Nursing research priorities and research lines: continuing the discussion
Denize Cristina de OliveiraI
IProfessor, Department of Fundamentals of Nursing and the Graduate Program in Nursing, Faculty of Nursing at the State University of Rio de Janeiro. Brazil. Email: firstname.lastname@example.org
ABSTRACT: This study aimed to present a proposal for a Priority Research Agenda for Nursing and a reflection on the importance of this agenda to redefine the lines of research. It is part of the National Agenda of Priorities in Health Research and of documents in the area of nursing for that proposition, organized around the following themes: Health, Environment, Work and Biosafety; Assessment of Nursing Technologies and Health Economics; Clinical Research; Work Management and Health Education; Health Systems and Policies; Health Care to Adult and Elderly; Care for Women's Health; Health Care of the Child and Adolescent; Mental Health Care; Care to Communicable Diseases; Care to Non-Communicable Diseases. It is concluded that nursing research priorities involve adjusting the focus on what is essential to give visibility to knowledge obtained in the area in order to define the disciplinary and interdisciplinary aspects of this field of knowledge.
Keywords: Research priorities; lines of research; investigation; nursing.
The concern with thematic research priorities in nursing is not new, but the continuity of their discussion is justified at a time when it is put on the agenda of the area to redefine the areas and expertise and the guiding lines of scientific research production in this field of knowledge. Nursing as a field of knowledge, science and technology has been strengthened since the 70s. Its inclusion in the National Council for Scientific and Technological Development (CNPq) occurred in 1986 and was consolidated as a specific area of knowledge production with the Advisory Committee on Nursing in 20061.
The need for clear definitions of policies and priorities for health research has been highlighted in the national and international scene in recent years. The National Policy on Science, Technology and Innovation in Health (PNCTIS) defines health research as "the set of knowledge, technologies and innovations produced that result in improved health for the population" (2: 4). Thus, the challenge of health research is to overcome the disciplinary approach and move towards a sectoral and interdisciplinary perspective, this approach including the full range of clinical, biomedical research and public health activities, in addition to those made in the applied human social sciences, and others that maintain this link.
The National Agenda of Priorities in Health Research (ANPPS) 3 is defined as an instrument for management for which the Ministry of Health has detailed research priorities related to this field. It arises as a fundamental part of PNCTIS and aims to increase the selectivity and induction capacity of research funding in the country 4.
The National Agenda of Priorities in Health Research presupposes to respect national and regional health needs and increase the selective induction to produce knowledge, procedural materials and goods in the priority areas for the development of social policies 3.
Through the ANPPS, the activities of knowledge production and promotion should become driven by health needs of the population, since it covers the whole chain of knowledge related to health, from basic research to operational. Its design and implementation was the responsibility of the Department of Science and Technology, one of three members of the Department of Science, Technology and Strategic Inputs (SCTIE) of the Ministry of Health 4.
This paper presents a synthesis and reinterpretation of exhibitions held in 2011, the 5th International Seminar of Research Centers and Knowledge Production, organized by the Anna Nery School of Nursing, and in 2013, at the 17th National Seminar on Nursing Research 5.6 and aimed a rescue of the main points of the construction of ANPPS, the update of this discussion on the field of nursing and a reflection on the importance of the priorities for the redefinition of lines of research in nursing.
PNCTIS and ANPPS
The SCTIE assumed leadership of the national effort for health research through the definition and implementation of PNCTIS and ANPPS. The document PNCTIS states that "the Ministry of Health should lead the process of building the National Agenda of Priorities in Health Research, by virtue of its strategic role in the organization of the national health research effort" 2: 3.
The text on ANPPS was partially approved in the 2nd National Conference on Science, Technology and Innovation in Health (CNCTIS) and subsequently endorsed by the 151st Annual Meeting of the National Board of Health (3).
