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Care of the Older Person

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 represen

ting 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.

To tell or not to tell? Honesty and hope in cancer nursing.

19 Mar, 17 | by dibarrett

Jan Hunter, Lecturer in Nursing, University of Hull

In the rather paternalistic past of the NHS, the established wisdom was that ‘doctor knew best’. If it was deemed a patient didn’t need to know they had a poor prognosis, then they didn’t find out (unless they had the wherewithal to put two and two together, or the audacity to ask outright). Thankfully, we are moving away from the days of selectively withholding information, with candour and truth-telling now at the centre of patient care. Nurses – with their ability to forge strong bonds of trust with patients – are well-placed to act as leaders in the discussion of disease progression and prognosis. Though this cements the place of nurses as autonomous practitioners, it also requires us to face one of the key challenges in cancer care: how do we balance truth-telling with the desire to reduce distress and give hope to patients and carers?

In some patients, there may be a temptation to try and ‘soften the blow’ of bad news. For example, a measured disclosure of bad news over time may be deemed the most appropriate approach in patients we judge to be vulnerable or those we perceive to have a lower ability to cope. Superficially, holding back some information might be viewed as nothing more than a ‘white lie’ to protect patients and help prepare them for bad news. However, no matter how well intentioned, making judgements on when to offer full disclosure may serve to undermine the bond of trust between a patient and nurse.

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.

 

The challenges of embedding spirituality into acute healthcare settings

2 Oct, 16 | by josmith

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

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

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

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at 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 Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

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

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

Question to think about in advance of the Twitter Chat:

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

References

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

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

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

Reflections on the hidden extent of restraint in critical care

11 Sep, 16 | by josmith

Angela Teece (A.M.Teece@leeds.ac.uk). Trainee Lecturer in Adult Nursing, University of Leeds

Angela

I recently left clinical practice, where I had worked as a critical care sister in a large district general hospital, to undertake a university role. Stepping back from practice and reading recent legislation on the deprivation of liberty (DoLS), enabled me to reflect on how the care I provided to patients could be viewed as restrictive.

Deprivation of liberty could relate to:

  • Is the patient under close supervision?
  • Is the patient free to leave the clinical area?

Clearly, on this level, all critical care patients, and many patients on general wards, are being deprived of their liberty. DoLS guidance is supported by the 2005 Mental Capacity Act (MCA) in its definition of restraint. This can be physical, chemical or verbal, for example, the use of bed rails restricts patient mobility, and regulated visiting times and controlled entry to the unit reduce opportunities for the patient to interact with their family.

Critical care is a specialised area of practice. Patients are commonly sedated to enable tolerance an endotracheal tube, ventilator and multiple vascular access devices. Each of these things, although used in the patient’s best interest, could be considered a form of restraint under the MCA and DoLS. Physical restraints in the form of ‘boxing gloves’ may be used to prevent agitated patients interfering with life-saving treatment (Happ, 2000) and chemical restraint may also be used to control agitation (Hofso and Coyer, 2007).

Screen Shot 2016-09-03 at 11.35.41On reflection, I believe nurse are generally tasked with applying restraints, either by putting ‘boxing mitts’ on an agitated patient, or by administering at their discretion as required medication. Nurses must be able to justify their actions. Any restrictive intervention must be in the patient’s best interests and decisions can only be made for a patient if they lack capacity (MCA, 2005). Nurses should fully assess the need to restrain their patient using a validated tool, and conduct reassessment regularly whilst maintain their patient’s dignity whilst restraints are being used. Links have been made to patient experience of critical care and long-term psychological problems such as post-traumatic stress disorder (Jones et al., 2001). Rigorous nursing documentation, completion of DoLS referrals and regular patient observation and evaluation are vital to prevent prolonged restrain and promote patient dignity.

Happ, M.B. 2000. Preventing treatment interference: The nurse’s role in maintaining technologic devices. Heart & Lung: The Journal of Acute and Critical Care. 29(1), pp.60-69.

Hofso, K. and Coyer, F.M. 2007. Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: contributing factors. Intensive Crit Care Nurs. 23(5), pp.249-255.

Jones, C., Griffiths, R.D., Humphris, G. and Skirrow, P.M. 2001. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine. 29(3), pp.573-580 578p.

