Monday, 26 December 2016

Inciting Dialogue and Disruption in Dementia – The Making of the Film ‘Michael’s Map’

Professor Charlotte L Clarke
University of Edinburgh

People with a diagnosis of dementia experience many changes to their social networks - and the dynamics of these changes and their effects were explored in a participatory secondary data analysis project funded by the Economic and Social Research Council held by Professor Charlotte Clarke and Heather Wilkinson (University of Edinburgh, UK) and in partnership with the Mental Health Foundation and Alzheimer Scotland (ES/L01470X/1 - Inciting dialogue and disruption –developing participatory analysis of the experience of living with dementia and dementia care). More information about the research is available at Talking Dementia.

The research re-analysed a qualitative dataset of 156 interviews with people diagnosed with dementia and their family carers which had been collected as part of the Department of Health funded study into peer support and dementia advisor roles within the National Dementia Strategy for England (see Clarke et al 2013, 2014, 2016; Keyes et al 2014). We worked with a further 35 people living with dementia to co-analyse the data, using the format of a series of four workshops with each of four groups to achieve this. An analytical framework was based on:
  • The cultural theory of risk (seeking to understand how the social organisation of communities influence the ways in which members of that community perceive and respond to risk), using Douglas’ classic group-grid analysis (Douglas & Wildavsky 1982). The ‘grid’ refers to regulation and the extent to which members of that community are expected to adopt the rules for personal and professional conduct that the community espouse. The ‘group’ refers to cohesiveness and is the extent to which individuals within a given community are bounded together and see themselves as a coherent community. 
  • An ethic of care framework, based on definitions of the five elements developed specifically for the application of an ethic of care to dementia care settings by Brannelly (2006). Our analysis began by taking the instances identified through the group-grid analysis of the data set and identifying where each of the five elements of the framework occur (attentiveness, responsibility, competence, responsiveness and trust). We then explored and mapped links between the occurrences of the five elements identified, thus tracing examples in the data set of interpersonal interaction that promote an ethic of care framework.
The key findings of the analysis were that:
  • Dementia and the effect it has on adhering to presumed but unspoken social expectations can lead to a gradual process of withdrawal of friends and withdrawing of oneself which culminates in social exclusion. 
  • Peer support, which is underpinned by a different set of social expectations, can restore a sense of social inclusion and is beneficial for some people, but not everyone. 
  • More attention to the collective nature of care which includes peer support, families, communities and professionals, with people with dementia recognised as playing an active role within this network, could better support social inclusion. 
  • New social expectations based on co-operative listening, co-operative action, and co-operative caring could lead to solidarity with people with dementia and a society where people with dementia can be included in community, social and public life. 

In this research process, the analysis moved between individual voices and composite pleural voices – firstly, having heard the ‘individual’ narratives of people living with dementia in the 156 interviews of the original dataset, and secondly worked with a further 35 people living with dementia during the secondary data analysis, the research process thirdly joins the identified research themes together in the development of a created and performed single narrative (Michael’s Map) – leaving the final voice of interpretation with yourself as audience rather than in the academic telling.

The film Michael's Map has been produced in a partnership between the University of Edinburgh and Skimstone Arts and is freely available at on Vimeo.

We would very much appreciate hearing about how you use the film and to what effect – so please do email me.


Brannelly, T. (2006) Negotiating ethics in dementia care. An analysis of an ethic of care in practice. Dementia 5:2;197-212.

Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Reynolds, J., McClelland, S., Hodgson, P., Corner, L. and Cattan, M. (2013) HEALTHBRIDGE: The NationalEvaluation of Peer Support Networks and Dementia Advisers in implementation ofthe National Dementia Strategy for England. Published by the Department of Health and accessed 11/10/13

Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Corner, L. & Cattan, M. (2014) Organisational Space for Partnership and Sustainability: Lessons from the Implementation of the National Dementia Strategy for England. Health & Social Care in the Community. Published online: 22 SEP 2014 | DOI: 10.1111/hsc.12134

Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Reynolds J., McClelland S., Hodgson P., Corner, L. & Cattan, M. (2016) ‘I just want to get on with my life’ – A mixed methods study of active management of quality of life in living with dementia. Ageing & Society. DOI:

Douglas, M. & Wildavsky, A. (1982) Risk and Culture. University of California Press, Berkeley, CA.

Keyes S.E., Clarke C.L., Wilkinson H. et al. (2014) ‘We’re all thrown in the same boat…’ A qualitative analysis of peer support in dementia care. Dementia Published online 17/4/14 DOI: 10.1177/1471301214529575

Tuesday, 20 December 2016

How do we select potential nurses?

Roger Watson, Editor-in-Chief

In the UK recently a great deal of attention has been paid to the preparation of nurses, including the initial selection process. Interviewing - despite a complete lack of evidence - appears to be the backbone of UK government policy, and this study from the UK by Traynor et al (2016) studies the use of interviews in nursing student selection. The study titled: 'Identifying applicants suitable to a career in nursing: a value-based approach to undergraduate selection' is published in JAN and aimed to: 'complement existing evidence on the suitability of Multiple Mini Interviews as a potential tool for the selection of nursing candidates on to a BSc (Hons) nursing programme.'

Over 300 undergraduate nursing students took part with over 30 assessors and used the Multiple Mini Interview which is: 'modelled on the Objective Structured Clinical Examination and consists of several stations each with a different examiner.' The results were promising in that the method appeared to be reliable between assessors. However, there was no correlation with original interview scores or with academic performance. The authors conclude: 'We have shown that implementing an (Multiple Mini Interview) based on the assessment of  values is a feasible approach to selection in undergraduate nursing' but that there is a 'need for further improvement.'

You can listen to this as a podcast


TRAYNOR M., GALANOULI D., ROBERTS M., LEONARD L. & GALE T. (2016) Identifying applicants suitable to a career in nursing: a value-based approach to undergraduate selection. Journal of Advanced Nursing doi: 10.1111/jan.13227

What do nursing support workers do?

Roger Watson, Editor-in-Chief

What do nursing support workers do that is the same or different form Registered Nurses? Nursing support workers is a general term coined by Christine Duffield - a co-author in this study from Australia - which describes nursing co-workers such as nursing assistants, care assistants and auxiliary nurses. The study by by Roche et al. (2016) and published in JAN titled: 'A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study' aimed to: 'determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not.' As explained by the authors: 'Data were collected from 10 sampled units: six in one large teaching hospital and four in two small non-teaching  hospitals. Nurses on the units were observed in randomly assigned 2 hour blocks occurring Monday through Friday between the hours of 7 am-7 pm over 2 weeks.'

