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Safeguarding Looked after Children- Does Looked After mean safe?

17 Sep, 17 | by josmith

Lin Graham-Ray Designated Nurse Looked After Children


This weeks EBN Twitter chat Wednesday 20th September 2017 between 8 pm and 9 pm (UK time) on ‘Safeguarding Looked after children- Does Looked After mean safe’ will focus on the concept of safeguarding vulnerable children in the care system and challenge the conception that once in care safeguarding ends. The Twitter chat will be hosted by Lin Graham-Ray who commenced her Professional Doctorate studies in October 2015 at The Tavistock and Portman NHS Foundation Trust and is currently the Designated Nurse for Looked After Children and Care Leavers in Merton and Wandsworth CCGs.

To participate in the Twitter chat, you will need a  Twitter account. If you do not have an account, you can create one easily at Once you have an account, it is easy to get started. You can follow the discussion on Twitter by searching for #ebnjc – this is the EBN Twitter chat hashtag and by searching for this in Twitter, you’ll only see the relevant tweets related to the Twitter chat. Include #ebnjc in every tweet you send, to ensure that everyone participating in the Twitter chat can see your tweet. But remember, each tweet is limited to 140 characters of text, so make your tweets informative and concise.

Once accommodated into care children (under the age of 18) become ‘Looked After Children’ and subject to legal orders which give full, or partial legal responsibilities (depending on the type or order) to the state for their parenting. Much has been written about the poor outcomes and life chances for children in care (DfE 2015) and for the lack of support for children who stay in the care system and then progress to be care leavers. Among the main themes around poor outcomes mental health, offending and poverty feature.

The national trajectory is that we are accommodating older ‘Looked after Children’ throughout their adolescence who have experienced a range of challenges and traumas, with this in mind the chat will focus on the following questions:

  • Is it time to refocus our safeguarding thinking and challenge the concept of safe care?
  • Being ‘Looked After’ removes the child from an unsafe environment but the experience of being unsafe stays with them and their vulnerability continues, how can these children / young people be best supported?
  • Should Looked after children and care leavers who remain vulnerable despite being in the care system have more regard from health professionals?
  • Rather than defining them as hard to reach, difficult to engage or challenging, should we be challenging ourselves to see how we can deliver services to them rather than how they don’t fit into the services offered?


Department of Education (2015) Promoting the Health and wellbeing of Looked After Children, DfE


It’s time to revisit ‘tribalism’

11 Sep, 17 | by hnoble

Doris Corkin, Senior Lecturer (Education), School of Nursing and Midwifery, Queen’s University Belfast

Despite a dearth of literature, professional tribalism has been recognised both positively and negatively within healthcare for some time and is the state of existing as a group, who may have different training, but will have very strong feelings of loyalty, for example when working in the acute critical care setting.

Registered nurses are being given opportunities to work collaboratively within an inter-professional team and accept greater responsibility, whilst shaping their careers and deepening their roots (Baxter & Brumfitt, 2008). However, professional clinical differences known as ‘tribalism’ (Beattie 1995) can soon dissolve when experienced clinicians who often cluster in profession-based tribal silos are taken out of their comfort zone, become deskilled and feel vulnerable in their new environment (Braithwaite et al, 2016).

Also highlighted within Baxter and Brumfitt’s (2008) qualitative study and Stepney et al’s (2011) survey is the significant barriers of power and status within professional groups, which are closely linked with decision-making and the medical model. To-date any ongoing changes and modernisation within healthcare systems appears to have had little impact in changing the tribal power and status within medicine.

Furthermore, in relation to collaborative working, some nursing students have perceived professional tribalism as a problem during their experience of inter-professional education (Stepney et al, 2011). Acknowledging that issues such as power dynamics and clinical differences may influence the way different work cultures develop and the values healthcare professionals hold about themselves and the respect they should have for each other.

Every organisation has a tribe, which humans naturally form and always will, demonstrating how people’s values and qualities unite them, interacting and succeeding as thought leaders, who effectively go above and beyond the call of duty to get the job well done.

