Abstract
In this editorial, I will reflect on methodological aspects of evidence-based nursing research, particularly on standard methods in accounting for the validity of study results. As editor of the NJNR, I find that evidence-based nursing research is progressively becoming an applied methodology in many studies submitted for publication. My current thoughts about evidence-based approaches were inspired by The 2017 European Conference in Nursing and Nursing Research, a nursing conference that I attended in July of this year. 1 The conference was jointly convened by the European Academy of Nursing Science and the Swedish Society of Nursing, in Malmö, Sweden. Although the overall theme of the conference was to explore the future direction of European nursing and nursing research, I am convinced that the future pathways of evidence-based research are of global nursing interest.
Professor Denise Polit, world-renowned research methodologist in nursing and author of nursing research publications, highlighted in her keynote speech important methodological developments that will have an impact on the future direction of nursing research, specifically the scientific principles that characterize the methods of securing validity in evidence-based research. 1 Since the goal of nursing research is to obtain knowledge that will lead to improvements in clinical practice, it has both the healthcare needs of the individual person and the healthcare needs of a population in its knowledge spectrum. Therefore, as Professor Polit pointed out, the present research methods used to secure, for example, concept validity as well as the method of collecting data, such as randomization, need to be critically re-examined from both the individual and the group perspective.
Professor Polit presented the COSMIN ‘check list’ as an example of a method that was developed by an international research group. COSMIN is the acronym for COnsensus-based Standards for the selection of health Measurement INstruments. 2 The COSMIN check list builds on the requirement to ensure that instruments used are of good scientific quality, such as measurements and scales focused on health-related patient-reported outcomes. Based on a Delphi study, consensus on ‘standard design and appropriate statistical methods for assessing measurement properties’ was reached.3 The COSMIN contains a taxonomy or check list for assessing the standards for the evaluation of the methodological quality of articles on measurement properties. In a reply to a published review of the COSMIN check list, the authors make a distinction between ‘the quality of measurement properties’ and the ‘qualities of the measurement’. 3 None the less, the distinction does imply that the quality of the instrument selected, for example an attitude questionnaire, determines whether a study meets the standard of good scientific quality in evidence-based research.
Similar to the background reasons for developing the COSMIN, Robert DeVellis, a well-known authority on scale developments in health and social research, and often cited as expert in psychometric methods used in nursing research, points out in his fourth edition of Scale development, theory and applications that the field of developing measurement scales in healthcare research is rapidly expanding and changing. 4 In agreement with Professor Polit, the COSMIN group, and DeVellis, I foresee that methodological assessments of the results of evidence-based nursing research require updating of the standards of, above all, obtaining concept validity.
The current interest in evidence-based research and its relevance for advancing nursing research reminds me of the paradigm debate, in Sweden and elsewhere, concerning qualitative and quantitative research methods that escalated during the nineties. Professor Polit’s first edition of nursing research methodology was published 1978. 1 This first and following editions were welcomed and included in nursing educations curriculums. Knowledge of principles and methods in nursing research opened the door for advancing the field of nursing science. This led to an increased awareness in the academic world of nursing of the epistemological differences in quantitative and qualitative research approaches. The concept of paradigm borrowed from Thomas Kuhn’s conception of scientific revolutions as a paradigm shift kindled a way to look at research methods, especially in nursing. 5 In the early history of developing nursing as a science, theories and methods were adopted from other academic disciplines.
Professor Polit and her work on advancing knowledge about the principles and methodology of nursing research may have in a positive way contributed to the paradigm debate. Critical thinking, and constructive methodological debates are necessary for the future development of nursing research. The methodological prerequisite of objectivity in randomized studies and the necessity of subjectivity in phenomenological studies characterizes the whole research process of each. For example, the findings of a study of patient-reported health outcomes compared to a phenomenological interpretive study of how patients experience and understand their health needs can be generalized. It follows that how validity is determined in evidence-based research cannot be used to determine, for example, ‘validity’ in study with a qualitative approach. Even DeVellis points out, measuring what we observe is a ‘fundamental activity of science’.4(p.2) However, it is ‘evident’ that not all phenomena can be measured and scored.
Does the ambition of nursing research to improve nursing practice and nursing education lean exclusively on evidence-based research methodology? What are the future pathways for qualitative research methodology that focus on the experiences of the individual patient? In summary, and in response to these two questions, it is my opinion that the future direction of nursing research depends on critical analysis and open dialogues on how evidence-based research methods and qualitative methods collaboratively can be used to improve and advance nursing practice.