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It’s time to revisit ‘tribalism’

11 Sep, 17 | by hnoble

Doris Corkin, Senior Lecturer (Education), School of Nursing and Midwifery, Queen’s University Belfast

Despite a dearth of literature, professional tribalism has been recognised both positively and negatively within healthcare for some time and is the state of existing as a group, who may have different training, but will have very strong feelings of loyalty, for example when working in the acute critical care setting.

Registered nurses are being given opportunities to work collaboratively within an inter-professional team and accept greater responsibility, whilst shaping their careers and deepening their roots (Baxter & Brumfitt, 2008). However, professional clinical differences known as ‘tribalism’ (Beattie 1995) can soon dissolve when experienced clinicians who often cluster in profession-based tribal silos are taken out of their comfort zone, become deskilled and feel vulnerable in their new environment (Braithwaite et al, 2016).

Also highlighted within Baxter and Brumfitt’s (2008) qualitative study and Stepney et al’s (2011) survey is the significant barriers of power and status within professional groups, which are closely linked with decision-making and the medical model. To-date any ongoing changes and modernisation within healthcare systems appears to have had little impact in changing the tribal power and status within medicine.

Furthermore, in relation to collaborative working, some nursing students have perceived professional tribalism as a problem during their experience of inter-professional education (Stepney et al, 2011). Acknowledging that issues such as power dynamics and clinical differences may influence the way different work cultures develop and the values healthcare professionals hold about themselves and the respect they should have for each other.

Every organisation has a tribe, which humans naturally form and always will, demonstrating how people’s values and qualities unite them, interacting and succeeding as thought leaders, who effectively go above and beyond the call of duty to get the job well done.

Question is … can our professional tribe continue to change the world!


Baxter, S.K & Brumfitt, S.M. (2008) Professional differences in interprofessional working. Journal of Interprofessional Care, 22(3): 239-251.

Beattie, A. (1995). War and peace among the health tribes. In: Soothill, K., Mackay, L. & Webb, C. (Eds). Interprofessional relations in health care. London: Edward Arnold.

Braithwaite, J., Clay-Williams, R., Vecellio, E., Marks, D., Hooper, T., Westbrook, M., Westbrook, J., Blakely, B. & Ludlow, K. (2016). The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open 6:e012467.

Stepney, P. Callwood, I. Ning, F. & Downing, K. (2011). Learning to collaborate: a study of nursing students’ experience of inter-professional education at one UK university. Educational Studies, 37: 4, 419-434.


The importance of interprofessional curriculum for building high performing healthcare teams

29 Aug, 17 | by ashorten

By Allison Shorten, Associate Editor, Evidence Based Nursing

Last week I had the opportunity to attend The Nexus Summit: Provocative Ideas for Practical Interprofessional Education (IPE) in Minneapolis, Minnesota, USA. Hosted by the National Center for IPE, this annual conference provides an amazing showcase of what happens when creative interprofessional (IP) teams get together to design innovative educational experiences and build collaborative models of healthcare.

What is IPE and why is it important for nursing education?

“Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”1

The WHO framework for IPE and collaborative practice emphasizes the benefits of IP care in reducing fragmentation within our systems of care to improve patient experiences and outcomes.1,2 A consistent theme throughout the Nexus Summit was the importance of building high performing IP healthcare teams to create better experiences and outcomes for patients. This comes back to how we educate students in all healthcare professions and design programs that embed meaningful rather than tokenistic experiences, for students of different professions to learn about each other and how they can work together to improve patient care.

Conference participants shared some wonderful examples of how they had pushed the boundaries of traditional healthcare education and practice models to develop a wide range of case-based, simulation-based, virtual simulation, and community-based IPE experiences. There were numerous examples of community-based IP service learning experiences with students working together to address health disparities in their local communities.

