Rival research programmes and their influence on nursing practice

In most forms of industry, there is an explicit link between research and development and subsequent technological processes. New discoveries can alter the direction or trajectory of technological progress. In this respect, health care is no different to any other form of industry. There are several theories of science which attempt to explain this link and predict its behaviour. According to Lakatos (1978), rival research programmes may co-exist, whilst Brouwer (1990) suggests they may vie with each other to alter the direction of technological progress. Presently, there are at least two research programmes which are competing to capture the activities of nurses. These are: the Health Care as Industrial Process programme, generating guideline driven nursing, and use of care pathways to maximize throughput plus labour substitution to minimize costs; and the Health Care as Therapeutic Interaction programme, focused on the management and delivery of the fundamental aspects of nursing care, and the use of emotional labour and psychological care to enable patients to cope and make sense of their situation. Ideally, the direction of practice should reflect both of these valid research programmes, with nurses as the staff best placed to integrate medical technology with humanity. Arguably, it is the Industrial Process programme which is currently dominant, at the price of decreased quality of care, and loss of the health benefits of therapeutic interaction. Greater effort is needed, in terms of research to reduce the apparent 'invisibility' of emotional labour, and education of nurses to boost therapeutic interaction skills. In order to re-direct the trajectory, managers should acknowledge and accommodate aspects of therapeutic interaction in service re-engineering, and use quality assurance tools which may accurately detect and monitor therapeutic interaction by nurses.