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

Spirituality, Compassion and Mental Health

23 Jul, 17 | by josmith

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

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

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

Images courtesy of the University of Huddersfield

 

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

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

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

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

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

This account is partly based on a report on the University of Huddersfield website: https://www.hud.ac.uk/news/2017/july/spiritualityinhealthcareconferencewelcomesformerarchbishop/

Family Nursing: Transforming Health for Families

9 Jul, 17 | by josmith

 

Dr Joanna Smith, Lecturer Children’s Nursing, School of Healthcare, University of Leeds, UK

I have had a busy few months – conference season always seems to coincide with a busy period of student assessments & juggling commitments, with a never again often following a frenetic few months. Then I reflect on what I have learned, exciting new contacts & a feeling of enthusiasm about nursing follows. The opportunity to attending presentations & seminars is a great way of keeping updated & debating nursing issues is always of value.

The empathise of the 2017 bi-annual International Family Nursing Conference held in Pamplona, Spain focus was ‘Improving The Art & Science of Family Nursing: Transforming Health for Families’, with an emphasise on global issues related to family health was an ideal opportunity to consider the meaning of family across the globe and share research that is aiming to transform the lives of families. The sits well with the International Family Nursing Association (IFNA) conference IFNA’s mission is to transform family health globally. http://internationalfamilynursing.org

 

In addition to undertaking two presentations (an expert qualitative methods lecture with my colleague Dr Linda M
ilnes, & concurrent session on collaborating with families with Dr Sarah Kendal), the posters I co-presented won awards.

The networking was great with lots to learn.

International Council of Nurses Congress – Using Social Media to Engage with Nurses

21 May, 17 | by josmith

Roberta Heale (@robertaheale) & Joanna Smith (@josmith175) Associate Editors, EBN

We are presenting how Evidence Based Nursing (EBN) is using social media to engage with nurses at the International Council of Nurses (ICN) Congress, being help at the end of May 2017 in Barcelona, Spain. Nurses across the globe will be exploring nurses’ roles in leading the transformation of care, & is an opportunity for nurses to build networks, share & disseminate nursing practices across specialties, cultures & countries, http://www.icnbarcelona2017.com/

The ICN ams to

Demonstrate & advance the nursing contribution to informed & sustainable health policies;

Support nursing’s contribution to evidence-based healthcare & encourage problem-solving approaches to health priority needs:

Provide opportunities for an in-depth exchange of experience & expertise within & beyond the international nursing community.

We are excited to be representing the work of EBN at the ICN Congress, and networking with peers. Although the journal’s main purpose is to publish expert commentaries on current research that is relevant to nursing, over the last few years EBN editors have implemented a social media strategy to increase engagement with our readers, their access to evidence for practice & awareness of important health issues. We will be sharing our social media strategies that include:

  • Posting regularly on our Facebook @BMJNursing & Twitter account @EBNursingBMJ;
  • Hosting fortnightly Twitter Chats which are linked to a new Opinions article series relating to discussing participants’ key messages during the Twitter chat;
  • Publishing weekly blogs (http://blogs.bmj.com/ebn/);
  • Recording podcasts with authors of commentaries to expand & debate in more depth issues raised in the commentary.

Caring for agitated patients

14 May, 17 | by josmith

This week’s EBN Twitter Chat on Wednesday 17th May 2017 between 8-9 pm (UK time) will focus on caring for agitated patients and is being hosted by Angela Teece (A.M.Teece@leeds.ac.uk), Trainee Lecturer in
Adult Nursing, University of Leeds @AngelaTeece and Sam Freeman (samantha.freeman@manchester.ac.uk) Lecturer in Adult Nursing, University of Manchester Twitter @Sam_Freeman.

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 adding #ebnjc (the EBN Twitter chat hash tag) to your tweet, this allows everyone taking part to view your tweets.

What is an agitated patient? It could be a patient who is restless, kicking their legs over the bed rails or refusing to lie still. Or maybe it is the patient who repeatedly flicks off the saturation probe, causing the machine to alarm. Or do you see an agitated patient as one whose behaviour risks serious harm to themselves or you as their nurse? The underlying causes for admission to critical care areas is vast. The commonality is the individual is experiencing illness so severe they cannot be managed elsewhere and require drastic intervention. The admission can be traumatic and potentially life altering event. Delirium, which is common amongst intensive care (ICU) patients, can present as extreme agitation, and lead to poor compliance with essential therapies and rehabilitation (Collinsworth et al., 2016). Awakening from sedation or withdrawal from alcohol and drugs may also lead to agitated behaviour.

