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NURSING
RESEARCH
A WHO Study
Participation, Productivity and
Prospects in Nursing Research in the
Western Pacific
Region
EXECUTIVE SUMMARY ... 1
PREFACE ... 6
ACKNOWLEDGEMENTS ... , ... 8
INTRODUCTION ... 9
1. TIlE OBJECTIVES OF lHE STUDY ... 9
2. MElHODS ... 10
3. RESPONDENT'S PROFILE ... 12
4. FINDINGS ... 12
4.1 Status of nursing research in the Region ... 12
4.2 Utilization of nursing research outputs ... 15
4.3 The needs for nursing research development ... 16
4.4 Priority areas for nursing research ... 17
5. CONCLUSIONS AND RECOMMENDATIONS ... 18
REFERENCES ... 22
TABLES: TABLE 1 - NUMBER OF QUESTIONNAIRES SENT AND RETURNED BY COUNTRIES AND AREAS IN lHE WESTERN PACIFIC REGION ... 23
TABLE 2 - DEMOGRAPHIC AND SOCIAL CHARACTERISTICS OF RESPONDENTS ... 24
TABLE 3 - PERCENT DISTRIBUTION OF NURSES WIlH A NON-NURSING DEGREE AND LEVEL OF NON-NURSING DEGREE RECEIVED ... 25
TABLE 4 - RESPONDENTS UNDERTAKING RESEARCH ACTIVITY AND MEAN FREQUENCY OF UNDERTAKING ACTIVITY, 1986-1990 ... 26
TABLE 5 - PERCENT OF RESPONDENTS WHO DEVELOPED OR ASSISTED IN lHE DEVELOPMENT OF A NURSING OR HEALlH DATA BASE AND WHETHER DATA BASE WAS COMPUTERIZED ... 27
TABLE6 - TYPESOFINFORMATIONINlHEDATABASES THAT NURSE RESEARCHERS DEVELOP OR HELP DEVELOP ... 27
TABLE 7
TABLE 8
TABLE 9
TABLE 10
TABLE 11
TABLE 12
TABLE 13
TABLE 14
TABLE 15
TABLE 16
TABLE 17
TABLE 18
TABLE 19 TABLE 20
PERCENT DISTRIBUTION OF THE NUMBER OF RESEARCH PROJECTS CONDUCTED OR
PARTICIPATED IN BY NURSE RESEARCHERS,
1986-1990 ... 28 PERCENT DISTRIBUTION OF THE CATEGORIES
OR AREAS OF RESEARCH PROBLEMS OR OBJECTIVES OF STUDIES CONDUCTED BY
NURSE RESEARCHERS ... 28 FREQUENCY DISTRIBUTION OF AREA OF
CONCERN OF STUDY/PROJECT ... 29 FREQUENCY DISTRIBUTION OF PRIMARY
PURPOSE OF STUDY/PROJECT ... 30 FREQUENCY DISTRIBUTION OF NATURE OF
PARTICIPATION OF RESPONDENTS IN
STUDy/PROJECT ... 31 PERCENT DISTRIBUTION OF TYPES OF
PERSONNEL RESPONDENT WORKED WITH
DURING LAST PROJECT 1986-1990 ... 32 . FREQUENCY DISTRIBUTION OF GEOGRAPHICAL
SCOPE OF STUDY /PROJECT ... .32 FREQUENCY DISTRIBUTION OF THE
PRIMARY RESEARCH DESIGN USED IN THE
STUDY /PROJECT ... 33 FREQUENCY DISTRIBUTION OF PRIMARY
METHODS OF DATA COLLECTION OF
STUDY /PROJECT ... 33 PERCENT DISTRIBUTION OF COLLABORATION
IN PROJECTS UNDERTAKEN BY NURSE
RESEARCHER, LAST PROJECT 1986-1990 ... 34 PERCENT DISTRIBUTION OF MULTI-
DISCIPLINARY PROJECTS BY NURSE
RESEARCHERS, LAST PROJECT 1986-1990 ... 34 PERCENT DISTRIBUTION OF WHETHER
PROJECT CONDUCED BY NURSE RESEARCHER IS BASIC OR APPLIED, LAST PROJECT
1986-1990 ... 35 PERCENT DISTRIBUTION OF LEVEL OF DATA
ANALYSES MADE, LAST PROJECT 1986-1990 ... 35 PERCENT DISTRIBUTION OF COMMISSIONED
RESEARCH DONE BY NURSE RESEACHERS,
LAST PROJECT 1986-1990 ... 35
TABLE 21
TABLE 22
TABLE 23
TABLE 24
TABLE 25
TABLE 26
TABLE 27
TABLE 28
TABLE 29
TABLE 30
TABLE 31
TABLE 32
TABLE 33 TABLE 34
PERCENT OF YES RESPONSE REGARDING OTHER QUALITATIVE ASPECTS OF THE RESEARCH PROJECT, LAST PROJECT
1986-1990 ... 36 PERCENT DISTRIBUTION OF RATING OF
OVER-ALL QUALITY OF THE PROJECT,
LAST PROJECT 1986-1990 ... 36 FREQUENCY DISTRIBUTION OF PROGRAMME
TOWARD WHICH STUDY/PROJECT IS
EXPECTED TO CONTRIBUTE ... 37 PERCENT DISTRIBUTION OF RESPONDENTS
BY PRIMARY AREA OF NURSING ... 38 PERCENT DISTRIBUTION OF NURSES BY
PRIMARY SPECIALTY ... 38 PERCENT DISTRIBUTION OF RESPONDENTS
BY CURRENT POSITION OR RANK. ... 39 PERCENT DISTRIBUTION OF NURSES WITH
FORMAL TRAINING IN RESEARCH,
STATISTICS AND COMPUTERS, AND MEAN
HOURS OF TRAINING IN THESE AREAS ... .40 PERCENT DISTRIBUTION OF RESPONDENTS
ON SELF-ASSESSMENT OF COMPETENCE
IN DOING RESEARCH ... .41 PERCENT DISTRIBUTION OF RESPONDENTS
ON DEGREE OF INTEREST IN DOING
RESEARCH ... 42 PERCENT DISTRIBUTION OF RESPONDENTS
ON DEGREE OF IMPORTANCE PLACED ON
RESEARCH ... 43 PERCENT DISTRIBUTION OF NURSES ON
VARIOUS ASPECTS OF RESEARCH AT
WORK ... 44 PERCENT OF RESPONDENTS WITH ACCESS
TO RESEARCH CONDITION OR FACILITY AND MEAN RATINGS OF HOW CRITICAL CONDITION OR FACILITY TO FURTHER DEVELOPMENT OF
NURSING RESEARCH ... 45 WHETHER STUDY/PROJECT WAS FUNDED ... .47 LEVELS OF PROJECT FUNDING ... .48
TABLE 35
TABLE 36
TABLE 37
TABLE 38
ANNEXES:
ANNEXA
ANNEXBl
ANNEXB2
ANNEXC
PERCENT OF RESPONDENTS USING RESEARCH OUTPUTS AND MEAN FREQUENCY OF USE OF
RESEARCH OUTPUTS, 1986-1990 ... 49 SIGNIFICANT RELATIONSHIPS BETWEEN
PARTICIPATION AND PRODUCTIVITY IN NURSING RESEARCH AND SOCIO-
DEMOGRAPHIC, EDUCATION AND TRAINING, WORK-RELATED AND ATTITUDINAL VARIABLES:
RESULTS OF CHI-SQUARE TESTS ... 50 DEGREE OF RELATIONSHIPS BETWEEN
PARTICIPATION AND PRODUCTIVITY IN NURSING RESEARCH AND SOCIO·
DEMOGRAPHIC, EDUCATION AND TRAINING, WORK-RELATED, AND ATTITUDINAL
VARIABLES: COEFFICIENTS ... 52 STEPWISE MULTIPLE REGRESSION
ANALYSES RESULTS, REGRESSION
COEFFICIENTS AND OTHER STATISTICS ... 53
INVENTORY OF RESEARCH PROBLEMS STUDIED BY NURSE RESEARCHERS BY CATEGORY OR AREA AND VARIABLE TYPE,
1986-1990 ... 57 NAMES AND ADDRESSES OF NURSE
RESEARCHERS IN THE WESTERN PACIFIC
REGION - 1991 ... 71 NAMES AND ADDRESSES OF INSTITUTIONS
INVOLVED IN NURSING RESEARCH IN THE
WESTERN PACIFIC REGION - 1991 ... 83 LETTERS OF INVITATION AND DATA
