FROM THE EDITOR: Giving voice to nurses’ expertise, resilience, endurance and creativity

TĒNĀ KOUTOU, TĒNĀ KOUTOU, tēnā tatou katoa.

Welcome to the 2021 edition of Kai Tiaki Nursing Research. This year has brought further significant COVID-19-related challenges for nurses working in all fields of practice, from clinical settings to education and research. As we know, these challenges have been amplified by the emergence of the Delta strain in community-acquired infections in 2021. Nurses have been core in managing the Aotearoa New Zealand response to the pandemic, across all sectors of the health service. Nurse educators and nurse researchers have flipped teaching and data collection online with skilled determination to overcome the limitations of the social distancing required in their fields. Our postgraduate students have also shown remarkable determination in completing their programmes of learning, albeit with support from their lecturers and supervisors. The pandemic has highlighted nurses’ skilful participation in responding to the health needs of our people and their communities.

Maximising the contribution that our existing nursing workforce can make to population health outcomes has been one of the drivers of postgraduate clinical education in Aotearoa New Zealand in recent years (Holloway, 2012). Postgraduate education has enabled nurses to gain advanced knowledge and skills to more capably respond to the demands of rapidly changing and increasingly complex health-care environments, including the COVID-19 pandemic. A capable nursing workforce is the most important factor determining the ability of health services to provide safe and high-quality care (Torabizadeh et al, 2019). Capability describes the expertise, resilience, endurance and creativity of nurses working to the top of their regulated scope of practice, who can respond to challenging, unexpected, unusual and demanding clinical and professional situations. In other words, they can capably work beyond their usual comfort zone, using a complex combination of knowledge, skills and professional self-awareness (O’Connell et al, 2014).

Capability is underpinned by macro-level thinking, or recognition of demographic, epidemiological and social determinants of health that affect a specific client’s experience of health. Macro-level thinking – underpinned by research evidence and knowledge about how nurses can respond more ably – is central to widening nurses’ thinking about the client and their situation (Hean et al, 2009). Postgraduate education enables nurses to engage with research, both as end users working in evidence-based activities that have direct application to practice, and in conducting research that illuminates nursing’s voice in interpreting what nurses know and how they think in practice. Nursing research documents practice knowledge derived from the cumulative integration and synthesis of multiple and challenging care experiences (Tanner, 2006). It is imperative that nurses emerging from postgraduate programmes are supported to publish their research as new voices informing nursing knowledge and practice in Aotearoa New Zealand.

Nursing workforce

The health and wellbeing of a nursing workforce is core to the effectiveness of any health service. The COVID-19 pandemic has illuminated the work nurses do in health services, but what is less well understood is how it has strained an already stretched nursing workforce (Gottlieb et al, 2021). Gottlieb et al suggest the pandemic has also exacerbated challenges in nursing leadership and had an impact on nurses’ agency and autonomy in their practice. Sustaining the nursing workforce within the demands of a pandemic requires nurses to feel empowered at work.

Nurses’ experience of living and working with a disability or impairment was the focus of research by Hughes, Rose and Trip in this issue. The findings of this study suggest nurses are committed to safe nursing practices, but many of the participants in this study did not feel safe to disclose disabilities or know where to seek support. These authors note that more effective support for nurses who have disabilities may help them to remain in the workforce. Moss, Were and Pipi conducted an evaluation of a national Māori nursing and midwifery leadership programme. The key themes from the findings of this evaluation – whakamana, or a sense of empowerment, and ngā manukura, a concept that speaks to starting or progressing leadership journeys – were vital elements of personal, professional and cultural development. The findings of this evaluation also suggest that the kaupapa Māori approach of the programme may help Māori clinical leaders to address future health workforce needs.

Miles, Lea and Ritchie evaluated the experiences of nurses working in decentralised workstations in New Zealand hospitals to understand more about the intersection of the physical environment and its impact on nurses and the delivery of nursing care. The findings of this study suggest that while there were benefits for patients in having nurses close by, nurses experienced isolation from their colleagues, lack of space in the decentralised nursing station, and limited knowledge of other patients on the ward.

