Wednesday, 19 December 2018

Patients' experiences with patient participation in the clinical pathway of heart attack

Our study by Bårdsgjerde et al. (2018), Patients’ narratives of their patient participation in the myocardial infarction pathway, is the first study to explore patient participation in all phases of the heart attack pathway. Every year cardiovascular disease causes 7.4 million deaths (WHO 2017). Over the last decades, the treatment has been improved, and today the hospital stay is short, approximately 2-4 days. Heart attack is often treated with percutaneous coronary intervention (PCI), and in many countries with sparse population this treatment is centralized to a few hospitals (Chew et al. 2013, Clune et al. 2014, Hagen et al. 2015, Tanguay et al. 2015). In Norway, this centralization results in many patients being transferred over long geographical distances (often more than 300km) to receive PCI treatment. After a heart attack, secondary prevention with lifelong medication and lifestyle changes is crucial to prevent new cardiac events (Piepoli et al. 2016). Short hospital stays and transfers between different hospitals can reduce the opportunity for information and patient participation regarding further medication and lifestyle changes. In our study, we have investigated how ten patients living in areas without local PCI facilities experienced to participate in their own treatment in different phases of the pathway.

We found that patient participation changed during the pathway, from a low level of involvement in the acute phase to shared decision-making in the rehabilitation phase. In the acute phase, a highly qualified medical team that took control over the situation met the patients. The patients were passive participants and received little verbal information at this time, but felt that they were in safe hands. Later in the pathway, some challenges emerged. The patients revealed that they received a varying amount of information about medication, lifestyle changes and further follow-up. The long journey from the PCI hospital back to their home often posed practical challenges for the patients as it often included several bus lines, planes and ferries, and they lacked personal belongings, e.g. clothes, money, credit cards etc. Not until they started at a cardiac rehabilitation program, they took an active role in their own treatment and became motivated to initiate lifestyle changes.

We argue that there is a need for individual plans for information and patient participation to improve patient involvement in an earlier stage of the pathway. While still in hospital, patients need specific guidance regarding secondary prevention, which should be structured and standardized, and implemented in clinical and educational guidelines. The problems related to the discharge process and the homeward journey reveals a need for improvement. Further research from a healthcare professional perspective can be valuable to understand more about this topic and the challenges that might exist in the clinical pathway.



Bårdsgjerde, E.K., Kvangarsnes, M., Landstad, B., Nylenna, M. & Hole, T. (2018) Patient's narratives of their patient participation in the myocardial infarction pathway. Journal of Advanced nursing Article accepted on 12th November, 2018. Doi: 10.111/jan.13931

Chew, D.P., French, J., Briffa, T.G., Hammett, C.J., Ellis, C.J., Ranasinghe, I., Aliprandi-Costa, B.J., Astley, C.M., Turnbull, F.M. & Lefkovits, J. (2013) Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. The Medical Journal of Australia, 199(3), 185-191.

Clune, S.J., Blackford, J. & Murphy, M. (2014) Management of the acute cardiac patient in the Australian rural setting: A 12 month retrospective study. Australian Critical Care, 27(1), 11-16.

Hagen, T.P., Häkkinen, U., Belicza, E., Fatore, G. & Goude, F. (2015) Acute myocardial infarction, use of percutaneous coronary intervention, and mortality: a comparative effectiveness analysis covering seven European countries. Health economics, 24(S2), 88-101.

Piepoli, M.F., Corrà, U., Dendale, P., Frederix, I., Prescott, E., Schmid, J.P., Cupples, M., Deaton, C., Doherty, P. & Giannuzzi, P. (2016) Challenges in secondary prevention after acute myocardial infarction: A call for action. European journal of preventive cardiology, 23(18), 1994-2006.

Tanguay, A., Dallaire, R., Hébert, D., Bégin, F. & Fleet, R. (2015) Rural patient access to primary percutaneous coronary intervention centers is improved by a novel integrated telemedicine prehospital system. The Journal of emergency medicine, 49(5), 657-664.

WHO (2017) Cardiovascular diseases (CVDs).

Sunday, 9 December 2018

Graduate nurses adaptation to individual ward culture

Roger Watson, Editor-in-Chief

In a time when nursing shortages are acute and many leave their jobs or leave nursing altogether, there is increasing attention on the experience of newly qualified nurses. The aim of the present study from Australia by Feltrin et al (2018) and published in JAN was to: 'increase understanding of strategies graduate nurses use on a day‐to‐day basis to integrate themselves into pre‐existing social frameworks.'

A small sample of nurses was interviewed who were at least four months into their first year of clinical practice. The strategies used by new nurses included: self‐embodiment and self‐consciousness, navigating the social constructs and raising consciousness. Self‐embodiment and self‐consciousness was exemplified by a comment from one of the nurses: 'Being vocal about what you don't know and being confident with what you do know.' In terms of navigating the social constructs, one students said: 'Learning from the senior staff. I guess they've been there the longest. They know what they are talking about.' And, as the authors explained: 'Raising consciousness involved the adaptation processes through reflectivity. Being aware of the differences between fitting in
not fitting in was integral to the (graduate nurses') eventual successful navigation of the social constructs.'

The authors concluded that newly qualified nurses: 'require preparation and to be adequately supported in their adaptation to ward culture'  and if they: 'are not supported in this process, the individual, their colleagues and the patient are probably affected.'

You can listen to this as a podcast


Feltrin C, Newton JM, Willetts G. How graduate nurses adapt to individual ward culture: A grounded theory studyJ Adv Nurs2018;

Thursday, 22 November 2018

Beta-Glucan Gel Doubles Healing Rate of Chronic Wounds

Over 2.2 million people in the UK suffer with ‘long-term’ wounds, i.e. those insufficiently responsive to standard care protocols within 3 months. [1] Chronic wounds cause significant distress and effects on the quality of life of patients, particularly for diabetics and the elderly. An overspent NHS already spends over £4.5 billion on chronic wound care every year. [1] Yet many patients cope daily with slow healing wounds, many for extended periods of time.

A new study has shown long term, chronic wounds heal twice as fast when a new beta-glucan based gel is applied. [2] The study (read here), compared wound healing times in 300 patients, 150 of whom had a beta-glucan gel applied twice a week alongside a normal dressing change. The data shows significant improvements in healing across various wound types with Woulgan [2], showing more than double healing rates (107%) for ulcer-type wounds over standard care at week 8, 12 and 24 [2].

Woulgan, a novel wound therapy, contains beta-glucan, a fibre found in fungi and yeast and used for hundreds of years for its effects on the immune system. [3] The active component, soluble beta-glucan, can restart healing in the wound through macrophage activation [2]. The gel promotes a moist healing environment and helps rehydrate necrotic tissue, supporting cell proliferation and stimulation of the wound bed itself, kick-starting the healing process.

The study showed that using Woulgan on slow healing wounds, not only improved the rate of healing significantly, but delivered cost savings of £211 per patient.

Clinicians’ early adoption of a cost-effective healing treatment such as Woulgan, has the potential to significantly reduce the overall financial burden that chronic wound care currently represents. Ineffective assessment and management of the underlying pathologies of a wound are some of the main barriers to successful wound healing. [4] Woulgan provides an easy-to-use solution with application straight from a tube, simple to use for both healthcare professionals and patients.

