Friday, 25 November 2016

Nursing students and LGBQ adolescents

Roger Watson, Editor-in-Chief

How comfortable are nursing students working with lesbian, gay, busexual or questioning adolescent and what makes them more or less comfortable? This is the topic of a study from the UK by Richardson et al (2016) titled: 'Do student nurses feel a lack of comfort in providing support for Lesbian, Gay, Bisexual or Questioning adolescents: what factors influence their comfort level?' and published in JAN.

The aim of the study was: 'to find out if student nurses feel comfortable in caring by providing support for Lesbian, Gay, Bisexual or Questioning adolescents and what factors influence their level of comfort.' Over 150 students responded to a questionanire and nine were interviewed. It transpires that nursing students do feel discomfort, despite holding positive attitudes. The authors concluded: 'The increase in ethnic and cultural diversity throughout the world will have an impact on the recruitment of student nurses who may come from cultures unlike their adopted country, It would seem from this study that for those students moving to cultures that are accepting of LGB people this may be difficult when caring for them due to factors identified above. When LGBQ adolescents disclose their sexuality it is essential they receive the right support.' and: 'The question is what can be done to support student nurses in increasing their levels of comfort. Firstly, it is important for educational institutions to raise self-awareness and increase confidence in nursing students by ensuring LGB issues are taught in nursing curricula.'

You can listen to this as a podcast

Reference

RICHARDSON B. P , ONDRACEK A.E, ANDERSON D. ( 2 0 1 6 ) Do student nurses feel a lack of comfort in providing support for Lesbian, Gay, Bisexual or Questioning adolescents: what factors influence their comfort level? Journal of Advanced Nursing. doi: 10.1111/jan.13213

'Mental health day' is nothing to celebrate

Roger Watson, Editor-in-Chief

We are well used to celebrating a wide range of - so-called - 'days' these days; for example, World Cancer Day, World Diabetes days and so on. When I first saw the title of this article I assumed that it was about celebrating Mental Health Day. However, this study from Australia by Scott et al (2016) titled: '‘Mental health day’ sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics' and published in JAN is about something very different.

Due to the stress of the job many nurses get to the point where they simply have to take a day off and this is colloquially referred to as taking a 'mental health day'. The aim of this study was: '(t)o examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’.' A sample of over 5000 nurses in New South Wales was surveyed.

It transpires - amongst other things - that younger nurses, those working shifts where they found it hard to sit down for a while and also those who smoked, had been admited to hospital recently or had mental health problems were more likelty to be absent on the basis of a 'mental health day'. The authors concluded: 'Study findings indicate that nurses and midwives who take mental health days have specific workplace and health profiles which offer healthcare organizations opportunities to implement workforce measures to ameliorate their need to do this and reduce such absences. Study findings indicate characteristics that should flag consideration of how such nurses and midwives might be supported to retain their health and well-being and their positive presence in the workforce.'

You can listen to this as a podcast

Reference

LAMONT S., BRUNERO S., PERRY L., DUFFIELD C., SIBBRITT D., GALLAGHER R. & NICHOLLS R. (2016) ‘Mental health day’ sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics. Journal of Advanced Nursing. doi: 10.1111/jan.13212

Tuesday, 22 November 2016

Clinical decision-making: nurse practitoners versus doctors

Roger Watson, Editor-in-Chief

We have published many articles in JAN on how well doctors and nurses perform on tasks traditionally the domain of the doctor and we have featured several in JAN interactcive. This UK study by Thompson et al (2016) titled: 'A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment' and published in JAN demonstrates - again - that nurses perfom favourably when compared with doctors.

The aim of the study was to: 'investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors.' As explained by the authors, to do this: 'The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview.' Data were processed over five months and the results showed that nurses took three minutes longer to complete the scenarios.  It was interesting to note that: 'NPs elicited more information when history taking.'

In conclusion the authors state: 'This research suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of identifying the correct diagnosis and therapeutic treatment. The information processing theory highlighted that the decision-making processes of both types of professionals were similar.' One implication is that: '(n)urse practitioners should be allowed to assume a wider role in the assessment and treatment of patients in secondary care.'

