Home / Arsip Untuk 2016

Selasa, 05 Juli 2016

Graduate nurses save more lives

Komentar
Roger Watson, Editor-in-Chief

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

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

You can listen to this as a podcast

Reference

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


Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, Spandorano F, Icardi G, Watson R, Sermeus W (2015) RN4CAST@IT: why is it important for Italy to take part in the RN4CATS project? Journal of Advanced Nursing doi: 10.1111/jan.12709
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Rabu, 29 Juni 2016

Nursing in the year AD 2000*

Komentar
Roger Watson, Editor-in-Chief

When I was very young - and even in 1975 when the lecture by Peggy Nuttall on which the paper is based was delivered - the year AD 2000 was one when we would have solved most of the problems of humanity; cars would fly and we would be able to communicate by speaking to our wristwatch. The 'crisis' in the UK National Health Service (NHS) referred to by Nuttall would no longer be an issue as economic and social progress would be such that we could look back over 25 years and laugh at our ignorance.  Well, how wrong was that assessment?  In fact, of the three things mentoined above only one has been achieved: we can speak to people via our wristwatches!  But the NHS remains in crisis and cars seem to be as dependent on tarmacadam roads as they were then.  I learned a great deal from Look and Learn magazine but I think it raised my hopes too much.

I urge you to read this excellent and prescient piece and tick off the issues which Nuttall identifies will be relevant in AD 2000: chronic ill-health; immigration; primary healthcare; retention of nurses in the workforce; the effect of night-shift working on nurses.  All of these are issues now and, while she did not refer to non-communicable diseases or global health, you feel that she could see how these would be issues in the next century.  She also points to the internal strife in nursing, that was evident then and it is evident now.

I think that this JAN classic paper from the first volume indicates the quality of some of our nursing leaders at this time, to whom we probably owe the survival of and the progress made by our profession.  It also demonstrates the vision of Founding Editor Dr James P Smith who ensured that JAN was reflecting the very best thinking about the situation of and the future of nursing; in this case 25 years on.

You can listen to this as a podcast


Reference

Nuttal P (1976) Nursing in the year AD 2000 Journal of Advanced Nursing 1, 101-110

* Peggy Nuttall was Vice Chairman, Royal College of Nursing, London and this was an address, the First Battersea Memorial Lecture, on 7 November 1975 to the Association of Integrated and Degree Courses in Nursing
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Selasa, 28 Juni 2016

Are nursing students imposters?

Komentar
Roger Watson, Editor-in-Chief

I recall, having been deemed fit to manage the ward, having the keys to the ward slid along the floor to me by the charge nurse as she was going off the ward to dinner and her saying 'you're in charge'; I was a final year student nurse and it was my first time and - yes - I felt like an imposter.  Surely someone else should be doing this and not me.

This article from New Zealand, Australia and the UK by Christensen et al. (2016) titled: 'Do nursing students experience Imposter Phenomenon? An international comparison of final year undergraduate nursing students' readiness for registration' and published in JAN looks at the Imposter Phenomenon in nursing students.  The aim of the study was 'to examine the extent at which imposter phenomenon is evident in four final year nursing student cohorts in Australia, New Zealand and the UK.'  Over 200 final year nursing students were invovled and completed two questionnaires: one about preparedness to work as a nurse; and one about fear of not being able to perform properly.  The results suggest that 38.5% of the sample could be classifed as 'imposters'.  While the reasons for imposter feelings were not clear the authors conclude: 'nursing students report internalized feelings which suggest their performance and competence once qualified may be compromised' and 'it is recommended that educational programmes designed for this student cohort should be mindful of this internal conflict.'

You can listen to this as a podcast


Reference

CHRISTENSEN M., AUBEELUCK A., FERGUSSON D., CRAFT J., KNIGHT J., WIRIHANA L. & STUPPLE E. (2016) Do nursing students experience Imposter Phenomenon? An international comparison of final year undergraduate nursing students' readiness for registration. Journal of Advanced Nursing doi:10.1111/jan.13034
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Minggu, 26 Juni 2016

Contemplations on the Tasks of Motherhood: 1976 - 2016

Komentar
Rita H. Pickler, Editor

In the first volume of the Journal of Advanced Nursing, author, researcher, theorist, and educator Reva Rubin wrote:
Pregnancy is more than a period of gestation, growth and development of the fetus…Pregnancy is also a period of identity reformulation, a period of reordering interpersonal relationships and interpersonal space, and a period of personality maturation (Rubin 1976).
Still true.

Rubin, whose work often seems overshadowed by that of her student, mentee, and fellow theorist, Ramona Mercer (i.e. Mercer & Ferketich 1990), introduced the concept of Maternal Role Attainment in the late 1960’s. She described the maternal role as a complex cognitive and social process that is learned, reciprocal, and interactive. Rubin developed her theory through a series of case studies over her many years as nurse and teacher. She observed how mothers used their senses to become familiar with their infants. She was an early proponent of “rooming-in” and other strategies to keep mother and baby together after birth. As a nursing student in the 1970’s, I remember reading, discussing, and applying Rubin’s work to my clinical practice.

But times change and theories, and ideas, go out of style and use. And in fact, much has changed about what we know happens physically, psychologically, and socially to women during pregnancy. We know much more than we did about how a woman’s well-being affects the fetus and her child. We know that what happens during pregnancy, and even before pregnancy, can have long-lasting effects on both mother and child.

Poor pregnancy outcomes throughout the world continue to exact a toll in terms of prematurity, congenital illness, and lifelong risk for poor health. So, we might be wise to rethink Rubin’s “tasks” as important to the repertoire a pregnant woman needs in order to traverse the gap to motherhood. As a nurse long interested in promoting healthy birth outcomes, this re-reading of Rubin’s paper from 30 years ago has given me fresh ideas about ways to facilitate the work of maternal role attainment. For although the language and yes, some of the ideas need refreshing, most certainly the general notion that promoting maternal health and well-being will lead to improved health and well-being for the world’s children will never be out of style.


