Monday, 10 February 2020

“Nurses and Midwives: clean care is in your hands”: The 5th May 2020 World Health Organization SAVE LIVES: Clean Your Hands campaign

Alexandra Peters1, Nasim Lotfinejad2, ChloĆ© Guitart1, Alice Simniceanu2, Maria Clara Padoveze2, Tcheun Borzykowski1, Benedetta 
Allegranzi2, Didier Pittet 1
1Infection Control Program, University of Geneva Hospitals and Faculty of Medicine
2Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland

In honor of Florence Nightingale’s 200th birthday, the World Health Organization (WHO) has declared 2020 the “Year of the Nurse and Midwife”. In addition to championing the nursing profession, Nightingale’s role was also fundamental for the recognition of the importance of infection prevention and control (IPC), as she was among the first to recognize that a caregiver could transmit germs, and thus cause patient harm. Nurses and midwives make up nearly 50% of the global health workforce,1 and are the group of healthcare workers that have the most frequent contact with patients. This makes them pivotal figures in the fight against healthcare-associated infections (HAI) as well as neonatal and maternal sepsis.
On the 5th May 2020, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, WHO will focus on the essential role that nurses and midwives play in contributing to saving millions of lives each year by championing clean care. Despite many improvements around the world, rates of HAI remain unacceptably high, and the majority of them are transmitted by healthcare workers’ hands. Therefore, hand hygiene promotion strategies must be constantly reinforced and improved. Clean healthcare has recently been recognized by WHO as one of the most urgent challenges to be tackled by the global community over the next ten year.2 Actively engaging the expertise of nurses and midwives in the development, implementation and evaluation of hand hygiene promotion contributes to clean healthcare.
Along with recognizing the critical importance of nurses and midwives to patient care, the aim of the “Year of the Nurse and Midwife” is also to highlight that there is a major global shortage of healthcare workers, and that more than half of the shortage is of nurses and midwives.1 WHO estimates that for countries to succeed in reaching the Sustainable Development Goal # 3 on health and well-being, the world will need an additional 9 million nurses and midwives by the year 2030.1 It has been proven that investing in education and job creation in the health and social sectors will result in improved health outcomes, global health security, and economic growth.1  Having adequate healthcare worker staffing reduces the risk of HAI and antimicrobial resistance, and is thus recommended by WHO as a core component of effective IPC programmes.3
It is crucial to recognize both the work and the immense responsibility that nurses and midwives carry: we cannot achieve Universal Health Coverage without investing in them. Everyone- including policy makers, healthcare workers, and patients themselves- can contribute to improving hand hygiene and preventing infections (Table 1).
Table 1.

The 5 May 2020 World Health Organization SAVE LIVES: Clean Your Hands Campaign Calls to Action
Campaign Participants 
Call to Action 

Clean and safe care starts with you.”

Your hands make all the difference for mothers and babies.”

IPC leaders 
Empower nurses and midwives in providing clean care.”

Policy makers 

Increase nurse staffing levels to prevent infections and improve quality of care. Create the means to empower nurses and midwives.”

Patients and families
Safer care for you, with you.”  

Abbreviations: IPC, infection prevention and control; WHO, World Health Organization.                                  

Please join us in celebrating this vital and often underappreciated group of HCW; “Nurses and Midwives: CLEAN CARE is in YOUR HANDS”!
1“Nursing and midwifery”. Fact sheets. World Health Organization. 9 January 2020.
2“Decade of Action” Geneva: World Health Organization. Accessed January 27, 2020.
3“Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level”. Geneva: World Health Organization; 2016.

Disclaimer: The views expressed in this article are those of the authors alone and do not necessarily represent the views, decisions, or policies of the institutions with which the authors are affiliated. The World Health Organization (WHO) takes no responsibility for the information provided or the views expressed in this article.

Financial support: This work is supported by WHO, Geneva, Switzerland, and the Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; hand hygiene research activities at the SPCI/WCC are also supported by the Swiss National Science Foundation (grant number 32003B_163262). Potential conflicts of interest. 

All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed

Sunday, 9 February 2020

Effects of a telehealth educational intervention on medication adherence in rheumatoid arthritis patients

Roger Watson, Editor-in-Chief

Telehealth is an attractive alternative to having patients visit hospital from home or having busy health professionals visit patients' homes from hospital. It offers economies of scale, the technologies involved are always improving and more people have access to those technologies. It is especially attractive in managing long-term conditions as these require regular maintenance but not, usually, direct intervention by health professionals. But, does it work?

A recent study from China by Song et al (2020) titled: 'A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients' and published in JAN aimed to: 'examine the effects of a tailored telehealth educational intervention on medication adherence and disease activity in discharged patients with rheumatoid arthritis'. The study involved nearly 100 patients and the intervention group received: 'four educational sessions delivered through a telephone across a 12‐week intervention' and the control group received instructions on discharge.

