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From “nursogyny” to “nursology”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "141" "paginaFinal" => "143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio Jesús Ramos-Morcillo, María Ruzafa-Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Antonio Jesús" "apellidos" => "Ramos-Morcillo" "email" => array:1 [ 0 => "antoniojesusra@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Ruzafa-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Facultad de Enfermería, Universidad de Murcia, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Investigación enfermera y políticas públicas de salud. De la «enfermeraginia» a la «enfermerología»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Health policies and research are the result of various processes. Inevitably the point of convergence is where policies must resolve specific health problems and research projects must direct decisions towards obtaining the best outcomes. However, it is not so clear that policies influence research, or vice versa.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> In this editorial we will reflect on this situation in the specific case of nursing in Spain. We shall cover aspects such as the need for research into care, the presence of this type of research in research institutes and accessibility to public calls. And finally we shall demonstrate the manner in which some of the features of our profession might have affected its development.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the latest data from the Spanish National Institute of Statistics for 2015, there are currently 284,184 registered nurses, including midwives, compared to 242,840 registered doctors.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> It is evident that nurses and doctors comprise the majority of healthcare professionals in Spain. On the one hand, both collectives are targeted by health policies, and on the other, they are made responsible for health research. Nurses and doctors share common clinical scenarios, although the issues that they attempt to resolve, the problems they observe and how they approach them may be different. As an example, it is unlikely that we would find a traumatologist showing a trauma patient how to self-inject low molecular weight heparin. However, it is quite likely that a nurse will teach hospital patients how to self inject within that same clinical context.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are many examples of this, clinical situations into which professions other than nurses would find difficult to conduct research. This is justified by the clear link with how we undertake our work. Thus, by way of illustration, we can find various clinical practice guidelines on stoma care, people and family-focussed care, care and maintenance of vascular access towards reducing complications, building therapeutic relationships, prevention of falls and resulting injury, etc. These examples were developed by the Registered Nurses’ Association of Ontario.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Without doubt one of the major challenges faced by public policies is how to tackle their own population's specific problems. To that end, specific problems (clinical scenarios) should be approached in different ways, at different times and by different professionals. This should be sufficient to justify the need to support and finance research, regardless of the time of clinical care or professional profile. Yet, this is not what happens in our country in general.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We cite the Biomedical Research Institute of Murcia (IMIB) (<span class="elsevierStyleItalic">Instituto Murciano de Investigación Biosanitaria</span>) as our example, sponsored by the Regional Government of Murcia, with the collaboration of, amongst others, the Murcian Health Service and the University of Murcia. This institute is the Region of Murcia's instrument for healthcare, science and technology policies.</p><p id="par0030" class="elsevierStylePara elsevierViewall">On consulting the available data,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> our attention was caught by the leading role played by biomedical research in comparison to healthcare research. Firstly, we would question whether its name, Biomedical Research Institute of Murcia, is the most appropriate, and whether it should be named in a broader sense “Health Research”.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Furthermore, the IMIB is organised into 7 areas of research, which in turn include several lines of research, yet there is no area for nursing. Neither is there any nursing research line, despite the fact that there are several lines relating to care research, such as those of area 5 “epidemiology, public health and health services”. Nor are there research lines into other areas covering aspects such as nutrition, high blood pressure, respiratory disease, etc.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In addition, the conditions and requirements demanded to form part of the Institute and form visible and fundable research groups are ambiguous and not very transparent, to say the least. Amongst the IMIB's principles and objectives, as contained in their statutes,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> is the principle of non-discrimination. This principle ensures that all actions and proposals received by the Institute are assessed objectively, irrespective of whether they come from consolidated or emerging research groups and/or researchers. Of course, in this regard, what is considered a (consolidated) and/or emerging research group, and how and when is the pertinent question.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The next principle is leadership, which indicates that the Institute will exclusively support those activities, projects and lines of work that they objectively consider relevant. Again we have to ask, what, who and how they consider an activity, project or line of work objectively relevant. Observing the areas and lines that “are objectively relevant”,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> given that they are already underway, the absence can be appreciated of areas as relevant epidemiologically as research into health inequalities and strategies to combat them and the care of chronicity, to cite some examples. However, we found very many lines of research where we observed the prefix “bio” acquiring a meaning: bioinformatics, bioengineering, bioenzymatic, molecular and biochemical bases of digestive tract disorders, solid organ transplant immunology, immunotherapy, immunomodulation and cell-mediated tolerance, etc.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another example that serves to illustrate how difficult to obtain financial support for care research is access to funding for health research in the autonomous region of Andalusia. Although it is slightly more transparent than the previous example, for some issues calls for financial grants are still ambiguous and are not explicitly linked to care. There are some structural similarities with the IMIB such as the use of the term biomedical in favour of everything else. In the latest call,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> it is indicated that funding will be provided for research, development and biomedical innovation and the Health Sciences. Is it possible that the Health Sciences do not include biomedicine? Moreover, their project lines never explicitly include nursing. We do however acknowledge that they positively discriminate towards women in research teams.