Resolving slow-to-heal wounds is a priority for patients and health professionals. Early treatment with Woulgan has the potential to limit the negative effects to a patient’s quality of life and reduce the overall amount of nursing care required and therefore the associated costs.

Sarah Winterbottom
ROAD Communications


[1] J. Guest and N. Ayoub, “Health economic burden that wounds impose on the NHS in the UK,” BMJ Open, vol. 5, 2015.

[2] S. Hunt, “A retrospective Comparison Evaluation of Bioactive Beta-Glucan Versus Standard Care Alone,” Journal of Woundcare, 2018.

[3] Journal of American College of Nutrition, vol. 1, no. 16, pp. 15-6, 1997.

[4] L. Grothier, “Three goals, deslough, manage exudate and promote healing. Clinical benefits of Urgoclean,” British Jounral of Nursing, vol. 25, 2016.

Tuesday, 13 November 2018


On November 6, voters in the state of Massachusetts were presented with a binding referendum question that would have had major ramifications for the profession of nursing in Massachusetts and possibly throughout the United States.
A Yes Vote on ballot Question #1 would have established mandatory nurse staffing ratios in hospitals throughout Massachusetts. A No vote would have maintained the status quo. While Massachusetts voters voted overwhelmingly against Question #1, the ballot question itself was a no-win for nursing and, by extension, the patients for whom nurses care.
The problem with Question #1 was that regardless of the result, nursing’s authority in determining how best to meet patient care needs was destined to remain limited. The No vote reinforced healthcare administrators' control of nurse staffing, while a Yes vote would have put nurse staffing in the hands of state legislators. The bottom line is that none of these parties is at the bedside delivering care to patients. Nurses are. And yet their voices often remain unheard in discussions of what constitutes appropriate staffing levels in hospitals throughout Massachusetts and the nation as whole.
As a professor of nursing and a hospital-based nurse scientist, I know that today’s nurses are stressed, often worried about what they may have missed at shift’s end. Turnover rates among nurses are on the rise, now approaching 17%, and the highest among licensed healthcare personnel. Patient complexity continues to outpace increases in staff nursing positions. The failure to address long-standing staffing issues is what led to Question #1 in the first place. It is an issue that presents itself in hospitals nationwide.
Another issue raised by the referendum: If Question #1 had passed, the immediate need for additional nurses would not have been matched by an expansion of nursing’s educational pipeline, which is already struggling with a faculty shortage. Current nursing student education also would have been jeopardized. Prior to the November 6 election in Massachusetts, healthcare facilities began informing nursing schools that student clinical placements could not be ensured should Question #1 pass. Institutional budget reallocations and personnel shifts would have resulted in more nurses at the bedside. However, a reduction in advanced nursing positions would have diminished nursing’s capacity for educating staff nurses about the newest technologies, addressing system-wide patient safety issues, improving care coordination between hospital and home, or advancing other strategic initiatives designed to improve the patient experience. Meeting mandated staffing needs by hiring travel nurses or recruiting internationally come with their own societal costs.
The upside to the debate about Question #1 is that it has served as a clarion call for change. Professional nurses play a vital role in helping to ensure good patient outcomes. The public has the right to demand high quality nursing care from well-educated nurses who have a say in best-practices.
Since virtually all of us will be a patient at some point, what can we do in an effort to achieve the best possible patient care? 
Unlike the Question # 1 referendum, solutions are less complicated:
  • Demand that hospitals be transparent about their nursing staffing policies, nursing staff mix, and turnover rates.
  • Inquire how hospitals determine new budgeted positions for professional nursing compared to those for non-clinical services.
  • Ascertain how many nurses sit on hospital or insurance company boards, as these board decisions will directly affect patient care.
  • Question why nurses are still restricted from working to the full scope of their license in many hospitals in and outside of Massachusetts.
  • Help create opportunities that support collegiate nursing education and professional advancement opportunities in clinical practice settings.
Our collective voice is needed to influence the future direction of patient care for the better. Too much is at stake to ignore the problem any longer. The question Massachusetts voters faced on November 6 is one that could easily find its way into other states that offer binding referenda questions, once again putting the decision making in the hands of either hospital executives or state government, as opposed to listening to the experts—hospital nurses themselves—who know what is best for the health and well-being of their patients.

Judith A. Vessey, Ph.D., MBA, RN, FAAN

Lelia Holden Carroll Professor of Nursing, Boston College

Monday, 29 October 2018

Sleep, gender and nursing

Roger Watson, Editor-in-Chief

There has been a lot of interest in JAN recently on the relationship between sleep patterns and well-being in nursing. For example, we recently reported in JAN interactive on 'napping' and 'social jet-lag'. Now we have an article on a phenomenon that arose in the latter piece - on 'chronotype', the individual preference for a particular pattern and times for sleeping and waking.

This recent article comes from Spain and is by López‐Soto et al. (2018) and titled: titled: 'Chronotype, nursing activity and gender: A systematic review'. The study aimed to: ' synthesize evidence about the effect of individual circadian preference (chronotype) and gender in the development of sleep and mood problems in nursing professionals.' Twenty-three studies were included in the review and the main finding was that: 'Female nurses with eveningness‐oriented personality seem to be more prone to having sleep disorders, insomnia, fatigue, and anxiety than male and morningness ones.'

The authors concluded: 'Personal chronotype, mediated mainly by individual, familiar and work behavioural factors and coupled with gender, represent variables of great interest in attempts to prevent sleep and mood disorder in nursing workers.'

You can listen to this as a podcast

López‐Soto, P. J., Fabbian, F. , Cappadona, R. , Zucchi, B. , Manfredini, F. , García‐Arcos, A. , Carmona‐Torres, J. M., Manfredini, R. and Rodríguez‐Borrego, M. A. (2018), Chronotype, nursing activity and gender: A systematic review. J Adv Nurs. doi:10.1111/jan.13876

Obese nurses and health promotion

Roger Watson, Editor-in-Chief

If you do not lead a healthy lifestyle as a nurse - and it shows - then can you be a role model for good health with your patients? Nurses seem to understand this and accept it, but they would not like to see professional obligations, for example, not to be obese. These were the findings from the UK by Wills et al. (2018) in a study titled: 'Nurses as role models in health promotion: piloting the acceptability of a social marketing campaign' and published in JAN. The participants were obese nurses.

The study aimed to: 'To pilot the acceptability to practising nurses of the concept of being healthy role models as regards obesity and weight'. The findings of the study have already been stated but the method of recruitment of nurses is also worth reporting. My guess is that this could have provoked some difficult situations, nevertheless, the authors recruited 71 obese nurses to participate. As reported by the authors: 'Nurses’ eligibility for the panel was based on being visually identified as obese by trained researchers aided by a validated visual rating scale . To confirm the visual identification, potential participants were asked if they had ever worn clothes sized XXL or size 18 and above.'

