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Emotional Intelligence

16 Oct, 17 | by hnoble

Lindsay Hanna, MSc nursing student and busy mother, School of Nursing and Midwifery, Queen’s University Belfast, UK.

This week’s EBN Twitter chat is on Wednesday 18th October between 8 pm and 9 pm (UK time) and will explore ‘Emotional Intelligence’. The chat will focus on how Emotional Intelligence is expressed in healthcare and the challenges faced by all as emotions are managed on a daily basis.

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.

Emotional Intelligence (EI) is an emerging concept with a differing range of thoughts and opinions.  One might even say EI is a new ‘fad’ or ‘buzz word’ within the nursing arena, with little substance or evidence to support the development of EI.  Within nursing many concepts come and go, with new emerging theories and best practice guidelines being regularly generated – therefore understandable should nurses dismiss EI.  It may be considered another useless tactic to attempt to change leadership qualities in today’s nurses.  However, nursing evidence to support EI continues to grow.

EI emerged as a concept in 1990 and has grown in popularity over the decades.  Key theories to explain this shiny new concept have been strengthened and supported with growing evidence.   Theorists argue the foundation of EI, suggesting EI is a learned behaviour that can be taught in the class room and the clinical setting, irrespective of background, education or genetics (Salovey and Mayer, 1990).  According to Bar-On (2005) EI is a personality trait that strengthens and grows with age and experience.  Although both theorists / authors differ in their foundation they both agree EI is an ability to manage and process the range of emotions that take place within a situation.  The level of EI one has will indicate their ability to function, act and manage emotionally challenging situations and has been highlighted as a key skill for nursing students and registered nurses.

A review of current literature investigating the impact the development of EI makes to the academic and clinical performance of nursing students, shows a positive connection.  Research studies (Fernandez et al, 2012; Senyuva et al, 2014) demonstrate that EI is a key concept that drives decisions and directs the actions nurses take in the clinical setting.  A nurse who is managing their own emotions, thoughts and feelings coupled with the emotions of co-workers and patients, is said to be better equipped to process the stresses that come alongside the nursing role.  To have EI, nurses need an inner strength to channel and direct their unconscious thought for the greater good of patients within their care.

If nurses continue to learn the importance of EI, confidence in the benefits of EI will strengthen and mature.  Researchers have investigated the impact of EI, studying a wide range of effects and challenges.  However, the evidence to support how to develop EI remains unclear.  Studies will support or discourage the development of El however evidence is limited on strategies to develop this.  Questions that need to be asked include: Is EI a concept that needs the classroom, or is this an involuntary skill that develops through mentorship and observation?  Many questions still remain regarding the validity of EI; are students mature enough to allow themselves to explore their own feelings?  Or do nursing students simply ignore their true feelings and learn avoidance techniques, as a method of coping when faced with emotional challenges.

Whilst these questions remain unclear, Government policy continues to support the development of EI. Personally, I feel EI has an innate natural element that can be exploited as one goes through the nursing dimensions.  A student with the professionalism and maturity to travel through the complexities of patient care with the upmost respect and dignity is a nursing student who has captured the essence of EI.  A sense of protection and perseverance towards the nursing profession is found in someone who has EI and may not be a skill or quality that all nurses accept. However further research into ‘how’ we develop EI is needed, to allow the potential impact of EI to be fully appreciated.


Bar-On, R. (2005) The Bar-On model of emotional-social intelligence, Piscothema 17, 1-28.

Fernandez, R. Salamonson, Y. & Griffiths, R. (2012) Emotional intelligence as a predictor of academic performance in first year accelerated graduate entry nursing students, Journal of Clinical Nursing, 21, 3485-3492.

Salovey, P. & Mayer, J.D. (1990) Emotional intelligence Imagination, Cognition, and Personality, 9, 185-211.

Senyuva, E. Kaya, H. Isik, B. & Bodur, G. (2014) Relationship between self-compassion and emotional intelligence in nursing students, International Journal of Nursing Practice, 20, 588-596.

Younger women may reconsider breast cancer screening after using decision aids

11 Oct, 17 | by ashorten

Decision aids are designed to help patients weigh up the benefits and tradeoffs for a wide range of healthcare screening and treatment decisions. In addition they help patients take into account their individual risk profile, values and preferences. One of our most recent EBN commentaries explores an interesting study about the use of decision aids for supporting women’s decision making about mammographic screening for breast cancer, across different age groups. Expert commentators Dr Jolyn Hersch and Dr. Kirsten McCaffery from the School of Public Health, University of Sydney, Australia, highlight the work of Ivlev, Hickman, McDonagh and Eden (1) who examined the effect of using decision aids to help women consider whether to undergo mammographic screening. The systematic review and meta-analysis of RCTs and observational studies found that using a decision aid increased screening reluctance and prompted younger women (38–50 years) to reconsider whether to undergo mammography. These findings are relevant for providers who counsel women about health screening plans. Read more about this interesting study, implications for clinical practice and recommendations for future research –

Hersch J, McCaffery K. (2017) Using a decision aid may prompt some younger women (38–50 years) to rethink breast cancer screening plans, Evidence Based Nursing,

Original Article:
Ivlev I, Hickman EN, McDonagh MS, et al. Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med 2017;32:802–13.

