9 2 5
NURSI NG RESEARCH I N LATI N AMERI CA: 1 9 8 8 - 1 9 9 8
Rit a L. Ailinger1 Rosa Mar ia Naj er a2 Mar ia Consuelo Cast r illón3 Mar icel Manfr edi4
Ailinger RL, Naj er a RM, Cast r illón MC, Manfr edi M. Nur sing r esear ch in Lat in Am er ica: 1988- 1998. Rev Lat ino-am En fer m agem 2 0 0 5 n ov em br o- dezem br o; 1 3 ( 6 ) : 9 2 5 - 8 .
The pur pose of t his ar t icle is t o pr ov ide an ov er v iew of nur sing r esear ch in Lat in Am er ica dur ing t he decade from 1988 t o 1998. Dat a from t he bi- annual Pan Am erican Colloquia in Nursing Research from 1988 t o 1998 were subj ect t o secondary analysis. Findings indicat e t hat m ost of t he research em anat ed from Brazil, t he only count r y w it h a doct or al pr ogr am in nur sing in t he 1990’s. Resear ch t opics included: public healt h issues, clinical st udies ( usually of adult s) , nursing care st udies of process, t herapeut ic com m unicat ion, and adm inist rat ive issues such as st andar ds of car e and qualit y. The m ost com m on design w as descr ipt ive quant it at ive, alt hough t her e w er e sever al qualit at ive st udies. The analysis pr ovides dir ect ions for fut ur e r esear ch and indicat es ar eas of concer n, especially t he need for t heor y based nur sing r esear ch.
DESCRI PTORS: Lat in Am er ica; nur sing; r esear ch
LA I NVESTI GACI ÓN EN ENFERMERÍ A EN AMÉRI CA LATI NA: 1 9 8 8 - 1 9 9 8
El pr opósit o de est e ar t ículo es ofr ecer un panor am a sobr e la invest igación en enfer m er ía en Am ér ica Lat ina durant e la década de 1988 a 1998. La inform ación reunida en los Coloquios Panam ericanos de I nvest igación en Enfer m er ía, que se celebr an cada dos años, fue som et ida a análisis secundar io. Descubr im os que la m ayor par t e de las inv est igaciones em ana del Br asil, el único país con un pr ogr am a de doct or ado en enfer m er ía en los años novent a. Los t ópicos de invest igación incluyen asunt os de salud pública, est udios clínicos ( norm alm ent e de adult os) , est udios del proceso de at ención de enferm ería, com unicación t erapéut ica y asunt os adm inist rat ivos t ales com o norm as de at ención y calidad. El diseño m ás com ún fue el est udio cuant it at ivo descript ivo, aunque t am bién encont r am os v ar ios est udios cualit at iv os. El análisis ofr ece dir ecciones par a fut ur as inv est igaciones e indica áreas de preocupación, especialm ent e la necesidad de una invest igación en enferm ería con base t eórica.
DESCRI PTORES: Am ér ica Lat in a; en fer m er ía; in v est igación
A PESQUI SA EM ENFERMAGEM NA AMÉRI CA LATI NA: 1 9 8 8 - 1 9 9 8
O ob j et iv o d o p r esen t e ar t ig o é of er ecer u m p an or am a d a p esq u isa em en f er m ag em n a Am ér ica Lat ina r ealizada dur ant e a década de 1 9 8 8 a 1 9 9 8 . A infor m ação r eunida nos Colóquios Pan- Am er icanos de Pesqu isa em En f er m agem , or gan izados a cada dois an os, f oi su bm et ida à an álise secu n dár ia. Descobr im os qu e a m aior par t e das pesqu isas foi pr odu zida n o Br asil, o ú n ico país com u m pr ogr am a de dou t or ado em en f er m ag em n os an os n ov en t a. Os t em as d e p esq u isa in clu em t óp icos d e saú d e p ú b lica, est u d os clín icos ( n or m alm en t e de adu lt os) , est u dos do pr ocesso de assist ên cia de en f er m agem , com u n icação t er apêu t ica e assu n t os adm in ist r at iv os, t ais com o n or m as de cu idado e qu alidade. O desen h o m ais com u m f oi o est u do quant it at iv o descr it iv o, m as t am bém encont r am os v ár ios est udos qualit at iv os. A análise ofer ece dir eções par a fut ur as pesquisas e indica ár eas de pr eocupação, especialm ent e a necessidade de pesquisas de enfer m agem com f u n dam en t ação t eór ica.