Contemporary topics in respiratory care

4 Sep, 16 | by josmith

Following our summer recess, we are delighted at EBN to welcome new and established Tweeters to our next series of Twitter chats. We have an exciting range of topics planned, starting on Wednesday the 7th of September 8-9pm (UK/BST) with a debate on developments in respiratory care hosted by Jacqui Pollington a respiratory nurse specialist (Jacqui.Pollington@midyorks.nhs.uk).  She leads a home oxygen assessment and review service and an outreach service for patients who are frequently admitted with exacerbations of respiratory disease.

Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The last 10 years have seen significant advances in the diagnosis and management of non malignant respiratory disease. There are around 11 inhaler devices available now, and in total around 25 choices depending on drug, dose and combination required – all to treat airways disease, be that asthma, COPD or….dare I say, ACOS (asthma/copd overlap syndrome). Phenotyping could be considered the vogue, but it is very likely in the era of personalised medicine that phenotyping is here to stay and therefore significantly expand the diagnostic workup currently undertaken by many in primary care. The increasing identification of multi-morbidity in COPD and the profound effects of some comorbidity (for example, the biggest co-morbid predictor of death in the female with COPD is anxiety) brinScreen Shot 2016-09-02 at 17.54.38gs another clinical dimension to respiratory care. In this context, how does the nurse dealing with a patient with obstructive respiratory disease keep up to date in this very changeable clinical landscape.

Screen Shot 2016-09-02 at 17.57.13

 

https://www.nice.org.uk/Guidance/cg101

https://www.guidelines.co.uk/gold/copd

This twitter chat will focus on the following key themes:

  • NICE or GOLD in COPD? Which guidance should we be following and why?
  • ICS or not? That is the question? And after the pneumonia? Do we involve patients in the decision?
  • Pulmonary rehab….why wait til MRC3?
  • Smoking – how do we expose the elephant in the room? What do respiratory clinicians know about addiction?
  • How can nursing influence lung health?

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 www.twitter.com. 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.

more…

Dementia and Advance Care Planning

19 Feb, 16 | by Gary Mitchell, Associate Editor

We are delighted to share with you our latest guest blog, in partnership with @WeEOLC, from Sarah Russell on the topic of dementia and advance care planning.

Sarah Russell is the Head of Research and Clinical Innovation at Hospice UK.  She is also the full time carer for her mother who lives well with Alzheimer’s.  Sarah tweets as @learnhospice, @WeEOLC and @swaydemfriend

image

Click Here to Read Sarah’s Guest Blog

Therapeutic Lying in Dementia Care

29 Dec, 15 | by Gary Mitchell, Associate Editor

In our #ebnjc blog series we have already celebrated children’s nursing; with blogs from Jayne Pentin, Kirsten Huby & Marcus Wootton, learning disability nursing; with blogs from Professor Ruth Northway, Jonathan Beebee & Amy Wixey, midwifery; with blogs from Louise Silverton CBE , Gina Novick & Lynsey Wilgaus, and adult nursing from Clare McVeigh, Professor Roger Watson, Professor Jan Dewing & Professor Elizabeth Robb

This week our #ebnjc December blog series concludes with four guest blogs on mental health nursing from Neil Withnell, Jessie McGreevy, Paul Canning & Peter Jones.

Today we welcome Jessie McGreevy, a dementia care specialist from Four Seasons Health Care.  Today Jessie, a finalist in the recent Nursing Times Awards, discusses the topical issue of therapeutic lying in dementia care.

imageimage

Click Here to Read Jessie McGreevy’s Guest Blog

Older People and Learning Disabilities

7 Dec, 15 | by Gary Mitchell, Associate Editor

This December EBN has been sharing inspiring blogs from across all the fields of nursing and midwifery practice.  This week we are delighted to bring you three contributions from Learning Disability Nursing.  Today’s blog comes from Professor Ruth Northway on the topic of meeting the needs of older people with learning disabilities.  Remember to check out our forthcoming blogs from Learning Disability Nurse Jonathan Beebee & Learning Disability Student Nurse Amy Wixey on Wednesday and Friday of this week!

Click Here to Read Professor Ruth Northway’s Blog

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