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We have given two examples, obviously we are not being exhaustive, but in general the situation nationally is not much better. An example we would highlight in this regard and which is positive, is the express inclusion of nursing care in the call for awarding grants of the <span class="elsevierStyleItalic">Acción Estratégica en Salud</span> (AES) (Strategic Action on Health) of the Spanish National Plan for Scientific and Technical Research and Innovation 2013–2016.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Although still not established as a broad subject area, “the promotion of research into care” does feature as a priority line of research in this Strategic Action. Two descriptors relating to care models have also been added, to the CIBER Consortium.</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are many aspects or factors of our profession that have given rise to this situation that we could discuss. But we want to highlight one in particular, the disregard for and undervaluing of daily nursing practice. This is what Chinn<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> terms nursogyny. The author links nursing with misogyny since nursing achievements are presented by women. It is possible that the fact that nursing is a markedly feminine profession has a determining influence.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Furthermore, it is a known fact that women's work in science is underestimated, that science remains institutionally sexist, and even peer-review processes are sexist.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> Nursing research does not escape this systematic undervaluing. Perhaps the fact that being female is a major axis of inequality might in part explain this nursogyny. Let's look at an example: in international competitive calls for funding the composition of research teams does not discriminate between professional profiles when allocating financial resources to the team members. However some calls that we looked at in our country, such as the Strategic Action on Health, discriminate negatively in awarding funds and make a distinction between nurses and other professions (Río Hortega contracts).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> This is clearly another example of nursogyny, since the allocation criterion should not be the profile of the professional but rather the level of their research competency, which is vouched for by their academic level.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Another feature of our profession which might have influenced the trajectory and current status quo, is that nurses as a collective in general experience “power anorexia”.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> To this feeling we must add that the dedication required to undertake funded research, adds to nurses' workload and in many cases, their family responsibilities. Both aspects are also explained by the profession being predominantly female, and would explain why nurses have fewer aspirations when it comes to gaining research funding.</p><p id="par0075" class="elsevierStylePara elsevierViewall">These reflections beg the question as to how nursing research is going to influence health policies. Before this can occur some things will have to change, and as we have shown, the situation is no better for research into nursing. Without any doubt, public health policies are required that impact the development and progress of research into care. And when we state this, we are not merely referring to the most elementary of the issues: inclusion in health research institutions and management bodies and standardised access to public research grants. We are referring to there being a “real” possibility of funding, with nurse evaluators for projects, with access criteria to said funding which are also “real”, and that the difficulties historically faced by nurses in undertaking research should be taken into consideration (it has only recently been possible to study for a doctorate in nursing). By “real”, we mean demanding criteria that ensure the quality of the research, but which are reasonable. For example, a strategy line of the Health Council of the Government of Andalusia considers a group to be emerging if it has had at least 3 JCR (they need to be included in the first and second JCR quartile) with principal authorship in the past 5 years.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> This profile in nursing is clearly not an emerging group.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this brief, non-exhaustive analysis, we have flagged up some of the difficulties and barriers to research access faced by nurses. We have only been able to refer to those that are visible in the documents we studied. However there are structural barriers, subtle discriminatory practices (that are not acknowledged), cumulative disadvantages, and the presence of “gatekeepers” in research funding as well as hidden power dynamics governing access to the most advantaged positions.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> We have not been able to speak objectively about all of this, since we have no data available to us to quantify the budget used for research into care, the number of care research groups in Spain included in institutes or other research structures, the number of projects presented by nurses, that which eventually obtains funding, or the percentage of funding represented by nursing, etc.</p><p id="par0085" class="elsevierStylePara elsevierViewall">This situation is not easy to resolve. We are aware that it is currently unthinkable, even if nurses were given the best conditions for access to research grants, for us to be able to direct a major volume of research studies. We have limited potential for research due to our historical trajectory and the characteristics of the profession. However this should not stop us defending that which we are due as a scientific discipline that seeks to improve the health and living conditions of the population we serve.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We conclude by highlighting that the nursing collective has the most members in the national health system and policies should meet the needs of the people on whom research needs to be carried out, and therefore public funding should be invested into care research. We consider it necessary that the design of public funding policies should coordinate corrective measures to enable nurses access to research on an equal basis with others. In turn, policies should be committed to nursing research in a broader sense, promoting research into care yet going further and incorporating funding in order to implement the results of research. As nurses we must aspire to excellent care based on nursing research. It is time that we were allowed to contribute towards the creation of nursology<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> with the help of public funding.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramos-Morcillo AJ, Ruzafa-Martínez M. Investigación enfermera y políticas públicas de salud. De la «enfermeraginia» a la «enfermerología». 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Journal Information
Vol. 27. Issue 3.
Pages 141-143 (May - June 2017)
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Vol. 27. Issue 3.
Pages 141-143 (May - June 2017)
Editorial
Nursing research and public health policies. From “nursogyny” to “nursology”
Investigación enfermera y políticas públicas de salud. De la «enfermeraginia» a la «enfermerología»
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Antonio Jesús Ramos-Morcillo
, María Ruzafa-Martínez
Corresponding author
Facultad de Enfermería, Universidad de Murcia, Murcia, Spain
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