Tuesday, 23 December 2014

‘We DECide – Discussing End-of-life Choices’: how to realize advance care planning for nursing home residents with dementia?

Sophie Ampe
KU Leuven, LUCAS, Centre for care research and consultancy

Advance care planning (ACP) is the communication process of preparing care choices for when persons no longer have decision-making capacity. In this respect, it is of utmost importance for nursing home residents with dementia. However, ACP is mostly not realized for this group. Advance care planning consists of discussing care choices and making decisions, and corresponds to shared decision making: the involvement of persons and their families in care and treatment decisions.

Our paper describes the implementation and evaluation of ‘we DECIDE’, an educational intervention for nursing home staff on shared decision making in the context of advance care planning for residents with dementia. ‘We DECide’ is expected to result in a higher realization of shared decision making in individual conversations on advance care planning. A better implementation of advance care planning will lead to a higher quality of end-of-life care and more person-centred care. The study findings will support policy makers, on the one hand, to implement advance care planning in practice and professional caregivers, on the other hand, to conduct conversations about advance care planning.

‘We DECide’ could eventually be integrated in continuing education programs to teach shared decision making skills in the context of advance care planning.

Sophie Ampe, MSc, PhD candidate
KU Leuven, LUCAS, Centre for care research and consultancy
E-mail: sophie.ampe@med.kuleuven.be


Ampe S., Sevenants A., Coppens E., Spruytte N., Smets T., Declercq A. & van Audenhove C. (2014) Study protocol for ‘we DECide’: implementation of advance care planning for nursing home residents with dementia. Journal of Advanced Nursing. doi: 10.1111/jan.12601

Perceptions, experiences and needs of patients with idiopathic pulmonary fibrosis (IPF)

Annette Duck, MRes BSc RGN, Interstitial Lung Disease Specialist Nurse1
L G Spencer, MB ChB, Chest Consultant2
Simon Bailey, MD, Chest Consultant3
Colm Leonard, M.D, Consultant4
Jennifer Ormes, BSc, Lung Physiologist4
Ann-Louise Caress, PhD RGN RHV, Professor of Nursing4,5

1University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
2Aintree University Hospital, NHS Foundation Trust, Liverpool, UK
3Central Manchester University Hospitals, NHS Foundation Trust, Manchester, UK
4University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
5University of Manchester, UK

Idiopathic Pulmonary Fibrosis (IPF), previously known as cryptogenic fibrosing alveolitis (CFA) is a chronic, rapidly progressive, incurable, lung disease that currently has a mean life-expectancy of 2-4 years from diagnosis. The 5 year survival rate is estimated to be between 20-40% which is worse than most cancers. Despite this, patients with IPF have many unmet diagnostic and support needs as this research illustrates. If this was a cancer, patients could expect an urgent referral pathway to specialists who are familiar with their condition, be offered the latest treatment and given priority in the form of NHS available support.

The UK NHS is in the process of developing regional Interstitial Lung Disease (ILD) networks which will aim to deliver specified services that should improve the national delivery of ILD care. Until regional ILD networks have been fully developed patients may continue to experience the problems outlined in this research with inaccurate diagnosis and ad hoc manner of treatment and support depending upon local service provision.

This research tells in patients' own words what it is like to be diagnosed and live with IPF, illustrating that there is a general lack of knowledge amongst healthcare practitioners, trivialisation of symptoms and adds to the growing body of evidence of inadequate service provision in the UK for patients with IPF.


Duck A, Spencer LG, Bailey S, Leonard C, Ormes J, Caress A-L (2014) Perceptions, experiences and needs of patients with idiopathic pulmonary fibrosis (IPF). Journal of Advanced Nursing. DOI:10.1111/jan.12587
OnlineOpen article free to view

Tuesday, 16 December 2014

Obesity – the epidemic that can be stopped if we address it as a societal as well as individual issue

Lin Perry, PhD RN RNT
Faculty of Health, University of Technology, Sydney and South Eastern Sydney Local Health District

Response to Lee, G. (2014), Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing. doi: 10.1111/jan.12584

Health services around the world are all now very familiar with the impending ‘pandemic’ of obesity. Until recently I resisted use of the term ‘pandemic’, in recognition of the primarily psycho-social origins of the problem. However, with the American Medical Association's determination of obesity’s disease status, it would seem that ‘pandemic’ it is.

Lee (2014) provides a very neat synopsis of this obesity ‘pandemic’: its precursors and consequences, its place in history and its dominance of the future. Simple advice – ‘eat less and exercise more’ – is cited as the 1816 solution, and for Lee, the ‘humble healthcare practitioner’ and ‘healthcare changes led by a nurse or similar practitioner’ remain the mainstay, albeit with ‘a need to acknowledge the local environments and the issue of socio-economic deprivation’.

I don’t disagree with these statements but I do think the emphasis is not quite right.

I do believe that nurses have a pivotal role to play in health promotion and the World Health Organisation has emphasised the need to strengthen the capacity of this workforce to meet the demands it is facing (World Health Organisation 2006). Nurses deliver the bulk of health education and health promotion initiatives world-wide. Nurses are visible and accessible as health behavioural role models. Nurses have the socio-economic benefits of above-average education, high health literacy and, generally, the social advantages of being employed. Yet our and others’ work shows that nurses are not just equally but even more affected by this ‘pandemic’ than the populations they serve (Bogossian et al 2012; Perry et al 2014). Our 2014 findings from 5,000 New South Wales nurses are beginning to tease out the implications of this for nursing as a profession and a workforce.

What is very clear, both from what Lee et al (2014) discuss and what we are finding, is that we must address this ‘pandemic’ from within as well as without, taking policy and practice steps to address obesity within the nursing workforce in order to enable nurses to play their pivotal role in addressing this within the world’s populations. Many common characteristics of the nursing workplace can be labelled as ‘obesogenic’. These include, for example, lack of facilities for healthy eating (Wong et al 2010), working practices that exhaust without opportunity for exercise, lack of change facilities to support cycling or running to work, etc. Many could be relatively easily addressed.

