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Twenty-five years of critical care nursing scholarship in Australia
Australian Critical Care 26 (2013) 7–11
Contents lists available at SciVerse ScienceDirect
Australian Critical Care journal homepage: www.elsevier.com/locate/aucc
Twenty-five years of critical care nursing scholarship in Australia Sharon McKinley (RN PhD) a,b,∗ , Doug Elliott (RN PhD MAppSc ICCert) a,1 a b
Faculty of Health, University of Technology, Sydney, NSW, Australia University of Technology, Sydney & Northern Sydney Local Health District, NSW, Australia
article information
s u m m a r y
Article history: Received 31 August 2012 Received in revised form 17 October 2012 Accepted 23 October 2012
Background: Australian Critical Care has been published since 1988 and has been an important medium for the development of critical care nursing scholarship in Australia over 25 years. Purpose: To review scholarship in critical care nursing in Australia since 1988 and record its progress in the context of developments in nursing education and intensive and critical care practice. Approach: Australian Critical Care issues since 1988 were reviewed, and abstracts from the Australian and New Zealand Annual Scientific Meeting on Intensive Care published in Australian Critical Care since the 1991 Meeting. Available evidence for the contribution of this body of scholarship to critical care nursing practice and patient care was considered. Results: Original research reports and review articles have steadily increased from 1988 to 2012. The peak years for research publications were 2001, 2005 and 2012, and for reviews 2010 and 2011. Approximately 760 abstracts were presented at the Annual Scientific Meeting from 1991 to 2010; overall 24% were found lead to peer-reviewed publications, with an increase to 30% in recent years. Summary: Over 25 years, the scholarship of critical care nursing in Australia has evolved into an established area of disciplinary knowledge, based firmly in practice. Our discipline has witnessed the opportunity for PhD training, the introduction of professorial positions, a knowledge base built on original research and rigorous reviews, and sustainable dissemination. The challenges are to further strengthen this development, increase publication of research that is done, to demonstrate the influence on practice and to develop sustainable research funding. © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
Keywords: Intensive care Critical care nursing Scholarship Research Publication
Introduction The birth and growth of critical care nursing as a professional specialty in Australia has been well documented in the publication of the Australian College of Critical Care Nurses, ‘There’s a Bird in My Hand and a Bear by the Bed: I Must be in ICU’.1 Another decade has passed since then, and of similar importance, this journal has now been in publication for over 25 years, with the first issue printed in 1988. In this paper, we review 25 years of scholarship in critical care nursing in Australia within the context of developments in nursing education and intensive and critical care practice. Our discussion focuses on the scholarly development of critical care nursing toward a practice-based academic discipline, with a defined body
∗ Corresponding author at: Critical Care Nursing Professorial Unit, Level 6, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia. Tel.: +61 2 9926 8281. E-mail addresses: [email protected] (S. McKinley), [email protected] (D. Elliott). 1 Tel.: +61 2 9514 4832.
of knowledge, together with related methods of dissemination and communication within a community of practice and scholarship. As a professional college, the Australian College of Critical Care Nurses (ACCCN) provides a range of resources that support scholarship in the discipline, notably through Australian Critical Care, funding of research grants for members and co-hosting the Annual Australian and New Zealand Annual Scientific Meeting on Intensive Care (the ASM) with our intensivist colleagues from the Australian and New Zealand Intensive Care Society. At the ASM, prizes have been awarded for the Best Nursing Free Paper since 1983, the Nursing Scholarship Prize since 1996 and the Best Nursing Review Paper since 1997. For the purposes of this paper, scholarship includes peerreviewed reports of original research and reviews of the research literature, plus abstracts of original research and literature reviews selected by peer review for presentation at scientific meetings. We initially provide some context with a brief overview of undergraduate and postgraduate nursing education in Australia since the 1980s, including the introduction of higher degrees by research (masters and doctoral degrees) in nursing within Australian universities. Next we examine the publication of original research and
1036-7314/$ – see front matter © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
http://dx.doi.org/10.1016/j.aucc.2012.10.002
8
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11
reviews of the research literature in Australian Critical Care from 1988 to 2012, followed by a summary of the nursing abstracts presented at the Australian and New Zealand ASM on Intensive Care from 1992 to 2010 that were translated into full-text publications in the peer-reviewed literature. Finally the contribution of this body of nursing scholarship to critical care nursing practice and patient care is considered. Transfer of nursing education to the higher education sector In the 1980s and 1990s there were significant changes in nursing education across the State and Territory jurisdictions, with the transfer of hospital-based registered nurse training programs to undergraduate preregistration education in the higher education sector. Postregistration programs for specialty nursing practice, which were mainly hospital-based at that time, were then subsequently also largely replaced by postgraduate university programs. Of particular importance from a scholarship perspective, nurses were able to access all levels of education with research training through Masters and Doctoral degrees in nursing after unification of the higher education sector when schools or faculties of nursing were established in universities. Undergraduate education In 1984 the Australian government announced its support for the full transfer of preregistration nursing education from state-run hospitals to the tertiary