Tuesday, 29 September 2015

FGM - a practice that must be banned

Roger Watson, Editor-in-Chief

The repulsive practice of female genital mutilation (FGM) is the subject of a recent review from Spanish authors Reig-Alcarez et al. (2015) and published in JAN titled: 'Health professionals and Female Genital Mutilation'.  The aim of the study was: 'To synthesize knowledge, attitudes and experiences of health professionals about Female Genital Mutilation.'

Publications between 2006–2014 were reviewed and it appears, worldwide, that while nurses and midwives are at the forefront of preventing FGM, they are also responsible in some countries for condoning it.  As the authors explain: 'WHO estimates that between 100 and 140 million girls and women have been subjected to genital removal, and that every year 3 million girls are at risk of FGM. Currently, 29 African countries continue this practice, and countries in Southeast Asia. Migration of women who come from cultures where FGM is practiced have contributed to the increase in women affected by FGM in countries where it was not previously practiced.'

Seventeen full text articles were reviewed and they are analysed in detail in the article by Reig-Alcarez et al. (2015) who state: 'This is the first synthesis of evidence on the perspectives and experiences of Health Professionals concerning FGM that raises important implications for nursing and midwifery practice.'  The authors conclude: 'Health and legal systems, professional regulation and governance, and professional training require strengthening to eradicate FGM, prevent the medicalization of FGM as an acceptable procedure, and to better manage the lifelong consequences for affected girls and women.'

You can listen to this as a podcast.


Reig-Alcaraz M, Siles-Gonz alez J, Solano-Ruiz C (2015) Health professionals and Female Genital Mutilation Journal of Advanced Nursing doi: 10.1111/jan.12823

Smoking in China

While smoking is declining globally, it is not declining in China and, in the words of these authors 'China is the epicentre of the tobacco epidemic'. The aim of this study from China by Sarna et al. (2105b) titled 'Helping smokers quit: behaviours and attitudes of Chinese Registered Nurses' and published in JAN was to use the 5 As (i.e. Ask, Advise, Assess, Assist, Arrange) framework to assess Chinese nurses' involvement in smoking cessation.  The 5 As framework was also evaluated by Sarna et al. (2015a)

A large sample of nurses (N=2240) participated from two major cities in China.  The authors found that 'the majority of nurses asked about smoking status, but few assisted patients with quitting. Further efforts are needed to help nurses actively promote smoking cessation interventions.'  Nurses did think that they should be non-smoking role models.

The authors conclude: 'Given the enormous proportion of the health threat of tobacco use in China, nursing involvement in tobacco control is essential, especially in supporting quit efforts of patients.' and 'This survey provides important information about frequencies of intervention prior to the launch of an educational intervention, especially the need to support follow-up after hospitalization to
prevent relapse after quitting.'

Listen to this as a podcast.


Sarna L, Bialous SA, Zou XN, Wang W, Hong J, Wells M, Brook J (2015a) Evaluation of a web-based educational programme on changes in frequency of nurses’ interventions to help smokers quit and reduce second-hand smoke exposure in China Journal of Advanced Nursing doi: 10.1111/jan.12816

Sarna L, Bialous SA, Zou XN, Wang W, Hong J, Chan S, Wells MJ, Brook J (2015b) Helping smokers quit: behaviours and attitudes of Chinese Registered Nurses Journal of Advanced Nursing doi: 10.1111/jan.12811

World Heart Day 2015 Tuesday 29 September 2015

David Thompson
David R Thompson PhD FRCN FAAN
Professor and Director, Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia

To mark World Heart Day, we asked Professor David Thompson to select some recent relevant papers from JAN.
Heart disease not only remains the world’s leading cause of death but also results in significant disability and distress, which impose a major human and economic burden. Two key areas where nurses have made major research contributions to the care of people with heart disease are in cardiac rehabilitation and heart failure self-care. I have therefore selected two very recent papers, both from Canada, that address these topics.