The results showed that: 'Nursing support staff spent the majority of their time engaged in direct care tasks, e.g. admission and assessment, hygiene and mobility. Although licensed/regulated nurses were less likely to undertake direct care tasks compared with support workers, those who worked on units with support workers undertook more direct care compared with those who worked on units without support workers.'  The authors conclude: 'Using objective work sampling data, it was determined that direct patient care tasks were most frequently undertaken by (assistants in nursing) in a sample of medical and surgical units in (Western Australia). Evidence was also found that nursing teams supplemented with (assistants in nursing) tended to be observed providing more direct care overall compared with nursing teams without (assistants in nursing) and that both (assistants in nursing)and regulated nursing staff (RNs and ENs) contributed to this difference.'

You can listen to this as a podcast


ROCHE M. A., FRIEDMAN S., DUFFIELD C., TWIGG D. E. & COOK R. (2016) . Journal of Advanced Nursing doi: 10.1111/jan.13224

Cancer screening by nurses and midwives

Roger Watson, Editor-in-Chief

Do nurses and midwives practice what they preach about cancer screening? These professions may be at higher occupational risk of various cancers and are part of an ageing workforce so the risk of cancer is possibly higher than in other workforces. This study titled: 'The personal cancer screening behaviours of nurses and midwives' from Australia by Nicholls et al. (2016) and published in JAN aimed: 'to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake.'

Over 5000 nurses and midwives were surveyed and the data analysed to see what factors were related to cancer screening behaviours. Generally, nurses and midwives underwent cancer screening more frequently than the general population but part-time workers were more likely to do this than full-time workers and those working shifts were less likely to undergo screening than those in office-based jobs.  There were differences for the different types of cancer: breast; bowel; skin; and prostate, which are explained in the article.

The authors concluded: 'Higher participation rates in nurses, compared with the general public, are good news for the health of nurses and midwives and the community that relies on their care. Study findings suggest this ageing workforce is making protective choices which will impact their future risk of illness and premature departure from the workforce. However, findings also indicate avenues to further improve participation rates, particularly for skin and bowel cancer screening, and to ensure those thinking of undergoing screening fully understand its relative risks and benefits.'

You can listen to this as a podcast


NICHOLLS R., PERRY L., GALLAGHER R., DUFFIELD C., SIBBRITT D. & XU X. (2016) The personal cancer screening behaviours of nurses and midwives. Journal of Advanced Nursing  doi: 10.1111/jan.13221

Sunday, 18 December 2016

Women's attitudes to menstruation

Roger Watson, Editor-in-Chief

I could not introduce this better than to use the author's own words: 'Although menstruation is a shared experience for most women, it is a subject and a process that historically has been surrounded with secrecy, shame and lack of knowledge.'

This study from Iceland titled: The role of menstruation in women’s objectification: a questionnaire study' by Sveinsdötter (2016) and published in JAN aimed 'to investigate the concepts of objectification and self-objectification among young women in the context of attitudes towards menstruation, menstrual suppression, menstrual and menarche experiences, disorder eating and exercise habits and to detect predictors of objectification and self-objectification.'  A series of questionanires was administered to over 300 Icelandic women and regression statistical methods were used to analyse the data. Various models were tested and these are described in detail in the article.

The author concluded: 'The study confirms that menstrual-related experiences influence women’s objectification, in particular age at menarche and belief that menstruation predicts behaviour in some
way.' She made a series of recommendations for research and, with relevance to practice, said: Healthcare providers and in particular nurses, could and should assist girls and women in developing a positive view of their body and its reproductive functions. Because of the central role nurses occupy in healthcare systems worldwide, they are optimally placed to give consultations to women and girls on their body and menstruation.'

You can listen to this as a podcast


SVEINSDӦTTIR H. (2016) The role of menstruation in women’s objectification: a questionnaire study. Journal of Advanced Nursing doi: 10.1111/jan.13220

Wednesday, 14 December 2016

What influences burnout in newly graduated nurses?

Roger Watson, Editor-in-Chief

Newly graduated nurses are a valuable commodity. There has been a lot of investment in their education and they bring new knowledge and enthusiasm to the health services where they work. So what causes them to burnout and, in many cases, leave? This study by Boamah et al. (2016) from Canada titled: 'Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study' aimed to: 'test a hypothesized model linking new graduate nurses’ perceptions of their manager’s authentic leadership behaviours to structural empowerment, short-staffing and work–life interference and subsequent burnout, job satisfaction and patient care quality.'

Nearly 4,000 nurses were involved in responding to a survey at two time points approximately two years apart. The findings were simple: 'short-staffing and work–life interference are important factors influencing new graduate nurse burnout.' The authors conclude: 'Our results highlight the need for authentic leadership and empowering, supportive working conditions with adequate staffing to help mitigate work–life interference and subsequent burnout development and its negative effects.'

You can listen to this as a podcast


BOAMAH S. A., READ E. A . & SPENCE LASCHINGER H.K. (2016) . Journal of Advanced Nursing doi: 10.1111/jan.13215

How do children who use wheelchairs view exercise?

Roger Watson, Editor-in-Chief

It can be hard to convince children who are not disabled about the benefits of exercise but what about children who use wheelchairs? How well do they understand the benefits of exercise and what part do their parents play in encouraging them? This is the focus of a stduy from the UK by Noyes et al. (2016) titled: 'Conceptualization of physical exercise and keeping fit by child wheelchair users and their parents'  which aimed to: 'gain a better understanding of how children aged 6–18 years who use wheelchairs and their families conceptualized physical exercise and keeping fit.' Twenty four children and 23 parents were interviewed.

The majority of the children claimed that they regularly took part in exercise, mostly three times per week. The children took part because they enjoyed the activities and met friends. Generally, they could see the benefits. The benefts, for example confidence, transferred to other activities. However, children did confuse exercise with therapy. On the other hand, parents were able to distinguish between therapy and exercise.

The authors conclude: 'Proactive and physically active parents can go some way to compensate for the lack of health promotion support and advice and to overcome the considerable barriers, to enable their disabled children to engage in and benefit from physical exercise' and '(m)isconceptions and misunderstandings of children about the differences between and benefits of therapy and physical exercise are likely to hinder their ability to better self-manage their health and weight as they grow up. Professionals (including nurses) need to improve the clarity of their communications to correct children’s misunderstandings about the respective benefits of therapy and physical exercise.'

You can listen to this as a podcast


NOYES J., SPENCER L.H., BRAY N., KUBIS H.- P., HASTINGS R., JACKSON M. & O’BRIEN T. (2016) Journal of Advanced Nursing doi:10.1111/jan.13209

Friday, 25 November 2016

Nursing students and LGBQ adolescents

Roger Watson, Editor-in-Chief

How comfortable are nursing students working with lesbian, gay, busexual or questioning adolescent and what makes them more or less comfortable? This is the topic of a study from the UK by Richardson et al (2016) titled: 'Do student nurses feel a lack of comfort in providing support for Lesbian, Gay, Bisexual or Questioning adolescents: what factors influence their comfort level?' and published in JAN.

