A conceptual framework for teaching research in nursing

Curationis 28(3): 4-10 Though research is often referred to the lifeblood, hallmark or cornerstone in the development of a profession (Brink, 1996:2), teaching research in Nursing is a challenge. The challenge does not just lie in teaching the subject, but in resistance and unwillingness of students to engage in the subject. In the experience of the researcher, registered nurses identify themselves with being a nurse and a caregiver; the role of researcher has never been internalised. The challenge is to achieve the outcome envisaged, namely, nurses who are knowledgeable consumers of research as well as continuous productive scholars in their application of nursing. Research generates knowledge and knowledge is the basis of caring with excellence. Nursing is an art and a science and the science must produce the knowledge upon which the art is based. The purpose of this article is to propose a conceptual framework of how to teach research in order to achieve such a successful outcome. The conceptual framework proposed in this article is based on four pillars, theoretical knowledge of research, scientific writing, psychological support and experiential learning. The importance of the research facilitator, not just as a teacher but also as a positive role model, is also described.

T e a c h in g n u rsin g re se a rc h is challenging.The challenge does not just lie in the ability o f the teach er and teaching the subject, but also in the resistance and unwillingness of students to engage in the subject (Ax & Kincade, 2001:161).The challenge is thus to achieve the outcome envisaged, namely, nurses who are also researchers.
T he te rm re s e a rc h e r is used as an umbrella term.The definition of a nurse re s e a rc h e r d o e s n o t o n ly in c lu d e academ ic teaching staff or a clinical specialist in a research position o f an academic hospital.Being a researcher also does not necessarily imply having all the knowledge about research or being able to publish scientific articles.There should rather be a researcher continuum with a starting point where nurses may lack knowledge and feel uncertain on the one side, to distinguished researchers in n u rsin g on th e o th e r s id e .
A com prehensive definition o f a n u rs e r e s e a r c h e r is th u s a n u rse w ith an inquiring mind, a nurse who is not willing to accept the status quo, and a nurse that can see patterns and ask the question: why?
Nurses should engage in research for the simple reason to gather know ledge on their subject.According to Emerson and Records (2005:9), the viability o f any profession is dependent upon ongoing g e n e ra tio n and d is s e m in a tio n o f k n ow led g e. N ursing is an art and a science and the science m ust produce the know ledge upon w hich the art is based.A ccording to Searle and Pera (1992:404), the credibility of nursing lies in the value and quality o f its service to p e o p le , w h ich re q u ire s a so u n d k n o w le d g e b a se .
U n fo rtu n a te ly , knowledge in nursing is often based on tradition, authority, borrow ing, trial and error and personal experience (Burns & G rove, 1997:12).T he scope o f the problem is delineated by Kaunda and Low (1998:135) who writes that none or very little clinical research is done outside the realm of academia and that clinical studies generated by registered nurses are non existent.The authors ascribe part of the underlying problem to the way students are educated.
O bserving registered n u rse s' attitude to w a rd s re se a rc h fro m a p a rtic u la r perspective, the experience of fourth-year B Tech Nursing students o f Technikon Pretoria in 2003, is worth reporting.As part of their nursing research module, the students are required to write a protocol in the first semester.The topic o f the re se a rc h is p r e -d e te r m in e d , as th e protocol and the implem entation o f the p ro to c o l are e x p e r ie n tia l le a rn in g activities.In 2003, the topic was to determine the knowledge and attitude of registered nurses in a clinical setting regarding nursing research.Each student prepared his/her own protocol, and after approval, conducted the research in the specific clinical setting that he/she was working.The students were all working in one o f nine p riv a te high c are