Wednesday, 17 October 2018

Music for pain in childbirth

Roger Watson, Editor-in-Chief

Does music make you feel better and do you think it could help to alleviate pain? Many people do and music therapy and music interventions are very popular, especially in Taiwan, where this study comes from. However, it is not a study only about the use of music in Taiwan, it is a review of the best evidence for pain in childbirth.

The study is by Chuang et al. (2018) and titled: 'Music Intervention for Pain and Anxiety Management of the Primiparous Women During Labour: A Systematic Review and Meta‐Analysis' and published in JAN. The study aimed to: 'determine the effect of music on the management of pain and anxiety in primiparous women during labour'. Five studies involving nearly 400 women were included and results were in favour of music as an intervention for pain and anxiety. 

The authors conclude: 'Music intervention may prove an effective intervention for the management
of pain and anxiety for primiparous women during labour. Future randomized controlled trials with good methodological quality and adequate power are necessary to strengthen this conclusion.'

You can listen to this as a podcast

Reference

Chuang, C. , Chen, P. , Lee, C. S., Chen, C. , Tu, Y. and Wu, S. (2018) Music Intervention for Pain and Anxiety Management of the Primiparous Women During Labour: A Systematic Review and Meta‐Analysis. J Adv Nurs. doi:10.1111/jan.13871

Saturday, 6 October 2018

Does personality in nurses matter?

Roger Watson, Editor-in-Chief

Does it matter what your nurse is like as a person? I am sure you think it does; but does it matter in practical terms - is he or she more likely to forget or simply to omit to do something, depending on personal characteristics? This study from Israel suggest that it does matter.

The study, by Drach-Zahavy and Srulovici (2018) titled: 'The personality profile of the accountable nurse and missed nursing care' and published in JAN used an international gold standard measure of personality - the NEO-FFI (Five Factor Index) and looked at the extent to which people were likely to miss care. Missed care was measured using the widely used MISSCARE survey instrument. Nearly 300 nurses participated.

The results of the study suggest that nurses who are less conscientious are more likely to miss aspects of care. This may seem an obvious outcome but it is interesting to see it demonstrated by this study. In the words of the authors: 'The current findings portray the personal configuration of the accountable nurse, arguing that whereas high conscientiousness, high agreeableness and low neuroticism are crucial for moral behaviours in general settings, nursing settings require also that nurses be characterized with high openness to change, so that they can critique ward authorities and standing against risks, while demonstrating accountable behaviours in their workplaces.'


You can listen to this as a podcast

Reference
Drach-Zahavy A, Srulovici E (2018) The personality profile of the accountable nurse and missed nursing care Journal of Advanced Nursing DOI: 10.1111/jan.13849

Social jetlag in nurses

Roger Watson, Editor-in-Chief

I must admit, despite frequently suffering from jetlag - induced by many hours of long-haul flying - I had never heard the expression 'social jetlag' until this manuscript was submitted to JAN. Social jetlag  ('indicating a misalignment of biological and social time') seems to be induced by working unsocial hours - such as shift work - and may be associated with 'chronotype' - the type of sleep pattern preferred by an individual. For example, 'individuals with evening chronotypes, who prefer to wake up late in the morning, are forced to start their day earlier than their desired rhythm.'

This study by Chang and Jang from South Korea titled: 'Social jetlag and quality of life among nursing students: A cross‐sectional study' and published in JAN aimed to: 'investigate chronotype categories and social jetlag among nursing students and to identify associations between rhythm asynchrony and participants’ physical and psychological health, academic performance and quality of life.' Nearly 350 nursing students were involved. The average level of social jetlag was approximately 90 minutes and: 'Social jetlag was negatively correlated with chronotype, academic performance and quality of life.'

The authors conclude: 'Findings from the present study suggest significant associations between social jetlag and academic performance and quality of life. Moreover, social jetlag, depression, a positive emotional state and resilience were all predictive of quality of life.'

You can listen to this as a podcast

Reference
Chang SJ, Jang SJ (2018) Social jetlag and quality of life among nursing students: A cross‐sectional study Journal of Advanced Nursing DOI: 10.1111/jan.13857


Napping on night shift

Roger Watson, Editor-in-Chief

It is a long time since I did night shifts in clinical practice and once - to obtain a promotion - I did them permanently for six months and hated the effect it had on my life, my appetite, my sleeping patterns. Initially I resisted have a nap during my break but latterly, unable to function towards the end of a shift, I began to take them. I was never sure if it helped or not and the worst aspect was waking up and having to get to work again. Happy days!

A study from China by Li et al (2018) and published in JAN titled: 'Napping on night‐shifts among nursing staff: A mixed-methods systematic review' aimed to: 'synthesize research on the influence of night‐shift napping on nurses.' Twenty-two studies were found. The results showed: 'Napping is beneficial to the well‐being of nurses and could improve their psychomotor vigilance and performance. However, the related studies are limited. The evidence on reducing sleepiness and fatigue was also insufficient and napping in nursing still faces challenges.'