The authors concluded: 'Taken together, the findings suggest that although the belief that healthcare professionals have a special obligation with regard to their health behaviours is normatively accepted, its implementation is devalued in the challenging working life of a nurse. When shown campaign materials highlighting how unhealthy behaviours might look in the real‐life scenarios (and the effect this could have on the impact of health advice delivered to patients), nurses became pragmatic and engaged in self-affirmation via increasing emphasis on other dimensions of the nursing identity ‐ being a “good nurse” or healthcare professional. This was expressed in part by reconceptualizing healthy behaviours as a private matter of individual choice.'

You can listen to this as a podcast


Wills, J. , Kelly, M. and Frings, D. (2018), Nurses as role models in health promotion: piloting the acceptability of a social marketing campaign. J Adv Nurs. doi:10.1111/jan.13874

Wednesday, 17 October 2018

Music for pain in childbirth

Roger Watson, Editor-in-Chief

Does music make you feel better and do you think it could help to alleviate pain? Many people do and music therapy and music interventions are very popular, especially in Taiwan, where this study comes from. However, it is not a study only about the use of music in Taiwan, it is a review of the best evidence for pain in childbirth.

The study is by Chuang et al. (2018) and titled: 'Music Intervention for Pain and Anxiety Management of the Primiparous Women During Labour: A Systematic Review and Meta‐Analysis' and published in JAN. The study aimed to: 'determine the effect of music on the management of pain and anxiety in primiparous women during labour'. Five studies involving nearly 400 women were included and results were in favour of music as an intervention for pain and anxiety. 

The authors conclude: 'Music intervention may prove an effective intervention for the management
of pain and anxiety for primiparous women during labour. Future randomized controlled trials with good methodological quality and adequate power are necessary to strengthen this conclusion.'

You can listen to this as a podcast


Chuang, C. , Chen, P. , Lee, C. S., Chen, C. , Tu, Y. and Wu, S. (2018) Music Intervention for Pain and Anxiety Management of the Primiparous Women During Labour: A Systematic Review and Meta‐Analysis. J Adv Nurs. doi:10.1111/jan.13871

Saturday, 6 October 2018

Does personality in nurses matter?

Roger Watson, Editor-in-Chief

Does it matter what your nurse is like as a person? I am sure you think it does; but does it matter in practical terms - is he or she more likely to forget or simply to omit to do something, depending on personal characteristics? This study from Israel suggest that it does matter.

The study, by Drach-Zahavy and Srulovici (2018) titled: 'The personality profile of the accountable nurse and missed nursing care' and published in JAN used an international gold standard measure of personality - the NEO-FFI (Five Factor Index) and looked at the extent to which people were likely to miss care. Missed care was measured using the widely used MISSCARE survey instrument. Nearly 300 nurses participated.

The results of the study suggest that nurses who are less conscientious are more likely to miss aspects of care. This may seem an obvious outcome but it is interesting to see it demonstrated by this study. In the words of the authors: 'The current findings portray the personal configuration of the accountable nurse, arguing that whereas high conscientiousness, high agreeableness and low neuroticism are crucial for moral behaviours in general settings, nursing settings require also that nurses be characterized with high openness to change, so that they can critique ward authorities and standing against risks, while demonstrating accountable behaviours in their workplaces.'

You can listen to this as a podcast

Drach-Zahavy A, Srulovici E (2018) The personality profile of the accountable nurse and missed nursing care Journal of Advanced Nursing DOI: 10.1111/jan.13849

Social jetlag in nurses

Roger Watson, Editor-in-Chief

I must admit, despite frequently suffering from jetlag - induced by many hours of long-haul flying - I had never heard the expression 'social jetlag' until this manuscript was submitted to JAN. Social jetlag  ('indicating a misalignment of biological and social time') seems to be induced by working unsocial hours - such as shift work - and may be associated with 'chronotype' - the type of sleep pattern preferred by an individual. For example, 'individuals with evening chronotypes, who prefer to wake up late in the morning, are forced to start their day earlier than their desired rhythm.'

This study by Chang and Jang from South Korea titled: 'Social jetlag and quality of life among nursing students: A cross‐sectional study' and published in JAN aimed to: 'investigate chronotype categories and social jetlag among nursing students and to identify associations between rhythm asynchrony and participants’ physical and psychological health, academic performance and quality of life.' Nearly 350 nursing students were involved. The average level of social jetlag was approximately 90 minutes and: 'Social jetlag was negatively correlated with chronotype, academic performance and quality of life.'

The authors conclude: 'Findings from the present study suggest significant associations between social jetlag and academic performance and quality of life. Moreover, social jetlag, depression, a positive emotional state and resilience were all predictive of quality of life.'

You can listen to this as a podcast

Chang SJ, Jang SJ (2018) Social jetlag and quality of life among nursing students: A cross‐sectional study Journal of Advanced Nursing DOI: 10.1111/jan.13857

Napping on night shift

Roger Watson, Editor-in-Chief

It is a long time since I did night shifts in clinical practice and once - to obtain a promotion - I did them permanently for six months and hated the effect it had on my life, my appetite, my sleeping patterns. Initially I resisted have a nap during my break but latterly, unable to function towards the end of a shift, I began to take them. I was never sure if it helped or not and the worst aspect was waking up and having to get to work again. Happy days!

A study from China by Li et al (2018) and published in JAN titled: 'Napping on night‐shifts among nursing staff: A mixed-methods systematic review' aimed to: 'synthesize research on the influence of night‐shift napping on nurses.' Twenty-two studies were found. The results showed: 'Napping is beneficial to the well‐being of nurses and could improve their psychomotor vigilance and performance. However, the related studies are limited. The evidence on reducing sleepiness and fatigue was also insufficient and napping in nursing still faces challenges.'

The authors conclude: 'Although no clear policy, many nurses have reported napping during the night‐shift. Research on this topic has just started. However, some studies have identified night‐shift napping is beneficial to the well‐being and performance of nurses. Currently, night‐shift napping
is not widely implemented among nurses and faces many obstacles. In the future, the effects of night‐shift napping on nurses, people and organization should be explored by using sound methodological designs. Nursing managers should actively develop strategies to address the barriers of implementing night‐shift napping in nursing.'

You can listen to this as a podcast

Li H, Shao Y, Xing, Z Li1 Y, Wang  S, Zhang M, Ying J, Shi Y, Sun J (2018) Napping on night‐shifts among nursing staff: A mixed-methods systematic review Journal of Advanced Nursing DOI: 10.1111/jan.13859

Thursday, 4 October 2018

The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit

Dear Editor,

This letter is in response to the article “The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit” by Butler, Hall and Copnell (2018) published in the January 2018 edition. This carefully conducted qualitative study enlightens “transitional togetherness”, a multi-phases concept in which the parents-healthcare professional relationships evolve through the pediatric intensive care unit (PICU) hospitalization and grieving process. As a nurse clinician in a PICU, this article particularly resonates with the challenges we face in trying to provide exceptional care for a dying child, along with building strength-base relationships with the family in the most compassionate and holistic way possible. This research is notably relevant considering that clinician interactions with families are the largest determinants of parental role empowerment in an intensive care unit (Butler, Hall & Copnell, 2018), therefore emphasizing the crucial importance for healthcare providers to recognize the needs and expectations of a grieving family.