It is not a case of ‘physician (or nurse) – heal thyself’; it is not just a case of individual responsibility to ‘eat less and exercise more’. The power-brokers and policy-makers in nursing and healthcare as well as the wider world need to play their parts in making the environmental and socio-economic changes required to halt this pandemic. Halting it in nursing would be a good start.

Lin Perry
Faculty of Health, University of Technology, Sydney and South Eastern Sydney Local Health District
Editor, Journal of Advanced Nursing


Bogossian FE, Hepworth J, Leong GM, Flaws DF, Gibbons KS, Benefer CA, Turner CT. A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United KingdomInternational Journal of Nursing Studies 49 (2012) 727–738

Lee G. Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing 2014 DOI: 10.1111/jan.12584
Perry L, Gallagher R, Hoban K, Shea A. The health of nurses: health risk factor profiles of Australian metropolitan nurses. Wellbeing at Work Third International Conference, Copenhagen 2014 

WHO (2006). Resolution WHA59.27. Strengthening nursing and midwifery. Geneva, World Health Organization.
Wong, H., Wong, M., Wong, S., Lee, A., 2010. The association between shift duty and abnormal eating behaviour among nurses working in a major hospital: a cross sectional study. International Journal of Nursing Studies 47, 1021–1027

Military nurses returning from war

Roger Watson, Editor-in-Chief

Then involvement of western countries in war has been a constant feature of life since 1990 and the First Gulf War which, in addition to the mobilisation of fighting troops and their support, saw one of the largest mobilisations of military medical services since the Second World War.  Nurses play a significant role in military medicine and these are constituted of both regular military and reservists.  Either way, large numbers continue to be mobilised, most recently to Afghanistan, and when they return to their countries they return to 'normal' life working in military and civilian hospitals.  But coming back is never normal and military service changes nurses' perspectives, provides stress and feelings that they no longer fit in on return.

Some of the conflicts, dilemmas and stresses are explored in a recent article from the USA published in JAN by Elliott (2014) titled Military nurses' experiences returning from war.  Elliott interviewed 10 military nurses returning from conflict and developed nine themes including 'Facing the reality of multiple loss', 'Serving a greater purpose', and 'Looking at life through a new lens'.  Clearly there were positive and negative experiences and, in the words of the author: 'Through this research, nurses and healthcare providers will be better prepared to interact and support returning veteran nurses'.


Elliott B (2014) Military nurses' experiences returning from war Journal of Advanced Nursing DOI: 10.1111/jan.12588

Saturday, 13 December 2014

Education, certification and employment of assistants in nursing

Roger Watson, Editor-in-Chief

'Assistants in nursing' encompasses a wide range of titles ascribed to an occupational group that works alongside registered nurses to perform a range of duties normally associated with the 'basic' aspects of care. Examples of these aspects of care include washing and feeding patients and performing routine tasks such as bed-making. That is the traditional picture; in fact, assistants in nursing  variously called 'nursing assistants', 'nursing auxiliaries', 'auxiliary nurses', 'nurse aides' and, in the UK, 'healthcare assistants' (HCAs)  often do much more. Assistants in nursing in the UK take vital signs and elsewhere have been reported to take electrocardiograms and to initiate intravenous infusions (Duffield 2014).

It is easy for registered nurses to take exception to various aspects of their traditional domain being encroached on while, at the same time, encroaching on various aspects of medicine and surgery. I doubt those for whom we purport to care  our patients and the general public  care about who does what in clinical practice; often they are not clear who is who in any case. The registered nursing scope of practice is, according to the International Council of Nurses, 'dynamic' but, whatever their scope of practice, registered nurses are registered; their names appear on a register which testifies to their preparation and good standing. Frequently, and in most of the UK, assistants in nursing do not appear on any kind of register. The question arises: does it matter?

It clearly does matter. Following the scandals at the Mid-Staffordshire NHS Foundation Trust in England, the Francis Inquiry specified several points which were relevant to assistants in nursing. Specifically, Francis called for standardised preparation, a code of practice and some form of registration. Specifically, the British government have refused to implement these steps, notwithstanding that a form of education and training for HCAs exists in Scotland and, 'in the wake of the Francis Inquiry' the first recommendations of the The Cavendish Review in England referred to the need for education and certification of healthcare assistants.

The risks and advantages around regulation of assistants in nursing can be weighed as follows:
  • Risks: without regulation an assistant in nursing can be dismissed from one hospital for providing poor care or worse and, provided they have not committed a criminal offence, they can take up employment elsewhere with impunity.
  •  Advantages: the above risk is obviated; preparation can be specified and standardised; and an expected standard of practice can be expected. As some may say: 'what's not to like?'
Naturally, regulation costs money and the issue of who regulates assistants in nursing could occupy our politicians and civil servants for months. Nevertheless, the end in this case must justify whatever means evolve. The issue of payment is surely straightforward; those who are regulated and seek to be recognised as such must pay. Currently the Nursing and Midwifery Council is struggling to regulate the nursing register but, surely, they are the obvious choice and if 'pump-priming' funding is required from central government resources, then surely this would be money well spent. After all, we are dealing with people's lives, safety and physical and psychological comfort. If we really think this is too expensive then we may, consequently, get the kind of healthcare we do not deserve.

Duffield C (2014) How long in forever? 2014 Australian Capital Region Nursing and Midwifery Research Conference Canberra, Australia

Thursday, 27 November 2014

Is there an economic case for nursing?

Roger Watson, Editor-in-Chief

Interest in nurse staffing levels and whether or not nursing is money well spent is intense. Perhaps international economic recession has focused attention on this against a background of changing demographics leading to deteriorating dependency ratios, increasing illness and the ‘bottomless pit’ that healthcare has become—especially in the developed world—as ever more illness becomes treatable, people survive longer and some seek healthcare for reasons that, to many, seem trivial. A systematic review from Australia by Twigg et al. (2014) titled ‘Is there an economic case for investing in nursing care –what does the literature tell us?’ and published in JAN investigates the economic case by looking at the existing evidence.

