An examination of nurses' inquiry processes in Singapore hospitals

Nursing has gradually become a mature profession recognised by society. The positivistic inquiry processes that occur in nursing are valued as a means of generating relevant disciplinary knowledge. Rapid social and economic change has resulted in scholars encouraging the profession of nursing to identify its own methods of inquiry in articulating and generating knowledge and to assert its own values and identities that are specific to healthcare contexts. Nonetheless, there has still been a dearth of literature examining the inquiry processes that nurses undertake on their own and follow. This is probably due to a lack of time for them to engage in self-discovery and self-reflection. In addition, most research has been conducted in Western countries; people in Eastern countries may engage in inquiry in nursing contexts differently due to cultural differences.

Conducting studies that examine nursing inquiry processes help fill the gap in this research area. Simultaneously, it can potentially help to improve the standard of health care services and allows the public to have a more informed view about the nursing profession. This could, in turn, result in improved understandings and cooperation with other professionals in the healthcare sector. A review of the literature about nursing inquiry in the last two decades found multiple inquiry methods from other disciplines being used to help nursing students and staff keep up with the increasing requirements for nursing. For example, the engagement of arts-related inquiries that use guided imagery and poetry to help students unpack their assumptions and design patient care plans. This helped to promote diversity-sensitive practice, planning ability and interpretation skills. Simultaneously, this indicated the tendency of nursing towards a profession with multi-disciplinary thinking in education.

Disciplinary thinking usually underpins the inquiry processes in a one discipline while multi-disciplinary thinking is cross-cutting. Multi-disciplinary thinking is valued in STEAM (science, technology, engineering, arts and mathematics) education worldwide to foster 21st century skills such as critical thinking and problem-solving. Nursing entails more human touch, communication and cooperation to unpack personal data from patients that are more likely related to empathy, appreciation and designing thinking that could be cultivated by arts-related inquiry. As compared to nursing practices, the scientists use systematic objective data and practices to
address the questions. Comparing the identified nursing inquiry to scientific inquiry could provide a better vision on its strengths and limitations for improvement.

The research data collection involved interviews with nursing staff currently working in Singapore hospitals. For the interview protocols, open-ended questions followed by case studies specially designed based on the nurses’ working contexts were conducted. Five registered nurses were interviewed at each session, and the sessions continued until the required data was fully collected for further analysis. The data were analysed using prescriptive and emergent coding methods, and a data analysis tool such as Excel was used to facilitate the data analysis process. The findings of this study would help to better understand the inquiry processes that nurses engage in so as to create case studies for designing professional development courses for emerging nurses or nursing students.

The study revealed that nursing is a discipline with multi-disciplinary thinking related to STEAM. The modified assessing tool, S-T-E-A-M model, was used to describe the multidisciplinary thinking in nursing. The senior staff were more likely with S-t-E-a-m (relatively more focus on scientific and engineering and relatively less focus on technological, arts and mathematical) thinking in their daily work, while junior staff nurses were more likely with S-T-e-A-m thinking in their daily work. As compared to scientific inquiry adopted by scientists that usually involves systematic objective data, nursing inquiry also engaged empathy, appreciation and design thinking to improve their cooperative working environment with much of human touch. Nursing still needs to improve on retrieving contextual data objectively to further improve their quality of practices. In addition, the nursing education programs should focus on the engagement of arts-related inquiry among senior staff nurses to promote the problem-solving ability as well as the understanding between senior and juniors staff nurses. The consolidation of problem-solving skills such as iterative process and foregrounding patient needs should be continuously emphasised not only to provide high quality patient care services, but also to improve the relationship between nurses and doctors to alleviate the inter-disciplinary power relationships.