education sector. This development saw the introduction of the 3-year Diploma of Applied Science (Nursing) in colleges of advanced education or universities, with full transfer to the tertiary sector by 1993. Subsequently the nursing profession’s target of a Bachelor of Nursing preparation for registered nurses in universities was achieved in the early 1990s. This was facilitated by the national unification of colleges of advanced education into the university sector, with preregistration education funded by the Commonwealth Government.2,3 The first state to achieve full transfer was NSW in 1985, while other states phased the transfer from hospital to tertiary programs more gradually, with Queensland having its last entry to hospital-based programs in 1990.2 Postgraduate education for specialty practice Following the transfer of undergraduate nursing education to the tertiary sector there was rapid growth in postgraduate nursing courses for specialty practice at the Certificate, Diploma and Masters levels,3–5 notably in clinical specialties but also in fields such as education and management. Students of Graduate Diploma programs often continued on to Masters of Nursing degrees, while other diplomates later returned to university to complete masters degrees.5 Postgraduate critical care courses were established in universities in each state between 1990 and 1997, often in collaboration with hospitals or wider health services.1 While ACCCN does not record specific qualifications of members, in 2012 their records showed that members reported 3463 qualifications in intensive/critical care nursing, 488 in education and 262 in management. (Note these numbers exceed the total number of members responding to the survey as respondents could indicate that they had more than one qualification). Higher degrees by research Following the merging of colleges of advanced education into the university sector in 1990, nurses were finally able to undertake Masters in Nursing by research and Doctorates of Philosophy (PhD) within the discipline of nursing.3 Prior to this, some nurses with Bachelors Degrees completed nursing-related topics in research
degrees within schools or faculties such as health sciences or sociology. More recently the option of the Doctorate in Nursing (DN), a form of professional doctorate, has become available in Australia. This form of qualification is intended to be more orientated to advancing professional practice than the traditional PhD intended for those wishing to pursue research/academic careers.6 The numbers of Australian Critical Care nurses with masters by research and doctoral degrees is not recorded, but anecdotally numbers have increased considerably since 1990. This is evidenced to some extent by the numbers of applicants for the Nursing Scholarship Prize at the ASM, whose presentations must be from their higher degree research studies, as well as the qualifications listed by Australian authors in Australian Critical Care and other journals for which we perform editorial and review duties. In the 2012 ACCCN survey, 116 respondents reported that they had research qualifications, but this may be an underestimate as not all members complete the survey. Increasing numbers of Australian Critical Care nurses with doctoral qualifications means that there are increasingly more potential supervisors for research degree students, increasingly including Bachelor Honours as well as masters and doctoral candidates. Through their publications, graduates of these degrees continue to contribute to the expansion of knowledge for the care of the critically ill in Australia and internationally. Related to this is the development of the nurse academic role in critical care with the potential to make an impact on the care of patients through their own research, the work of their coursework and research students, and academic leadership. Nurses with PhD training and a developing publication track record were eligible for both academic promotion and newly created roles as professors of critical care nursing, often as conjoint appointments with partner health services. These conjoint appointments, colloquially referred to as clinical chairs, are primarily based in the health service and have regular contact with clinical critical care nurses. This facilitates ready access by critical care nurses to academic advice and support for development of research ideas and evidence-based practice based on published research, plus currency in practicebased research for the clinical chairs. The first chair in critical care nursing in Australia was established in 1993, and three are currently four professors with critical care nursing in their job title, as well as a number of professors in university-based positions who cite critical care as their core area of scholarship. Publications in Australian Critical Care, 1988–2012 Reports of original research and review articles published in Australian Critical Care have both increased over 25 years. To evaluate the numeric contribution of publications we examined the Tables of Contents (TOC) of every issue of the journal from 1988 [1(1)] to 2012 [25(3), plus articles in press on 30th August, 2012]. Articles listed as Research Papers in the TOC or had titles denoting research (e.g. an observational study or a randomized controlled trial) were classified as research. When the titles were ambiguous, abstracts were reviewed to determine whether the articles were original research, reviews or neither. Results are shown in Fig. 1. During the first six years (1988–1993) there were very few original research articles (1 each in 1990, 1991, 1992) or reviews (2 in 1992 and 1 review in 1993). Peak years for research articles were 2001 (n = 12) and 2005 (n = 11), with some variability from year to year but an overall increase over time. Review papers peaked at 6 each in 2010 and 2011 (Fig. 1). Of note, the review articles published over this time demonstrated a qualitative trend to more explicit search and rigorous review methods in recent years, such as systematic reviews, in keeping with trends in nursing and health care literature generally. A search of the Elsevier database ScopusTM shows
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11 14 12 10 8 Research
6
Reviews
4 2 0 1988
1992
1996
2000
2004
2008
2012
Fig. 1. Research and review articles in Australian Critical Care, 1988–2012 (ACC 1988; 1(1) to 2012; 25(3), plus articles in press on 30th August, 2012).