The aim of the study was: 'to find out if student nurses feel comfortable in caring by providing support for Lesbian, Gay, Bisexual or Questioning adolescents and what factors influence their level of comfort.' Over 150 students responded to a questionanire and nine were interviewed. It transpires that nursing students do feel discomfort, despite holding positive attitudes. The authors concluded: 'The increase in ethnic and cultural diversity throughout the world will have an impact on the recruitment of student nurses who may come from cultures unlike their adopted country, It would seem from this study that for those students moving to cultures that are accepting of LGB people this may be difficult when caring for them due to factors identified above. When LGBQ adolescents disclose their sexuality it is essential they receive the right support.' and: 'The question is what can be done to support student nurses in increasing their levels of comfort. Firstly, it is important for educational institutions to raise self-awareness and increase confidence in nursing students by ensuring LGB issues are taught in nursing curricula.'

You can listen to this as a podcast


RICHARDSON B. P , ONDRACEK A.E, ANDERSON D. ( 2 0 1 6 ) Do student nurses feel a lack of comfort in providing support for Lesbian, Gay, Bisexual or Questioning adolescents: what factors influence their comfort level? Journal of Advanced Nursing. doi: 10.1111/jan.13213

'Mental health day' is nothing to celebrate

Roger Watson, Editor-in-Chief

We are well used to celebrating a wide range of - so-called - 'days' these days; for example, World Cancer Day, World Diabetes days and so on. When I first saw the title of this article I assumed that it was about celebrating Mental Health Day. However, this study from Australia by Scott et al (2016) titled: '‘Mental health day’ sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics' and published in JAN is about something very different.

Due to the stress of the job many nurses get to the point where they simply have to take a day off and this is colloquially referred to as taking a 'mental health day'. The aim of this study was: '(t)o examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’.' A sample of over 5000 nurses in New South Wales was surveyed.

It transpires - amongst other things - that younger nurses, those working shifts where they found it hard to sit down for a while and also those who smoked, had been admited to hospital recently or had mental health problems were more likelty to be absent on the basis of a 'mental health day'. The authors concluded: 'Study findings indicate that nurses and midwives who take mental health days have specific workplace and health profiles which offer healthcare organizations opportunities to implement workforce measures to ameliorate their need to do this and reduce such absences. Study findings indicate characteristics that should flag consideration of how such nurses and midwives might be supported to retain their health and well-being and their positive presence in the workforce.'

You can listen to this as a podcast


LAMONT S., BRUNERO S., PERRY L., DUFFIELD C., SIBBRITT D., GALLAGHER R. & NICHOLLS R. (2016) ‘Mental health day’ sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics. Journal of Advanced Nursing. doi: 10.1111/jan.13212

Tuesday, 22 November 2016

Clinical decision-making: nurse practitoners versus doctors

Roger Watson, Editor-in-Chief

We have published many articles in JAN on how well doctors and nurses perform on tasks traditionally the domain of the doctor and we have featured several in JAN interactcive. This UK study by Thompson et al (2016) titled: 'A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment' and published in JAN demonstrates - again - that nurses perfom favourably when compared with doctors.

The aim of the study was to: 'investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors.' As explained by the authors, to do this: 'The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview.' Data were processed over five months and the results showed that nurses took three minutes longer to complete the scenarios.  It was interesting to note that: 'NPs elicited more information when history taking.'

In conclusion the authors state: 'This research suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of identifying the correct diagnosis and therapeutic treatment. The information processing theory highlighted that the decision-making processes of both types of professionals were similar.' One implication is that: '(n)urse practitioners should be allowed to assume a wider role in the assessment and treatment of patients in secondary care.'

You can listen to this as a podcast


THOMPSON S., MOORLEY C. & BARRATT J. (2016) . A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environmenJournal of Advanced Nursing.  doi: 10.1111/jan.13206

Thursday, 10 November 2016

Should nurses be role models for healthy lifestyles?

Muireann Kelly
Jane Wills
Rebecca Jester
Viv Speller

This study investigated the expectation for nurses to be healthy role models and the assumptions attached to this expectation. Although frequently expressed in policy and professional discourse, the expectation for nurses to be healthy role models remains a contentious topic for the nursing profession. Arguments in support of nurses being healthy role models refer to credibility in health promotion and view role modelling a healthy lifestyle as a professional duty. Unhealthy nurses may be less willing to discuss lifestyle with patients to avoid appearing hypocritical, and patients may question the credibility of nurses who appear not to follow their own advice. The objection most frequently raised is that the expectation for nurses to be healthy role models is paternalistic and nurses should be free to make their own decisions about their lifestyles.

The study findings suggest a disconnect between front line nurses and service users as to whether nurses should be expected to be healthy role models. Stakeholders from the practising nurse and nursing student groups argued that demonstrating healthy behaviours was less important than providing evidence-based, patient-centred care. The first round findings showed that practising nurses and nursing students felt that being unhealthy oneself was sometimes beneficial to share experiences and develop rapport with patients when discussing behaviour change. This finding has been noted by other research examining nurses’ health behaviours (González et al. 2009; Brown & Thompson 2007). Whether the front line nursing workforce believes nurses should or should not be expected to be healthy role models, the reality may be that service users do expect nurses to lead by example. The service user group in this study reported that they negatively judged nurses who appeared unhealthy and questioned their credibility and competence. There is an absence of research into the factors mediating patients’ decisions to follow or ignore behaviour change advice (NICE 2014). It would be beneficial to understand how the nurse-patient relationship is mediated and in what circumstances nurses’ health behaviours influence patient perceptions and their response to health promotion practices.

Although the stakeholders in this study argued that simply appearing healthy is not likely to affect how patients receive a public health message, the findings of this study should not be taken to imply that nurses’ health behaviours are of no importance. Maintaining a healthy lifestyle is important for the individual health of nurses as well as limiting the impact of unhealthy behaviours on performance, sickness absence, and the associated costs of lost working days within a health care system that relies on resilient workers.

Nurse education is an obvious starting point to emphasise the importance of a healthy lifestyle within nursing practice. At any one time, there are a considerable number of nurses studying in universities, either through pre-registration training courses or accessing post-qualification education or continuing professional development (CPD) programmes. The pre-registration curriculum should acknowledge the impact that nursing can have on an individual’s ability to lead a healthy lifestyle in order to better prepare nursing students for the reality of their future careers. Universities have a role to support healthy choices during education by providing a supportive studying and working environment for nurses (Wills & Kelly, 2016).The nursing students in this study reported that they imitate the behaviour of staff on placement to “fit in” and adapt to the work environment. Support for healthy lifestyles during education would ingrain the benefits of a healthy lifestyle and help nursing students to maintain their health at the outset of their nursing careers.