or intensive care units.O f all the personnel in the nine units, only 16 registered n u rse s w ere w illin g to c o m p le te a questionnaire.In some units, only one registered nurse was willing to complete a questionnaire.The refusal to consent was a direct result of reading the informed consent letter, which indicated that their p articip ation was to determ ine basic research knowledge.The results of the 16 com pleted questionnaires revealed a serious lack of basic research knowledge.on people with a health-related problem that they can assist and care for in some w ay, be it p re v en ta tiv e, p ro m o tiv e , curative or rehabilitative.While thinking is part o f this process, it is demarcated by th e lin e s o f d o in g a s p e c ific intervention.R egistered nurses, who have been in their specific fields of nursing for some time, hardly 'think' at all outside those lines.They are masters o f their discipline and can diagnose a p ro b le m and p re s c rib e a n u rsin g intervention without consciously going through the systematic decision-making process.They are knowledgeable in their field of expertise and comfortable in their role as a nurse.In fact, they are safe practitioners o f the art and science of nursing.
Knowledge has its place in this whole process; knowledge is needed to be able to fulfil this role safely and efficiently.K n o w le d g e is a p re re q u is ite to registration, but registration is only an arrival.Registration is the purpose most students work so hard to achieve.After reg istratio n , the focus is honing the learned skills in the registered nurse's chosen speciality.For most registered nurses, this is what nursing is about and there is nothing wrong with the concept.The only problem is the definition of nursing.
The definition embraces another equally im p o rta n t c o n c e p t, n a m e ly the 'development of knowledge'.Registered nurses are charged with not only using existing knowledge, but also to develop new knowledge and the method for doing so, is research.The definition does not stipulate a specific category of nurse to T h ese q u a lif ic a tio n s are a lso on th e b accalau reate level and the research module is a core module in the elective programme for which they are registered.The elective program m e m ay be, for e x a m p le , o n c o lo g y n u rs in g or o c c u p a tio n a l h e a lth n u rsin g .T he c o m p o s itio n o f th is g ro u p is q u ite variable.Some students are from rural areas working in the primary health care environment while others are working in intensive care units in urban areas.Their nursing experience is vastly different.Some completed their basic training thirty years ago while other qualified recently.Their ages vary from late twenties to late fifties.Som e o f the students are unit managers while others are still on a junior level.However, there are two attributes present in all m em bers o f the group.Firstly, they are all registered nurses, and secondly, they all had previous exposure to a taught research module.These students were asked, during the first contact session, to quantify their ability and w illingness to do research using a Visual Analogue scale (Scale: from 0-10, where 0 = not able or not willing and 10 = able and willing).The results fo r 2 0 0 3 w ere as fo llo w s: fo r the evaluation o f their own ability, the mean was three (range 0-7) and for their willingness, the mean was 7.5 (range 2 -10).These results are in line with the results of previous groups in 2000 to 2002 (Zeelie, 2002:182).None of the students engaged in an own research project since re g is tra tio n .P rev io u s e x p o su re to research did not empower these students to write a research proposal, implement research or publish the results.To facilitate the students' exploration of the th e o re tic a f b asis o f re se a rc h , a structured approach has been developed.The approach is an 11 -decision proposal development guide (Table 1), and it is the basis o f a core lecture at the beginning o f the year.T he g u id e p ro v id e s a sy n o p sis o f the c h o ices the student c o u ld tak e and is not m ean t to be exhaustive.The most common research decisions taken in a first attempt at writing a proposal is pro v id ed .A w orking knowledge of this guide is important.The students must understand the theoretical

