International Journal of Nursing Studies 47 (2010) 929–930

Editorial

Classic papers in nursing and midwifery research

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International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

Nursing and midwifery are practice disciplines andapplied fields of research enquiry. Few, if any, researchmethods are unique to nursing/midwifery and seminalpapers which have informed research in these fields aredrawn predominantly from other disciplines. In this issueof the International Journal of Nursing Studies (IJNS) wefeature one such paper in the first of what we expect to bean occasional series of ‘classic’ research papers, publishedtogether with a commentary which draws out thecontribution of the paper to nursing and midwiferyresearch.

This year is the 200th anniversary of the death ofFlorence Nightingale who is well recognised as the one ofthe founders of professional nursing. Her role as a pioneerof nursing research is less well known, but her use ofhospital mortality statistics to make judgements about thequality of nursing care and the contribution of nursingto patient outcomes broke new ground and had a majorpolitical impact. The data with which Nightingale wasmost concerned raised technical challenges of data col-lection, but had the advantage of being directly observableand unambiguous – death or discharge. In those days thedivision of labour in healthcare was simpler than it istoday. Once the surgeons had done their work, whether thepatient lived or died was attributable to some considerableextent to the quality of nursing they received. Thusmortality was a relatively sensitive indicator of the qualityand quantity of nursing care.

Fortunately, the relationship between nursing care andmortality is less close today than it was in Nightingale’sday although the nature of the relationship betweennumbers of nurses, quality of care and patient deathsremains an important question which continues to bepursued; for example, by Aitken and her collaborators (e.g.West et al., 2009; Griffiths, 2009; Van den Heed et al.,2009). Today research into nursing and midwifery isconcerned not only with unambiguous phenomena whichcan be observed directly, or measured indirectly (such asarterial blood pressure) but also those whose presence canonly be inferred from self-reports of attitudes, beliefs andexperiences or require both observation and the exercise ofsubjective judgement.

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doi:10.1016/j.ijnurstu.2010.05.013

The science of measuring psychological states ordirectly observed phenomena which can vary in intensityor degree relies substantially on the development ofreliable and valid questionnaire and observation scales.Most scales used in nursing research have been derivedfrom other disciplines, but an increasing number havenow been developed by nurse researchers and we havepublished many of these in the IJNS; these includemeasures of technical skills of operating room nurses(Sevdalis et al., 2009), fear of falling (Huang and Wang,2009) and risk of pressure ulcers (Kotter et al., 2009; Kotterand Dassen, 2008) and family nursing (Astedt-Kurki et al.,2009).

The classic methods paper by Bland and Altman (1986)reprinted in this issue is primarily concerned withreliability assessment and approaches to determiningagreement between clinical measurements but sets outprocedures and identifies issues which apply to anymeasure which can be treated as ratio or interval level.In their commentary on the paper Griffiths and Murrells(2010) point to what is often a blurred distinction betweencorrelation and agreement. We hope that reprinting Blandand Altman’s paper will help to dispel this confusion andprovide timely guidance to nursing researchers who areengaged in scale development and validation.

References

Astedt-Kurki, P., Tarkka, M.-T., Rikala, M.-R., Lehti, K., Paavilainen, E.,2009. Further testing of a family nursing instrument (FAFHES). Inter-national Journal of Nursing Studies 46 (3), 350–359.

Bland, J.M., Altman, D.G., 1986. Statistical methods for assessing agree-ment between two measures of clinical measurement. Lancet 1(8476), 307–310.

Griffiths, P., 2009. Editorial: RN + RN = better care? What do we knowabout the association between the number of nurses and patientoutcomes?. International Journal of Nursing Studies 46 (10), 1289–1290.

Griffiths, P., Murrells, T., 2010. Commentary: reliability assessment andapproaches to determining agreement between measurements: clas-sic methods paper. International Journal of Nursing Studies 47 (8),936–937.

Huang, T.-T., Wang, W.-S., 2009. Comparison of three establishedmeasures of fear of falling in community-dwelling older adults:psychometric testing. International Journal of Nursing Studies 46(10), 1313–1319.

Editorial / International Journal of Nursing Studies 47 (2010) 929–930930

Kotter, J., Dassen, T., 2008. An interrater reliability study of the Bradenscale in two nursing homes. International Journal of Nursing Studies45 (10), 1501–1511.

Kotter, J., Halfens, R., Dassen, T., 2009. An interrater reliability study of theassessment of pressure ulcer risk using the Braden scale and theclassification of pressure ulcers in a home care setting. InternationalJournal of Nursing Studies 46 (10), 1307–1312.

Sevdalis, N., Undre, S., Henry, J., Sydney, E., Koutantji, M., Darzi, A., Vincent,C.A., 2009. Development, initial reliability and validity testing of anobservational tool for assessing technical skills of operating roomnurses. International Journal of Nursing Studies 46 (9), 1187–1193.

Van den Heed, K., Sermeus, W., Diya, L., Clarke, S.P., Lesaffre, E., Vleugels,A., Aiken, L.H., 2009. Nurse staffing and patient outcomes in Belgian

acute hospitals: cross-sectional analysis of administrative data. In-ternational Journal of Nursing Studies 46 (7), 928–939.

West, E., Mays, N., Rafferty, A.M., Rowan, K., Sanderson, C., 2009. Nursingresources and patient outcomes in intensive care: a systematic review ofthe literature. International Journal of Nursing Studies 46 (7), 993–1011.

Ian NormanKing’s College London, Florence Nightingale School of Nursing

and Midwifery, James Clerk Maxwell Building,

57 Waterloo Road, London SE1 8WA, London, UK

E-mail address: ian.j.norman@kcl.ac.uk