Capacity building in nursing and midwifery research and development: an old priority with a new...

Capacity building in nursing and midwifery research and development:

an old priority with a new perspective

Tanya V. McCance, Donna Fitzsimons, Sinead Keeney, Felicity Hasson & Hugh P. McKenna

Accepted for publication 28 January 2007

Correspondence to T. V. McCance:

e-mail: [email protected]

Tanya V. McCance BSc MSc DPhil RN

Nursing R&D Director

Ulster Community and Hospitals Trust/

Reader,

University of Ulster,

Belfast, UK

Donna Fitzsimons BSc PhD RN

Director for Nursing R&D

Belfast City Hospital/Reader,


Belfast, UK

Sinead Keeney BA MRes

Senior Research Fellow

Institute of Nursing Research,


Belfast, UK

Felicity Hasson BA MSc

Research Fellow

Institute of Nursing Research,


Belfast, UK

Hugh P. McKenna BSc DPhil RN RMN RNT

FRCSI

Dean of the Faculty of Life and Health

Sciences


Belfast, UK

MM CC CANCE T. V. , F ITZSIMONS D. , KEENEY S. , HASSON F. & MCANCE T. V. , F ITZSIMONS D. , KEENEY S. , HASSON F. & M CC KENNA H. P.KENNA H. P.

(2007)(2007) Capacity building in nursing and midwifery research and development: an

old priority with a new perspective. Journal of Advanced Nursing 59(1), 57–67

doi: 10.1111/j.1365-2648.2007.04280.x

AbstractTitle. Capacity building in nursing and midwifery research and development: an old

priority with a new perspective

Aim. This paper is a report of a study to identify strategic priorities to inform the

development of a regional strategy for nursing and midwifery research and devel-

opment.

Background. Research capacity has been highlighted internationally as a crucial

element in the advancement of nursing and midwifery research and development.

Research capacity has been defined as that which relates to the ability to conduct

research. In a strategic context, however, there is a broader perspective that

encompasses activities related both to ‘using’ and ‘doing’ research.

Methods. A modified nominal group technique was employed. Three rounds were

used to identify the main strategic priorities for nursing and midwifery research and

development. Round one was based on the Delphi Technique and further rounds

were based on the nominal group technique approach. Data were collected during

February 2005. Participants (n ¼ 105) were those involved in the research and

development agenda for nursing and midwifery in Northern Ireland.

Findings. Capacity building was highlighted as a central component from the final

12 priorities, with three key areas identified: (1) the importance of strong and visible

leadership; (2) developing research expertise that will enable the profession to de-

liver programmes of research and (3) increasing the capacity of individuals and

organizations to engage in development activity.

Conclusion. The 12 priorities identified emphasize the need for a broad perspective

on building capacity that reflects involvement in a range of activities that span

‘research’ and ‘development’. This has important implications globally if nurses and

midwives are to develop the knowledge and skills required to engage in research and

development as an integral part of their practice. Embracing this broader perspective

has the potential to enhance performance that will contribute to continuous quality

improvement.

Keywords: Delphi technique, midwifery, nominal group technique, nurse educa-

tion, nursing, research and development, research capacity, research in practice

ORIGINAL RESEARCHJAN

� 2007 The Authors. Journal compilation � 2007 Blackwell Publishing Ltd 57

Introduction

Building nursing research capacity is recognized as a

significant challenge worldwide (Segrott et al. 2006) and

has been a clear focus in the policy debate for some time

(Rafferty & Traynor 1999, Wilson-Barnett 2001, Rafferty

et al. 2003). It is therefore not surprising that building

capacity has featured as a central theme in the strategy and

policy literature, with the clear message being that educa-

tional programmes and job opportunities are needed that

enable nurses and midwives to actively participate in research

(HEFCE 2001, UKCRC 2006). Identifying common goals is

an important first step in advancing this agenda. In this paper

we report the findings from the final phase of a regional

project, which resulted in the identification of 12 strategic

priorities for nursing and midwifery research and develop-

ment (R&D). The identified priorities relate to capacity

building at a variety of levels, suggesting that while building

research capacity is still a key priority in developing this

agenda, it may be timely to consider carefully what is

commonly understood by this term. Evidence from our study

suggests that a broader perspective on building capacity

within nursing and midwifery has the potential to enhance

performance across the spectrum of activity that constitutes

R&D. The focus, therefore, of our paper is on revisiting the

concept of capacity building for R&D and identifying

components that would advance policy and strategy in this

area.

