You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Health Promotion

The Role of Nursing in a Violent World

26 Jun, 17 | by rheale

By Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ

Recent years have seen a growing number of violent attacks by extremists of all sorts, which target innocent bystanders and civilians. Although attacks have been noted across the globe, two recent include a concert in Manchester and in the streets of London.

Initial assistance is swift and comprehensive.  Civilians at the scene do what they can to help.  Rescue and health care workers flood in to tend to the injured.  Law enforcement officers secure the site and begin the process of evaluating the event. The rest of the world follows the incident and aftermath in horror, clinging to any information that will allay our concerns and lessen our anxiety.  But then, things die down and we are no longer riveted to our devices.  The area is cleaned up, funerals have been conducted for the victims, and we turn our attention away from those who will remain in hospital and rehabilitation for many months to come. This, however, is when the real work of healing should happen and where nursing can, and should, take the lead in providing care to individuals, families, and communities that have experienced trauma.

Research into the aftermath of violent attacks shows us that survivors of terrorism may suffer from ongoing mental health problems including post-traumatic stress disorder (PTSD) and depression, for years after the incident. The mental health effects of violent attacks impact not only those at the scene but also their families and communities. Crisis intervention and long-term mental health counseling and services are beneficial.1

Nurses are front-line workers, most often in direct contact with people both in healthcare institutions and in the community.  We are uniquely positioned to assess the effects of a violent attack and to provide support to those who are suffering from the consequences.2  However, a proactive approach is required.  Nurses should be trained and given the appropriate resources to meet the needs of individuals, families, and communities that are suffering the effects of violent attacks.

It’s terrible to think that we live in a world where preparation for random violent attacks is necessary.  Yet, this preparation has the potential to facilitate healing among countless people.  Nursing has an important role to play and, as a profession, we should not shy away from this difficult work.



The importance of public health in the nursing curriculum

12 Dec, 16 | by dibarrett


Lizzie Ette – Lecturer in Nursing, University of Hull

It’s easy to imagine that public health is falling out of favour in the UK in the current era of austerity, which has ushered in cuts for local authorities, who are now predominantly responsible for the public health of their local population. With the Local Government Association (LGA) itself expressing concern and disappointment in the government’s approach to the funding of this essential remit, it would be easy to believe that improvements to public health are a fading aspiration.

However, the NHS’s own Five Year Forward Plan commits to ‘getting serious about prevention’, and cites examples of integrated models of care which are aimed at addressing health needs and promoting better health.

So what does this mean for nurses?  And what kind of nurse education do we need to deliver to ensure that future nurses are as equipped as possible to embrace and contribute to this challenging future?



Breast feeding research: reflections on the evidence-base

11 Jul, 16 | by josmith

Jo Smith (@josmith175) Associate Editor at Evidence-Based Nursing and Lecturer Children’s Nursing, School of Health Care, University of Leeds.


I have always been committed to teaching and promoting that patient care is underpinned by robust evidence. However, it is increasingly challenging to keep abreast of new evidence, let alone the time to appraise and consider the quality of the evidence, appraise research and consider the implications for practice: a good systematic review is often a life-line in an increasingly demanding world. One of the reasons I enjoy my role as associate editor at Evidence-Based Nursing (EBN) is that it enables me to review and consider research on a wide range of topics, and engage and debate the implications of research with experts in the field. Sharing information, through our published commentaries, networking and using social media are core to the journals objectives.

Promoting breast feeding is a global health priority with a vast evidence base highlighting the benefits of breast feeding to provide young infants with the nutrients they need for healthy growth and development. Despite most mothers being able to breastfeed the World Heath Organisation’s 5th target is to increase the rate of exclusive breastfeed infants in the first 6 months up to at least 50%: Shot 2016-07-11 at 20.37.25df






A recent commentary I edited for EBN highlighted that ‘breast feeding could reduce the risk of childhood leukaemias’ (, which highlighted yet again the protective properties of breast milk. The systematic review and meta-analysis that compared no or short duration of breastfeeding with breastfeeding for 6 months or more, and childhood leukaemia (Amitay et al, 2015) found that:

  • Breastfeeding reduces the risk of all childhood leukaemias; the effect is greater if feeding continued for more than 6 months.

It was a pleasure to interview Dr Colin Michie, Consultant Paediatrician, about his thoughts on the evidence and discusses issues raised in his commentary of the meta-analysis: a recommendation from the commentary was that infant feeding histories should become a central components of paediatric data, in order to identify the potential benefits of breast feeding in relation to childhood illnesses in addition to leukaemias. For more insights listen to the podcast:


Amitay EL, Keinan-Boker L. Breastfeeding and Childhood Leukemia Incidence: A Meta-analysis and Systematic Review. JAMA Pediatr. 2015 Jun;169-175.

The #hellomynameis campaign reaches its 3rd anniversary

28 Feb, 16 | by josmith

This weeks ENB twitter chat on Wednesday the 2nd of March between 8-9pm(GMT) UK will be hosted by Kate Granger a doctor, but also a terminally ill cancer patient. and founder of the #hellomynameis campaign, and will focus on the importance of healthcare workers introducing themselves to patients. 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.

Hello, my name is Kate Granger and I’m the founder of the #hellomynameis campaign, which will reach its third anniversary in August 2016.  Three years of tireless work trying to spread one simple message across the globe. Three years of trying to improve the experience for other patients all facing their own health problems. A straightforward premise that any healthcare worker who approaches a patient should first introduce themselves, with the innovative use of social media to spread the message.


Infection Control in Care Homes

17 Sep, 15 | by Gary Mitchell, Associate Editor

EBN are delighted to share their latest blog on the important topic of infection control in care homes.  This blog coincides with an innovative “Infection Prevention and Control CPD Link Day” which is taking place today, Thursday 17th September 2015, for care home staff in Northern Ireland with specialist input from Rose Gallagher, RCN UK National Infection Control Advisor.  The organiser of the event, Gary Cousins, provides us with an overview in this guest blog.

Gary Cousins 2 (2)

Gary Cousins (@Cousins_Gary) is Infection Control & Clinical Development Nurse for Four Seasons Healthcare in Northern Ireland, Wales and the Isle of Man. A new position in Four Seasons and the first of its kind with the company UK wide. Gary has been developing the role, educational programmes and support systems to empower staff and facilitate greater ownership of day to day practice in relation to infection control. Gary’s link programme within Four Seasons earned recognition at the Nursing Times Awards 2014 earning the runner up spot in the IPC category.

When I started in IPC (infection prevention and control) 3 years ago there was no internal educational programme for IPC link staff. In addition there was no criteria for taking on the link role nor definition of what the role should be. In essence any staff who had been identified as IPC links were names on paper who attended an external education session every once in a while. External sessions were non-mandatory so care homes had no obligation to facilitate staff attendance.

Dawson (2003) said that, IPC link staff can play an important role in their clinical area to facilitate liaison with the infection control team and to act as a resource for colleagues.

With this in mind I thought “how can the link role be developed so that it is meaningful, how can staff be provided with education relevant to the environment they work in and can a system be created which allows staff to easily access specialist support?” Then it hit me a mandatory internal link programme. It seemed simple, if only! There were things to consider;-

  • Who would be invited to attend?
  • Can criteria for taking on the link role be established?
  • What topics are going to be covered?
  • Can all the topics be covered in one day or are multiple days required?
  • Where are the link days going to be held? Care homes under my remit are split into 9 regions based on geographical location.

