Sunday, 27 January 2019

A wee problem for nurses

Roger Watson, Editor-in-Chief

Nursing work is not always conducive to getting to the toilet regularly. Long hours, hard physical work and many hours of standing. The nature of the work means that you cannot necessarily drag yourself away to the toilet when you need to go. This is a problem for all nurses, how much more so for those with a overactive bladder.

This study from China by Xu et al (2018) titled: 'Relationships among occupational stress, toileting behaviors, and overactive bladder in nurses: a multiple mediator model' and published in JAN aimed to: 'investigate: (a) the prevalence of overactive bladder among male and female operating room nurses; (b) the unhealthy toileting behaviours that nurses adopt to void their bladders; and (c) the mediating roles that different toileting behaviours play in the relationship between occupational stress  and overactive bladder.'

Involving 400 nurses, the study surveyed their stress, toileting behaviour and whether or not they had overactive bladder. One in three of the nurses had overactive bladder - which is higher than in the general population - yet reported delayed toileting. In fact, the nurses who engaged in delayed toileting were those most likely to have overactive bladder.

The authors concluded: 'To accommodate occupational stress, nurses engaged in unhealthy toileting behaviours that had detrimental effects on their bladder health. Hence, nurses should not overlook their own basic physical needs of voiding. Moreover, it is much easier for interventions to change
unhealthy toileting behaviours than to reduce occupational stress from high patient loads and inadequate staffing. Thus, identifying and changing such unhealthy toileting behaviours through organizational‐level interventions are urgently needed to prevent, alleviate and manage overactive bladder symptoms in nurses.

You can listen to this as a podcast

Reference

Xu, D. , Zhu, S. , Li, H. , Gao, J. , Mou, H. and Wang, K. (2019), Relationships among occupational stress, toileting behaviors, and overactive bladder in nurses: a multiple mediator model. J Adv Nurs. doi:10.1111/jan.13940

Saturday, 12 January 2019

Bullying at work

Roger Watson, Editor-in-Chief

Which aspects of organisations are related to bullying in nursing? This study from the USA, titled: 'Organizational determinants of bullying and work disengagement among hospital nurses' and published in JAN,  aimed to: 'identify organizational determinants of bullying and resulting work disengagement among hospital nurses'.

Over 300 nurses responded to a questionnaire about bullying at their work. Not surprisingly, the more trust and respect there was in an organisation the less bullying there was. Likewise, more emphasis on competence development was associated with less bullying.

The authors concluded: 'Results of this study suggest that the single most important measure that nurse managers and staff nurses can take to reduce bullying and mitigate its negative impact on work engagement is to create a supportive, psychologically safe environment in which nurses dare to discuss work problems and difficult issues with each other. Work disengagement due to bullying can also be counteracted by enhancing nurses’ competence development opportunities.'

You can also listen to this as a podcast

Reference

Arnetz JE, Sudan S, Fitzpatrick L, et al. Organizational determinants of bullying and work disengagement among hospital nursesJ Adv Nurs2019  https://doi.org/10.1111/jan.13915

Wednesday, 9 January 2019

Bedside to Bench: Rethinking Nursing Research

Cowman presented his candid views concerning research and how it is taught in schools of Nursing and Midwifery among graduate and postgraduate students. As a PhD student with aspirations of full time research in the future, I wish to respond to some assertions made by Cowman who (2017) claims research is just ‘an academic exercise’, and that the lack of clarity and distinction among students in terms of how the subject is taught make health professionals fail to apply the knowledge gained into patient care. The author in the end advocates for mandatory nursing research that links with clinical nursing and patient care.
 
I appreciate that applying research knowledge to the real-world situation is difficult, and takes a long time to achieve (Curtis, et al., 2016), I take a different position and disagree with his assertion that a lack of clarity to teaching research in Schools of Nursing and Midwifery is the cause of this knowledge-practice disconnect. In the first place, the author categorically presented his personal observation in a generalized global context yet did not use any literature to substantiate the global picture of his assertion, thus committing fallacy of hasty generalizations (i.e. a universal statement based on limited evidence) and Fallacy of inadequate grounds (i.e. insufficient grounds for drawing conclusions).
 
Cowman’s view might hold true in certain jurisdictions, but that notwithstanding, a situation observed in one educational system cannot be extrapolated to worldwide health professionals. Each Nursing and Midwifery school has specific, and purposefully tailored curricula for teaching nursing research for knowledge application. Cowman (2017) failed to delineate between the category of graduate studies in nursing and the existing role each is trained to perform in the discipline of nursing.
 
Nevertheless, the tenets of knowledge acquisition and knowledge application are different; they are variably impacted by different factors. They can therefore not be boxed together as one and be attributed to a single source in a global sense. It should be noted also that knowledge translation and subsequent application is a complex nonlinear process that takes a long time to be fully realized (Curtis, et al., 2016). Several factors should be blamed for this occurrence. The lack of communication between researchers and policy makers (Jessani, Kennedy, and Bennett, 2016; Gimbel, et al., 2017), power dynamics, institutional politics and bureaucracy (Gita, et al., 2017), problems of global partnerships and investment in nursing research (Gimbel, et al., 2017), all lead to constraints on material resources needed for development of research knowledge and skills. Again, non-alignment of administrative goals and policies of Healthcare Institutions with ‘current[ly] available [research] knowledge and care protocols’ (Wray, 2013) affect knowledge application among clinical staff; a situation that cannot be blamed on the training or professional abilities of the bedside practitioner.
 
