Research and diabetes nursing. Part 1: Terms of engagement

“A good scientist has freed himself of concepts and keeps his mind open to what is.”
(Lao Tzu)

 Research plays an important role at all levels of modern clinical practice because of the focus on evidence-based health care; thus, all healthcare professionals have a responsibility to engage in research. Research is exciting and full of promise, but it is also frustrating and challenging. But what is research and how does it relate to the DSN’s clinical role? This article is the first in a six-part series designed to help DSNs understand “research” and how it relates to their role and scope of practice. 

Defining research
There are many definitions of research. Essentially, research involves seeking “the truth” by trying to find answers to questions. Smith (1929 p24) stated:

“Research involves continual re-examination of the doctrines and axioms upon which current thought and action are based. It is therefore critical of existing practices.”

Although this is an old reference, it still applies today. It encompasses key aspects of research, such as that research is a systematic process of investigating and reinvestigating problems, and questioning existing practices that enable progress and innovation to occur (new truths to emerge). In the context of this series, “research” is used to refer to ways of knowing, practising in, and contributing to an environment of research awareness. 

Research is not an optional extra for DSNs; it is a core component of their role, and might, in fact, be part of their duty of care. Therefore, to provide evidence-based care and be expert clinicians, DSNs need to understand and keep up-to-date with research findings – a daunting task in a rapidly changing field like diabetes. 

In addition, research might contribute to the survival of many DSN positions. Hicks (2010) pointed out that research may be essential to “protect specialist nursing positions” in the face of budget cuts and not replacing staff who leave or retire – that is, to substantiate the value and benefit of DSNs. This might also apply in Australia where the Government is increasingly expecting general practitioners and practice nurses to provide diabetes care, and roles are changing rapidly. Likewise, evidence for the benefit of the role is relevant to all countries seeking to establish DSN positions.

Research occurs on an inclusive, interrelated, cyclic continuum, rather than in a linear hierarchical structure that implies one method more valuable than another (Table 1, Figure 1). Research encompasses four broad categories of activities (Dunning, 2010), which reflect levels of research competency and training:

1. Being a discerning research consumer, which includes asking questions, reading research and understanding the research process and the contribution the different research methods make to clinical care to effectively critique research publications; that is, understanding what “good research” is (Table 2).
2. Applying relevant research findings in clinical care and education to achieve evidence-based care, including developing evidence-based policies and procedures and monitoring the outcome(s), which is part of the research cycle.
3. Participating in, responding to, or being a subject in research (depending on the data collection method).
4. Leading research teams to undertake and/or collaborate in research to generate data that can be applied in care, or to evaluate the outcome of, or impact on, care. This level encompasses training and mentoring beginning researchers.

These activities suggest that various levels of knowledge and competency are required to engage in the various research activities. DSNs can use this framework to determine their current level of research engagement and plan professional development activities to enhance their research skills, which will ultimately enhance their clinical practice. 

Research and the DSN
DSNs can demonstrate their role and the contribution they make to diabetes care through research (value-adding). However, many DSNs view themselves as clinicians rather than researchers, may have a narrow view of research, and find it difficult to balance the competing requirements – such as balancing employer expectations that they deliver care and education, with engaging in research activities. Significantly, many DSNs (like other healthcare professionals) do not consider themselves to be researchers and face common barriers to participating in research. Such “barriers to research” are well documented and have been demonstrated in all healthcare professional groups (Funk et al, 1991; Happell et al, 2003; Dunning, 2006; Table 3). However, most of these barriers appear to concern “doing research” rather than encompassing the broader perspective of research outlined in this article.

DSNs are often required to explain research findings to people with diabetes and their significant others, as well as their healthcare professional colleagues. Thus, research, like the DSN, is a change agent. DSNs are the interface between diabetes research and clinical practice. The DSN–research partnership represents a powerful change agent. In addition, people with diabetes are becoming active and discerning research consumers. They expect their care to be evidence-based, ask questions about research reported in the media and what the findings mean to them. They like regular research updates and to have the opportunity to participate in research trials (Diabetes Australia Victoria, 2004). 

Employers and other organisations value research because it can help them reduce the likelihood of litigation, market their organisation, meet accreditation standards, benchmark care, justify costs, and develop policies and procedures as part of organisational risk management strategies. On that basis, organisations have a responsibility to provide support and infrastructure that enables healthcare professionals to engage in research. Significantly, research is more likely to occur in organisations that include research in their mission statements and in staff position descriptions (Happell et al, 2003).

Employing organisations could help address some of the barriers to research by actively supporting clinicians’ research endeavour, for example enabling clinicians to allocate specific time to undertake research activities and recognising and rewarding research efforts. That is, provide the infrastructure to engender research awareness and develop a workforce that actively engages in research to ensure care is delivered in a proactive, dynamic, evidence-based environment.

In turn, DSNs have a responsibility to:

• Participate in research at the level of their knowledge and competency.
• View themselves as being engaged research consumers and include developing their research capacity as part of their continuing professional development (CPD) programme.
• Consider research from a broad perspective that encompasses reading, using, and participating in other people’s research as well as developing and managing their own research programmes.
• Be able to critically review research publications and understand the different contributions that quantitative, qualitative, and audit and evaluation studies make to clinical care (). 
• Understand how marketing forces use research findings to promote and sell products.
• Be able to explain research to individuals with diabetes and their families, which is a key aspect of person-centred, evidence-based care.
• Use appropriate and valid methods and tools to audit and/or evaluate the services they provide.
• Find ways to participate in research within their capacity to change practice rather than focusing on the barriers. Barriers such as lack of knowledge and competency can be changed through CPD activities. 
• Current diabetes educator researchers have a responsibility to promote and mentor future researchers to build research capacity and sustainability. 

Conclusion
Reflection is essential to good clinical practice; it is also part of research engagement and is vital to learning. Different research methods contribute different information to clinical practice. The methods are complete in themselves but are part of an interrelated “research continuum” rather than a hierarchical structure. This article, and the series of articles that follow in future issues of the journal, will focus on the critical appraisal process and will help readers reflect on their role in and contribution to research.