Monday, 29 June 2015

The RN4CAST@IT project

Roger Watson, Editor-in-Chief

You can listen to a podcast version of the editorial by Sasso et al. 2015 by one of the members of the RN4CAST@IT team Dr Giuseppe Aleo from The University of Genoa.


Sasso, L., Bagnasco, A., Zanini, M., Catania, G., Aleo, G., Santullo, A., Spandonaro, F., Icardi, G., Watson, R. and Sermeus, W. (2015), RN4CAST@IT: why is it important for Italy to take part in the RN4CAST project?. Journal of Advanced Nursing. doi: 10.1111/jan.12709

Monday, 22 June 2015

JAN - a top ten journal

Roger Watson, Editor-in-Chief

I am very pleased to tell you that the JAN Thomson Reuters impact factor for 2014 increased from 1.685 to 1.741 moving us to the 10th place out of 110 academic nursing journals.  This represents a 5% increase in our citations from 11,383 in 2103 to 12,024 in 2014.  JAN remains the highest cited academic nursing journal in the world with submissions from over 50 countries annually.

Wednesday, 17 June 2015

Smoking among health professional students

Roger Watson, Editor-in-Chief

Smoking among health professionals is a paradox; why would people well aware of the risks do it? But they do and smoking among health professional students is common as shown by the plumes of smoke rising up from any group of nursing students at my university as they cross the campus.

A study form Spain of nursing and physiotherapy students by Ordás et al. (2105) titled:'Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysisand published in JAN analyses 'changes in prevalence, knowledge, beliefs and attitudes relating to smoking among undergraduate nursing and physiotherapy students' over 10 years.  The study showed that these students still smoked but that over the 10 years of the study (2003-2013) that it has reduced as follows: 'The proportion of smokers among nursing and physiotherapy students in 2003, 2008 and 2013 was 29 .3%, 24 .7% and 18. 2% respectively.'

While the above may be good news, there was an appalling lack of knowledge among these students of the risks they were taking.  Specifically: 'Students were not aware of any relationship between pulmonary emphysema, bladder cancer, coronary artery disease or
leukoplakia and tobacco use, this lack of knowledge increasing significantly over the years, in some cases to over half of the cohort. This was the case for bladder cancer where the lack of awareness of any relationship rose from 32-55.3%. Deficient knowledge was also noted in respect of links between health problems and exposure to second-hand smoke. For instance, the percentage of students that did not identify any relation with cardiovascular diseases, childhood asthma and under-weight new-born children increased statistically over the years, in the case of under-weight new-borns reaching 31%.'

In conclusion, the authors say: 'Most of the students who smoked had begun to do so before commencing their university studies. Hence, smoking prevention policies should pay special attention to adolescents and continue through university education, but should also implement active programmes to help university sudents who smoke to give up the habit. The decline in the
level of awareness of features of smoking declared by students of Health Sciences over the ten years provides evidence of a significant deficiency in undergraduate training.

You can listen to this as a podcast


Ordás B, Fernández D, Ordóňez C, Marqués-Sánchez P, Álvarez MJ, Martínez S, Pinto A (2105) Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysis Journal of Advanced Nursing doi: 10.1111/jan.12703

Thursday, 11 June 2015

How influential is carer burden in institutionalisation?

Nora-Ann Donnelly & Frank Doyle
Royal College of Surgeons in Ireland, Dublin

The recent article by Verbeek et al. (2015) analyses inter-country variation of factors associated with institutionalisation of people with dementia. It is very beneficial to have empirical data from a number of European countries on the factors which influence the admission of people with dementia to long-term care. However, we would like to put forward some comments for consideration regarding the authors’ conclusions, which we feel do not match the data presented in the article.

The authors conclude in both the Abstract and Discussion that ‘caregiver burden appeared the most consistent factor associated with institutionalisation’ (Verbeek et al. 2015 p.9). However, from our examination of the results as presented, the findings do not appear to fully support this assertion.

Firstly, the authors examine differences between people with dementia who were recently admitted to a nursing home (between 1-3 months), compared with those living at home with dementia who were regarded as at risk of institutionalisation. This analysis enables us to examine how these independent groups differ. However, it does not take into account the effect of institutionalisation on caregiver perceptions of burden. For example, previous research has found that carers are likely to experience considerable reductions in burden after nursing home admission (Gaugler et al. 2011). Given that institutionalisation can alleviate burden, the analysis, as presented, is not an accurate test of whether burden is associated with subsequent institutionalisation, but merely a demonstration of difference between two independent groups. This association could be confounded by other factors.

