Convergent-assistential research: an integrative review of scientific nursing production

Abstracts

Objetivou-se analisar produções científicas da enfermagem, publicadas no período de 2005 a 2010, que utilizaram a metodologia convergente-assistencial. Trata-se de revisão integrativa para responder à questão da adequabilidade ao seu desenho metodológico, nos estudos que afirmam tê-lo utilizado. Consultaram-se sete periódicos brasileiros de enfermagem, de novembro a dezembro de 2010. A partir da leitura dos resumos das publicações que respondiam ao período estipulado, foram selecionados 19 artigos, submetidos à avaliação criteriosa, com leitura exploratória dos textos completos e preenchimento de instrumento de coleta de dados, seguidos de leitura analítica com análise textual, temática e interpretativa dos dados. Retrata-se a caracterização da pesquisa com exposição de desenhos metodológicos, temáticas, contextos, participantes, inserção do pesquisador no contexto assistencial, contribuições e aspectos relevantes apontados nos diferentes estudos. Identificou-se crescente utilização dessa metodologia e infere-se a necessidade de maior atenção às suas especificidades e na descrição dos procedimentos metodológicos e contribuições da pesquisa.

Enfermagem; Pesquisa qualitativa; Pesquisa em enfermagem

LITERATURE REVIEWS

Convergent-assistential research: an integrative review of scientific nursing production¹

Metodología convergente-asistencial: una revisión integrativa de la producción científica de enfermería

Flávia Lamberti Pivoto^I; Wilson Danilo Lunardi Filho^II; Silvana Sidney Costa Santos^III; Valéria Lerch Lunardi^IV

^IDoctorate student on the Post-Graduate Nursing Program of the FURG. Nurse at the Porto Alegre Teaching Hospital. Porto Alegre, Rio Grande do Sul, Brazil. E-mail: [e-mail]

^IIPh.D. in Nursing. Associate Professor III of the FURG College of Nursing. Rio Grande, Rio Grande do Sul, Brazil. E-mail: [e-mail]

^IIIPh.D. in Nursing. Adjunct Professor IV of the FURG College of Nursing. Rio Grande, Rio Grande do Sul, Brazil. E-mail: [e-mail]

^IVPh.D. in Nursing. Associate Professor III of the FURG College of Nursing. Rio Grande, Rio Grande do Sul, Brazil. E-mail: [e-mail]

Correspodence

ABSTRACT

The aim was to analyze scientific nursing production, published between 2005 and 2010, which used the convergent-assistential methodology. It is an integrative review to respond to the question of the suitability of its methodological design in the studies which stated that they used it. Seven Brazilian nursing periodicals were consulted from November to December 2010. Based on reading of the abstracts of the publications which responded to the stipulated period, 19 articles were selected and submitted to thorough evaluation, with exploratory reading of the complete texts and filling out of a data collection instrument, followed by analytical reading with textual and thematic analysis, and interpretive analysis of the data. The research's characterization is depicted through the showing of methodological designs, thematic designs, contexts, participants, insertion of the researcher in the assistential context, and relevant contributions and aspects indicated in the different studies. A growing use of this methodology was identified, and the need for greater attention to its specific characteristics, in the description of its methodological procedures, and in the research's contributions is inferred.

Descriptors: Nursing. Qualitative research. Nursing research.

RESUMEN

El objetivo fue analizar producciones científicas de enfermería publicadas en el periodo 2005 y 2010 que utilizó el método convergente-asistencial. Es una revisión integrativa para responder a la cuestión de la adecuación del diseño metodológico en los estudios que lo han utilizado. Se consultó siete periódicos brasileños, de noviembre a diciembre 2010. De la lectura de los resúmenes de las publicaciones que han respondido al plazo, 19 artículos fueron seleccionados, sometidos a una cuidadosa evaluación, con la lectura exploratoria de los textos completos y lectura analítica con el análisis de los datos. Representa a la caracterización de la investigación con la exposición de diseños metodológicos, temas, contextos, participantes, inserción del investigador en el cuidado, contribuciones y aspectos relevantes mencionados. Se identificó un creciente uso de esta metodología y se infiere la necesidad de una mayor atención a sus especificidades y la descripción de los procedimientos metodológicos y contribuciones de la investigación.

Descriptores: Enfermería. Investigación cualitativa. Investigación en enfermería.