Cowman (2017) again advocates that it should “be mandatory that all nursing research activity in whatever form should have meaningful links with clinical nursing and patient care” (p. 235). Academia engage in research that leads to change in various aspects of the social fibre within which nursing and patient care are centrally located. Some nurse scholars conduct research that address health systems, and administrative policy formulation to aid the implementation of care protocols at the bedside. Others engage in studies that inform and influence the direction of clinical practice; the art of care. Several others undertake studies to inform nursing education to add to knowledge acquisition for enhanced skills in clinical practice. At the intersection of these three ‘spheres’ lies the patient and family. Therefore, narrowing the scope of nursing research to only patient care will be detrimental, and could skew and narrow clinicians’ capacity of care oblivious of the influence of other external determinants on health (Kurth, et al., 2016). Again, I emphasize that academic nursing research contain as a norm ‘a portion’ that addresses its implication to nursing practice. The suggestion made by Cowman (2017) is therefore not new to nursing education and research.
 
All in all, it ought to be noted that there are many more influences that affect patient care outcomes than presented. The scope of nursing research should never be restricted; gaps in literature inform research objectives. We should allow gaps from existing knowledge to inform nursing students’ research direction. After all, healthcare, or nursing practice is a global and all-encompassing multidisciplinary activity impacted by other external health determinants such as environmental, administrative and global political frameworks. In this way, nursing academe will contribute meaningfully to advances in healthcare.

Gyamfi Sebastian, RMN, MPHIL,
PhD student, Western University
 
References

Cowman, S. (2017). Bedside to bench: rethinking nursing research. Journal of Advanced Nursing. Doi: 10.1111/jan.13254.
 
Curtis, K., Fry, M., Shaban, R. and Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing. 26, pp. 862–872. Doi.org/10.1111/jocn.13586
 
Gimbel, S., Kohler, P., Mitchell, P. and Emami, A. (2017). Creating academic structures to promote nursing's role in global health policy. International Nursing Review, 64(1), pp. 117-125 Doi.org/10.1111/inr.12338

Gita, S., Virani, A., Iyer, A., Reddy, B. and Selvakumar, S. (2017). Translating Health Research to Policy: Breaking through the Impermeability Barrier. Available at http://www.theimpactinitiative.net/impact-lab/collection/translating-health-research-policy [Accessed on 12/05/2018]

Jessani, N.; Kennedy, C. and Bennett, S. (2016). ‘Enhancing Evidence-Informed Decision Making: Strategies for Engagement between Public Health Faculty and Policymakers in Kenya’, Evidence & Policy: A Journal of Research, Debate and Practice. Doi: http://dx.doi.org/10.1332/174426416X14595114153349

Kurth, E., Jacob, S., Squires, P., Sliney, A., Davis, S., Stalls, S. and Portillo, C. J. (2016). Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage. Journal of the Association of Nurses in AIDS Care, 27 (3), pp. 344354.

Wray, J. (2013). The impact of the financial crisis on nurses and nursing. Journal of Advanced Nursing 69(3), pp. 4979. Doi: 10.1111/jan.12031.

Monday, 7 January 2019

How grandparents experience the death of a grandchild

Modernising our understanding of family centred, children’s palliative care

Child focused, family centred care is at the foundation of children’s nursing. However that simple statement is more complicated than it first appears, due to how we define ‘family’. Grandparents play an important and increasing part in the lives of children affected by life limiting conditions and their family, yet they are often not considered when designing bereavement support that follows the death of a child. 
 
Effective bereavement support enables families to prepare for, and cope with loss. The progressive and degenerative nature of many of the life limiting conditions that affect children and young people means that multiple losses are experienced by the child and witnessed by families. These include the loss of mobility, the ability to eat and drink orally, speech and neurological function, and death. 
 
Like the majority of bereavement services, research exploring the effects of child death on a family have focused on the experiences of parents and siblings, with few that examine the perspective of grandparents (Gilrane-McGarry and O’Grady, 2011). Understanding of the emotional support needs of grandparents is largely limited to the generalisation of work undertaken with parents, siblings and health workers (Gilrane-McGarry and O’Grady, 2012). 
 
Numerous researchers have considered the grandparenting role both in general and in the context of illness, however this is often from the perspective of and from research conducted with parents, and is often in isolation, rather than in the context of their family (Gilrane-McGarry and O’Grady, 2011; Nehari et al., 2007). The nature of life limiting conditions in childhood present a unique set of circumstances, shaping the experience of families, including, but not limited to, a high association with profound disability, the progressive nature of many of these conditions, as well as the longevity and trajectory of life limiting conditions in childhood. 
 
Our paper provides insight into the experience of bereaved grandparents, though the synthesis of empirical research. Our findings highlight the needs of grandparents within families, developing understanding of contemporary family. We hope the insight our meta-ethnography provides will have a direct impact on grandparents, improving the care and support available to better meet their needs as a parent, grandparent and individual, following the death of a grandchild.
 
Our paper, entitled ‘understanding the bereavement experience of grandparents following the death of a grandchild from a life‐limiting condition: a meta‐ethnography’ can be accessed via: https://doi.org/10.1111/jan.13927
 

Dr Michael J Tatterton (Twitter: @MJTatterton)
Consultant Nurse and Head of Nursing, Martin House Children’s Hospice

Professor Catherine Walshe (Twitter: @CEWalshe)
International Observatory on End of Life Care, Lancaster University

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References:

Gilrane-McGarry, U. and O’Grady, T. (2011) ‘Forgotten grievers: an exploration of the grief experiences of bereaved grandparents (part one)’, International Journal of Palliative Nursing, 17(4), pp. 170–176.

Gilrane-McGarry, U. and O’Grady, T. (2012) ‘Forgotten grievers: an exploration of the grief experiences of bereaved grandparents (part 2)’, International Journal of Palliative Nursing, 18(4), pp. 179–187.

Nehari, M., Grebler, D. and Toren, A. (2007) ‘A voice unheard: grandparents grief over children who died of cancer’, Mortality. 12(1), pp. 66–78.