Journal of Advanced Nursing, 1976, I , 437-442
r/re Edinburgii University's Nursing Researcii Unit: tlie first four years Lisbeth Hockey B.Sc.(Econ.) S.R.N. S.C.M. H.V.Tutor's Cert. Queen's Nurse Director, Nursing Research Unit, Department of Nursing Studies, University of Edinburgh Accepted for pithlication ;^o April ig-/6
HOCKEY LISBETH {i()j6) Journal of Advanced Nursing i , 437-442
The Edinburgh University's Nursing Research Unit: the first four years The Edinburgh University's Nursing Research Unit, under the direction ofa nurse-researcher, was established in October 1971: the first unit of its kind in the United Kingdotn, This paper describes its development, philosophy and future strategy. In the first histancc attempts were made to identify nursing problems from which a common core of probletns was identified. This provided specific pointers for future research activity. The unit offers research training facilities for trained nurses and research appreciation courses have also been provided for nursing students and their teachers. A major bonus to the unit has been the opportunity and facilities for interdisciplinary and collaborative research. The unit's future activities include plans to develop new statistical, computer and data management techniques and information retrieval systems more appropriate to nursing research.
Vision, determination and finance were the operative factors in the creation of the Nursing Research Unit in October 1971. The Head of the Department of Nursing Studies, Professor Margaret Scott Wright, contributed the first two of these; the Scottish Home and Health Department, in agreement with the university, provided the third by financial support for a period of seven years in the first instance. The Unit's remit is wide, it includes: research into nursing problems, education in relation to research, dissemination of information, both nationally and internationally. It was with considerable enthusiasm and a corresponding sense of responsibility that I accepted the leadership of this new venture. The potential seemed tremendous in that there were possibilities for development in many directions. The problem was one of choice, especially the initial choice of a suitable research project which would be useful to the nursing profession in Scotland. It is one thing to pursue one's own interests and hunches on money awarded on a personal basis, 437
438
L. Hockey
but quite another to be accountable for the wise spending ofa block government grant involving a team of workers over a prolonged period. Before launching research into nursing problems it seemed logical to attempt their identification. It appeared prudent, moreover, to enlist the help of a crosssection ofthe profession for this purpose. Meetings and discussions were, therefore, arranged to talk to groups and individuals about their jobs—not specifically about their problems. It was felt that the real problems causing concern would be voiced spontaneously, whereas if discussion were earmarked for problems distortions might occur. All discussions were recorded cither on paper or on tape and later their content was analysed by a research assistant who had not been involved in the meetings. The purpose ofthe exercise was the possible identification ofa common core of problems, if any, which could be used as a starting point for the Unit's research strategy, i.e. profession generated research. This strategy resulted in a descriptive study Women in Nursitig to be published by Hodder and Stoughton Educational in 1976. This study covers a wide range of topics focusing particularly on employment problems created and experienced by female nurses. Though deliberately designed as a base line study we wove into it specific pointers to future work. Thus, the nurse respondents were asked questions on aspects of patient care, so that a transition from studying nurses to investigating nursing would also be profession generated. This approach yielded one immediate project on patients' fears and worries on planned admission to hospital which was launched in mid 1975. Two further studies were generated directly by the major basic investigation. One of these was a feasibility study ofthe implementation of flextime in nursing which was undertaken by two nurses m the health service in collaboration with Unit staff. The other is a study of'The nursing auxiliary in the health service' and began in January 1976, financed jointly by the Scottish Home and Health Department and the Department of Health and Social Security. Apart from attracting such additional monies from government research funds for specific projects, the Unit's constitution permits it to submit grant applications to trusts, foundations and research councils. In the course ofthe first four years five grants for specific projects, additional to the Unit's basic budget, have been held either solely within the Unit or jointly with other units or departments. The Unit's second major function—education in relation to research—is being developed in a variety of ways. Two nurses are employed as