Monday, 8 June 2020

Nurse staffing levels and workload do matter

Roger Watson, Editor-in-Chief

It seems self-evident that the fewer nurses we have relative to patients and the more that nurses have to to, the more patients must be at risk. And that is exactly what this study, recently published in JAN shows.

The study was conducted in Finland by Jansson et al. (2020) and they published an article titled: The proportion of understaffing and increased nursing workload are associated with multiple organ failure: A cross‐sectional study The study was conducted in one hospital over 10 years. A range of measures of nurse interventions and the nurse to patient ratios were recorded daily as was sequential organ failure. Over 10,000 patient incidents were studied.

Nurses intervention was higher in patients with multiple organ failure and in those who died. According to the authors: '(t)he proportion of understaffing was significantly more common in patients with multiple organ failure than in those without' and '(t)he levels of nursing associated with workload and understaffing were at their worst on weekends.'

The authors concluded: 'The proportion of understaffing and increased nursing workload are associated with multiple organ failure, demonstrating that an adequate level of nurse staffing in relation to patient complexity is a prerequisite for the availability and quality of critical care services.'  Finally, it is worth noting that '(t)he proportion of understaffing did not differ between survivors and non‐survivors.'

You can listen to this as a podcast


Jansson, M, Ohtonen, P, Syrjälä, H, Ala‐Kokko, T. The proportion of understaffing and increased nursing workload are associated with multiple organ failure: A cross‐sectional study. J Adv Nurs. 2020;

Tuesday, 2 June 2020

Transforming Faculty Scholarship through Academic Blogging; An Autoethnographical Viewpoint

Catherine Best
Webmaster for the Phi Mu (All England) Chapter of Sigma

Writing for publication is fundamental in the effort to extend nursing knowledge and is a solid platform upon which nurses, can effectively disseminate professional knowledge and personal experience to a wider audience (Montoya, 2020). 

Expanding the body of knowledge through publication is therefore considered an essential element within nursing practice; one which enables the sharing of nursing knowledge; new initiatives and research findings and directly contributes to the advancement and development of the profession (Oermann and Hays, 2018).
Traditionally, academia has emphasised the importance of peer-review, above any other form of communication (Stoneham and Kite, 2017); disappointingly this method can create a significant barrier to the accessing of information (Oliver et al. 2014), for much of the data is available simply to the few in ‘subscription only journals’. Furthermore, the peer review process continues to limit publishing success, for not only can it be lengthy as demonstrated by Happell, (2012), it can also stifle performance and encourage self-doubt, especially if feedback is particularly critical (Wilcox, 2019). Many papers are simply rejected outright, a process that from personal experience can be intensely painful. It is important to note however, that the publishing world is filled with authors who have received rejections. It didn’t stop them from publishing, they just simply found another way. Indeed, this very blog has been developed from my abstract submitted to the Nightingale Conference 2020, which sadly has been cancelled, due to the pandemic. There is always, I have found, another way to publish and through blogging nurse academics can build a portfolio of publications, without undergoing the often-damaging process of peer review.

Originally termed ‘Weblogs’, and now more commonly known as blogs, are according to Anders, (2018) used extensively to engage students more fully with education, providing opportunities and challenges to increase autonomy and encourage a responsible attitude towards their own learning.

Blogging in academic circles, commonly known as academic blogging, has emerged as a channel through which faculty staff can disseminate research findings and encourage scholarly debate (Cameron et al. 2016) without going through the rigors connected with academic journals (McGlynn, 2017). Every blog published is a contribution to a wider discussion, its strength being in its ability to connect people to information that really matters (Moss, 2018).

There are many benefits of academic blogging (Northam, 2012) and from personal experience I have found that these have emerged throughout my writing practice.

Blogging helps to quieten my very busy mind. It has provided space to experiment with myriad of ideas, finetune my writing skills and build my confidence. Ultimately supporting the development of an invaluable writing habit (Thomson, 2016).

Used appropriately I believe that academic blogging can become a catalyst for change as it can encourage deeper levels of learning and ultimately self-reflection, which in turn can facilitate action and help advance nursing practice.

Disappointingly however, reticence continues to exist, with many refusing to accept blogging as a valid form of scholarship, citing a lack of peer review, ‘wasted time’ and ideas made too freely available (Fullick, 2011). Although this appears to be changing rapidly, as increasingly academics are entering the so-called Blogosphere to publish their work (ibid) and build their professional profile (Campbell, n.d.)

Personal Insight
I have found blogging to be a great way to develop my professional interests, creating a framework through which, I can structure my learning and engage with my personality. Having such a diverse repertoire of ideas, enables creativity in my writing. It has supported the development of a writing portfolio of which I am extremely proud and, in a way, has become addictive, feeding my habit and my passion for quality and collaborative learning. My academic blogs feature prominently in my aspirations and help create ideas for peer reviewed journal articles as well as conference abstracts and presentations. It enables critical reflection and action and ultimately helps to showcase my love for my profession as a nurse and academic.

Personal Benefits
My blogs have helped to build the confidence to engage with social media and have been used as a catalyst for personally led Twitter Chats. Having considered for some time that social media can be a viable CPD event which promotes reflective practice, these thoughts have now been corroborated by Moorley and Chinn (2019), in their work on Revalidation (NMC, 2019). Blogs, like articles, can be read, enjoyed and then critiqued, the resulting CPD hours [for me] being both an enjoyable and positive experience.

Perhaps as importantly blogging has helped me to build new working and professional relationships, engage with journal editors and supported the commissioning of my work.

I know that there are those who are concerned about writing something that may be libelous and I have to profess I too had those doubts. To reduce this risk however, I chose to engage with publishers and highly respected organisations who were keen to publish my work; this approach giving me the confidence to continue.

An abundance of support continues to come from a variety of different publishing avenues and I am grateful to all those who have given me and continue to give me opportunities to publish and promote my work.

So, why not consider writing a blog. If it’s not for you then fine; but how do you know, unless you write one?


Anders, A.D. (2018) Networked learning with professionals boosts students' self-efficacy for social networking and professional development. Computers & Education, 127, 13–29.

Cameron CB, Nair V, Varma M, Adams M, Jhaveri KD, Sparks MA (2016) Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs JMIR Med Educ, 2(1):e10.

Campbell, L.M. (n.d.) What is academic blogging and how can you use it to build your professional profile? [Online blog] Available from: [Accessed 20 May 2020]

Fullick, M. (2011) Should you enter the academic blogosphere? A discussion on whether scholars should take the time to write a blog about their work. 30 November. [Online blog] Available from: [Accessed 19 May 2020].

Happell, B. (2012) Writing and publishing clinical articles: a practical guide. Emergency Nurse, 20 (1) April, pp.33-37.

McGlynn, T. (2017) Why blogging is still good for your career. 23 October [Online blog]. Available from: [Accessed 27 May 2020].

Montoya, V. Schafer, K and Decker, V. Nurses Need to Publish Scholarly Articles: Overcoming Reticence to Sharing Valuable Experience. Nephrology Nursing Journal, 47 (2) March-April, pp. 153-162.

Moorley, C. and Chinn, T. (2019) Social media participatory CPD for nursing revalidation, professional development and beyond. British Journal of Nursing, 28 (13) July, pp. 870-877.