You can listen to this as a podcast

Reference

THOMPSON S., MOORLEY C. & BARRATT J. (2016) . A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environmenJournal of Advanced Nursing.  doi: 10.1111/jan.13206

Thursday, 10 November 2016

Should nurses be role models for healthy lifestyles?



Muireann Kelly
Jane Wills
Rebecca Jester
Viv Speller



This study investigated the expectation for nurses to be healthy role models and the assumptions attached to this expectation. Although frequently expressed in policy and professional discourse, the expectation for nurses to be healthy role models remains a contentious topic for the nursing profession. Arguments in support of nurses being healthy role models refer to credibility in health promotion and view role modelling a healthy lifestyle as a professional duty. Unhealthy nurses may be less willing to discuss lifestyle with patients to avoid appearing hypocritical, and patients may question the credibility of nurses who appear not to follow their own advice. The objection most frequently raised is that the expectation for nurses to be healthy role models is paternalistic and nurses should be free to make their own decisions about their lifestyles.

The study findings suggest a disconnect between front line nurses and service users as to whether nurses should be expected to be healthy role models. Stakeholders from the practising nurse and nursing student groups argued that demonstrating healthy behaviours was less important than providing evidence-based, patient-centred care. The first round findings showed that practising nurses and nursing students felt that being unhealthy oneself was sometimes beneficial to share experiences and develop rapport with patients when discussing behaviour change. This finding has been noted by other research examining nurses’ health behaviours (González et al. 2009; Brown & Thompson 2007). Whether the front line nursing workforce believes nurses should or should not be expected to be healthy role models, the reality may be that service users do expect nurses to lead by example. The service user group in this study reported that they negatively judged nurses who appeared unhealthy and questioned their credibility and competence. There is an absence of research into the factors mediating patients’ decisions to follow or ignore behaviour change advice (NICE 2014). It would be beneficial to understand how the nurse-patient relationship is mediated and in what circumstances nurses’ health behaviours influence patient perceptions and their response to health promotion practices.

Although the stakeholders in this study argued that simply appearing healthy is not likely to affect how patients receive a public health message, the findings of this study should not be taken to imply that nurses’ health behaviours are of no importance. Maintaining a healthy lifestyle is important for the individual health of nurses as well as limiting the impact of unhealthy behaviours on performance, sickness absence, and the associated costs of lost working days within a health care system that relies on resilient workers.

Nurse education is an obvious starting point to emphasise the importance of a healthy lifestyle within nursing practice. At any one time, there are a considerable number of nurses studying in universities, either through pre-registration training courses or accessing post-qualification education or continuing professional development (CPD) programmes. The pre-registration curriculum should acknowledge the impact that nursing can have on an individual’s ability to lead a healthy lifestyle in order to better prepare nursing students for the reality of their future careers. Universities have a role to support healthy choices during education by providing a supportive studying and working environment for nurses (Wills & Kelly, 2016).The nursing students in this study reported that they imitate the behaviour of staff on placement to “fit in” and adapt to the work environment. Support for healthy lifestyles during education would ingrain the benefits of a healthy lifestyle and help nursing students to maintain their health at the outset of their nursing careers.

Employers also have a responsibility to create environments that encourage nurses in making healthy choices part of their daily lives. In this study, the workforce lead and practising nurse groups argued that employers should do more to support healthy lifestyles at work. The nursing workplace was in itself considered inherently unhealthy because of lack of breaks, poor provision of healthy options and lack of access to catering at night. The workforce lead group thought that currently, workplace support for a healthy lifestyle was insufficient. The ability to lead a healthy lifestyle may be mediated by busy and stressful workloads, long working hours, shift-working patterns, and the emotional labour of nursing work. Initiatives to improve nurses’ health should recognise that it would be more appropriate to try to tackle these constraints rather than focusing entirely on individual behaviour change.


