BY: SCOTT McCONNAHA, M.A.
An Interview with Sr. Clarann Weinert, SC, RN, PhD
Although nursing research is not new, the discipline of nursing science
is a more recent development in the history of professional nursing, according
to Dr. Clarann Weinert, a Sister of Charity of Cincinnati and professor in the
College of Nursing at Montana State University–Bozeman. Sr. Weinert, the director
of the College of Nursing's Center for Research on Chronic Health Conditions
in Rural Dwellers, is known internationally as a leader of the growing community
of nurses who are making important connections between nursing practice and
nursing research.
In a conversation with Health Progress, Sr. Weinert recently discussed
nursing, nursing science, and the status of health care in rural areas.
Have nursing practice and nursing research only recently come together?
Historically, as far back as Florence Nightingale, there has been nursing
research going on. Nightingale was, in fact, a very eminent scientist. She was
a statistician, doing outstanding epidemiological kinds of research, research
on hospitals and the design of hospitals and the ways that such design affected
the care and recovery of sick people. But the science, or discipline, of nursing
research only really began to come into maturity in the 1960s, when more nurses
started to acquire advanced college degrees in major disciplines such as sociology,
anthropology, physiology, and biology.
It is, in that sense, a young science. But nursing research has been conducted
throughout modern times. Early in this century, it was primarily research about
nursing and nursing education, because at that time women seeking a profession
were pretty much relegated to schools of education. So what did they study?
They studied nurses: What sort of people make good nurses? What are the best
ways to prepare people for nursing careers? How should nursing be taught?
What we call nursing science, which is the science of building and
maintaining a research-grounded knowledge base for our practice, has blossomed
since the mid-1960s.
What differentiates current nursing research from that of 40 or 50 years
ago?
Today we have a very rich knowledge database that drives and informs our practice,
our theory, and our research. As we continue to expand, more opportunities arise
for nurses to get their doctorates, so that they can be in a position to do
nursing science. When I was looking to get my doctorate in 1973, there was only
a handful of programs—perhaps six or eight—that gave an advanced degree in nursing.
Now we have nearly 80 programs that provide a doctorate in nursing.
My doctorate is not in nursing—it's in sociology. In my era, most nurses who
wanted to teach got a degree in another, non-nursing discipline. This has turned
out to be helpful, because our backgrounds in those different disciplines helped
us to form nursing school faculties that are equipped to train students in the
research skills needed for nursing science. People are beginning to realize
that nursing is a science-based practice. The complexity of health, health care,
and nursing intervention today is such that we must have a strong science base.
What are some of the key aspects of nursing research today?
Nursing is about care of the entire individual. The scope of nursing science
ranges from nurse scientists looking through microscopes at cells—I have a friend
at the University of Mississippi, for example, who examines rat cells as a means
of studying wound healing in human adults with diabetes—to people who study
the world health situation from a perspective of public health nursing, to people
(like myself) who are looking at ways individuals and families might better
manage chronic health conditions.
Nursing science is people doing all kinds of research using all kinds of different
physiological and psychosocial measures. Nursing research spans all nursing,
and nursing is about helping people respond to the threat of illness or helping
them recover from illness. Nursing is the caring piece, the healing piece. But
we are not into things like drug trials, for example. That's not nursing
research.
Aside from that, it's very hard to say what nursing research isn't.
It has to do with looking at how people adjust to environmental influences,
how people are able to manage in health and illness situations, and how nursing
interventions can help people either stay healthy, recover their health, or
die with dignity.
What kind of research are you currently conducting?
It's highly varied. I always have six or seven projects going at one time.
My major project is the "Women to Women2" project, which we have
been working on for the past five or six years. Basically, it's a melding of
the use of blossoming technologies with the science that we've been studying.
I've been studying social support—environmental influences and their impact
on the way people manage their lives. Physiologists and psychosocial researchers
started studying social support back in the 1970s. It seems like a no-brainer
today, but back then people did not really recognize the impact that adequate
social support can have on disease prevention and health promotion, as well
as on recovery from illness.
In the early 1980s, I was involved in developing a nursing measure of social
support that we could use in our science and in the clinical arena. Over the
25 years that I have been doing research, this whole idea of support—how it
influences the way people with chronic illness are able to manage—has become
vital.
For the past 21 years, I have lived in Montana and so have focused—not exclusively,
but primarily—on families in a rural setting. As our work progressed, we saw
that social support was important and that we could document scientifically
that it worked. We know that one way to mobilize support is through support
groups, Alcoholics Anonymous being one of the primary examples. We also know
that in rural areas there are a lot of barriers to people getting together on
a face-to-face basis. As the technology became available, we sought ways to
provide support and education for women using the computer, using online methods
through which rural women could have chat rooms to run their support groups.