Moss, G. (2018) Why blogging is great for your career. 11 October [Online Blog]. Available from:[Accessed 26 May 2020].

Northam, J. (2012) The benefits of academic blogging – should you enter the blogosphere?! 11 January [Online blog] Available from: [Accessed 18 May 2020].

Nursing and Midwifery Council (2019) Revalidation. London: NMC.

Oermann, M.H. and Hays, J.C. (2018) Writing for Publication in Nursing. 4th ed. New York: Springer Publishing.

Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. (2014) A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Services Research, 14 (2) January, pp. 1-12.

Stoneham, M.J. and Kite, J. (2017) Changing the knowledge translation landscape through blogging. Australian and New Zealand Journal of Public Health, 41 (4) February, pp. 333-334.

Thomson, P. (2016) Seven reasons why blogging can make you a better academic writer. 2 January [Online blog] Available from: [Accessed 27 May 2020).

Wilcox, C. (2019) Rude paper reviews are pervasive and sometimes harmful, study finds. 12 December [Online blog]. Available from: [Accessed 27 May 2020]

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

Monday, 18 May 2020

Thematic Analysis: A Research Method

Catherine Best

Webmaster for the Phi Mu (All England) Chapter of Sigma
Qualitative research is described as a process through which, an open and flexible approach to enquiry and data collection can emerge (Kumar, 2014). It seeks to explore diversity, emphasise feelings and critique the lived experience, the findings of which can be communicated using a narrative approach (ibid).

Moreover, qualitative research has been widely used within healthcare as a means of acquiring knowledge and to provide insight into the real lives, events and perspectives of both patients and health care professionals (Braun and Clarke, 2014).

One way in which qualitative data can be analysed is through the process of thematic analysis, described by Clarke and Braun (2017, p.297) as ‘a method for identifying, analysing and interpreting patterns of meaning (‘themes’) within qualitative data’.

Such patterns emerging through a meticulous process of data familiarisation and data coding; theme development and revision (Guest et al, 2012). Coding, being used to represent identified themes and provide summary markers for further development (ibid). There is however, much more to thematic analysis than simply summarising the data, for as Maguire and Delahunt, (2017, p.3353) purport ‘a good thematic analysis’ also ‘interprets and makes sense’ of the data collected.

Furthermore, thematic analysis also offers a set of established tools that researchers can use, to ensure the development of a robust and high-level critique of qualitative data; making the data more easily accessible to those not considered part of academia (Braun and Clarke, 2014).

It could be argued therefore, that this type of research method, is the most empowering of all research. For ultimately it allows early career researchers to develop an understanding of how to interpret data (Braun and Clarke, 2006). Research and its outcomes should not be confined to the ivory towers of universities, but made widely available to a more expansive audience, delivered in such a way that it can be understood by the many, rather than the elitist few.

Thematic analysis therefore, offers a flexible approach [within qualitative research] towards the analysis of data, creating a more structured and implicit construct, without compromising depth of the analysis undertaken (Javadi and Zarea, 2016). Moreover, an effective thematic analysis enables both reflection and clarification of the research itself (ibid).

Any form of research is required to demonstrate rigour, reliability and validity, a process which helps to determine trustworthiness (Roberts et al, 2019) and a critique of the literature as to the rigour of thematic analysis, has generated an interesting discourse. Thematic analysis, argues Bazeley (2009), fails to stand up to scrutiny as a valid research method and asserts that problems can occur with the interpretation of data, with particular reference to themes. Furthermore, reliability is of greatest concern within thematic analysis because more interpretation is required when defining the codes used (Guest et al, 2012).

Moreover, the lack of extensive literature on thematic analysis compared to other types of research, may lead to novice researchers being unclear as to how to undertake such research (Nowell et al, 2017).

On a more positive note, however, thematic analysis argues Braun and Clarke, (2006) provides a flexible and accessible form of analysis, an understanding of which, can be easily grasped. It can also be useful in analysing small, medium and even large sized data sets (Herzog et al, 2019), although as Guest et al, (2012) argue, interpretation of large amounts of data, using thematic analysis, can also be challenging.

To demonstrate a clear, replicable and transparent method and therefore effectively manage direct criticism, Braun and Clarke (2006) outline a series of phases which researchers must embrace in order to produce a thematic analysis. This phased approach is considered the most influential and the clearest of the frameworks as it offers a well-defined structure upon which to theme and analyse data (Maguire and Delahunt, 2017). This framework argues Braun and Clarke, (2006) ensures the researcher familiarises self with the data, adequately prepares the data for analysis, reduces the data into a set of codes, searches for themes, reviews and then define themes and ultimately critiques the findings in the format required.

Overall, considering the advantages and limitations of this method, thematic analysis could be considered a valid research method as it enables the generation of a rich source of information, through which a clear unbiased approach to the analysis of data can emerge and effective interpretations made.


Bazeley, P (2009) Analysing Qualitative Data: More than ‘Identifying Themes’. The Malaysian Journal of Qualitative Research, 2 (2) pp. 6-21.

Braun, V. and Clarke, V. (2014) What can ‘‘thematic analysis’’ offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Wellbeing 9 (1), pp.1-2.

Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3 (1) pp.77-10.

Clarke V. and Braun V. (2017) Thematic analysis, The Journal of Positive Psychology, 12 (3) pp.297-298.

Guest, G. Macqueen K.M. and Namey, E.E. (2012) Applied Thematic Analysis. Sage Publications.

Herzog, C. Handke, C and Hitters, E. (2019) Analyzing Talk and Text II: Thematic Analysis. In: Van den Bulck, H. Puppis, M. Donders, K. and Van Audenhove, L. (Eds.) The Palgrave Handbook of Methods for Media Policy Research. Basingstoke: Palgrave Macmillan.

Javadi, M. and Zarea, K. (2016) Understanding Thematic Analysis and its Pitfalls. Journal of Client Care 1 (1) pp.33-39.

Kumar, R. (2014) Research Methodology. A step-by-step guide for beginners. 4th edition. Sage.

Maguire, M. and Delahunt, B. (2017) Doing a Thematic analysis: A Practical, step-by-step Guide for Learning and Teaching Scholars. All Ireland Journal of Teaching and Learning in Higher Education, 8 (3) pp.3351-33514.

Nowell L. S. Norris J. M. White D. E. and Moules N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16 (1) pp.1-13

Roberts, K. Dowell, A. and Nie, J. Attempting rigour and replicability in thematic analysis of qualitative research data; a case study of codebook development. BMC Medical Research Methodology, 19 (66) pp.1-8

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

Monday, 11 May 2020

Using Autoethnography as a critical path in research

Catherine Best
Webmaster for the Phi Mu (All England) Chapter of Sigma
Autoethnography, I am reliably informed, evidently features in some of my published work. So, armed with this knowledge, I began to explore autoethnography as a viable research tool, a model through which I can build upon my personal experiences as a human being, a woman and a Registered Nurse.

This research methodology, which draws upon ‘subjective experience to examine the interplay between self and culture’ (Peterson, 2014, p.227) allows me to step beyond [my own] personal and professional opinions and in so doing creates a significant paradigm shift, one which empowers me to scaffold my thoughts, feelings and experiences within the cultural, political and social constructs in which I live, work and play.