COLLECTION TOOL ... 93
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NURSING RBSBARCH
PARTICIPATION, PRODUCTIVITY AND PROSPBCTS IN NURSING RESEARCH IN THE WESTERN PACIPIC REGION
SUKMARY
This is a report on the participation, productivity and prospects for nursing research in the Western Pacific Region, which has 2.5 million nurses. Nursing research includes research, creative work, and other related activities done by nurses. The report provides
information on the the following:
(1) types, quantity, and quality of research projects/activities, human resources and facilities;
(2) availability and levels of funding for nursing research;
(3) individuals and institutions involved in nursing research;
(4) degree to which nursing research outputs are utilized;
(5) needs for nursing research development in the Region;
(6) factors that affect participation and productivity in nursing research;
(7) priority areas for nursing research; and (8) recommendations.
Twenty-two of the 35 countries and area in the Region
participated in the survey undertaken between May and August 1991. A questionnaire, developed, critiqued and pre-tested for the study, was sent to 514 nurses, 153 returned them. The period covered was 1986- 1990.
Both qualitative and quantitative methods were used in the treatment of the data. The latter include frequency distributions, means and standard deviations, chi-square, product-moment
correlation, and step-wise multiple repression. In addition, a registry of nurse researchers was compiled from published sources on the period covered by the survey.
The typical nurse researcher is female, 46 years old, married, with a 3-year certificate or a bache~or degree; at least one in five with a master's or doctoral degree.
Sixty-three per cent of the nurses participated in research in the form of undertaking at least one project or study between 1986 and 1990. Participation was highest in the research-related
activities like writing a paper on a completed research, writing proposals for funding, establishing a research network, having a paper published, and consultancy. Half participated in the development of a nursing or health data base. Very frequent
participation was also reported in the review of manuscripts for a professional journal and research proposals f0r funding. The mean hours spent on research was 34 hours per month.
Average per capita productivity was 2.77 projects or studies over the five-year period.
Majority of the studies dealt with nursing practice, followed by nursing administration, nursing education, and theory and
methodology. The most frequently studied concepts were care and caring, health needs, quality, management systems, organization, service operationalization, effectiveness of curricular programmes, needs, curricular development, scale development/validity/
reliability, and measuring phenomena.
The primary reasons for undertaking the projects were to gain more information, to decide between possible courses of action, and to solve a problem.
Eighty-two per cent of the respondents were directors, principal investigators, co-investigators or consultants of the projects.
Other qualitative aspects of the research projects include the following:
(1) the majority were local in geographic scope and one in five. was national;
(2) designs used were survey, field experiment and secondary data analysis;
(3) data collection.methods used were questionnaires, face-to-face interview, and observation;
(4) average sample size was 445 and average duration of the project was 15 months;
(5) research was multidisciplinary and applied in nature;
II
(6) it was bivariate and multivariate in levels of analyses invqlving the use of computers;
(7) in at least seven out of ten cases reports were written and disseminated; 39% of these reports were published.
The projects were expected to contribute to more than one programme; these programmes are health service development, health personnel development, research promotion and development, and health information.
The human resources in nursing research came from nursing
education, followed by administration and practice; by specialty they were in medical-surgical, community health, and maternal and child health nursing.
About three in five had formal training in research and statistics, and although only one in four had been trained in computers more than half knew how to use them.
Their interest in research was "high" and they considered
research "very important". More than half claimed that research was part of their job description.
The conditions and facilities that are highly available for nursing research are interest in doing research, duplication and reproduction equipment, library assistance, computers and office space.
About six out of ten projects were funded and the level of this funding was usually from US$ 1000 to 9999 per project.
A total of 140 individuals and 93 institutions were identified in the survey as doing nursing research throughout the Region.
Dissemination of research fundings in the form of presentation to or discussion with various target groups ranged from 18% to 65%.