The authors do provide a more appropriate test of the association between burden and subsequent institutionalisation within the article, but again it is questionable whether the reported results support their conclusions. The authors followed people with dementia and their carers who lived at home and analysed the differences at baseline between those institutionalised after three months and those who were not. The univariate analysis found that those who had made the transfer to institutional long-term care had an informal caregiver who experienced a higher caregiver burden at baseline than people who remained at home (t=-2.31; p=0.021). However, this association did not survive adjustment for other factors. The overall multivariate analysis using a multi-level model found three other factors that explained the transition from living at home to institutional care at follow-up. These were: living situation; neuropsychiatric symptoms; and cognitive status. Unfortunately, the authors did not report the overall multivariate model including burden. Therefore, we do not know the results for caregiver burden when other factors have been taken into account. If burden is a consistent factor in institutionalisation, it should remain so after taking both the characteristics of the person with the dementia and the carer into account. The actual reported results therefore contrast with the conclusions of the article, and it seems that burden is not a consistent factor in institutionalisation when controlling for these other important factors.

However, these results are actually more in keeping with our recent work, which has meta-analysed the association between carer stress, distress and burden and subsequent care recipient institutionalisation. We found, from 54 articles, that while carer stress has significant association with institutionalisation, the actual size of this effect is negligible (SMD=0.05, 95% CI=0.04-0.07; I2=79.2%; p=<0.001). Moreover, sensitivity analysis found that whether analysing the association between carer burden, stress, distress or depression the effect size remains small to negligible (Donnelly et al. 2015). Furthermore, there was evidence of significant small study effects (potential publication bias). These results, and indeed the results of Verbeek et al. suggest that other factors are more critical for institutionalisation than carer stress or burden.

Combined, these findings should not be interpreted as undermining the significance of chronic stress on a carer. Indeed, several meta-analyses and systematic reviews have demonstrated the detrimental impact care stress can have on a carer’s psychological well-being and physical health (Pinquart & Sorensen 2003, Schulz & Sherwood 2008). However, the results as presented do not support the contention that carer burden is an important predictor of institutionalisation. While it may be a significant predictor, it is not an important one, even if we would like it to be so. As a research community it is important that we direct our efforts towards factors which are truly predictive of health service utilisation, based on a rigorous review and evaluation of the available evidence.

Ms Nora-Ann Donnelly
MA (SocSci) (Hons), MSc
PhD Scholar Health Services Research,
Department of Psychology,
Royal College of Surgeons in Ireland,

Dr Frank Doyle
BA (Hons), MLitt, PhD, Reg Psychol PsSI
Senior Lecturer
Department of Psychology,
Royal College of Surgeons in Ireland,


Donnelly N-A, Hickey A, Burns A, Murphy P, Doyle F (2015) Systematic Review and Meta-Analysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People. PLoS ONE 10(6): e0128213. doi: 10.1371/journal.pone.0128213

Gaugler, J. E., Roth, D. L., Haley, W. E. & Mittelman, M. S. (2011). Modeling trajectories and transitions: results from the New York University caregiver intervention. Nursing Research, 60, S28-S37

Pinquart, M. & Sorensen, S. (2003). Differences between caregivers and non-caregivers in psychological health and physical health: a meta-analysis. Psychol Aging, 18, 250-67

Schulz, R. & Sherwood, P. R. (2008). Physical and Mental Health Effects of Family Caregiving. The American Journal of Nursing, 108, 23-27

Verbeek, H., Meyer, G., Challis, D., Zabalegui, A., Soto, M. E., Saks, K., Leino-Kilpi, H., Karlsson, S., Hamers, J. P. & RightTimePlaceCare Consortium (2015). Inter-country exploration of factors associated with admission to long-term institutional dementia care: evidence from the RightTimePlaceCare study. Journal of Advanved Nursing doi: 10.1111/jan.12663

Health Problems of Military Staff

Adem Parlak
Sedat Devele
Gulhane Military Medical Academy

Nehir Parlak

Etimesgut Public Hospital

We are very interested in the article by Elliot (2015) on military nurses' experiences returning from war. In this article psychological problems of military nurses after their missions are mentioned. We think that this article makes a significant contribution to the literature because it mentioned problems which military medical staff face because of their duties, unlike other health professionals.