Autoethnography can be defined as the ‘inclusion of the self (auto) in an investigation (graphy) of cultural process (ethno)’ (Liggins et al. 2013, p.106) and as Grant (2019, p. 88) posits, is a type of ‘narrative qualitative inquiry’, an approach which values relationships, revelations and other powerful experiences as acceptable research data. This is supported by (Uotinen, 2011) who argues that autoethnography allows the personal experiences of the researcher to become entwined in the research undertaken and by Wall (2016) who opines that autoethnography can be used to explore social phenomena through the researcher's own experience.

The use of autoethnography as a research process argues Chang and Bilgen (2020) propels self-exploration, through which a deeper and broader level of both social and cultural understanding can emerge, a process based on one’s lived experience. Furthermore, through ‘self-reflection and self-reflexivity’, autoethnography has the capacity to facilitate ‘internal dialogues’, the ‘reconstruction of memories’, and ‘the analysis of meanings’ (Chang and Bilgen, 2020, p.94).

Disappointingly however, despite autoethnography being recognised as a viable research method, it remains in its infancy within the nursing profession, or as Peterson (2014, p227) purports ‘understudied and underused’. There could be many reasons for this. When exploring autoethnography as a valid research framework, some researchers consider this approach as being narcissistic and self-indulgent (Roulston, 2018). This is reiterated in the work of Chang (2016) who argues that a continued criticism of autoethnography is its excessive focus on self. This it could be argued, goes against the very essence of what it means to be a nurse.

Just as uncomfortable a scenario is the notion of vulnerability on the part of the researcher and disconcertingly this cannot be avoided (Chang, 2016). Furthermore Hamood, (2016, p.47) argues that autoethnography is simply considered too ‘artful’ and ‘literary’ due to a perceived lack of rigour, theory and analysis. At a time when emphasis continues to be placed on nursing as a science, one which requires rigorous evidence-based outcomes, is it no wonder that autoethnography as a viable research method continues to remain in its infancy.

Despite these challenges however, autoethnography argues Peterson, (2014) has the potential to raise the voice of nurses and create new insights and knowledge into the ways in which practice can be improved. Furthermore, autoethnography encourages the researcher to write using reflection and inquiry, (McCormack, 2009). Interestingly, attempts to encourage nurses to become reflective practitioners has assumed a strong position in recent years with Revalidation (NMC, 2015), (a process through which nurses meet their fitness to practice requirements), becoming firmly embedded within the profession.

The ability to reflect on professional practice has therefore become essential and requires nurses to understand the importance of analysis a means by which, they have the potential to gain greater insight into their personal and professional experiences and in so doing help to secure new ways of working. Perhaps this is no more required than during the current pandemic crisis, when nurses need to think creatively and with compassion to meet the continued needs of patients and their families, with social distancing being the norm.

The nursing profession, therefore, is currently working in a time of unprecedented change, when the health of the nation is at stake and new ways of working have been adopted quickly to reduce the significant impact of the Covid-19 pandemic. This on the back of increasing nurse shortages, (NHS Providers, 2019) a lack of resources, no more evident than the current lack of personal protective equipment (Campbell, 2020) and with average student attrition rates in 2019 at 24% (The Health Foundation, 2019) means the profession is under enormous pressure. Many of these pressures and in particular nursing shortages are not unique to England or indeed the UK, but across the globe (WHO, 2020). The continuance of which could be catastrophic.

The exemplary way nurses have embraced the significant challenge that the pandemic has created is firmly embedded in the hearts and minds of the nation; their sacrifice unchallenged. But what will happen when this is all over and we return to some degree of normality. Will their commitment be forgotten as the political and financial crisis that is likely to occur becomes apparent and the failings, as well as the successes emerge?


So, what will emerge is yet to be seen. What is clear however, is that nurses are in a unique position to explore and critique their experiences of Covid-19 within the cultural, social and political paradigms that exist, not only within the NHS, but the healthcare sector as a whole.

Moving forward, the nursing profession could crucially benefit from undertaking or commissioning research that puts nurses at the heart of the crisis; enabling the creation of personal narrative seen through the lens of a political, social and emotionally charged storm.

But is this something that is likely to happen, or will nurses simply want to metaphorically forget about the crisis and move on? Disappointingly, this may become the increasing consensus, however if we can encourage some to become active researchers or work with others to raise awareness of nurses experience during this time, then the voice of nursing will not diminish, but become a thunderous roar, which will eventually be heard globally.


Campbell, D. (2020) Hospital leaders hit out at government as PPE shortage row escalates. [Online]. The Guardian. Available from: [Accessed 6 May 2020].

Chang, H and Bilgen, W. (2020) Autoethnography in Leadership Studies: Past, Present, and Future. Journal of Autoethnography, 1 (1) January, pp. 93-98.

Chang H. (2016) Autoethnography in health research: Growing pains? Qualitative Health Research, 26 (4) March, pp. 443-51.

Grant, A. (2019) Dare to be a wolf: Embracing autoethnography in nurse educational research. Nurse Education Today, 82, November, pp. 88-92.

Hamood, T. (2016) An autoethnographic account of a PhD student’s journey towards establishing a research identity and understanding issues surrounding validity in educational research. The Bridge: Journal of Educational Research-Informed Practice, 3 (1) June pp. 41-60.

Liggins, J. Kearns, R.A. and Adams, P.J. (2013) Using autoethnography to reclaim the ‘place of healing’ in mental health care. Social Science and Medicine 91, August, pp. 105-109.

McCormack, D. (2009). A Parcel of Knowledge: An Autoethnographic Exploration of the Emotional Dimension of Teaching and Learning in Adult Education, Adult Learner: The Irish Journal of Adult and Community Education pp.13-28.

NHS Providers (2019) The State of the NHS Provider Sector. London: Foundation Trust Network

Nursing and Midwifery Council (2015) Revalidation. NMC. [Online]. Available from: Accessed 6 May 2020.

Peterson, A.L. (2014) A case for the use of autoethnography in nursing research Journal of Advanced Nursing, 71 (1) August, pp. 1-19.

Roulston, K. (2018) What is Autoethnography. [Online]. Available from: [Accessed 7 May 2020].

The Health Foundation (2019) Nursing students are still dropping out in worrying numbers. [Online]. Available from: [Accessed 6 May 2020]

Uotinen, J. (2011). Senses, bodily knowledge, and autoethnography: Unbeknown knowledge from an ICU experience. Qualitative Health Research, 21 (10) June, pp. 1307-1315.

Wall, Sarah S. (2016) Toward a moderate autoethnography. International Journal of Qualitative Methods, 15 (1) October, 1-9.

World Health Organisation (2020) Nursing and midwifery. [Online] Available from: [Accessed 6 May 2020]

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

Wednesday, 6 May 2020

Advancing the nursing profession through the synergy of praxis

Catherine Best

Webmaster for the Phi Mu (All England) Chapter of Sigma

Nursing is both an art and a science (Jasmine, 2009). This understanding precipitates the need for a plethora of teaching and learning approaches that ensures the continued development of nurses who not only, have the ability to advance practice through evidence-based knowledge, but also have the capacity to act with kindness and compassion. This is supported by Renolen and Hjalmhult (2015) who argue that nurses are required to apply evidence-based practice and provide effective patient care based on the best knowledge available. Central to these tenets therefore is the ability to integrate theory and empirical research findings into professional practice.
Nurse education, with its emphasis on fitness to practice is experiencing fundamental change within the UK. This is no more evident than with the newly adopted Nursing and Midwifery Council Standards of Proficiency for Nurse Education (NMC 2018), the aim of which is to develop future healthcare professionals who are sufficiently skilled and knowledgeable to deliver care needs for the 21st Century. In a global healthcare arena where a shortage of healthcare professionals exist, nurses within the UK are being asked to develop new skills that were once considered solely the domain of the physician, (Neiezen and Mathijssen, 2014).

