Joumal of Advanced Nursing, 1992,17,1361-1368
Nursing science in The Netherlands: the Utrecht contribution Johanna C M H Diepeveen-Speekenbnnk MPhil BSN RN Pro)ed Director, Nursing Saence, Unwerstty of Utrecht, The Netherlands
Accepted for publicahon 30 March 1992
DIEPEVEEN-SPEEKENBRINK J C M H (1992) Journal of Advanced Nursmg 17, 1361-1368 Nursing science in The Netherlands: the Utrecht contribution The two goals of a 5-year nursing science project at the State University of Utrecht were the establishment of graduate nursmg science studies and a nursmg research programme The project formally started on I January 1987 and is now nearmg completion This paper builds on a paper previously published m the Joumal of Advanced Nursmg It first descnbes the history of nursmg science m The Netherlands and sets out to demonstrate hov^ the Utrecht goals were achieved
INTRODUCTION The Utrecht nursing science project (DiepeveenSpeekenbnnk 1990a) IS nearmg complehon Thus it is appropnate to reflect upon the outcome What were the aims, what has been achieved and what does the future look bke? After a bnef summary of key histoncal events, this paper addresses the Dutch national collaborahon m the field of nursing saence, foUowed by Ufrecht's systematic endeavours towards the achievement of its specific goals 1
the establishment of part-hme graduate nursing science studies, the mihahon of a nursmg research programme
nursing education The North Amencan development of nursing was, however, greatly influenced by Florence Nighhngale (1820-1910), generaUy accepted as the founder of nursmg research Her numerous sigmficant reforms were based upon careful systematic mvestigahons and dear statistics In recogmtion of her achievements, she was actually made a fellow of the Engbsh Royal Stahstical Society m 1858 and became an honorary member of the Amencan Statistical Soaety m 1874 (Donahue 1985) It therefore seems more correct to argue that nursing saence ongmated m Europe
Nursing's first entry mto the academic world was in 1899 at Teachers CoUege, Columbia Umversity in New 2 York, with a course in hospital economics for nurse leaders Finally, the outcome hitherto and the expectahons for the At the time this course did not yet lead to an acadenuc future are discussed degree The next milestone, agam at Teachers College, was the appointment of Adelaide Nuttmg as the world's first professor m nursing Her ongmal htle was professor of domeshc admimstrahon, later, m 1910, it was changed to KEY HISTORICAL FACTS professor of nurses' education (Donahue 1985) The start of the first programmes leadmg to a baccalaureate degree The followmg review is necessanly bnef and thus only dates back to 1916 Agam it was Columbia Umversity who highlights very few milestones It m no way captures the took the lead later foUowed by other North Amencan entirety of important events which enhanced the develop- universities Donahue (1985) distmgiushes the foUowmg ment of nursmg saence stages m nursmg education 1939-1952 — mcrease of It IS often argued that nursmg science has its roots m the baccalaureate programmes, 1953-1964 — fransihonal stage USA The USA mdeed has the longest history of academic (dunng this penod master's preparahon was recogmzed as the desired level of advanced nursing educahon), 1964Correspondence Johanna CMH Diepeveen-Speekenbrmk Jan Steentaan 45 3723 BT 1975 — maturation of master's degree education BiUhovtn The Netherlands 1361
JCMH Dtepeveen-Speekenbnnk
Unfortunately, m the first decades after her death, bttle is found in the North Amencan bterature to indicate that Nightingale's example pertainmg to research was bemg followed Then, m the 1920s, a number of important studies were performed in the USA on nursing education, resulting m the publicahon of the Goldmark Report Gradually other investigations followed, while the real breakthrough came in the 1950s (Diepeveen-Speekenbnnk 1990b) Two key events were the estabbshment, m 1955, of nursmg research grants and feUowship programmes by the Division of Nursing of the US Pubbc Health Service, and the estabbshment, m 1986, of the National Center for Nursmg Researdi (NCNR) at the National Institutes of Health (NIH) (Hinshaw 1990)
Table I Key histoncal facts in Europe Second half of the 19th century 1956 1961
1963 Mid-1960s
1966 First nursing research 1972 It IS difficult to frace back the first nursing research p>erformed m Europe followmg Florence Nightingale's initial mvestigations In 1979 Finland reported that nursing research had been camed out smce 1944, while the first known researdi by a nurse m Great Bntam was SkeUem's work, pubbshed m 1953 The UK certainly played a leadmg role m the nursmg saence history, where groundbreaking work was done by the pioneer researchers Doreen Norton, Lisbeth Hockey and Marjone Simpson Finland also seems to have had a headstart in 20th century European development (NZI1979, Lelean & Clarke 1990) A key event m Finland was the foundmg of the Research Inshtute of Nursmg m Helsinki m 1966 (Laun 1990, NZI 1979) Other major milestones m Europe were the estabbshment, in 1956, of the Department of Nursmg Studies at the University of Edmburgh and the founding, m 1961, of the Belgian Inshtute for Hospital Saence at the Cathobc University of Leuven, where nurses were admitted to pursue academic studies The next key fador m Eurojjean developments was the appomtment of Marjone Simpson as nursmg researdi officer of the Mmistry of Health m London m 1963, foUowed m the mid-1960s by the estabbshment of two nursmg research umts m London one was at the Royal College of Nursmg and the other at the General Nursmg Counal for England and Wales Two other events of major significance were the 1972 conference 'Higher Educahon m Nursmg', organized by the European chapter of the World Health Orgamzahon, and the conference 'CoUaborative Research and its Implementahon m Nursing' held m 1978 m Woudschoten, The Netherlands, m wbch the Bnhsh Royal College of Nursmg played a cruaal role Nurses from 18 countnes partiapated and, accordmg to their reports on the state of 1362
1978
Florence Nightmgale (1820-1910) founder of nursing research Department of Nursing Studies, Umversity of Edinburgh, established The National Center for Hospital Science (Het Centrum voor Ziekenhuiswetenschap) established at the Catholic University of Leuven, Belgium Marjone Simpson appointed as nursmg research officer at the Ministry of Health m London Nursing research units estabbshed at the Royal College of Nursing and the General Nursing Council for England and Wales Research Inshtute of Nursmg m Helsinki founded WHO-Europe conference 'Higher Education m Nursmg' Conference on 'Collaborative Research and its Implementation in Nursmg' m Woudschoten The Netherlands, with nurse partiapants from Austna, Belgium, Denmark, England, Finland, France, Germany, Ireland, Israel, Italy, Norway, Poland, Scotland, Sweden, Switzerland, The Netherlands, USA, Yugoslavia Foundmg of workgroup European Nurse Researchers
affairs, some of these countnes at the time already had academic programmes in nursing In others they were lmmment, due to recent changes m policy or law, for example More or less the same holds for nursing research (NZI 1979) One of the aims of the conference was to explore the desirability of creahng a Eurojsean group of nurse researchers, emd the major outcome of the conference was the establishment, m 1979, of the Workgroup of European Nurse Researchers, which smce then organizes bi-armual nursmg research conferences m Europe The presentations at these conferences are an exceUent example of the impressive European evolution since the begmnmg in the 1950s Tables 1 and 2 summanze the above
NURSING SCIENCE IN THE NETHERLANDS Table 3 lUustrates the development of nursing saence m The Netherlands, where basic nursmg educahon first moved
Nursing saence m The Netherlands Table 2 Key histoncal facts m the USA
Table 3 Nursmg science in The Netherlands
1899
1972
1907 1916 1920 1939-1952 1953-1964
1955
1964-1975 1986
First steps into the academic world at Columbia University Adelaide Nuttmg first professor of nursmg First baccalaureate programmes Gradual start of nursing research Increase m baccalaureate programmes Gradual expansion of master's degree education Gradual increase in nursing research Grants and fellowships from Division of Nursmg,
