Research
Nursing Research—Moving Forward Through Networking, Collaboration, and Mentorship Marilyn Hockenberry-Eaton, RNC, PhD, PNP the past 20 years nursing has undertaken the task of developing the theoretical body of knowledge necessary to guide and refine nursing practice. The need to develop theoretical nursing knowledge is understood more clearly by defining the differences between nursing as a profession and nursing as a scientific discipline. The profession of nursing refers
D URING -L~
provide a comprehensive review of every study performed by nurses in pediatric oncology ; rather, it presents examples of contributions that have impacted nursing practice. Nursing research contributions in pediatric oncology not
to
major focus areas: late treatment, adolescent issues, support groups, effects on the family, parental decision-making abilities, and symptom man-
the
agement.
the activities performed by the practitioners in field.’ The discipline of nursing is developed through systematic study of individuals as they adapt to health, illness, disability, and change in relation to environmental influences and nursing
actions.’
As the Association of Pediatric OncolNurses (APON) continues to develop goals ogy and plan strategies to attain these goals, closer examination is necessary to assess the advantages of integrating nursing research into clinical practice. The purpose of this article is to reflect on nursing research accomplishments in the specialty and to discuss ways that will help pediatric oncology nursing bridge the gap between research and clinical practice.
Stepping Stones From the Past A review of the literature shows numerous in pediatric oncology who have provided a foundation for integrating nursing research findings into clinical practice. This article does nurses
From the Graduate Pediatric Oncology Program, Emory GA. Address reprint requests to Marilyn Hockenberry-Eaton, RNC, PhD, PNP, Emory University School of Nursing, Atlanta, GA 30322. © 1992 by Association of Pediatric Oncology Nurses.
University, Atlanta,
1043-454219210903-0005$03.0010
132
have been made in five
effects of
cancer
One of the first nursing research contributions to the childhood cancer literature evaluated the
psychological late effects of childhood cancer.2 Fergusson’s pioneer work initiated her role as a model for advanced nursing practice, paving the way for others to investigate the effects of therapy on the survivors of childhood cancer. 3.4 Research by Moore et al4 established the credibility for nursing’s involvement in the evaluation of the physiological and psychological effects of cancer treatment on the child. Other significant contributions have been made by nurses who have increased our understanding of adolescents with cancer.5~9 For example, the work by Hinds6 has evolved into a theory of adolescent hopefulness that provides a scientific foundation for the care of adolescents with cancer. The importance of evaluating the effectiveness of nursing interventions is exemplified in the work by Heineyl0 and others who have evaluated support groups for children and their families.&dquo; Nurses have contributed to the body of knowledge through research evaluating pain management for children and adolescents with cancer.12.13 cursing research involving parental decisionmaking practices regarding informed consent
_
133
scientific basis for the need for involved in parent educa-
nursing interventions will be developed to improve quality patient care. For example, re-
tion and support. 14 Hymovich’sl5 work regarding families and chronic illness lends support for a theory of pediatric oncology nursing. Nursing research assessing the impact of childhood cancer on the family provides knowledge of the magnitude of changes that occur in the family following the diagnosis of a child or adolescent with cancer.16.17 Evaluation of the effects of living with a brother or sister who has cancer provides insight regarding the needs of the siblings in the family.18.19 Recently, nurses have contributed to the knowledge base regarding nursing management issues such as central line care 2° Implementation of research studies to investigate
search findings of adolescents who have cancer have increased awareness of the need for adolescents to be treated differently than the child with cancer. 5-9 Additionally, investigation of pain in children and adolescents with cancer has improved nursing care by providing rationale for
has
provided
. nurses to
be
a
actively
symptom management strategies
is
increasing,
by the number of research abpresented in this area at the last two national conferences. The work completed by nurses involved in research has provided the demonstrated
stracts
foundation on which to build scientific knowledge that will guide future pediatric oncology
nursing practice.
