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Revision of the Rehabilitation Nursing Research Agenda
In 2005, the board of directors of the Association of Rehabilitation Nurses (ARN) directed the Rehabilitation Nursing Foundation (RNF) to evaluate and revise the Rehabilitation Nursing Research Agenda. Following a review of the processes used by other nursing organizations to evaluate their research agendas, RNF first evaluated the effectiveness of the agenda, and then RNF embarked on a process to update and revise the agenda. The process included generating new and revised statements of research priorities based on the evaluation process, followed by a survey of members of ARN to rate the relevance of each statement to the profession. The results are a new Rehabilitation Nursing Research Agenda consisting of 19 statements of research priorities grouped into four categories. This new agenda has the potential to drive rehabilitation nursing research for the next 10 years.
Evidenced-based practice is the standard of excellence in nursing practice. Research is needed to provide the evidence upon which to base practice. In addition, rehabilitation nurses need research-based information regarding the context in which rehabilitation occurs, the experience of living with a disability or chronic health problem, and the nursing specialty of rehabilitation nursing. This evidenced-based knowledge will be useful to rehabilitation nurses wherever they practice. It will also be useful to the larger rehabilitation community, as well as policy makers, legislators, and individuals with disabilities and chronic health problems.
Originally developed in 1995, the Rehabilitation Nursing Research Agenda (RNRA; Gordon, Sawin, & Basta, 1996) has provided a standard to guide rehabilitation nursing research for the last 10 years. The 1995 RNRA was developed by a task force that (a) reviewed the processes of other nursing organizations, (b) surveyed a sample of the ARN membership to develop a list of topics important to rehabilitation nurses, and (c) employed a panel of experts to rank the research priorities. The priorities were then synthesized into five categories by the Rehabilitation Nursing Foundation (RNF) Board of Trustees (RNF, 1996).
During 2005 a comprehensive review and revision of the RNRA was undertaken. The new task force used several sources to design the process for review and revision. The task force began with reviewing the process to develop the original RNRA described in a previous article.
The original methods were adapted to guide the process of evaluation and revision. First, other nursing organizations were contacted to determine the process they used for evaluation and revision. Few organizations had embarked on revision of their research agendas, and the information obtained from those who had was too vague to be useful in designing our process. Then, an evaluation of the research published and of the research grants funded by RNF was conducted (Jacelon, Pierce, & Buhrer, 2006). The results of this evaluation were used to revise the RNRA. The revised RNRA was subjected to two rounds of evaluation, once by the RNF Board of Directors, and once by a sample of the ARN membership before the revisions were completed. The phases of the RNRA revision follow.
The RNF project to evaluate and revise the RNRA proceeded in five phases. Phases I and II are briefly reviewed below and are described fully in the Jacelon and associates article (2006). Phases III–V represent the processes and outcomes for the 2005 RNRA (see Table 1).
During the 1990s several specialty organizations, including the Oncology Nursing Society (ONS), the American Association of Critical-Care Nurses, and the American Association of Neuroscience Nurses, developed research agendas. Only one organization, ONS, reported a regular procedure for evaluating and updating its research agenda (ONS, 2003).
Analysis of the Effectiveness of RNRA
This process has been described in detail elsewhere (Jacelon et al., 2006). Briefly, all research articles published in Rehabilitation Nursing Research (RNR) journal and Rehabilitation Nursing (RNJ) journal between 1995 and 2005 were sorted according to the 28 priorities listed in the 1995 RNRA. Also, all research grants awarded by RNF were sorted according to the priorities. Of the 203 articles identified as research by CINAHL, 167 (82%) were categorized under a priority. Of research funded by RNF, 37 (90%) could be categorized by RNRA priorities. Those that did not fit the RNRA were coded by topic in preparation for the revision.
