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Nursing Handovers: Important Complex Interactions with Limited Guidance

26 Sep, 16 | by rheale

Roberta Heale, Associate Editor EBN, @robertaheale @EBNursingBMJ

I don’t know about you, but when I was in nursing school I was never taught anything about the ‘nursing handover’, or report given to the oncoming nurse. We learned what to do from our nursing preceptors and from the other nurses when we started practicing. The content provided about patients during handovers was completely dependent upon the individual nurse reporting.  Detail was most commonly provided for specific incidents, like a patient fall, but with the complexity of care for up to 12 patients, there was very little time to discuss important information, such as the medications prescribed to the patient(s). Like many other things in nursing, it has just been accepted as ‘how things are done’.

I recently became interested in the process when I hosted a podcast with Dr. Bernice Redley who discussed a research article that explored medication communication during nursing handovers.

Article:Braaf S, Rixon S, Williams A et al. Medication communication during handover interactions in specialty practice settings. J Clin Nurs. 2015 Oct;24(19-20):2859-70

Click here to listen to the podcast

Looking back, it’s clearly such a complex and important part of nursing.  It seems odd that this critical process has been so overlooked in my education, and possibly in the education of many other nurses.  There is definitely the need for more research into the complex communication of nursing handovers.  It’s important to identify the priorities for the patient care for the incoming shift, but also to anticipate issues, such as medication interactions.  Development of standardized information for handovers may be helpful, yet it would need to be flexible enough to account for the unexpected and unusual circumstances.

If you are like me and haven’t given a lot of thought to nursing handovers, I encourage you to listen to the podcast as a start.


Reflections on the hidden extent of restraint in critical care

11 Sep, 16 | by josmith

Angela Teece ( Trainee Lecturer in Adult Nursing, University of Leeds


I recently left clinical practice, where I had worked as a critical care sister in a large district general hospital, to undertake a university role. Stepping back from practice and reading recent legislation on the deprivation of liberty (DoLS), enabled me to reflect on how the care I provided to patients could be viewed as restrictive.

Deprivation of liberty could relate to:

  • Is the patient under close supervision?
  • Is the patient free to leave the clinical area?

Clearly, on this level, all critical care patients, and many patients on general wards, are being deprived of their liberty. DoLS guidance is supported by the 2005 Mental Capacity Act (MCA) in its definition of restraint. This can be physical, chemical or verbal, for example, the use of bed rails restricts patient mobility, and regulated visiting times and controlled entry to the unit reduce opportunities for the patient to interact with their family.

Critical care is a specialised area of practice. Patients are commonly sedated to enable tolerance an endotracheal tube, ventilator and multiple vascular access devices. Each of these things, although used in the patient’s best interest, could be considered a form of restraint under the MCA and DoLS. Physical restraints in the form of ‘boxing gloves’ may be used to prevent agitated patients interfering with life-saving treatment (Happ, 2000) and chemical restraint may also be used to control agitation (Hofso and Coyer, 2007).

Screen Shot 2016-09-03 at 11.35.41On reflection, I believe nurse are generally tasked with applying restraints, either by putting ‘boxing mitts’ on an agitated patient, or by administering at their discretion as required medication. Nurses must be able to justify their actions. Any restrictive intervention must be in the patient’s best interests and decisions can only be made for a patient if they lack capacity (MCA, 2005). Nurses should fully assess the need to restrain their patient using a validated tool, and conduct reassessment regularly whilst maintain their patient’s dignity whilst restraints are being used. Links have been made to patient experience of critical care and long-term psychological problems such as post-traumatic stress disorder (Jones et al., 2001). Rigorous nursing documentation, completion of DoLS referrals and regular patient observation and evaluation are vital to prevent prolonged restrain and promote patient dignity.

Happ, M.B. 2000. Preventing treatment interference: The nurse’s role in maintaining technologic devices. Heart & Lung: The Journal of Acute and Critical Care. 29(1), pp.60-69.

Hofso, K. and Coyer, F.M. 2007. Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: contributing factors. Intensive Crit Care Nurs. 23(5), pp.249-255.

Jones, C., Griffiths, R.D., Humphris, G. and Skirrow, P.M. 2001. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine. 29(3), pp.573-580 578p.

Contemporary topics in respiratory care

4 Sep, 16 | by josmith

Following our summer recess, we are delighted at EBN to welcome new and established Tweeters to our next series of Twitter chats. We have an exciting range of topics planned, starting on Wednesday the 7th of September 8-9pm (UK/BST) with a debate on developments in respiratory care hosted by Jacqui Pollington a respiratory nurse specialist (  She leads a home oxygen assessment and review service and an outreach service for patients who are frequently admitted with exacerbations of respiratory disease.

Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The last 10 years have seen significant advances in the diagnosis and management of non malignant respiratory disease. There are around 11 inhaler devices available now, and in total around 25 choices depending on drug, dose and combination required – all to treat airways disease, be that asthma, COPD or….dare I say, ACOS (asthma/copd overlap syndrome). Phenotyping could be considered the vogue, but it is very likely in the era of personalised medicine that phenotyping is here to stay and therefore significantly expand the diagnostic workup currently undertaken by many in primary care. The increasing identification of multi-morbidity in COPD and the profound effects of some comorbidity (for example, the biggest co-morbid predictor of death in the female with COPD is anxiety) brinScreen Shot 2016-09-02 at 17.54.38gs another clinical dimension to respiratory care. In this context, how does the nurse dealing with a patient with obstructive respiratory disease keep up to date in this very changeable clinical landscape.

Screen Shot 2016-09-02 at 17.57.13

This twitter chat will focus on the following key themes:

  • NICE or GOLD in COPD? Which guidance should we be following and why?
  • ICS or not? That is the question? And after the pneumonia? Do we involve patients in the decision?
  • Pulmonary rehab….why wait til MRC3?
  • Smoking – how do we expose the elephant in the room? What do respiratory clinicians know about addiction?
  • How can nursing influence lung health?

Finding a way through the woods: Equipping student nurses with evidence appraisal skills

29 Aug, 16 | by dibarrett

Dr David Barrett, Director of Pre-Registration Nurse Education, Faculty of Health and Social Care, University of Hull

The place of research-mindedness and evidence appraisal in pre-registration nursing curricula has been the subject of much debate and scrutiny over the decades. Though there has long been recognition that care should be evidence-based, providing student nurses with the fundamental skills required to read, appraise and apply research findings was not always a central element of predominately skills-based programmes of nurse education.

Incrementally, there has been a move towards nursing being recognised as an academic profession and not purely a skilled vocation – in the UK, this has manifested in a number of ways:

  • the move from tradition-based to evidence-based practice in the 1970s
  • the transfer of nurse ‘training’ into Higher Education in the 1990s
  • nursing programmes becoming only graduate-level (or higher) from 2011.

The Nursing and Midwifery Council in the UK recognise the importance of evidence-appraisal skills, requiring nurses who join the register to be able to “…appreciate the value of evidence in practice, be able to understand and appraise research…” (NMC, 2014)

Whilst these developments have been welcome, they only put in place the foundation for a research-minded nursing profession. Simply making nursing a Degree-level subject and teaching it in a University does not automatically produce evidence-based practitioners. However, embedding research-focused content into nurse education programmes can make a difference – Leach et al (2016) demonstrated that a research education programme for student nurses can enhance their research skills and application of evidence-based practice.


Simulation: Experiential, Safe Learning in Healthcare

22 Aug, 16 | by hnoble


Dr Ian Walsh, @Bigianbo – Queen’s University Belfast, School of Medicine

Simulation is encountered increasingly in healthcare education, throughout both undergraduate and postgraduate arenas. Particularly in key areas such as patient safety, it has evolved significantly from simulated clinical tasks deploying high fidelity manikins to replication of complex clinical scenarios addressing nontechnical skill issues such as communication, decision making and teamworking.

A succinct description is: “an educational technique that allows interactive, and at times immersive activity by recreating all or part of a clinical experience without exposing patients to the associated risks”1

The need for a “uniform mechanism to educate, evaluate, and certify simulation instructors for the health care profession” was recognized by McGaghie et al. in their critical review of simulation-based medical education research2.


Mission Possible – Putting Neonatal Pain Knowledge into Action

14 Aug, 16 | by josmith

Dr Denise Harrison (RN, PhD), Associate Professor, Chair in Nursing Care of Children, Youth and Families, University of Ottawa &  Children’s Hospital of Eastern Ontario (CHEO) Research Institute OR

This week’s EBN Twitter Chat is being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), between 1900-2000 (British Summer Time) and is a joint venture with the Council of International Neonatal Nurse (COINN) conference 2016 being lead by Dr Densie Harrison. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

We have the knowledge how to reduce pain in sick and healthy newborns during routine, frequently occurring painful procedures – breastfeeding,1 skin-to-skin care2 or very small volumes of sweet solutions, either sucrose3 or glucose.4 Evidence from randomized controlled triaAlice Englishls – synthesized into systematic reviews – further distilled into clinical practice guidelines and finally concentrated into usable evidence; YouTube videos showing these strategies during bloodwork (BSweet2Babies & Power of Parent’s touch) give us ample knowledge and tools to inform our practice and help us translate the knowledge into action. Yet, studies of newborn pain practices around the world continue to show that neonatal pain in under-treated We do not consistently facilitate parents to breastfeed or hold their babies skin-to-skin during procedures, and sweet solutions are not always made available.5 Ultimately, the babies we care for in our Neonatal Intensive Care Units, Special Care Units, other hospital wards and even our healthy newborn babies suffer from pain that is easily preventable.

