Guidelines as governance: Critical reflections from a documentary analysis of guidelines to support user involvement in research

Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty‐two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers.     

Cultural humility: Essential foundation for clinical researchers

Cultural humility is a process of self-reflection and discovery in order to build honest and trustworthy relationships. It offers promise for researchers to understand and eliminate health disparities, a continual and disturbing problem necessitating attention and action on many levels. This paper presents a discussion of the process of cultural humility and its important role in research to better understand the perspectives and context of the researcher and the research participant. We discern cultural humility from similar concepts, specifically cultural competence and reflexivity. We will also explore ways to cultivate cultural humility in the context of human subjects research. Mindfulness is one approach that can be helpful in enhancing awareness of self and others in this process. With a foundation in cultural humility, nurse researchers and other investigators can implement meaningful and ethical projects to better address health disparities.     

‘Outside the Original Remit’: Co‐production in UK mental health research,lessons from the field

The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process.     

An attempt to give nursing home residents a voice in the quality improvement process: the challenge of frailty

• ? Advanced frailty and confusion of many nursing home residents present a particular conundrum to researchers committed to resident participation. While the research is set in Australia, the challenge of frailty is common to researchers working with compromised older persons.
• ? This study was conducted in an Australian 32 bed nursing home. As researchers we took on the roles of facilitators and negotiators within a quality improvement process using the approach of fourth generation evaluation.
• ? The overall aim of the project was to provide all stakeholders, including residents and their significant others, with a voice in the negotiations and decisions that impact on their lives.
• ? The focus of this paper is our attempt to gain the perspective of residents and significant others.

     

Patient narratives in the investigation and development of nursing practice expertise: a potential for transformation

This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners' concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient-participants' role as a sophisticated evaluator of health-care. As a result, we present a case for transformational qualitative research. Such research is values-driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its 'ends' (i.e. research products) but also, intentionally, through its 'means' (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self-reflection) to examine and critique their personal values.     

Secondary analysis: a method for learning research activities

Secondary analysis may be an efficient, effective method of providing graduate students in nursing with experience in specified stages of the research process. The availability of archived data sets is increasing as are the numbers of researchers who recognize the value of sharing data with others. Thus, the development of nursing as a research-based practice can be enhanced by tapping into this source of data and asking relevant research questions that address issues in nursing.     

Towards a new model of nursing research

Nursing research is generally located within the paradigm of the social sciences, and therefore reflects the concerns and agenda of social research. In particular, nursing has become embroiled in the ongoing dispute between the advocates of qualitative and quantitative methodologies. However, it is argued in this paper that whereas the aim of social research is to develop knowledge, the aim of nursing research is primarily to advance practice. This paper offers an alternative model of nursing research which categorizes approaches to research not according to the methodology employed but on the extent to which the research process is likely to bring about change. These approaches are termed level 1, level 2 and level 3 research, where level 1 researchers are concerned with generating information for others to conceptualize and implement, while level 3 researchers see their aim as directly bringing about clinical change. Two approaches to level 3 research are suggested, and examples of projects at all three levels are examined. Finally, it is contended that only by adopting an appropriate model of research for a practice-based discipline can nursing address the real issues of relevance to nurses and patients in clinical settings.     

Nursing research conventions: objectivity or obfuscation?

This paper is a critique of naive realism, the philosophy which animates much nursing research, and which leads researchers to assume that the attainment of objective knowledge is possible The nature of naive realism, and its relationship to objectivity, is discussed Central to this outlook is the belief that the values and interests of the researcher can and should be divorced from the prosecution of research This is reflected in the literary convention of referring to the researcher in the third person Contrary to this position, I argue that the interpretations, values and interests of the researcher are central to the research process Moreover, nursing research may be affected by the interests of managers, educationalists, and those who wish to see nursing attain professional status Nursing researchers should accept that they are part of the social situations which they study They should therefore become reflexive in their outlook This entails recognizing and attempting to understand the effects of the researcher, rather than trying to eliminate or ignore them     

Achieving statistical power through research design sensitivity

The challenge for nurse researchers is to design their intervention studies with sufficient sensitivity to detect the treatment effects they are investigating In order to meet this challenge, researchers must understand the factors that influence statistical power Underpowered studies can result in a majority of null results in a research area when, in fact, the interventions are effective The sensitivity of a research design is not a function of just one element of the design but of the entire research design its plan, implementation and statistical analysis When discussing factors that can increase a research design's statistical power, attention is most often focused on increasing sample size This paper addresses a variety of factors and techniques, other than increasing sample size, that nurse researchers can use to enhance the sensitivity of a research design so that it can attain adequate power     

Evidence-based nursing practice, Part 2: Building skills through research roundtables

Numerous articles describe barriers to nurses conducting research and achieving evidence-based practice as well as strategies for overcoming barriers. The Research Roundtable format is one such strategy. It is an interactive means for providing novice nurse researchers and nursing students with the skill sets required to drive application of existing evidence to nursing practice and conduct outcome studies to derive new evidence. The authors discuss their Research Roundtable series that addressed a number of barriers to research, research utilization, and evidence-based practice and how the series increased nurses knowledge and skills, demystified the research process, provided role models, demonstrated managerial and collegial support, and provided library, fiscal, and other resource support to complete staff projects. The details of the Research Roundtable series will guide others in replicating the process in their own organizations and academic communities.     