We've experimented with education modules as well.
So that's what we have been doing with Women to Women2: putting computers
in women's homes, thereby allowing them to run their support and education groups
online. And then, of course, we've conducted measurements of this process throughout
the year.
What have the measurements revealed?
They've shown that women will take to the program like ducks to water. They
find it extremely helpful. The women not only appreciate but grow with the
opportunity to be talking to other women who are managing chronic illnesses.
And we don't do an illness—we do illnesses. So we're asking: What is
it about having any chronic illness that can be helped through having somebody
else's support? One person might be dealing with fibromyalgia and another with
multiple sclerosis, but both of them are dealing with fatigue and having to
talk with their physicians about a disease that's difficult to diagnose. Having
these women be able to come together has been tremendous! We get outstanding
feedback from the women involved.
What are you measuring?
We're looking at such things as levels of depression, loneliness, self-esteem,
social support, and knowledge gained through the teaching units.
What is your advice to nurses wanting to pursue the scientific research
side of their profession?
Get your doctorate. Don't pursue one of the many other ways that you can get
a registered nurse's degree these days. Take advantage of the time you're in
an undergraduate program to get exposed to science. And set your sights
from Day One on getting an advanced degree.
It used to be that very few people got a master's. Then it was that very few
people got a doctorate. What we need to be saying to nurses now is that nursing
is both an art and a science, and you need to be excellent at both. To do the
science piece, you need to get the necessary training. And don't wait until
you're 55 to get your doctorate; start thinking about it earlier. We need to
have people coming out of doctoral programs earlier, so that their research
programs can make more of an impact and move the science and knowledge base
forward.
What excites you about nursing research today?
I'm a passionate scientist. I love science and see how it can make a difference
in nursing practice. I'm a mentor; I enjoy bringing others along. It gives me
as much pleasure to see someone else's research succeed as it does to see my
own succeed. I love working with students and getting them enthusiastic about
science.
I think we're at a wonderful place in nursing. If you're a nurse, you can
do absolutely anything. You can be a newscaster, you can work at the bedside,
you can be a scientist, you can be an administrator—there's nothing that you
can't do with a good solid nursing background. But my passion is science, and
it always has been.
You're a religious at a state university carrying out nursing research.
What part of this turns the most heads?
I'm an internationally known scientist at a smaller school with fewer research
resources, and that turns as many heads as anything else. In the professional
arena I am "Dr. Weinert." But I also always identify myself as a woman religious,
and very frequently people are quite interested in that combination. I think
it's a wonderful portrayal of where religious life is today. Religious life
is everywhere. I like doing a good job and being able to bring to the position
my values, expectations, and integrity. Living my passion for science and succeeding
in this situation is more important to me than turning any heads.
Do you see yourself as a trailblazer?
In my religious community, quite a few of us are academics, doing wonderful
things in whatever area we are in. I think anybody who knows about religious
life knows that it's very diverse. We usually consider such diversity as having
more to do with working with the poor on the streets than being in leadership
positions. But I think both are equally important. Whether the work is political,
administrative, or academic, I think religious life has a place in it.
What are your thoughts on the current nurse staffing crisis?
I think that some of the ways we have dealt with nursing and the use of the
professional competencies of nursing have really made for some problems. We
have not allowed nurses to fully practice, in the sense of exercising their
autonomy and ability to practice. And I think we need to enable nurses to use
their skills in the most appropriate ways—rather than in inappropriate ways,
such as performing a lot of unnecessary paperwork.
I think we are still not allowing nurses to fully do what nurses can do. So
people are being turned off and leaving the profession. People are working 12-hour
shifts and burning out. I think there is an urgency for us to—not just bring
more people in—but change nursing. Nursing needs to take its proper role
in health care so that we can best use nurses' skills and talents.
Once we do that, we will have the flow of nursing talent we need. We've got
people standing at our doorstep ready to come in. It's not that there are not
enough people. One of the major issues is the lack of faculty at nursing schools.
You just can't say, "Double your enrollment" when there are too few faculty
members. Society hasn't put a lot of emphasis on the academic side. Money is
flowing to other places, and academia is not well paid. That's a values thing.
There's a huge looming vacuum: Many of us who graduated in the early 1980s are
going to be retiring in the next five or six years. That's what I would call
the "hidden nursing shortage crisis."
How is the health of people in a rural setting affected by the nursing shortage?
There has been basically a chronic nursing shortage in rural areas.
