Friday, 29 April 2016

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

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

Friday, 22 April 2016

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

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.



How do pregnant women justify smoking?

Eliza Goszczyńska
Kamila Knol-Michałowska
Alicja Petrykowska



How do pregnant women justify smoking? A qualitative study with implications for nurses’ and midwives’ anti-tobacco interventions


Despite widespread knowledge of the harmfulness of smoking during pregnancy, this behaviour is a challenge in the majority of the Euro-American world. Smoking during pregnancy, the knowledge about its harmful effects and social pressure to abstain from smoking generate a cognitive dissonance among expectant mothers (stemming from the contrast between viewing themselves as responsible mothers and smokers). One way of diminishing such stress and mental discomfort is their subjective rationalisation that quitting during this period is unnecessary, impossible, ineffective and even detrimental. To improve anti-tobacco interventions, it was imperative to perform an analysis of pregnant smoking women’s explanations of continuing the behaviour, which allow them to subjectively rationalise it. Conducting this analysis seems crucial also since previous research has not focused on a detailed recognition of such thought patterns (numerous authors have examined only their selected elements, i.e. barriers to quitting during pregnancy).Most of these studies were face-to-face interviews, which might have influenced the content/spectrum of the women’s responses, especially considering that the topic of the interviews is not socially accepted. Therefore, there existed a need to perform a qualitative, unobtrusive study.

Thereafter, the aim of the paper in question was to recognise pregnant smoking women’s thinking patterns called lay justifications, to present their diversity and to create their typology. To achieve it a qualitative, unobtrusive study based on the thematic analysis of the content of the textual data collected from internet forums where women presented reasons for smoking during pregnancy was conducted. The source of data collection were three parenthood on-line forums most popular in Poland in terms of the number of registered users (babyboom.pl, dziecko-info.rodzice.pl and mamazone.pl).

The analysis allowed for identification of 35 sub-themes of lay justifications assigned to two main themes. The first main theme was questioning the need to refrain from smoking and its positive effects. It consisted mostly of the ways mothers diminish the feeling of risk resulting from smoking (i.e. convictions that the addiction to nicotine is harmless in a particular trimester, withdrawal might negatively influence the pregnancy, smoking harmfulness can be compensated for by the love offered to the child). What is important, some women claimed that they had built these subjective justifications based on the health professionals’ authority. The analysis showed that some of these mothers over-interpreted the medical recommendations to justify the behaviour. The second identified main theme of lay justifications was questioning the possibility to quit smoking and exaggerating the barriers to achieve this (i.e. putting the blame on others, namely smoking: to mollify negative emotions stirred by the societal pressure to quit smoking during pregnancy, to rebel against the societal pressure imposed on expectant mothers to combat the addition, due to lack of social support to refrain from smoking, or because of undertaking the behaviour by the members of the closest environment).

The paper concluded with practical recommendations for the medical staff concerning anti-tobacco counselling for smoking pregnant women stemming from the identified spectrum of expectant mothers’ lay justifications.


Wednesday, 6 April 2016

A qualitative study of the barriers and enablers to fertility-awareness education in general practice

Kerry D. Hampton
Jennifer M. Newton
Rhian Parker
Danielle Mazza


A qualitative study of the barriers and enablers to fertility-awareness education in general practice


Infertility is a global public health issue that affects 9% of couples worldwide (Boivin et al. 2009). A plethora of published research exists on assisted reproductive technology (ART) treatment. Similarly, the growth of available ART clinics worldwide providing care services for infertile people has been exponential (Kamphuis et al. 2014).

However, concern is mounting about the rising trend in increasing use of ART treatment. This stems from the increased risks associated with ART-conceived children compared with naturally-conceived children, including higher overall healthcare costs and increases in morbidity and mortality for both mothers and children (Kamphuis et al. 2014).

There is a substantial literature on fertility-awareness (a woman’s ability to identify the fertile period of the menstrual cycle) as one way of reducing infertility (Stanford et al. 2008, Tham et al. 2012). However, to date, no primary care model in fertility-awareness has been described.

In this study published in JAN, titled: ‘A qualitative study of the barriers and enablers to fertility-awareness education in general practice’, the authors report the views of general practitioners’ (GPs) and practice nurses’ (PNs) on the barriers and enablers, and how general practitioners and practice nurses can best work together to improve the delivery of fertility-awareness education for women who first report trouble conceiving (Hampton et al. 2016).

Our previous work established that poor levels of fertility-awareness exist in women, and that most women would like to receive this type of education before they are referred to ART clinics (Hampton et al. 2013, Hampton and Mazza 2015). Similarly, most GPs and PNs are aware of women’s overall poor understanding of fertility-awareness. They nominated PNs (nurses and midwives) as the most appropriate health practitioner in general practice to enhance women’s fertility-awareness in the belief that the knowledge may assist some infertile women to conceive (Hampton 2014).

The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The main enablers were a greater use of nurses and midwives trained in fertility-awareness who work in a collaborative team care arrangement with GPs.

The authors conclude that a primary care model in fertility-awareness would fill an important gap in the initial care of infertile women, and build capacity in general practice to reduce infertility through women’s enhanced fertility-awareness.



References

Boivin, J., Bunting, L., Collins, J. A. & Nygren, K. G. (2009). Reply: International estimates on infertility prevalence and treatment seeking: potential need and demand for medical care. Human Reproduction, 24(9), 2380-2383. doi:10.1093/humrep/dep218

Hampton, K. D. (2014) Informing the development of a new model of care to improve the fertility-awareness of sub-fertile women in primary health care. PhD Monash University

Hampton, K. D. & Mazza, D. (2015). Fertility-awareness knowledge, attitudes and practices of women attending general practice. Australian Family Physician, 44(11), 840-845.

