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Primary healthcare access for post-release prisoners

14 Aug, 17 | by hnoble

Claire Carswell, PhD candidate, October 2017, Queens University Belfast.

Twitter chat on Wednesday 16th August 2017 between 8 pm and 9 pm (UK time) Primary Healthcare access for post-release prisoners’ will focus on the barriers to primary healthcare faced by people on release from prison Everyone is welcome to participate in the Twitter chat, regardless of profession or experience. The Twitter chat will be hosted by Claire Carswell who commences her PhD studies in October 2017 at Queens University Belfast.

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 is limited to 140 characters of text, so make your tweets informative and concise.

The transition period from prison to the community is a high-risk period for offenders. There are significantly increased mortality and morbidity rates during the months following release, with post-release prisoners at high risk of suicide, substance misuse relapse and accidental overdose.

Continuity of care for post-release prisoners is a particular problem and could contribute to the mortality rate of this population. Primary healthcare services in particular have been identified as a crucial health resource when prisoners leave prison (Kinner et al., 2015). The National Institute of Health Research published ‘Care for Offenders Continuity of Access’ (COCOA) in June 2012 ( This report not only highlighted the higher morbidity rates of prisoners compared to the general population, but also identified barriers that prevented post-release prisoners from accessing statutory healthcare services.

The main barriers that the report identified included prisoners not being registered with GPs prior to release from prison and difficulties registering once back in the community. The report also highlighted that this resulted in post-release prisoners being unable to receive necessary chronic medications, having only been provided short-term courses on release. There was also an overall feeling of being unsupported by services, including health and probation services.

The dramatic decline in health following release from prison makes the need for continuity of care essential. The COCOA report found that it was easier to access services while still in prison, and that stigma post-release prisoners faced in the community also contributed as a barrier to access primary healthcare services. Further research could be conducted to identify the difficulties associated with providing treatment to this specific population, as the high morbidity rate and complex mental health issues of post-release prisoners could present a substantial burden on primary care resources. Improved relationships between the criminal justice system and the primary healthcare service could help reduce stigma and improve the transition of care. Other ways of addressing these barriers include registration with a GP prior to release from prison and provision of longer term prescriptions on release that take into account the waiting times for a GP appointment.


Kinner, S.A., Young, J.T., and Carroll, M. (2015) The pivotal role of primary care in meeting the health needs of people recently released from prison, Australasian Psychiatry, 23 (6) 650-653

“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”.


Using healthcare models to inform obesity interventions.

31 Jul, 17 | by hnoble

Emma McGleenan, School of Nursing and Midwifery, Queens University Belfast.


One in four adults are now obese and the Government has introduced several initiatives to combat this problem and its growing cost on NHS services. Examples of Government schemes include‘Nutrition Now’; laws on food labels and advertisements aimed at decreasing one’s waist circumference But this alone is not enough to prevent cardiovascular disease. The Health Belief Model, when applied to nutrition and hydration, indicates that people are more likely to follow a healthy diet and make changes to their lifestyle if they feel that failure to change would increase their risk of developing a serious disease; the benefits of the change outweigh the barriers faced due to the change; they place enough value in their life to make the change and they are prompted to make the changes

The theory of planned behaviour addresses three aspects: the attitude, the subjective norm and the perceived behavioural control. The attitude is the values and judgement we hold about a healthy diet. The subjective norm refers to what is important to the patients’ family and friends. Perceived behavioural control is how much control the person believes they have over their ability to keep to a healthy diet i.e. whether or not they have the skills or resources to succeed.

These models assume all behaviours are based on conscious thoughts but people may not think of the ill effects to their health every time they eat an unhealthy meal. Many health related behaviours are used as coping mechanisms and when you get rid of the behaviour, this may result in an increase in stress levels. The change is therefore more likely to be unsuccessful. Perception of control should be increased to help people feel empowered and more likely to succeed. Those who take part in unhealthy eating may already understand the dangers of eating unhealthily and may already have ill health due to eating unhealthily but they enjoy the food and so continue. This can cause upset in an individuals’ mind known as cognitive dissonance. Nurses can use this to persuade the individual to make a change.

A good way of introducing the concept of change to the individual is by brief intervention. Brief intervention has been shown effectively when dealing with alcohol addiction within the primary care sector (Kaner et al, 2009). Minimal intervention is an opportunistic process where the health professional attempts to find out how the service user feels about the behaviour, challenge the persons’ views on eating healthy and helps them to weigh up the pros and cons of the a healthy diet. The main aim is to get the individual to engage cognitively about the behaviour. When linked up with the stages of change, the person moves into the contemplating stage of change and is more likely to change their behaviour and sustain change.

Nurses can help prevent cardiovascular disease by promoting a healthy diet and hydration. Brief intervention can introduce people to a new concept in a short time and has been proven to be effective. Further help could be offered by combining the Health Belief Model with the Theory of Planned behaviour. Within this, views should be challenged, coping mechanisms and perception of control examined and advice given, barriers identified, social networks and context discussed and the benefits reiterated. This should be a positive experience, leaving the individual empowered. Cognitive behavioural therapy may also be adapted and has been shown effective in preventing acute myocardial infarctions (Gulliksson, 2011).


Kaner EF.S., Dickinson HO, Beyer FR, Campbell F, Schlesinger C, Heather N, Saunders JB, Burnand B, Pienaar ED (2009) ‘Effectiveness of brief interventions in primary care populations’ The Cochrane Collaboration [Online] Available at: (Accessed: 20/04/2015)

Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, and Svärdsudd K. (2011) ‘Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease: Secondary Prevention in Uppsala Primary Health








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.

