hr. 1. Nun. Stud.. Vol. 27. No. 2. pp. 105-122. 1990. Printed in Great Britain.

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Nursing research: the Canadian scene SHIRLEY M. STINSON, R.N., Ed.D., L.L.D. Professor, Faculty of Nursing, Department of Health Services Administration and Community Medicine, University of Alberta, Edmonton, Alberta, Canada

MARIANNE

LAMB, R.N., M.N.

Doctoral Candidate, Department of Health Administration, Division of Community Health, University of Toronto, Toronto, Ontario, Canada

MARIE-FRANCE

THIBAUDEAU,

R.N., M.Sc.N.

Dean and Professor, Fact&P des sciences, infirmieres, Universite de Montreal. Montreal, Quebec, Canada

Introduction

The intent in this article is twofold: to provide an overview of nursing research development in Canada for readers who are new to this topic, and to provide updated and expanded content for those who are not. To understand nursing research in Canada, and particularly to appreciate the significance of what has and has not been achieved to date, one must understand the context within which developments have occurred and are taking place. For example, Canada has been a confederation since 1867; and while there is indeed a strong federal government, the provinces and territories have authority in the areas of education and health. This feature entails profound implications for the development of nursing research. Of particular import is the fact that the Canadian federal government does not have a structure for providing any leadership for nursing research. Another key feature of Confederation is the provision for two official languages, English and French. 105

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Three other contextual features of special importance to nursing research in Canada are highlighted below: science policy, key national nursing organizations, and provincial and territorial nursing associations. Attention is then directed to the main topics: nursing research literature and libraries; manpower; networking; funding; and comments on the future of nursing research in Canada. Science policy According to Wilmot, the essence of ‘science policy’ lies in “fostering the rational use of science and technology in pursuit of national goals” (1986, p. 77). The Medical Research Council (MRC) evolved first as a subcomponent of Canada’s National Research Council (NRC), becoming an entity in its own right by 1969 (pp. 76-77). While the funding for MRC, which amounted to some 188 million dollars for 1988-89, comes directly from the federal government, additional funding can come from industry through MRC’s UniversityIndustry Programs which were initiated in 1986 (MRC, 1989b). The MRC’s terms of reference pertain broadly to ‘health’ research; however, in spite of that broad science policy provision, the fact is that to date the MRC has been essentially irrelevant in the development of and support for nursing research in Canada, albeit that since 1986, guidelines for MRC funding do include support for nursing research, a policy change that may eventually result in substantial improvement in funding. In addition, a new MRC program in conjunction with the National Health Research Development Program (NHRDP), to provide support for the development of nursing research was scheduled to begin in 1989 but no funding has yet been allocated. The research funding programs of the Social Sciences and Humanities Research Council (SSHRC) offer no support for nursing research. On the more positive side, Canada’s policy of using science and technology to further the national goals in health care resulted in the creation of the National Health Research and Development Program (NHRDP) under the Department of National Health and Welfare (NHW). The NHRDP research awards budget averages about 12 per cent of that of the MRC. From time to time there are additional ‘infusions’, such as the $9 million in special grants to the NHRDP for AIDS research. As evident below, while the NHRDP is not an autonomous national council, it has been and is a pivotal force in relation to the support of nursing research, particularly in terms of support of nursing research conferences and projects, and research training. However, it is underlined here that the NHRDP’s terms of reference are essentially to support the endeavours of the NHW, not to develop Canadian health research per se, for the latter terms of reference are those of the MRC. In short, there is dejure national science policy provision for Council level support for nursing research, but de facto there has been little support given to date. As such, nursing research in Canada has depended upon other initiatives, and attention is now turned to some of the principal actors: national nursing organizations. national nursing organizations Three national nursing organizations have been key in nursing research development: the Canadian Nurses Association (CNA), established in 1908, which is a federation of nine provincial and two territorial nursing associations; the Canadian Association of University Schools of Nursing (CAUSN), established in 1942, which has as its membership base 27 of the 31 university faculties/schools of nursing which have baccalaureate in nursing programs (11 of these have a master’s program in nursing); and the Canadian Nurses Key

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Foundation (CNF), which was created by CNA in 1962 for the purpose of providing research and educational support for nurses. For decades the CNA has addressed itself not only to improving standards of nursing practice but also of education, research and administration. In contrast, the CAUSN’s central focus was, first and foremost, the improvement and expansion of university degree programs in nursing. Although the CAUSN’s terms of reference did permit an emphasis on research, relatively few of its meagre resources have been utilized for research, even though increasing attention has been given to research over the past 25 years, especially in relation to graduate education and support for the development of PhD in Nursing programs. became regular in 1971 with the formation of a Special Committee on Nursing Research which continued until a Standing Committee was established in 1976. At the 1976 Annual Meeting of CNA, a resolution was proposed by two Quebec nurses to the effect that the CNA should take a leadership role in relation to doctoral preparation for Canadian nurses. Space constraints in this article do not permit a detailed description of the research-related events that both preceded and followed the above resolution, but of special mention here is the work of the CNA’s research committees and the CNA’s leadership in pressing for doctoral preparation for nurses. The CNA’s research committees pioneered in providing ethical guidelines for nurse researchers, advising the CNA Board on a vast number of research policies and researchrelated issues since 1971 and in 1984 produced a five-year plan for the development of nursing research in Canada (CNA, 1984). Also of major importance was the 1978 Kellogg National Seminar on Doctoral Preparation for Canadian Nurses (Zilm et al., 1979) which was instigated by CNA in concert with the CNF and CAUSN under a grant from the W.K. Kellogg Foundation of Battle Creek, Michigan. “The consensus of this [seminar] group was that the greatest and most pressing priority is the instigation of a Ph.D (Nursing) program or programs in Canada” (p. iii). The Kellogg Seminar led to the joint endeavour of the CNA and CAUSN in 1982 to press the Medical Research Council (MRC) proactively to provide support for nursing research, a move which resulted in the MRC establishing an ad hoc-working group in nursing research (MRC, 1985). As observed by Stinson, while “nursing research in Canada is only loosely organized. . . the achievements to date are nevertheless of considerable substance, characterised by a cordial tone and by wide scale involvement of all of the major national nursing organizations” (1986, p. 251).

