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			Research line: Nursing care and practice Rosita Daza de Caballero1 1Magíster en Filosofía, Magíster en Dirección Universitaria, Especialista en Enfermería Pediátrica, Profesora Asociada Departamento de Enfermería clínica. Facultad de Enfermería. Pontificia Universidad Javeriana, Bogotá (Colombia) Manuscript received by 23.01.2004 Manuscript accepted by 5.04.2004 Index de Enfermería [Index Enferm] 2005; 50: 57-60 (original version in Spanish, printed issue)
	How to cite this document
	Daza de Caballero R. Research line: Nursing care and practice. Index de Enfermería [Index Enferm] (digital version) 2005 50. In </index-enfermeria/50revista/e4911.php> Consulted

Introduction

     The Seminar Nursing Conceptualization and Praxis is a permanent academic activity performed by the professors of the Faculty of Nursing at the Pontificia Universidad Javeriana in Bogotá, Colombia. It takes place since 1980 and its main topics are "the essence" and "work tasks" of nursing, focused on care. Nursing Care is tackled within a phenomenological approach, having this fact permitted the elaboration of renewed nursing concepts based on the professional experiences of each of its members. The creation of this seminar meant the beginning of a process of theoretical construction that has illuminated and recreated the image and professional space of Nursing.
     A series of concerns appeared as a result of this activity, crystallizing in the idea of creating Research Projects pointing at the comprehension of the phenomenon of Care, its problems, dimensions and development within the professional praxis. First works were focused on the Nursing Image and Field (Torres Ana María), Professional Identity (Daza de Caballero Rosita) and Nursing Conceptualization (Romano Gloria Inés, Torres Ana María and Daza de Caballero Rosita)¹.
     Despite the existence of a certain level of agreement among the professionals about the fact that care is one of the mainstays of Nursing, there are few original research works in our environment exploring in a systematic manner the theoretical references on which it is sustained, the various dimensions, the problems of a practice sustained on care, and the models of health services which favor or obstruct the praxis of nursing based on Care.
     As a result of this agreement on the fact that the exploration and comprehension of the phenomenon of care is a fundamental aspect for the professional and disciplinary development, a strategy to build a research line was commonly defined. This research line would have to permit, during a time period of continuous work, to contribute with its analysis to the phenomenon of Care. It would strengthen it on the area of Conceptualization and Practice on the one hand, and it would enrich the particular look on care in the Colombian scene on the other hand. This means a contribution in the medium term to improve the quality of the nursing care and to enrich the education of future professionals.

Areas and lines of Research

     The designation of the areas and lines of research in Colombia has been related to the academic field, and points out to the effort to organize the diverse research results obtained during several years by the different academic communities. This is the way in which the concept of area is linked to a certain wide thematic or problematic field that has been dealt with during a certain period of time by groups of researchers from a certain faculty or department, within the universities. The interest of those researchers is focused on discovering and generating new knowledge, validating the actual techniques and bringing up new alternatives.
     The concept of research line represents the set of investigations about the same objectual field, the same region of reality or area of knowledge that articulates concrete projects on the bases of which the academic processes are invigorated. In order to make this possible it is necessary to count on research groups that constitute the fundamental unit to carry out the research activities within the academic units, departments and faculties.²
     The strength and consolidation of a research group is translated to: its ability to elaborate financiable projects, its administrative capacity to establish national and international relationships, its publications in national and international magazines, and the way it faces the education of its future researchers' seedbed, the grade and post-grade students.³

