Tuesday, 20 January 2015

Pregnant and in prison

Roger Watson, Editor-in-Chief

Being pregnant can be a difficult time for some women; being in prison must be a difficult time for anybody but can you imagine being pregnant and in prison with the prospect of giving birth there?

A recent UK study by Shaw et al. (29014) and published in JAN titled 'Systematic mixed-methods review of interventions, outcomes and experiences for imprisoned pregnant women' investigates, using a literature review, the experiences of women who are pregnant and give birth in prison.  This is against a background of an increasing number of women who are pregnant and in prison worldwide; estimated, for example, to be 600 annually in the UK.  Studies were only obtained from the UK or USA and there were bot quantitative and qualitative studies.

The qualitative studies, emanating from interviews with pregnant prisoners are heart-rending; for example:

'...knowing it’s coming to an end. Picturing myself leaving my baby at the hospital. How lonely will it be...it’s tearing me up inside...I’m going to feel empty. Words just cant describe how bad it hurts. I don’t want to let him go.'

Sadly there is little good research in the area; in the words of the authors: 'There is very limited published data on the experiences and outcomes of childbearing women in prison. There appear to be no good quality intervention studies examining the effectiveness of interventions to improve well-being in the short or longer term for these women and their babies.'



Reference

Shaw J, Downe S, Kingdon C. (2014) Systematic mixed-methods review of interventions, outcomes and experiences for imprisoned pregnant women. Journal of Advanced Nursing. DOI: 10.1111/jan.12605

Wednesday, 14 January 2015

Can nursing handovers be more effective?

Roger Watson, Editor-in-Chief

Nursing handovers are a routine, a ritual almost, between nursing shifts. I recall many different patterns during my time in clinical practice. At one end of the spectrum there was the the mass exodus of the majority of nursing staff  to the ward office for a long and quite boring summary of each patient; aimed at everyone at once and nobody in particular with a great deal of irrelevant information included. At the other end of the spectrum - and exemplified on intensive care - one-to-one handovers in considerable detail, all of it easily obtained at a glance form the patient chart.  There were varying philosophies about writing things down during handover: some saw this as a potential breach of patient confidentiality if the notes became lost; others expressed surprise that you were not capturing their words of wisdom on a scrap of paper. In any case, questions were discouraged. Whatever model was in operation I felt that they were all a considerable waste of time.

However, nursing handovers are potentially valuable and some modes of conductung them may be safer than others as a recent study published in JAN shows (Drach-Zahavy and Hadid 2015).  The study comes from Israel and is titled: 'Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift'.  The authors studied 200 randomly selected handovers, including the accompanying documentation, and found a great deal of inaccuracy in terms of medication dosage and missing information. The best model for handover was one that was face-to-face and where an open and questioning attitude was adopted. In the words of the authors: 'Our study presents opportunities for interventions aimed to improve communication during handover. The findings, which support the association between specific handover strategies, errors and handover quality, suggest the integration of flexibility alongside standardized procedures.'

Listen to this post as a podcast:



Reference

Drach-Zahavy A, Hadid N (2015) Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift Journal of Advanced Nursing doi: 10.1111/jan.12615

Staffing levels and patient outcomes

Roger Watson, Editor-in-Chief

Does it matter how many staff you have in a clinical area? Of course it does - we can all recall shifts with fewer than expected staff, where corners had to be cut and care delivery prioritised. But what effect does understaffing really have on the things that nurses do, or are supposed to do, and can these be measured?

In an article from Australia by Twigg et al. (2015) titled 'The impact of understaffed shifts on nurse-sensitive outcomes', the authors claim that it does.  They define nurse sensitive outcomes as 'adverse patient outcomes that can be used as indicators of the quality of nursing care' and they conducted a secondary analysis of data on a sample of over 30,000 admissions over two years. The outcomes studied were: surgical wound infection, urinary tract infection, pressure injury, pneumonia, deep vein thrombosis, upper gastrointestinal bleed, sepsis and physiological metabolic derangement.  In all cases understaffing had an adverse impact. These findings are very important and the authors are looking to expand the outcomes that could be linked to understaffing; in their own words: 'The methods developed for this study could be used to add other variables of interest at the patient level, for example patient turnover or nurse skill mix, to aid understanding of nurse staffing and the context of care and their impact on patient outcomes.'

