Readers sometimes wonder why the articles published in Nursing Research do not give more attention to the clinical nursing implications of the research reported. They, as many others, believe that all research published in nursing journals should conclude with clear directions for practice. I understand some of the reasons for these demands. However, given the tentative state of much that is published, it seems to me that extraordinary care needs to be taken before findings are recommended for adoption or as the basis for specific interventions.
The work that appears in Nursing Research has been carefully screened for accuracy in design, method, and a parsimonious interpretation. A considerable amount of the research is based on theoretical material that has been drawn from a number of sources and synthesized by the investigator to reflect nursing concerns. In this sense, it is not "practical" in the narrow meaning of the word. The importance of the work rests on its ability to fill some gap in knowledge, which, if pursued further, may have implications for nursing as well as other disciplines. Although it is true that these studies do not have immediate bearing on clinical work, they do lay a solid base for further scientific advances in nursing.
I am not at all pessimistic about the direction our research is taking, even if the results do not seem to be immediately evident. Science is a long-term investment. I believe the growth in published midlevel theories is one of the most exciting developments in our field. They testify to the tremendous progress researchers have made in their attempts to refine and redefine the underlying rationales for what we do. We can expect these theories to produce knowledge in the years ahead that is solidly based in the best thinking available. Testable theories are the future of nursing practice.
As many of your have noted, the theoretical models are complicated, and at times difficult to understand. But human interactions are not simple, and attempts to make them so belie reality. If the findings are baffling, only more refinement of the models will help to bring clarity to the relationships. It is always tempting in such situations to dismiss inconsistencies and make recommendations that are out of keeping with the results. This is a decidedly dangerous practice in a discipline whose focus is the well-being of people.
In a health care environment that is characterized by cost containment, downsizing, and new methods of patient care delivery, ideas that seem to produce more efficient results are likely to be seized upon. However, the pragmatics of evaluating new approaches underscore the need for caution if the quality of patient care is to be safeguarded. Hard evidence is needed to support innovations, even those that are cost-effective.
Clinical findings are notoriously fickle, given the variety of samples that are available for testing hypotheses. It has become clear that what works in one place may not work in another. Leaps of faith in the interpretation of data are simply not warranted after single trials. When changes are made in clinical practice, we need to demand that they be those that are most likely to be of benefit to the patients for whom we care.
The establishment of multisite clinical trials has helped enormously in reducing the problems inherent in single trials. These studies are a prime example of the importance of taking a calculated approach to estimating the worth of a particular clinical practice. Their careful design and coordination are keys to their success and a further example of the growing sophistication of our researchers. In time, we can expect these studies to produce solid information that can be relied on as the basis for change.
When such clear-cut information becomes available, it needs to be firmly supported by practitioners. Despite the conservative approach taken in this editorial regarding recommendations derived from research, there is evidence that practitioners tend to be even more conservative when it comes to making actual changes, even those based on compelling evidence. We need to establish a mind-set that is consistent with the strength of current evidence.
Researchers must be freed from pressure to jump to premature conclusions about the applications of their work. Applications will become clear in time. Clinicians must move more quickly to alter practice in the face of conclusive findings that indicate that change is needed. The crucial issue is to identify where we are in the process of information formulation and act accordingly.
Florence S. Downs, EdD, FAAN
Editor