US Pubbc Health Service Maturation of master's degree programmes Nahonal Center for Nursing Research (NCNR) estabbshed at the Nahonal Institutes of Health (NIH)
1973 1975 1978 1979
1980 1984 1984-1986 1986
mto higher educahon m 1972 m Leusden and Nijmegen At the hme, these 4-year courses did not lead to a baccalaureate degree as is the case today There are now 19 programmes prepanng students at the baccalaureate level for entry into the practice of the nursmg profession As a result, today approximately 24% of all graduating professional nurses have completed baccalaureate education Soon after the 1973 conference mentioned above, a small group of Dutch nurse leaders formed a workgroup geared at the estabbshment of master's degree nursing education Their intenm report was submitted to the government m 1975 and the final report foUowed m 1979 The group's initiahve then lead to the assignment to the Umversity of Limburg (m Maastncht), to implement the plan Thus, the country's first master's degree programme actually started m 1980 The key events at the University of Limburg were the graduation of the first seven master's-degree students in 1984 and the appomtment in 1986 of Armeke van den Bergh-Braam as the first Dutch extraordmary professor of nursmg Elsewhere in The Netherlands, Utrecht and Gronmgen undertook their first endeavours towards nursmg saence between 1984 and 1986, followed m 1987 by the request of the mimster of educahon to make a national plan This prompted the universities m Maastncht, Utrecht and Gronmgen together with the local schools for higher professional education in Utrecht and Gronmgen — the Hogeschool Midden Nederland (HMN) and the Rijkshogeschool Grorungen (RHG) — to form the nahonal Maastncht-Utrecht-Gronmgen (MUG) workmg group geared at creahng a joint master's degree programme The
1987
1988
1989 1990
1990—1991
1991
Start of higher education m Leusden and Nijmegen as forerunners of later baccalaureate programmes Workgroup of Umversity Education in Nursmg (WUEN) mihated by Von Nordheim Intenm report of WUEN to the government Conference Collaborative Research and its Implementation in Nursing held m Woudschoten Final report of WUEN to govemment Umversity of Limburg in Maastricht (RL) assigned to start nursmg saence studies Start of nursing science programme at RL First seven RL graduates (master's degree) Imtiahves m Utrecht and Gromngen towards the start of nursmg science programmes A H M van den Bergh-Braam appomted as the first Dutch extraordinary professor of nursmg saence Mimster of Education requests the umversities of Maastncht, Utrecht and Gronmgen (MUG) to devise a national plan Foundation work group MUG Start of part-time post-baccalaureate master's degree programme in nursmg saence at RL Proposal of MUG submitted to umversity hoards of MUG Start in Utrecht of part-time off-campus Umversity of Wales (UW) master of nursmg programme Start in Gronmgen of post-baccalaureate nursing science programme MUG requests permission of the mmister of education for MUG nursing saence programme MUG nursing saence contract signed between universities of MUG H Huyer Abu-Saad appomted professor of nursmg saence Correspondence with mimster of education Mimster withholds permission for MUG programme First 11 UW master's of nursmg m Utrecht First two master's of nursing saence in Gromngen Delay and uncertam future no new students admitted m Utrecht and Gromngen, Gromngen contmues post-haccalaureate programme in nursmg science, Utrecht continues UW master of nursmg programme Evaluation of RL nursmg science programme Report of Wemer Commission
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group completed its pobcy document compnsmg a proposal for a collaborative programme m 1988 The boards of the coliaboratmg universities presented the plan to the mmister of educahon requestmg permission for execuhon ml989 Meanwhile, m 1988 both Utrecht and Gromngen had mitiated mtenm solutions, permittmg nurses to embark on graduate studies in nursing The University of Wales opened an off-campus Master of Nursmg Degree Course m Utrecht, in collaborahon with the HMN, and m Gronmgen a non-degree nursing saence course was launched in collaboration with the Umversity of Limburg as a forerunner of the plarmed joint programme (Diepeveen-Speekenbrmk 1990a,b)
1990 — a tumultuous year The year 1990 can be labelled as quite tumultuous First to be menhoned is the fact that the nunister of educahon was hesitant m responding posihvely to the introduction of the joint programme There was, however, a general view that mimstenal support would eventually be forthcoming and thus the three universihes proceeded to sign an agreement consobdating their collaborahon, and the MUG part-time master's degree programme admitted its first students m September, with a total of 142 students (17 m Utrecht, 30 m Gronmgen and 85 in Maastncht) This was legally possible because the students are ofificiaUy enroUed at the Umversity of Limburg, and the Utrecht and Gronmgen programmes are an mtegral part of the Limburg programme AU students who complete their studies successfuUy will receive their master's degree from the University of Limburg Unfortunately, the minister of educahon armounced m early 1991 that he did not agree with the MUG-programme and that he would not support it finanaally A happy event at the end of 1990 was the appointment m December of Huda Huyer Abu-Saad as The Netherlands' first ordinary professor of nursmg saence
THE UTRECHT C O N T R I B U T I O N The project organization Imtiahves m the early 1980s led the Board of the Faculty of Medicme of the State Umversity of Utrecht (Rijksuniversiteit Uh-echt, RUU) and the Board of the Faculty of Health Care Educahon of the Utrecht School for Higher Professional Educahon (HMN) to coUaborate m estabbshmg graduate nursmg saence studies and nursmg research (DiepeveenSpeekenbnnk 1987, 1988, 1990a,b) In order to adueve 1364
these goals a project group was set up, a temporary organizahon with a dearly defined goal, strategy and budget As such, the group is not part of a standing organization, but does make use of its staff and facibhes either fuU-hme or part-time Upon achieving its goals, such a project group is discontinued The goals of the Utrecht nursmg saence project organization were 1
2
to estabbsh a part-time nursing science programme for nurses who had completed baccalaureate education or its equivalent, to mitiate nursing research (programmes)
With the appomtment of a project director at the begmmng of 1987, an excitmg pioneer adventure started Numerous Dutch and mtemational experts contnbuted enthusiashcally to the enhre process In this paper, which summanzes the entire project penod, speafic gratitude is expressed towards three intemahonal coUeagues The first to menhon is Rebecca Bergman, professor of Nursmg at the Tel Aviv University, who was the first to be our consultant m 1987 Throughout the five project years, she has been an invaluable source of stimulating support and mspirahon Chnstme Chapman, at the time professor of nursing of the University of Wales, was the second to enter formaUy into the process Her major highly valued achievement was the successful estabbshment of the off-campus Master of Nursmg Degree Course m Utrecht m 1988 LiUie Shortndge, professor of nursmg at Pace University New York, is the third mtemahonal colleague who ments very speaal thanks After having been mvolved in the project informally smce the first initiative, she accepted a posihon as part-hme professor of nursmg science at the RUU m 1990 Her dynamic expertise promises a successful nursing saence future m Utrecht
The University of Wales Master of Nursing Degree Course A most rewardmg result of mtemahonal networking was the start in 1988 m Utrecht of the part-time University of Wales Master of Nursing Degree Programme When m 1987 it became dear that the plarmed implementahon of the Utrecht programme would take longer than desirable, the project director foimd Chnstme Chapman wiUmg to help The result is known (Diepeveen-Speekenbnnk 1988, 1990a) As of October 1988, 19 nurses commenced their graduate nursing studies m Utrecht as part of the collaborahve Master of Nursmg Programme of the Umversity of Wales (UW) and the Uh«cht school for higher
Nursing science m The Ndherlands