The first paper by Angus et al. (2015) addresses the issue of gender and access to cardiac rehabilitation. It is well recognized that access to, and uptake and completion of, cardiac rehabilitation is poor, especially for women, older people, ethnic minority groups and rural and remote communities. Why women, for example, are less likely to attend cardiac rehabilitation is unclear and there is a need to understand the barriers to uptake that exist. This meta-synthesis of 69 qualitative studies found that only four of them had specified a definition or theoretical position on gender. The authors argue that conceptual clarity about the social origins of gender is needed in order to work towards understanding the social determinants of access disparities.

The other paper by Spaling et al. (2015) addresses the issue of heart failure patients’ self-care. It is well recognized that there is inconsistency in patients’ knowledge and practices around self-care and interventions to improve it. Thus, patient-focused recommendations are needed to improve this care. This systematic review and qualitative interpretive synthesis of 37 studies found, for instance, that while patients could often recall health professionals’ self-care advice, they were unable to integrate this knowledge into daily life. The authors argue that merely providing patients with more sophisticated knowledge of heart failure is unlikely to improve heart failure self-care. What are also needed are strategies with patients and family members to promote mastery and self-efficacy, learning and adaptation/application. 

Both of these papers make important contributions to the nursing literature and will, hopefully, influence the provision of better care to people with heart disease.


Angus JE., King-Schier KM., Spaling MA., Duncan AS., Jaglal SB., Stone JA. & Clark AM. (2015) A secondary meta-synthesis of qualitative studies of gender and accessto cardiac rehabilitation. Journal of Advanced Nursing doi: 10.1111/jan.12620

Spaling MA., Currie K., Strachan PH., Harkness K. & Clark AM. (2015) Improving supportfor heart failure patients: a systematic review to understand patients’ perspectiveson self-care. Journal of Advanced Nursing doi: 10.1111/jan.12712

The stethoscope, a patient and me

Mr Jamie Ranse
Faculty of Health, University of Canberra, Canberra, Australia
Flinders University, South Australia, Australia

During the 2015 Miss America pageant, a contestant and nurse, Kelley Johnson, stood on the stage dressed in her nursing uniform wearing her stethoscope. Kelley delivered a monologue about nurses, including her first-hand accounts of interacting with patients. Following the pageant, commentators on the American Broadcasting Company television program The View commented about the monologue stating: ‘what is she doing with a doctor’s stethoscope’? Internationally, nurses responded via social media.

The anecdote below provides insight into the phenomenological natural attitude of the stethoscope and what it may be like to experience a stethoscope as a nurse or as a patient. A stethoscope is a thing that has concrete properties, purpose and meaning. The stethoscope holds purpose and meaning for me as nurse:
I walk into the hospital and place my stethoscope around my neck. The stethoscope turns me from a lay person into a nurse, with tools ready-at-hand. My stethoscope is ready to be used for a particular purpose, auscultation. When I use my stethoscope I am interested in the patient as a whole, but I am concentrating on the sound that is reverberating through the tubing of the stethoscope. I am concentrating on the intricacies of the sound that is being listened to, such as the lub dub of a heartbeat. Whilst the stethoscope amplifies a sound of interest; I find it difficult to hear the conversations of those nearby or the sound of monitors alarming in the distance. External sounds are reduced to a muffle. I need to concentrate. The stethoscope allows for the unheard to be heard. The unheard provides insight into the patient’s condition. I hear what the patient themselves do not hear, I now know what the patient themselves do not know. My auditory insight provides knowledge about the patient’s condition for the sake of planning and evaluating care.
The patient’s experience of the stethoscope maybe different from that of the nurse. Perhaps patients have an expectation of a nurse with a stethoscope around their neck? That the nurse has a certain level of clinical knowledge? The stethoscope partners the nurse and patient in a collaboration of care:
As a patient I willingly lift my shirt for the nurse to use their stethoscope. I may not always be willing; on occasions I am hesitant to lift my shirt. The stethoscope may be cold. The stethoscope reminds me of my previous illness. The illness of a loved one. It may evoke a stressfully moment in life. I cannot hear my own heartbeat; it is only heard by the nurse that uses the stethoscope.
The young child or confused older person may not want the stethoscope near them. They may use their hand to brush away the stethoscope. Fighting against the stethoscope. Not realising that this tool is being used with the intent to assist, not hinder. For the unconscious patient or deceased, they have no choice. The nurse just uses the stethoscope without their willing or knowing.