Service user's actual involvement in mental health research practices: A scoping review

Service user involvement in mental health research is on the international political agenda, for example mirrored by an emphasis on user involvement in funding of research. The idea is that service users contribute with their lived experiences of mental distress to the research process and thereby heighten the quality and relevance of the research. The purpose of this scoping review was to identify and evaluate empirical research of how mental health service users actually partake in collaborative research processes and to summarize this research in dialogue with mental health user‐researchers. The review included 32 studies. Main findings indicated that actual involvement of service user‐researchers in research processes encompassed a complex set of precarious negotiation practices, where academics and service user‐researchers were positioned and positioned themselves in alternative ways. The review accounts for how mental health service users were involved in collaborative research processes. The extracted themes concerned: (i) Expectations of research processes, (ii) Contribution to research processes, and (iii) Training and learning from research processes. The study reveals that collaborative research in mental health requires changes to traditional research practices to create and support genuine collaborative partnerships and thereby avoid tokenism and power inequalities.     

Madness in our methods: nursing research, scientific epistemology

This paper is a critique of some research methods evident in contemporary nursing literature. The arguments derive from critical-feminist, humanist and ethical perspectives. As a consequence of investigating specific aspects of scientific method, an approach to research that is congruent with values intrinsic to an holistic approach to nursing practice is articulated. Such methodologies also render problematic with status quo power relations between nurses and other health professionals, as well as between nurses and patients. The central themes in this paper are: the absence of overt conceptual frameworks; an avoidance of complex social contexts within which research subjects live; an apparent lack of empathy; and an apolitical articulation of research problems and data analyses. All four of these difficulties may be traced to scientific methodology by many researchers. Most nurse researchers may not actually adhere to this technique, but I propose that they have been informed by belief systems associated with scientific methodology and diat these have dire consequences for the discipline of nursing. A key argument is diat the apparent lack of conceptual frameworks in the majority of nursing research is due to the epistemology, which therefore provides a pre-existing, non-declared conceptual framework, that is incorporated into the research by drawing upon scientific mediodology. A further argument is diat scientific, or scientistic, ways of approaching situations are antithetical to nursing values and to constructive social change for the benefit of patients, nursing and nurses.     

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others.

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.     

Reflections on self in qualitative research: stories of family.

Reflexivity is a qualitative research strategy that addresses our subjectivity as researchers related to people and events that we encounter in the field. Reflexivity also addresses the subjective nature of the research account as a narrative constructed by us as researchers. Reflexivity enhances the quality of research through its ability to extend our understanding of how our positions and interests as researchers affect all stages of the research process. The reflexive account presented here frames the analysis and interpretation of previously published findings on work and play in families by highlighting aspects of the researcher's reflexivity across the entire research process, including situating the study, gaining access, managing self, living in the field, and telling the story. Its purpose is to demonstrate use of reflexivity in qualitative research as a strategy to consider our subjectivity as researchers and serve as signposts for readers about what is happening throughout the research process.     

Examining the methods used for a critical ethnographic enquiry

Methodology articulates the broad theoretical and philosophical framework which researchers employ when conducting an inquiry. Methods are the procedural rules by which research inquiry is conducted; giving authority to articulate and communicate information as reliable and accurate in nature. Critical ethnography delves beneath the surface to examine the power relations and influences affecting phenomena by using field methods to identify not only culture, the 'consciousness' or the 'lived experiences' of others, but also exposing the political, social and material disempowerment of individuals and disadvantaged groups in order to elicit change. Fieldwork is central to all ethnographies and in this critical ethnography it forms the platform from which the delivery of palliative care to aged residents in a multi-purpose centre can be scrutinised. This paper explicates the fieldwork adopted in conducting such a study.     

The Doctor of Nursing Practice degree and research: are we making an epistemological mistake?

There has been much discussion in the literature about whether Doctor of Nursing Practice (DNP) curricula should prepare students to be principle investigators of research or whether this skill should be left to other doctorally prepared nurses. Currently, nurse practitioners have to rely on medical research to support their practice due to a lack of research and researchers. Consequently, these practitioners run the risk of adopting practice values of medicine rather than those unique to this specialty. Despite this risk, several national organizations have recommended that DNP programs not prepare graduates to be principle investigators. Epistemologically, this decision poses several levels of concern, including failure to analyze the adequacy of our current approach to research, the mixed messages presented in the position statements of these national organizations, and the effects of the looming doctoral faculty shortage. These issues, among others, are explored in this article.     

A problem with inclusion in learning disability research

People with severe learning disability are particularly difficult to include in the research process. As a result, researchers may be tempted to focus on those with learning disability who can be included. The problem is exacerbated in this field as the political agenda of inclusion and involvement is driven by those people with learning disability who are the higher functioning. To overcome this we should first detach the notion of consent from ideas about autonomy and think instead of it as a way to avoid wronging others; this fits the original historical use of consent in research. This allows us to think in terms of including participants to the best of their abilities rather than in terms of a threshold of autonomy. Researchers could then use imaginative ways to include the least able and to ensure they are not wronged in research or by exclusion from it.