Trends in nursing and midwifery research and the need for change in complementary therapy research

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, ‘the 1980s ushered in an array of diverse, sophisticated research methods…’ with other authors adding that ‘nursing is just beginning to authenticate new territory that incorporates a plurality of methods’ (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies

Transformatory learning in nurse education

This study aimed to explore the effects of a transformatory learning programme in a group of Project 2000 nursing students. A secondary focus of the study was to monitor the effectiveness of reflexive action research as a tool for reducing the theory-practice gap that persists between nurse education and nursing practice. The learning programme was developed around the process of reflection and evaluated within a framework of a hierarchical model of nursing research and critical social theory. The first level of research used formal theory to generate an action strategy with a group of first year student nurses (n=42). The action strategy was evaluated after an initial period of six months and provided the data for the level two research. The level two research facilitated a macro view of the learning situation which was then examined in more detail for the level three research. Reflection on action was adopted as the method of generating informal theory with the aim of facilitating a micro view of the learning environment. Data was collected using a variety of strategies, both within methods and across methods triangulation assisted a holistic view of the phenomena under exploration. The process of transformatory leaning was found to be a notable factor in developing reflective and effective practice amongst student nurses. Additionally, reflexive action research proved an effective strategy for narrowing the theory-practice gap. The insights gained from the study have considerable significance for informing the future practice of teaching in nursing, not least the challenge that teachers, like nurses, have a professional obligation to develop and review their practical knowledge and explore the effectiveness of their practice. It is proposed that reflexive action research and reflective practice are an appropriate formula for addressing these issues

Transformatory learning in nurse education

This study aimed to explore the effects of a transformatory learning programme in a group of Project 2000 nursing students. A secondary focus of the study was to monitor the effectiveness of reflexive action research as a tool for reducing the theory-practice gap that persists between nurse education and nursing practice. The learning programme was developed around the process of reflection and evaluated within a framework of a hierarchical model of nursing research and critical social theory. The first level of research used formal theory to generate an action strategy with a group of first year student nurses (n=42). The action strategy was evaluated after an initial period of six months and provided the data for the level two research. The level two research facilitated a macro view of the learning situation which was then examined in more detail for the level three research. Reflection on action was adopted as the method of generating informal theory with the aim of facilitating a micro view of the learning environment. Data was collected using a variety of strategies, both within methods and across methods triangulation assisted a holistic view of the phenomena under exploration. The process of transformatory leaning was found to be a notable factor in developing reflective and effective practice amongst student nurses. Additionally, reflexive action research proved an effective strategy for narrowing the theory-practice gap. The insights gained from the study have considerable significance for informing the future practice of teaching in nursing, not least the challenge that teachers, like nurses, have a professional obligation to develop and review their practical knowledge and explore the effectiveness of their practice. It is proposed that reflexive action research and reflective practice are an appropriate formula for addressing these issues

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme