Most respondents reported conducting or using nursing research focused on nursing education (competencies and curricula), nursing roles, and nursing interventions to improve individual and/or population health outcomes. To a large, but lesser extent, respondents reported conducting or using research related to evidence-based nursing practice. Research on health systems’ organization and structure was the topic familiar to most study respondents, whereas conducting research or being aware of nursing research that examines health policies, the impact of nursing on public health, nurse migration, and information technologies were least often reported. These findings suggest that some rebalancing of research is needed, with perhaps less focus on education and roles and more focus on health policy, public health, information technology, and especially nurse migration. If nursing curricula included foundational content about the importance of policy, and if advanced education related to policy were available to nurse leaders who can and should influence policy [11], the profession would no doubt be better prepared to address global health challenges such as social, racial/ethnic and sexual/gender inequalities and health inequities [9]. Moreover, by increasing the number of doctoral programs more nurses would have the specialized knowledge and skills to address social determinants of health, human resources for public health, and innovation in health. However, doctoral programs must have the resources, including qualified faculty, to train professionals who have strong skills in statistics, research methods and critical thinking and are capable of conducting rigorous and socially relevant research [14, 15]. The fact that 36% of respondents reported conducting research to identify effective interventions in improving individual health and/or population health (and about 50% reported that they used or knew about this research) is one of the most encouraging findings from the survey.
It is noteworthy that research on issues related to migration was barely explored among respondents, indicating that this topic is ripe for expansion in the coming years. Understanding nurse migration is of even greater importance given the impact of the COVID-19 pandemic on health systems, including its impact on the nursing workforce. Understanding the labor market; issues related to attractiveness, working conditions and retention of nurses; and the capacity of educational systems to address the shortage of bedside nurses and the importance of the clinical and academic nursing workforce in addressing this, are critically important in Latin America and in most parts of the world [16].
Information and communication technology is fundamental to meeting patient safety and care quality needs [17]. So, although it is encouraging that 32% of respondents reported using research informed by data science, the low rate of conducting research using big data highlights another area in which there is need for more nurse scientists to develop programs of research. If nurses were to harnesses the power of predictive analytics patient outcomes could be improved through the identification of evidence-based care that can prevent or ameliorate health problems before they develop.
Themes such as quality and safety, which most participants indicated knowing about, should be a greater focus in future research. This is particularly important given evidence that the quantity of nurses and the quality of their training has measurable impact on care and patient safety [18]. In addition, the provision of adequate working conditions and the safety of health professionals are also essential to providing safe, high quality patient care [19]. Thus, expanding evidence of nursing’s impact on patient safety and quality (and workforce safety) should be of interest to all stakeholders in the healthcare system.
The need to invest in leadership, governance and decision-making is aligned with the Strategic Directions for Nursing and Midwifery policy priorities, which highlight the need to expand management capabilities and leadership positions for nurses. This requires the ability to use research data for high-impact decision-making and implementation of practices and policies geared to the health needs of the population [20].
Understanding health systems and services is the responsibility of nurses in leadership positions at governmental and health service levels. However, the dearth of nurse researchers limits the production of information related to this priority [9]. Focus on health administration and governance in nursing doctoral programs and investment in nursing leadership positions can help increase the production of evidence and foster a greater number of publications and information about governance generated by nurses.
Recently, the WHO led several initiatives related to the health workforce including designating 2020 as the International Year of the Nurse and Midwife, and 2021 as the International Year of Health and Care Workers with the launch of the Global Strategic Direction for Nursing and Midwifery 2021–2025 (SNDM), in April 2021 [20]. To that end, it is important that more nurses in Latin America have senior leadership roles and responsibilities. To support this goal, the nursing profession needs more highly educated nurses. A study on the relationship between the 2030 Sustainable Development Goals (SDGs) and nursing doctoral research in Latin America emphasized the need for nurses with higher levels of education to address the SDGs and highlighted the uneven distribution of doctoral nursing programs in the region [21]. Specifically, of the 53 doctoral nursing programs in Latin America, 72% of them are in Brazil; research conducted in Brazil accounts for 90% of all published clinical nursing and midwifery research in LAC [22]. To expand doctoral nursing programs in Latin America, in 2017 PAHO conducted a study and developed an action plan [11] and has since been working with universities and representatives of ministries of health and education in the region to increase investments in doctoral nursing education and to encourage greater cooperation and collaboration between universities and between countries.
The survey results also highlight the relationship between the number and quality of nursing journals and the investment in graduate education for nurses. Nursing journals in Latin America are typically produced by schools of nursing that have doctoral programs and these peer-reviewed scientific nursing journals are an important means of disseminating nursing research. Despite the expansion of peer-reviewed scientific nursing journals, the production and dissemination of research findings continues to be concentrated in a few countries. Not surprisingly, Brazil leads Latin America in the number of nursing journals and the production of nursing research largely because it has the greatest number of nursing programs that offer graduate degrees (master and doctoral) for nurses. One of the reasons for Brazil’s success is that graduate programs in the country are supported by the Ministry of Education without cost to students. Other Latin American countries need to consider ways to support graduate nursing education as an important means of improving the health of their populations, such as the expansion of graduate educational programs and through collaborative actions and establishment of partnerships [22].
Unfortunately, a substantial proportion of biomedical journals produced in Latin America are not indexed in any major biomedical literature databases. To address this the Iberoamerican Network of Scientific Publishing in Nursing (RedEdit) was created by PAHO in 2006. This network compiles a list of all nursing journals published in Spanish, both in Spain and Latin America, along with descriptions of their focus and primary content [23]. Another initiative, the Portal of Nursing Journals (REV@ENF), which is part of the Virtual Health Library-Nursing (BVS-Enf), aims to expand and strengthen the dissemination of scientific knowledge by providing free access to articles from a selected collection of scientific journals in nursing [24].
Limitations
The study has several key limitations that should be considered when evaluating the findings. First, because we wanted to ‘cast the net’ as broadly as possible to understand the breadth and depth of nursing engagement in health systems and services research we used a non-probability, convenience sampling strategy which prohibits generalizability and drawing strong conclusions from the findings. Second, the study was cross-sectional, so it is not possible to determine whether or how much impact initiatives to increase nursing research in Latin America has had. Third, to encourage participation, we opted to make the survey anonymous. This precluded collection of more information about the participants and characteristics associated with engagement in nursing research—as well as the possibility of follow-up. Fourth, based on written in responses to the option “other, please specify, in the question about educational level, it appears that some respondents did not understand the question. Thus, it is possible that other questions may not have been clear to respondents—a factor that may also have led to some bias in the findings. However, because the survey instrument was carefully translated and back translated to ensure that respondents could participate using the language version they felt most comfortable using—and because the survey questions were short and uncomplicated, we believe that bias caused by misunderstanding was not a major concern.
