护理与跨学科研究：凤凰还是渡渡鸟？

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Introduction

Internationally, there is a drive towards, and a plethora of incentives for more interdisciplinary research. The reason for this is obvious; big societal problems do not come in neat uni-disciplinary packages. Rather, they will be addressed by the best researchers from different professions investigating global challenges from diverse perspectives. The day of the sole researcher in an isolated lab or in a lonely writer’s garret is gone, if it ever existed. However, it has been said that just because a nurse, an engineer, a pharmacist, and a computer scientist are all part of the same research team does not make it interdisciplinary, any more than putting eggs, milk, butter and flour into a bowl automatically produces a cake. What’s important is how the components interact, and the transformational potential of this interaction.

Academic disciplines emerge over long periods of time, developing their own history, jargon, journals, approaches, prizes, awards and theories along the way. This has often led to isolation, a phenomenon best illustrated by Charlton et al.1 They compare the various health disciplines to individual tribes inhabiting adjacent islands in the same part of an ocean. Each tribe has evolved a different culture, different ways of doing things and different language to explain what they do. From time to time, the inhabitants of one island notice those on another island getting excited about some new practice or discovery. However, it makes no sense to them so they ignore it and continue in their isolation.

Such disciplinary segregation and narrow focus have had benefits for some of the more traditional professions but it will be argued here that it has not benefited science as a whole. Moreover, how subject areas are managed and located within universities have not encouraged interdisciplinarity.

Shared Space

Winston Churchill famously said “we shape our buildings and afterwards our buildings shape us”.2 Because of its late entry into the academy, it is often the case that nursing schools are in buildings at a distance from other disciplines, commonly outside the main campus. This has done little to integrate nursing into the fabric of the university or drive interdisciplinary teaching and research. If people from different disciplines do not even go for coffee together, how do we expect them to research together?

This reminds me of what may be an apocryphal story about Steve Jobs. He was overseeing the planning of a new building for Apple Headquarters. The architects proposed a quadrant of buildings - one for the designers, one for the engineers, one for marketing and one for administration. In his own inimical style, Jobs argued that there should be a single building with the washrooms, whiteboards, water cooler points strategically placed. This was to ensure that there would be ample opportunities for people from different disciplines and backgrounds to meet frequently and generate new ideas. Hence the iconic doughnut shaped Apple building in Cupertino, California, which was opened in April 2017.3

Innovation and collaboration through being located together is not new. In ancient Athens, the Agora, or business unit, was located beside the Academy on the slopes of the Acropolis. This was to ensure that there was every opportunity for merchants and scholars to meet and share problems and solutions, an early example of cross disciplinary working.

Taking Job’s lead, we should work closer with architects and physical resource experts to create interdisciplinary research spaces. In essence, these are like Hadron Colliders – environments where interdisciplinary researchers, health professionals, business and policy makers are encouraged to collaborate and collide innovative ideas off each other. This works best when such individuals are in the same physical space, where they work on a joint problem and where they form a sense of trust and common enterprise. Such an environment becomes a place where interdisciplinary constructive dialogue occurs and, as a result, science progresses. The new Francis Crick Institute, which opened in London in 2016 is based on such a philosophy. The Labs within the building are composed of four interconnected blocks, designed to encourage interaction between scientists working in different research fields.4

Is the Drive for Interdisciplinary Research Good for Nursing?

Compared to some other professions, nursing has only just begun to solidify its presence within the university sector. Established disciplines like medicine, law and pharmacy have had many decades, if not centuries, to establish deep roots and build their research base. This engenders confidence and a strong body of work that will be strengthened rather than diluted by interdisciplinary collaboration. Further, strategic and substantial funding for nursing research is a relatively new phenomenon and there is a danger that the policy drive to fund more interdisciplinary research will disperse such scarce research funding among more mature disciplines.

There is a related view that academics should start their career by enhancing their research profile in their own discipline. Thereafter, they would have the luxury and reputation to be invited to join and/or lead large interdisciplinary research programmes. From this perspective, getting involved in interdisciplinary research may be seen as too risky for PhD students and early-career researchers. If they lack a disciplinary home it could make it harder for them to publish papers and win jobs and funding. This is recognised as one of the biggest challenges for both academics and funders. Researchers are often only given acclaim for publishing in select journals within their specific field; this discourages individuals from working in partnership with other disciplines.

