Abstract
I am delighted to present the final edition of JRN for 2019, which offers a rich mix of papers and commentaries and a deeply thought-provoking Perspectives piece.
Using a variety of approaches, all the papers in this edition make connections through research to inform policy or practice. Two papers look for patterns and connections in the published literature, three have employed qualitative, and four quantitative approaches. One has reviewed research activity, and another presents an evaluation of a nurse-led service innovation.
The paper by Gammon and colleagues examined the literature to identify if there is a reported association between stigma and source isolation. They concluded that there was, and recommend practitioners and policymakers take appropriate steps to mitigate negative feelings associated with the stigmatization patients feel when they are cared for in isolation.
DeFord and colleagues’ narrative literature review surfaced the risk factors associated with substance abuse amongst staff involved in the provision of anaesthesia. They concluded that there is a gap in our knowledge of the prevalence of substance abuse amongst student registered nurse anaesthetists in particular, and whether preventative strategies delivered in an education setting were effective.
Wood and colleagues report an ethnographic study undertaken to develop understanding of nurses’ and patients’ interpretation of ‘direct patient care’ in a hemodialysis unit. Their insights serve to challenge traditional interpretations of direct patient care used when assessing nursing ‘efficiency,’ and provide insights for managers of health care services and designers of health care environments.
Fawkes and Moore report on a study that used interpretative phenomenological analysis to increase understanding of newly qualified nurses’ readiness to provide patient education in acute settings. In the face of an increasing policy push for the self-management of health conditions, the authors identify a disconnect between the realities of both educational and clinical practice and patient need for education if they are to self-manage effectively. Ominyi and colleagues report on a qualitative case study across two Nigerian acute care settings developed to examine the impact of bureaucratic managerialism on initiatives to implement evidence-based practice and improve the quality of patient care. Here, the pull for cost containment appeared to undermine the push for quality improvement, and the authors concluded that nurse managers required more power to create the conditions for evidence-based practice to flourish.
Johnson and colleagues used a cross-sectional survey to investigate relationships between bullying, discrimination, burnout, and patient safety in nurses and midwives. They demonstrated connections between bullying and discrimination, and burnout. In this study, experiences of discrimination were three times more common amongst Black and Minority Ethnic (BAME) than White nurses and midwives, but there was no significant difference in experiences of bullying. Burnout was shown to impact negatively on individual and ward level perceptions of patient safety, and the authors called upon healthcare organisations to implement strategies to reduce workplace bullying and discrimination in order to improve patient care.
Acknowledging that emergency department (ED) visits for mental health care were on the rise across North America, Mowbray and colleagues undertook a secondary data analysis of 13,114 mental health-related ED visits in Ontario. Using logistic regression with generalized estimating equations modelling, their findings suggested age, season, time of day, access to primary health care, mode of arrival, hospital type, referral source, and patient diagnosis may be predictive of non-urgent emergency department use for mental health care, thus assisting clinicians and policy makers in identifying and managing patients using the ED for non-urgent mental health care. Again in the ED, Al-Abdallah and Malak investigated factors correlated with prolonged fatigue among ED nurses in Jordon using a descriptive correlational study design. They concluded that prolonged fatigue is a multidimensional phenomenon that can be affected by a number of factors, including job-related psychosocial factors and psychological health – factors which, they argue, should be taken into account when developing and testing interventions to minimize prolonged fatigue.
Mousavi and colleagues also undertook a descriptive correlational study focusing on the correlation between happiness and professional autonomy in a sample of Iranian nurses. Their conclusion, that more attention should be paid to happiness and professional autonomy by those seeking to increase the efficiency of nursing care, is a stark one.
Ndyetukira and colleagues reviewed two multi-site HIV clinical trials in order to highlight the contribution of research nurses in sub-Saharan Africa. The authors concluded research nurses play a key role in communicating clinical research goals to patients, obtaining informed consent, minimizing loss to follow up and ensuring that research practices are translated and written into standards of care. They acknowledge, however, that more work needs to be done to ensure that non-study patients receive the same level of care as clinical trial participants.
The Leask and Tennant paper presents an evaluation which tested the feasibility of a model of care where advanced nurse practitioners provided unscheduled afternoon visits that would otherwise have been undertaken by a general practitioner (GP). The authors report that the service was deemed both feasible and acceptable to patients and GPs. Consideration was given to the potential of rolling out the service to other practices and involving practitioners from other disciplines.
The Perspectives piece by Sanderson and Dawe that concludes this edition is a sobering read. It reminds us that we neglect the health and wellbeing of our colleagues and the nursing workforce at our peril. There is not a shadow of doubt that we are nursing in extraordinarily challenging times, where the demand for nursing care is outstripping supply, policy is lagging behind in its response, and practitioners are shouldering the burdens of workforce insufficiency and policy failure. There is a personal cost, which is unacceptable, and nursing as a service is becoming increasingly unsustainable. Nevertheless, it is encouraging to read of the proactive role researchers are playing in helping to address what is nothing short of a crisis in health care.
2020 has been identified by the World Health Organization as the year of the nurse and midwife. We can, and we must, collectively make the connections needed to capitalise on the leverage such exposure will offer us, whilst being mindful that a single year of attention can only be the start of any campaign to address the challenges we face. We must all, at every level, create space for intelligent thinking about how our profession should develop and is sustained. Then, we must take on the most difficult task of all: transforming thought to action by lobbying for significant investment to improve the health and well-being of the global nursing and midwifery workforce and those in our collective care.