Provincial/territorial nursing associations The ration d’&re of the provincial/territorial

professional nursing associations is the protection of the public and the promotion of high standards of nursing practice and education. Within those parameters, the promotion and development of nursing research may or may not be made explicit. These associations have committed and are committing considerable time, expertise, energy and resources to nursing research, in one or more of the following ways: establishing nursing research committees (CNA, 1985a); establishing trust funds or foundations that provide nurses with small research, grant programs and/or scholarships and educational loan funds; providing organizational and financial support for some of the National/International Nursing Research Conferences held in Canada; including nursing research content in their workshops, annual conferences and journals; influencing provincial governments to support nursing research; maintaining nursing

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libraries; conducting research on matters of particular concern to the profession, including standards of practice; and, in the case of the Saskatchewan Registered Nurses Association (SRNA) and the Manitoba Association of Registered Nurses (MARN), jointly establishing and funding nursing research units in collaboration with their provinces university schools of nursing. The contributions of the provincial/territorial nursing associations are impressive to say the least, particularly when one recognizes that some 85 per cent of Canadian nurses who comprise the membership of these associations do not have any type of research Preparation, and most of the members have not been involved directly in nursing research. - _

Research

Literature

and Libraries

Canadian nursing research literature and libraries are discussed below in terms of the two official languages. It is underlined here that while some of the literature is available in both English and French, much of it is available only in one or other languages. Approximately two-thirds of Canada’s nurses have English as their first language and onethird have French as their first language (the majority of the latter live in Quebec). Many Canadian nurses are bilingual, but if literature is to be useful to all Canadian nurses it should be in both official languages. Research literature Prior to the 70’s, Canadian nurses relied almost exclusively on the nursing research literature published in the United States and the United Kingdom. Even today, there is only one Canadian peer reviewed nursing research journal, ‘The Canadian Journal of Nursing Research/Revue canadienne de recherche en sciences infirmieres’, which is the official journal of CAUSN, published by the McGill University School of Nursing since 1969. Currently it has a circulation of under 1,000 and recieves some financial support from SSHRC. The most comprehensive compendia of nursing research articles by Canadian nurses, however, are the proceedings of the National Nursing Research Conferences (NNRC), which got underway in 1971 (see King, 1971). The early proceedings of these conferences were published in both official languages (e.g. Allen and Thibaudeau, 1973); due to financial constraints, the more recent pattern has been to present French abstracts of English articles and/or to publish in the language of presentation, without an accompanying translation (King er al., 1986). The proceedings of the NNRCs and the papers of Canadian nurses presented at the 1986 International Nursing Research Conference held in Canada (Stinson et al., 1986) reflect shifts in the content of Canadian nursing research. While the proceedings of the 1971 conference reflected a heavy emphasis on research on various aspects of nursing education and nursing administration, even as early as 1973 (Allen and Thibaudeau, 1973) and since then, the majority of papers presented here had a distinct clinical focus. A limited amount of historical nursing research has been conducted in Canada over the past 20 years. Although that literature is small in quantity, it contains some research of outstanding quality.* There *E.g., M. Allemang(1973). The development in ideas about nursing education in the United States and Canada. 1873-1950. In Proceedinns of the colloauium on nursing research. March 28-30, 1973. M. Allen and M. F. Thibaudeau, Eds. (pp. S-k, Part One). hiontreal: McGillUniversity~School of Nursing; and J. C. R. Kerr(1978). Financing university nursing education in Canada: 1919-1976. Unpublished Ph.D. dissertation. Ann Arbor: University of Michigan.

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is important Canadian literature on the conceptualization of nursing and health, notably the works of Allen (1974.1982) and Allen as reported in the School of Nursing of McGill conference (1985), Levesque (1981), Simmons (1982), Kikuchi and Simmons (1986) and Payne (1986). Second, the methods employed in Canadian nursing research have been expanded. The first studies were largely descriptive, often exclusively entailing the use of quantitative techniques in contrast to the wider variety of methods now seen, entailing ‘scientific’ hard data approaches and often extensive qualitative approaches. Third, there is a trend toward using nursing and related conceptual frameworks as the major paradigms underlying the research design. Finally, the locus of the research now extends beyond the parameters of hospitals and schools of nursing to include community health, home, industrial, private clinic nursing care settings and professional associations. Although there is still little Canadian research on the economics of nursing practice, education or research, and relatively little historical research, there are some encouraging developments. A Halifax hospital’s Nursing Research and Development Department recently received a second grant from NHRDP to continue a project on clinical promotion and its impact on patient care, nurse satisfaction and costs ($108,000 grant, 1989). Also, the newly-formed Canadian Association for the History of NursingIL’association canadienne pour l’histoire du nursing provides a valuable network for nurse historians. Overall, as Allen, the grande dame of Canadian nursing research has observed, the progress has been remarkable (1986a). While there are still leagues to go, the focus of Canadian nursing has finally shifted to clients and their families, in sickness and health, from before birth to after death.* Canadian nurses publish research articles in many nursing journals throughout the world, one of the earliest such journals being ‘Nursing Research’. ‘The Canadian Nurse/L’infirmiere canadienne’ (CNIICO), the official journal of the CNA, which has a circulation of 107,000,t publishes some research articles, mainly focussed on findings rather than theoretical underpinnings, design and data analysis. Most doctoral dissertations of Canadian nurses who study in universities in the United States are given visibility in ‘Dissertation Abstracts International’ as are some (though not all) of the dissertations done by nurses undertaking doctoral degrees in Canada. Abstracts of nursing masters’ degree theses submitted to the Helen K. Mussallem Library of the CNA may be published in the ‘CN/IC’, and an on-line computerized list of completed masters’ theses is available through the University of Alberta Faculty of Nursing’s CAMN system, a project which was instituted by Dr Janice Morse in 1983. The most comprehensive index of Canadian nursing research is the bilingual index published by the CNA (CNA, 1987) which includes masters’ theses and doctoral dissertations and/or studies on which the CNA has received an abstract. French language research literature in the world is small. Canada’s French language nursing literature is especially relevant not only to the more than 50,000 nurses in Canada whose mother tongue is French but also to nurses in the many countries abroad in which French is spoken. The Province of Quebec has the largest pool, world-wide, of French nursing research reports related to clinical nursing research. Unfortunately, no systematic compilation of this material has been done. L’Universite de Montreal (UM) probably has the largest collection of all nursing research literature published in French. In 1986, the *The published proceedings of the 10th NNRC stand as particular testimony to these points. See K. King, E. Prodrick and B. Bauer. Eds. (1986). Nursing research: Science for quality. Toronto: Faculty of Nursing, University of Toronto. tPersonal communication with CN/fC Publication Manager Judith Banning, July 31, 1989.