professional educahon, the Hogeschool Midden Nederland (HMN) Three students disconhnued their studies soon after the start, 11 graduated m July 1991 and more graduahons are expected at the end of 1991 Of a second group of 20 students, similar results are expeded This collaborative programme wiU no doubt continue to contnbute valuably to the academizahon of nursmg in The Netherlands and m Europe
3 4
5
6 The part-time MUG Nursing Science Course This part-hme coUaborahve national programme has already been discussed above The speafic Utrecht contnbutions are summanzed in the foUowing paragraphs
7
Inventory of research priorities
8
In 1989 a preliminary Delphi survey was performed amongst Dutch institutions for health care, geared at investigating their nursmg research pnonhes The ongmal aim was to identify by subsequent rounds the national pnonhes for nursmg research Performmg a sound Delphi study at this early stage proved too ambitious However, the findmgs of this first round were quite valuable and were presented at the 1990 Utrecht Intemational Nursmg Research Round Table (Gamel et al 1990) Excellent examples of Delphi studies performed elsewhere will serve as a source of inspiration for future studies (Shortndge et al
Apprenhceship educahon is a topic for senous cnhasm There are senous concems about the perceived lack of knowledge and slaUs of nurses Nurses are often descnbed as not bemg sufficiently equipped to meet today's health care needs Pertaming to the above, the majonty of the mformants dearly indicate a need for graduate nursing educahon and nursing research Others express ambivalence There are senous concems about the lack of consensus conceming potenhal solutions for exishng problems This lack of consensus has a negative effed on policy makmg, resultmg m a lack of adequate nahonal pobcy decisions Fundamental restructunng of nursing education, mdudmg basic and post-basic programmes, and an mcrease m higher education are mandatory Informcmts indicate the need for developmg a body of scientific nursmg knowledge and plead for nursmg research Some mformants emphasize that nursmg research should be done by nurses, rather than by mvestigators of other disaplmes The value of mulhdisaplmary research is also pertment
Because of the small size of the stmiple, these condusions do not permit generalization Therefore, one of a senes of recommendations for further research was to perform similar studies using the same or different methodologies and indudmg a larger and more veined szimple
1989, Welch etal 1990) Study findings
THE NEED FOR NURSING SCIENCE IN THE NETHERLANDS In 1987 and 1988 research was performed m both Utrecht and Gronmgen mvestigatmg the local needs for nursing science programmes (Weikgroep Verplegmgswetenschap 1988, Diepeveen-Speekenbnnk 1990a) In 1989 a new research project was undertaken, aimed at explonng the need for graduate nursmg education and nursmg research as ldenhfied by diredors of Dutch health care mshtutions The appbed methodology and findmgs were presented extensively elsewhere (Diepeveen-Speekenbnnk 1990b) Condusions of the study are summanzed below 1
2
Many diverse changes m today's health care have weighty effeds on nursmg care Advances m science, changing systems and health care needs are topics of significance There is widespread discontent with the present preparation of nurses for practice This pertams to basic, as weU as post-basic, educahon programmes
The findmgs of this study, mdudmg the data from the interviews and the bterature, pose a cheiUenge for Dutch nursing leaders and other leaders in the fields of health and health care educahon The widespread discontent with the present preparahon of nurses, bnked with today's pressures on nursmg, which require knowledge and skiUs not previously expected, demand fundamental reapprcuscd of current systems Studies performed m Israel and m the UK (Bergman et al 1982, Bergman 1990, Bircumshaw & Chapman 1988) reveal a clear correlation between higher educahon in nursmg, work retention and sahsfaction They also suggest that manpower problems cannot be solved by lowenng standards of education, nor by mamtammg programmes with extremely high attnhon rates
Intemational Nursing Research Round Table Nursmg research conferences are normally part of regular academic nursmg adivities When one takes place as part of 1365
JCMH Diepeveen-Speekenbnnk
a developmg process towards the start of a new academic programme, a research conference is a rather unique event The International Nursmg Research Round Table in 1990 IS remembered with pnde and sahsfachon National and mtemational experts contnbuted to the success, and the excellent presentations, foUowed by dynamic discussions, served as a further source of inspiration for the Utrecht achvihes (University of Utrecht Faculty of Mediane 1990)
NURSING SCIENCE PROFESSORS APPOINTED
for building depth m the saence of nursmg As researchers develop new studies, based on the results of previous studies, informahon wiU be replicated, questioned and lead to new areas of investigation (Hinshaw 1990)
The Utrecht Nursing Research Interest Group (UNRIG) One of the adivities of 1990 was prepanng the start of the UNRIG, which convened for the first hme early in 1991 The purposes of nursing research mterest groups were summanzed by Shortndge (1991b) as foUows
1 Heading up nursmg research requires expenenced nurse 2 researchers Based upon this convidion, a search for such a 3 nurse professor started m 1989 and resulted m September 4 1990 m the appointment of Utrecht's first visihng pro5 fessor of nursing saence, the Amencan Lilbe M Shortndge of Pace University, New York Acceptmg a part-time position, she committed herself to getting nursmg research started in Utrecht, within the context of a nursmg research programme Meanwhile, a second expenenced nurse researcher, the Belgian Mana Grypdonck of the Catholic University cyf 6 Leuven, has also accepted a part-time posihon as visihng 7 professor of nursmg research, while negohations are 6 weU under way for the appointment of a third part-time 9 extraordmary professor The latter will be m charge of a 10 programme for home care nursing 11 12 The researdi programme Professor Shortndge commenced her work with enthusiasm m September 1990, together with nurses and experts from other disaplmes fi-om the HMN, the RUU, the Uh-echt University Hospital (Academisch Ziekenhuis Utrecht, AZU) and the Uh-echt WiUiebnma Children's Hospital (WiUiebnma Kmder Ziekenhuis, WKZ) The result at the end of 1991, only 1 year later, was that there was now the beginnmg of a nursmg research programme mdudmg a number of research branches There are between 12 and 17 potential doctorate students with some at present workmg on their proposals The growing coUaborahon between the RUU, HMN, AZU, WKZ and other key Utrecht mstituhons is also recognized as a factor of significance for further progress (Shortndge 1991a) The importance of research programmes can hardly be over-emphasized They mcorporate a senes of studies m the same or common areas of mveshgahon and are cruaal 1366
research informahon shanng, translating nursing problems mto research questions, cntical review of research literature, faabtahng access to research subjeds, networhng withm an organization, among several organizations with other disaplmes within a metropolitan cirea at regional or nahonal levels at the mtemational level, coUegial support, collaboration on projects, coUechve action on professional issues, disseminatmg research findmgs, discussion of research techniques, shanng researdi mstruments, contnbuhng to the development of nursing science
After an enthusiashc, but still somewhat hesitant start, with over 70 partiapants, the group is now working weU and convenes about four times a year Research is presented and discussed, with the above purposes serving as giudelmes The mterest and motivation of the group are quite impressive
THE UTRECHT NURSING SCIENCE STRUCTURE Underpinned by the now-achieved collaborahon between the Faculty of Health Care Education of the HMN and the Faculty of Mediane of the RUU, these institutions have set the following goals 1
to contnbute mutually to educahon and research pertainmg to nursmg and other health care professions as well as pertainmg to contmued and post-imhal educahon.