In order to develop these skills and thus build capacity however, the ability to critically reflect and act, a term coined praxis, by Paulo Freire in his work Pedagogy of the Oppressed published in English in 1970, (Freire, 2017) and developed further by Chinn and Kramer, (2018) within professional nursing practice, could be considered a fundamental requirement if nurses are to transcend the often restrictive nature of traditional learning and teaching strategies such as banking, (Freire, 2017). Banking a process through which teachers teach and learners repeat, rather than effectively applying their learning, limits the ability of the learner to reflect and act, for by its very nature it is passive. Learners, therefore need to adopt new ways of learning, such as self-directed learning through which, the capacity to challenge any given situation is increased.

To adopt this model of reflection successfully however, the learner is required to have the aptitude to self-regulate personal learning needs and therefore embrace a self-directed learning style, although essentially some level of guidance such as an inspiring curriculum, is still a necessity (Bodkyn and Stevens 2015).


In order to develop a self-directed or heutagogical approach to developing knowledge; nurses can benefit from adopting a blended style of learning that sees them become active participants in their own professional development. Heutagogy empowers learners to take responsibility for ‘how, what and when they learn’ (Blaschke et al. 2014), examples of which include the use of social media technology (Blaschke, 2014) work-based learning (Nisbet et al. 2013), competency-based learning (Pijl-Zieber et al. 2013) and portfolio development (Ryan, 2011). Blaschke (2012) argues that such an approach to learning is feasible through the development of learning contracts defined by the learner, curriculum or curricula which is flexible, questions, which are learner directed; assessments which are both flexible and negotiated and collective learning. Ultimately, heutagogy is considered a powerful learning strategy - one that provides learners with the means by which, they can learn and grow throughout their lives (Davis, 2018).

By becoming self-directed learners, learners are able to effectively utilise education, undertake research and analysis, increase personal motivation and assertive behaviours (Avdal, 2013) and self-nurture high order thinking skills, an example of which is emancipatory reflection, a process which seeks to transform the way in which nurses construct, confront, deconstruct and reconstruct professional experiences (Taylor, 2010). In order to do this successfully however, requires nurse educators to be aware of how praxis can be integrated successfully, not only into nurse education but also clinical practice.

Educating the Workforce

Nurse educationalists ultimately play a significant role in educating the nursing workforce; others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges integrating praxis into nurse education at all levels can facilitate a collaborative partnership between both the student and educator; essentially learning can become of high quality, promote critical thinking and create a shared social purpose (Bono-Neri, 2019), perhaps more relevant in a world where technology has made sharing knowledge globally relatively trouble-free.

Encouragingly, nurses are now considered to be global nurses, with a role that challenges the impact of social inequality on public health and wellbeing, as evidenced in the Nursing Now Campaign (Crisp, 2017) and yet there continues to be a lack of understanding of the public health role of nurses. Not all nurses have the title of public health nurse, however in reality all nurses should have an understanding of the impact of policies that fosters social injustice; processes which Galtung (1969) called ‘structural violence’ and by their actions seek to reduce the continued inequalities, not only nationally, but globally. Nurses who are able to understand and invoke praxis (Freire, 2017) are invaluable to their professional colleagues, their workplace and the wider economic communities in which they live and work. For if nurses are able to understand the social, political and economic constraints under which healthcare is delivered and social injustice prevails, then by taking one step further from reflection to action, nurses can become the catalyst for fundamental change.


Nursing lecturers play a significant role in educating the nursing workforce, others include, work colleagues, mentors and patients. As diverse opportunities for professional development emerges and time constraints continue to exist, introducing the concept of praxis into nurse education may be deemed challenging, although having a capable workforce of the future may depend upon it.

Understanding praxis therefore can be the force that enables nurses to become independent heutagogical researchers, activists and a force for change. Integrating praxis into nurse education, however will not be easy and the limitation of this work has already become evident as nurses continue to work in challenging, dynamic environments where the emphasis is on the diagnosis, treatment and discharge, only to see many return through a revolving door of the same. Nurses however must begin somewhere. Through my continued research, how nurses achieve this, I hope will become evident.

In order to instigate social reform, nursing as a profession, with its increasing emphasis on global healthcare is in a strong position to continue to promote the development of advanced skills and high order thinking in order to influence future nursing care. It is important however that nurses have the support of leaders, managers and governments to do this. A nurses role is to honour humanity and foster nursing scholarship, (Taylor, 2010) for it is these behaviours along with those associated with praxis (Freire, 2017) that could begin to see the reform that is so badly needed.


Avdal, E.Ü. (2013) ‘The effect of self-directed learning abilities of student nurses on success in Turkey’, Nurse Education Today 33: 838-841.

Blaschke, L.M. (2012) ‘Heutagogy and lifelong learning: A review of heutagogical practice and self-determined learning’, The International Review of Research in Open and Distributed Learning, 13, 1. doi:10.19173/irrodl.v13i1.1076.

Blaschke, L.M. (2014) Using social media to engage and develop the online learner in self-determined learning, Research in Learning Technology, 22: 21635,

Blaschke, L.M. Kenyon, C. and Hase, S. (eds) (2014) Experiences in Self-determined Learning. Createspace Independent Publishing Platform.

Bodkyn, C. and Stevens, F. (2015) Self-directed learning, intrinsic motivation and student performance Caribbean Teaching Scholar, 5, 2: 79–93.
Bono-Neri, F. (2019) Pedagogical Nursing Practice: Redefining nursing practice for the academic nurse educator, Nurse Education in Practice, 37, 105–108.

Chinn, P.L. and Kramer, M.K. (2018) Knowledge Development in Nursing. Theory and Process. St Louis, Missouri: Elsevier.

Crisp, N. (2017) ‘Nursing Now’, n.d. [Online]. Available at (accessed 15 May 2018).

Davis, L. (2018) ‘Heutagogy Explained: Self-Determined Learning in Education’. [Online].

Freire, P. (2017) Pedagogy of the Oppressed. London: Penguin.

Galtung, J. (1969) ‘Violence, Peace, and Peace Research’, Journal of Peace Research, 6, 3: 167-191.

Jasmine, T. (2009) ‘Art, science, or both? Keeping the care in nursing’, Nursing Clinics of North America, 44, 4, 415-21. Doi: 10.1016/j.cnur.2009.07.003.

Niezen, M.G. and Mathijssen, J.J. (2014) Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain, Health Policy, 117, 2, 151-69. Doi: 10.1016/j.healthpol.2014.04.016.

Nisbet, G. Lincoln, M. and Dunn, S. (2013) ‘Informal interprofessional learning: an untapped opportunity for learning and change within the workplace’, Journal of Interprofessional Care, 27, 6, 469-475.