DESCRI PTORES: Am ér ica Lat in a; en fer m agem ; pesqu isa
1
PhD, RN, College of Nursing and Healt h Science, George Mason Universit y, railinge@gm u.edu; 2 Direct ora, División Ciencias Bilológica UNAM-X, Mexico,
rm naj era@correo.xoc.uam .m x; 3 Mg.Ed., Universidad de Ant ioquia, Colom bia, concast ri@epm .net .co; 4 MSN, Ret ired, Pan Am erican Healt h Organizat ion,
m aricelm anfredi@aol.com
Art igo Original
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Rev Lat ino- am Enferm agem 2005 novem bro- dezem bro; 13( 6) : 925- 8 w w w .eer p.usp.br / r lae
I NTRODUCTI ON
W
hile nursing research is flourishing in Lat in Am er i ca, t h er e i s a p au ci t y of r ep or t s i n En g l i sh-l a n g u a g e n u r s i n g j o u r n a -l s a b o u t t h a t r e s e a r c h .
Colleagues in English- speak ing count r ies could lear n
m u c h f r o m t h e i r c o u n t e r p a r t s i n t h e s o u t h e r n
h em i sp h er e ab o u t t h e st at e o f t h e ar t o f n u r si n g
k n ow led g e if su ch r ep or t s w er e m or e w id esp r ead .
There has been no syst em at ic report in English of t he
st at e of nursing research in Lat in Am erica for t he last
14 y ear s. Pr ior t o t hat t im e, Manfr edi; Ailinger ; and
Co l l a d o( 1 ) r e p o r t e d o n a Pa n A m e r i c a n H e a l t h
Organizat ion st udy of seven Lat in Am erican count ries’
nur sing r esear ch. Only Chile has r ecent ly r epor t ed in
t h e En g l i sh l a n g u a g e n u r si n g l i t e r a t u r e o n t h e i r
r esear ch pr ogr ess( 2). While t her e is a need t o shar e
k n o w l e d g e , i t i s a l so i m p o r t a n t t o k n o w w h a t i s
occu r r in g in or der t o plan f u t u r e r esear ch , ar r an ge
f o r co n t i n u i n g e d u ca t i o n f o r n u r se s, a n d t o p l a n
r esear ch con f er en ces.
Th e p u r p ose of t h is st u d y w as t o ex am in e
t he six Pan Am er ican Colloquia in Nur sing Resear ch
( PACI NR) t o ident ify t he st at e of t he science of nursing
research in Lat in Am erica during t he decade from 1988
t o 1998.