The patients were followed up at 12 and 24 weeks after the intervention and the intervention group 'had significantly higher medication adherence compared with the control group'; there was no effect on disease activity. The authors concluded: 'This study demonstrated that the tailored telehealth educational intervention by nurses could improve medication adherence. Based on our results, further studies should explore the long-term effects of patient education on medication adherence and disease activity.

You can listen to this as a podcast.


Monday, 6 January 2020

Let’s Welcome in 2020… The Year of the Nurse and Midwife

The Global Nursing Profession Must Speak with One Voice

Catherine Best

The declaration by the World Health Organisation (WHO) in May 2019, that 2020 would be The Year of the Nurse and Midwife affirms the significant commitment and contribution that nurses and midwives make to global healthcare (ICN, 2019).

By understanding the importance of this significant milestone, nurses are able to recognise the role we play in helping to make our workplaces safer, our labour recognised and our voices heard, a voice which can be made stronger through the effective use of social media; a medium through which nurses can find their voice and catalyse collective action. Although there is considerable debate as to whether the use of social media is indeed a legitimate form of action (Chatfield, 2011), it is still a well-recognised way in which nurses can share their voice publicly and drive forward social change, and is one, which has the potential to benefit both our patients and society as a whole. 

Engaging and uniting the nursing workforce to speak with one voice is challenging. The nursing profession is not a harmonised workforce, and often engages in bullying. A term used to define a number of personal factors, such as sex, race and age as well as organisational factors such as culture (Yun and Kang, 2014). Bullying seeks to harm the personal and professional relationships of the targeted by socially excluding and harassing the individual concerned (Johnson, 2011). Nurses in particular have been frequently criticised for engaging in lateral violence; (Sanner-Stiehr and Ward-Smith, 2017) a process of peer-peer bullying and has far too often been admonished for ‘eating their young’ (Meissner, 1986) a colloquial term, used to recognise the failure of nurses to support those newly registered. Furthermore, cyberbullying is considered of particular concern due to its ‘boundaryless nature’ (Heatherington & Coyne, 2014).

Disappointingly, this behaviour could be considered a contributory factor in creating critical divisions, through which nurses can be easily exploited. On this evidence alone, it could be argued that the nursing profession has created significant barriers to collaboration. Rather than being strong collective leaders, who nurture both our young and more experienced alike, we are seen as being significant contributors to our own demise. After all, if we are unable to work harmoniously, how can we lead collaboratively?

So, in order to facilitate and drive forward the change so desperately needed, as evidenced throughout the lead-up to the Year of the Nurse and Midwife, and during a year when we all celebrate our professional lives, nurses must utilise their ‘strength in numbers’ to bring the global workforce together, rather than be ‘at odds’ with each other, and in so doing, unlock the social power that exists within the profession.
Social power a term used by the Sheila McKechnie Foundation (2018) is defined as:

‘the capacity that civil society has to deliver profound transformational change - in individual lives, in communities, and in society as a whole’.

Change the word civil to nursing and we have a nursing society, a collective, through which we can bring about fundamental change, not only nationally but globally.

If we are to unlock the social power of the profession, nursing needs bold leaders, willing to recognise the professions potential, encourage solidarity and create a combined purpose.
Rather than continuing to be led by others, including the patriarchal world of medicine, management and government agendas, nurse leaders must focus on what is important to nurses and be vocal and prominent, rather than passive recipients of change.

Managers and governments who make nurses scapegoats for the delivery of increasingly pressurised care, at a time of unprecedented nursing shortages, should be brought to account for their actions. For these actions which have sought to demoralise nursing and bring it to its knees, a good example of which is the loss of the bursary, (RCN, 2018), requires accountability.

Although the UK government following its re-election in December 2019, has declared its intention to provide financial support to student nurses, (which may help to encourage more students into nursing), (RCN, 2019), this may simply be too little, too late. The greatest concern however, as argued by Professor Roger Watson, Editor-in-Chief of the Journal of Advanced Nursing which presents an interesting viewpoint; is not of nurse recruitment, (asserted by many as being the root cause of nursing shortages), but of nurse retention.  His Twitter response to this headline news on 18th December captures his thoughts:

‘Why are we doing this when we don’t have a recruitment problem? We have a retention problem once these nurses enter practice. This is building cabins on a sinking boat when we should be patching the holes. Can anyone provide an answer that does not include ‘they deserve it’?

It could be argued however that these differences of opinion only seek to create divisions between the nursing profession, creating barriers to collaboration and collective action.  So
should nurses put aside such opinions and their differences and engage in collective action, one with vision and restore faith in its ability to create its own destiny. By working as a collaborative force nurses can bring about change that can benefit the whole of society globally as well as nationally. Through targeted and positive, collective action we have so much to gain and so little to lose.