Background

In placing the concept of capacity building within an

international context it is important to acknowledge that a

large proportion of the published literature in this area

originates in the United Kingdom (UK). This is evidenced in a

recent literature review undertaken by Segrott et al. (2006)

who reported that, of 33 studies with an empirical focus, 21

focused on the UK. Evidence suggests, however, that the

issues presented in our paper are of international relevance

(Greenwood & Gray 1998, Hartley 2005, Moreno-Casbas

2005).

Research capacity has been defined very specifically in the

literature as that which relates to the ability to conduct

research. Finch (2003) defined research capacity building as

‘enhancing the ability within a discipline or professional

group to undertake high-quality research’ (pp. 427). A

European scoping report also adopts a similar definition

referring to research capacity, capability and culture as

activity which ‘typically involves training nurses as research-

ers’ (Moreno-Casbas 2005, pp. 9). Capacity building, how-

ever, has been defined in much broader terms within some

strategy documents as that which encompasses a range of

research-related activities. McKenna and Mason (1998), pp.

112) discuss research capacity in terms of becoming

‘informed and critical consumers of research’ at one level.

They suggest, however, that it will only be a small percentage

of individuals in any given profession who will actually carry

out research. Similarly, the Scottish Executive (2002) discus-

ses levels of involvement ranging from developing research

awareness to acting as research collaborators, but highlights

the very real barriers that exist to individuals attaining these

competencies. This is reiterated by Newell (2002), from a

nurse education perspective, who argues that nursing is

currently in a weak position if a workforce is to be created

that has the capacity to understand, undertake, disseminate

and utilize research. In the context of our study, building

capacity is defined as that which focuses on the need for

educational programmes and job opportunities that enable

nurses and midwives to participate actively in R&D at a

variety of levels.

How we view building capacity is closely linked to how we

define R&D. ‘R&D’ is often used as a single term without

differentiation between activities that represent the ‘R’ and

those that represent the ‘D’. This distinction, however, is

worth making if the breadth of issues within R&D are to be

developed at a strategic level. The definition of ‘research’ used

for the purpose of the study was borrowed from the HPSS

Research and Development Strategy (R&D Office for the

HPSS 1999). As with many other definitions of research, the

focus is on knowledge generation. The definition of ‘devel-

opment’ draws on contemporary literature and has been

deliberately kept broad, so that it will encompass the range of

activities which focus on improving practice through know-

ledge transfer and research utilization (DoH 1993, Scottish

Executive Health Department 2002). The definitions are as

follows:

Research: the search for new knowledge using scientific methodol-

ogies and approaches (R&D Office 1999, pp. 27).

Development: the planned implementation and utilization of

evidence through the use of systematic processes of change (McCance

& Fitzsimons 2005).

Given that both activities are dependent on each other, the

nursing and midwifery professions need to achieve a balance

between ‘R’ and ‘D’. Knowledge generation in itself is merely

an academic endeavour unless successful approaches can be

identified to integrate evidence into practice. Equally, to

improve the quality of care, there is a need for evidence on

which to base changes in practice. This provides a strong

argument for building capacity at all levels.

T. V. McCance et al.

58 � 2007 The Authors. Journal compilation � 2007 Blackwell Publishing Ltd

A useful categorization presented by the R&D Office

(1999) in terms of the knowledge and skills required to build

capacity across the spectrum of R&D activity is presented in

Table 1. Level 1 points to evidence-based practice and the

skills required to understand and interpret the potential

benefits of research to practice. The application of these skills

in implementing evidence-based practice is increasingly

recognized as a complex activity. Furthermore, it has been

argued that evidence is only part of the formula that leads to

positive changes in practice. This is reflected in more than

two decades of international research identifying the barriers

to research utilization (Hunt 1981, Funk et al. 1991, Parahoo

2000, Nilsson Kajerno et al. 1998, McKenna et al. 2004).

The ‘Promoting Action on Research Implementation in

Health Services Framework’ developed within the UK repre-

sents a substantial body of knowledge that highlights the

importance of evidence, context and facilitation, and the

relationship between these elements in developing effective

change strategies to improve practice (Kitson et al. 1998,

Harvey et al. 2002, McCormack et al. 2002, Rycroft-Malone

et al. 2002, Rycroft-Malone et al. 2004). How practitioners

understand and work with these concepts in a systematic way

to effect change is what constitutes the ‘D’ of R&D.

The attainment of knowledge and skills at level 2 focuses

on direct research training and the ability to be involved in

the practice of research. This has been the key focus for

capacity building to date with funded opportunities for

doctoral level preparation becoming increasingly accessible

to nurses and midwives (HEFCE 2001, McCance &

Fitzsimons 2005). While progress has been achieved, with

rising investment in nursing and midwifery R&D, building

capacity and infrastructure remain important challenges

(Cook & Green 2000, Hartley 2005, UK Clinical Research

Collaboration (UKCRC) 2006).

Building capacity at the highest level (level 3) focuses on

career opportunities that can support and develop future

research leaders. The need for strong and visible leaders who

can proactively lobby and influence this agenda are identified

as important policy imperatives for nursing (UKCRC 2006).

This is the context in which the work of the UKCRC on

developing clinical academic careers has been driven forward.

The position on a European level would present a similar

picture with findings indicating that there is ‘a lack, for the

most part, of nursing research career pathways that straddle

clinical work and higher education and enhance the genera-

tion and utilization of research in practice settings (pp. 11).

Thus the international impetus for focusing on capacity

building as a means to enhance nursing and midwifery

productivity in this arena is evident.

The study

Aim

The aim of the part of our study presented in this paper was

to identify strategic priorities to inform the development of a

regional strategy for nursing and midwifery R&D.

The aims of the wider study of which it formed part were

to evaluate existing R&D activity in nursing and midwifery

in Northern Ireland, and engage with key stakeholders to

identify current strengths and weaknesses to facilitate

strategic planning for the next 3–5 years. The first stage of

this project was the development of a ‘R&D Best Practice

Framework’ for nursing and midwifery (McCance et al.

2006). This was used to evaluate R&D activity in a range of

organizations (Fitzsimons et al. 2006). This provided an

evidence base to inform the identification of future R&D

priorities, which comprised the second phase of the study.

This latter part of the study forms the basis for this paper and

had the following objectives:

• to inform key stakeholders on the current state of nursing

and midwifery R&D within Northern Ireland;

• to engage all key stakeholders in informed discussion and

debate through the use of consensus methods; and

• to gain consensus from this stakeholder group on the main

R&D priorities for the next 3–5 years.

Methodology

Consensus building, also known as collaborative problem-

solving or collaboration (Burgess & Spangler 2003), is a

process used to generate ideas, understand problems and to

settle complex, multiparty issues. Two of the most common

consensus building methods are the Delphi technique and the

nominal group technique (NGT).

The Delphi technique, originally developed by the Rand

Corporation in the USA, is a group facilitation technique

(Dalkey & Helmer 1963). The purpose of the technique is to

obtain consensus on the opinions of ‘experts’ through a series

Table 1 Levels of research and development (R&D) activity

Level 1: the need to educate and train practitioners to be aware of

research findings and research methodology and, through this

understanding, to be able to appreciate the significance and

potential benefits of research to their professional practice

Level 2: the need for direct research training through personal

involvement with and practice of research

Level 3: the need for continued personal career development of

specialist researchers and the development of future research leaders

R&D 1999, pp. 41.

JAN: ORIGINAL RESEARCH Capacity building in nursing and midwifery


of structured questionnaires, commonly referred to as rounds

(Hasson et al. 2000). It does not use a random sample that is

representative of the target population; rather, the question-

naires are completed anonymously by ‘experts’ (Keeney et al.

2001). Panel members are selected because each is an expert

in the area in which the researchers are interested (Davidson

et al. 1997, Lemmer 1998, Green et al. 1999). This process is

used to gather opinion without the need to bring panellists

together physically. The responses from each round are fed

back in summarized form to the participants. The Delphi

technique is, therefore, an iterative multistage process

designed to combine opinion into group consensus (McKenna

1994, Lynn et al. 1998). Unlike other methods, however, it

requires a continued commitment from participants over a

series of rounds. The process can take up to several weeks

and is heavily dependent upon the participants having the

time to commit to it. An increasingly popular option to this

time-consuming approach is the use of email to distribute the

Delphi questionnaires (Jacobs et al. 2005).

The NGT was developed by Van de Ven and Delbecq

(1972). Participants are brought together for a discussion

using a highly structured group approach, led by a moder-

ator. This usually comprises four phases: silent generation of

individual ideas; round-robin recording of those ideas;

discussion and priority voting. ‘Nominal’ means that the

participants form a group in name only. For most of the

session, they do not interact as they would in other group

processes. Rather, this method encourages contributions

from everyone by allowing equal participation among group

members (Gibson 2001). The process begins with a question

being posed to the group. Individually and silently, partici-

pants write their answers or ideas. These are then shared in

‘round-robin’ fashion. Within the NGT, ideas are generated

in a short period of time and participants can see at first hand

the process of reaching consensus.

Each technique has strengths and limitations (Linstone &

Turoff 1975, Brahm & Kleiner 1996, Lang 1998). Never-

theless, both provide professionals with a format for

exploring opinions, reaching a consensus and re-evaluating

their original opinions. Both techniques minimize opportu-

nities for a few individuals to dominate the process. Some

studies have combined the two techniques to draw on their

strengths and overcome their individual weaknesses. For

example, Davidson et al. (1997) employed both methods to

identity the research priorities in mental health nursing from

the perspective of nurse clinicians and nurse academics in

Canada. The Delphi technique was used for data collection

purposes and the NGT was applied to ensure that all

participants were given the opportunity to express their

opinions and thoughts on the subject. In the context of our

study, the combined use of the Delphi Technique and the

NGT was identified as an appropriate approach to facilitate

the involvement of all key stakeholders in the discussion and

decision-making processes.

Participants

The participants comprised those who were involved in the

R&D agenda for nursing and midwifery in Northern Ireland.

Initially, a purposive sample of 105 respondents was

identified as having a vested interest in this agenda, and they

therefore constituted the expert group. These participants

were approached in writing, inviting them to give informed

opinion on R&D priorities. They included:

• representatives from health and care provider organiza-

tions such as directors of nursing, senior nurses with a

remit for research and development, and practitioners from

a variety of clinical areas (n ¼ 48);

• representatives from higher education institutions and

other education provider organizations ranging from

senior personnel such as deans and heads of school/

directors to staff who were working as postdoctoral

researchers (n ¼ 25);

• senior personnel from a selection of research funders

(n ¼ 6);

• joint appointees with shared posts between a higher edu-

cation institution and a health and care provider (n ¼ 5);

• representatives from government and professional bodies

(n ¼ 12);

• commissioners of health and care services (n ¼ 4); and

• lead researchers from other disciplines (n ¼ 5).

Data collection

Three rounds were used to identify the main strategic

priorities for nursing and midwifery R&D. Round 1 was

based on the Delphi technique and further rounds were based

on the NGT approach. The data were collected in February

2005.

Round 1: Delphi technique

The first round of the Delphi technique was conducted via

email and was based on 24 statements that represented the

key priority areas derived from a regional survey (Fitzsimons

et al. 2006). The validity of the 24 statements was tested with

the Project Steering Group comprising acknowledged experts

in the field of R&D. Participants were emailed a ques-

tionnaire with an explanatory covering letter and asked to

rate each of the statements on a 1–5 Likert-type scale

according to the level of importance, with one being the most



important and five being the least important. Participants

were asked to return their responses by email by an agreed

deadline. An email reminder was sent to all those who had

not responded within the timeframe. Data from round 1 of

the Delphi study were analysed and used as the basis for

round 2. The percentage frequency distribution for each item

was generated from the replies and was included in round 2

feedback. This enabled participants to take the majority

viewpoint into consideration before making their second

response.

Rounds 2 and 3: Consensus Conference using the NGT

approach

All participants who were invited to take part in round 1 of

the Delphi technique were also invited to attend a Consensus

Conference in which two rounds of the NGT approach were

conducted. The rationale for this decision was based on a

number of factors, but the primary reason was that the NGT

facilitates face-to-face dialogue and highly structured debate

which can be useful when gaining consensus from a group

who hold strong opinions. On a more practical level it is un-

likely that the sample would have had the time to commit to a

prolonged Delphi process through correspondence. In addi-

tion, the use of the NGT ensured that everyone had an equal

opportunity to present their ideas and to foster stakeholder

participation in planning and reaching group consensus.