Nursing and Midwifery Council (2018) ‘Future nurse: Standards of Proficiency for registered nurses’, n.d. [Online]. Available at (accessed 1 June 2018).

Nursing and Midwifery Council (2018a) ‘Realising professionalism: standards for education and training’, n.d. [Online]. Available at (accessed 1 June 2018).

Pijl-Zieber, E.M., Barton, S, Konkin, J, Awosoga, O, Caine, V. (2014) Competence and competency-based nursing education: finding our way through the issues, Nurse Education Today, 34, 5, 676-8. Doi: 10.1016/j.nedt.2013.09.007.

Renolen Å, and Hjälmhult E. (2015) Nurses experience of using scientific knowledge in clinical practice: a grounded theory study. Scandinavian Journal of Caring Science, 29, 4: 633-41. doi: 10.1111/scs.1219.

Ryan, M. (2011) ‘Evaluating Portfolio Use as a Tool for Assessment and Professional Development in Graduate Nursing Education’, Journal of Professional Nursing, 27, 2, 84-91.

Taylor, B.J. (2010) Reflective Practice for Healthcare Professionals. 3rd ed. Open University Press: Maidenhead.

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

Tuesday, 14 April 2020

Creating a Culture of Authentic Learning within Nurse Education

Catherine Best


Higher education environments encourage learning through a plethora of systems and structures; such structures define what is taught and how, and therefore ultimately determine the type of knowledge gained (Snowden and Halsall, 2014). Meeting the needs of 21st Century learners however, presents educators with a significant challenge (Iucu and Marin, 2014). For today’s learners are more likely to be motivated by learning new concepts and skills, and being prepared to work in a variety of situations relevant to their professional lives; a process considered external to academia (Iucu and Marin, 2014).

Within contemporary nurse education, in order to correct this problem, adopting a more constructivism approach to learning has been encouraged (Ellis, 2016). This approach enabling learners to effectively engage in knowledge discovery by the ‘working through’ of problems that arise within practice (Ellis, 2016). A process it could be argued encourages authentic learning.

The idea of authentic learning, has emerged as a result of the disconnect that has occurred between real life experience and education and the concern raised as to how this can be remedied Karakaş-Özür and Duman (2019). Within this concept is the importance of an authentic learning strategy, the aim of which is to bring real world themes and learners together. Furthermore, adopting an authentic approach to learning has the potential to motivate learners, with an emphasis now being placed on the importance of self-directed (van Rensburg and Botma 2015) and self-determined or heutagogical learning (Kenyon and Hase, 2013).

Heutagogy, emphasises the importance of how learners prefer to learn, rather than on what is being taught (Kenyon and Hase, 2013). This position affirms Halsall et al. (2016) offers a paradigm for scholarship that harnesses and effectively supports the dynamic and complex notion of self-determined learning; providing an approach to education congruent with the demands of modern-day society.

Self-directed learners are able to identify personal learning needs, develop and implement a structured approach to learning and ultimately become adept in monitoring own progress (van Rensburg and Botma, 2015). Furthermore, self-determined learners are considered to be highly autonomous, the emphasis being on learner capacity and capability; the goal of which is to equip learners for the complexities of latter-day work (Blaschke, 2012).

One way in which nurses can channel professional learning is through reflective practice and portfolio development a key requirement of revalidation (NMC, 2015).

Reflexivity v Reflective Practice

In his work on transformative and reflexive learning, Arvanitis, (2017) argues that modern-day educationalists need to develop a more epistemological approach to learning, one which is based on ‘professional knowing and action’ requiring educationalists to develop a greater reflexive approach.

Definitions abound as to the meaning of reflexivity and is often synonymously used with the term, reflective practice, creating what Archer (2010) calls ‘fuzzy borders’. Reflexivity defined by Archer (2010) is the ability to consider self in relation to social and cultural contexts and vice versa; reflexive internal actions considered the means by which the individual can contemplate their next steps, which in turn has the capacity to allow new knowledge and practices to emerge. Situated within nursing practice reflexivity it could be argued is the process whereby nurses seek to locate themselves within their own professional experiences, and are thus able to effectively learn from them.

Furthermore, today’s business leaders and educational organisations want the inception of educational policies that have the capacity to support the ‘development of broad transferrable skills and knowledge’ and in so doing create a deeper level of learning (Goldman and Pellegrino, 2015).

According to Graham and Johns, (2019) intellectual discourse extols the importance of reflection as being a learning strategy, by which professional practice can be improved. Such strategies they argue, emphasise the importance of reflective practice. Through such strategies, reflection can be considered a purposeful learning tool enabling the practitioner to look beyond their experience and in so doing gain useful insight into the way in which things can be done better using directed future development (Graham and Johns 2019).

Furthermore, reflective practice argues Chinn and Kramer, (2018) is a process that leads to an understanding about the rationale of one’s own actions and in so doing has the potential to improve one’s practice and ‘contribute to personal growth’.

It could be argued therefore that reflection with its emphasis on real life experiences and ‘guided future development’ is indeed a true expression of authentic learning.


Situated within modern-day educational systems is a diverse range of educational theories, curricula design, education programmes and teaching strategies (Crawford, 2019). In order to effectively research these increasingly complex issues requires an equally diverse range of methodologies that have the capacity to contribute to such research (Crawford, 2019). This may present a particular challenge to educationalists as they continue to weather the storm of student expectations, university policies and government expectations.

Kelsey and Hayes (2015) in their work on reflective practice, postulate words of encouragement. In order to meet the expanding demands placed upon nurse education, the increasing expectations of learners and the growing needs of an expanding global society, nurse educationalists who understand the importance of learners ‘learning how to learn’ have the potential, through their actions, to build a workforce that takes responsibility for its development and in so doing can change the future of nurse education for the better.


Archer, M.S. (2010). Introduction: The reflexive re-turn. In Archer, M.S. ed. Conversations about reflexivity. London: Routledge, pp. 1-14.

Arvanitis, E. (2017) Preservice teacher education: Towards a transformative and reflexive learning Global Studies of Childhood pp. 1–17.

Blaschke, L.M. (2012) Heutagogy and Lifelong Learning: A Review of Heutagogical Practice and Self-Determined Learning. Accessed 23 March 2018.

Chinn, P.L. and Kramer, M.K. (2018) Knowledge Development in Nursing. Theory and Process. 10th ed. St Louis, Missouri: Elsevier.

Crawford, R. (2019) Using Interpretative Phenomenological Analysis in music education research: An authentic analysis system for investigating authentic learning and teaching practice. International Journal of Music Education 37(3) pp. 454–475

Ellis, D.M. (2016) The role of nurse educators' self-perception and beliefs in the use of learner-centered teaching in the classroom. Nurse Education in Practice, 16 pp.66-70. http://dx.

Goldman, S. and Pellegrino, J. (2015) Research on learning and instruction: Implications for curriculum, instruction, and assessment. Policy Insights from the Behavioral and Brain Sciences, 2(1), 33–41.

Graham, M.M. and Johns, C. (2019) Becoming student kind: A nurse educator′s reflexive narrative inquiry. Nurse Education in Practice, 39 pp. 111-116

Halsall, J.P. Powell, J.L. and Snowden M. (2016) Determined learning approach: Implications of heutagogy society based learning. Cogent Social Sciences 2 (1) pp. 1-11

Iucu R.B. and Marin, E. (2014) Authentic Learning in Adult Education. Procedia - Social and Behavioral Sciences, 142 pp. 410-415.