Presentation to local peers was highest followed by programme implementors, national and international peers and administrative policy-makers. Dissemination was low to legislative policy-makers, lay people and the ministry of health.
High use of research outputs was reported in teaching
administration and practice, solving problems in the work setting, and as reference.
Availability of time and funds were rated as the two most
critical conditions for the further development of nursing research.
Other critical factors are availability of resource persons with research expertise and atmosphere conducive to research.
Participation in research by the respondents would be significantly increased by making available more time and funds, as well as staff, administrative support, training and recognition. In addition to lack of time, funds and training, too much bureaucracy, and lack of administrative support and manpower were cited as significant
constraints to increased participation.
Socio-demographic variables, as well as education and training, work-related, and attitudinal variables were related to participation and productivity in nursing research. The following factors were significantly related to participation: job description (work- related); highest nursing degree; training in research, statistics and computers, and competence (education and training); and degree of interest and important place in research (attitudinal) were
significantly related to with participation. Only formal training in research (education and training) was associated with productivity.
Job description and competence were the most important factors in predicting participation. Formal training in
research/statistics/computers, age, job description, and level of research development in the work place were significant in predicting use of research outputs. Productivity, on the other hand, was
determined only by formal training in research/statistics/ computers.
Eighteen percent of the respondents reported the presence of statements on nursing research priorities in their respective
countries. The research priorities as indicated by the respondents in this survey are:
(1) care and caring;
(2) nursing manpower;
(3) role of nurses and nursing;
(4) nursing theories and methodologies;
(5) nursing interventions and outcomes; and
(6) primary health care.
The following recommendations are made:
(1) To maximize the contribution of nursing research to health services development and health for all, qualified nurse researchers should be invited or appointed to policy-level health research bodies at the national and regional levels:
(2) Resource sharing and collaboration between countries should be encouraged with the WHO Collaborating Centres for Nursing Development in Primary Health Care taking the lead:
(3) Training in research, statistics, and computers should be integrated in the basic nursing curriculum:
(4) Health and nursing managers should allocate a specified percent of nursing positions or time for research activities:
(5) Opportunities and support for formal and continuing education training in research should be provided.
It is further recommended that WHO in the Western Pacific Region should do the following:
(1) create a Regional Advisory Committee on Nursing Research Development;
(2) allocate a proportion of the regional health research budget to support nursing research projects in accord with country-specific and regional priorities; and
(3) strengthen the WHO Collaborating Centres for Nursing Development in Primary Health Care through regional and international
collaboration and cooperation.
P R B PAC B
Background
This study was undertaken pursuant to the Forty-Second World Health Assembly resolution WHA42.27 on strengthening nursing and midwifery in support of strategies for health for all, which urges Member States to encourage and support the development of research on more efficient and effective methods of employment of nursing/midwifery resources,
including training in research methodologies and requests the Director- General to promote and support the training of nursing/midwifery
personnel in research methodology in order to facilitate their
participation in health research programmes, including the development of information systems on nursing/midwifery.
Modern nursing, one of the main 'caring professions', has existed in most countries in the Region since the early 1900s. Yet by global standards the profession has still not been able to adapt satisfactorily to current needs. There are now over 2.5 million nurses in the Region, an order of magnitude enjoyed by no other health professional group.
Nursing and other health planning experts are aware of the dearth of scientific knowledge on which to base nursing practice in the Western Pacific Region, although such knowledge is gradually accumulating.
Therefore, the joint meeting of the fourteenth session of the Western Pacific Advisory Committee on Health Research (WPACHR) and Health Research Councils for Analogous Bodies (HRC/AB), which will meet on 10 to 14 August 1992, placed on the agenda this special report on the role of nursing research and nursing in health care in this Region.
Role of the Western Pacific Advisory Committee on Health Research (WPACHR) and Health Research Councils or Analogous Bodies (HRC/AB)
The role of the WPACHR is to advise the Regional Director on the following matters:
(a) definition of policies for the promotion of research in the Region with the framework of the global WHO policy;
(b) determination of regional priorities for research and establishment of mechanisms for this purpose;
(c) development of research capability in the Region,
identification and maximum utilization of locally available talent, and better use of untapped talent;
(d) collection of data on institutions, facilities, personnel and projects in the Region with a view to ultimately developing a regional research information system;
(e) by these and other means, stimulating research in the Region on problems whose solution is identified as being of priority importance for the health of the people, improvement of
coordination among countries of the Region, and promotion of a sense of awareness and communications among all scientists wor~ing
on common problems; and
(f) evaluation of the programmes in terms of stated objectives and the mechanisms for implementation.
The objectives of the HRC/AB are as follows:
(a) to review the present status of national systems for the organization, development, management and coordination of health research;
(b) to develop a mechanism for cooperation in health research to facilitate implementation of the strategies for health for all;
(c) to promote the establishment of a single national focal point for the effective management and coordination of health research;
and
(d) to strengthen national research capabilities.
While the populations of the Region have been growing and health care technology has been modernized, nursing development has not been able to keep up with the demand. However, noting the concern of the two above-mentioned bodies, and their wish to place the topic of nursing and nursing research on the agenda for this meeting, new possibilities for
strengthening this area of the health research are expected.
ACKBOWLBDGKBBTS
The World Health Organization Western Pacific Regional Office gratefully acknowledges the enthusiastic response of nurses from Member States, without whose willingness to make the time to answer the questions, this study could not have been completed.
Also gratefully acknowledged is the work of Dr Leda Layo-Danao, Ph.D., Dean and Professor, and Director of the WHO Collaborating Centre for
Nursing Development in Primary Health Care. College of Nursing. University of the Philippines, Manila, without whose expertise and dedication to nursing research the success of this study would not have been possible.
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NURSING RESEARCH
PARTICIPATION, PRODUCTIVITY AND PROSPECTS IN NURSING RESEARCH IN THE WESTERN PACIFIC REGION
INTRODUCTION
This is a report on the study of the status of nursing research in the Western Pacific Region. The term 'nursing research'refers here to the systematic process of generating, testing, and applying knowledge. Not included in this study is the more general process of problem-solving or decision-making that nurses continually use in the practice of their profession.
The report consists of four parts. Part 1 states the objectives of the study. Part 2 describes the methods that were used. Part 3 deals with the respondents' profile. Part 4 presents the findings and Part 5 deals with the recommendations in support of nursing research and in strengthening the nursing research inputs to health service development and health for all in the Region.