There is also the view that to be a profession worthy of the name, nurses require a body of knowledge that is unique to nursing. It intimates that borrowed or shared knowledge from established disciplines is only valuable if it pushes forward the boundaries of nursing as a profession.5 If this stance is supported, then interdisciplinary research would be seen as distracting nurse researchers from constructing nursing’s distinct knowledge base. Perhaps Brown et al had the answer.6 He identified the need for “T-shaped” researchers’, who are able to nurture both their own discipline, and to look beyond it. Such investigators work with other disciplines to address global problems, while enhancing scholarship within their own profession.

An Interdisciplinary Trend in Nurse Doctoral Education

The Research Excellence Framework (REF) is the system for assessing research in UK higher education institutions (HEIs). It was first conducted in 2014, and replaced the previous Research Assessment Exercise. Because of its improved performance in these exercises, nursing across the UK has been allocated increased numbers of full time PhD studentships. Invariably, these studentships are funded at 25 to 50% of a clinical nurse’s salary, which makes them unappealing for many practice based nurses. In contrast, such a stipend is very attractive to graduates from other disciplines such as social science, psychology, sociology, business and management, and arts and humanities. The result is that very good students, who just happen to be non-nurses, are applying successfully for nursing PhD studentships.

While this has increased the amount of interdisciplinary scholarly interactions in UK schools of nursing, there are possible downsides to this phenomenon. First, it could be argued that government funded PhD studentships are being misdirected from nursing to other disciplines. Second, this could reduce the future cohort of nursing scholars. Third, the resultant research is probably not contributing specifically to an unique knowledge base for nursing. Fourth, because they are not nurses, the successful doctorally-prepared postgraduates have limitations in teaching students clinically and so have difficulty gaining employment in schools of nursing. One might also wonder what success they would have in getting their research published in mainstream nursing journals.

Interdisciplinary Research: The Way Forward

In their report on promoting interdisciplinary research, Lyall and Meagher go some way to addressing these issues.7 They differentiate “academically-oriented interdisciplinary research” from “problem-focused interdisciplinary research”. The former is an evolutionary process where disciplines have reached the limits of their methodological capacity and have to incorporate learning from other fields. While it may produce some short-term instability, it should lead to the creation of new understandings or disciplines. Past examples include genetic counselling, bioinformatics, and medical sociology. In problem-focused interdisciplinary research, a researcher may see a gap in knowledge and set out to close that gap by bringing together knowledge from more than one discipline. Both of these approaches could help nurses take the lead on interdisciplinary research programmes; but it requires confidence, maturity and the commitment to take on a leadership role in interdisciplinary studies.

There are a number of ways to enhance nursing research so that interdisciplinary collaboration is perceived as positive and something for which to strive. Those established disciplines alluded to above tend to have created their scientific credibility through the use of quantitative research methods. In contrast, nurse researchers, as with many social scientists, often employ qualitative research approaches. For these disciplines to become research partners, clarity of these methodological approaches is vital. This is especially the case where one discipline’s rigorous qualitative investigation can be misinterpreted by another as anecdotal subjectivity. Therefore, a shared understanding of, and respect for, each other’s methodological approaches are vital for meaningful interdisciplinary research collaboration. In addition, because terminologies, networks and ways of working may be different across disciplines, valuing diversity is essential for interdisciplinary research to flourish.

For the first time, the forthcoming 2021 REF, provides a definition of interdisciplinary research:8

“Interdisciplinary research is understood to achieve outcomes (including new approaches) that could not be achieved within the framework of a single discipline.”

Furthermore, it maintains that interdisciplinary research involved “significant interaction between two or more disciplines”. It may also go beyond traditional ways of applying or assimilating research methods from other disciplines.

In conclusion, some nurse researchers may be concerned that joining with other, more established disciplines, will dilute their ability to formulate their own distinct knowledge base. In contrast, it is argued here that nurse researchers will thrive from greater involvement in interdisciplinary studies. This is because the problems facing the profession and those we care for are so complex that no single discipline and no individual intervention are likely to solve them. For example, better mental health care, improving infant mortality and healthy aging are goals identified by many international organisations. Nurses have a key role in addressing these issues through being partners in, or taking the lead role in, interdisciplinary research programmes.

The Dodo did not survive the arrival of new predators onto its native Mauritius. In contrast, the Phoenix is a bird that continually reinvents itself as its environment changes. As stated at the outset, the big problems facing humankind cannot be solved by any one discipline working alone. Nursing research cannot continue to focus solely on studies pertaining to the development of nursing. To survive and thrive, it must evolve like the Phoenix and embrace interdisciplinarity. To do otherwise will lead to devolution rather than evolution and take the path of the Dodo into obscurity.

