The Status of Nursing Research in the Republic of South Africa: past and Present Perspectives

Paper delivered at the 10th Anniversary Conference on Research In Nursing Education at the Hyatt Regency, Embarcadero Centre, San Francisco, California, 12-14 February 1992.

Nursing research in South Africa is relatively young.D epending on how broadly or specifically one defines the term nursing research and more specifically the purpose of nursing research, different answers will emerge as to its age.Most nurses would agree that the cornerstone for the development of nursing research in South Africa was laid forty years ago in 1951, when the first nurse in South Africa to obtain an earned masters degree did so in Sociology.In the same year (1951) the President of the South African Nursing Council clinched an argument for the need for nursing research by publicly stating "Nursing progress without research is a house without foundation" (Searle, 1990).As nursing degrees were not available at South African universities .atthat stage steps were taken to include a research component in the post-registration diploma course in nursing administration.Students in this course were required to complete elementary descriptive studies on problem areas in their field under the leadership of Charlotte Searle, the first nurse who had obtained her masters degree.These studies though elementary and practical were presented in a systematic and organised manner.They augmented the first masters study and made a notable contribution to the reform of nursing service and education (S e a rle , 1990).
U n fo rtu n ately , no documented evidence is available that these early post-registration students continued with independent research after completion of their studies.On the whole research activity in the practice area was negligible and consisted largely of co-operation with and/or assistance to members of other disciplines.
Several nurse leaders have discounted this early period in the development of nursing research and have identified 1969 as the year in which nursing research in South Africa originated (Uys 1982, Uys 1991).This was the year in which a group of six nurses successfully completed the first masters programme in nursing in South Africa launched at the University of Pretoria in 1967 (Uys, 1982).
The initiation of post-graduate nursing in South Africa certainly constituted a most important impetus in the development and progress of nursing research in the country.During die 1970s growth was gradual but pace increased during the eighties and certain highlights were achieved during this decade.Evidence of the growth of nursing research activity in South Africa during the period 1951-1990 is reflected in Table 1.
As depicted in Table 1 a total of 256 research studies were completed over a span of 33 years from 1951 to 1984, giving an average of 7,7 studies annually, while a six to thirteen fold increase in studies occurred annually over the pastsixyears (1985 to 1990).Doctoral studies more than tripled during the eighties while masters studies more than doubled and basic degree studies increased by almost 700 percent over the last decade.Projects done as a requirem ent for diploma studies and independent projects grew at a much slower rate.By 1990 some 645 completed studies  Unfortunately, judging from the very low increase in independent projects, it seems that most nurses prepared at post-graduate level tend to regard their research degree as an end, rather than a means to an end.

T H E NATURE O F NURSING RESEARCH
To establish the nature of South African nursing research all abstracts on post-graduate studies completed during 1980 to 1990 were reviewed, coded and classified, according to the same criteria used in a study on the nature of post-graduate nursing research completed during the period 1969 to 1979 (Uys, 1982).
Classification was done according to area or field of nursing, design and purpose of the study.Tables 2,3 and 4 depict these findings.

Areas or fields of study
The most significant differences among study areas during the decade of the seventies and that of the eighties are the decrease in intensive and clinical specialty areas from 30,9% to 3,3 % and the increase in Community Health studies from 5,4 to 21,4 percent The latter is welcom e, particularly because of the important contribution community nursing can make in developing areas of South Africa.The dearth of clinical studies in post-graduate work gives rise to concern.Though clinical studies comprise almost 49 percent of all research studies documented in South Africa, the bulk of these studies are very elementary studies done as group projects by diploma and basic degree students and were not included in this study.
A further analysis of the studies under each of these areas indicated that the majority of studies in each of the areas (a total of 44%) are caregiver centered (role and function -characteristics and perceptions) while only one single study is patient-centered.Just over seven percent deal with standards and quality of care and another seven percent with curriculum and teaching strategies.Ten percent deal with psycho-social aspects or interpersonal relations, while only one study was found on theory development and two on transcultural aspects of nursing.

Design of study
As reflected in Table 3 the survey approach dominates the scene.Over 84 percent of students used this approach for their studies during the 1980s.

Purpose of the study
No dramatic changes occurred during the decade of the eighties as far as the purpose of the research studies is concerned.As during the decade of the seventies, most of students in the eighties presented descriptive level one studies.A small beginning has been made in theory testing and theory development which is encouraging.

