Response: to be or not to be? Nurse? Researcher? Or both?

Organizational predicaments: ethical conditions for nursing research

AIM

This paper highlights the sometimes problematic matter of access to the field in clinical ethnographic research by discussing a hypothetical scenario of an instance of change in the terms of access.

BACKGROUND

A review of the methodological literature about research access revealed that there was little in the nursing literature about this issue, although anecdotally many nurse researchers reveal that access is not unproblematic and requires active maintenance to ensure smooth operation of a project. However, in returning to literature in sociology and anthropology, where gaining access for fieldwork is not considered so routine, we found much in the literature about dilemmas, predicaments and conflicts over access, confidentiality and anonymity that were not mentioned in nursing research about access to clinical areas. We returned also to the ethical and legal framework guiding access practices so as to explore the issues in fieldwork situations.

DISCUSSION

In exploring the problems arising from maintaining confidentiality, safety of participants and researchers, it is clear that the much-vaunted insider status is both a boon and a burden. Intimate and inquisitive research using ethnographic techniques has the potential to unsettle organizations and workers through the very processes used to undertake the research.

CONCLUSION

Ethical comportment is not enough to protect a study. A more overt and less naïve approach to access for fieldwork is required to better inform future nurse researchers how to maintain access to the field and the requirement of constant negotiation and adjustment.

Nurse researcher: always a researcher, sometimes a nurse

A number of theoretical papers have highlighted the concept of the duality and dichotomy of roles when nurses are carrying out research in the clinical arena. The conflicts that can occur are between the roles of researcher and nurse and in the balance between research integrity and the welfare of the individual. There are various personal accounts in the literature of nurse researchers' experiences of unclear role expectations when doing research. There appears to be no consensus on how nurse researchers should handle these varying expectations. No comparative analysis of the reflections of a collective of nurse researchers on role expectations in different clinical contexts was found in an extensive literature search. This paper attempts to do this by analysing stories of a small group of nurse researchers in different clinical contexts. Data were analysed from written stories and audio-taped interviews with nurse researchers about moving from the researcher to the nurse role in doing clinical research. Thematic analysis indicated that the participants' reactions could be classified as either those of a nurse researcher, always the researcher, or as the nurse researcher, sometimes the nurse. There were no distinct differences in relation to research topic, methodology or context. The study highlights the fact that nurses need better research education, team and management support when conducting research and opportunities to debrief after encountering mixed role expectations in the field. Open debate amongst nurse researchers about role delineation is essential to both novices and experts for them to share their experiences and their solutions.

Professional journalling over time: position of the inside nurse-researcher in intensive care

The purpose of this paper is to examine the use of professional journalling in an intensive care unit. In particular, this paper explores the power and contextual relations that shaped nurse-nurse and nurse-doctor decision-making, from the author's perspective as the inside nurse-researcher. A variety of research methods were used for this study, including professional journalling, participant observation, and individual and focus group interviews. The author also worked as a clinical nurse specialist, as the inside nurse-researcher, in the unit under investigation. The results indicated that the power and contextual relations constructing nurse-nurse and nurse-doctor decision-making focused on two major issues. These concerned: drawing on particular forms of knowledge and acquiring differential visibility by the nurse in decision-making. The study demonstrated that professional journalling is an effective research method for helping nurses to question decision-making critically, not for examining the position of an inside nurse-researcher, and for supporting data obtained from other research methods.

Situating wound management: technoscience, dressings and 'other' skins

This paper addresses the notion of wound care as a technology of skin and other skins imbued with the combined power of technology and science. It presents the discourses of wound care evident in the accounts of patients and nurses concerning this care, and discussions about wounds in wound care interest groups, journals, and advertising material about wound care products. The discussion focuses on wounds and wound dressings as effects immanent in the power relations of discourses of wound care. These effects colour and influence nurses' responses to wounds and wound care products. Moreover, the discourses that portray these practices are evidence of the complex articulation between technoscience and gender. Nurses and patients are fascinated by wound technoscience and lured towards it by its potential for mastery and control over wounds. Such seductions are evident in the texts of nurses, patients, and pharmaceutical advertisements for wound care products. Finally, the ways that these representations are used to talk about and market wound care products are shown as exemplifying the finer points of wound management as a nursing technoscience.

Phenomenologies as research methodologies for nursing: from philosophy to researching practice

This paper is concerned with the popularity of phenomenologies and the tensions that arise from their use as research methodologies in nursing. Among these tensions are: the troublesome issues of adapting a fundamentally philosophical means of understanding human being(s) for use as a more pragmatic and robust research approach in a practice discipline; the various types of phenomenology and the confusions that surround these and other interpretive methodologies, particularly within different intellectual and cultural traditions; and the need for nursing to find a space in which it can give voice to aspects of its practice that are silenced in less existentially oriented methodologies. Although phenomenologies are currently popular and possibly fashionable in nursing, there are important issues in relation to their use in a methodological sense that remain to be addressed.

The nurse researcher: an added dimension to qualitative research methodology

Nurse researchers are increasingly adopting qualitative methodologies for research practice and theory development. These approaches to research are, in many cases, more appropriate for the field of nursing inquiry than the previously dominant techno-rational methods. However, there remains the issue of adapting methodologies developed in other academic disciplines to the nursing research context. This paper draws upon my own experience with interpretive research to raise questions about the issue of nursing research within a social science research framework. The paper argues that by integrating the characteristics of nursing practice with the characteristics of research practice, the researcher can develop a 'nursing lens', an approach to qualitative research that brings an added dimension to social science methodologies in the nursing research context. Attention is drawn to the unique nature of the nurse-patient relationship, and the ways in which this aspect of nursing practice can enhance nursing research. Examples are given from interview transcripts to support this position.