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.

Nursing Issues

Seeing the Wood and the Trees: Using Construal Level Theory to see what Proxy Decision Makers are thinking about

23 Apr, 17 | by josmith

Helen Convey. Lecturer in Adult Nursing, School of Healthcare, University of Leeds

Individuals who are living with dementia and who lack decision making capacity require proxy decision makers to make decisions for them. Individuals may express their interests and desires through behaviour and verbal communication, however, memory loss results in a lack of psychological continuity between the past and the present self. When there is a conflict between the individual’s past values and interests and their present values and interests proxy decision makers encounter an ethical dilemma. The aim of this feasibility study was to explore the potential use of Construal Level Theory (CLT) as a way of analysing the thinking of proxy decision makers where this conflict occurs.

CLT (Liberman and Trope, 2014; Trope and Liberman, 2010) contends that people use mental construal to traverse psychological distance and to think about choices, alternatives and perspectives in different dimensions; temporal, spatial, social and hypothetical. In mental construal abstraction is used to move beyond direct, real experiences of the self, across psychological distance, to form a subjective view of an object or action. High-level construal is more abstract, central values receive attention. Low-level construal is concrete, detailed and contextualised.

Participants were given a scenario in one to one semi-structured interviews. They read the scenario and were asked what they were thinking and feeling. Thematic analysis was used to discover patterns of decision making. Participant responses within the themes were then analysed for abstractness of language using the Linguistic Category Model (Semin and Fiedler, 1991). Participants were found to travel across psychological distance to think abstractly about the person in the scenario. They used mostly abstract thinking to establish central values and beliefs and mostly concrete thinking to express pragmatic concerns. We concluded that CLT can be used to analyse the thinking of proxy decision makers.


References:

Liberman, N. and Trope, Y. 2014. Traversing psychological distance. Trends in Cognitive Sciences. 18(7), pp.364-369.

Semin, G.R. and Fielder, K. 1991. The Linguistic Category Model, its Bases, Applications and Range. European Review of Social Psychology. 2(1), pp.1-30.

Trope, Y. and Liberman, N. 2010. Construal-Level Theory of Psychological Distance. Psychological review. 117(2), pp.440-463.

 

 

Treating pain during pregnancy and breast feeding

16 Apr, 17 | by josmith

This week’s EBN Twitter Chat on Weds 19th April at 8-9pm UK time will focus on pain during pregnancy, how important and difficult is to treat pain during pregnancy and breast feeding.

The Twitter Chat will be hosted by Dr Massimo Allegri, Assistant Professor in Anesthesia Intensive Care and Pain Medicine at the University of Parma (Italy),@allegri_massimo. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. 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 chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The Pain Department of University Hospital of Parma is one of the biggest pain clinic in Italy and it is the most important research centre about acute ad chronic pain in Italy and one of the most important in Europe.

Furthermore, next year a new PhD Position in Pain will be settled up together with Alborg University and Prof Lars Arendt Nielsen about chronic pain and central sensitization. Furthermore, University of Parma organizes one of the most important translational pain meeting in the world: SIMPAR (www.simpar-pain.com).

Pain affects 20% of adult population worsening not only quality of life, but also outcome of patients who refer it. Unfortunately, pain continues to being undertreated and under-recognized. Chronic pain is not just a symptom but it is a real disease that needs an accurate diagnosis and appropriate therapy against the pain generator pathophysiology.

This problem is even more important during pregnancy and breastfeeding. The fear to give drugs that can hurt foetus/neonate can drive the physician to a “wait and see” approach that cannot solve the problem to the mother. Furthermore, during pregnancy there are several physiological changes that can worsen previous pain or generate new one. Finally, all the drugs are obviously off label and it is difficult to know exactly their real toxicity.

On Wednesday 19th April during the twitter chat we will continue the conversation to consider how to drive the therapy for patients during pregnancy and breastfeeding. We will discuss all together which multidisciplinary approach could be useful and how important is to diagnose the right pathophysiological mechanism that triggers the acute or chronic pain:

  • Which are the classifications of the drugs that could drive clinicians to use the drugs to alleviate pain?
  • When is more harmful to use some specific drugs?
  • Which concerns do we have to consider when we give a drug to a breastfeeding mother?
  • How to perform the right pathophysiological diagnosis?
  • Do we have to stop some drugs if the women would like to become pregnant

Please join us to discuss this important medical, nursing and public health challenge.