Monday, 28 September 2015

Family group conferences outcomes are not always sustainable

Gideon De Jong
Researcher, Department of Medical Humanities
EMGO+, VU University Medical Centre Amsterdam, Netherlands

Gert Schout
Senior Researcher, department of Medical Humanities
EMGO+, VU University Medical Centre Amsterdam, Netherlands

Since 2009, we have been studying the process and outcomes of Family Group Conferencing (FGC) in mental health care as a social intervention to restore ties between psychiatric clients and their social network, and promote their social resilience. This resulted in two reports: a report focusing on FGC organised for ‘underserved groups’ in public mental health care (Schout & De Jong 2013) and, recently, a second report on the possibilities of FGC in preventing coercion in psychiatry (Schout et al. 2015). In total, more than 100 conferences were analysed and 600 semi-structured interviews conducted with the participants. To date, this is the world’s most in-depth research into FGC for adult clients in mental health care.

Eighteen months after the Eigen Kracht-conferenties

We reported earlier in JAN about the successful outcomes of a conference organised in a small neighbourhood where an imminent involuntary admission to a psychiatric ward and home eviction of a client was prevented and the living conditions restored (De Jong et al. 2014). During a period that lasted several months, in this neighbourhood liveability problems were reported where a man with psychotic problems was involved. The conference that got organised in the spring of 2012 took place without the client; participation in an upcoming conference caused too much stress and thereby worsening of psychotic problems. The conference was prepared in consultation with his sister, neighbours and professionals, and a plan was maintained that helped the neighbourhood becoming liveable again while the threat of an involuntary admission and home eviction was averted. The co-operation that was set in motion during and shortly after the conference, initially ensured rest: the neighbourhood had a short communication line to the mental health services and the sister for advice on psychotic and unacceptable behaviour.

In this commentary we want to share the insight that the positive outcomes in this case, but in other cases as well, may not always be sustainable. A year after the initial successes, the living conditions worsened gradually. The neighbourhood had increasingly difficulties to keep up with the client. Moreover, they and the client’s sister experienced less support from the mental health services. At the moment the situation seemed to escalate, no co-operation between the mental health services, the local police men, the housing association and the municipality got off the ground. This finally resulted in that the client being involuntarily admitted to a psychiatric ward and evicted from his home. He was hospitalised for several months, and during his admission, professionals were looking for another place for him to live.

Several lessons can be learned from this case. First, a family group conference does not mean that professionals afterwards can stay aloof. On the contrary, professionals are needed to provide information and support so that clients and their network can establish the potential most effective plan. In this case also by providing mediating techniques so that conflicts and disruptive behaviour can be addressed when they are still small. This requires professionals who are sensitive, approachable and accessible to not only clients but also their close relatives, friends and neighbours. The conference helps professionals getting a better picture of their clients so that subsequently they can adept more effectively to the given situation. Professionals who also have more than just the psychiatric problems of individual clients in mind; who address the necessity of their socio-cultural integration; who present themselves as the link between clients and their social environment. A professional who is also able to apply the pressure that is usually deployed by police men and housing associations to curb unacceptable behaviour. When not only clients but also their social environment experience support of professionals and other neighbours, they dare to show their commitment and are better able to endure the situation.

Interviews with the neighbourhood and the client’s sister that were held two years after the conference revealed that the company of other clients in the psychiatric ward did do the client visibly well. In other words, the admission was not any longer a nightmare for him. Simultaneously, the involuntary admission was a springboard to a form of supportive housing. Although the conference did not provide grounds for a sustainable positive outcome (prevention of coercive measures) in the long run, it helped the neighbourhood and mental health services to connect with each other. The mental health services thus became a partner who has something to offer, not only to the client but also to his social environment.

Balance between direct and indirect malleability

The FGC decision-making model is strongly embedded in the tradition of indirect malleability as it encourages learning processes and self-organisation. Convening stakeholders around an issue and empowering them to come up with solutions of their own meets the complexity of contemporary issues. The problems of the client population studied in this research project are complex. Apart from the unruliness of the psychiatric symptomatology itself, most clients have other problems as well, such as addictions, social isolation, a lack of sense of purpose and daily activities, debts and housing problems. Problems which altogether have a complex character. A core fundament of the FGC philosophy is that the fusion of the brain power from a large social network with professional expertise, responds to the complexity of clients’ problems. Here it is also crucial that a wider circle of concerned bystanders gets involved, generating new ideas and solutions the other actors may not have thought of, thus preventing blind spots and providing a wider range of solutions.