As with so many systematic reviews and studies on the cost of nursing care, the outcome is ambiguous. This will be sad news for those who simply advocate spending more money on nurses to increase nursing care with the aim of improving patient outcomes. Again, in common with many reviews, the problems are methodological with disparate methods being applied and multiple outcomes being used. In the words of the authors: ‘This review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies.’ Nevertheless, this rigorous review provides a valuable insight into the ‘state of the science’ of economic evaluation of nursing and should be a stimulus for further work with agreed outcomes and methods whereby the issue can be investigated consistently.


Twigg DE, Myers H, Duffield C, Gies M, Evans G (2014) Is there an economic case for investing in nursing care – what does the literature tell us? Journal of Advanced Nursing doi: 10.1111/jan.12577

Friday, 21 November 2014

Do nurse staffing levels influence patient outcomes?

Roger Watson, Editor-in-Chief

As much as I would like it to be, the relationship between nurse staffing and patient outcomes is not clear. A recent article from an Australian study by Winton et al. (2014) titled ‘The relationship between nurse staffing and inpatient complications’ and published in JAN cites methodological problems as one reason. Of course, this is a difficult area to investigate. It would be hard envisage clinical trials which compared nursing care with no nursing care  — which I imagine would easily demonstrate the value of nursing per se — and the situation is further complicated by definitions of nursing (RNs versus unqualified assistants) and the various levels of skill mix that can be implemented. It is even further complicated by the myriad outcomes and patient complications that could be selected as comparative measures. Nevertheless, this area merits investigation as arguments about staffing levels and skill mix are common, and those who hold healthcare budgets need to know how to spend their money (often it is our money) wisely. Insufficient nursing care may lead to expensive complications but unnecessary spending on nursing staff may waste valuable resources.

The article by Winton et al. (2014) compared 256,984 hospitalizations with and without complications against staffing levels in a retrospective longitudinal study and found that the pattern was not consistent. Specifically, they said: ‘our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates.’ Clearly, further investigation is required.


Winton LW, Bremner AP, Geelhoeld E, Finn J (2014) The relationship between nursestaffing and inpatient complications Journal of Advanced Nursing doi: 10.1111/jan.12572

Thursday, 13 November 2014

Nightingale versus Seacole…round two!

Roger Watson, Editor-in-Chief

You may recall ‘Nightingale versus Seacole…round one!’ which I wrote after we published McDonald’s (2013) less than complimentary piece on Mary Seacole’s contribution to modern nursing. That piece did not go unnoticed and as a result Staring-Derks et al. (2014) have recently published an article titled, ‘MarySeacole: global nurse extraodinaire’. I say as a result, rather than in reaction to, as Staring-Derks et al– while citing McDonald’s article – decided not to confront her arguments ‘head on’ and what results is a very measured, polite and well-referenced piece.

Clearly, by labelling these rounds one and two respectively I am hoping that further correspondence and articles will arise, perhaps not from the original ‘protagonists’ but from others with a view on the relative contributions of Nightingale and Seacole to modern nursing and healthcare.Whatever one’s view – and JAN is neutral in this debate – the influence of Mary Seacole is undeniable. I was in Edgbaston in Birmingham recently, taking a taxi past Birmingham City University, and noticed another Seacole Building; few universities where nursing is taught are without one. The Seacole ‘lobby’ and the move in the UK, for example, to have a statue erected in her honour, are well organised and influential. I am not aware of a similar ‘lobby’ for Florence Nightingale; perhaps her place in the history of nursing is assured.

If you wish to contribute to the debate then please check our author guidelines for how to contribute to JAN interactive.


McDonald L (2013) Florence Nightingale and MarySeacole on nursing and health Journal of Advanced Nursing 70, 1436-1444

Staring-Derks C, Staring J, Anionwu E (2014) MarySeacole: global nurse extrodinaire Journal of Advanced Nursing doi: 10.1111/jan.12559

Tuesday, 11 November 2014

Nurses' overtime and patient care

Roger Watson, Editor-in-Chief

Nursing work is hard enough with physical and psychological demands and long and often unsocial hours. Nursing shortages and often poor salaries mean that overtime working is often a feature of many nurses' lives. It appears that there is little rigorous research into the extent to which working overtime influences patient care, according to a recent paper from Canada by Lobo et al. (2014) titled Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes.

The paper reports on nine articles related to how nursing overtime affects patient outcomes. As with many such studies, the review showed methodological weaknesses in the area related to defining overtime and working out what effect confounding variables had on the measurement of outcomes. The findings of the studies, therefore, need to be interpreted cautiously. Nevertheless, there was some evidence to show that nurses' overtime was related to such things as infection rates, deaths from pneumonia and medication errors.

If there is any truth in these findings, these phenomena are surely worth investigating further; if upheld, they would certainly strengthen the argument for a better resourced nursing workforce. In the words of the authors: 'additional funding and attention needs to be directed at this topic area to mitigate the negative patient outcomes that may be a result of the use of nursing overtime.'

Lobo v, Fisher A, Peachey G, Ploeg J, Akhtar-Danesh N (2014) Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes Journal of Advanced Nursing doi: 10.1111/jan.12523

Wednesday, 5 November 2014

Response to Commentary: Is there a spiritual life outside religion?

Katia G. Reinert, PhD, CRNP, FNP-BC, PHCNS-BC

Response to Bert Garssen's Commentary on Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152

Thank you for a thoughtful response to our article (Reinert & Koenig 2013). While we understand the concern voiced in the response, we would like to restate what we proposed and why. We proposed that reducing spirituality to religion (not for clinical practice but for the purposes of research) is critical, since it is difficult if not impossible to measure spirituality as a distinctive construct except by measuring religion.

We agree and fully support the notion that spirituality can be broadened beyond religion to be inclusive for clinical purposes, but for conducting research, there is too much overlap with mental health constructs due to the way spirituality is currently being measured in nursing research, as we described in the article.

Our main point is that the results of research examining spirituality and mental health is virtually impossible to interpret due to the tautology in relationships between constructs being measured. Only by measuring spirituality by religion can we retain the distinctiveness of the concept.

Katia G. Reinert, PhD, CRNP, FNP-BC, PHCNS-BC
Johns Hopkins University School of Nursing
Baltimore, MD
e-mail: kreiner1@jhu.edu


Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152

Tuesday, 4 November 2014

Commentary: Is there a spiritual life outside religion?