Nursing science m The Netherlands
2 3
4
to stimulate mutual exchange of educahonal programme components, to strengthen the relahonships between post-basic higher professional education and scientific educahon, so as to enhance streamlining of the educational process, to promote applied research in nursing by establishing a research programme that addresses research problems m the field and in which faculty members and students of the educational programmes mentioned above can serve as investigators
Table 4 The Utrecht contnhution 1984
1986
1987
In order to matenalize the above, a steenng committee has been installed In tum this committee now has two subcommittees the Nursing Science Cumculum Committee and the Nursmg Science Development Committee The foundation of a third sub-committee, the Committee for Post-basic Higher Professional Educahon, is imminent The agreement, encompassmg the above, portrays and formabzes the achieved collaborahon between the parhcipatmg institutions, the HMN and the RUU, mutually complementing and inspmng each other, while makmg use of each other's expertise With the growmg collaboration with other Utrecht mshtutions, such as AZU, WKZ, The Netherlands Institute for Pnmary Health Care (Nederlands Instituut voor Onderzoek van de Eerstelijnsgezondheidszorg, NFVEL) and the Nahonal Orgamzahon for Home Care (Landebjke Verenigmg voor Thuiszorg, LVT), a Utrecht Center for Nursmg Saence may be a new and achievable goal for the future Table 4 summanzes the Utrecht contnbution
THE FUTURE With her systemahc investigations and dear statistics, Florence Nightmgale founded nursing science weU over 140 years ago For many years her recommendations were hardly foUowed It would take tiU after World War II for the academic disaplme of nursmg to gam momentum Since then, however, the developments worldwide are momentous, m The Netherlands nursmg saence has rooted weU Many have contnbuted to the achievements thus far on a national and local scale m Maastncht, Utrecht and Gronmgen Many problems and prejudices must stiU be overcome, but the potential for a fruitful way forward are clearly present Workmg towards clear targets, bebef in the goals and determination wiU remain essential for progress It is the author's firm bebef that m order to attam and maintain the place nursmg deserves in society the profession needs academic mmds while its practice should be saence based
1988
1989 1990
1991
Symposium entitled The Nursmg Profession on the Move' First moves towards the start of graduate nursing saence studies Symposium 'Changing Pattems m Nursing Education' Faculty of Medicine RUU and Faculty of Health Care Educahon HMN decide to estabbsh collaborative programme and sign agreement Appointment of a nursing science project director Start of a nursing science project Rebecca Bergman appointed as consultant Work group of MUG estabbshed Completion of MUG proposal Start of UW Master of Nursing Degree Course m Utrecht under final responsibibty of Chnstme M Chapman Preliminary Delphi survey Intemahonal Nursmg Research Round Table m Uh-echt Start of MUG part-time nursing saence course. Little M Shortndge part-time visitmg professor of nursmg saence Utrecht structure nursing saence with three committees Utrecht Nursmg Research Interest Group (UNRIG) founded First endeavours towards research programme AZU and WKZ become partners First I I UW masters of nursmg 12 to 17 potential doctorate candidates Revised agreement between RUU and HMN Mana Grypdonck second part-hme visitmg professor of nursmg saence Part-time extraordmary chair for home care forthcoming Utrecht Center for Nursmg Saence bemg planned
Acknowledgements The author expresses sincere gratitude to all national and mtemational coUeagues who contnbuted to the success of the projed In addihon to Rebecca Bergman (Israel), Chnstine Chapman (UK) and Lillie Shortndge (USA) who have already been mentioned m the paper, heartfelt thanks are jJso expressed to June Clark (UK) for her mihal support and advice m 1987, pointing the way towards the Umversity of Wales, to Manlyn Jaffe-Ruiz (USA) for her conhnuous inspinng support throughout the projed years, and to 1367
JCMH Diepeveen-Speekenbnnk Esther Haloburdo (USA) and PhyUis Tyzenhouse (USA) for their expert contnbuhons durmg their 1990 sabbatical m Uh-echt The pubbshers of the Dutch Ziekenhuis Management Magazxne have granted permission to pubbsh data from the author's paper in the November 1991 issue of that joumal References Bergman R (ed) (1990) Pnonties m nursing resestfch change and conhnuity In Nursing Research for Nurstr^ Pradtce An Intemahonal Perspechve Chapman & Hall, New York Bergman R, Shatzman H & Danon A (1982) FoUow-up study of the Tel Aviv University nursmg graduates Intemahonal Joumal of Nursing Shidies 19(2), 79-88 Bircumshaw D & Chapman C (1988) A foUow up of the graduates of the Cardiff Bachelor of Nursmg Degree Course Journal of Advanced Nursing 13(2), 273-279 Cathobc Umversity Leuven (1988) Het Centrum voor Ziekenhutswetenschap en 25 Jaar Vervolmahngscycbis voor Beleid van Gezondheidslnstellingen 1963-1988 (The Center for Hospital Saence and 25 years of Management Perfection Courses m Health Care Inshtuhons) Cathobc Uruversity, Leuven Diepeveen-Speekenbnnk J C M H (1987) Wetenschappebjke opleidmg verpleegkunde (Acadenuc Nursmg Educahon) Ziekenhuis Management Magazine (Hospital Management Magazine) 3(6), 5-7, 24 Diepeveen-Speekenbnnk J C M H (1988) Wetenschappebjke opleidmg voor verpleegkundigen (Academic Education for Nurses) Ztekenhuts Management Magazine (Hospital Managem«it Magazme) 4(9), 13-18 Diepeveen-%)eek«ibnnk J CMH (1990a) Creahve mtemahonal networking towards academic nursing educahon and research m The Netherlands Joumal of Advanced Nurstng 15(6), 738-743 Diepeveen-^jeekenbnnk J C M H (199(ft>) The need for graduate nursmg education aiui nursmg research m The Netherlands an exploratory study Unpubbshed dissertahon submitted m fulfilment for the Degree of Master of Philosophy Tlie Umversity of Wales CoUege of Medicme, Cardiff Donahue M P (1985) Nurstng The Finest Art An Ulustraterd History C V Mosby, St Louis First Conference, European Nurse Researchers (1979) Collaborahve Research and its Implementahon m Nursing Nahonal Hospital Institute of the Netherlands (NZI), Uh-echt
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Gamel C, Diepeveen-Speekenbnnk J C M H & Pasman K (1990) Estabbshmg nursing research pnonties mitial endeavours m Utrecht Nurstng Research Round Table Proceedings B55-B77 University of Utrecht Faculty of Mediane, Utrecht Haloburdo E & Tyzenhouse P (1990) Toward Nursing Saence at the Universtty of Utrecht, The Netherlands Profile and Recommendahons University of Utrecht Faculty of Mediane, Uh-echt Hinshaw A S (1990) Nursing knowledge generation and faabtahon Nursing Research Round Table Proceedings B78-B90 University of Utrecht Faculty of Medicme, Utrecht Laun S (1990) The history of nursing research m Finland Internahonal Joumal of Nursing Studies 27(2), 169-174 Lelean S R & Clarke M (1990) Research resource development in the Umted Kingdom Intemahonal Joumal of Nursmg Studies 27(2), 123-138 Nahonal Ziekenhuis Instituut (National Hospital Inshtute) (1979) Collaborative Research and its Implementation in Nursmg Uh-echt Shorhndge L M , Doswell W , Evans M E, Levin R F, MiUor G K k Carter E (1989) 1988 Delphi Survey of Nursmg, research pnonties for New York State 1989 Joumal of New York State Nurses'Assoaahon 20(3), 15-19 Shortndge L M (1991a) Een gemeenschappebjk verpleegkundig onderzoeksprogramma (Collaborative Nursing Research Program) Ziekenhuts Management Magazine (Hospital Management Magazme) 7(11), 287-291 Shortndge LM (1991h) Nurstng Research Interest Groups Intemal document Department of Nursmg Saence, State University of Uh-echt, The Netherlands Scellem E (1953) Report on an Inveshgation Camed Out to Study and Make Recommendations on the Fh-achcal Appbcation to Ward Administration of Modem Methods m the Instruchon and Handling of Staff and Student Nttrses Royal College of Nursmg, Ward and Departmental Sisters' Section, London Umversity of Utrecht Faculty of Medicine (1990) Nursmg Research Round Table Proceedtngs University of Utrecht, Uh-echt, The Netherlands Welch C A , Shorhidge LM & Tucker LM (1990) Forgmg a Nursmg Research Agenda for New York State Joumal of the New York State Nurses'Assoaahon 21(3), 15-18 Werkgroep Verplegmgswetenschap (1988) Naar Een Universitatre Opletdmg Verplegmgswetenschap in Gronmgen Academisch Ziekenhuis Gronmgen, Gronmgen, The Netherlands