And so the scoping began. I visited care homes to observe IPC related clinical practice, finding gaps in basic practices such as hand hygiene and use of PPE (personal protective equipment) amongst other things. When I reviewed the opportunities for hand hygiene or using PPE, these fell mainly to the non-nurses. Care staff were providing the majority of assistance with personal care/continence care. Domestic staff were moving from room to room looking after environmental cleanliness. This meant that these staff groups were in the best position to identify good practice, poor practice, cultural practice and potentially to influence a positive change in clinical practice. In contrast when reviewing the nurses role, they were responsible for planning care relating to residents who may have active or colonised healthcare associated infections (HAIs). To implement an appropriate and person centred plan of care the clinical knowledge of nurses is of fundamental importance.

IMG_1042 (2)

Link staff are traditionally defined as practising nurses with an expressed interest in a speciality and a formal link to specialist team members (MacArthur, 1998). However, following my visits to Care Homes I decided that the role, needed to be expanded to include senior healthcare assistants and domestic supervisors. The rationale behind this expansion was very simple; if we want/expect there to be a high standard of IPC practices within care homes then those staff who have the potential to have the greatest influence in practice must be included. The only stipulation was that senior healthcare assistants or domestic supervisors taking on the role must also have a link nurse within their care home.

Following the scoping the plan to take forward a link programme was;-

  • Every home with a nursing unit must send a nurse (but could also send a senior healthcare assistant and/or domestic supervisor).
  • As this was a pilot, we had a very loose criteria for the link role – the main point was that the person must have an interest in IPC. Lack of interest equals lack of motivation and lack of motivation equals poor utilisation of the role.
  • Based on observations in the homes and discussion with staff the topics needed to range from a definition of what the link role is, basic practices – standard precautions, environmental cleanliness, care of the person with MRSA living in a hare home, Clostridium Difficile awareness, seasonal Influenza and identification and management of gastroenteritis outbreaks.
  • With the volume on the programme the topics were split into 3 separate sessions held at appropriately identified times throughout the calendar year.
  • Each of the 9 regions received the 3 sessions so that meant delivering 27 link sessions throughout the year. No mean feat.

From the pilot programme in 2013-14 the programme was a great success, with approximately 80% of Homes represented. This coincided with a 61% reduction in outbreaks of infections such as gastroenteritis. The feedback was extremely positive so the programme was replicated for 2014-15. Again the results were positive with a link nurse, Shauna Rooney, winning the National Nursing Standard IPC Link person award in May ’15. This very much highlighted what can come from positive and effective implementation of the link role with the drastic improvement in basic and fundamental practices.

This month I have the opportunity to do something a bit different for the link staff. On the 17th September 2015 I am running an IPC CPD day for link staff. Whilst it is important to provide information for staff as the link programme has done in the past 2 years, focus on development of the role and further assessment of staff perception of the role is essential to driving improvement.

The focus of the day is effective use of the role and driving quality improvement in day to day practice. I have been lucky to have the involvement of Rose Gallagher from the Royal College of Nursing as part of the day. Rose is running a workshop called ‘build a link person’ which asks link staff to assess their capabilities and limitations in communicating with and influencing others. Other areas of the day will be ‘using clinical audits effectively- quality improvement versus quality assurance’ and ‘A Clostridium Difficile outbreak- what did we learn?’. The day can be followed on Twitter with the hashtag #FSHCNI, it promises to be a great day.

Gary Cousins, Infection Control and Clinical Development Nurse, Four Seasons Health Care

A Personal Account of Caring

10 Jun, 15 | by Gary Mitchell, Associate Editor



This week is Carers Week and it runs from the 8th of June to the 14th June 2015.  

It’s a time where healthcare professionals and individuals, like myself, raise awareness of the important role that carers play.  This awareness pertains to what a carer is, what they do on a daily basis and where it is that they can go to access support services.  It’s a cause that is inherently close to my heart because I am in actual fact, a carer.  I have been since the age of 11. You might think this is young but the truth is there are carers younger than me and a lot of carers older than me.  Being very young or very old then doesn’t give you immunity from the role of caring for a loved one.  Irrespective of age or individual circumstances, we all share the same role of carer.  We look after a loved one who needs help – be it a family member, a friend or neighbor.  The people we care for may have physical or learning disability, a long term health condition, a mental health problem or even have problems with addiction.  Some carers may even fit into any of these categories themselves.  I know I do.  I have anxiety and OCD, but I continue to care for five people in my family.

I started caring from the age of 11 – it’s all I’ve ever known.  My grandma and granddad used to look after my great grandfather who had dementia and had one of his legs amputated so caring has always been in my family.  He used to live with them until he moved into care and he died in 2006.  Just before this, in 2005, my grandma fell down the stairs and this accident changed the life of my family and me forever.  Everything just spiraled downwards from that point in time. When my grandma got out of hospital, 4 months after her accident, we thought everything would just go back to normal.  It didn’t.  It was only beginning.  She was diagnosed with epilepsy and diabetes.  To make matters worse, we were told that the brain damage she had already sustained would get progressively worse.

Caring from my grandma became more difficult as I then had to play a role in caring for 3 other members of my family.  I don’t want to go into that, because it’s still so raw for me.  Not all carers want to talk, tell their story or raise awareness.  Some of us prefer to remain in silence and some people struggle alone.  While I don’t want to go into details I will say that mental health problems are involved as well as substance misuse.  There is a lot of stigma surrounding these issues and unfortunately it is not something I can discuss further.  I have been living with this aspect of caring since I was 14 years old.  My grandma eventually went into care when I was 17, I think.  It sounds terrible but my life from the age of 11 has basically been a blur of events.  From then, my granddad’s health began to decline.  He drank a lot – probably to cope with grandma’s deterioration and his health problems worsened.  Then something we weren’t expecting happened – he was diagnosed with dementia.  The dementia caused a number of hospital admissions and eventually changed his personality and behaviour.

In September 2014, it was time for me to move away from home to go to university.  I left my physical caring responsibilities at home, but I would still be the person at the end of the phone if anything happened to anyone.  My family was always in my thoughts and that caring responsibility never went away.  When I went back home, my caring responsibilities would resume immediately. The last time I went back, which was for my 21st birthday, everything seemed good but my grandma was experiencing hallucinations and my granddad’s dementia had progressed rapidly.

He was now in psychiatric care.  I went to see him on the day of my birthday and when I saw him, I didn’t recognize him.  He had completely changed.  He didn’t know who I was, which was difficult. He was very distressed because he couldn’t communicate what he wanted and he didn’t have the capacity to hold a conversation with me.  I couldn’t believe what I was seeing.  The feelings I experienced were crushing, will he be able to speak, go to the bathroom himself or recognize anyone again in the future?  He’s only 67 years old.

Caring can be difficult and heartbreaking.  But to be able to give back to my family, the same family who cared for me growing up, is a very rewarding feeling.  There is a considerable burden on my life at times but I wouldn’t change anything.  I know that the people I care for will not always be around and so I enjoy the time I have with them the best that I can.  As a person I have become more caring, more able to adopt a non-judgmental approach and learned how to be resilient.  On caring, I would say – It’s the gift of giving back that counts.



Sophie Dishman

Sophie Dishman is a carer & undergraduate journalism student at Sunderland University.

Follow Sophie on Twitter @SophieSW14 or check out more of her blogs


Using health promotion theory with patients

16 Feb, 15 | by josmith

Nova Corcoran, University of South Wales will be leading this week’s ENB twitter chat on Wednesday the 18th of February between 8-9pm focusing on ‘5 Quick ways to use health promotion theory with patients’. 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 @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.

5 Quick ways to use health promotion theory with patients by Nova Corcoran

Many nurses view health promotion theory as something they vaguely remember from university and very few would claim to use health promotion theory in practice. Here’s the good news – you don’t need to remember a whole theory to use theory? There are many common elements in health promotion theories that can be incorporated in day to day practice. Here are five quick ways to use health promotion theory with patients.