Question is … can our professional tribe continue to change the world!


Baxter, S.K & Brumfitt, S.M. (2008) Professional differences in interprofessional working. Journal of Interprofessional Care, 22(3): 239-251.

Beattie, A. (1995). War and peace among the health tribes. In: Soothill, K., Mackay, L. & Webb, C. (Eds). Interprofessional relations in health care. London: Edward Arnold.

Braithwaite, J., Clay-Williams, R., Vecellio, E., Marks, D., Hooper, T., Westbrook, M., Westbrook, J., Blakely, B. & Ludlow, K. (2016). The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open 6:e012467.

Stepney, P. Callwood, I. Ning, F. & Downing, K. (2011). Learning to collaborate: a study of nursing students’ experience of inter-professional education at one UK university. Educational Studies, 37: 4, 419-434.


How do we ensure that what we teach in university is applied in nursing practice?

3 Sep, 17 | by atwycross

Written by Dr Amelia Swift @nurseswift

This week’s EBN Twitter Chat on Wednesday 3rd May between 8-9 pm (UK time) is being hosted by Dr Ameila Swift (@nurseswift) from the University of Birmingham and Professor Alison Twycross (@alitwy), Editor of EBN. This Blog provides some context for the Chat. To participate in the chat you need a Twitter account; if you do not have one you can create an account at You can contribute to the chat by sending tweets with #ebnjc included within them.

Teaching and learning in nursing can be thought of as happening in two separate locations: the university and the clinical environment.  The separation between the two has long been understood to be problematic for several reasons including

  • difficulty applying in practice the theory has been taught in the university
  • a mismatch between what is taught in university and the reality of practice.

This theory-practice gap causes anxiety for students and a sense of inadequacy for the newly qualified nurse.  These feelings are enhanced by the attitudes and behaviours of some qualified staff that denigrate the nurse education system rather than support it.

The problem is not confined to students and newly qualified nurses though – being a nurse requires a commitment to life-long learning in order to keep up to date and deliver the best care. The NHS responds to this need by providing opportunities for updates, often in the form of lectures and workshops – a relatively cheap way to educate large numbers of staff.  These teaching methods are often relied upon in University teaching too due to the large numbers of students and the breadth of the curriculum.  However, these education strategies have limited impact and their success has tended to be evaluated using pre and post knowledge testing.  This evaluation strategy has the effect of demonstrating the short term success of education but doesn’t examine longer term behavioural change or sustained use of the new strategies.

There are a number of different methods that could be used to create sustainable good practice and when necessary behavioural change, underpinned by a sound evidence base.  Students themselves want more skills teaching in the University setting, educationalists want to create teaching resources that bridge the two environments using mobile technology, and we recognise the need to generate lifelong learning skills for our students and qualified staff that will enhance the ability to both learn and to teach or challenge.

Here are a couple of questions that we will be discussing during the Twitter Chat:

1) What methods have you come across that effectively bridge the theory practice gap and ensure knowledge is used in practice?

2) What are the most sustainable and effective teaching methods used in the clinical practice environment to ensure knowledge is used in practice?

3) How do universities and clinical areas work better together to educate tomorrow’s nurses to ensure knowledge is used in practice?


The importance of interprofessional curriculum for building high performing healthcare teams

29 Aug, 17 | by ashorten

By Allison Shorten, Associate Editor, Evidence Based Nursing

Last week I had the opportunity to attend The Nexus Summit: Provocative Ideas for Practical Interprofessional Education (IPE) in Minneapolis, Minnesota, USA. Hosted by the National Center for IPE, this annual conference provides an amazing showcase of what happens when creative interprofessional (IP) teams get together to design innovative educational experiences and build collaborative models of healthcare.

What is IPE and why is it important for nursing education?

“Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”1

The WHO framework for IPE and collaborative practice emphasizes the benefits of IP care in reducing fragmentation within our systems of care to improve patient experiences and outcomes.1,2 A consistent theme throughout the Nexus Summit was the importance of building high performing IP healthcare teams to create better experiences and outcomes for patients. This comes back to how we educate students in all healthcare professions and design programs that embed meaningful rather than tokenistic experiences, for students of different professions to learn about each other and how they can work together to improve patient care.