The authors conclude: 'Although no clear policy, many nurses have reported napping during the night‐shift. Research on this topic has just started. However, some studies have identified night‐shift napping is beneficial to the well‐being and performance of nurses. Currently, night‐shift napping
is not widely implemented among nurses and faces many obstacles. In the future, the effects of night‐shift napping on nurses, people and organization should be explored by using sound methodological designs. Nursing managers should actively develop strategies to address the barriers of implementing night‐shift napping in nursing.'

You can listen to this as a podcast

Reference
Li H, Shao Y, Xing, Z Li1 Y, Wang  S, Zhang M, Ying J, Shi Y, Sun J (2018) Napping on night‐shifts among nursing staff: A mixed-methods systematic review Journal of Advanced Nursing DOI: 10.1111/jan.13859

Thursday, 4 October 2018

The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit

Dear Editor,

This letter is in response to the article “The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit” by Butler, Hall and Copnell (2018) published in the January 2018 edition. This carefully conducted qualitative study enlightens “transitional togetherness”, a multi-phases concept in which the parents-healthcare professional relationships evolve through the pediatric intensive care unit (PICU) hospitalization and grieving process. As a nurse clinician in a PICU, this article particularly resonates with the challenges we face in trying to provide exceptional care for a dying child, along with building strength-base relationships with the family in the most compassionate and holistic way possible. This research is notably relevant considering that clinician interactions with families are the largest determinants of parental role empowerment in an intensive care unit (Butler, Hall & Copnell, 2018), therefore emphasizing the crucial importance for healthcare providers to recognize the needs and expectations of a grieving family.

When working in an environment where life prolonging treatments and great advances in the resuscitation technologies are at the forefront, it can be challenging for nurses to have a child’s care transitions from cure to palliative without proper training on how to navigate such situations. In fact, in a recent study conducted amongst healthcare professionals, it was evident that a lack of training in end-of life care lead to a sense of personal discomfort, higher level of stress and avoidance at a time when support is most needed by a family (Bergsträsser, Cignacco & Luck, 2017). Butler, Hall & Copnell (2018) identified the desire from parents during the hospitalization to have a “collaborative relationship” with the staff, as well as creating a parental role within the PICU for themselves. Once it was clear that their child would die, parents identified the need for a higher level of support from staff to navigate their child’s transition to end-of-life care and to “gradually disengage” from the relationships they had built in the PICU. Such a clear breakdown of phases in the parent-healthcare provider relationship is precisely why this research is needed to help build our understanding on how to approach collaborative end-of-life, family-centered care. Currently, the medical/nursing training on intensive care units is focused on medical and technological advances and lacks a structured curriculum for end-of-life care. To help meet this knowledge gap, multidisciplinary training, “real-life” interventions, palliative care education and parents’ testimonies have shown to be effective ways of learning (Yang &al., 2011) and should be available for clinicians on the unit. Such “toolkits” have started to be implemented in PICUs, such as literature supplements in the SickKids Critical Care Program (Dryden-Palmer & Parshuram, 2018), to provide a reflection on how clinicians can best provide compassionate evidence-based care.

Most interestingly, was that Butler, Hall & Copnell (2018) identified parental needs for an ongoing relationship with health care providers after the child’s death. This is a compelling concept within the grieving process that is lacking support/acknowledgement in our current Quebec healthcare system, particularly when children die in an intensive unit. The incorporation of outreach programs to support debriefing and long-term family coping (October & al., 2018) is needed to complement the legacy items (handprints, pictures, photos, etc.) that parents receive after their child’s death.

In conclusion, rich insight was provided through this article by Butler, Hall & Copnell (2018) on parental needs when losing a child in the PICU and established the foundation for education regarding the changing nature of collaborative relationships with healthcare professionals and grieving families. Together, both hospitals and our healthcare system must take into consideration during the development of protocols, educational tools and support programs, the profound impact of a child’s death and the unique challenges faced by these families inside and outside of the PICU. 

Sincerely,

Estelle Simon, RN, BScN
Master student (M.Sc.A.)
Ingram School of Nursing
McGill University
estelle.simon@mail.mcgill.ca

____________________________________________________________________

References

Bergsträsser Eva, Cignacco, E. and Luck, P. (2017) “Health Care Professionals’ Experiences and Needs When Delivering End-Of-Life Care to Children: A Qualitative Study,” Palliative Care: Research and Treatment, 10, pp. 117822421772477–117822421772477. doi: 10.1177/1178224217724770

Butler, A. E., Hall, H. and Copnell, B. (2018) “The Changing Nature of Relationships between Parents and Healthcare Providers When a Child Dies in the Paediatric Intensive Care Unit,” Journal of Advanced Nursing, 74(1), pp. 89–99. doi: 10.1111/jan.13401.

Dryden-Palmer, K., & Parshuram, C. (Eds.). (2018). “Death and dying in the pediatric intensive care unit” [Special issue]. Pediatric Critical Care Medicine, 19 (8S).

