Nursing research in Latin America: 1988-1998

La investigación en enfermería en América Latina: 1988-1998

A pesquisa em enfermagem na América Latina: 1988-1998

ORIGINAL ARTICLE

Nursing research in Latin America: 1988-1998

La investigación en enfermería en América Latina: 1988-1998

A pesquisa em enfermagem na América Latina: 1988-1998

Rita L. Ailinger^I; Rosa Maria Najera^II; Maria Consuelo Castrillón^III; Maricel Manfredi^IV

^IPhD, RN, College of Nursing and Health Science, George Mason University, [e-mail]

^IIDirectora, División Ciencias Bilológica UNAM-X, Mexico, [e-mail]

^IIIMg.Ed., Universidad de Antioquia, Colombia, [e-mail]

^IVMSN, Retired, Pan American Health Organization, [e-mail]

ABSTRACT

The purpose of this article is to provide an overview of nursing research in Latin America during the decade from 1988 to 1998. Data from the bi-annual Pan American Colloquia in Nursing Research from 1988 to 1998 were subject to secondary analysis. Findings indicate that most of the research emanated from Brazil, the only country with a doctoral program in nursing in the 1990's. Research topics included: public health issues, clinical studies (usually of adults), nursing care studies of process, therapeutic communication, and administrative issues such as standards of care and quality. The most common design was descriptive quantitative, although there were several qualitative studies. The analysis provides directions for future research and indicates areas of concern, especially the need for theory based nursing research.

Descriptors: Latin America; nursing; research

RESUMEN

El propósito de este artículo es ofrecer un panorama sobre la investigación en enfermería en América Latina durante la década de 1988 a 1998. La información reunida en los Coloquios Panamericanos de Investigación en Enfermería, que se celebran cada dos años, fue sometida a análisis secundario. Descubrimos que la mayor parte de las investigaciones emana del Brasil, el único país con un programa de doctorado en enfermería en los años noventa. Los tópicos de investigación incluyen asuntos de salud pública, estudios clínicos (normalmente de adultos), estudios del proceso de atención de enfermería, comunicación terapéutica y asuntos administrativos tales como normas de atención y calidad. El diseño más común fue el estudio cuantitativo descriptivo, aunque también encontramos varios estudios cualitativos. El análisis ofrece direcciones para futuras investigaciones e indica áreas de preocupación, especialmente la necesidad de una investigación en enfermería con base teórica.

Descriptores: América Latina; enfermería; investigación

RESUMO

O objetivo do presente artigo é oferecer um panorama da pesquisa em enfermagem na América Latina realizada durante a década de 1988 a 1998. A informação reunida nos Colóquios Pan-Americanos de Pesquisa em Enfermagem, organizados a cada dois anos, foi submetida à análise secundária. Descobrimos que a maior parte das pesquisas foi produzida no Brasil, o único país com um programa de doutorado em enfermagem nos anos noventa. Os temas de pesquisa incluem tópicos de saúde pública, estudos clínicos (normalmente de adultos), estudos do processo de assistência de enfermagem, comunicação terapêutica e assuntos administrativos, tais como normas de cuidado e qualidade. O desenho mais comum foi o estudo quantitativo descritivo, mas também encontramos vários estudos qualitativos. A análise oferece direções para futuras pesquisas e indica áreas de preocupação, especialmente a necessidade de pesquisas de enfermagem com fundamentação teórica.

Descritores: América Latina; enfermagem; pesquisa

INTRODUCTION

While nursing research is flourishing in Latin America, there is a paucity of reports in English-language nursing journals about that research. Colleagues in English-speaking countries could learn much from their counterparts in the southern hemisphere about the state of the art of nursing knowledge if such reports were more widespread. There has been no systematic report in English of the state of nursing research in Latin America for the last 14 years. Prior to that time, Manfredi; Ailinger; and Collado⁽¹⁾ reported on a Pan American Health Organization study of seven Latin American countries' nursing research. Only Chile has recently reported in the English language nursing literature on their research progress⁽²⁾. While there is a need to share knowledge, it is also important to know what is occurring in order to plan future research, arrange for continuing education for nurses, and to plan research conferences.

