Monday, 31 October 2016

Comment on: Duffield et al. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing

Comment on: Duffield C., Roche M., Twigg D., Williams A. & Clarke S. (2016) A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing 72(9), 2218–2225


Annette Ayers, RN, BSN, MHA
University of Texas at Arlington

I recently read the article “A protocol to assess the impact of addition nursing support workers to ward staffing” in the September 2016 issue of JAN. With a potential nursing shortage, which is being caused by multiple factors, healthcare facilities are going to have to look at new ways to provide care. As a nursing executive, I believe the addition of non-licensed staff or the LVN, to provide some aspects of patient care, is a way to accomplish this goal (Lafer & Moss, 2007).

I do feel that there is one additional limitation that should be addressed in the study. As required by the Board of Nursing, the delegation of tasks by the Registered Nurse can only be done for those with stable and predictable health conditions (Texas Board of Nursing, 2016). As patients in the hospital are becoming more critical, the addition of non-licensed staff may become less beneficial because many tasks will still be required to be accomplished by the licensed staff member.

One recommendation for the study would be to include types of units when the pairing of units to be studied is completed. Pairing of units based on nursing hours per day, is just one factor to be considered. For example a medical-surgical unit that cares for orthopedic patients may have the same nursing hours per day as the medical-surgical unit with dialysis patients, but these units are very different. For example, orthopedic patients require much more time for education related to physical limitations, whereas dialysis patients typically require many more interventions and medications. Pairing of units based on similar patients, with similar nursing tasks that can or cannot be delegated, could be beneficial to the study.
References

Duffield, C., Roche, M., Twigg, D., Williams, A., & Clarke, S. (2016). A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing, 72, 2218-2225.

Lafer, G., & Moss, H. (2007). The LPN: A practical way to alleviate the nursing shortage. Retrieved from www.afscme.org/news/publications/health-care/the-lpn-a-practical-way-to-alleviate-the-nursing-shortage

Board of Nurse Examiners (2016). Nursing practice act. Retrieved from http://www.bon.texas.gov/pdfs/delegation_pdfs/Delegation-Rule225.pdf


Friday, 28 October 2016

Healthy eating for nurses

Roger Watson, Editor-in-Chief

Nurses sometimes advise others on healthy eating but how healthy are their own diets and how easy is it for them to adhere to a healthy diet at work? This is the topic of this study from Australia by Nicholls et al (2016) titled: 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review' and published in JAN.

The aim of the study was: 'to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses.' Twenty-six articles were reviewed. The results showed that: 'Long work hours, shift work, a high workload, low staffing levels and short/few work breaks were all reported as organizational barriers to nurses’ healthy eating. No organizational factors that facilitated healthy eating were reported'. The authors concluded: 'By addressing the complexity of reasons for unhealthy eating in the workplace, change can be strategic and effective' and: 'While not an inconsiderable undertaking, the potential benefits in terms of staff health and well-being and the potential knock-on effects for the community make this worthwhile'.

You can listen to this as a podcast

Reference

NICHOLLS R., PERRY L., DUFFIELD C. & GALLAGHER R. (2016) Barriers and facilitators to healthy eating for nurses in the workplace: an integrative reviewJournal of Advanced Nursing  doi: 10.1111/jan.13185

Keeping nursing and medical students fit

Roger Watson, Editor-in-Chief

What helps or hinders keeping fit among nursing and medical students? This is the subject of a UK study by Blake et al (2016) titled: 'Predictors of physical activity and barriers to exercise in nursing and medical students' and published in JAN. The aim of the study was: 'To investigate physical activity levels of nursing and medicine students, examine predictors of physical activity level and examine the most influential benefits and barriers to exercise.'

The study involved over 300 students - roughly equally divided between nursing and medical students who were surveyed over one year and asked about: 'physical activity level, benefits and barriers to exercise, social support, perceived stress and self-efficacy for exercise'.  The results showed that: 'a significant proportion of healthcare students responding to our survey was not meeting recommended levels of physical activity required to benefit their health'. Older students were less likely to get enough physical activity. There was no difference between nursing and medical students in levels of physical activity. The authors conclude: 'Efforts should be made to promote physical activity in healthcare students to increase the proportion meeting the basic daily recommendation for the level of physical activity required to benefit health. This is important since healthcare professionals are often regarded as health role models for general society'.

You can listen to this as a podcast

Reference

BLAKE H., STANULEWICZ N. & MCGILL F. (2016) Predictors of physical activity and barriers to exercise in nursing and medical students. Journal of Advanced Nursing  doi: 10.1111/jan.13181

Thursday, 27 October 2016

Are you type D personality?

