RESEARCH — THE CORNERSTONE OF MODERN NURSING MANAGEMENT Paper presented at the symposium Nursing in the Eighties held at the Rand Afrikaans

OPSOMMING Navorsing is ’n noodsaaklike aktiwiteit in enige beroep. In Suid-Afrika is verpleegnavorsing nog op "n vroeë stadium van ont­ wikkeling. Baie verpleegkundiges toon nog geen belangstelling daarin nie, en die rede hiervoor blyk 'n gebrek aan kennis en insig oor die waarde van navorsing vir verpleegpraktyk te wees. In die meeste werkbeskrywings van geregistreerde verpleegkundiges word daar na navorsing verwys. Daar is egter getoon dat die saalsuster besonder min van haar tyd daaraan bestee. Vir effektiewe bestuur behoort navorsing die hoeksteen van elkeen van die bestuursprosesse te wees. Voorstelle oor hoe om aan navorsing sy prioriteitsposisie in verpleegbestuur te gee word aan die hand gedoen. Die nodige beleidsbesluite moet geneem word en voorsiening moet vir ’n navorsingsbegroting gemaak word. Die werksklimaat moet navorsing bevorder en geselekteerde verpleegkundiges behoort as navorsers voorberei te word. Verder moet bevindinge op ’n verstaanbare wyse bekend gemaak en in die praktyk toegepas word.


INTRODUCTION
In m ost professions research is an essen tial p art of the activities of th e profes sion.It not only enables the profession to earn its place in history as a bona-fide profession b u t it enables it to rem ain dy nam ic by evaluating past achievem ent, im proving p resent practice and collect ing d ata on which to base fu tu re deci sions.
In ternationally nursing as a profesion has been slow in beginning enquiry into its own subject m a tte r and in building its own m ethods of research.Faw cett says th a t th e prim ary purpose of nursing research is to g enerate and validate the know ledge need ed for practice (C haska :169).It therefo re seeks -new inform ation -relationships betw een the inform a tion -problem areas -answ ers to problem s -b etter ways of doing things -the evaluation of past and present practices.In South A frica nursing research is still at a relatively early stage of de velopm ent.This picture needs to change.G re at changes are taking place in health care provision; effective deci sion m aking is becom ing m ore com plex and requires a d ata base of accurate facts and findings.

WHAT IS A CORNERSTONE
The title of this article says th at research is the cornerstone of nursing m anage m ent.W hat is a cornerstone?C ham bers T w entieth C entury D ictio nary says it is a stone that unites the two walls o f a building at a corner; the p rin ciple stone especially the corner o f the foundation o f a building; the stone by which others are measured.If the cor n erstone is n ot set right the walls are cracked.Figuratively speaking it is som ething of great im portance.K now ledge of the value and use of re search m ust pervade every aspect of nursing adm inistration, and m ust con tribute to the effective im plem entation of every function.Smith says th at the present practice of nursing in Britain does not rest on a body of know ledge based on system atic investigation.(Smith: 324) T he position in this coun try is the sam e. R esearch is n ot at p re sent the co rnerstone of m anagem ent.

WHAT DO NURSES IN THE PROFESSION FEEL ABOUT RESEARCH
Clark and H o ckey, p io n eer researchers in B ritain, say th a t nurses do n ot n atu rally em brace research and find it diffi cult to question th e value of procedures that have always existed and the quality of m ethods th a t w ork (C lark: 32).M any nurses are still apathetic and show no in terest in increasing the know ledge base o f nursing.T hey are not able to give a reasoned answ er for w hat they do.You might ask: Why is this?W hat is the problem ?T he following are som e of the answers th a t the author has heard from nurses or has found in the litera ture: M ost of these answ ers show that there is lim ited know ledge and insight into the value of research in nursing practice.This is understandable since m ost nurses have had little or no intro duction to the subject in any of their training courses.T he picture is not all dark , for som e nurses research is fulfil ling.T hey feel -it is a grow th experience -it helps them to im prove their prac tice -it helps them to confront problem s and issues basic to nursing practice -they are involved in improving patient care -it provides them w ith a d ata base for decision m aking -it enables them to increase pro ductivity and to use staff m ore effec tively.Such attitudes help to create an envi ronm ent in which staff enjoy job satis faction and the ripple effect will be b etter staff recru itm en t, g reater staff re tention and im proved patient care.

WHAT IS THE PRESENT SITU ATION IN SOUTH AFRICA?
This is a difficult question to answer.O ne can but point to three indicators.

The inclusion of research activities on job descriptions
In all the jo b descriptions from the ward sister upw ards th a t have been review ed th ere was som e reference to research.T he following is an exam ple of the re search aspect from the job description of a senior nursing service m anager: -evaluates cu rren t research in m an agem ent -assesses its relevance for nursing m anagem ent T he references how ever give no indi cation of w hat is done in research.In m ost South A frican jo b descriptions two aspects found in A m erican job d e scriptions are missing, nam ely the appli cation of research findings to support nursing practice and the use of research findings as a d ata base in decision making.