The purpose of this study was to examine the six Pan American Colloquia in Nursing Research (PACINR) to identify the state of the science of nursing research in Latin America during the decade from 1988 to 1998.

LITERATURE REVIEW

Throughout various parts of the globe, nurses have examined the state of the art of nursing research and priorities for the future. In Canada the Office of Nursing Policy⁽³⁾ convened a group of nurse-scientists to identify the challenges in the nursing science agenda. Participants reported the following needs: to increase the number of nurse scientists, to improve linkages between research and practice, and to develop convergence between research foci and available funding. Borbasi's review of Australian nursing research, published between 1995-2000, led the author to conclude that nurse researchers should align their research with national health priorities⁽⁴⁾. Using a Delphi methodology, to study the priorities for nursing research in Korea and Kim⁽⁵⁾ concluded that the first priority was advanced practice, while other priorities included nursing interventions and effectiveness of nursing care. Another Delphi study was conducted by nurses in Spain⁽⁶⁾ who found that coordination and quality of care were priorities for nursing research.

In an Israeli study, the authors found a change in the type of nursing research from the 1960s to the 1990s and suggested a master plan that emphasized the culture and geography of Israel⁽⁷⁾ . Almost 200 nurses in China participated in a national forum concerning research priorities⁽⁸⁾. The authors concluded the priorities in nursing administration were cost, personnel, and effectiveness.

According to Tlou⁽⁹⁾, the priorities for nursing research in Africa were HIV/AIDS and health behavior. There was a need for epidemiological studies in HIV/AIDS, applied research in prevention and care, studies on the impact of HIV/AIDS on child health and nursing retention of personnel, and home care investigations. With regard to the topic of health behavior, the priorities were lifestyle choices, care alternatives, and self-care. Additional priorities for Africa include cultural, political, and economic influences on the elderly; occupational studies; research on the impact of war on women and children; and women's health.

Kim⁽¹⁰⁾ reported on the status of nursing research in Asia and Australia, based on country reports at a World Health Organization (WHO) meeting. Nursing research in Australia has only been active since 1992, but research funds, conferences, and enrollment of students in research has increased. In China, more nurses are being trained in research each year and current studies include policy, education, administration and services. In India, a nursing research society was established in 1988. There has been an increase in the number of graduate programs in Japan in recent years. While this has led to an increase in nursing research, barriers for implementing research findings in practice have been reported. Korean nurses tend to focus on health services research in their studies. There has also been an increase in graduate nursing programs in Korea, including 19 masters and 12 doctoral programs. The increase in doctoral programs has influenced the growth of nursing research although most of the research is done by educators. Reports from Thailand indicate that the increase in Masters programs since 1994 has led to more research with a focus on clinical nursing, nursing education, and administration⁽¹⁰⁾.

The report on Europe noted that " nursing research has been developing in some countries over the past 30 years e.g. Denmark, Finland and the UK—and in others for less than a decade—e.g. Estonia, Lithuania and Slovenia "⁽¹¹⁾ . The author further addressed the dearth of national priorities for nursing research in most European countries. However, in 1995 five research priorities were identified in the Scandinavian countries: health promotion, symptom management, elderly care, health care systems research, and self-care in health and illness. Nurses in Great Britain had identified six priorities: patients' perspectives of care, the function of informal care-givers, nursing interventions, access to health services and the nurses' role in access, coping with chronic illness, and technologies in nursing⁽¹²⁾. In 1997, the WHO established a list of priorities for a common nursing research agenda: effects of healthcare reform, workforce supply and demand, work conditions, quality of service and education, delivery of care, vulnerable populations, ethics, culturally relevant care, home care, occupational healthcare, and infection control⁽¹³⁾.

According to Hinshaw⁽¹⁴⁾, the five nursing research priorities in the U.S. are outcomes of quality of care, the efficacy of nursing interventions, assessment and management of symptoms, health care delivery, and health promotion/risk reduction. In summary, the status of nursing research can be identified for most the world's continents, however, there were no recent references for Latin America. The purpose of this paper is to provide an overview of the status of nursing research in Latin America for the decade from 1988-1998 as reported at the biannual nursing research meeting.

