Pergamon hr. J. Nurs. Stud., Vol. 34, No. 2, PP. I I I-1 LB, 1997

0 1997 Elsevier Science Ltd. All rights reserved Printed in Great Britain

002&7489/97 $17.00+0.00

PII: SOOZO-7489(96)00044-Z

Research-based nurse education: understandings and personal accounts

Stephen Tilley,“* Phyllis Runcimanb and Lisbeth Hockeybt

“Department of Nursing Studies, University of Edinburgh, Edinburgh, Scotland, U.K.

bDepartment of Health and Nursing, Queen Margaret College, Edinburgh, Scotland, U.K.

(Received 1 May 1996; revised 30 July 1996; accepted 21 October 1996)

Abstract

Despite longstanding recognition, in Britain and elsewhere, of the problems of relating research to nursing practice and education, the authors found no previous research on nurse educators’ understandings of the term ‘research-based nurse education’ (RBNE). In a cooperative inquiry, four nurse educators with varying lengths of experience in different kinds of educational institutions explored their understandings of the term and gave accounts of practice of RBNE. Themes from the data are discussed, including the central role of questioning in teaching and learning.

These individuals’ constructions of RBNE were related to their particular, situated experiences, but also reflect common concerns and issues. The study highlights contradictions and dilemmas arising when the constraints of nursing practice are ‘married to knowledge generation and freedom to learn. The implications of these tensions for higher education of nurses are discussed and further research is proposed. 0 1997 Elsevier Science Ltd.

Keywords; Nurse education; nursing research; understanding RBNE.

Introduction

Given the slow but steady development of nursing research in the UK and of its place in nurse education since the 196Os, it might be expected that there would be a shared understanding, by the 1990s of the mean- ing of the term ‘research-based nurse education’ (RBNE). To date, however, the concept does not seem to have been systematically explored. This article reports the findings of a small cooperative study that shed light on some current interpretations of the term.

Current educational reform

Nurse education in the UK, at pre-registration and post-registration levels, is now linked to the higher education sector, albeit in a variety of forms of associ- ation and stages of development (UKCC, 1986; Scot- tish Office, 1993). Within nursing departments of the older universities, research is a firmly established first priority. In the newer universities, the pressure on

*Author to whom correspondence should be addressed at: Department of Nursing Studies, University of Edinburgh, Adam Ferguson Building, 40 George Square, Edinburgh EHS YLL, Scotland; e-mail: s.tilley@ed.ec.uk. tvisiting Professor, Department of Health Studies, Buck- inghamshire College, Chalfont St Giles, England.

nurse educators to establish a research identity is now creating considerable tension and uncertainty, par- ticularly amongst those formerly secure in teaching roles in colleges and schools of nursing (Draper, 1996).

There are now clear expectations placed on edu- cators to foster the development of research skills at both pre-registration and post-registration levels. In the UKCC’s (1995) recommendations for the devel- opment of post registration education and practice (PREP) programmes, personal research is cited as a relevant focus for study; the specialist practitioner is expected to monitor and improve standards of care through research; an increase in research-based prac- tice is linked to the work of advanced practitioners; and return-to-practice programmes are expected to foster ability to use relevant literature and research to inform practice.

Authors have made various claims for gains from educational reforms and greater exposure to research. These include: intellectual challenge (Akinsanya, 1994); improved knowledge base (Fitzpatrick et al., 1993); and a multidisciplinary context for learning, with enhanced opportunities to explore the theoretical bases and practice of other academic and health care disciplines (Scottish Office, 1993). Such gains could be construed as applying both to students and educators.

Over 20 years ago, the Briggs Report (DHSS, 1972) noted that research should be a specific concern of

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112 S. Tilley et a/./Research-based nursing education

nurse educators; as specialists, they were expected to have advanced knowledge of research for use in teach- ing and ability to conduct research. Writers in the 1990s however, suggest that there is still much to be achieved with respect to research and education; for example, stronger links between research, education and practice (English, 1994; Mulhall, 1995) more widespread distribution of research skills and experi- ence among educators; and the establishment of prin- ciples of investigation at the centre of basic nurse education (Akinsanya, 1994). It has also been rec- ommended that issues in teaching, learning and assess- ing research be explored (Cavanagh and Coffin, 1993; Hardiman, 1993; Winson, 1993) and that careful thought be given to the preparation of nurse teachers for their research-related work (Perkins, 1992; Clifford, 1993).