Promote the benefits of change –not just the health benefits

We tend to focus on changing behaviour being ‘good for you’ but often patients find it difficult to quantify health benefits that are twenty years or more down the line. Benefits are recognized in a number of theoretical models and tangible benefits can include saving money, losing weight, not smelling of smoke or making new friends. Use resources to help you promote the short term benefits, for example websites that calculate how much money you save by quitting smoking (refer to resources list).

Promote patient behavioural control

A feature of a number of health promotion models is the role of self-efficacy or behavioural control. This is the patients’ perception of their own ability to be able to achieve something. Patients with low self-efficacy are much less likely to change. Be positive with your patients; tell them they can achieve their goal. Focus on small goals for example swapping instead of stopping. Change4life has good ideas for nutrition smart swaps (refer to resources below). Equally swaps could be in other lifestyle areas for example alcohol by swapping higher to lower strength beers.

Identify barriers to change

Numerous theoretical models acknowledge that barriers stop many behaviour change efforts. Ask patients what they think will stop them achieving a behavior, for example quitting smoking and how they plan to overcome this barrier. For example barriers to quitting smoking include peer pressure from friends, habit and cravings. If the response can be planned relapse is less likely. You might suggest a distractor app for iPhone/android phones such as the Filter Distractor app (refer to resources below) or Nicotine Replacement Therapy (NRT).

Recognize the wider environment

The environment is an important element of behaviour change. Safety, traffic and aesthetics can discourage exercise outdoors and unfriendliness, unfamiliarity and embarrassment can discourage exercise indoors. If you wanted to encourage a patient to exercise more then you need to be able to signpost them to friendly, safe spaces. Become familiar with your local area; which physical activity groups are easy to access? Does your leisure centre run special classes for teenagers or older people? and which green spaces are safe?

Tailor information to the patient

If you work with children you probably communicate health information use simple words or pictures. The same tailoring ethos should also apply to other patients; for example providing information in a different language or large print. Recognize that patients are at different stages of change. For example does your patient have all the information they need? Are they very knowledgeable? Have they tried to change before? What is stopping them from changing? Being a good signposter can help you tailor information. If a patient wanted support to change a behaviour i.e. diet some patients would prefer a group, some would prefer a website and others might just want to do it by themselves. Ask the patient what they would prefer and signpost accordingly.

You do not need to be an expert in health promotion theory to do any of these five things – just think small changes, short term goals and know the assets in your local area that will support your patient when they are back at home.

Can you think of any more quick ways to include theory in practice?


Change4life (2014) Smart Swaps available at

NHS (2014) Smokefree calculate the cost available at

Filter (2014) Distractor app available at

A useful online resource for nursing theories is available at


Addition information on theoretical models can be found in Corcoran N (2013) Health Communication; strategies for health promotion, Sage, London.

A good overview of different theories for nurses in behaviour change can be found in is Davies N (2011) Healthier Lifestyles: behaviour change. Nursing Times 107 23 20-23 available at

Should we expect nurses to be role models for healthy living?

1 Feb, 15 | by atwycross

This week’s EBN twitter chat on Wednesday 4th February between 8-9 pm (UK time) will focus on whether we should expect nurses to be role models for healthy living. This links very nicely with last week’s Blog “Loosing the fight against obesity”. This week’s Blog has been written by Professor Jane Wills from London South Bank University and provides some areas to think about ahead of the Twitter Chat. The Twitter Chat will be hosted by PhD student Muireann Kelly (@muireanntweets), also from London South Bank University, who is looking at the subject of nurses as role models for her doctoral studies. 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 @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.

NHS chief executive Simon Stevens has claimed that obesity in the UK is a “slow motion car crash” that could be financially disastrous for the health service. The NHS is now spending more on bariatric surgery for obesity for example, than on the national rollout of the intensive lifestyle intervention programmes. The health service has to “get its own act together” on obesity by helping staff to lose weight. Stevens claims that more than half of the NHS’s 1.3 million staff are overweight or obese.