Roger Watson, Editor-in-Chief

Are you type D personality? Do you know what that means and what effect it may have on your life? The effect of this personality tpe - described as being someone who is: 'vulnerable to negative affect, such as depression or anxiety and consciously suppresses self-disclosure in social interactions' is the focus of this sudy from Korea by Kim et al (2016) titled: 'Influence of type D personality on job stress and job satisfaction in clinical nurses: the mediating effects of compassion fatigue, burnout, and compassion satisfaction' and published in JAN.

The aim of the study was: 'To test a hypothetical path model evaluating the influence of type D personality on job stress and job satisfaction and to identify the mediating effects of compassion fatigue, burnout, and compassion satisfaction among clinical nurses in South Korea.'  The study involved nearly 900 nurses who were given several questionnaires to measure personality, stress and job satisfaction.

The results of the study showed that: 'type D personality was significantly associated with compassion fatigue, burnout, and compassion satisfaction.' The authors conclude: 'Because having a type D personality affects job stress and job satisfaction, identifying the personalities vulnerable to stress is needed to relieve job stress and to enhance job satisfaction when nurses experience a high level of compassion fatigue and burnout and a low level of compassion satisfaction. More interventions that can reduce negative affect and social inhibition of nurses with type D personality need to be developed in addition to methods that can decrease compassion fatigue and burnout and increase compassion satisfaction.'

You can listen to this as a podcast

Reference

KIM Y. H., KIM S .R., KIM Y. O., KIM J. Y., KIM H.K. & KIM H. Y. (2016) Influence of type D personality on job stress and job satisfaction in clinical nurses: the mediating effects of compassion fatigue, burnout, and compassion satisfaction. Journal of Advanced Nursing doi: 10.1111/jan.13177

Monday, 24 October 2016

Mindfulness works

Roger Watson, Editor-in-Chief

Mindfulness is trendy, but does it do any good? A recent study from Canada but Guillaunie et al. (2016) titled: 'A mixed-methods systematic review of the effects of mindfulness on nurses' and published in JAN suggests that it does. The study aimed: 'To review the effects of mindfulness-based interventions on Registered Nurses and nursing students'. The definition of mindfulness used was: 'Mindfulness can be defined as a form of mental training
through a variety of exercises that involve stilling or emptying the mind or intentionally bringing one’s attention to an inner object such as the present moment or the breath (Baer 2003, Chen et al. 2012).

Reviewing 32 studies published between 1980-2014, 17 of which were controlled designs, and applying meta-analysis they found that: 'mindfulness-based interventions may be effective in significantly reducing state anxiety and depression at posttreatment and state anxiety and trait anxiety at follow-up'. Qualitative studies were also reviewed and supported these findings. The authors conclude: 'Mindfulness training seems to be an effective strategy for organizations wishing to improve nurses’ mental health, as meta-analysis suggests positive effects on anxiety and depression'.

You can listen to this as a podcast

References

Baer R.A. (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice 10(2), 125–143.

Chen K.W., Berger C.C., Manheimer E., Forde D., Magidson J., Dachman L. & Lejuez C. (2012) Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety 29(7), 545–562.

GUILLAUMIE L., BOIRAL O. & CHAMPAGNE J. (2016) A mixed-methods systematic review of the effects of mindfulness on nurses. Journal of Advanced Nursing  doi: 10.1111/jan.13176

Thursday, 13 October 2016

Nurses do not see role modelling healthy behaviours as a reasonable professional expectation

Roger Watson, Editor-in-Chief

Should patients and the public expect nurses to be good role models for healthy behaviours? Apparently not - according to nurses.  This surprising finding comes from a UK study by Kelly et al. (2016) titled: 'Should nurses be role models for healthy lifestyles? Results from a modified Delphi study' and published in JAN which aimed: 'To explore the expectation that nurses should be role models for healthy behaviours'. The study involved: 'practising nurses, nursing students, service users, policy makers, workforce development leads and stakeholders working in nurse education' in telephone interviews and a questionnaire. I have to declare that I was one of the respondents.

The authors concluded: 'This study has shown attitudes towards role modelling healthy behaviours different from the views expressed in nursing literature. Behaviour change was thought much more complex than simple imitation; contesting the assumption that role modelling can effect behaviour change. The ‘ideal’ role model proffered by stakeholders was someone who had struggled with unhealthy behaviours but eventually successfully changed the behaviour. Apart from the service user group, stakeholders felt that the healthy role model conceptualized in policy and professional guidance as best placed to encourage behaviour change was unhelpful and unrealistic'.