INTRODUCTION

The convergent-assistential methodology is a mode of qualitative research, essentially characterized by the convergence between research, assistance and the participation of the subjects involved in the practice, concomitantly with the process of the construction of knowledge. It proposes reflection and the production of knowledge for guiding practice through theorization and investigation of phenomenon emerging from the assistance, in the context where it occurs.^1-2

The convergent-assistential investigation follows the phases of conception, instrumentation, examination, analysis and interpretation. In the conception phase, one proceeds to establish the area of interest which, detailed in its theoretical and practical aspects, and considering the interest of the professionals involved, results in the theme of the research, based on which the guiding question and the objectives are established, and the theoretical support, the introduction and the rationale for the study are elaborated. In the instrumentation phase, one adopts the methodological decisions referent to the research space, the participants, and the methods of collecting and analyzing the data. In the next phase, of examination, the strategies for obtaining the data are adopted and established, being followed by the phase of analysis. The process is finalized with the phase of interpretation, in the summarizing processes, with subjective analysis of the associations and variations of the data; of theorization, conferring theoretical grounding to the interpretation of the information reported in the summary; and of transference, attributing meaning to the results, with explanation of how they affect the assistance.¹

The research's questions and information are the result of experiences had in the practice context and the results are aimed at solving problems and introducing innovations and improvements into the study locale itself. The research field is the context of development of assistential activities, where the problem was identified and for which the changes are desired. In addition to this, the researcher must, necessarily, be part of the practice context, even if temporarily, during the research. The subjects are those involved in the context, both of the research and the assistential practice, valuing the representativity of the participants, who contribute actively, suggesting, criticising and validating the results. The collection and analysis of the data must be concomitant with the practice; specific techniques are not stipulated, bringing together different methods, as long as the information obtained in the assistential practice is recognized as data from the research.^1-2

The convergent-assistential methodology makes it possible to reflect and improve professional practice, conferring scientificity on the assistance and reducing the dichotomous belief between theory and practice. This investigatory mode is being adopted by nurses, in research which seeks to make explicit the convergence between theory and professional practice, aimed at improvements and the introduction of innovations in nursing's assistential practice. For implementation of this type of research, peculiarities and relevant aspects need to be taken into account.

In the light of the above, and basing the conditions of its use, the present study sought to answer the following research question: what is the suitability to the convergent-assistential research design of the studies published in the period 2005 to 2010 which stated that they used this design? To this end, the aim was to analyze scientific nursing production, published in the period 2005 to 2010, which used the convergent-assistential methodology.

METHOD

This is an integrative review, a method which makes it possible to investigate an issue through summarizing research undertaken so as to obtain new conclusions and a better understanding of the phenomenon studied. The operationalization of this review took place during the stages of delimitation of the issue and the research question; definition of the inclusion criteria for the scientific productions; the seeking of the studies; analysis of the abstracts with selection of the studies; thorough evaluation of, and making notes on, the studies selected; and analysis of the data.^3-4

The inclusion criteria for the scientific productions were the period of publication of 2005 to 2010 and the utilization of the convergent-assistential methodology. The choice by the time interval sought to cover a significant and up-to-date period, regarding the quantity and representativity of the publications. The Brazilian nursing journals consulted were those with the greatest scientific impact in the country: Revista Latino-Americana de Enfermagem, Texto & Contexto Enfermagem, Acta Paulista de Enfermagem, Revista Brasileira de Enfermagem, Revista da Escola de Enfermagem da USP and Revista de Enfermagem da UERJ, from the months of November and December 2010. For the selection of the studies, the abstracts from all the publications in the above-mentioned journals in the stipulated period were read, with the identification of the articles which used the convergent-assistential methodology for the development of the research.

These articles were submitted to thorough evaluation, through exploratory reading of the complete texts, with filling out of the data collection instrument, constituted of the following items: numerical identification, bibliographic reference, year of publication, theme of the research, context of the research; participants, type of insertion of the researcher in the assistential context, data collection technique, data analysis technique, and relevant contributions/aspects of the convergent-assistential research as a scientific investigation methodology. Finally, the authors proceeded to the qualitative analysis of the data, through analytical reading,⁵ with textual analysis, based on thorough reading and obtaining of a wider vision of the data; thematic analysis, for clarifications regarding the issue; and interpretive analysis, with the problematization of the data.

PRESENTATION OF THE RESULTS

Based on the results of the bibliographic survey and considering the inclusion criteria, 19 scientific articles were selected. The data of the research carried out is presented below, constituted of the issues and methodological designs adopted in the different studies in which the convergent-assistential methodology was utilized, and the points raised from this methodology's contributions.

Of the productions analyzed, one was published in 2005; four, in 2006; frequency repeated in 2009; two, in 2007; three, in 2008; and five, in 2010. The Revista Brasileira de Enfermagem and Texto & Contexto Enfermagem were the scientific journals with the largest number of studies which utilized this research methodology, in a total of six articles each, followed by the Revista Latino-Americana de Enfermagem, with four publications, in the period of six years. See table 1 for the topics of the studies analyzed.