Conference participants shared some wonderful examples of how they had pushed the boundaries of traditional healthcare education and practice models to develop a wide range of case-based, simulation-based, virtual simulation, and community-based IPE experiences. There were numerous examples of community-based IP service learning experiences with students working together to address health disparities in their local communities.

IPE faculty development programs and toolkits are readily available to help those interested in getting started with IP curriculum in their institutions. Evaluating IP education is important but also challenging. There are numerous resources to help with this as well. These resources can be found on the NEXUS web-site

IPE is not a new idea, but it has been challenging to implement in practice. It requires active engagement and commitment from all professions in the healthcare team – to put the patient in the center and to examine new ways of learning, teaching, and practicing as we implement different ways of communicating and working together as a collaborative IP healthcare team.

1. World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization.
2. American Association of Colleges of Nursing (AACN), Interprofessional Education
3. About the NEXUS

Allison Shorten, RN, RM, PhD
School of Nursing
University of Alabama at Birmingham (UAB)
Director, Office of Interprofessional Curriculum

Benefits of Nursing Autonomy

20 Aug, 17 | by rheale

By Roberta Heale, Associate Editor EBN @robertaheale

I spent a few days in hospital this past June. Other than the birth of my children, I’d never been hospitalized. Knowing how long and hard shift work is, as well as the pressures put on staff nurses in this day and age, I was apprehensive about what my experience would be like. Turns out, I shouldn’t have worried. The nurses were wonderful, not only in responding to my emotional needs, but also in the assessment and treatment of my physical symptoms. I was reminded how important it is for nurses to work in an environment where they are able to use their expert clinical skill and judgment in the care of patients.

Greater nursing autonomy promotes better patient outcomes. As a reminder for you, check out the commentary Greater nurse autonomy associated with lower mortality and failure to rescue rates. It’s free and can be found at this link:

Nursing is under ongoing pressure in many countries. It’s not uncommon to learn that nursing positions have been reduced and replaced by non-nursing, generic workers, or that nurse-to-patient ratios are climbing. Support of nurses to ensure that their work environment not only allows them autonomy of practice, but also appropriate resources to do their job well, is important. In doing so, you may be helping out a friend or family, or maybe even yourself.

Primary healthcare access for post-release prisoners

14 Aug, 17 | by hnoble

Claire Carswell, PhD candidate, October 2017, Queens University Belfast.

Twitter chat on Wednesday 16th August 2017 between 8 pm and 9 pm (UK time) Primary Healthcare access for post-release prisoners’ will focus on the barriers to primary healthcare faced by people on release from prison Everyone is welcome to participate in the Twitter chat, regardless of profession or experience. The Twitter chat will be hosted by Claire Carswell who commences her PhD studies in October 2017 at Queens University Belfast.

To participate in the Twitter chat, you will need a registered Twitter account. If you do not have an account, you can create one easily at Once you have an account, it is easy to get started. You can follow the discussion on Twitter by searching for #ebnjc – this is the EBN Twitter chat hashtag and by searching for this in Twitter, you’ll only see the relevant tweets related to the Twitter chat. Include #ebnjc in every tweet you send, to ensure that everyone participating in the Twitter chat can see your tweet. But remember, each tweet is limited to 140 characters of text, so make your tweets informative and concise.

The transition period from prison to the community is a high-risk period for offenders. There are significantly increased mortality and morbidity rates during the months following release, with post-release prisoners at high risk of suicide, substance misuse relapse and accidental overdose.

Continuity of care for post-release prisoners is a particular problem and could contribute to the mortality rate of this population. Primary healthcare services in particular have been identified as a crucial health resource when prisoners leave prison (Kinner et al., 2015). The National Institute of Health Research published ‘Care for Offenders Continuity of Access’ (COCOA) in June 2012 ( This report not only highlighted the higher morbidity rates of prisoners compared to the general population, but also identified barriers that prevented post-release prisoners from accessing statutory healthcare services.