members ofthe core staff team, thereby learning on the job, which is probably the most effective way of coming to grips with all aspects ofthe research process. The Scottish Home and Health Department awards annual research training fellowships for nurses. Although fellowship holders can be linked with any Scottish university or other institution for higher education, many have selected the Nursing Research Unit as their training base. In addition to these research training Fellows the Unit houses other research students and undertakes all the administration associated with such students; academic supervision is shared by members of the departmental academic staff. A graduate nurse educator from Dublin chose to spend a sabbatical year with us in order to deepen the research base of her teaching
The Edinburgh University's Nursing Research Unit on her return to Eire. She became a participant observer in a variety ofthe Unit's activities, exchanging hard work for this type of experience. For the benefit of other members of the nursing profession, short summer schools are organized annually. We believe that the relevance and usefulness of research to nursing are determmed by the sphere and level of professional functioning. Therefore, we now arrange a specific eourse for nurse educators, another for senior nurse managers and yet another for nurses who are about to embark on, or have recently become involved in, research. In the first four years we have run eight summer schools with a total of 153 participants from the United Kingdom and overseas. Countries represented included Switzerland, Holland, West Germany, Austria, Denmark, Eire, Turkey and Canada. The Department of Nursing Studies has always encouraged international links and it is gratifying that the Research Unit is proving to be a further focus for education and debate at international level. We were privileged to w^elcome a distinguished Canadian nurse, Dr M. C. Cahoon, Professor and Chairman of Research, Faculty of Nursing, Universit)' of Toronto and Canadian adviser to the Journal of Advanced Nursing, who elected to spend a sabbatical year in the Unit on a postdoctoral fellowship. She has designed an instrument for the classification, categorization and appraisal of clinical nursing studies in Britain and North America. In an attempt to cater for the research needs of student nurses, we experimented with study days specifically designed for them with the ready approval of their tutors. However, as these activities had to be confined to students in the Edinburgh area, it was decided to divert our resources to nurse educators, thereby reaching a wider group. Requests for advice have come from a wide range of nurses in many parts of the country and also from overseas. The nature ofthe requests has ranged equally widely both in subject matter and in the level of consultation. Whenever possible, some help was offered either by direct communication or by referral to other resource persons within or outside the Department of Nursing Studies. Our weekly seminars serve a variety of purposes; they give experience in the presentation of reports of research activity, they afford the opportunity to obtain reactions and feedback on tentative ideas, they provide sources ofinformation and a platform for debate. Often, outside speakers are invited and most ofthe seminars are open not only to staff and students within the university but also to professional colleagues outside it. One ofthe bonuses of working within a university is the possibility of interdisciplinary activity both in research per se and in education related to research. Departments within the University of Edinburgh with which we are associated through collaborative research arc The Godfrey Thomson Unit for Academic Assessment in the Department of Educational Sciences and the Department of Community Medicine. The shared project with the former is the design of a selection instrument for admission to the nursing profession. The research in which we are collaborating with the Department of Community Medicine is a randomized controlled trial of stroke rehabilitation. Through academic supervision of
439
440
L. Hockey
students we eurrently have links with the Departments of Psychology, Social Administration, Business Studies, Community Medicine and Applied Linguistics. We also enjoy many contacts with agencies and departments outside our own university and are developing a close working relationship with the Health Services Operational Research Unit, University of Strathclyde. Dissemination of information is attempted mainly on an informal basis on request. We are in regular eontaet with some North Ameriean universities and researeh centres and I have been privileged to visit some of these, as well as some in European countries, in the cause of nursing research. We aim to publish a report of our activities approximately every two years. The Unit's second biennial report, covering the period from i Oetober 1973 to 31 December 1975, is obtainable from the Unit. The systematic collection and dissemination of