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The concepts of study forms the basis of the background narrative style is a skill that has to be developed.Another factor that influence the students' writing ability is that most students are writing in a second language -English, and their freedom of expression is thus limited.
To address the problem, the following a sp e c ts s h o u ld be c o n s id e re d .Instruction in scientific writing should be guided by a pre-planned curriculum .Specific objectives m ust be developed and the learning activities to achieve the objectives m ust be planned.Develop assessm ent criteria that clearly indicate to the student the expected standard.A ccept that the students do not have any scientific writing skills and develop learning activities that will develop the skills to an acceptable level.According to P im p le (2 0 0 2 :n o p ag e n u m b er), frequent writing assignments, regardless of content, dramatically improve writing skills.A sking students to think "on paper" about topics encourages them to think about those topics in greater depth.At Tshwane U niversity o f Technology both undergraduate and p o stgraduate students, the objective for the research module is to develop a research proposal on a theme of their own choice.Proposal writing demands a high level o f scientific writing competence.
Students should also be taught how to organise a complex docum ent such as a research proposal.N ot ju st the macro organisation of the various com ponents o f th e p ro p o sa l fo r e x a m p le th e background and justification, research p ro b le m and re s e a rc h d e s ig n an d methods but also the m icro organisation o f the paper.The follow ing aspects are important: writing of a paragraph, linking o f paragraphs, organisation o f a complex argum ent, w riting concisely, proving their assertions, and revision o f the final draft.Clear, succinct writing is a valuable asset for any researcher.Students also struggle with citations and the references in their proposals.Guidance early in the year saves many revisions for both the facilitator and the student.U sin g th e 1 1 -d e c is io n p ro p o s a l development framework as the backbone o f the proposal facilitates the student's progression towards a proposal that is theoretically well founded.The students n ee d a s tru c tu re d a p p ro a c h on th e b a c c a la u re a te le v e l, w h ic h m ay be abandoned at the m asters or doctorate level.At the baccalaureate level, the students do not yet have the necessary self-confidence to develop a research proposal from scratch.A structured approach also makes the students feel secure and at least, in charge to some extent.

Psychological support
Psychological support is the most crucial o f the four pillars.Students may have theoretical know ledge and be able to write a scientific paper, but if their feelings o f insecurity are not addressed, their attitude towards research will not change.Students feel co n fu sed and insecure even though they have b een guided through the process of w hat and how to write.To be able to understand the level o f confusion and incom petence students are experiencing when they are writing a research proposal the first tim e, the sequence of learning experiences in the research module must be described.
As was explained earlier, the students are required to write a group proposal in the firs t se m e ste r and th ey are g u id e d through the process by using the 11d e c is io n p ro p o sa l d e v e lo p m e n t framework.Before they attempt their first proposal, the following instruction has already taken place: • All the decisions, upon which the proposal is based, are taken in class; thus, the students know exactly what they have to write in each section o f the proposal.
• They are facilitated in the macro organisation of the proposal by being given the index to follow throughout the document.
• They are guided through the principles of paragraph writing and linking paragraphs together.

Experiential learning
The fourth pillar o f the fram ew ork is experiential learning.W ithout doing research and becoming experienced to some extent before they com plete the module, students will still not overcome their negativity regarding research.The students have to accomplish the specific outcomes o f the module.In terms o f the research module, this means a num ber of doing assignm ents, for example: • Presenting the proposal and evaluating co-students' proposals.At the time of writing their own proposal, the students have some experience in doing so and as a rule, they enter into this phase quite positively.

Role of the research facilitator in the conceptual framework
The role o f the facilitator is varied.One has to be a knowledgeable researcher, a p u b lis h e d a u th o r, a p s y c h o lo g ic a l su p p o rte r an d m o st im p o rta n tly , a research role model.As the educational philosophy o f the departm ent is self d ire c te d le a rn in g , the s tu d e n ts are responsible for their own learning.Using the framework, a core lecture is presented during the first contact session o f the year.Thereafter, specific elements of the research process will be dealt with in more depth, for example, sampling methods or data analysis.As the focus is not only on theoretical knowledge, the role o f the f a c ilita to r is to g u id e the stu d e n ts through achieving the specific objectives of the module.

