Sunday, 19 November 2017

Burnout in midwives

Roger Watson, Editor-in-Chief

Midwifery is a caring profession and caring professionals are prone to burnout. Burnout leads to indifference to those in your care and a feeling that your job is not worth it and that nobody cares for you. The ultimate problem is that it leads to psychological morbidity and to absence from work.

This article from Australia titled: 'Personal, professional and workplace factors that contribute to burnout in Australian midwives' by Fenwick et al (2017) and published in JAN is based on a study that aimed to: 'identify personal, professional and workplace factors that contribute to burnout in midwives'. A survey of over 1000 midwives using a burnout questionnaire showed that nearly half of the midwives were suffering from severe burnout. Midwives were more burned out in some states of Australia than others; for example, burnout was highest in Victoria and lowest in South Australia. A caseload model of care was associated with lowest burnout and also those less happy at work were more burned out.

The authors conclude: 'Understanding the factors contributing to burnout will enable healthcare organizations to reduce costs associated with staff attrition, reduce human costs in regard to the health and well-being of midwives and most importantly, improve the health and safety of women and their newborns. Flexible, activity-based work patterns afforded in midwifery caseload models should be the norm.

You can listen to this as a podcast


Fenwick, J., Lubomski, A., Creedy, D. K. and Sidebotham, M. (2017), Personal, professional and workplace factors that contribute to burnout in Australian midwives. J Adv Nurs.  doi:10.1111/jan.13491

Thursday, 16 November 2017

Violence Against Women: JAN Special Section

Violence against women (VAW) refers to ‘any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life’ (United Nations Declaration on the Elimination of Violence against Women 1993). VAW is associated with significant morbidity and mortality of victims and, therefore, the role of health care professionals becomes much more important. Available evidence suggests that one in three women worldwide are subjected to physical or sexual violence at some point in their lives (Garcia-Moreno et al. 2005). In most cases, the perpetrator is someone known to the woman, such as an intimate partner, ex-partner, husband, boyfriend or a family member. While men can of course also experience violence, in most cases the perpetrator is usually a stranger. In addition, the extent and impact of the injuries appears to be much more intense for women than men. VAW can take many different forms including female infanticide, female genital mutilation, child marriage, grooming, trafficking, forced marriage, honour killing, domestic violence and abuse (DVA), and intimate partner violence (IPV).

As the role of nurses, midwives and other health care professionals is very important with regards to identification and prevention of domestic violence, it is important that the issue is highlighted in nursing scholarly and academic arena. Therefore, this year, JAN is highlighting the issue of VAW by contributing to the United Nations campaign of ‘16 days of activism’ which will start on International Day for the Elimination of Violence against Women (25 November 2017) and ends on Human Rights Day (10 December 2017). We will run a series of JAN interactive entries each day and have launched a special section on gender-based violence. We had a fantastic response to the call for papers, four of which were excellent enough to be included in the special section. The topics of these range from exploring validity of a risk assessment tool (Messing et al., 2017), to examination of breast feeding practices, domestic violence and its relationship with displacement, and abused women experiences of accessing support from primary care nurses. 
Major natural or man-made disasters can contribute to increased vulnerability of displaced individuals. One of the articles (Soland et al. 2017) uses a descriptive correlational design to explore physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake. While findings suggest similar risk of physical and sexual abuse pre- and post-earthquake, there is a need to ensure appropriate preventive measures are in place to protect vulnerable adolescent girls and others.

Messing, Campbell & Snider (2017) assessed the predictive validity of the DA-5, a shortened version of the Danger Assessment, an intimate partner violence risk assessment, assault using sensitivity, specificity and ROC curve analysis techniques. The tool was identified as accurate as the original version. 

Another paper included in the special section reported a cross-sectional study to explore the impact of domestic violence on breastfeeding practices of mothers (Finnbogadottir & Thies-Lagergren, 2017). However, it is good to know that domestic violence did not influence mothers’ determination to breastfeed their children. Breastfeeding practices as well as the rate didn’t differ in women with or without a history of domestic violence. However, symptoms of depression influenced duration of exclusive breastfeeding as those with fewer symptoms of depression were more likely to exclusively breastfeed than those with several symptoms of depression. The study emphasised the need to identify and support women with symptoms of depression to enhance their mental health and wellbeing. 

Based on a qualitative case study, another paper reported abused women’s experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care (Bradbury-Jones, Clark and Taylor, 2017). The study highlighted the role of nurses in identification of domestic violence, referral of abused women to appropriate services, and safety planning. 

All these papers provide important insight into the complex issue of domestic violence from various perspectives. We need to continue with the effort of exploring and developing practices, challenging stereotypes, and developing strategies to provide quality care to those experiencing abuse. We as nurses have a unique role to play in this regard as we not only provide care to victims but, at times, it may be the perpetrator who is the recipient of care. Therefore, nurses really need to understand the complex nature of the issue of domestic violence and also need to be aware of their own emotional reactions to situations that they can come across. Such efforts will help them develop a clear understanding of their role and responsibilities with regards to provision of appropriate care to those affected by domestic violence. 