This process began in 2003, when a group designated by the National Health Council proposed 20 sub-agendas to take into account the specificities of health research. The second step was to identify research priorities for each sub-agenda during the national seminars involving researchers and policymakers 3,4,7.
During the preparatory phase of the 2nd CNCTIS, municipalities and Brazilian states organized local conferences, during which delegates from the health sector were indicated. Besides these, also representatives of the sectors of education and science and technology were designated to participate in the debate. During the conference, the ANPPS was approved and four other sub-agendas were introduced into the initial proposal 7.8.
The ANPPS is a technical and political process in permanent construction and presupposes to meet national and regional health needs and selectively induce the production of knowledge, material goods and services in strategic areas for the development of social policies in force 2 3,7. The document consists of 24 sub-agendas that represent the priority areas of research. Each of these sub agendas, in turn, breaks down into themes and lines of research, specifying what is essential to investigate in the health sector.
The objectives that guided the agenda are: pointing out the main national and regional needs for health research, with a view to the development of social policies; increase the selectivity and capacity of induction of initiatives to foster research in the country; to guide the actions of research fostering, allowing researchers and funders to align their activities with national requirements; enable the government to measure the impact of national health research; enable informed citizens and civil society organizations to monitor the researchers, research institutions and the government 3.
The criteria that guided the definition of the priorities included: burden of disease; analysis of the determinants and persistence of the disease burden for intervention levels: individual, family, community; and health services system; government policies and other sectors with impact on health; state of the art of available scientific and technological knowledge; cost-effectiveness of potential interventions and chances of success; effect on equity and social justice; ethical, political, social and cultural acceptability; possibility of finding solutions; scientific quality of the proposed research; feasibility of human and financial resources 3.
The sub-agendas define broad areas of research, involving many disciplines, which include different priority research themes and are presented in Figure 1 3,7.
PRIORITIES OF NURSING RESEARCH
Nursing is constituted as a field of applied knowledge in the health area and as such aligns health policies in a more general way. Thinking about research priorities in nursing means to point out foci of interest and investment, on which the group of researchers can build consensus.
Some authors state that "the policy of Health Research Agenda and are currently guiding the allocation of funds from the Ministry of Health for research and scientific development" 4:35. These features are significant when compared with the total amount of investments made by the Ministry of Science, Technology and Innovation.
Thus, the alignment of researchers to this reality means not only to adhere to a particular policy, but also to enhance efforts towards resolution of some major national health issues, mobilizing the knowledge of its own.
The theme is not new in nursing, since the document of the Brazilian Strategic Agenda for Research and Graduate Studies of Nursing proposes a "collective construction of a national agenda of research priorities in nursing, with the selection of themes and research problems, based on the relationship between the initiatives of universities and social demands" 9:599. This paper demonstrates the concern of the nursing area with the definition of research priorities, in line with the discussions of the Ministry of Health, even before the final document ANPPS had been prepared.
The establishment of prioritization of nursing research (PPE) involves adjusting the focus of this field of research on what is essential to give visibility to its own knowledge, ie, the nursing care as a theoretical category, the subject of care, professional skills and also the large cross-national issues in order to better define the disciplinary field and the interdisciplinary aspect of this field of knowledge.
In this context, based on the proposition of the 24 sub-agendas and considering the historical movement of development of nursing research, the author has been discussing the topic and presenting proposals for the reorganization of the research fields of the area 5,6,10-13.
These propositions were based on the following methodological steps: from 24 sub-agendas of ANPPS, 11 accustomed directly to the field of nursing research topics were selected; each of the 11 selected subjects were retranslated into its specificity to the field of nursing; these 11 subjects, five are characterized as Thematic Cross Axes, three as Thematic Axes of Vertical Actions and three as Vertical Thematic Axes by Population Groups; the intersection of the five transverse axes and six vertical axes allows to match the research field of nursing 5,6,10,13.