For 15 of the studies, the context of development was the hospital; for five of these, support groups for chronically-ill patients from the institutions; and a further two studies, besides the hospital setting, completed the production of data in the participants' homes. Four studies were undertaken in Primary Health Care Centers.

The majority of the participants in the studies analyzed were hospitalized patients in inpatient units or belonged to health institutions' support groups. In five of these studies, family members were included in the group of participants. Only three studies were undertaken with health professionals from the study contexts. The data collection techniques utilized in the studies are presented in table 2, and the analysis techniques in table 3.

Regarding the insertion of the researcher in the assistential context, in 10 of the studies analyzed, the researcher was inserted, carrying out care activities in the research context. In the others, it was not possible to identify the type of insertion originated.

Regarding the relevant contributions and aspects of the utilization of the convergent-assistential methodology for the development and carrying out of the research, indicated by the authors of the scientific productions analyzed, in seven of them it was not possible to identify any consideration referent to the methodology adopted or association between the methodological design and the contributions resulting from the research. In the others, points were made about the methodology.

DISCUSSION OF THE RESULTS

Based on the data raised in this research, it was possible to identify a smaller number of publications which adopted the convergent-assistential methodology in 2005. Since then, studies which utilize it have been published continuously in the Brazilian journals consulted, with a greater incidence in 2010, which reflects a growing utilization of this methodology in nursing research, demonstrating acceptance and recognition of this approach. On the other hand, it leads to discussion of how this proposal is being presented and developed, such that possible weak points in the investigations made may be indicated, making clarification of the same possible through their investigative designs.

The convergent-assistential research modality has its core in an initiative from the Federal University of Santa Catarina's Post-Graduate Nursing Program, which instigated Master's students to produce knowledge related to phenomena of their professional practice, resulting in studies with specific methodological trajectories and which were difficult to categorize using already-described methods. Such characterization, of linkage between research and care in the works undertaken, led to commitment to construct a new methodological approach which would respond to such singularity, with the publication of the first edition of the specific work of this methodology in 1999, and its second edition in 2004, with an increase in the dissemination and utilization of the method in nursing research.² The editorial relationship between this Post-Graduate Program and the journal Texto & Contexto Enfermagem may be a possible reason for this periodical being one of those which had the highest number of publications of studies which adopted the convergent-assistential methodology.

As may be seen in table 1, regarding the topics of the studies analyzed which utilized this methodology, whose aim was to articulate the nursing assistance and the production of scientific knowledge, all of the productions address professional care practices, with only the groups researched and the contexts covered differing, with prevalence in these studies of the hospital context. In this way, this investigatory modality can be utilized in studies which address the distinct groups of nursing care, in the different contexts of development of professional activities and in the varying areas in which nursing is present, whether care, management, teaching or short university-based courses.

Thus, in the convergent-assistential methodology, the field of research is the space of development of professional activities where the problem was identified, and in which the locale and the relationships are inherent to the study, and the development of and reflection on the practical activities produce the research questions and provide the information. Therefore, the aim of this type of research needs to include the resolution of practical problems or introduce innovations.¹ It can be translated into a type of study which allies research and professional practice, making it possible to attribute practical applicability to the research, and theoretical foundations to the practice.

Regarding the participants in the studies analyzed, the diversity identified corroborates the versatility of the convergent-assistential methodology, highlighting that the participants are not mere informants, rather that they are integral to the research,¹ with the investigation possibly being compromised, should this engagement not be effective. This is because, if the purpose is to resolve assistential problems or produce changes which impact on practice, such aspirations depend on subjective changes in those involved, and the best way for this situation to occur is their involvement in the constructive process.

The most utilized data collection strategy was that which allied the techniques of participant observation and interview, indicated in the literature as a base for the convergent-assistential methodology and as a privileged method, as "the descriptive record of observation, the highlights of the individual interview, the intertwining of the accounts, salient points and behaviors of the social actors in the physical environment"^1:98 make possible the revealing of the phenomenon investigated.

Other studies allied or adopted, separately, the techniques of participant observation and interview, group techniques, such as focus groups and convergence groups, which does not invalidate them, as, as previously highlighted, this methodology does not stipulate methods for data collection and analysis, it being possible to unite more than one method.¹

For data analysis, the strategy adopted by the majority of the studies was that proposed by the literature which convergent-assistential methodology is based on, which indicates four generic processes of qualitative analysis, which should occur simultaneously with the data collection: apprehension, summarization, theorization, and transference.¹ The other two techniques utilized were discourse of the collective subject and content analysis.

Regarding the insertion of the researcher in the assistential context, in the majority of studies analyzed, the researcher was inserted, carrying out professional activities in the context of the research. The researcher's involvement as a carer and researcher in the professional activities of the locale where the scientific investigation was carried out is one of the peculiarities of the convergent-assistential methodology which lacks rigor in its thorough application, as his or her cumulative involvement as a researcher in the assistential work, alongside those who conventionally practise the assistance in that locale's daily routine, is fundamental to the development of the process of construction of the research, such that the data emerging from the assistential practice may be recognized and that there may be possibilities for genuine involvement of the participants in the research to take place.

