“You cannot do science from a practice setting.” This was the counsel from an academic colleague to the author who was at that time a part-time nursing researcher located at the corporate offices of a large integrated health care system. Now some five years later as the research position has become a Nursing Research Program, a systematic review and analysis of the evidence for that proposition is called for.
OBJECTIVE: The objective of this inquiry was to determine: (1) the characteristics of a Nursing Research Program in a large Health Maintenance Organization (HMO); (2) the drivers and barriers to the development and growth of a Nursing Research Program in a corporate practice environment; and (3) the state of the science at the Nursing Research Program.
DESIGN: This investigation used a case study design.
POPULATION: The population was Nursing Research Programs outside of academic settings. The setting was a large HMO. The sample was one of the two regional Nursing Research Programs. Data were collected from the start of the program in 1996 until January 2002.
CONCEPTS: The variables of focus being investigated were Nursing Research Program, characteristics, drivers and barriers, and state of the science.
METHODS: Data were collected from all written documents chronologically catalogued by the researcher since the inception of the nurse research position. The documents included all strategic plans, business cases, annual reports, minutes of meetings, informal meeting notes, newsletters, research databases, research proposals, presentation outlines, grant applications/proposals, and manuscripts submitted. The data were analyzed using constant comparison that proceeded from open, then axial, and finally to selective coding.
FINDINGS: In this case, a Nursing Research Program was a functional unit of the larger HMO. The unit had local representation and constituencies in six service areas and 12 medical centers. The functional unit had two components: personnel and purposeful units. The personnel were two nurse researchers and their administrative support. The purposeful units are the Nursing Research Committee, Research Studies, Evidence Based Practice Functions, Communications, Professional Development, and Operations. The drivers to the development of the program included a clear vision for the program, an operational definition of research, strategic planning that integrated the organizational and funding initiatives, communication mechanisms for research findings, and participation of nurses at all levels of the organization. Barriers included the rapid changes in leadership and leadership structure, that is, the organizational culture of the system, competing value systems between business and professional units at all levels of the organization, and diminishing availability of all resources. Science as a term in the documents was not defined but rather was an intuited term used to describe both personnel (Nurse Scientist) and the nursing research projects. There were no documented nursing projects at the beginning of the documentation. In the latest documents reviewed, there were 34 active studies, 19 completed studies, 6 publications, and 24 research or evidence based practice presentations. All of the studies undertaken or supported by the program were clinical studies. There were no bench or basic laboratory, animal model studies identified. Themes identified from the studies (active and completed) included quality of life, symptom management, and nursing workforce.
CONCLUSIONS: The concept Nursing Research Program may have a meaning in the practice setting that is different from that found in the academic setting. In the academic setting, a Nursing Research Program’s meaning usually is an individualized program of research studies. In the practice setting, it may refer to a functional unit of the organization. The drivers and barriers to research in the practice setting reflect the organizational culture. Furthermore, the state of the science may be more closely tied to addressing the issues of the organizational culture in the practice setting than it is in the academic setting.
IMPLICATIONS: When the agenda is building nursing science, it is important for nurse researchers in these unique environments to ensure that they understand the diversity, and yet, arrive at common meanings of core concepts such as science and nursing research. The state of the science in any environment, practice or academic, is closely tied to the organizational culture of that organization. With proper attention to that culture, nursing science can thrive in either an academic or practice environment.
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