IPE faculty development programs and toolkits are readily available to help those interested in getting started with IP curriculum in their institutions. Evaluating IP education is important but also challenging. There are numerous resources to help with this as well. These resources can be found on the NEXUS web-site

IPE is not a new idea, but it has been challenging to implement in practice. It requires active engagement and commitment from all professions in the healthcare team – to put the patient in the center and to examine new ways of learning, teaching, and practicing as we implement different ways of communicating and working together as a collaborative IP healthcare team.

1. World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization.
2. American Association of Colleges of Nursing (AACN), Interprofessional Education
3. About the NEXUS

Allison Shorten, RN, RM, PhD
School of Nursing
University of Alabama at Birmingham (UAB)
Director, Office of Interprofessional Curriculum

“Extraordinarily diverse??” – beyond the marketing rhetoric of corporate academia

6 Aug, 17 | by josmith

Dr Fiona McGowan, Cordinator Global Health and Quantified Self, School of Healthcare Studies, Hanze University of Applied Sciences, Netherlands

e-mail –

Say Burgin’s recent blog in the Times Higher Education (May 20th 2017)

highlighted how both racial and gender discrimination remain rife within higher education and refers to the persistent and deeply embedded lack of will at managerial level for any real and meaningful change. Why?   “Because what an absence of will comes down to is a fierce protective impulse for a status quo that benefits those who are already in power – in universities or anywhere else”. How true this is. And even more shocking is the extent that those in power will employ what appears as non-discriminatory terminology and policy to further enforce the position of white male privilege in academia. Figures show that the institutions gave their bosses above-average pay increases of up to 13 per cent in 2015-16.

One such example is that of a post 1992 university in the Greater London area, which proudly promotes itself as being one of the “most diverse” institutions, promising students the experience of belonging to a “global family”. Really? Scratch away the glossy veneer of inclusive language to reveal what lies beneath. A corporate plan that boasts a remit of 28,000 students from a 120 countries worldwide. Impressive? Certainly, especially considering the financial bounty attached to those recruitment figures. Yet….93% of those students are from the UK, with 52% from the immediate locality. Somehow these figures appear to have been” lost in translation” – how is this indicative of a global student body? Or how does this illustrate a cohort – again to quote their corporate jargon – as being “extraordinarily diverse”.


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:

Health 2.0: social media in healthcare

16 Jul, 17 | by josmith

Simon Stones @SimonRStones

Twitter chat on Wednesday 19 July 2017 between 8 pm and 9 pm (UK time) ‘Health 2.0: social media in healthcare’ will focus on using social media to engage and involve people and organisations in your work and research. Everyone is welcome to participate in the Twitter chat, regardless of profession or experience. The Twitter chat will be hosted by Simon Stones (@SimonRStones), a patient research ambassador and PhD student at the University of Leeds who is working on long-term condition self-management by children and their families.

To participate in the Twitter chat, you will need a registered Twitter account. If you do not have an account, you can create one easily at Once you have an account, it is easy to get started. You can follow the discussion on Twitter by searching for #ebnjc – this is the EBN Twitter chat hashtag and by searching for this in Twitter, you’ll only see the relevant tweets related to the Twitter chat. Include #ebnjc in every tweet you send, to ensure that everyone participating in the Twitter chat can see your tweet. But remember, each tweet islimited to 140 characters of text, so make your tweets informative and concise!Like it or not, social media is here, and it is here to stay.

While the very mention of the phrase ‘social media’ fills some people with dread, it’s really not that bad – especially once you become familiar and confident about using it. Essentially, social media is an interactive communication platform that enables conversations amongst individuals. Merriam-Webster describe social media as “forms of electronic communication (as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (as videos).”[1]

The presence and use of social media has grown exponentially in the last decade, revolutionising the way in which we communicate with each other. Most importantly, it removes geographical barriers by enabling people to talk directly with each other – wherever and whenever they wish. Nowadays, the phrase social media is often used interchangeably to describe popular social networking sites such as Facebook, Twitter, LinkedIn, Instagram and Snapchat.