Bert Garssen, PhD
Helen Dowling Institute, Center for Psycho-oncology

Commentary on Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152

Spirituality questionnaires that contain items referring to spiritual well-being or mental health should not be used to investigate the causal relationship between spirituality and mental health. This concern was expressed before (Migdal & MacDonald 2013) and has been repeated in a recent article in JAN (Reinert & Koenig 2013). Reinert & Koenig (2013) object to using mental health concepts in the definition of spirituality, though in my view their use in spirituality scales seems most problematic.

Reinert & Koenig (2013) plead for a further reduction of the concept by restricting spirituality to religiosity. One of the reasons for preferring this restriction is that many definitions of spirituality have become very broad and include mental health concepts. I agree, if this would refer to terms like well-being and enjoyment. However, I consider terms like “the experience of meaningfulness or purpose in life” of a different category. According to Reinert & Koenig (2013), these terms refer to the core mental symptoms of the DSM-IV diagnosis of major depression. “Worthlessness”, they say, “is one of the nine cardinal symptoms”. However, worthlessness is not simply a lack of meaningfulness or purpose in life. One may experience life in general as meaningful and yet - at least temporarily – experience anxiety or depression. This indicates that there is a distinction between the two concepts. So, in my view there is no decisive reason for the advice of the authors “...that spirituality in research is better served if defined in the context of religious involvement” (Reinert & Koenig 2013).

What to think of people who consider themselves spiritual but not religious, if we would accept the opinion of Reinert & Koenig? Their number cannot be neglected. Zinnbauer et al. (1997) selected people from different churches, New Age groups, students, nursing professionals, and nursing home residents in Pennsylvania and Ohio, and found that 19% defined themselves as spiritual, but not religious. The same number was found in a more recent study among the Dutch general population (Berghuijs et al. 2013).

In fact, there is no decisive logical argument to decide which definition should be accepted, and Reinert & Koenig (2013) also indicate that how one defines spirituality is a matter of personal preference; dependent upon the background and religiosity of the researcher. Nevertheless, I would like to propose some arguments against reducing spirituality to religion. First, non-religious spiritual people describe experiences and attitudes that are also mentioned by religious people, and which both groups find very important in their lives. According to the persons themselves and according to scientists, these are spiritual experiences and attitudes. If so, how can the existence of a non-religious form of spirituality be denied? Experiences that seem essential for both religious people and for non-religious people who consider themselves spiritual are: feeling part of a larger whole, detaching oneself from daily routines and rising above oneself, letting go of the ego focus, experiencing awe for and connectedness with nature (‘God’s creation’ in religious terms), and feeling a deep connection to other people (the congregation or ‘God’s people’ for religious people).

Second, Reinert & Koenig (2013) argue that a definition in religious terms would yield a clearer concept, but even within and among religious traditions is a wide variety in beliefs, experiences, and attitudes. In addition, there presently are definitions of spirituality that are consistent, have not arisen from personal preference, and can be used across international borders, as Reinert & Koenig (2013) prefer. Conceptual analyses (Reed 1992, Chiu et al. 2004) have shown that connectedness is an essential element of spirituality. In nursing research, spirituality is also often defined in terms of connectedness. Reed defined spirituality on the basis of conceptual, empirical, and clinical nursing literature as “the propensity to make meaning through a sense of relatedness to dimensions that transcend the self in such a way that empowers and does not devalue the individual. This relatedness may be experienced intrapersonally (as a connectedness within oneself), interpersonally (in the context of others and the natural environment) and transpersonally (referring to a sense of relatedness to the unseen, God, or power greater than the self and ordinary source)” (Reed 1992, p. 350). Connectedness with oneself is expressed by aspects such as authenticity, inner harmony/ inner peace, consciousness, self-knowledge, and experiencing and searching for meaning in life. Connectedness with others and with nature is related to compassion, caring, gratitude, and wonder. Connectedness with the transcendent includes connectedness with something or someone beyond the human level, such as the universe, transcendent reality, a higher power or God. I am, of course, aware of several other definitions of spirituality. My only aim was to briefly indicate the possibility of presenting a coherent, accepted and usable definition of spirituality that is not (strictly) framed in religious terms.

To summarize, I welcome the warning of Reinert & Koenig (2013) to ban elements of mental health from definitions and operationalizations of spirituality. However, I do not agree with their suggestion that a definition in religious terms would advance the scientific development in this area.

Bert Garssen, PhD
Helen Dowling Institute, Center for Psycho-oncology
The Netherlands
e-mail: bgarssen@hdi.nl

The author of the original article has responded to this commentary.


Berghuijs J, Pieper J, and Bakker C (2013) Being 'spiritual' and being 'religious' in Europe: Diverging life orientations, Journal of Contemporary Religion, 28 (1), 15-32.

Chiu L, Emblen JD, van Hofwegen L, Sawatzky R, and Meyerhoff H (2004) An integrative review of the concept of spirituality in the health sciences, Western Journal of Nursing Research, 26, 405-428.

Migdal L and MacDonald DA (2013) Clarifying the Relation Between Spirituality and Well-Being, Journal of Nervous and Mental Disease, 201, 274-280.

Reed P (1992) An emerging paradigm for the investigation of spirituality in nursing, Research in Nursing & Health, 15, 349-357.

Reinert KG and Koenig HG (2013) Re-examining definitions of spirituality in nursing research, Journal of Advanced Nursing, 69 (12), 2622–2634 doi 10/1111/jan.

Zinnbauer BJ, Pargament KI, Cole B, Rye MS, Butter EM, Belavich TG et al. (1997) Religion and spirituality: Unfuzzying the fuzzy, Journal for the Scientific Study of Religion, 36 (4): 549-564.

Monday, 27 October 2014

Alcohol and nursing students

Roger Watson, Editor-in-Chief

Alcohol and students are often synonymous in Europe and alcohol abuse in younger people is a significant problem in society. Nursing students are students and many of them are young people. So, is there any reason to expect them to take a responsible attitude towards alcohol? A recent study by Rabanales Sotos et al. (2014) titled: Prevalence of hazardous drinking among nursing students and published in JAN investigates alcohol use among nursing students in Spain.