information about research are complex endeavours and methods for information retrieval are currently being explored in conjunction with other interested parties. The appointment of a Nursing Officer—Researeh, in the Scottish Home and Health Department, is bound to facilitate dissemination of information in Scotland and the Joimial of Advanced Nursing should provide a fruitful medium for the exehange of new knowledge. Probably one of the most important events in the life of the Unit was the official visit by the Chief Scientist's Sub Committee in May 1975. The Chief Scientist Organization is the official machinery for the facilitation and control of Government funded research. The Committee, presided over by the Chief Seientist for Scotland, ineluded the Chief Scientist for England and Wales, senior nursing representatives from both Health Departments, nursing and medical representatives from the Health Serviees Research Committee, professorial representatives from this and other British universities and senior medieal and nonniedieal civil servants. After a day's presentation of work and discussions with staff, the Committee decided to recommend that the Unit should be finaneed for a further period of four years after the expiry ofthe eurrent eontraet and to appoint an additional member of staff We have, therefore, seven assured years of life before us, which allows long term planning. Grants from other trusts and foundations augur reasonably well for further expansion of the Unit's aetivities. However, as 'man does not live by bread alone' we need w^isdoni to proceed in a way w^hieh will prove of maximum benefit to the nursing profession. We hope to develop an identifiable eoherent research programme. This, in itself, is not a novel idea but what may make our strategy different from others is the underlying premise. Some researeh centres focus on the development of knowledge in a elinical specialty area, such as geriatrie care; others concentrate on work in specific patient situations, sucli as patients' reactions to threatening events, primary eare, ete.; still others put their efforts into specific research techniques, such as operational research. Our plan is to make the best possible use ofthe Unit's potential for continuity which individual researehers tend to lack. First, we would encourage the replication of studies or parts of studies, thereby strengthening their validit)'; seeondly, we would promote interdisciplinary research thereby, one
The Edinhurgh University's Nursing Research Unit
441
hopes, enriching all participating disciplines. Thirdly, and probably most importantly, we have already embarked on a policy of allowing the findings of one study to generate the next, thereby establishing functional connections, neither the subject of study nor the methods being predetermined. We hope that our proposed strategy may have two major advantages: (i) it should fit in most closely with the Unit's terms of reference to undertake applied research into current probletns and (2) it should make possible the accommodation ofthe disparate interests and types of expertise of current nurse researchers, integrating them into a meaningful whole. Such integration might proceed in at least three ways, which I have labelled horizontal, lateral and vertical as presented in Figure i. Horizontal integration is intended to convey a growth of knowledge Horizontal integration
Lateral integration
knowledge
Vertical integration Related \discipline
Related discipline
\J Related
discipline
I Integration of interests and expertise of ntirse-rescarchers {the shaded area represents the or^^anizationa! structure)
through a policy of replication. Lateral integration refers to a growth of knowledge through cross-fertilization and collaboration with other related disciplines. Vertical integration represents a growth of knowledge through one project being directly generated from another. The three types of integration are not mutually exclusive and in all cases the Unit would provide the necessary organizational structure and framework. Because nursing represents a complex fusion ofa variety of sciences, conventional statistical techniques developed in those sciences have been legitimately used in nursing research. At the same time it must be realized that these sciences have their own assumptions and frames of reference which are not necessarily congruent with nursitig. We hope to be able to develop other techniques, more appropriate to our partieular needs, capable of handling the diversity of data sources which confront us and, at the same time, sensitive enough to be of value within the inevitable constraints. Nursing research, though a growth area, has limited resources, a factor which, in a vicious circle, has resulted in limited implementation of findings, thereby attracting criticism ofthe purpose and value ofthe research. The main statistical problems challenging us are related to the difficulty of developing sufficiently sensitive techniques which will justify meaningful inferences for implementation from relatively small samples.