Whilst the source of the figure is not known, the latest Health Survey for England states that a quarter of adults are obese (24% of men and 26% of women), while 65% of men and 58% of women are overweight or obese. So these figures on the health care workforce reflect those of the general population and nurses are not that different. Weight-related problems are strongly related to economic factors, but so too is the difficult task of rectifying them. For nurses, long hours, shift work, low pay and the work itself of caring for others all make addressing personal health a challenge.

Why does it matter if nurses don’t lead particularly healthy lifestyles themselves? The argument being put forward is that nurses and midwives are credible sources of advice and support to patients about how to improve their own and their family’s health. ‘Making Every Contact Count’ (MECC) is the initiative to train nurses and midwives to find out what motivates people and to work out with them what are the best steps they personally can take to improve their own health. Yet this kind of health promotion is rare to observe in practice. Why? Maybe nurses and midwives think it would not be welcome or may damage a good relationship between the health care professional and patient.

Question: Why do you think there is a reluctance to take health improvement opportunities to talk to patients about their lifestyle?

The national press responded to Stephens’ speech with headlines such as “Weight’s up doc . Fat medics told to slim by NHS chief” (Sun newspaper) and there followed a blaming discourse that, irrespective of the health system’s failure to enable better health, somehow nurses “ought to know better”.

Question: Should nurses and midwives adopt healthy lifestyles themselves so they can act as role models?

Both government policy and professional nursing bodies have shown that they are concerned about nurses’ lifestyles and about nurses being healthy role models. The recent Five Year Forward View called on all healthcare workers to “stay healthy, and serve as health ambassadors in their local communities” (p.11), and the NMC have included role modelling health-promoting behaviour as a competency for all nurses.

The argument being put forward for nurses to ‘practise what they preach’ is multifaceted. Last week, Jane Cummings said staff might find it hard to give advice until they themselves start to make some changes in their own lifestyles. Patients may be less likely to follow the health advice of nurses who do not personally engage in the behaviours they are seen to promote. An Ipsos Mori survey found that 37% of the public would not accept health advice from a healthcare professional who appeared to have an unhealthy lifestyle (

Furthermore, unhealthy nurses may have higher sickness absence rates and lower productivity, which place an avoidable strain upon NHS resources. This may also impact on the quality of care and patient safety.

There is a counter-argument that nurses are only human, and that they should be free to make individual choices about their lifestyles. Nursing is a stressful job which can encroach into an individual’s personal life. The constraints of the job can sometimes make it more difficult for nurses to choose a healthy option. A focus of the Five Year Forward View plan is highlighting the health system’s role in promoting healthy lifestyle change. The plan includes moves to reduce the sale of high-sugar and high-fat products on hospital premises, and all hospital trusts should offer healthy food for their staff 24 hours a day. At present only a quarter of hospitals offer healthy food to night staff, which means they have to rely on vending machines and microwave meals. Trusts will also be told to encourage staff to join work-based weight-watching and exercise schemes via sponsored membership of local leisure centres and gyms.

There is a widespread view that patients are more likely to listen and heed the advice and support given by someone like themselves. A nurse who is overweight or a smoker may be better able to empathise with patients faced with making lifestyle changes. Is nursing more about giving health promotion advice and information with confidence and experience than trying to be an exemplar of healthy living? The views of nurses themselves are not well-researched, and so little is known about how nurses themselves feel about being role models for healthy lifestyles.

Question: What do you think? Is it reasonable to expect nurses to be role models for healthy living?




Losing the Fight Against Obesity

26 Jan, 15 | by rheale

By Roberta Heale  @robertaheale

Look to any blog, news or health website and you’ll find a story about the world obesity epidemic almost every day from every angle: Financial obesity programs health & & from the fashion and beauty industry etc. etc. etc.  Despite the news, the world is getting fatter and fatter and fatter.  The World Health Organization indicates

·  worldwide obesity has more than doubled since 1980.

