Friday, 16 June 2017

Addressing the needs of first-time fathers

Roger Watson, Editor-in-Chief

Childbirth is time when attention is, rightly, focused on the woman and the baby. But what about the father and, esepecially, first-time fathers? What are their needs and how can they be addressed? This is  the topic of an article from Singapore by Shorey et al. (2017) titled: 'First-time fathers’ postnatal experiences and support needs: A descriptive qualitative study' and published in JAN.

The study aimed to: 'explore first-time fathers’ postnatal experiences and support needs in the early postpartum period'. Fifteen first time fathers were interviewed  and, hardly unexpectedly, the researchers found: '1) No sense of reality to sense of responsibility, (2) Unprepared and challenged, (3) Support: needs, sources, experience and attitude and (4) Future help for fathers'. For example, one father said: 'One thing that we want to do (as a father) is to get more involved. But, another thing, maybe, from the hospital or from institutes, is telling us what we have to do. So, to be more aware, involve us more so that we will feel more important (laugh)'. The authors concluded: 'This study provides empirical evidence on the experiences and support needs of first-time multiracial fathers in Singapore. The fathers in this study underwent a series of emotional and personal challenges during their transition to fatherhood in the early postnatal period. They shared their support needs and the desire to be considered as an integral part of their family by Singapore healthcare professionals, especially nurses and midwives'.

You can listen to this as a podcast.


Shorey, S., Dennis, C.-L., Bridge, S., Chong, Y. S., Holroyd, E. and He, H.-G. (2017), First-time fathers’ postnatal experiences and support needs: A descriptive qualitative study. J Adv Nurs doi:10.1111/jan.13349

Wednesday, 7 June 2017

Are nurses fit to work?

Roger Watson, Editor-in-Chief

How fit are nurses compared with those they look after - the general population, and what happens to nurses' fitness when they work as nurses? That was the focus of a study from Australia by Perry et al. (2017) which aimed to: 'examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave'. The outcome of this study is an article published in JAN titled: 'Health, workforce characteristics, quality of life and intention to leave: The ‘Fit for the Future’ survey of Australian nurses and midwives'.

Physical and mental health in over 4,500 nurses was studied over two years in New South Wales and compared with the general public and the characterstics of the nurses related to their fitness was examined. The results showed that nurses were more physically fit than the general public but less fit in terms of mental health. Nurses became less physically fit as they aged but reported better mental health. Nurses with poor mental health were more likely to want to leave their job.

The authors concuded: 'The study provides evidence for nursing/midwifery managers, researchers, decision-makers and policy-makers, and advocates for the development and implementation of targeted interventions for the nursing and midwifery workforce. Findings indicate potential benefit in terms of staff quality of life and workforce retention, for interventions focused not only on mental health, well-being, coping and resilience particularly but also on better sleep, pain reduction, smoking cessation and general health screening/health promotion.

You can listen to this as a podcast


Perry, L., Xu, X., Duffield, C., Gallagher, R., Nicholls, R. and Sibbritt, D. (2017), Health, workforce characteristics, quality of life and intention to leave: The ‘Fit for the Future’ survey of Australian nurses and midwives. J Adv Nurs. doi:10.1111/jan.13347

Tuesday, 6 June 2017

Can a nurse who smokes promote health?

Roger Watson, Editor-in-Chief

Does it matter if a nurse smokes? Will they be effective at health promotion? This was the subject of an article from Spain which was based on a study aiming to: 'explore the views of current and ex-smoker nurses on their role in supporting patients to stop smoking.' The article by Mijika et al (2017) was titled: 'Health professionals’ personal behaviours hindering health promotion: A study of nurses who smoke'.

The study used interviews with nurses who had or who still smoked in one hospital in Spain. The views of the nurses varied; one nurse who thought it made no difference said: 'I think that in terms of patients it (being a nurse who smokes) doesn’t have an impact (on the care provided to the patient), I mean . . . the patient knows, when you are at work you are a nurse...'. But another disagreed, saying: 'I think it does have an impact. I think it does. [. . .] For example, if a patient is trying to quit and has a lung cancer and a smoker nurse who smells of tobacco approaches him advocating for something that she’s doing wrong. . ., that has to provoke some kind of reaction in the patient.' Even in the face of patients ill from a smoking related disease, nurses were able to justify smoking: 'I have experienced situations like when you are taking care of a patient who is very ill, grasping for breath, with a lung cancer, the family very uptight, with...very bad...and I have got out and said “I’m going to smoke.” I mean situations that overwhelm you, that you can’t control with medication, that you can’t control...that affects your human nature, you know?'

The authors concluded: 'Nurses with an unhealthy behaviour such as smoking experience
internal processes that might have a negative impact when engaging in health promotion practice. Smoking nurses may be inhibited as health promoters without noticing it, and they may need help to
address the conflict that they experience between their professional responsibility and their smoking behaviour. If health promotion practices are to be enhanced, interventions that help these health professionals are necessary.'

