Nursing research: understanding nursing innovations for the transformation of communities of care.

Author:Burge, Donna M.
Position:Report
 
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Introduction

"I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past. "

... Clara Barton

The purpose of this article is to explain the phenomenology of nursing and nursing research, describe the history of nursing research, and consider the impact of recent and future nursing researchers in meeting the needs of society. Understanding the underlying paradigm of nursing research, its passion for discovery of new facts, and the power of nursing research to innovate and transform communities of care is essential to understanding nursing. The outcome of understanding the purpose and trajectory of nursing research is an appreciation of the legacy of nursing research and its many contributions to healthcare innovations that promote health and healing across all healthcare settings and amongst all people.

The term research derives from the Middle French term "recherche" which translates as "to go about seeking." (Merriam-Webster, 2012). One modern definition describes research as "systematic investigation in order to establish facts and reach new conclusions." (Polit & Beck, 2008). Researchers systematically and objectively attempt to provide answers to questions. The consequent knowledge transforms the world with new paradigms.

As research endeavors enter the second decade of the 21st century, the auspices of transformation take on entities contributing innovations for the betterment of humankind. Contemporary healthcare faces the challenge to transcend old models and build communities of care. (Kuhlmann & Annandale, 2012). This century is seeing a reshaping of the epistemologies of research; yet, the ability to communicate a clear understanding of nursing research to interdisciplinary research administrators remains ever challenging. (Egnew, 2009). Each nurse has both moral and ethical obligations to seek better possibilities for caring for society. Nursing research specifically seeks knowledge to reframe past health assumptions, thus altering the healthcare paradigm and enabling nurses to provide innovations to improve care, promote healing, decrease suffering, and expand communities of caring past inefficient precedents. (Harrowing, Mill, Spiers, Kulig, & Kipp, 2010).

Nursing is one of the disciplines contributing to the transformation of healthcare into communities of care. Yet, the transformation affects nursing research itself. (Watson, 2009). Comparatively, nursing research is relatively young, with the majority of peer-reviewed publications occurring over just the last 50 years. (National Institute of Nursing Research, 2003). One early definition stated that nursing research is the systematic investigation of patients and their health experience. (Burns & Grove, 2005). This definition does not seem to appreciate fully nursing research's rich legacy and the range of innovations and transformations resulting from this discipline. Today it is realized that nursing research has evolved from a simplistic "bedside" and single patient perspective to a complex and broad-ranging societal change agent. (International Council of Nurses, 1999).

The Phenomenology of Nursing

"I think one feelings waste themselves in words; they ought all to be distilled into actions which bring results."

... Florence Nightingale

The term phenomenology is a term originating from the Greek terms phainomenon "that which appears;" and logos "study," which combined means the study of the structure of a subjective experience and consciousness. (Moran, 2000). In its most basic form, phenomenology thus attempts to create conditions for the objective study of traditionally viewed subjective topics: consciousness and the content of conscious experiences including judgments, perceptions, and emotions. Phenomenology utilizes systematic reflection to determine the essential properties and structures of experience. Understanding the phenomenology of nursing enables others to understand how the nursing profession fills so many diverse roles yet shares a common goal: to support humanity on their journey across the illness-wellness continuum. As Nightingale's quote indicates, nursing takes action based on subjective experiences and consciousness ("feelings and words") to the needs of individuals and their respective societies.

Nursing phenomenology encompasses the structures and experiences defining the discipline of nursing as a whole. The foundational philosophy of nursing is the use of art and science to commit nursing knowledge to the holistic wellbeing of individuals and groups. Nursing provides a multifaceted paradigm. This paradigm is focused on care from the patient's perception and interpretation of the same events as well as the patient's responses to stimuli and motivations for individual behaviors. Logically, it also includes necessarily the nurse's perceptions ad interpretations of what is occurring. Florence Nightingale and Virginia Henderson, nursing research pioneers, provide classic definitions of nursing sensitive to this paradigm. Nightingale defined nursing as "the act of utilizing the environment of the patient to assist him in his recovery." (Nightingale, 2010, Preface). Henderson explains the role of nursing as "... assist(ing) individuals sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that the individual would perform unaided if he had the necessary strength, will, or knowledge, and to do this is such a way as to help him gain independence as rapidly as possible." (Henderson, 1966, p. 15). Both Nightingale and Henderson acknowledge that nursing research must relate to the patient and the context in which he or she lives.

The American Nurses Association (ANA) speaks of nursing operations as "the diagnosis and treatment of human responses to actual or potential health problems." According to the ANA, nursing care has four principal characteristics: 1) the phenomena of patient care concerning nurses; 2) use of theories to observe the need for nursing intervention and to plan nursing action; 3) the nursing action taken; and 4) an evaluation of the effects of the actions relative to the phenomena. (American Nurses Association, 2010). Intrinsic to this definition is the nursing process. The nursing process is a framework consisting of an assessment of the phenomena of interest, data collection, diagnosis, planning, treatment, and evaluation. Standards of Practice support the nursing process. Nursing scholars developed the standards from systematic, continuous collection of data concerning phenomena of interest in providing nursing care.

Nursing Research and Its History

"Nurses have come a long way in a few short decades. In the past, our attention focused on physical, mental, and emotional healing. Now we talk of healing your life, healing the environment, and healing the planet. "

... Lynn Keegan

Consistent with other federal agency usages, the United States Department of Defense defines basic research as "systematic study directed toward greater knowledge or understanding of the fundamental aspects of phenomena and/or observable facts without specific applications toward process or products in mind." Applied research is defined as "systematic study to gain knowledge or understanding necessary to determine the means by which a recognized and specific need...

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