To facilitate rounds 2 and 3, a highly structured NGT

approach was used during the Consensus Conference. A total

of 76 participants took part in round table discussions

(n ¼ 10). Each table had a trained facilitator to guide this

process. Round 2 required delegates to identify the 10

priority areas they considered to be the most important from

the full list of 24 statements. The scoring system used was

based on allocation of the highest score i.e. 10 to the most

important statement, then nine to the next most important

statement and then eight to the next important and so on,

until they reached one. Participants were provided with data

from round 1 which they could take into account, if they so

wished. Results were collated by the facilitators for each

table, and were then combined to obtain a picture of

consensus for the group as a whole. The facilitators did not

participate in the ranking process and were solely there to

facilitate discussion. The results from round 2 were then fed

into round 3, which required participants to refine their

selection to their top five priority areas. Again the highest

score of five was allocated to the most important statement,

then four to the next most important statement and so on.

They could take into account, if they so wished, consensus on

the most important areas derived from round 2, which again

were presented as frequency distributions for each item.

Collation of results was repeated as before with the final

outcome being a ranked list of priority areas based on their

level of importance on round 3 results.

Ethical considerations

The study was approved by the local Research Ethics

Committee. The usual assurances of anonymity and confi-

dentiality were given where appropriate, and informed

consent was obtained.

Data analysis

Responses to the Delphi questionnaire administered as round

1 of the process were analysed using the Statistical Package

for Social Science (SPSSSPSS version 11; SPSS Inc., Chicago, IL,

USA). Responses to NGT rounds 2 and 3 were collated and

used to rank order statements for each subsequent round. The

data were analysed by two independent researchers who did

not take part in any of the rounds of consensus building.

Results

The results from the Delphi technique and the NGT are

presented in relation to rounds 1, 2 and 3. Results from the

round 1 postal survey are presented in Table 2, which

includes percentage of participants rating each priority area

‘very important’. It is interesting to note that data from round

1 indicated that most participants considered all statements

to be of importance. The response rate to the emailed round 1

was 53% (56 of 105). Of the 105 invited to participant in

round 1, 76 (72%) participated in rounds 2 and 3. It must be

acknowledged that it is unusual to have a higher number of

participants in rounds 2 and 3 than in round 1, but this is

reflective of the modified consensus methodology used in our

study. Furthermore, justification for inclusion of a greater

number of participants in round 2 was that no statements

were dropped between rounds 1 and 2.

Results from rounds 2 and 3 are presented in Table 3 to

allow comparison. It is interesting to note that when

comparing results across the three rounds, four areas retained

priority throughout:

• the need for a vision;

• the need for a strong and visible leadership at senior level

within organizations to deliver on that vision;

• the need to integrate research and development into pro-

fessional practice; and

• the need to enhance regional strategic leadership.

It is important to highlight that all priority areas represen-

ted in the 24 statements were considered important, but for



real progress to be made, selectivity and focus were required.

Based on the ranked list of priority areas following round 3,

the top 12 priority areas were carried forward into the action

planning stage. The selection of the top 12 as opposed to, for

example, the top 5 or 10 was based on the balance and

breadth of issues covered across the range of R&D activity.

Table 4 presents the agreed priorities, which were then used

as the basis for developing detailed action plans.

Discussion

On review of the 12 identified priorities, three key areas

emerge that have implications for building research capacity

consistent with the levels of R&D activity presented in

Table 1. The first area focuses on the importance of strong

and visible leadership, which is required for the development

of nursing and midwifery R&D regionally, nationally and

internationally (priorities 2, 3 and 5). The second area

focuses on building expertise that will enable the profession

to deliver programmes of research that are competitive in a

multiprofessional arena (priorities 8, 9 and 11). Finally, the

third area focuses on increasing the capacity of individuals

and organizations to engage in development activity (the ‘D’

of R&D) to effect changes in practice based on best available

evidence (priorities 6, 7 and 10).

Participants in this study articulated the need for nurses

and midwives to have influence at a high level regionally,

nationally and internationally. This was considered an

important skill for leaders working in R&D, requiring them

to think strategically in a broader health and care context

(McKenna & Mason 1998). A similar argument was pre-

sented by White (2002) who acknowledged the importance

Table 2 Results from modified nominal group technique – round 1

Research and development (R&D) priority areas

Round 1% rating

very important

A All organizations need a vision for R&D that can be translated into strategy, taking account of regional

developments

79%

D Strong and visible leadership for nursing and midwifery R&D activity should be present in all health and

personal social services trusts at a senior level

71%

B There is a need to enhance regional strategic leadership for nursing and midwifery R&D in Northern Ireland 68%

E R&D leads should have appropriate lines of influence and access to resources 66%