When working in an environment where life prolonging treatments and great advances in the resuscitation technologies are at the forefront, it can be challenging for nurses to have a child’s care transitions from cure to palliative without proper training on how to navigate such situations. In fact, in a recent study conducted amongst healthcare professionals, it was evident that a lack of training in end-of life care lead to a sense of personal discomfort, higher level of stress and avoidance at a time when support is most needed by a family (Bergsträsser, Cignacco & Luck, 2017). Butler, Hall & Copnell (2018) identified the desire from parents during the hospitalization to have a “collaborative relationship” with the staff, as well as creating a parental role within the PICU for themselves. Once it was clear that their child would die, parents identified the need for a higher level of support from staff to navigate their child’s transition to end-of-life care and to “gradually disengage” from the relationships they had built in the PICU. Such a clear breakdown of phases in the parent-healthcare provider relationship is precisely why this research is needed to help build our understanding on how to approach collaborative end-of-life, family-centered care. Currently, the medical/nursing training on intensive care units is focused on medical and technological advances and lacks a structured curriculum for end-of-life care. To help meet this knowledge gap, multidisciplinary training, “real-life” interventions, palliative care education and parents’ testimonies have shown to be effective ways of learning (Yang &al., 2011) and should be available for clinicians on the unit. Such “toolkits” have started to be implemented in PICUs, such as literature supplements in the SickKids Critical Care Program (Dryden-Palmer & Parshuram, 2018), to provide a reflection on how clinicians can best provide compassionate evidence-based care.

Most interestingly, was that Butler, Hall & Copnell (2018) identified parental needs for an ongoing relationship with health care providers after the child’s death. This is a compelling concept within the grieving process that is lacking support/acknowledgement in our current Quebec healthcare system, particularly when children die in an intensive unit. The incorporation of outreach programs to support debriefing and long-term family coping (October & al., 2018) is needed to complement the legacy items (handprints, pictures, photos, etc.) that parents receive after their child’s death.

In conclusion, rich insight was provided through this article by Butler, Hall & Copnell (2018) on parental needs when losing a child in the PICU and established the foundation for education regarding the changing nature of collaborative relationships with healthcare professionals and grieving families. Together, both hospitals and our healthcare system must take into consideration during the development of protocols, educational tools and support programs, the profound impact of a child’s death and the unique challenges faced by these families inside and outside of the PICU. 


Estelle Simon, RN, BScN
Master student (M.Sc.A.)
Ingram School of Nursing
McGill University



Bergsträsser Eva, Cignacco, E. and Luck, P. (2017) “Health Care Professionals’ Experiences and Needs When Delivering End-Of-Life Care to Children: A Qualitative Study,” Palliative Care: Research and Treatment, 10, pp. 117822421772477–117822421772477. doi: 10.1177/1178224217724770

Butler, A. E., Hall, H. and Copnell, B. (2018) “The Changing Nature of Relationships between Parents and Healthcare Providers When a Child Dies in the Paediatric Intensive Care Unit,” Journal of Advanced Nursing, 74(1), pp. 89–99. doi: 10.1111/jan.13401.

Dryden-Palmer, K., & Parshuram, C. (Eds.). (2018). “Death and dying in the pediatric intensive care unit” [Special issue]. Pediatric Critical Care Medicine, 19 (8S).

October, T., Dryden-Palmer, K., Copnell, B. and Meert, K. L. (2018) “Caring for Parents After the Death of a Child,” Pediatric Critical Care Medicine, 19(8s Suppl 2), p. 68. doi: 10.1097/PCC.0000000000001466.

Yang, C. P., Leung, J., Hunt, E. A., Serwint, J., Norvell, M., Keene, E. A. and Romer, L. H. (2011) “Pediatric Residents Do Not Feel Prepared for the Most Unsettling Situations They Face in the Pediatric Intensive Care Unit,” Journal of Palliative Medicine, 14(1), pp. 25–30. doi: 10.1089/jpm.2010.0314.

Tuesday, 18 September 2018

Professional identity and conflict: has the higher education of nurses changed professional relations between nurses and doctors?

Dear Editor,
In reference to the article in JAN by Fealy et al. (2018) titled: from September 2018: Discursive constructions of professional identity in policy and regulatory discourse, we would like to include a significant element – question – to this discourse. Can we talk about the conflict of professional identities?
In the period from October to December 2017, we conducted focus group interviews (FGI), which were attended by nurses and physicians in two university centres in Poland educating medical personnel - Gdansk and Bydgoszcz. The research concerned the professional identity of nurses and professional relations between nurses and doctors. The results of the research allow to draw two main conclusions:

  • Doctors see weakening of teamwork, which was a principle in health care. They talk about the tension between the doctor and the nurse, which makes the situation worse. The opinion prevails that the increase of formal requirements - higher education - in the profession of nurses destabilized the working conditions in hospitals.
  • Nurses place emphasis on their dependence on the doctors, but modern nursing is, above all, the extension of professional tasks. In their opinion, the doctors rather defend the previous state of professional subordination and treat this state as obvious. Nurses see the doctors' attitudes as seeking to transform nurses work into a doctor's secretary's: writing cards, writing sick leave, etc. Nurses building their professional identity put the main emphasis on being perceived and appreciated as highly specialized professional staff (Luca & others, 2015).

Statements of physicians and nurses participating in research show a clearly outlined conflict between these groups of medical professions (Hartog, Benbenishty, 2015). It seems that nowadays their professional identity changed, hence they can not clearly defined the field of cooperation, and sometimes even differently define their participation in therapeutic and caring activities (Hughes, 1988, Radcliffe, 2000). Particularly difficult situations arise when the nurse has doubts as to the procedure proposed by the doctor. Doctors treat this situation as unacceptable and even as a proof of personal dislike towards a doctor. It also seems characteristic that both professional groups blame each other for the resulting situation.

The research results indicate the need to develop new relationships between doctors and nurses, including changes in university study that would improve the skills of cooperation and partnership and mutual respect for their work (Donelan & others 2013). Regular training in this area is also necessary in the course of specialization and professional work (Cummings & others, 2018).

We also want to support the thesis contained in the article, that academic study of identity construction is important to disciplinary development by raising nurses and physicians consciousness, alerting them to the ways that their own discourse can shape their identities, influence public and political opinion and, in the process, shape public policy on their professions.

Your Sincerely,

Prof. Janusz Erenc, Department of Sociology, University of Gdańsk,

Dr. Piotr Pankiewicz, Department of Psychiatry, Medical University of Gdańsk,

Dr. Małgorzata Filanowicz, Nicolaus Copernicus University,

Carciati, L., Guberti, M., Borgognoni, P., Prandi, C., Spaggiari, I., & Iemmi, M. (2015), The role of professional and team commitment in nurse–physician collaboration: A dual identity model perspective Journal of Interprofessional Care 29: 464–468.

Cummings, G.G., MacGregor, T., Wong, LH., Lo, E., Muise, M., & Stafford, E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review International Journal of Nursing Studies 85:19-60.

