Posted by: ayrshirehealth | January 23, 2013

Tears, tantrums and chocolate – why research in nursing? by @mz_kimb

Tears, tantrums and chocolate

When I was assigned the date for my blog I began the frenzied thought process of what to write. I find the process of deciding what to write about potentially more challenging that writing the blog itself – what is interesting me at the time, why would a blog reader be interested in what I’m saying? chocolateTantrumOn a particularly challenging academic day, consisting of the obligatory tears, tantrums and consumption of chocolate, that realistically you are only allowed to do under the age of 5 or when undertaking postgraduate education …………… I was asked – so why are you doing this? Great question! Why did I chose to do a course that I was fully aware would challenge me in areas that I was unfamiliar, that I was lacking skills in? I realised it was because I believed in it – it being research. I believe in what research can offer nurses and those we care for, I believe without it nursing would not be the discipline I am so proud to be part of.

  • It’s scary and removed from day to day practice

However that is not to say I don’t understand why nurses don’t engage in what is traditionally considered ‘research’. It is scary and can seem removed from the daily practice of caring for someone. As a discipline nursing is young, when you compare it to medicine, law or physics: much of the philosophical underpinnings of nursing research continue to be debated in languages distant from that used in practice. I have discovered through my studies that even academics can’t agree upon what these terminologies mean, another layer of confusion! The frequent debate, claim and counter claim that nursing is an ‘art’ or it’s a ‘science’, its a ‘profession’ or its a ‘vocation’. Perhaps it is no wonder that those nurses working clinically day to day leave these type of academic musings to others. artFor my part I believe it is both an art and a science. scienceThe art of compassion, the intuition to know when something is ‘not quite right’, the understanding and demonstrating empathy, however this goes hand in hand with the knowledge and application of science to recognise bio/physiological factors that impact on the person, we need to understand physiology, biology, psychology as well as pharmacology each of which brings a piece of the psychosocial puzzle. This is what I believe those in our care should expect from us and what I hope I would receive when using services. At the centre of ‘why’ To undertake a research project in nursing you have to appease many stakeholders, which can seem like a daunting process; you have to satisfy academic values and nursing values all within the frameworks of the multidisciplinary arena within our organisations and institutions – all without losing the person who is at the centre of ‘why’ – the patient. Bishop and Scudder (1997) remind us of this point, that the overemphasis on philosophical issues and concerns can lead is to miss the point and forget the person. I also think that, as a practitioner if we spend too much time rumination on these issues, it could lead us to forget our main role overall, which is to provide care and treatment (this is different from academics where their role frequently requires that level of contemplation).

Understanding new evidence and critical appraisal

Two hatsFor me this is a particularlypertinent point, I am undertaking an MRes very early in my career. The two hats problem is made trickier when you are still trying to work out how to wear your new hats and what your hats really really are. However, these issues and debates should not scare us, as nurses, from engaging with the literature and potentially undertaking some research activities of your own. The benefits far outweigh the difficulties you will come up against. I believe all nurses should be research literate to some degree, by this I don’t mean conducting meta-analysis and ethnography every other afternoon but have an ability to use the research to their advantage, to understand the skills of critical appraisal i.e just because its written in a paper doesn’t mean it’s good research. We should as a nurses be able to understand new evidence and critical appraise its worth within practice so we can implement it.

Surround yourself with support

I know that a level of support is required to enable nurses to do this, I certainly know I would not be writing this without having had the support of the great people I have been lucky to surround myself with. Although I’ve only been a registered nurse for two years, I have met several of these great people, they are out there, I’d would encourage everyone to find them. And of course, encourage myself to read my own blog when the next round of tears, tantrums and chocolate is on the horizon!

About: @mz_kimb is a community mental health staff nurse working in NHS Ayrshire & Arran

Next week

@AlexNeilSNP looks back on his first four months as Cabinet Secretary for Health and Wellbeing in the Scottish Government and looks forward to leading future improvements in ‘Putting patients first’.