With a generation of millennials who are more likely to seek initial medical advice from the internet rather than a doctor or nurse, it is indisputable that the professional community must get to grips with social media, in order to remain relevant to the people they meet. When you take into consideration that at least 40% of people say that information they find on social media affects the away in which they deal with their health,[2],[3] it remains the responsibility of professionals and patient groups to ensure that accessible, evidence-based information is freely available through social media to attenuate potentially misleading or inaccurate information out there.

Now, you may be thinking, “Patients won’t think that it is appropriate for health professionals to use social media”. Well, that is utter nonsense! After all, you’re still human, and in fact, your presence on social media can often help the patient-professional relationship, as you are removing yourself from the ivory towers that once existed by virtue of the traditional roles of healthcare professionals and researchers in years gone by. We are, and must be, outward facing professionals, engaging and involving the people we care for, and include as participants in our research.

With those points in mind, and many more questions and ideas about using social media, in this Twitter chat, we would like to explore:

  1. The benefits of using social media as a patient, parent/carer, health care professional or researcher to connect with others who share a common interest;
  2. The barriers of using social media as a patient, carer, health care professional or researcher to connect with others who share a common interest;
  3. Ways that patients, carers, healthcare professionals and researchers can be both professional and human on social media;
  4. Tools to help you to be active and noticed on social media.

[1] Merriam Webster. 2017. Social media. [online]. [Accessed 13 March 2017]. Available from:

[2] Honigman, B. 2013. 24 outstanding statistics & figures on how social media has impacted the health care industry. ReferralMD. [online]. [Accessed 02 June 2017]. Available from:

[3] Antheunis, M.L., Tates, K. & Nieboer, T.E. 2013. Patients’ and health professionals’ use of social media in health care: Motives, barriers and expectations. Patient Education and Counseling. 92(3): 426-431.

Consultation on the new education standards – have your say!

3 Jul, 17 | by dibarrett

Joanna Smith (@josmith175) Associate Editor, EBN

There will be no EBN Twitter chat this week, as there is an important chat being hosted by the Nursing & Midwifery Council (NMC) and Royal College of Nursing (RCN) on the proposed changes to nurse education. The chat will be held on Wednesday 5th July 2017 from 6-7pm UK time. Join in the conversation by using #RCNchat

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 for #RCNchat. Once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets. To join in, add the #RCNchat hash tag your tweets, this allows everyone taking part to view your contribution.

The purpose of the Shape of Caring: Raising the Bar review published in March 2015 was to review models of education & training for nurse registrants & healthcare assistants in England with 34 recommendations made that would shape the future of nurse education:

The Nursing & Midwifery Council is responsible for the regulation of nurses & midwives in England, Wales, Scotland & Northern Ireland, with the purpose of protecting the public (

The council set standards of education, training, conduct & performance so that nurses & midwives can deliver high quality healthcare. Since the publication of Shape of Caring: Raising the Bar review there has been consultation & much debate, consternation & expectation from nurses in practice, managers & educators in anticipation of the proposed framework and whether it will meet the rapidly changing health & social care landscape and reflect the shift in nurses’ roles over the next 10 years.

The standards will establish:

  • How nurses & midwives are educated – the standards for education & training;
  • What nurses & midwives can do when they join our register – standards of proficiency;
  • What their education & training courses need to set out – course requirements.

The consultation will close on 12 September 2017 and can be accessed at

The following links outline the main changes that have been proposed:


Draft standards of standards of proficiency:

Draft standards for education & training–standards-for-education-and-training.pdf


Supporting newly qualified nurses into the world of work

30 May, 17 | by dibarrett

Jane Wray, Senior Research Fellow, Director of Research, School of Health and Social Work, University of Hull

Finishing university and starting employment is an exciting time for newly qualified nurses. It’s the beginning of what is generally a long, successful and exciting career within the profession. It can, however, also be a stressful or challenging time as they make the transition from student nurse to registered, fully autonomous practitioner. Newly qualified nurses can feel that they are unprepared for their new role and the demands made upon them (Feng and Tsai, 2012); this can lead to stress and dissatisfaction (Edwards et al. 2015), and some decide to leave the profession within a year of qualifying. This results in significant personal costs for individual nurses and has an impact upon employers, organisations and patients.


