Sunday, 9 December 2018

Graduate nurses adaptation to individual ward culture

Roger Watson, Editor-in-Chief

In a time when nursing shortages are acute and many leave their jobs or leave nursing altogether, there is increasing attention on the experience of newly qualified nurses. The aim of the present study from Australia by Feltrin et al (2018) and published in JAN was to: 'increase understanding of strategies graduate nurses use on a day‐to‐day basis to integrate themselves into pre‐existing social frameworks.'

A small sample of nurses was interviewed who were at least four months into their first year of clinical practice. The strategies used by new nurses included: self‐embodiment and self‐consciousness, navigating the social constructs and raising consciousness. Self‐embodiment and self‐consciousness was exemplified by a comment from one of the nurses: 'Being vocal about what you don't know and being confident with what you do know.' In terms of navigating the social constructs, one students said: 'Learning from the senior staff. I guess they've been there the longest. They know what they are talking about.' And, as the authors explained: 'Raising consciousness involved the adaptation processes through reflectivity. Being aware of the differences between fitting in
not fitting in was integral to the (graduate nurses') eventual successful navigation of the social constructs.'

The authors concluded that newly qualified nurses: 'require preparation and to be adequately supported in their adaptation to ward culture'  and if they: 'are not supported in this process, the individual, their colleagues and the patient are probably affected.'

You can listen to this as a podcast


Feltrin C, Newton JM, Willetts G. How graduate nurses adapt to individual ward culture: A grounded theory studyJ Adv Nurs2018;

Thursday, 22 November 2018

Beta-Glucan Gel Doubles Healing Rate of Chronic Wounds

Over 2.2 million people in the UK suffer with ‘long-term’ wounds, i.e. those insufficiently responsive to standard care protocols within 3 months. [1] Chronic wounds cause significant distress and effects on the quality of life of patients, particularly for diabetics and the elderly. An overspent NHS already spends over £4.5 billion on chronic wound care every year. [1] Yet many patients cope daily with slow healing wounds, many for extended periods of time.

A new study has shown long term, chronic wounds heal twice as fast when a new beta-glucan based gel is applied. [2] The study (read here), compared wound healing times in 300 patients, 150 of whom had a beta-glucan gel applied twice a week alongside a normal dressing change. The data shows significant improvements in healing across various wound types with Woulgan [2], showing more than double healing rates (107%) for ulcer-type wounds over standard care at week 8, 12 and 24 [2].

Woulgan, a novel wound therapy, contains beta-glucan, a fibre found in fungi and yeast and used for hundreds of years for its effects on the immune system. [3] The active component, soluble beta-glucan, can restart healing in the wound through macrophage activation [2]. The gel promotes a moist healing environment and helps rehydrate necrotic tissue, supporting cell proliferation and stimulation of the wound bed itself, kick-starting the healing process.

The study showed that using Woulgan on slow healing wounds, not only improved the rate of healing significantly, but delivered cost savings of £211 per patient.

Clinicians’ early adoption of a cost-effective healing treatment such as Woulgan, has the potential to significantly reduce the overall financial burden that chronic wound care currently represents. Ineffective assessment and management of the underlying pathologies of a wound are some of the main barriers to successful wound healing. [4] Woulgan provides an easy-to-use solution with application straight from a tube, simple to use for both healthcare professionals and patients.

Resolving slow-to-heal wounds is a priority for patients and health professionals. Early treatment with Woulgan has the potential to limit the negative effects to a patient’s quality of life and reduce the overall amount of nursing care required and therefore the associated costs.

Sarah Winterbottom
ROAD Communications


[1] J. Guest and N. Ayoub, “Health economic burden that wounds impose on the NHS in the UK,” BMJ Open, vol. 5, 2015.

[2] S. Hunt, “A retrospective Comparison Evaluation of Bioactive Beta-Glucan Versus Standard Care Alone,” Journal of Woundcare, 2018.

[3] Journal of American College of Nutrition, vol. 1, no. 16, pp. 15-6, 1997.

[4] L. Grothier, “Three goals, deslough, manage exudate and promote healing. Clinical benefits of Urgoclean,” British Jounral of Nursing, vol. 25, 2016.