The time spent on research
In the U N ISA observation study on the sisters-in-charge of hospital w ards, Brow nlee shows th a t research is the m ost poorly d eveloped p art of her func tion.O nly 1,79% of her tim e in m edi cal/surgical w ards an d 2,2% in midwif ery units was spent on this activity.She states In only one instance were any res pondents fo u n d to be involved in re search per se (B row nlee: 37).
T he above p ercentage of tim e in cluded the tim e spent in discussion with the U N ISA p ersonnel on the research being done by them .It is difficult to d e term ine how m uch tim e should be spent on research, b u t it should not be som e thing added to an already full w ork p ro gram m e.It should be part of every nurse's quest to find answers to p ro b lem s and to discover new know ledge.

The National Nursing Register
T he S. A. N ursing A ssociation has com piled a n ational nursing register of re search done an d being done on nursing as a profession and in the field of n u rs ing betw een 1960 -1983.
T able 1 gives a sum m ary of research com pleted and on-going research done and being d one by students and inde penden t researchers.T able 2 shows the am ount of research already done and on-going in som e m anagem ent and practice aspects.

Table 1 Summary of completed and
This does n ot m ean th a t this is a com plete list of all the research th at has b een done; it is a list o f studies known to the A ssociation.

LIMITATIONS AND HINDRANCES TO RESEARCH
A s has been seen m ost of the research w ork is done by stu d en ts and is not p u b lished.Findings th a t could be useful are th erefo re not available.T he profession still lacks nurses w ith expertise in re search m ethodology b o th to im plem ent research and to evalu ate the relevance of findings in research th at has been com pleted.A t p resen t very little repli cation of studies has been done to verify findings.
T h ere is still a lack o f interest in re search activities and a reluctance on the part of som e to try o ut new ideas and to m ake changes based on research find ings.It always seem s easier and safer to m aintain the status qu o .In som e in stances th e co n tin u ed heavy w ork load and staff shortages result in staff b u rn out and m ake creative thinking difficult.
All this is an indication th a t the n u rs ing profession an d , in p articu lar, the nurse administrator, still have a long way to go if research is to be the cornerstone of nursing m anagem ent.on-going research.B oth these aspects cover a wide area of nursing practice and it is not possible to discuss both.If you can picture a wall being built you will notice that there is a co rn ersto ne for every row of bricks.For effective nursing m anagem ent research should form th e basis for each of the m anagem ent processes.

Planning
This is a prerequisite for the successful o peratio n of any nursing d ep artm en t, w hether it be a nursing unit o r a nursing m anag er's departm en t.In o rd er to m ake th e best use o f scarce resources, b oth hum an and m aterial, adequate facts and figures are required.A basic research approach to get this type of in form ation is the situational analysis.In planning th e new curriculum tutors have been busy with this, but have admi nistrators m ade an analysis of all the as pects th a t m ust be considered and u n d erstoo d if planning is to be sound?Som e of these may be the -legal fram ew ork for practice -g overnm ent, provincial and hospital policy -epidem iological profile -available resources -illness continuum -com m unity needs -philosophy of institution -philosophy of nursing adm inis tratio n d epartm ent -philosophy of nursing -cultural aspects -views of population on health -staff expectations.
M uch of this inform ation is available but needs to be collected, verified and collated.It should provide the base-line d ata for all planning.

Organising.
In organising one is creating a structure in w hich nursing activities can take place.It includes the process of group ing activities, outlining job resp o n sib ili ties, setting out lines of authority and c r e a tin g c o m m u n ic a tio n c h a n n e ls .T here is an aw areness of the need to do away with duty sheets containing a list of tasks to be done and to provide staff with p ro p e r job descriptions.These should be a list of activities for which particular persons are responsible, based on w hat research has show n to be relevant.
N ot much prom inence is given to record keeping in a job description, yet B row nlee's rep o rt shows that sisters-incharge spend 11,19% -26,39% of th eir tim e in recording.Tw enty-three different records, forms and files that have to be com pleted w ere identified (B row nlee: 27; 163).A n average of three hours in the tw elve-hour day period are spent on this activity.R esearch questions th at com e to mind are: -is this the right am ount of tim e to be spent on record keeping? -is this the best use of professional expertise?-is this the position in the w ards of the institution w here I w ork? -is there an allow ance in the sister's job description for alm ost a qu arter of her tim e to be spent on this activ ity?
Personnel issues Most research has been done in these areas but it should be obvious that to be effective and to prom ote professional developm ent much m ore research will have to be done.Staff b u rnout, and the effect of the bureaucratic system on job perform ance and job satisfaction need investigation.T he quality of care ren dered is dep en d en t on the m easure of job satisfaction enjoyed by those who carry o ut the care.