Employers also have a responsibility to create environments that encourage nurses in making healthy choices part of their daily lives. In this study, the workforce lead and practising nurse groups argued that employers should do more to support healthy lifestyles at work. The nursing workplace was in itself considered inherently unhealthy because of lack of breaks, poor provision of healthy options and lack of access to catering at night. The workforce lead group thought that currently, workplace support for a healthy lifestyle was insufficient. The ability to lead a healthy lifestyle may be mediated by busy and stressful workloads, long working hours, shift-working patterns, and the emotional labour of nursing work. Initiatives to improve nurses’ health should recognise that it would be more appropriate to try to tackle these constraints rather than focusing entirely on individual behaviour change.


Brown, I. and Thompson, J., 2007. Primary care nurses’ attitudes, beliefs and own body size in relation to obesity management. Journal of Advanced Nursing, 60(5), pp.535-543

González, S., Bennasar, M., Pericás, J., Seguí, P. and De Pedro, J., 2009. Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship. International Nursing Review, 56(3), pp.381-386

Kelly M., Wills J., Jester R. & Speller V. (2016) Should nurses be role models for healthy lifestyles? Results from a modified Delphi study. Journal of Advanced Nursing. doi: 10.1111/jan.13173

National Institute for Health and Clinical Excellence, 2014. Behaviour change: Individual approaches (Public health guidance 49), London: NICE 2014

Wills, J., and Kelly, M. What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study. Nurse Education Today. 48(1), pp.180-184

Monday, 31 October 2016

Comment on: Duffield et al. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing

Comment on: Duffield C., Roche M., Twigg D., Williams A. & Clarke S. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing 72(9), 2218–2225

Annette Ayers, RN, BSN, MHA
University of Texas at Arlington

I recently read the article “A protocol to assess the impact of addition nursing support workers to ward staffing” in the September 2016 issue of JAN. With a potential nursing shortage, which is being caused by multiple factors, healthcare facilities are going to have to look at new ways to provide care. As a nursing executive, I believe the addition of non-licensed staff or the LVN, to provide some aspects of patient care, is a way to accomplish this goal (Lafer & Moss, 2007).

I do feel that there is one additional limitation that should be addressed in the study. As required by the Board of Nursing, the delegation of tasks by the Registered Nurse can only be done for those with stable and predictable health conditions (Texas Board of Nursing, 2016). As patients in the hospital are becoming more critical, the addition of non-licensed staff may become less beneficial because many tasks will still be required to be accomplished by the licensed staff member.

One recommendation for the study would be to include types of units when the pairing of units to be studied is completed. Pairing of units based on nursing hours per day, is just one factor to be considered. For example a medical-surgical unit that cares for orthopedic patients may have the same nursing hours per day as the medical-surgical unit with dialysis patients, but these units are very different. For example, orthopedic patients require much more time for education related to physical limitations, whereas dialysis patients typically require many more interventions and medications. Pairing of units based on similar patients, with similar nursing tasks that can or cannot be delegated, could be beneficial to the study.

Duffield, C., Roche, M., Twigg, D., Williams, A., & Clarke, S. (2016). A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing, 72, 2218-2225.

Lafer, G., & Moss, H. (2007). The LPN: A practical way to alleviate the nursing shortage. Retrieved from

Board of Nurse Examiners (2016). Nursing practice act. Retrieved from

Friday, 28 October 2016

Healthy eating for nurses

Roger Watson, Editor-in-Chief

Nurses sometimes advise others on healthy eating but how healthy are their own diets and how easy is it for them to adhere to a healthy diet at work? This is the topic of this study from Australia by Nicholls et al (2016) titled: 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review' and published in JAN.

The aim of the study was: 'to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses.' Twenty-six articles were reviewed. The results showed that: 'Long work hours, shift work, a high workload, low staffing levels and short/few work breaks were all reported as organizational barriers to nurses’ healthy eating. No organizational factors that facilitated healthy eating were reported'. The authors concluded: 'By addressing the complexity of reasons for unhealthy eating in the workplace, change can be strategic and effective' and: 'While not an inconsiderable undertaking, the potential benefits in terms of staff health and well-being and the potential knock-on effects for the community make this worthwhile'.

You can listen to this as a podcast


NICHOLLS R., PERRY L., DUFFIELD C. & GALLAGHER R. (2016) Barriers and facilitators to healthy eating for nurses in the workplace: an integrative reviewJournal of Advanced Nursing  doi: 10.1111/jan.13185

Keeping nursing and medical students fit

Roger Watson, Editor-in-Chief

What helps or hinders keeping fit among nursing and medical students? This is the subject of a UK study by Blake et al (2016) titled: 'Predictors of physical activity and barriers to exercise in nursing and medical students' and published in JAN. The aim of the study was: 'To investigate physical activity levels of nursing and medicine students, examine predictors of physical activity level and examine the most influential benefits and barriers to exercise.'

The study involved over 300 students - roughly equally divided between nursing and medical students who were surveyed over one year and asked about: 'physical activity level, benefits and barriers to exercise, social support, perceived stress and self-efficacy for exercise'.  The results showed that: 'a significant proportion of healthcare students responding to our survey was not meeting recommended levels of physical activity required to benefit their health'. Older students were less likely to get enough physical activity. There was no difference between nursing and medical students in levels of physical activity. The authors conclude: 'Efforts should be made to promote physical activity in healthcare students to increase the proportion meeting the basic daily recommendation for the level of physical activity required to benefit health. This is important since healthcare professionals are often regarded as health role models for general society'.

You can listen to this as a podcast


BLAKE H., STANULEWICZ N. & MCGILL F. (2016) Predictors of physical activity and barriers to exercise in nursing and medical students. Journal of Advanced Nursing  doi: 10.1111/jan.13181

Thursday, 27 October 2016

Are you type D personality?

Roger Watson, Editor-in-Chief

Are you type D personality? Do you know what that means and what effect it may have on your life? The effect of this personality tpe - described as being someone who is: 'vulnerable to negative affect, such as depression or anxiety and consciously suppresses self-disclosure in social interactions' is the focus of this sudy from Korea by Kim et al (2016) titled: 'Influence of type D personality on job stress and job satisfaction in clinical nurses: the mediating effects of compassion fatigue, burnout, and compassion satisfaction' and published in JAN.