442
L Hockey
Through the appointment in mid 1975 ofa comptiter scientist, we hope to increase the computer potential of the Unit, to proceed with developments in interactive computing, data management techniques and information retrieval systems. The excellent facilities provided through the Edinburgii Regional Computing Centre and the Computer Program Library Unit are conducive to such plans. It is my hope that our Nursing Research Unit will be the first of several in the United Kingdom, so that a growing number of nurse researchers can benefit from the type of back-up facilities and services, particularly peer group support, which such a Unit is able to provide.
r/re Edinburgii University's Nursing Researcii Unit: tlie first four years Lisbeth Hockey B.Sc.(Econ.) S.R.N. S.C.M. H.V.Tutor's Cert. Queen's Nurse Director, Nursing Research Unit, Department of Nursing Studies, University of Edinburgh Accepted for pithlication ;^o April ig-/6
HOCKEY LISBETH {i()j6) Journal of Advanced Nursing i , 437-442
The Edinburgh University's Nursing Research Unit: the first four years The Edinburgh University's Nursing Research Unit, under the direction ofa nurse-researcher, was established in October 1971: the first unit of its kind in the United Kingdotn, This paper describes its development, philosophy and future strategy. In the first histancc attempts were made to identify nursing problems from which a common core of probletns was identified. This provided specific pointers for future research activity. The unit offers research training facilities for trained nurses and research appreciation courses have also been provided for nursing students and their teachers. A major bonus to the unit has been the opportunity and facilities for interdisciplinary and collaborative research. The unit's future activities include plans to develop new statistical, computer and data management techniques and information retrieval systems more appropriate to nursing research.
Vision, determination and finance were the operative factors in the creation of the Nursing Research Unit in October 1971. The Head of the Department of Nursing Studies, Professor Margaret Scott Wright, contributed the first two of these; the Scottish Home and Health Department, in agreement with the university, provided the third by financial support for a period of seven years in the first instance. The Unit's remit is wide, it includes: research into nursing problems, education in relation to research, dissemination of information, both nationally and internationally. It was with considerable enthusiasm and a corresponding sense of responsibility that I accepted the leadership of this new venture. The potential seemed tremendous in that there were possibilities for development in many directions. The problem was one of choice, especially the initial choice of a suitable research project which would be useful to the nursing profession in Scotland. It is one thing to pursue one's own interests and hunches on money awarded on a personal basis, 437
438
L. Hockey
but quite another to be accountable for the wise spending ofa block government grant involving a team of workers over a prolonged period. Before launching research into nursing problems it seemed logical to attempt their identification. It appeared prudent, moreover, to enlist the help of a crosssection ofthe profession for this purpose. Meetings and discussions were, therefore, arranged to talk to groups and individuals about their jobs—not specifically about their problems. It was felt that the real problems causing concern would be voiced spontaneously, whereas if discussion were earmarked for problems distortions might occur. All discussions were recorded cither on paper or on tape and later their content was analysed by a research assistant who had not been involved in the meetings. The purpose ofthe exercise was the possible identification ofa common core of problems, if any, which could be used as a starting point for the Unit's research strategy, i.e. profession generated research. This strategy resulted in a descriptive study Women in Nursitig to be published by Hodder and Stoughton Educational in 1976. This study covers a wide range of topics focusing particularly on employment problems created and experienced by female nurses. Though deliberately designed as a base line study we wove into it specific pointers to future work. Thus, the nurse respondents were asked questions on aspects of patient care, so that a transition from studying nurses to investigating nursing would also be profession generated. This approach yielded one immediate project on patients' fears and worries on planned admission to hospital which was launched in mid 1975. Two further studies were generated directly by the major basic investigation. One of these was a feasibility study ofthe implementation of flextime in nursing which was undertaken by two nurses m the health service in collaboration with Unit staff. The other is a study of'The nursing auxiliary in the health service' and began in January 1976, financed jointly by the Scottish Home and Health Department and the Department of Health and Social Security. Apart from attracting such additional monies from government research funds for specific projects, the Unit's constitution permits it to submit grant applications to trusts, foundations and research councils. In the course ofthe first four years five grants for specific projects, additional to the Unit's basic budget, have been held either solely