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Quebec region of CAUSN compiled a repertory of all ongoing nursing research in the Province of Quebec. It is foreseeable that all of this information will be fed into the online system of the University of Alberta Faculty of Nursing’s Canadian Clearinghouse for Ongoing Research in Nursing (CCORN). Major Canadian nursing research literature in French includes published reports, texts and journal articles as well as unpublished research reports by members of faculties of Nursing and masters’ theses. ‘La recherche infirm&e au Quebec’, edited by Thibaudeau, KCrouac and Fortin in 1980, is a report of a Colloquium held in 1980 to review the nursing research situation in Quebec and to set research priorities. ‘The Canadian Journal of Nursing Research/La revue canadienne de recherche en sciences infirmitres’ publishes reports of research studies in French as do the nursing journals, ‘L’inftiere canadienne’ and ‘Nursing Quebec’. Because of a lack of nursing periodicals that publish research reports in French, many authors have been publishing in other French language Canadian periodicals such as: ‘Sante mentale au Quebec’, ‘Sante mentale au Canada’, ‘Revue de L’administration hospitaliere et sociale’, etc. The masters’ theses completed by students in the Universitt de Montreal Master of Nursing Science program since 1967 constitute a significant body of nursing research literature in French. ‘Introduction a la recherche. Auto-apprentissage assiste par ordinateur’, by Fortin, Taggart, Kerouac and Normand (1988), is composed of a student’s book, a teacher’s guide and a software program for the teaching of research to baccalaureate nursing students. This system is used now to teach research in many undergraduate programs in various disciplines because it constitutes a complete introductory research course. In terms of nursing research textbooks per se, the first such book by Canadian nurses, authored by Field and Morse, was published in 1985, on the topic of qualitative approaches, followed by an internationally oriented textbook on issues in nursing research by Stinson and Kerr (1986). There is a beginning literature specific to the development of nursing research in Canada. The most important baseline document is the Proceedings of the First National Conference on Research in Nursing Practice (King, 1971), which contains overviews on the topics of research conducted by government and service agencies (Poole), professional associations (Imai), and university faculties of nursing (Griffin). ‘State of the art’ literature on that topic was subsequently published by Stinson in 1977, 1979, 1982 and 1986. The overview by Cahoon (1986) on research developments in clinical settings; the overview by Allemang and Cahoon (1986) on nursing education research; the overview of ‘The Contribution of Nursing to Science in Canada’ (1986a); and the analysis of graduate education and research by Allen (1986b) are instructive, as is the 1984 document of the CNA which is focused on a ‘Five Year Plan’ for the development of nursing research in Canada. Within and outside Canada, literature on Canadian nursing research can also be found in the academic and professional journals of related disciplines (such as social work, psychology, health services administration, sociology). The fact remains, however, that many Canadian nursing research reports are not published, are not highly accessible and/or are available only in one of the two official languages. Further, the cataloging of Canadian nursing research is still far from comprehensive.

Libraries

The outstanding nursing library in Canada is the CNA’s Helen K. Mussallem Library,

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housed in the headquarters in Ottawa. * It contains copies of hundreds of masters’ theses and doctoral dissertations, reports of research studies and the proceedings of the NNRC’s and international nursing conferences held in Canada. The other major national library of relevance is the federally operated Health Science Resource Centre of the Canada Institute for Scientific and Technical Information (CISTI), located in Ottawa. In Quebec, each university and some nursing colleges (CEGEP) have library collections which include both French and English literature on nursing research. There are, however, three large French language libraries situated at the Universite de Montreal (UM), Universite Laval, and at the Order of Nurses of Quebec (ONQ), which is the provincial professional nurses’ association. Of the three, the UM library is by far the most relevant to nursing research because it contains all of the specific literature described above. The ONQ has also been developing its research documentation center to serve the professional nursing population. In Canada, the CNA’s Helen K. Mussallem Library has acquired all of the Canadian research publications available in French. However, the CNA does not have a comprehensive collection of French language unpublished documents and reports, so these must be pursued on an individual basis. While all Canadian hospital and community college nursing dipolma and generic baccalaureate nursing programs have nursing libraries, the better nursing research libraries are located in the 11 universities offering graduate degree programs in nursing. In terms of intra-provincial collections, some of the professional nursing associations, notably the Alberta Association of Registered Nurses, maintain collections of nursing research undertaken by members of their associations. All of Canada’s 84 teaching hospitals have libraries which include at least some reference material on nursing research. It will be interesting to see what applications of advanced technology are made to the amassing, cataloging, marketing, communicating and utilization of Canadian nursing research literature, and what impacts technology will have on the structure and functions of nursing libraries, both within and outside of Canada. For example, the development of on-line catalogs at university libraries holds great potential for nursing research, particularly in terms of distance learning and health care agency based nursing research.

Nursing Research

Manpower

The topic of nursing research manpower in this article is primarily confined to the nursing research component in nursing education programs in Canada and to the more specific question of nurses prepared at the doctoral level. While 20 years ago there were only some 20 nurses in Canada qualified at the doctoral level, even today with some 200 such nurses (St&on et al., 1988), throughout Canada there is a shortage of sufficient numbers of nurses adequently prepared to design and conduct research; to undertake scholarly clinical practice based on a firm grasp of nursing theory, practice and research; to develop nursing research programs in health care agencies; to teach and give academic leadership in relation to research; and to provide executive leadership in professional associations, government departments and a wide range of health related organizations. Nevertheless, the situation is improving due to such interrelated factors as the increased numbers of nurses prepared at the doctoral level; the increased emphasis on research in university nursing programs; somewhat wide opportunities for research funding; the development of nursing research ?? Viiginia Henderson laments the fact that the U.S. has produced nothing comparable to the CNA, Royal College of Nursing or Japanese National Organization libraries. (Personal communication to S. Stinson, April 19, 1984.)

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units; and the growing interest of nursing departments in hospitals and community health agencies in establishing nursing research development programs within clinical settings. Neither the federal nor any provincial or territorial government has systematically addressed the question of nursing research manpower. There are no current data on the number of full-time nurse researchers; these authors estimate that the current total in all sectors of employmet to be fewer than 25.* A finding reported to these authors by Faux (research in process)t is that in 1986, 16 nurses held appointments that had as their major ( > 50%) emphasis the conduct of nursing research and/or the development of nursing research programs in clinical settings in health care agencies, and that approximately half of these held a doctoral degree. Education for research Of Canada’s over 249,000 actively registered nurses, the highest level of educational preparation for about 70 per cent is their initial two- to three-year hospital or community college program (Statistics Canada, 1988). These programs do not involve students in any specific course work in nursing research or introductions to quantitative and qualitative research. Some 14 per cent of Canadian nurses hold at least a baccalaureate in nursing, either by way of a four-year generic program or a two- to three-year post-RN program in one of Canada’s 31 university faculties/schools of nursing. By the 1980’s an introductory statistics course and/or an introductory course in the content and design of nursing research was a requirement in most Canadian baccalaureate nursing programs. Approximately one per cent of Canadian nurses have a master’s degree as their highest level of preparation. In Canada’s 11 nursing masters’ programs research is stressed in all of the course work, including the clinical practica; a thesis is required in some programs or is optional, the exception being the University of Calgary which does not offer a thesis option (Field and Stinson, 1986). The nature of these programs has changed over time as have the research emphases (Allen, 1986b). Before 1965, the teaching emphasis in most Canadian graduate nursing programs was on preparing nursing educators and nursing administrators; between 1965 and 1980 that emphasis changed to clinical specialization, primarily based on the medical model (e.g. medical-surgical, psychiatry). Currently, these graduate programs emphasize nursing qua nursing (theory, practice and research). The concomitant developments in terms of research emphases in these three eras were: pre-1965: ‘problem solving, descriptive and evaluative’ research; 1965-1980: ‘application of knowledge from other desciplines’ plus ‘descriptive and evaluative’ research; and post-1980: ‘seeking knowledge from problems and situations arising in [nursing] practice’, and emphasis on the ‘scientific approach’ (p. 152). Although there are some exceptions to these patterns, as is evidenced in the works of Allen (1974) and Thibaudeau (1973), they generally portray the evolution of graduate teaching and research in Canada. As yet, Canada has not yet established a PhD in Nursing program (see below). However, particularly over the past decade, several universities have been establishing infrastructures that support research training and the conduct of nursing research. McGill University’s Nursing Research Unit, University of Montreal’s Nursing Research Unit, the Manitoba Nursing Research Institute, the Saskatchewan Nursing Research Institute, the University ‘A survey by J. L. Starch, C. B. Hazlett and S. M. Stinson. (1977). A Canadian Survey for Nurses Engaged Division of Health Services Administration, University of Alberta, indicated that there were 6 in 1976. tPersonal communication with Sandra Faux, September 30. 1986. in Research in 1976, Edmonton:

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of Calgary’s Family Nursing Unit and the University of Alberta’s Research Facilitation Office and Institute for Philosophical Nursing Research are examples of such infrastructures. Nurses prepared at the doctoral level By 1986, Canada had 193 nurses prepared at the doctoral level. As reflected in Table 1, close to one-quarter had undertaken a doctoral degree focused primarily on nursing (Stinson et al., 1988, p. 7). Table 1. Major discipline of study undertaken by nurses in Canada with an earned doctoral degree: 1986 data* Disciplinet

N

(%)

Education Nursing Social Sciences Health Related Arts & Humanities

96 44 25 22 7

(49) (23) (13) (11) ( 4)

194$

(100%)

Total

*Source: S. M. Stinson; J. Larsen; & J. MacPhail (1988). Canadian nursing doctoral statistics: 1986 update, p. 25. Ottawa: Canadian Nurses Association. Used with the permission of the Canadian Nurses Association. tNursing includes Nursing per se, Nursing and Nursing Education; Social Sciences includes Psychology, Sociology and Anthropology; Health Related includes Epidemiology, Medical Science and Health Services/Public Health Administration, Microbiology, Physiology, Neurology. SOne nurse holds two PhD’s, one in Nursing, the other in Anthropology.

Fifty per cent of the 193 nurses had obtained a degree from a Canadian university (p. 27); the median age at completion of the doctoral degree was high: 42 years of age, compared to the degree completion ages of women scientists in other fields such as mathematics and the social sciences-29 and 31 years respectively (p. 27). Of these 193 nurses, 69 per cent were employed in universities; and 14 per cent were employed in health care agencies (p. 21), which is a burgeoning market, a trend that is reflected in the findings of Thurston, Tenove and Church (1987).* In 1986,224 Canadian nurses were currently enrolled in doctoral programs: 65 per cent were enrolled in Canadian universities, 28 per cent in U.S. universities, and the rest (7Oro) abroad (p. 34). In this population, education is still the modal discipline (38Vo), followed by nursing (25%); social sciences (16%); health related (14070)and other (7070)disciplines (p. 33). The nursing profession in Canada has made valiant efforts since the mid-70’s to establish one or more PhD in Nursing programs in Canada (e.g. see Zilm, et al., 1979). There are two recent proposalst and two advanced Canadian PhD in Nursing initiatives: the conjoint proposal of the UniversitC de Montreal and McGill University and the proposal of the University of Alberta. The conjoint PhD in Nursing program was approved recently by the Universite de Montreal and McGill University. At the time of writing this article, the proposal is being forwarded to the Quebec Council of Universities and the Ministry of Higher Education *Findings from the survey, ‘Nursing research in Canadian teaching hospitals’, conducted by Thurston, Tenove and Church indicate a remarkable level of research activity, given that nursing research development in hospitals is in an early stage: 37 of 47 respondents described 129 nursing research projects focused on patient care and 37 ‘profession related’ projects. tThe University of Toronto and the University of British Columbia are at the proposal stage in planning PhD programs in Nursing. The intent is that these programs will be operational in 1991. Personal communications with Dr Dorothy Pringle (UT), 28 August, 1989 and Dr Marilyn Willman (UBC). 12 September, 1989.

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and Sciences for approval and it is anticipated that the program will begin in September 1990. This conjoint program is aimed at preparing nurse researchers. The basic entrance requirement is a MScN, as well as previous research and relevant clinical experience. The University of Alberta’s PhD in Nursing program proposal was approved by its Board of Governors and the Universities Coordinating Council in May 1986, “subject to appropriate funding.” However, funding has not as yet been secured. The University of Alberta program was developed by its Faculty of Nursing in concert with the University of Calgary Faculty of Nursing. The degree offered will be a research degree, the program aim being to prepare nurses for leadership positions in a wide range of settings. Students will choose one of four substantive areas of concentration: nursing theory, research, practice or the history and politics of nursing. In September 1988, three ‘special case’ PhD (Nursing) students were admitted for doctoral study at the University of Alberta. However, establishment of the ongoing PhD (Nursing) program must await funding approval. Given the tremendous interest in doctoral education, it is clear that having even one or two PhD in Nursing programs in Canada will not be adequate to meet either the needs of Canadian nurses or the expanding market for nurses with doctoral level preparation. However, the ‘good news’ is that while 15 years ago the prime question was, “should there be doctoral degree programs in nursing per se ?” the emphasis has now shifted dramatically to getting such programs established-without further delay. Post-doctoral preparation Post-doctoral preparation for Canadian nurses is a rarity. These authors estimate that only five per cent of Canadian nurses with doctoral degrees have undertaken any formalized training beyond the doctoral level. While in many disciplines post-doctoral education is the norm, there are several reasons why it is unlikely to be so in the case of Canadian nursing for at least another decade or two: no Canadian university has yet systematically developed such programs for nurses; the majority of nurses obtaining a PhD already have considerable professional experience; employers do no insist on post-doctoral preparation; and the immediate job market and relatively high salaries for nurses with doctoral degrees combined with what are often substantial debts accrued during the process of obtaining a doctoral degree make postdoctoral education seem anything but a priority for the new graduates. Moreover, postdoctoral fellowships are few while the demand for those is great as postdoctoral preparation is considered the norm by the Medical Research Council and FRSQ (Quebec) to become a ‘full independent researcher’. Networking

Communication within the nursing profession in Canada has always depended both on formal and informal networks. The vast size of Canada (over 11,ooO km from east to west) and relatively sparse population (under 27 million) make networking a particular challenge-one that Canadians, including nurses, find many ingenious ways of approaching. In terms of specific structure, national conferences, international conferences and research committees provide the greatest opportunities for establishing if not maintaining nursing research networks. National and provincial conferences The first Canadian National Nursing Research Conference (NNRC) was held in Ottawa

