For the past 35 years, I have been engaged in nursing research. As a nurse scientist, my passion has been the development of a program of research focused on management of chronic health conditions of rural dwellers. Thinking about capturing the essence of the state of the science brings to mind a vision of the mountains of the Pacific Northwest in the morning, cloaked in a low-hanging shroud of clouds. The mountains are there, but their full dimension, depth and detail are expansive and unclear.
Nursing practice is holistic, dealing with multiple aspects of individuals, families, groups, communities and entire populations of a country. Solid evidence-based nursing practice is built on solid nursing research, so it is not surprising that nursing research is nearly borderless. Thus, the challenge of capturing the essence of the state of the science of nursing research is daunting.
Ten years ago, after attending a State of the Science Congress, Carole A. Anderson, PhD, RN, FAAN, stated, “Overall, I believe that the state of nursing science is one of good health” (Anderson, 1999). She cited the progress that had been made through descriptive research, but emphasized that, for nursing to press to the forefront in assisting in management and prevention of illness, nursing science would need to test interventions.
While Anderson’s statement was encouraging, conducting a comprehensive evaluation of the state of the science, as a whole, remains a herculean endeavor, too large to get our arms around. To break it down into more manageable parts, nurse scholars have focused on specific areas of nursing research and attempted to examine the state of the science for each. A case in point is a skillful overview of the state of the science with regard to culturally competent care for people with chronic illness that Linda Phillips (2008), PhD, RN, FAAN, presented in her Western Institute of Nursing address. The Annual Review of Nursing Research is also an excellent, resource-rich volume with chapters that describe the state of the science for a wide range of specific nursing-research areas.
Given the constraints of commenting on the global state of the science of nursing research, let me make a few observations about what I know best—the state of the science of rural nursing research. I will offer both personal and broader research perspectives.
In the mid-1990s, a colleague, Mary Burman, PhD, APRN, BC, FAANP, and I were invited to do a chapter for the Annual Review of Nursing Research on the state of the science of rural health. Although we were assigned a very circumscribed area of nursing research to evaluate, fulfilling our commitment required us to laboriously examine published sources, ferret out unpublished research and solicit input from active rural nurse researchers (Weinert & Burman, 1994). Our resulting critique pointed out the dearth of rural nursing theory to guide rural nursing research; lack of clarity about the definition and measurement of rurality; absence of replication; restricted programs of nursing research; widely differing levels of study sophistication; limitations in approaches, such as multisite, cluster or collaborative studies; and scarcity of adequate rural-versus-urban comparisons.
In 1995, a Priority Expert Panel convened by the National Institute of Nursing Research (NINR) concluded that a significant portion of rural health research had been largely descriptive and epidemiological, often conducted with the goals of describing health status, reporting the distribution and utilization of health services, and examining issues of formal and informal care. They noted the need for studies to identify and develop outcomes measures for community-based interventions and encouraged community-based participatory approaches. The panel was concerned that the meaning of health and the health and illness experiences of rural populations across the United States and across the life span were still poorly understood and understudied (Department of Health and Human Services, 1995).
Late in the 1990s, Burman and I again examined the state of rural nursing science, keeping in mind that our challenge as rural nursing researchers was to closely examine the rural context, a construct that has not been well-specified or measured in much of rural nursing research. We noted that, without careful consideration of the contextual factors, determining whether a study is actually “rural” can be problematic, that generalizing findings to other rural areas is difficult, that a clear understanding of rural-versus-urban differences becomes blurred, and that conducting appropriate and meaningful rural nursing research to enhance the rural nursing knowledge base and support rural nursing practice is hampered (Weinert & Burman, 1999).
For the 2002 Western Institute of Nursing Research Conference, I was asked to give a keynote address on the state of the science of rural nursing research (Weinert, 2002). To prepare, I went back to the literature to see what strides had been made over the past 10-plus years and found that, clearly, some of the nagging problems persisted. The diversity of rural settings and the problems with definition and measurement continued to hinder accurate description and understanding of the health profile and needs of rural dwellers. Moreover, due to the few programs of rural nursing research available, limited interdisciplinary and cross-institutional collaboration, and lack of replication of studies, the development of a body of knowledge relevant to rural health and rural nursing continued to lag. Overall, the health of rural nursing science was still seen to be a concern, and conclusions from earlier reviews still haunted the field: small sample sizes, lack of random sampling and cross-sectional designs, problems with operationalization and measurement of rurality, few intervention studies, lack of comparison-group descriptions, failure to account for key demographic variables, and studies with small, specific populations.
Yet, lamenting over the limitations and inadequacy of rural nursing research will not energize us to develop new strategies and approaches that will ultimately enhance the state of the science. So, let’s explore a few indicators that rural nursing science is alive, well and moving in a positive direction.
