Jacinta Kelly

The 'good' apprentice - revisiting Irish nursing's coming of age

A decade ago Irish nursing was lauded as the envy of Europe for its coming of age with the introduction of a four-year honours degree for preparatory nurse training and the prospect of an all graduate profession (Cowman, 2001, Watson, 2003). The new preparatory degree course was designed, chiefly, to respond to increasingly complex healthcare needs but also to raise the esteem of the nursing profession, including parity of esteem with other professionals, public esteem and the individual and collective self-esteem of nursing professionals. While the introduction of the undergraduate system in Ireland was instigated with relative ease, due in much part to a then healthy Irish economy, it was nonetheless heralded as a triumph as it came about despite strident calls from the media and from within the ranks of many in the nursing profession for less emphasis on the intellectual aspects of nursing and the retention of the more practical based and trusted apprenticeship system (Fealy and McNamara, 2007). In 2008, the economic downturn left nurses facing pay reductions, graduate and faculty staff recruitment embargos, dwindling student places and crippling increases in student registration fees. All indicators pointed towards a crushing reversal of fortune for Irish nursing. Over half a century ago, employment prospects for nurses in Ireland qualifying under the apprenticeship model were decidedly more optimistic. In the light of the present economic downturn in Ireland and reforms which see the UK follow Irelands initiative to introduce degree-level preparatory nurse training by 2013, it is useful to revisit the traditional apprenticeship system in Ireland to consider whether, in the face of challenging economic circumstances, it is worth the effort to persevere with the aim of achieving an all-graduate profession.

Legitimacy in legacy : a discussion paper of historical scholarship published in the Journal of Advanced Nursing, 1976-2011

AIMS This paper presents a discussion of historical scholarship published in the Journal of Advanced Nursing. BACKGROUND The Journal of Advanced Nursing provides a forum for disseminating high-quality research and scholarship. For over 35 years, scholars have used the Journal of Advanced Nursing to disseminate research into aspects of nursing, including nursing history. DATA SOURCES The data source was Wiley Online electronic database for the Journal of Advanced Nursing for the period 1976-December 2011. DISCUSSION Relative to other academic concerns, nursing history represents a topic of limited concern to nursing scholars, as evidenced in published scholarship in the Journal of Advanced Nursing. The trends in historical scholarship in the journal have been on disciplinary development, the place and context of practice, and gendered relationships. While these are legitimate academic concerns, they suggest a lack of attention to clinical practice in historical research, that which confers social legitimacy on the discipline. IMPLICATIONS FOR NURSING Nursing derives its social legitimacy, in part, through its history, including reliable accounts of the legacy of nursing work in the development of healthcare systems. Disciplinary development in nursing is advanced by giving greater prominence to nursing history in nursing scholarship, including the history of nursing practice CONCLUSIONS Relative to other academic concerns, nursing scholarship affords little prominence to the topic of nursing history and less still to the history of practice, as evidenced in the outputs of one of nursings major organs of scholarship. Not to assign due importance to the history of nursing and its practice demonstrates nursings lack of disciplinary maturity.

Commentary on: Clark A. M. & Thompson D. R. (2013) Succeeding in research: insights from management and game theory. Journal of Advanced Nursing 69(6), 1221-1223.

January Forum Contribution. Clark and Thompson’s (2013) editorial forces us to consider the certainty that management science repays a certain degree of study in terms of being successful in competitive research grant bids and high-impact publications (Drucker 1967).

Editorial: Learning is still the real business of the University.

Introduction - In his paper, Dissent and Dissensus: Making a Difference in the Corporate University, Professor of Nursing at the University of Swansea and Master of Controversy, Gary Rolfe, announced during a seminar at the University of Cambridge on the occasion of this year’s Nurse Education Tomorrow (NET) conference, that the University lies in ‘ruin’. As delegates foraged in their conference packs for disaster survival kits and scanned the nearest exit out of the parlous confine, the presenter fearing abandonment moved swiftly to reassure attendees that the ‘ruin’ was metaphoric and that the University of Cambridge, specifically, was not being referred to. While calm descended this soon gave way to the nascent discipline being plunged into despair on realising the bleak news that The University; the very fabric of civilised society from which our professional cloth is cut, was actually in tatters. In his paper, Rolfe attacked the state of education provision for nurses at universities, presumably in the UK. First, he bemoaned the fact that educators no longer have any power to effect change in clinical practice. Second, the modern university has developed itself as a corporate business trading in the merchandise of degrees with student consumers content to being administered through an educational system which values student retention and satisfaction above healthcare education needs. Third, Rolfe argued that the role of educators as scholars and researchers is threatened by the need to secure the ‘right’ research grants and to publish in the ‘right’ journals. Finally, in response to these developments he advised educators should stay in the ‘ruin’, but dissent, be subversive.