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in 1971 (King, 1971), attended by 380 nurses from all sectors of the profession. This was the first time that the nursing profession in Canada formally addressed itself to issues, trends, problems and approaches in the development of research. The questions were very fundamental in nature, e.g. what is nursing research and what investigative methods are used? In contrast, the NNRC’s that followed (see Allen, 1986a) were based on the classical model of the presentation and critique of scientific papers and, until the late 1970’s, limited to the few (30-70) people giving papers. By the 1980’s, critiques are not systematically included, any interested persons could attend these conferences, and now they include students and a wide range of nursing personnel. These conferences, originally planned on an ad hoc basis and sponsored by one or more universities and provincial nursing associations, provide superb opportunities for nursing research networking. Since 1987, CAUSN has sponsored the annual NNRC in cooperation with the faculty/school of nursing of the host university of the annual meetings of the Learned Societies. The most recent one was held at Lava1 University in Quebec City. In the 1970’s, the several ‘Evaluation Seminars’, sponsored by the NHRDP and instigated in 1970 at McMaster University, were very helpful not only in helping nurses to develop their design and grantsmanship skills but also in establishing research networks among nurses and beginning and experienced researchers. Specialized clinical research conferences sponsored by nursing and/or other health related professions now provide similar opportunities. Many professional conferences are held yearly at the provincial level and all provide important networking opportunities for nurse researchers, directly or indirectly. Some of these conferences are focused on particular content, such as the nursing needs of chronically ill people and their families; some on processes, including approaches to evaluating the quality of nursing care. Other conferences fall ‘outside’ the domain of nursing but can be of great relevance to nurse researchers in establishing effective networks. International conferences Key elements in international networking for Canadian nursing research include the involvement of Canadian nurses in the International Council of Nurses (ICN), the World Health Organization (WHO), and in special nursing research endeavors such as those of Project Hope. Also of great importance are the international endeavors of officers and staff of the CNA, and of Canada’s current and past Principal Nursing Officers, who often act as emissaries for Canadian nursing research and Canada’s nurse researchers. Of prime import to networking are the international nursing research conferences.* The first was held in Edinburgh, Scotland in 1981. It was sponsored by the Department of Nursing Studies of Edinburgh University and attended by over 200 nurses. The second, held in Edmonton, Canada, in 1986 was sponsored by the University of Alberta in collaboration with the CNA, CAUSN, the Alberta Association of Registered Nurses, the University of Calgary, the University of Lethbridge, the Workgroup of European Nurse Researchers (WENR) and the American Nurses Association (ANA). Funding support included the Alberta Heritage Medical Research Foundation and the Alberta Foundation for Nursing Research. This conference was attended by some 800 nurses from 38 countries. Networks established in 1981 and through the involvement of Canadian nurses in the *The above use of the term ‘international nursing research conference’is limited to those conferences promoted world-wide, open to all persons, not associated with any particular nursing association and/or which entail an international panel of reviewers to select the papers to be presented.

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biennial conferences of the WENR, the ICN and other national and international conferences contributed greatly to the success of the 1986 conference. In turn, these networks are of importance to the promotion and substance of other international conferences such as the 1987 International Nursing Research Conference in Washington, D.C., sponsored by the ANA. International nursing research conferences such as the maternal and newborn research conference sponsored by the University of Calgary Faculty of Nursing in 1986, the 1985 nursing and health-related conference on the use of computers in nursing and the 1987 international conference in clinical decision making in nursing (sponsored by that same Faculty) are examples of other conferences which are both outgrowths of and stimulators for international networking. It is noteworthy that the type of networking involved has been and still is accomplished under very difficult circumstances, including little funding for research travel. Skills in networking are perhaps a reflection of an underlying characteristic of the consummate nurse: finding ways to communicate effectively regardless of the barriers involved. Organization of nurse researchers The establishment of an organization of nurse researchers in Canada has been the subject of considerable discussion and debate. A background paper on issues in and alternative approaches to the organization of nurse researchers was prepared by Stinson in 1975 (pp. 199-204) for a discussion on that topic held at the 1975 NNRC. Debate continued at the various NNRC’s over the next ten years (Allen, 1986a). Then, at the 1986 International Nursing Research Conference, approximately 80 Canadian nurses got together informally and agreed that some type of national nursing research speciality organization should be formed. Bylaws for the Canadian Nursing Research Group were accepted in 1987, the first elections were held in 1988 and a beginning plan of action was developed in 1989. The intent of the group is to develop a national research network, recognize excellence in nursing research and lobby for increased funding for nursing research. Some of the interrelated points of controversy that are at stake in the continuing (and often emotionally charged) debate about creating a separate research organization include: the role of the CNA vis ti vis a separate research organization (given that the CNA is the spokesman for the profession at the national level and has as one of its corporate objects the promotion and development of nursing research in Canada); the purpose and financing of a national level organization; and the roles of the CAUSN and CNF (which historically have viewed nursing research as being fundamental to their territorial imperatives). Related issues centre around criteria for membership, structure, and the role of a specialized nursing research organization in planning, conducting and/or financing the National Nursing Research Conferences and related nursing research conferences. Debate also centres on ways and means of avoiding deeper schisms among nurse researchers, practitioners, educators and administrators. Of these, the role of a nursing research organization separate from that of the CNAper se is an issue which entails the fundamental issues of both purpose and money, and would seem the most pivotai. It is too early to tell what role the Canadian Nursing Research Group will play in networking and the development of nursing research or what connections will be made between that group and key national nursing organizations. Canadian literature on the topic of organization (Stinson, 1975, 1977, 1982, 1986; Allen, 1986a) and international literature (Poletti, 1986; Brimmer, 1986, Hamrin, 1983) can be instructive in the creation of sound organization that serves nursing research nationally as well as internationally.

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Research committees The national, regional, provincial and local committees, and annual meetings of the CAUSN and CNA were especially important in developing research networks in the 1950’s and 1960’s. Then from 1971 to the present the CNA’s series of research committees* proved to be a factor of profound importance in nursing research networking, both among the various committee members and nurse researchers across the country, particularly in terms of the linkages established with members of the research committees of provincial nursing associations and the CNA Board. By 1984, the Quebec Region of the CAUSN, acting as a ‘committee of the whole’, had started its work on assembling the repertory of ongoing nursing research referred to above. By the mid-19803 the CNF’s research grants committee had become another structure of major relevance to the networking process. Nationally, the interdisciplinary research review committees of the National Health Research Development Program continue to be useful as well in providing opportunities for networking both within nursing and across health related disciplines. Internationally, since 1980 the CNA has been an observer at the WENR’s policy and planning committee meetings. Some of the members of the 1986 INRC’s international scientific review committee were nurses involved in committees of the WENR, ICN, WHO and/or nursing research endeavours of Project Hope. Some national and international ‘committees’ do not meet in person, as is the case with some editorial boards and groups of people who review research funding proposals and nursing research manuscript reviewers. These too can provide valuable opportunities for networking. Provincially, the research committees of the provincial nursing associations (CNA, 1985a) are important in nurses’ establishment and maintenance research networks. These networks, in turn, are important to the development of national and local linkages. Networking at the local level Locally, research networks are developed through a number of formal and informal mechanisms including nursing research interest groups, joint appointments between university faculties of nursing and health care agencies, inter-institutional collaborative research projects, open lecture series involving local and visiting nurse researchers, and community based research seminars. Innumerable networking opportunities are open to nurse researchers through contacts made in health agencies, faculties of graduate studies in universities, and locally based health-related research foundations. Of special importance are the nursing research units based in various universities and hospitals across Canada (see Cahoon, 1986; Stinson, 1986). Such ‘local’ structures strengthen the networking capabilities of nurses locally and also link nurse researchers provincially, nationally and internationally. Research Funding