that of 644 papers published in Australian Critical Care since 1990, 348 (54%) were research articles and 86 (13%) reviews. Abstracts to peer-reviewed publications Since 1992, Australian Critical Care has published the nursing abstracts accepted for oral or poster presentations at the Australian and New Zealand ASM on Intensive Care, beginning with the 16th Meeting in 1991. The number of nursing abstracts has gradually increased since that time, again with some variability evident from year to year, and with a peak of 64 accepted abstracts in 1999 (Fig. 2). The number of abstracts accepted for the ASM each year is partly determined by conference programming. For example, the peak of 64 accepted abstracts was related to inclusion of brief poster-oral presentations, in which presenters gave a 3 min oral presentation to supplement their poster presentation, and responded to audience questions. This approach allowed for more abstracts to be presented. In most years this format was not used and the number of accepted abstracts for oral or poster presentation was determined by their relative scores based on peer review. To explore the translation of nursing ASM abstracts to fulltext peer reviewed publications we searched PubMed Medline using author and keyword searches. Author searches were conducted first using the names of first and second authors; if these did not yield any publications, other author combinations were used. If author searches alone did not reveal publications, generic key words were added to the author names (e.g. intensive care, nursing, Australia), with or without key words specific to the
9
abstract (e.g. resuscitation, nutrition, oxygen therapy). An effort was made to discern if the ASM abstract was related to a subsequent published article, for example if the abstract was a presentation of pilot or preliminary work, or presenting a subset of the data in the published article. A total of 758 abstracts were identified as being presented at the ASM from 1991 to 2010 (excluding local abstracts presented at the combined ASM and World Congress of Intensive and Critical Care in 2001). Of this total, 184 (24%) peer reviewed articles were identified as being directly or indirectly related to the ASM abstracts from that period (Fig. 2). Overall there has been a gradual increase in the proportion of identifiable articles related to ASM abstracts, with approximately 30% in recent years. This increase in the number of ASM abstracts leading to journal publications is a credit to Australian Critical Care nurses, their collaborators and mentors, the institutions they are associated with and to ACCCN. Nevertheless the ratio of less than one in three suggests that there is a body of research and scholarship competitive enough to be selected for presentation at the ASM that is not being translated into peer reviewed publications that are available internationally in the public domain. It is acknowledged that some free paper and poster presentations at the ASM are not intended for further dissemination. There is also often a long lead time from submission of manuscripts for publication to their final appearance as articles. This process usually includes requests for revisions and resubmission, or the need to submit to an alternate journal. This process may be interpreted by new researchers and authors as failure, and lead to abandonment before completing the writing and editing task through to publication. To improve the ratio of translation of abstracts to peer-reviewed publications and initial manuscript submission to acceptance and publication requires diligence and motivational collaboration from mentors and research supervisors, and tenacity by nurse researchers and research students. Research teams who submit conference abstracts should plan and develop a full-text manuscript for submission to a target journal in conjunction with the conference presentation. Students and supervisors should submit sections of their evolving thesis for publication during candidature and prior to thesis submission. These deliberate activities may allay our recent history of research that is presented at a conference or initially submitted to a journal, but does not result in a peer-reviewed published article available for readers in our broader community of critical care practice.
Fig. 2. Australian and New Zealand Annual Scientific Meeting nursing abstracts and associated peer reviewed publications 1991–2010.
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S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11
Box 1: Citations in Australian Critical Care that have been cited 20 or more times in other journal articles. 1 2 3 4 5 6
7 8 9 10 a
Citation details
Citation ratea
Hammond, F., Saba, M., Simes, T., Cross, R. Advanced Life Support: retention of registered nurses’ knowledge 18 months after initial training. (2000) Australian Critical Care, 13 (3), pp. 99–104. Magarey, J.M. Sedation of adult critically ill ventilated patients in intensive care units: a national survey. (1997) Australian Critical Care, 10 (3), pp. 90–93. Morrison, A.L., Beckmann, U., Durie, M., Carless, R., Gillies, D.M. The effects of nursing staff inexperience (NSI) on the occurrence of adverse patient experiences in ICUs. (2001) Australian Critical Care, 14 (3), pp. 116–121. Boyle, M., Green, M. Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools. (2001) Australian Critical Care, 14 (1), pp. 24–30. Groves, N., Tobin, A. High flow nasal oxygen generates positive airway pressure in adult volunteers. (2007) Australian Critical Care, 20 (4), pp. 126–131. Roberts, B., Rickard, C.M., Rajbhandari, D., Turner, G., Clarke, J., Hill, D., Tauschke, C., Chaboyer, W., Parsons, R. Multicentre study of delirium in ICU patients using a simple screening tool. (2005) Australian Critical Care, 18 (1), pp. 6–16. O’Reilly, M. Oral care of the critically ill: a review of the literature and guidelines for practice. (2003) Australian Critical Care, 16 (3), pp. 101–110. Boyle, M., Hundy, S., Torda, T.A. Paracetamol administration is associated with hypotension in the critically ill. (1997) Australian Critical Care, 10 (4), pp. 120–122. Evans, D. The use of position during critical illness: current practice and review of the literature. (1994) Australian Critical Care, 7 (3), pp. 16–21. Crispin, C., Daffurn, K. Nurses’ responses to acute severe illness. (1998) Australian Critical Care, 11 (4), pp. 131–133.