Despite the wealth of nursing literature since the 1970s about research and its relationship to the devel- opment of practice, to professionalisation and, in a general sense, to education, there is little direct ref- erence to, or exploration of, the profession’s under- standing of the concept of ‘research-based nurse education’. The aim of the study was therefore, to illuminate understandings of the term as perceived by nurse educators.

The study design and process of analysis

The study was designed as a process of collaborative inquiry, with participants interviewing each other. This approach is akin to Reason’s (1994) ‘co-operative inquiry’. In Reason’s first phase, co-researchers “agree on an area for inquiry and identify some initial research propositions” and agree to record their own experience. The co-researchers in this study agreed the area for inquiry, identified that there was a need to clarify the meaning of the concept, and agreed to explore their experiences of RBNE. In Reason’s second phase, the “group then applies these ideas and procedures in their everyday life and work... This phase involves practical knowing”. In a cognate way, the co-researchers in this study reflexively drew on their practical knowledge of RBNE based on varying periods of teaching and learning. They did so, not to change, but to develop reflexively their under- standings of RBNE. Reason’s third phase is charac- terised by ‘experiential knowing’ as participants understand their practice differently. In our study, the co-researchers’ understandings of RBNE developed over the course of the study through the process of reflexive inquiry. Reason’s final phase is the return to the original propositions and new ‘propositional knowing’. The counterpart in this study is the authors’ formulation of mutual understandings of RBNE through shared writing of this paper.

The findings presented here are based on analysis of four semi-structured interviews with UK participants selected on the basis of their interest in cooperative enquiry and their experience, ranging from 2 to

40 years, of research-based nurse education. The par- ticipants had experience in the various nurse edu- cation sectors: ‘old’ university, ‘new’ university level institution (those which may or may not have full university status), and college of nursing associated with a higher education institution.

Interviews were focused on two topics: first, par- ticipants’ understanding of the term ‘research-based nurse education’; and second, an incident chosen by each participant as informative about their current practice and perspective. The method is akin to what Cunningham (1988) calls ‘interactive holistic research’. This approach to research is iterative, both in the sense that the researchers as co-participants in mutual interviewing could refer to matters brought up in earlier interviews, and in the sense that the researchers could clarify and elaborate during the cooperative analysis matters raised during the inter- views. In Cunningham’s terms, it can be characterised as ‘dialogic research’, “(centred) around the two-per- son interaction and (using) the dialogue as a mode of ‘finding out”‘; and as ‘experiential research’, focused on the co-researchers’ experience of teaching and in some cases learning about research. Cunningham notes that this style of research entails ‘contextual locating’, whereby the co-participants locate their understandings and accounts in relation to more objective, policy-based understandings of the topic.

Interviews were transcribed by an audio typist and examined to identify concepts, categories and emerg- ent themes. The findings reported here are based mainly on thematic analysis, which was done in two stages. First, one of the authors read the transcripts to identify concepts, categories, and emergent themes. One main theme, for example, was ‘person-context fit’. Further analysis focused on similarities and differences in the interviews, related to the themes. Summary preliminary analyses were discussed by the co-researchers, including the interviewee, to assure face and corroborative validity, and to develop the analysis further. Finally, co-researchers read, com- mented on and developed successive drafts of the paper.

RBNE: problems of meaning

The central question asked of respondents was: “What does the term research-based nurse education mean to you?‘. In the course of their responses, mean- ings of each term-‘research’, ‘based’, ‘nursing’, and ‘education’-and the ‘fit’ between the terms, were elaborated. Respondents distinguished between terms and suggested possible alternatives-eg. ‘research’ and ‘knowledge’. They also noted the linkages between key concepts, e.g. between ‘research’ and ‘education’. In doing so they indicated the complexity of the topic. Each respondent’s conception of RBNE depended on how terms were construed.

S. Tilley et aLlResearch-based nursing education 113

‘Research’ and ‘knowledge’

One respondent linked ‘research’ to the term ‘knowledge’ and to the notion of the ‘knowledgeable doer’, a term used to describe the changes in prep- aration of registered nurses:

The... P2000 document uses the terminology ‘knowl- edgeable doer’ which I quite like and I wonder whether it wouldn’t be a good idea to link that Project 2000 terminology with our term ‘research-based edu- cation’ and call it ‘knowledge-based education’... Knowledge can only be created by research... if you want to educate knowledgeable doers you have got to provide a knowledge-based education. (RI)

This respondent thought that ‘knowledge’ may be a better term to use than ‘research’, since the term ‘research’ puts nurses off:

I think including the term ‘research’ is bad and I’ve learned that from my own bitter experience which I think is the best teacher of all. I think people shy away from the term research, they feel it’s something very academic and artificial and they don’t know too much about it and, you know, with respect, some researchers are so very mysterious about their activi- ties and put such a lot of, kind of, aura on it that people just shy away from it. (RI)

For educators concerned with RBNE, these terms were working words. Their meaning changed through time, with experience of teaching. One respondent described “working with the two words, ‘research’ and ‘knowledge”‘. “Starting with the word ‘knowledge”’ marked a move in her teaching practice:

. ..it’s in the last 2 years that I’ve moved away from starting by talking about research or even using the word ‘research’ much, or starting to try and define research, to working with two words, ‘research’ and ‘knowledge’. But if anything in this last year starting with the word ‘knowledge’ rather than ‘research’, UW

‘Research’ and ‘education’

Respondents distinguished between teaching about research and teaching based on research; and between the latter and education for research-based practice. For example, one respondent noted the different emphasis that could be placed on the different terms in RBNE.

1 would want to distinguish in research-based nursing education+ducation for research-based nursing practice from research-based nursing education... (R4)

Again:

I think ‘research-based’ means that your teaching should be research-based, should be up-to-date, well investigated..., so that’s the first thing. I think... also,., that it means that our practice should be research- based and it’s not at the moment,,, (R3)

Respondents’ sense of the meanings and dis- tinctions had developed over time:

I think the emphasis is on nursing education where teachers are drawing on research findings, current research, present state of knowledge... Where I would have put more of an emphasis before I think would have been on research as a topic to be learned by the students. (R4)

‘Nursing’ and ‘research-based nursing’

The characteristics of ‘nursing’ as a distinctive disci- pline, with respect to knowledge production, were explored by one respondent:

If you think of the origin... nursing is a very, very old activity and creation of knowledge within nursing is new. You know, it’s all been done on the basis of trial and error in the past....Nursing having been there for I don’t know how many years, the Old Testament talks about nursing so it’s many thousands of years old and then the creation of knowledge now has to be married to the old concept of nursing... (Rl)

This respondent emphasises that nursing-as-prac- tice preceded knowledge-based nursing.

RBNE: problems of context

Each respondent was asked to give an example from personal experience which would convey their under- standing of RBNE. In doing so, respondents referred to different contexts which shaped their under- standing: contexts of personal experience, intra-insti- tutional and inter-institutional relations, and the wider context of changes in nursing and education.

Personal experience

Respondents referred to their own experiences of learning about research. For example:

And one of the first questions I suppose I asked myself was “Well, how have I learned about research and what’s my own personal experience been?’ and I had a dilemma there because I’m essentially self-taught. I have had very little formal research teaching. As a learning experience it (NOTE: a Research Training Fellowship) wasn’t right or what I needed at that time and looking back on it the most significant learning was certainly experience, it was, learning by doing, backed up with a) discussion and b) literature in that order... Discussion with supervisors, discussion with people who obviously had first hand experience and therefore could set my experiences against experiences of others. (R2)

. ..And feeling like a fool initially and thinking I’m not letting this get the better of me, going and finding an idiot’s guide book and I always did manage to find one that sort of got me in there initially and then I could work my way up to the sort of Bulmers of this world. That was really quite good. And it was for me, it wasn’t for anybody else. I wasn’t doing this (NOTE: Masters degree) for the College, although they had sent me here and that was nice of them; this was my year and it was a year that I was allowed to kind of investigate something I really wanted to do. So it became alive then... (R3)

114 S. Tilley et aLlResearch-based nursing education

Intra-institutional context

The meaning of RBNE was for some respondents conveyed through accounts of their jobs. One described the suddenness of a research development job in a college of nursing being ‘thrown’ at her:

It was kind of thrown at me. It was advertised with 16 objectives to the job about 10-12 weeks ago. We all looked at it and thought “Aye, very good” and walked off-an exciting job but far too much. So nobody applied... over the last wee while I certainly have been making it known that I’m interested in research and I had indeed gone to the Head of Depart- ment to complain bitterly about what they had done in Foundation (NOTE: the Common Foundation part of a P2000 course)... I think I got my just rewards by being told to apply for this job. And initially I resented it, and I thought no, you know, this is wrong... I’m not the most qualified person here to do this job, there are people who have more expertise. And that was difficult, but the choice wasn’t, it wasn’t open to debate. (R3)