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.


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.

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


The Role of Nursing in a Violent World

26 Jun, 17 | by rheale

By Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ

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

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

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

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

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



Medication Errors: Let’s Chat

15 Jun, 17 | by rheale

Gilberto Buzzi,

Guest Host of #ebnjc Twitter Chat on Wed., June 21 at 8pm UKM time

Senior Lecturer – Adult Nursing, School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, t: +44 (0)20 7815 6739 | e:

Medication Errors

Ever experienced the terrors of been involved in a medication error, particularly one that had the potential to result in patient harm? If so, it is likely that you remember that moment quite vividly which may even have left you traumatized. These are some of the worse situations healthcare professionals may find themselves in as it goes against every core principle of their moral and professional duty. An entire section of The Code for Nurses and Midwives is dedicated to the preservation of patient and public safety and the importance of self-awareness to reduce potential harm associated to their practice (NMC, 2017), nonetheless, medication errors are still common.

In a review of medication error incidents reported to the National Reporting and Learning Systems (NRLS) over six years between 2005 to 2010 there were 525,186 incidents reported. Of these, 86,821 (16%) of medication incidents reported actual patient harm, 822 (0.9%) resulted in death or severe harm (Cousins et al 2012). A report commissioned by the Department of Health estimated the costs of preventable errors in the NHS, particularly relating to improper use of medication, to be around £770 millions a year, but most importantly, medication errors can cost lives.

“Medication errors occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death” (WHO, 2017). This suggests that medication errors could be preventable at different levels. Whilst there is robust legislation and guidelines to ensure patient safety particularly in relation to the administration of medicine, following simple and practical steps such as the 10 rights of Medication Administration can greatly reduce the risk of errors and literally save lives. These are:

  1. Right patient: Ask patient to identify themselves and check the name on the prescription and wristband. Ideally, use 2 or more identifiers.
  2. Right medication: Check the name of the medication and the expiry date with the prescription. Make sure medications, especially antibiotics, are reviewed regularly.
  3. Right dose: Check appropriateness of the dose using the BNF or local guidelines. If necessary, calculate the dose and have another nurse calculate the dose as well.
  4. Right route: Again, check the order and appropriateness of the route prescribed.
  5. Right time: Check the frequency of the prescribed medication. Confirm when the last dose was given.
  6. Right patient education: Check if the patient understands what the medication is for and who to contact in case of side-effects.
  7. Right documentation: Ensure you have signed for the medication AFTER it has been administered. Ensure the medication is prescribed correctly.
  8. Right to refuse: Ensure you have the patient consent to administer medications.
  9. Right assessment: Check your patient actually needs the medication. Check for contraindications. Baseline observations if required.
  10. Right evaluation: Ensure the medication is working the way it should and reviewed regularly. Ongoing observations if required.

Points 1 to 5 refer to NMC standards for medicine management. Points 6-10 are additional checks that have been adopted by multiple US nursing boards and research panels to enhance patient safety.


Cousins, D.H., Gerrett, D. and Warner, B. (2012) A review of medication incidents reported to the National Reporting and Learning System in England and Wales over 6 years (2005–2010). British Journal of Clinical Pharmacology, 74(4): pp. 597–604

Frontier Economics (2014) Exploring the costs of unsafe care in the NHS. [online] London, pp.1-21. Available at: [Accessed 10 Jun. 2017]. (2017). Read The Code online. [online] Available at: [Accessed 10 Jun. 2017].

World Health Organization. (2017). Medication Without Harm: WHO’s Third Global Patient Safety Challenge. [online] Available at: [Accessed 10 Jun. 2017].

Standards for medicine management:

Report a problem with a medicine or a medical device:

Medicines & Healthcare products Regulatory Agency:

Interesting read:



Beyond the Sleeping Pill: Cognitive Behavioral Therapy for Insomnia

11 Jun, 17 | by rheale

Contributed by Roberta Heale, Associate Editor EBN, @robertaheale, @EBNursingBMJ

There’s not a more frustrating than tossing and turning all night.  However, between 30-50% of adults identify ongoing sleep disturbances.  While restless sleep once in a while is a nuisance, insomnia is a different story. It can be a significant problem particularly with older adults who are at higher risk of depression, falls, stroke, decline in cognitive and overall functioning.  The risks are exacerbated when mixed with sleeping pills which, themselves, increase the risk of falls, fractures and mortality. 1

So what is there to offer a patient other than medication?  Turns out, a lot.  One treatment is showing great promise, Cognitive Behavioural Therapy-Insomnia, or CBT-I.  Using the same exploration of the interactions between thoughts, emotions and behaviours, the focus is on sleep.  Sleep patterns, sleep hygiene, anxieties and thoughts that run through a patient’s mind at night are addressed.  CBT-I requires a commitment from the patient to make changes to their routines and practice the techniques that are offered, however, the outcomes can be very good.

One study, reviewed in a commentary in the EBN journal, identifies the usefulness of CBT-I.  Check out: Cognitive–behavioural therapy for insomnia is effective, safe and highly deployable  Encouragingly, although training is required to deliver CBT-I, but one does not need to be a healthcare professional to provide CBT-I therapy, which adds to the potential of this treatment.

Sleep permeates every part of our lives.  With so many adults struggling with insomnia, CBT-I is an encouraging, positive, non-pharmacological option.

1. Alessi  C, Martin  JL, Fiorentino  L, et al. Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial. J Am Geriatr Soc 2016;64:1830–8.


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