Moving Toward Scientific Nursing Practice The
question has been raised by nurses in all specialty areas: Why is research-based practice so important? To state it clearly, research-based practice enables nursing to provide the highest quality of care possible based on scientific knowledge. To examine research-based practice further, nurses must ask themselves how often are nursing interventions performed because &dquo;that’s policy&dquo; or, even worse, because &dquo;it has always been done that way.&dquo; Rationale based on past experiences and procedures that have not been established through scientific inquiry may not provide for the best possible quality patient care. Nurses frequently practice nursing without understanding the scientific basis for the intervention. Of equal concern is the realization that nurses frequently must provide care when no scientific knowledge is available at all to support nursing actions. It is through nursing research that improved
pain-management strategies based on scientific
inquiry. 12,13 Nurses who have provided us with the stepping stones from past research have answered many questions already and provide the catalyst for further investigation. Building
a
Future for
Nursing Research
The three major components for successful nursing research in pediatric oncology are networking, collaboration, and mentorship. These three elements must be developed further within APON for nursing research to impact future pediatric oncology nursing practice.
IYefworking Communication between
expert. clinicians
and researchers is the first step towards building future research studies. Networking occurs when a group that has common goals communicates at regular intervals to define and direct efforts to meet these goals. Sharing ideas and insight creates questions that will contribute to
improving nursing practice. Networking be= tween the clinician and the researcher is essential. The nurse in clinical practice holds the key to developing appropriate research questions that will improve the quality of care for children with cancer. The researcher offers the clinician advanced knowledge of the research process. Through networking, the researcher must work with the clinician to develop the research team.
Collaboration
.
As members of an organization devoted to the of children with cancer, pediatric oncology nurses must consider common nursing research interests and provide ways to facilitate care
134
research collaboration. Working jointly with othallows for stronger research programs to evolve. Collaboration is exemplified in the work by Ruccione et al 14 who conducted a research project at several clinical sites, providing the nursing literature with specific interventions that facilitate parent understanding of informed consent. Collaborative efforts facilitate the development of quality research programs by providing the population, resources, and clinical and research experts that promote research growth. The literature shows that a major limitation of many nursing studies is an inadequate sample size. In a specialty with a small patient population, collaborative efforts allow for increased opportunities to examine childhood cancer issues that could not be studied by one research team ers
independently.
Mentorship A mentor is defined as a trusted counselor or guide. Trust is a key word in the development of a mentoring relationship. Respect of each other’s strengths as well as the ability to identify one’s own weaknesses is a requisite for the development of a trusting relationship that facilitates
mentorship opportunities. Unfortunately,
clinicians and researchers sometimes have difficulty working together, both unable to trust the other’s expertise. Research teamwork requires that individuals with different expertise come together to bring their strengths to the project.
Individuals committed to research must be willing to become mentors for others less experienced in the research process. Sharing of ideas and expertise will facilitate professional growth within the specialty and ultimately influ’
ence
patient care.
Summary Numerous pediatric oncology nurses have provided the specialty with research that has established a foundation for the nursing care of children and adolescents with cancer. The research committee within APON is committed to facilitating further research development among pediatric oncology nurses. Research growth within APON will continue with the development of precongress research workshops for nurses interested in developing research projects, an advanced nursing research session to be held at the next national conference, and the organization of networking among pediatric oncology nurse researchers. Additionally, the research column will provide nurses with a review of the research process over the next several issues
Knowledge building is an evolving, dynamic process that is rapidly changing due to the newness of the specialty. As the pediatric oncology specialty continues to grow, networking, collaboration, and mentorship must become the keys to facilitating future research growth within APRON.
Referenc’es 1. Donaldson C: The
discipline of nursing.
Nurs Outlook
26:113-120.1978 2. Fergusson J: Psychological late effects of a serious illness in childhood. Nurs Clin North Am 11:83-93, 1976 3. Hobbie W: Late effects of childhood cancer: A program approach. J Assoc Pediatr Oncol Nurs 6(2):39, 1989 4. Moore [M, Kramer JH, Wara W, et al: Cognitive function in children with leukemia. Effect of radiation dose and time since irradiation. Cancer 68(9):1913-1917, 1991 5. Chambas K: Sexual concerns of adolescents with cancer. J Pediatr Oncol Nurs 8:165-172, 1991 6. Hinds PA: Adolescent hopefulness in illness and health. Adv Nurs Sci 10(3):79-88, 1988 7. Hinds PA, Martin J: Hopefulness and the self-sustaining process in adolescents with cancer. Nurs Res 37(6) :336-
340, 1988 8.
