Keeping the science in nursing

Roger Watson

03/05/2023

© The University of Sheffield / Department of Marketing and Communications

3

Nursing science

When we relate nursing AND science:

Are we talking about:

• Science in nursing?

0r

• A science of nursing?

A science of nursing

Where has the pursuit of a Science OF Nursing taken us?

• Theories and models

• Proliferation

• Hi-jacked curricula

• Lots of publications

• Little evidence of efficacy

Where has it led us…?

Bewildered students and patients

Ridicule of non-nursing colleagues

The problem with nursing theories…

• …and trying to demonstrate them

Science in nursing

Where has the pursuit of Science IN Nursing taken us?

• Imported theories and models

• Proliferation

• Hi-jacked curricula

• Lots of publications

• Little evidence of efficacy

Imported theories

Closing the theory-practice gap

…at all costs!

The shortcuts

• Critical thinking

• Evidence-based practice

• Physiology ‘for nurses’

• Sociology ‘for nurses’

Science (for nurses)

• How do we know the earth revolves round the sun?

• How do we know space is expanding?

• How do we know the blood circulates in the body?

• How do we know that spontaneous generation does not take place?

• How do we know that vitamin C prevents scurvy?

• How do we know that staff to patient ratios influence patient mortality?

What counts as evidence?

• The outcome of systematic enquiry

© The University of Sheffield / Department of Marketing and Communications

32

Regression towards the mean

• In statistics, regression toward (or to) the mean is the phenomenon that if a variable is extreme on its first measurement, it will tend to be closer to the average on its second measurement—and if it is extreme on its second measurement, it will tend to have been closer to the average on its first.

Where do we find evidence?

• Evidence synthesis databases

05/03/2023

© The University of Sheffield / Department of Marketing and Communications

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05/03/2023

© The University of Sheffield / Department of Marketing and Communications

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Real science in nursing

• RN4CAST

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422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries.

Findings

An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients.

Findings

An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients.

SCIENCE

r.watson@hull.ac.uk

0000-0001-8040-7625

@rwatson1955