Historical context

     The research lines' experience is framed in the context of construction and generation of knowledge, as one of the ways of projection of the human being, who looks for new concepts, new relations, and new meanings to permit the enrichment of the life's semantic field and the professional tasks⁴. The construction of knowledge conceived as a human activity requires the active concurrence of members making up the different academic communities, scientific communities according to Khun, which are those that share certain beliefs, values and ways to proceed. The scientific communities can be defined ad those "which share a paradigm and practice a certain speciality with a similar education and professional initiation as mainstays"⁵.
     Since the starts of Nursing as a practice oriented to the improvement of the health conditions and the care of patients, it was undoubtedly recognised that this task, which began as a vocation to become later a trade, demanded an amount of knowledge. This knowledge arisen from intuition was firstly transmitted orally from one generation to the other and latter became an area of knowledge, derived from experience, which managed to face and solve the problems and challenges found.
     This type of task, focused on actions and proceedings that constituted the routines of care, prevailed for a long time together with sanitary practices that combined plants and proceedings contemporary with the period, and that were used for the treatment and relief of patients. Without any doubt, all of this became part of a knowledge accumulated for many years, and helped to solve many of the most frequent morbid problems.
     Later in time, in accordance with the developments and advances of other sciences' knowledge, and due to the need to find the causes and explanations for many illnesses that decimated the lives of big populations, some concepts from other disciplines started to be used, permitting to support the tasks of Nursing.  Bigger levels of efficiency and effectiveness against those ills were achieved. These incipient developments managed to have an important influence on the handling and treatment of patients. They contributed to improve the health conditions and to implement strategies that helped to face illnesses. They also helped to better explain and understand the therapeutic alternatives. These experiences that enriched the knowledge and improved the practice of care, educated and trained a new staff that was more prepared to face the phenomena related to illness.
     The advance and development of the practice of care across history has been the result of the legacy left by the ancestors of the assistance and research. This is the way in which the diverse models and theories generated around the practice of nursing have contributed to elucidate the concepts of person, environment, health, illness and nursing that are currently used within this profession's scientific community. These models and theories have at the same time contributed from different theoretical perspectives, offspring of the experience and research, to consolidate a theoretical body of knowledge that feeds-back the professional tasks⁶.
     The effort and results have permitted the generation of paradigms that identify the essence of the discipline and the tasks of the profession of Nursing. The definition of these aspects has contributed to the epistemological, ethic, aesthetic and personal development that surrounds this profession. Nevertheless, to continue strengthening and impelling the construction of knowledge in Nursing, is a life project that concerns all the members of the scientific community from the diverse scopes of contribution.

Orientative questions

     The creation of the research line of Care and Practice has been preceded by a series of queries concentrated on care in the research group⁷: Which are the dimensions of care?, In which manner does the way I practice care affect me and the ones I take care of?, Which are the implications of taking care of people?, Is care an ontical or an ontological category?, What is care? - The essential question in nursing -, Which are the educational implications of accepting that care is a human science?, How can the technical-instrumental dimension of care and its interpersonal dimension be coordinated?, How to build a language corpus for care? In which way the technical care prevails over the human care? How are we dealing with the ethics of care? In which way can the re-conceptualization of care contribute to the quality of the attention in nursing?, How could a model of nursing attention centered in care be achieved?, How can we build a  pedagogy of care?, In which way is the reflection on care manifested in the curriculum programs for the education of professionals in Colombia?

Methodology

     In order to face some of these concerns, it was initially proposed to undertake the analysis of the concept of care using the methodology of state of the art, type of documentary research inspired by a search of structures of meaning, in the light of which a critical analysis of the concept could be done. During the review of the theoretical premises that uphold the concept of care and its dimensions, we find out that many of the authors in nursing (Imogene King, Ida Orlando, Joyce Travelbee, Ernestine Wiedenbach, Josephine Paterson y Loreta Zderad) have discovered that the dimension interaction is fundamental in the relationship nurse-patient. Others like Myra Levine and Dorotea Orem have pointed out the therapeutic value of the nursing intervention. Martha Rogers emphasizes the relation between the human being and the environment, and others like Dorothy Jonson, Sister Calista Roy and Betty Neuman underline the patient as a fundamental piece⁸.
     In the same way, affection and participation as dimensions of care have been cause for analysis for diverse theoretical researches who consider these aspects as fundamental in the relation nurse-patient. Nevertheless, despite the existent level of agreement around these dimensions, the articulation of the reviewed theoretical aspects is not that clear in the everyday professional practice.
     This second stage were we are at he moment has been tackled through the qualitative research, and particularly through the phenomenology that has permitted to understand and interpret the different meanings of care, not only for the one who receives it but also for the one who offers it¹⁰. We believe that the results of these experiences can contribute to the comprehension of the phenomenon under study and to the improvement of the quality in the professional practice.