The aim of the study was: 'To test a hypothetical path model evaluating the influence of type D personality on job stress and job satisfaction and to identify the mediating effects of compassion fatigue, burnout, and compassion satisfaction among clinical nurses in South Korea.'  The study involved nearly 900 nurses who were given several questionnaires to measure personality, stress and job satisfaction.

The results of the study showed that: 'type D personality was significantly associated with compassion fatigue, burnout, and compassion satisfaction.' The authors conclude: 'Because having a type D personality affects job stress and job satisfaction, identifying the personalities vulnerable to stress is needed to relieve job stress and to enhance job satisfaction when nurses experience a high level of compassion fatigue and burnout and a low level of compassion satisfaction. More interventions that can reduce negative affect and social inhibition of nurses with type D personality need to be developed in addition to methods that can decrease compassion fatigue and burnout and increase compassion satisfaction.'

You can listen to this as a podcast


KIM Y. H., KIM S .R., KIM Y. O., KIM J. Y., KIM H.K. & KIM H. Y. (2016) Influence of type D personality on job stress and job satisfaction in clinical nurses: the mediating effects of compassion fatigue, burnout, and compassion satisfaction. Journal of Advanced Nursing doi: 10.1111/jan.13177

Monday, 24 October 2016

Mindfulness works

Roger Watson, Editor-in-Chief

Mindfulness is trendy, but does it do any good? A recent study from Canada but Guillaunie et al. (2016) titled: 'A mixed-methods systematic review of the effects of mindfulness on nurses' and published in JAN suggests that it does. The study aimed: 'To review the effects of mindfulness-based interventions on Registered Nurses and nursing students'. The definition of mindfulness used was: 'Mindfulness can be defined as a form of mental training
through a variety of exercises that involve stilling or emptying the mind or intentionally bringing one’s attention to an inner object such as the present moment or the breath (Baer 2003, Chen et al. 2012).

Reviewing 32 studies published between 1980-2014, 17 of which were controlled designs, and applying meta-analysis they found that: 'mindfulness-based interventions may be effective in significantly reducing state anxiety and depression at posttreatment and state anxiety and trait anxiety at follow-up'. Qualitative studies were also reviewed and supported these findings. The authors conclude: 'Mindfulness training seems to be an effective strategy for organizations wishing to improve nurses’ mental health, as meta-analysis suggests positive effects on anxiety and depression'.

You can listen to this as a podcast


Baer R.A. (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice 10(2), 125–143.

Chen K.W., Berger C.C., Manheimer E., Forde D., Magidson J., Dachman L. & Lejuez C. (2012) Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety 29(7), 545–562.

GUILLAUMIE L., BOIRAL O. & CHAMPAGNE J. (2016) A mixed-methods systematic review of the effects of mindfulness on nurses. Journal of Advanced Nursing  doi: 10.1111/jan.13176

Thursday, 13 October 2016

Nurses do not see role modelling healthy behaviours as a reasonable professional expectation

Roger Watson, Editor-in-Chief

Should patients and the public expect nurses to be good role models for healthy behaviours? Apparently not - according to nurses.  This surprising finding comes from a UK study by Kelly et al. (2016) titled: 'Should nurses be role models for healthy lifestyles? Results from a modified Delphi study' and published in JAN which aimed: 'To explore the expectation that nurses should be role models for healthy behaviours'. The study involved: 'practising nurses, nursing students, service users, policy makers, workforce development leads and stakeholders working in nurse education' in telephone interviews and a questionnaire. I have to declare that I was one of the respondents.

The authors concluded: 'This study has shown attitudes towards role modelling healthy behaviours different from the views expressed in nursing literature. Behaviour change was thought much more complex than simple imitation; contesting the assumption that role modelling can effect behaviour change. The ‘ideal’ role model proffered by stakeholders was someone who had struggled with unhealthy behaviours but eventually successfully changed the behaviour. Apart from the service user group, stakeholders felt that the healthy role model conceptualized in policy and professional guidance as best placed to encourage behaviour change was unhelpful and unrealistic'.

You can listen to this as a podcast


KELLY M., WILLS J., JESTER R. & SPELLER V. (2016) Should nurses be role models for healthy lifestyles? Results from a modified Delphi study. Journal of Advanced Nursing doi: 10.1111/jan.13173

Friday, 7 October 2016

Caring for ebola patients

Roger Watson, Editor-in-Chief

Ebola is not new and appeared in the pages of JAN over a decade ago in an article by Locsin and Matua (2002).  However, what is new is the more recent extent to which it spread across some parts of Africa and the ensuing death toll.  Of course, it 'hit the headlines' in the UK following the unfortunate case of the 'ebola nurse' Pauline Cafferkey. Ebola has resurfaced in the pages of JAN in a study from Sweden by Andertun et al. (2016) titled: 'Ebola virus disease: caring for patients in Sierra Leone – a qualitative study' and published in JAN. 

The aim of the study was to: 'describe Norwegian healthcare staffs’ experiences of participating in care of patients with Ebola virus disease in Sierra Leone'.  Eight nurses and one doctor were interviewed and the results provided some insight into the experience of these health professionals. Various themes came across about conquering fears and taking safety precautions and living with death.  The authors concluded: 'Our findings revealed that Ebola workers were relying highly on safety and used strategies to minimize risks of contagion. Safe care was central in working with Ebola patients, but the caring relation was challenged. They were constantly reminded of death and had to defeat their fears, but nevertheless they found their experiences of the hazardous work as meaningful and an important motivator.'

You can listen to this as a podcast


ANDERTUN S., HÖRNSTEN A. & HAJDAREVIC S. (2016) Ebola virus disease: caring for patients in Sierra Leone – a qualitative study. Journal of Advanced Nursing doi: 10.1111/jan.13167

Locsin, R. C. and Matua, A. G. (2002) The lived experience of waiting-to-know: Ebola at Mbarara, Uganda – hoping for life, anticipating death. Journal of Advanced Nursing, 37: 173–181. doi:10.1046/j.1365-2648.2002.02069.x

Improving outcomes of surgery on children for children and parents

Roger Watson, Editor-in-Chief

Having a child go through surgery can be difficult for parents, as well as the child. If the problems of lack of knowledge about what the child is going through and the stress associated with that and problems such as post-operative pain for the child are not alleviated, the outcomes from surgery can be made worse. This study from Canada by Chartrand et al. (2016) and published in JAN titled: 'The effect of an educational pre-operative DVD on parents’ and children’s outcomes after a same-day surgery: a randomized controlled trial' aimed to: 'examine the effect of a pre-operative DVD on parents’ knowledge, participation and anxiety and on children’s distress, pain, analgesic requirements and length of recovery after same-day surgery.'