Donelan, K., DesRocjes, C.M., Dittus, R.S., & Buerhaus, P. (2013) Perspectives of Physicians and Nurse Practitioners on Primary Care Practice New England Journal of Medicine 368:1898-1906.

Fealy, G., Hegarty, J-M., McNamara, M., Casey M., O'Leary, D., Kennedy, C., O'Reilly, P., O'Connell, R., Brady, A-M., & Nicholson, E. (2018) Discursive constructions of professional identity in policy and regulatory discourse Journal of Advanced Nursing 74: 2157-2166.

Hartog, C. S., & Benbenishty, J. (2015). Understanding nurse–physician conflicts in the ICU Intensive Care Medicine 41:331-333

Hughes, D. (1988). When nurse knows best: some aspects of nurse/doctor interaction in a casualty department Sociology of Health and Illness 10: 1–9.

Radcliffe, M. (2000) Doctors and nurses: new game, same result BMJ,320: 1085.

Sunday, 9 September 2018

Scared of needles?

Roger Watson, Editor-in-Chief

Are you frightened of needles, by which I mean injections given for medical purposes? I guess we all are as, no matter how often you have one at the dentist or at a surgery, it hurts Yes, it does and we all anticipate that initial stab as the outer layer of the skin, where the pain receptors are located, is punctured. But most of us 'put on a brave face' and pretend not to be frightened. Some brave souls may, genuinely, not be frightened - but I am and I don't mind admitting it. However, while most people learn to accept the momentary discomfort, some people never do and genuinely have what is described as 'fear of needles.'

This fear of needles was the subject of a study from the USA by McLenon et al. (2018) and published in JAN titled: 'The Fear of Needles: A Systematic Review and Meta‐Analysis'. The review found 35 relevant articles and established that the fear of needles ranged from 20-50% in young people and up to 30% in adults. In some people this has serious personal and workplace protection significance as: 'Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long‐term care facilities, and 8% of healthcare workers at hospitals.' According to the authors: 'Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.'

The authors concluded: 'fear of needles occurs frequently in populations throughout the world, with higher prevalence at younger ages and in women. Fear of needles is common in patients requiring preventive care and those undergoing treatment. Greater attention should be given to alleviate this fear with an ultimate goal of improving health. We recommend implementation studies of nonneedle approaches to standard needle injection, with direct application to public health and clinical settings. We also recommend randomized trials to assess specific cognitive and behavioural strategies to alleviate fear.'

You can listen to this as a podcast

Mclenon, J. and Rogers, M. A. (2018), The Fear of Needles: A Systematic Review and Meta‐Analysis. J Adv Nurs. doi:10.1111/jan.13818

Saturday, 25 August 2018

Reflexology may work

Roger Watson, Editor-in-Chief

I have to admit that I am sceptical about all things 'alternative' in medicine. I tend to agree with the Irish comedian Dara O'Briain that there are only the things that work, ie 'medicine', and that there is the rest which has not been shown to work. But occasionally a review comes along which challenges my view, and if it passes the scrutiny of my editorial colleagues and our reviewers then it is worth publishing - like this article from India and Oman by Chandrababu et al. (2018) and published in JAN which is a based on a systematic review and meta-analysis of reflexology. The aim of the review was to: 'appraise the evidence concerning the effect of reflexology on the anxiety in patients undergoing cardiovascular interventional procedures.'

The review found five articles which included over 750 participants. The results were clear: 'Reflexology significantly decreased the anxiety of patients undergoing cardiovascular interventional procedures in the treatment group compared with the control group.' The authors concluded, however: 'Due to relatively small sample size and low quality of included trials in this review, it is difficult to conclude on the effect of reflexology on anxiety among patients undergoing cardiovascular interventional procedures or implications for clinical practice. Very few higher quality RCTs evaluated the effectiveness of reflexology among patients following cardiovascular procedures. Hence, rigorous research is needed to prove the efficacy of reflexology, and higher methodological qualities of RCTs are necessary for creating strong evidence among patients following cardiac interventional procedures.

You can listen to this as a podcast


Chandrababu, R. , Rathinasamy, E. L., Suresh, C. and Ramesh, J. (2018), Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: A systematic review and meta‐analysis of randomized controlled trials. J Adv Nurs. doi:10.1111/jan.13822

Wednesday, 15 August 2018

What helps residents to thrive in nursing homes?

Roger Watson, Editor-in-Chief

Are there factors that can be identified that help older people to thrive in nursing homes? A study from Sweden by Björk et al. (2018) published in JAN may have some answers. The study aimed to: 'explore the extent to which environmental factors are associated with resident thriving' and used data from over 4000 residents, over 3500 staff and nearly 150 nursing homes. Data on the cognitive functioning of residents and their activities of daily living were used to estimate resident thriving and staff were given a questionnaire to measure psychosocial climate and other features of the nursing homes.

The strongest factor identified in helping residents to thrive was having a positive psychosocial climate. Other factors identified by the authors, taking into account the individual characteristics of the residents, were: 'having access to newspapers, living in a special care unit, and living in an unlocked facility.' The authors concluded: 'Creating a welcoming psychosocial climate of everydayness, safety, and community in units seems to have an important role in facilitating thriving in nursing home residents and can be included in clinical nursing practice as environmental nursing interventions to facilitate thriving in nursing home residents.'

You can listen to this as a podcast


Björk, S. , Lindkvist, M. , Lövheim, H. , Bergland, Å. , Wimo, A. and Edvardsson, D. (2018), Exploring resident thriving in relation to the nursing home environment: a cross‐sectional study. J Adv Nurs. doi:10.1111/jan.13812

Tuesday, 14 August 2018

The clock drawing test and dementia

Roger Watson, Editor-in-Chief

As the authors state: 'The clock drawing test is one of the most used cognitive screening tools for dementia. However, due to its scoring system, the accuracy of the clock drawing test remains a topic of debate.' The aim of this study from South Korea by Park et al. (2018) and published in JAN was: 'to evaluate the accuracy of the clock drawing test and to compare its scoring methods.'

A systematic review found 18 relevant articles including over 5,500 patients. Seven scoring systems were found and evaluated. A detailed analysis of the systems is presented in the article but two systems were shown to be superior. In the words of the authors: 'the Shulman scoring system is recommended for use with the CDT as a screening test for dementia because it is the most studied and highly sensitive system. However, the Sunderland scoring system showed the highest specificity at 87.9%, meaning that it demonstrates highest accuracy for detecting dementia.'

In conclusion, the authors say: 'Through a systematic review and meta‐analysis of the diagnostic accuracy of the CDT, the Shulman scoring system, which was the most studied and highly sensitive, was determined to be the most useful in the cognitive testing for dementia. After gaining a better understanding of how to use the CDT and its accuracy with different scoring systems through this study, we recommend it for widespread use in the diagnosis of dementia.'

If you want to know more about the clock-drawing test see this link.