Achievements and results

     The achievements and results can firstly be expressed in the consolidation of an academic community that is motivated and interested in contributing to the building of the knowledge in Nursing starting the phenomenon of care. The results are made evident in research projects made during the first phase like:
     - State of the art of Care from the dimension of participation. Participation is considered as one of the fundamental dimensions of care, understanding it as the appropriation of his situation made by the patient, under the guidance of the professional nurse. Participation implies a series of processes that range from the identification of the needs to the planning, execution and evaluation of the interventions.
     It has been proved that the active participation of the person in his care (self -care) generates a series of benefits that are translated into the active collaboration of the patient in his process of recovery, and into the reduction of the stay in hospital, which consequently brings a reduction in the social costs. In the same way, a higher level of satisfaction not only personal but also professional is achieved for the nurse.
     - State of the art of Care from the dimension of interaction. The concept of interaction has evolved from a relation nurse-patient focused on help, up to arriving to a relation from person to person that is nowadays the one universally accepted.
     - State of the art of Care from the dimension of affection. Work has been done on studying affection as a category that eases the recovery of ill persons. It is important to underline that an efficient and effective therapeutic relation is not enough if there are no signs of affection, human warmness and regard for the other one, who is equal to me, and is going through a difficult situation at the moment.
     - State of the art of Care of patients with a mental disorder¹¹. This research gathers the evolution of the concept of patient with a mental disorder throughout history, and the diverse therapeutic approaches that nursing has used in its interventions. Among many others, the approaches behaviorist, existential humanist, interpersonal and transcultural are underlined.
     Those states of the art permitted the achievement of projects focused on the previously referred dimensions, from the perspective of the patients who receive the care, and from the perspective of the professionals of nursing who provide such care. Projects were developed on the following topics: experiences of care focused on participation from the perspective of patients; experiences of care   focused on the interaction and affection from the perspective of patients; meanings of care and the way to face it from the perspective of nurses.
     The results obtained reassert that, in general terms, the dimensions of interaction, affection and participation constitute fundamental aspects of the therapeutic relation nurse-patient. Patients expect to be provided with an attention of high human and scientific quality in order to solve their health situation, and to learn how to deal with the chronic alterations that affect the quality of life. Nowadays the research group is focused on continuing with the study in depth of the dimensions of care in different age groups, ancient adults, women, and hospitalized children.
     Projects oriented to caretakers of patients with a mental disorder are being tackled in the actual stage. Due to the chronic nature of this kind of illnesses, they demand a special preparation for the members of the family who become primary caretakers.
     Other aspect under development at the moment is the quality of the nursing care from the perspectives of welfare structures, processes of attention provided by the nursing team, and satisfaction of both the nursing team and the persons receiving the care in the health institutions. Similarly, the dimension of the ethics of care constitutes a fundamental aspect of the Conceptualization and Practice Group, especially in the within the research line of care. Theoretic reflections have been advanced within the permanent activity of the seminar and the research projects oriented towards the patient's rights, the informed consent and their perception of care.
     Other achievements to mention are the publication of the text Conceptualización y práctica de Enfermería, published by CEJA de la Pontificia Universidad Javeriana, Bogotá 2001, and the text Cuidado y Género: debate moral (2004), developed by the professors of the permanent seminar.
     The socialization of the results is done every six months in diverse scientific events of national and international scale, through dissertations made by the different professors of the research group (Daza de Caballero R., Experiencia de construcción de la línea de Cuidado; Proceedings of the Symposium de Enfermería pediátrica. Bogotá, 2000, not published). In addition to this, a nationwide exchange with academic groups working on the phenomenon of care has been achieved, summed up to the creation of a national care network. The exchange with other professionals working in the same subjects, specifically those of the Faculty of Nursing of San Francisco, California, has permitted to transfer and receive experiences enriching the course of the actual work of the research line. In 2003 the group was accredited as research group at a national scale, being this acknowledgement endorsed by Colciencias, the Colombian government organism for science and technology.

Future scope

     - One of the proposed goals under development is the acquisition of the capacity to call assistance nurses from the diverse hospitals were the grade and post-grade students from the Faculty of Nursing of the Pontificia Universidad Javeriana are, to participate in the permanent seminar of reflection. We consider that the experience from the assistance's perspective can add aspects about the reality of the profession that without any doubt will help to enrich the results obtained up to now, and to jointly propose alternative and renewed models of the Nursing Care.
     - The upbringing and organization of groups of reflection within the social health institutions can contribute to strengthen the educational and service strategies. In the long term, strengthening strategies can be built to improve the quality of the attention in nursing.
     - The socialization of the research line results through participations in seminars, debates, and professional meetings, added to the publication of such results, are some of the tasks that are being done as a way to share the outcomes with the scientific community and receive the suggestions and critics to continue strengthening the Group of Conceptualization and Practice.
     - The importance of thinking about international research projects on the topics currently under analysis that are incumbent upon the disciplinary and professional development of nursing in the world, must be underlined. Such international projects constitute an opportunity to strengthen the bonds of cooperation and participation in multicentric and pluricultural works.
     - The creation of an international Care Network is one of the goals of the group in the near future. Sharing experiences and exchanging ideas related to care helps to consolidate the academic communities that, from different perspectives and approaches, extend the horizon of our profession.

References

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