Professor Allison Shorten, Director Center for Interprofessional Education and Simulation, University of Alabama, and Associate Editor Evidence-Based Nursing

Family-witnessed resuscitation – benefits, barriers and best practice

1 Oct, 17 | by dibarrett

Dr David Barrett – Academic Manager, Faculty of Health Sciences, University of Hull

This week’s EBN Twitter chat is on Wednesday 4th October 2017 between 8 pm and 9 pm (UK time) and will explore ‘Family-witnessed resuscitation in hospitals’. The chat will focus on benefits, challenges and best practice in this area of care.

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.

It is over 20 years since the Resuscitation Council (UK) published the report ‘Should relatives witness resuscitation?’ The report concluded that relatives should be offered the opportunity to be present during resuscitation and identified several recommendations for best practice. In 2002, the Royal College of Nursing (RCN) published their own guidelines, stating that witnessed resuscitation should be supported in accordance with the wishes of relatives.

Despite the long-held belief of the Resuscitation Council (UK) and the RCN that families should be permitted to be present during resuscitation, the subject remains a contentious one. Though there is evidence that being present at resuscitation attempts can lead to reduced incidence of post-traumatic stress disorder symptoms in relatives (Jabre et al, 2013), concerns from healthcare practitioners – such as altered decision-making ability or lack of support for family members – act as powerful barriers to implementation (Sak-Dankosky et al, 2017).

This week’s Twitter feed will focus on four key questions;

  • What is current practice in relation to family-witnessed resuscitation in your area of work?
  • What benefits have you seen, or do you envisage, from giving families the choice to be present during resuscitation?
  • What challenges are there to facilitating family-witnessed resuscitation?
  • How can nurses best support families during resuscitation attempts?


Jabre P, Belpomme V, Azoulay E (2013) Family presence during cardiopulmonary resuscitation. New England Journal of Medicine 368:1008-1018

Resuscitation Council (UK) (1996) Should relatives witness resuscitation? Available from

Royal College of Nursing (2002) Witnessing resuscitation: Guidance for nursing staff. Available from

Sak-Dankosky N, Andruszkiewicz P, Sherwood PR, Kvist T (2017) Health care professionals’ concerns regarding in-hospital family-witnessed cardiopulmonary resuscitation implementation into clinical practice. Nursing in Critical Care DOI: 10.1111/nicc.12294

What is in a name?

24 Sep, 17 | by josmith

Emma Wilson, recently graduated Children’s Nurse (University of Leeds) @Emzieness

Recently I took part in a twitter chat hosted by @SucessDiabetes and @Anniecoops focusing on language use in the context of diabetes management. This is something, that while not having a diagnosis of diabetes myself really struck a chord. In my own practice, I actively try to avoid terms such as asthmatic, epileptic, diabetic, autistic when referring to my patients as I feel that this detracts from the individual behind the disease / situational state and that diagnostic labeling has the potential to lead to stereotyping and inadvertent discrimination. However, while this may be my personal preference, it is also important that when we communicate with patients, that we use terminology that they are not only comfortable with but also doesn’t cause either offence or confusion. While I am a huge advocate for appropriate usage of terminology in relation to diagnosis, prognosis and outlook, questions remain about who defines what is appropriate and how can we best ensure we don’t cause offence when we engage with our patients.

In 2015 The National Epilepsy Society reviewed the infographics they used on social media to raise awareness of the condition; they realised a need to clarify the language used to describe seizures as there appeared to be some ambiguity which was causing confusion. Specifically considering diagnostic labeling, concluded that it is most appropriate to say ‘person with epilepsy’ as this focuses on a person first prior to their disease state. They found that this had a mixed reaction, with some people not liking being defined by their medical condition and others feeling saying ‘I’m epileptic’ is not offensive as this accurately describes how their condition affects them. However with the addition of ‘AN’ to ‘I’m an epileptic’ the general consensus changed and people perceived this emphasises the focus on their epilepsy as opposed to them as a person which was deemed inappropriate.

The late Dr Kate Granger used her own experiences with a terminal cancer diagnosis to specifically highlight the importance of human interaction within healthcare. She recognised the importance of communication between patient and professional and the importance of making interactions with patients respectful and meaningful. By highlighting the importance of bringing the human touch in interactions through the international #hellomynameis campaign there has been a huge increase in professional introducing themselves and using a patient’s name to first acknowledge them rather than their diagnosis or bed number whether this is directly or indirectly with conversations which may be overheard ( ;

I think what can be drawn from both of these examples is importance of having an open dialogue with people to ensure we are being clear, not causing offence and using terminology that is respectful and appropriate. Clearly this cannot take ‘a one size fits’ all approach.


Epilepsy Society. 2015. Epilepsy terminology on Facebook. [Online]. Accessed September 2017. Available from:

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

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