A journal specifically focused on dissemination of rural health research is certainly a sign of progress. Jeri Dunkin, PhD, RN, at the University of Alabama, manages the Online Journal of Rural Nursing and Health Care, which offers the latest in peer-reviewed research and practice-related features for rural nurses and other health professionals.
The development of the MSU Rurality Index, based on access and population variables (Weinert & Boik, 1995), has helped address the challenge of achieving an accurate estimate of a study’s degree of rurality. Assigning a degree of rurality to each study participant on a rural-to-urban continuum avoids artificial categorization and allows for a finer urban-rural distinction.
Doctoral preparation with a focus on rural health will increase the pool of those prepared to conduct needed research. Taking the lead is Binghamton University, State University of New York. Its PhD program in nursing is producing nurse scholars prepared in theory generation and equipped with the ability to do research relevant to delivery of health care to rural residents.
The explosion of activity in telecommunications, which has been a boon to rural nursing education in general, is also proving effective in research studies. Our Women to Women project, in which rural women with chronic illness engage in a virtual self-help support group and participate in health education activities on the Web, is an example of applying technology to a research-based nursing intervention. A significant boost to enhancing collaborative efforts among rural nursing investigators came from the NINR exploratory (P20) research centers initiative. The goal was to increase the number of research-intensive nursing schools by facilitating a specific area of inquiry and developing the infrastructure components that would enable investigators to enhance their research productivity. The Center for Research on Chronic Health Conditions in Rural Dwellers (CRCHC) at Montana State University, for which I had the privilege of serving as director, provided a vehicle for nurse investigators and their colleagues from various disciplines to strengthen rural research on chronic health conditions.
Among other initiatives, the center hosted an hour‑long telephone-research, brown-bag session each month with eminent researchers across North America; supported the Western Writers Coercion Group (to improve writing skills and increase scholarly productivity); and provided funding for mentored research projects. CRCHC activities have energized, motivated and enhanced the research skills of nurse investigators across Montana and the region. Rural research teams have formed within and across five sites in Montana and also in Iowa, North Dakota, Nebraska, Oregon, Wyoming and Nevada. The CRCHC truly became a “center without walls,” forging bonds of colleagueship and friendship that have gone well beyond its impact on rural nursing science, forming a lasting research culture among rural nurse scientists that continues to make a difference.
One barrier to rural nursing research is that the literature tends to be “gray” or “fugitive,” with some very fine research hidden in obscure and hard-to-retrieve locations. A major tool in overcoming this barrier is Sigma Theta Tau International’s ever-evolving Virginia Henderson International Nursing Library. This repository is an ideal vehicle for disseminating results of rural nursing studies and a rich source of information that includes conference proceedings and conference paper abstracts. Much of this information is cutting-edge but not easy to track. By making it easy to search for a topic or investigator, the library enhances networking among researchers, enabling them to connect and exchange ideas and research strategies.
The encouraging reality is that we are making progress in the field of rural nursing science. While the state of the science of rural nursing research continues to have many weaknesses, we are making strides in expanding the body of knowledge, conducting more sophisticated and methodologically sound studies, and developing ongoing programs of nursing research. So let’s celebrate our accomplishments and appreciate the dedication, commitment and unfailing efforts of nurse investigators who are striving to meet the health needs of those living in rural areas across the United States and around the globe. RNL
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| Clarann Weinert, SC |
Clarann Weinert, SC, PhD, RN, FAAN, is a professor at Montana State University College of Nursing in Bozeman, Montana, USA.
Editor’s note: Click here to learn more about the Women to Women project and research by Katie Worth, a professional artist and junior at Montana State University College of Nursing, that reveals how art is helping rural women cope with chronic health conditions. Worth received a “Rising Star” award for her research at the honor society’s 40th Biennial Convention in Indianapolis.
References:
Anderson, C. (1999). What is the state of the science? Nursing Outlook, 47(6), 241.
Department of Health and Human Services. (1995). Community-based health care: Nursing strategies (NINR Publication No. 95-3917). Bethesda, MD: Author.
Phillips, L. (2008). Thoughts about the state of the science related to culturally competent care for persons with chronic illness and its relationship to practice. Communicating Nursing Research, 41, 47-57.
Weinert, C., & Boik, R. (1995). MSU Rurality Index: Development and evaluation. Research in Nursing and Health, 18, 453-464.
Weinert, C., & Burman, M. (1994). Rural health and health seeking behaviors. Annual Review of Nursing Research, 12, 65-92.
Weinert, C., & Burman, M. (1999). The sampler quilt: A metaphor of rural communities. In A. Hinshaw, S. Feetham, & J. Shaver (Eds.), Handbook of clinical nursing research (pp. 75-86). Newbury Park, CA: Sage.
Weinert, C. (2002). Rural nursing research: Riddle, rhyme, reality. Communicating Nursing Research, 35, 37-49.