Management of agitation is dependent upon the severity of the problem and the clinical area where the patient is being nursed. A restless patient might require extra supervision, particularly at night when staffing and patient visibility is poor. Such patients benefit from regular reorientation. In ICU, agitated patients are at risk of removing essential devices, such as central venous catheters, potentially causing serious harm or death (Mion, 2008). In more severe cases of agitation the management approach may be either sedation (chemical) or physical restraint, such as cuffs or ‘boxing gloves’. Management of agitated patients presents many issues for nurses in terms of staff morale, resource management and patient safety. Nurses might be concerned about the ethical issues underpinning the use of restraint. A recent court case highlighted that sedation cannot be classed as a deprivation of liberty to critical care patients as they physical illness is restricting their freedom, rather than any sanctions imposes by the hospital. Howver the use and role of physical restraint in management of agitation in critical care was not clarified.

Freeman et al. (2015) sought the opinions of nurses in relation to the use of physical restraint and  found some nurses expressed discomfort about the use of physical restraint and needed more education and support regarding physical restraint use. The authors of this blog are currently involved in further research in this area and would welcome your responses and opinions in this week’s Twitter chat., which will focus on:

  • How do you feel about caring for agitated patients?
  • Have you experienced problems with patient agitation where you work?
  • Do you receive help when managing agitated patients?
  • Do you use restraint?

https://medhealth.leeds.ac.uk/profile/1100/1715/angela_teece

https://www.research.manchester.ac.uk/portal/Samantha.Freeman.html

COLLINSWORTH, A. W., PRIEST, E. L., CAMPBELL, C. R., VASILEVSKIS, E. E. & MASICA, A. L. 2016. A Review of Multifaceted Care Approaches for the Prevention and Mitigation of Delirium in Intensive Care Units. J Intensive Care Med, 31, 127-41.

FREEMAN, S., HALLETT, C. & MCHUGH, G. 2015. Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses. Nurs Crit Care, 21, 78-87.

MION, L. C. 2008. Physical Restraint in Critical Care Settings: Will They Go Away? Geriatric Nursing, 29, 421-423.

Do we need to rethink how we educate healthcare professionals about pain management?

30 Apr, 17 | by atwycross

Do we need to rethink how we educate healthcare professionals about pain management?

This week’s EBN Twitter Chat on Wednesday 3rd May between 8-9 pm (UK time) is taking place live from the British Pain Society’s (@BritishPainSoc) Annual Scientific Meeting in Birmingham. The chat will focus on whether we need to rethink how we educate healthcare professionals about pain management. The Twitter Chat will be hosted by Dr Ameila Swift (@nurseswift) and Professor Alison Twycross (@alitwy). This Blog provides some context for the Chat.

Participating in the Twitter Chat

Participating in the chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. You can contribute to the chat by sending tweets with #ebnjc included within them.

Current approach to pain education

The International Association for the Study of Pain (IASP) have published curricula for pre-registration training for healthcare professionals (see: http://www.iasp-pain.org/Education/CurriculaList.aspx?navItemNumber=647). These consist of lists of topics specifying the knowledge students need to obtain about pain management during pre-registration courses. This reflects the traditional approach to curriculum design where learning outcomes focus on theoretical knowledge and pay little attention to application in practice. Indeed, research in this area has tended to focus on knowledge and curricula deficits (Briggs et al. 2011, Twycross & Roderique 2013). As patients of all ages continue to experience unnecessary unrelieved pain (Twycross & Finley 2013; Meissner et al. 2015) there is a need to explore ways of ensuring knowledge is used in practice. This is timely because the International Association for the Study of Pain (IASP) has named 2018 the Global Year for Excellence in Pain Education (see: http://www.iasp-pain.org/GlobalYear).

Is part of the problem the way we evaluate the education provided?A literature review of research into pain education, conducted for this blog, suggests the impact of educational interventions does not look beyond three months with most studies only assessing pre- and post-intervention knowledge gain. Students and junior staff feel powerless and might ‘shy away from their incompetence’ in treating patients when management is not straightforward (Tellier et al. 2013), demonstrating the gap between increased knowledge and increased competence.

more…

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…

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