You can listen to this as a podcast


Mujika, A., Arantzamendi, M., Lopez-Dicastillo, O. and Forbes, A. (2017), Health professionals’ personal behaviours hindering health promotion: A study of nurses who smoke. J Adv Nurs.  doi:10.1111/jan.13343

Monday, 5 June 2017

Response to commentary on Blake, Stanulewicz & McGill (2017) Predictors of physical activity and barriers to exercise in nursing and medical students

Response to commentary on Blake, Stanulewicz & McGill (2017) Predictors of physical activity and barriers to exercise in nursing and medical students. Journal of Advanced Nursing, 73(4), 917-929

Holly Blake
Natalia Stanulewicz
Francesca McGill

On the May 10th 2017, JAN interactive published a commentary on Blake, Stanulewicz and McGill (2017) by Chappel et al. (2017). The authors of the commentary raised two main concerns regarding the study:(1) a possible misinterpretation of physical activity (PA) as solely “formal exercise” by the participants, and (2) a questionable extrapolation of the proposal for the need for PA interventions from student to staff nurse populations.

Regarding the first concern, the IPAQ-SF has been established as a reliable measure (e.g., Craig et al., 2003), that has been employed extensively across populations, cultural groups and demographics, and is extensively utilised worldwide. It was the preferred measure for use in this study due to its short format and ease of use, and has been described as ‘the most appropriate outcome measure for clinical and research use, as it has excellent reliability and moderate correlation with accelerometry’ (Silsbury et al, 2015).

We cannot report on exactly how participants interpreted the individual IPAQ-SF items in this online survey, although the measure includes items relating to walking, and vigorous or moderate intensity activities, and examples of activities were provided. Importantly, our participants were healthcare students, who receive education and training around health behaviours as part of their studies. At the institution where the data were collected, this includes both the distinction between types and levels of PA, and the relevance of work-related PA (including incidental activities) and their contribution to overall daily activity. Therefore, recognising there will be individual variation in the retention of learning, the overall potential for misinterpretation of PA and what it entails is likely to be low, or certainly lower in this sample than for other populations. For nurses, health promotion is a core aspect of their future professional role and as such is emphasised early in the first year of training.

We accept that PA may be either under, or over-reported using self-report measures, and that objective data is required to accurately measure PA levels. We do not dispute the potential for under-reporting of PA, although a systematic review of the validity of the IPAQ-SF including 23 studies, found that in almost all of the included studies, PA was actually overestimated using the IPAQ-SF by 36-173% (Lee et al, 2011).

Chappel and colleagues were concerned about extrapolating from student nurse to nurse populations, given the likelihood of higher PA in nurses within clinical settings. However, we remain convinced that our recommendations, based on our student sample and taken in context alongside the published literature, remain highly relevant to nurses as well as students of nursing.

First, workplace PA interventions can generate benefits in a range of occupational groups (see review by Anderson et al, 2009) including occupations incurring highly physical demands, such as home care workers (Pohjonen & Ranta, 2001). Physically demanding work does not necessarily have positive effects on physical fitness and so worksite PA intervention may offer additional benefits beyond work-related activities Further, we make no claim in our article that nurses and healthcare students are one and the same, although it is of clear relevance that all of the nursing students who completed our survey were registered on courses involving integrated clinical placements, and were regularly working alongside registered nurses in diverse clinical areas; therefore it follows that they may be exposed to similar work-related physical activities, and they were asked to report their activities with relation to clinical placements as well as university time.

Second, if high levels of work-related PA are observed in nurses (note: we do not know how this compares with students PA whilst on shifts), or if registered nurses self-report higher levels of PA than student nurses, we feel it would be unwise to focus only on the differences between the two populations in debating where to target PA intervention. The published evidence suggests that barriers to exercise reported by both groups can be similar, and that many nurses and students [a] do not meet government recommendations for daily PA, [b] are overweight or obese, and [c] report that their own health habits can impede their willingness to promote PA to patients. This sits clearly in line with the national call for health improvement of the health and medical force made in the 2010 Prime Minister’s Commission on the Future of Nursing and Midwifery in England, and the current government investment in health and well-being through the NHS Five Year Forward Plan.

With efforts to increase retention of nursing graduates, there is an increasing drive to instil healthy lifestyle behaviours in student nurses to ensure a healthy public health workforce for the future. This may help to establish patterns of healthy behaviours early on that will continue into the nursing career, and be promoted to patients and their families. Patterns of health behaviours that are established early on are likely to continue beyond registration and through the nursing career. Orr et al (2014) propose that PA positively correlates with motivation, well-being, coping and positive attitude, and that these attributes in turn impact on employability, retention and absence; they advocate that poor health and well-being of nurses may present risks around fitness to practice and may even breach the Nursing and Midwifery Council (NMC) Code of Conduct. These are all relevant factors for students and nurses, and for the transition between the two roles; and so it would be challenging to claim that these populations were unrelated.