References

Mercer, R.T, & Ferketch. (1990) Predictors of parental attachment during early parenthood.
Journal of Advanced Nursing, 15, 268–280, DOI: 10.1111/j.1365-2648.1990.tb01813.x

Rubin, R., (1976) Maternal tasks in pregnancy. Journal of Advanced Nursing, 1, 367-376.



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Rabu, 22 Juni 2016

It's not only patients who suffer in emergency care

Komentar
Roger Watson, Editor-in-Chief

When I first read the title of this article when it arrived in manuscript form I assumed it referred to patients but then realised it referred to nurses and the effect that working in emergency care can have on them.  And it makes sense.  I always consider emergency nurses as a relatively robust bunch.  I have to confess - as a nurse who formerly and exclusively worked with older people - that emergency care never appealed to me and my very brief encounters with it as a student and in the army left me a quivering wreck...and nothing even happened.  Imagine if it had.

This article from Scotland by Morrison and Joy (2016) titled: 'Secondary traumatic stress in the emergency department' and published in JAN aimed to 'To investigate the prevalence of secondary traumatic stress among emergency nurses in the West of Scotland and explore their experiences of this.'  It used quantitaive and qualitative methods and studies 80 nurses in 4 hospitals.

The results are alarming in that 75% of nurses reported recently at least one secondary traumatic stress (STS) symptom and 39% could be classified as suffering from STS.  The work shows some similarrity and some differences from previous work on the same phenomenon in the USA.  Acknowledging some limitations of their work, the authors conclude: 'Further research is required to corroborate these results and findings and develop the evidence base further, with particular regard to the effects of STS among Emergency nurses of differing levels of experience and the impact of this on the provision of quality patient care.'

You can listen to this as a podcast

References

MORRISON L.E. & JOY J.P. (2016) Secondary traumatic stress in the emergency department Journal of Advanced Nursing doi: 1 10.1111/jan.13030
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Selasa, 14 Juni 2016

World Sickle Cell Day

Komentar
Roger Watson, Editor-in-Chief

According to the US National Heart, Lung and Blood Institute: 'The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal haemoglobin, called haemoglobin S or sickle haemoglobin, in their red blood cells.' Sickle cell disorder leads to crises whereby the small blood vessels in the body become occluded leading to extreme pain in several areas of the body. Such crises require hospitalisation. While understanding of the condition and treatment has improved, sickle cell disorder is life-limiting and in some parts of the world is an economic and family burden.

The condition is unequally distributed geographically with populations of sub-Saharan and African origins being affected more commonly. In some communities, due to the recessive nature of the gene for sickle cell disorder, consanguineous (mainly cousin) marriage is responsible for the prevalence of the disorder.

World Sickle Cell Day is on 19 June and JAN is marking this with a Special Section on sickle cell disorders. These six articles were published in the June issue and covered in an editorial by Diana Wilkie, University of Florida USA.



You can listen to this entry as podcast.
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Rabu, 08 Juni 2016

Lands End & Gloria Steinem: So What’s the Big Deal?

Lands End & Gloria Steinem: So What’s the Big Deal?

Komentar
The Vice Chairperson of UHPP's Board of Directors, Jill Rafferty-Weinisch, has written a scathing dissertation of Lands End's resent goof regarding Gloria Steinem.

For those of you who may not have heard, Lands End decided to feature a different "icon" every season to appear as a model on their website and in their catalogs.  Gloria Steinem is a prominent American feminist, activist, and author.  She appeared as the first guest in the icon series.  Pretty great, right?  Or maybe not for some.

Some anti-feminist and anti-choice people protested the selection of Steinem as an icon, and threatened boycotts.  Lands End caved, and pulled the feature.

Jill goes on to describe the backlash:
"The response to the apology has been fierce, and although there is no way for me to gauge whether the company has lost more customers because of the original article or the ensuing backlash, damage to their reputation is assured. The company’s liberal “if you’re not satisfied for any reason” policy is leading to mass returns. Their Facebook page has become a rallying point for angry women feeling their trust (and consumer dollars) have been betrayed.
Women and girls are routinely socialized that their rights are acceptable – as long as they do not offend or make anyone else uncomfortable. Our existence is regularly constrained by the possibility we might make someone feel bad, or horny, or angry, or threatened. It has broad and sweeping ramifications in terms of violence against women, educational attainment, workplace equity, the provision of medical care, basic bodily autonomy… virtually every part of our lives."
Read her full blog here.

What Jill doesn't tell you in her blog, is that she gathered up every single article of Lands End clothing she had, no matter how old it was, and returned it. She was a big fan of their stuff, and had accumulated quite a bit of it over the years.  True to their policy, they refunded her every cent; over $2000 worth.

Do you have Lands End clothing in your home?  Are you unhappy with their decision to remove Steinem from their website and materials?  If so, you can do something about it.  Take a stand!

#bringbackgloria
https://www.facebook.com/bringbackgloria/
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Rabu, 01 Juni 2016

The Ongoing-Yet-Completely-Curable Epidemic

Komentar



By Youth Health Promoter Omiyea Stanford


Omiyea Stanford
Did you know that one out of every four teens becomes pregnant at least once before age 20? Did you know that despite a dramatic decline in teen birth rates and teen pregnancy, the United States still has one of the highest teen birth and pregnancy rates in the industrialized world? Do you know why? Well there are a mess load of reasons, but, a lack evidence-based sex education plays a huge part. Discuss, dissect, and digress? Yes we shall.