In addition to the analysis of effectiveness described above and elsewhere (Jacelon et al., 2006), the statements of the RNRA were compared to major nursing and health documents such as the National Institutes of Health (NIH) Roadmap, the National Institute of Nursing Research (NINR) Strategic Plan, and the goals of Healthy People 2010. Specifically, the goal of the NIH Roadmap to enhance interdisciplinary research informed revisions to area 1 of the new RNRA, the focus on self-management of chronic illness of the NINR led to broadening the focus in area 2, and review of the health indicators of Healthy People 2010 led to inclusion of broader language related to sexuality and health promotion. This analysis provided the context for the next phase of the process, in which the new and revised statements for the RNRA were proposed.
From the data obtained in Phase II, each statement of the 1995 RNRA was reviewed for scope, relevance, and currency. Those statements that remained important to rehabilitation nursing research by virtue of their relevance were retained or combined, those that were unclear or not addressed over the past 10 years were carefully evaluated, then revised or deleted.
In the 1995 RNRA, the statements describing the research priorities were divided into five categories: nursing interventions; health promotion and prevention strategies; rehabilitation practices; community context of care; and outcomes and costs influenced by rehabilitation nurses. These categories did not adequately reflect the priorities of rehabilitation nursing research in 2005. For example, although nursing interventions are still a priority of rehabilitation nurses, nurse-led collaborative interventions are more consistent with the NIH roadmap. Also, the experience and practice of rehabilitation nursing was missing from the 1995 agenda. Finally, in 1995 it appeared that rehabilitation services were increasingly being delivered in community settings. Ten years later, rehabilitation services are delivered across the continuum of care. The original categories and areas identified in Phase II were synthesized into four new categories: (a) nursing and nursing-led interdisciplinary interventions to promote function in people of all ages with disability and/or chronic health problems, (b) experience of disability and/or chronic health problems for individuals and families across the lifespan, (c) rehabilitation in the changing healthcare system, and (d) the rehabilitation nursing profession. The new categories reflected the current thinking in rehabilitation. The first category from the old agenda was expanded to include nursing and nursing-led interdisciplinary interventions, including management of symptoms, to promote function in people with chronic health problems and physical disability. The 1995 RNRA category focused on health promotion was expanded to incorporate the experience of disability and chronic health problems for individuals and families. Health promotion is one aspect of the experience of living with a disability, but the statement was expanded to include other aspects. The third category, rehabilitation practices in the changing healthcare system, was retained intact. A category focused on the profession of rehabilitation nursing was added. The final category, outcomes and costs of rehabilitation, was broadened. The category that was focused on the community context of care was incorporated into the new categories (Table 2).
The new and revised research statements were then organized into the new categories. At each step of the process, language was modified to fit the new areas. Several of the original statements were combined and expanded while only one statement was deleted. At the end of this activity, there were 23 statements. Table 2 provides a comparison of the proposed statements and categories at the beginning of the process to the 1995 RNRA categories and statements, and includes explanatory comments regarding the proposed revisions.
The ARN/RNF board of directors evaluated the proposed statements. At the time of the evaluation, this ARN/RNF board included two PhD prepared nurse researchers and several rehabilitation nurses prepared at the baccalaureate and master’s level who practiced as case managers, nurse practitioners, and educators. The system used for evaluation was based on the work of Grant and Davis (1997). The system was developed in order to evaluate items on newly developed instruments. It was adapted for the evaluation of the proposed agenda items. Each item was rated on a scale of 1 to 4 for clarity of the statement and relevance to rehabilitation nursing. Higher scores indicated items that were more understandable and relevant to rehabilitation nursing. The directors commented on each proposed statement, as well as the entire proposed agenda; they were invited to suggest additional priorities. After the ARN/RNF board reviewed the proposed agenda, the taskforce edited, combined, and added statements based on the board’s responses. This activity increased the total number of priority statements to 25.
Following the evaluation by the ARN/RNF directors, 1,701 (30%) members of ARN were contacted by e-mail and invited to evaluate and comment on the proposed items through an online survey. To obtain a representative sample, 100% of the ARN members with either a master’s or doctoral degree, and those indicating pediatrics or research as their practice area, were invited to participate. In addition, a random sample of 10% of the total ARN membership was invited to participate. A reminder was sent to all potential respondents 2 weeks after the initial invitation. Two hundred and eighty six (n = 286) ARN members responded to the survey. This number represents 17% of those invited to participate, and 5% of the ARN membership. Table 3 provides demographic information about the respondents with respect to age, years of practice, years of education, present position, and rehabilitation interests (Table 3). The respondents were a diverse group of which 20% were researchers.