Conclusion
T e a c h in g re s e a rc h in n u rs in g is c h a lle n g in g .If th e f a c ilita to r is in ex p erien ced and insecure, it is an intimidating task without much hope of success.The facilitator will hide behind theoretical knowledge and unconscious ly create a distance between her/him and research.Success is directly correlated w ith th e d e g re e the fa c ilita to r has internalised research her/himself.The following aspects are o f importance:

Figure
Figure 1: A conceptual framework to teach research in Nursing One o f the reasons why nursing students find research so challenging may be the u n d erstan d in g o f the S outh A frican Nursing Council's definition o f nursing:"N ursing science is a human clinical health science that constitutes the body o f knowledge fo r the practice o f persons, registered or enrolled under the Nursing A ct as nurses or midwifes.Within the param eters o f nursing philosophy and e th ic s it is c o n c e r n e d w ith the d e v e lo p m e n t o f k n o w le d g e (m y accentuation) fo r the nursing diagnosis, treatm ent and personalised health care o f p e rso n s exp o sed to, suffering, or recovering from physical or m ental illhealth.It encompasses the knowledge o f preventative, promotive, curative and r e h a b ilita tiv e h e a lth c a re f o r individuals, groups an d com m unitiesand covers man's life span from before birth"(Searle & Pera, 1992:156).This definition of nursing incorporates th e b a sic e le m e n ts o f m o st o th e r d e fin itio n s o f n u rsin g and is a c o m p re h e n s iv e s ta te m e n t o f w h at nursing is.My premise is that nurses, students or registered, only focus on a few aspects o f the definition such as c lin ic a l h e a lth , n u rsin g d ia g n o s is , treatm ent, health care and individuals, groups and communities.The focus is Curationis August 2005

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Figure 2: Students' feelings after their first attempt to write a research proposal However, this group of students is very important to nursing.These registered n u rse s are fu tu re o rie n te d and are a d v a n c in g th e ir c a re e rs w ith an additional qualification.They are careero rie n te d re g is te re d n u rse s w ho are prepared to study part-time.They are the future leaders o f nursing in South Africa.Theoretical knowledge Theoretical knowledge is the foundation o f any d is c ip lin e .W h at m u st be considered though is how much o f the vast body o f re search k n o w le d g e a baccalaureate student should have to cope w ith.U n d erg rad u ate stu dents sh o u ld be ta u g h t e n o u g h re s e a rc h th e o ry to a s s is t them to use th e ir textbooks intelligently, because research is an open book discipline.There is no need to m em o rise theory.S tudénts should be able to apply the principles in d ra ftin g an a c c o u n ta b le p ro p o sa l, implementing the research and writing a s c ie n tific re p o rt.A p p lic a tio n and synthesis is the cognitive levels required o f the student, not memorising.

Table 1 : The 11-decision proposal development guide
applicable.Guided by the framework, the students learn to use research textbooks as a resource.S tudents use the 11decision guide for the initial draft o f the p ro p o s a l, p e n c il, p a p e r, an d tw o landscape A4 sheets o f paper, cellotaped it in the middle with 11 colum ns drawn on the paper.These colum ns are headed by the titles of the 11 decisions.In the The advantage of this framework is that th e re s e a rc h p ro c e ss is re d u c e d to manageable pieces of information that are user-friendly.Once students have some experience, for example, when they have to develop their own proposal, they are k n o w s th a t h is /h e r d e c is io n s are approved, w riting the proposal is less frustrating.The focus can then shift to the quality o f the scientific writing.The bridge from the 11 -decisions to the proposal is presented in Table 2.All the d e c is io n s are in c o rp o ra te d in the proposal.As can be seen from the table, 7

Table 2 : Using the 11-decision framework as the basis of the research proposal
fo r th e lite ra tu re s e a rc h fo r th e b a c k g ro u n d o f the p ro p o sa l.F rom experience, it is clear that students find it difficult to write a suitable background.H a v in g th e s tu d e n ts fo c u s on th e concepts again provides a structured approach.The students are taught to arran g e the co n cep ts from the m ost important concept for the study and build H ow ever, w riting a paragraph o f 300 w ords in the p o stg ra d u a te resea rc h m o d u le is a c o m p le te ly d iffe re n t challenge.Students are asked to write a paragraph o f 300 words on an innocuous subject such as water or chocolate or a m ilkshake.To em phasise the lack o f writing skills, most of students from a Curationis August 2005 class o f 35 -40 are unable to complete such a learning activity.W riting in a