The aim of the study was: 'To estimate the frequency of alcohol consumption among nursing students and describe their behaviour patterns in relation to excessive consumption.' Nursing students (N=1060) were surveyed using the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcoh olicos/ ISCA) and Alcohol Use Disorders Inventory Test (AUDIT). The findings are described in the words of the authors: 'A considerable proportion of students show evidence of hazardous alcohol consumption and, while there are no sex-related differences, the proportion of hazardous drinkers tends to be higher among the youngest subjects, smokers and persons living outside the family nucleus.'


Rabanales Sotos J, López Gonzalez A, P árraga Martí ınez I, Campos Rosa M, Simarro Herraez MJ, L ópez-Torres Hidalgo J (2014) Prevalence of hazardous drinking among nursing students Journal of Advanced Nursing doi:10.1111/jan.12548

Recovery from bulimia

Roger Watson, Editor-in-Chief

Most people know of someone with bulimia nervosa, but they probably know more people than they realise. This is often a hidden condition; when and if people recover, they may be unwilling to speak about it. The condition is more common in young women and the causes are not fully understood.

A recent study by Lindgren et al. (2014) titled: A qualitative study of young women’s experiences of recovery from Bulimia Nervosa and published in JAN interviewed women who had recovered from bulimia. The study aimed to: 'describe experiences of recovery from bulimia nervosa among young adult women'. The study size was small, but this could be considered a 'hard to reach' group; five women, between 23–26 years of age were interviewed about their recovery. The women described feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality. In the words of the authors: 'feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality'.


Lindgren B-M, Enmark A, Bohman A, Lundström M (2014) titled: A qualitative study of young women’s experiences of recovery from Bulimia Nervosa Journal of Advanced Nursing doi:10.1111/jan.12554

Sunday, 19 October 2014

Ebola and nursing history

Christine Hallett
Professor and Director of the UK Centre for the History of Nursing and Midwifery and Chair of the UK Association for the History of Nursing

Professor Hallett
On Wednesday 15 October 2014, the Guardian newspaper reported that Will Pooley, the British nurse who had contracted Ebola virus while working in Sierra Leone, was returning to Africa to continue his work. Pooley had been brought back to his home country to be nursed in isolation, and had survived against 70% odds. He said that he could not now ‘sit in the UK and watch the people of Sierra Leone die’. Like any other reader, I was moved by his courage and professional dedication; but as a historian, I was also aware that such astonishing bravery is not a new phenomenon. It is as old as epidemic disease itself, and has most often been shown by nurses.  

During the plagues of Medieval and Early Modern Europe, it was nurses, many of them belonging to religious communities, who put their lives in danger by entering the homes of the sick - places that were shunned and avoided by everyone else.  When bubonic plague – the so-called Black Death – became endemic in the fleas carried on Europe’s black rat population, city-states were subjected to frequent outbreaks. Italy was one of the worst-affected regions. Unhygienic conditions meant that rat populations expanded rapidly and commercial travel ensured that these disease-carrying vectors could move easily from place-to-place. The bacterium, later to be known as Yersinia pestis, mutated – a new, highly virulent airborne strain appeared as pneumonic plague – a form that could be transmitted directly from person to person, with a case-fatality rate of 80%. Populations reacted by isolating sufferers. In cities like Venice and Florence, the sick were moved to isolation hospitals called lazzaretti, where conditions were appalling. ‘Attendants on the sick’ had no professional identity, did not belong to any unions and had no workers’ rights. They were as trapped as their patients. Yet stories of immense courage came out of these places of horror, and some nurses did survive. Like Will Pooley, they used the immunity conferred by such survival to continue their work.  

The Ebola virus
But those who respond with courage and compassion to the plight of populations devastated by epidemic disease are a tiny minority. The response of so-called civilized nations to the Ebola crisis in West Africa has shown that, although technology has advanced, humanity itself has made little progress.  Its ethics remain medieval. Wealthy nations seem to be putting more effort into keeping Ebola beyond their borders than into saving lives in Africa. Like (I suspect) most other British citizens, I must confess to a cowardly relief that my own safety is being given the highest priority. But, as a health professional, I also know that such efforts are misplaced.  Ebola cannot be kept at bay for long unless the epidemic is tackled at its root, in Africa.  If the compassion of Northern nations had been stronger than the false sense of security afforded by their border controls, the epidemic might now be under control and threatening no-one.

And bubonic plague is not the only world pandemic that can provide lessons. At the end of the First World War, the world’s population, weakened by four years of industrial warfare, deprivation and food shortages, experienced one of its worst-ever pandemics: the so-called Spanish influenza. Nurses in military hospitals wrote of how, on Armistice day, 11 November, 1918 - as entire populations were engulfed in the heady atmosphere of victory - they themselves could only watch helplessly as young men who had survived active war-service died horrible deaths, suffocating, their faces turning blue or black, their entire systems shutting-down. The virus killed within days, sometimes within hours, affecting people of all ages and backgrounds – but predominantly young, apparently healthy adults.  Again, it was nurses who were at the forefront of the fight against disease.  Historian, Arlene Keeling has shown how the visiting nurses of cities like New York, Baltimore and Philadelphia went into the homes of the sick and dying, taking canisters of soup to helpless victims and offering the fundamental nursing care that kept bodies alive until immune systems had a chance to react. Many of these nurses, themselves, caught the disease, and some died.

Health workers dressed to handle Ebola victims
For as long as human communities have dominated the earth, they have been at risk of epidemic disease.  However well-prepared we are, pandemics always seem to take us by surprise. Even as we stockpile vaccines against the latest strains of influenza, Ebola is poised to threaten our existence. A mutation of the virus, producing an airborne form like the pneumonic plague or Spanish flu is said by experts to be unlikely, but the longer the organism has to move, uncontrolled, from host to host, the more likely such mutation becomes. Meanwhile, it is nurses such as Will Pooley who will continue to fight a losing battle – one disease-host at a time – because his compassion as a nurse will not allow him to ‘watch the people of Sierra Leone die’.