Parveen Ali
University of Sheffield
Editorial Board member, JAN

Monday, 6 November 2017

The need to know

Commentary on: Douglas T, Redley B, Ottmann G. The need to know: The information needs of parents of infants with an intellectual disability—a qualitative study. Journal of Advanced Nursing 2017; 73:2600–2608.

Tatiana Kudzman

I write this commentary in response to “The need to know: The Information Needs of Parents of Infants with an Intellectual Disability —a Qualitative Study” by Douglas, Redley & Ottmann (2017).

Providing appropriate information to families and patients is crucial in healthcare. As described in the article by Douglas et al. (2017), “the lack of timely access to knowledgeable and responsive health professionals has been previously recognised as a barrier to achieving equitable access to health care and optimal health outcomes amongst people with intellectual disabilities” (Krahn, Hammond & Turner 2006). Knowledgeable and responsive health professionals should be able to provide the right information at the right time.

However, what is considerably overlooked in this article is the individual needs of each family. When reading the parents’ (participants) quotes, you can clearly see that all parents did not have the same needs. What is apparent is a crying need to be heard and to have an individualized response according to their needs and specific to their child. This is illustrated in the following quote by Anne-Marie “I needed that to know that my child wasn’t going to die” (Douglas et al., 2017). Whereas some other parents wanted to have medical information in laymen’s terms, some others wanted to know experiences from other parents with children with the same disability.

We see further example of this when the researchers try to generalize their findings by including children with not only Down Syndrome, but cerebral palsy as well. However, in doing so, they assume that all children with cerebral palsy have intellectual disability as this article pertains to infants with such disability. When in reality, only 50% of children affected by cerebral palsy have intellectual disability (Glader & Barkoudah 2017). Also, by focusing on a pre-determined way of delivering information, they focus on deficits associated with each disease and may cause health professionals to overlook each infants’ individual strengths despite the disease.

This article provides with a clear-cut protocol about what knowledge parents require, when they require it and how to refer parents to other professionals. I do not want to minimize the importance of the need for accurate timely information. The knowledge provided by this article can be very useful for health professionals to know and to guide them in increasing their own knowledge, however it brings us back into a traditional medical model of paternalistic direction instead of a collaborative partnership recognizing the uniqueness of each family (Gottlieb 2013).

Tatiana Kudzman, RN, MScA (c)
McGill Universtity, Montreal, Canada


Douglas, T., Redley, B., Redley, B., & Ottmann, G. (2017) The need to know: The information needs of parents of infants with an intellectual disabilitya qualitative study. Journal of Advanced Nursing, 73(11), 2600-2608.

Glader, L. & Barkoudah, E. (2017) Clinical features and classification of cerebral palsy. In C. Armsby (Ed.). Retrieved 1 November 2017 from:

Gottlieb, L. N. (2013). Strengths-Based Nursing Care: Health and healing for person and family.
New York, New York: Springer Publishing Co.

Krahn, G. L., Hammond, L., & Turner, A. (2006). A cascade of disparities: Health and health care access for people with intellectual disabilities. MRDD Mental Retardation and Developmental Disabilities Research Reviews, 12(1), 70-82.

Wednesday, 1 November 2017

Sex after birth

Roger Watson, Editor-in-Chief

How soon can we have sex after the birth of our baby and how is sex after the birth of a baby? These questions must be prominent in the minds of many couples who are expecting or who have just had a a baby. And this is the focus of an article from Spain by Triviño-Juárez et al (2017) titled: 'Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study' and published in JAN which aimed to: 'evaluate the association between mode of birth and the resumption of sexual intercourse, self-reported decline in sexual intercourse and dyspareunia in women at the 6th week and 6th month postpartum.'

The study on which the article is based sent a questionnaire to over 500 women who had given birth only once. They found that mode of birth and any tears but also social class was related to non-resumption of intercourse 6 weeks after birth. So, forceps birth and higher social class led to lower resumption of intercourse in addition to tears at birth. At six months, mothers who were depressed after birth or who had used emergency admissions for a health problem were less likely to resume intercourse. At both 6 weeks and 6 months, breastfeeding was associated with more painful intercourse.

The authors conclude: 'Our results give reasonable support to the idea that limiting forceps birth and perineal trauma could reduce time until resumption of intercourse after childbirth. Counselling by midwives about sexual functioning and resumption of intercourse should be provided in antenatal and postnatal educational classes; in addition, women could be given advice on lubrication for sexual intercourse and alternative sexual positions. Every attempt should be made to relieve the anticipated fear of resumption of intercourse, especially if the woman has experienced perineal trauma. Midwives often do not see women beyond 7–10 days postpartum and they may not ask questions about sexual intercourse at this time.'

You can listed to this as a podcast


Triviño-Juárez J-MRomero-Ayuso DNieto-Pereda B, et al. Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up studyJ Adv Nurs. 2017.