1. THE OBJECTIVES OF THE STUDY
The objectives of the study were as follows:
1.1 To assess the status of nursing research in the Region specifically:
1.1.1. the types, quantity, and quality of research
projects/activities, human resources, and facilities 1.1.2. availability and level of funding
1.1.3. individuals and institutions involved in nursing research 1.2 To assess the degree to which the outputs of nursing research are
utilized;
1.3 To assess the needs for nursing research development in the Region;
1.4 To identify the priority areas for nursing research;
1.5 To identify the factors that affect participation and productivity in nursing research· and
1.6 To recommend policies. directions. and/or mechanisms in support of nursing research and strengthening the nursing research inputs to health service development and health for all in the Region.
2. METHODS
Thirty-two countries and areas in the Region were divided into three groups according to the number of nurses in each. In the first group were ten countries with less than 200 nurses; in the second were 11 countries with 200 - 2000, and in the third group were 11 countries with 2000 or more.
Based on the objectives of the study, a questionnaire was developed, pretested, and presented to experts for critique. The questionnaire had four
parts as follows: 1) participation and productivity in research and related ~
activities; 2) research environment and the conditions/facilities that are critical to nursing research development; 3) individuals and institutions involved in nursing research and priority areas for nursing research; and 4) socio-demographic, work-related, attitudinal and other information. A sample questionnaire is provided in Annex C.
The population of the study consists of nurses who are knowledgeable or active in research and related activities in their respective countries. At the time of the conduct of this study no listing of these nurses was available from which a random sample could be drawn. However, a list of nursing
education and service leaders was available at WPRO, and a letter requesting the names of individuals who were actively involved in nursing research was sent to them.
On the basis of personal knowledge and judgment of the status of nursing research in the various countries in the Region, a decision was made that for the group I countries there would be seven respondents, and for groups II and III countries, nine and thirty respectively. The corresponding number of questionnaires were sent by mail or by personal delivery to the selected nursing education and service leaders. The instructions were for the leader
to be a respondent herself if she was active in nursing research and to send or give the rest to an equal number of education and service nurses who were knowledgeable or active in nursing research. In addition, 50 questionnaires were sent to researchers, all from Group III, who were identified and referred
to the investigators in response to the request letter sent to the nursing leaders.
A total of 514 questionnaires were sent to 32 countries and areas in the Region in May and June 1991. By the end of August 1991, 153 questionnaires from 22 countries had been returned. Questionnaires received after
August 1991 were not included in the study. Details of the distribution of respondents by country are found in Table 1.
The response rate of 29.77% is low. The constraints of resources and time precluded call-backs. If we assume that those who responded were more highly motivated and more actively involved in research than those who did
not, the responses in this study probably overestimate the participation, productivity, and quality of research being done.
It should also be noted that the rates of return of the questionnaires varied across the three groups of countries: Groups I and II had a
questionnaire return rate of 22% while Group III had a rate of 33%. The questionnaires from these latter countries comprised 78% of the total questionnaires considered in this study. The over-representation of the information from these countries has biased the results in favour of the nursing research situation in these countries.
The questionnaire used in the study was written in English. Inaccuracies in the answers to some questions discovered during the examination of the data suggest that the range of understanding of the English language of the
respondents in countries where this language is not a common medium of communication may be a factor to consider in assessing the validity and reliability of the information provided by these respondents.
The major variables used to measure research participation include:
1) whether the respondent undertook any of the research activities in the 18 - item research activity list, and if so how often; 2) whether the
respondent developed or assisted in the development of a health/nursing data base; 3) whether the respondent conducted or participated in a research study/project; 4) the frequency of the respondent's dissemination and utilization of research outputs; and 5) the hours spent on research activities.
The variable used to measure productivity is the number of research studies/projects undertaken during the five-year period of the study. This was chosen because it is easily understood, measurable, and reflective of a
tangible output or outcome.
The independent variables that were hypothesized to affect participation and productivity may be grouped into socio-demographic, education and
training, work-related, and attitudinal variables. These were chosen on the basis of available literature showing these to be significant predictors of nurse performance (e.g. Schwirian, 1981; 1978; Layo-Danao, 1989; 1983).
The socio-demographic variables are age, civil status, and presence of children 0-5 years. The education and training variables are highest nursing degree, whether respondent had formal training in research, statistics and computers, whether respondent knows how to use computers and degree of competence in doing research. The work-related variables are whether the researcher is a salaried employee, whether research is part of the job
description, whether research is done within regular working hours, position, rank, and primary classification of current nursing specialty. The
attitudinal variables are degree of interest in doing research and importance placed on research.
Programme frequency distributions were generated using the Statistical Package for Social Sciences (SPSS) computer and, when appropriate, means and standard deviations of the variables, were generated. To determine the factors associated with research participation and productivity, the chi- square test was used. The degree of association between the relevant variables and the relative importance of the independent variables were
determined with the Pearson product-moment correlation coefficient and stepwise multiple regression, respectively.
In addition, a directory of nurse researchers and their respective
projects was drawn up from published data sources covering the same period as the 1991 survey.
3. RESPONDENTS' PROFILE
Nine out of ten respondents were female. Their age ranged from 27 to 64 years with a mean of 45.68. About 62% were married and 31% percent were single. Of the married, 17% had children five years old and below.
About one in three respondents had a 3-year certificate (36%) while ~
slightly more than one in five had a BSN degree. Seventeen per cent held master's and 10% held doctoral degrees. Close to two-fifths (39%) had a non- nursing degree at the bachelor's (29%), master's (38%), and doctoral levels
(33%). (See Tables 2 and 3).
4. FINDINGS
4.1 Status of nursing research in the Region
4.1.1 Types, quantity, and quality of research projects/activities
Participation of nurses is highest in the following research activities:
writing a paper on a completed piece of research, conducting a study, writing research proposals for funding, developing or helping to develop a research
network, having a paper published in a non-referred journal, and research ~
consultancy. On the other hand, participation is least frequent in research activities such as editing a published book or monograph, serving on the editorial board of a referred journal and writing a book or monograph.
