Editorial

Our November issue of JRN focuses on some of the methods that nurses use to understand their patients’ and their carers’ needs and circumstances. Increasingly nurses augment their skills of observation and communication by using scales to assess and evaluate a patient’s physical, psychological or spiritual state and the progress or deterioration of their health and wellbeing. Scale development is a complex and time-consuming business, so most practitioners use tools that are already available and thus rely on researchers to develop and validate new tools. These tools are an adjunct to high-quality care and need to be designed and used appropriately. In this issue we explore, through five papers and their related commentaries, a variety of assessment techniques and how they may be used and developed.

We bring readers two papers about the use of existing tools. The first investigates people’s self-management of insulin-dependent diabetes (Gharaibeh and Tawalbeh) and the second focuses on quality of life among older people with cancer (Malak et al). Both papers show how researchers and practitioners can successfully use structured measurement techniques to understand patients better and thereby fine-tune care to suit individual needs. However, the compendium of scales available for use in care is understandably not comprehensive, so researchers often find that they need to develop measurement tools to use in their research and later, once validated, in everyday practice. Bilsin and Bal Yılmaz’s paper is an example of scale development focused on taste alterations in children undergoing chemotherapy in Turkey. Having such a scale enables nurses as well as researchers to consistently assess a child’s needs and sensitively modify care. However, sometimes researchers do not understand a ‘problem’ well enough to immediately set about designing a tool to measure it, so their first job is to find out more, either through literature reviews or exploratory studies. In this issue Salem and Ahmad report their literature review on ways to improve communication for mechanically-ventilated patients in Iran and Valizadeh Zare et al discuss the insights they gained from a phenomenological study of coping in people who have had kidney transplants. All of these approaches can be used successfully to build ways to assess, monitor and evaluate patients’ and carers’ needs and thus gain a better understanding of people’s requirements, wishes and expectations.

Understanding patients and their carers better is only part of the story since high-quality care requires both understanding and action. Achieving this double act often requires researchers, practitioners and patients – with their carers, to come together to co-produce research studies and/or improvements. Last week I attended such an event – a piece of theatre, designed by Kate Beckett, a nurse and NIHR Knowledge Mobilisation Research Fellow (https://www.nihr.ac.uk/our-faculty/trainees/meet-some-of-our-trainees/meet-the-kmr-fellows/kmr-fellow-kate-beckett.htm), to enhance post-injury psychological care. Beckett’s work is novel – both in its approach and the potential immediacy of its outcomes. Working closely with a specialist theatre group, Cardboard Citizens (https://www.cardboardcitizens.org.uk/) and with a patient and practitioner advisory group, she blended patient and practitioner stories of injury with research evidence to create and deliver a short provocative play. Acted by professional actors, the play told the story of a woman injured after a cycle accident from just before the accident to one year after her discharge from hospital. It was a raw portrayal of her experiences based on real stories told to Beckett by patients and practitioners in her current and previous research. After seeing the performance, the 50-strong invited audience of practitioners, researchers and patients reworked aspects of the play that they had most identified with to improve the care and experiences shown. By the end of the event we all had a better understanding of what such injuries mean to people and how improvements to care could be made throughout a patient’s journey – often entailing the simplest things such as the ways people talked to each other and listened (or not). The immediacy of the event was palpable as we watched and enacted not only research-into-practice, with audience members repeatedly re-shaping scenes to make suggestions for making future patients’, and their carers’ care better but also practice-into-research. The event revealed plenty of gaps in our knowledge about averting or ameliorating the psychological impact of trauma. The afternoon concluded by identifying improvements to be fed back to and acted on by key health and care stakeholders: as we went home we felt we had understood and acted in every sense of the word. Of course, this was not the first time theatre had been used to develop understandings and make changes in health care practice [e.g. Rossiter et al (2008), Kontos et al (2012), Wilson (2013) and le May (2014)] and as I left I hoped it would not be the last!

November 2018 marks the 100^th anniversary of the end of the First World War, reminding us that trauma can be experienced on a massive scale. A century ago, nurses had to manage without the help of research, let alone measurement scales, to help them to understand their patients; but they still provided care through blending their experience and education with a deep knowledge of the person and their condition, and of the context within which they had to function. Conflicts and violence still abound; how much better might we care for its traumatised victims with the benefit of research to guide our actions? JRN plans to present a forthcoming issue on Nursing, Health and Conflict and we will soon be issuing a call for papers (see http://jrn.sagepub.com/). We hope nurses will submit papers on research studies of any design, case-studies, evaluations or practice development initiatives that focus on the myriad issues that arise during or following situations of conflict and so contribute to the growing knowledge-base in this area.