LI TERATURE REVI EW
Throughout various part s of t he globe, nurses have exam ined t he st at e of t he art of nursing research and pr ior it ies for t he fut ur e. I n Canada t he Office of Nursing Policy( 3) convened a group of nurse- scient ist s t o i d e n t i f y t h e ch a l l e n g e s i n t h e n u r si n g sci e n ce agenda. Par t icipant s r epor t ed t he follow ing needs: t o incr ease t he num ber of nur se scient ist s, t o im pr ov e l i n k a g e s b e t w e e n r e se a r ch a n d p r a ct i ce , a n d t o d e v e l o p co n v e r g e n ce b e t w e e n r e se a r ch f o ci a n d a v a i l a b l e f u n d i n g . Bo r b a si ’ s r e v i e w o f Au st r a l i a n nur sing r esear ch, published bet w een 1995- 2000, led t he aut hor t o conclude t hat nurse researchers should align t heir r esear ch w it h nat ional healt h pr ior it ies( 4). Usin g a Delph i m et h odology, t o st u dy t h e pr ior it ies f or n u r sin g r esear ch in Kor ea an d Kim( 5 ) con clu ded t h at t h e f ir st pr ior it y w as adv an ced pr act ice, w h ile ot h er p r ior it ies in clu d ed n u r sin g in t er v en t ion s an d ef f ect iv en ess of n u r sin g car e. An ot h er Delph i st u dy w as conduct ed by nur ses in Spain( 6) w ho found t hat coor d in at ion an d q u alit y of car e w er e p r ior it ies f or n u r sin g r esear ch .
I n a n I sr a e l i st u d y, t h e a u t h o r s f o u n d a
change in t he t ype of nursing research from t he 1960s
t o t h e 1 9 9 0 s a n d su g g e st e d a m a st e r p l a n t h a t
em ph asized t h e cu lt u r e an d geogr aph y of I sr ael( 7 ) .
Alm ost 200 nurses in China part icipat ed in a nat ional
f or u m con cer n in g r esear ch pr ior it ies( 8 ). Th e au t h or s
concluded t he priorit ies in nursing adm inist rat ion were
cost , per sonnel, and effect iv eness.
According t o Tlou( 9), t he priorit ies for nursing
research in Africa were HI V/ AI DS and healt h behavior.
There w as a need for epidem iological st udies in HI V/
AI DS, applied research in prevent ion and care, st udies
on t he im pact of HI V/ AI DS on child healt h and nursing
ret ent ion of personnel, and hom e care invest igat ions.
W i t h r e g a r d t o t h e t o p i c o f h e a l t h b e h a v i o r, t h e
priorit ies were lifest yle choices, care alt ernat ives, and
se l f - ca r e . Ad d i t i o n a l p r i o r i t i e s f o r Af r i ca i n cl u d e
cu lt u r al, p olit ical, an d econ om ic in f lu en ces on t h e
elder ly; occupat ional st udies; r esear ch on t he im pact
of w ar on w om en and children; and w om en’s healt h.
Ki m( 1 0 ) r ep o r t ed o n t h e st a t u s o f n u r si n g
r esear ch i n Asi a an d Au st r al i a, b ased o n co u n t r y
report s at a World Healt h Organizat ion ( WHO) m eet ing.
Nu r sin g r esear ch in Au st r alia h as on ly b een act iv e
si n ce 1 9 9 2 , b u t r esear ch f u n d s, con f er en ces, an d
enr ollm ent of st udent s in r esear ch has incr eased. I n
China, m ore nurses are being t rained in research each
y ear an d cu r r en t st u d ies in clu d e p olicy, ed u cat ion ,
a d m i n i st r a t i o n a n d se r v i ce s. I n I n d i a , a n u r si n g
r esear ch societ y w as est ablished in 1988. Ther e has
been an increase in t he num ber of graduat e program s
in Jap an in r ecen t y ear s. Wh ile t h is h as led t o an
increase in nursing research, barriers for im plem ent ing
r esear ch f i n d i n g s i n p r act i ce h av e b een r ep o r t ed .
Ko r e a n n u r se s t e n d t o f o cu s o n h e a l t h se r v i ce s
r esear ch in t h eir st u d ies. Th er e h as also b een an
i n cr ea se i n g r a d u a t e n u r si n g p r o g r a m s i n Ko r ea ,
including 19 m ast er s and 12 doct or al pr ogr am s. The
i n cr ease i n d o ct o r al p r o g r am s h as i n f l u en ced t h e
g r o w t h o f n u r si n g r esear ch al t h o u g h m o st o f t h e
research is done by educat ors. Report s from Thailand
indicat e t hat t he incr ease in Mast er s pr ogr am s since
1994 has led t o m ore research wit h a focus on clinical
nur sing, nur sing educat ion, and adm inist r at ion( 10).