Friday, 17 October 2014

Genetics in nursing: long overdue for a tipping point

Rita Pickler, Editor

We all know about the tipping point, described by Malcolm Gladwell as that moment when an idea crosses a threshold, tips, and spreads like wildfire (Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference). The authors of the collected papers in the JAN’s latest virtual issue would argue that nursing is overdue for its tipping point in genetics education, genetic knowledge, genetic research and genetics in practice for the nursing profession. Advances in genetics have brought great benefit to humans, revealing the basis of health and illness, disease risk and treatment response. The progress in genetics and genomics can be applied to the entire spectrum of health care; we can all potentially benefit from what is known now and will be known in the future. And yet, a barrier to those benefits is nursing’s minimal involvement in the genetics knowledge explosion.

Nursing and genetics work share a focus on health promotion and disease prevention. Nursing clearly then has a place in genetics work. But nurses are woefully undereducated about even the most basic of genetics knowledge. Moreover, nursing educational programs have not followed the longstanding recommendations in both the US and Europe regarding essential genetics education and minimal genetics competencies needed in order for nurses to meet the needs of the public they serve. Further, despite a growing body of evidence about the contribution of genetics and genomics to health and illness, the evidence specific to outcomes of nursing practice provided by genetics competent nurses and the impact on the public’s health is very limited.

For people to benefit from the growing arsenal of genetic and genomic discoveries, nurses must be competent in obtaining comprehensive family histories. They need to help identify family members at risk for developing a genetically influenced condition or having a genetically influenced drug reaction. They need to understand the potential benefit or harm that may ensue from participating in genetics and genomic research. The public depends on nurses, the most trusted of health care providers, to help them make informed decisions about and understand the results of their genetic/genomic tests and therapies and to refer them, if they are at-risk to the most appropriate health care professionals and agencies. All of that requires knowledge and competence in using that knowledge.

More than that, qualified nurses need to be engaged in research about genetics and genomics Nurses are well poised to do the work of investigating the behavioral, social, and physiological benefits and risks for individuals and families who are asked to participate in genetics research or to use genetically engineered interventions. Moreover, nurses need to study the epigenetic effects of our own practices in order to understand the potentially long reaching effects of the care we give.

As providers of quality health care services, it is essential that nursing cross the threshold and embrace genetics knowledge, tip the balance from passive bystanders of genomic research to active participants in genetic discoveries and their application, and join other scientists and health care practitioners in ensuring that genetics knowledge is used wisely and well to improve health around the world. Yes, we are overdue for our tipping point. Perhaps the time is now.

The selection of papers in JAN’s Genetics Virtual Issue are available for view now on the JAN website. There readers will find papers about nursing’s current genetics competencies and abilities in applying genetics knowledge to care (Barnoy et al, 2009; Godino et al, 2012; Skirton et al, 2012), interesting efforts and strategies to improve genetics competencies within nursing curricula (Andrews et al, 2013; Kirk et al, 2013) and practice (Andrews et al, 2014), as well as papers that will educate readers about the breadth of genetics knowledge (Bancroft, 2010), newly emerged genomic tests (Prows et al, 2014), and future possibilities for genetics research in nursing science (Munro, 2014). The selection of papers reveals nursing’s gaps and also its potential to reach the genetics tipping point.

Andrews V, Tonkin E, Lancastle D, Kirk M (2013) Using the Diffusion of Innovations theory to understand the uptake of genetics in nursing practice: identifying the characteristics of genetic nurse adopters. Journal of Advanced Nursing DOI: 10.1111/jan.12255

Andrews V, Tonkin E, Lancastle D, Kirk M (2014) Identifying the characteristics of nurse opinion leaders to aid the integration of genetics in nursing practice. Journal of Advanced Nursing DOI: 10.1111/jan.12431

Bancroft EK (2010) Genetic testing for cancer predisposition and implications for nursing practice: narrative review. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2010.05286.x

Barnoy S, Levy O, Bar-Tal Y (2010) Nurse or physician: whose recommendation influences the decision to take genetic tests more? Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2009.05239.x

Godino L, Turchetti D, Skirton H (2013) Knowledge of genetics and the role of the nurse in genetic health care: a survey of Italian nurses. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2012.06103.x

Kirk M, Tonkin E, Skirton H (2013) An iterative consensus-building approach to revising a genetics/genomics competency framework for nurse education in the UK. Journal of Advanced Nursing DOI: 10.1111/jan.12207

Munro C (2014) Individual genetic and genomic variation: a new opportunity for personalized nursing interventions. Journal of Advanced Nursing DOI: 10.1111/jan.12552

Prows C, Tran G, Blosser B (2014) Whole exome or genome sequencing: Nurses need to prepare families for the possibilities. Journal of Advanced Nursing DOI: 10.1111/jan.12516

Skirton H, O’Connor A, Humphreys A (2012) Nurses’ competence in genetics: a mixed method systematic review. Journal of Advanced Nursing DOI: 10.1111/j.1365-2648.2012.06034.x

Saturday, 11 October 2014

Will nursing be influenced by genomics?

Roger Watson, Editor-in-Chief

My original training was in biochemistry and I always considered the discovery by Watson & Crick of the double-helical structure of DNA to be one of the most exquisite and important in biology. It was exquisite in the sense that it explained how DNA was able to replicate and yet conserve the genetic code; it also provided a mechanism whereby messenger RNA, the template for building proteins, was coded and it started the search for the genetic code. This one discovery had many 'spin-offs' for the rest of biology and it was important as it also led to an understanding, at the molecular level, of how things go wrong in genetics and – ultimately – what we may be able to do about it. But, apart from in the role of genetic counselling, I did not consider that it may lead to changes in the way we deliver nursing practice...until I read a recent discussion paper by Munro (2014) and published in JAN titled Individual genetic and genomic variation: a new opportunity for personalized nursing interventions.

Pointing out that nursing has not yet embraced the possibilities of exploiting the consequences of genetic variation, Munro says: 'There are potentially many nursing interventions that would be more effective if they were individually tailored to the patient’s genetic/genomic profile.' The potential for this has manifest itself in the new relatively new fields of personalized medicine and pharmacogenomics, but Munro discusses the possibility, based on people's individual genetic make up of moving towards personalized nursing interventions. In the words of the author: 'The use of genetic variation to understand and predict human responses and to tailor nursing interventions is a powerful concept that could inform – and fundamentally change – nursing practice.'


