What may best distinguish nursing research from other forms of clinical research, says Dr. Patricia Grady, is that nursing research starts at the bedside and ends at the bedside. It is patient centered. Nurse researchers are drawn to the particular areas that they study by their clinical observations -- frightened children crying in pain, surgery patients who cannot get comfortable, accident victims disoriented and distressed by their injuries. Other clinical researchers, whose approach to experimentation does not reflect the nursing perspective, are more likely to develop ideas at "the bench" -- that is, in research laboratories -- and only later consider how their findings can help patients.

Grady, who is the Director of the National Institute of Nursing Research (NINR), was a shock trauma nurse in the 1970s. She worked mostly with patients who had strokes and serious head injuries. Few treatments eased these conditions, and most of the efforts of the health care team were directed toward preventing secondary damage, like brain swelling. Grady says she realized that new approaches would be essential for improving prospects for her patients and that better therapies required further research. She returned to graduate school to study physiology and the nervous system, specifically addressing in her experiments the causes and consequences of strokes. She was interested, for example, in what happens when the brain is deprived of its normal blood supply; she assessed physical and physiological changes in the nervous and circulatory systems after strokes; and she explored what could be done to halt further damage.

Grady was one of the early nurse researchers. She comments that many pioneering nurse researchers actually ended up doing little research, because, with their advanced degrees, they were quickly scooped up into administrative jobs. Now, says Grady, more nurses are doing research, because undergraduate courses provide them with research experience, and some universities offer "expedited" Ph.D. programs to make pursuit of joint nursing and research careers easier. Grady noted at the tenth anniversary of her institute that "doctoral preparation in nursing (became) available in the last 25 years, thus paving the way for nursing scientific research to grow and flourish at universities and hospitals."

Nursing

The term "nursing" comes from the Latin word "nutrire," which means to nourish, and this fits with the statement that "caring, healing, and health (are) nursing’s professional context and mission . . . to society (1)." The field of nursing has three components -- practice, theory, and research. One nurse writes that "the theorist, researcher . . . and practioner exist to some extent in all of us (2)." The practice of nursing has always been about how nurses care for patients. Theory has always addressed the aims of the field and what it works to accomplish. But the focus of nursing research has shifted over the years.

In the 1940s in England and in the 1950s in the United States, nursing research was mostly about nurses and nursing -- who becomes a nurse? what do nurses do? what training do they receive? -- and the research was done by sociologists, not nurse researchers. The American journal Nursing Research published its first edition in 1952. By the 1960s, nurses were studying these subjects themselves, looking into both the demographics of their profession and the approaches taken by schools of nursing to teach nurses how to do what they do. In the early 1970s, an influential report released in England prompted nurses in that country to take charge of their profession and give it a solid research base (3, 4, 5, 6). Nursing research up to that time had, according to the report, contributed to nursing theory but had done little to alter the way nurses actually cared for patients.

Contemporary Nursing Research

Nursing research today focuses mostly on practice, as nurse researchers look for solutions to the health problems that confront people "from cradle to grave." Studies address both the ordinary and the extraordinary; they can lead to new procedures for treating patients or they can validate standard procedures that already are in place.

Grady says that some of the most fruitful nursing research projects have involved collaborations among nurses, doctors, dentists, and others. "Each member brings a different perspective and different expertise to a collaboration," she says. Subtle but real differences in the motivations and goals of collaborators can both enrich and complicate studies. For example, nursing aims to promote health, whereas medicine focuses more on the treatment of disease and the preservation of life (7). When researchers from nursing and medicine backgrounds work together both perspectives must be accommodated. The end product is "a constellation of information that addresses what is best for the patient."

Nursing research addresses the physiological factors that affect health and well-being as well as the behavioral and psychological ones. But, comments Grady, nursing research also includes a large measure of common sense, and she cites the development of the "Oucher scale" as a prime example. In the mid-1980s, a nurse researcher was grappling with how best to assess and appropriately treat the pain of children in her hospital. Many of the children were too young to say how awful they felt. So the researcher developed a poster series that showed a group of unhappy children (8). Children could look at the poster and simply point to the children on the poster who seemed to be hurting as much as they were hurting. Thanks to the Oucher scale, nurses and others taking care of sick children now have a better fix on how much pain children are experiencing and which pain treatments are likely to be most effective.

From Research Into Practice

Of the more than 2.5 million nurses in the United States, only a fraction engage in research. But all of them can benefit from the results of research projects. The trick is to find effective strategies for disseminating information to that many individuals. Not all nurses in hospitals and clinics have access to the latest nursing literature or time to read it, and typically routines in hospitals are so ingrained that it is difficult to change procedures even when experiments have shown that a better approach exists (5). Time helps to spread news of state-of-the-art nursing interventions, but that is not enough. Some nurse researchers are looking for ways to deal with this problem.

"As the health care landscape is changing, nurses have new opportunities," says Grady. The field is "moving, exciting, and making major changes, and it has much to offer." Nursing research may seem to be a relatively new field -- the precursor to NINR was only established at NIH in 1986 -- but, in fact, a call for nurses to do research came more than 100 years ago from Florence Nightingale, arguably the most famous nurse of all time. Grady says that Queen Victoria once said of Nightingale, "Such a head -- I wish we had her in the war office."

1. Nursing Science Quarterly 1997, 10(1):49-52.
2. Nursing Standard 1990, 5(4):34-35
3. Annual Review of Nursing Research 1996, 14:207-224.
4. Journal of Advanced Nursing 1995, 21:576-583.
5. British Journal of Nursing 1994, 3(8): 402-406.
6. Journal of Clinical Nursing 1994, 3:199-204.
7. Journal of Advanced Nursing 1994, 19:320-327.
8. MCN 1994, 19:314-320.
9. AAOHN Journal 1989, 37(6):238-239.

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All images in this article courtesy of the National Institute of Nursing Research.