35 34 25 25 23 22
21 21 21 20
Scopus does not have complete citation information for articles published before 1996.
Nursing scholarship, critical care nursing practice and patient care There has been a remarkable increase in critical care nursing research and scholarship in Australia since Australian Critical Care was transformed in 1988 from it forebears, ‘The Journal of the Clinical Nurse Specialists Association of NSW’ and ‘Pulse’ of the Australian Society of Critical Care Nurses. As noted in our above review, there have been increases in the number of research and review articles in Australian Critical Care and an increase in the number of abstracts presented at the ASM accepted for publication in peer reviewed journals. Is there evidence however of the impact of this increase in research and scholarship on the practice of Australian Critical Care nurses and care of the critically ill in Australia and elsewhere? In a survey of Australian graduates of postgraduate coursework programs (n = 236) that included critical care nurses around 80% of respondents believed that their postgraduate education had positively impacted on their patient care practices, such as conveying information, enhancing advocacy skills and making care decisions based on research findings.7 Impact of the research and publications of Australian Critical Care nurses in practice is however difficult to quantify. Box 1 lists articles from Australian Critical Care that have been cited 20 or more times in other journal articles (based on ScopusTM ). Note that this does not include the citation rates of the many articles published by Australian authors in other critical care, nursing or health journals internationally. Although these findings provide some evidence on the productivity of Australian Critical Care nurse researchers and authors, and also the influence of Australian Critical Care articles on subsequent publications, we cannot highlight the impact that this scholarship has had on clinical practice. We therefore invite readers to reflect on how our collective research, both that in Australian Critical Care and in other peer-reviewed journals, has influenced their clinical practice, and to respond by writing a Letter to the Editor via post or email. Summary and conclusion In the last 25 years, the scholarship of critical care nursing has evolved into an established area of disciplinary knowledge, based firmly in practice. Since the first publication of Australian Critical Care, the discipline has witnessed the opportunity for PhD training
with critical care nursing topics, the development of professorial positions, a knowledge base built on original research and rigorous reviews, and a strong and sustainable dissemination process through our journal and the ASM, as well as other journals and conferences. What is possible for Australian Critical Care nursing scholarship in the next 25 years? Amongst the opportunities to continue to grow and strengthen the basis of knowledge for practice and patient care, there remain some challenges. The reviews above in the paper indicate that there remains considerable scope to increase the rate of submission of manuscripts based on the research presented at the ASM for peer reviewed publication, a challenge for nursing investigators, their collaborators and supervisors of candidates completing higher degrees by research. This is particularly important at a time the profession, universities, funding bodies and governments are wanting to see evidence that research is being translated into practice; publication is the first step in this process. A corollary of this is the need to provide systematic evidence that our research and scholarship are influencing practice and patient care. In preparing this paper we have not been able to quantify research funding received for Australian Critical Care nursing research, though we observe that success is patchy. This is another challenge for us for the future, and again publication of our research and scholarship is crucial to this endeavor. Our history shows that we have an identifiable and sustainable scholarly discipline. Our collective challenges are to build on our successes, reflect on activities where we can improve our productivity and dissemination of research, mentor our colleagues, consider and implement succession planning within the College and our employing institutions, and to further develop our community of critical care nursing scholars. Our hope is that in the 50th year of Australian Critical Care, other authors will write a similar piece, highlighting the many achievements of a new generation of critical care nurse scholars. References 1. Wiles V, Daffurn K. There’s a Bird in my Hand and a Bear by the Bed – I must be in ICU. The Pivotal Years of Australian Critical Care Nursing. Melbourne: Australian College of Critical Care Nurses Ltd; 2002. 2. Lusk B, Russell RL, Rodgers J, Wilson-Barnett J. Preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States of America. Journal of Nursing Education 2001;40(5):197–202.
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11 3. Russell RL. From Nightingale to now: nurse education in Australia. Sydney: Churchill Livingstone; 1990. 4. Aitken L, Currey J, Marshall A, Elliott D. The diversity of critical care nursing education in Australian universities. Australian Critical Care 2006;19(2):46–52. 5. Pelletier D, Donoghue J, Duffield C. Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study. Australian Journal of Advanced Nursing 2005;23(1):37–43.
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6. Cleary M, Hunt GE, Jackson D. Demystifying PhDs: a review of doctorate programs designed to fulfil the needs of the next generation of nursing professionals. Contemporary Nurse 2011;39(2):273–80. 7. Pelletier D, Donoghue J, Duffield C. Australian nurses’ perception of the impact of their postgraduate studies on their patient care activities. Nurse Education Today 2003;23(6):434–42.