Tuesday, 13 November 2018


On November 6, voters in the state of Massachusetts were presented with a binding referendum question that would have had major ramifications for the profession of nursing in Massachusetts and possibly throughout the United States.
A Yes Vote on ballot Question #1 would have established mandatory nurse staffing ratios in hospitals throughout Massachusetts. A No vote would have maintained the status quo. While Massachusetts voters voted overwhelmingly against Question #1, the ballot question itself was a no-win for nursing and, by extension, the patients for whom nurses care.
The problem with Question #1 was that regardless of the result, nursing’s authority in determining how best to meet patient care needs was destined to remain limited. The No vote reinforced healthcare administrators' control of nurse staffing, while a Yes vote would have put nurse staffing in the hands of state legislators. The bottom line is that none of these parties is at the bedside delivering care to patients. Nurses are. And yet their voices often remain unheard in discussions of what constitutes appropriate staffing levels in hospitals throughout Massachusetts and the nation as whole.
As a professor of nursing and a hospital-based nurse scientist, I know that today’s nurses are stressed, often worried about what they may have missed at shift’s end. Turnover rates among nurses are on the rise, now approaching 17%, and the highest among licensed healthcare personnel. Patient complexity continues to outpace increases in staff nursing positions. The failure to address long-standing staffing issues is what led to Question #1 in the first place. It is an issue that presents itself in hospitals nationwide.
Another issue raised by the referendum: If Question #1 had passed, the immediate need for additional nurses would not have been matched by an expansion of nursing’s educational pipeline, which is already struggling with a faculty shortage. Current nursing student education also would have been jeopardized. Prior to the November 6 election in Massachusetts, healthcare facilities began informing nursing schools that student clinical placements could not be ensured should Question #1 pass. Institutional budget reallocations and personnel shifts would have resulted in more nurses at the bedside. However, a reduction in advanced nursing positions would have diminished nursing’s capacity for educating staff nurses about the newest technologies, addressing system-wide patient safety issues, improving care coordination between hospital and home, or advancing other strategic initiatives designed to improve the patient experience. Meeting mandated staffing needs by hiring travel nurses or recruiting internationally come with their own societal costs.
The upside to the debate about Question #1 is that it has served as a clarion call for change. Professional nurses play a vital role in helping to ensure good patient outcomes. The public has the right to demand high quality nursing care from well-educated nurses who have a say in best-practices.
Since virtually all of us will be a patient at some point, what can we do in an effort to achieve the best possible patient care? 
Unlike the Question # 1 referendum, solutions are less complicated:
  • Demand that hospitals be transparent about their nursing staffing policies, nursing staff mix, and turnover rates.
  • Inquire how hospitals determine new budgeted positions for professional nursing compared to those for non-clinical services.
  • Ascertain how many nurses sit on hospital or insurance company boards, as these board decisions will directly affect patient care.
  • Question why nurses are still restricted from working to the full scope of their license in many hospitals in and outside of Massachusetts.
  • Help create opportunities that support collegiate nursing education and professional advancement opportunities in clinical practice settings.
Our collective voice is needed to influence the future direction of patient care for the better. Too much is at stake to ignore the problem any longer. The question Massachusetts voters faced on November 6 is one that could easily find its way into other states that offer binding referenda questions, once again putting the decision making in the hands of either hospital executives or state government, as opposed to listening to the experts—hospital nurses themselves—who know what is best for the health and well-being of their patients.

Judith A. Vessey, Ph.D., MBA, RN, FAAN

Lelia Holden Carroll Professor of Nursing, Boston College

Monday, 29 October 2018

Sleep, gender and nursing

Roger Watson, Editor-in-Chief

There has been a lot of interest in JAN recently on the relationship between sleep patterns and well-being in nursing. For example, we recently reported in JAN interactive on 'napping' and 'social jet-lag'. Now we have an article on a phenomenon that arose in the latter piece - on 'chronotype', the individual preference for a particular pattern and times for sleeping and waking.

This recent article comes from Spain and is by López‐Soto et al. (2018) and titled: titled: 'Chronotype, nursing activity and gender: A systematic review'. The study aimed to: ' synthesize evidence about the effect of individual circadian preference (chronotype) and gender in the development of sleep and mood problems in nursing professionals.' Twenty-three studies were included in the review and the main finding was that: 'Female nurses with eveningness‐oriented personality seem to be more prone to having sleep disorders, insomnia, fatigue, and anxiety than male and morningness ones.'

The authors concluded: 'Personal chronotype, mediated mainly by individual, familiar and work behavioural factors and coupled with gender, represent variables of great interest in attempts to prevent sleep and mood disorder in nursing workers.'

You can listen to this as a podcast

López‐Soto, P. J., Fabbian, F. , Cappadona, R. , Zucchi, B. , Manfredini, F. , García‐Arcos, A. , Carmona‐Torres, J. M., Manfredini, R. and Rodríguez‐Borrego, M. A. (2018), Chronotype, nursing activity and gender: A systematic review. J Adv Nurs. doi:10.1111/jan.13876

Obese nurses and health promotion

Roger Watson, Editor-in-Chief

If you do not lead a healthy lifestyle as a nurse - and it shows - then can you be a role model for good health with your patients? Nurses seem to understand this and accept it, but they would not like to see professional obligations, for example, not to be obese. These were the findings from the UK by Wills et al. (2018) in a study titled: 'Nurses as role models in health promotion: piloting the acceptability of a social marketing campaign' and published in JAN. The participants were obese nurses.

The study aimed to: 'To pilot the acceptability to practising nurses of the concept of being healthy role models as regards obesity and weight'. The findings of the study have already been stated but the method of recruitment of nurses is also worth reporting. My guess is that this could have provoked some difficult situations, nevertheless, the authors recruited 71 obese nurses to participate. As reported by the authors: 'Nurses’ eligibility for the panel was based on being visually identified as obese by trained researchers aided by a validated visual rating scale . To confirm the visual identification, potential participants were asked if they had ever worn clothes sized XXL or size 18 and above.'

The authors concluded: 'Taken together, the findings suggest that although the belief that healthcare professionals have a special obligation with regard to their health behaviours is normatively accepted, its implementation is devalued in the challenging working life of a nurse. When shown campaign materials highlighting how unhealthy behaviours might look in the real‐life scenarios (and the effect this could have on the impact of health advice delivered to patients), nurses became pragmatic and engaged in self-affirmation via increasing emphasis on other dimensions of the nursing identity ‐ being a “good nurse” or healthcare professional. This was expressed in part by reconceptualizing healthy behaviours as a private matter of individual choice.'

You can listen to this as a podcast


Wills, J. , Kelly, M. and Frings, D. (2018), Nurses as role models in health promotion: piloting the acceptability of a social marketing campaign. J Adv Nurs. doi:10.1111/jan.13874

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


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