Overbaugh KA, Sawin K: Future life expectations and
self-esteem of the adolescent survivor of childhood cancer. J Pediatr Oncol Nurs 9:8-16, 1992 9. Rechner M: Adolescents with cancer: Getting on with life. J Pediatr Oncol Nurs 7:139-144, 1990 10. Heiney SP, Goon-Johnson K, Ettinger RS, et al: The effects of group therapy on siblings of pediatric oncology patients. J Pediatr Oncol Nurs 7:95-100, 1990 11. Wells LM, Heiney SP, Swygert E, et al: Psychosocial stressors, coping resources, and information needs of par-
of adolescent cancer patients. J Pediatr Oncol Nurs 7:145-148, 1990 12. Broome ME, Bates TA, Lillis PP, et al: Children’s medical fears, coping behaviors, and pain perceptions during a lumbar puncture. Oncol Nurs Forum 17(3)361-367, 1990 13. Pfefferbaum B, Adams J, Aceves J: The influence of culture on pain in Anglo and Hispanic children with cancer. J Am Acad Child Adolesc Psychiatry 29(4):642-647, 1990 14. Ruccione K, Kramer RF, Moore IK, et al: Informed ents
135
consent for treatment of childhood cancer. Factors
parents’
decision
affecting
making. J Pediatr Oncol Nurs 8:112-121,
1991 15. Hymovich DP: A theory for pediatric oncology nursing practice and research. J Pediatr Oncol Nurs 7:131-138, 1990 16. Bossert E, Martinsen IM: Kinetic family drawingsrevised : A method of determining the impact of cancer on the family as perceived by the child with cancer. J Pediatr Nurs 5(3):204-213, 1990 17. Martinson IM, Cohen MH: Themes from a longitudinal
study of family reaction to childhood cancer. J Psychosocial Oncol 6(314):81-98, 1988 18. Kramer RF: Living with childhood cancer: Healthy siblings perspectives. Issues Comp Pediatr Nurs 5(3):155-165, 1981 19. Walker CL Stress and coping in siblings of childhood cancer patients. Nurs Res 37(4):208-212, 1988 20. Freiberger D, Bryant J, Marino B: The effects of different central venous line dressing changes on bacterial growth in a pediatric oncology population. J Pediatr Oncol Nurs
9(1):3-7, 1992
Nursing Research—Moving Forward Through Networking, Collaboration, and Mentorship Marilyn Hockenberry-Eaton, RNC, PhD, PNP the past 20 years nursing has undertaken the task of developing the theoretical body of knowledge necessary to guide and refine nursing practice. The need to develop theoretical nursing knowledge is understood more clearly by defining the differences between nursing as a profession and nursing as a scientific discipline. The profession of nursing refers
D URING -L~
provide a comprehensive review of every study performed by nurses in pediatric oncology ; rather, it presents examples of contributions that have impacted nursing practice. Nursing research contributions in pediatric oncology not
to
major focus areas: late treatment, adolescent issues, support groups, effects on the family, parental decision-making abilities, and symptom man-
the
agement.
the activities performed by the practitioners in field.’ The discipline of nursing is developed through systematic study of individuals as they adapt to health, illness, disability, and change in relation to environmental influences and nursing
actions.’
As the Association of Pediatric OncolNurses (APON) continues to develop goals ogy and plan strategies to attain these goals, closer examination is necessary to assess the advantages of integrating nursing research into clinical practice. The purpose of this article is to reflect on nursing research accomplishments in the specialty and to discuss ways that will help pediatric oncology nursing bridge the gap between research and clinical practice.
Stepping Stones From the Past A review of the literature shows numerous in pediatric oncology who have provided a foundation for integrating nursing research findings into clinical practice. This article does nurses
From the Graduate Pediatric Oncology Program, Emory GA. Address reprint requests to Marilyn Hockenberry-Eaton, RNC, PhD, PNP, Emory University School of Nursing, Atlanta, GA 30322. © 1992 by Association of Pediatric Oncology Nurses.
