Every anniversary is an opportune occasion to commemorate events that are considered exemplary, both great events that deserve being celebrated and those regrettable mistakes that need to be mentioned only to avoid being incurred in. I think the birth of the Index project two decades ago now probably has a little of the two, and everything will depend on the point of view adopted: whether it is a valuable resource for researchers or a threat to surrogate initiatives that, even having been born chronologically later, do not forgive having being denied the possibility of fully boasting about the occupation of an exclusive place in the history of nursing research, a place that we have never claimed for, in any case. I would like to mention briefly all those whom we daily upset only for the simple fact that we exist. And now let us go to other matters.
Although it would be a normal thing to do, I will not bring to memory the circumstances that lead to the birth of Index, as other colleagues already made so with occasion of the 10th anniversary of the journal and the history has not changed.1 However, I would like to share the reflections that we have been encouraging throughout the current year, aiming to try to set the Index project in the context where it has been working (see acts of commemoration of 20th anniversary in www.index-f.com/20a.php). Besides that, I would like to present it in a critical manner, as we normally do, but throwing a glance to the future. On the other hand, it will be unavoidable repeating ideas I have already put forward throughout the current year in successive forums, although I will try to summarize them so we can go on to more useful matters.
Let us start from a premise that we will use as a thread for the rest of the presentation: Index has developed an activity in a concrete field of health care, that has spontaneously achieved great repercussion far beyond the limits within which the project was originally created. Doing so from nursing, a discipline having a marginal position in the market of knowledge, is a language mistreated by science, the same as happens to Spanish language,2 having produced in Andalusia, one of the less developed regions in the world, a paradoxical effect: on the one hand, a huge difficulty in making itself understand in a world that is dominated by the scientific imperialism and is unable to see nursing as a business, it does not speak Spanish, and probably it does not know Andalusia beyond the usual topics (bullfighting, flamenco and the Holy Week); on the other hand, however, it has allowed us to become aware of the existence of a huge territory with a lot of things in common with Andalusia: the Latin American Scientific Space (ECI, Espacio Científico Iberoamericano).3 This cultural space has been freely growing relationships in other knowledge areas such as the arts, humanities, social science or trade, but not in health matters, and consequently in nursing matters.
Throughout these twenty years of activity of Index, we can certainly identify at least a dozen landmarks that have caused appreciable effects in production, dissemination and consumption of nursing knowledge in the ECI. Among the most influential ones are the CUIDEN,4,5 environment, including the entries index CUIDEN Citación,6,7 the Journal Index de Enfermeria,8 Cantárida journal library and different groups of research (LIC,9 OEBE,10 RIHPE,11 GED,12 CIBERE, etc), conceived as a network internet structure that has managed to set in motion more than 500 people in several continents to make possible all the issues that can be consulted in the Ciberindex platform (www.index-f.com), perhaps the most used one, by far, by ECI nurses. However, we have not appreciated whether they have managed to alter considerably the conception and behaviour of the traditional knowledge management systems, that mostly go on idolizing what the so-called Anglo-Saxon world produces, disseminates and consumes.
I regard it inappropriate to finance this project, as the researchers have not justified sufficiently the need for the creation of an index of nursing specific impact in the (supposed) "Latin American scientific space" ([sic],communication by the Deputy Director of Assessment and Promotion of ISCIII Research, dated 16.11.2006). It is an exact quotation, and in fact, one of the recurring arguments used by the assessors of the Carlos III Health Institute (research agency dependent on the Spanish Ministry of Health) and institutionally assumed to systematically reject the projects of assessment of nursing knowledge presented by the Index Group of Documental Studies in a stupid stubbornness that denies the existence of Latin America as a scientific reality with a capacity to generate a universally valid knowledge. What is the reason for this obstinacy in questioning what is evident? Let us see it in detail.
If there is something we have learnt throughout the last two decades of researching activity is that ECI does exist, as we have already stated, and that nursing knowledge fills an outstanding place in it.3 As far as we have analysed, we have noticed that this knowledge grows quickly, shaping a contextualized knowledge (as it tries to give an answer to many health necessities), a creative knowledge (it adopts its own ways of expression) and, be it good or bad, a knowledge that, even being constructed from quite different social realities, it shares the same fortunes and misfortunes. Besides that, it is a knowledge non-existent for those who refuse to see it, as they do not consider it as business or because they do reject their own knowledge. In other words, they feel more comfortable fostering relations of dependence towards foreign scientific contexts, thus hindering any possibility for creative dialogue between complementary scientific contexts, something that calls for improvement. In Index we have learnt that nursing knowledge is more necessary wherever it takes place, as it is the most suitable place where it can be useful. We have also got convinced that knowledge produced by Latin American nurses will only be able to emancipate itself in the case that it will be managed as an Open Knowledge Community. What is the meaning of this? We will also clarify it below.