Th e r epor t on Eu r ope n ot ed t h at “ n u r sin g
research has been developing in som e count ries over
t he past 30 years e.g. Denm ark, Finland and t he UK—
an d in ot h er s f or less t h an a decade—e. g. Est on ia,
Li t h u a n i a a n d Sl o v e n i a ”( 1 1 ) . Th e a u t h o r f u r t h e r
addressed t he deart h of nat ional priorit ies for nursing
Nursing research in Lat in Am erica: 1988- 1998
9 2 7
research in m ost European count ries. However, in 1995 f i v e r e s e a r c h p r i o r i t i e s w e r e i d e n t i f i e d i n t h e Scandinav ian count r ies: healt h pr om ot ion, sy m pt om m a n a g e m e n t , e l d e r l y ca r e , h e a l t h ca r e sy st e m s r esear ch, and self- car e in healt h and illness. Nur ses in Gr eat Br it ain had ident ified six pr ior it ies: pat ient s’ per spect iv es of car e, t h e f u n ct ion of in f or m al car e-g i v e r s , n u r s i n e-g i n t e r v e n t i o n s , a c c e s s t o h e a l t h ser v ices and t he nur ses’ r ole in access, coping w it h chronic illness, and t echnologies in nursing( 12). I n 1997, t he WHO est ablished a list of priorit ies for a com m on n u r s i n g r e s e a r c h a g e n d a : e f f e c t s o f h e a l t h c a r e r e f o r m , w o r k f o r c e s u p p l y a n d d e m a n d , w o r k condit ions, qualit y of ser v ice and educat ion, deliv er y o f ca r e, v u l n er a b l e p o p u l a t i o n s, et h i cs, cu l t u r a l l y r elev an t car e, h om e car e, occu p at ion al h ealt h car e, and infect ion cont r ol( 13).
Acco r d i n g t o Hi n sh aw( 1 4 ), t h e f i v e n u r si n g research priorit ies in t he U.S. are out com es of qualit y o f c a r e , t h e e f f i c a c y o f n u r s i n g i n t e r v e n t i o n s , assessm en t an d m an ag em en t of sy m p t om s, h ealt h car e deliv er y, and healt h pr om ot ion/ r isk r educt ion. I n su m m ar y, t h e st at u s of n u r sin g r esear ch can be iden t if ied f or m ost t h e w or ld’s con t in en t s, h ow ev er, t h er e w er e n o r ecen t r ef er en ces f or Lat in Am er ica. The pur pose of t his paper is t o pr ov ide an ov er v iew of t he st at us of nursing research in Lat in Am erica for t he decade from 1988- 1998 as report ed at t he biannual n u r sin g r esear ch m eet in g.
METHODOLOGY
The pr ogr am s for t he PACI NR for t he y ear s 1 9 8 8 - 1 9 9 8 w er e r ev i ew ed f o r co u n t r i es o f o r i g i n , t o p i c s , m e t h o d s , a r e a s o f h e a l t h a n d n u r s i n g , char act er ist ics of inv est igat or s and inst it ut ions. Since t his was a secondary dat a analysis and did not involve h u m an su bj ect s, n o in for m ed con sen t w as obt ain ed nor w as it r eview ed by an et hics com m it t ee.
