EDITORIAL
Vol. 19 No. 1 - March 2003
When asked to write an editorial for Nursing Praxis, having just completed my first year as Chairperson of the Nursing council, the topic that immediately came to mind was the pressing need for published research from New Zealand nurses. Having been involved in nursing education and research for a number of years I have long been committed to the publication of research by nurses as a means of developing knowledge to support practice. As Chairperson of the Council I have been confronted by opposition to some of the developments taking place in nursing, particularly in the area of advanced clinical roles. Consequently I have become even more conscious of the importance of research in arguing for the possibilities and positive outcomes of these developments. In some instances the changes have provoked negative reactions from colleagues in other health disciplines. Although not entirely unexpected the vehemence of the opposition has been a surprise.
The main points of contention are the title Nurse Practitioner and more especially the associated idea of nurses prescribing. Although the Medicines Act changed in 1999 to allow prescribing by nurses these changes were restricted to the areas of Child Family Health and Aged Care. At the time of the law change there were no nurses educationally prepared to take advantage of this aspect of advanced practice, nor did the Council have the processes in place to regulate this function. The latter have now been developed and prescribing is firmly and publicly positioned within the Nurse Practitioner role, thereby alerting all health professionals to the reality of advanced nursing practice.
I emphasise that the negative and vociferous reaction has come from only some health professionals. Many others support the emergence of expanded practice for nurses acknowledging that this may assist the provision of quality health care. However there are critics who continue to question the value of the innovations, often positioning their critique within a tautological argument about there not being enough research on the role of Nurse Practitioners - completely ignoring the fact that such nurses need to be in place before the research can be undertaken.
The connection between scholarship and issues such as those referred to above lies in the nature of the debates. Both those arguing for, and against, current developments in nursing practice make frequent references to research (and the lack of it). When arguing the case for supporting nursing practice developments such as prescribing it is essential to be able to cite evidence from relevant and rigorous research. The reality of this situation has reinforced both my commitment to research and its dissemination, and the belief that this issue is one of the most important issues with which nurses and researchers in New Zealand must deal. It must be our focus over the next few years.
There is a range of evidence required. In New Zealand nurses have an excellent reputation for qualitative research. Although quantitative research has been less popular with nurses quantitative data are important for purposes of comparison and to provide the full picture of how professional development is to be best supported.
While I have a working knowledge of quantitative methodologies, in terms of depth of research experience I am a qualitative researcher situated primarily within the critical paradigm. However I have always argued that, given nursing is an applied discipline, it is necessary to utilise the appropriate method for the research question, rather than reshape the latter to fit a particular methodology. This makes life difficult in some respects, as it means that our research courses must cover the whole range of methodological possibilities rather than, for example, in a discipline such as anthropology where the focus is mainly on ethnographic approaches. On the positive side it promotes a body of research evidence which has both breadth and depth. If
new researchers are encouraged to focus on the research question as their starting point (rather than being tied to one paradigm or methodology) they are more likely to appreciate, and want to develop, the skills of quantitative research. With that will come an understanding of statistics as being able to contribute a further, although not definitive, dimension to nursing knowledge.
Methodology aside, the most important and urgent concern must be with publication.
Everyone involved in nursing education and research knows that, of the considerable amount of research is undertaken much does not reach a wider audience through publication. Yet New Zealand generated research evidence is vital to support decisionmaking in policy formulation and practice. While being able to draw on international research is extremely useful the uniqueness of the New Zealand context limits generalisability and may even negate the findings. Nurses who have already published, or are intending to do so are to be congratulated and encoura.
A special plea is made here to the many others who are either unwilling to undertake the extra work required to shape their research report into publishable form, or are nervous about the refereeing process. Critical review is part of developing a credible body of knowledge and the process is essential if journals are to ensure quality. In the same way that students value their work being assessed by their lecturers so journal reviews are comments on the content of the manuscript, not the author, and are designed to facilitate progress towards publication.
Overcoming reluctance to submit work to peer review is part of a growth process. Further, rather than being thought of as an optional extra, publication needs to be recognised as an integral part of the research - in the absence of which the project remains incomplete. As a further incentive I repeat the urgent need expressed by planners and policy-makers arguing for changes such as implementation of advanced nursing practice roles. To support their case they require access to a body of New Zealand generated nursing research.
Dr Annette Huntington RGON, PhD.
Chairperson, Nursing Council of New Zealand
Associate Professor, School of Health Sciences
Massey University - Wellington Campus
