Historical Developments in the Field of Nursing

Historical Developments in the Field of Nursing

 

Introduction

            Nursing has responded to and always will continue to respond to the needs of its clients. In times of war, nursing has responded by meeting needs of wounded in the combat zones and in military hospitals in the United States and abroad. When communities face health care crises, such as those that occur from infectious diseases or a lack of health care sources, nursing is their to establish community-based immunization and screening programs, treatment clinics and health promotion activities.

            Throughout the nursing profession’s history, nurses have studied and tested new and better ways to help their clients, their families and their communities. Nurses have been leaders in expanding knowledge in nursing and other health care disciplines through healthcare research. Early in nursing’s history during the Crimean War, Florence Nightingale studied and implemented methods to improve battle field sanitation, which ultimately reduced illness, infection and mortality. Today nurses are active in determining the best practice for skin care management, and care of older adults, to cite just a few examples.

            Nursing continually responds and adapts to new challenges as they arise. However, for nurses to understand and prepare for the future direction of nursing, the past shows how nursing evolved to meet the needs of the service community. The evolution of nursing has brought the profession to one of the most challenging and exciting times in history.

Discussion

Many milestones and achievements have been recorded throughout history and have been attributed to many revolutionary icons, especially Florence Nightingale. Developments in nursing research include the following:

Ø  Historical Research- Systematic studies designed to establish facts and relationships concerning past events (2004).

Ø  Exploratory Research- Initial Study designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena ( 2004).

Ø  Evaluation Research- Study that tests how well a program, practice or policy is working.

Ø  Descriptive Research- Study in which the objective is to accurately portray characteristics of persons, situations or groups and the frequency with certain events of characteristics occur.

Ø  Experimental Research- Study in which the investigator controls the study variable & randomly assigns subjects to different conditions.

Ø  Correlational Research- Study that explores the interpersonal relationships among variables of interest without any active intervention by the researcher.

Evidence Based Nursing ( 2001) is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences. Three areas of research competence are: interpreting and using research, evaluating practice, and conducting research. These three competencies are important to Evidence Based Nursing. To carry out the following factors must be considered: (1) sufficient research must have been published on the specific topic; (2) the nurse must have skill in accessing and critically analyzing research and (3) the nurse’s practice must allow her/him to implement changes based on Evidence Based Nursing.

            Evidence Based Nursing Practice solves problems encountered by nurses by carrying out four steps: (1) clearly identify the issue or problem based on accurate analysis of current using knowledge and practice, (2) search the literature for relevant research, (3) evaluate the research evidence using established criteria regarding scientific merit, and (4) choose interventions and justify the selection with the most valid evidence (2001).

            Rating System for the Hierarchy of Evidence*

Level I

Evidence for a systematic review or meta-analysis of all relevant RCTs or evidence-based clinical practice guidelines based on systematic reviews of RCTs.

Level II

Evidence obtained from at least one well-designed RCT

Level III

Evidence obtained from one well-designed controlled trials without randomization

Level IV

Evidence from well-designed case-control and cohort studies

Level V

Evidence from systematic reviews of descriptive or qualitative study

Level VI

Evidence from a single descriptive or qualities study

Level VII

Evidence from the opinion of authorities and/or reports of expert committees.

Table 1: Rating System for the Hierarchy of Evidence

 (2005)

The levels of evidence is useful in rating importance as of the effectiveness of a particular research study, in this way, the researcher can compare evidences that will support their claims as to the recent and most valuable research. It can also be use to designate sources of information.      

In a study conducted by  (1998) identified the following constraints in evidence based nursing: (1) practicing clinicians lack time to actively participate in conducting and implementing research, (2) practicing clinicians lack to read current research findings, (3) practicing clinicians perceive nurses who are involved in conducting and implementing research to be removed from the clinical setting, (4) practicing clinicians do not understand the importance of research, and (5) research is a minute and difficult component of undergraduate nursing programs. Further the first three concerns were raised by  (1971), in which the research – practice gap was the result of: (1) failure to directly involve clinical nurses in research projects, (2) researchers not directly being involved with patient care, and (3) nurses failing to read research.

suggests that the wider communities, including the clients of professional practices who are affected by the practices, need to change their ideas and actions. The ‘PARIHS Framework’, developed out of a desire to move beyond reductionist models of research utilization that were one – dimensional, suggesting some linearity and logic, represents one such framework for paying attention to the changing of practice settings through the emphasis on the evidence, the context in which the evidence is used and the way the evidence is facilitated into practice (2002).

            On the other hand, the  defines practice development as an approach that helps you, your team and organization to provide care that patients feel is right for them. As they stated that practice development can help in many ways as possible such as: (1) offer better choices for patients and provide evidence – based care, (2) recognize and overcome obstacles that limit delivery of best care, (3) involve patients as partners in developing services, (4) influence local policy, organizational strategy and workplace culture; (5) deliver evidence – based care, innovation and service improvement, (6) challenge and reflect on the care you provide, (7) demonstrate the impact you have on practice, and (8) sustain yourself and your team to continue with learning and positive change. The benefits of practice development are: (1) improve patient care, (2) create a good place to work in, (3) meet government targets, (4) contribute to your organization’s innovation and service improvement, and lastly (5) implement clinical, shared and research governance agendas.

Conclusion

            I can say that evidence based practice is almost applicable to any nursing situation especially in Neuroscience wherein nursing care must not only be efficient and effective it must be the best quality of care especially in delivering service with alterations in the nervous system.  Let’s connect Neuroscience nursing in practical development and evidence based wherein, the ground point of the said concepts would only want the following: (1) to expound better than the existing theories and to stabilize predictions in research outcomes to further enhance health care service delivery. In summary, the paper has proven that evidence based nursing and practice developments are not just assets in any research continuum but they are the key for the betterment of service. Though, there are challenges to face and changes that must occur in which research outcomes are unexpected, simplified by the adage, “expect the unexpected.” How can we do that? Merely, through constant monitoring or simply action research is essential. In this, we are not only adopting the significant changes, we are promoting future changes to occur for enhancement of quality service.

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