National level “Funding for nursing research is sadly lacking in Canada. While more than half the multibilliondollar [over 30 billion dollars] operational budget in Canadian health care is spent in providing nursing care, proportionally little money is spent in support of nursing research-only half a million to just over one million dollars from all sources in any given year. Given that nursing research is pivotal to increasing nursing’s knowledge base and providing improved care for our clients, a strong nursing voice on the MRC is more important than ever” (‘CNA’s Ginette Rodger appointed to MRC; 1986. p. 12). *Due to financial constraints since 1985, the CNA research committee meets only on an ad hoc basis.

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The above announcement pertaining to the appointment of the Executive Director of the CNA to the Medical Research Council was reported to 135000 nurses and to the medical research community in September 1986, and sums up the nursing research funding picture referred to under the science policy section discussed earlier in this chapter. The paucity of research funding pertains not only to the design and conduct of investigations but as well to the support of such infrastructure as research training,* university and health care agency based clinical researchers, seed money, research development programs in health care agencies, scientific travel, conferences and journals-and the development of research units. As emphasized earlier, the prime supporter of nursing research in Canada at the national level to date has been the NHRDP as there has been no national Council which proactively supported nursing research. The MRC has awarded funding to some nurses engaged in fundamental (basic) research, as members of teams comprised of researchers from several disciplines; however, these projects cannot be considered nursing research. Although nurses have been fairly active on NHRDP committees, there is currently no nurse on the Medical Research Council and only a few nurses have participated on MRC review committees. Through the efforts of the CNA and CAUSN however, the MRC struck an ad hoc committee on nursing research in 1983. The report of this group (MRC, 1985) contained a number of substantial recommendations for the development of nursing research in Canada. As yet there is little in the way of concrete results. The NHRDP and MRC have established a Joint Program for the Development of Research in Nursing that was to begin in 1989 (MRC, 1989a). University schools of nursing were invited to submit letters of intent describing current research, objectives for planned development and means of development. Eighteen university schools submitted letters of intent describing proposed research development programs and six schools were chosen to submit full applications for grants that could provide salary support for investigator(s) for up to five years and operating funds for up to three years. In June of 1989, the six schools learned that MRC will be providing Career Investigator Awards to three nurse researchers in Canada rather than the described grants to schools. Clarification of the intent with regard to the announced joint program was sought by the Deans of the six schools that submitted proposalst Further to the subsequent meeting held jointly by the six Deans, MRC and NHRDP, provision is being made for additional nursing research development grant proposals to be submitted. The general view held amongst those committed to the development of nursing research in Canada is that if the MRC does not become substantially proactive, the nursing profession should press the federal government to establish a separate Council for nursing research and/or for all of the other health professions which do not as yet benefit from MRC funding. While the elite may argue that ‘real’ nurse researchers can compete successfully in the absence of funding programs specifically intended for nursing research, the facts to date indicate that the ‘purists’ are in error: research in any emerging professional discipline requires specific interventions, including the development of policies and priorities which promote rather than exclude emerging researchers. Also it must be emphasized here that the purists’ point of view largely ignores the fact that one of the greatest impediments to

*E.g. on the basis of NHRDP and CNA data, these authors estimate that only one in 13 nurses currently enrolled in a doctoral program holds a major research training award. TPersonaI communication with Dr Dorothy Pringle, Dean, Faculty of Nursing, University of Toronto, 28 August, 1989.

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the development of nursing research in Canada is not so much the lack of project funding for top flight researchers as the lack of support for a comprehensive infrastructure. The Canadian Nurses Foundation has attempted to offer a modest number of scholarships (a total of $78,750 in 1988-89 for baccalaureate and graduate studies) and has recently established a ‘small research grants program’, but its coffers are very limited and in no way can the CNF respond to the extensive need for research support. Also at the national level, while there is some support from health related voluntary organizations such as the Canadian Heart Foundation, the National Cancer Institute and the Kidney Foundation of Canada (see CNA, 1985b), such funding is of limited importance in the overall development of an infrastructure for nursing research. Provincial and local levels Various provincial level health research organizations, foundation and provincial government departments award some research funds to nurses, primarily for research investigation (see CNA, 1985b), but both in Canada and world wide, there is only one province which has earmarked funds exclusively for nursing research. In 1982, the government of Alberta set aside $1 million over a five-year period for this purpose when it established the Alberta Foundation for Nursing Research (AFNR). Then in 1988, a minimum of $1.2 million was earmarked for the following five years. (As emphasized by Scott Wright, 1989, Alberta nurses are ‘uniquely blessed’ in having AFNR support.) The long-term future of the AFNR is not yet secured, but it is hoped that the Alberta government will continue to support this important initiative. Provincial nursing associations have often led the way in making small research grants available to nurses. The monies come from operating funds and/or foundations established by these associations. Other non-governmental supporters include provincial service organizations, many of which contribute money for health related research to their national counterparts. The variety of sources of research funding at the local level is impressive in terms of the commitment and ingenuity involved in raising these funds, albeit that local funding is usually of no more than a few thousand dollars and is often much less than that (e.g. grants of $100 dollars for a computerized search of the literature). Although the CNA has some information on research grants currently held by Canadian nurses and has recently published a document on current sources of research funding available to nurses (1985b), there is as yet no comprehensive literature of the development, nature and extent of nursing research funding in Canada. Beginning national overviews have been published by Stinson (1977), Kerr (1986), and Wilmot (1986), but these provide little information specific to given provinces and no information specific to Quebec. As a beginning step in the latter regard, a brief overview of the funding situation in Quebec is presented below. In Quebec, there are three provincial funding bodies: Formation des chercheurs et aide a la recherche (FCAR), Fonds de la recherche en Sante du Quebec (FRSQ) and Conseil qutbecois de la recherche sociale (CQRS). The first body gives grants to university professors in all disciplines except medicine provided that they work in research teams which include a number of graduate students. The training of researchers is a main objective of the FUR. This Council is under the Ministry of Higher Education and Sciences; it distributes money to universities for research development and training. The ‘seed’ money that professors receive from this source is extremely useful for beginning researchers. The FRSQ is the largest granting Council for health research in Quebec. It is only in the last several years that it has considered nursing research projects more favorably. Biomedical, epidemiological