Mean frequency of engaging in research activity is highest in reviewing a manuscript for a professional journal, reviewing a research proposal for
funding, authorship of a paper published in a referred journal and research conSUltancy. It is lowest in developing a nursing theory or model that was published, publishing a book review, and writing a chapter of a book.
(Table 4).
Half of the respondents developed or assisted in the development of a nursing or health database. The databases include information on nursing manpower, nursing schools or colleges, hospitals and other establishments, health indicators, nurse registries, and other information. (Tables 5 and 6)
Over a five-year period, the respondents reported a total of 269 research projects that they conducted or participated in for an average of 2.77
research projects per capita. (Table 7).
More than half (56%) of the research projects conducted were in the area of nursing practice, one-fifth (21%) were on nursing administration, about 16%
were on nursing education, and the remaining 7% were on nursing theory and methodology. (Table 8).
Under nursing practice the most frequently studied dependent variables include care and caring; health; needs; quality; knowledge, attitudes and behaviours; mental health and functioning; pain; aspects of primary health care; effectiveness; use. The elderly were the most frequent subjects, followed by chronic and cancer patients. Under nursing administration the more common dependent variables studied were aspects of nursing administration
such as management systems, organization, and service operationalization;
continuing education; needs of nurses; and work variables like history, routines, and relationships. Under nursing education the dependent variables were effectiveness of curricular programmes; needs; and other aspects of the curriculum such as construction, development and review. Under methodology the more frequent concerns were scale development, validity and reliability;
measuring phenomena; and conceptualization. (Annex A).
Turning now to some indicators of the quality of the projects based on the last project conducted, Table 9 shows that the areas of concern more frequently mentioned were primary health care implementation (16%), policy (11%), manpower (10%), and operations (8%). As to the primary purpose of the study, the top three purposes mentioned are to gain more information about the phenomenon, get information that will help decide between courses of action, and help solve existing problems. (Table 10).
Indicating that the respondents were senior researchers, they were project directors or principal investigators in 60% of the projects. In 13%
of the projects they were co-investigators and in 9% consultants. In the remaining 18% the respondents were interviewer/observers, research assistants, programmers, field supervisors and the like. (Table 11).
The categories of personnel that the respondents worked with in the projects by order of descending frequency are data collector, clerk,
statistician, research assistant, consultant, and field supervisor. The least used were programmers, research associates, and librarians. (Table 12).
Seven out of ten projects were local in geographic scope, about one in five were national, and the remainder (3%) were regional and international.
(Table 13). With respect to designs and data collection methods, the survey, field experiment, and secondary data analyses were favoured for the former, while these were questionnaires, face-to-face interview, and observation for
the latter. (Tables 14 and 15). Mean sample size of the projects was 445.
The majority of the last research project of the respondents was done with others (67% ), multi-disciplinary (51%), applied in nature (55%) and multivariate in level of analysis. Twenty nine per cent of the projects were
commissioned projects. (Tables 16-20).
In 59% of these projects computers were used, in 78% reports were
written, and 71% of the time these reports were disseminated. Thirty nine per cent of the reports were published. Self ratings of the overall quality of the project was a mean of 2.01 or "Good". (Tables 21 and 22).
Going back to the total number of projects and the programmes towards which these are expected to contribute, Table 23 reveals that 48% contributed to more than one programme; of the one-programme projects the highest expected contribution was to health services development, followed by health manpower development, research promotion and development, and health information.
4.1.2 Human resources in nursing research
Nurses who do research are likely to be in nursing education followed by nursing administration and far below are those who are in nursing practice and continuing education. Only 3.5% of the respondents classify their primary area of nursing as nursing research.
Of specialties, medical surgical nursing is the highest, followed by community and public health and maternal and child health. By position, the
instructors are ahead of the professors and associate professors. It is the reverse in nursing service rank where the chief nurse or director is one of four nurse researchers, followed by the matron and the supervisor. Not too far behind are the head nurse and staff nurse. (Tables 24-26).
As regards training in research and statistics, 58% - 60% of the
respondents had formal training in these areas; while only 26% had training in computers, more than half of the respondents (55%) know how to use them.
Mean hours of formal training are highest in research which is roughly
equivalent to 2.1 person months, followed by statistics (1.14 person months) and computers (21.44 person days). (Table 27).
Self-assessments of the respondents' competence to do research ranges from "quite competent" to "competent". On the average, interest in research was rated "high" and research was considered "very important" by the
respondents. (Tables 28 - 30) .
Table 31 presents a picture of a working environment that is relatively conducive to research. It shows that 64% of the respondents spent part of their working time on research, usually within the regular work time, and that for more than half of these respondents (52%) research is a part of their job description. The table also shows that the mean time spent on research per month is 34.16 hours.
4.1.3 Conditions and facilities for nursing research
Access to and availability of conditions and facilities for nursing research are presented in Table 32. Interest in doing research is highest in the list, at 89%. Duplication and reproduction is likewise high at
81%, followed by library assistance, computers, office space, opportunities, and computer software. Lowest in the list are research space, research assistants, research funds, programmer assistance, and superiors who do research.
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4.1.4 Availability and levels of funding
Information on the availability and level of funding for nursing research is found in Tables 33 and 34. About six out of ten projects were funded and the modal category (at 52%) for the amount of funding is
US$
1000 to US$ 9999 US dollars per project.It should be noted that of the 146 projects that were reported to have been funded, data on the amount of project funding was available for only 67, 46%, of the funded projects.
Twelve per cent of the projects were funded at 10 000 to 19 999
US dollars, and 7% each at the 20 000 to 29 999 and 30 000 to 39 999 levels.
Four per cent had funds of less than US$ 1000 and the remaining 16% were funded at US$ 40 000 or more.
4.1.5 Individuals and institutions involved in nursing research
There were 140 researchers and 93 institutions reported to be doing nursing research throughout the Region. The names and addresses of these individuals and institutions are found in Annexes Bl and B2. The information is arranged alphabetically by country.
About 66% of the individuals doing nursing research are working in university or college settings. Of these educational institutions, slightly more than half (52%) have departments or schools of nursing. the other
individuals are based in hospitals, professional nursing associations, government ministries or other types of agencies.
