By Dr Taleb Durgahee PhD
It was good to hear the Ministry of Health talk about medical research and its place in the Mauritian healthcare system. This is good news and let’s hope it will attract evidence-based medical care for our people. But there was no mention of nursing or nursing research. Why such a glaring omission? Can medical research cure everything on its own? Can Mauritius become a medical research hub without nursing research?
What follow are some thoughts on how to reinforce the research idea and to think nursing and its contribution. Can you imagine a healthcare system without nurses?
Nursing
Nursing and nursing research are firmly established pillars of care working alongside medical research across developed healthcare systems. Nursing makes a tremendous contribution to healthcare. People value nurses because they are the constant factor supporting the patients through the experience of illness, medical treatment, surgery, rehabilitation and recovery. The doctor is there but for a short period and moves on. The interaction of doctors with patients is brief and periodic. Some suggest that doctors “cure” or “treat” and that nurses “care”, but this is not upheld by research. In a study of professional boundaries, the management of complex wounds was perceived by nurses as firmly within their domain. Nurses justified their claim to “control” wound treatment by reference to scientific knowledge and practical experience, just as medicine justifies its claim in other areas of treatment. Nursing has consequently seen the emergence of the Tissue Viability Nurse, a specialist in wound care giving further credibility to specialist nursing roles and evidence-based nursing care.
It is well-known that nursing is about working with people who may be ill, undernourished, and with physiologically deficient bodies. Nurses are responsible for supporting people when they are living the difficult experience of illness and this requires knowledge from different disciplines such as anatomy and physiology, psychology, social sciences and humanity. Nurses harness knowledge from all these disciplines, integrate them into highly informed and polished verbal and non-verbal interaction within nursing situations. The expectations from nurses are increasing and changing in this digital world saturated with information.
If medical research is to become a reality, then ways of treating and working with people will change. This means nurses and other healthcare disciplines need to be educated differently, nursing knowledge would be integrated innovatively to support medical research findings and its implementation. Medical research and nursing research must move forward alongside each other as independent disciplines. It is not a practical strategy to move medical research forward and leaving nursing lagging behind. The large sophisticated and experienced pharmaceutical companies will not suddenly shift to Mauritius unless and until it is demonstrated that nursing is also flourishing. There is an Institute of Nursing which we must value and energise to launch nursing research.
Medical research may be seeking outcomes of research-based treatment, but nursing research leads the process to recovery. Diseases may be treated but if the process is not managed by skilful nurses then one may have a failed treatment program, dissatisfied patient, poor quality of service or no patient at all. It is that important. Clinical research trials for example are better carried out by nurses. When non-nurses are employed as research assistants, this produces a situation of variability and unaccountability that is at odds with the safe and effective management of clinical trials. Nurses are Registered professionals and are accountable to a professional body with defined safe and ethical code of practice. A well-defined role boundaries can help mitigate these risks by ensuring transparency and accountability.
Nursing and nursing research should be constantly empowered to ensure the service to the population is of a civilised superior standard. Be proactive, be nursing-oriented and be prepared to fund nursing to uphold dignity, safe care for an evolving population. Nursing strengthens medical research and pharmaceutical companies know this from their experience in conducting complex clinical research.
Clinical Research Practitioners
It is true that other staff from other academic and professional disciplines can and do contribute to clinical research. They essentially are data managers, analysts and interpretive experts. This poses a problem in that healthcare managers cannot assume a common body of knowledge that Registered professionals bring. Professional Registration confers knowledge of good clinical practice whereas non-nurses have to be inducted and educated into what is good clinical practice. It is dangerous to allow research personnel to learn on the job as this will interfere with the smooth running of trials as well as the credibility of outcomes. There is some evidence in UK that staff without specific preparation for clinical research roles find the experience stressful and daunting. Mauritius should not allow the transformation of graduates into clinical research practitioners to be an on-the-job experience and learning. The risks are high and our people could be harmed. An apprenticeship system is the way forward for developing research minded graduates and non-graduates is essential to achieve safe research practices.
The Institute of Nursing is preparing nurses at graduate level; they are undertaking research projects at BSc level and there are several international collaborations with reputable universities. This is most welcome. However to support the policy of establishing healthcare hubs and medical research, the Institute should develop a course in Clinical Nursing Research to prepare clinical research practitioners. The course should have innovative clinical trials training and insightful competency assessments. This will also help develop training materials, curriculum and competency frameworks to standardise job descriptions and put in place a structure for clinical research. This is all about patient safety and research outcomes within the changing clinical research landscape.
Conclusion
Medical research is a great slogan to attract and make connections to new industry. This is a legitimate and laudable strategy. It will bring a new thrust to our healthcare system if there is adequate preparation on the ground. We need regulatory mechanisms, enforcement powers and code of conduct. Reputable pharmaceutical companies will insist on these.
New industries need new skills and competent staff. Mauritius has the infrastructure to produce the competence and support the MOH search for medical research but it should not leave nursing behind.
Nursing is a major element of the healthcare system. Nurses are key to the delivery of an ethical and morally responsible research programme. Knowing, understanding, and addressing the ethical challenges that complicate clinical research are essential functions for all nurses in the diverse roles.
Apprenticeship is expanding into law, agriculture, accountancy, medicine and engineering. Nursing has traditionally embraced apprenticeship for years where young men and women work, learn and earn. Nursing has pointed the way forward and others now follow. The plea is for the MOH to follow the lead, and think nursing.