Rural nursing is very demanding. It takes the highest set of skills because—in
many settings, such as small hospitals—you're expected to do all things. So
you're not an emergency room nurse or an obstetrics nurse or a medical/surgical
nurse—you're all of them. And you might be all of them on the same
shift. So it's very demanding to be a rural nurse. You're often working
with only a few colleagues, without a lot of backup. Using today's technology,
you can at least bring the knowledge stream in, and there are some communities
of science out there with chat rooms and that sort of thing, which breaks a
little of that isolation. But when you're talking about living in truly rural
communities, you have to have tremendous commitment. If you live in that kind
of isolation and have a spouse, the spouse has to be able to find a job too.
So the nursing shortage in rural areas, like Montana, has been what I would
call chronic. But we've managed.
The big nursing shortage that we're talking about in other parts of the country
has not really hit hard here yet. But what will happen—what we're beginning
to see happen now—is that headhunters will come out here and offer much better
salaries than we can pay. They'll start pulling nurses away from rural areas.
This is a worldwide issue. We in the United States think we can headhunt in
South Africa, Canada, or the Philippines—any place we want—and bring those nurses
here. That's an ethical, global issue in nursing and health care. The same kind
of thing is beginning to happen here in Montana—luring our people away to go
someplace else because it's fancier and offers more money.
What effect is your research having on rural health care?
A year ago, the National Institutes of Health granted our university the funds
to open a Center for Research on Chronic Health Conditions in Rural Dwellers.
This was an important event—it showed that we have developed our nursing science
to such a level that the federal government would give us money for a center.
The center allows us, under the umbrella of researching chronic illness in
the rural setting, to build an infrastructure that will support research around
the state—and the region as well—for the development of nurse scientists. We
are well situated here to understand rural health care issues. The center allows
us to provide small grants to our faculty and faculty members from other nursing
programs, thereby pulling intellectual capital together.
The center has allowed us to have a focal point in this part of the country
for dealing with rural issues that are common across the Dakotas, Wyoming, and
Idaho—large areas without much access to health care, mostly with farm and ranching
economies, where the weather often makes availability and accessibility to care
a problem. What we've been able to do with the center is terribly exciting.
We're involved in a large variety of projects. For example, we just finished
a project on the Crow reservation. One of our faculty members and a nurse from
one of the hospitals in Billings set up the technology to carry out what we
call "telehealth." With it, they can conduct a pain management program so the
nurse need not drive all the way out to the reservation to provide the appropriate
nursing intervention.
We have a project that looks at the ways rural people manage after having
treatment for cancer. Another looks at the way older couples, living alone in
the rural setting, maintain their health. A third project is examining the impact
of spirituality on chronic illness management.
So the center has allowed us to pull together common educational and research
opportunities and to bring people together to talk about common research problems.
A lot of it is done through telecommunication. The center is allowing us to
address more of the rural health issues and to build a cadre of people to continue
to address them.
What might a nurse in rural America experience differently from a nurse
in an urban setting?
In Montana you might live in a town of 500, which means you're on call practically
24 hours a day. Even when you're in the checkout line at the grocery store,
you'll have someone asking you about (for example) a pain in his or her elbow.
You'll have a sense of isolation from other colleagues. Because so many people
depend on you, you find it hard to get away: You're it.
Health care today is extremely complex—and complex in rural areas, as well
as in urban ones. Medications are complex; treatments are complex. When you're
in a more urban hospital setting, you can go down the hallway and say to another
nurse or to a respiratory therapist, "I'm dealing with such-and-such a problem;
can you help me?" Well, you don't have that kind of backup in the rural setting.
You have to be very highly prepared and committed to what you are doing. You
must be able to work independently because the closest physician you'll have
to work with might be in a town 50 miles away. In my opinion, understanding
rural people and their needs is crucial. You must appreciate that kind of lifestyle,
because when you're in a town of 300 or 400 people, you have to be part of what's
going on. A nurse in a large city can go to the hospital, do his or her 10 hours,
and then go home and be a totally different person. Out here, you have to appreciate
the rhythm of what we call "the rural subculture." You can't decide that you're
going to hold some kind of health educational session in the middle of haying
season. People are out haying all night long. It's necessary to get into a rhythm
with people, so that you can provide what they need when they need it.
What are your hopes for the future of nursing?
I hope that the profession of nursing can come to terms on basic education,
that we soon see that we need a very strong foundation in an academic setting
even for entry-level clinical practice. I would love to see more people with
a passion for the science. We need nurses with a passion for the caring side,
but it has to be blended. I think nursing is and will continue to make a serious
contribution to the world's health, through our leadership and through our scholarship.
—Scott McConnaha
Copyright © 2003 by the Catholic Health Association of the United States
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