The 11 priorities for research proposals aim to characterize the research field of nursing and allow the expression of its own knowledge and the interdisciplinary aspect of this field. The retranslation of these 11 research priorities in its specificity to the field of nursing considered the focus on nursing care in population groups subject of this care, in large cross-national issues, in specific professional skills and also in research topics that require induction for its development.
This retranslation determined the five Transverse Axes and six Vertical Axes, that systematize research priorities Nursing 5-6,10,13.
The five Thematic Cross Axes are featured below:
1. Health, Environment and Biosecurity Working in Nursing
2. Assessment of Nursing Technology and Health Economics
3. Clinical Research in Nursing
4. Work Management and Health Education
5. Health Systems and Policies
In turn, the six Vertical Axes are subdivided into three Thematic Axes of Vertical Actions and three Thematic Axes by Population Groups, 5-6,10,13 defined as follows:
1. Nursing Care for Mental Health
2. Nursing Care of Communicable Diseases
3. Nursing care of Noncommunicable Diseases
1. Nursing Care for Health of the Adult and the Elder
2. Nursing Care for Women's Health
3. Nursing Care to Health of Children and Adolescents
The intersection of the transverse and vertical axes allows to reconcile the characteristic of disciplinary and interdisciplinary research fields of nursing. It is recognized that the clear identification of the disciplinary facet of a field of knowledge is an essential condition to the exercise of interdisplinarity, protecting the identity of the field 5-6,10,13.
The discussion of the research today is compelling and is expressing itself in different initiatives. One was the seminar organized by the Advisory Committee on Nursing of CNPq in 2013, which results were reported in events and publications11-13, translating a first approximation to the problem. A second initiative was a study developed for the analysis of 617 research projects submitted to the CNPq, in the Nursing Area, Universal Edicts in 2010, 2011, 2012, which results are presented in Figure 212:
As can be seen in comparison of Figures 1 and 2 the same thematic dimensions express themselves to the elected research subjects of the projects and towards priorities of proposed research, varying the more or less aggregation of those and the disciplinary or interdisciplinary trend. This finding can be taken as an indicator that we may have a path to an organic setting of priorities and lines of research here.
The politics of health research and ANPPS are currently guiding the allocation of funds from the Ministry of Health for research, impacting the overall Brazilian investment for the scientific and technological development, and innovation. This finding requires a positioning from nursing to their alignment or independence from the agenda in defining their research priorities and also of its research and knowledge areas.
We presented in this text the proposition that the Nursing Research Priorities are defined from guiding paradigms such as nursing care, the subject of care, the cross-national issues, professional skills and research fields that require induction for its development and enhancement, expressing the disciplinary aspect of the field of research, focused not only on morbid processes and clinical issues, but also in full view of the health-illness-care process. In turn, the interdisciplinary aspects were incorporated through the transverse theme axes.
These guiding paradigms require the alignment of the knowledge areas and lines of research in thematic axes that allow to express the identity of the practices of research in this field, namely: Health, Environment, Work and Biosafety in Nursing; Assessment of Nursing Technology and Health Economics; Clinical Research in Nursing; Work Management and Health Education; Health Systems and Policies; Nursing Care of the Health of the Adult and Elderly; Nursing Care for Women's Health; Nursing Care to Health of Children and Adolescents; Nursing Care for Mental Health; Nursing Care of Communicable Diseases; Nursing care of Noncommunicable Diseases.
It is noteworthy that the strengthening of technological research and innovation presents itself as a challenge to the proposition of products and processes of nursing care, seeking to better define the development of hard technologies but also relational technologies of care. The difficulties inherent in the interdisciplinary approach to the object of nursing research should be faced, articulating the process of nursing care for its particular conditions and requirements, allowing to circumscribe a field of knowledge itself, impacting both research and professional practice.
Therefore, the specificity of research and research priorities in nursing is stated in the context of the priorities for health research in order to allow articulation of auxiliary theories with own paradigms guiding this field of knowledge, in order to construct a science of nursing, as proposed by several authors.
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