00. Building Nursing Science in Canada (Judith Shamian) [English]

Building Nursing

Science in Canada

Judith Shamian, RN PhD LLDPresident

Canadian Nurses Association

20th Anniversary of the Vietnam Nurses Association

Title goes here • Page 2 • www.von.ca

Congratulations!!!!

ObjectiveTo provide a brief overview of nursing research in Canada

• Global nursing has a long history of developing, using and marketing evidence; we had a superb example in Florence Nightingale.

• The evolution of Canadian nursing research mirrors the evolution of women in science, and the influence of women more broadly in Canadian society

• The Canadian Nurse journal first began to talk about nurse-driven evidence before 1910.

• CNA’s influence on Canadian nursing research is strongly tied to its related work in nursing education , nursing policy, nursing practice and so on.

• The research agenda has to be imagined as a “package deal” that both demands and drives many other inter-related programs and services.

1926At the request of the federal government,

CNA produced its first evidence-based nursing HR report in 1926 – containing

statistics, trends and issues, and concerns about recruitment, attrition and deployment

of nurses.

‘1932

The evidence-driven Weir Report, Survey of Nursing Education

in Canada, was published by CNA and changed the course of nursing education and

practice.

…the training school for

nurses provides cheap

nursing for the hospital;

hence the protests of

small, inadequately

equipped training

schools against closing

their schools and

staffing their wards with

graduate nurses.

‘

CNA presents landmark nursing paper to WHO in preparing for technical discussions of the 9th General Assembly.

CNA presents

extensive statistical

brief to the Royal

Commission on Canada’s

Economic Future

First university faculty of nursing in Canada.

First nursing

bacc program

1920 1930 1940 1950 1960 1970 1980 1990 20001900 20101910

CNA founded

First nursing

PhD program

First nursing masters program

Selected Milestones in Canadian Nursing Science & Education

CNA members vote to pursue development of a doctoral program in nursing.

CNA’s Board makes landmark recommendation on BScN entry to practice in 2000

CNA publishes The Research Imperative for Nursing in Canada: A Five-Year Plan Toward Year 2000

BSN entry to practice

$25M Nursing Research Fund

1962The Canadian Nurses

Foundation was established to provide

scholarships, bursaries and fellowships for

graduate study in nursing. By 1966

baccalaureate study was included.

1976The Canadian Nurses

Foundation provided its first research grant of

$5,000 to the Canadian Association of University

Schools of Nursing to advance its work in

accreditation of nursing.

A helpful step in the journey

Why does nursing research matter so much?• Nurses have more “face time” with patients

worldwide than any other provider; they work at all points in health systems with citizens of all ages and backgrounds.

• Nurses need knowledge to deliver effective, cost efficient care – and they also generate knowledge that can shape healthy public policy.

• Knowledge based on research drives quality practice and, in turn, the best outcomes for citizens.

• If you really want better health for the nation, you must invest in research in all the health disciplines.

Research & Innovation

Resolution WHA59.27, adopted at the 59th World Health Assembly in May 2006, urged all member states to: – Confirm commitment to strengthen nursing

and midwifery by establishing comprehensive programs for the development of human resources

– Actively involve nurses and midwives in the development of their health systems

– Ensure continued progress towards implementation at country level of WHO's strategic directions

– Regularly review legislation and regulatory processes relating to nursing and midwifery, and

– Provide support for the collection and use of nursing and midwifery core data as part of national health information systems.

All these activities demand nursing knowledge based on evidence!

Funding for nursing science historically has been sparse• The lack of funding was mirrored in the

dearth of doctoral-level nurse researchers and leaders educated in Canada until the 1990s.

• The situation began to reverse during the 1990s and has significantly changed since establishment by the federal government of the $25 million Nursing Research Fund (1999-2009).

• As a result, solo researchers have grown into teams and a national network but we are still in early days.

• The production of nursing science, clinical, and health services research has similarly begun to grow.

Investments in Canadian nursing science have made a difference

• The Canadian Health Services Research Foundation, along with the resources made available through the Nursing Research Fund has built substantial capacity in the creation, translation and use of nursing research in Canada.

• Significant portions of that fund were used to build capacity over the past decade – and the investments paid off. For example: – Canada currently has 15 doctoral

programs in nursing where there were none in 1990.

Investments in Canadian nursing science have made a difference

– 12 nurses graduated from doctoral programs in nursing between 1990 and 1997; 39 graduated in 2006 alone – and the number of enrolled candidates was more than ten times the number of graduates in 2005 and 2006.

– We have a program of 12 funded, capacity-building, health science research “chairs” across Canada - 5 are held by nurses and 3 more are nursing–related.

