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.