Hampton, K. D., Mazza, D. & Newton, J. M. (2013). Fertility-awareness knowledge, attitudes and practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076-1084. doi:10.1111/j.1365-2648.2012.06095.x.

Hampton, K. D., Newton, J. M., Parker, R. & Mazza, D. (2016). An examination of the barriers and enablers to fertility-awareness education in general practice: a qualitative study. Journal of Advanced Nursing. Kamphuis, E. I., Bhattacharya, S., Van Der Veen, F., Mol, B. W. J. & Templeton, A. (2014). Are we overusing IVF? British Medical Journal, 348(g252). doi:10.1136/bmj.g252

Stanford, J. B., Parnell, T. A. & Boyle, P. C. (2008). Outcomes from treatment of infertility with natural procreative technology in an Irish general practice.  Journal of the American Board of Family Medicine, 21(5), 375-384.

Tham, E., Schliep, K. & Stanford, J. B. (2012). Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice. Canadian Family Physician, 58(May), e267-e274.



Consequences of nurses' burnout

Ufuk Basar
Nejat Basim 
Baskent University, Ankara, Turkey


A cross-sectional survey on consequences of nurses’ burnout: moderating role of organizational politics

The aim of this study was to assess whether perceptions of organizational politics influence the prospective associations between nurses’ burnout and its consequences, namely, intention to quit and neglect of work. Burnout is a psychological syndrome, a state of depletion and excessive mental fatigue that many people experience when they are under permanent stress. Intention to quit is defined as a conscious plan and will to leave the organization. Neglect refers to inattentive behaviours, such as lack of caring or staying away from work. Other symptoms of neglect may be psychological inattention and abandonment. It occurs because of negative occupational factors, such as a psychological contract breach, job dissatisfaction or other stressors. Organizational politics refer to employees’ self-serving behaviours at the expense of others towards achieving their individual objectives through approved or unapproved influence mechanisms, or achieving the organization’s objectives through unapproved influence mechanisms and perceptions of organizational politics refer to the extent to which employees perceive their working climate as political which encourages self-interest and causes injustices.

The research was conducted according to a cross-sectional survey design. Data were collected by questionnaire from a sample of 456 nurses from six private hospitals in Ankara, Turkey in March 2015. Four different previously-designed scales were used to measure research variables (burnout, intention to quit, neglect of work and perceptions of organizational politics). Following confirmatory validity and reliability analyses of data collection instruments, descriptive statistics for each research variable were analysed. Structural regression models were created to assess relationships among variables. Findings indicated that burnout was an antecedent of both intention to quit (β=0.59, p<0.01) and neglect of work (β=0.25, p<0.01). In addition to that, intention to quit partially mediated the association between burnout and neglect. Moreover, burnout gave rise to intention to quit (β=0.65, p<0.01) slightly more strongly in nurses who had greater perceptions of organizational politics. This study uncovered and emphasized the moderating role of perceptions of organizational politics in consequences of burnout. This may help hospital managers and nurses to improve costs, efficiency, satisfaction and productivity.


Reference

Basar U. & Basim N. (2016) A cross-sectional survey on consequences of nurses' burnout: moderating role of organizational politics. Journal of Advanced Nursing. doi:10.1111/jan.12958


Wednesday, 23 March 2016

Protected mealtimes - worth the effort?

Roger Watson, Editor-in-Chief

Protected mealtimes became very 'trendy' a few years ago due to the idea that patients, especially those who have difficulty eating, eat less and their nutrition becomes compromised when they are disturbed, for example, by consultant rounds or medicine administration. I know that one small study I was involved in showed that they were ineffective but that was carried out on the basis of audit and not a rigorously designed research study.

Two studies from Australia and published in JAN investigate protected mealtimes.The first by Young et al. (2016) titled: 'Assisted or Protected Mealtimes? Exploring the impact of hospital mealtime practices on meal intake' aimed to: 'evaluate the impact of mealtime practices (meal time preparation, assistance and interruptions) on meal intake of inpatients in acute hospital wards.' A survey design was used. Counterintuitively: 'There was no difference in meal intake between patients who were interrupted, compared with those who were not interrupted.' Various aspects of positioning and assisting were shown to be effective in helping patients to eat and the authors conclude: 'clinicians and managers should consider adopting an ‘assisted mealtimes’ focus to improve meal intake, rather than only focusing on Protected Mealtimes.'

The second study by Porter et al. (2016) titled: 'Implementation of protected mealtimes in the subacute setting: stepped wedge cluster trial protocol' aims 'to determine if protected mealtimes implementation closes the energy deficit of 1900 kJ between estimated requirements and actual energy intake of hospitalized adults in the subacute setting.' Given the outcome of the previous study, it will be interesting to see what the outcome of this study is. It is good that the evidence-base is building in this important area of patient care and that JAN is contributing to it.


You can listen to this as a podcast.


References

PORTER J., HAINES T. & TRUBY H. (2016) Implementation of protected mealtimes in the subacute setting: stepped wedge cluster trial protocol. Journal of 1 Advanced Nursing doi: 10.1111/jan.12930


YOUNG A. , ALLIA A. , JOLLIFFE L . , DE JERSEY S . , MUDGE A. , MCRAE P. & BANKS M. (2016) Assisted or Protected Mealtimes? Exploring the impact of hospital mealtime practices on meal intake. Journal of Advanced Nursing doi: 10.1111/jan.12940