Nursing science in The Netherlands: the Utrecht contribution Johanna C M H Diepeveen-Speekenbnnk MPhil BSN RN Pro)ed Director, Nursing Saence, Unwerstty of Utrecht, The Netherlands
Accepted for publicahon 30 March 1992
DIEPEVEEN-SPEEKENBRINK J C M H (1992) Journal of Advanced Nursmg 17, 1361-1368 Nursing science in The Netherlands: the Utrecht contribution The two goals of a 5-year nursing science project at the State University of Utrecht were the establishment of graduate nursmg science studies and a nursmg research programme The project formally started on I January 1987 and is now nearmg completion This paper builds on a paper previously published m the Joumal of Advanced Nursmg It first descnbes the history of nursmg science m The Netherlands and sets out to demonstrate hov^ the Utrecht goals were achieved
INTRODUCTION The Utrecht nursing science project (DiepeveenSpeekenbnnk 1990a) IS nearmg complehon Thus it is appropnate to reflect upon the outcome What were the aims, what has been achieved and what does the future look bke? After a bnef summary of key histoncal events, this paper addresses the Dutch national collaborahon m the field of nursing saence, foUowed by Ufrecht's systematic endeavours towards the achievement of its specific goals 1
the establishment of part-hme graduate nursing science studies, the mihahon of a nursmg research programme
nursing education The North Amencan development of nursing was, however, greatly influenced by Florence Nighhngale (1820-1910), generaUy accepted as the founder of nursmg research Her numerous sigmficant reforms were based upon careful systematic mvestigahons and dear statistics In recogmtion of her achievements, she was actually made a fellow of the Engbsh Royal Stahstical Society m 1858 and became an honorary member of the Amencan Statistical Soaety m 1874 (Donahue 1985) It therefore seems more correct to argue that nursing saence ongmated m Europe
Nursing's first entry mto the academic world was in 1899 at Teachers CoUege, Columbia Umversity in New 2 York, with a course in hospital economics for nurse leaders Finally, the outcome hitherto and the expectahons for the At the time this course did not yet lead to an acadenuc future are discussed degree The next milestone, agam at Teachers College, was the appointment of Adelaide Nuttmg as the world's first professor m nursing Her ongmal htle was professor of domeshc admimstrahon, later, m 1910, it was changed to KEY HISTORICAL FACTS professor of nurses' education (Donahue 1985) The start of the first programmes leadmg to a baccalaureate degree The followmg review is necessanly bnef and thus only dates back to 1916 Agam it was Columbia Umversity who highlights very few milestones It m no way captures the took the lead later foUowed by other North Amencan entirety of important events which enhanced the develop- universities Donahue (1985) distmgiushes the foUowmg ment of nursmg saence stages m nursmg education 1939-1952 — mcrease of It IS often argued that nursmg science has its roots m the baccalaureate programmes, 1953-1964 — fransihonal stage USA The USA mdeed has the longest history of academic (dunng this penod master's preparahon was recogmzed as the desired level of advanced nursing educahon), 1964Correspondence Johanna CMH Diepeveen-Speekenbrmk Jan Steentaan 45 3723 BT 1975 — maturation of master's degree education BiUhovtn The Netherlands 1361
JCMH Dtepeveen-Speekenbnnk
Unfortunately, m the first decades after her death, bttle is found in the North Amencan bterature to indicate that Nightingale's example pertainmg to research was bemg followed Then, m the 1920s, a number of important studies were performed in the USA on nursing education, resulting m the publicahon of the Goldmark Report Gradually other investigations followed, while the real breakthrough came in the 1950s (Diepeveen-Speekenbnnk 1990b) Two key events were the estabbshment, m 1955, of nursmg research grants and feUowship programmes by the Division of Nursing of the US Pubbc Health Service, and the estabbshment, m 1986, of the National Center for Nursmg Researdi (NCNR) at the National Institutes of Health (NIH) (Hinshaw 1990)
Table I Key histoncal facts in Europe Second half of the 19th century 1956 1961
1963 Mid-1960s
1966 First nursing research 1972 It IS difficult to frace back the first nursing research p>erformed m Europe followmg Florence Nightingale's initial mvestigations In 1979 Finland reported that nursing research had been camed out smce 1944, while the first known researdi by a nurse m Great Bntam was SkeUem's work, pubbshed m 1953 The UK certainly played a leadmg role m the nursmg saence history, where groundbreaking work was done by the pioneer researchers Doreen Norton, Lisbeth Hockey and Marjone Simpson Finland also seems to have had a headstart in 20th century European development (NZI1979, Lelean & Clarke 1990) A key event m Finland was the foundmg of the Research Inshtute of Nursmg m Helsinki m 1966 (Laun 1990, NZI 1979) Other major milestones m Europe were the estabbshment, in 1956, of the Department of Nursmg Studies at the University of Edmburgh and the founding, m 1961, of the Belgian Inshtute for Hospital Saence at the Cathobc University of Leuven, where nurses were admitted to pursue academic studies The next key fador m Eurojjean developments was the appomtment of Marjone Simpson as nursmg researdi officer of the Mmistry of Health m London m 1963, foUowed m the mid-1960s by the estabbshment of two nursmg research umts m London one was at the Royal College of Nursmg and the other at the General Nursmg Counal for England and Wales Two other events of major significance were the 1972 conference 'Higher Educahon m Nursmg', organized by the European chapter of the World Health Orgamzahon, and the conference 'CoUaborative Research and its Implementahon m Nursing' held m 1978 m Woudschoten, The Netherlands, m wbch the Bnhsh Royal College of Nursmg played a cruaal role Nurses from 18 countnes partiapated and, accordmg to their reports on the state of 1362
1978
Florence Nightmgale (1820-1910) founder of nursing research Department of Nursing Studies, Umversity of Edinburgh, established The National Center for Hospital Science (Het Centrum voor Ziekenhuiswetenschap) established at the Catholic University of Leuven, Belgium Marjone Simpson appointed as nursmg research officer at the Ministry of Health m London Nursing research units estabbshed at the Royal College of Nursing and the General Nursing Council for England and Wales Research Inshtute of Nursmg m Helsinki founded WHO-Europe conference 'Higher Education m Nursmg' Conference on 'Collaborative Research and its Implementation in Nursmg' m Woudschoten The Netherlands, with nurse partiapants from Austna, Belgium, Denmark, England, Finland, France, Germany, Ireland, Israel, Italy, Norway, Poland, Scotland, Sweden, Switzerland, The Netherlands, USA, Yugoslavia Foundmg of workgroup European Nurse Researchers
affairs, some of these countnes at the time already had academic programmes in nursing In others they were lmmment, due to recent changes m policy or law, for example More or less the same holds for nursing research (NZI 1979) One of the aims of the conference was to explore the desirability of creahng a Eurojsean group of nurse researchers, emd the major outcome of the conference was the establishment, m 1979, of the Workgroup of European Nurse Researchers, which smce then organizes bi-armual nursmg research conferences m Europe The presentations at these conferences are an exceUent example of the impressive European evolution since the begmnmg in the 1950s Tables 1 and 2 summanze the above
NURSING SCIENCE IN THE NETHERLANDS Table 3 lUustrates the development of nursing saence m The Netherlands, where basic nursmg educahon first moved
Nursing saence m The Netherlands Table 2 Key histoncal facts m the USA
Table 3 Nursmg science in The Netherlands
1899
1972
1907 1916 1920 1939-1952 1953-1964
1955
1964-1975 1986
First steps into the academic world at Columbia University Adelaide Nuttmg first professor of nursmg First baccalaureate programmes Gradual start of nursing research Increase m baccalaureate programmes Gradual expansion of master's degree education Gradual increase in nursing research Grants and fellowships from Division of Nursmg,
