Nursing research — allowing good practices to travel

Tēnā koutou, tēnā koutou, tēnā tatou katoa.

Welcome to the 2023 edition of Kaitiaki Nursing Research. As we publish the 14th edition of the journal, it is worth reflecting on the value of research in contributing to knowledge for contemporary nursing practice and in documenting the history of our role in health care for future generations of nurses. Nursing is a constantly evolving profession that is driven to seek new solutions for the contemporary challenges we experience in complex health care and tertiary education contexts. Our research documents the creative responses and innovations we have made to manage the challenges we face.

Nursing is a profession that is defined by its social relevance and ethical positions (Hoeck & Delmar, 2018). As Hoeck and Delmar suggest, it is a profession that is constantly re-evaluated in relation to its contribution to health care and the values that guide nurses as health professionals. Nursing is characterised by a distinct body of knowledge that underpins clinical decision-making, and by the ability to navigate complex client situations according to a set of shared values. Nursing research helps us negotiate and conceptualise the space between practice and scholarship, connecting the everyday work of nursing to formal knowledge and evidence for practice.

Ceci et al (2017) note that nursing knowledge should be derived from the contexts in which it occurs, taking account of the organisational influences that push and pull the thinking and reasoning of nurses in practice. Research is critical in this process of recording, analysing and synthesising observations and measurements of practice in specific contexts. It enables “good practices to travel outside of the very particular circumstances where we find them to make practice better in other locations” (Ceci et al, 2017, p. 51). Publishing research enables us to capture the essence of nursing in our place and time in ways that generate evidence for practice, and knowledge for policy and quality improvement. It also shapes the historical narratives of nursing in Aotearoa New Zealand by documenting how we have navigated the ethical, cultural and political challenges of our time and made an impact on the delivery of health care.

This edition of Kaitiaki Nursing Research offers insights into some of the ideas that are unfolding in nursing scholarship in Aotearoa New Zealand. We offer these in the hope that the research documented in this edition will be useful to nurses in other contexts.

Care workers need support

Care and support workers make an important contribution to health care in Aotearoa New Zealand, particularly in assisting registered nurses (RNs) to provide holistic care for older adults. It is important that the needs of care and support workers are met, both in terms of financial reward and support from their employers (Garces-Ozanne & Carlos, 2022). Barry et al explored the impact of the Care and Support Worker (Pay Equity) Settlement Act (2017) on the work-related quality of life of homecare support workers. The findings of this study suggest that while the support workers they interviewed reported increases in their pay rate, their hours of guaranteed employment were reduced. They also experienced intense stress in the workplace due to understaffing, high workload, lack of coordination and problems with scheduling. This study emphasises the need for more oversight in the homecare industry to ensure the safety and wellbeing of both support workers and clients. This oversight could also encompass nurses working in the sector.

Clinical placements across a variety of settings provide essential learning opportunities for bachelor of nursing students, particularly in gaining real-world skills and experience to competently practise as RNs (Moroney et al, 2022). The research conducted by Thomson et al explored the experiences of nursing students who had clinical placements in managed isolation and quarantine facilities (MIQFs) during the COVID-19 pandemic. The findings of this research illuminate an innovative and responsive approach to providing community-based clinical experience under the restrictions of the pandemic. Using MIQFs as a community placement enabled nursing students to gain unique experiences for clinical learning, rather than resorting to clinical projects and simulation as an alternative. This research highlights how nurse educators used a challenging situation to create innovative opportunities for clinical learning, while providing a safe, student-centred experience.

Link-nurse programmes aid the prevention of pressure injuries by designating specific nurses as experts in this field of care, who can act as a resource for their colleagues (Moir et al, 2022). This further study by Moir et al asked link nurses to identify changes in their practice areas brought about by participation in a pressure injury prevention link nurse programme. They found that all of the nurse participants noticed an increase in their knowledge and awareness of pressure injury prevention. This research highlights how positive changes in care occur when nurses are supported to lead quality improvement processes. Leading by example and being seen to be able to make improvements, such as in new equipment purchases, increased link nurses’ sense of autonomy. Recognising a need and leading their own change project was a positive process for nurses, management and colleagues in this study.