Also in other cases we observed that clients and/or their social network were unable to participate in a FGC process, let alone to take part in the private family time of the conference and establishing the final plan. In all these case, nevertheless, (the preparations of) the conferences were valuable in the eyes of the interviewees. What the case as described in this commentary illustrates is that the mental health services sometimes need to act in the tradition of direct malleability by first treating psychiatric symptoms so that in a later stage – following the tradition of indirect malleability—they can bring in their expertise when clients together with their social network establish their own plan. In other words, sometimes family driven should alternate with professional driven. (e.g. Merkel-Holguin 2004).


De Jong G., Schout G. & Abma T. (2014) Prevention of involuntary admission through Family Group Conferencing: A qualitative case study in community mental health nursing. Journal of Advanced Nursing 70(11), 2651-2662.

Merkel-Holguin L. (2004) Sharing power with the people: Family Group Conferencing as a democratic experiment. Journal of Sociology and Social Welfare 31(1), 155-173.

Schout G., Landeweer E., Van Dijk M., Meijer E. & De Jong G. (2015) Eigen Kracht-conferenties bij verplichte GGz. Een onderzoek naar proces en uitkomsten [Family Group Conferencing in coercive psychiatrie. A study into process and outcomes]. VU Medical Centre, Amsterdam.

Schout, G. & De Jong, G. (2013). Eigen Kracht-conferenties in de Openbare Geestelijke Gezondheidszorg. Een onderzoek naar proces en uitkomsten [Family Group Conferencing. A study into process and outcomes]. Lectoraat OGGz, Hanzehogeschool Groningen, Groningen.

Thursday, 24 September 2015

More on the dark side of open access

Lack of knowledge about hijacked journals is another dark side

Mehdi Dadkah
Foulad Institute of Technology
Tehran, Islamic Republic of Iran

I read the article: 'Authors and readers beware the dark side of Open Access' (Pickler et al. 2015). I would like to comment about hijacked journals as another dark side. In the editorial, the authors introduced predatory publishers as the dark side of open access publishing and state predatory journals are not generally indexed and published papers may not be available for other authors. I agree with the authors of this paper; most of the published papers in predatory journals are of low quality or have been copied from published papers in other journals by amateur researchers. Predatory journals are repository for bogus research and this work may get cited from reputable journals as explained by Beall; this can manipulate original research, thus it is necessary not to index predatory journals. Also most predatory journals are not in any reputable index, thus they do not deserve to receive papers from most authors.

Hijacked journals are fake websites for indexed journals. Forgers create websites for print version journals and cheat authors as explained by Jalalian. There is a lack of knowledge about hijacked journals and authors consider them to be reputable open access journals. These journals abuse the name of reputable publishers and have more chance of receiving papers from authors. It is necessary to start research about hijacked journals. By doing simple search Scopus, there are only eight papers about hijacked journals, but there are 37 papers which discuss the problem of predatory publishers. Hijacked journals lead to lost science, because their websites are available for only a short time. Also, we cannot consider all published papers in hijacked journals as bogus research, because professional researchers may be cheated by forgers due to their hijacked journal indexes.


Pickler, R., Noyes, J., Perry, L., Roe, B., Watson, R. and Hayter, M. (2015), Authors and readers beware the dark side of Open Access. Journal of Advanced Nursing, 71: 2221–2223. doi: 10.1111/jan.12589

Monday, 21 September 2015

How well do nurse prescribers perform?

Roger Watson, Editor-in-Chief

Nurses now commonly perform roles that were once the preserve of medical practitioners and prescribing medication is one example. Nurse prescribers are now very common and, according to a recent article by Courtenay et al. (2015) titled: 'A comparison of prescribing and non-prescribing nurses in the management of people with diabetes' and published in JAN, there are 28,000 nurses in the UK who can prescribe the same medications as their medical colleagues.  But are they any better at this than nurses who do not prescribe and who after people with diabetes but who depend on their medical colleagues to prescribe?

