Abstract
This time last year I hoped that by this September we would be moving towards a balance between the familiarities of our pre-virus lives and the virus-driven changes of a newer order and, to some extent, that new balance is being forged through the roll out of effective COVID-19 vaccines. Ironically, but not unexpectedly, the positive impact of this gamechanger has not been felt equally, with its global impact being dulled by a noxious mix of vaccine-privilege and vaccine-hesitancy. As Sumengen et al. remind us, vaccine-hesitancy is, of course, neither new nor entirely incomprehensible but its combination with unequal access to COVID-19 vaccines confirms that vaccinating the world, simultaneously, is an impossible dream. Governments’ hesitancy to move forward together puts our well-being at risk, and another trepidatious year lies ahead for us all.
More generally, hesitancy is something that we all recognise every day in our personal or working lives and those of our patients/clients and their families. This month’s issue highlights several areas where nurses and patients have been hesitant in their actions, and where understanding and minimising hesitance could improve either quality of care and/or quality of life. For example, Gibson et al. draw our attention to ways through which nurses may be able, for people who have had a stroke, to reduce their hesitancy to adhere to their medication and Wagoro and Duma illustrate how a new Kenyan model of mental health care, which emphasises homeliness rather than hostility, may improve services and reduce people’s hesitancy in using them. Building confidence in care or medications is key to minimising hesitance when we think about vaccine-hesitancy and treatment-adherence, but it is also central to building assured, knowledgeable practitioners as Walsh et al.’s paper suggests. Confident practitioners will be more able to deliver care with certainty and make sure that the right and best patient-focused care is available and provided.
It pained me to read the papers by Ekpenyong et al. and Doshi et al. – dignity and mouthcare are such fundamental elements of care that I wondered how either could have escaped normalisation and still be shrouded with hesitance. But then, of course, I was presuming that what is fundamental to one generation of nurses remains fundamental to all. However, the changing context of care inevitably impacts on the components of care. If there is less time, less resource and less push to ensure that care is completed, then some things are forced off our list of essentials. Hesitancy to work in a certain way soon becomes normalised and our guiding principles shift accordingly unless they are deeply enculturated or systemically embedded in our working practices and organisations’ monitoring mechanisms. Together, these papers show that nurses and the people they work with can be hesitant in both learning and prioritising best practice and responsibility.
There is, however, a balance to be struck. The trick is to minimise the hesitancy that harms and maximise the hesitation that can allow us to think through the pros and cons of our actions, alert us to poor practice, or create the space to justifiably question what we do – and what is done to us – as a profession. When we, either as researchers or practitioners, create the necessary space to pause, stand back and document the decline in essential care such as dignity or mouthcare, we can uncover the early signs of deterioration in the quality of care, which in turn points to a wider professional malaise we need to find and rectify. That malaise must surely reflect the recent worsening of the well-being of nurses. JRN this year continues to highlight this as a concern that needs urgent and particular actions, aptly summed up by Joanne Bosanquet in last month’s issue (https://journals-sagepub-com-s.web.bisu.edu.cn/doi/full/10.1177/17449871211031708) and in our Special Collection on Wellbeing (https://journals-sagepub-com-s.web.bisu.edu.cn/page/jrn/collections/virtual-special-issues/wellbeing). We need, as a profession, to continue to focus on well-being whilst seeking out the markers that highlight, in advance of serious breaches in care, where our profession itself needs care.
Finally, Hidalgo’s closing Perspectives piece focuses on the Rural Health Conversation JRN facilitated recently (https://www.youtube.com/watch?v=X2rHx8E1u_A) and reminds us that reluctance to support people in rural and remote communities appropriately and sufficiently will risk their well-being, and the well-being of those who provide care and support to them. Surely this is true for all our communities. Nurses cannot do what is required of them with confidence, skill and empathy if they are impeded by their own, their clients’ or our leaders’ hesitancy to act.
So we must all ask ourselves, what we can each do to support nurses and nursing at a time when we are short on personal and professional energy and resources, and governments hesitate to enable nursing and health and social care workforces to recuperate from the demands of the pandemic. For our part, JRN, although only a tiny bit of the picture, endeavours to bring readers evidence that will diminish unnecessary hesitance in nurses’ practice. This should, nevertheless, allow the necessary pause for thought that permits us to build the confidence needed to enable the best care available.