Members were asked to respond to an online survey in which they rated each item for clarity and relevance to rehabilitation nursing. As in the ARN/RNF board survey, participants could comment on individual statements, on the agenda as a whole, and/or make suggestions regarding additional areas to be considered.
Development of the Final Version of the Revised Agenda
Based on the results of the member survey, the agenda was further refined. Any statement that did not receive at least 65% of responses as clear and relevant was modified, combined, or deleted. Respondents’ comments were taken into account when refining the document. The total number of statements was reduced to 19. The total number of categories was reduced from five to four (Figure 1).
The revision of the RNRA was completed in time for the 2005 ARN Annual Educational Conference. The RNRA was introduced at all organizational events, including regional meetings, the annual member meeting, and the RNF informational sessions. In addition, a research poster describing the development process was displayed in the poster area of the conference hall. Copies of the RNRA were available at the ARN member’s desk.
Plans for dissemination include plans for exposing ARN members to the agenda through an article in ARN Network and a revised RNF section of the ARN Web site (www.rehabnurse.org) highlighting the RNRA. The agenda will be sent to the American Nurses Association, other nurse specialty organizations, and organizations representing the other specialties in the rehabilitation interdisciplinary team (physical therapy, occupational therapy, physiatry, and so forth). In addition, the RNRA will be sent to funding agencies, such as the National Institute of Nursing Research, in order to heighten the awareness of rehabilitation nursing research and the research priorities of ARN.
Other nursing organizations have been asked to link to the ARN Web site for the RNRA. The agenda will be presented and discussed at the 2006 RNF Nursing Research Symposium. In addition, marketing literature and e-mail messages will be distributed to graduate schools to encourage doctoral students to use the agenda in applying for the available RNF grants.
The second edition of the RNRA is a document that can potentially guide the development of the science of rehabilitation nursing for the next decade. Nurses are encouraged to use the agenda’s priorities as they design and implement research projects and seek RNF grant support.
The authors would like to thank those rehabilitation nurses who responded to the online evaluation of the RNRA.
The development of this manuscript was partially supported by Center for Self and Family Management for Vulnerable Populations, Yale School of Nursing (T32NR008346).
About the Authors
Cynthia S. Jacelon, PhD RN CRRN-A, is an assistant professor at the School of Nursing, University of Massachusetts Amherst; Postdoctoral Fellow, Center for Self and Family Management for Vulnerable Populations. Address correspondence to her at University of Massachusetts School of Nursing, 233 Arnold House, 715 N. Pleasant Street, Amherst, MA, 01003 or firstname.lastname@example.org.
Linda L. Pierce, PhD RN CNS CRRN FAHA, is a professor at the College of Nursing, Medical University of Ohio at Toledo.
Richard Buhrer, MN RN CRRN-A ARNP, is a clinical nurse specialist/adult nurse practitioner at Seattle VA Medical Center.
Gordon, D., Sawin, K., & Basta, S. (1996). Developing research priorities for rehabilitation nursing. Rehabilitation Nursing Research, 5, 60–66.
Grant, J., & Davis, L. (1997). Selection and use of content experts for instrument development. Research in Nursing and Health, 20, 269–274.
Jacelon, C., Pierce, L., & Buhrer, R. (2006). Evaluation of the rehabilitation nursing research agenda. Rehabilitation Nursing Journal.
Oncology Nursing Society. (2003). Research Agenda & Priorities Research Agenda. Retrieved October 11, 2005, from http://www.ons.org/research/information/agenda.shtml.
Rehabilitation Nursing Foundation. (1996). A Research Agenda for Rehabilitation Nursing. Retrieved January, November 11, 2005, from www.rehabnurse.org.