by Manu Thakral, PhD, Research Associate, Kaiser Permanente Washington Health Research Institute
Florence Nightingale is often considered the mother of modern nursing. Indeed, she was a revolutionary figure in nursing practice. She pioneered infection control before germ theory was introduced, founded a nursing school, and produced more than 200 publications. The “lady with the lamp” was also a social reformer and statistician — and more than anything, a scientist. She was the first to discover how the physical environment of the hospital affected health outcomes and how good nutrition improved healing of wounded soldiers. As the first nurse scientist, she addressed a public health crisis and lobbied for health policy changes to improve conditions and reduce risks, setting the stage for future generations of nurses.
Flo, as I imagine I would call her if we ever met, is a hero of mine, as she helped define the comprehensive and crucial role that modern-day nursing still holds. Today’s nurses work in quality and safety, leadership, education, and evidence-based practice, to name a few. Of the multiple conceptual models that define nursing, there are always three common elements:
These elements are interrelated and can’t exist without one another. Therefore, nursing care is dependent on an understanding of relevant contextual factors, which could mean a physical space, medical history, or even a personal attitude.
This basic philosophy not only applies to nursing practice — but to research as well. One example is my work over the past two years at Kaiser Permanente Washington Health Research Institute (KPWHRI), where we’ve been addressing a serious public health crisis: the opioid epidemic. Our team evaluated clinical initiatives to change prescribing practices — steps that were proven effective at reducing doses for patients using opioid therapy to manage chronic pain. Nurse scientists are in a position to study the social and structural inequalities that result in health disparities and find ways to improve health equity in our community. So I was particularly interested in finding out whether dose reductions were consistent across different groups of patients, like those with mental health conditions or history of substance use. My heightened awareness of personal and environmental factors that could potentially play a role in which patients were selected for dose reduction allowed me to make a unique contribution to our interdisciplinary research team.
In a broader context, questions such as these are about health care equity. Flo was a visionary and a steward of social justice. She fought for equal access to hospitals for patients of all faiths and those with mental health and chronic conditions. She also collected empiric evidence to support her advocacy efforts. In today’s uncertain political climate, the risk for health disparities among vulnerable populations is high and the need for evidence-based solutions is great. Here in Washington State, older adults and people with disabilities, especially in rural counties, are at higher risk for social isolation, less opportunity for employment and education, and barriers to health care access. Demographic shifts in the coming years will only increase those risks.
Kaiser Permanente, with its strong commitment to the health of entire communities is a particularly promising environment for nurse scientists to study such issues. For one, researchers here have access to comprehensive data on large populations as they get their care in real-world, community-based settings. Also, the organization expresses strong support for the 50,000+ nurses it employs. According to its National Nursing Research and Evidence-Based Practice website, Kaiser Permanente is committed to maintaining and reigniting nurses’ passion for science and discovery by conducting original studies and reviewing published evidence to inform and improve practice. It also commits to documenting and communicating the value of nursing research; the systematic and rigorous study and evaluation of nursing practice and nursing-sensitive indicators; and the impact of nursing on patient care and resulting outcomes.
From my perspective at KPWHRI, opportunities for nursing research are plenty. Examples include:
Contributions may also include:
An ambitious list? I suppose so. But I think Flo would approve.
Do you have thoughts on how to move the field of nursing science forward — here at KPWHRI or elsewhere? If so, please leave a comment below or reach out to me personally at firstname.lastname@example.org.
Fawcett J, Watson J, Neuman B, Walker PH, Fitzpatrick JJ. On nursing theories and evidence. Journal of nursing scholarship. 2001;33(2):115.
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