US Pubbc Health Service Maturation of master's degree programmes Nahonal Center for Nursing Research (NCNR) estabbshed at the Nahonal Institutes of Health (NIH)
1973 1975 1978 1979
1980 1984 1984-1986 1986
mto higher educahon m 1972 m Leusden and Nijmegen At the hme, these 4-year courses did not lead to a baccalaureate degree as is the case today There are now 19 programmes prepanng students at the baccalaureate level for entry into the practice of the nursmg profession As a result, today approximately 24% of all graduating professional nurses have completed baccalaureate education Soon after the 1973 conference mentioned above, a small group of Dutch nurse leaders formed a workgroup geared at the estabbshment of master's degree nursing education Their intenm report was submitted to the government m 1975 and the final report foUowed m 1979 The group's initiahve then lead to the assignment to the Umversity of Limburg (m Maastncht), to implement the plan Thus, the country's first master's degree programme actually started m 1980 The key events at the University of Limburg were the graduation of the first seven master's-degree students in 1984 and the appomtment in 1986 of Armeke van den Bergh-Braam as the first Dutch extraordmary professor of nursmg Elsewhere in The Netherlands, Utrecht and Gronmgen undertook their first endeavours towards nursmg saence between 1984 and 1986, followed m 1987 by the request of the mimster of educahon to make a national plan This prompted the universities m Maastncht, Utrecht and Gronmgen together with the local schools for higher professional education in Utrecht and Gronmgen — the Hogeschool Midden Nederland (HMN) and the Rijkshogeschool Grorungen (RHG) — to form the nahonal Maastncht-Utrecht-Gronmgen (MUG) workmg group geared at creahng a joint master's degree programme The
1987
1988
1989 1990
1990—1991
1991
Start of higher education m Leusden and Nijmegen as forerunners of later baccalaureate programmes Workgroup of Umversity Education in Nursmg (WUEN) mihated by Von Nordheim Intenm report of WUEN to the government Conference Collaborative Research and its Implementation in Nursing held m Woudschoten Final report of WUEN to govemment Umversity of Limburg in Maastricht (RL) assigned to start nursmg saence studies Start of nursing science programme at RL First seven RL graduates (master's degree) Imtiahves m Utrecht and Gromngen towards the start of nursmg science programmes A H M van den Bergh-Braam appomted as the first Dutch extraordinary professor of nursmg saence Mimster of Education requests the umversities of Maastncht, Utrecht and Gronmgen (MUG) to devise a national plan Foundation work group MUG Start of part-time post-baccalaureate master's degree programme in nursmg saence at RL Proposal of MUG submitted to umversity hoards of MUG Start in Utrecht of part-time off-campus Umversity of Wales (UW) master of nursmg programme Start in Gronmgen of post-baccalaureate nursing science programme MUG requests permission of the mmister of education for MUG nursing saence programme MUG nursing saence contract signed between universities of MUG H Huyer Abu-Saad appomted professor of nursmg saence Correspondence with mimster of education Mimster withholds permission for MUG programme First 11 UW master's of nursmg m Utrecht First two master's of nursing saence in Gromngen Delay and uncertam future no new students admitted m Utrecht and Gromngen, Gromngen contmues post-haccalaureate programme in nursmg science, Utrecht continues UW master of nursmg programme Evaluation of RL nursmg science programme Report of Wemer Commission
1363
JCMH Diepeveen-Speekenbnnk
group completed its pobcy document compnsmg a proposal for a collaborative programme m 1988 The boards of the coliaboratmg universities presented the plan to the mmister of educahon requestmg permission for execuhon ml989 Meanwhile, m 1988 both Utrecht and Gromngen had mitiated mtenm solutions, permittmg nurses to embark on graduate studies in nursing The University of Wales opened an off-campus Master of Nursmg Degree Course m Utrecht, in collaborahon with the HMN, and m Gronmgen a non-degree nursing saence course was launched in collaboration with the Umversity of Limburg as a forerunner of the plarmed joint programme (Diepeveen-Speekenbrmk 1990a,b)
1990 — a tumultuous year The year 1990 can be labelled as quite tumultuous First to be menhoned is the fact that the nunister of educahon was hesitant m responding posihvely to the introduction of the joint programme There was, however, a general view that mimstenal support would eventually be forthcoming and thus the three universihes proceeded to sign an agreement consobdating their collaborahon, and the MUG part-time master's degree programme admitted its first students m September, with a total of 142 students (17 m Utrecht, 30 m Gronmgen and 85 in Maastncht) This was legally possible because the students are ofificiaUy enroUed at the Umversity of Limburg, and the Utrecht and Gronmgen programmes are an mtegral part of the Limburg programme AU students who complete their studies successfuUy will receive their master's degree from the University of Limburg Unfortunately, the minister of educahon armounced m early 1991 that he did not agree with the MUG-programme and that he would not support it finanaally A happy event at the end of 1990 was the appointment m December of Huda Huyer Abu-Saad as The Netherlands' first ordinary professor of nursmg saence
THE UTRECHT C O N T R I B U T I O N The project organization Imtiahves m the early 1980s led the Board of the Faculty of Medicme of the State Umversity of Utrecht (Rijksuniversiteit Uh-echt, RUU) and the Board of the Faculty of Health Care Educahon of the Utrecht School for Higher Professional Educahon (HMN) to coUaborate m estabbshmg graduate nursmg saence studies and nursmg research (DiepeveenSpeekenbnnk 1987, 1988, 1990a,b) In order to adueve 1364
these goals a project group was set up, a temporary organizahon with a dearly defined goal, strategy and budget As such, the group is not part of a standing organization, but does make use of its staff and facibhes either fuU-hme or part-time Upon achieving its goals, such a project group is discontinued The goals of the Utrecht nursmg saence project organization were 1
2
to estabbsh a part-time nursing science programme for nurses who had completed baccalaureate education or its equivalent, to mitiate nursing research (programmes)
With the appomtment of a project director at the begmmng of 1987, an excitmg pioneer adventure started Numerous Dutch and mtemational experts contnbuted enthusiashcally to the enhre process In this paper, which summanzes the entire project penod, speafic gratitude is expressed towards three intemahonal coUeagues The first to menhon is Rebecca Bergman, professor of Nursmg at the Tel Aviv University, who was the first to be our consultant m 1987 Throughout the five project years, she has been an invaluable source of stimulating support and mspirahon Chnstme Chapman, at the time professor of nursing of the University of Wales, was the second to enter formaUy into the process Her major highly valued achievement was the successful estabbshment of the off-campus Master of Nursmg Degree Course m Utrecht m 1988 LiUie Shortndge, professor of nursmg at Pace University New York, is the third mtemahonal colleague who ments very speaal thanks After having been mvolved in the project informally smce the first initiative, she accepted a posihon as part-hme professor of nursmg science at the RUU m 1990 Her dynamic expertise promises a successful nursing saence future m Utrecht
The University of Wales Master of Nursing Degree Course A most rewardmg result of mtemahonal networking was the start in 1988 m Utrecht of the part-time University of Wales Master of Nursing Degree Programme When m 1987 it became dear that the plarmed implementahon of the Utrecht programme would take longer than desirable, the project director foimd Chnstme Chapman wiUmg to help The result is known (Diepeveen-Speekenbnnk 1988, 1990a) As of October 1988, 19 nurses commenced their graduate nursing studies m Utrecht as part of the collaborahve Master of Nursmg Programme of the Umversity of Wales (UW) and the Uh«cht school for higher
