Research priorities

Applied Nursing Research 19 (2006) 223 – 224 www.elsevier.com/locate/apnr Ask an Expert Research prioritiesB Ronda G. Hughes, PhD, MHS, RN Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA New innovations in health care, the growing need for chronic disease management, and the constant pressure to control health care costs are only few of the factors that contribute to the challenges within our health care system for patients, clinicians, and health care leaders. Historically, nurses have particularly been challenged to demonstrate and convey the impact of nursing, effectively address issues and patient needs amenable to nursing interventions, and improve the delivery of health care services centered on patients. Having been now actively involved in both health policy and research for more than 15 years, I offer the following observations to summarize the future possibilities of research for nurses and current trends and to provide a framework for subsequent columns. First, nursing care has an inherent multifaceted nature; therefore, research involving nurse researchers is multifaceted. Nursing practice is changing almost daily, with advances in research and improvements in technology and practice. It is because nurses have incredible insight into patients’ needs and perspectives about the actual delivery of care that nursing research is broad and should not be restricted to only what have typically been nursing-related issues. Because research can have a fundamental role in setting current and future health care priorities, investment of nurse researchers throughout research on health care will be a key aspect in meeting the ongoing need for information about the quality and effectiveness of health care and in making better use of health resources. Second, there continues to be greater value given to interdisciplinary research. Although interdisciplinary research is widely defined, the advantage of conducting research involving individuals from nursing, medicine, and physical as well as psychosocial therapy, among others, who can offer different perspectives from their particular discipline, is yet to be fully appreciated in health care. There are many opportunities to learn from other industry B The views in this article are those of the author and do not necessarily reflect those of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. E-mail address: ronda.hughes@ahrq.hhs.gov. 0897-1897/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.apnr.2006.07.003 disciplines outside of health care and to incorporate the theories, methods, and measures to health care. One of the popular examples of this of late has been in applying lessons from the aviation industry and human factors engineering to health care settings. Efforts to find common ground among theories from different industries possess the potential for improving communication with a larger audience, enhancing the significance of research findings, and better understanding aspects of health care that may be biased from only having a health care lens. Third, the constant demand for having access to valid and situation-specific tools and measures necessitates continual testing as well as refinement of current instruments and the development of new ones. As health care providers and organizations attempt to meet the changing health care demands from insurers (both private and public), regulators, and accreditors (e.g., Joint Commission on Accreditation for Healthcare Organizations and National Committee for Quality Assurance), nurse scientists, leaders, and managers need to be able to access tools and measures that are applicable to their institution and patients. There are advantages and disadvantages to the growing number of measures, surveys, and similar tools for assessing and grading the quality or clinical relevance of individuals, small groups, and/or organizations. However, because reliability and validity as well as the feasibility and utility of these tools are often unmeasured or incredibly variable, there is a timely need for research to refine both methods and theories to meet this demand. As a result, high-quality and cost-effective care will be more likely to happen consistently. Fourth, there is great benefit in thinking forward, past the initial work of research, in which research is done in a strategic way. Research may begin with fully exploiting existing databases, not stopping there, and then moving forward by focusing on subsequent research and what cannot be assessed from secondary databases. Although not easy, nurse researchers can plan for the persistent changes in knowledge encompassing not only new diagnostic techniques and drug treatments but also ways of developing needed health policies as well as effectively delivering and organizing health services. 224 R.G. Hughes / Applied Nursing Research 19 (2006) 223 – 224 Fifth, given the potential of research to change health care outcomes, the need for generalizability of research is fundamental. The availability of published research using biased sampling is commonplace. Researchers need to be responsive to leaders, funders, and policymakers who are constantly challenged to use scarce resources to fund research in which findings can be used to improve health care in more than one setting, by more than one individual clinician, and in more than just a handful of patients. As researchers continue to compete for research funds, efforts for collaboration and expanding the sample size to ensure representativeness need to be encouraged and rewarded. Sixth, because we now have strategies and interventions that have been proven to be effective, there is a significant need for both researchers and clinicians to implement and replicate what we know works in clinical practice and across settings. This includes what we have called translational research, applied research, and evidence-based practice. Health care continues to evolve, and more care that has traditionally been given in acute care settings is now occurring in outpatient and community settings. Because the gap between generation of new knowledge and change in everyday practice can be lengthy, almost making the new knowledge obsolete, research that encompasses implementing the best-known practices into the clinical setting using a scientific approach can immediately improve health care. Finally, seventh, there is a need for research that answers high-priority questions that clinicians, leaders, and other researchers must know, not casually bwould be nice to know.Q Central to the continued emphasis on evidencebased practice and patient-centered decision making are the unanswered research questions defined from systematic reviews of the literature. Systematic reviews may offer a starting point for determining research priorities. Because identifying and setting research priorities are done by many researchers, policymakers, health care organizations, funders, and professional organizations, it is not clear as to what the top research questions should be or are. Furthermore, because qualitative methods are becoming better understood and their value is appreciated, developing plans of research should use the best available methods, both qualitative and quantitative methods used either separately or in combination, because various methods can offer different dimensions of needed answers. Then, for those setting research priorities, the typical evidence-based reviews would need to be expanded to include syntheses of high-quality evidence from both qualitative and quantitative research findings. Because the benefits of research are not fully known and the list of possible areas, topics, and issues needing high-quality research abounds, all researchers are challenged to investigate that which is most critical to advance the potential of health care. Nurse researchers are and can become even more essential contributors to unlinking the mysteries of health care from which we will all benefit.