References

1 Coluzzi F, Valensise H, Sacco M, Allegri M Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014 Feb;80(2):211-24.

2  Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med (Lond). 2016 Dec;16(Suppl 6):s110-s116.

3 Tepper D. Pregnancy and lactation–migraine management. Headache. 2015 Apr;55(4):607-8.

Caesarean section increases risk of preterm birth in subsequent pregnancy

12 Apr, 17 | by josmith

Professor Allison Shorten

Center for Interprofessional Education and Simulation, University of Alabama at Birmingham

Prevention of preterm birth remains an important priority for international perinatal research. Identification of risk factors is important for development of effective preterm birth prevention strategies. One of our latest EBN commentaries, by international experts Laura Visser, Marjon A de Boer and Ben W Mol, presents an interesting discussion of recent research by Wong and Wilks (2016), which highlights a relationship between caesarean section and preterm birth in subsequent pregnancies. As the quest to identify risk factors for preterm birth continues, our commentators note that large observational studies are needed to determine the pathophysiology and possible causal relationships between the risk factors identified (Caesarean section, new tobacco use, short interpregnancy interval) and preterm birth. Caesarean section rates remain high and are increasing in many countries around the globe, making it important to examine relationships between Caesarean section and problems that may arise in subsequent pregnancies. Read more about this interesting case control study and recommendations for future research and clinical management.

 

Reference:

Wong LF, Wilkes J, Korgenski K, et al. Risk factors associated with preterm birth after a prior term delivery. BJOG 2016;123:17728.

Read EBN cimmentary :

http://ebn.bmj.com/content/20/2/42

Engaging Students with Twitter

26 Mar, 17 | by josmith

Kirsten Huby, Lecturer Children’s Nursing, University of Leeds (@KirstenHuby)

Emma Wilson, Children’s Nursing Student, University of Leeds (@Emzieness

The latest Horizon report (Adams Becker et al., 2017) recognises collaborative learning as one of the key trends that will be driving Higher Education for the next few years. It suggests that collaborative learning improves engagement, encourages learning that relates to practice and enables communities of practice to be developed. For healthcare students this type of learning can be used to develop the skills to think critically, problem solve and become open to recognising the diverse nature of the health and social care arena. Technology can help to promote collaborative learning but will only be successful if we can engage students and ensure they see the purpose of what is to be achieved.

 

It has been suggested social networking sites (SNS) encourage the type of collaborative learning advocated by (Adams Becker et al., 2017, Prestridge, 2014) ,we cannot assume that a particular type of SNS will necessarily work. In a study on the use of Twitter, students tended to use a tweet to ask a question of a lecturer rather than to collaborate between themselves. The author considers that students may need to be guided and supported to recognise the depth of knowledge and understanding that can be shared in this way (Prestridge, 2014). This implies that in order to be fully engaged students need to understand the purpose of the interaction and the tool that is being used.

To do this, informative learning opportunities and consultation with students needs to occur. The twitter community is diverse; some nurses opt to have separate ‘nursing’ accounts, others opt to combine professional and personal tweets as one online personality. Ultimately this comes down to personal preference. However, it must be considered that social media guidance has been set by the NMC (Nursing and Midwifery Council, 2015) and this and the requirements of the NMC Code must be adhered to at all times; on and offline and regardless of whether an account is identified as personal, professional or both. Student nurses therefore need to have an awareness of their responsibilities and potential accountabilities surrounding any social media use in relation to this.

A significant factor which potentially hinders student participation with SNS in a learning environment is whether they are comfortable with lecturers/mentors potentially having the ability to view personal posts/tweets. One such way around this is to have a specific agreement to not follow students back from University curated accounts. This means that students can view informative tweets / retweets on their timelines, but their own postings aren’t automatically or as easily visible. This leads to an element of ‘privacy’ and choice, allowing students to choose whether to engage with lecturers if they want to, but also benefit from some of the wider aspects of using SNS such as furthering knowledge / sharing views on current research or topical issues and collaborating and engaging with other students and professionals. As we take the next steps with the @UoLchildnursing account we hope to increase our engagement with students and with the help of motivated student twitter champions such as @Emzieness we hope this will be possible.

Adams Becker, S. et al. 2017. NMC Horizon Report: 2017 Higher Education Edition. 2017 ed. Austin, Texas: The New Media Consortium.

Nursing and Midwifery Council. 2015. Guidance on using social media responsibly. London.

Prestridge, S. 2014. A focus on students’ use of Twitter – their interactions with each other, content and interface. Active Learning in Higher Education. 15(2), pp.101-115.

The power of reflection in nursing

30 Jan, 17 | by dibarrett

Lizzie Ette. Lecturer in Nursing, The University of Hull

This week’s EBN Twitter Chat is on Wednesday 1st February between 8-9 pm (UK time).

The chat will be led by Lizzie Ette (j.ette@hull.ac.uk ), Lecturer in Pre-registration Nursing, The University of Hull.

Participating in the Twitter chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. 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 adding #ebnjc (the EBN Twitter chat hash tag) to your tweet, this allows everyone taking part to view your tweets

The power of reflection in nursing

As is so often the case, professional and personal lives are intricately related, and the recent experience of losing our family cat Reggie, following a road traffic accident at Christmas, really got me to reconsider the power of reflection on a personal level, and this got me thinking deeply about how important reflection is in my professional capacity, as a nurse.

  Reggie: 2000-2017

more…

Turning Japanese – the global inequalities of ageing

22 Jan, 17 | by josmith

Dr Fiona McGowan, School of Health Care Studies, Hanze University of Applied Sciences, Eyssoniusplein Netherlands f.e.mcgowan@pl.hanze.nl

We are all very much aware of how societies are ageing and this ‘demographic transition ‘ is widely recognised as a global phenomenon. How this shift in population composition impacts health and illness is not so conclusive. While trends have emerged indicating the rise in non-communicable diseases such as heart disease, cancer and diabetes, global patterns of health problems also reflect disparities between and within countries. Different ‘ peoples’ experience ageing in different ways and these are not equal.

WHO (World Health Report 2013) showed that health inequalities remain ingrained globally and reflect disparities marked by sex, age, socio economic status, education, place and other more specific factors including migrant status, race, ethnicity and religion. Mortality data shows that in high-income countries, 7 in every 10 deaths are among people aged 70 years and older. People predominantly die of chronic diseases. Only 1 in every 100 deaths is among children under 15 years. In low-income countries, nearly 4 in every 10 deaths are among children under 15 years, and only 2 in every 10 deaths are among people aged 70 years and older. People predominantly die of infectious diseases and complications of childbirth. (World Health Statistics 2015). These facts illustrate the contrast between what an ageing society looks like in a developed, high-income country and in a low income, developing country (a further example being expected years of retirement which is 24 years in France but only 9 years in Mexico – both countries have retirement age at 65) This also highlights how our knowledge and understanding of ageing societies has been shaped by inequality. The focus remains on how westernised societies experience ageing. The social constructionist approach to ageing largely applies to societies in which people are living longer and sufficiently long enough to experience what Laslett (1996) has defined as a ‘Third Age’. A period post retirement, conceptualised as ‘the crown of life’, a time of self- fulfilment and achievement(Jones et al. 2008).

More recent theorising in the field of social gerontology, categorises the third age and later life as a ‘new cultural and social field’ particular to Westernised consumer society marked by sustaining a youthful appearance, and a ‘performing fit, healthy and sexualised lifestyle’ is maintained (Gilleard & Higgs, 2005). While this presents a more positive approach to ageing – in contrast to dependency and disengagement theories – again the focus is on a specific demographic cohort and this ‘generational field’ is not globally situated. Whether a ‘later life’ is experienced mirrors the accumulative process of ageing and the extent to which illness and disability are suffered. While the worldwide ‘epidemiologic shift’ that has accompanied socioeconomic development is reflected in both individual and population health, inequality remains as a powerful determining force. Global health then is dependent on the global context – environmental, economic, political and social. How a society ages is similarly shaped. As Michael Marmot writes in The Health Gap, “ Societies have cultures, values and economic arrangements that set the context through the life course that influence health” (2015, p259). This is clearly supported by Life expectancy indicators (OECD 2016) which show, for example, Nigeria – 54.5 years, Japan – 83 years.

References

Gilleard, C. & Higgs, P. ( 2005) Contexts of Ageing: Class, Cohort and Community. Polity Press. Cambridge.

Jones, I. , Hyde, M. , Victor, C., Wiggins, R. , Gilleard, C. and Higgs, P (2008) Ageing in a Consumer Society: From passive to active consumption in Britain. The Policy Press. Bristol.