RESULTS
I n t he six PACI NRs held bet w een 1 9 8 8 and 1 9 9 8 , t h e r e w e r e 2 6 3 p r e s e n t a t i o n s . A l l 2 6 3 pr esen t at ion s w er e in clu ded in t h e an aly sis. Br azil, Pa n a m a , Ve n e z u e l a , a n d Ch i l e , h a d t h e h i g h e st n u m ber of per son s pr esen t in g ( see Figu r e 1 ) . Ov er h alf ( 5 3 % ) t h e in v est igat or s w er e f r om edu cat ion al inst it ut ions, 13% were from nursing service, 5% were fr om ot h er ar eas, an d n o in for m at ion w as av ailable for 29% of t he invest igat ors. Several universit ies were r ep r esen t ed m or e f r eq u en t ly in t h e p r esen t at ion s,
including Concepcion and Cat olica in Chile, Ribeir ao and Carabobo in Brazil, Truj illo in Peru, and Ant ioquia in Colom bia.
Met h od s u sed in t h e r esear ch in clu d ed ( in order of frequency) : surveys, int erviews, t riangulat ion, o b s e r v a t i o n , s c a l e s , a n d r e c o r d r e v i e w s . Th e s e m et hods w er e used in 79% of t he st udies. Resear ch p ar t icip an t s con sist ed of con su m er s ( 3 5 % ) , h ealt h per son n el ( 3 3 % ) , ot h er s ( 1 3 % ) , docu m en t s ( 1 1 % ) , and at risk populat ions ( 8% ) . More st udies were done in public healt h ( 32% ) t han in hum an resources ( 23% ) or clinical set t ings ( 14% ) or ot her sit es ( 31% ) . Public healt h st udies focused on epidem iology, occupat ional h e a l t h , p r e v e n t i o n , h e a l t h e d u ca t i o n , co m m u n i t y h ealt h , an d m en t al h ealt h . Th er e w as con sid er ab le em p h asis in h u m an r esou r ces on t h e ed u cat ion of pr ofessional nur ses. Clinical st udies w er e m or e oft en of adult s and childr en w it h few er st udies focused on ad o l escen t s an d t h e el d er l y. Nu r si n g car e st u d i es f o c u s e d o n n u r s i n g p r o c e s s , t h e r a p e u t i c c a r e , t h er ap eu t ic com m u n icat ion , st an d ar d s of car e, an d plans of car e.
I n adm inist rat ion, t he focus was on personnel, q u a l i t y o f c a r e , a n d e v a l u a t i o n o f p r o g r a m s . Qualit at ive st udies included phenom enological st udies on a v ar iet y of t opics in clu din g people w it h ch r on ic diseases, elder ly, pr egn an cy, sex u alit y, an d AI DS.
Over t he years t here has been a progressive in cr ease in t h e n u m ber of pr esen t at ion s an d in t h e n u m b e r o f co u n t r i e s t h a t w e r e i n v o l v e d i n su ch p r esen t at ion s. Th e m aj or it y of st u d ies cam e f r om academ ic inv est igat or s. The r esear ch w as conduct ed alm ost ex clusiv ely by nur ses but did not include t he u se o f m u l t i d i sci p l i n a r y t e a m s a n d co l l a b o r a t i o n . Alt hough t he st udies w ere predom inant ly quant it at ive t her e w er e a few qualit at iv e st udies in r epor t s fr om Br azil and Chile. Nur sing t heor y w as not r efer enced in ay of t he pr esent at ion. Ther e w er e few r epor t s of financial or inst it ut ional suppor t .
DI SCUSSI ON
S e v e r a l r e c o m m e n d a t i o n s f o r n u r s i n g r esear ch in Lat in Am er ica h av e ev olv ed ou t of t h is secondary dat a analysis. First , on an inst it ut ional level, t h er e is a n eed f or n u r sin g r esear ch pr ogr am s an d inst it ut ional support for research. Addit ionally, t he need exist s for net work building, const ruct ion of a t axonom y o f n u r s i n g r e s e a r c h , p u b l i c a t i o n o f r e s e a r c h pr oceedings, and cont inued suppor t for t he biannual colloqu iu m . Secon d, on an in v est igat or lev el, m or e em p h asis is n eed ed on p r og r am s of r esear ch an d n e t w o r k i n g w i t h o t h e r r e s e a r c h e r s . Th i r d , t h e
Nursing research in Lat in Am erica: 1988- 1998
Ailinger RL, Naj era RM, Cast rillón MC, Manfredi M.