Editorial: What has Florence Nightingale ever done for clinical nurses?

Introduction - Until recently, Florence Nightingale’s portrait featured on the British 10- pound note. This year, marking the centenary anniversary of her death at 90 years of age on the 13 August 1910, Miss Nightingale’s name has now been etched on 2-pound coins. However, lest we think the standard-bearer of modern nursing is losing currency, commemorative events held that year in the UK and elsewhere confirm that the ‘Lady with the Lamp’, as dubbed by the poet Longfellow, remains highly valued. In fact, praise has been heaped on this national treasure in the form of an imaginative £1.4 million redevelopment of the Florence Nightingale Museum. The Museum takes pride of place on the grounds of St Thomas’s hospital in London’s vibrant South Bank where Nightingale established her first Nightingale Training School for Nurses. In this audacious tribute, supported by the Wellcome Trust, Guys and St Thomas’ Charity and Garfield Weston Foundation, the Victorian nursing pioneer is celebrated as a sanitary reformer, statistician, administrator, researcher and educationalist. The Museum exhibits a vast collection of ‘Nightingalia’ organised under three pillars: her early childhood; her activities in the Crimean war; and finally her contribution to international health reform. The net effect of this careful assembly of Florence’s singular life story leaves the public in no doubt as to why her appeal as ‘The Queen of Nurses’ or ‘Soldier’s Friend’ has endured well into the 21st century. But does this enduring appeal for all things Nightingale extend to modern day clinical nursing? What did Florence Nightingale actually ever do for clinical nurses?

Commentary on Furnes B and Dysvik E (2012) Therapeutic writing and chronic pain: experiences of therapeutic writing in a cognitive behavioural programme for people with chronic pain. Journal of Clinical Nursing 21, 3372–3381

Writing is a mysterious thing. It poses a unique problem set. There are awful barren days and agonising troughs when nothing flows. Where despite careful marshalling of evidence or anecdote, the words and necessary vigour, muscle and rhythm of prose refuse to find its way to sensible assembly on a blank page. A painful aching exercise at times even excruciating. It is hard to resist the speculation that there are few amongst us who would volunteer for the personal hardship of writing and that recruiting people to conduct some writing tasks would be an exercise in futility. This must be especially true of those who as a result of established illness may already feel at the end of their rope with chronic pain. The last thing they expect to receive is homework writing tasks. However, new evidence reported in a qualitative paper by Furnes and Dysvik (2012) defies such speculations and provides interesting ideas on writing tasks and its relationship to individuals’ experiences of pain. Based on a study of the perspectives of the experiences of therapeutic writing in a cognitive behavioural programme for people with chronic pain, the authors found that for the majority of participants, the very task of writing was instrumental in providing pain relief.

Commentary on Cone PH and Giske T (2013) Teaching spiritual care – a grounded theory study among nursing educators. Journal of Clinical Nursing 22, 1951–1960

Spirituality is defined for example as a ‘sunset, springtime or a symphony’ (Stoll 1989, pp. 4–23). However, hospitals are inhospitable to these expressions of spirituality. Many hospitals are designed deprived of natural light. We regularly discourage flowers being brought into hospitals, and with space at a premium, there is hardly room for a string quartet to position itself. Patients who are hospitalised and do not express spirituality through religiosity or faith and cannot draw comfort and ‘inner strength’ from aesthetic expressions of spirituality very much rely on relationships with others (Coyle 2001). In hospitals, nurses are closest to the patient, and therefore, nurses may require instruction in spiritual care. Cone and Giske (2013) explored the teaching of spiritual care through a grounded theory study with nursing educators on how best to prepare undergraduate nurses. They found that students should be taught how to recognise spiritual cues and make spiritual assessment and interventions in theory and practice more visible. Irish soul musician Van Morrison (1986) asserted in spirituality – there is no method, no guru and no teacher. Burkardt (1994) agreed that spirituality is not an intellectual exercise but a lived experience. The most we can achieve in the preparation of students is awareness-raising of the profoundness of human nature, spirit and interaction. We have to accept there are some aspects of humanity which resist explanation and structure. That formalisation and formulations would be undesirable. The beauty and boundless meanings of spirituality in their raw experienced form is what makes nursing individual and compelling and responses to spiritual needs creative. We have to consider whether it is wise to educate future nurses out of their creative abilities with structured approaches to spiritual assessment and care.