Contents lists available at SciVerse ScienceDirect
Australian Critical Care journal homepage: www.elsevier.com/locate/aucc
Twenty-five years of critical care nursing scholarship in Australia Sharon McKinley (RN PhD) a,b,∗ , Doug Elliott (RN PhD MAppSc ICCert) a,1 a b
Faculty of Health, University of Technology, Sydney, NSW, Australia University of Technology, Sydney & Northern Sydney Local Health District, NSW, Australia
article information
s u m m a r y
Article history: Received 31 August 2012 Received in revised form 17 October 2012 Accepted 23 October 2012
Background: Australian Critical Care has been published since 1988 and has been an important medium for the development of critical care nursing scholarship in Australia over 25 years. Purpose: To review scholarship in critical care nursing in Australia since 1988 and record its progress in the context of developments in nursing education and intensive and critical care practice. Approach: Australian Critical Care issues since 1988 were reviewed, and abstracts from the Australian and New Zealand Annual Scientific Meeting on Intensive Care published in Australian Critical Care since the 1991 Meeting. Available evidence for the contribution of this body of scholarship to critical care nursing practice and patient care was considered. Results: Original research reports and review articles have steadily increased from 1988 to 2012. The peak years for research publications were 2001, 2005 and 2012, and for reviews 2010 and 2011. Approximately 760 abstracts were presented at the Annual Scientific Meeting from 1991 to 2010; overall 24% were found lead to peer-reviewed publications, with an increase to 30% in recent years. Summary: Over 25 years, the scholarship of critical care nursing in Australia has evolved into an established area of disciplinary knowledge, based firmly in practice. Our discipline has witnessed the opportunity for PhD training, the introduction of professorial positions, a knowledge base built on original research and rigorous reviews, and sustainable dissemination. The challenges are to further strengthen this development, increase publication of research that is done, to demonstrate the influence on practice and to develop sustainable research funding. © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
Keywords: Intensive care Critical care nursing Scholarship Research Publication
Introduction The birth and growth of critical care nursing as a professional specialty in Australia has been well documented in the publication of the Australian College of Critical Care Nurses, ‘There’s a Bird in My Hand and a Bear by the Bed: I Must be in ICU’.1 Another decade has passed since then, and of similar importance, this journal has now been in publication for over 25 years, with the first issue printed in 1988. In this paper, we review 25 years of scholarship in critical care nursing in Australia within the context of developments in nursing education and intensive and critical care practice. Our discussion focuses on the scholarly development of critical care nursing toward a practice-based academic discipline, with a defined body
∗ Corresponding author at: Critical Care Nursing Professorial Unit, Level 6, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia. Tel.: +61 2 9926 8281. E-mail addresses: [email protected] (S. McKinley), [email protected] (D. Elliott). 1 Tel.: +61 2 9514 4832.
of knowledge, together with related methods of dissemination and communication within a community of practice and scholarship. As a professional college, the Australian College of Critical Care Nurses (ACCCN) provides a range of resources that support scholarship in the discipline, notably through Australian Critical Care, funding of research grants for members and co-hosting the Annual Australian and New Zealand Annual Scientific Meeting on Intensive Care (the ASM) with our intensivist colleagues from the Australian and New Zealand Intensive Care Society. At the ASM, prizes have been awarded for the Best Nursing Free Paper since 1983, the Nursing Scholarship Prize since 1996 and the Best Nursing Review Paper since 1997. For the purposes of this paper, scholarship includes peerreviewed reports of original research and reviews of the research literature, plus abstracts of original research and literature reviews selected by peer review for presentation at scientific meetings. We initially provide some context with a brief overview of undergraduate and postgraduate nursing education in Australia since the 1980s, including the introduction of higher degrees by research (masters and doctoral degrees) in nursing within Australian universities. Next we examine the publication of original research and
1036-7314/$ – see front matter © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
http://dx.doi.org/10.1016/j.aucc.2012.10.002
8
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11
reviews of the research literature in Australian Critical Care from 1988 to 2012, followed by a summary of the nursing abstracts presented at the Australian and New Zealand ASM on Intensive Care from 1992 to 2010 that were translated into full-text publications in the peer-reviewed literature. Finally the contribution of this body of nursing scholarship to critical care nursing practice and patient care is considered. Transfer of nursing education to the higher education sector In the 1980s and 1990s there were significant changes in nursing education across the State and Territory jurisdictions, with the transfer of hospital-based registered nurse training programs to undergraduate preregistration education in the higher education sector. Postregistration programs for specialty nursing practice, which were mainly hospital-based at that time, were then subsequently also largely replaced by postgraduate university programs. Of particular importance from a scholarship perspective, nurses were able to access all levels of education with research training through Masters and Doctoral degrees in nursing after unification of the higher education sector when schools or faculties of nursing were established in universities. Undergraduate education In 1984 the Australian government announced its support for the full transfer of preregistration nursing education from state-run hospitals to the tertiary education sector. This development saw the introduction of the 3-year Diploma of