The main barriers that the report identified included prisoners not being registered with GPs prior to release from prison and difficulties registering once back in the community. The report also highlighted that this resulted in post-release prisoners being unable to receive necessary chronic medications, having only been provided short-term courses on release. There was also an overall feeling of being unsupported by services, including health and probation services.

The dramatic decline in health following release from prison makes the need for continuity of care essential. The COCOA report found that it was easier to access services while still in prison, and that stigma post-release prisoners faced in the community also contributed as a barrier to access primary healthcare services. Further research could be conducted to identify the difficulties associated with providing treatment to this specific population, as the high morbidity rate and complex mental health issues of post-release prisoners could present a substantial burden on primary care resources. Improved relationships between the criminal justice system and the primary healthcare service could help reduce stigma and improve the transition of care. Other ways of addressing these barriers include registration with a GP prior to release from prison and provision of longer term prescriptions on release that take into account the waiting times for a GP appointment.


Kinner, S.A., Young, J.T., and Carroll, M. (2015) The pivotal role of primary care in meeting the health needs of people recently released from prison, Australasian Psychiatry, 23 (6) 650-653

“Extraordinarily diverse??” – beyond the marketing rhetoric of corporate academia

6 Aug, 17 | by josmith

Dr Fiona McGowan, Cordinator Global Health and Quantified Self, School of Healthcare Studies, Hanze University of Applied Sciences, Netherlands

e-mail –

Say Burgin’s recent blog in the Times Higher Education (May 20th 2017)

highlighted how both racial and gender discrimination remain rife within higher education and refers to the persistent and deeply embedded lack of will at managerial level for any real and meaningful change. Why?   “Because what an absence of will comes down to is a fierce protective impulse for a status quo that benefits those who are already in power – in universities or anywhere else”. How true this is. And even more shocking is the extent that those in power will employ what appears as non-discriminatory terminology and policy to further enforce the position of white male privilege in academia. Figures show that the institutions gave their bosses above-average pay increases of up to 13 per cent in 2015-16.

One such example is that of a post 1992 university in the Greater London area, which proudly promotes itself as being one of the “most diverse” institutions, promising students the experience of belonging to a “global family”. Really? Scratch away the glossy veneer of inclusive language to reveal what lies beneath. A corporate plan that boasts a remit of 28,000 students from a 120 countries worldwide. Impressive? Certainly, especially considering the financial bounty attached to those recruitment figures. Yet….93% of those students are from the UK, with 52% from the immediate locality. Somehow these figures appear to have been” lost in translation” – how is this indicative of a global student body? Or how does this illustrate a cohort – again to quote their corporate jargon – as being “extraordinarily diverse”.


Using healthcare models to inform obesity interventions.

31 Jul, 17 | by hnoble

Emma McGleenan, School of Nursing and Midwifery, Queens University Belfast.


One in four adults are now obese and the Government has introduced several initiatives to combat this problem and its growing cost on NHS services. Examples of Government schemes include‘Nutrition Now’; laws on food labels and advertisements aimed at decreasing one’s waist circumference But this alone is not enough to prevent cardiovascular disease. The Health Belief Model, when applied to nutrition and hydration, indicates that people are more likely to follow a healthy diet and make changes to their lifestyle if they feel that failure to change would increase their risk of developing a serious disease; the benefits of the change outweigh the barriers faced due to the change; they place enough value in their life to make the change and they are prompted to make the changes

The theory of planned behaviour addresses three aspects: the attitude, the subjective norm and the perceived behavioural control. The attitude is the values and judgement we hold about a healthy diet. The subjective norm refers to what is important to the patients’ family and friends. Perceived behavioural control is how much control the person believes they have over their ability to keep to a healthy diet i.e. whether or not they have the skills or resources to succeed.

