Research in Nursing & Health, Editorial, 15. 407
EDITORIAL
Politics, Policy, and Research Editorials don’t always come easily. Sometimes I find myself preoccupied with issues that, on the surface at least, seem unrelated to the usual editorial topics of conduct, substance, or reporting of nursing research. As I write, it’s early Fall and the national elections in the United States are about 6 weeks away. By the time you read this, the elections will be history. Nothing I write could possibly influence the outcome of this particular election, but my preoccupation with it persists. The need for reform of the health care system has turned out to be a major campaign issue this year. Perhaps, when all the campaign rhetoric is done, there will be some meaningful changes in our approach to the provision of health services. At the moment, though, it’s hard to be optimistic that those changes will occur in the foreseeable future or that they will be anything other than cosmetic. Curiously absent from the discussions of the issues is any real evidence that nurses, the largest group of health professionals, will figure very prominently in any of these program changes-we have been only minimally involved in policy development and are unlikely to have much control over the implementation of whatever programs evolve. There are several factors that might be identified as reasons for this state of affairs. The first and most obvious is our relative lack of involvement as individuals, and particularly as nurses, in the political processes that are essential to policy formulation. A second reason, and just as obvious, is the customary equation of health care with medical (physician) care. The two terms have been used interchangeably for so long that it is hardly surprising to find the reins of control so firmly in the hands of our physician colleagues. Nor is it surprising that the media infrequently mention nurses in their discussions of health care or look to them as experts. Other issues, including those of gender and status, could be cited as well. More to the point from my perspective as a nursing research journal editor, however, is the extent to which our ideas for health care reform have any real substance. Just what is it that we want, beyond universal access to care? And what good is universal access if that means no more
than making current, inadequate health care prescriptions more widely available? In the best of all possible worlds, we would have research data upon which to base proposals for nursing programs that might be expected substantially to improve the health of our constituents. To date, however, such data seem to be largely nonexistent. Despite an exponential increase in the number of nurses prepared to do research, and a concommitant increase in both the absolute number of nursing studies and the number of journals in which they are published, disturbingly few research efforts seem designed to solve health care problems. The manuscripts now on my desk awaiting editorial decisions are fairly typical of the work being done in the field. The majority are reports of descriptive studies, a few of which may add to our understanding of the phenomena of concern to nurses. Most, however, are so illconceived that, even at a descriptive level, they can add nothing to our knowledge base. Reports of experimental studies testing conceptually sound nursing interventions and using adequate methods to do so remain a rarity in submissions to this and every other clinical or research journal you might care to review. We have vast potential within the discipline to alter materially the nature of health care programs. If that potential is to be realized, however, we will need to stop using our limited resources on research of limited significance that can be expected to have little effect on either the practice of nursing or the broader health care challenges before us. The establishment of clear priorities by funding agencies, such as those of the National Center for Nursing Research, certainly is a step in the direction of concentrating resources where they have the most potential for good. Most of our research is either unfunded or funded locally, however, and such priorities are not applied. At an even more basic level, perhaps it is time to take another look at what constitutes a meaningful research experience for graduate students, particularly those preparing for careers as scientists in the field. Students ought to be engaged in meaningful research from the outset, research focused on finding real answers to important questions. While this implies that they learn the best methods to use, it also implies that consider-
408
EDITORIAL
able attention will be directed to guiding students in the identification of questions that are both appropriate and important for the discipline’s scientists to be concerned about. I’d like to believe that this is happening in our doctoral programs but, as yet, see only limited evidence to support that belief. In the absence of hard data, it is not possible to propose and convincingly defend our ideas about
health care! programs. Neither policy makers nor health care consumers will be markedly influenced by our good intentions. Isn’t it time that we got on with the business of generating the data we need? Marilyn T. Oberst Edltor
EDITORIAL
Politics, Policy, and Research Editorials don’t always come easily. Sometimes I find myself preoccupied with issues that, on the surface at least, seem unrelated to the usual editorial topics of conduct, substance, or reporting of nursing research. As I write, it’s early Fall and the national elections in the United States are about 6 weeks away. By the time you read this, the elections will be history. Nothing I write could possibly influence the outcome of this particular election, but my preoccupation with it persists. The need for reform of the health care system has turned out to be a major campaign issue this year. Perhaps, when all the campaign rhetoric is done, there will be some meaningful changes in our approach to the provision of health services. At the moment, though, it’s hard to be optimistic that those changes will occur in the foreseeable future or that they will be anything other than cosmetic. Curiously absent from the discussions of the issues is any real evidence that nurses, the largest group of health professionals, will figure very prominently in any of these program changes-we have been only minimally involved in policy development and are unlikely to have much control over the implementation of whatever programs evolve. There are several factors that might be identified as reasons for this state of affairs. The first and most obvious is our relative lack of involvement as individuals, and particularly as nurses, in the political processes that are essential to policy formulation. A second reason, and just as obvious, is the customary equation of health care with medical (physician) care. The two terms have been used interchangeably for so long that it is hardly surprising to find the reins of control so firmly in the hands of our physician colleagues. Nor is it surprising that the media infrequently mention nurses in their discussions of health care or look to them as experts. Other issues, including those of gender and status, could be cited as well. More to the point from my perspective as a nursing research journal editor, however, is the extent to which our ideas for health care reform have any real substance. Just what is it that we want, beyond universal access to care? And what good is universal access if that means no more
than making current, inadequate health care prescriptions more widely available? In the best of all possible worlds, we would have research data upon which to base proposals for nursing programs that might be expected substantially to improve the health of our constituents. To date, however, such data seem to be largely nonexistent. Despite an exponential increase in the number of nurses prepared to do research, and a concommitant increase in both the absolute number of nursing studies and the number of journals in which they are published, disturbingly few research efforts seem designed to solve health care problems. The manuscripts now on my desk awaiting editorial decisions are fairly typical of the work being done in the field. The majority are reports of descriptive studies, a few of which may add to our understanding of the phenomena of concern to nurses. Most, however, are so illconceived that, even at a descriptive level, they can add nothing to our knowledge base. Reports of experimental studies testing conceptually sound nursing interventions and using adequate methods to do so remain a rarity in submissions to this and every other clinical or research journal you might care to review. We have vast potential within the discipline to alter materially the nature of health care programs. If that potential is to be realized, however, we will need to stop using our limited resources on research of limited significance that can be expected to have little effect on either the practice of nursing or the broader health care challenges before us. The establishment of clear priorities by funding agencies, such as those of the National Center for Nursing Research, certainly is a step in the direction of concentrating resources where they have the most potential for good. Most of our research is either unfunded or funded locally, however, and such priorities are not applied. At an even more basic level, perhaps it is time to take another look at what constitutes a meaningful research experience for graduate students, particularly those preparing for careers as scientists in the field. Students ought to be engaged in meaningful research from the outset, research focused on finding real answers to important questions. While this implies that they learn the best methods to use, it also implies that consider-
408
EDITORIAL
able attention will be directed to guiding students in the identification of questions that are both appropriate and important for the discipline’s scientists to be concerned about. I’d like to believe that this is happening in our doctoral programs but, as yet, see only limited evidence to support that belief. In the absence of hard data, it is not possible to propose and convincingly defend our ideas about
health care! programs. Neither policy makers nor health care consumers will be markedly influenced by our good intentions. Isn’t it time that we got on with the business of generating the data we need? Marilyn T. Oberst Edltor