Applied Science (Nursing) in colleges of advanced education or universities, with full transfer to the tertiary sector by 1993. Subsequently the nursing profession’s target of a Bachelor of Nursing preparation for registered nurses in universities was achieved in the early 1990s. This was facilitated by the national unification of colleges of advanced education into the university sector, with preregistration education funded by the Commonwealth Government.2,3 The first state to achieve full transfer was NSW in 1985, while other states phased the transfer from hospital to tertiary programs more gradually, with Queensland having its last entry to hospital-based programs in 1990.2 Postgraduate education for specialty practice Following the transfer of undergraduate nursing education to the tertiary sector there was rapid growth in postgraduate nursing courses for specialty practice at the Certificate, Diploma and Masters levels,3–5 notably in clinical specialties but also in fields such as education and management. Students of Graduate Diploma programs often continued on to Masters of Nursing degrees, while other diplomates later returned to university to complete masters degrees.5 Postgraduate critical care courses were established in universities in each state between 1990 and 1997, often in collaboration with hospitals or wider health services.1 While ACCCN does not record specific qualifications of members, in 2012 their records showed that members reported 3463 qualifications in intensive/critical care nursing, 488 in education and 262 in management. (Note these numbers exceed the total number of members responding to the survey as respondents could indicate that they had more than one qualification). Higher degrees by research Following the merging of colleges of advanced education into the university sector in 1990, nurses were finally able to undertake Masters in Nursing by research and Doctorates of Philosophy (PhD) within the discipline of nursing.3 Prior to this, some nurses with Bachelors Degrees completed nursing-related topics in research
degrees within schools or faculties such as health sciences or sociology. More recently the option of the Doctorate in Nursing (DN), a form of professional doctorate, has become available in Australia. This form of qualification is intended to be more orientated to advancing professional practice than the traditional PhD intended for those wishing to pursue research/academic careers.6 The numbers of Australian Critical Care nurses with masters by research and doctoral degrees is not recorded, but anecdotally numbers have increased considerably since 1990. This is evidenced to some extent by the numbers of applicants for the Nursing Scholarship Prize at the ASM, whose presentations must be from their higher degree research studies, as well as the qualifications listed by Australian authors in Australian Critical Care and other journals for which we perform editorial and review duties. In the 2012 ACCCN survey, 116 respondents reported that they had research qualifications, but this may be an underestimate as not all members complete the survey. Increasing numbers of Australian Critical Care nurses with doctoral qualifications means that there are increasingly more potential supervisors for research degree students, increasingly including Bachelor Honours as well as masters and doctoral candidates. Through their publications, graduates of these degrees continue to contribute to the expansion of knowledge for the care of the critically ill in Australia and internationally. Related to this is the development of the nurse academic role in critical care with the potential to make an impact on the care of patients through their own research, the work of their coursework and research students, and academic leadership. Nurses with PhD training and a developing publication track record were eligible for both academic promotion and newly created roles as professors of critical care nursing, often as conjoint appointments with partner health services. These conjoint appointments, colloquially referred to as clinical chairs, are primarily based in the health service and have regular contact with clinical critical care nurses. This facilitates ready access by critical care nurses to academic advice and support for development of research ideas and evidence-based practice based on published research, plus currency in practicebased research for the clinical chairs. The first chair in critical care nursing in Australia was established in 1993, and three are currently four professors with critical care nursing in their job title, as well as a number of professors in university-based positions who cite critical care as their core area of scholarship. Publications in Australian Critical Care, 1988–2012 Reports of original research and review articles published in Australian Critical Care have both increased over 25 years. To evaluate the numeric contribution of publications we examined the Tables of Contents (TOC) of every issue of the journal from 1988 [1(1)] to 2012 [25(3), plus articles in press on 30th August, 2012]. Articles listed as Research Papers in the TOC or had titles denoting research (e.g. an observational study or a randomized controlled trial) were classified as research. When the titles were ambiguous, abstracts were reviewed to determine whether the articles were original research, reviews or neither. Results are shown in Fig. 1. During the first six years (1988–1993) there were very few original research articles (1 each in 1990, 1991, 1992) or reviews (2 in 1992 and 1 review in 1993). Peak years for research articles were 2001 (n = 12) and 2005 (n = 11), with some variability from year to year but an overall increase over time. Review papers peaked at 6 each in 2010 and 2011 (Fig. 1). Of note, the review articles published over this time demonstrated a qualitative trend to more explicit search and rigorous review methods in recent years, such as systematic reviews, in keeping with trends in nursing and health care literature generally. A search of the Elsevier database ScopusTM shows
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11 14 12 10 8 Research
6
Reviews
4 2 0 1988
1992
1996
2000
2004
2008
2012
Fig. 1. Research and review articles in Australian Critical Care, 1988–2012 (ACC 1988; 1(1) to 2012; 25(3), plus articles in press on 30th August, 2012).
