Guiding and fostering nursing research

THE INAUGURAL EDITION OF the annual journal Kai Tiaki Nursing Research was published in 2010. The naming of the journal was significant because the words “kai tiaki” are derived from kaitiakitanga. The meaning of “tiaki” is “to guard, preserve, foster, protect and shelter” (Te Ara, 2007). Since 2010, Kai Tiaki Nursing Research has generated a body of knowledge and evidence for nursing practice that reflects the interests and concerns of nurses from differing perspectives across the breadth of nursing in Aotearoa New Zealand. The journal also serves as a medium to foster nurses as both emerging and experienced researchers, especially in publishing research that is relevant to our local context.

While the research published in Kai Tiaki Nursing Research represents a comprehensive body of knowledge for nursing, there are some gaps in its representation of voices and interests across the profession. Three key themes in this edition attempt to address those gaps, including representation of the work of Māori nurse researchers, research on health disparities, and support for emerging researchers.

The guest editorial by Tipa explores the significance of kaupapa Māori research methodology in challenging dominant cultural approaches to conducting research with Māori, and the importance of legitimising Māori knowledge in nursing research. We encourage Māori nurse researchers to publish their research and become a stronger voice in future editions of this journal. Research on the contribution nursing could make to reducing inequalities in health outcomes and avoidable hospital admissions is also a focus of this edition, particularly in relation to disparities between Māori and Pākehā.

Nursing workforce

Contemporary approaches to developing the nursing workforce need to look beyond models that have served past health-service needs. The World Health Organization (WHO, 2016, p. 12) advocates investment in transformative education, streamlining education pathways for people wishing to change careers from other disciplines to the health professions, enabling direct entry of graduates from other professional fields. Jamieson and Harding present a case study reporting on the establishment of the first graduate-entry nursing programme in New Zealand. The research captured the views of key stakeholders on the complexities and success of the programme, which is now in its seventh year.

Increasing the number of Māori and Pacific nurses is another contemporary issue for the nursing workforce in Aotearoa New Zealand. One strategy to reduce health disparities between Māori and Pakeha involves “localisation” (Callister, Badkar & Didham, 2011) – increasing the number of Māori health workers and using Māori knowledge to improve health outcomes. Chittick, Manhire and Roberts examined the experiences of Māori graduate nurses to understand factors that help Māori students succeed in a bachelor of nursing programme. The research noted that providers of tertiary education and clinical learning environments could do more to create teaching and learning environments that are culturally appropriate for Māori. Registered nurses also need to develop more cultural competence in working with Māori nursing students in clinical practice.

Reducing health disparities

The New Zealand Health Strategy (Ministry of Health, 2016) proposes a health workforce for the future focused on community-based services. These services would deliver people-centred care which encompassed social determinants of health, health promotion, disease prevention and management of long-term conditions. Nurses have an obligation to find ways to engage all cohorts of our population with health services, particularly people with long-term conditions. The Tāne Takitu Ake programme combines cultural, physical and clinical interventions to build cultural competency, increase health literacy and provide tools to improve well-being. Ryan’s research on this health programme, specifically designed for Māori men, showed how the health-service environment is integral to providing a culturally safe, relational space for self-growth and for tāne to learn about their health and well-being.

Taylor, Budge, Hansen, Mar and Fai evaluated the relationship between care planning and support for health goals for a sample of Māori and non-Māori clients with long-term conditions. The study found that people with documented care plans were more active in managing their health and reported better interactions with health professionals. More Māori than non-Māori reported having a written care plan, and support for health goals in the absence of a written care plan. The findings of this study suggest that providing written care plans and support for health goals appears to benefit people with long-term conditions, but there are challenges in embedding care planning into routine primary care.

Immunisations are effective in preventing communicable diseases, but a proportion of children in Aotearoa New Zealand have either missed or delayed vaccinations. Wyllie-Schmidt, Tipa and McClunie-Trust conducted an integrative review of the international research on factors affecting timely immunisation of children. The findings of this review suggest that child poverty is a significant barrier to timely immunisations. Health literacy, level of formal education, income, and accessibility of health services for families are important contributing factors that nurses need to consider in providing immunisations.

Quality care

The health-service contexts nurses work in affect their ability to provide safe, appropriate and professional care. Research by Westrate, Cummings, Boamponsem and Towers investigated factors influencing compliance with disability and health service standards for aged residential care facilities. They were interested in how much the outcomes of individual certification audits have changed over time and what factors possibly influenced this change. The research concluded that the 2016 level of compliance with the standards had significantly increased from previous audits.

The literature review by Donaldson explores the emerging need for emergency departments in New Zealand to establish specialist roles for forensic clinical nurses. The findings of the review suggest nurses potentially lack the specialist education in forensic nursing needed to manage the medico-legal requirements of some situations presenting to emergency departments. These situations include documenting the handling of evidence for victims of violence or unexplained death.

Research briefs

The research briefs in this issue provide limited reports on research that has implications for the nursing workforce. Wraight reports on research using a clinical communication assessment framework (CCAF) to assess the English-language proficiency of internationally qualified nurses with English as an additional language. This pilot study found the CCAF assessment tool allowed easy identification of the specific clinical English-language training needs of IQNs, to ensure their success in the clinical environment, beyond the minimal requirements for registration.

Ledesma-Libre’s research explored factors influencing nurses’ decision to work in mental health services for older people (MHSOP), including their perceptions of the service. This research suggests that nurses attached importance to the idea of being able to use all of their skills to provide the most comforting and therapeutic environment for their patients. Despite challenges experienced in the work setting, MHSOP nurses are generally motivated to continue working in this specialty.

Methodology focus

Supporting emerging researchers to undertake and publish research is a significant responsibility for the nursing profession. Experienced researchers are encouraged to publish methodological reviews and critiques in this journal that relate their “know how” and practice expertise to guide our emerging researchers. In this issue, two experienced researchers share their experiences of using particular methodological approaches. Crawford reflects on her use of focused ethnography to study nurse-parent emotional interaction, while Lesa shares her experience of designing a research case study to examine how nursing students experience simulation as an environment for learning.

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References

Callister, P., Badkar, J., & Didham, R. (2011). Globalisation, localisation and implications of a transforming nursing workforce in New Zealand: opportunities and challenges. Nursing Inquiry, 18(3), 205-215.

Ministry of Health. (2016). New Zealand Health Strategy: Future direction.

Te Ara. (2007). Kaitiakitanga – guardianship and conservation.

World Health Organization (WHO). (2016). Global strategy on human resources for health: workforce 2030.