Of the 98 institutions reported to be doing nursing research, 52% are universities and colleges, 23% are hospitals and the remaining 24% are
professional associations, government ministries, research institutes or other types of institutions. Fifty-nine per cent of the educational institutions had schools of nursing.
The researchers doing nursing research were paired with the titles of their respective projects and this directory is found in Annex C. A similar directory of researchers and their projects was culled from published sources such as research directories, research bulletins and other such listings covering the same time period as the 1991 survey. This is in Annex D.
4.2 Utilization of nursing research outputs
It can be seen from Table 35 that the utilization of nursing research outputs ranged from a low of 18% in the case of presentation of policies to legislative policy-makers implied by research findings and writing a popular version of the report for lay people to a high of 76% in the case of using
research findings in teaching, administration or practice.
Frequency, was highest in the use of research findings in teaching, administration or practice, followed by use of results in solving problems in the work setting, paper presentation, and use of research output as reference.
4_3 The needs for nursing research development
The availability of time for research and the availability of research funds were rated as the two most critical conditions for the further
development of nursing research. These were followed by availability of resource persons with research expertise and an atmosphere that is conducive to research. At approximately similar levels of criticalness are interest in doing research, attendance at research meetings, opportunities for doing research, and availability of computer software. The lowest ratings (least critical) went to other research space, programmer and research assistance, superiors who do research, clerical support, and rewards for doing research.
(Table 32).
Results of the chi-square test, done to determine whether significant relationships exist between the independent variables and the dependent variables are found in Table 36.
The work-related variable of whether research is part of the respondents' ~
job description was signficantly related to the participation variables of whether they spent any working time in research, whether they conducted or participated in the conduct of a study, and the quality of their last research project. Also significantly related to participation were the education and
training variables of highest nursing degree; training in research, statistics, and computers; and competence. The attitudinal variables of interest and degree of importance placed in research were likewise
significantly related to participation. The only variable that was
significantly related to productivity (number of research projects undertaken) was whether respondent had had a formal course on research.
These results suggest that job description, education, and training, and to some extent attitudes are important considerations in the participation and productivity of nurses in research.
To determine the degree of association between the variables referred to above, product-moment correlation coefficients were computed. The means and standard deviations of the variables in the correlation and regression
analyses are found in Table 37.
The results show that the degree of association between whether the respondents spent any working time in research and job description was highest, followed, in the order of decreasing magnitude, by competence, interest, importance placed in research, and highest degree. (Table 38) As to whether the respondent conducted a study, correlation was highest with job description, then formal training, and then highest degree. Degree of use of research outputs was highly correlated with formal training. The latter variable was the only one with a high significant correlation with
productivity (number of research projects undertaken).
The results of the stepwise multiple regression analysis, a procedure to determine the relative importance of the independent variables in explaining variance in participation and productivity are found in Table 39.
Job description and competence are two significant factors in influencing whether the respondent spent any work time in research activities. Formal training in research, statistics, and computers; age; job description; and
level of research development in the workplace were significant predictions of degree of use of research outputs. Productivity, on the other hand, was
determined solely by formal training in research, statistics and computers.
To the specific question on the conditions on factors that will increase researchers' future participation in nursing research the, following were mentioned, in order of decreasing frequency:
(1) time and reduced workload;
(2) funding on budget;
(3) peer, manpower, and other administrative support;
(4) knowledge, training and interest; and
(5) recognition and equipment/suppliesfbuilding.
The top five conditions or factors existing at present that discourage or hinder researchers from participating in research, in order of decreasing
frequency of mention, are:
(1) lack of time and heavy workload;
(2) lack of funds;
(3) lack of knowledge, training, experience, interest or opportunity;
(4) too much bureaucracy and lack of administrative support; and (5) lack of manpower.
4.4 Priority areas for nursing research
Respondents were asked about whether there were statements from
government or private sources on priority areas for nursing research in the country. Eighteen per cent responded 'Yes'. The steps or processes that were taken to generate these statements include: workshops and seminars conducted by the Ministry of Health; establishment of national action groups; survey of nursing needs; review of records and reports on quality of nursing care
rendered; adoption of recommendations of nursing studies; and pilot testing mechanisms or strategies.
The priority areas for nursing research, based on the frequency of mention of the area or topic by the respondents, are:
Priority number 1
2 3 4
Area on topic Care and caring Nursing manpower
Role of nurses and nursing Nursing theories and
methodology
Frequency of mention by researchers
45 41 29 26
Priority number 5
6 7 8 9
10 11 12
13
14
15
Area on topic
Frequency of mention by researchers Nursing interventions and
outcomes
Primary health care, general Nurses attitud~s, beliefs and behaviours
Curricular development and evaluation
Health education Nursing processes and procedures
Clinical practice, general nursing practice, general Health economics and nursing Health problems, specific Turnover of nurses
Wellness and health Information systems Management of changes Quality assurance
Working conditions of nurses Evaluation of college versus hospital graduates
Family planning and population Relationships between education and practice
Specialty nursing
Ethical issues in nursing Health policy analyses Teaching methods
Use and development of health services
5. CONCLUSIONS AND RECOMMENDATIONS 23 20 13 13 12 10 9 8 8 8 8 6 6 6 6 5 5 5 5 4 4 4 4
There is a significant body of nurse researchers who are actively and productively engage in nursing research in the Region. In numbers, the study identifies 97 of them who conducted at least one research project within a five-year period. Of these, ·27 researchers conducted one project every year.
Per capita productivity was 2.77 projects over a five-year period.
Participation and productivity are high as well in research-related activities such as writing research reports/articles, writing research
proposals, consultancy, reviewing manuscripts for professional journals, and reviewing proposals for funding. Furthermore, nurse researchers participated actively in the development of a nursingfhealth data base.
The research problems investigated by nurse researchers reflect areas of common interest as well as wide diversity. These researchers focused first on
nursing practice, second on nursing administration, and third on nursing education. On nursing practice the more frequently recurring concepts are health; knowledge, attitudes and behaviours; needs; nursing activities and outcomes; primary health care; and quality of care.
On the whole, at least the majority of the projects may be considered of good quality; these are projects done with others, multidisciplinary
projects, bivariate or mutivariate analyses projects, and projects where reports were written and disseminated. At least one-fourth to one-third of the projects are of high quality; these are commissioned projects and
projects where reports were published. Self-ratings of the nurse researchers of the quality of their projects reveal similar results.
