Abstract
I recently had the privilege of attending the 2016 Robert Burns Humanitarian Awards. At the awards ceremony, a Scottish government minister spoke of the very real potential of a collective sense of despair in the light of recent and current global events. The shortlisted candidates, he said, demonstrated that when humanity seems to be at its lowest point, the true potential of the human condition most often shines through. The humanitarian acts of the three men shortlisted for the 2016 award demonstrated just that. The message from the minister was, essentially, don’t despair, be inspired.
It was indeed both humbling to learn of the personal sacrifice and commitment of each of the shortlisted candidates and it was inspiring to hear of the impact of their endeavours. The winner of the 2016 award was David Nott, a UK surgeon who for over 20 years has practised surgery in conflict and natural disaster zones including Bosnia, Afghanistan, Pakistan, Iraq, Syria, Yemen, Liberia, Chad, Ivory Coast, Libya, Sierra Leone, Central African Republic, Democratic Republic of the Congo and Haiti, very often at great personal risk. Clearly a man with exceptional skills and intellect, nevertheless his acceptance speech was tinged with humility. I could only imagine the Scottish poet Robert Burns, in whose name the awards are made, would have been impressed. The egalitarian Burns would expect no less, that each and every one of us use our skills and talents for our collective wellbeing ‘A man’s a man for a’ that’.
In my experience as a nurse, I have been humbled and inspired almost every day of my career by colleagues who presume their extraordinary acts of human kindness and compassion to be nothing more than ordinary. They are not, and we should do much much more to acknowledge the contribution of nursing, not just in the face of conflict and natural disasters, but in the mundane messiness of everyday practice. The trouble is’ ‘though that good nursing care is often only visible to the untrained eye when it is set against poor care (or indeed no care). Arguably this can make it something of a challenge to defend the value of nursing if it is only recognised or valued when it is suboptimal. And it is ironic that it is the most expert of nurses, whose impact on the lives of individuals in their care is arguably the most profound, whose contribution is most poorly understood, or valued, by those who hold the purse strings.
But I will not despair. I will remain inspired, and I will continue to do whatever I can to make nursing more visible and valued, while recognising, for the reason outlined above, that in doing so, it may feel like I’m swimming against the tide. But I won’t despair, because I’m not alone, I am surrounded by inspirational nurses and supporters of nursing, and together, when we organise ourselves, we can make a significant impact on the collective consciousness of the value of nursing and the difference nurses make because of their humanitarianism, their knowledge, their skills and their intellect.
This journal aims to make the connections explicit between nursing knowledge, the practice of nursing and health and social care policy. Therefore we have decided that our contribution to making nursing visible and valued will be through the establishment of an annual prize for the paper we have published within a calendar year that has impacted, or is deemed to hold the greatest potential to impact, on nursing practice or health and social care policy. We have rightly decided to name this award after our founding editor. Veronica Bishop established this journal under the title of NT Research in 1996 and provided inspirational leadership for over 14 years. It is therefore with great pleasure that Andrée and I formally launch the JRN 2016 Veronica Bishop Award and invite our readership to nominate a paper published in JRN in 2015. Eligible papers were published in volume 20.
Details of how you can submit your nomination are available on our webpage jrn.sagepub.com. The deadline for nomination is Friday 13 May. The editorial board will draw up a shortlist and a distinguished panel will select the best paper of 2015 based on the compelling nature of the nomination and the quality of the nominated paper. The winner will receive £100 SAGE book vouchers.
This edition contains four papers, which of course are not eligible for the prize announced above but will be eligible for our 2017 award. There are also two reports of lively professional debates in our open-access perspectives section at the end of this edition.
Two of the papers focus on end of life care, the first, by Charman and Esterhuizen, takes a phenomenological approach to increase understanding of doctors’ decision making at the end of life. Born from a sense of conflict and dissonance between the first author, an experienced specialist nurse in palliative care, and trainee oncology doctors in practice, this paper and its associated review clearly speak to practice and inform what underpins some of the challenges of working within a multidisciplinary team at the end of a patient’s life. One issue the paper highlights is that the lack of recording of patients’ wishes at the end of life by their primary carers creates a significant burden on junior doctors who, when on call, care for patients they don’t know. Moreover, they feel a duty to follow the preferences of the lead consultant to whose care the patient is assigned. Not only did this study contribute to knowledge, the research process proved to be both insightful and cathartic for the research participants, further demonstrating the value of clinically driven, carefully considered and sensitively conducted nursing research in this context.
The second paper which focuses on end of life care by Wye et al. offers an evaluation of a tool developed to endeavour to ensure that patients’ end of life care wishes are identified, recorded, shared and wherever possible, adhered to. The tool is an electronic patient record available for use by all relevant health and social care providers, for all patients assumed to be within the last 12 months of their life. Hitherto, high level quantitative analysis of data reported that use of the tool appeared to increase the chances of patients dying at home, their preferred place. Indeed, these studies have been cited to justify the use of the tool. An economic assessment has highlighted the costs avoided from hospital admissions, presumably helping to justify the costs of the tool itself. Wye and colleagues scratched beneath the surface of these reports and conducted a mixed methods study to understand better any relationship between the use of the tool and home death.
The authors conducted their mixed methods service evaluation in two English counties where the tool had been implemented. Their analysis led them to challenge assumptions that the tool itself could be directly attributed to any increase in home deaths. In concert with Charman and Esterhuizen, they highlight the reluctance of some professionals to have ‘end of life’ discussions and the problematic nature of professional silo working (and therefore decision making). They argue it is these longstanding cultural issues that need to be addressed, if patients’ wishes at the end of their lives are to be met. It was only by adopting a mixed methods approach that these underpinning issues surfaced.
In the third paper in this edition, Gharaibeh et al. explore the relationships between diabetes self-care management, depression, self-care agency and self-efficacy using statistical modelling techniques. A better understanding of the relationships between these concepts, they argue, is good for people living with diabetes and using insulin, good for professionals caring for these patients and good for the economy as self-care shifts diabetes management responsibilities away from professionals and back to patients. However, they acknowledge the limitations of their study and call for more research in the field.
In the final paper in this edition, Fallatah and Laschinger contribute to the global debate on the recruitment and retention of newly qualified staff, within a Canadian context. They posit that authentic leadership theory offers managers the means to create positive and supportive environments that facilitate the transition of newly qualified nurses into professional practice. The consequence of which, they argue, benefits the nurses themselves as well as the organisations that employ them. The authors tested a theoretical model linking authentic leadership to newly qualified nurses’ job satisfaction. Their sample was drawn from acute care nurses within the first two years of graduation. The authors rightly advise caution on the generalisability of their findings and encourage others to test the model in different contexts. Nevertheless, I was struck by their findings that the strongest characteristic of supportive professional environment identified was nurse–physician collaboration, followed by autonomy and then control over practice. I have therefore elected to theme this edition of JRN ‘relationships’ as each paper in this edition highlights the fundamental importance of relationships within professional nursing practice, whether that be in understanding the relationship between concepts or the relationships between people: nurses and patients; nurses and nurses; nurses and doctors; nurses and other professional support and lay members of the health and social care team. The nature of these relationships is clearly fundamentally significant in our practice.
Two perspectives conclude this edition, in the first, Duncan Hamilton, an undergraduate nurse, reports on a debate on government proposals to change the funding arrangements for student nurses in England. The relationship between the UK government and health care professionals appears to be at an all-time low.
The second perspective by Taylor and Olson reports on a debate held by doctoral students at the European Academy of Nursing Science on the relationship between nurse–patient ratios and access to high quality care. I hope you too will be inspired by the quality of these debates.