Saturday, 14 October 2017

VI Adult Palliative Care: The changing landscape of adult palliative care in the 21st Century

To coincide with Hospice Care Week (October 9th-15th) and World Hospice and Palliative Care Day on October 14th, JAN has created a virtual issue to showcase cutting edge research. The selected papers clearly demonstrate the changing landscape of palliative care in the 21st Century. Nurses still find it highly challenging to break bad news and need more support and training to do it well (Warnock et al 2017). Two conceptual papers help advance understanding on the importance of hope (Broadhurst & Harrington 2015) and autonomy and choice (Wilson et al 2015) for people at the end of life.

Many more people are living and dying with dementia and yet planning ahead and involving residents living in nursing homes and their families is not sufficiently consistent and practice varies widely (Ampe et al 2015). Hospices are broadening their services beyond the original group of people with cancer and there is also a movement towards people wanting more end of life care facilitated at home. In order for this to happen, hospices have extended their reach and specific services such as ‘hospice at home’ and community palliative nursing services have been established. Jack et al (2017) provide some insights into the experiences of people who are dying and their families who receive hospice at home services. Delivering palliative care at home involved multiple agencies and professionals, which can be difficult to coordinate efficiently. Van der Plas et al (2015) explore the benefits of palliative care case managers to coordinate between community nurses and general practitioners.
People generally fear distressing symptoms and in particular whether they will experience pain at the end of their lives. Three papers look at these important issues and offer nurses evidence to inform their decision-making and practice in these areas (Van Lancker et al 2016Hökkä et al 2014, and Bowers & Redsell 2017). Finally, many people die in intensive care settings. There is less evidence to inform optimal patient and family centred end of life care and practice in these medically dominated contexts. Three papers look at the highly sensitive issues of withdrawal of treatment (Coombs et al 2016), life after the Liverpool Care Pathway (Venkatasalu et al 2015), and implementing a new end of life care guideline in intensive care (Noome et al 2016).
Jane Noyes

Articles will be free to access until April 2018
Ampe S., Sevenants A., Smets T., Declercq A. & Van Audenhove C. (2016) Advance care planning for nursing home residents with dementia: policy vs. practiceJournal of Advanced Nursing 72(3), 569–581. doi: 10.1111/jan.12854
Bowers B, Redsell S. A qualitative study of community nurses’ decision-making around the anticipatory prescribing of end-of-life medicationsJournal of Advanced Nursing. 2017;73:2385–2394.
Broadhurst K. & Harrington A. (2016) A mixed method thematic review: the importance of hope to the dying patientJournal of Advanced Nursing 72(1), 18–32. doi: 10.1111/jan.12765
Coombs M.A., Parker R., Ranse K., Endacott R. & Bloomer M.J. (2017) An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive careJournal of Advanced Nursing 73(1), 39–55. doi: 10.1111/jan.13097
Hökkä M., Kaakinen P. & Pölkki T. (2014) A systematic review: non-pharmacological interventions in treating pain in patients with advanced cancerJournal of Advanced Nursing 70(9), 1954–1969. doi: 10.1111/jan.12424
Jack B.A., Mitchell T.K., Cope L.C. & O'Brien M.R. (2016) Supporting older people with cancer and life-limiting conditions dying at home: a qualitative study of patient and family caregiver experiences of Hospice at Home careJournal of Advanced Nursing 72(9), 2162–2172. doi: 10.1111/jan.12983
Noome M., Dijkstra B.M., van Leeuwen E. & Vloet L.C.M. (2017) Effectiveness of supporting intensive care units on implementing the guideline ‘End-of-life care in the intensive care unit, nursing care’: a cluster randomized controlled trialJournal of Advanced Nursing 73(6), 1339–1354. doi: 10.1111/jan.13219
Ramasamy Venkatasalu M., Whiting D. & Cairnduff K. (2015) Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life careJournal of Advanced Nursing 71(9), 2108–2118. doi: 10.1111/jan.12680
van der Plas A.G.M., Onwuteaka-Philipsen B.D., Vissers K.C., Deliens L., Jansen W.J.J. & Francke A.L. (2016) Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire studyJournal of Advanced Nursing 72(1), 147–157. doi: 10.1111/jan.12818
Van Lancker A., Beeckman D., Van Den Noortgate N., Verhaeghe S. & Van Hecke A. (2017) Frequency and intensity of symptoms and treatment interventions in hospitalized older palliative cancer patients: a multicentre cross-sectional studyJournal of Advanced Nursing 73(6), 1455–1466. doi: 10.1111/jan.13230
Warnock C., Buchanan J. & TOD A.M. (2017) The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad newsJournal of Advanced Nursing 73(7), 1632–1645. doi: 10.1111/jan.13252
Wilson F., Ingleton C., Gott M. & Gardiner C. (2014) Autonomy and choice in palliative care: time for a new model? Journal of Advanced Nursing 70(5), 1020–1029.doi: 10.1111/jan.12267