The primary reasons for conducting research are to gain more information, to decide between alternative courses of action, and to solve existing
problems. The major areas of concern of these projects are primary health care implementation, policy, manpower, operations, and methods. The
programmes to which the studies are expected to contribute include health services development, health manpower development, and research promotion and development.
Access to or availability of conditions or facilities conducive to
participation and productivity in research was relatively good (at least half of the respondents had access) except in the following: research space other than office space, research assistants, research funds, programmer assistance, superiors who do research, formal and continuing education training in
research and statistics, and attendance at research meetings.
Availability of research funds and time for research stood out as the two most critical conditions for the further development of nursing research.
Also highly critical are resource persons with research expertise, atmosphere conducive to research interest in doing research, attendance at research meetings and computer software.
Funding was available in six out of ten projects. More than half of the funded projects were at the $ 9999 level or below.
On the whole, use of research outputs was relatively low, with the
exception of findings being used in teaching, administration, or practice; to solve problems in work setting; presentation of results before a local meeting and as reference. This suggests that awareness and use of nursing research findings are usually confined to nursing.
Formal degree and training in research/statistics/computers; research as part of job description; and attitudinal variables where significantly
associated with participation in research. Degree of participation was affected by attitudes. The correlate for productivity and use of research outputs was formal training in research/statistics/computers.
Competence, job description, and training in research/statistics/
computers were the significant predictors of participation. The last two were also the significant predictors of degree of use of research outputs plus age and level of research development in the workplace.
Awareness or knowledge of the existence of statements on priority areas of nursing research is very low. To begin with, there may be no statements.
However, there is a consensus that priority areas for nursing research include studies on care and caring, nursing manpower, role of nurses and nursing, theories and methodology, interventions and outcomes, and primary health care.
The following recommendations are made:
(1) Qualified nurse researchers, by virtue of formal training and experience, should be invited or appointed to policy-level health research bodies at the national and regional levels. At the national level, these include bodies in the planning ministry, the health ministry, academic institutions, research institutions, and the like.
The primary reasons for this are: (1) to contribute to the determination of the health and development research agenda; (2) to participate in the formulation of policies on health and development research; (3) for the nursing sector to align its research priorities more closely with the
mainstream of health and development research considering the overall ~
national and regional priorities; and (4) to maximize the contribution and utilization of nursing research in the overall health services development;
(2) Countries with a higher level of nursing research development should serve as resources for the further development of nursing research in other less well-situated countries. In this regard, the WHO
Collaborating Centres for Nursing Development in Primary Health Care should be tapped for technical support and assistance for region-wide nursing research development.
(3) Training in research, statistics, and computers should be integrated in the basic nursing curriculum. Attitudes regarding the importance of research, utilization of research outputs, and the other conditions that facilitate research are desirable competencies as well. Training
materials in the form of modules, visuals, and. research apprenticeship programmes should be developed to facilitate implementation.
(4) Mechanisms for national and regional research collaboration should ~
be developed to encourage participation, productivity, and recognition.
(5) Nursing management should allocate a specified percent of nursing positions or time for research activities and projects.
(6) Opportunities and support for formal and continuing education training in research should be provided.
It is further recommended that WHO/WPRO should do the following:
(1) Create a Regional Advisory Committee on Nursing Research Development.
(2) Allocate a proportion of the regional health research budget to support nursing research projects taking into consideration country- specific and regional priorities.
(3) Strengthen the WHO COllaborating Centres for Nursing Dev~lopmant in Primary Health Care through regional and international technical
collaboration and cooperation.
REFERENCES
Commission on Health Research for Development. Health Research.
New York: Oxford University Press, 1990.
Layo-Danao, L. "Nurse Performance: Concepts, Methods, and Findings", College of Nursing, University of the Philippines, Manila, 1983. Unpublished paper.
Layo-Danao, L. "Nurse Performance: Professional and Administrative Considerations", College of Nursing, University of the Philippines, Manila, 1989. Unpublished paper.
Schwirian, P. "Toward an Explanatory Model of Nursing Performance"
Nursing Research 30:4 (July - August 1981) 247-253.
Schwirian, P. "Evaluating the Performance of Nurses: A Multidimensional Approach" Nursing Research 27:6 (November-December 1978) 347-351.
UNDP. Human Development Report 1991. New York: Oxford University Press.
WHO. Forty-Second World Health Assembly WHA42.27. Geneva, 19 May 1989.
WHO. Forty-Fifth World Health Assembly WHA45.5, Geneva, 11 May 1992.
World Bank. World Development Report 1991. New York: Oxford University Press.