A lack of Evidence Based Programming (EBP), is an enormous part of the problem. Abstinence Only Education (AOE), EBP’s bitter enemy and arch nemesis that just won't die, is still used in classrooms across the country. There are so many reasons why AOE programming doesn’t work, including its misogynistic foundations and messages, idealism of heterosexual marriage, sex and gender bias and oppression, lack of consistency in teaching even the most basic aspects of sexual health like anatomy and reproduction, and lack of regulation of information accuracy and bias. However, one of the most prominent problems, is that it is just plain unrealistic! It’s not enough to offer one solution, especially one where the only answer is to do nothing, which is completely impractical and futile. Sex and sexual stimulation are basic human wants and needs, and AOE teachings disregard and create shame around that fact. AOE teachings leave students who become sexually active as teens with zero knowledge of how to protect themselves. EBP, however, works a little bit differently. Ok, actually, it works a lot differently. 

Evidence Based Programming (EBP) teaches that abstinence is an option, but not the only option. EBP prepares students for any path they choose by providing them with accurate, inclusive, and unbiased information that spans every aspect of sexual health, sexual safety and responsibility, and even the aspects of healthy relationships. Despite the facts indicating that EBP is effective in reducing teen pregnancy and STD/HIV rates, it is still is meet with googolplexes of opposition. A common critique, is that if you teach kids about sex, then they will be more likely to have sex. My reply is, "and?"  Firstly, EBP obviously doesn't encourage and teach kids how to have sex. It teaches them what sex is, and how to be safe if/when they have it. Come on people, that one was a given. Secondly, why do adults feel like it is their solemn duty to keep teens from being sexually active? That’s half of the problem in the nutshell! Teens having sex isn’t the issue! That isn’t what we should be trying our very hardest to prevent. It’s ignorance! This urge in adults to stop teens from becoming sexually active is more about keeping teens “innocent” then it is about keeping them safe. Leave them in the dark and hurl a “just don’t do it” at them every time sex comes up, and I guarantee you they’ll be defenseless. Make sure that they are given the information they need about all the aspects of sexual health, and they will have the ability to make informed, safe and healthy decisions about their own sexual health based on what they want for themselves. Sounds like EBP is our cure-all right? Well, not exactly. There is still something vital to sexual health education that is missing from even the EBP curriculum. And what is that? Pleasure and sex positivity! 

Obviously sex isn’t just about reproduction. If it was we’d barely do it, and we’d probably have a lot less humans on earth than we currently do. Humans are one of the very few species of animals on earth that have sex for fun. If this is true, then why is it that pleasure and sex positivity are missing from EBP curricula in our classrooms? Even with EBP, information about sexual health is given in sex negative ways; in other words, sex is only ever really talked about as it relates to anatomy, reproduction, and preventing the negative consequences. The topic of pleasure is treated similarly. This is an extension of our inability to accept and acknowledge true human sexuality and sexual nature. Pleasure positive sex education curricula really means not disconnecting pleasure and positivity from sex. It’s all a matter of keeping a balance between teaching young people that, yes, sex can be dangerous and it can have very serious consequences, but it can also be fun, pleasurable, satisfying, and enjoyable as well. Sex and pleasure positive EBP would provide the information young adults need to be safe, and dispel shame around sexual desire. Four words: two birds, one stone. 

Fellow YHP Blinky Lawrence
making his voice heard
And now for the big question: what do we do? Education is an enormous factor in the teen pregnancy epidemic, but in the larger scheme of things, our issues with sex education is just a symptom of a bigger issue. Our culture and society’s lack of ability to accept and acknowledge true human sexuality and nature is not a problem that can be repaired overnight, and as an extension, neither will the teen pregnancy epidemic. Want to know how you can do your part? Be an advocate for sex positive EBP education! If you’re a parent, make sure your kids are informed. If their school won’t teach them, you teach them. Teens; fight for your right to be educated! Get the right information from anywhere you can. Fight for sex positive EBP in your schools and communities. Last but not least: spread the word. A huge part of why the teen pregnancy epidemic is an epidemic at all is that people don’t know what they’re up against. So get the real numbers and statistics, and put the information into circulation in and around your communities. 

May is National Teen Pregnancy Prevention Month, but efforts shouldn’t end after May 31. Be an advocate 365 days a year! The teen pregnancy epidemic is an incredibly large issue to tackle, but it’s the small efforts of individuals that will bring it down to size. So go ahead people-- get out there and knock this epidemic down a peg or ten.
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Kamis, 26 Mei 2016

Sexual expression in long-term care

Komentar
Roger Watson, Editor-in-Chief

Sexual expression among older people remains a taboo subject and sexual expression among older people in long-term care is virtually ignored.  Yet, as nurses, part of our regular assessment of patients - young and old - is about sexuality; a line we often simply leave blank in assessment forms.

This study from the USA by Syme et al. (2016) titled: 'Recommendations for sexual  management in long-term care: a qualitative needs assessment' and published in JAN aims: 'To conduct a qualitative needs assessment of Directors of Nursing  regarding challenges and recommendations for addressing sexual expression and consent.'  Twenty Directors of Nursing across a range of long-term care facilities were interviewed.  The topics they discussed were  around raising awareness of the issue, educating staff and actually carrying out initial assessments of sexuality.  They also said that national guidelines were required.  One interviewee said: 'I think that level of connection with another human being changes a lot about your demeanor and how you move through life and long-term care is so isolating to begin with. You’ve left your home, you’ve  just enough belongings in a box to take up half of only an 80  foot room and so, so many things are lost and disconnected.  But if we had a better way to maintain intimate relationships with people, that would change the perception of long-term care to some.'  Another said: 'We have to realize that the residents that we have are our primary focus. Family is second. We have to stand our ground when it  comes to what the residents wants versus what the family wants. And at facilities we have to have that ability to stand our ground. To know that, even if somebody took us to court, we have a better chance of winning because we are meeting the needs of the resident.'