Munro CL (2014) Individual genetic and genomic variation: a new opportunity for personalized nursing interventions Journal of Advanced Nursing DOI:10 1111/jan.12552

Thursday, 25 September 2014

Shall we speak, or...?

Roger Watson, Editor-in-Chief

The first computer in the hospital where I was a Charge Nurse was the one I took in with me on night duty. I unloaded my excellent (in my view unsurpassed as a dedicated word-processing tool) Amstrad PCW from the car and set it up at the nurses' station where, between my nursing duties, I would write manuscripts and I even developed a program using the programming language Mallard for PCW which calculated cost-effectiveness data in the clinical trial I was running. Well, those were the days! My computer was not linked up to anything or anyone and I was viewed as some kind of technological wizard, mainly eccentric, who was engaged in something that would probably 'never catch on'.

Fast forward approximately 25 years and every clinical area and office in my GP surgery, the local hospitals and anywhere healthcare is delivered is festooned with electronic equipment. A Finnish study entitled The use of electronic devices for communication with colleagues and other health professionals - nursing professionals' perspectives by Koivunen et al. (2014) and published in JAN looks at how nurses experience the use of electronic devices for professional communication. The study involved 123 Finnish nurses and found that a variety of electronic means of communication was used with email being the most popular. Synchronous communication - Skype, FaceTime - was used very little. While the nurses found the use of electronic devices useful and efficient, concerns remained about security of information. However, some were concerned about the lack of social interaction and, I guess, it will be a sad day if electronic communication replaces such interaction in a profession which aims to be person-centred and caring.


How dementia affects carers

Roger Watson, Editor-in-Chief

The adverse consequences for informal caregivers of people with dementia are well known: physical exhaustion, depression, burnout, and financial hardship. A pan-European study entitled The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study by Alvira et al. (2014) and published in JAN, considers the effect of caring for someone with dementia on informal carers. This is the second appearance in our blog of a study from the RightTimeRightPlace Consortium.

A questionnaire called the Caregiver Reaction Assessment was used in Estonia, Finland, France, Germany, Spain, Sweden, The Netherlands and the UK involving 2014 people with dementia and their informal caregivers. The questionnaire measures a range of variables related to caring for someone with dementia. While differences in demographics and care environments differed across Europe there was an essential message from the study, as expressed by the authors: Health problems were clearly associated with caregiver burden, psychological well-being and quality of life.


Alvira MC, Risco E, Caberera E, Farre M, Hallberg IR, Bleijlevens MHC, Meyer G, Koskenniemi J, Soto M, Zabalegui A, on behalf of the RightTimeRightPlace Consortium (2014) The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study Journal of Advanced Nursing doi:10.1111/jan.12528

Wednesday, 3 September 2014

Measuring learning outcomes in healthcare students

Annamaria Bagnasco, MSc PhD, Researcher in Nursing & Education Coordinator1
Lucia Cadorin, MSc PhD, Student in Methodology of Nursing Research2
Angela Tolotti, MSc PhD, Student in Methodology of Nursing Research2
Nicola Pagnucci, MSc PhD, Student in Methodology of Nursing Research2
Gennaro Rocco, MSc, President3
Loredana Sasso, MSc, Associate Professor of Nursing2

1Department of Health Sciences, Faculty of Medicine, University of Genoa, Italy
2Department of Health Sciences, University of Genoa, Italy
3IPASVI Centre of Excellence, Rome, Italy

A group of Italian researchers has recently published in JAN a paper titled: ‘Instruments measuring meaningful learning in undergraduate healthcare students: a systematic review protocol’. The aim of this systematic review protocol by Bagnasco et al. (2014) was to establish the psychometric properties of instruments to measure learning outcomes in healthcare students.

Learning outcomes in healthcare students is an important issue that has been debated on an international level due to the difficulty of measuring learning, specifically meaningful learning.

Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge, it produces a long-term change, and it is exclusively built by the learner.

This systematic review offers a synthesis of the data related to instruments that measure learning outcomes and will help to decide which tools to use, as well as design a model to assess meaningful learning in its three dimensions:

a.) ‘cognitive and metacognitive processes’,
b.) ‘behavioural and emotional aspects of learning’ and
c.) ‘attitude towards learning’.

The successful implementation of meaningful learning in nursing students also requires educators to have specific skills and competences. Measuring learning outcomes is very important because it makes students feel responsible for their own learning and helps them understand the process of interaction between the new information they gain and what they already know, making an innovative contribution to this field.


Bagnasco A, Cadorin L, Tolotti A, Pagnucci N, Rocco G, Sasso L (2014) Instruments measuring meaningful learning in undergraduate healthcare students: a systematic review protocolJournal of Advanced Nursing doi: 10.1111/jan.12520

Friday, 22 August 2014

e-learning or the old way?

Roger Watson, Editor-in-Chief

I am a great advocate of online learning having been converted several years ago when I undertook a course in how to teach online which I took...online.  The programme was called Learning to Teach Online (LeTTOL in short) run by Sheffield College and I simply cannot praise it highly enough.  I was able, immediately, to set up an online module at The University of Sheffield as part of an online Masters in Nursing (we never saw the students face-to-face) in writing for publication and Wiley colleagues participated as guest tutors.  The module was popular and demanding but several publication by participants were the result.

Therefore, I came to this article by McCutcheon et al. (2014) already biased in favour of the medium; the article is titled: A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education and is published in JAN.  The article is paper-based, being a review of evidence, and the conclusion is that online learning is just as effective as face-to-face learning.  The outcome was no surprise to me but I was very glad to see it.  The authors advocate further research in the area, especially to see how effective blended learning (a combination of online and face-to-face) is in teaching clinical skills to undergraduate students.


  1. McCutcheon K,
  2. Lohan M,
  3. Traynor M,
  4. Martin D (2014) 
  5. A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education Journal of Advanced Nursing 
    DOI: 10.1111/jan.12509

Tuesday, 19 August 2014

Career choice by nursing undergraduates

Roger Watson, Editor-in-Chief

I was speaking to a medical doctor recently whose daughter was a nursing student and when I asked which area of nursing she might enter he said that she most liked that last clinical area in which she had worked - whatever that happened to be.  I well recall that phenomenon from my own time as a student nurse.