You can listen to this as a podcast

Reference

KELLY M., WILLS J., JESTER R. & SPELLER V. (2016) Should nurses be role models for healthy lifestyles? Results from a modified Delphi study. Journal of Advanced Nursing doi: 10.1111/jan.13173

Friday, 7 October 2016

Caring for ebola patients

Roger Watson, Editor-in-Chief

Ebola is not new and appeared in the pages of JAN over a decade ago in an article by Locsin and Matua (2002).  However, what is new is the more recent extent to which it spread across some parts of Africa and the ensuing death toll.  Of course, it 'hit the headlines' in the UK following the unfortunate case of the 'ebola nurse' Pauline Cafferkey. Ebola has resurfaced in the pages of JAN in a study from Sweden by Andertun et al. (2016) titled: 'Ebola virus disease: caring for patients in Sierra Leone – a qualitative study' and published in JAN. 

The aim of the study was to: 'describe Norwegian healthcare staffs’ experiences of participating in care of patients with Ebola virus disease in Sierra Leone'.  Eight nurses and one doctor were interviewed and the results provided some insight into the experience of these health professionals. Various themes came across about conquering fears and taking safety precautions and living with death.  The authors concluded: 'Our findings revealed that Ebola workers were relying highly on safety and used strategies to minimize risks of contagion. Safe care was central in working with Ebola patients, but the caring relation was challenged. They were constantly reminded of death and had to defeat their fears, but nevertheless they found their experiences of the hazardous work as meaningful and an important motivator.'

You can listen to this as a podcast

References

ANDERTUN S., HÖRNSTEN A. & HAJDAREVIC S. (2016) Ebola virus disease: caring for patients in Sierra Leone – a qualitative study. Journal of Advanced Nursing doi: 10.1111/jan.13167

Locsin, R. C. and Matua, A. G. (2002) The lived experience of waiting-to-know: Ebola at Mbarara, Uganda – hoping for life, anticipating death. Journal of Advanced Nursing, 37: 173–181. doi:10.1046/j.1365-2648.2002.02069.x

Improving outcomes of surgery on children for children and parents

Roger Watson, Editor-in-Chief

Having a child go through surgery can be difficult for parents, as well as the child. If the problems of lack of knowledge about what the child is going through and the stress associated with that and problems such as post-operative pain for the child are not alleviated, the outcomes from surgery can be made worse. This study from Canada by Chartrand et al. (2016) and published in JAN titled: 'The effect of an educational pre-operative DVD on parents’ and children’s outcomes after a same-day surgery: a randomized controlled trial' aimed to: 'examine the effect of a pre-operative DVD on parents’ knowledge, participation and anxiety and on children’s distress, pain, analgesic requirements and length of recovery after same-day surgery.'

Several outcomes were measured in this study including post-operative pain in the children who, along with their parents, watched the DVD and those who did not.  Outcomes for the parents in the DVD group were positive, including knowledge and pain in the children in this group was reduced. The authors concluded that the DVD intervention was useful in helping parents to help their children in the immediate post-operative period but that the effect may not, necessarily, be sustained.

This article is available open access and you can listen to this as a podcast

Reference

CHARTRAND J., TOURIGNY J. & MACCORMICK J. (2016) The effect of an educational pre-operative DVD on parents’ and children’s outcomes after a same-day surgery: a randomized controlled trial. Journal of Advanced Nursing doi: 10.1111/jan.13161

Decreasing depression in caregivers of people with dementia

Roger Watson, Editor-in-Chief

Depression amongst those who care for people at home with dementia is a significant problem. The adverse effects of the burden and the stress of care can have adverse psychological consequences which, if they are not alleviated, can then have an adverse effect on the person with dementia: their carer will become unable to care for them. This problem is addressed in a study from Taiwan by Kuo et al. (2016) titled: 'A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia' and published in JAN.

The aim of the study was: 'to explore distinct trajectories of caregivers’ depressive symptoms and the effects of a training programme on these trajectories over 18 months after the programme'. As explained by the authors: '(t)he experimental group received the training programme with telephone consultation and the control group received written educational materials and social telephone follow-ups'. The intervention worked to alleviate the depressive symptoms of the carers.  The authors concluded: 'The results of this study can provide a reference for healthcare providers who regularly deal with persons with dementia and their caregivers to identify high-risk groups and to reduce family caregivers’ depressive symptoms by providing the individualized family caregiver training programme. Our study can also serve as a model for future studies on trajectories and related interventions for family caregivers’ depressive symptoms.'

You can listen to this as a podcast

Reference

KUO L.-M. , HUANG H.-L., L IANG J., KWOK Y.-T., HSU W.- C., SU P.- L. & SHYU Y.- I.L. (2016) A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia. Journal of Advanced Nursing doi: 10.1111/jan.13157