CatherineBest is Chair RCN Yorkshire and Humber Regional Board 


Chatfield, T. (2011) The Net Delusion: How Not to Liberate the World by Evgeny Morozov – review. The guardian [Online]. 9 January. Available from: <> [Accessed 02 January 2020]


Heatherington, W. and Coyne, I. (2014) Understanding individual experiences of cyberbullying encountered through work. International Journal of Organizational Theory and Behavior, 17, September, pp. 163-192


International Council of Nurses. (2019) International Council of Nurses and Nursing Now welcome 2020 as International Year of the Nurse and Midwife. International Council of Nurses [Online]. Available from: <>
[Accessed 02 January 2020]

Johnson, S. L. (2011). An Ecological model of workplace bullying: A guide for intervention and research. Nursing Forum, 46 (2), April-June, pp. 55-63.

Meissner, JE. (1986) Nurses: are we eating our young? Nursing, 16 (3) March, pp. 51-3

Royal College of Nursing (2019) Student funding announcement what we know so far
[Accessed 02 January 2020]

Royal College of Nursing (2018) Removing the student nurse bursary has been a disaster
[Accessed 02 January 2020]

Sanner-Stiehr, E. and Ward-Smith, P. (2017) Lateral Violence in Nursing: Implications and Strategies for Nurse Educators Journal of Professional Nursing, 33 (2), March-April, pp. 113-118

Sheila McKechnie Foundation (2018) Social Power. How civil society can ‘Play Big’ and truly create change. London: The Sheila McKechnie Foundation

Yun, S. and Kang, J. (2014). Factors affecting workplace bullying in Korean hospital nurses. Korean Journal of Adult. Nursing, 26 (5), October, pp. 553-562.

Sunday, 5 January 2020

Publishing studies in traditional Chinese medicine

Roger Watson, Editor-in-Chief

Read our editorial on Publishing studies in traditional Chinese medicine:

Traditional Chinese medicine (TCM) has a history of thousands of years in China and is officially sanctioned by the government as a treatment option for Chinese citizens alongside, what we will refer to here as western medicine, which is also very well developed in China. In the west, TCM is becoming increasingly popular with some people who become worried about the efficacy and side‐effects of western medicine.

Listen to the entire editorial as a podcast


Watson, R. and Xue, C. (2020), Publishing studies in traditional Chinese medicine. J Adv Nurs.  doi:10.1111/jan.14297

Sunday, 15 December 2019

Turnover prevention among newly qualified nurses

Roger Watson, Editor-in-Chief

Nursing turnover, especially in the early days in clinical practice, is of intense interest as this is a period when many nurses are lost to the profession. The aim of this study from The Netherlands by Hoeve et al. (2019) and published in JAN was to gain: 'insight in the most crucial organizational job stressors for novice nurses’ professional commitment and whether the job stressors are mediated through negative emotions.'

Eighteen newly qualified nurses provided nearly 600 diary entries related to their time in practice and this was combined with measures on emotions and commitment. The results showed that: 'lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions.'

The authors concluded: ' anticipation of growing nursing shortages, it is essential to prevent turnover of novice nurses. Therefore, nurses need a supportive work environment for coping with the most crucial organizational job stressors to enhance professional commitment. In particular, support in the clinical environment is crucial because not feeling supported by colleagues, negative experiences with patients, encountering existential events and conflicting job demands proved to be critical to professional commitment. Retaining novice nurses by creating a supportive work environment for the nursing workforce can be considered a major challenge for nurse managers, organizational management and policy makers.'

You can listen to this as a podcast


Hoeve, Y.T., Brouwer, J. and Kunnen, S. (2019), Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses. J Adv Nurs. Accepted Author Manuscript. doi:10.1111/jan.14281

Sunday, 8 December 2019

Is urinary urgency in older women associated with falls?

Roger Watson, Editor-in-Chief

There is good reason to suspect that having to go to the toilet frequently by older women may be associated with falls. These older women are possibly more likely to be frail and, in addition to frequent visits to the toilet during the day - which can be exhausting in itself - having to go at night adds additional danger.

This study from South Korea by Park et al (2019) titled: Association Between Urinary Urgency and Falls Among rural dwelling Older Wome and published in JAN aimed to: 'examine the association between urinary urgency and falls in older women living in rural areas in South Korea.' The study included nearly 250 women aged over 65. The frequency of falls and the factors associated with them were examined. Just over 30% of the women had experienced a fall in the past year and a range of hazards such as slippery floors was associated with this. Also, urinary frequency and osteoporosis were associated with falls.

The authors concluded: 'The current study found that urinary urgency was associated with falls among older women living in Korean rural areas. The sense of a strong urge to void often makes older women with urinary urgency rush to the bathroom and places them at a high risk of falls.' Among other recommendations: 'The findings also have implications for policymakers with regard to designing safer indoor and outdoor environments for older women living in rural areas, such as by amending building codes for elder-friendly environments or by providing funds for remodeling their residence spaces or neighbourhood.'

You can listen to this as a podcast.


Park, J., Lee, K. and Lee, K. (2019), Association Between Urinary Urgency and Falls Among rural dwelling Older Women. J Adv Nurs. doi:10.1111/jan.14284