On Invisible knowledge. Let us imagine that knowledge or, as we also call it science or wisdom, would become something tangible for a moment; a material that could be extracted from the inside of human beings, as gold nuggets are extracted from inside earth. It would be undoubtedly paradoxical, as it would stop being everybody's heritage to become a precious merchandise, especially coveted by those who are moved by ambition and insatiable power. Something similar happens with the "knowledge trade", an activity that is yielding huge benefit to those who exploit it disproportionately. A well-known example is the American Firm Thomson ISI/Thomson Scientific, that produces the Journal Citation Reports (JCR), perhaps the most used journal repertoire in the Western world to assess the quality of scientific publications.13 JCR is a database that quantifies the quotes received, not those coming from all journals, but only those Thomson ISI decides should be analysed, always infinitely less than the total amount produced. Regarding the nursing journals produced in Latin America, we have no proof of any of them having entered such a privileged repertoire; could it be a deliberate omission, since in certain occasions Thomson ISI has threaten to bring a lawsuit against Index Foundation for performing bibliometric studies with this journal corpus and publishing them in its own repertoire (CUIDEN Citación), reasoning that they are the only right holder to exploit this knowledge: Impact factor is COPYRIGHT of Thomson ISI/Thomson Scientific and can only be acquired through our product Journal Citation Reports, a database owned by Thomson ISI and a subscription is needed to get access ([sic], e-mail of the Thomson ISI's manager for Latin America and Caribbean, 4-6-2004).
Let us take a look at the consequence of not appearing in a repertory. Not long ago, the Andalusian Regional Ministry of Health published a summary of the bibliometric indicators that concern bio-medical and health science production in Andalusia, using JCR-ISI as the unique source. In the Nursing area, it shows up to 6 articles published between 1990 and 2004.14 On the other hand, if we look at the production by Andalusian nurses that was indexed in CUIDEN in a similar period (1991-2004), the amount of articles raised to 1591 [CUIDEN plus, date of reference 1-6-2007]. This means that knowledge exists or not depending on the source where it is searched in. The Andalusian Health Service, very interested in promoting research among nurses and so recognising their researching activity, decreed in 2005 that publications by group B staff, to which nurses belong, must be assessed according to the impact of CUIDEN Citación,15 instead of JCR_ISI, as it was usual till that moment.
In fact, Thomson ISI and other firms producing well-known instruments related to scientific knowledge are part of the model of knowledge management in an "imperialist" fashion that spreads globalization in a centripetal sense, granting privileges to hegemonic spaces that generate great dependence, where the only valid knowledge is profitable knowledge; this excludes ECI as a space for business, and consequently, for nursing. The problem does not come from these firms (consistent with their profit motive) but from the entities that pay attention to it and buy their products to use them in an excluding sense, even at the risk of discrediting their own scientific production, as it happens in many ECI governmental institutions devoted to knowledge management.
Starting from this reflection, there are several consequences of knowledge management according to a model that we are calling globalizer-imperalist: (a) invisibilization of non-hegemonic knowledge, and consequently of ECI nursing knowledge; (b) promotion of the relations of dependence by discrediting the clinical researcher, reducing him to a consumer condition; (c) flight of knowledge: regional knowledge emigrates to the media leaving a scarce impact on the native space, causing a great social damage to the researching activity; and (d) weakening and risk of disappearance of a crucial part of scientific-professional journals.16
On co-operative knowledge. It is my wish not to be radical. Initiatives like the ones I have just criticized, especially JCR, have been doing a great favour to science for many years, and they have shown an undoubted merit by making us aware that not all scientific products are equally valuable. The problem lies in the fact that they have become stagnated in the policy of unimpeded development established by the US by the middle of 20th century, that was based on a paternalistic conception of the scientific advance, according to which, the most developed countries used to assume the guardianship of the industrial and technological advance of the rest of the world.17 They seem not to have been aware that we are in a new century and so they do not seem to be conscious of the need of adapting to the dramatic social changes being experienced in current times, that also affects science, of course.
The reconstruction of the scientific knowledge in the 21st century is determined by new factors related between them: (a) the vertiginous evolution of information and communication technologies, that will exert a determining influence on the accessibility to the sources of information and the dissemination of knowledge. (b) the establishment of research networks elaborated by researchers willing to share resources and knowledge; and (c) the strengthening of emancipatory knowledge, linked to the problems of a highly sensitized, that will allow traditionally invisibilized sectors to come on stage.