Karakaş-Özür, N. and Duman, N. (2019) The Trends in Authentic Learning Studies and the Role of Authentic Learning in Geography Education International Education Studies, 12 (12) pp. 28-42

Kelsey, C. and Hayes, S (2015) Frameworks and Models Problematising Reflective Practice. Nurse Education in Practice 15 (6), 393-396.

Kenyon C and Hase, S (2013) Heutagogy Fundamentals. In: Hase, S and Kenyon C. (editors). Self-determined Learning. Heutagogy in action. London: Bloomsbury, 7-38.

Nursing and Midwifery Council (2015) Revalidation How to revalidate with the NMC Requirements for renewing your registration. London: NMC.

Snowden, M and Halsall, J. (2014) Community Development: A Shift in Thinking Towards Heutagogy. International Journal of Multi-Disciplinary Comparative Studies 1 (3), pp. 81­91

Van Rensburg, G.H. and Botma, Y. (2015) Bridging the gap between self-directed learning of nurse educators and effective student support. Curationis 38 (2), pp.1-7 doi:10.4102/curationis.v38i2.1503

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

Information about the COVID-19 pandemic in northern Italy: the experience of the A&E in Alessandria, Piedmont.

T.Bolgeo1  M-Bertolotti2 M.Betti3  A.Roveta4 A.Maconi5

1. Head of the Research Unit of the Health Professions RN, MSc, PhD ( stud) Infrastructure Research, Training and Innovation Hospital A.O. SS Antonio and Biagio Alessandria, Italy, EU.
2. Epidemiology biologist Clinical Trial Centre Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio Alessandria – Italy, EU.
3. PhD Clinical Study Coordinator Clinical Trial Centre Infrastructure Research, Training and Innovation AO SS. Antonio and Biagio Alessandria – Italy, EU.
4. Biologist Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio of Alessandria – Italy, EU.
5. Responsible manager Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio of Alessandria – Italy, EU.

On 22 February, the first COVID-19 case was diagnosed in Piedmont. The total number of deaths involving COVID-19 in Piedmont as of 7 April 2020 was 1417 (267 Alessandria; 72 Asti, 96 Biella, 100 Cuneo, 145 Novara, 572 Turin, 73 Vercelli, 68 Verbano-Cusio-Ossola, 24 resident from other regions but died in Piedmont).

COVID-19 recovery trend in Piedmont: in recovery 834, recovered 732. There are currently 423 patients in intensive care. The number of diagnostic swabs performed so far are 51,311 of which 28,236 gave negative results. The Italian crude mortality average is 4 per 10,000. In Piedmont it is lower (3 per 10,000).

On 27 February 2020, the Ministry of Health issued a document prepared by the Superior Council of Health which gave guidance on the criteria for subjecting people to examination for the SARS-CoV-2 infection (Shah & Farrow, 2020). The document indicated the use of swaps only for symptomatic cases, stating that the test in the absence of symptoms does not appear to be supported by scientific rationality, and does not provide indicative information for clinical purposes, indeed it can be misleading. According to the Superior Council of Health, the literature data reports a share of false negatives in the first phase of the disease in excess of 15%.

Since the beginning of the epidemic, public health measures put in place to contain infection (suspected patient isolation, contact tracing) have been instigated on ‘suspicion of infection’, before testing and the availability of the results to prevent the timing of diagnostic analysis and false results from impacting on the spread of the infection data.

The Hospital Company "SS. Antonio and Biagio and Cesare Arrigo" of Alessandria, part of the Health System of the Piedmont Region, has been recognized as a reference Hub Hospital, home to the II level DEA, within the hospital network related to the South East Piedmont Area that includes the provinces of Asti and Alessandria, with a reference population of about 650,000 inhabitants.

Alessandria hospital works in close contact with the Piedmont Region Crisis Unit, to promptly reorganise the users services and rapidly adapt them to the evolving situation. A COVID-19 emergency management business crisis unit has been set up to meet twice a day to take operational decisions that are important to contain and manage the COVID-19 emergency in both the short and long term.(Remuzzi & Remuzzi, 2020)

Reception places have been created for suspected COVID-19 cases where triage is carried out. Inpatient wards have been redefined into COVID-19 and non COVID-19 wards. All scheduled non-urgent outpatient services have been suspended. For non-deferable visits, patients are pre-triaged in front of each clinic. Pre-triage involves a short interview and in cases of cough, cold or fever the patient is handed a surgical mask.

Oncology and haematological therapies, including clinics, remained active. These include: Blood and biopsy testing at the Gardella Testing Point, TAO testing, Post-surgical medications, Check-ups and post-discharge evaluation, Scheduled visits and check-ups for pregnant women, Dialysis, Direct distribution of drugs in hospitals and dedicated clinics. Blood donations; Visits for expiring driving licence renewal and visits and administration of drugs for various disciplines.

In addition, on the recommendation of the DPCM of 8 March 2020, patient carers are prohibited from staying in the waiting rooms of emergency departments (DEA/A&E). Only one person per patient is permitted to visit at a time - who does not have respiratory symptoms (cold, cough, etc.) or fever. Before entering the room, they are asked to use the gel placed at the entrance of the inpatient rooms. Visitors are advised to avoid contact with potentially contaminated surfaces and furnishings (furniture, handles, bed straps, etc.).

Following the guidance provided by the Crisis Unit, the Directorate General regulates the way relatives, visitors and carers enter as follows:

· Two check points managed by the nursing service have been set up, where body temperature is detected for both employees and visitors and patients and antiseptic hand gel is provided.

· In order to cope with the emergency, doctors (11), nurses (30), other professional operators (32).

· Emergency facilities have been implemented and training courses have been activated for their proper use (Figure 1).

· The Psychology professionals of Alessandria Hospital have activated a psychological emergency service for citizens and health professionals subjected to extraordinary stress due to coronavirus and its consequences on the individual and on relations with the community.

· In addition, within Alessandria Hospital we operate an Innovation Training Research Infrastructure (IRFI) that promotes, organises and coordinates the research and training activities of operators, according to the models highlighted by publications.

· The IRFI consists of the following areas: Clinical Trial Centre - Grant Office, Documentation Centre - Biomedical Library, Communication and Scientific Disclosure, Administrative Coordination, Training, UVT-HTA Units, Research Unit for Health Professions.

· Each sector works with professionals on a daily basis to manage the COVID-19 emergency in collaboration with the crisis unit.

· Hospitals have been identified for COVID patients and other hospitals that accept patients discharged from other centres, but not yet fully recovered.

Figure 1

References .