These models assume all behaviours are based on conscious thoughts but people may not think of the ill effects to their health every time they eat an unhealthy meal. Many health related behaviours are used as coping mechanisms and when you get rid of the behaviour, this may result in an increase in stress levels. The change is therefore more likely to be unsuccessful. Perception of control should be increased to help people feel empowered and more likely to succeed. Those who take part in unhealthy eating may already understand the dangers of eating unhealthily and may already have ill health due to eating unhealthily but they enjoy the food and so continue. This can cause upset in an individuals’ mind known as cognitive dissonance. Nurses can use this to persuade the individual to make a change.

A good way of introducing the concept of change to the individual is by brief intervention. Brief intervention has been shown effectively when dealing with alcohol addiction within the primary care sector (Kaner et al, 2009). Minimal intervention is an opportunistic process where the health professional attempts to find out how the service user feels about the behaviour, challenge the persons’ views on eating healthy and helps them to weigh up the pros and cons of the a healthy diet. The main aim is to get the individual to engage cognitively about the behaviour. When linked up with the stages of change, the person moves into the contemplating stage of change and is more likely to change their behaviour and sustain change.

Nurses can help prevent cardiovascular disease by promoting a healthy diet and hydration. Brief intervention can introduce people to a new concept in a short time and has been proven to be effective. Further help could be offered by combining the Health Belief Model with the Theory of Planned behaviour. Within this, views should be challenged, coping mechanisms and perception of control examined and advice given, barriers identified, social networks and context discussed and the benefits reiterated. This should be a positive experience, leaving the individual empowered. Cognitive behavioural therapy may also be adapted and has been shown effective in preventing acute myocardial infarctions (Gulliksson, 2011).


Kaner EF.S., Dickinson HO, Beyer FR, Campbell F, Schlesinger C, Heather N, Saunders JB, Burnand B, Pienaar ED (2009) ‘Effectiveness of brief interventions in primary care populations’ The Cochrane Collaboration [Online] Available at: (Accessed: 20/04/2015)

Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, and Svärdsudd K. (2011) ‘Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health








Spirituality, Compassion and Mental Health

23 Jul, 17 | by josmith

Professor John Wattis, visiting Professor of Psychiatry for Older Adults at the University of Huddersfield, and Dr Melanie Rogers Senior Lecturer in the Division of Health and Rehabilitation University of Huddersfield.

The second biennial conference, organised jointly by he University of Huddersfield Spirituality Special Interest Group (SSIG), and the South West Yorkshire Partnership NHS Foundation Trust (SWYFT) explored research and practice addressing spirituality in health care. Evidence-based nursing is often seen being as all about knowledge and skills but the emphasis of this conference was on the evidence-base for the importance of good healing relationships, facilitated by approaches that recognise the value of person-centred care that demands personal qualities in nurses and time spent with patients.

The conference had a buss and excitement with 220 delegates, mainly from the UK included people who use services, students, academics and researchers. The conference was also the setting for the launch of a new book Spiritually Competent Practice in Health Care to which several of the speakers had contributed. Professor John Wattis,gave an overview of the book and Dr Melanie Rogers spoke about her research into availability and vulnerability as a way of operationalising spirituality.

Images courtesy of the University of Huddersfield


The main keynote speaker, former Archbishop of Canterbury Dr Rowan Williams, talked on Nourishing the spirit: relations, stories, rhythms, and drew on poetry, literature, academic research and philosophy. He stressed the importance of dependable relationships, opportunities to construct and tell our ‘stories’ and looking after our physical needs. Spiritual life needed to be grounded in our physicality. “The spiritual life is at least as much to do with knowing how to cultivate a garden or make loaf of bread as it is to do with church or chapel.”

Professor of Nursing at Staffordshire University, Wilf McSherry addressed the research around what spiritually competent practice looks like in health and social care and emphasised that it was an integral part of good practice.

Fiona Venner, Chief Executive of Leeds Survivor Led Crisis Service, followed this with a talk asking What does compassion and love look like in crisis care? stressing how important the ‘dependable other’ was, in the voluntary service she led, to the recovery of people in crisis.