As explained by the authors: 'Despite numerous challenges identified, all DONs interviewed in this study were supportive of sexual expression, and they had many suggestions to successfully tackle these challenges, both locally and system-wide. First and foremost is the need to address sexual expression and consent openly in LTC, which has been largely ignored due to issues such as stigma and legal worries.'  In conclusion, they state: 'Sexual expression and consent among LTC residents
can no longer be ignored.'

You can listen to this as a podcast.

Reference

SYME M.L., LICHTENBERG P. & MOYE J . (2016) Recommendations for sexual expression management in long-term care: a qualitative needs assessment. Journal of Advanced Nursing doi: 10.1111/jan.13005
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Selasa, 24 Mei 2016

Recommendations for sexual expression management in long-term care

Recommendations for sexual expression management in long-term care

Komentar
Maggie L. Syme, PhD, MPH
Peter Lichtenberg, PhD, ABPP
Jennifer Moye, PhD


Syme M.L., Lichtenberg P. & Moye J. (2016) Recommendations for sexual expression management in long-term care: a qualitative needs assessment. Journal of Advanced Nursing. DOI: 10.1111/jan.13005


Intimacy and sexual expression in later life is consistently reported as important to older adults. Also, we continue to engage in intimate and sexual activities across the lifespan, and it continues to provide physical, psychological, and social benefits, regardless of how old you are, where you live, or if you have physical and/or cognitive limitations (DeLamater 2012, Doll 2013, Nay 1992, Syme et al. 2015). Unfortunately, the privileged, and often limited, way in which Western values have framed sexuality has many individuals, healthcare providers, and older adults themselves believing that sexual activity is not for the aged (Bouman et al. 2006, Hinchliff & Gott 2011, Hillman 2012).

Nowhere is this a bigger reality than in nursing home settings. Sex is even more taboo for older adults living in long-term care (LTC) with dementia, and the sexual rights of elderly LTC residents are often unacknowledged (Roach 2004, Frankowski & Clark 2009). This is partially due to difficulties reported in managing sexual expression among LTC residents (Elias & Ryan 2011, Lester et al. 2015). Sexual expression management among long-term care residents is a complex issue for nursing home staff, and there is little to no guidance available for many wanting to follow a person-centered approach. Policies and procedures are needed, and must be usable across long-term care settings.

Balancing challenges of supporting sexual and intimate expression with residents’ rights and autonomy is an ongoing struggle for homes. The purpose of this study is to explore both the challenges LTC facilities face in addressing sexual expression and consent and their subsequent recommendations for improving care.

A qualitative design was followed, with semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013. Interview questions prompted them to identify recommendations that address their key challenges to improving sexual expression management within long-term care settings.

Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories.

Directors of Nursing report several challenges to sexual expression management within their facilities, and perceive their current methods to be ad hoc versus proactive. They report that residents’ sexual rights should be seen as important, and recommend that more training and tools be provided from the top (e.g., national organization such as Centers for Medicare and Medicaid in the US) down to the local homes.


References

Bouman W.P., Arcelus J. & Benbow S.M. (2006) Nottingham Study of Sexuality & Aging (NoSSA I). Attitudes regarding sexuality and older people: a review of the literature. Sexual and Relationship Therapy 21(2), 149–161. DOI:10.1080/14681990600618879

DeLamater J. (2012) Sexual expression in later life: a review and synthesis. Journal of Sex Research 49(2–3), 125–141. doi:10.1080/00224499.2011.603168.

Doll G.M. (2013) Sexuality in nursing homes: practice and policy. Journal of Gerontological Nursing 39(7), 30–37. doi:10.3928/00989134-20130418-01.

Elias J. & Ryan A. (2011) A review and commentary on the factors that influence expressions of sexuality by older people in care homes. Journal of Clinical Nursing 20, 1668–1676. DOI: 10.1111/j.1365-2702.2010.03409.x

Frankowski A.C. & Clark L.J. (2009) Sexuality and intimacy in assisted living: residents' perspectives and experiences. Sexuality Research and Social Policy 6(4), 25–37. DOI: 10.1525/srsp.2009.6.4.25

Hillman J. (2012) Sexuality and Aging: Clinical Perspectives. Springer, New York, NY.
Hinchliff S. & Gott M. (2011) Seeking medical help for sexual concerns in mid- and later life: a review of the literature. Journal of Sex Research 48(2–3), 106–117. doi:10.1080/00224499.2010.548610.

Lester P.E., Kohen I., Stefanacci R.G. & Feuerman M. (2015) Sex in nursing homes: a survey of nursing home policies governing resident sexual activity. Journal of the American Medical Directors Association 000, 1–4. doi:10.1016/j.jamda.2015.08.013.

Nay R. (1992) Sexuality and aged women in nursing homes. Geriatric Nursing 13(6), 312–314.
doi:10.1016/S0197-4572(05)80377-5

Roach S. (2004) Sexual behavior of nursing home residents: staff perceptions and responses. Journal of Advanced Nursing 48(4),371–379. DOI: 10.1111/j.1365-2648.2004.03206.x

Syme M.L., Cordes C.C., Cameron R.P. & Mona L.R. (2015) Sexual health and well-being in the context of aging. In: APA Handbook of Clinical Geropsychology (Lichtenberg P.A. & Carpenter B., eds), American Psychological Association, Washington, DC, pp.395–412.