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and operational research have been given priority in this body that resembles the MRC in structure and philosophy. Recently, a request has been made to this Council to extend programs to include nurse researchers and to develop a special nursing research program. Another council where nurse researchers have been successful is the CQRS. This Council, which is oriented to social health and welfare, has funded many nursing research projects in the past. Although the grants were not extremely large ($120,000 maximum per grant), they were nevertheless very useful to research on women’s health, family violence and similar health related issues. Until the mid-1960’s, most Canadian nursing research was not funded or minimally so. Some 20 years later, although greater funding is more readily available, it is more than evident that improving patient care through nursing research requires extensive, comprehensive funding on a continuous basis, with substantively related policy formation, peer review and priority setting primarily determined not by epidemiologists, biostatisicians, physicians, sociologists, politicians and governmental bureaucrats-but by nurses. The Future of Nursing Research in Canada?

What, then, is the future of nursing research in Canada? On the negative side the national debt is profound and deficit funding is the norm of governments, nationally and provincially; women, including nurses, lack solid political power and an effective voice in health research policy formation; most of Canada’s nurses know little about nursing research; most of the generalizable nursing research findings and the conceptual frameworks for nursing practive are not implemented in practice,* in most universities they are not integrated systematically in the curricula of basic nursing education programs; and the budgets of nursing education programs and nursing service departments are becoming stretched to the limit even in terms of established activities, much less new ventures in conducting nursing research and communicating and utilizing research findings in nursing education and practice-to name but a few examples. On the positive side, however, the strides that have been made over the past 15 years are truly remarkable, and these were made under very difficult circumstances. Further, it would seem clear that Canada is a nation of people who place great value on health and health care-and increasingly on holistic health care. To the extent that nurses contribute to the health and health care of Canadians through nursing research and to the extent that the linkage between nursing research and health is perceived by nurses and others to be a meaningful one, the future of nursing research in Canada will be seen ultimately as an ongoing national priority, not as a luxury. References Allemang, M. (1973). The development in ideas of nursing education in the United States and Canada. In Proceedings of the colloquium on nursing research. Allen, M. and Thibaudeau, M. F. (eds), pp. S-22, Part One. McGill University School of Nursing, Montreal. ABemang, M. M. and Cahoon. M. C. (1986). Nursing education researchin Canada. In Werley, H. H., Fitzpatrick, J. J. and Taunton, R. L. (eds), Annualreview of Nursing Research Vol. 4, pp. 261-278. Springer, New York. *Some exceptions to this generalization include the use of the family nursing care model developed by Allen at McGill, Levesque’s research on nursing chronically ill people, the widespread implementation of the research on pre- and post-operative teaching and the use of some of Barnard’s 1984 research, including her Nursing Child Assessment Scale. Exceptions to the generalization about the use of conceptual frameworks in nursing practice include the Montreal Children’s Hospital Nursing Department’s implementation of the McGill model, as evidenced in the Proceedings of a conference (School of Nursing, McGill University and Departments of Nursing of Affdiated Hospitals, 1985).

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Allen, M. (1974). Design to evaluate a model of nursing across primary care settings: A comparative systems approach. In Godden. J. 0. and Cahoon, M. C. (eds), Decision-making in Nursing Research. Proceedings of the Third National Conference on Research in Nursing. pp. 27-47. Faculty of Nursing, University of Toronto, Toronto. Allen, M. (1982). A model for nursing: A plan for research development. In Research-A base for the future: Proceedings of the I981 International Conference. Edinburgh, Scotland, September 1981. pp. 3 I s-330). Nursing Studies Research Unit, University of Edinburgh, Edinburgh. Allen, M. (1986a). The contribution of nursing to science in Canada. In King, D., Prodrick. E. and Bauer, B. (eds), Nursing research: Sciencefor quality care. Proceedings of the IOth National ReseaKh Conference, April 9-11, 1985. pp. 5-14. Faculty of Nursing. University of Toronto. Toronto. Allen, M. (1986b). The relationships between graduateteaching and research in nursing. In Stinson, S. M. and Kerr, J. C. (eds), International Issues in Nursing Research, pp. 151-167. Croom Helm, London. Allen, M. and Thibaudau. M. F. (eds). (1973). Actes du colloquesur la recherche inftrmiete 28-30 mars I973-trois parties. Montreal: Universite McGill. Also available in English under the same authors (1973). Proceedings of the colloquium on nursing research. March 28-30. 1973. McGill University, Montreal. Barnard, K. (1984). Nursing research related to infants and young children. In Werley, H. H. and Fitzpatrick, J. J. (eds). Annual review of nursing research. Vol. 1. 1985 (pp. 3-25). Spinger, New York. Brimmer, P. (1986). The American Nurses’ Association: Its role in research. In Stinson S. and Kerr, J. C. (eds), International Issues in Nursing Research, pp. 289-312. Croom Helm, London. Cahoon. M. M. (1986). Research developments in clinical settings: A Canadian perspective. In Stinson, S. M. and Kerr, J. C. (eds), International issues in nursing research, pp. 182-204. Croom Helm, London. Canadian Nurses Association (1984). A Five Year Plan for the Development of Nursing Research in Canada. Ottawa. Canadian Nurses Association. (1985a). Compilation of Information on Nursing Research Committees. Ottawa. Canadian Nurses Association. (1985b). Sources of Funds for Nursing Education, Nursing and Health-related Research Projects. Ottawa. Canadian Nurses Association. (1987). Index of Canadian Nursing Research/Index de recherche infirmiere au Canada. Ottawa. CNA’s Ginette Rodger appointed to MRC. (1986). Canadian Nurse/L’injirmei&e canadienne 82, (September), 12. Faux, S. (1990). Nurse researchers in clinical settings in Canada. School of Nursing, University of Western Ontario, London, Ontario (in press). Field, P. A. and Morse, J. M. (1985). Nursing research: The Application of Qualitative Approaches. Croom Helm. London. Field, P. A. and Stinson, S. M. (1986). A beginning survey of selected characteristics of Canadian nursing masters’ programs. Faculty of Nursing, University of Alberta, Edmonton. Fortin, F., Taggart, M. E., KCrouac. S. et Normand, S. (1988). Introduction a larecherche. Auto-apprentisssage assist& par ordinateur. Decarie. Montreal. Fortin, F., Taggart, M. E.. et Ktrouac, S. et Normand, S. (1988). Introduction b la recherche. Auto-apprentissage assist& par ordinateur. Le guide du professeur. Decarie, Montreal. Fortin, F., Taggart, M. E., et KCrouac, S. et Normand, S. (1988). Introduction 6 la recherche. Auto-apprentissage assist6 par ordinateur. Didacticiel el Edulogic. Decarie, Montreal. Hamrin. E. (ed.). (1983). Research: A challenge for nursing practice. Proceedings of thefifth Workgroup [of European nurse researchers] meeting, Uppsala, Sweden, August II-14, 1982. Swedish Nurses’ Association, Uppsala. Kerr, J. C. (1986). Structure and funding of nursing research in Canada. In Stinson, S. M. and Kerr, J. C. (eds) International Issues in Nursing Research, pp. 97-l 12. Croom Helm, London. Kerr, J. C. R. (1978). Financing university nursing education in Canada: 1919-1976. Ph.D. dissertation. University of Michigan, Ann Arbor. Kikuchi. J. F. and Simmons. H. (1986). A science in jeopardy. In King, K., Prodrick, E. and Bauer, B. (eds). Nursing research: Science for Quality Care, pp. 28-31). Faculty of Nursing, University of Toronto, Toronto. King, F. (cd.) (1971). f;“vsrNational Conference on Rmeatvh in Nursing Practice: JWceedings of the [First]National Nursing Research Conference, Ottawa, Februaty WI% 1971. School of Nursing, University of British Columbia. Vancouver. King, K., Prodrick, E. and Bauer. B. (eds) (1968). Nursing research: Science for quality care. Proceedings of the Tenth National Nursing Research Conference, Toronto, April 9-11. 1985. Faculty of Nursing, University of Toronto, Toronto. Levesque, L. (1981). Rehabilitation of the chronically-ill elderly: A method of operationalizing a conceptual model for nursing. In MacKay, R. C. and Zilm, G. (eds), Research in practice: Proceedings of the National Nursing Reseurch Conference, October 22-24, 1980. pp. 22-34. School of Nursing, Dalhousie University, Halifax. Medical Research Council. (1985). Report of the MRC Working Group in Nursing Research. Ottawa. Medical Research Council (1989a). MRC Grants and Awards Guide: 1986-87. Ottawa. Medical Research Council. (1989b). Newsletter. 17 (July), 2.

