护理科学供应链

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In a previous editorial, I addressed sustainable science from a variety of perspectives (Pickler, 2022). In particular, I noted that sustainability of a program of research or, specifically, a focus of scientific inquiry is important for scientific progress. In that editorial, I primarily focused on the individual scientist and the challenges associated with sustaining an established, productive research program during scientific shifts. However, there are additional challenges to the broader sustainability of nursing science, influenced by the “supply chain” of people and ideas necessary to meet the health needs of those who look to us for guidance, aid, and support.

Briefly, a supply chain includes all the resources needed to obtain, produce, and deliver goods from start to finish (Chopra & Meindl, 2010). A critical element of an effective supply chain is a design that avoids gaps in resources and production (Sukati et al., 2012). Unfortunately, nursing has not always been as deliberate in designing its scientific supply chain. Thus, although there are plenty of health problems that need attention from nurse scientists, as a discipline, nursing has let demands get ahead of our capabilities. In particular, we have failed to keep up with the human resources needed to conduct nursing science, and importantly, we remain unclear about our scientific purpose.

In nursing science, our supply chain starts with nurse scientists who identify gaps in knowledge about health and well-being and who study ways to eliminate those gaps in order to help individuals achieve health goals. Much has been written about the diminished numbers of persons completing PhD programs in nursing (Smiley et al., 2018), generally the first step in becoming a nurse scientist with the associated knowledge and skills necessary to solve disciplinary problems. Many individuals and organizations have offered suggestions for increasing enrollments in PhD programs (Ayoola et al., 2021). Unfortunately, despite significant efforts, the number of nursing PhD students training to become nurse scientists has increased only slightly. Moreover, projected retirements of many seasoned nurse scientists contribute to concerns about the nursing science supply chain; these experienced scientists are needed to guide the education of clinically focused nurses while also engaging nursing students in active, important programs of research (Fang & Kesten, 2017). Indeed, the “aging” of nurse faculty and nurse scientists is a concern because of the potential drain of talent of the most experienced of our scientists. Many thought the recent COVID-19 pandemic would accelerate the departure of aging scientists. However, this observer has noted that a number of high-profile scientists have continued working and plan to do so for some time, with a particular focus on supply chain issues. Anecdotally, it is noted that some senior scientists have stepped out of administrative positions in order to devote more time and effort to bringing their own scientific efforts to closure while at the same time increasing their efforts to mentor emerging scientists, thus building sustainable teams for the future. These actions enable continuation of important scientific work to improve health outcomes in which much time, thought, and money have been invested. I am personally and professionally grateful for the continued wisdom provided by these leaders of science.

One recent phenomenon that may enhance the supply chain for nursing science is the increased interest of young people in nursing as a profession (American Association of Colleges of Nursing, 2022). Although many schools of nursing have reported for some years that they received many more applications than they could accept, the recent increase in applications for baccalaureate programs is exciting. Equally encouraging is the increase in funding and support for baccalaureate nursing education, particularly through state initiatives. In addition, schools of nursing have been adapting strategies to enable individuals to gain baccalaureate degrees more quickly while still maintaining rigorous social and biological science foundations. Most of these “fast-track” programs are not new or innovative. Nonetheless, the growth of these programs is important to increase the number of nurses, some of whom will be future scientists. In addition, schools and professional organizations have increased recognition for the need to more fully diversify the profession (Redeker et al., 2021). Greater appreciation of the importance of diversity as well as the efforts needed to make diversity happen have led to small but important increases in nurses and nurse scientists from diverse backgrounds.

To sustain our supply chain for nursing science, we also need to continue to strengthen scientific thought and focus. It is important for nursing science to continue to build upon the important scientific advances made over the last 30 years, particularly in the areas of symptom science, self-management, and health promotion. At the same time, nursing scientists need to thoughtfully consider—discuss, debate, affirm, and disconfirm—the gaps in our current knowledge and address those gaps systematically. This could start in our PhD programs, although many PhD programs do not identify specific areas of focused substance within their training plans (Dobrowolska et al., 2021). That is, many nursing PhD programs do not have an identified focus on the substance of scientific problems important to the discipline. Rather, many PhD programs are largely about methods—how to do science rather than the study of the scientific focus. This creates a serious gap in our thought supply chain that possibly limits scientific advancement and attainment of scientific and professional goals. It also makes our science susceptible to disorder and interference from sources both within and outside the discipline.

Although there is evidence of serious discussion about the nature of nursing science (Tobbell, 2018), there remains little evidence of coalescence on the critical substance of our discipline. It is perhaps time for a more unified approach to our work; it is perhaps time for thought leaders within the discipline to gather for serious discussion about the focus for nursing science. This could logically begin in schools and colleges of nursing, whose resident scientists are busy at the work of doing nursing science. It will, however, take more than local conversation if we want to clearly explicate the purpose of our science in order to design a more stable and consistent supply chain.