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Jumat, 20 Mei 2016

Multidimensional symptom clusters: An exploratory factor analysis in advanced chronic kidney disease

Multidimensional symptom clusters: An exploratory factor analysis in advanced chronic kidney disease

Komentar
Robyn Gallagher, Editor

One of the hallmarks of  chronic diseases is the presence of multiple symptoms, the severity of which increases as the disease progresses or exacerbation occurs. In chronic disease these symptoms often occur together in a relatively predictable way, yet research persistently focusses on single entities such as breathlessness or pain for example. However, the patient experience is of a cluster of symptoms, and it is this cluster that can impact their lives profoundly. In the study by  Almatury et al., the most common clusters of symptoms are identified in patients who have chronic kidney disease and the relative influence of severity, distress and frequency. They found that while some symptoms clustered around distinct aspects of the underlying disease process, such as excess fluid volume, there were other symptoms, such as fatigue, sleep disturbance and restless legs, that were present in several of the clusters. Symptoms did not occur in isolation. This means that clusters of symptoms should not only be assessed comprehensively, and that treatments should aim to by synergistic so that multiple benefits can be experienced. Finally, as patients with chronic disease, as in this study, often have concurrent conditions, treatment of symptom clusters may also benefit patients' experience of other conditions.

Reference
Almutary H, Douglas C, Bonner A (2016) Multidimensional symptom clusters: An exploratory factor analysis in advanced chronic kidney disease Journal of Advanced Nursing doi: 10.1111/jan.12997

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Rabu, 18 Mei 2016

Commentary on Empathy and stress in nurses working in haemodialysis

Commentary on Empathy and stress in nurses working in haemodialysis

Komentar
Comment on: Vioulac C., Aubree C., Massy Z.A. & Untas A. (2016) Empathy and stress in nurses working in haemodialysis: a qualitative study. Journal of Advanced Nursing 72(5), 1075–1085

Nakisha Ice, BSN, RN
The University of Texas at Arlington


The article by Vioiulac et al. (2016) was eye-opening and very true to the past and current issues in the field of dialysis. The chronic haemodialysis setting continues to suffer from increased nurse burnout and turnover due to the demands of the work environment. As an eleven-year dialysis nurse, I have experienced burnout personally and have been impacted by increased rates of nursing turnover. Böhmert et al. (2011) discuss how the lack of knowledge and education related to dialysis contributes to the increased turnover rate of dialysis nurses. Nurses want to be comfortable in their role and feel they are providing safe care to their patients. The field of dialysis has experienced such high rates of nursing turnover the education and orientation to dialysis is little to be desired. The inability to troubleshoot the technical issues and have adequate training on how to handle emergent situations in the dialysis setting increases the stress level of dialysis nurses (Vioulac et al. 2016).

The rising demands and expectations set forth by regulatory entities continue to increase the already heavy workload of haemodialysis nurses. Researching and investigating the demands of companies’ expectations to manage a successful, profitable business while striving to meet the stringent guidelines of federal and state regulations, as well as following a strict budget that requires the dialysis team to provide exceptional quality care based on the bundled reimbursement rate will be beneficial to the field of dialysis. The federal and state guidelines are necessary for quality patient care; however, the implementation and continuous improvement comes with a price. The cost of living fluctuates as does the cost of adequately caring for the end-stage renal disease population. Medication costs increase, employee salaries increase and the overall cost to operate a facility continues to rise. While so many aspects of the business are becoming more costly the expectation of caring for more patients with limited resources tends to be the accepted norm.



References

Vioulac, C., Aubree, C., Massy, Z. A., & Untas, A. (2016). Empathy and stress in nurses working in haemodialysis: A qualitative study. Journal of Advanced Nursing, 72, 1075-1085. doi:10.1111/jan.1289

Böhmert, M., Kuhnert, S., & Nienhaus, A. (2011). Psychological stress and strain in dialysis staff‐a systematic review. Journal of Renal Care, 37, 178-189. doi:10.1111/j.1755-6686.2011.00236.x

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Rabu, 11 Mei 2016

Thoughts on International Nurses Day

Komentar
Cathy Catrambone PhD, RN
President, The Honor Society of Nursing, Sigma Theta Tau International

As a lifelong nurse and nurse educator, I have always respected Nurses Week and International Nurses Day. Throughout my career, I have taken advantage of that day each year to celebrate my profession and the impact it has made on world health. This year continues the theme of Nurses: A Force for Change. And while the official theme concentrates on improving health systems resilience, I think of that in terms of influence.

In my current role as President of the Honor Society of Nursing, Sigma Theta Tau International (STTI), International Nurses Day takes on additional significance. As all STTI presidents before me, I created a Presidential Call to Action to guide my biennium of service; the theme of that Call to Action is Influence to Advance Global Health and Nursing. In my call, I identified four ways that nurses can develop influence through advocacy, policy, philanthropy, and lifelong learning. I believe the theme of influence is relevant to today’s celebration of International Nurses Day, and relevance, when it comes to nurses, can be traced back to one woman.

We celebrate International Nurses Day on Florence Nightingale’s birthday. If you want an example of influence in its purest form, look no further. Florence Nightingale was a woman whose life, work, and writings transformed the profession of nursing and forever impacted healthcare. She was so influential that the humble utilitarian lamp most associated with her has become a time-honored icon of the nursing profession, with its image on countless logos and seals of nursing schools and organizations. If one person can have that kind of influence, imagine the possible influence of millions of nurses today. That’s right – millions. The World Health Organization estimates that there are 19.3 million nurses and midwives woven into every element of healthcare worldwide.
One of the great gifts that my STTI leadership position has afforded me is the opportunity to travel to many regions of the world, from Asia to the Middle East to Europe and Latin America. This summer, I will add South Africa and Australia to that growing list. In every one of my travels, no matter the cultural differences, I have been thrilled to meet passionate, masterful nurses and midwives who care deeply about their profession and their colleagues, but most importantly, about the lives and health of those they serve. They are influencing nursing and healthcare in their own way every day.

