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Finding a role for cancer nurses in research
GUE S T EDI TORI AL
Finding a role for cancer nurses in research There is a growing pressure on cancer nurses to utilize research, develop evidence-based practice and engage in research activities. The muchdebated concept of the `theory-practice gap' continues to be discussed in the oncology nursing literature (Ferrell et al. 1990) and recommendations proered for how this may be bridged (Graydon et al. 1993). Despite the wealth of literature in this area, there is continuing evidence that despite valuing research, cancer nurses are not able to routinely participate in research-related activities, with a number of barriers being identi®ed (Walczak et al. 1994). One approach to overcome this is to acknowledge that not all nurses are required to be fully pro®cient in instigating, undertaking and evaluating research, and that there are dierent levels of research awareness and competence required in the cancer nursing ®eld (Arrigo 1991). Fitch and Thompson (1996) identi®ed a number of research-related roles for cancer nurses: consumer, facilitator, contributor and advocate. Delegates at the 2nd European Oncology Nursing Society (EONS) Convention, held in Prague (13±15 April 2000), were invited to utilize the framework in one of the conference workshops outlined by Fitch and Thompson (1996) in order to ®nd a place for research in their practice. This proved a challenging framework to interpret and translate across a breadth of nursing roles and clinical areas from a variety of countries. However, the data derived from the conference workshops enables the critical analysis of this framework across the spectrum of nursing experience. A key ®nding from this exercise was that a major barrier for many nurses was the lack of accessible literature in a format and language that enables key research ®ndings to be translated into practice in any clinical setting. One workshop group recommended that EONS could play a role in summarizing key nursing research in useable formats for oncology nurses across Europe. Another issue that became apparent was that research utilization guidelines described in the literature are also not readily transferable amongst cancer nurses from such diverse professional and organizational cultures, and we must ®nd ways to interpret them within the practice arenas of all cancer nurses. This was highlighted by the challenge of translating a Canadian European Journal of Oncology Nursing 4 (2), 73^74 # 2000 Harcourt Publishers Ltd DOI: 10.1054/ejon.2000.0090, available online at http://www.idealibrary.com.on
framework for research-related roles (Fitch & Thompson 1996) into a form comprehensible to nurses from a variety of countries. Feedback from the participants suggested that within practice there was considerable overlap in the research-related roles of consumer, facilitator, contributor and advocate. Many of the expectations for each of these roles, as outlined by Fitch and Thompson (1996), were dicult to relate to the diversity of practice experiences. The workshop data demonstrated that in order to be eective consumers of research, nurses still require considerable support and training in accessing appropriate research, critical analysis of research and the development of a questioning approach to care. However, a role common to all cancer nurses was that of contributing ideas from practice to research in order to identify and prioritize clinical problems. There are a number of good examples of where this has happened in practice in the literature (Oberst 1978, Degner et al. 1987, Mooney et al. 1991, Bakker & Fitch 1998, Daniels & Ascough 1999). It appears that in reality other elements of the role of contributor and facilitator of research, such as the design and implementation of research, were dicult to achieve for nurses involved in direct care-giving roles. A barrier to implementing any of the research-related roles, expressed by oncology nurses from dierent countries, was that of resistance from other disciplines, management and even fellow nurses. Therefore a new role of `motivator' emerged which required skills in leadership, team building and changing practice. The re¯ections of the nurses attending the Spring Convention with the theme `Finding a place for research in your clinical practice' support the view that there are dierent levels of research awareness and competence required in the cancer nursing ®eld (Arrigo 1991). If research is to become an integral component of practice, this should be recognized through speci®cally designated roles as advocated in cancer nursing strategy documents in the UK (RCN 1996) rather than a pressure on all nurses to perform research. Despite guidelines for the integration of research within oncology clinical nurse specialist roles (OCNS) (Dodd 1992, Spross et al. 1992), evidence suggests that less time is spent on research than other aspects of
74 European Journal of Oncology Nursing
the OCNS role (Smith & Waltman 1994). If research is to become a key component of OCNS practice then we must consider the resources required to facilitate this more eectively. Support for developing research-related roles amongst nurses involved in direct care giving appears to be best focused initially on facilitating the consumer, advocate and the newly identi®ed motivator roles. Oncology nurses are expected to develop policy, protocols and practice in response to changes in treatment modalities, side-eect pro®les and needs of families and survivors. Education and professional organizations must respond by facilitating the attainment of skills to incorporate research ®ndings into protocols for care, bring about change in practice and facilitate team-working strategies. The roles of contributor and facilitator will evolve with the advent of designated nursing research roles that enable practitioners and researchers to work alongside each other in practice settings. With thanks to the workshop leaders at the EONS Convention for their comments.