Laslett, P. (1996) A Fresh Map of Life: The Emergence of the Third Age ( 2nd ed). Palgrave MacMillan.

Marmot, M. (2015) The Health Gap: The Challenge of an Unequal World. Bloomsbury. London.

Organisation for Economic Co-operation and Development (OECD) (2016) OECD Data: Life Expectancy at Birth. https://data.oecd.org/healthstat/life-expectancy-at-birth.htm Accessed 2nd July 2016.

World Health Organisation (WHO) National Institute on Aging (2011) Global Health and Aging. http://www.who.int/ageing/publications/global_health.pdf?ua=1 Accessed 1st July 2016.

World Health Organisation (WHO) World Health Report 2013. Research for universal health coverage. http://www.who.int/whr/en/ Accessed 2nd July 2016.

World Health Organisation (WHO) (2015) Global Health Observatory (GHO) Data

World Health Statisitics 2015. http://www.who.int/gho/publications/world_health_statistics/2015/en/ Accessed 1st July 2016.

 

Using Technology to Support Learning – confident, terrified or indifferent?

15 Jan, 17 | by josmith

 

This week’s EBN Twitter Chat on Wednesday 18th January between 8-9 pm (UK time) will be lead by Kirsten Huby, Lecturer in Children’s Nursing, University of Leeds, @KirstenHuby focussing on learning technologies. Participating in the Twitter chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. 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 adding #ebnjc (the EBN Twitter chat hash tag) to your tweet, this allows everyone taking part to view your tweets.

We are surrounded by technology that assists us in every aspect of our life and education is no exception. It has never been easier to access information and learning resources on an almost infinite number of topics. We can collaborate and attend conferences in virtual spaces and share ideas in real time or whenever we have a minute spare! Our learning can incorporate teacher-led instruction, be led by our own interest and desire to learn or a combination; what is becoming apparent is that social learning in digital forums is enhancing learning by bringing interested parties together (Simon Nelson 2017). As health professionals continually learning and demonstrating how this learning has occurred in the digital world is opening doors and making digital learning easier. Whilst digital learning enables us to be flexible in our learning it also requires a degree of digital literacy. This has been defined by the European commission (2010) as “the confident critical use of ICT for work, leisure, learning and communication”. Digital literacy is a wider concept than just being able to use specific tools it also encompasses the ability to find, manage and evaluate the information that is available and understand how data is stored and shared in order to remain safe in virtual spaces. Ultimately educational technology is there to help improve education and facilitate student learning (Forest, 2015), the educational goals should be identified first but we need to be able to engage with the technology if we are to enhance our learning.

Within the Twitter chat I would like to explore:

  1. What technologies you currently use to support your learning and how effective you think they are?
  2. The reasons why you would choose or not choose to learn using technology?
  3. The facilitators that help you to engage with learning using technology?
  4. The barriers you have encountered to engaging with learning using technology?
  5. And finally the one app, device or program that you wouldn’t want to be without!

For those that feel they would like to learn more about working and learning in digital ways FutureLearn (a digital platform that hosts courses produced by educational institutions, organisations and businesses) offer a number of free online courses to get you started. https://www.futurelearn.com/courses?utf8=%E2%9C%93&filter_category=online-and-digital&filter_availability=new-and-upcoming

European Commission, 2010. Digital Literacy European Commission Working Paper and Recommendations from Digital Literacy High-Level Expert Group. [online]. [Accessed 12 January 2017]. Available from: http://www.ifap.ru/library/book386.pdf

Forest, E., 2015. Educational technology: An Overview. 18 November. Educational technology [online]. [Accessed 12 January 2017]. Available from: http://educationaltechnology.net/educational-technology-an-overview/

Nelson, S. 2017. DigiFest Keynote – Simon Nelson, CEO, FutureLearn. Student Education Conference and Digital Festival, 5 January, Leeds.

2016 @ EBN

25 Dec, 16 | by josmith

The holiday season is well underway & here at Evidence Based Nursing (EBN) we recognise that may nurses will be working to provide care & support to people with health issues over the festive period, but hope that for many you are all having a well deserved break. This year, as in previous years, the challenges facing nursing & healthcare have often dominated the news. The weekly EBN blog has enabled the editorial team & our guest bloggers to raise a range of issue relevant to contemporary nursing practice, often responding quickly to current policy and health issues.