Given the global nature of our work, I am delighted to share a new publication that provides a definition of global health and global nursing. I hope this will be useful in providing a framework to guide your work in the many arenas in which we practice and influence.

As I consider the impact that Florence Nightingale made on an entire profession and the world, I think about the vast number of nurses serving in various roles today. I will repeat here what I say in my Call to Action: Now is the time for nurses to leverage our expertise to influence the health of the world’s people and to advance the profession. Happy International Nurses Day!



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Selasa, 10 Mei 2016

Residents who thrive in nursing homes

Komentar
Roger Watson, Editor-in-Chief

We tend to hold negative perceptions of nursing homes and, generally, envisage them as places where older people go simply to die and where there is little hope for them. However, this is not always the case; some older people thrive in nursing homes as this study from Sweden by Patomella et al. (2016) titled: 'Characteristics of residents who thrive in nursing home environments: a cross-sectional study' and published in JAN shows.

The aim of the study was to: 'describe what characterizes residents with higher levels compared with
those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale.'  The study involved 191 older people in one large Swedish nursing home.  They were divided into those with higher and those with lower scores on the thriving scale. Gender and age had no influence on thriving but, as explained by the authors: 'the characteristics of residents reported to have higher levels of thriving in relation to those with lower levels of thriving, it was found that residents with higher levels of thriving were more independent in their ADLs (activities of daily living), had a higher quality of life and had less psychological and behavioural symptoms.'

The authors conclude: 'The study show that independence in ADL, higher quality of life, shorter lengths of stay, ability to walk and spend time outdoors are potential characteristics of residents who thrive in nursing home environments. The study contributes to existing knowledge by showing that the experience of thriving in nursing homes seems to be related to residents’ level of functioning and thereby their possibilities to have a varied everyday life in the nursing home. The findings also contribute by highlighting the characteristics of residents with lower levels of thriving. The findings have some clinical implications. The results can be used by nursing home staff to identify residents in risk of not thriving and also be used to initiate interventions such as outside walks, everyday activities, etc. that can improve the level of thriving in residents.

You can also listen to this as a podcast.

Reference

PATOMELLA A.-H., SANDMAN P.-O., BERGLAND A. & EDVARDSSON D. (2016) Characteristics of residents who thrive in nursing home environments: a cross-sectional study. Journal of Advanced Nursing doi: 10.1111/jan.12991
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Green gardens are important to older people in residential homes

Komentar
Roger Watson, Editor-in-Chief

Does it matter if a residential home has a garden? How does that affect the quality of life of residents? In the background to this study the authors say: 'Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health.' This study by Dahlkvist et al. (2106) comes from Sweden and is titled 'Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study' and published in JAN and aimed to: 'test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden.'


Nearly 300 residents in 72 residential homes were questioned about their experiences of gardens and their health. While the effects were moderate, the use of gardens and green spaces increased the feelings in older people of 'being away' and the extent to which older people benefited from green spaces was inversely related to the barriers to access to those spaces. In conclusion, the authors say: 'This study suggests that having more greenery and other natural elements in outdoor spaces at residential facilities for older people will promote experiences of being away and fascination when residents’ go outdoors and that this in turn will promote more frequent visitation and better health. It also appears, however, that such advantages will not be fully realized if residents face multiple barriers to going outdoors. It is therefore important that staff in residential facilities for older people know how residents can realize psychological and physical activity benefits from their garden visits and how barriers to visitation can disallow or reduce those benefits. Moreover, the siting and design of residential facilities should consider the amount of greenery as an important aspect of outdoor space provisions.'

You can listen to this as a podcast.


Reference

DAHLKVIST E., HARTIG T., NILSSON A., HÓ¦GBERG H., SKOVDAHL K. & ENGSTRÓ¦M M. (2016) Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study. Journal of Advanced Nursing doi: 10.1111/jan.12968
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Can e-learning help with medication calculations?

Komentar
Roger Watson, Editor-in-Chief

Drug miscalculations cost lives.  Nursing students in the UK seem to struggle with drug calculations because they struggle with maths and basic arithmetic.  This may be the result of new schooling methods or simply the demographics of the entrants to nursing programmes, but it has necessitated a great deal of effort by nursing lecturers to set entrance tests for nursing students and to provide remedial support in calculation skills during nursing programmes.

This study from Belgium by Van Lancker et al. (2106) titled 'The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study' and published in JAN investigates the use of e-learning to help nursing students with drug calculations. The aim of the study was: 'To evaluate the effectiveness of an e-learning course compared with a
face-to-face lecture on medication calculation' and over 400 nursing students were involved and divided between those receiving e-learning and those receiving face-to-face tuition.

The outcome will be disappointing for advocates of e-learning (which is commonly used to support calculation skills) because, while both groups improved, the face-to-face teaching was more effective.  However, there was an interesting observation regarding the type of student: 'The nursing degree was shown to be a predictor of medications calculation skills prior to the course and immediately after the course. Bachelor nursing students had higher skills compared with vocational-level nursing students, which indicates that more efforts need to be made in the vocational-level nursing programme concerning the provision of a medication calculation course, to obtain the same level of final competencies in medication calculation skills in nursing students.'

The authors concluded: 'Both medication calculation courses had a positive effect on medication calculation skills. Students in the control group received a face-to-face lecture and improved significantly more than the students receiving the e-learning program. Further research could focus on the improvement of the medication calculation e-learning programs by including strategies such as repetition, practice exercises, provision of feedback and interactivity.'

