Friday, 25 November 2016

Taking a baby home from neonatal intensive care

Roger Watson, Editor

Having a new born baby in neonatal intensive care must be a very stressful experience for parents.  However, the period immediately after taking the baby home, while a considerable relief, must also be stressful. Parents need to be adequately prepared as this study from Sweden by Larsson et al (2016) titled: ‘Parentsexperiences of discharge readiness from a Swedish neonatal intensive care unit’ and published in Nursing Open shows.

The aim of the study was: ‘to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home.’ Parents of 93 neonatal infants were approached and given a questionnaire about their experiences. Some were answered by mothers, some by fathers and some by both parents. The results were very positive: ‘When asked if the parents felt adequately prepared for discharge home, 55 (83%) responded “yes,” three (5%) responded “no,” and eleven (17%) answered the question in free text. When asked if they felt they received sufficient support from the NICU for the first few days at home, 49 (74%) responded “yes,” no parent answered “no,”’. Nevertheless, some parents did express worries: ‘The first few days at home were a little bit scary without the NICU staff near as we were used to. We checked frequently that he was breathing!’ and ‘I don’t think you can really be sufficiently prepared; it’s something so totally new in your life, so you will never be prepared enough.’

The authors concluded: ‘Factors favouring the parents’ sense of being prepared for going home and affecting their experience of the first period at home were being present during, and involved in, the infant’s care at theNICU; the infant’s being medically examined and declared healthy;the parents getting sufficient medical and practical information; and the transition to home occurring gradually. At discharge, several parents wished they had had more information about breastfeeding, tube feeding, and the infants’ food intake; they also would have liked emotional support and follow-up counselling after discharge.’


Larsson C, Wägström U, Normann E, Thernstrom Blömqvist Y (2016) Parents experiences of discharge readinessfrom a Swedish neonatal intensive care unit Nursing Open DOI: 10.1002/nop2.71 

Friday, 28 October 2016

Nursing home resident transfer to emergency care

Roger Watson, Editor

The aim of this study was: 'To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department.'  The study is from Sweden by Kirsebom et al. (2106) titled: 'Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates' and published in Nursing Open.

Five nursing homes were studied and, as explained by the authors: 'All of the nursing homes’ websites, where the facilities are described, were read to establish whether they expressed some sort of care philosophy or theory.'  Other aspects of care were also studied such as nurse training in care of older people with dementia and years of caring for people with dementia. Nurisng homes were also classified as private for-profit or public. There was an association between being a high transfer to emergency care home and being private for-profit. In the low transfer homes more nurses had training in caring for older people with dementia and had worked longer with people with dementia. 

The authors concluded: 'Taken together, the present findings indicate that organizational factors could be related to differences in transfer rates between nursing homes. Our data reveal that nursing homes identified with the highest transfer rates to ED (emergency departments) were run by for-profit providers to a higher extent and had updated ACPs (advanced care plans) for their residents to a lower extent than did nursing homes with the lowest transfer rates. Further, RNs’ level of competence may be related to transfer rates. Improved use of ACPs in nursing homes needs to be in focus if the care provided is to conform to the wishes of residents and their families. Better adherence to ACPs could enhance the care and outcome for residents, thereby possibly reducing transfers to the ED. This needs to be further explored.'


Monday, 27 June 2016

Socialising new graduates

Roger Watson, Editor

As explained by the authors of this Canadian study: 'The purpose of this study was to explore the relationships between preceptor characteristics (emotional intelligence, personality and cognitive intelligence) and new graduate nurse socialization outcomes regarding turnover intent, job satisfaction, role conflict and ambiguity during a preceptorship programme.'  The authors are Lalonde and McGillis Hall (2016) and the articel is titled: 'Preceptor characteristics and the socialization outcomes of new graduate nurses during a preceptorship programme' and is published in Nursing Open.  