Listen to this post as a podcast:



Reference

Twigg DE, Gelder L, Myers H (2014) The impact of understaffed shifts on nurse-sensitive outcomes Journal of Advanced Nursing doi:10.1111/jan.12616

Thursday, 8 January 2015

What happens to my manuscript after submission to JAN?

Roger Watson, Editor-in-Chief

This podcast explains what happens to a manuscript after submission and covers screening by the Editor-in-Chief, the Managing Editor and the Editors.



Tuesday, 6 January 2015

Response to Commentary: Obesity – the epidemic that can be stopped if we address it as a societal as well as individual issue

Geraldine A. Lee, NFESC, PhD

Response to commentary by Perry to editorial: Lee, G. (2014), Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing. DOI: 10.1111/jan.12584

Obesity is one topic that elicits a response and attempting to convey an important message in an editorial can prove testing. In response to the commentary from Perry, there are two very important points that need to be taken into consideration. Firstly, obesity is a complex global problem that nurses alone cannot address and secondly singling out a particular workforce such as nurses is not an ideal approach especially with the evidence regarding circadian disturbance associated with shift work.

Obesity is not a single entity and is an independent risk factor for conditions such as hypertension, type 2 diabetes and cardiovascular diseases (CVD). In relation to CVD, many physiological markers such as C-reactive protein, interleukin-6 and other cytokines have been implicated in the development of CVD in obese individuals but the paradoxical relationship between obesity and mortality is not fully understood (Ghoorah et al. 2014). Given this, we need scientists and clinicians of all disciplines to play an active role in investigating and managing obesity. Nurses are well placed to deliver education and advice to patients but care needs to be delivered in collaboration with other healthcare professionals, in particular dieticians and physiotherapists. Many studies in obesity report positive results with motivational interviewing and cognitive behavioural therapy and unfortunately not many nurses have these skills or qualifications. I would also argue that epigenetics and obesity as a speciality topic is not mandatory in most nursing education courses (either at pre-registration or post-registration). The World Health Organisation acknowledge the importance of educating healthcare professionals about diet and physical activity (Branca et al. 2007) and a multidisciplinary approach seems the most appropriate approach.

Obesity is not only prevalent in high-income countries but also in low to middle-income countries with 1 billion adults overweight globally and 300 million clinically obese with these numbers expected to increase. Although nurses are visible and highly educated in high-income countries, this is certainly not the case in low and middle-income countries and thus my statement that healthcare professionals playing a role and not just nurses. The on-going Ebola crisis brings home the lack of nurses and resources.

Although nurses play a pivotal role, I disagree with Perry’s comment that; ‘Halting it [obesity] in nursing would be a good start’. From a physiological perspective, attempting to address obesity solely in nurses is unwise. There is a plethora of research highlighting the negative effects of shift work on the body, down to the molecular level with evidence of increased risk of diabetes and obesity (Wang et al. 2011; Feng & Lazar, 2012; Archer et al. 2014). A recent study reported that 97% of rhythmic genes are out of sync in those who work shifts and this has serious implications in terms of potential transcription errors (Archer et al. 2014). The recent Health Survey for England data revealed that shift workers are sicker and fatter (Weston, 2014). Shift workers were more likely to have a long-standing illness, have diabetes, be obese, smokers and have lower daily fruit and vegetable consumption than non-shift workers. This suggests that attempting to treat obesity in nurses is not advisable. From a research perspective, it would be more appropriate to manage and treat obesity in a group who don’t work shifts as it is clearly a major confounder.

There is no doubt that national and international policies are important and all shift-workers including nurses should have access to healthy food rather than the usual unhealthy vending machine options at 4am. I am not advocating that individuals alone can correct their obesity but like the ill-effects of cigarettes now known to us all, there is no excuse for people not to be aware that having a diet high in saturated fat and not doing the minimally required physical activity leads to weight gain and obesity. Given that most of us overestimate our height and underestimate our weight, suggest that some self-truths, especially at this time of the year, wouldn't go amiss. The news today from the European Court of Justice that obesity can constitute a disability has major ramifications within the European Union that may adversely hinder progress in reducing obesity (The Guardian, 2014).