This weeks sources:

Allmark,P., 2003. Popper and nursing theory. Nursing Philosphy, 4

Atkinson, P. J. & Crowe, P. M., 2006. Interdisciplinary Research – Diverse Approaches in Science, Technology, Health and Society. West Sussex: John Wiley and Sons Ltd.

Bishop, A. & Scudder,J., 1997. Nursing as a Practice Rather Than an Art or a Science. Nursing Outlook, 45(2).

Gerrish, K. & Lacey, A., 2010. The Research Process in Nursing. 6th ed. Oxford: Wiley Blackwell.

Gillies, A., 2002. Using Research in Nursing – a workbook for practitioners. Abingdon: Radcliffe Medical Press Ltd.

Hickson, M., 2008. Research Handbook for health care professionals. West Sussex: John Wiley and Sons Ltd.

Kettles, A. M., Creswell, J. W. & Zhang, W., 2011. Mixed methods research in mental health nursing. Journal of Psychiatric and Mental Health Nursing, Volume 18, pp. 535-542.

Mackenzie, N. & Knipe, S., 2006. Research dilemmas: Paradigms, methods and methodology. Issues in Educational Research, Volume 16.

Moule, P. & Goodman, M., 2009. Nursing Research – An Introduction. London: SAGE Publications.

Peplau, H. 1988. The Art and Science of Nursing: Similarities, Differences and Relations. Nursing Science Quarterly. 1 (1)

Perry,D., 2004. Self-transcendence: Lonergan’s key to integration of nursing theory, research, and practice. Nursing Philosophy, 5.

Potempa, K. Redman,R & Anderson, C., 2008. Capacity for the Advancement of Nursing Science : Issues and Challenges. Journal of Professional Nursing, 24 (6)

Smith, P., 1998. Nursing Research – Setting New Agendas. London: Arnold.

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Responses

  1. Enjoyed reading your view of research in nursing and especially the discussion around vocation/profession… Agree with your view that it’s both – my view is that the best nurses achieve a good balance of study and research with clinical practice which may look different depending on their role.
    Have been contemplating re-energising my studies again…..and you have pushed me one step closer – thanks!

    • Im glad that its helped in your considerations. I’ve certainly needed others to do that for me too! 🙂
      Had fun doing it and was good to remind myself!

  2. I equally enjoyed reading this. It is a wonderful gift to be able to re-energise people. Given Susan’s reply, it sounds you have helped her to find some momentum.

    “Find great people”, what an inspiring term. I was particularly struck by the section on critical appraisal. it has me thinking “How much content should we spend on the pre-reg curriculum helping students critically appraise research papers?” Just as important “What difference does this really make to patient care?” Thank you for sharing your thoughts.

    Paul

    • Hi Paul
      Thanks for your lovely comments 🙂
      I think the foundations for research mindedness starts with our pre reg education, I was lucky I had a really engaging lecturer.
      Glad you liked it!

  3. I came to nursing over twenty five years ago from engineering. The one thing I have applied to my caring career is that I never try to wear the hats that other people give me or say I should wear but wear the hat that workds for me and my clients. Much “science” is psuedo and applied without thought and much science is ignored because it is not sufficiently academic or because “we have always done it this way”. As an engineer I have always worked on the basis of doing what works. The art is learning to notice what works and do more of it!

    • Steve, thanks for your comments on the blog. You present an interesting perspective – if you do something, you observe it works and you do more of it, what is the difference between that and research (albeit it research may have more rigour underpinning it)? If you then apply that ‘evidence’ wider than just your practice it may influence change, rather than ‘we’ve always done it that way’. I’m not sure I agree that research isn’t implemented because it isn’t sufficiently academic, my interpretation is it isn’t implemented because its based in academia and perceived as unrelated to day to day practice – there is often a practice/academic divide – Balas & Boren (2000) found that it takes 17years to implement 14% of research findings, this underlines the gap: if we know there’s a better way, why don’t we do it? I think you’ve hit the nail on the head “we’ve always done it this way”. Thanks for taking the time to comment on the blog, hope you’ll come back and read it again in the future.