Although education levels of nurses are not specified in the study, we can understand from the age of participants that they were experienced. It is also understood that staff served several times in Afghanistan and Iraq in the scope of their duties. In our country military medical staff take active positions as indicated in Elliott’s study or in response to the casualties occurred after terrorist attacks. In this context, we would like to share our experiences. Disorders which Elliott has mentioned are observed in almost every geographical area in military medical personnel undertaking heavy duties. Doctors and nurses carrying out military health services in our country are trained by a faculty particularly experienced in this regard. Therefore, to cope with conditions which they may face with, doctors, nurses and non-commissioned officers dealing with military health services are informed and trained by apprenticeship, military drills and simulated military operations. In these trainings experienced staff play key roles by sharing their experience. However, by assigning staff to areas with the possibility of military operations, they gain experience that will reduce the likelihood of encountering psychological problems. Maintenance of a supportive environment is also be useful in solving the problems staff faced (Schok et al. 2010, Gibbons et al. 2012). The educational institutions of participants in Elliot’s study or their training for combat conditions were not specified. We consider that this could affect the have enhanced the study. However, we thank to Elliott for her contribution.


Elliott B. (2015) Military nurses’ experiences returning from war. Journal of Advanced Nursing 71, 1066–1075.

Gibbons S.W., Hickling E.J. & Watts D.D. (2012) Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review. Journal of Advanced Nursing 68, 3–21.

Schok M.L., Kleber R.J., Boeije H.R. (2010) Men with a mission: veterans meanings of peacekeepingin Cambodia. Journal of Trauma and Loss 15, 279–303.

Tuesday, 9 June 2015

Electroconvulsive therapy: ‘phenomenally helpful’ or ‘the most barbaric treatment’?

John Adams
Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland

Jack Nicholson in
One Flew Over the Cuckoo's Nest*
In my paper: ‘British nurses’ attitudes to electroconvulsivetherapy, 1945 – 2000’, I set out to assemble and discuss some of the evidence relating to this controversial topic. It is not the role of the historian to provide a definitive answer to this conundrum – that is a task for the clinical sciences – but it is rather to reconstruct and analyse the views held in the chosen period of study.

History advances ever closer to this goal through the medium of debates amongst historians. There is no agreed answer to the question: ‘was Oliver Cromwell a great statesman or a homicidal fanatic?’, but debates between historians taking opposing views bring us closer to the real man. So in my paper I hope to stimulate such a debate among those with an interest in the history of mental health nursing. Key questions include: ‘Did British nurses’ attitudes to ECT change over time?’, ‘What influence did the anti-psychiatry movement have on them?’, and ‘Did nurse educators rise to the challenge of preparing students adequately?’. In addition, I also hope to promote a greater focus on the history of mental health nursing in general, which is currently a neglected area of research. Peter Nolan, Claire Chatterton and Niall McCrae have made pioneering contributions, but numerous areas remain to be explored from a scholarly perspective. There is also an urgent need for mental health nurses to contribute oral history accounts of their views and experiences. The RCN Archive in Edinburgh holds a major collection of such material from current and retired nurses, but only a tiny fraction of the recordings and documents relate to mental health care. We need to beat the grim reaper and archive this material before it is too late.


Adams J (2015) British nurses’ attitudes to electroconvulsivetherapy, 1945 – 2000, Journal of Advanced Nursing doi: 10.1111/jan.12704

* the film of the book by Ken Casey features electroconvulsive therapy

Work life conflict in nurses

Roger Watson, Editor-in-Chief

Getting the balance between work and life right in any modern career is tricky but nursing is one of the jobs where this becomes acute due to the nature of the work, the often long hours of work and the anti-social nature of shift work.  This leads people to leave their jobs leading to turnover and shortage of nurses.

A study from Taiwan by Chen et al. (2105) titled: 'Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention' and published in JAN aimed to: 'investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings.'

The study surveyed 186 nurses about their job satisfaction, work-to-family conflict and their intention to leave their job. Intention to leave was  related to both work-to-family conflict and to job satisfaction such that the less satisfied nurses were the more likely they were to leave and the more work-to-life conflict they had, the more likely they were to leave and some of the intention to leave due to low job satisfaction was exacerbated by work-to-family conflict.  The authors conclude that: 'administrators have generally focused only on developing strategies to increase nurse satisfaction with their jobs and reduce turnover. Such strategies may not be effective because nurse demographics are changing and more nurses now belong to dual-earner families or single-parent families' and 'strategies that reduce or prevent work-to-family conflict can lessen the turnover rate and improve job satisfaction...'

You can listen to this as a podcast.


