Sustainability is important to equitable health and healthcare delivery. As scientists, we think and talk a lot about sustainability, particularly sustainability of health interventions. Let’s face it—interventions are expensive to develop and test, and the public and funders expect scientists to develop interventions that work. That is, the public and those who fund research want and expect scientists to apply scientific knowledge to the development of interventions that will meet health needs and improve quality of life.
The truth is that some really interesting interventions never work as intended—they just do not lead to improved outcomes. We do not often hear about these interventions because scientists do not often try to publish these “null” results (Fanelli, 2012). Sometimes, when scientists do try to publish the results of “failed” interventions, they are not able to do so because their papers cannot get beyond the peer review (or editorial) process. Whatever the case, it is unfortunate that we do not have more reports of failed interventions, as the knowledge of these—what they are, how they failed, and so on—would certainly be informative to other scientists and to the public.
In other situations, interventions do work, but their effects may not be sustained. That is, although an intervention works within the context of a well-controlled research study, the intervention fails to be sustained, either in use or effect, after the study ends (Whelan et al., 2014). However, the need for long-term intervention sustainability is great, particularly as funders, policy-makers, healthcare providers, and the public become increasingly focused on the allocation of scarce resources. At the very least, scientists should identify indicators that are supportive of longer term effects and of ways in which an effective intervention can be sustained.
Healthcare institutions are also concerned with sustainability, particularly the sustainability of structures that preserve social, economic, and ecological resources and meet the needs and interests of stakeholders, including healthcare professionals, patients, and the community (Molero et al., 2021). The COVID-19 pandemic has heightened our awareness of institutional unsustainability, particularly in relationship to interventions that limit the spread of infectious organisms and, more importantly, safe care delivery with bare-bones staffing.
Another area of sustainability is that involving a program of research or, specifically, a focus of scientific inquiry. Scientists talk about having a program of research or a research trajectory. These terms are reflective of an understanding that scientific progress occurs through continued nurturance and growth of a research focus. Science does not advance by abandoning lines of inquiry that have resulted in improved health outcomes. Science does advance by adapting methods, by including newly discovered measures or emergent variables of interest that may explain or clarify research results, or by realigning focus to address pressing healthcare concerns (Shelton et al., 2018). With these adaptations and realignments, strong scientific programs continue because of potential benefits to science in the form of new discoveries and improved outcomes for people, which is the primary goal of nursing science. Benefits also accrue to scientists-in-training, who learn with and from skilled mentors with deep and broad scientific acumen. These benefits are lost when scientists abandon well-developed programs of research because of pressure to be funded or pressure to conform to untested changes in concepts and methods.
Today, many nurse scientists are grappling with how to maintain their well-established programs of research in order to continue advancing in nursing science, train emerging scientists, and meet standards of quality and integrity. It seems clear that nurse scientists should be engaged with a broad spectrum of society, perhaps broader than they have been in the past; the health of those whom they seek to serve relies on this broader view. However, although nurse scientists do need to consider how science can contribute to the health and well-being of all, they cannot afford to dismantle or abandon existing research programs and their supporting structures. In fact, what we know at Nursing Research is that nursing science that is focused on the health needs of all individuals, across all ages and health conditions and across all settings of life, health, and illness, will continue to be needed for both the near and long-term future.
Rita H. Pickler https://orcid.org/0000-0001-9299-5583
Fanelli D. (2012). Negative results are disappearing from most disciplines and countries. Scientometrics
, 90, 891–904. 10.1007/s11192-011-0494-7
Molero A., Calabrò M., Vignes M., Gouget B., Gruson D. (2021). Sustainability in healthcare: Perspectives and reflections regarding laboratory medicine. Annals of Laboratory Medicine
, 41, 139–144. 10.3343/alm.2021.41.2.139
Shelton R. C., Cooper B. R., Stirman S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual Review of Public Health
, 39, 55–76. 10.1146/annurev-publhealth-040617-014731
Whelan J., Love P., Pettman T., Doyle J., Booth S., Smith E., Waters E. (2014). Cochrane update: Predicting sustainability of intervention effects in public health evidence: Identifying key elements to provide guidance. Journal of Public Health
, 36, 347–351. 10.1093/pubmed/fdu027