9 2 8
est ablishm ent of nursing research organizat ions, such
a s t h e Ea st e r n Nu r si n g Re se a r ch So ci e t y o r t h e
Council on t he Advancem ent of Nursing Science would
b e an im p or t an t st ep in t h e d issem in at ion of t h eir
m e m b e r s ’ r e s e a r c h . Fi n a l l y, a n d p e r h a p s m o s t
im por t ant ly, inv est igat or s should confr ont t he dear t h
of nursing t heory in t heir research. Nurse researchers
n eed t o ov er com e obst acles in t h e dev elopm en t of
n u r sin g k n ow ledge. Th ese obst acles in clu de lack of
s t u d i e s o f v u l n e r a b l e p o p u l a t i o n s , p a u c i t y o f
qu alit at iv e st u dies, an d t h e lack of m u lt idisciplin ar y
m em ber s on t he r esear ch t eam s. A lim it at ion of t his
st udy was t hat no at t em pt was m ade t o exam ine t he
published r esear ch dur ing t he decade
Nur sing r esear ch in Lat in Am er ica has com e
a long way in t he last few decades. I f nursing research
is going t o help im prov e healt h care in t he 21st cent ury,
nurse researchers need t o look at t he lim it at ions and
b u i l d o n t h e st r e n g t h s o f t h e i r n u r si n g r e se a r ch
p r e s e n t a t i o n s . B r a z i l w a s t h e m o s t f r e q u e n t l y
m ent ioned sour ce of r esear ch st udies because it w as
t he only count ry t hat had a doct oral program in nursing
during t he decade of t his st udy. I t is realist ic t o expect
h o w e v e r, t h a t m o r e d o c t o r a l p r o g r a m s w i l l b e
e s t a b l i s h e d i n t h e 2 1s t c e n t u r y p r o v i d i n g n e w
in v est ig at or s. Th is t r en d h as alr ead y b een seen in
Eu r ope Asia, an d Nor t h Am er ica. New in v est igat or s
will provide t he research evidence for nursing pract ice,
educat ion, and adm inist rat ion, t hus cont ribut ing t o t he
dev elopm en t of n u r sin g k n ow ledge.
Figur e 1 - Nur sing r esear ch pr esent at ions at t he bi-an n u al Pbi-an Am er icbi-an Colloqu ia in Nu r sin g Resear ch from 1988 t o 1998 by count ry in Lat in Am erica.
ACKNOW LEDGEMENTS
Th e a u t h o r s a c k n o w l e d g e S i l v i a Or r e g o Si e r r a , Ma r i a Ol a n d a Sa l a za r H e n a o a n d Ne l so n Fer n an do Molin a f or t h eir con t r ibu t ion t o t h e st u dy a n d Ma r y A n n B r a u n a n d Je a n Mo o r e f o r t h e i r t hought ful r ev iew of t he m anuscr ipt .
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1 3 . Hi r sch f el d MJ. WHO p r i o r i t i es f o r a co m m o n n u r si n g
r esear ch agen da. I n t Nu r s Rev 1 9 9 8 ; 4 5 ( 1 ) : 1 3 - 4 .
1 4 . Hin sh aw AS. Nu r sin g k n ow ledge f or t h e 2 1 st cen t u r y :
o p p o r t u n i t i e s a n d ch a l l e n g e s. J Nu r s Sch o l a r sh i p 2 0 0 0 ;
3 2 ( 2 ) : 1 1 7 - 2 3 .
Recebido em : 6.7.2005 Aprovado em : 21.10.2005
Rev Lat ino- am Enferm agem 2005 novem bro- dezem bro; 13( 6) : 925- 8 w w w .eer p.usp.br / r lae Nursing research in Lat in Am erica: 1988- 1998