The aim of this study, in the authors own words, were: 'to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs.'  Six nurses managing people with diabetes who could prescribe were compared with six who did not and they were followed up over 6 months.

The main finding was that both cared equally well but that patients were more satisfied with nurse prescribers and they were more expensive to employ than non-prescribing nurses.  This is good news for nurse prescribers and for patients but, as the authors warn in their conclusion: 'From nurses’ perspectives, holding an independent prescribing qualification may enhance career prospects and add to job satisfaction, but budget conscious GP practices may question the rationale of investing in a more expensive resource when a nurse commanding a lower salary can produce similar outcomes.'

Listen to this as a podcast.


Courtenay M, Carey N, Gage H, Stenner K, Williams P (2015) A comparison of prescribing and non-prescribing nurses in the management of people with diabetes Journal of Advanced Nursing doi: 1 10.1111/jan.12757

Lecture at University of Eastern Finland on writing for pubilcation by Roger Watson

This lecture was on 'Scientific writing: waking up the reader's attention' and was given by Roger Watson, Editor-in-Chief of JAN in Koupio, Finland at the University of Eastern Finland to masters and doctoral students in health on 17 September 2015.
Roger Watson

Listen to the podcast.

Friday, 18 September 2015

What happens when a nursing student becomes a nurse?

Roger Watson, Editor-in-Chief

Nursing student and registered nurse attrition is an international phenomenon as this study from Australia by Cowin and Johnson (2105) titled: 'From student to graduate: longitudinal changes in the qualities of nurses' points out.  One particular point of attrition is when nursing students enter practice for the first time and, as the recent Shape of Caring review in the UK by Lord Willis suggests, a period of support once nurses enter practice for the first time should become the norm.

The study by Cowin and Johnson (2015) shows that good qualities such a caring and empathy tend to increase across the course of a nursing education programme.  However, when faced with the realities of clinical practice 'workplace misfit' is experienced and scores in these desirable qualities decline.

In the words of the authors: 'An important finding from this study is that the pattern of change was not a linear one where qualities are initially rated low, increasing each year until the highest rating is at the workplace. Rather, there is a trend in many qualities where there is an increase in 3rd year and a sharp decline on entering practice...' and conclude: 'Our educational and clinical experiences for students are supporting the development of qualities of the nurse that have the potential to provide superior healthcare to patients. How to best support the initial 
graduate years remains the immediate challenge.'

You can listen to this as a podcast.


Cowin L. S. & Johnson M. (2015From student to graduate: longitudinal changes in the qualities of nurses. Journal of Advanced Nursing doi: 10.1111/jan.12763

Tuesday, 15 September 2015

Researchers Investigated Effects of Self-Efficacy in Weight loss Treatments to Improve Emotionally-Controlled Eating

James Annesi
YMCA of Metro Atlanta

Nicole Mareno
Kennesaw State University - WellStar School of Nursing

Emotional eating affects many women with obesity who seek weight loss treatments. Understanding relationships among factors that predict and mediate emotional eating might enable the construction of improved weight loss treatments.

Ninety-five women with obesity participated in one of two 6-month, community based weight-management programs where specific self-regulatory skills were taught through either (1) use of a manual plus phone follow-ups, or (2) a combination of 6 one-on-one sessions of exercise support plus in-person, group-based nutrition behavior change classes. The study confirmed that improved body satisfaction was associated with less emotional eating for women. Improvement in the women’s moods and greater use of self-regulatory skills predicted an improvement in the women’s self-efficacy to control eating while experiencing negative feelings. The in-person treatment format had the greater impact on the predictors of emotional eating.

Increasing individuals’ self-efficacy by incorporating mood and self-regulatory skills to overcome barriers to eating behavior changes in nursing interventions may serve to improve weight-loss efforts by reducing emotionally cued eating noted authors Drs. James J. Annesi and Nicole Mareno in a study in the Journal of Advanced Nursing.


How important is hope to dying patients?