Therefore, the contact with the assistential context of the development of the research needs to precede and originate the research question. The researcher cannot arrive in the research context with the research problem ready; this needs to emerge from the practice.

In nine of the studies, it was not possible to identify how the researchers were inserted in the research scenarios and the core of the research problem. In one of these studies, on weaving together considerations about the utilization of the convergent-assistential methodology, which were fairly relevant, such as the fact of making possible the joint construction of problems, the authors comment that this methodology made possible "the contact with the field of action of the nurses working in the clinics".^6:182

In this way, attention is necessary to the specific characteristics of this type of research and to the presentation of the methodological procedures adopted for its development. The consideration of the characteristics of the convergent-assistential modality needs to be clear in the description of the study, including the emergence of the research question in the practice context, the insertion of the researcher in the assistential activities, the active involvement of the participants, the intended changes and those achieved through the study, and the contributions of the methodology adopted.

However, some studies seem not to exhibit the comprehension of the real pretensions of this type of research,² in ceasing to adopt or, sometimes, to describe the criteria of implementation of this methodology. This observation shows the relevance of discussing the utilization of this investigatory modality, as presented in this study.

The points made referent to the relevant contributions and aspects of the utilization of the convergent-assistential methodology include that of being "relevant and appropriate for a work which sought, based on professional practice, to collectively develop the scientificity of 'doing' in nursing".^7:669

Further, the convergent-assistential methodology was considered appropriate, because it made "research associated with care practice"^8:170 possible, and made it possible to mobilize the health professionals for the collective construction of improvements and innovations in the professional field,⁹ to accompany the resolution of problems identified and addressed in the research,^10-11 and to improve the dialogic interaction and exchange of information and guidance between the researchers/health professionals and the participants/patients.^12-15

In all the publications analyzed, the authors did not make comments referent to negative aspects of the methodology, neither did they indicate weaknesses of the option, regarding the suitability for the research problem or the methodological development. However, it was possible to observe weaknesses in the description and adoption of the methodological procedures and in the presentation of the research's contributions. These are questions which need to be described well, such that one can direct greater scientificity of the convergent-assistential research.

FINAL CONSIDERATIONS

Based on this integrative review of the scientific publications of Brazilian nursing which adopted the convergent-assistential methodology, it was possible to identify what has been developed under this nomenclatura, as well as the different issues researched and points made referent to the methodology in question. It should be noted that the methodological choice, on falling on this research method, requires an adaptation to the research problem and the available resources. However, once a methodology like this has been adopted, consideration and attendance to its characteristics are necessary, as well as the description of the corresponding conducts.

In the specific case of convergent-assistential methodology, it seems there is a certain difficulty in comprehension of, and different interpretations of, the rules of developing this methodology; in the same way that there seems not to be a more homogenized understanding of the real meaning of the immersion in the study's context, based on assistential practice. And, further, of this modality's intentions, which makes it possible to highlight the primary function of the research: to result in improvements to the space and subjects of the study, as well as to highlight the relevance of participation and joint construction of improvement, delineation and greater visibility and valorization of the profession, through production of knowledge emerging from the nursing care practices.

Regarding the method of integrative review adopted in the present study, it is worth emphasizing that it satisfied this research's initial intentions, also making possible the linking of data for greater recognition of the distinct methodological procedures in the light of convergent-assistential research. In addition to this, this research has an interface which is instructive and disseminates knowledge referent to the question researched, and which can serve as a source of information for authors who wish to work with, or know a little more about, the research design termed by its authors as 'convergent-assistential research', dealt with here in the interests of wider clarification of this methodology.

REFERENCES

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• 14. Teixeira MLO, Ferreira MA. Uma tecnologia de processo aplicada ao acompanhante do idoso hospitalizado para sua inclusão participativa nos cuidados diários. Texto Contexto Enferm. 2009 Jul-Set; 18(3):409-17.
• 15. Teixeira MLO, Ferreira MA. Cuidado compartilhado: uma perspectiva de cuidar do idoso fundamentada na educação em saúde. Texto Contexto Enferm. 2009 Out-Dez; 18(4):750-8.

1

Estudo elaborado na Disciplina de Pesquisa Qualitativa na Enfermagem/Saúde do Curso de Doutorado em Enfermagem da Universidade Federal do Rio Grande (FURG)

Publication Dates

• Publication in this collection
  01 Oct 2013
• Date of issue
  Sept 2013

History

• Received
  12 Aug 2011
• Accepted
  14 Mar 2012