Editorial: Patient experiences, family participation and professional

roles

It is with great pleasure that I preparethis, my first editorial for JCN. I amdelighted to be appointed as Editor forthe issues of the journal covering patientexperiences, family participation andprofessional roles. These three areas,while seemingly disparate, are ones thatcaptured my interest during my years ofnursing practice, and have absorbed andengaged much of my intellectual andresearch endeavour. The decision tofocus on patient experiences and familyparticipation reflects the desire to illu-minate the experiences, needs and per-spectives of the end users of healthservices and nursing care, and positionthese accounts as central to our dis-courses about nursing, nursing knowl-edge and clinical practice. In doing so,there is acknowledgement of the valueand significance we as nurses place onthe consumers of nursing services –patients, clients and families.

Patient experience and familyparticipation

The focus on participation of familiesacknowledges not only the importanceof families in promoting health andwellness, but reflects awareness of anincreasing reliance on family membersin caring for people during illness andincapacity, rehabilitation and recovery.In focusing on family participation, wetake a broad and inclusive stance, andrecognize that families take many formsand may or may not be linked by bloodor legal ties. Family members engagewith nurses in diverse clinical and com-munity settings, and participate inshared caring and other, sometimesquite lengthy, professional relationshipswith nurses (Kellett 2007). Experiencesof illness and infirmity, injury and

disability, health and healing are livedwithin the context of family relation-ships (Eggenberger & Nelms 2007,Taylor & McMullen 2008) and often,nurse interaction with family membersoccurs during times of trauma, stressand crisis (Brysiewicz 2008). Eggenber-ger and Nelms (2007) have recentlyhighlighted the need people have for acaring and connected nursing presencewhen faced with the critical illness of afamily member, and the ways nursescontribute to shaping their experiences.

Primary among the major obligationsof researchers and scholars in nursingand midwifery is the imperative togenerate knowledge that can contributeto improved outcomes for patients, theirfamilies and communities, and to sup-port nurses and midwives in their clin-ical practice. That is, to provideinformation that is accessible, usefuland relevant, and cognizant of the con-texts in which nurses and midwives goabout their practice. Nurses are facingseveral challenges in seeking to providebetter care to more people. Many workin climates of constant change with verylimited resources, and serve complex,troubled and disadvantaged communi-ties in which people are living in envi-ronments of conflict, penury, tensionand stress. In facing these challenges,and meeting the needs of these commu-nities, there is an imperative to reflect onhow we organise and deliver care, andto envision new roles for nurses andmidwives.

Professional roles

In selecting professional roles as thethird key area for this section of JCN,there is a commitment to contribute tothe development of new nursing roles

and to create a forum where nurses andmidwives can engage in critical conver-sations about nursing, nursing practice,practice-related issues and possibilitiesfor role development. Phrases such asextended role, role expansion and ad-vanced practice are increasingly visiblein our literature and influence ourpractice, research and education. In hispaper on advanced nursing practice,Callaghan (2008) positions the ‘ad-vanced nurse practitioner as expert,leader and collaborator’ and a catalystfor challenging and transforming en-trenched values and practices. However,many of the extended roles that nursestake on are more in the manner ofphysician assistant. That is, they areself-limiting, task-based and initiated asa response to breakdowns in the healthsystem due to shortages of allied healthor medical staff and thus, as Callaghan(2008) points out, could be seen asarising from organizational necessity,rather than any imperative for develop-ing enhanced professional autonomy fornurses.

When considering this nature of pro-fessional role expansion there is a needto consider workforce issues, and care-fully reflect on the implications andpossible repercussions. Many questionsarise. If nurses are taking on ever moreextended roles, how do the demands ofthese roles affect the work environment?The nursing workforce is facing severalthreats associated with putative short-ages of experienced nurses, an ageingworkforce, limited resources and chal-lenging working environments. Do ex-tended roles contribute to workplacestress by putting individual nurses insituations in which they just cannotmeet all the demands placed on them?Are nurses supported adequately to

� 2008 The Author. Journal compilation � 2008 Blackwell Publishing Ltd 147

doi: 10.1111/j.1365-2702.2007.02207.x

meet the demands of their extendedroles? Are nurses adequately remuner-ated and legally protected to enact theseextended roles? While nurses are actingin de facto physician (assistant) roles,who is it that will provide the nursingcare to patients and families?

