This post was written by Lorna Luy-Kenny as part of her final assessment for the module EDM122: Digital Literacies and Open Practice.
Introduction
Nursing practice has changed and improved significantly over the years primarily because of individual research and scientific studies (Hedges,2006). The advent of the internet has fundamentally transformed the pace at which clinical knowledge and practices are disseminated on a global scale.
However, despite living in a digital era, many institutions and underdeveloped countries still lack adequate access to even half of the available research and international journals (Georgiou and Dave, 2023). In this essay I will be reflecting the broader implication of open access to literature in nursing Practice.
Description
As a Clinical Practice Facilitator, my responsibilities encompass training and development of staff and students within the operating theatre. Additionally, I also engage in teaching sessions which necessitates preparation and exploration of pertinent evidence-based studies and guidelines. Accessing high-quality research literature is crucial for my role as we oftentimes encounter new procedures, surgical equipment, and clinical challenges requiring current and credible evidence to guide and improve my practice. Due to constant evolving in medical knowledge, nurses need to regularly access literature to stay informed about new advancement in treatments, guidelines, and best practices. (Fossum, Opsal and Ehrenberg, 2022). By having free access to literature, I could provide an in-depth knowledge to help educate nurses and student in the clinical area. However, it is important that I can cite credible sources to support my teaching and training as they are more likely to trust the information and follow the recommendations which are crucial for their clinical training and development.
Challenges of Paywalls in Nursing Research
One significant obstacle I encountered during literature searches has been the prevalence of Paywalls, which limit my ability to access crucial medical research and scientific studies unless I pay subscription fees. I had previously subscribed to these services hoping in obtaining more efficient and timely access to the latest resources vital for my perioperative practice (Quick, 2022). Fortunately, throughout my postgraduate studies, the availability of Library access has provided me with much broader accessibility to journal articles. However, I frequently pondered the sustainability of this access once my affiliation with the institution ends. In my situation, the temporary relief provided by free resources through the university library addressed these challenges, yet this solution is not viable in the long term. This reflection has led me to consider the wider implications of restricted access, especially for professionals in resource-limited countries, where paywalls can significantly worsen existing disparities (Bautista & Aranas, 2023).
Upon learning the concept of Open Access and Paywalls, I experienced a sense of frustration and injustice regarding these limitations. It appeared inequitable that 78% of essential research (Khabsa and Lee Giles, 2014), frequently financed by taxpayer contributions and charity organisations, remained concealed behind Paywalls (Torok, 2024). The absence of universal open access means that obtaining the latest information on advancements in specific fields for research or teaching is contingent upon an institution’s ability to afford increasingly costly journal subscriptions (Lariviere, Haustein, and Mongeon, 2015).
My sense of frustration intensified as I recognised how these barriers not only restricted my own professional development but also hindering the nursing profession to deliver evidence-based care, which can consequently affect nurses’ decision making in clinical (Saunders & Vehviläinen‐Julkunen, 2016)
The Global Knowledge Gap
The restricted access to scientific literature highlights a broader issue within global nursing practice. I felt concern for healthcare professionals and students in under-resourced settings, who might face even greater barriers to accessing research especially Nurses in developing countries, such as the Philippines where I was originally trained. Nurses from underdeveloped countries can face challenges accessing up-to-date research, limiting their ability to contribute to international policy discussions and clinical debates (Langer et al., 2004). Teaching hospitals and institutions in low-income countries can also experience similar constraints. Without OA, nurses in resource-limited settings will struggle to stay informed on advancements, limiting their capacity to enhance global healthcare standards. Perhaps without Paywall causing the barrier, Nurses experiences from underdeveloped countries can be shared contributing more to improving global nurse’s standard of clinical practice (Ramage and Paula, 2023).
Equity in Knowledge Sharing
Research suggests that open access is beneficial only when individuals have the digital literacy skills to navigate and interpret scholarly articles (Tenopir et al., 2020). My role as a Clinical Practice Facilitator (CPF) is to ensure that all staff members, irrespective of their diverse backgrounds, have unrestricted access to vital knowledge and resources necessary to support their practice in a clinical setting. Even if educational resources are OA, clinical staff especially the new joiner and students may struggle to find these educational resources or finding complex medical or clinical information. Failure to obtain this information can have fatal consequences to health. Hence the WHO recommended sharing research data through OA.
To support equitable learning, one of my roles includes mentoring and training practitioners how to search or signposting educational resources available that can help them engaged in high-quality and continuous learning aligning with UNESCO’s advocacy for bridging knowledge gaps, thereby fostering an environment where every individual can thrive.
Advocating for Open Access Initiatives
I felt inspired after learning about initiatives such as Sci-Hub and the Open Access movement, which aim to make research freely available (Elbakyan, cited in Milova, 2017). These feelings motivated me to advocate for equitable access to knowledge by supporting the idea of Creative Common licensing allowing lawful use, reproduction, and distribution of creative work which would make them ideal for my teaching and training purposes (Creative Common, 2001).
This level of accessibility facilitates easy dissemination of nursing literature ensuring that nurses remain informed about current practices, emerging technologies, and advancements in surgical techniques (Ramage & Foran, 2023). Nurses worldwide would also benefit having the freedom to read, download, copy, distribute, print, or link to full-text articles without encountering any financial, legal, or technical barriers to the latest scientific research. (BOAI 2001),
Similarly, Gotzsche (2011) highlighted the challenge of selective research reporting by publisher which impedes healthcare professionals from making optimal treatment decisions. This disproportionately also in large affects teaching hospitals and healthcare institutions especially in developing countries (Quick, 2022).