October, T., Dryden-Palmer, K., Copnell, B. and Meert, K. L. (2018) “Caring for Parents After the Death of a Child,” Pediatric Critical Care Medicine, 19(8s Suppl 2), p. 68. doi: 10.1097/PCC.0000000000001466.

Yang, C. P., Leung, J., Hunt, E. A., Serwint, J., Norvell, M., Keene, E. A. and Romer, L. H. (2011) “Pediatric Residents Do Not Feel Prepared for the Most Unsettling Situations They Face in the Pediatric Intensive Care Unit,” Journal of Palliative Medicine, 14(1), pp. 25–30. doi: 10.1089/jpm.2010.0314.

Tuesday, 18 September 2018

Professional identity and conflict: has the higher education of nurses changed professional relations between nurses and doctors?

Dear Editor,
 
In reference to the article in JAN by Fealy et al. (2018) titled: from September 2018: Discursive constructions of professional identity in policy and regulatory discourse, we would like to include a significant element – question – to this discourse. Can we talk about the conflict of professional identities?
In the period from October to December 2017, we conducted focus group interviews (FGI), which were attended by nurses and physicians in two university centres in Poland educating medical personnel - Gdansk and Bydgoszcz. The research concerned the professional identity of nurses and professional relations between nurses and doctors. The results of the research allow to draw two main conclusions:

  • Doctors see weakening of teamwork, which was a principle in health care. They talk about the tension between the doctor and the nurse, which makes the situation worse. The opinion prevails that the increase of formal requirements - higher education - in the profession of nurses destabilized the working conditions in hospitals.
  • Nurses place emphasis on their dependence on the doctors, but modern nursing is, above all, the extension of professional tasks. In their opinion, the doctors rather defend the previous state of professional subordination and treat this state as obvious. Nurses see the doctors' attitudes as seeking to transform nurses work into a doctor's secretary's: writing cards, writing sick leave, etc. Nurses building their professional identity put the main emphasis on being perceived and appreciated as highly specialized professional staff (Luca & others, 2015).

Statements of physicians and nurses participating in research show a clearly outlined conflict between these groups of medical professions (Hartog, Benbenishty, 2015). It seems that nowadays their professional identity changed, hence they can not clearly defined the field of cooperation, and sometimes even differently define their participation in therapeutic and caring activities (Hughes, 1988, Radcliffe, 2000). Particularly difficult situations arise when the nurse has doubts as to the procedure proposed by the doctor. Doctors treat this situation as unacceptable and even as a proof of personal dislike towards a doctor. It also seems characteristic that both professional groups blame each other for the resulting situation.

The research results indicate the need to develop new relationships between doctors and nurses, including changes in university study that would improve the skills of cooperation and partnership and mutual respect for their work (Donelan & others 2013). Regular training in this area is also necessary in the course of specialization and professional work (Cummings & others, 2018).

We also want to support the thesis contained in the article, that academic study of identity construction is important to disciplinary development by raising nurses and physicians consciousness, alerting them to the ways that their own discourse can shape their identities, influence public and political opinion and, in the process, shape public policy on their professions.

Your Sincerely,

Prof. Janusz Erenc, Department of Sociology, University of Gdańsk, erenc@poczta.fm

Dr. Piotr Pankiewicz, Department of Psychiatry, Medical University of Gdańsk, piotr.pankiewicz@gumed.edu.pl

Dr. Małgorzata Filanowicz, Nicolaus Copernicus University, gosiafilanowicz@cm.umk.pl
 
____________________________________________________________________
 
 
References

Carciati, L., Guberti, M., Borgognoni, P., Prandi, C., Spaggiari, I., & Iemmi, M. (2015), The role of professional and team commitment in nurse–physician collaboration: A dual identity model perspective Journal of Interprofessional Care 29: 464–468.

Cummings, G.G., MacGregor, T., Wong, LH., Lo, E., Muise, M., & Stafford, E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review International Journal of Nursing Studies 85:19-60.

Donelan, K., DesRocjes, C.M., Dittus, R.S., & Buerhaus, P. (2013) Perspectives of Physicians and Nurse Practitioners on Primary Care Practice New England Journal of Medicine 368:1898-1906.

Fealy, G., Hegarty, J-M., McNamara, M., Casey M., O'Leary, D., Kennedy, C., O'Reilly, P., O'Connell, R., Brady, A-M., & Nicholson, E. (2018) Discursive constructions of professional identity in policy and regulatory discourse Journal of Advanced Nursing 74: 2157-2166.

Hartog, C. S., & Benbenishty, J. (2015). Understanding nurse–physician conflicts in the ICU Intensive Care Medicine 41:331-333

Hughes, D. (1988). When nurse knows best: some aspects of nurse/doctor interaction in a casualty department Sociology of Health and Illness 10: 1–9.

Radcliffe, M. (2000) Doctors and nurses: new game, same result BMJ,320: 1085.