within the Unit or jointly with other units or departments. The Unit's second major function—education in relation to research—is being developed in a variety of ways. Two nurses are employed as members ofthe core staff team, thereby learning on the job, which is probably the most effective way of coming to grips with all aspects ofthe research process. The Scottish Home and Health Department awards annual research training fellowships for nurses. Although fellowship holders can be linked with any Scottish university or other institution for higher education, many have selected the Nursing Research Unit as their training base. In addition to these research training Fellows the Unit houses other research students and undertakes all the administration associated with such students; academic supervision is shared by members of the departmental academic staff. A graduate nurse educator from Dublin chose to spend a sabbatical year with us in order to deepen the research base of her teaching
The Edinburgh University's Nursing Research Unit on her return to Eire. She became a participant observer in a variety ofthe Unit's activities, exchanging hard work for this type of experience. For the benefit of other members of the nursing profession, short summer schools are organized annually. We believe that the relevance and usefulness of research to nursing are determmed by the sphere and level of professional functioning. Therefore, we now arrange a specific eourse for nurse educators, another for senior nurse managers and yet another for nurses who are about to embark on, or have recently become involved in, research. In the first four years we have run eight summer schools with a total of 153 participants from the United Kingdom and overseas. Countries represented included Switzerland, Holland, West Germany, Austria, Denmark, Eire, Turkey and Canada. The Department of Nursing Studies has always encouraged international links and it is gratifying that the Research Unit is proving to be a further focus for education and debate at international level. We were privileged to w^elcome a distinguished Canadian nurse, Dr M. C. Cahoon, Professor and Chairman of Research, Faculty of Nursing, Universit)' of Toronto and Canadian adviser to the Journal of Advanced Nursing, who elected to spend a sabbatical year in the Unit on a postdoctoral fellowship. She has designed an instrument for the classification, categorization and appraisal of clinical nursing studies in Britain and North America. In an attempt to cater for the research needs of student nurses, we experimented with study days specifically designed for them with the ready approval of their tutors. However, as these activities had to be confined to students in the Edinburgh area, it was decided to divert our resources to nurse educators, thereby reaching a wider group. Requests for advice have come from a wide range of nurses in many parts of the country and also from overseas. The nature ofthe requests has ranged equally widely both in subject matter and in the level of consultation. Whenever possible, some help was offered either by direct communication or by referral to other resource persons within or outside the Department of Nursing Studies. Our weekly seminars serve a variety of purposes; they give experience in the presentation of reports of research activity, they afford the opportunity to obtain reactions and feedback on tentative ideas, they provide sources ofinformation and a platform for debate. Often, outside speakers are invited and most ofthe seminars are open not only to staff and students within the university but also to professional colleagues outside it. One ofthe bonuses of working within a university is the possibility of interdisciplinary activity both in research per se and in education related to research. Departments within the University of Edinburgh with which we are associated through collaborative research arc The Godfrey Thomson Unit for Academic Assessment in the Department of Educational Sciences and the Department of Community Medicine. The shared project with the former is the design of a selection instrument for admission to the nursing profession. The research in which we are collaborating with the Department of Community Medicine is a randomized controlled trial of stroke rehabilitation. Through academic supervision of
439
440
L. Hockey
students we eurrently have links with the Departments of Psychology, Social Administration, Business Studies, Community Medicine and Applied Linguistics. We also enjoy many contacts with agencies and departments outside our own university and are developing a close working relationship with the Health Services Operational Research Unit, University of Strathclyde. Dissemination of information is attempted mainly on an informal basis on request. We are in regular eontaet with some North Ameriean universities and researeh centres and I have been privileged to visit some of these, as well as some in European countries, in the cause of nursing research. We aim to publish a report of our activities approximately every two years. The Unit's second biennial report, covering the period from i Oetober 1973 to 31 December 1975, is obtainable from the Unit. The systematic collection and dissemination of information about research are complex endeavours and methods for information retrieval are currently being explored in conjunction with other interested parties. The appointment of a Nursing Officer—Researeh, in the Scottish Home and Health