The traditional model of highly competitive researchers working on their own or collaborating in reduced groups often more aimed at curricular than scientific purposes, is undergoing a crisis. Society demands for quicker and safer advance and force researchers to cooperate with each other adopting multi-disciplinary approaches. The European Commission has adopted a quite different model of promoting scientific knowledge18 based on the idea of complex networks where not only researchers can find room, but also Universities, companies and even average people. The research sceneries are not only reduced to hermetic high-modernized laboratories; now they extend to society and they offer the opportunity of giving great-scale solutions to problems that concern population seriously. (for ex. European Network of Living Labs, in www.cdt.ltu.se/~zcorelabs). On the other hand, we are listening to new voices in traditionally less developed contexts such as Latin America that demand for a different role in their relationship with the scientific knowledge and reject the structural exclusion that has subjected them in the benefit of a new science that will give importance to knowledge diversity and the plurality of contexts (pluriverso).19 At the same time, they demand a different approach to local and regional knowledge as a consequence of the huge migratory movements characteristic of our age, that would suit a global solidarity that some people have called glocality.20
So we are in front of the awakening of a new model of knowledge management that could be called cooperative-glocalizer, where the scientific advance is supported mainly by the opportunities offered by the promotion of relations that base on cooperation in a diverse and dynamic world.
An open community of knowledge. The research in nursing makes part of the new social approaches of science. In the case of Spain and after assessing the great contribution by the new researchers from the 80s on, an effect of stagnation can be observed regarding knowledge creation, what it shares in some way with other Latin-American realities. It becomes evident because of: (a) shortage of cooperative research (even the attempts of establishing research nuclei has meant little more than re-affirming the dispersion of initiatives); (b) difficulty to identify care as an object of study (technological research in a Western and developed world has been privileged); (c) promotion of disciplinary dependence vs. a dialogical knowledge based on interdependence; and (d) isolation and little international repercussion: the localism of the researching activity has invisibilized both researchers and the knowledge they have generated.21
The accumulated experience of a cooperative project like INDEX leads us to assert that the best alternative to normalize nursing research in the pluriverso where we are immersed is the construction of an Open Community of Knowledge, that will be supported by three basic pillars: (a) going from competing to sharing knowledge; (b) recognizing de Latin American space as a scientific and cultural reality, a fact as difficult to deny as impossible to reduce; and (c) to place emphasis on the transfer of knowledge.
When we speak of an Open Community of Knowledge we are referring to a cultural and disciplinary identity space where knowledge is generated and shared attending to principles of equity, charity, dialogue and interrelation with other communities alike. The Open Community of Knowledge does not admit this way the idea of hegemony, exclusion or scientific elitism, but it pleads for democratic knowledge in the service of society.
It is within this notion of Open Community of Knowledge where the task developed by the Index Foundation makes sense. It promotes a model of management of knowledge based on the universalization of local and regional knowledge (glocalization), that is why Index has been developing instruments that highlights Latin-American nurses' potential for constructing knowledge that is universally valid without renouncing their language nor their media of dissemination..
CUIDEN environment has revealed that the Latin American Community of Knowledge is an unquestionable reality, at least when speaking of health care, and for evidence it offers the following figures on their contents:
From the middle of the 90s, CUIDEN can be consulted freely through the internet and since then a change has being experienced regarding the quotation pattern of Latin American nurses, that has caused own production journals to have greatest repercussion in their scientific space, not excluding those belonging to other communities of knowledge.22 This model of assessment from inside, exhaustive and contextualized, has allowed us to confirm that authors with most repercussion in the ECI correspond also with relevant scientific careers in Latin America.7 The fact that Index Foundation web page has gone beyond 500,000 visitors throughout 2006 reveals the high level of socialization we have reached.
Latin American nursing knowledge, that is still experiencing a dramatic increase, is not submitted to pressure of market economy, so we can undertake projects and initiatives based on cooperation. We are aware that we need resources in order to get it, but it is also true that nowadays we enjoy a great variety of forums, specialized journals, databases and documentary sources, and especially an increasing researching activity that makes it possible to think of a project sustained by cooperation. A relevant step consists of making existing initiatives evolution towards this idea of Open Knowledge Community in Latin America nursing with the capacity to share resources and to promote creative dialogue, going from interdependence with similar geographic and disciplinary areas.
The future of research in health care is full of opportunities and we are sure that Index Foundation, in collaboration with organizations that increasingly come up on top of the challenge of constructing knowledge by sharing ideas and resources, will play a determining role for scientific growth of our cultural space.
The transfer of knowledge, that is, the possibility that research discoveries are useful to bring about great changes in society, undoubtedly makes up one of the biggest challenges of our age. We are convinced that as far as new projects and innovation related with health care is concerned will be exposed starting from the notion of an Open Knowledge Community as the central axis of a cooperative movement, this crucial disciplinary field will succeed in increasing dramatically both its heritage and its impact on society.
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