that of 644 papers published in Australian Critical Care since 1990, 348 (54%) were research articles and 86 (13%) reviews. Abstracts to peer-reviewed publications Since 1992, Australian Critical Care has published the nursing abstracts accepted for oral or poster presentations at the Australian and New Zealand ASM on Intensive Care, beginning with the 16th Meeting in 1991. The number of nursing abstracts has gradually increased since that time, again with some variability evident from year to year, and with a peak of 64 accepted abstracts in 1999 (Fig. 2). The number of abstracts accepted for the ASM each year is partly determined by conference programming. For example, the peak of 64 accepted abstracts was related to inclusion of brief poster-oral presentations, in which presenters gave a 3 min oral presentation to supplement their poster presentation, and responded to audience questions. This approach allowed for more abstracts to be presented. In most years this format was not used and the number of accepted abstracts for oral or poster presentation was determined by their relative scores based on peer review. To explore the translation of nursing ASM abstracts to fulltext peer reviewed publications we searched PubMed Medline using author and keyword searches. Author searches were conducted first using the names of first and second authors; if these did not yield any publications, other author combinations were used. If author searches alone did not reveal publications, generic key words were added to the author names (e.g. intensive care, nursing, Australia), with or without key words specific to the
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abstract (e.g. resuscitation, nutrition, oxygen therapy). An effort was made to discern if the ASM abstract was related to a subsequent published article, for example if the abstract was a presentation of pilot or preliminary work, or presenting a subset of the data in the published article. A total of 758 abstracts were identified as being presented at the ASM from 1991 to 2010 (excluding local abstracts presented at the combined ASM and World Congress of Intensive and Critical Care in 2001). Of this total, 184 (24%) peer reviewed articles were identified as being directly or indirectly related to the ASM abstracts from that period (Fig. 2). Overall there has been a gradual increase in the proportion of identifiable articles related to ASM abstracts, with approximately 30% in recent years. This increase in the number of ASM abstracts leading to journal publications is a credit to Australian Critical Care nurses, their collaborators and mentors, the institutions they are associated with and to ACCCN. Nevertheless the ratio of less than one in three suggests that there is a body of research and scholarship competitive enough to be selected for presentation at the ASM that is not being translated into peer reviewed publications that are available internationally in the public domain. It is acknowledged that some free paper and poster presentations at the ASM are not intended for further dissemination. There is also often a long lead time from submission of manuscripts for publication to their final appearance as articles. This process usually includes requests for revisions and resubmission, or the need to submit to an alternate journal. This process may be interpreted by new researchers and authors as failure, and lead to abandonment before completing the writing and editing task through to publication. To improve the ratio of translation of abstracts to peer-reviewed publications and initial manuscript submission to acceptance and publication requires diligence and motivational collaboration from mentors and research supervisors, and tenacity by nurse researchers and research students. Research teams who submit conference abstracts should plan and develop a full-text manuscript for submission to a target journal in conjunction with the conference presentation. Students and supervisors should submit sections of their evolving thesis for publication during candidature and prior to thesis submission. These deliberate activities may allay our recent history of research that is presented at a conference or initially submitted to a journal, but does not result in a peer-reviewed published article available for readers in our broader community of critical care practice.
Fig. 2. Australian and New Zealand Annual Scientific Meeting nursing abstracts and associated peer reviewed publications 1991–2010.
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S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11
Box 1: Citations in Australian Critical Care that have been cited 20 or more times in other journal articles. 1 2 3 4 5 6
7 8 9 10 a
Citation details
Citation ratea
Hammond, F., Saba, M., Simes, T., Cross, R. Advanced Life Support: retention of registered nurses’ knowledge 18 months after initial training. (2000) Australian Critical Care, 13 (3), pp. 99–104. Magarey, J.M. Sedation of adult critically ill ventilated patients in intensive care units: a national survey. (1997) Australian Critical Care, 10 (3), pp. 90–93. Morrison, A.L., Beckmann, U., Durie, M., Carless, R., Gillies, D.M. The effects of nursing staff inexperience (NSI) on the occurrence of adverse patient experiences in ICUs. (2001) Australian Critical Care, 14 (3), pp. 116–121. Boyle, M., Green, M. Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools. (2001) Australian Critical Care, 14 (1), pp. 24–30. Groves, N., Tobin, A. High flow nasal oxygen generates positive airway pressure in adult volunteers. (2007) Australian Critical Care, 20 (4), pp. 126–131. Roberts, B., Rickard, C.M., Rajbhandari, D., Turner, G., Clarke, J., Hill, D., Tauschke, C., Chaboyer, W., Parsons, R. Multicentre study of delirium in ICU patients using a simple screening tool. (2005) Australian Critical Care, 18 (1), pp. 6–16. O’Reilly, M. Oral care of the critically ill: a review of the literature and guidelines for practice. (2003) Australian Critical Care, 16 (3), pp. 101–110. Boyle, M., Hundy, S., Torda, T.A. Paracetamol administration is associated with hypotension in the critically ill. (1997) Australian Critical Care, 10 (4), pp. 120–122. Evans, D. The use of position during critical illness: current practice and review of the literature. (1994) Australian Critical Care, 7 (3), pp. 16–21. Crispin, C., Daffurn, K. Nurses’ responses to acute severe illness. (1998) Australian Critical Care, 11 (4), pp. 131–133.