REFERENCES Arrigo C (1991) Meeting the research needs of nurses in cancer care. European Journal of Cancer Care 1(1): 19±22 Bakker DA, Fitch MI (1998) Oncology nursing research priorities: A Canadian perspective. Cancer Nursing 21(6): 394±401 Daniels L, Ascough A (1999) Developing a strategy for cancer nursing research: identifying the priorities. European Journal of Oncology Nursing 3(3): 161±169
European Journal of Oncology Nursing 4 (2), 73^74
Degner L (1987) Priorities for cancer nursing research. Cancer Nursing 10(6): 319±326 Dodd MJ (1992) The role of the oncology clinical nurse specialist in research. Oncology Nursing Forum 19(1): 25±27 Ferrell BR, Grant MM, Rhiner M (1990) Bridging the gap between research and practice. Oncology Nursing Forum 17(3): 447±448 Fitch MI, Thompson L (1996) Fostering the growth of research-based oncology nursing practice. Oncology Nursing Forum 23(4): 631±637 Graydon JE, West P, Galloway S, Burlein-Hall S, PalmerWickham S, Blair A, Evans-Boyden B, HarrisonWoermke D, Limoges J, McCollin A, Rich-van der Bij L (1993) Bridging the gap between research and clinical practice: A collaborative approach. Oncology Nursing Forum 20(6): 953±957 Mooney KH, Ferrell BR, Nail LM, Benedict SC, Haberman MR (1991) Oncology Nursing Forum 18(18): 1381±1388 Oberst MT (1978) Priorities in cancer nursing research. Cancer Nursing 1(4): 281±290 Royal College of Nursing (1996) A Structure for Cancer Nursing Services. RCN, London Smith JE, Waltman NL (1994) Oncology clinical nurse specialists' perceptions of their in¯uence on patient outcomes. Oncology Nursing Forum 21(5): 887±893 Spross JA, Gallagher J, Powel LL (1992) Conference Recommendations: Practice, Administration, Research, Education, and Healthcare Policy. Oncology Nursing Forum 19(Suppl 1): 32±41 Walczak JR, McGuire DB, Hais®eld ME, Beezley A (1994) A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses. Oncology Nursing Forum 21(4): 710±715
Lilian Daniels Macmillan Research Lecturer Centre for Palliative Care & Oncology University of Central England UK
Finding a role for cancer nurses in research There is a growing pressure on cancer nurses to utilize research, develop evidence-based practice and engage in research activities. The muchdebated concept of the `theory-practice gap' continues to be discussed in the oncology nursing literature (Ferrell et al. 1990) and recommendations proered for how this may be bridged (Graydon et al. 1993). Despite the wealth of literature in this area, there is continuing evidence that despite valuing research, cancer nurses are not able to routinely participate in research-related activities, with a number of barriers being identi®ed (Walczak et al. 1994). One approach to overcome this is to acknowledge that not all nurses are required to be fully pro®cient in instigating, undertaking and evaluating research, and that there are dierent levels of research awareness and competence required in the cancer nursing ®eld (Arrigo 1991). Fitch and Thompson (1996) identi®ed a number of research-related roles for cancer nurses: consumer, facilitator, contributor and advocate. Delegates at the 2nd European Oncology Nursing Society (EONS) Convention, held in Prague (13±15 April 2000), were invited to utilize the framework in one of the conference workshops outlined by Fitch and Thompson (1996) in order to ®nd a place for research in their practice. This proved a challenging framework to interpret and translate across a breadth of nursing roles and clinical areas from a variety of countries. However, the data derived from the conference workshops enables the critical analysis of this framework across the spectrum of nursing experience. A key ®nding from this exercise was that a major barrier for many nurses was the lack of accessible literature in a format and language that enables key research ®ndings to be translated into practice in any clinical setting. One workshop group recommended that EONS could play a role in summarizing key nursing research in useable formats for oncology nurses across Europe. Another issue that became apparent was that research utilization guidelines described in the literature are also not readily transferable amongst cancer nurses from such diverse professional and organizational cultures, and we must ®nd ways to interpret them within the practice arenas of all cancer nurses. This was highlighted by the challenge of translating a Canadian European Journal of Oncology Nursing 4 (2), 73^74 # 2000 Harcourt Publishers Ltd DOI: 10.1054/ejon.2000.0090, available online at http://www.idealibrary.com.on