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在之前的一篇社论中，我从多个角度探讨了可持续科学（Pickler，2022 年）。我特别指出，研究计划的可持续性，或者特别是科学探究的重点，对科学进步很重要。在那篇社论中，我主要关注个体科学家以及与在科学转变期间维持既定的、富有成效的研究计划相关的挑战。然而，受人的“供应链”和满足那些向我们寻求指导、帮助和支持的人的健康需求所必需的想法的影响，护理科学的更广泛的可持续性还面临着额外的挑战。

简而言之，供应链包括从开始到结束获取、生产和交付商品所需的所有资源（Chopra & Meindl，2010 年）。有效供应链的一个关键要素是避免资源和生产缺口的设计（Sukati 等人，2012 年）。不幸的是，护理在设计其科学供应链时并不总是那么深思熟虑。因此，尽管有很多健康问题需要护士科学家关注，但作为一门学科，护理已经让需求超越了我们的能力。特别是，我们未能跟上开展护理科学所需的人力资源，重要的是，我们仍不清楚我们的科学目的。

在护理科学领域，我们的供应链始于护士科学家，他们发现健康和福祉方面的知识差距，并研究消除这些差距的方法，以帮助个人实现健康目标。关于完成护理博士课程的人数减少（Smiley 等人，2018 年）的文章已经很多，这通常是成为具有解决学科问题所需的相关知识和技能的护士科学家的第一步。许多个人和组织提出了增加博士课程入学率的建议（Ayoola et al., 2021）。不幸的是，尽管付出了巨大的努力，但培养成为护士科学家的护理博士生人数仅略有增加。此外，许多经验丰富的护士科学家的预计退休导致对护理科学供应链的担忧；需要这些经验丰富的科学家来指导以临床为重点的护士的教育，同时让护理专业的学生参与积极、重要的研究计划（Fang & Kesten，2017）。事实上，护士教师和护士科学家的“老龄化”是一个令人担忧的问题，因为我们最有经验的科学家可能会流失人才。许多人认为最近的 COVID-19 大流行将加速老龄科学家的离开。然而，这位观察家注意到，一些知名科学家已经继续工作并计划这样做一段时间，特别关注供应链问题。有趣的是，一些资深科学家已经辞去行政职务，以便投入更多时间和精力来结束自己的科学工作，同时加大对新兴科学家的指导力度，从而为未来。这些行动使重要的科学工作得以继续，以改善健康结果，其中很多时间，想了想，钱也投入了。我个人和专业地感谢这些科学领袖提供的持续智慧。

最近可能增强护理科学供应链的一个现象是年轻人对护理这一职业的兴趣增加（美国护理学院协会，2022）。尽管多年来许多护理学院报告说他们收到的申请比他们能接受的多得多，但最近学士学位课程申请的增加令人兴奋。同样令人鼓舞的是增加了对本科护理教育的资助和支持，特别是通过国家倡议。此外，护理学院一直在调整策略，使个人能够更快地获得学士学位，同时仍保持严格的社会和生物科学基础。这些“快速通道”计划中的大多数都不是新的或创新的。尽管如此，这些项目的发展对于增加护士的数量很重要，其中一些护士将成为未来的科学家。此外，Redeker 等人，2021 年）。对多样性重要性的更大认识以及实现多样性所需的努力导致来自不同背景的护士和护士科学家的数量虽小但很重要。

为了维持我们的护理科学供应链，我们还需要继续加强科学思想和重点。对于护理科学来说，继续在过去 30 年取得的重要科学进步的基础上继续发展是很重要的，特别是在症状科学、自我管理和健康促进领域。与此同时，护理科学家需要深思熟虑——讨论、辩论、肯定和否定——我们当前知识中的差距，并系统地解决这些差距。这可以从我们的博士课程开始，尽管许多博士课程并未在其培训计划中确定重点内容的特定领域（Dobrowolska 等人，2021 年）。也就是说，许多护理博士课程并没有明确关注该物质对学科重要的科学问题。相反，许多博士课程主要是关于方法——如何做科学，而不是研究科学重点。这在我们的思想供应链中造成了严重的差距，可能会限制科学进步以及科学和专业目标的实现。它还使我们的科学容易受到学科内外来源的混乱和干扰。

尽管有证据表明对护理科学的性质进行了认真的讨论（Tobbell，2018 年），但几乎没有证据表明我们学科的关键实质是合并的。也许是时候对我们的工作采取更统一的方法了；也许是该学科内的思想领袖聚集在一起就护理科学的重点进行认真讨论的时候了。从逻辑上讲，这可以从护理学校和学院开始，他们的常驻科学家正忙于从事护理科学的工作。然而，如果我们想清楚地阐明我们的科学目的以设计更稳定和一致的供应链，这将需要更多的本地对话。

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