The daily struggle of psoriasis

Evidence synthesis provides summaries and interpretations of primary research and other published information that are essential to inform nursing practice and improve health care. We have included three qualitative reviews in this edition, including a meta-synthesis, an integrative review, and a qualitative systematic review. Greenwood and McClunie-Trust used meta-ethnography to synthesise qualitative research on the experiences of people who live with psoriasis. Participants in the primary studies illuminated the daily struggles they experience, including how psoriasis shapes the way they live their lives and how they work to make themselves and their bodies invisible as a coping strategy. These powerful narratives reveal important insights into how people live with psoriasis as a long-term condition. The findings of this synthesis show how important it is that health professionals understand the impact of psoriasis on the lives of those people who live with it as they play a pivotal role in helping people to successfully manage their condition.

Sibley and Mercer conducted an integrative review on the management of behavioural and psychological symptoms of dementia. The objective of this review was to determine the factors that created nurses’ reliance on PRN antipsychotics in those with behavioural and psychological symptoms of dementia. The findings of this review show that using person-centred care plans that focus on the individual, reduces use of PRN antipsychotics. However, the management of symptoms of dementia is complicated by a mix of low staffing, and/or inadequate training in aged-care facilities, leading to increased risk for both the individual client and staff, who are vulnerable to burnout. Appropriate education and training for nurses and care and support workers further reduces these risks, when paired with the use of non-pharmacological care plans.

Weber used a qualitative systematic review to explore how nurses decide on a safe site for intramuscular injections in an acute mental health setting. The risks and benefits of different intramuscular injection sites remain a subject for debate in the acute mental health literature. Although a few primary studies have investigated the issue of the safe site for intramuscular injections, the evidence remains varied and sometimes contradictory. This review reports on a synthesis of primary research that determined whether accessing the dorsogluteal site is safer in an inpatient acute mental health setting where there is the potential for violence and agitation, as well as during personal restraint. The overall goal of the review was to provide practical guidance for health-care providers to help ensure the safe and effective administration of intramuscular injections in acute inpatient mental health settings.

A protocol for research

Research protocols are important to publish to create a detailed account of a research topic and approach, because publication invites peer review and makes it possible for other researchers to replicate the study. It also avoids duplication of research and enables greater collaboration between researchers (Ohtake & Childs, 2014). In this edition, Oda et al share a protocol for their planned research on improving nursing oral care practice for care-dependent older adults through interprofessional collaboration. This research aims to develop a guideline for conducting a nurse-led oral care assessment and care plan for care-dependent older adults. It will involve the development of training and other resources to support the implementation of the guideline by enhancing nurses’ knowledge and confidence and encouraging the normalisation of daily oral care in nursing practice.

The role of oral history

Oral history has an important role in preserving the lived experiences of nurses who have gone before us. The life stories of our nurse elders preserve knowledge about nursing practice and patient care in health systems over time. They also capture how these nurses have responded to the challenges they have encountered in their professional lives. Heather Woods, the NZNO librarian, has contributed an article for our methodology section in this edition emphasising the importance of oral traditions in recording and enriching our nursing culture.

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References

Ceci, C., Pols, J., & Purkis, M. E. (2017). Privileging practices: Manifesto for “New Nursing Studies”. In T. Foth, D. Holmes, M. Hülsken-Giesler, S. Kreutzer & H. Remmers (Eds.), Critical approaches in nursing theory and nursing research. Implications for nursing practice (pp. 51–67). V & R Univeritätsverlag Osnabrück.

Garces-Ozanne, A., & Carlos, M. R. (2022). An exploratory study of workers in the residential aged care sector of New Zealand: what drives them to stay or leave? International Journal of Social Economics, 49(6), 867-881.

Hoeck, B., & Delmar, C. (2018). Theoretical development in the context of nursing —the hidden epistemology of nursing theory. Nursing Philosophy, 19(1), e12196.

Moir, C., Taylor, P., Seaton, P., & Snell, H. (2022). An Evaluation of Barriers and Facilitators for a Pressure Injury Prevention Link Nurse Role: A Mixed-Methods Study in New Zealand. Journal of Wound, Ostomy and Continence Nursing, 49(4), 314-321.

Moroney, T., Gerdtz, M., Brockenshire, N., Maude, P., Weller-Newton, J., Hatcher, D., Molly, L., Williamson, M., Woodward-Kron, R. & Molloy, E. (2022). Exploring the contribution of clinical placement to student learning: A sequential mixed methods study. Nurse Education Today, 113, 105379.

Ohtake, P. & Childs, J. (2014). Why publish study protocols? Physical Therapy, 94(9), 1208-1209.