Table 1. Number
or
questionnaires sent and returned by countries and areas In the Westempacmc:
RegionCountry
Countries with less than 200 nurses
Marshall Islands New Caledonia Cambodia Cook Islands Kiribati
Northern Mariana Islands American Samoa
Tokelau Palau Niue
Countries with over 200 and less than 2000 nurses
Tonga Guam
Micronesia Solomon Islands Vanuatu
Western Samoa
Lao People's Democratic Republic
French Polynesia Macao
Brunei Fiji
Countries with 2000 or more nurses
Papua New Guinea Singapore
Hong Kong Philippines Malaysia New Zealand Korea
Australia Viet Nam Japan China
TOTAL
Number of questionnaires sent
7 7 1 7 7 7 7 1 5 1
9 9 9 9 9 9 9 9 9 9 9
16 32 32 32 31 38 30 44 31 49 31 515
NUlllber of questionnaires returned
*
*
3 3 2 1 23 2 2 4
3
8
1 14 11 9 13 23 7 18 7 10 7 153
*
Questionnaires from Cambodia and Marshall Islands were received after the deadline for data processing.Table 2. Demographic and social characteristics
or
respondentsAge in years Percent
35 or less 10.7
36 - 40 15.7
41 - 45 22.1
46 - 50 22.9
51 - 55 17 .1
56 and above 11.4
Total 100.0
Number of cases 140
Sex Percent
Female 91.6
Male 8.4
Total 100.0
Number of cases 143
Civil Status Percent
Single 31. 2
Married 61. 7
Divorced, separated, widow 6.4
Others .7
Total 100.0
Number of cases 141
-
Table 3. Percent distribution of nurses with a
non-nursing degree and level of non-nursing degree received
With non-nursing Yes
No Total
Level of non-nursing degree
Bachelor Master Doctorate Total
Percent 38.5 61. 5 100.0
29.1 38.2 32.7 100.0
Number of cases
135
55
Table 4. Respondents undertaldag research activity and mean frequency of undertaking activity,
1986·1990
Percent Mean frequency
undertaking Number undertaking Number
Activity activity of Cases activity of Cases
Authored or co-authored
article published 33.6 128 5.25 40
refereed journal Authored or co-authored
article published 35.9 131 4.57 45
non-refereed journal
Authored or co-authored manuscript submitted
-
for publication 32.0 128 3.63 38
refereed journal Authored or co-authored
publication, 27.4 124 3.32 34
non-refereed
Authored or co-authored
paper of completed 51. 9 135 3.59 61
research
Authored or co-authored
published book 25.0 124 1. 93 29
chapter
Authored or co-authored
published book or 17.11 123 2.14 22
-
monograph
Authored a published
book review 21. 6 125 1.44 25
Edited a published
book or monograph 13.8 123 3.69 16
Reviewed a manuscript
for a professional 24.4 127 11.19 27
journal
Served on editorial
board, refereed 17.9 123 2.05 20
journal
Written a research
proposal for 47.3 131 3.00 58
funding
Table 5. Percent of respondents who developed or assisted In tbe development of a nursing or bealtb data base and wbetber data base was computerized
Respondent developed or help develop nursing(health data base
Whether data base is computerized
Number Percent of Cases
49.6 141
58.3 72
Table 6. Types of Information in tbe data bases tbat nurse researcbers develop or help develop
Information
Nursing manpower or workforce Data on nursing schools and
colleges
Data on hospitals and other health establishment Health indicators
Nurse registries
Demographic and socio-economic data on households
Abstract of nursing studies Migration of nurses
Total
Number of cases 93
Percent of data bases containing
information 34.4 18.3 17.2 12.9 6.4 5.4 4.3 1.0 99.9
Table 7. Pen:ent distribution of the number of research projects conducted or participated in by nurse researchers, 1986-1990
Number of research projects
Percent of projects One
Two
Three Four Five
36.06 23.79 17.10 13.01 10.04
Total 100.0
Number of cases 269 Hean
Note:
Table 8.
2.77
Haximum number of projects that could be listed was 5.
Percent distribution of the categories or areas of research problems or objectives of studies conducted by nurse researchers
Category Percent
Nursing administration 20.66
Nursing education 15.70
NurSing practice 56.20
Nursing theory and
methodology 6.61
Other .83
Total 100.0
Number of cases 242
-
-
Table 9. Frequency distribution
or
~or
mncem 01, study/projectArea of Concern Operations
Technology Manpower
Cost and finance Policy
Methods
PHC implementation Others
Total
Number of cases 252
Percent 7.9 6.0 9.5 .8 11.1 7.9 15.5 23 100.0
Table 10. Frequency distribution or primary purpose or study/project
Pu~ose Percent
Gain more information about selected phonemena
Determine presence of relationships between variables
Fulfill requirements for a course/
degree
Get into that shall help decide between courses of action Help solve an existing problem
Suggest or support an administrative policy
Suggest or support a piece of legislation Others
Total
Humber of case.
23.5
9.7
6.7
14.6 12.7
6.7 .4 25.7
100.0 268
-
--
Table 11. Frequency distribution of qatore
of participation of·respondents in study/project
Nature of participation Percent
Project Director 23.0
Consultant/advisor 9.3
Principal Investigator 36.8
Co-investigator 13.0
Research Associate .4
Research Assistant 2 .6
Field Supervisor 1.5
Interviewer/observer 5.2
Coder 0
Programmer 3.7
Others 4.5
Total 100.0
Number of ca.e. 269
Table 12. Percent distribution or types or personnel respondent worked with during Jut project,
1986-1990
Type of research personnel Data collectors
Clerk
Statistician
Research assistant Consultant
Field supervisor Librarian
Research associate Programmer
Other Total
Number of cases 252
Percent 16.27 12.70 12.30 11.90 11.51 10.71 7.54 6.75 5.16 5.16 100.0
Table 13. Frequency distribution of
geographic:al scope or study/project Geographical Bcope
Local National
2 or more countries involved in 1 region
Countries from several regions Total
Number of cas •• 260
Percent
72 .3 24.2 2.3 1.2
100.0
-
-
Table 14. Frequency cHstribution 01 the primary research design used in the
study/project
Research design
Secondary data analyses Survey
Laboratory experiment Field experiment Historical
Percent 6.2 52.0 4.2 15.8 1.9 Comparative or Cross-cultural 1.9
Bthnographic 4.2
Cohort 2.3
Others 11.5
Total 100.0
Number of cases 260
Table 15. Frequency distribution 01 primary method 01 data colledion 01 study/project
Method of data collection Observation
Interviews, Face-to-Face Questionnaire
Telephone interview Standardized tools/tests Others
Total
Number of casas 257
Percent 10.9 23.3 28.8 .4 9.3 27.2 100.0
Table 16. Percent distribution 01 collaboration in projects undertaken by nurse researdter, last project
19M-1M
Category Percent
Done by myself 33.3
Done with others 66.7
Tot.l 100.0
RWllber of e •••• 96
Table 17. Percent distribution 01 multi- disciplinary projeds by nurse researchers, last project 1986-1990
Category Percent
One discipline 49.3
More than one discipline 50.7
Tot.l 100.0
Humber of e.ses 69
-
Table 18. Percent distribution or whether project conducted by nurse researcher is basic or applied, last project
1986-1990
Category Basic Applied Both Total
Number of cases 95
Percent 24.2 54.7 21.1 100.0
Table 19. Percent distribution or level or data analyses made, last project 1986-1990
Level of data analyses One-variable Two-variable
Three-or more variable Total
Number of cases 90
Percent 23.8 23.8 52.5 100.0
Table 20. Percent distribution or commisioned research done by nurse researchers, last project 1986-1990
Category None Yes Total
Number of cases 91
Percent 71.4 28.6 100.0