Nursing science m The Ndherlands
professional educahon, the Hogeschool Midden Nederland (HMN) Three students disconhnued their studies soon after the start, 11 graduated m July 1991 and more graduahons are expected at the end of 1991 Of a second group of 20 students, similar results are expeded This collaborative programme wiU no doubt continue to contnbute valuably to the academizahon of nursmg in The Netherlands and m Europe
3 4
5
6 The part-time MUG Nursing Science Course This part-hme coUaborahve national programme has already been discussed above The speafic Utrecht contnbutions are summanzed in the foUowing paragraphs
7
Inventory of research priorities
8
In 1989 a preliminary Delphi survey was performed amongst Dutch institutions for health care, geared at investigating their nursmg research pnonhes The ongmal aim was to identify by subsequent rounds the national pnonhes for nursmg research Performmg a sound Delphi study at this early stage proved too ambitious However, the findmgs of this first round were quite valuable and were presented at the 1990 Utrecht Intemational Nursmg Research Round Table (Gamel et al 1990) Excellent examples of Delphi studies performed elsewhere will serve as a source of inspiration for future studies (Shortndge et al
Apprenhceship educahon is a topic for senous cnhasm There are senous concems about the perceived lack of knowledge and slaUs of nurses Nurses are often descnbed as not bemg sufficiently equipped to meet today's health care needs Pertaming to the above, the majonty of the mformants dearly indicate a need for graduate nursing educahon and nursing research Others express ambivalence There are senous concems about the lack of consensus conceming potenhal solutions for exishng problems This lack of consensus has a negative effed on policy makmg, resultmg m a lack of adequate nahonal pobcy decisions Fundamental restructunng of nursing education, mdudmg basic and post-basic programmes, and an mcrease m higher education are mandatory Informcmts indicate the need for developmg a body of scientific nursmg knowledge and plead for nursmg research Some mformants emphasize that nursmg research should be done by nurses, rather than by mvestigators of other disaplmes The value of mulhdisaplmary research is also pertment
Because of the small size of the stmiple, these condusions do not permit generalization Therefore, one of a senes of recommendations for further research was to perform similar studies using the same or different methodologies and indudmg a larger and more veined szimple
1989, Welch etal 1990) Study findings
THE NEED FOR NURSING SCIENCE IN THE NETHERLANDS In 1987 and 1988 research was performed m both Utrecht and Gronmgen mvestigatmg the local needs for nursing science programmes (Weikgroep Verplegmgswetenschap 1988, Diepeveen-Speekenbnnk 1990a) In 1989 a new research project was undertaken, aimed at explonng the need for graduate nursmg education and nursmg research as ldenhfied by diredors of Dutch health care mshtutions The appbed methodology and findmgs were presented extensively elsewhere (Diepeveen-Speekenbnnk 1990b) Condusions of the study are summanzed below 1
2
Many diverse changes m today's health care have weighty effeds on nursmg care Advances m science, changing systems and health care needs are topics of significance There is widespread discontent with the present preparation of nurses for practice This pertams to basic, as weU as post-basic, educahon programmes
The findmgs of this study, mdudmg the data from the interviews and the bterature, pose a cheiUenge for Dutch nursing leaders and other leaders in the fields of health and health care educahon The widespread discontent with the present preparahon of nurses, bnked with today's pressures on nursmg, which require knowledge and skiUs not previously expected, demand fundamental reapprcuscd of current systems Studies performed m Israel and m the UK (Bergman et al 1982, Bergman 1990, Bircumshaw & Chapman 1988) reveal a clear correlation between higher educahon in nursmg, work retention and sahsfaction They also suggest that manpower problems cannot be solved by lowenng standards of education, nor by mamtammg programmes with extremely high attnhon rates
Intemational Nursing Research Round Table Nursmg research conferences are normally part of regular academic nursmg adivities When one takes place as part of 1365
JCMH Diepeveen-Speekenbnnk
a developmg process towards the start of a new academic programme, a research conference is a rather unique event The International Nursmg Research Round Table in 1990 IS remembered with pnde and sahsfachon National and mtemational experts contnbuted to the success, and the excellent presentations, foUowed by dynamic discussions, served as a further source of inspiration for the Utrecht achvihes (University of Utrecht Faculty of Mediane 1990)
NURSING SCIENCE PROFESSORS APPOINTED
for building depth m the saence of nursmg As researchers develop new studies, based on the results of previous studies, informahon wiU be replicated, questioned and lead to new areas of investigation (Hinshaw 1990)
The Utrecht Nursing Research Interest Group (UNRIG) One of the adivities of 1990 was prepanng the start of the UNRIG, which convened for the first hme early in 1991 The purposes of nursing research mterest groups were summanzed by Shortndge (1991b) as foUows
1 Heading up nursmg research requires expenenced nurse 2 researchers Based upon this convidion, a search for such a 3 nurse professor started m 1989 and resulted m September 4 1990 m the appointment of Utrecht's first visihng pro5 fessor of nursing saence, the Amencan Lilbe M Shortndge of Pace University, New York Acceptmg a part-time position, she committed herself to getting nursmg research started in Utrecht, within the context of a nursmg research programme Meanwhile, a second expenenced nurse researcher, the Belgian Mana Grypdonck of the Catholic University cyf 6 Leuven, has also accepted a part-time posihon as visihng 7 professor of nursmg research, while negohations are 6 weU under way for the appointment of a third part-time 9 extraordmary professor The latter will be m charge of a 10 programme for home care nursing 11 12 The researdi programme Professor Shortndge commenced her work with enthusiasm m September 1990, together with nurses and experts from other disaplmes fi-om the HMN, the RUU, the Uh-echt University Hospital (Academisch Ziekenhuis Utrecht, AZU) and the Uh-echt WiUiebnma Children's Hospital (WiUiebnma Kmder Ziekenhuis, WKZ) The result at the end of 1991, only 1 year later, was that there was now the beginnmg of a nursmg research programme mdudmg a number of research branches There are between 12 and 17 potential doctorate students with some at present workmg on their proposals The growing coUaborahon between the RUU, HMN, AZU, WKZ and other key Utrecht mstituhons is also recognized as a factor of significance for further progress (Shortndge 1991a) The importance of research programmes can hardly be over-emphasized They mcorporate a senes of studies m the same or common areas of mveshgahon and are cruaal 1366
research informahon shanng, translating nursing problems mto research questions, cntical review of research literature, faabtahng access to research subjeds, networhng withm an organization, among several organizations with other disaplmes within a metropolitan cirea at regional or nahonal levels at the mtemational level, coUegial support, collaboration on projects, coUechve action on professional issues, disseminatmg research findmgs, discussion of research techniques, shanng researdi mstruments, contnbuhng to the development of nursing science
After an enthusiashc, but still somewhat hesitant start, with over 70 partiapants, the group is now working weU and convenes about four times a year Research is presented and discussed, with the above purposes serving as giudelmes The mterest and motivation of the group are quite impressive
THE UTRECHT NURSING SCIENCE STRUCTURE Underpinned by the now-achieved collaborahon between the Faculty of Health Care Education of the HMN and the Faculty of Mediane of the RUU, these institutions have set the following goals 1
to contnbute mutually to educahon and research pertainmg to nursmg and other health care professions as well as pertainmg to contmued and post-imhal educahon.
