Dr. Laurie Gottlieb

PHOTO: OWEN EGAN

Nursing a better understanding about health

BRONWYN CHESTER | As Laurie Gottlieb, director of McGill's School of Nursing, noted in her editorial: "The year 1969 is associated with the landing of a man on the moon. Few will recall that in the same year, the first Canadian scholarly nursing journal was founded... A much less seismic event than the moon landing, the launching of Nursing Papers, now known as the Canadian Journal of Nursing Research, was nonetheless a milestone in the evolution of academic nursing in Canada."

Much less seismic, perhaps, in terms of one-shot dramatic value. But one could argue that the advancements in nursing research, education and care, documented, debated and promoted by the CJNR over the past 30 years have been far more of a "giant step for mankind" than putting a man on the moon.

Little known and little understood by the public, nursing research is what creates a base of knowledge for the discipline and the profession. "And we need knowledgeable nurses," says Gottlieb emphatically.

"Nursing research deals with peoples' responses during health and illness, it deals with the continuum of care, prevention and health promotion," says the editor of the CJNR, emphasizing that "responses" include the psychic, cultural and social as much as the physical.

When a patient with cancer, for instance, has to decide between chemo or radiotherapy, "it's the nurses who will help people decide on which according to a person's situation and beliefs as well as their physical state." Anthropology, sociology and psychology all come into it, says Gottlieb, as well as the nurse's own sensitivity.

Compared to medical research, which frequently involves a laboratory, nursing research uses the whole clinical area as its research lab, says Gottlieb.

If, for instance, the area is palliative care, "you need to understand the process of dying if you are going to help someone die," says Gottlieb, citing the all-too-common situation of people who are ready to die but won't because their families have not yet let go.

If the area is premature infants, it's important to understand the short -- and long-term effects of pain and sensory stimulation, she continues, for this will affect how the babies are treated by nurses.

Or, in the case of community nursing, it might be important, for instance, to understand why some poor women manage to give up smoking while others can't; the expectations of the health care system as they vary from one cultural group to another; and different attitudes toward breastfeeding.

The results of nursing research affect not only how nurses do their work but how health policy is formulated, especially in these days of health reforms, says Gottlieb. She adds that it's the nurses who experience first hand their patients' reactions to their states of health and to the treatment or changes proposed for their care.

Gottlieb took over the reins of the CJNR in 1993 when she succeeded Mary Ellen Jeans as the journal's editor. One of Gottlieb's innovations has been "focus issues."

Recent "focus issues" have examined the impact of chronic diseases on patients' lives, gerontology, loss and bereavement and young families. Each issue has its own senior scholar as guest editor, chosen from the CJNR's 15 section editors, who come from universities across the country as well as the University of Washington.

Gottlieb is immensely proud of the journal she produces in collaboration with associate editors Mary Grossman of McGill and Lise Talbot from the Université de Montréal and managing editor Joanna Toti.

Boasting a subscription rate of 650, which includes nursing libraries throughout North America as well as some in Europe, and an operation that runs in the black (with a little help from the Social Sciences and Humanities Research Council), Gottlieb proclaims: "I run a small business here."

The number of nursing journals has burgeoned since the late Moyra Allen, a McGill nursing professor and one of Canada's first PhD-holding nurses, created Nursing Papers as a forum for "scholarly debate about the issues that would shape the discipline and the profession." The CJNR remains the first refereed nursing journal in the country and is the only one published by a university rather than a publishing house.

Under her editorship, 1969 to 1984, Allen began to solicit articles in French and by 1975, the journal bore the title Nursing Papers/Perspectives en Nursing. Most subjects covered concerned nursing education -- not surprising, writes Gottlieb, given the number of schools of nursing either setting up or expanding their graduate programs during that period.

By 1980, writes Gottlieb, "clinical research was now the focus." In part, this was due to the growing number of nurses doing their PhDs. Under Jeans's editorship the journal changed its name and expanded its board of editors. In what is a certain closing of a circle, McGill's first doctoral graduate in nursing, Francine Ducharme (PhD 90), now at the Université de Montréal, was one of the people who chose the articles for a recent retrospective issue.

As for the future, Gottlieb can only see the journal getting bigger, as more nurses graduate with their doctorates, and more widely read, as the demand increases for nursing to be an "evidence-based" practice.

An on-line version, in the planning stages, will also add to the international readership. Furthermore, she says, because of nursing's multidisciplinary and holistic nature, the journal is gaining popularity among researchers in the social as well as biological and medical sciences. Hence its being indexed not only in health and medicine abstracts but in Canadian Business & Current Affairs, Sociological Abstracts and Social Planning/Policy and Development Abstracts.