Leading and directing
All registered nurses, regardless of their seniority, have a leadership and direct ing function.W hat type of leadership theory do we subscrribe to?Students in nursing adm inistration frequently state that dem ocratic leadership is the best; but is it?This is a decision based on sup position.
H as research established the type of leadership th a t fits best into the present hierarchical system in a health service?Is it necessary to be a leader in order to direct a nursing service?W hat is in volved in directing a service?T he nurs ing profession can only be im proved if our own researchers endeavour to find appropriate answers to these questions.F urtherm ore, the findings of nurse re searchers in A m erica cannot be applied blindly to South A frican nursing.

Evaluation.
Strasser et al say th at evaluative re search are studies done to m easure any part of the operating effectiveness of an organisation o r d ep artm en t (Strasser:71) and may m easure the quality of care, the utilisation of the service or CURATIONIS staff m orale.T here is an urgent need to develop standards against which to m easure the entire spectrum of care from the sim ple action of getting a patient up into a chair to sophisticated interventions such as take place in an in tensive care unit.

WHAT IS THE SOLUTION
How can research be given a priority place in nurse m anagem ent?T he fol lowing are som e suggestions.
* It is tim e to stop talking about m aking research the cornerstone of m anage m ent and to start making it the cor nerstone.* T he required policy decisions m ust be m ade on -procedure to be followed in initiat ing research -procedure to ensure the protection of patients and staff -procedure for the docum entation and im plem entation of results.* R esearch is expensive, it needs tim e, effort, staff, finance and m aterial re sources.
It is so easy to say there is no money.If no provision is m ade on the budget proper research will never begin.It may be necessary to persist with m em oranda and m otivations for several years before the proposals are accepted.In the m eantim e mini-research projects can be u n d ertaken w ithout additional costs being involved.
T renchard says Cutting back on fact fin d in g and planning exercises is a short sighted policy which will be detrimental to the well-being o f patients, clients and staff.In the longer term, is does not m ake sense in financial terms (T re n chard: 62).
It is tim e to m ake provision in the budget for research.W ho is a good research person?It is the person with an enquiring mind and an adven tu ro u s spirit; probably that person w ho as a student gave the m atro n grey hairs, broke m any of the residence rules and was always up to som ething.This person usually has an above average intelligence.N ot all of us will be researchers but every nurse can develop an enquiring mind and question w hat she is doing.* T he findings of existing research must be put into practice.M ore research is being do n e, b ut the know ledge is not being tran sferred to the practical set ting.W ays of im plem enting findings on a trial basis m ust be found.A w ord of caution -too rapid change has the opposite effect, it increases resistance.Be p rep ared to take a risk and if it should fail determ ine w hat was learn t from the situation and w hat pitfalls could be avoided in future.
* The nurse ad m in istrato r m ust be com m itted and innovative.M ake sure th a t everyone know s about p ro jects th a t are to be im plem ented.The nursing service m anager is going to relinquish som e o f h er routine adm i nistration tasks co n n ected with stu dent training.Isn 't this a good tim e to m ake a com m itm ent to developing an on-going research program m e? * T he tim e has com e for th e profession to consider startin g a research jo u r nal.T h ere is a need for som e publica tion o th er th an "Curationis" w here research findings can be published and m ade available to everyone.R e search is an expensive activity and the inform ation needs to be shared.Find ings will be lost if they are not com m unicated.R esearch m ust be repli cated and unified; a body of theory m ust be built up. In Prof B Robertson.BCur (I et A)(UP>, B A (C u r)(H o n s)(U n isa ), M A (C ur) (Unisa), RN, RM, CHN, N.Educ.NAdmin.Department of Nursing, University of South Africa.
-considers how existing research find ings im pact on the research in the nursing d epartm ent.T he research aspect o f the job d e scription for the A m erican counterpart of this person states -know s curren t research findings in nursing -m akes sound judgem ent about the significance of research findings for nursing m anagem ent -evaluates cu rren t research in m an agem ent and assesses its relevance for nursing m anagem ent -applies research findings to support sound nursing practice -uses research findings as a d ata base for m aking m anagerial decisions (R ole objectives.N ursing O rganis ation E xecutive R ole, U .S .A .).

W
ithin the m anagem ent fram ew ork re search has tw o m ain b ran ch es nam ely -research related to clinical practice and -research related to the m anagem ent process.
the m eantim e nurses can read, for exam ple, th e Journal o f A dvanced Nursing.It p resen ts som e of the best in tern atio n al research and o th er arti cles on a w ide spectrum of subjects.Nursing Research, th e oldest A m eri can research jo u rn al, is also recom m ended.* C ollaboration w ith the dep artm en ts of nursing in universities is necessary.T hese d ep artm en ts have expertise and access to a w ide range of litera tu re.C o -o p eratio n w ith a nursing d e p artm en t prom otes -team work -security for nurses new to research -the use of individual talents -the pooling of ideas.This enables the best m ethod to be follow ed and p ro m otes m utual und erstan d ing and im proves practice (M arriner:381).