Commentary on Jones C and Hayter M (2013) Editorial: Social media use by nurses and midwives: ‘a recipe for disaster’ or ‘a force for good’? Journal of Clinical Nursing 22, 1495–1496

Media theorist Marshall McLuhan described media as an extension of man and that each new medium or technology introduces a change to the scale or pace or pattern in human affairs (McLuhan 1994). In 100 BC paper discovery permitted recording of information and stories, the Guttenberg press invention in 1455 encouraged literacy, photography in 1814 permitted visual record keeping and the invention of Morse code in 1835, Telegraph in 1843 and the Telephone in 1876 broke the distance barrier. Film discovery in 1898 and radio in the 1920s provided forms of electronic mass media. Television in the 1950s and Web 1.0 Internet since the 1990s have become common features in peoples homes throughout the world. Most recently, Web 2.0 in the 2000s introduced digital participatory media such as Twitter, YouTube, Facebook and Bebo, which have created continuous and instant access to events happening around the world.

Nursing issues and concerns in the care of older persons in acute hospital care in the Republic of Ireland: a Delphi study.

Having experienced the second highest population increase in the European Union, older people in the Republic of Ireland constitute 14% of the population (Central Statistics Office 2012). Older people, adults aged 65 and older, are at disproportionate risk of becoming seriously ill and requiring hospital care, whether it is in an emergency department, on a medical or surgical ward, or in a critical care unit (Landefeld et al. 2005, p. 111–117). They account for over 40% of the inpatient days in Irish hospitals, amounting to nearly half of hospital expenditures for adults. Nursing holds a prominent position in the delivery of acute care for older people. Mcalfatrick and Keeney (2003, p. 629) advised that nursing research is an essential element of enhancing care and for its successful implementation in practice, ownership and identification must come from clinical nurses. In the absence of knowledge of what the most substantive problems or questions are, nursing research efforts may be directed to areas of least priority. To date, no studies exploring nursing research priorities relating to the care of the older adult in acute hospital care in the Republic of Ireland have been conducted.

Commentary on Horsburgh D and Ross J (2013) Care and compassion: experiences of newly qualified staff nurses. Journal of Clinical Nursing 22, 1124–1132

A story goes that a newly qualified midwife arrived on duty to find she was in charge and on expressing her anxiety was issued with the advice, ‘if the mother gets a pain bring her to the delivery room. If the baby cries take it to the nursery and if there is a cross on the mother’s notes, be nice to her she has lost her baby’ (J. Kelly, unpublished PhD thesis). It takes an effort to remember this but the first few months as a newly registered staff midwife or nurse invariably induced at once terror and enthusiasm. While excited receipt of the necessary parchment and donning of the staff nurse attire went some way towards rendering a spring loaded step, it was never enough to conceal the ragged edges of a newly qualified nurse faced with the responsibility of providing high-quality compassionate care as clinical mentors and academic tutors dropped out of view. The study by Horsburgh and Ross (2013) allows us to focus on this often forgotten but crucial transition in nurse development and the most essential and yet seemingly overlooked aspect of quality health care, compassionate care. A qualitative study using focus group data from (n = 6) focus groups, totalling 42 participants, provides a critical exploration of newly qualified nurses’ perceptions of the enablers and inhibitors to the delivery of compassionate care. Horribly revealing, newly qualified nurses describe the current clinical environment as staid and clinical practice as devoid of engagement with emotional aspects of care. The authors establish the existence of tension between ‘agency’ – the ability of individuals to act and ‘structure’ – the physical, social, managerial and cultural environments of care delivery, as being at the heart of the problem. Horsburgh and Ross (2013) point to preparation in undergraduate programmes and formalised supportive frameworks during the first year of practice as levers to success in the delivery of compassionate care. Certainly, there is room for greater emphasis on the teaching and assessment of compassionate care in undergraduate programmes. This can be achieved with a greater balance between science and humanities in the curriculum (Dellasega et al. 2007). In some jurisdictions, such as Ireland, a supervised internship is offered in the final year of undergraduate nursing programmes as salaried and valued members of healthcare team. There are also formalised supportive frameworks in the form of preceptorship programmes for newly qualified nurses in many places which can aid transition. All of these strategies can help alleviate the challenges associated with what can be a very difficult time for newly qualified nurses. However, the need for individual nurses instinctively to take personal responsibility for quality healthcare delivery, to break through cynicism and malaise and to effect change requires individual leadership attributes described by Friedman et al. (2003) as resilience which includes self-mastery, bounce-back-ability or ability to handle stress together with resourcefulness, selfbelief and motivation. These are all traits which can and should be nurtured through supportive clinical environments but to a large degree should be innate in the next generation of nurses and cannot always be reliant on others to direct and instruct on these matters.