One respondent noted that the meaning and prac- tice of RBNE differs for different teachers in the same institution, for example, between those who teach on the basis of their own research and those who do not:

It’s that if somebody is teaching an Honours option, they might want to offer an option on the basis of their research interest or the field that they’re working in... and these are courses which wouldn’t be taught probably by anybody else in the department, couldn’t be taught specifically by anybody else in the depart- ment because they’re the field of interest of that par- ticular person... it’s heightened for me the connection between research-based nursing education as some- thing which, from the teaching point of view, is prac- tised differently by people who do research than it would be by people who use research in their teaching. (R4)

Differences in the way ‘research’ was taught within an institution might result in some ‘killing’ it, others making it ‘live’. To promote the ‘live’ version, the ‘dead’ had to be fended ofi

..it’s quite sad that we hear students from Foundation saying “Oh God, research” and you think this is what’s coming to us in Branch (NOTE: the Branches following the Common Foundation in P2000 courses) and we’re going to have to get their attention and how on earth are we going to do that because somebody is going to kill the subject for them... these students have sat and listened to somebody going on and on and on and haven’t really spent time looking at how this can help them... I know that’s condemning my colleagues and well... I do it without any hesitation actually because I know what they’re teaching. (R3)

Inter-institutional context

Respondents indicated the impact of changes in institutional relationships on RBNE, e.g. the incor- poration of nursing colleges into higher education. They raised questions about who teaches what, how RBNE is organised, and whether, if it becomes the province of ‘experts’, these are to be found among nurse teachers or lecturers from higher education set-

tings. Two respondents noted differences in the ethos and function of universities compared to other insti- tutions in which nurses learn. One asked:

What’s the difference and what is the university there for, what is its raison d’etre? I think it’s terribly impor- tant... Well the crucial... difference is really the ter- minology we use. We talk about ‘reading for a degree’. You don’t talk about ‘reading for a nursing quali- fication’ and I think the focal point is ‘reading’... I mean the difference between a college and a university is the freedom that students should have unless... you pressure them too much... over-structure your courses which makes them more a college course and no longer a university course. And the freedom to learn at your own pace and to go to the library in your own time and to get out of it what you want to get out of it. To me it’s the secret of university education. (Rl)

Another respondent, based in a university, noted how different institutions might play different roles in RBNE:

. ..what marks out the Universities...is that they are involved in producing the knowledge which then feeds into, through the educational process, practice and through the educational process at all levels... It’s like they’re producing the people who produce the goods... Insofar as they’re doing that they are involved in a process at postgraduate level which means that they’re the location for the people who are doing the research and therefore able to teach at that Honours level and with that version of research- based nursing education. I think that the production of dissertations which reflect ability to critically han- dle and organise literature and so on is distributed in higher education generally, not probably at the colleges. I mean not at diploma level, for P2000 courses say there’s no expectation that the student would be able to read, organise, critically appraise literature to the extent that a dissertation would be so Honours people are out at that level, they’re exclusive to polys and universities. So it’s where the people producing the goods are if those are seen as the goods... (R4)

The wider context

The wider contexts have shaped RBNE for some time. One respondent related this to her job in a higher education institution due for institutional review. Over a five-year period the development of RBNE was stimulated by ‘contextual pressures’:

In ‘88 there were pressures on the department to develop the courses from unclassified to honours. Now where did these pressures come from? These pressures were institutional... the institutional review that was about to take place. That was a short term pressure, with a middle term desire to go for accredit- ation (NOTE: institutional accreditation, i.e. to ach- ieve degree-awarding powers). (R2)

In the wider context of linkage with higher education, the questions of institutional survival, of the expertise of teachers, and teachers’ job security, have a bearing on RBNE:

S. Tilley et aLlResearch-based nursing education 115

We’re in a position (NOTE: college of nursing) where we’re fighting for survival and I think we know that and I suspect that people will either roll over and die or they’ll fight, I’m going to fight... (R3)

RBNE: teaching and learning issues

Teachers’ experience of learning about research

Respondents’ current understandings were some- times based on overthrowing of previous conceptions of research, based on their prior educational experi- ence. These teachers of research had themselves been students, and their experience as learners was one source of their understandings of RBNE. For exam- ple, one person talked about a negative experience of being taught about research:

I remember being at a central institution and hating research, hating the term research and thinking “Oh for God’s sake, how can this possibly have any mean- ing for me?‘... because I didn’t associate research and questions and I didn’t associate research with nursing practice. It just didn’t have a place for me there. (R3)

The role qf questioning in teaching and learning

Respondents had questioned practice (of nursing and of education) and saw both learning and teaching in RBNE in terms of questioning. They referred to the central importance of questioning. For example one said that RBNE implied:

. ..asking the question why am I teaching this and what authority have I to teach it in this way, that’s the kind of thing that I’m after. (Rl)

Another respondent noted the role of questioning in getting students to understand the sources of their knowledge:

This year I started by getting them (first year students) to think about how we learn things, how do we learn about things in life in general... I used the example of hand-washing as something we’ve done from child- hood and posed them the question “how did you learn about this?’ and “how do you wash your hands?” and just got them in groups of two or three to simulate handwashing, just look at each other, what you’re doing, jot down some of the reasons for what you’re doing, what do you notice. Then work back over your life till now, “how did you learn about hand- washing?“, “what do you know about hand- washing?“, “why do we do it?“,... and project from that to handwashing in nursing. “So what do you imagine yourself doing in nursing on the basis of what you’ve been talking about, thinking about, wat- ching?” “ What’s the significance of this, what’s the significance of your existing knowledge for nursing?” WI

Through this process of asking questions, the topic of knowledge and learning was raised:

HOW do they know what they know? Sources of knowledge and processes of learning. And they ident- ified sources of knowledge very nicely from that.., And they could move themselves into validity of

knowledge from that and raise questions about val- idity of this knowledge for a new context, the new context being nursing practice... (R2)

For this respondent, RBNE could be conceived in terms of the movement of the questioning nurse into the educational institution and between education and practice:

. ..I’m particularly interested... in teaching and learn- ing about research, this business of moving from per- sonal experience... Thinking about that out of context in college then moving into practice trying to get questions in the mind to get them noticing, observing. Bring that knowledge from practice, bring these observations from practice back into college and move it forward. (R2)

Tensions, divisions and constraints

RBNE as depicted by the respondents was the site of tensions and divisions. Some of these tensions con- cerned relations within and between institutions. Others were to do with constraints inherent in the relationship between research and nursing.

The importance of questioning in RBNE has been noted. For example, questioning could be prob- lematic:

(In practice I learned) ways to account for what was being done like in terms of behaviour therapy, learn- ing a particular discourse, a way to speak, taking part in the discourse community and then finding it challenged by other people who didn’t participate in the discourse community...It’s the problem of the possibility of a better account or different account...1 should say that the original practice-based anxiety or insecurity based on the questioning of the account is still around but in a different form but the old insecur- ity of being in the academic institution and being challenged by students or oneself or people in practice about knowledge which, you know, sits in a classroom rather than knowledge which risks itself in practice. (R4)

What is ‘questioning’? Questioning of students about their knowledge of research could in effect be a questioning of colleagues’ teaching, and the coherence of the curriculum on research:

I’ve looked (with colleagues at the curriculum for teaching research) and said you know, at term 2 you can’t do a research critique with somebody because they’ve sort of, they don’t know. How can you cri- tique something you don’t know? How can you do that? And then they (students) come to us in Branch and we say “Eh we’re doing a research cri- tique”...“Well you haven’t actually, you’ve looked at how this was a research study that was done and they used this method but you haven’t really begun to question”... (R3)

A respondent with long experience of the issues of RBNE noted practitioners’ earlier attitude toward RBNE and resistance to education which created doubts for practitioners. There is a taboo against ques- tioning because it conflicts with the need for certainty:

116 S. Tilley et al./Research-based nursing education

. ..I well remember, I’m speaking from experience...the very first sort of research-based venture we had just to

mon concerns and issues. Of particular note is the

tell students about research, when we had 10 students emphasis these respondents place on the central from each of the (local) colleges and we brought them importance of questioning: questioning of nursing together, we talked about research generation. I mean practice and of education practice. ‘research awareness’ and what you can use and what the difference is and all those key issues and then we . ..it’s the whole process I think of getting people to

had the Directors of Education to give us feedback question and that goes back to your point about

on what the students went back with and they said knowledge-based versus research-based because

“Well it was all very interesting but we couldn’t, we knowledge is about questioning... (R3)

couldn’t tolerate that because we can’t give students grey issues, they have to be black or white and we

It is as if there is a counterpart to the ‘actual’

can’t live with that uncertainty”. (Rl) moments when students of nursing are asked to ques- tion themselves and each other about their practices; a metaphorical moment in which nursing questions

RBNE, emotions and ethical commitments itself and becomes RBNE.