Department, is bound to facilitate dissemination of information in Scotland and the Joimial of Advanced Nursing should provide a fruitful medium for the exehange of new knowledge. Probably one of the most important events in the life of the Unit was the official visit by the Chief Scientist's Sub Committee in May 1975. The Chief Scientist Organization is the official machinery for the facilitation and control of Government funded research. The Committee, presided over by the Chief Seientist for Scotland, ineluded the Chief Scientist for England and Wales, senior nursing representatives from both Health Departments, nursing and medical representatives from the Health Serviees Research Committee, professorial representatives from this and other British universities and senior medieal and nonniedieal civil servants. After a day's presentation of work and discussions with staff, the Committee decided to recommend that the Unit should be finaneed for a further period of four years after the expiry ofthe eurrent eontraet and to appoint an additional member of staff We have, therefore, seven assured years of life before us, which allows long term planning. Grants from other trusts and foundations augur reasonably well for further expansion of the Unit's aetivities. However, as 'man does not live by bread alone' we need w^isdoni to proceed in a way w^hieh will prove of maximum benefit to the nursing profession. We hope to develop an identifiable eoherent research programme. This, in itself, is not a novel idea but what may make our strategy different from others is the underlying premise. Some researeh centres focus on the development of knowledge in a elinical specialty area, such as geriatrie care; others concentrate on work in specific patient situations, sucli as patients' reactions to threatening events, primary eare, ete.; still others put their efforts into specific research techniques, such as operational research. Our plan is to make the best possible use ofthe Unit's potential for continuity which individual researehers tend to lack. First, we would encourage the replication of studies or parts of studies, thereby strengthening their validit)'; seeondly, we would promote interdisciplinary research thereby, one
The Edinhurgh University's Nursing Research Unit
441
hopes, enriching all participating disciplines. Thirdly, and probably most importantly, we have already embarked on a policy of allowing the findings of one study to generate the next, thereby establishing functional connections, neither the subject of study nor the methods being predetermined. We hope that our proposed strategy may have two major advantages: (i) it should fit in most closely with the Unit's terms of reference to undertake applied research into current probletns and (2) it should make possible the accommodation ofthe disparate interests and types of expertise of current nurse researchers, integrating them into a meaningful whole. Such integration might proceed in at least three ways, which I have labelled horizontal, lateral and vertical as presented in Figure i. Horizontal integration is intended to convey a growth of knowledge Horizontal integration
Lateral integration
knowledge
Vertical integration Related \discipline
Related discipline
\J Related
discipline
I Integration of interests and expertise of ntirse-rescarchers {the shaded area represents the or^^anizationa! structure)
through a policy of replication. Lateral integration refers to a growth of knowledge through cross-fertilization and collaboration with other related disciplines. Vertical integration represents a growth of knowledge through one project being directly generated from another. The three types of integration are not mutually exclusive and in all cases the Unit would provide the necessary organizational structure and framework. Because nursing represents a complex fusion ofa variety of sciences, conventional statistical techniques developed in those sciences have been legitimately used in nursing research. At the same time it must be realized that these sciences have their own assumptions and frames of reference which are not necessarily congruent with nursitig. We hope to be able to develop other techniques, more appropriate to our partieular needs, capable of handling the diversity of data sources which confront us and, at the same time, sensitive enough to be of value within the inevitable constraints. Nursing research, though a growth area, has limited resources, a factor which, in a vicious circle, has resulted in limited implementation of findings, thereby attracting criticism ofthe purpose and value ofthe research. The main statistical problems challenging us are related to the difficulty of developing sufficiently sensitive techniques which will justify meaningful inferences for implementation from relatively small samples.
442
L Hockey
Through the appointment in mid 1975 ofa comptiter scientist, we hope to increase the computer potential of the Unit, to proceed with developments in interactive computing, data management techniques and information retrieval systems. The excellent facilities provided through the Edinburgii Regional Computing Centre and the Computer Program Library Unit are conducive to such plans. It is my hope that our Nursing Research Unit will be the first of several in the United Kingdom, so that a growing number of nurse researchers can benefit from the type of back-up facilities and services, particularly peer group support, which such a Unit is able to provide.