Kathleen Broadhurst
Ann Harrington
School of Nursing and Midwifery, Flinders University, Australia

Hope has been identified internationally as being crucial to life. Given its subjectivity, hope can be a difficult concept to comprehend although a general definition described a sense of anticipation and longing for a specific event to occur.

Hope was found to be important for patients dealing with adversity. The question arises as to how patients keep hope alive when confronted by a diagnosis of a terminal illness?

A literature review was instigated to investigate the meaning of hope to patients receiving palliative care and to examine the themes that foster hope for dying patients:
  1. Disease status: Good symptom control, hope for a cure, accepting prognosis and hope for a peaceful death all featured.
  2. Positive personal relationships: Love of family and friends and good relationships with professional carers increased hope.
  3. Positive character traits in the individual such as determination and optimism assisted with hope-generation.
  4. Quality of life: living life to the full, everyday living and well-being together with uplifting memories increased hope.
  5. Setting and achieving goals, including retaining independence and symptom control, generated hope and were seen as the converse of hopelessness. 
  6. Spirituality/Religion: faith in God and prayer were a vital resource for maintaining hope.
  7. Hope after death: Leaving a legacy and focusing on a positive future for family and friends enabled hope to be maintained despite life-limiting illness.
The review clearly showed that hope was beneficial to those with a terminal illness and hope was maintained in the face of dying. In some studies hope actually increased in some patients despite approaching death.


Broadhurst K & Harrington A (2015) A mixed method thematic review: The importance of hope to the dying patient. Journal of Advanced Nursing DOI: 10.1111/jan.12765

Cancer and Serious Mental Illness: what are the perspectives of patients and those who care for them?

James Millman
Karen Galway
Olinda Santin
Joanne Reid

Queens University Belfast - School of Nursing and Midwifery

It is well known and documented that people with serious mental illness (SMI) are more likely to suffer from physical comorbidities, such as diabetes, respiratory disease and cardiovascular disease. It is also becoming clear that SMI patients who develop cancer are more likely to die than cancer patients without an SMI diagnosis. Often these health inequalities are linked to medication side-effects and lifestyle factors such as smoking. This problem is being treated increasingly seriously and is gaining more and more attention in the literature. There have been some suggestions that psychiatric symptoms and related stigma may result in patients receiving sub-optimal care. The area has however received little robust research attention. The views of patients and of those caring for them is an area that has been particularly neglected. In our paper ‘Cancer and Serious Mental Illness: Patient, Caregiver and Professional Perspectives’ we outline a study currently underway, consisting of semi-structured interviews with these groups. The study aims are to develop recommendations that can benefit the stakeholders involved. The process of the study will also illuminate what works, and what doesn’t, when it comes to accessing mental health service users and their families for qualitative research. We look forward to publishing results of the study in due course, in JAN.


Millman J.Galway K.Santin O. & Reid J. (2015Cancer and serious mental illness – patient, caregiver and professional perspectives: study protocol Journal of Advanced Nursing DOI: 10.1111/jan.12812

Tuesday, 1 September 2015

Cost effective strategies for pressure ulcer prevention

Roger Watson, Editor-in-Chief

Pressure ulcers are the problem that never goes away.  From a mentality that used to say that they should always be prevented and always could be prevented, it is now clear that they are very hard to prevent but that some strategies are better than others.  However, where differences in effectiveness are marginal the issue of cost-effectiveness is an essential factor to study.

A recent UK study by Marsden et al. (2015) titled 'A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers' and published in JAN uses a health economics approach to 'assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention'.  The data for the inputs to the model were obtained from a systematic review and the health economic methods are fully described.

The outcome of the study is best described in the authors own words: 'this analysis found that alternating 2 and 4 hourly repositioning is not cost-effective compared with 4 hourly repositioning, as a PU prevention strategy in older people in a nursing home with non-blanchable erythema. This conclusion was robust to a range of sensitivity analyses, demonstrating that despite uncertainty around the model inputs, variation within reasonable ranges does not alter the conclusion.'

You can listen to this as a podcast.


Marsden G, Jones K, Neilson J, Avital L, Collier M, Standby G (2015) A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers Journal of Advanced Nursing doi: 10.1111/jan.12753