Several outcomes were measured in this study including post-operative pain in the children who, along with their parents, watched the DVD and those who did not.  Outcomes for the parents in the DVD group were positive, including knowledge and pain in the children in this group was reduced. The authors concluded that the DVD intervention was useful in helping parents to help their children in the immediate post-operative period but that the effect may not, necessarily, be sustained.

This article is available open access and you can listen to this as a podcast


CHARTRAND J., TOURIGNY J. & MACCORMICK J. (2016) The effect of an educational pre-operative DVD on parents’ and children’s outcomes after a same-day surgery: a randomized controlled trial. Journal of Advanced Nursing doi: 10.1111/jan.13161

Decreasing depression in caregivers of people with dementia

Roger Watson, Editor-in-Chief

Depression amongst those who care for people at home with dementia is a significant problem. The adverse effects of the burden and the stress of care can have adverse psychological consequences which, if they are not alleviated, can then have an adverse effect on the person with dementia: their carer will become unable to care for them. This problem is addressed in a study from Taiwan by Kuo et al. (2016) titled: 'A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia' and published in JAN.

The aim of the study was: 'to explore distinct trajectories of caregivers’ depressive symptoms and the effects of a training programme on these trajectories over 18 months after the programme'. As explained by the authors: '(t)he experimental group received the training programme with telephone consultation and the control group received written educational materials and social telephone follow-ups'. The intervention worked to alleviate the depressive symptoms of the carers.  The authors concluded: 'The results of this study can provide a reference for healthcare providers who regularly deal with persons with dementia and their caregivers to identify high-risk groups and to reduce family caregivers’ depressive symptoms by providing the individualized family caregiver training programme. Our study can also serve as a model for future studies on trajectories and related interventions for family caregivers’ depressive symptoms.'

You can listen to this as a podcast


KUO L.-M. , HUANG H.-L., L IANG J., KWOK Y.-T., HSU W.- C., SU P.- L. & SHYU Y.- I.L. (2016) A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia. Journal of Advanced Nursing doi: 10.1111/jan.13157

Wednesday, 28 September 2016

The power of multiple perspectives: service user involvement enhanced research quality

Nina Helen Mjøsund, Monica Eriksson, Geir Arild Espnes, Mette Haaland-Øverby, Sven Liang Jensen, Irene Norheim, Solveig Helene Høymork Kjus, Inger-Lill Portaasen, Hege Forbech Vinje

Service user involvement enhanced the research quality in a study using interpretative phenomenological analysis – the power of multiple perspectives

Persons with mental illness and their family members possess experiences that when shared can become valuable contributions to nursing research and mental health research. Service user involvement is requested; however, evidence for its quality-enhancing potential in research needs to be examined. Our article emphasises this. In doing so, our envisioned impact is threefold:
  1. to encourage researchers to utilise this experiential knowledge
  2. to remind the health service users of the valuable knowledge they possess
  3. to positively influence attitudes towards patients with severe mental illness
We aimed to examine how service user involvement contributed to the development of interpretative phenomenological analysis methodology and enhanced research quality. Interpretative phenomenological analysis is a qualitative methodology used in health research internationally to understand human experiences that are essential to the participants. Included are some ideas about how to improve breadth and depth of findings when working on interpretation of texts.

We, service users and researchers, shared experiences from four years of collaboration (2012 – 2015) on a qualitative mental health promotion project. Five research advisors either with a diagnosis or related to a person with severe mental illness constituted the advisory team. They collaborated with the research fellow throughout the entire research process, and have co-authored this article. In the project we explored how twelve persons diagnosed with severe mental disorders and with experiences of in-patient care perceived positive mental health. In this article we have described and examined the joint process of analysing the empirical data from interviews. Our analytical discussions were audiotaped, transcribed and subsequently interpreted following the guidelines for good qualitative analysis in interpretative phenomenological analysis studies.

The advisory team became ‘the researcher’s helping hand’. The power of multiple perspectives came across in the interpretation of interview texts. Multiple perspectives gave more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants’ accounts. The interpretative element of interpretative phenomenological analysis was enhanced by the emergence of multiple perspectives in the analysis of the empirical data.

Our conclusion was that service user involvement improved the research quality in our project. We argue that service user involvement and interpretative phenomenological analysis methodology can mutually reinforce each other. The methodology has the potential to make service user involvement meaningful, creative and manageable. The methodology holds features that may benefit from service user involvement in terms of more breadth and depth, as well as validation of findings.

Our research contributes to the ongoing process of improving nursing and health research methodology. These findings should be of value to all qualitative researchers and especially for those who are required by funding bodies to involve service users in their research projects. Our experiences can be included in academic training of nurses and other health professionals as a way of advancing the methodological approaches in qualitative research. We hope this article can inspire nurses in clinical practice and service users to be aware of the synergy and the power of multiple perspectives when service users are brought into decision making in nursing and health care.


Mjøsund N.H., Eriksson M., Espnes G.A., Haaland-Øverby M., Jensen S.L., Norheim I., Kjus S.H.H.,Portaasen I.-L. & Vinje H.F. (2016) Service user involvement enhanced the research quality in a study using interpretative phenomenological analysis – the power of multiple perspectives. Journal of Advanced Nursing. doi: 10.1111/jan.13093

Wednesday, 14 September 2016

Drinking and pregnancy

Roger Watson, Editor-in-Chief

It is generally accepted that drinking alcohol during pregnancy is unwise due to the possibility of adverse consequences for the unborn baby.  This study from Scotland by Symon et al. (2016) titled: 'Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary' and published in JAN aimed: 'to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption.'

Over 500 women participated and, in the light of prevailing health warnings about drinking alcohol in pregnancy, the results are worrying.  As the authors explain: 'Over half the participants admitted to drinking above recommended daily limits at least occasionally in the peri-conceptual period; over a fifth did so weekly' and 'Twenty-eight women said they had drunk more than the recommended two units a day since finding out they were pregnant.' Saturday night was the most common night for drinking and: '196 women drank varying amounts of wine and 177 drank spirits. Six women admitted to drinking on their own peri-conceptually; one also said she drank on her own during pregnancy. All others said they only drank with family and/or friends.'

The authors concluded: 'We found some evidence to confirm the link between pre-pregnancy and pregnancy drinking reported in the wider literature, particularly when infrequent but heavy' and 'Existing alcohol screening instruments do not capture well the complexity of drinking patterns. As we found, some women engage in heavy episodic drinking without exceeding recommended weekly pre-pregnancy limits.'

You can listen to this as a podcast


SYMON A., RANKIN J., SINCLAIR H., BUTCHER G., BARCLAY K., GORDON R., MACDONALD M. & SMITH L. (2016) Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. Journal of Advanced Nursing doi: 10.1111/jan.13112

Nurses better than doctors - again!