There is high quality evidence supporting eating less and moving more but many of the effects are short-lived (less than 2 years) and that is why the healthcare practitioner has a vital role to play in collaboratively managing long-term health problems associated with obesity. The job is too big for nurses, individuals and society have to take responsibility too.


Geraldine A Lee, NFESC, PhD.
Lecturer, Department of Postgraduate Research,
Florence Nightingale Faculty of Nursing & Midwifery,
Kings College London,
Email: Gerry.lee@kcl.ac.uk



References:

Archer SN, Laing EE, Moller-Levet CS, van der Veen D, Bucca G. et al. (2014) Mistimed sleep disrupts circadian regulation of the human transcriptome. Proceedings of the National Academy of Sciences of the United States of America; 1111 (6): E682-689.

Branca F, Nikogosian H, Lobstein T (2007) The Challenge of Obesity in the WHO European Region and the Strategies for response-summaries. World Health Organisation: Denmark.

Feng D, MA Lazar (2012) Clocks, Metabolism, and the Epigenome. Molecular Cell 47 (2): 158–167.

Ghoorah K, Campbell P, Kent A, Maznyczka A, Kunadian V. (2014) Obesity and cardiovascular disease: a review. European Heart Journal: Acute Cardiovascular Care. DOI: 10.1177/2048872614523349.

Lee, G. (2014), Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing. DOI: 10.1111/jan.12584

The Guardian (2014) Obesity can be disability, EU court rules. Accessed on 18/12/14 at http://www.theguardian.com/society/2014/dec/18/obesity-can-be-disability-eu-court-rules

Wang XS, Armstrong MEG, Cairns BJ, Key TJ, Travis RC (2011) Shift work and chronic disease: the epidemiological evidence. Occupational Medicine 61 (2): 78-89.

Weston L. (2014) ‘Shift Work’ in The Health Survey for England. The Health and Social Care Information Centre; London.





Increase the influence of your article

Roger Watson, Editor-in-Chief

These days, getting your manuscript published is only the first step. With the rise in the importance of downloads and citations and - assuming that you want your article to be read and to influence policy, practice or research - we can help you to make sure your article reaches as wide an audience as possible. For accepted and published authors we specifically encourage this in our guidance.

One of the easy ways to do this is to make a podcast. Here I offer some advice, in a podcast, as to how this can be done using some free software and an inexpensive podcasting facility. The main thing to note is that you must be able to make audio files in the MP3 format. If you do not wish to make the podcast yourself, you are welcome to send us an MP3 file of a recording and we can do the rest for you.

To demonstrate just how easy it is to make a podcast, I demonstrate the whole process in the video below.

Once you have made a podcast, we can promote it on the JAN webpage, here on JAN interactive, and via Twitter.


Friday, 2 January 2015

What determines whether or not nursing faculty stay?

Roger Watson, Editor-in-Chief

There is a worldwide shortage of nursing academics (‘faculty’ in North American terminology). Our detractors may say there are already too many but, of course, faculty are required to teach future generations of nurses and provide the evidence—along with practitioners—for best practice. The number of faculty compared with those registered and in practice is very small in any case and, in fact, a great many faculty make a significant contribution to practice. However, there are insufficient people wanting to take academic jobs and many who do are inadequately prepared for the task. So, the issue arises of how to keep faculty and what do they say as the factors that push them out of academia and those which attract them to stay. Remarkably, the answer is not money as an article from Canada by Tourangeau et al. (2014) titled ‘Generation-specific incentives and disincentives fornurse faculty to remain employed’ and published in JAN shows.

The article by Tourangeau et al. (2014) reveals some generational differences in what motivates and repels faculty but there is a general pattern related to have manageable workloads and supportive environments—specifically deans—which must ‘ring a bell’ with most of us. Unlike other university subjects, nursing is often taught across three ‘semesters’ with additional expectations of clinical supervision and professional requirements not expected of many others. The expectations regarding administrative roles, research income generation and publication remain the same. The situation requires investigation and solutions and, as the authors conclude: ‘the findings of this study may be used to develop and test generation-specific retention-promotion strategies.’


Reference

Tourangeau AE, Wong M, Saari M, Patterson E (2014) Generation-specific incentives and disincentives for nurse faculty toremain employed Journal of Advanced Nursing doi: 10.1111/jan.12582