J It is important to identify mechanisms by which R&D activity is integrated into professional practice 66%

F There is a need to develop career opportunities within the health and personal social services for nurses and

midwives with R&D capacity

63%

I There should be a separate funding stream to support projects focusing in the ‘D’ of R&D 61%

U There is need to build capacity within nursing and midwifery to facilitate activities relating to the ‘D’ of R&D 59%

H We need to invest in developing ‘champions’ of nursing R&D activity, who have strategic influence at national and

international levels

57%

L There is a need to increase facilitation expertise at organizational level to promote the ‘D’ of R&D 55%

G There needs to develop strong links between leaders of R&D and the regional support mechanisms, (e.g.) Clinical

Research Support Centre, Programme Manager Nursing

46%

M Improved support mechanisms should be developed to enhance the quality of nursing and midwifery grant

applications

46%

R New opportunities are required which offer ring fenced, competitive funding to develop nursing and midwifery

research capacity at doctoral level

46%

V There is a need to increase opportunities for multidisciplinary working for the purposes of R&D 46%

W There is a need to explore innovative ways to develop multidisciplinary alliances for the purposes of R&D 41%

X There is a need to agree on an appropriate set of outcomes indicators for nursing and midwifery R&D 41%

P Stronger relationships should be developed between health and care providers and education providers 39%

N Education providers should invest in development of activity that supports their staff to undertake research

supervision

38%

T There needs to be increased emphasis on postdoctoral training opportunities to develop nurse researchers to become

principal investigators

38%

C The development of more joint appointments would enhance career opportunities 30%

K There is a need to explore how nurses and midwives can exploit governance structures for the purpose of R&D 30%

O There is a need to actively promote increased application rates of nurses and midwives to existing funding schemes 30%

S New opportunities are required which offer ring fenced, competitive funding to develop nursing and midwifery

research capacity at postdoctoral level

30%

Q Stronger relationships should be developed between charitable organizations 18%



of the strategic, as well as the operational, dimensions

of capacity building for health research in developing

countries. The centrality of visionary leadership as integral

to strategy development was highlighted by Fitzsimons et al.

(2006), with strategy providing the vehicle to translate vision

into operational goals. The evidence, however, suggests

that there is a significant variation in the level of nursing

involvement in government and government funded R&D

bodies, with few countries having nursing research strategies

or agreed nursing research priorities (Moreno-Casbas 2005).

Table 3 Results from modified nominal group technique – rounds 2 and 3

Research and development (R&D) priority areas

Round 2

Group Score

Round 3

Ranked Group Score

A All organizations need a vision for R&D that can be translated into strategy,

taking account of regional developments

465 197

D Strong and visible leadership for nursing and midwifery R&D activity should be

present in all health and personal social services trusts, at a senior level

430 177

J It is important to identify mechanisms by which R&D activity is integrated into

professional practice

326 138

F There is a need to develop career opportunities within the HPSS for nurses and

midwives with R&D capacity

262 77

B There is a need to enhance regional strategic leadership for nursing and

midwifery R&D in Northern Ireland

306 71

H We need to invest in developing ‘champions’ of nursing R&D activity, who have

strategic influence at national and international levels

217 51

U There is need to build capacity within nursing and midwifery to facilitate

activities relating to the ‘D’ of R&D

236 50

V There is a need to increase opportunities for multidisciplinary working for the

purposes of R&D

115 30

X There is a need to agree on an appropriate set of outcomes indicators for nursing

and midwifery R&D

62 27

L There is a need to increase facilitation expertise at organizational level to

promote the ‘D’ of R&D

169 23

O There is a need to actively promote increased application rates of nurses and

midwives to existing funding schemes

71 21

M Improved support mechanisms should be developed to enhance the quality of

nursing and midwifery grant applications

84 15

P Stronger relationships should be developed between health and care providers

and education providers

63 13

E R&D leads should have appropriate lines of influence and access to resources 119 11

T There needs to be increased emphasis on postdoctoral training opportunities to

develop nurse researchers to become principal investigators

54 11

K There is a need to explore how nurses and midwives can exploit governance

structures for the purpose of R&D

57 7

W There is a need to explore innovative ways to develop multidisciplinary alliances

for the purposes of R&D

70 6

Q Stronger relationships should be developed between charitable organizations 9 3

R New opportunities are required which offer ring fenced, competitive funding to

develop nursing and midwifery research capacity at doctoral level

58 2

I There should be a separate funding stream to support projects focusing on the

‘D’ of R&D

124 1

G There is need to develop strong links between leaders of R&D and the regional

support mechanisms (e.g.) Clinical Research Support Centre, Programme

Manager Nursing

53 0

C The development of more joint appointments would enhance career

opportunities

27 0

N Education providers should invest in development of activity that supports their

staff to undertake research supervision

27 0

S New opportunities are required which offer ring fenced, competitive funding to

develop nursing and midwifery research capacity at postdoctoral level

11 0



The need to continue to develop politically minded research

leadership is crucial to the further advancement of the R&D

agenda (Rafferty & Traynor 2004).