Whilst considering these matters, it isalso important to take account of thepatients and families with whom wework. Extended roles for nurses do havethe potential to enhance the health careand health seeking experiences of pa-tients and families, particularly in underresourced areas and populations. How-ever, in adopting new roles it is impor-tant that we do not accept themuncritically, and take the time to reflecton the impact these will have on ourability to meet our traditional roles, andhow we ourselves position these newroles and skills in relation to our existingroles and skills. In drawing links be-tween nursing knowledge and nursingshortages, Fawcett (2007) has noted thetendency to privilege the medical func-tions performed by nurses. This privi-leging of tasks normally associated withphysicians may result in the attenuationand diminution of nursing specific activ-ities and knowledge. It is important thatwe engage in debate and robust discus-sion about the consequences of roledevelopment, and thus retain someself-determination and autonomy aboutits nature, intent and extent. In claimingour autonomy, we reduce the possibilitythat role extension for nurses be seen aslittle more than a political measuredesigned to cover cracks in the healthsector, and of little inherent benefitto nurses, nursing, patients or theirfamilies.

While recognizing the contested nat-ure of nursing shortages, it is undeniablya fact that many facilities across theworld experience difficulties in recruit-ing adequate numbers of skilled nurses.Many wealthy countries (in particular)have sought to ease their own nursingshortages through aggressive interna-tional recruitment. However, the hard-ship this can cause in source countries is

causing growing concern (Pittman et al.2007), therefore, this strategy is becom-ing increasingly viewed as morallydubious. Source countries are ofteneconomically disadvantaged, and arethemselves in urgent need of a strongand effective nursing workforce. How-ever, despite their investment in educat-ing and preparing their nurses, thesenations are unable to match the enticingoffers made by more wealthy countries(Pittman et al. 2007), nor are they able,easily, to replace the nurses who arepoached. Furthermore, this strategy isshortsighted and does not address theunderlying causes of local nurse reten-tion problems. Rather than relying oninternational recruitment as the majorresponse to shortages in the workforce,it is preferable to increase local nursingworkforces by addressing the issuescausing shortages, identifying and initi-ating strategies to enhance the workinglives of nurses, and improve recruitmentthrough better positioning of nursing asa gratifying, worthwhile and fulfillingcareer.

Challenges ahead

The challenges facing nursing are press-ing, complex and defy simple solution.Nursing has never been in greater needof a relevant and robust research basefrom which generate knowledge to in-form positive change. However, heretoo are challenges: in this age of evi-dence-based practice, we are engagingwith important epistemological issuesincluding ways of knowing, and thenotion of hierarchy of evidence. Nursingdraws on many forms of knowledge,and debate continues about what countsas evidence in a discipline such asnursing (Mantzoukas 2008). These de-bates are important, and critical com-ment is necessary as we continue togenerate a strong research basegrounded in nursing and responsive toissues of concern to nurses and nursing.

In taking the stance of ensuring thatpublished papers must be directly appli-cable to practice, JCN actively embeds

our scholarship and research into thepractice of nursing. JCN has a strongand increasing role to play as an inter-national forum for nurses and midwivesto disseminate finding of their research,raise issues, share ideas, interrogateproblems and canvass solutions. I lookforward to working with the editorialteam of JCN to contribute to fosteringstrong discourses around the practiceand scholarship of nursing and to thecontinued development of nursing as aresponsive, effective and sustainablepractice profession.

Debra JacksonEditor, JCNE-mail: debra.jackson@uws.edu.au

References

Brysiewicz P (2008) The lived experience of

losing a loved one to a sudden death in

KwaZulu-Natal, South Africa. Journal ofClinical Nursing 17, 224–231.

Callaghan L (2008) Advanced nursing prac-

tice: an idea whose time has come. Journalof Clinical Nursing 17, 205–213.

Eggenberger S & Nelms T (2007) Being

family: the family experience when an

adult member is hospitalized with a critical

illness. Journal of Clinical Nursing 16,1618–1628.

Fawcett J (2007) Nursing qua nursing: the

connection between nursing knowledge

and nursing shortages. Journal ofAdvanced Nursing 59, 97–99.

Kellett U (2007) Seizing possibilities for

positive family caregiving in nursinghomes. Journal of Clinical Nursing 16,

1479–1487.

Mantzoukas S (2008) A review of evidence-

based practice, nursing research andreflection: levelling the hierarchy. Journalof Clinical Nursing 17, 214–223.

Pittman P, Aitken L & Buchan J (2007)

International migration of nurses: intro-duction. Health Services Research 42,

1275–1280.

Taylor LA & McMullen P (2008) Living

kidney organ donation: experiences ofspousal support of donors. Journal ofClinical Nursing 17, 232–241.

148 � 2008 The Author. Journal compilation � 2008 Blackwell Publishing Ltd

Editorial