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,

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 (;
  • 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 (, Trainee Lecturer in
Adult Nursing, University of Leeds @AngelaTeece and Sam Freeman ( 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 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?

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.

Music therapy in improving the quality of life of palliative care patients: does it work?

8 May, 17 | by hnoble

Dr Joanne Reid, Reader in Cancer Nursing, School of Nursing and Midwifery, Queens University Belfast.

Research Collaboration in Northern Ireland between Queen’s University, ‘Every Day Harmony’ and Marie Curie Hospice Belfast, funded by the Public Health Agency, Northern Ireland.

Despite recent advances in medicine, patients with advanced illness continue to report high rates of suffering due to psychoexistential concerns such as loss of function, meaninglessness and anxieties in relation to death and dying. Palliative care recognises the ‘total pain’ experienced by end-of-life patients and supports the use of adjunct complementary therapies to address aspects of patient suffering still outside the remit of medical science and technology.

Music therapy is frequently used as a palliative therapy and entails the use of music to achieve individual goals in the context of a therapeutic relationship with a professional music therapist. Aligning with the goals of palliative care, the primary aim of music therapy is to improve people’s quality of life by relieving physical and psychological symptoms, facilitating communication and alleviating spiritual or existential concerns.

However, there are currently no guidelines in place for the use of music therapy in palliative care. This highlights the need for a stronger evidence base that demonstrates both the benefits and risks to help inform future music therapy provision. To date, primarily because of a lack of robust research, the evidence for music therapy’s effectiveness on patient reported outcomes is positive but weak. Music therapy is an allied health profession and can help a wide range of people affected by illness and disability. It uses musical interaction, and creativity through music, to address a patient’s clinical needs – whether they are psychological, physical, emotional, cognitive or social.

The core of music therapy is the relationship between the music therapist and the client. The client can either actively play instruments alone or with the music therapist, sing, or listen as they play. If the patient’s family is present, they may also be involved in the music therapy session. Patients can play to music already known to them, or play spontaneously and the therapist uses their musical skills to support them in this form of expression. Music therapy can also involve legacy work where the music therapist supports the patient to write a song for their family. In music therapy, our musical tastes and song choices can reveal the ‘person’ behind the terminal illness, helping patients reminisce about happier times, have fun in the moment, and leave a legacy for the future. As Shakespeare simply put it “When words fail, music speaks”

We are currently managing a study which is open for recruitment and running at Marie Curie Hospice Belfast with Music therapy provided by the Belfast based company Ever Day Harmony. A full study protocol is published elsewhere (DOI: 10.1186/s40814-016-0111-x ). The aim of the study is to determine the benefits of music therapy to people at the end of their lives. Fifty-two patients at the hospice are taking part. Half will receive six music therapy sessions over three weeks, as well as standard palliative care. The other half will receive standard palliative care (although they will also be offered up to two sessions of music therapy once the research period has finished). We will also collect data from HCPs and carers to understand their views on the impact of music therapy for patients. This is a feasibility study, with a view to undertaking a larger multi-site trial across the UK to evaluate the effectiveness of music therapy in improving the quality of life of palliative care patients.

Everyone has their own unique taste in music. It’s part of who we are. There’s been such a wide range of suggestions in the hospice so far: from classical music, such as Chopin, to traditional Irish music, to pop music. The music therapist delivering the intervention made a recent comment: I’ve learned so much from my clients. Everyone has so much to give, right up until the end, and it’s a privilege to be able to work with them at such an important time.”


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