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$108,ooO grant awarded Halifax hospital for nursing research. (1989). Canadian J. Nurs. Admin. 2 (MarchApril), 28. Payne, L. (1986). The meaning of health: A phenomenological perspective. In King, K., Prodrick, E. and Bauer. B. (eds) Nursing Research: Sciencefor Quaiity Care, pp. 32-39. Faculty of Nursing, University of Toronto, Toronto. Poletti. R. A. (1986). Aspects importants, tendances et problemes dam le developpement de la recherche en soins infirmiers en Europe. In Stinson, S. M., Kerr, J. C., Giovannette. P.. Field, P. A. and MacPhail. J. (eds), New frontiers in nursing research: Proceedings of the International Nursing Research Conference, Edmonton, Alberta, Canada, May 7 & 9, 1986, pp. 34-38. Faculty of Nursing, University of Alberta, Edmonton. School of Nursing, McGill University and Departments of Nursing of Affiliated Hospitals. (1985). A professional approach to nursing practice: The McGill model [Oct. 2 I, 1985 Conference proceedings]. Sir Mortimer B. Davis Jewish General Hospital, Montreal. Scott Wright, M. (1989). Twenty years of learning to care through nursing research. Unpublished paper presented at the University of Calgary Faculty of Nursing’s 20th Anniversary Presentation Day, Calgary, Alberta. September 29, 1989. Simmons, H. (1982). Toward a unifying vision of health. In Research-A base for the future? Proceedings of the International Conference, University of Edinburgh, September 22-25, 1981. pp. 560-569. Nursing Research Unit, University of Edinburgh, Edinburgh. Statistics Canada. (1988). Registered Nurses Management Data. Ottawa. Stinson. S. M. (1975). Some notes on selected issues and alternatives regarding nursing research organizations in Canada. In Zilm, G., Stinson, S., Steed, M. and Overton, P. (eds), Development and use of indicators in nursing research: Proceedings of the 1975 National Nursing Research Conference, pp. 199-204. School of Nursing, University of Alberta. Edmonton. Stinson, S. M. (1977). Central issues in Canadian nursing research. In LaSor, B. and Elliott, M. R. (eds), Issues in Canadian Nursing, pp. 3-42. Prentice-Hall of Canada, Scarborough, Ontario. Stinson, S. M. (1979). Nursing research: The state of the art. In Zilm, G., Larose, 0. and Stinson, S. (eds), Ph.D. (Nursing), pp. 11-21. Canadian Nurses Association, Ottawa. Stinson, S. M. (1982). Pivotal issues in nursing research in Canada. In Zilm, G., Hilton, A. and Richmond, M. (eds), Nursing research: A base for practice, service and education. Proceedings of the National Nursing Research Conference, April 28-30, 1982 (pp. 155-161). School of Nursing, University of British Columbia, Vancouver. Stinson, S. M. (1986). Nursing research in Canada. In Stinson and S. M., Kerr, J. (eds) International Issues in Nursing Research (pp. 236-258). Croom Helm, London. Stinson, S. M. and Kerr, J. C. (eds) (1986). International Issues in Nursing Research. Croom Helm, London. Stinson, S. M., Kerr, J. C., Giovannetti, P.. Field. P. A. and MacPhail. J. (eds) (1986). Newfrontiers in nursing research: Proceedings of the International Nursing Research Conference, Edmonton, Alberta. Canada, May 7 & 9, 1986. Faculty of Nursing, University of Alberta, Edmonton. Stinson. S. M., MacPhail, J. and Larsen, J. (1988). Canadian nursing doctoral statistics: 1986 update. Canadian Nurses Association, Ottawa. Starch. J., Hazlett, C. B. and Stinson. S. M. (1977). A Canadian Survey for Nurses Engaged in Research in 1976. Division of Health Services Administration, University of Alberta, Edmonton. Thibaudeau. M. F. (1973). Effects on children’s health and on parents’ health behaviour of primary care in three health agencies. In Allen, M. and Thibaudeau, M. F. (eds) Proceedings of the Colloquium on Nursing Research. March 28-30. 1973. McGill University, Montreal. Thibaudeau, M. F., KCrouac, S. et Fortin, F. (1980). La recherche infirmiere au Quebec. Rapport du colloque tenu a la Facultr!des sciences infirmieres, Universite de Montreal, 24 et 25 avrill980. Universiti de Montreal, Montreal. Thurston, N., Tenove, S. and Church, J. (1987). Nursing research in Canadian teaching hospitals. Foothills Hospital, Calgary. Wilmot, V. (1986). Health science policy, health research and nursing research funding. In Stinson. S. ,M. and Kerr, J. C. (eds) International Issues in Nursing Research, pp. 76-96. Croom Helm, London. Zilm, G. N., Larose, D. and Stinson. S. M. (1979). Ph.D. (Nursing). Canadian Nurses Association, Ottawa.