The Role of Open Access in Clinical Practice
Many scholars and institution believed that Paywall creates global knowledge gap is a transgression of a human rights issue as exclusion from accessing research literature can harms global public health according to Yamey (2013). In situations where there are gaps in evidence, Scantlebury, Booth and Hanley, (2017) highlighted the importance of nursing research to address these deficiencies. However, without OA to scientific literature, (Smith et al.,2017) argue this knowledge gap can suppress future innovation and collaboration among students and professional. OA can level up this gap and facilitate scientific conversation between those in the rich and underdeveloped countries in which clinical evidence or new clinical reports is critiqued and discussed according to Connor and colleagues, (2023). In contrast, limited access can significantly hinder both students and researchers, as it restricts their ability to obtain the necessary resources for conducting primary research or pursuing their educational objectives. Although Publishing companies often justify Paywalls as necessary for sustaining operations, critics argue that this practice prioritises profit over public good (Smith, 2006).
One of the interesting blogs I have read was Jack Andraka’s blog on the necessity of eliminating Paywalls in scientific journals, which he profoundly influenced my perspective on open access. In his discussion, Andraka emphasises the significant progress that could be achieved through broader public access to medical research, illustrating his own experience of navigating the limited availability of non-paywalled articles online to develop an award-winning early detection test for pancreatic cancer (Andraka, 2013).
Challenges to Open Access to Literature
United Kingdom Copyright law is designed to safeguard creative works and prevent unauthorised use by others. However, my task involves sharing or downloading education material for staff training and development purposes. With copyright, I encountered difficulties either the material is not downloadable or are restricted copy making my supporting documents and teaching materials challenging to prepare. Stilglitz (2006) has described this act as a facade for monopoly power, allowing individuals or corporations to exert exclusive control over and restrict access to essential knowledge. The core of the ongoing crisis regarding limited access to research literature is fundamentally rooted in this publishing arrangement (Yamey,2013)
Many scholars such as Alexandra Elbakyan, the founder of Sci-Hub, has also expressed the same view expressing that copyright law obstructs the free exchange of information and dissemination of knowledge on the Internet. Although this idea has roused some dissenting opinions amongst some academics (Belluz, 2016). This issue highlighted the tension between intellectual property rights and the ethical principle of equitable knowledge dissemination.
According to Bhattad and Pacifico (2022) Open access is not only be about bringing down paywalls or building repositories, but also understanding and addressing wider accessibility issues, such as IT skills required to navigate the publishing platforms as well as discoverability of the content. An article may be freely available digitally, but this is no help to someone without online access and technical ability. As a CPF, I always ensure that theatre practitioners and students are not just being provided OA to education and training resources, but they are also supported with the skills to access, understand, apply, and engage with research resources effectively in clinical practice. Bloomberg et al, (2018) argue that without OA, nurses will be stuck in their old practice, which can potentially compromise patient safety. By utilising OA, error can be minimised as nurses are currently updated with scientific and clinical evidence to support their practice.
Another challenges Gotzsche (2011) has pointed out facing evidence-based healthcare is the selective reporting of research findings by the publisher which may impact healthcare professionals from making optimal treatment decisions for their patients.
After viewing the documentary “Paywall: The Business of Scholarship,” I felt a deep sense of injustice regarding the plight of scholars who relinquish their work to publishers without compensation, only for those publishers claim ownership and copyright over the researchers’ contributions (Baverstock, 2019). I can’t help pondering why scholars would send their work to big publishing company like Elsevier and consequently losing their right to their scholarly work. According to Elbakyan, scholars feel pressured to do this, because Elsevier is an owner of so-called “high impact” journals. Researcher who wanted to gain recognition and build a career are left with no choice but hand in their work to big publishing company such as Elsevier (Elbakyan, 2015).
Sustainable Solutions for Knowledge Access
While university and institution library access temporarily alleviate these challenges through paid subscription, long-term solutions are needed. OA resources, licensed under Creative Commons can offer a viable solution. Creative Common platform not only provide Open Access to education but also attributes the work of the scholars.
Advocating Creative commons redistributes power from the hands of the few to the minds of the many and leverage global view of knowledge as a public good and a human right (Creative Common 2001). As a CPF, this can greatly benefit my work as I can actively share free articles and journal on legal platforms with colleagues, without fear of copy right infringement, promoting an equitable environment where not only nurses or other health professionals or students benefiting from this free access to education but also the entire global community aligning with global health and educational agenda of UNESCO.
Conclusion
Reflecting on my experience, I recognise the importance of OA in advancing nursing education and practice. While university access provided a temporary solution, systemic reliance on Paywalls persists. As a CPF, I advocate for OA models that promote equity and inclusivity (Day et al., 2020). With OA, we can create an environment where healthcare professionals can easily access research, ultimately aligning with global health agendas and equitable healthcare practices. Supporting OA not only enhances our nursing practice and educational development of students but also ensures that knowledge remains accessible for the betterment of humanity and society.
I fully support and advocate for creative common licencing and I share the organisation ethos that Knowledge must be accessible, discoverable, and reusable. I will be publishing my essay under
CC BY-NC 4.0
Creative Commons Attribution- 4.0 International@ https://creativecommons.org/share-your-work/
This license requires that reusers give credit to the creator. Allowing reusers to distribute, remix, adapt, and build upon the material in any medium or format, for noncommercial purposes only.
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