Remuzzi, A., & Remuzzi, G. (2020). COVID-19 and Italy: what next? Lancet, 395(10231), 1225-1228. doi: 10.1016/s0140-6736(20)30627-9

Shah, S. G. S., & Farrow, A. (2020). A commentary on "World Health Organization declares global emergency: A review of the 2019 novel Coronavirus (COVID-19)". Int J Surg, 76, 128-129. doi: 10.1016/j.ijsu.2020.03.001

National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management

Emanuele Nicastri, Nicola Petrosillo, Tommaso Ascoli Bartoli, Luciana Lepore, Annalisa Mondi, Fabrizio Palmieri, Gianpiero D'Offizi, Luisa Marchioni, Silvia Murachelli, Giuseppe Ippolito, Andrea Antinori, for the INMI COVID-19 Treatment Group (ICOTREG) Infect Dis Rep. 2020 Feb 25; 12(1): 8543. Published online 2020 Mar 16. doi: 10.4081/idr. 2020.8543

Rapid response to COVID-19 outbreak in Northern Italy: how to convert a classic infectious disease ward into a COVID-19 response centre E. Asperges, S. Novati, A. Muzzi, S. Biscarini, M. Sciarra, M. Lupi, M. Sambo, I. Gallazzi, M. Peverini, P. Lago, F. Mojoli, S. Perlini, R. Bruno, COVID-19 IRCCS San Matteo Pavia Task Force J Hosp Infect. 2020 Mar 20 doi: 10.1016/j.jhin. 2020.03.020 [Epub ahead of print]

Sunday, 12 April 2020

Covid-19 and the nursing response

Roger Watson, Editor-in-Chief

Covid-19 is infecting thousands of people, including nurses and doctors, and killing some of these. The crisis has shown that the United Kingdom National Health Service (NHS) may not have enough nurses to cope. Also, nursing students are being badly affected by this as their nursing education is going to be affected for several months and this will affect their ability to qualify and practice as nurses.

Rumours have spread that many retired nurses will be brought back into practice and that these will not be safe to practice in the health service. Another rumour is that final year nursing students will be ‘fast-tracked’ to qualification and will, also, not be safe to practice. Strictly speaking neither of these is true. I wish to clarify what the situation is.

In the United Kingdom, nursing is regulated by the Nursing and Midwifery Council (NMC). When nurses qualify, they must have passed their final year university examinations and have spent at least 50% of their programme in clinical practice. Then they become Registered Nurses. This means that their names are recorded on the Nursing Register held by the NMC. Nurses who are already registered must continue to meet high standards of practice and continuing education or they can be removed from the register.

In the present crisis the NMC has taken two actions:

Returning retired nurses to the wards
The NMC has created a Covid-19 temporary register and only nurses who have retired within the past three years will be eligible to join this register. These nurses will not have to pay to join this register, but they will have to meet all the standards expected by the NMC. These nurses will only be on the register for as long as they are needed to help with the Covid-19 crisis. Having only left practice in the past three years and, mostly being very experienced, they should quickly fit in an regain their skills. They will have to get up to date with some recent legislation affecting the NHS such as data protection and safeguarding. They will also have to be up to date on observation skills for patients and resuscitation.  These will include ‘early warning’ so that they can spot patients whose condition is likely to get worse and who will need intensive care.

Nursing student education and training
For nursing students the NMC has instructed universities to suspend clinical practice for first year nursing students. They will make up for this in the next two years of their university programme. If first year nursing students wish to work on the wards to help with the Covid-19 crisis then they may do so at their own risk. The time they spend on the wards will not count towards their nursing education and registration.

All other students will spend 80% of their time in clinical practice and 20% in education. At the time of writing, with universities closed to students, the education will be delivered online. Universities will be given more flexibility over where final year nursing students practice in their final six months to make sure that they are able to qualify safely.

The role of Universities
To make all this happen, universities are central to the process. They have had to make enormous changes to the way they deliver education to all students, including nursing students. Students, like nursing students and medical students who must spend time with patients, pose an extra challenge. University nursing departments are already making huge changes to their programmes and timetables to make these new arrangements work. They are also working out how to support nursing students working on the wards in hospitals. University nursing departments are responsible, along with the NHS, in making sure that those nurses being admitted to the Covid-19 temporary register are properly prepared to look after patients safely.

The present situation has shown how important nurses are in the NHS and at this time. The NMC, the NHS and the universities are working closely to ensure that the number of nurses will increase, that nursing students will be able to register and that patients will be looked after safely.

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

Friday, 10 April 2020

Problems with current UK government lockdown policy

Kevin Corbett, UK
Independent Research Consultant

David Crowe, Canada


1. There might be a real increase in cases but there is form of categorization occurring in the NHS where deaths with the non-specific symptoms of SARS-CoV-2 (the presumed viral agent)(Covid19 is the disease) are being attributed to SARS-CoV-2 without serological or laboratory (tissue culture) confirmation. Are autopsies being undertaken on all the deceased? SARS-CoV-2/Covid19 is not like Ebola or the Hantavirus and has not been categorized by the Government as a ‘Highly Contagious Infectious Disease’ (HCID). This peculiar categorization of non-specific cases being due to SARS-CoV-2 will act to confound the epidemiological picture by inflating the actual numbers of illness due to SARS-CoV-2.

2. This picture of people with a ‘new’ condition is relatively smaller in the context of annual winter deaths from flu and pneumonia (which in no way discounts the awfulness of any of these deaths). For example, see the Government’s statistics from the flu epidemic 2018/19 (attached). In 2018/19 there were 1,692 deaths attributed to flu and many more for pneumoniae. By comparison, what is being described by the Government and all of the media as an ‘epidemic’ or a ‘pandemic’ fails to reach the proportions of last year’s flu epidemic where 1,692 people died (according to the Government) with many more deaths attributed to pneumoniae. Therefore in 2018/19 we could expect around 25,000-30,000 deaths from flu/pneumonia without the same ‘pandemic’ label. This lack of any relative comparison with 2018/19 by either the government or the media isolates the current events from those which occurred last year, and thereby solidifies in the public psyche the frightening idea that a huge epidemic is now happening.

3. The tests for Covid19 are not yet calibrated to different populations like those without symptoms. ‘Died after testing positive for Covid19’ (what we hear daily in the media) is not the same as ‘died due to Covid19’ which is an evidence-based statement of disease causation. Tests are giving false positive and false negative readings, where people’s symptoms are being falsely attributed to Covid19 and where those without any symptoms are being falsely told they have Covid19. Test manufacturer data sheets warn about this fact of medical test technology and public health authorities in different jurisdictions are charged with advising on the calibration of these tests for the different populations in which they are to be used. This explains why only hospital patients are being tested and why there is a delay in rolling out tests (e.g. antibody tests) to the wider population which has understandably become extremely worried about Covid19 through Government messages. The lack of calibration of these tests will add to the number of Covid19 positives, further bolstering a perception of a disease out of control.

4. The NHS has consistently and continually been telling sick people via NHS 111 - as well as in high profile advertising in billboards, TV and radio etc. - to self-isolate and not to attend their usual health services when they have a set of generic non-Covid19 specific symptoms. This list of symptoms can apply to literally hundreds of different diseases and illnesses. Who doesn’t have a cough or runny nose living in our heavily polluted capital? This reduction and now virtual closure of primary care GP services in London has been gaining momentum since February. This may have been effective in causing people to let their illnesses/symptoms advance and thus when they finally show up at A&E they are in a much worse and fulminating condition. The Government advice therefore may be helping to create some of the dire clinical status that is being experienced in A&E departments with patients presenting in acute respiratory distress syndrome (ARDS).