University, Atlanta,
1043-454219210903-0005$03.0010
132
have been made in five
effects of
cancer
One of the first nursing research contributions to the childhood cancer literature evaluated the
psychological late effects of childhood cancer.2 Fergusson’s pioneer work initiated her role as a model for advanced nursing practice, paving the way for others to investigate the effects of therapy on the survivors of childhood cancer. 3.4 Research by Moore et al4 established the credibility for nursing’s involvement in the evaluation of the physiological and psychological effects of cancer treatment on the child. Other significant contributions have been made by nurses who have increased our understanding of adolescents with cancer.5~9 For example, the work by Hinds6 has evolved into a theory of adolescent hopefulness that provides a scientific foundation for the care of adolescents with cancer. The importance of evaluating the effectiveness of nursing interventions is exemplified in the work by Heineyl0 and others who have evaluated support groups for children and their families.&dquo; Nurses have contributed to the body of knowledge through research evaluating pain management for children and adolescents with cancer.12.13 cursing research involving parental decisionmaking practices regarding informed consent
_
133
scientific basis for the need for involved in parent educa-
nursing interventions will be developed to improve quality patient care. For example, re-
tion and support. 14 Hymovich’sl5 work regarding families and chronic illness lends support for a theory of pediatric oncology nursing. Nursing research assessing the impact of childhood cancer on the family provides knowledge of the magnitude of changes that occur in the family following the diagnosis of a child or adolescent with cancer.16.17 Evaluation of the effects of living with a brother or sister who has cancer provides insight regarding the needs of the siblings in the family.18.19 Recently, nurses have contributed to the knowledge base regarding nursing management issues such as central line care 2° Implementation of research studies to investigate
search findings of adolescents who have cancer have increased awareness of the need for adolescents to be treated differently than the child with cancer. 5-9 Additionally, investigation of pain in children and adolescents with cancer has improved nursing care by providing rationale for
has
provided
. nurses to
be
a
actively
symptom management strategies
is
increasing,
by the number of research abpresented in this area at the last two national conferences. The work completed by nurses involved in research has provided the demonstrated
stracts
foundation on which to build scientific knowledge that will guide future pediatric oncology
nursing practice.
Moving Toward Scientific Nursing Practice The
question has been raised by nurses in all specialty areas: Why is research-based practice so important? To state it clearly, research-based practice enables nursing to provide the highest quality of care possible based on scientific knowledge. To examine research-based practice further, nurses must ask themselves how often are nursing interventions performed because &dquo;that’s policy&dquo; or, even worse, because &dquo;it has always been done that way.&dquo; Rationale based on past experiences and procedures that have not been established through scientific inquiry may not provide for the best possible quality patient care. Nurses frequently practice nursing without understanding the scientific basis for the intervention. Of equal concern is the realization that nurses frequently must provide care when no scientific knowledge is available at all to support nursing actions. It is through nursing research that improved
pain-management strategies based on scientific
inquiry. 12,13 Nurses who have provided us with the stepping stones from past research have answered many questions already and provide the catalyst for further investigation. Building
a
Future for
Nursing Research
The three major components for successful nursing research in pediatric oncology are networking, collaboration, and mentorship. These three elements must be developed further within APON for nursing research to impact future pediatric oncology nursing practice.
IYefworking Communication between
expert. clinicians
and researchers is the first step towards building future research studies. Networking occurs when a group that has common goals communicates at regular intervals to define and direct efforts to meet these goals. Sharing ideas and insight creates questions that will contribute to
improving nursing practice. Networking be= tween the clinician and the researcher is essential. The nurse in clinical practice holds the key to developing appropriate research questions that will improve the quality of care for children with cancer. The researcher offers the clinician advanced knowledge of the research process. Through networking, the researcher must work with the clinician to develop the research team.
Collaboration
.
As members of an organization devoted to the of children with cancer, pediatric oncology nurses must consider common nursing research interests and provide ways to facilitate care
134
research collaboration. Working jointly with othallows for stronger research programs to evolve. Collaboration is exemplified in the work by Ruccione et al 14 who conducted a research project at several clinical sites, providing the nursing literature with specific interventions that facilitate parent understanding of informed consent. Collaborative efforts facilitate the development of quality research programs by providing the population, resources, and clinical and research experts that promote research growth. The literature shows that a major limitation of many nursing studies is an inadequate sample size. In a specialty with a small patient population, collaborative efforts allow for increased opportunities to examine childhood cancer issues that could not be studied by one research team ers
independently.
Mentorship A mentor is defined as a trusted counselor or guide. Trust is a key word in the development of a mentoring relationship. Respect of each other’s strengths as well as the ability to identify one’s own weaknesses is a requisite for the development of a trusting relationship that facilitates
mentorship opportunities. Unfortunately,
clinicians and researchers sometimes have difficulty working together, both unable to trust the other’s expertise. Research teamwork requires that individuals with different expertise come together to bring their strengths to the project.