In our COINN pain panel titled Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and live Twitter Chat (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), we will work together as neonatal pain champions in our organizations, to work at best ways to put our neonatal pain knowledge into action. Our panel includes our audience @COINN2016, as well as Dr Linda Franck, Dr Bonnie Stevens, Dr Marsha Campbell-Yeo (‏@DrMCampbellYeo),and myself, as the Session Chair (@dharrisonCHEO). Our discussion will include myths surrounding recommended pain care; effectiveness of maternal-led interventions to reduce procedural pain; ways we can support and empower parents and facilitate their role as partners in pain care, and improving practices at the organizational level.

I really look forward to our session, our speakers and, from our audience, ways to move forward to embed our knowledge into normalized pain management practices.

1         Shah PS, Herbozo C, Aliwalas LI, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012. DOI:10.1002/14651858.CD004950.pub3.

2         Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014. DOI:10.1002/14651858.CD008435.pub2.

3         Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2013 2016; DOI:10.1002/14651858.CD001069.pub5.

4         Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of non-sucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153–61.

5         Harrison D, Reszel J, Wilding J, et al. Neuroprotective Core Measure 5: Neonatal Pain Management Practices during heel lance and venipuncture in Ontario, Canada. Newborn Infant Nurs Rev 2015; 15: 116–23.

The Power of a Parent’s Touch on Newborn Procedural Pain

14 Aug, 16 | by josmith

Dr Marsha Campbell-Yeo PhD RN, Neonatal Nurse Practitioner, Associate Professor and Clinician Scientist, School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health Centre

No parent wants toBaby SSC image for ebnjc see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event with preterm and sick babies ofte
n undergoing on average 12 painful procedures every day with the majority receiving little or no pain relief. In addition to the immediate pain and stress babies experience during these procedures, the
se babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. This has to change.

As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and wellbeing but they are not always involved in critical care settings. Over my time at the bedside, I noticed that the power of touch could have a positive impact on infants and mothers. So I decided to study this. We found that Skin-to-Skin Contact (SSC), sometimes called kangaroo care, where an infant lies directly on a mothers’ chest, between moms and infants has powerful benefits and can even significantly decrease pain responses in preterm and full term infants undergoing a single painful procedure such as blood collections and needle pokes. However, it is not just mothers that can provide pain relief – fathers, alternative care providers and co-bedding twins have been found to effectively reduce pain during procedures as well!

Despite these positive findings related to pain management in newborns, pain is still associated with regular procedures and continues to be undermanaged for these infants during their hospital stay. A significant challenge remains related to practice change in the NICU. We found that while nurses reported fewer concerns over time related to helping mothers provide SSC as a pain-relieving strategy in the NICU, the amount of the time SSC was actually used did not change.tumblr_maq3vwaULq1rog5d1o1_500

Knowing the positive impact that families can have on minimizing pain during painful procedures by simply asking for it is something that I felt I had to get into the hands of parents. Therefore, I created a parent friendly video titled “Power of a Parent’s Touch” that is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 156,000 views so far in over 150 countries around the world!

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years! Parents are one of our most underutilized resources to help relive this pain.

We need to change that. Parents can make a difference.

Join COINN live Twitter Chat – Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

Let’s do it With Parents!

14 Aug, 16 | by josmith

Professr Family Health care, School of Nursing, Univisrt of California San Francico @lfranck77 @UCSFnurse @UCSFPTBI

Joining together for COINN 2016 is a wonderful opportunity to reflect on how far we’ve come – and where we still need to do better – in preventing and treating neonatal pain. As I think about the role of parents as partners in neonatal pain management, we seem to be on a 15 year cycle of paradigm shifts in our thinking.

It wasn’t until the mid-1980s that neonatal pain was first recognized as a serious health condition, and parents played an important role in bringing public attention to the untreated pain of infants in neonatal intensive care units. Then, in the early 2000’s we started asking parents about their views on how we were managing infant pain and, guess what? – they had many questions, worried about how not being able to comfort their baby meant that they weren’t able to be a good parent, and parents wanted to be more involved, but didn’t know how.

This realization began a very fruitful era of research where we all discovered that parents were our best “medicine” for preventing or treating much of the day-to-day pain that infants experienced. We learned it was safe and effective – often more safe and effective than traditional analgesics. We also discovered that nurses were more attentive to infant pain assessment and management when parents were more actively involved. Involving parents in infant’s comfort care is a classic “win-win” example – reducing a serious adverse outcome of neonatal intensive care for infants, and promoting confidence and competence of new parents.94368575-4ABE-44D8-96B0-AFFCEF303AC3

And now in 2016, it is time to take the next big leap in knowledge and action to continue to improve infant pain prevention and manage. Let’s include parents as full partners from the very beginning of this next idea generation. I can’t wait to see what great new innovations our nurse-parent partnership will discover together!!


Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (British Summer Time)

Mission Possible – Prioritize Pain Prevention

14 Aug, 16 | by josmith

Professor Bonnie Stevens, Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada

We hbabyskintoskinave heard repeatedly about the high numbers of painful procedures undertaken with hospitalized neonates and their potential consequences. We are also aware of insufficient practices to treat the pain associated with these procedures. This inadequacy is often attributed to lack of knowledge of care providers, when really it is a lack of organizational commitment to decreasing pain and changing behavior.

I have devoted my research career to studying pain in infants. However, even with 50 infant  pain measures and multiple systematic reviews synthesizing pain-DadSSCrelief strategies for health care professionals (e.g. sucrose [1]) and parents (e.g. skin-to-skin care and breastfeeding), effectively implementing these strategies remains challenging. Therefore, I have refocused my research within implementation science to determine how healthcare organizations can effectively change practice and influence practice, research and policy agendas.

I believe that evidence or champions alone cannot change behavior or outcomes. Institutions need to prioritize pain prevention and demonstrate their commitment at the point of care. They can facilitate dialogue amongst health care providers, support leaders and the efforts of local champions, and provide resources. Without organizational support for pain relief, the best evidence and individual efforts will go unnoticed.I have completed a large national study, funded through the Canadian Institutes of Health Research, where with strong leadership, committed resources and local champions, hospital units improved pain assessment and treatment and decreased procedural pain in children [2,3]. However, this approach, which supported an on-site research nurse was not feasible or sustainable [4].

We have now developed a multiplatform web-based infant pain resource that we will implement and evaluate. The resource consists of a 7-step evidence-based quality improvement strategy for changing behavior and enhancing outcomes. Initial evaluation indicates that health care professionals are highly satisfied and excited about this resource. It is my hope that this strategy will stop the conversation on inadequate procedural pain management and start the dialogue on successful change management.

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)


  1. B. Stevens, J. Yamada, A. Ohlsson, A. Shorkey, S. Haliburton. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3.
  2. B. Stevens, J. Yamada, S. Promislow, J. Stinson, D. Harrison and The CIHR Team in Children’s Pain. (2014). Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children. Implementation Science, 9, 120.
  3. B. Stevens, J. Yamada, C. Estabrooks, J. Stinson, F. Campbell, S.D. Scott, G. Cummings and CIHR Team in Children’s Pain. (2013). Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 155(1):60-68.
  4. B. Stevens, J. Yamada, S. Promislow, M. Barwick, M. Pinard, CIHR Team in Children’s Pain. Sustainability of pediatric pain outcomes following a knowledge translation booster intervention. Pediatrics (In Press).

Key messages from INANE

7 Aug, 16 | by josmith

Alison Twycross (@alitwy), Editor and Joanna Smith (@josmith175) and Roberta Heale (@robertaheale), Associate Editors, EBN
R Heale photoIMG_0206image

Last week we shared our excitement at the prospect of representing EBN, and presenting the successes and challenges of embedding social media as a core EBN activity at the International Academy of Nursing Editors (INANE), conference.

IMG_0155The opening gala was a great opportunity to network, debate and consider how journals and their editorial teams are shaping nursing, and included a
thoughtful and stimulating presentation of Florence Nightingale’s Reluctant Life in Portraiture by Natasha McEnroe, Director of the Florence Nightingale Museum.

Our presentation focused on the ways social media activities can be used in nursing journals to engage the journal readership and outline the purpose of social media strategy media activities within EBN, and despite anxieties about web access we managed a live Twitter chat (#ebnjc) demonstration! We shared some of EBN social media successes:

The EBN social media strategy has:

  • Widened our opportunities to engage with our readership
  • Meant we engage with a more diverse audience than the traditional paper journal copy readership.

Other key messages from INANE included:

  • The bad practice / poor reporting of clinical trials outcomes such as reporting favorable results that often are different from those in their original protocol and often negative results aren’t reported. Dr Ben Goldacre unpicked the dodgy scientific claims made by scaremongering journalists, dubious government reports, pharmaceutical corporations, PR companies and quacks; his similar TED talk can be accessed below
  • A concurrent session led by Alistair Hewison, questioned the need for journal editors to reflect on how they can develop political awareness among their readers (and the stages of political awareness)
  • A keynote on the role of ORCID ID to facilitate identification of an individual’s body of work was a timely reminder of the role of journals in maximizing consistent identifiers for authors and journals.

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