5. Healthcare practice in hospital to lessen the perceived risk of Covid19 transmission via aerosolized contaminants discounts treating hypoxia in patients presenting with cough and fever with non-invasive ventilation (NIV) based on some limited evidence of Covid19 existing on surfaces, in favour of intubation and ventilation (possibly irrespective of clinical need), which may also help to explain the reported increased use of the existing critical care capacity. This situation is further exacerbated by the lack of personal protective equipment (PPE) and the necessary hardware, like ventilators, and workforce such as suitably trained critical care nurses and doctors, all of which have been negatively impacted in the last 12 years by Government austerity policies.

6. The current lockdown picture can be clouded by the ‘fog of war’ (meaning: the uncertainty in our current situation of lockdown due to a perceived threat to the public health). Healthcare staff will see cases as more serious through the ‘lens’ of a positive SARS-CoV-2 test and given the widespread awareness that there is something ‘out there’ that is officially perceived as ‘dangerous’ to everyone. Every presenting clinical picture in a patient will be attributed to the agency of SARS-CoV-2 when a test result is returned as positive. This will act to further inflate the statistics on Covid19 deaths and further bolster the perception of an epidemic which is getting out of control.

7. Many patients are being enrolled in clinical trials of antiviral, rheumatoid arthritis and malaria drugs around the world, although no drugs have been tested on more than a handful of SARS-CoV-2 patients, if any. This may be encouraged by doctors who are desperate to find a ‘silver bullet’, and obviously by pharmaceutical companies who are racing to get drugs approved for Covid19. However, it is not clear that it is possible to obtain informed consent from elderly patients with pre-existing health conditions, particularly those on ventilators, who may not realize that the probability of benefits is unknown, and the probability of side effects is very real. Furthermore, the trials will almost certainly not be double-blinded, randomized, placebo-controlled trials, so the data will be of limited use.

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

Coronavirus outbreak: A turning point in nursing education

1. Assistant professor of nursing, Department of Nursing, Necmettin Erbakan University, Konya, Turkey.

2. Professor of nursing, Department of Nursing, Necmettin Erbakan University, Konya, Turkey.


We are a faculty member of nursing and are writing to you to raise the issue of current nursing education and put forward some solutions for this issue. The epidemic of the Coronavirus in the world in 2020 was a shock to educational systems in some countries in the world which cause a cessation in education. During this period the managers, faculties, and students fully comprehend the importance of distance education and the necessity of incorporating information technology in the educational curriculum. There is a popular fable about a penguin colony quoted by Kotter and Rath­geber in 2006. This penguin colony lived on an iceberg in Antarctica area for several years. But when they identified the problematic symptom of the iceberg, they eventually realized that the environment had changed and it is a need to modify and change how they lived (Murray, 2018).

The current health care system is dynamic and rapidly changing in line with modern technological breakthroughs. To keep pace with these trends, the nursing profession has to be vigilant and incorporate appropriate technologies, especially in educational settings (Nwozichi, Marcial, Farotimi, Escabarte, & Madu, 2019). The nurses of 2025 will most certainly work in a very different environment than what we work today and these trends require a shift in how we educate future generations for the nursing profession (Risling, 2017). We have to stop educating tomorrow’s nurses for yesterday’s jobs; now and tomorrow we are in an unceasing change; thus, con­tinuous adaptation is needed. We have to fully realize that tomorrow’s grad­uates will require a special arts background and have to contribute to soci­ety much more meaningfully by therapeutic re­lationship and creativity and give the mechanized responsibilities to the robots. If we continue to teach as we have done now, we will have to face and struggle with infrastructure shortage and global crises such as war, weather prolusion, and infectious diseases such as Coronavirus (Murray, 2018). So, curricular revisions are required to educate nurses to meet the challenges of the 21st-century (Tellez, 2012), (Darvish, Bahramnezhad, Keyhanian, & Navidhamidi, 2014), (Hunter, McGonigle, & Hebda, 2013) (Ainsley & Brown, 2009Krau, 2015).

These issues are not insurmountable provided that appropriate measures are adopted. Undoubtedly, the most effective way to iron out them is faculty engagement. To have faculty involved in this process adequately, managers should allocate a substantial amount of time, energy and resources to release time and compensate for those who participate in curricular revision. The faculty should receive training to become familiarized to effectively review the curricula (Tellez, 2012) (TOPAZ et al., 2016). Furthermore, they should try to create an atmosphere to promote students’ positive caring attitude and a love of learning for being informed and staying up-to-date on strategies to improve professional practice (Ainsley & Brown, 2009).

In addition to faculty engagement, preparing the atmosphere of the clinical setting cannot be denied. For the clinical setting, it is recommended that information technology become a requirement for all nurses to improve the quality of care. Creating some roles such as Chief Nursing Information Officers or other types of field informatics specialists at organizational or country levels is a good approach. For successful implementation, increasing awareness of information technology relevance and the representation of it at leadership, organizational, and policy levels is a prerequisite. One solution for acceptance is creating a clear relationship between nursing data and health outcomes and improved decision making by nurses in systems (TOPAZ et al., 2016).

Another challenge facing the integration of information technology in nursing education is the lack of support from administration and government. It is therefore recommended that governments should provide sufficient support for the integration of information technology in the various nursing institutions (Nwozichi et al., 2019). Deans of nursing programs were encouraged to create opportunities for faculty to develop the skills and knowledge necessary to teach nursing informatics, to provide the resources for infrastructure (Tellez, 2012). Creating more funding opportunities for information technology research at a government and other levels is highly recommended and existing research funding institutions should allocate information technology specific funds (TOPAZ et al., 2016). Increase multi-disciplinary collaboration and combine resources at the international level, among various nursing organizations, and integrate collaborative and multidisciplinary approaches is a foundation in this trend (Tellez, 2012) (Madsen, Cummings, & M., 2015) (Button, Harrington, & Belan, 2014).

In conclusion, we should assign a high priority to incorporate information technology into the nursing curriculum. A combination of different solutions such as faculty engagement, preparing the clinical atmosphere, and management support would definitely produce more desirable results. As the situation is serious, I request you to highlight it through your journal so that the authorities are sensitized towards it and do the needful. Thank you for allowing us to express our opinion.


Ainsley, B., & Brown, A. (2009). The impact of informatics on nursing education: a review of the literature. J Contin Educ Nurs, 40(5), 228-232. doi: 10.3928/00220124-20090422-02

Button, D., Harrington, A., & Belan, I. (2014). E-learning & information communication technology (ICT) in nursing education: A review of the literature. Nurse Educ Today, 34(10), 1311-1323. doi: 10.1016/j.nedt.2013.05.002

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics on promoting quality of health care and the need for appropriate education. Glob J Health Sci, 6(6), 11-18. doi: 10.5539/gjhs.v6n6p11

Hunter, K., McGonigle, D., & Hebda, T. (2013). The integration of informatics content in baccalaureate and graduate nursing education: a status report. Nurse Educ, 38(3), 110-113. doi: 10.1097/NNE.0b013e31828dc292

Krau, S. D. (2015). The influence of technology in nursing education. Nurs Clin North Am, 50(2), 379-387. doi: 10.1016/j.cnur.2015.02.002

Madsen, I. , Cummings, E. , & M., Borycki. (2015). Current Status for Teaching Nursing Informatics in Denmark, Canada, and Australia. Stud Health Technol Inform, 216, 1016-.

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