      • Hi There, I can agree with all of that. I guess my perspective re research and academia is related to IAPT in England where the science is clearly psuedo, the interventions don’t work and it is being seen that the academic approach sholud be increased to make it work.

        As well as being a clinician working with trauma I am also directing a programme of research into psychological distress in cardiac surgery in collaboration with NIHR and the difficulty is not the work on the ground but trying to get people to look at what works rather than what the theory says. I love this work as it requires teaching people to learn to look, to be curious, to listen. Directing research programmes in real world research is often hampered by unwarranted academic assumptions which then limits scope and understanding. Academia has become far too focused on the next grant or the next theory, rather than on what the real purpose of the research.

        We are a social enterprise company who cannot make a profit, which does work in association with universities and our work is outcome focused rather than process focused, which then drives the need to produce a direct benefit to clients and patients in order to get the next traunch of funding. This is the way social research should work and has to be driven by what works! It is far from perfect but it is far better than an academic driven approach which tends to try to underpin theories and ideas rather than produce change.

        In my opinion social science can never be a science because the subject matter has a degree of free will built in that can subvert expectations and theories every time – we have to learn to work with that, hence my original response to your blog. BTW at sometime in the dim and distant past I did a piece in one of the nursing journals critiquing thew P2000 approach as it would take the nurse away from core tasks – do we care or do we talk about caring? They don’t have to be seperate, but by god the academics are trying to separate them.

        Best wishes,

        Steve Flatt

  4. […] Tears, tantrums and chocolate – why research in nursing? by Kim Barron on the Ayrshire Health blog. […]

  5. Great blog Kim and very provocative discussion. As an academic I don’t agree with Steve’s final point. Nothing personal! I just believe social science can be classified as science based on the degree of rigour associated with the claim. Have a look at rasch analysis, and in this the perception of ‘free will’ can be studied just like anything else. I am also very much not trying to separate anything from anything else (just for the sake of it). However, I think the essence of your point following Kim is that ethics and practical application of best evidence should always be the focus of any research endeavour and in that I completely agree.

    Now, back to my rumination station

    Austyn

    • Hi Austyn, I’m quite happy to take your point on the chin from a research point of view, we have statisticians who do all that for us and it is a very useful tool. However, sitting in front of people in distress and trying to ask the right questions to help them find the right ideas, concepts and the means to bring about change in their lives constantly reminds me that they confound the best interventions and predictions because they “don’t want to do that”, “are too frightened to do that” “can’t do that”, “s/he won’t let me do that”, or, “I’m going to do this” and then delight me by doing something that “shouldn’t work” and get on with their lives. It is this bit of my work that gives me the most profound satisfaction, that I never really know what impact my intervention has on another person. The number of times someone has come back and said, “do you remember that comment you made just as I was leaving?” to which I ask excitedly, “which one?”, thinking that some hard thought through intervention is going to see the light of day as a new technique. Only to discover it was, “remember to slow down, take your time and relax”, or some other homily that changed their behaviour. I sometimes think I should do “door step therapy” and not bother with the previous hour!
      Very best wishes to you all,

      Steve

      • Nothing to argue with there Steve as that resonates so completely with my clinical experience. Funnily enough I used to call it ‘front door therapy’…we could be onto something here!

  6. Thanks for the comments! Giving me lots to think about! 🙂

  7. […] last observation. Writing this post was partly prompted by reading this blog post  from Ayrshire Health, and a very brief twitter conversation with Derek Barron (@dtbarron) about […]

  8. […] learning, this time in Tears, tantrums and chocolate – why research in nursing? by Kim Barron on the Ayrshire Health blog, Kim shares why she loves research into nursing and […]

  9. Very interesting blog, i enjoyed reading it 🙂

  10. […] Kim Barron, who is a staff nurse and researcher shared why she thinks nurses should be active participants in undertaking research.  At the same time the title of her blog demonstrated that it is not always an easy thing to do “tears, tantrums and chocolate – why research in nursing”. […]


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