References

Brown, I. and Thompson, J., 2007. Primary care nurses’ attitudes, beliefs and own body size in relation to obesity management. Journal of Advanced Nursing, 60(5), pp.535-543

González, S., Bennasar, M., Pericás, J., Seguí, P. and De Pedro, J., 2009. Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship. International Nursing Review, 56(3), pp.381-386

Kelly M., Wills J., Jester R. & Speller V. (2016) Should nurses be role models for healthy lifestyles? Results from a modified Delphi study. Journal of Advanced Nursing. doi: 10.1111/jan.13173

National Institute for Health and Clinical Excellence, 2014. Behaviour change: Individual approaches (Public health guidance 49), London: NICE 2014

Wills, J., and Kelly, M. What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study. Nurse Education Today. 48(1), pp.180-184


Monday, 31 October 2016

Comment on: Duffield et al. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing

Comment on: Duffield C., Roche M., Twigg D., Williams A. & Clarke S. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing 72(9), 2218–2225


Annette Ayers, RN, BSN, MHA
University of Texas at Arlington

I recently read the article “A protocol to assess the impact of addition nursing support workers to ward staffing” in the September 2016 issue of JAN. With a potential nursing shortage, which is being caused by multiple factors, healthcare facilities are going to have to look at new ways to provide care. As a nursing executive, I believe the addition of non-licensed staff or the LVN, to provide some aspects of patient care, is a way to accomplish this goal (Lafer & Moss, 2007).

I do feel that there is one additional limitation that should be addressed in the study. As required by the Board of Nursing, the delegation of tasks by the Registered Nurse can only be done for those with stable and predictable health conditions (Texas Board of Nursing, 2016). As patients in the hospital are becoming more critical, the addition of non-licensed staff may become less beneficial because many tasks will still be required to be accomplished by the licensed staff member.

One recommendation for the study would be to include types of units when the pairing of units to be studied is completed. Pairing of units based on nursing hours per day, is just one factor to be considered. For example a medical-surgical unit that cares for orthopedic patients may have the same nursing hours per day as the medical-surgical unit with dialysis patients, but these units are very different. For example, orthopedic patients require much more time for education related to physical limitations, whereas dialysis patients typically require many more interventions and medications. Pairing of units based on similar patients, with similar nursing tasks that can or cannot be delegated, could be beneficial to the study.
References

Duffield, C., Roche, M., Twigg, D., Williams, A., & Clarke, S. (2016). A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing, 72, 2218-2225.

Lafer, G., & Moss, H. (2007). The LPN: A practical way to alleviate the nursing shortage. Retrieved from www.afscme.org/news/publications/health-care/the-lpn-a-practical-way-to-alleviate-the-nursing-shortage

Board of Nurse Examiners (2016). Nursing practice act. Retrieved from http://www.bon.texas.gov/pdfs/delegation_pdfs/Delegation-Rule225.pdf


Friday, 28 October 2016

Healthy eating for nurses

Roger Watson, Editor-in-Chief

Nurses sometimes advise others on healthy eating but how healthy are their own diets and how easy is it for them to adhere to a healthy diet at work? This is the topic of this study from Australia by Nicholls et al (2016) titled: 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review' and published in JAN.

The aim of the study was: 'to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses.' Twenty-six articles were reviewed. The results showed that: 'Long work hours, shift work, a high workload, low staffing levels and short/few work breaks were all reported as organizational barriers to nurses’ healthy eating. No organizational factors that facilitated healthy eating were reported'. The authors concluded: 'By addressing the complexity of reasons for unhealthy eating in the workplace, change can be strategic and effective' and: 'While not an inconsiderable undertaking, the potential benefits in terms of staff health and well-being and the potential knock-on effects for the community make this worthwhile'.

You can listen to this as a podcast

Reference

NICHOLLS R., PERRY L., DUFFIELD C. & GALLAGHER R. (2016) Barriers and facilitators to healthy eating for nurses in the workplace: an integrative reviewJournal of Advanced Nursing  doi: 10.1111/jan.13185