We have noted that the ‘actual’ moments are prob- Respondents made clear that RBNE is an emotive lematic, in that they entail challenges to accepted ways

topic. One (see above) noted the ‘bitter’ quality of her of doing things, and are tied up with relationships experience of taking a position promoting research. based on power and respect. To challenge, to call Another noted the ‘bewilderment and anxiety’ into question the practices of another, or of another’s occasioned by her first experience of receiving formal authorities, or of the past-all of these are problematic teaching about research: for nurses. Clearly there is also a tension in the meta-

I can remember in the context of the research training phoric moment when nursing as historical practices is

fellowship having a small number of lectures, what challenged by knowledge-based nursing. would be called formal lectures and I can remember the sense of bewilderment and anxiety associated with

And the other main...issue... is the problem of safety

quite a number of them because the input was early and certainty because nurses have to be safe and the

in the research training which you would think is people who are in charge of nurses want to be certain

appropriate. But as a learning experience it wasn’t that they are safe, and research almost by definition

right or what I needed at that time... (R2) gives an element of uncertainty...So the cer- tainty/uncertainty dilemma is a very important one

The following respondent’s concern at the basis of to grapple with I think... There are lots of constraints

practice she observed while in the wards suggests that that nurses have and we still want to marry those constraints with knowledge generation and freedom.

whatever dispassionate, rational aspects RBNE may And freedom and certainty, you know, there are con-

have, it is also rooted in judgements which have an tradictions there which have to be faced. (Rl)

ethical and emotional element: The emphasis on ‘have to be faced’ is noteworthy. . ..when I worked on wards, particularly when I We could draw an implication from this respondent’s worked with children, disturbed children, the practice that we used in that area was wrong. It wasn’t

emphasis: that a ‘programme’ of RBNE or for RBNE

research-based; it was practice that was half stolen that does not acknowledge these contradictions, or

from other areas and it concerned me that we would that does not encourage nurses to face them, is use a practice like that at such an early stage in some- unlikely to succeed because it will not have addressed body’s life. Em and that I think was the start of it for a key dilemma in nursing. me; that we had nurses, who, some of whom were trained to registered level, some ofwhom were nursery

But these respondents emphasise that nursing has

nurses involved in concepts, involved in therapies, for not been superceded by research-based nursing:

which they had no basis. No basic knowledge, just . ..we do make the mistake sometimes of putting learning bits and pieces and doing it and not knowing research in as something that’s “you have to do this or not being able to evaluate if that was right. (R3) to understand nursing” and I don’t think that that’s

These ethical and emotional aspects might be the case. (R3)

related to what another respondent saw as a fun- There is a history of nursing prior to RBNE, and damental ethical obligation inherent in nursing, which the problem is to ‘marry’ “the creation of distinguishes it from other disciplines: knowledge...to the old concept of nursing”. It could

So you know, it’s easy, you don’t have to do anthro- be argued that nursing cannot be ‘based’ on research,

pology if you don’t want to. We have to do nursing at least at this time and as ‘nursing’ and ‘research’ whether you want to or not because the need is there are construed by these respondents. Research is not and so I think it’s terribly important to realise the two foundational to nursing. different disciplines’ background. (Rl) Due to these inherent contradictions, RBNE poses

problems which these respondents perceived and Discussion responded to as parts of a struggle or challenge:

We have argued from our data that RBNE is a I mean in some ways this is a bit of a... struggle to

complex topic, variously construed. While indi- maintain a relevance to practice while still keeping a

viduals’ constructions of RBNE are related to their seat in the office... (R4)

particular, situated experiences, they also reflect com- The themes we have noted, to do with challenge

S. Tilley et aLlResearch-based nursing education 117

and with contradiction, suggest that RBNE has an important rhetorical dimension. These respondents can be thought of as people seeking to establish POS- itions from which to speak and challenge others’ and their own practices of nursing and nursing education:

. ..I want to get out of here and get into a point where I can look at nurse teaching and look at nurse practice and be able to say, you know, “we do it this way because...“-not because we are told to do it, not because the doctor recommends that that’s the way it’s done, not because... that is the way it has always been done, but because that is the right way to do it. (R3)

Seeking ‘the right way to do it’ through questioning and argument is akin to the ancient rhetorical enter- prise. This spirit of inquiry and argument central to nursing, and to research-based nursing, and to research-based nurse education, is situated by this respondent in the context of an actual or imagined attempt to ‘keep people quiet’:

You know, you ask questions, you find meaning, you seek answers, em, and I’m very, very strong on the idea now that the practice we use should be practice that we know works and not a practice that is done because that keeps the people quiet or because we are the experts, because we are not. None of us are. (R3)

What is sought is not ‘expert’ knowledge, but the grounds of an argument for what one is doing.

The data highlight questions about knowledge cre- ation related to research, and knowledge derivation related to experience. Respondents were concerned with the knowledge base of both clinical and edu- cational practice. The connection between these two topics is a matter of great concern. The terms ‘knowl- edge’ and ‘research’ have been thrown into sharp relief with changes in educational institutions and the move of nurse education into higher education. Nursing educators in these new institutions may be called on to provide education for nurses from diploma to doc- toral levels. This will necessitate widespread dis- cussion of issues related to the status of knowledge and knowledge creation. Moreover the Research and Development Strategy (1993) implies that nurses need to question the knowledge base of their practice and extend it. This further increases the pressure on nurses to be able to understand issues related to knowledge and knowledge creation.

With respect to RBNE and education, the data suggest a number of important questions for further exploration. How do we learn about research, and how do we teach research? What constitutes effective teaching and learning in these areas? It is clear that these questions are relevant for teachers-as-learners as they are for other learners. Another set of questions then hinges on who will and can teach research. Respondents in this study distinguish between insti- tutions, and between teachers within institutions, with respect to knowledge about research and ability to teach it appropriately at different levels.

The data suggest lines for further investigation of

the basis of the approach to teaching research. For example, do teachers who are themselves doing research (research-active teachers) teach research differently than those who are not (not research- active)? If so, is this associated with qualitatively different learning experiences for students? These questions indicate the need for approaches to teaching and learning research to be evaluated, and for good practice to be disseminated. We need to know more about what works, what does not work, and why.

Conclusion

As nursing in the UK seeks to establish itself more firmly in higher education, it will be important to study further the concept of ‘research-based nurse education’, to capture its development and to extend the debate about its context, processes and outcomes. Analysing the personal accounts of nurse teachers has proved to be a useful way to shed light on the concept.

These data are a snapshot of a moment in the devel- opment of RBNE. Are the arguments made about universities “producing the people who produce the goods” of nursing research still valid? Is this now true of all the new institutions formed through amal- gamation of colleges into institutions of higher edu- cation? In the age of Teaching Quality Assessment (a programme of review of teaching in all higher edu- cation institutions, by discipline) and the Research Assessment Exercise (a quadrennial review of research in all higher education institutions), all nurse edu- cators now inhabit a sphere in which research and teaching make intense and sometimes conflicting demands. How will the ‘goods’ of research, of teach- ing, and of teaching about research in the context of RBNE, be reconciled?

We are moving from an era characterised by differ- ent expectations of nurse educators based on differ- ences between kinds and levels of educational institutions, to one in which sets of expectations will be shared by, and most importantly about, nurse lec- turers and their colleagues in higher education estab- lishments. What impact will this have on staff, on processes of teaching, learning and assessment, on products (students), and on practice?

To conclude by questioning is appropriate. The data presented here indicate the central, problematic, role of questioning in RBNE. Some of our respon- dents have painted a familiar picture, of previous gen- erations of nurses, and perhaps some of the current generation, as unquestioning and non-reflexive. They emphasised the need to question practice and saw questioning as a central aspect of research and RBNE. In the accounts of these respondents, students are asked to question the basis of their own and others’ practice, and teachers including teachers of research cannot but do likewise. Our choice of research method was based on a recognition of the value of col- laborative questioning and answering, of mutual development of understandings toward a shared goal.

118 S. Tilley et al./Research-based nursing education

We recommend this ethos for further research on RBNE.

Comparative analysis of interviews with three inter- national respondents, carried out at the same time as the interviews reported on in this paper, is in progress. An extension of the inquiry to other countries, guided by this further analysis, could contribute further to development of shared understandings of RBNE.

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