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