You can listen to this as a podcast.

Reference

VAN LANCKER A., BALDEWIJNS K., VERHAEGHE R., ROBAYS H., BUYLE F., COLMAN R. & VAN HECKE A. (2016) The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study. Journal of Advanced Nursing doi: 10.1111/jan.12967
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Blog Contest Winner: Emergency nursing leadership shouldn't be traumatic

Komentar
We were very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. Today we are posting the winning entry.

Emergency nursing leadership shouldn't be traumatic
Anna Ballantyne


I clearly remember my first shift in emergency. The nurse in charge greeted me by name and with a warm smile. She said that she would look out for me and affirmed my nursing background as desirable in emergency… she ‘had me at hello’.

When I think about leadership impact, it is the actions and/or words that show trust, belief and respect - these are the things that inspire me, these are the things that ‘keep me going’, and these have had a pivotal impetus in my career. Granted, I was always interested in emergency. Possibly, I am made for it and it for me. The nurses who directly or indirectly said, 'you are good at this', have shaped where and who I am in nursing today.

Soon after that first shift, I was working permanently in the bustling ED. As a junior there, I remember a late shift from hell during which a 6-foot plus aggressive man stepped well into my personal space. Before he had finished his angry rant, before I said a word in response, the team leader stepped in. Literally. He stepped in between the angry man and me and clearly outlined the expected behaviour towards "his" staff. I could have defended my care, but I didn’t have to. This action spoke volumes to me. He trusted my character and my care. I felt protected, encouraged and relieved!

Life is not all roses. A manager once verbally tore strips off me in the front of the team. For my break that afternoon - I snuck outside and privately shed some hot little tears (then wiped my face and returned with my chin up). What was the outcome of that meeting? I knew that the manager hadn’t listened. I realised that it was her stress, thrown at the nearest member of the team. I then tried to avoid having to approach her at all. She lost, in that moment, the opportunity to contribute to my development as a nurse.

Not that leadership avoids the difficult decisions. I have been on both sides of challenging conversations. I have seen recipients of a difficult conversation return to learn more so they can continue bettering their skills. It is so simple when embedded in trust. I remember listening to one of my mentors, amused at his assurance of my ability. In a later discussion, that same nurse made a comment to me regarding care, “that’s not best practice” he said and then kept talking. I thought, ‘he is right’ and changed my practice. I respect the clinical care he gives and I know that he encourages my best in nursing, whether that is in progress or best practice.

I now induct staff into emergency and general nursing. I welcome them warmly. I also teach 'my' team leaders to protect and encourage their team. These people are great nurses who are capable of great things - this is my baseline for leadership and I have learned it from many inspiring colleagues.


Anna Ballantyne is a Clinical Nurse / Clinical Coach specialising in emergency nursing. She mentors nursing staff as they navigate their way through the crazy, exciting world of emergency critical care. Drawing from a career spanning 20 years, Anna reflects that showing kindness in all you do takes great strength and builds strength in yourself and those around you.
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Senin, 09 Mei 2016

Blog Contest Finalist: How many nurses does it take to change a lightbulb?

Komentar
We were very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. And we have decided that we will post the top three entries this week. The winner will be posted this Wednesday. We hope you enjoy these posts and are inspired by them.

How many nurses does it take to change a lightbulb?
Liz Charalambous

If you light a lamp for someone else, it will also brighten your path.
Buddha

I wonder how many nurses does it take to change a lightbulb?

Does it even matter?

In today’s busy healthcare environment, it seems that the most crucial thing is to get the job done, no matter what. Yet teamwork and the support of our colleagues are vital for success. Having started off in nursing over 30 years ago, I have seen leadership styles vary wildly, from autocracy to laissez faire, but two constants that facilitated and enabled me to work at my best, were good leadership and praise. Years ago I would hide in the sluice whenever I heard the clickety-clack of matron’s heels marching down the ward. Such behaviour is hardly surprising when, as a student nurse in theatres, we were routinely ignored and no one spoke up to defend us when the gynaecology surgeons would pause, mid operation, to throw a freshly removed and soggy ovarian cyst our way just for ‘fun’.

Today it is different, with fresh new perspectives. For example, shared governance takes a bottom up democratic approach to leadership and managing change. Instead of working alone in the dark, we can work together to harness bright ideas and take them from ‘ward to board’ where nurses at the front line have become empowered to work with managers to create meaningful change.

We have recently revised the hospital policy to allow open visiting at our Trust. This was in response to the needs of patients and staff, but it would never have happened without the good leadership, praise and kind encouragement of others. It took two years for the glimmer of an idea to be nurtured and kindled by others to burst from a spark to a flame.

Good leadership and praise promote a strong organisational culture and creates a positive climate of confidence. A virtuous circle emerges where engaged and satisfied staff can encourage others to do their best for patients, and in doing so improve care. The team approach ensures that change happens at all layers of the organisation. There is a good chance that involved and happy staff lead to happy and contented patients.

So, how many nurses does it take to change a lightbulb?

The answer is ‘all of them’.

Because by working as a team and breaking down barriers and hierarchical boundaries something magical happens. By encouraging nurses to shine, not only do we become dazzled and motivated by their brilliance, but by working together we can intensify our efforts and so improve the quality of care for patients.



Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently working on a doctoral thesis researching volunteerism in dementia and acute hospitals. She tweets as @lizcharalambou
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Minggu, 08 Mei 2016

Blog Contest Finalist: Out with the old, in with the new!

Komentar
We are very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. And we have decided that we will post the top three entries this week. The winner will be posted this Wednesday. We hope you enjoy these posts and are inspired by them.


