Guest Editorial
The case for critical research
Annette F Street
Professor, Cancer and Palliative Care Studies; Director, Centre for Research in Nursing, School of Nursing, La Trobe University, Bundoora VIC
PP: 050 - 052
Article Text
Government statistics show that nurses are dealing with more patients than ever before and the demands on nursing skill and knowledge are higher. Nurses care for people whose health needs have to be addressed in relation to their race, age, culture, gender, sexuality, socio-economic status or different ability.
Health reforms are restructuring the relationships of nurses with their employers. The advent of enterprise bargaining and business units has meant that the costs of the nursing budget have come under serious review. Nurses are expensive- deservedly so. But much of the complexity of their work is invisible to the uninitiated. If nurses are going to convince others of their value then they need to make sure that they are able to describe and explain what it is that they do. Too often descriptions of the nursing role look like lists of tasks which, to the business eye, could be arguably handed on to technicians or aides who are cheaper.
When change is proposed, governments and managers require evidence- usually in the form of research findings. Many nurses feel angry when told to do research because their daily work is so demanding. They recognise a need for career researchers and academics who are researching nursing questions, but don't see that research will help them deal with the frustrations they encounter in their work.
Without denying the necessity for nurses to be involved in other people's research and to read and use research findings, the challenge remains for nurses to conduct and participate in research which applies to their own concerns. Although these concerns may be small they may have important effects on the care nurses provide and on the contexts in which they work. Critical and feminist forms of research provide processes designed to address practice issues in relation to the politics of the context in which they occur. This research requires that the competing demands and claims of the various stakeholders are examined.
Research becomes an explicitly political activity which acknowledges the power relationships inherent in any research. The debates surrounding critical research processes initially raged between proponents of nursing science and critical research designs. These debates were concerned to prioritise one form of research over another as better serving the interests of nursing. This debate has been most unhelpful as nursing needs all kinds of research to serve the further development of the discipline. So why would nurses engage in critical research? The forms of research which are generally regarded as coming under the umbrella of critical processes, such as action research, participatory or praxis research, are useful when nurses need to not only understand a particular situation-but do something about it. Critical research is not able to be generalised but uncovers issues which may be generalised to others in similar situations.
Early forms of critical research were based on the premise that groups of people who shared a common concern could investigate and make rational choices to improve their situation. This assumption was part of a modern world view that people agree on some basic foundational ethics and that individuals can critique their own experiences against some universal criteria of rationality and justice. Critical research of this kind was interested in the ethical content of research-not just what happened-but how did it happen, under what circumstances and to serve whose interests?
This understanding and action component of critical research fits well with nursing practice. Nurses assess a health situation and take action to improve it for other people. The assumptions were that if nurses could analyse their practice, the discourses which inform it and the situation, then they could reconstruct their actions to improve the situation. This improvement would take time. A number of action steps would be enacted as the emergent, tentative understandings were checked out with the participants in a reciprocal process. Then the information gathered would be analysed and collaboratively reflected upon in light of the bigger picture. Action research is probably the most familiar form of critical research which arose from these ideas and it is receiving more general acceptance in a range of disciplines.
However, as critical research began to gain recognition it came under fire from the proponents of postmodern ideas. They challenged the underlying assumption that there is a universally accepted notion of 'justice' or 'right' or 'ethical action' which is independent from the culturally constructed beliefs of a group of people. Postmodern critiques demonstrated that language not only expresses what we can think or say, but limits and shapes what it is possible for us to think or say. Postmodern processes of deconstruction remind us that the world is a place of multiple and contradictory views and decision making processes. Who we are and how we are is constituted historically as a product of our society, race, age, gender, sexuality and culture. At different moments we can define ourselves differently depending on the context and how we are placed in it. This thinking challenges the very idea that it is possible for a group of nurses to understand and reconstruct their practice from a position which does not marginalise others in the health field.
Postmodern thinking questions the notion that any research process will enable us to find a true or right answer or to choose a correct course of action. Research conclusions are multiple, contradictory and partial rather than definitive. Decisions made in one context may not be right for all time or even for other places, only fitting the needs of those nurses at that particular time, place and context. Nurses find themselves continually enmeshed in contradictory and fluid power relations with medical staff, patients and clients, their families and significant others, and with other members of staff. Nursing research needs to take account of these relationships as well as highlighting the power relations exercised in the context by the presence and interventions of the researchers.
In response to the concerns of postmodernists, some nurse academics have broadened the scope of what is called critical research to include postmodern processes of deconstruction. They act to discover a politics of difference which can inform how nurses can think and act ethically. However they do not claim to do postmodern research, rather they use the theories and strategies of post-modernity to inform and broaden the scope of their critical research enterprises. In this way the scope of critical research is expanded.
So let's return to the question 'Why would nurses want to do critical research? I consider that critical research is important because it not only permits nurses to conduct research which matters to them but, because of its political nature, it requires them to understand the effects of their research actions in relation to policies, systems, institutions, their colleagues and those for whom they care. It makes them aware of how power is exercised by others and of their own roles in the exercise of power.
Recently, my research has involved working with nurses in community and institutional settings in New Zealand and Australia, to explore the complexity of their practice in order to influence change. These research projects have demonstrated the capacity of critical research to activate change at a number of levels personal, local, legal, industrial, educational, policy, resource and practice. The cyclical, participatory action-oriented structure of the research processes has meant that nurses became involved in defining their issues and developing strategies to deal with government, unions, educationalists, policy analysts and management. Not all the nurses agreed on the problems or the solutions. White nurses understood their issues and strategies very differently from Maori or nurses from other races, crisis team nurses from community or ward based nurses, rural from urban, male from female, experienced from inexperienced. This is to be expected. However, it was also apparent that although a group of nurses may appear to be homogeneous- as in a ward group of white heterosexual, female, middle aged nurses-they were animated by different discourses, understood things differently, sided with different stakeholders, and proposed radically different solutions.
However, there was a general consensus that nurses are practising in a rapidly changing health system and they need to research ways to adequately describe and explore the value and complexity of their practice for those who exercise decision making power over their futures. I consider that critical research, when it is broadly defined to encompass the postmodern strategies, has the potential to enable nurses to explore issues and to influence change in ways that value and affirm diversity and collegiality.
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