You can listen to this as a podcast


Park, J. , Jeong, E. and Seomun, G. A. (2018), The Clock Drawing Test : A Systematic Review and Meta‐analysis of Diagnostic Accuracy. J Adv Nurs. doi:10.1111/jan.13810

Sunday, 12 August 2018

Social media and nursing students

Roger Watson, Editor-in-Chief

Nursing and education have long harboured suspicion about social media and their concerns mimic those of society at large. Despite the widespread use of social media, it rarely gets a good press. Criticism ranges from it being a waste to time, through its use being anti-educational and unprofessional to it being downright harmful, especially to the very young. However, people continue to use it, it is rare to find students who don't and some enlightened educationalists are accepting that students use social media and are integrating it into their learning experience. But the question remains, in nursing education: does it have any benefits?

A study from the UK buy O'Connor et al. (2018) and published in JAN is claimed to be the first rigorous assessment of the issue using the method of systematic review. Specifically, the study aimed to: 'synthesize evidence on the effectiveness of social media in nursing and midwifery education.' A wide search of relevant databases found over 2000 articles of which 12 were considered suitable for detailed analysis. The results were positively in favour of the impact of social media. Studies had been conducted in the UK, USA, Canada, Australia and Taiwan.

The positive effects of social media included effects on: learning outcomes; knowledge; networking and skills. With specific reference to skills, according to the authors: 'Some nursing and midwifery students stated they acquired new abilities such as research, communication, digital literacy, stress management, and study skills from taking part in a social media intervention.'

The authors concluded: 'Social media has the potential to give students a more interactive experience as it promotes the creation, sharing, and consumption of educational content and resources that could improve learning. The findings and recommendations of this review can help inform a future agenda for nursing and midwifery research, practice, and policy that could help transform learning in higher and continuing education.'

You can listen to this as a podcast


O'Connor, S. , Jolliffe, S. , Stanmore, E. , Renwick, L. and Booth, R. (2018), Social media in nursing and midwifery education: a mixed study systematic review. J Adv Nurs. doi:10.1111/jan.13799

Friday, 10 August 2018

Obesity in women who have experienced intimate partner violence

Roger Watson, Editor-in-Chief

I was very pleased to see an article from Saudi Arabia in JAN on the issue of intimate partner violence. I visit Saudi regularly and over the years it has been good to see the development of academic nursing. There are many myths and stereotypes about the country. It is a very different place to live and work from most other countries and I would not pretend that all is well. But issues such as violence against women are not ignored and this article by Ahlalal (2018) titled: demonstrates that the issue is being activley researched.

The aim of the study on which the article is based was to: 'examine the pathway through which intimate partner violence (IPV) severity and child abuse severity influence obesity among women who have experienced IPV'. Questionnaires were given to nearly 300 women and the outcome showed that there was an 'alarming' level of obesity. The author concluded: 'This is the first study to examine the mechanism through which IPV and child abuse influence
obesity among IPV survivors.' and 'Since obesity is a global public health concern, recognizing that IPV survivors are at great risk for obesity is a significant contribution to the field...Prevention of violence against women needs to receive a high priority on the national and international policy agenda.

You can listen to this as a podcast


Alhalal, E. (2018), Obesity in women who have experienced intimate partner violence. J Adv Nurs. doi:10.1111/jan.13797

Monday, 6 August 2018

Cognitive complaints, stress, depressive symptoms and nursing work function

Tomoyuki Kawada
Department of Hygiene and Public Health, Nippon Medical School

Working conditions in any job are supposed to be related to health condition, and poor health would affect working life (van der Noordt et al., 2014; Landsbergis et al., 2014). Nursing work stress was also closely related to health-related quality of life (Oyama and Fukahori, 2015). These studies present a need for exploring psycho-physio-social factors affecting working condition.

Barbe et al. (2018) examined the relationship among subjective cognitive complaints, psychosocial factors and nursing work function by stepwise multiple linear regression analyses. Although depression was not associated with nurses' work function, perceived stress and subjective concerns about cognitive function were significantly associated with impairment of work function. The authors recommended stress reduction strategies for keeping nurses' work function well. I have some concerns about their study.

First, McIntyre et al. (2015) reported that workplace performance was mainly explained by cognitive dysfunction, and depressive symptom severity was closely related to disability measures. In addition, cognitive dysfunction was improved by workforce participation and performance, which was independent from depressive symptom. This report would partly explain the lack of association between depression and nurses' work function.

Second, Lee et al. (2018) investigated inter-relationship among depressive symptoms, cognitive function, and workplace impairment in patients with type 2 diabetes mellitus (DM). Self-rated questionnaires were used for the analysis and the significant association between depressive symptoms and workplace impairment was mediated by cognitive function. They recruited patients with DM, and health status would become a confounder or mediator for the impairment of work function. Wiltink et al. (2014) also reported that progression of DM showed subsequent depressive symptoms in patients with DM, and there is a possibility that depression would be derived from comorbid disease

Finally, Faragher et al. (2005) conducted a meta-analysis on the association between job satisfaction and health. Job satisfaction was significantly associated with burnout, self-esteem, depression, and anxiety. In addition, subjective physical illness was also moderately associated, and they recommended stress management to avoid job dissatisfaction.

Taken together, multi-dimensional approaches including depression and emotional stress management should be conducted to keep or to improve job satisfaction in nursing work (Ruggiero 2005).


Barbe T., Kimble L.P. & Rubenstein C. (2018) Subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care. Journal of Advanced Nursing 74(4), 914-925.

Faragher E.B., Cass M. & Cooper C.L. (2005) The relationship between job satisfaction and health: a meta-analysis. Occupational and Environmental Medicine 62(2), 105-112.

Landsbergis P.A., Grzywacz J.G. & LaMontagne A.D. (2014) Work organization, job insecurity, and occupational health disparities. American Journal of Industrial Medicine 57(5), 495-515.

Lee Y., Smofsky A., Nykoliation P, Allain S.J., Lewis-Daly L., Schwartz J., Pollack J.H., Tarride J.E. & McIntyre R.S. (2018) Cognitive impairment mediates workplace impairment in adults with type 2 diabetes mellitus: results from the Motivaction study. Canadian Journal of Diabetes 42 (3), 289-295.

McIntyre RS, Soczynska JZ, Woldeyohannes HO, Alsuwaidan M.T., Cha D.S., Carvalho A.F., Jerrell J.M., Dale R.M., Gallaugher L.A., Muzina D.J. & Kennedy S.H. (2015) The impact of cognitive impairment on perceived workforce performance: results from the International Mood Disorders Collaborative Project. Comprehensive Psychiatry 56, 279-282.

Oyama Y. & Fukahori H. (2015) A literature review of factors related to hospital nurses' health-related quality of life. The Journal of Nursing Administration 23(5), 661-673.

Ruggiero J.S. (2005) Health, work variables, and job satisfaction among nurses. The Journal of Nursing Administration 35(5), 254-263.

van der Noordt M., IJzelenberg H., Droomers M. & Proper KI. (2014) Health effects of employment: a systematic review of prospective studies. Occupational and Environmental Medicine 71(10), 730-736.

Wiltink J, Michal M, Wild PS, Schneider A., König J., Blettner M., Münzel T., Schulz A., Weber M., Fottner C., Pfeiffer N., Lackner K. & Beutel M.E. (2014). Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study. PLoS One 9(8), e105499.

