In the May issue, AJN reported that nurses didn't produce the expected results in a heart failure study (In the News) and that the Cochrane Collaboration has withdrawn and plans to revise two systematic reviews that didn't appear to support the widespread use of the Nurse-Family Partnership (NFP) model (Letters). Originally described by Donna Diers in a brief report in AJN's November 2007 issue, the results of these NFP studies were challenged by David Olds and colleagues, who objected to the methods used to compare home visits made by nurses with those made by paraprofessionals (as noted in an editor's note to Diers's article).
All of these studies described what the nurses did (interventions in the home and by phone) and for whom (heart failure patients and pregnant women or new mothers and their infants). However, the researchers were not sufficiently explicit about what was expected of the nurses.
Perhaps another perspective of nursing provides a more compelling expression of what nurses can accomplish. Henderson described nurses' unique function this way1:
[Nurses] help people, sick or well, in the performance of those activities contributing to health, its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge. It is likewise the function of nurses to help people gain independence as rapidly as possible.
The work of nurses is complex and the measurement of its benefit is further confounded by the work of physicians who are caring for the same patients at the same time. Physicians, too, want independence for their patients, but they often use pharmaceuticals and surgery to achieve it.
In science, we need to tease out the discrete effects of medicine and nursing in the way that Olds and colleagues have.2 Nurses provide interventions and often care for patients with specific diseases, but neither of these two common and important ways to characterize the work of nurses should substitute for the third: what Henderson referred to as "the nature of nursing."1
Edward J. Halloran, PhD, RN, FAAN
Diane C. Halloran, MPH, RN
Chapel Hill, NC
REFERENCES