·  In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese.

·   39% of adults aged 18 years and over were overweight in 2014, and 13% were obese.

·   Most of the world’s population live in countries where overweight and obesity kills more people than underweight.

·   42 million children under the age of 5 were overweight or obese in 2013.


Most importantly, obesity is preventable.  Think about it.  What other epidemic has affected so many people?

As with all epidemics, nurses are on the front line in the fight against obesity.  Health care education and programs are important steps.  However we aren’t winning this war. Albert Einstein, is credited with saying “The definition of insanity is doing the same thing over and over again, but expecting different results.”  Given this, maybe we need to change our approach.

I just watched the movie The Imitation Game. It portrays the important work of another genius, Alan Turing, who refused to waste his time on the traditional code breaking techniques that were not making any headway in breaking the German code system used in WWll.  Instead he designed the first computer, which cracked the codes that were previously unsolvable.  Maybe we need to change our approach and think in an innovative and strategic manner with the ‘big picture’ in sight.

Advocacy and leadership are among the list of nursing competencies and nurses have been involved in many campaigns for health public policy.  There has been success in reducing smoking rates through strategic policies in some jurisdictions. Perhaps increasing our efforts in advocating for meaningful health policy changes will make a difference in the fight against rising obesity rates.  Success has already been achieved in my province through the implementation of policy removing vending machines with fat-promoting food from high schools.  It’s just a small start, but worth a try in the war against the obesity epidemic.

‘Our National Shame’ Older people and loneliness ‘ by Nova Corcoran, University of South Wales, (@NovaCorks); Calvin Moorley London South Bank University (@CalvinMoorley)

28 Sep, 14 | by Calvin Moorley, Associate Editor

The Rt Hon Jeremy Hunt MP in a speech in 2013 referred to loneliness in the UK as ‘our national shame’ highlighting the millions of people who are part of the ‘boarder problem of loneliness that in our busy lives we have utterly failed to confront’ (DOH/Hunt 2013). Loneliness is not just something we feel when we don’t have anyone to talk to, but a state of isolation, depression or abandonment, MIND (2014) call the feeling of loneliness ‘not feeling part of the world’.

Loneliness is not a constant state and recent research suggests that while there is an increase in loneliness with age, older people move in and out of frequent loneliness over time (Dahlberg et al. 2014). Loneliness can affect older men and women differently as for each group there are different predictors and outcomes for loneliness. It may also be difficult to both recognize and admit to feelings of loneliness by the older person who is affected.

Older people are particularly vulnerable to loneliness through a mixture of circumstances including loss of family and friends, lack of mobility, no access to private transport, living alone, increasing disabilities and low levels of income and geographical location for example see Moorley & Corcoran 2014 editorial on older people living in inner cities. Loneliness and social isolation has a negative impact on health and well-being and numerous studies have examined the link between health and loneliness. This includes early admission to residential or nursing care, poorer function in daily activities (DOH/Hunt 2013) and specific poor mental health outcomes such as depression, low life satisfaction and low resilience (Zebhauser et al. 2014).

As with most public health interventions to tackle complex health problems there needs to be a focus at micro and macro levels and thus both individual and community responses to loneliness need consideration. A multi-sectorial response is also important that includes not just health professions but organizations, groups or charities that operate within the community.

A systematic review in 2011 noted that interventions to address loneliness that offer social activity and/or support within a group format, along with interventions in which older people are active participants were found to be the most effective in reducing loneliness (Dickens et al. 2011). Strategies to reduce loneliness may also have an impact on other health domains such as mental health or physical health. For example, programs that use social support to reduce loneliness can reduce rates of depression (Liu et al. 2014).