Below are some of the highlights & initiatives that occurred at ENB in 2017:

  • In March, we had the pleasure of Dr Kate Granger (doctor, terminally ill cancer patient, founder of t #hellomynameis) hosting a twitter chat focusing on the#hellomynameis campaign. As anticipated the chat was high successful generating 2,842,612 impressions; 524 tweets; 210 participants. A summary of the chat and Storify can be found at:

http://ebn.bmj.com/content/19/3/68.full.pdf+html?sid=0b2fe014-af24-44ba-b04e-565eb1220e81 https://storify.com/josmith175/hellomynameis

Sadly, Kate passed way earlier this year.

  • Our EBN Opinion series is going from strength to strength, which summarises out Twitter chats. The latest article focuses on m
    eeting the needs of families: facilitating access to credible healthcare information:

http://ebn.bmj.com/content/20/1/2.short?g=w_ebn_current_ta

  • October was the launch of EBN Perspectives which brings together key issues from the commentaries in one of our nursing topic themes, the first article summarised commentaries on child health issues:

http://ebn.bmj.com/content/19/4/107.extract

screen-shot-2016-12-23-at-17-33-00screen-shot-2016-12-23-at-17-36-11With the latest focusing on advanced care planning & palliative care:
http://ebn.bmj.com/content/20/1/5.short?g=w_ebn_current_tab

  • Our Research Made Simple series continues to be popular offering a concise summary of key issues in research methods & their practical application; the next article focuses on the ethical context of nursing research:

http://ebn.bmj.com/content/20/1/7.short?g=w_ebn_current_tab

  • This year we presented at two important conferences; the International Academy of Nursing Editors (INANE), conference in August & the Royal College of Nursing International Centenary Conference in November both presentations focused on the ways social media activities can be used in nursing and nursing journals to promote evidence based practice.

We are looking forward to restarting our Twitter chats in January, beginning with

‘Loosing the child’s voice’ and ‘the captive mother’- an inevitable legacy of family-centred care? 4th January 2017, 8-9pm UK time

Learning technology in nurse education 18th January 2017, 8-9pm UK time

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?

determinants-of-health

more…

Recognising, Assessing and Managing Deteriorating Adult Patients

20 Nov, 16 | by josmith

By Gilberto Buzzi Senior Lecturer, School of Health and Social Care / Institute of Vocational Learning | London South Bank gilberto-buzziUniversity e-mail: buzzig2@lsbu.ac.uk

When patients are admitted to hospital, the expectation is that they entering a place of safety. Their families, relatives and friends trust that once in the hands of healthcare professionals, their loved ones are not only going to find comfort but also receive the best treatment possible. Patients trust they will be looked after by competent and confident nurses who will prevent their situation from getting worse, and in the event their condition deteriorates, that they will indeed manage it effectively. Sadly, this is not always the case. Hospital mortality statistics have been linked to staff failures to identify or manage early signs of deterioration.

Recognising and responding to deteriorating hospitalised patients is an important global issue in nursing. By closely monitoring changes in physiological observations and interpreting early sings of physical and psychological decline, nurses are more likely to identify, manage and therefore avoid serious adverse events before they occur. The National Early Warning System (RCP, 2012) has been introduced to help address this issue. The system is based on objective physiological parameters being scored according to the amount of deviation from normal. The scores are weighted depending on the severity of deviation.  screen-shot-2016-11-18-at-17-37-47
The aggregate score is then calculated and acted upon accordingly. As with everything, the tool is only as good as the professional using it. Therefore, all nursing staff caring for patients in acute hospital settings must be competent in monitoring, measurement, interpretation and prompt response to the acutely ill patient, appropriate to the level of care they are providing as supported by their code of conduct (NMC, 2015).

To be able to calculate accurate NEWS the following should be assessed and documented.

  1. RR (respiratory rate) Record rate on every set of observations (RR is an early indicator of clinical deterioration.
  2. Oxygen Saturations (SpO2) Oxygen saturation should be measured by pulse oximetry.
  3. Temperature (Internal body temperature is preferable over axilla).
  4. BP (Systolic blood pressure) in case of acute deteriorating or if automated machines giving an inaccurate or suspect reading then check with a manual sphygmomanometer.
  5. HR (heart rate) Palpate the pulse, assess rhythm and rate and volume.
  6. Level of Consciousness (AVPU – Alert, responds to Voice, responds to Pain or Unresponsive, is a quick and easy method to assess level of consciousness. Change in consciousness is another sensitive indicator of clinical deterioration.

more…

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