The clinician and the researcher

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I SPENT THIS past weekend immersed in an intensive learning experience with a group of expert clinicians. I once again was impressed by the breadth and depth of their clinical knowledge and fascinated by the process by through which clinicians identify problems. Clinical expertise makes it possible for professionals to zero in on clinical problems without much apparent reflection and analysis. Expert clinicians know what to do in clinical situations; they know how to intervene with clinical problems.

Researchers, on the other hand, often deliberate for long periods of time about the nature of scientific problems. It often takes researchers several studies to determine the essence of the clinical problem that they want to solve. After a few attempts to delineate the variable of interest or many attempts at instrument development and refinement, researchers approach the truth that they are seeking. Researchers can spend a lifetime on delineating a knowledge base for interventions with patients with postoperative pain, evaluating more and more complex interventions. Or they can dedicate their scientific careers to measurement issues in relation to one or two variables that are deemed essential to the core nursing concepts of and the relationship of selected nursing interventions to manifestations of patient health and illness.

Although the researcher most often thinks about problems to reduce them to discrete measurable dimensions, the clinician thinks about patients more holistically and intervenes in clinical problems more quickly. The clinician is taught to make judgments by gathering and synthesizing data as quickly as possible; the analysis occurs at the same time as the data collection and the clinical judgment and intervention follows.

The expert clinicians that I spent time with quickly identified the clinical problems in their area of practice. In addition, they know clinically how to solve the problems. I would put my bets on the accuracy of their judgments, even though we often were not able to identify research support for the clinical judgments or the interventions.

We were left asking questions about the validity of the beliefs that we have in the value of our clinical interventions. We were left searching for clinical evidence to compensate for the absence of research evidence. We searched for support in all of the nursing literature, clinical, scientific, and expert opinion sources as well as support from other disciplines. And most of all, we were left with the realization that the best and perhaps only valid way to develop knowledge in a clinical discipline such as nursing is to develop teams of clinicians and researchers. On this score, we are proud that Applied Nursing Research has been a pioneer. Our clinician researcher review teams may not always agree on the clinical and scientific relevance of the knowledge presented in the manuscripts reviewed, but when they do agree, we are assured that the products, the articles we publish, are truly of value to knowledge development in nursing.