– $450,000 in training funds (including postdoctoral awards) awarded in 2006, more than twice the amount awarded in 1999.

Investments in Canadian nursing science have made a difference

In terms of research, the fund supported:• 47 open grants competition awards, 1999-

2004• 3 full-scale nursing-related programs of

research• Operating grants to nurses as principal

investigators increased from 38 grants in 2000-2001 to 130 in 2005-2006.

• Between 2003 and 2007 the Canadian Nurses Foundation provided more than $2.2 million to 160 nursing care research projects, leveraging $4.7 million from partners for a total investment of nearly $6.9 million.

Make the Research to Policy March Meaningful to you and to Society.

The Policy Cycle• Policy Development has 4 Major Stages:

1. Setting the policy agenda2. Moving into

Action/Legislation3. Policy Implementation4. Policy Evaluation

Values & BeliefsValues & Beliefs

Problemor IssueEmerges

Problemor IssueEmerges

KnowledgeDevelopment& Research

KnowledgeDevelopment& Research

PublicAwareness

PublicAwareness

Public PolicyDeliberation &Adoption

Public PolicyDeliberation &Adoption

Interest Group

Activation

Interest Group

Activation

Political EngagementPolitical Engagement

Getting

to

Policy

Agenda

Movinginto

Action

Regulation,Experience& Revision

Regulation,Experience& Revision

The Policy Cycle

Adapted by J. Shamian and ONP, from Tarlov,

1999

Evidence really can influence policy…1997• Stunning policy-

makers across the country, CNA’s Ryten Report predicts that Canada could be short 113,000 nurses by 2011.

1998• Federal government

announces creation of the new federal Office of Nursing Policy

1999• A 10-year, $25-million

national nursing research fund is established

• 2000 • Work begins on the

Nursing Strategy for Canada and a national occupational/sector study of nursing

Evidence really can influence policy…

• A nurse-led Ontario study found that of the approximately six million home care visits conducted in 2002, 10% of clients receiving home care could benefit from equal or better quality care at centralized nurse-run clinics.

• This move would generate equal quality health outcomes while freeing up 146 full-time equivalent RNs to work in other areas of the health system experiencing shortages.

• Estimated savings: $10 million.

Evidence really can influence policy…• At the University of Toronto, Dr. Linda O’Brien-Pallas’ chair in Nursing Human Resources, funded through the federal

Nursing Research Fund, has raised Canada’s profile in this area of science to global

leadership levels. During the course of her tenure she supervised dozens of master’s and

doctoral students; their work is now leading to compelling findings that have impacts on

human resources, patient safety and organizational outcomes. The work of two of

her former students is attracting global attention for the ways they help shape

operational decisions around care delivery models and skill mix at the organizational

level, hiring and deployment practices and health human resources planning and policy

from local to international levels.

Evidence really can influence policy…• The implementation in Ontario of a nurse-led

best practice guideline on wound care resulted in a 66 per cent reduction in costs compared with standard community care, and a 33-57 per cent reduction in infections and lower extremity amputations.

• Dr. Elizabeth Saewye’s work on youth issues, and British Columbia’s province-wide Adolescent Health Survey, helped to determine the appropriate age for administering the human papillomavirus (HPV) vaccine. The Solicitor General used information about trends in youth “binge drinking” (alcohol) to change laws related to liquor licensing and fake identifications.

The story in 2010

We know that evidence from research informs good policy and decision-making and vice versa.

Research provides evidence, which is one tool, but is not “the answer” in and of itself.

Evidence matters but it’s not all that matters: Dr. Phil Davies, who was U.K. prime minister Tony Blair’s senior health/social policy director (and was a lifelong academic researcher) said in 2005 that, “evidence-based decision-making is no substitute for thinking-based decision making.” Healthy public policy depends on both.

The story in 2010

Today in Canada we would not think about policy, program or practice development without thinking about the evidence – it has become part of nursing culture..

A century into this agenda we talk

more confidently now about the

importance of a balance of

evidence-driven practice and

practice-driven evidence. They

both matter.

Show me theevidence!money!

Values & BeliefsValues & Beliefs

Problemor IssueEmerges

Problemor IssueEmerges

KnowledgeDevelopment& Research

KnowledgeDevelopment& Research

PublicAwareness

PublicAwareness

Public PolicyDeliberation &Adoption

Public PolicyDeliberation &Adoption

Interest Group

Activation

Interest Group

Activation

Political EngagementPolitical Engagement

Getting

to

Policy

Agenda

Movinginto

Action

Regulation,Experience& Revision

Regulation,Experience& Revision

The Policy Cycle

Adapted by J. Shamian and ONP, from Tarlov,

1999

© Canadian Nurses Association, 2010

Photo credits:

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