practice to illustrate the points made. No single group of practitioners is confined to an area of interest, and research in health care practice includes not only clinical practice, but also management and education for practice. Increasingly the emphasis in health care research is on multi-disciplinary, collaborative projects in which care is examined from a variety of perspectives.

At a practice level, the practitioner is well placed to carry out clinical care research projects, whilst at management level the manager may choose to vary the emphasis in any research into care and consider the effects of any research-based changes in managing the unit. Finally lecturers in health care may be interested to examine the impact of teaching on the quality of care produced by students. These examples indicate very briefly the range of subject areas that could be incorporated under the title of health care research. Add to this the study of ‘care’ itself, which has provided a focus not only for health care practitioners but also for many other disciplines such as sociologists and psychologists, and the area of research in health care becomes even wider.

Before moving from this section it is worth emphasising one point that has relevance for all readers – whilst all health care practitioners can do research, it would not be appropriate for all to do so. In contrast all health care workers should be able to use research. To do so, however, requires understanding about what is involved in research – research awareness, which we will review in the next chapter.

ACTIVITY

Consider your own professional background and the point at which you were first introduced to research:

• Was this introduced positively?

• Were you clear about the purpose of research for your own discipline?

• Did you understand the process involved?

• Try to define research in the context of your own discipline.

Summary

This chapter has briefly explored definitions of research and considered why we need research in health care. The issue of who can do research has been briefly addressed and the use of research-based practices in the context of clinical practice, management or education outlined.

Further reading

Abbott, P. and Sapsford, R. (1992) Research Methods for Nurses and the Caring Professions, Open University Press, Buckingham.

Altshull, A. (1991) ‘The development of research in nursing’, in Cormack, D. F. S., The Research Process in Nursing, 2nd edn, Blackwell Scientific Publications, Oxford, Ch. 2.

Chapman, J. (1991) ‘Research – What it is and what it is not’, in Perry, A. and Jolley, M., Nursing – A Knowledge Base for Practice, Edward Arnold, London, C...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Introduction to the second edition
• Introduction to the first edition
• 1 Research for health care
• 2 Research awareness
• 3 Ideas for research
• 4 Planning for research
• 5 Considering the approach to research
• 6 The research process outlined
• 7 Research designs using qualitative approaches
• 8 Research designs using quantitative approaches
• 9 Techniques used in data collection
• 10 Analysing and presenting research data
• 11 Writing for research
• 12 Using research in clinical practice
• Glossary
• Index