Roger Watson, Editor-in-Chief

In the pages of JAN we have published several studies comparing nurse and physician led care in a range of settings and nursing frequently comes out 'on top'. A study from the USA by Lutfiyya et al. (2016) titled: ' Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?' and published in JAN aimed to address the question: 'Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)?'

Medicare records from over 53 million patients were sampled to provide, sequentially, three criteria based 5% samples to provide over 200,000 records for analysis.  The data were analysed for patient outcomes and cost and the results were very favourable towards nursing care.  The authors stated that patients cared for by nurses: '...had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare utilization, patient health outcomes and healthcare costs.'  They conclude: 'Our results, suggest nurse practitioner engagement in chronic patient management is associated with lower cost and quality care' and: 'This research might also provide direction and influence conversations taking place in other developed countries such as the UK, Canada and the Netherlands.'

You can listen to this as a podcast


LUTFIYYA M.N., TOMAI L., FROGNER B., CERRA F., ZISMER D. & S. ( 2016) Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners? Journal Advanced Nursing doi: 1001111/jan.13108

Tuesday, 13 September 2016

Extreme thinness in adolescents

Roger Watson, Editor-in-Chief

Some boys and girls are not just slim or 'thin' but extermely thin. The aim of this study from Finland by Mason et al. (2016) titled: 'Family factors and health behaviour of thin adolescent boys and girls' and published in JAN was: 'to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls.'

A large national sample of over 70,000 boys and girls (12-17) was studied and they were classed as being within the normal weight range, thin or extremely thin.  Then lifestyle and family factors were studied in relation to thinness. The results showed that more girls than boys were extremely thin and there was a range of factors such as exercise and smoking associated with this as well as family factors. Education among mothers and being familiar with the social patterns of the adolescents was associated with thinness - if parents were unfamiliar and mothers had lower education, the children were likely to be thinner. Eating a proper family meal was associated with less thinness. Smokers were also likely to be thin as were those who did not actively exercise.

The authors conclude: 'The results show thinness in adolescent girls to be more common than in adolescent boys. The results also show associations between adolescent thinness and health behaviour and family factors. These results are partly supported by previous international studies. However, longitudinal studies are needed to explain the causes of adolescent thinness' and: '(f)indings of this study can be used by both nursing and other healthcare professionals when planning and evaluating adolescents’ health check-ups or interventions in weight management, health behaviour or exercise. Nurses should be aware of the results when meeting up with adolescents and their families and discussing issues in adolescent health in clinics or at schools. For the healthcare policy makers, it is important to know that thin adolescents co-exist among their normal weight and overweight peers and the prevalence of thinness is similar to the other developed countries.'

You can listen to this as a podcast


MASON A., RANTANEN A., KIVIMӒKI H., KOIVISTO A.-M. & JORONEN K. (2016) Family factors and health behaviour of thin adolescent boys and girls. Journal of Advanced Nursing doi: 10.1111/jan.13096

Friday, 9 September 2016

How best to place a nasogastric tube

Roger Watson, Editor-in-Chief

The debate about placing nasogastric tubes continues. It was a procedure I hated carrying out and when I was a student some of my classmates volunteered to have one passed - not me!  I sincerely hope that students are no longer asked to volunteer; the procedure is not without its risks. The options for verifying placement when I was in practice were aspiration of contents (hopefully from the stomach) and testing for acidity with litmus paper followed by lisening to the stomach with a stethoscope while some air was introduced into the tube with a syringe.  If all was well you'd hear a bubbling sound; if not, the patient would cough violently and develop pneumonia.  I sincerely hope the latter practice has ceased;  x-ray was an option but I don't recall its use.

The aim of a study by McFarland (2016) titled: 'A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients' and publshed in JAN was: 'to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.'  McFarland obtained six studies using a systematic review method.  A cost utility analysis was performed and also a sensitivity analysis. The methods are described in full in the article.

The results showed that: 'the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.'

You can listen to this as a podcast


MCFARLAND A. (2016) A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients. Journal of Advanced Nursing doi: 10.1111/jan.13103

Sunday, 14 August 2016

Adjusting to being a nursing student - does alcohol help?

Roger Watson, Editor-in-Chief

Being any kind of student is not easy, especially at the start of your course. Often you have moved away from home, you are entering an unfamiliar situation and all of this may be compounded by the difficulty of the programme and financial worries. Self-doubt sets in. Nursing students experience all of this and more as they have the added dimension of having to cope with clinical work and there has never been a nursing student who wondered if and how they were going to cope.

A study from Ireland by Horgan et al. (2016) titled:'Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students' and publised in JAN aimed to: 'to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students.'  Over 400 students were involved in completing a standard and validated set of instruments and the investigators looked at the relationship between what was measured.

All the key measures in the study were related: depressive symptoms, social adjustment, personal adjustment and peer support.  The quantity of alcohol the students consumed was related to depressive symptoms but not in the way that may be expected; those who consumed more alcohol appeared to be less depressed. However, the effect of this alcohol consumption had on academic performance was not studied and the authors were not advocating the use of alcohol.  Furthemore, other studies have shown contradictory results.

The authors concluded: 'Poor mental health of nursing and midwifery students may impact on both academic and clinical performance. As such, strategies need to be put in place to support healthcare students in striving toward positive mental health and well-being. These students are the future of the healthcare system and it is important that they are able to monitor their own mental health and seek treatment when needed.

You can listen to this as a podcast


HORGAN A., SWEENEY J., BEHAN L. & MCCARTHY G. (2016) Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students Journal of Advanced Nursing doi: 10.1111/jan.13074

Thursday, 4 August 2016

Integral Option for Mitigating Conflict in Healthcare

Response to: Almost J., Wolff A.C., Stewart-Pyne A., McCormick L.G., Strachan D. & D'Souza C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505

Wesley A. Harris  BSN, RN, CCRN
Baylor Scott & White Medical Center – White Rock
Texas, USA

I recently read the Almost et al. (2016) review regarding mitigating conflict in the healthcare arena, and I would like add an additional perspective. I was an ICU nurse for eight years, but have been a facility educator for the past two. I have dealt with serious conflict resolution several times in my career (with varying degrees of success), and I am always looking for new ways to manage conflict. Of course, conflict resolution is an important aspect of leadership because there will always be dissenting opinions and unpopular viewpoints that will need to be integrated into the team.

Yi (2016) recently completed a quasi-experimental investigation to measure the impact of team building exercises on young healthcare professionals. They emphasize the importance of formal training with regards to team building in order for healthcare professionals to improve communication and therefore mitigate conflict. My facility recently mandated biennial training from the Crisis Prevention Institute (CPI) and we are hopeful we will see similarly decreased conflict in our facility as well. It is my suggestion that your readers should also advocate for a formalized team building training program if they are serious about taking further action to mitigate these obstacles.