Chen I-H, Brown R, Bowesr BJ, Chang WY (2015) Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention Journal of Advanced Nursing doi: 10.1111/jan.12706

Elastic band exercises

Roger Watson, Editor-in-Chief

I have to admit that I had to Google 'elastic band exercises' when I first encountered this article and it turns out that elastic band exercises are, indeed, exercises using elastic bands.  Having established what they were I now realise that, on my infrequent 'exploratory' visits to the gymn, I have seen these...usually lying in corners and only occasionally being used.  However, it transpires they offer a good method of 'resistance training' and, as this YouTube video shows, you can exercise the whole body.  In fact, they are also referred to as 'resistance bands'.

It transpires that elastic band exercises are beneficial in older people as a study from Taiwan by Yang et al. (2015) titled: 'Applying the transtheoretical model to promote functional fitness of community older adults participating in elastic band exercises' and published in JAN shows.  Yang et al. evaluated functional fitness - which included: 'included lung capacity, cardiopulmonary fitness, upper and lower body flexibility, upper limb muscle power and lower limb muscle endurance' - in 186 older people divided into two groups: one receiving elastic band therapy and one receiving their usual activities three times weekly at a centre for older people over 6 months.

As the results show, the elastic band exercise led to: 'better all of the functional fitness indicators after 3 months and 6 months of the senior elastic band exercises'.  The authors concluded that the elastic band exercises: 'improved the functional fitness of community older adults. The programme is inexpensive, easy to use, safe and suitable to be applied in the community centres or practiced at home.'

You can listen to this as a podcast.


Yang J-H, Chan K-M, CHen M-D, Wu H-C, Chang W-J, WangY-C. Huang H-T (2015) Applying the transtheoretical model to promote functional fitness of community older adults participating in elastic band exercises Journal of Advanced Nursing doi: 10 1111/jan.12705

Thursday, 4 June 2015

Men's Health Month 2015: Nursing care and health interventions for men

Dr Paul Galdas
Senior Lecturer, Department of Health Sciences, University of York

To mark Men's Health Month, we asked JAN editorial board member Paul Galdas to select some recent relevant papers from JAN.
Paul Galdas
Research over the past decade has consistently shown that gender identity plays a key role in men’s experience of illness and decisions to seek and access healthcare for a range of mental and physical health problems. Less common have been studies that have explored how understandings of men’s identities can be translated into more acceptable and satisfactory nursing care and health interventions. Three recent original qualitative investigations published in JAN have shed further light on this in the context of three differing conditions: penile cancer, prostate cancer, and out-of-hospital cardiac arrest.

Branney et al. (2014) explored how men with penile cancer construct humour in relation to their diagnosis and treatment. The use of humour in nursing practice has long been recognised in opinion-based literature, but there has been a paucity of empirical research on the concept. In this study, the researchers explored men’s perspectives on humour and masculinity using focus groups and interviews conducted during a one-day workshop. Humour was found to help men make light of their condition, which meant that they could laugh about the consequences of treatment (‘laughing about urination’) and build rapport with health professionals (‘humour with health professionals’).

Branney et al.’s findings suggest that humour may have a wider role to play in the nursing care of men; particularly those who are experiencing taboo or stigmatised health issues, such as sexual dysfunction. Relevant to this is McCaughan et al.’s (2015) exploration of the experience of prostate cancer survivors and their partners attending a group-based psychosocial intervention, which identified dissatisfaction with the way the issue of sexual dysfunction was dealt with. Also emerging strongly from the interviews was the role men’s partners played in highlighting the problems and issues experienced by their husbands; a theme replicated in Uren and Galdas’ (2014) study of men’s experiences post cardiac arrest. Men who had survived out-of-hospital cardiac arrest drew on masculine ideals of self-reliance, strength and stoicism, but also spoke of being reliant on their partner for help with accessing health care and expressing their needs to health professionals.
Overall, the findings from these three studies recently published in JAN serve to strengthen the growing body of qualitative work highlighting connections between men’s identities and their experience and recovery from ill-health, and will hopefully influence the provision of more acceptable and satisfactory nursing care to men and their families.


Branney P, Witty K, Braybrook D, Bullen K, White A, Eardley I (2014) Masculinities, humour and care for penile cancer: a qualitative study Journal of Advanced Nursing 70:2051-2060

McCaughan E, McKenna S, McSorley O, Parahoo K (2015) Theexperience and perceptions of men with prostate cancer and their partners of the CONNECT psychosocial intervention: a qualitative exploration Journal of Advanced Nursing doi: 10.1111/jan.12648

Uren A, Galdas P (2015) The experiences of male suddencardiac arrest survivors and their partners: a gender analysis Journal of Advanced Nursing 71:349-358