Evidence-based nursing practice

Evidence-based practice can be defined as “the conscious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (Aliki & Young, 2019, p. 137). It involves the interaction of best available evidence, the patient context and preferences, and clinical expertise. The following studies in this section highlight the importance of considering multiple sources of information to inform diagnostic reasoning and clinical judgement. McChesney and McClunie-Trust explored factors influencing anticipatory prescribing in community palliative and end-of-life care. Key themes identified in this meta-synthesis included expertise (knowing when to prescribe and knowing how to prescribe), teamwork and prioritisation. The study concludes that developing and maintaining expertise in primary palliative care, developing better interdisciplinary teamwork, and prioritising anticipatory prescribing practice are key factors underpinning effective palliative and end-of-life care.

The influence of a pulmonary rehabilitation education programme on health outcomes for people with chronic obstructive pulmonary disease (COPD) was the focus of an integrative review conducted by Chiyesu. The findings of this review suggest there is insufficient evidence to demonstrate the influence of this intervention on health outcomes. Further research is required to ascertain whether pulmonary rehabilitation education would be beneficial in the New Zealand context. A literature review by Nadeem and Healee explored the effectiveness and validity of the Waterlow scale in preventing pressure injuries in acute-care settings. The review identified that the Waterlow scale has limited reliability and validity in assessing the risk for pressure injuries in acute-care settings, and further research is needed to test the scale in this context.

Ryan’s study on the relationship between health outcomes for rural and urban patients and their proximity to a primary health care provider found that there was little difference between these populations in terms of HbA1c levels for people with type 2 diabetes mellitus. The study found people living rurally were more likely to be diagnosed with depression than those living in urban areas. A meta-synthesis by Harrison and Mercer explored the use of rapid antigen detection tests (RADT) for the diagnosis of group A streptococcus (GAS) for children who have clinical symptoms of pharyngitis. The findings of this review suggest that there are advantages in using RADT for more timely diagnosis and treatment of GAS infections, for reduction in the spread of GAS infection and therefore potential reduction of rheumatic fever hospital admission rates.

Methodology focus

In keeping with the principle of kaitiakitanga (NZNO, 2019) or guardianship of nursing research in Aotearoa New Zealand, fostering emerging researchers is a key responsibility for the Kai Tiaki Nursing Research journal. In this edition, two experienced researchers share their methodological “know how”, reflecting on their experiences of using methodologies to guide nursing research. Litchfield draws on her long experience in research to offer a rationale for nursing as a paradigm that frames nursing “research as-if practice”. Research as-if practice enables nurses, as practitioner researchers, to communicate nursing knowledge and expertise as practice wisdom for the distinctly nursing perspective of health in Aotearoa New Zealand.

In a different, but distinctly practical research approach, MacKenzie used a transdisciplinary research (TDR) methodology to explore some complex issues associated with the position of enrolled nurses in the Aotearoa New Zealand health workforce. Central to the TDR approach is the idea of “wicked problems” that require creative and flexible solutions derived from the perceptions and opinions of stakeholders as participants or key informants in research. The inclusion of viewpoints beyond the assumptions and perspectives of specific disciplines, where diverse voices with unique perspectives on how problems can be solved can be heard, is central to the TDR approach.

Finally, in the last article of the 2021 issue, Stodart and Woods explain how articles in each issue of Kai Tiaki Nursing Research are shared with the international world of practice and scholarship, via their inclusion in a range of international research databases. Some limited data is available from one of these databases about which articles are being downloaded and in what quantity, giving a tantalising glimpse of the reach and influence of this research journal.

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References

Aliki, T., & Young, M. (2019). Evidence-Based Practice and Clinical Reasoning: In Tension, Tandem or Two Sides of the Same Coin? – Clinical Reasoning in the Health Professions. In J. Higgs, G. Jensen, S. Loftus & N. Christensen (Eds), Clinical reasoning in the health professions (4th ed.), (pp. 137-146). Elsevier Limited.

Gottlieb, L. N., Gottlieb, B., & Bitzas, V. (2021). Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L). Journal of Healthcare Leadership, 13, 169-181.

Hean, S., Craddock, D., & O’Halloran, C. (2009). Learning theories and interprofessional education: a user’s guide. Learning In Health & Social Care, 8(4), 250-262.

Holloway, K. (2012). The New Zealand specialist framework: Clarifying the contribution of the nurse specialist. Policy, Politics, & Nursing Practice, 13(3), 147-153.

New Zealand Nurses Organisation. (2019). Guideline – Code of ethics.

O’Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728-2735.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.

Torabizadeh, C., Rakhshan, M., Freidooni, Z., Beygi, N., & Bijani, M. (2019). Professional capability in nursing. International Journal of Pharmaceutical Research, 11(1), 556-566.