A recent Norwegian study by Abrahamsen (2104) titled: 'Nurses’ choice of clinical field in early career' and published in JAN investigates what influences undergraduate nursing students' choices.

Two-hundred and ninety students were involved in a longitudinal study which started in 2001.  They were asked throughout about which clinical fields they wanted to enter and also about theoretical professional knowledge and practical skills acquired, and job values.  The outcomes focused on care of older people and psychiatry.  Gender played no part in the decision, but age did, with an increasing tendency to express an interest in working with older people, rather than hospital care, as nurses got older.  The higher the score on acquired practical knowledge and the lower the score on theoretical knowledge, the more likely students were to express an interest in psychiatry and as altruism increased, so did the tendency to express an interest in working with older people.

The study has practical implications; in the words of the author: 'The findings indicate that less popular nursing fields like care of older people and psychiatry need to develop recruitment strategies as to entice qualified nurses to choose these fields.' and 'Further research should pay greater attention to motives behind nurses’ choice of career path...A focus on motivation is essential to develop strategies both about recruitment and to ensure that nurses remain working in those fields.'


Abrahamsen B (2014) Nurses’ choice of clinical field in early career Journal of Advanced Nursing doi: 10.1111/jan.12512

Wednesday, 13 August 2014

Bullying is not nice

Roger Watson, Editor-in-Chief

Bullying is a problem in nursing as several papers over the years in JAN have shown (Randle 2003, Laschinger et al. 2010). A new paper titled: 'The effect of bullying on burnout in nurses: the moderating role of psychological detachment' and published in JAN by Allen and Holland (2014) examines: 'the relationship between bullying and burnout and the potential buffering effect psychological detachment might have on this relationship'.

Bullying is known to have negative consequences and one of these is burnout which leads to low sense of personal accomplishment, depersonalisation and exhaustion. The idea being tested in the present study was the theory that detachment from work - leisure time, 'recharging batteries' and just getting away from it - would have a positive effect in mediating the effect of bullying. In this sense the study is unique.

The outcome of the study was that, while psychological detachment may alleviate some of the effects of burnout, it did not alleviate the effect of bullying on burnout. Therefore, while 'switching off' from work is useful and should be encouraged, the effect of bullying is pervasive; in the words of the authors: 'Ensuring there are workplace policies and practices in place in healthcare organizations to reduce the instances of bullying and pro-actively address it when it does occur would therefore seem crucial'.


Allen BC, Holland P (2014) The effect of bullying on burnout in nurses: the moderating role of psychological detachment Journal of Advanced Nursing doi: 10.1111/jan.12489

Randle J (2003) Bullying in the nursing profession Journal of Advanced Nursing 4, 395-401

Laschinger HKS, Grau AL, Finegan J, Wilk P (2010) New graduate nurses’ experiences of bullying and burnout in hospital settings Journal of Advanced Nursing 12, 2732-2742

Capability, not just competence

Roger Watson, Editor-in-Chief

Ever since I encountered the 'capability envelope' of Stephenson and Yorke (1998) I have been an advocate. The theory of capability is that it enables people who are competent to move from their 'comfort zone' of competence into capability where they can apply themselves to new and unexpected problems. My fear about the competence agenda in nursing is that it keeps nurses in their 'comfort zones' and that the link between competence and capability is higher education.

A recent paper by O’Connell et al. (2014) titled: ‘Beyond competencies: using a capability framework indeveloping practice standards for advanced practice nursing’ and published in JAN discusses 'the application of a capability framework for advanced practice nursing standards/competencies'. In the words of the authors: 'Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency'.


O’Connell J, Gardner G, Coyer F (2014) Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing Journal of Advanced Nursing doi: 10.1111/jan.12475

Stephenson J, Yorke M (1998) Capability and Quality in Higher Education. Routlegde, Abingdon

Thursday, 31 July 2014

Seen the JAN app yet?

Roger Watson, Editor-in-Chief

Ever wished you could read JAN 'on the move' on your iPad or iPhone? Well, now you can. A link to the JAN app is available on the JAN webpage.

The app is free to download and the full text of the articles from Early View through to those in issues of JAN can be accessed if your have a personal subscription or your institution has a subscription.

What does the JAN app do?

Speaking only from the iPad perspective - and I welcome comments on the blog from users of other platforms - the app appears in your Newsstand and appears as a facsimile of the familiar JAN cover. Opening the app reveals a selection of options: Early view; Issues; and Saved articles. There is also a tool for selecting the appearance of the articles and an information button. Accessing issues and Early View articles is intuitive and easy. Early View articles are available to read immediately and issues have to be downloaded. If you see an article you like and want easy access to it in future, there is a star to the left of the article which you can press to save it.

Tuesday, 29 July 2014

Informal carers can predict when older people with dementia should be admitted to long-term care

Roger Watson, Editor-in-Chief

A pan-European study of dementia by a stellar team of European researchers from the UK, Netherlands, Finland, Sweden, Germany, Estonia and Spain titled 'Predicting institutional long-term care admission in dementia: a mixed-methods study of informal caregivers’ reports' has recently been published in JAN. The study is published on behalf of the RightTimePlaceCare consortium.

The study by Efram et al. (2014) had two aims, to investigate agreement between:
  1. expected reasons and actual reasons for admission of people with dementia according to informal caregivers
  2. scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers.
The investigators wanted to know if informal carers were a reliable source of information on whether of not an older person with dementia in their care required admission to long-term care. The results were promising; in the words of the authors: 'Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers’ statements and collaborate with them to strive for timely and appropriate admission.'


Afram B, Verbeek H, Bleijlevens MHC, Challis D, Leino-Kilpi H, Karlsson S, Soto ME, Renom-Guiteras A, Saks K, Zabalegui A, Hamers JPH on behalf of the RightTimePlaceCare consortium (2014) Predicting institutional long-term care admission in dementia: a mixed-methods study of informal caregivers’ reports Journal of Advanced Nursing doi: 10.1111/jan.12479