framework for research-related roles (Fitch & Thompson 1996) into a form comprehensible to nurses from a variety of countries. Feedback from the participants suggested that within practice there was considerable overlap in the research-related roles of consumer, facilitator, contributor and advocate. Many of the expectations for each of these roles, as outlined by Fitch and Thompson (1996), were dicult to relate to the diversity of practice experiences. The workshop data demonstrated that in order to be eective consumers of research, nurses still require considerable support and training in accessing appropriate research, critical analysis of research and the development of a questioning approach to care. However, a role common to all cancer nurses was that of contributing ideas from practice to research in order to identify and prioritize clinical problems. There are a number of good examples of where this has happened in practice in the literature (Oberst 1978, Degner et al. 1987, Mooney et al. 1991, Bakker & Fitch 1998, Daniels & Ascough 1999). It appears that in reality other elements of the role of contributor and facilitator of research, such as the design and implementation of research, were dicult to achieve for nurses involved in direct care-giving roles. A barrier to implementing any of the research-related roles, expressed by oncology nurses from dierent countries, was that of resistance from other disciplines, management and even fellow nurses. Therefore a new role of `motivator' emerged which required skills in leadership, team building and changing practice. The re¯ections of the nurses attending the Spring Convention with the theme `Finding a place for research in your clinical practice' support the view that there are dierent levels of research awareness and competence required in the cancer nursing ®eld (Arrigo 1991). If research is to become an integral component of practice, this should be recognized through speci®cally designated roles as advocated in cancer nursing strategy documents in the UK (RCN 1996) rather than a pressure on all nurses to perform research. Despite guidelines for the integration of research within oncology clinical nurse specialist roles (OCNS) (Dodd 1992, Spross et al. 1992), evidence suggests that less time is spent on research than other aspects of
74 European Journal of Oncology Nursing
the OCNS role (Smith & Waltman 1994). If research is to become a key component of OCNS practice then we must consider the resources required to facilitate this more eectively. Support for developing research-related roles amongst nurses involved in direct care giving appears to be best focused initially on facilitating the consumer, advocate and the newly identi®ed motivator roles. Oncology nurses are expected to develop policy, protocols and practice in response to changes in treatment modalities, side-eect pro®les and needs of families and survivors. Education and professional organizations must respond by facilitating the attainment of skills to incorporate research ®ndings into protocols for care, bring about change in practice and facilitate team-working strategies. The roles of contributor and facilitator will evolve with the advent of designated nursing research roles that enable practitioners and researchers to work alongside each other in practice settings. With thanks to the workshop leaders at the EONS Convention for their comments.
REFERENCES Arrigo C (1991) Meeting the research needs of nurses in cancer care. European Journal of Cancer Care 1(1): 19±22 Bakker DA, Fitch MI (1998) Oncology nursing research priorities: A Canadian perspective. Cancer Nursing 21(6): 394±401 Daniels L, Ascough A (1999) Developing a strategy for cancer nursing research: identifying the priorities. European Journal of Oncology Nursing 3(3): 161±169
European Journal of Oncology Nursing 4 (2), 73^74
Degner L (1987) Priorities for cancer nursing research. Cancer Nursing 10(6): 319±326 Dodd MJ (1992) The role of the oncology clinical nurse specialist in research. Oncology Nursing Forum 19(1): 25±27 Ferrell BR, Grant MM, Rhiner M (1990) Bridging the gap between research and practice. Oncology Nursing Forum 17(3): 447±448 Fitch MI, Thompson L (1996) Fostering the growth of research-based oncology nursing practice. Oncology Nursing Forum 23(4): 631±637 Graydon JE, West P, Galloway S, Burlein-Hall S, PalmerWickham S, Blair A, Evans-Boyden B, HarrisonWoermke D, Limoges J, McCollin A, Rich-van der Bij L (1993) Bridging the gap between research and clinical practice: A collaborative approach. Oncology Nursing Forum 20(6): 953±957 Mooney KH, Ferrell BR, Nail LM, Benedict SC, Haberman MR (1991) Oncology Nursing Forum 18(18): 1381±1388 Oberst MT (1978) Priorities in cancer nursing research. Cancer Nursing 1(4): 281±290 Royal College of Nursing (1996) A Structure for Cancer Nursing Services. RCN, London Smith JE, Waltman NL (1994) Oncology clinical nurse specialists' perceptions of their in¯uence on patient outcomes. Oncology Nursing Forum 21(5): 887±893 Spross JA, Gallagher J, Powel LL (1992) Conference Recommendations: Practice, Administration, Research, Education, and Healthcare Policy. Oncology Nursing Forum 19(Suppl 1): 32±41 Walczak JR, McGuire DB, Hais®eld ME, Beezley A (1994) A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses. Oncology Nursing Forum 21(4): 710±715
Lilian Daniels Macmillan Research Lecturer Centre for Palliative Care & Oncology University of Central England UK