35 34 25 25 23 22
21 21 21 20
Scopus does not have complete citation information for articles published before 1996.
Nursing scholarship, critical care nursing practice and patient care There has been a remarkable increase in critical care nursing research and scholarship in Australia since Australian Critical Care was transformed in 1988 from it forebears, ‘The Journal of the Clinical Nurse Specialists Association of NSW’ and ‘Pulse’ of the Australian Society of Critical Care Nurses. As noted in our above review, there have been increases in the number of research and review articles in Australian Critical Care and an increase in the number of abstracts presented at the ASM accepted for publication in peer reviewed journals. Is there evidence however of the impact of this increase in research and scholarship on the practice of Australian Critical Care nurses and care of the critically ill in Australia and elsewhere? In a survey of Australian graduates of postgraduate coursework programs (n = 236) that included critical care nurses around 80% of respondents believed that their postgraduate education had positively impacted on their patient care practices, such as conveying information, enhancing advocacy skills and making care decisions based on research findings.7 Impact of the research and publications of Australian Critical Care nurses in practice is however difficult to quantify. Box 1 lists articles from Australian Critical Care that have been cited 20 or more times in other journal articles (based on ScopusTM ). Note that this does not include the citation rates of the many articles published by Australian authors in other critical care, nursing or health journals internationally. Although these findings provide some evidence on the productivity of Australian Critical Care nurse researchers and authors, and also the influence of Australian Critical Care articles on subsequent publications, we cannot highlight the impact that this scholarship has had on clinical practice. We therefore invite readers to reflect on how our collective research, both that in Australian Critical Care and in other peer-reviewed journals, has influenced their clinical practice, and to respond by writing a Letter to the Editor via post or email. Summary and conclusion In the last 25 years, the scholarship of critical care nursing has evolved into an established area of disciplinary knowledge, based firmly in practice. Since the first publication of Australian Critical Care, the discipline has witnessed the opportunity for PhD training
with critical care nursing topics, the development of professorial positions, a knowledge base built on original research and rigorous reviews, and a strong and sustainable dissemination process through our journal and the ASM, as well as other journals and conferences. What is possible for Australian Critical Care nursing scholarship in the next 25 years? Amongst the opportunities to continue to grow and strengthen the basis of knowledge for practice and patient care, there remain some challenges. The reviews above in the paper indicate that there remains considerable scope to increase the rate of submission of manuscripts based on the research presented at the ASM for peer reviewed publication, a challenge for nursing investigators, their collaborators and supervisors of candidates completing higher degrees by research. This is particularly important at a time the profession, universities, funding bodies and governments are wanting to see evidence that research is being translated into practice; publication is the first step in this process. A corollary of this is the need to provide systematic evidence that our research and scholarship are influencing practice and patient care. In preparing this paper we have not been able to quantify research funding received for Australian Critical Care nursing research, though we observe that success is patchy. This is another challenge for us for the future, and again publication of our research and scholarship is crucial to this endeavor. Our history shows that we have an identifiable and sustainable scholarly discipline. Our collective challenges are to build on our successes, reflect on activities where we can improve our productivity and dissemination of research, mentor our colleagues, consider and implement succession planning within the College and our employing institutions, and to further develop our community of critical care nursing scholars. Our hope is that in the 50th year of Australian Critical Care, other authors will write a similar piece, highlighting the many achievements of a new generation of critical care nurse scholars. References 1. Wiles V, Daffurn K. There’s a Bird in my Hand and a Bear by the Bed – I must be in ICU. The Pivotal Years of Australian Critical Care Nursing. Melbourne: Australian College of Critical Care Nurses Ltd; 2002. 2. Lusk B, Russell RL, Rodgers J, Wilson-Barnett J. Preregistration nursing education in Australia, New Zealand, the United Kingdom, and the United States of America. Journal of Nursing Education 2001;40(5):197–202.
S. McKinley, D. Elliott / Australian Critical Care 26 (2013) 7–11 3. Russell RL. From Nightingale to now: nurse education in Australia. Sydney: Churchill Livingstone; 1990. 4. Aitken L, Currey J, Marshall A, Elliott D. The diversity of critical care nursing education in Australian universities. Australian Critical Care 2006;19(2):46–52. 5. Pelletier D, Donoghue J, Duffield C. Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study. Australian Journal of Advanced Nursing 2005;23(1):37–43.
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6. Cleary M, Hunt GE, Jackson D. Demystifying PhDs: a review of doctorate programs designed to fulfil the needs of the next generation of nursing professionals. Contemporary Nurse 2011;39(2):273–80. 7. Pelletier D, Donoghue J, Duffield C. Australian nurses’ perception of the impact of their postgraduate studies on their patient care activities. Nurse Education Today 2003;23(6):434–42.