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Arts in Renal Care: creatively impacting healthcare and education.

17 Oct, 16 | by hnoble

This week’s EBN Twitter Chat is on Wednesday 19th October between 8-9 pm (BST) and will be hosted by Dr Helen Noble (@helnoble) lecturer in Health Services Research, Queens University Belfast.

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.


Healthcare benefits greatly from collaboration with the arts, as this renders clinical practice truly inter- and multidisciplinary in the broadest of terms. An additional benefit is in enhancing healthcare education in challenging areas such as fostering empathy. The collaboration between medicine and the arts and humanities is rapidly becoming established as a powerful and fruitful alliance in improving healthcare delivery, education and outcomes See examples at and That said, the relationship between arts and healthcare, although long recognised, remains poorly defined. Whilst both areas might benefit from collaboration and partnership, with potential to promote well-being and improve quality of life, the interaction between healthcare and arts provides wide application, yet potentially poor focus. The meeting of arts and healthcare offers great potential for new ways of understanding how care can be provided to patients coping with chronic diseases such as renal, lung and heart disease or cancer. The challenge is to obtain sufficient evidence to support practical engagement in terms of arts based interventions.

The management of care for people with long-term conditions, should be proactive, holistic, and patient-centred, and should support a co-ordinated and integrated service delivery model that requires an active role for service users, with collaborative and individual care planning at its heart. A partnership model where patients take key roles in determining their care and support needs is essential. But is it possible to nurture the concept of service user and carer involvement in the use of the arts as a therapeutic medium and a mechanism for supporting the empowerment of service users? Arts in healthcare brings to bear a significant evidence base which demonstrates the benefits of the arts for individuals living with chronic and life-limiting conditions, such as service users with end-stage renal disease. Cultural activities and creative engagement, such as engagement in music, art, dance, or creative writing promote a sense of well-being and improvement in quality of life. Health outcomes may be positively affected. Can the arts can provide a way of seeing, engaging and expressing in a novel, meaningful, and hopefully impactful manner?


Academics at Queens University Belfast have been working closely with renal clinicians and people with renal disease to develop a programme of research with the ultimate aim of improving the physical and psychological quality of life of those with renal disease. A more recent collaboration has been between academics, service users, clinicians, and artists. Many of the staff and service users have artistic interests including music, poetry, glass-making, photography and dance. Arts and health, as yet an emerging field, has the potential to benefit service users with kidney disease and a Renal Arts Group has been established. The collaboration was established when a patient contributed a selection of poetry written about his life with kidney disease. This was integrated into a film to be used as an educational tool for renal staff. The film is being shown at the Northern Ireland Festival of Social Science in Nov 2016. The Renal Arts Group was awarded ESRC Northern Ireland Festival of Social Science funding for this public event titled: ‘Waiting for a transplant on dialysis: living while dying with kidney disease’ and has also received a small grant from the British Kidney Patient Association to pay for service user transport costs and refreshments at Renal Arts Group meetings.

Hopefully you can join the Twitter chat and help us answer some of the questions posed in this blog. We look forward to you participating.

Degree level education in nursing – time to move the discussion on.

10 Oct, 16 | by dibarrett

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

There is now an established body of evidence that in any given clinical setting, the greater the proportion of Registered Nurses (RNs) with graduate-level education, the better the patient outcomes. In one of the most far-reaching, comprehensive and robust studies in this area, Aiken et al (2014) found that a 10% increase in Bachelor’s Degree-educated nurses in the RN skill mix was associated with a 7% reduction in 30-day inpatient mortality. A recent systematic review and meta-analysis supported this finding, establishing that a 10% increase in the proportion of nurses with Bachelor degrees was associated with a 6% reduction in overall mortality (Liao et al, 2016). There is also evidence to suggest that increasing the proportion of graduate nurses is linked with shorter length of stay and reduced incidence of complications such as venous thromboembolism (Blegen et al, 2013).

Though findings such as this tend to focus on Western healthcare and relate largely to the care of surgical patients (Liao et al, 2016), the conclusion reached is clear: more nurses with degree-level education leads to better patient outcomes. However, there has been little consideration of the crucial follow-up question: why does a greater proportion of degree-level nurses improve patient outcomes?



The challenges of embedding spirituality into acute healthcare settings

2 Oct, 16 | by josmith

This wescreen-shot-2016-09-23-at-12-50-34ek’s EBN Twitter Chat is on Wednesday 5th October between 8-9 pm (BST) and will be hosted by Dr Janice Jones (@JaniceJ6873404) senior lecturer in the Institute of Vocational Learning, London South Bank University,

Wilf McSherry, Professor in Dignity of Care for Older People School of Nursing and Midwifery, screen-shot-2016-09-23-at-12-51-43Staffordshire University, The Shrewsbury and Telford Hospital NHS Trust, UK; Part-time Professor VID Specialized University (Haraldsplass Campus), Bergen, Norway (@WilfredMcSherr1), and

Dr JIMG_0206oanna Smith (@josmith175) lecturer in Children’s Nursing, University of Leeds. The chat will focus on the challenges of embedding spirituality into acute healthcare settings.

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.

Cultural, religious and spiritual beliefs influence how an individual makes sense of the world, often shaping their experiences. During acute or life-threatening illness drawing on these beliefs can provide comscreen-shot-2016-09-23-at-12-48-12fort, strength and support and often assume greater importance in times of stress. Spirituality can foster the development of coping strategies during acute illness where there is often a search for meaning and purpose in response to changing circumstances. 1 There is increased recognition that individual beliefs such as faith and hope can impact on the healing process, usually enhancing, but sometimes hindering, recovery. Incorporating spiritual care into practice helps health professionals to understand patients’ perspectives, and has the potential to increased patient satisfaction with care delivery.

Meeting the spiritual beliefs of patients in acute health care setting is challenging because of the increased demands on acute care services and meeting the needs of an increasingly diverse populations. Traditional working practices must adapt and respond to change yet ensuring patients are treated with respect, dignity and compassion remain fundamental to the provision of holistic, person-centred care needs to respect the patient’s cultural, religious and spiritual needs. 2 Spiritual care matters because it focuses care delivery on the individual, and recognises and utilises patients’ own resources, strengths, aspirations, hopes and experiences.3

Question to think about in advance of the Twitter Chat:

  1. What are your experiences of supporting patients in meeting their spiritual needs in acute healthcare settings?
  2. How can health professionals working in acute healthcare settings can practice holistically to address their patients’ spiritual needs?
  3. Lack of preparation to address the spiritual needs of patients is often cited as a barrier to implementation. What are your experiences of pre registration preparation or CPD opportunities to enhance your understanding of spirituality?
  4. How do you feel the wide range of dimensions relating to spirituality from religious and non religious perspectives relate to healthcare practice?


1Clarke, J. (2013) Spiritual Care in Everyday Nursing Practice. A New Approach. Basingstoke: Palgrave Macmillan;

2McSherry, W., Smith, J. (2012) Spiritual Care. In McSherry, W., McSherry, R., Watson, R. (eds) (2012) Care in Nursing: Principles, values and skills. Oxford: Oxford University press;

3McSherry, W., Jamieson, S. (2013) The qualitative findings from an online survey investigating nurses’ perceptions of spirituality and spiritual care. Journal of Clinical Nursing, 22, 3170-3318.

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)

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