CURRENT STATUS O F NURSING RESEARCH
An extensive review and evaluation of recent post-graduate studies (1980 to 1990) available in the libraries of the South African Nursing Association and the University of South Africa was done to obtain more information on the nature of the actual studies.A total of eighty studies was reviewed which constitutes 32% of the total number of masters and doctoral studies completed during the period under study.Care was taken to include studies from each of the classified areas.Evaluation criteria proposed by Polit and Hungler (1991) were used.
Some studies, though very few, could be classified as substantive, innovative and methodologically sound.On the whole the following picture emerged:  • There is a dearth of indepth studies, and studies focusing on theory, development and theory testing.
• The m ajority o f studies tend to be somewhat superficial, and at times shoddy.
• Samples used for descriptive surveys are very small and thus reduce the contribution of the study to the growing body of knowledge.
• In many cases designs are not the most appropriate for the stated purpose.
• There is almost a complete absence of conceptual or theoretical frameworks.If present, they are frequently incorrectly used.
• Statem ents and decisions are rarely substantiated, and many results are inconclusive.
• Results are seldom related to earlier findings.
• Though the research can be categorised in areas, within each area a shotgun approach is manifested and there is as yet no discernible body of focused nursing research.
Given these characteristics, nursing research in South Africa can be described as being in the toddler stage.Like a toddler it is heading off in all directions at once and influenced by immediate concerns rather than long term consideration.On the other hand in spite of many methodological defects, a considerable number of studies have served a very useful purpose for the improvement of nursing education, nursing practice and the profession as a whole (Searle, 1990).

ISSUES AND EVENTS WHICH HAVE INFLUENCED THE STATUS OF NURSING RESEARCH The Educational System
It is generally recognised that the development of nursing research depends among others on the availability of experts (Burns and Grove 1987;Bergman 1990;Kelly 1991;Polit and Hungler 1991).The development of research is thus closely allied to the education system of the country. Prior

Available Funding
Research as we all know is expensive.Most nurses undertaking research are therefore dependent on financial assistance.Before the 1980s fin a n cial assistan ce for nurse researchers was virtually non-existent The first nurse in South Africa to obtain a masters degree and subsequently a doctoral degree in 1951 and 1964 respectively was unable to obtain any form of financial support for her research as all the authorities who were approached were unable to accept that a nurse could do quality research (Searle 1990: 187).
Gradually attitudes changed and since the early eighties increasing numbers of nurses have been assisted financially.Research funding is now available from several sources:

□ The Medical Research Council
Funds from this body are allocated mainly to biomedical research and as far as is known, no nurse has yet been funded by this body.

□ The Human Sciences Research Council
Since the early eighties a number of nurses have been funded for masters and doctoral research.In 1984, a nurse was appointed as a member of the assessment panel for research grants made available to nurses by this body.

□ University Research Funds
These are limited to staff members of the university, and awarded according to merit

□ The South African Nursing Association
The Association established a National Research fund in 1983 and has since assisted a number of nurses with small grants.In 1987 this association introduced a post-masters bursary which is awarded every third year to one person for independent nursing research.Considered within the national context funding is still limited for nurse researchers.This is a powerful inhibiting factor to the progress of research in the 1990s.

Infrastructure
Until

CONCLUSION
Despite the fact that nursing research in South Africa is still in the toddler phase and has a long way to go, the future shows great promise if the progress of the past years is maintained, intra-and inter-disciplinary communication and collaboration improves and international colleagues remain committed to share their expertise.

TABLE : 3 Classification of post-graduate nursing studies completed during the periods 1969 to 1979 and 1980 to 1990 according to design
*Uys19 8 2:3 0

TABLE 4 . Classification of post-graduate nursing studies completed during the periods 1969 to 1979 and 1980 to 1990 according to purpose
•Uys 1982:30 the eighties resources such as computer facilities, research and clinical consultants, easy access to libraries, research publications and formal structurers for the conduct of research were very scarce, if at all available.This is gradually improving.Faculty and students at universities have reasonable access to such resources and facilities but nurses in clinical areas experience problems.For decades access to international bodies and international research literature has been virtually impossible for South African nurses, due to international sanctions and boycotts.South African nurses were excluded from International Research conferences and forums and therefore had no means to be on the cutting edge of nursing research.This is changing and since 1990 nurse researchers have begun to enter into collaborative research with international colleagues, particularly in the transcultural field.Establishment of the National Society of Nurse ResearchersA noteworthy landmark in the development of nursing research was the establishment of the Society of Nurse Researchers in 1987.This society functions under the auspices of the South African Nursing Association and with close on forty members aims to promote nursing research in South Africa.Since 1989 it has offered mentors courses, workshops and a consultation service for members and other interested parties, and organised annual research conferences.