Thus, we propose that health behaviours should be advocated and supported from student through to registered nurse rather than focusing solely on [i] either group, or [ii] the potential differences in PA between groups becoming determinants of whether it is timely to offer services, to which group, and to the exclusion of the other. Because of this we strongly disagree that it is premature to advocate PA intervention for nurses in the NHS workplace informed by findings from our sample, which sits alongside a wealth of published research evidence and national government-funded workplace intervention programmes.

Both nurses and nursing students consistently report low levels of PA, high levels of overweight and obesity, and barriers to healthy lifestyles influenced by common variables such as time pressure and shift work. We now need to move forwards in supporting healthcare professionals (of the current and next generation) to make healthy lifestyle choices. In workplace health practice, service commissioners do not necessarily distinguish between nurses and trainees who are not yet registered when it comes to promoting health – they all contribute to NHS healthcare through the profession of nursing, and can all access the same workplace physical activity interventions (see Nottingham University Hospitals NHS Trust as an exemplar of NHS well-being: Blake et al, 2013) and a ‘flagship’ trust in the UK Department of Health Five Year Forward Plan.

The ultimate goal of promoting PA to nurses or student nurses is broadly the same: to protect the physical and mental health of individuals, to reduce unnecessary burden to the NHS, and to support high quality patient care.

Dr Holly Blake
School of Health Sciences
University of Nottingham, UK

Natalia Stanulewicz
Department of Psychology
Durham University, UK

Francesca McGill, RN
Alder Hey Children’s Hospital
Liverpool, UK


Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, Johnson DB, Buchanan LR. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. Am J of Prev Med. 2009 Oct;37(4):340-57. doi: 10.1016/j.amepre.2009.07.003.
Blake H, Zhou D, Batt ME. Five-year workplace wellness intervention in the NHS. Perspect Public Health. 2013 Sep;133(5):262-71. doi: 10.1177/1757913913489611.
Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB.
Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International PA Questionnaire Short Form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act. 2011 Oct 21;8:115. doi: 10.1186/1479-5868-8-115.
Orr J, McGrouther S, McCaig M. Physical fitness in pre-registration nursing students. Nurse Educ Pract. 2014 Mar;14(2):99-101. doi: 10.1016/j.nepr.2013.10.002.

Pohjonen T, Ranta R. Effects of worksite physical exercise intervention on physical fitness, perceived health status, and work ability among home care workers: five-year follow-up. Prev Med. 2001 Jun;32(6):465-75.

Silsbury Z, Goldsmith R, Rushton A. Systematic review of the measurement properties of self-report PA questionnaires in healthy adult populations. BMJ Open 2015;5:e008430. doi:10.1136/bmjopen-2015- 00843

Wednesday, 31 May 2017

Nurses' Health Virtual Issue

The American Nurses Association has declared 2017 the Year of the Healthy Nurse. In recognition of this, JAN has put together a special Virtual Issue, comprised of previously published papers addressing key areas of nurses’ health, including the connection between health, workplace participation and strategies nurses use to self-manage their health and well-being.

All the JAN articles in the Virtual Issue will be free to access until 12 November 2017:

Breastfeeding in the face of domestic violence

Roger Watson, Editor-in-Chief

Can mothers continue to breastfeed if they are experiencing domestic violence? If so, what effects does it have on them? This was the topic of  an article from from Sweden by Finnbogadóttir and Thies-Lagergren (2017) titled: 'Breastfeeding in the context of domestic violence – a cross sectional study' and published in JAN aimed to: 'determine the differences in breastfeeding among women who did and did not experience domestic violence during pregnancy and postpartum in a Swedish context. In addition, to identify possible differences regarding breastfeeding between groups with or without a history of violence. Further, determine the relationship between exclusive breastfeeding and symptoms of depression'. Over 700 women resopnded to a questionnaire.

In fact, the majority of women experiencing domestic violence continued to breastfeed and this was no different from women not experiencing it. However, women who were depressed breastfed significantly less. This, of course, does not mean that women exeperiencing domestic violence did not experience difficulties with breastfeeding - but this was not part of the present study. It is still important to screen for domestic violence and also for depression. In conclusion the authors said: 'Not only is it desirable to recognize women who are exposed to violence but also crucial to identify and screen for depression in early pregnancy to give suitable treatment and support to those with symptoms of depression as the health of newborns depends on their mother’s mental well-being.

Yiou can listen to this as a podcast


Finnbogadóttir, H. and Thies-Lagergren, L. (2017), Breastfeeding in the context of domestic violence – a cross sectional study. J Adv NursDO10.1111/jan.13339