Nursing science m The Netherlands
2 3
4
to stimulate mutual exchange of educahonal programme components, to strengthen the relahonships between post-basic higher professional education and scientific educahon, so as to enhance streamlining of the educational process, to promote applied research in nursing by establishing a research programme that addresses research problems m the field and in which faculty members and students of the educational programmes mentioned above can serve as investigators
Table 4 The Utrecht contnhution 1984
1986
1987
In order to matenalize the above, a steenng committee has been installed In tum this committee now has two subcommittees the Nursing Science Cumculum Committee and the Nursmg Science Development Committee The foundation of a third sub-committee, the Committee for Post-basic Higher Professional Educahon, is imminent The agreement, encompassmg the above, portrays and formabzes the achieved collaborahon between the parhcipatmg institutions, the HMN and the RUU, mutually complementing and inspmng each other, while makmg use of each other's expertise With the growmg collaboration with other Utrecht mshtutions, such as AZU, WKZ, The Netherlands Institute for Pnmary Health Care (Nederlands Instituut voor Onderzoek van de Eerstelijnsgezondheidszorg, NFVEL) and the Nahonal Orgamzahon for Home Care (Landebjke Verenigmg voor Thuiszorg, LVT), a Utrecht Center for Nursmg Saence may be a new and achievable goal for the future Table 4 summanzes the Utrecht contnbution
THE FUTURE With her systemahc investigations and dear statistics, Florence Nightmgale founded nursing science weU over 140 years ago For many years her recommendations were hardly foUowed It would take tiU after World War II for the academic disaplme of nursmg to gam momentum Since then, however, the developments worldwide are momentous, m The Netherlands nursmg saence has rooted weU Many have contnbuted to the achievements thus far on a national and local scale m Maastncht, Utrecht and Gronmgen Many problems and prejudices must stiU be overcome, but the potential for a fruitful way forward are clearly present Workmg towards clear targets, bebef in the goals and determination wiU remain essential for progress It is the author's firm bebef that m order to attam and maintain the place nursmg deserves in society the profession needs academic mmds while its practice should be saence based
1988
1989 1990
1991
Symposium entitled The Nursmg Profession on the Move' First moves towards the start of graduate nursing saence studies Symposium 'Changing Pattems m Nursing Education' Faculty of Medicine RUU and Faculty of Health Care Educahon HMN decide to estabbsh collaborative programme and sign agreement Appointment of a nursing science project director Start of a nursing science project Rebecca Bergman appointed as consultant Work group of MUG estabbshed Completion of MUG proposal Start of UW Master of Nursing Degree Course m Utrecht under final responsibibty of Chnstme M Chapman Preliminary Delphi survey Intemahonal Nursmg Research Round Table m Uh-echt Start of MUG part-time nursing saence course. Little M Shortndge part-time visitmg professor of nursmg saence Utrecht structure nursing saence with three committees Utrecht Nursmg Research Interest Group (UNRIG) founded First endeavours towards research programme AZU and WKZ become partners First I I UW masters of nursmg 12 to 17 potential doctorate candidates Revised agreement between RUU and HMN Mana Grypdonck second part-hme visitmg professor of nursmg saence Part-time extraordmary chair for home care forthcoming Utrecht Center for Nursmg Saence bemg planned
Acknowledgements The author expresses sincere gratitude to all national and mtemational coUeagues who contnbuted to the success of the projed In addihon to Rebecca Bergman (Israel), Chnstine Chapman (UK) and Lillie Shortndge (USA) who have already been mentioned m the paper, heartfelt thanks are jJso expressed to June Clark (UK) for her mihal support and advice m 1987, pointing the way towards the Umversity of Wales, to Manlyn Jaffe-Ruiz (USA) for her conhnuous inspinng support throughout the projed years, and to 1367
JCMH Diepeveen-Speekenbnnk Esther Haloburdo (USA) and PhyUis Tyzenhouse (USA) for their expert contnbuhons durmg their 1990 sabbatical m Uh-echt The pubbshers of the Dutch Ziekenhuis Management Magazxne have granted permission to pubbsh data from the author's paper in the November 1991 issue of that joumal References Bergman R (ed) (1990) Pnonties m nursing resestfch change and conhnuity In Nursing Research for Nurstr^ Pradtce An Intemahonal Perspechve Chapman & Hall, New York Bergman R, Shatzman H & Danon A (1982) FoUow-up study of the Tel Aviv University nursmg graduates Intemahonal Joumal of Nursing Shidies 19(2), 79-88 Bircumshaw D & Chapman C (1988) A foUow up of the graduates of the Cardiff Bachelor of Nursmg Degree Course Journal of Advanced Nursing 13(2), 273-279 Cathobc Umversity Leuven (1988) Het Centrum voor Ziekenhutswetenschap en 25 Jaar Vervolmahngscycbis voor Beleid van Gezondheidslnstellingen 1963-1988 (The Center for Hospital Saence and 25 years of Management Perfection Courses m Health Care Inshtuhons) Cathobc Uruversity, Leuven Diepeveen-Speekenbnnk J C M H (1987) Wetenschappebjke opleidmg verpleegkunde (Acadenuc Nursmg Educahon) Ziekenhuis Management Magazine (Hospital Management Magazine) 3(6), 5-7, 24 Diepeveen-Speekenbnnk J C M H (1988) Wetenschappebjke opleidmg voor verpleegkundigen (Academic Education for Nurses) Ztekenhuts Management Magazine (Hospital Managem«it Magazme) 4(9), 13-18 Diepeveen-%)eek«ibnnk J CMH (1990a) Creahve mtemahonal networking towards academic nursing educahon and research m The Netherlands Joumal of Advanced Nurstng 15(6), 738-743 Diepeveen-^jeekenbnnk J C M H (199(ft>) The need for graduate nursmg education aiui nursmg research m The Netherlands an exploratory study Unpubbshed dissertahon submitted m fulfilment for the Degree of Master of Philosophy Tlie Umversity of Wales CoUege of Medicme, Cardiff Donahue M P (1985) Nurstng The Finest Art An Ulustraterd History C V Mosby, St Louis First Conference, European Nurse Researchers (1979) Collaborahve Research and its Implementahon m Nursing Nahonal Hospital Institute of the Netherlands (NZI), Uh-echt
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Gamel C, Diepeveen-Speekenbnnk J C M H & Pasman K (1990) Estabbshmg nursing research pnonties mitial endeavours m Utrecht Nurstng Research Round Table Proceedings B55-B77 University of Utrecht Faculty of Mediane, Utrecht Haloburdo E & Tyzenhouse P (1990) Toward Nursing Saence at the Universtty of Utrecht, The Netherlands Profile and Recommendahons University of Utrecht Faculty of Mediane, Uh-echt Hinshaw A S (1990) Nursing knowledge generation and faabtahon Nursing Research Round Table Proceedings B78-B90 University of Utrecht Faculty of Medicme, Utrecht Laun S (1990) The history of nursing research m Finland Internahonal Joumal of Nursing Studies 27(2), 169-174 Lelean S R & Clarke M (1990) Research resource development in the Umted Kingdom Intemahonal Joumal of Nursmg Studies 27(2), 123-138 Nahonal Ziekenhuis Instituut (National Hospital Inshtute) (1979) Collaborative Research and its Implementation in Nursmg Uh-echt Shorhndge L M , Doswell W , Evans M E, Levin R F, MiUor G K k Carter E (1989) 1988 Delphi Survey of Nursmg, research pnonties for New York State 1989 Joumal of New York State Nurses'Assoaahon 20(3), 15-19 Shortndge L M (1991a) Een gemeenschappebjk verpleegkundig onderzoeksprogramma (Collaborative Nursing Research Program) Ziekenhuts Management Magazine (Hospital Management Magazme) 7(11), 287-291 Shortndge LM (1991h) Nurstng Research Interest Groups Intemal document Department of Nursmg Saence, State University of Uh-echt, The Netherlands Scellem E (1953) Report on an Inveshgation Camed Out to Study and Make Recommendations on the Fh-achcal Appbcation to Ward Administration of Modem Methods m the Instruchon and Handling of Staff and Student Nttrses Royal College of Nursmg, Ward and Departmental Sisters' Section, London Umversity of Utrecht Faculty of Medicine (1990) Nursmg Research Round Table Proceedtngs University of Utrecht, Uh-echt, The Netherlands Welch C A , Shorhidge LM & Tucker LM (1990) Forgmg a Nursmg Research Agenda for New York State Joumal of the New York State Nurses'Assoaahon 21(3), 15-18 Werkgroep Verplegmgswetenschap (1988) Naar Een Universitatre Opletdmg Verplegmgswetenschap in Gronmgen Academisch Ziekenhuis Gronmgen, Gronmgen, The Netherlands