Tuesday, 3 July 2018

A NICE Future is One with Fewer Surgical Site Complications

Author of report Dr Vicki Strugala,
Smith & Nephew Professional Education
 – AWM; Europe.
Complications from surgical incisions are a significant economic and human burden, costing an approximate £1 billion[i] to the NHS each year and contributing to significant morbidity and mortality in the UK and globally. A recent World Union of Wound Healing Societies consensus guidelines reports that up to 60% of surgical site infections (SSIs) are preventable[ii] in the first place, which suggests that more needs to be done to reduce this figure.

One such medical innovation that is helping reduce the wound care burden is Negative Pressure Wound Therapy. A recent meta-analysis which included 16 studies, demonstrated the prophylactic application of PICO on surgical site incisions significantly reduced surgical site infections (SSIs) by 58%, wound dehiscence (wound rupturing along a surgical incision) by 26%, and length of stay by 0.5 days when compared to standard care[iii]*.

The meta-analysis evaluated results from 16 peer-reviewed publications (including 10 RCTs), involving 1863 patients and 2202 incisions. It assessed the average effect of the PICO Single Use Negative Pressure Wound Therapy System application across a wide variety of surgical indications.

This study is the latest body of evidence which adds to the literature and research supporting PICO as an effective prophylactic treatment option for SSIs. In addition, it helps provide important insights into optimising clinical management strategies for preventing SSIs, which are an increasing concern for healthcare providers and their patients around the world.

This week, NICE announced its first Medtech Innovation Briefing (MIB) for PICO, which is the first MIB awarded for a Negative Pressure Wound Therapy device, in relation to the prevention of surgical site complications. It is hoped that this latest announcement is expected to provide healthcare professionals with the confidence to treat at-risk patients and procedures with PICO, improving clinical and cost savings.

For example, in patients undergoing primary hip and knee arthroplasties, it was estimated that care with PICO enabled cost savings of more than £7,000 per high-risk patient (BMI ≥35 or ASA ≥3) compared with care with standard dressing[iv]**.

Pioneering medical technologies are therefore key to providing solutions that continue to improve current standards of care and economic outcomes, and most importantly, better patient outcomes.

Rachel Cunningham
Account Director
ROAD Communications


[i] Guest J et al, Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J 2016; doi: 10.1111/iwj.12603

[ii] World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds International, 2016

[iii] Strugala, V. and Martin, R. Meta-analysis of comparative trials evaluating a prophylactic single-usenegative pressure wound therapy system for the prevention of surgical site complications. Surgical Infections (2017). DOI 10.1089/ sur.2017.156 * Meta-analysis included 10 RCT & 6 observational studies. Reduction in SSI (16 studies included): 1839 patients (2154 incisions): PICO 5.2%; control group 12.5%; p<0.0001. Mean reduction in hospital length of stay 0.47 days (8 studies included): p<0.0001

[iv] Nherera LM, Trueman P, Karlakki SL. Cost-effectiveness analysis of single-use negative pressure wound therapy dressings (sNPWT) to reduce surgical site complications (SSC) in routine primary hip and knee replacements. Wound Repair Regen. April 2017. doi:10.1111/wrr.12530

   * 50-patient study; length of stay reduced: PICO 6.1 days; control group 14.7 days; p<0.019

   ** Calculations based on a 220-patient RCT

Sunday, 17 June 2018

Care-giving by family members

Roger Watson, Editor-in-Chief

Caring by family caregivers for family members is a considerable commitment and takes time away from work, leisure and life in general. But how much time do family caregivers spend on caregiving and how much time do they think they spend on it? This was the focus on an article from Spain by Timonet‐Andreu et al. (2018) titled: 'Overestimation of hours dedicated to family caregiving of persons with heart failure' and published in JAN which aimed to: 'profile the family caregivers of people living with heart failure, to determine the perceived and real time devoted to daily care and to identify the factors associated with caregivers’ overestimation of time dedicated to care'.

Nearly 500 patient-family caregiver dyads were involved in the study for three years. Caregivers overestimated the time spent on caring to be twice as much as the time they actually spent on caring. The factors which led them to overestimate caregiving time included the age of the caregiver and the length of the caregiving relationship. In conclusion, the authors say:

'The overestimation of time dedicated to care seems to be related to people living with heart failure and caregivers’ characteristics, such as functional status, caregiver burden, age and cohabitation. These patterns should be taken into account by nurses when carrying out assessments and care planning with these types of patients and their caregivers.

Moreover, objective measures to determine the real amount of time dedicated to caregiving should be developed to facilitate a comprehensive assessment of the caregiver’s situation. If this were done, specific interventions could be designed for caregivers with a strongly distorted perception of the time dedicated to care to detect underlying clinical or social circumstances that could be producing this misconception. This issue could then be addressed by means of educational or behavioural interventions.'

You can listen to this as a podcast


Timonet‐Andreu, E. , Canca‐Sanchez, J. C., Sepulveda‐Sanchez, J. , Ortiz‐Tomé, C. , Rivas‐Ruiz, F. , Toribio‐Toribio, J. C., Mora‐Banderas, A. and Morales‐Asencio, J. M. (2018), Overestimation of hours dedicated to family caregiving of persons with heart failure. J Adv Nurs. doi:10.1111/jan.13727

What affects clinical nurse educator’s perception of confidence in their role?

Van Nguyen, PhD 
Research officer, Alfred Health Clinical School, La Trobe University, Australia.

Associate Professor Helen Forbes, PhD
School of Nursing and Midwifery, Deakin University, Geelong, Australia.

Alfred Deakin Professor Maxine Duke, PhD
School of Nursing and Midwifery, Deakin University, Geelong, Australia.

Our article “The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence” provides an insight into the factors that assist clinical educators of nursing in Vietnam to develop confidence in their role. According to World Health Organisation (2013), there is a lack of evidence for the most effective preparation and support strategies for health educators. This study provides important evidence for the orientation and preparation of future nurse educators and other health professional educators. The results of this study will appeal specifically to current clinical nurse educators, those who are considering taking on this role or those who supervise clinical nurse educators.

This article is the third publication in our series about nursing education. The first article describes the development and validation of psychometric properties of the Clinical Nurse Educator Skill Acquisition Assessment tool (CNESAA) (Nguyen, Forbes, Mohebbi, & Duke, 2017b) which was used to identify preparation and support strategies for clinical nurse educators. The second article focuses on how confident Vietnamese clinical nurse educators were to undertake their role in the context of numerous restructures to professionalise nursing in Vietnam (Nguyen, Duke, & Forbes, 2017a). In these articles, the CNESAA was used not only to measure clinical nurse educator’s confidence but to explore important aspects related to the preparation of human resources for nursing education. Such use of the tool can also be applied in other contexts as well as other disciplines of health sciences.


Nguyen, V. N. B., Forbes, H., Mohebbi, M., & Duke, M. (Accepted for publication). The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence. Journal of Advanced Nursing.