The investment in senior leadership roles within organiza-

tions was a key priority that was ranked in the top five

throughout the three rounds. This type of strong and visible

leadership is important in building an organizational culture

that provides an environment that is both conducive to

research activity and to the implementation and evaluation of

best nursing practice (Scottish Executive Health Department

2002, Segrott et al. 2006). In a recent editorial, Jackson

(2005) called for ‘more nurses in places of influence – in

academia working towards professorships and at Trust Board

level’ (pp. 595). This is not surprising when data indicate that

professorial posts make up only 0Æ02% of the nursing

workforce. This represents 2Æ6% of the academic nursing

workforce, compared with 12% across the higher education

sector within the UK (O’Carroll & McMahon 2006).

The key priorities perceived to impact on building research

expertise at doctoral level focused largely on research funding

and the support required to successfully access available

funding opportunities. It can be argued that within the UK

funding opportunities for the professions are generally

improving. A good example is provided through the work

of Task Group 3 within the UK (HEFCE 2001). Its remit was

to enhance the contribution to research by members of the

nursing and allied health professions (Rafferty & Traynor

2003), which resulted in a dedicated research fund. The

opportunities to date, however, have tended to target

doctoral level preparation, with fewer directed to developing

programmes at postdoctoral level. Findings from the Eur-

opean scoping report (Moreno-Casbas 2005) support this

view, indicating that the vast majority of nurse researchers

obtaining doctorates and doing postdoctoral work do so on a

part-time, non-funded basis. The report from the UKCRC

(2006) emphasized this point further, citing that the nursing

and allied health professions proportion of research active

staff to total academic staff is 3Æ9%, compared with clinical

medicine at 42Æ5%. The report concluded that nurses are still

not making progress in sufficient numbers, as reflected in the

2001 Research Assessment Exercise.

The ability of nurses to perform in an increasingly

competitive arena is a further factor to be considered for

building capacity at this level. It has been argued that too few

nurses have the necessary skills to compete in the research

funding game (O’Carroll & McMahon 1999, Jackson 2005,

Fitzsimons et al. 2006). One indicator that provides evidence

is how infrequently nurses feature on grant applications to

major funding bodies, such as the Medical Research Council

or the Wellcome Trust (UKCRC 2006). This has implications

for how nurses and midwives develop programmes of

research and, more importantly, how they contribute to

multidisciplinary research. The support for the priority

relating to multidisciplinary working reinforces the view that

effective interprofessional partnerships are a key to improv-

ing the quality of nursing and midwifery R&D.