Almost, J., Wolff A.C., Stewart-Pyne, A., McCormick, L.G., Strachand, D. & D’Souza, C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505. doi: 10.1111/jan.12903

Yi, Y.J. (2016). Effects of team-building on communication and teamwork among nursing students. International Nursing Review, 63, 33-40.

i-Robot in the nursing home

Roger Watson, Editor-in-Chief

I was asked recently at a seminar I gave on feeding difficulty in older people with dementia about the use of robots with people with dementia.  I have to say that I stumbled over my words a bit as I was not very sure what to say; there is something a bit 'off' about the concept of unleashing robots on older people with dementia. They are already confused and robots are hardly likely to reinforce reality.  But can the use of robots - in this case 'PARO Therapeutic Robot' - have any benefits for older people with dementia?  This was the subject of an article from Norway by Jøranson et al. (2016) titled: 'Change in quality of life in older people with dementia participating in Paroactivity: a cluster-randomized controlled trial' and published in JAN.

As explained by the authors: 'The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia'.  The control group received treatment as usual while the intervention group had two 30 minute sessions of activities with Paro twice weekly for 12 weeks.  Quality of life and use of psychotropic medications were measured as outcomes.  The study was carried out in nursing homes (NH).

Quality of life was maintained in the intervention group while it deteriorated in the control group and less psychotropic medication was used by the control group.  In the words of the authors: 'Pleasant and engaging activities, such as group activity with Paro could improve QoL. We believe interaction with Paro in group sessions to be an accessible non-pharmacological activity in NH facilitated by nursing staff. Activity with Paro seems to be especially suitable for NH residents with severe dementia to maintain QoL and nursing staff should particularly focus on engaging this group, often challenged by apathy and withdrawal.

You can listen to this as podcast


JØRANSON N., PEDERSEN I., ROKSTAD A.M.M. & IHLEBÆK C. (2016) Change in quality of life in older people with dementia participating in Paroactivity: a cluster-randomized controlled trial. Journal of Advanced Nursing doi: 10.1111/jan.13076

Monday, 11 July 2016

The h-index: meritocracy or spurious reductionism?

Niall McCrae, King’s College London

A recent JAN editorial has put a few ‘noses out of joint’. Editor-in-chief Roger Watson, far from the metropolitan elites in the cool climes of Hull, has emulated the irreverent poet Philip Larkin, whose verbal bombs from that smoky port were as loud as those of the Luftwaffe’s blitz in the Second World War.

Surveying the publication activity of the nursing professoriate, Watson et al. (2016) found several cases of chairs of nursing departments whose output was no better than that of a novice research worker. According to the Scopus database, some had h-index scores of 1; this could amount to a single publication, cited once. Watson et al.’s exposé has drawn an angry response, but as the Lancaster bomb crews once said: the greater the flak, the closer you are to the target.

An eloquent riposte by Gary Rolfe (2016) in the Journal of Clinical Nursing showed Watson et al.’s findings to be flawed, partly due to reliance on a database of dubious comprehensiveness. Scopus misses some nursing journals, authors’ details are frequently incorrect, and a more fundamental problem in the blunt collation of data is in the loss to female scholars whose names changed on marriage.

Accepting some of the criticisms, Watson would prefer Web of Science for a future survey, and the ORCiD number should be used to prevent disadvantage to women. Perhaps someone could take this on, but the results will not be any more impressive across the board. My h-index in Scopus lingers at a modest 8; in Web of Science it is a paltry 6. These numbers are frustratingly low for a writer with two books, numerous book chapters and over 50 published papers. By contrast, Google Scholar would give me a reassuring score of 12, being more inclusive in journal coverage and in types of citation.

No metric will satisfy all, but the h-index is an objective measurement not merely of the number of publications but the author’s impact. A paper in The Lancet will contribute much more to the score than one published in the East Yorkshire Archives of Health & Postmodern Poetry (impact factor unavailable).

A nursing professoriate emerged later in the UK than in the USA, and it seems that confidence in the academic prowess of the discipline is not as well developed here as in other countries. Deans of nursing faculties or chairs of nursing departments have a vital role in contributing to the science and knowledge of healthcare, and publication is the vehicle for changing and improving practice. Rolfe suggested that professors be rated by a mystical p-index, for which no criteria were offered. The h-index may seem crude, but at least it is objective, whereas a nebulous notion of ‘influence’ would be highly subjective – and could perpetuate an 'old boys club'.

Indeed, Rolfe’s argument, while persuasive on many points, has a degree of the reactionary tone of the establishment. Professors of nursing are not suited to an ivory towers mentality, and they should be able to face criticism from the likes of Watson et al., who will keep us on our toes. Let’s not shoot the messenger.


Rolfe G (2016) Professorial Leadership and the h-index: the rights and wrongs of academic nursing Journal of Clinical Nursing DOI: 10.1111/jocn.13428

Watson R, McDonagh R, Thompson DR (2016) h-indices: an update on the performance of professors in nursing in the UK Journal of Advanced Nursing DOI: 10.1111/jan.12924

Editorial note: entries to JAN interactive are not reviewed and are published at the discretion of the Editor-in-Chief and may be subject to editing or removal by Wiley. We welcome replies, rejoinders, comments and debate on all entries provided they are not offensive or personal.

Tuesday, 5 July 2016

Graduate nurses save more lives

Roger Watson, Editor-in-Chief

The value of graduates in nursing is already well known from previous studies, for example, the RN4CAST study (Sasso et al. 2015).  However, these studies measured the extent to which graduate nurses were present in hospitals and the extent to which patients survive.  There was no direct link between the nurses providing care for specific patients.  Now a study from Qatar by Gkantaras et al. (2016) titled: 'The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study)' has made that link and it supports the view that the higher the proportion of graduates who care for a patient, the more likely the patient is to survive their stay in hospital.

The NuGaT study used patient electronic records where the nurses who cared for patients identifed themselves by a uniqure personal code each time nursing care was provided.  From this code it was possible to identify the nurses and find out whether or not they were a graduates.

You can listen to this as a podcast


Gkantaras I, Hafhoud ZR, Foreman B, Thompson DR, Cannaby AM, Deshpanda DH, Watson R, Topping A, Gray R (2016) The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study) Journal of Advanced Nursing doi: 10.111/jan.13059

Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, Spandorano F, Icardi G, Watson R, Sermeus W (2015) RN4CAST@IT: why is it important for Italy to take part in the RN4CATS project? Journal of Advanced Nursing doi: 10.1111/jan.12709