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介绍

在国际上，有更多的跨学科研究的动力和过多的激励措施。原因很明显；大的社会问题不会出现在整齐的单学科包中。相反，它们将由来自不同专业的最优秀的研究人员从不同的角度调查全球挑战来解决。一个单独的研究人员在一个孤立的实验室或一个孤独的作家阁楼里的日子已经一去不复返了，如果它曾经存在的话。然而，有人说，仅仅因为护士、工程师、药剂师和计算机科学家都是同一个研究团队的一部分，并不意味着它是跨学科的，就像把鸡蛋、牛奶、黄油和面粉放在碗里一样自动制作蛋糕。重要的是组件如何交互，以及这种交互的转化潜力。

学科在很长一段时间内出现，并在此过程中发展出自己的历史、术语、期刊、方法、奖项、奖项和理论。这经常导致孤立，查尔顿等人最好地说明了这一现象。1他们将各种健康学科与居住在同一海域相邻岛屿上的各个部落进行比较。每个部落都发展出不同的文化、不同的做事方式和不同的语言来解释他们的工作。有时，一个岛上的居民会注意到另一个岛上的居民对一些新的实践或发现感到兴奋。然而，这对他们来说毫无意义，所以他们忽略了它并继续孤立无援。

这种学科隔离和狭隘的焦点对一些更传统的职业有好处，但这里会说它并没有使整个科学受益。此外，学科领域在大学内的管理和定位方式并没有鼓励跨学科性。

共享空间

温斯顿丘吉尔有句名言：“我们塑造了我们的建筑，然后我们的建筑塑造了我们”。2由于进入学院较晚，护士学校通常位于远离其他学科的建筑物中，通常位于主校区之外。这对于将护理融入大学结构或推动跨学科教学和研究几乎没有起到什么作用。如果不同学科的人甚至不一起去喝咖啡，我们怎么期望他们一起研究？

这让我想起了关于史蒂夫乔布斯的一个可能是杜撰的故事。他正在监督苹果总部新大楼的规划。建筑师们提出了一个象限的建筑——一栋供设计师使用，一栋供工程师使用，一栋用于营销，一栋用于管理。以他自己的敌意风格，乔布斯认为应该有一个单独的建筑物，其中有洗手间、白板和饮水机的位置。这是为了确保来自不同学科和背景的人们有充足的机会经常见面并产生新的想法。因此，位于加利福尼亚州库比蒂诺的标志性甜甜圈形状的 Apple 大楼于 2017 年 4 月开业。3

通过共同定位进行创新和协作并不是什么新鲜事。在古代雅典，集市或商业单位位于雅典卫城山坡上的学院旁边。这是为了确保商人和学者有机会见面并分享问题和解决方案，这是跨学科工作的早期例子。

在乔布斯的带领下，我们应该与建筑师和物理资源专家更紧密地合作，创造跨学科的研究空间。从本质上讲，这些就像强子对撞机——鼓励跨学科研究人员、卫生专业人员、企业和政策制定者相互协作和碰撞创新想法的环境。当这些人在同一个物理空间中，他们在共同的问题上工作并且他们形成信任感和共同的事业时，这种方法最有效。这样的环境成为发生跨学科建设性对话的地方，结果是科学进步。2016 年在伦敦成立的新弗朗西斯·克里克研究所就是基于这样的理念。大楼内的实验室由四个相互连接的街区组成。

跨学科研究的驱动力对护理有好处吗？

与其他一些职业相比，护理学才刚刚开始巩固其在大学领域的地位。医学、法律和药学等成熟学科已经有数十年甚至数百年的时间来建立深厚的根基并建立其研究基础。这会产生信心和强大的工作体系，这些工作将被跨学科合作加强而不是稀释。此外，对护理研究的战略性和实质性资助是一个相对较新的现象，资助更多跨学科研究的政策驱动可能会将稀缺的研究资金分散到更成熟的学科中。

有一种相关观点认为，学者应该通过提高他们在自己学科中的研究概况来开始他们的职业生涯。此后，他们将享有被邀请加入和/或领导大型跨学科研究计划的奢侈和声誉。从这个角度来看，参与跨学科研究对于博士生和早期研究人员来说可能被认为风险太大。如果他们缺乏纪律处所，可能会使他们更难发表论文、赢得工作和资金。这被认为是学术界和资助者面临的最大挑战之一。研究人员通常只因在其特定领域的特定期刊上发表文章而获得赞誉；这不鼓励个人与其他学科合作。