Building capacity to develop practice based on best

available evidence is fundamental in terms of advancing

R&D, but is the aspect that receives less attention. There was

a sense from the findings from the scoping exercise under-

taken as part of this study that there was greater focus on the

‘R’ of the R&D equation, with tangible markers of progress

reflecting this emphasis (Fitzsimons et al. 2006). The devel-

opment side of the agenda presents a significant challenge

(Rafferty & Traynor 1999), and reflects the reality of the

practice setting and the culture and context within which

nurses and midwives work. How evidence is used to improve

practice is complex and requires particular skills that include

facilitating and managing change (Harvey et al. 2002,

McCormack & Garbett 2003). It is therefore not surprising

that a focus within the identified priorities was on building

capacity for the ‘D’ of R&D, linking to the need to increase

facilitation expertise at organizational level to promote

development of practice. There is, however, a clear message

within the literature that suggests R&D activity is not always

Table 4 Top 12 research and development (R&D) priority areas

1 All organizations need a vision for R&D that can be translated

into strategy, taking account of regional developments

2 There is a need to enhance regional strategic leadership for

nursing and midwifery R&D in Northern Ireland

3 Strong and visible leadership for nursing and midwifery R&D

activity should be present in all health and personal social

services trusts, at a senior level

4 There is a need to develop career opportunities within the HPSS

for nurses and midwives with R&D capacity

5 We need to invest in developing ‘champions’ of nursing R&D

activity, who have strategic influence at national and

international levels

6 It is important to identify mechanisms by which R&D activity

is integrated into professional practice

7 There is a need to increase facilitation expertise at

organizational level to promote the ‘D’ of R&D

8 Improved support mechanisms should be developed to enhance

the quality of nursing and midwifery grant applications

9 There is a need to actively promote increased application rates

of nurses and midwives to existing funding schemes

10 There is a need to build capacity within nursing and midwifery

to facilitate activities relating to the ‘D’ of R&D

11 There is a need to increase opportunities for multidisciplinary

working for the purposes of R&D

12 There is a need to agree on an appropriate set of outcomes

indicators for nursing and midwifery R&D



valued as part of everyday practice (Gerrish & Clayton 2004,

Pravikoff et al. 2005). This places a responsibility on the

profession to explore and consider ways of integrating this

agenda into mainstream activity and the knowledge and skills

nurses and midwives require if they are to engage in R&D as

an integral part of their professional practice.

Study limitations

As with all research, our study has some limitations that

should be noted. The low-response rate to the Delphi

questionnaire in round 1 could have been improved if more

time and resources had been available for the study. While

Jacobs et al. (2005) point out that email lends itself to the

Delphi survey, an obvious limitation is that, despite having a

public email address, all participants may not access their

email regularly. The NGT also has a number of limitations

including the fact that the lack of anonymity can make

participants feel that they should be reserved in their

comments. Furthermore, ideas may be evaluated on their

source, rather than on their merit. Nonetheless, readers will

note that there were fewer participants (n ¼ 56) in round 1

than rounds 2 and 3 (n ¼ 76). While this is not typical of

consensus methodologies, it shows that senior policy makers

and strategists were more eager to attend a Consensus

Conference for face-to-face discussions than they were to

participate in the anonymous email Delphi phase.

Conclusion

Building capacity is the key building block for advancing

R&D within nursing and midwifery. The priority areas

identified from our study reinforce the need for a broad

perspective on building capacity that embraces the full

spectrum of R&D activity. This has important implications

in the current international climate where R&D should be

harnessed as important vehicles for improving the quality of

patient care. The range of knowledge and skills required to

deliver on this agenda are important indicators for building

capacity at different levels. Growing and mentoring nurse

and midwife researchers to influence regionally, nationally

and internationally, and to lobby decision-makers across the

sectors is becoming increasingly important, particularly in

light of the relentless changes experienced within health care.

While progress is evident in relation to building capacity for

conducting research, further investment is required to move

towards postdoctoral programmes that are more multi-

disciplinary in their approach. To build capacity for the ‘D’

of R&D nurses and midwives working at all levels need the

knowledge and skills required to value R&D as a legitimate

activity that can influence their professional practice. In

conclusion, we consider that continued investment is required

in this area and building capacity should remain a high

priority for those leading the R&D agenda, but we would

argue that the strategic drive needs to recognize and target

capacity in a broader context.

Acknowledgements

This project was commissioned by the Northern Ireland

Department of Health, Social Services and Public Safety, and

undertaken by the Northern Ireland Practice and Education

Council for Nursing and Midwifery in partnership with the

Research and Development Office for the Health and

Personal Social Services.

Author contributions

TMCC, DF, SK, FH and HMCK were responsible for the

study conception and design and TMCC and DF were

responsible for the drafting of the manuscript. TMCC, DF,

SK and FH performed the data collection and SK and FH

performed the data analysis. TMCC, DF, SK, FH and HMCK

made critical revisions to the paper. SK and FH provided

statistical expertise.

What is already known about this topic

• Building capacity is fundamental to the advancement of

nursing and midwifery research and development.

• Barriers to the progress of nursing and midwifery

research and development are well-rehearsed in the

literature.

What this study adds

• Nursing and midwifery need to adopt a broader per-

spective on capacity building than is conventionally

used in the international literature.

• Developing the required knowledge and skills to engage

in research and development activity at different levels

is fundamental to building capacity.

• Developing leaders at the highest level who can influ-

ence strategy and policy is crucial to the further

advancement of the research and development agenda.

• A focus on building capacity for the ‘development’ of

research and development at a strategic level is needed

to effect changes in practice based on best available

evidence.



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