The authors used a sample of 41 preceptors and 44 new graduate nurses and used a rnage of validated questoinnaires to measure intelligence, emotional intelligence and personality.  Some characteristics of preceptors and nurses were related as follows: 'Three preceptor personality traits were related to new graduate nurse outcomes. First, preceptor openness was positively correlated with new graduate job dissatisfaction and role conflict. This indicates that the more open the preceptor, the higher the job dissatisfaction among new graduate and the higher their perception of role conflict. This cohort of new graduate nurses, with an average age of 24, is considered part of Generation Y, or the millennial generation, that is, individuals born between 1979 and 1994' and 'Second, preceptor conscientiousness was positively related to new graduate turnover intent. Specifically, the more conscientious the preceptor, the higher the intent to turnover among the new graduate participants. This implies that new nurses paired with more conscientious preceptors are more likely to want to leave their current job. As the preceptors provide the technical information surrounding their new role, along with important social cues, the new nurse assesses these social cues and the people surrounding them.'

The authors conclude: 'This study provides additional support to the existing literature that examines how preceptor characteristics may be worthy of consideration. However, further research is required to determine whether or not preceptor personality traits impact the socialization outcomes of new graduate nurses.'


Lalonde M, McGillis Hall L (2016) Preceptor characteristics and the socialization outcomes of
new graduate nurses during a preceptorship programme Nursing Open doi: 10.1002/nop2.58

Sunday, 26 June 2016

Psychological care of miitary veterans

Roger Watson, Editor

According to the authors: 'Each year, a proportion of personnel leave military service, which may place strain on their mental and physical well-being as well as their successful reintegration into society. Returning from war zones into civilian life can precipitate stress or further exacerbate existing mental health problems.'  The aim of this study from the UK by Clarkson et al. (2016) was 'To evaluate the outcomes of participants attending a psychological therapies service for military veterans.'

The study investigates the Military Veterans’ Improving Access to Psychological Therapies
Service (North West) (MV IAPT) and, as described by the authors: 'We undertook an observational, prospective cohort study of veterans accessing the MV IAPT service for a pilot period of 20 months from September 2011–April 2013. Data were collected anonymously from the clinical information system of general IAPT services, where standardized measures of depression, anxiety and social adjustment were administered to patients at each session and scores entered into the computerized system.'

Quoting directly from the article: 'Data were available on pre-(assessment) and post-treatment
(last available session) standardized measures for the 505 veteran patients accessing the service and receiving some form of treatment. Overall, across the whole sample, there were highly significant improvements on all measures. For the different types of service conclusion, there were highly significant improvements on all measures. These findings have implications for nurse therapists and others, working with this vulnerable patient group. In contrast to countries like the United States, where a dedicated infrastructure exists for veterans’ healthcare needs, the lack of specifically tailored help in the UK has been problematic. Many veterans have been confused by the different services on offer, their acceptance criteria and referral routes.'

The authors conclude: 'The findings reported here have much to offer in the context of providing
salient evidence, in particular to those commissioning mental health services, against the backcloth of an increased commitment to the veteran population, such as that in the Military Covenant, now enshrined in law.'


Clarkson C, Giebel CM, Challis D, Duthie P, Barrett A, Lambert H (2016) Outcomes from a pilot psychological therapies service for UK military veterans Nursing Open doi: 10.1002/nop2.57

Tuesday, 14 June 2016

Mindfulness and resilience in nursing students

Roger Watson, Editor

Dispositional mindfulness - a phenomenon that includes 'observing, acting with awareness, non-judging, self-compassion and non-reactivity or acceptance' - is related to resilience in nursing students as this study from Australia by Chamberlain et al. (2016) titled: 'Dispositional mindfulness and employment status as predictors of resilience in third year nursing students: a quantitative study' and published in Nursing Open shows.  According to the authors: 'Nursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities.'

As the authors explain: 'The aim of this study was to observe the predictors of resilience in third year nursing students as a strategy for dealing with or managing study and workplace related stress. Specifically assessed were, innate dispositional mindfulness, professional quality of life and employment during study enrolment to determine if these psychological and workload states were predictive of personal resilience.'  Using questionnaires to measure mindfulness and resilience the authors showed that: 'resilience correlated positively with dispositional mindfulness'.  The authors conclude: 'The strongest predictors of resilience were dispositional mindfulness and its subset of acceptance.'  This study could contribute to helping nursing students to develop good coping strategies to deal with the stress of being a nurse.


