Kaitiaki — guardianship of nursing knowledge

TĒNĀ KOUTOU, TĒNĀ KOUTOU, tēnā tatou katoa.

Welcome to the 2022 edition of Kaitiaki Nursing Research. The statement in this edition about the corrected name for the journal demonstrates what can happen when cultural representations are appropriated without consent or understanding, however well-meaning. It also raises questions about how nursing might respectfully engage with tikanga, reflecting the traditional knowledge and practices of Māori, to enhance nursing knowledge for the health and well-being of all people in Aotearoa.

This potential for appropriation reminds us that, as nurses, we need to kōrero with Māori as individuals, whānau and iwi to reflect on the most important things that will make a difference for people engaging with nurses in health-care services. We also need to study the findings of research published on the experiences of Māori in the health system to recognise what needs to change to create a more equitable environment for care that safeguards the cultural values and beliefs of health consumers (Graham & Masters-Awatere, 2020; Palmer et al., 2019). We should also not assume that what we are doing in our efforts to be culturally safe or responsive is right, without engaging in conversations with clients, whānau and colleagues. It is important for nurses to recognise that all people they encounter in health-care contexts have their own unique understanding of cultural knowledge that is relevant to their circumstances and their interactions with nurses (Tipa, 2021).

Kōrero needed on kaitiakitanga

From a Māori worldview, kaitiakitanga represents values and practices involving guardianship (NZNO, 2019) and conservation of the environment and its relationship to the health of communities (Royal, 2007). Royal identifies the role of kaitiaki as a person or group that carries out the role of guardian or conserver. So what does this idea of guardianship mean for Kaitiaki Nursing Research? This journal has an important role in disseminating research that represents the central and unique role of nursing’s contribution across the whole range of health-care services in Aotearoa New Zealand. But we need to kōrero with our nursing whānau across the whole spectrum of nursing roles to imagine how this journal might fully engage in kaitiakitanga for nursing practice and nursing research in Aotearoa. That is our challenge for the next year.

In this time of struggle to staff health services with nurses, as Litchfield notes in her guest editorial, there has never been a more important time to ensure that the contribution of nursing to health services and population health is made visible to the people of Aotearoa. The COVID-19 pandemic has offered opportunities for new ways of thinking in response to situations that are beyond our experience in living memory. Nursing responses, and the wisdom these responses have made visible, need to be recorded for future generations of nurses who find themselves similarly challenged.

This year’s edition presents articles that address some key issues in nursing education, practice and research. The first two articles explore opportunities to engage nursing students in activities that will support them as graduates entering health services that have high demand. Moir and Baby researched whether teaching communication skills early in a master of nursing science programme enabled graduate-entry nursing students to develop confidence in dealing with aggression in practice. Violence and aggression toward nurses have been exacerbated by the COVID-19 pandemic, and nursing students sometimes bear the brunt of aggression from both clients and staff in clinical practice settings. This study highlights that offering communication skills training early in the programme enables nursing students to develop confidence in dealing with aggression across all areas of health care.

Students expressed empathy and compassion

Nurse educators Bingham and Malone researched whether an educational intervention, based on face-to-face sharing of narratives with those who have a lived experience of mental illness and addiction, resulted in the expression of empathy and compassion by nursing students. In their study, an educational intervention was incorporated into the teaching and learning of mental health and addictions concepts in the bachelor of nursing curriculum, based on principles of narrative learning. The results indicated that a significant number of the student participants expressed empathy and compassion after listening to the narrative of a person who had experienced mental illness and/or addiction. The authors suggest that this intervention could be useful to enable nursing students to develop a deeper understanding of how to relate to people who have experienced mental illness and/or addiction.

Increasing nurses’ job satisfaction is one of the main considerations in enabling the delivery of high-quality patient care, and retention of nurses in the health workforce (Slåtten et al., 2022). Othman conducted a literature review to explore the impact of nursing managers using a transformational leadership style and its effects on nurses’ work satisfaction and retention. This review found that transformational nurse leaders have a positive impact on the quality of nurses’ working conditions, helping create a healthy work environment and supporting the autonomy of nurses in their clinical roles. Nurses’ mental health, job commitment and commitment to the organisation are crucial factors in their job satisfaction, which is an important consideration for health-care providers who are struggling to staff services with nurses.

The challenges of using clinical guidelines

Evidence-based clinical guidelines are an essential tool for nurses managing clients with complex conditions. Clinical guidelines enable the transfer of research-based knowledge into practice, with the understanding they are used alongside nursing judgment about what best fits the clinical context and the client’s preferences (Menlyk & Fineout-Overholt, 2011). However, Menlyk and Fineout-Overholt note that it can be challenging for nurses to incorporate evidence-based guidelines into everyday practice. Donkin et al. explored nurse perspectives on barriers and facilitators of implementing the nationally endorsed stroke guidelines, in a New Zealand acute stroke unit. The findings of this research contribute to understanding the barriers and facilitators nurses may face in using clinical guidelines, and offer ideas about how to enhance their use in this practice context.

People with long-term conditions such as diabetes, hypertension, chronic respiratory diseases, dementias, and chronic renal and liver diseases require complex and ongoing care. The research brief for this edition offers a summary of the findings from an integrative review on whether home visits from nurse practitioners improve outcomes for people living with long-term conditions. Laidlaw and Mercer found the research reported that home visits from nurse practitioners reduced barriers to care and improved the health and quality of life for people with long-term conditions. However, further clarity is needed in health teams about the potential role of nurse practitioners in providing equitable and accessible health care for high-risk populations.

To identify the most relevant research for practice, access to the most pertinent information is essential. This requires nurse researchers to apply the right kind of search strategies, including a clearly defined systematic search process. International databases contain a wealth of knowledge, but finding relevant published research can be daunting and confusing without the support of an experienced librarian. In the final article for the 2022 edition, Reynolds et al. present an example of an ordered and systematic advanced search process, providing a step-by-step guide for how an evidence-based review question could be searched in library databases.

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References

Graham, R. and Masters-Awatere, B. (2020), Experiences of Māori of Aotearoa New Zealand’s public health system: a systematic review of two decades of published qualitative research. Australian and New Zealand Journal of Public Health, 44, 193-200.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Implementing evidence-based practice: Real-life success stories. Sigma Theta Tau International.

NZNO. (2019). Code of ethics.

Palmer, S. C., Gray, H., Huria, T., Lacey, C., Beckert, L., & Pitama, S. (2019). Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis. International Journal for Equity in Health, 18, 163.

Royal, Te Ahukaramū Charles. (2007). Kaitiakitanga – guardianship and conservation – Understanding kaitiakitanga. Te Ara – the Encyclopedia of New Zealand.

Slåtten, T., Lien, G., & Mutonyi, B. R. (2022). Precursors and outcomes of work engagement among nursing professionals – a cross-sectional study. BMC health services research, 22(1), 1-15.

Tipa, Z. (2021). Mahi Ngātahi: Culturally responsive ways of working with whānau accessing Well Child/Tamariki Ora services. Doctoral dissertation, Auckland University of Technology.