METHODOLOGY

The programs for the PACINR for the years 1988-1998 were reviewed for countries of origin, topics, methods, areas of health and nursing, characteristics of investigators and institutions. Since this was a secondary data analysis and did not involve human subjects, no informed consent was obtained nor was it reviewed by an ethics committee.

RESULTS

In the six PACINRs held between 1988 and 1998, there were 263 presentations. All 263 presentations were included in the analysis. Brazil, Panama, Venezuela, and Chile, had the highest number of persons presenting (see Figure 1). Over half (53%) the investigators were from educational institutions, 13% were from nursing service, 5% were from other areas, and no information was available for 29% of the investigators. Several universities were represented more frequently in the presentations, including Concepcion and Catolica in Chile, Ribeirao and Carabobo in Brazil, Trujillo in Peru, and Antioquia in Colombia.

Methods used in the research included (in order of frequency): surveys, interviews, triangulation, observation, scales, and record reviews. These methods were used in 79% of the studies. Research participants consisted of consumers (35%), health personnel (33%), others (13%), documents (11%), and at risk populations (8%). More studies were done in public health (32%) than in human resources (23%) or clinical settings (14%) or other sites (31%). Public health studies focused on epidemiology, occupational health, prevention, health education, community health, and mental health. There was considerable emphasis in human resources on the education of professional nurses. Clinical studies were more often of adults and children with fewer studies focused on adolescents and the elderly. Nursing care studies focused on nursing process, therapeutic care, therapeutic communication, standards of care, and plans of care.

In administration, the focus was on personnel, quality of care, and evaluation of programs. Qualitative studies included phenomenological studies on a variety of topics including people with chronic diseases, elderly, pregnancy, sexuality, and AIDS.

Over the years there has been a progressive increase in the number of presentations and in the number of countries that were involved in such presentations. The majority of studies came from academic investigators. The research was conducted almost exclusively by nurses but did not include the use of multidisciplinary teams and collaboration. Although the studies were predominantly quantitative there were a few qualitative studies in reports from Brazil and Chile. Nursing theory was not referenced in ay of the presentation. There were few reports of financial or institutional support.

DISCUSSION

Several recommendations for nursing research in Latin America have evolved out of this secondary data analysis. First, on an institutional level, there is a need for nursing research programs and institutional support for research. Additionally, the need exists for network building, construction of a taxonomy of nursing research, publication of research proceedings, and continued support for the biannual colloquium. Second, on an investigator level, more emphasis is needed on programs of research and networking with other researchers. Third, the establishment of nursing research organizations, such as the Eastern Nursing Research Society or the Council on the Advancement of Nursing Science would be an important step in the dissemination of their members' research. Finally, and perhaps most importantly, investigators should confront the dearth of nursing theory in their research. Nurse researchers need to overcome obstacles in the development of nursing knowledge. These obstacles include lack of studies of vulnerable populations, paucity of qualitative studies, and the lack of multidisciplinary members on the research teams. A limitation of this study was that no attempt was made to examine the published research during the decade

Nursing research in Latin America has come a long way in the last few decades. If nursing research is going to help improve health care in the 21^st century, nurse researchers need to look at the limitations and build on the strengths of their nursing research presentations. Brazil was the most frequently mentioned source of research studies because it was the only country that had a doctoral program in nursing during the decade of this study. It is realistic to expect however, that more doctoral programs will be established in the 21^st century providing new investigators. This trend has already been seen in Europe Asia, and North America. New investigators will provide the research evidence for nursing practice, education, and administration, thus contributing to the development of nursing knowledge.

ACKNOWLEDGEMENTS

The authors acknowledge Silvia Orrego Sierra, Maria Olanda Salazar Henao and Nelson Fernando Molina for their contribution to the study and Mary Ann Braun and Jean Moore for their thoughtful review of the manuscript.

Recebido em: 6.7.2005

Aprovado em: 21.10.2005

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Publication Dates

• Publication in this collection
  26 Jan 2006
• Date of issue
  Dec 2005

History

• Accepted
  21 Oct 2005
• Received
  06 July 2005