还有一种观点认为，要成为一个名副其实的职业，护士需要具备护理独有的知识体系。它暗示从既定学科中借用或共享的知识只有在推动护理作为一个职业的界限时才有价值。5如果这一立场得到支持，那么跨学科研究将被视为分散护士研究人员构建护理独特知识库的注意力。也许布朗等人有答案。6他确定了“T 型”研究人员的需求，他们能够培养自己的学科，并超越它。这些研究人员与其他学科合作解决全球性问题，同时提高他们自己专业的学术水平。

护士博士教育的跨学科趋势

卓越研究框架 (REF) 是评估英国高等教育机构 (HEIs) 研究的系统。它于 2014 年首次进行，取代了之前的研究评估活动。由于在这些练习中的表现有所提高，英国各地的护理人员获得了更多的全日制博士生奖学金。这些助学金的资助金额总是临床护士工资的 25% 到 50%，这使得它们对许多执业护士没有吸引力。相比之下，这样的津贴对社会科学、心理学、社会学、商业和管理、艺术和人文学科等其他学科的毕业生非常有吸引力。结果是，非常优秀的学生，恰好不是护士，正在成功申请护理博士生。

虽然这增加了英国护理学校跨学科学术交流的数量，但这种现象可能存在不利因素。首先，可以说政府资助的博士生正在从护理学转向其他学科。其次，这可能会减少未来的护理学者群体。第三，由此产生的研究可能没有专门为护理的独特知识库做出贡献。第四，由于不是护士，成功读博的研究生在临床教学方面存在局限性，难以在护理院校就业。人们可能还想知道，他们将研究成果发表在主流护理期刊上会取得怎样的成功。

跨学科研究：前进的道路

在他们关于促进跨学科研究的报告中，Lyall 和 Meagher 采取了一些方法来解决这些问题。7他们将“以学术为导向的跨学科研究”与“以问题为中心的跨学科研究”区分开来。前者是一个进化过程，学科已经达到其方法能力的极限，必须吸收其他领域的学习。虽然它可能会产生一些短期的不稳定性，但它应该会导致产生新的理解或学科。过去的例子包括遗传咨询、生物信息学和医学社会学。在以问题为中心的跨学科研究中，研究人员可能会看到知识上的差距，并着手通过汇集来自多个学科的知识来缩小差距。这两种方法都可以帮助护士在跨学科研究项目中发挥带头作用；但这需要信心，

有许多方法可以加强护理研究，以便跨学科合作被认为是积极的和值得努力的事情。上面提到的那些已建立的学科往往通过使用定量研究方法来建立其科学可信度。相比之下，护士研究人员和许多社会科学家一样，经常采用定性研究方法。为了让这些学科成为研究合作伙伴，明确这些方法论方法至关重要。尤其是当一门学科严格的定性调查可能被另一门学科误解为轶事主观性的情况下。因此，对彼此方法方法的共同理解和尊重对于有意义的跨学科研究合作至关重要。此外，由于术语，

即将发布的 2021 REF 首次提供了跨学科研究的定义：

“跨学科研究被理解为实现在单一学科框架内无法实现的成果（包括新方法）。”

此外，它认为跨学科研究涉及“两个或多个学科之间的重大互动”。它也可能超越应用或吸收其他学科研究方法的传统方式。

总之，一些护士研究人员可能担心加入其他更成熟的学科会削弱他们形成自己独特知识库的能力。相比之下，这里认为护士研究人员将因更多地参与跨学科研究而茁壮成长。这是因为这个行业和我们所关心的人所面临的问题是如此复杂，以至于任何单一的学科和个人的干预都不可能解决它们。例如，改善精神卫生保健、降低婴儿死亡率和健康老龄化是许多国际组织确定的目标。护士通过成为跨学科研究计划的合作伙伴或在其中发挥主导作用，在解决这些问题方面发挥着关键作用。

渡渡鸟没有在新的掠食者到达其本土毛里求斯后幸存下来。相比之下，凤凰是一种随着环境变化而不断自我改造的鸟。正如开头所说，人类面临的重大问题，不是任何一门学科单独解决的。护理研究不能继续只关注与护理发展有关的研究。为了生存和发展，它必须像凤凰一样进化并拥抱跨学科。否则将导致权力下放而不是进化，并使渡渡鸟的道路变得默默无闻。

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