Nguyen, V. N. B., Duke, M., & Forbes, H. (2017a). Nurse educator confidence in clinical teaching in Vietnam: A cross-sectional study. Collegian. doi:10.1016/j.colegn.2017.09.008

Nguyen, V. N. B., Forbes, H., Mohebbi, M., & Duke, M. (2017b). Development and validation of an instrument to measure nurse educator perceived confidence in clinical teaching. Nursing & Health Sciences, 19(4), 498-508. doi:doi:10.1111/nhs.12373

World Health Organisation. (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines 2013. Retrieved from Geneva:

Friday, 25 May 2018

It’s time to agree on author order

by Terence McCann


Most of us have pondered the order of authors listed on a paper. Aside from our personal confusion about each author’s contribution, questionable authorship practices in leading peer-reviewed nursing and midwifery journals are a significant threat to the integrity of nursing and midwifery scholarship and research. Although broad guidelines regarding publishing practices exist, there appears to be a general absence of or adherence to regulatory guidance concerning authorship and author order. In addition, authorship trends differ across disciplines and countries, leaving the reader unable to determine which authorship convention has been followed. Hence, transparency in author attribution seems to be the exception rather than the rule. The confusion and contentiousness of author order are exacerbated by its potential influence on opportunities for employment, promotion, tenure and research funding. Although it is generally accepted that first and last authors receive the most credit – and the first author is almost always considered the most valuable position on a paper –there is little consistency in how author order is determined. Adoption of a set of principles to guide and justify author order is needed. In a forthcoming discussion paper, McCann and Polacsek (2018) recommend that the ‘first-last-author-emphasis’ be adopted uniformly internationally across nursing and midwifery research. The first author should have made the most significant contribution to the paper; the last author should have made the second most significant contribution to the study, or served as a senior academic or mentor on the study; and other authors should be listed in descending order of their contribution.

McCann, T. V., & Polacsek, M. (2018). Addressing the vexed issue of authorship and author order: A discussion paper. Journal of Advanced Nursing. DOI: 10.1111/jan.13720

Monday, 14 May 2018

Reply to Hoeltzell

Reply to: 

Austyn Snowden, PhD, RMN, FHEA

Thank you for commenting on our article, and for the opportunity to respond. To recap, our study found that there was a very small but positive correlation between ‘trait’ emotional intelligence and successful completion of a nursing degree at first attempt (Snowden et al., 2017). This was the finding from a three-year longitudinal study of a large cohort of Scottish student nurses who started training in 2013, and qualified in 2016. We also found that older females were more likely to complete the course, and that previous caring experience made absolutely no difference to whether students were successful or not, and in fact made it more likely for them to fail in year 1. 

We also found a slightly stronger correlation between ‘social connection’ and completion. Social connection was a factor we found in the Trait Emotional Intelligence Questionnaire- short form (TEIQue-SF) (Snowden et al., 2015), the questionnaire we used to measure trait EI in the study (Cooper and Petrides, 2010). ‘Social connection’ seemed to measure the ability to make connections between people, to apply EI. My interpretation is that it is this application of emotional intelligence that Ms Hoeltzell is referring to when arguing for ‘emotional competence’, the ability to express emotional intelligence in a social context. I’m not sure, but if my interpretation is correct, then we agree with her, because that’s what our research found.

However, I found the more interesting element of Ms Hoeltzell’s response to be the identification of emotional intelligence as ‘buzzword’. I couldn’t agree more with that. I think we have probably passed peak emotional intelligence, possibly even peak resilience, hence the need for related but extended concepts such as emotional competence. To me these less rigorous concepts simply signal that it’s time to move on, or at least look elsewhere. Our most recent data showed that in their first year of being qualified nurses, sickness/absence was associated with work experience, such that those with higher job satisfaction were less likely to go off sick. A bit obvious really, but still worth obtaining empirically. The relevant point to this response was that there was no relationship between emotional intelligence and sickness rates, or between resilience and sickness rates. Perhaps it’s time to stop blaming ourselves for lacking perfect personal attributes and instead consider a more practical analysis of the relationship between nurses and their work.

UK nursing has been through an unprecedented period of navel gazing as a consequence of care failings. Whilst it was right to reflect and repair, I think we have probably reached the end of the ‘attribute adventure’, and so I would personally consign emotional competence to history if I could, along with EI, compassion, and resilience. Instead, I would invite the social psychologists to have a go. John Paley’s critique of the compassion agenda (2013) was too early in the grief process for most to take at the time. I would urge another look.


Cooper, A., Petrides, K. V, 2010. A psychometric analysis of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) using item response theory. J. Pers. Assess. 92, 449–57. doi:10.1080/00223891.2010.497426

Paley, J., 2013. Social psychology and the compassion deficit. Nurse Educ. Today 33, 10–11. doi:10.1016/j.nedt.2013.05.011

Snowden, A., Stenhouse, R., Marshall, S., Duers, L., Brown, N., Carver, F., Young, J., 2017. The relationship between emotional intelligence, previous caring experience, and successful completion of a pre-registration nursing/midwifery degree. J. Adv. Nurs. early view. doi:10.1111/jan.13455

Snowden, A., Watson, R., Stenhouse, R., Hale, C., 2015. Factor and Rasch Analysis of the Trait Emotional Intelligence Questionnaire Short Form. J. Adv. Nurs. 71, 2936–2949. doi:10.1111/jan.12746

Thursday, 10 May 2018

Commentary: Emotional Intelligence or Emotional Competency?

Commentary on: Snowden, A., Stenhouse, R., Duers, L., Marshall, S., Carver, F., Brown, N., & young, J. (2018). The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registered nursing/midwifery degree. Journal of Advanced Nursing, 74(2), 433-442. doi: 10.1111/jan.13455

Deborah Hoeltzell, BSN, BFA, RN, CCRN, CPAN, CNRN

I was pleased to have read the article from the February 2018 edition, “The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registration of a nursing/midwifery degree”. Currently, emotional intelligence and emotional competence are the buzz-words for nursing management, leadership, and educators. The authors in-depth study correlated emotional intelligence with successful completion in nursing studies. The subject is valid for the competitive heath care field. Considering emotional intelligence as a trait, and in the “nature versus nurture” debate on traits and competency, would it not be more logical to base importance upon emotional competency, rather than intelligence? According to Na, Wilkinson, Karny, Blackstone, & Stifter (2016) emotional competency compromises skills, such as emotional self-efficacy, inter-relational communication, identifying other’s emotions, awareness of one’s emotions, and capacities for empathetic and sympathetic involvement. These are a few factors to be considered for future nurse candidates.

Including these skills as nursing competencies can provide a refined dimension to an educational curriculum. Whether the potential nursing student has a high or low emotional intelligence would not be a deterrent to completion of a nursing degree. Today’s nurse must be self-aware and equipped with skills to maintain emotional well-being.


Snowden, A., Stenhouse, R., Duers, L., Marshall, S., Carver, F., Brown, N., & young, J. (2018). The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registered nursing/midwifery degree. Journal of Advanced Nursing, 74(2), 433-442. doi: 10.1111/jan.13455

Na, J. Y., Wilkinson, K., Karny, M., Blackstone, S., & Stifter, C. (2016). A synthesis of relevant literature on the development of emotional competence: Implications for design of augmentative and alternative communication systems. American Journal of Speech-Language Pathology, 25, 441-452. doi: 10.1044/2016_AJSLP-14-0124