Individuals committed to research must be willing to become mentors for others less experienced in the research process. Sharing of ideas and expertise will facilitate professional growth within the specialty and ultimately influ’
ence
patient care.
Summary Numerous pediatric oncology nurses have provided the specialty with research that has established a foundation for the nursing care of children and adolescents with cancer. The research committee within APON is committed to facilitating further research development among pediatric oncology nurses. Research growth within APON will continue with the development of precongress research workshops for nurses interested in developing research projects, an advanced nursing research session to be held at the next national conference, and the organization of networking among pediatric oncology nurse researchers. Additionally, the research column will provide nurses with a review of the research process over the next several issues
Knowledge building is an evolving, dynamic process that is rapidly changing due to the newness of the specialty. As the pediatric oncology specialty continues to grow, networking, collaboration, and mentorship must become the keys to facilitating future research growth within APRON.
Referenc’es 1. Donaldson C: The
discipline of nursing.
Nurs Outlook
26:113-120.1978 2. Fergusson J: Psychological late effects of a serious illness in childhood. Nurs Clin North Am 11:83-93, 1976 3. Hobbie W: Late effects of childhood cancer: A program approach. J Assoc Pediatr Oncol Nurs 6(2):39, 1989 4. Moore [M, Kramer JH, Wara W, et al: Cognitive function in children with leukemia. Effect of radiation dose and time since irradiation. Cancer 68(9):1913-1917, 1991 5. Chambas K: Sexual concerns of adolescents with cancer. J Pediatr Oncol Nurs 8:165-172, 1991 6. Hinds PA: Adolescent hopefulness in illness and health. Adv Nurs Sci 10(3):79-88, 1988 7. Hinds PA, Martin J: Hopefulness and the self-sustaining process in adolescents with cancer. Nurs Res 37(6) :336-
340, 1988 8.
Overbaugh KA, Sawin K: Future life expectations and
self-esteem of the adolescent survivor of childhood cancer. J Pediatr Oncol Nurs 9:8-16, 1992 9. Rechner M: Adolescents with cancer: Getting on with life. J Pediatr Oncol Nurs 7:139-144, 1990 10. Heiney SP, Goon-Johnson K, Ettinger RS, et al: The effects of group therapy on siblings of pediatric oncology patients. J Pediatr Oncol Nurs 7:95-100, 1990 11. Wells LM, Heiney SP, Swygert E, et al: Psychosocial stressors, coping resources, and information needs of par-
of adolescent cancer patients. J Pediatr Oncol Nurs 7:145-148, 1990 12. Broome ME, Bates TA, Lillis PP, et al: Children’s medical fears, coping behaviors, and pain perceptions during a lumbar puncture. Oncol Nurs Forum 17(3)361-367, 1990 13. Pfefferbaum B, Adams J, Aceves J: The influence of culture on pain in Anglo and Hispanic children with cancer. J Am Acad Child Adolesc Psychiatry 29(4):642-647, 1990 14. Ruccione K, Kramer RF, Moore IK, et al: Informed ents
135
consent for treatment of childhood cancer. Factors
parents’
decision
affecting
making. J Pediatr Oncol Nurs 8:112-121,
1991 15. Hymovich DP: A theory for pediatric oncology nursing practice and research. J Pediatr Oncol Nurs 7:131-138, 1990 16. Bossert E, Martinsen IM: Kinetic family drawingsrevised : A method of determining the impact of cancer on the family as perceived by the child with cancer. J Pediatr Nurs 5(3):204-213, 1990 17. Martinson IM, Cohen MH: Themes from a longitudinal
study of family reaction to childhood cancer. J Psychosocial Oncol 6(314):81-98, 1988 18. Kramer RF: Living with childhood cancer: Healthy siblings perspectives. Issues Comp Pediatr Nurs 5(3):155-165, 1981 19. Walker CL Stress and coping in siblings of childhood cancer patients. Nurs Res 37(4):208-212, 1988 20. Freiberger D, Bryant J, Marino B: The effects of different central venous line dressing changes on bacterial growth in a pediatric oncology population. J Pediatr Oncol Nurs
9(1):3-7, 1992