Other interventions that have shown promise in reducing loneliness include mentoring and befriending schemes (Dury 2014) and social network maintenance and enhancement (Cohen-Mansfield & Perach 2014). The SCIE has produced guidance on reducing isolation and loneliness and they note community befriending schemes and community navigator schemes* are successful (Windle et al.2011). One campaign group that aims to reduce loneliness is ‘the campaign to end loneliness’ which supports organizations who want to tackle loneliness. They also have a comprehensive tool kit and a ‘loneliness harms health’ kit you can download for free (see references).

Environmental barriers can increase loneliness. Rantakokko et al (2014) note that barriers that increase loneliness including weather, hills, distances to services, and difficulties in walking more than 2km. Wider environmental modifications can reduce loneliness so although we cannot change the weather or move hills, we can situate services within local communities and provide groups and club activities or informal meeting spaces in easily accessible venues.

One area that has received attention is the use of the internet and social media, although there are no systematic reviews that examine this area. Generally research is mixed suggesting technology can both reduce and increase loneliness and isolation depending on how it is used. For example Sum et al (2008) found that if the internet was used as a communication tool then there were lower levels of social loneliness, but use of the internet to find new people was associated with higher levels of emotional loneliness.

In summary, older people are at risk of increased loneliness, and with budget cuts in both health and community services the risks around loneliness and isolation may increase. Join the evidence based nursing debate on Wednesday 1st Oct 2014 at 8.00 to consider what health professionals can do to address the challenge of reducing loneliness in older people.

Participating in the EBN Twitter Journal Chat

To participate in the EBN twitter chat, if you do not already have one, you require a Twitter account; you can create an account at Once you have a Twitter account contributing is straightforward:

  • You can follow the discussion by searching for links to #ebnjc or @EBNursingBMJ on Twitter
  • Or contribute to the discussion by sending a tweet starting with @EBNursingBMJ and ending with #ebnjc (the EBN chat hashtag).

NB not including #ebnjc means people following the chat won’t be able to see your contribution

*Sometimes called Wayfinder initiatives they use community workers in the local community (i.e. a library or pharmacy) who signpost people to local services i.e. clubs and groups.


Campaign to End Loneliness available at the tool kit is available at

Dahlberg L, Andersson L, McKee KJ & Lennartsson C (2014) Predictors of loneliness among older women and men in Sweden: A national longitudinal study Aging and Mental Health Aug 15 1-9 [pub]

Dickens AP, Richards SH, Greaves CJ, Campbell JL (2011) Interventions targeting social isolation in older people: A systematic review BMC Public Health 11: 647

DOH/Hunt (2013) the forgotten million available at

Dury R (2014) Social Isolation and loneliness in the elderly: An exploration of some of the issues British Journal of Community Nursing 19 (3) 125-8

Liu L, Gou Z, Zuo J (2014) Social support mediates loneliness and depression in elderly people Journal of Health Psychology Jun 11 [E pub ahead of print]

MIND (2014) Loneliness available at

Moorley, C. R. and Corcoran, N. T. (2014), Editorial: Defining, profiling and locating older people: an inner city Afro-Caribbean experience. Journal of Clinical Nursing, 23: 2083–2085. doi: 10.1111/jocn.12487 Avaiable at

Rantakokko M, Iwarsson S, Vahaluoto S, Portegijs E, Vilianen A, & Rantanen (2014) Perceived Environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people J Gerontology A Bio Sci Med Sci 26 [epub ahead of print]

Windle et al (2011) SCIE Research briefing 39: Preventing loneliness and social isolation: interventions and outcomes available at

Zebauser A, Hofmann XL, Baumert J, Hafner S, Lacruz ME et al (2014) How much does it hurt to be lonely? Mental health and physical differences between older men and women in the KORA-Age study. International Journal of Geriatric psychiatry 29 (3) 245-52


Analysis and discussion of developments in Evidence-Based Nursing

Evidence-Based Nursing blog

Analysis and discussion of developments in Evidence-Based Nursing. Visit site

Creative Comms logo

Latest from EBN

Latest from EBN