Out with the old, in with the new!
Marci Andrejko


It’s 7:30 am; I greet the night shift with a smile and a chipper “Good Morning”! I am confident and I am ready to start the day, proudly providing care to oncology patients. But no more than a few minutes of attending morning shift report, I quickly become deflated and feel defeated.

I remember my jaw dropping, mostly in disappointment, as our nursing leader sat at the morning shift report table, eagerly ready to point out the unit’s unmet outcomes, with a blind eye to all of the hard work we had done. This strategy was used as way to motivate staff. We, the staff, thought it was offensive. This leader was concerned with only day-to-day operations and how the unit affected her leadership position within the organization. Over time, this leader and the selected motivating style, led to a struggle among staff and teamwork.

The unit was falling apart. Staff was negative and drained. And the health care organization now the viewed the unit as a problem, but recognized that there was a need for change. This recognition created a buzz of talk among staff regarding the possibility of positive change. After patiently waiting, I remember rejoicing upon receiving the news that our unit would soon be welcoming a new leader! My heart felt light with joy, also heavy because this unit was so disconnected.

Our new leader came with hopes for improvement. One-on-one staff meetings were arranged in order to gain an understanding of each individual’s vision for the unit. Goals and barriers were discussed, attitudes were explored, and ideas for the future were shared. Monthly staff meetings were started as way to share the vision and decision-making, as well as the opportunity to reward staff for hard work. Trust was gained and the nursing unit’s environment became positive.

Burns (1978) originally developed the concept of transformational leadership, defined as a process where leaders and followers engage in a mutual process to inspire and raise each other up (Marshall, 2011). This nursing leader came to the unit at a time of crisis with the ability to inspire, instil trust, and successfully share a vision. The nurse leader was able engage staff to follow the change and to become an active part in what was to become something greater. The leader displayed commitment, support, and empathy during the difficult time on the unit. The characteristics of transformational leadership played an important role in the change that was created.

I have become empowered to be a transformational leader. I have now gone beyond my bedside nursing duties by becoming involved in professional organizations and furthering my education through the pursuit of a doctorate of nursing practice (DNP). It’s 7:30 am; I greet everyone I meet with a chipper “Good Morning”! I will not be deflated or defeated!


Marci Andrejko is an Oncology Certified Nurse OCN® She is currently a full-time student attending The Catholic University of America (CUA) in Washington, DC pursing a Masters of Nursing (MSN), Family Nurse Practitioner (FNP) and Doctorate of Nursing (DNP). Prior to attending CUA, Ms. Andrejko worked as a clinical research nurse at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD.





References

Burns J.M. (1978). Leadership. New York: Harper & Row.

Marshall, E. S. (2011). 'Expert clinician to transformational leader in a complex healthcare organization'. In E. S. Marshall (Ed.), Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (pp. 1-26). New York: Springer.

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Jumat, 29 April 2016

Wearable monitors for patients following discharge from an Intensive Care Unit; practical lessons learnt from an observational study

Wearable monitors for patients following discharge from an Intensive Care Unit; practical lessons learnt from an observational study

Komentar
Robyn Gallagher, Editor

Technological advances and availability of wearable devices for real-time monitoring of health have provided an opportunity to free patients from their bed during recovery and allow nurses to use remote monitoring. However, if the devices are need to be worn continually, then device attachment, weight and comfort become crucial to adoption in practice. For instance, slimline physical activity trackers worn on the wrist are likely to be more acceptable than larger devices worn on the upper arm or on chest halter. A paper by Jeffs et al. (2016) and published in JAN provides insights into one such device (Hidalgo EQO2 Sensor Electronics Module) which provides real-time monitoring of ECG, SpO2, skin temperature and activity (triaxial accelerometer). The study demonstrated the difficulties for Intensive Care Unit patients, few of whom persisted with wearing the device for their full rehabilitation stay. Discomfort and irritation were key issues due to the prevalence of chest, neck and arm wounds and skin damage in contact with the device. The impact of obesity may also be an increasingly important consideration for device design. Changes to the method used to attach the device, including location and harness, were undertaken, but acceptability was still a problem. This study underlines the key role nurses can play in designing devices that can be realistically translated into practice.


Reference

Jeffs E., Vollam S., Young J.D., Horsington L., Lynch B. & Watkinson P.J. (2016) Wearable monitors for patients following discharge from an intensive care unit: practical lessons learnt from an observational study. Journal of Advanced Nursing. doi: 10.1111/jan.12959
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Jumat, 22 April 2016

The effectiveness of an e-learning course on medication calculation in nursing students

The effectiveness of an e-learning course on medication calculation in nursing students

Komentar
Aurélie Van Lancker
Katleen Baldewijns
Rik Verhaeghe
Hugo Robays
Franky Buyle
Roos Colman
Ann Van Hecke


The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study


A quasi-experimental study was set up to evaluate the effectiveness of an e-learning course on medication calculation skills compared to the most widely used teaching method, namely face to face teaching, in nursing students. The study revealed that an e-learning course and face-to-face teaching both had a positive effect on medication calculation skills. Students receiving traditional face-to-face education improved significantly better than the students receiving the e-learning program. Also, a subgroup analysis based on nursing degree (bachelor nursing students versus vocational level/sub-degree level nursing students) demonstrated that long-term improvements in medication calculation skills could only be observed in vocational-level nursing students receiving a face-to-face course. Our results indicate that despite the wide attention given to e-learning nowadays, nursing education programs should be careful when considering the integration of e-learning into their curriculum. Further research is needed on the components of e-learning courses which might positively influence nursing students medication calculation skills. Additionally, the results suggest that repetition is needed to ascertain continuous adequate medication calculation skills. Also, nursing educations programs should give consideration to attune their type of teaching on medication calculation to their students.



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