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Warning over failure to retract ‘unsound’ research by nurses

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Substandard or dubious research by nurses may be going unchallenged, according to a new study by researchers who have called on nursing academics to “up their game”.

Their analysis found studies published in leading nursing journals were much less likely to be withdrawn than those from other disciplines such as medicine.

“Our observations suggest that unsound research is not being identified”

Review authors

This suggests “unsound research is not being identified” yet is continuing to influence nursing and midwifery care, they concluded in the International Journal of Nursing Studies.

The team, led by nurses from La Trobe University in Melbourne, Australia, have previously identified other potential weaknesses with research from the nursing sector, as reported by Nursing Times.

Thought to be the first to examine rates of retraction in nursing and midwifery journals, their new work involved a systematic review to identify instances of retracted research.

They said it came amid concern that “research misconduct is increasing in nursing research”, with academics of all types under “tremendous pressure” to publish.

“As a consequence, authors may be tempted to take short cuts, manipulate or even fabricate data,” they stated, describing retraction as an “important deterrent” that can damage someone’s career.

While overall rates of retraction in academic journals are increasing, the researchers found the proportion of nursing and midwifery studies that ended up being withdrawn was “remarkably low”.

“Our work highlights the need for research academics and clinicians to significantly up their game”

Richard Gray

In all, they identified 29 studies published in nursing science journals that were later retracted, all of which were led by people employed in a nursing or midwifery-related role.

This represents just 0.029% of all papers published in the nursing journals included in the study since 2007, and is much less than in “more established academic disciplines”.

“Our observations suggest that unsound research is not being identified and that the checks and balances incumbent in the scientific method are not working, as they should,” said the paper’s authors.

“In a clinical discipline, such as nursing and midwifery, our observations are particularly concerning because it may mean that research that should have been removed from the evidence base may continue to impact on the nursing care of patients and/or the midwifery care of women.”

Lead author Richard Gray, professor of clinical nursing practice at La Trobe’s school of nursing and midwifery, told Nursing Times the study raised serious questions for research nurses and the academic nursing community.

La Trobe University in Melbourne

Nurse research often ‘failing to adhere to trial best practice’

Richard Gray

“We think our work highlights the need for research academics and clinicians to significantly ‘up their game’ in order to ensure that practice is based on sound, high quality evidence,” he said.

Of the 29 withdrawn papers, 17 had been withdrawn due to “duplicate publishing”, which means the content had been published more than once or substantially overlapped another published paper.

Three papers had been withdrawn due to errors while two were retracted because of “ethics issues” and one because it used out-of-date data.

For four papers the reason for retraction was not stated and two were pulled because of questions around authorship. None had been retracted due to fraud.

In nearly a third of cases – nine papers in all – the main author was from China. Two papers were led by researchers from the UK and one by someone from Ireland. More than a quarter were randomised controlled trials – said to be the gold standard of research.

The researchers noted they were likely to have underestimated the number of retracted papers in nursing journals, due to significant delays between papers being published and withdrawn.

But even bearing that in mind, the retraction rate was still “extremely low” especially when compared to medicine. The research team suggested there were two “plausible explanations”.

“The first, perhaps somewhat unlikely reason, is that nurses have exceptionally high standards in conducting research and misconduct is rare,” said the paper’s authors.

“A potentially more plausible explanation is that the academic nursing and midwifery community are failing in their duty to hold researchers to account for the conduct of their work,” they said.

“For whatever reason, published nursing and midwifery research is not being subject to the level of review and post publication scrutiny seen in other scientific disciplines, notably medicine,” they added.

“Research that should have been removed from the evidence base may continue to impact on care”

Review authors

Another key finding was that more influential nursing journals were less likely to publish research that went on to be retracted. This is in contrast to medicine and other scientific disciplines, where retraction is more common in journals with a “higher impact factor”.

“It may be that papers published in top science journals come in for a tremendous amount of scrutiny from the scientific community but that this level of review is not mirrored when it comes to leading nursing and midwifery journals,” stated the paper.

It added that the “range of impact factors in nursing is much smaller than in science more generally”.

The researchers also pointed out that nurses do not only publish work in nursing journals, with some also appearing in high profile medical titles.

They may reserve their “best work” for medical journals, “where they perceive that they will reach a wider audience and their work will have more impact”, suggested the researchers.

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