Kevin Bond, former Chief Executive of NAVIGO, a social enterprise providing mental health services in NE Lincolnshire emphasised the importance of valued social roles in recovery, using principles of social role valorisation.

The final session was on creativity and spirituality from Phil Walters, Strategic Lead, and Debs Taylor, peer project development worker for Creative Minds. Debs spoke about her experiences as a service user and how important the activities and relational aspects of Creative Minds had been to her recovery.

This account is partly based on a report on the University of Huddersfield website:

Health 2.0: social media in healthcare

16 Jul, 17 | by josmith

Simon Stones @SimonRStones

Twitter chat on Wednesday 19 July 2017 between 8 pm and 9 pm (UK time) ‘Health 2.0: social media in healthcare’ will focus on using social media to engage and involve people and organisations in your work and research. Everyone is welcome to participate in the Twitter chat, regardless of profession or experience. The Twitter chat will be hosted by Simon Stones (@SimonRStones), a patient research ambassador and PhD student at the University of Leeds who is working on long-term condition self-management by children and their families.

To participate in the Twitter chat, you will need a registered Twitter account. If you do not have an account, you can create one easily at Once you have an account, it is easy to get started. You can follow the discussion on Twitter by searching for #ebnjc – this is the EBN Twitter chat hashtag and by searching for this in Twitter, you’ll only see the relevant tweets related to the Twitter chat. Include #ebnjc in every tweet you send, to ensure that everyone participating in the Twitter chat can see your tweet. But remember, each tweet islimited to 140 characters of text, so make your tweets informative and concise!Like it or not, social media is here, and it is here to stay.

While the very mention of the phrase ‘social media’ fills some people with dread, it’s really not that bad – especially once you become familiar and confident about using it. Essentially, social media is an interactive communication platform that enables conversations amongst individuals. Merriam-Webster describe social media as “forms of electronic communication (as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (as videos).”[1]

The presence and use of social media has grown exponentially in the last decade, revolutionising the way in which we communicate with each other. Most importantly, it removes geographical barriers by enabling people to talk directly with each other – wherever and whenever they wish. Nowadays, the phrase social media is often used interchangeably to describe popular social networking sites such as Facebook, Twitter, LinkedIn, Instagram and Snapchat.

With a generation of millennials who are more likely to seek initial medical advice from the internet rather than a doctor or nurse, it is indisputable that the professional community must get to grips with social media, in order to remain relevant to the people they meet. When you take into consideration that at least 40% of people say that information they find on social media affects the away in which they deal with their health,[2],[3] it remains the responsibility of professionals and patient groups to ensure that accessible, evidence-based information is freely available through social media to attenuate potentially misleading or inaccurate information out there.

Now, you may be thinking, “Patients won’t think that it is appropriate for health professionals to use social media”. Well, that is utter nonsense! After all, you’re still human, and in fact, your presence on social media can often help the patient-professional relationship, as you are removing yourself from the ivory towers that once existed by virtue of the traditional roles of healthcare professionals and researchers in years gone by. We are, and must be, outward facing professionals, engaging and involving the people we care for, and include as participants in our research.

With those points in mind, and many more questions and ideas about using social media, in this Twitter chat, we would like to explore:

  1. The benefits of using social media as a patient, parent/carer, health care professional or researcher to connect with others who share a common interest;
  2. The barriers of using social media as a patient, carer, health care professional or researcher to connect with others who share a common interest;
  3. Ways that patients, carers, healthcare professionals and researchers can be both professional and human on social media;
  4. Tools to help you to be active and noticed on social media.

[1] Merriam Webster. 2017. Social media. [online]. [Accessed 13 March 2017]. Available from:

[2] Honigman, B. 2013. 24 outstanding statistics & figures on how social media has impacted the health care industry. ReferralMD. [online]. [Accessed 02 June 2017]. Available from:

[3] Antheunis, M.L., Tates, K. & Nieboer, T.E. 2013. Patients’ and health professionals’ use of social media in health care: Motives, barriers and expectations. Patient Education and Counseling. 92(3): 426-431.

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