Diagnosis excellent for nursing research
It’s been a quarter of a century since Unitec started educating nurses and in that time the approach to research within the profession has changed considerably
The move to educate nurses in the tertiary system rather than the previous hospital-based system brought a parallel need for staff to have tertiary qualifications beyond the diploma typically held by nurses, meaning research in the early years of nursing at Unitec was very much focused on staff working towards undergraduate degrees, then on to masters and beyond.
“We were busy upgrading our qualifications and within that context there was the recognition that research was very important to underpin practice and was a very important component of the academic course, but first we had to position ourselves so we could teach it,” says Nursing Curriculum Leader, Dr Dianne Roy.
Both Dianne and Nursing Head of Department, Sue Gasquoine, have been with Unitec’s Department of Nursing since just after it started. They say the research culture for students and staff at Unitec has changed considerably in that time, reflecting the growth of nursing research here in New Zealand and around the world. This is certainly the case for staff in Unitec’s Department of Nursing, where staff are increasingly involved in collaborative research projects with colleagues both within Unitec and in external health organisations and universities.
“We are working much smarter in terms of collaborations. Trying to make progress as a solo you are never going to get anywhere but as part of a group you are taking on something bigger that is manageable together,” says Sue.
Sue is currently working with Unitec’s Judy McKimm and Mark Barrow and Deb Rowe from the University of Auckland on research into leadership in inter-professional healthcare teams. Sue was a member of a previous research team that looked at how newlyregistered nurses and doctors worked in healthcare teams and the latest study looks at senior nurses and doctors in the specialist areas of oncology and neonatal intensive care and how they learn leadership skills in those environments. As part of that study, staff in Unitec’s Department of Language Studies will also conduct a linguistic analysis of dialogue within the teams.
Sue is also working on a project with colleagues from Otago and Auckland universities, dubbed ‘The Facebook Study’. It will look at the use of social media and networks by students of health professions and how students learn boundaries and what is professionally appropriate or not. The first stage is underway and involves running focus groups with year one and five medical students from the University of Otago, year one and six medical students from the University of Auckland, and year one and three Bachelor of Nursing students from Unitec.
Dianne has been working on a Health Research Council-funded study for the past three years as part of a multi-disciplinary team looking at improving pre-pregnancy, maternity and early childcare health interventions and support for women experiencing disability or sensory impairment. She is also working with Lynne Goldings from AUT University on ongoing research into women’s experience of ageing with a long-term condition and how ageing shapes and is shaped by, a woman’s illness experience. The research continues with increasingly older age groups of women.
In addition, Dianne is involved in a study with colleagues from the University of Auckland looking at consumer health information needs, and has recently completed a study with another group from the University of Auckland to assess the effectiveness of the Flinders Programme in improving health outcomes for New Zealand populations with long-term conditions, with the final of four articles from the study to be published shortly in the Journal of Nursing and Healthcare of Chronic Illness.
And importantly for Unitec students, Dianne is leading a collaborative study with staff from Unitec’s Department of Nursing and the Waitemata District Health Board aimed at improving outcomes for the family/whanau of people who have experienced a stroke Lecturers Shireen Caldwell and Hongyan Lu are currently researching ethical decision-making for students of non-Western cultures and how they approach decision-making based on cultural beliefs and experiences. Lecturer Bernard Kushner is working on his masters thesis looking at gay men ageing in New Zealand and their decisions on issues such as retirement and rest homes, while Frances Ward continues to work with data generated by the Selwyn Project.
“In terms of staff research we are going from strength to strength,” says Sue.
The chance to be involved in active research has given Bachelor of Nursing students the chance to work first hand with data and research participants and has increased pass rates and grades along the way.
Over the past seven years, Bachelor of Nursing students have worked as research assistants on two ongoing research projects, which have not only delivered valuable research outcomes but also increased students’ pass rates and grades. Nursing Head of Department, Sue Gasquoine, says that the move to involve students more directly in research came when staff looked to change the way they delivered the second-year paper Research for Health Professionals.
“Students saw the paper as something quite removed from the exciting clinical papers where they got to do ‘real nursing’. It was seen as a boring add-on of questionable relevance but of course by the time students got to the end of third year they could see the relevance and many wished they had paid more attention,” laughs Sue.
Research in action
Nursing Curriculum Leader, Dr Dianne Roy, says the resulting discussions led to the creation of a five-year longitudinal study with the Selwyn Foundation, looking at the use and place of technology in the lives of older people in Selwyn Village. Over the following five years, different cohorts of supervised students collected data through qualitative interviews and a quantitative questionnaire. And at each stage the hands-on research was tiedback into the Research for Health Professionals paper to illustrate various components of the research process.
“We have a real live study to draw on to provide examples and illustrate the theory. The emphasis is on engaging the students and it’s much easier to do that when you can involve them in the research,” says Sue.The study has now concluded and staff then turned their attention to what further research options they could offer students.
“We realised the benefit it had been to the students and that was reflected in improved grades and pass rates in the course, but what is harder to measure is how they went into third year with a much better understanding and appreciation of the place of research in their practice. It’s hard to measure but the theory-practice gap has definitely been narrowed,” says Dianne.
New study with stroke families
Happily, the ‘what now?’ question coincided with an approach from colleagues at Waitakere Hospital offering the chance to research an area of clinical practice that was presenting challenges and the Stroke Family Whanau Study was born.
Each year has a slightly different focus, with the first year focusing on the education and information needs for families when a family member has a stroke. Students were involved in collecting data from family members and health professionals, and staff are working on the analysis.
“There are very good national guidelines around stroke management and stroke care for the person who has had the stroke but what health professionals find is that often the person who has had the stroke seems to move on with their life – even though it may be a different life to the one they had before – but that family members often get stuck.
Staff wondered what they might do in their clinical area to improve the outcomes for family members,” says Dianne.
There is currently very little literature on the needs of family members who are not the primary caregiver of the person who has had a stroke.
“Anecdotal evidence from our colleagues at Waitakere suggests some of the difficulties arise for the family beyond the principal caregiver. On the one hand the health professional is obligated to talk specifically and clearly with the primary caregiver of the person who has had the stroke but there seems to be this assumption that that person will then pass it on to the rest of the family but we know that this doesn’t necessarily happen,” says Dianne.
“We feel that we are on the right track with the wider family/whanau issues because it hasn’t been well researched,” says Sue. “And while the Selwyn study was a longitudinal study, we see this one turning into more of a research programme, where a number of studies will come together over the five years.”
The next strand in the Stroke Family Whanau project will be a fouryear phenomenological study (first-person experiences) following three or four families from the time when they become a stroke family. This will include not only the primary caregivers but as many people from a family as possible, who will all be interviewed at set intervals over a four-year period. Sue says keeping the students connected with the project is critical to their learning and in this instance they will be presented with a phenomenological interview and asked to distil the key messages.
Student research across the decades
Dianne says that just as the teaching has changed over the past 25 years to reflect the increased technology and acuity in today’s hospitals, the way research is studied and used in daily practice by nurses has also taken great leaps forward.
“Our early attempts (at student research), while we don’t look back on them in horror, were a little naïve,” says Dianne. “Students were expected to do a small research project and not necessarily related to nursing specifically but more to practise a research method. Our intentions were good in terms of experiential-based learning but in terms of the outcomes they were a bit unrealistic.”
As a result of that, the focus switched to developing students as critical consumers of research. “We focused on students having enough knowledge of research, research methods and research processes for them to read, critique and utilise in their practice the research that was being done by others,” says Dianne. “And that remains the underpinning of where we are at in teaching research in the programme.”
Last edited: 15 July 2011