Chamberlain D, Williams A, Stanley D, Mellor P, Cross W, Siegloff L (2016) Dispositional mindfulness and employment status as predictors of resilience in third year nursing students: a quantitative study Nursing Open doi: 10.1002/nop2.56

Saturday, 28 May 2016

Handling patient complaints

Roger Watson, Editor

'Patient complaints are considered a valuable source for quality improvement in health care. Moreover, patient satisfaction is an important issue for healthcare providers to fulfil their caring duties, to ensure patient safety and also for compassionate clinical nursing. In Sweden, the number of healthcare complaints is growing despite an increased patient focus in health care. In 2015 a new law was enrolled in Sweden – The Patient Act (2014:821) – that aims to reinforce and clarify the patients’ position and facilitate patients’ integrity, self-determination and participation.'

The aim of this Swedish study by Skålén et al. (2016) published in Nursing Open was: 'To describe patient complaints and to examine possible associations between healthcare providers’ statements and reports of satisfaction/dissatisfaction.'  Over 600 complaints were examined.

As the authors say: 'The study included 618 complaints at different clinics from either a patient (67%) or a relative (33%). Most complained by phone (71 5%) and the remaining by letter or e-mail. Most complaints concerned patients aged 20-79 (80%). Patients under the age of 20 or over the age
of 80 were represented in roughly equal proportions. A greater proportion of complaints concerned female patients (57%) than male patients and more women than men lodged complaints regarding themselves (60% vs. 40%). The most frequent category of relatives who lodged complaints were mothers (30%) followed by daughters and wives. The share of complaints at different clinics agrees well with the share of patient visits at each hospital clinic while primary care had a smaller proportion. In some cases, there were lodged complaints about more than one clinic, for example, both primary care and a hospital clinic.'

The authors conclude: 'The results of this study provide novel insights about patients’ complaints that can contribute to a scientific knowledge base and can be applied to facilitate quality improvements in clinical practice. The present results can be used in, for example, nursing education when teaching nursing ethics or for reflection and discussion among nurses in clinical practice. Procedure neglect, untrue explanations, lack of communication, blaming other clinics etcetera indicate that healthcare providers at times neither take their caring responsibility nor their obligation to learn from mistakes/incidents. Mistakes are inevitable, but healthcare providers need to learn a lesson from them, they need to listen and they need to respond in a helpful manner. To improve patient safety and contribute to quality improvement healthcare organizations should insure a leadership providing an ethical culture for receiving complaints and strive for transparency regarding complaints.'


Skålén C, Nordgren L, Annerbäck E-M (2016) Patient complaints about health care in a Swedish County –characteristics and satisfaction after handling Nursing Open doi: 10.1002/nop2.54

Wednesday, 11 May 2016

What is it like to live to over 100?

Roger Watson, Editor

Ever wondered what it is like to live to 100 and what the factors are that enable a person to do this?  Clearly, some luck is involved supported by a blend of genetic and environmental factors; but what is it like to outlive all your friends, your spouse and even some of your children?  This is precisely what was investigated by Hutnik et al. (2016) and reported in an article titled: 'Using a cognitive behavioural lens to understand psychological processes underlying resilience in the stories of 16 UK centenarians' and published in Nursing Open. 

Of the study, the authors say: 'In 2010, we interviewed 16 UK centenarians about their lives and later published a paper on the socio-emotional aspects of positive ageing. We were struck by their ability to ‘move on’ from difficult situations which we recognized conceptually as ‘resilience’. In the effort to understand aspects of resilience as portrayed in their stories, we re-examined their data.'

Some of the quotes are very revealing, for example: '. . quite a lot of things have happened. . .different things, what with my father being killed and then my husband going to the war and my brother being killed and things like that. But then again, you’re left and you’ve got to get on and that’s it. . .You just have to cope with it, don’t you? I’m afraid I’m one of those resilient people, I don’t just sit down and cry when it comes, I’ve just got to get on with it.'  and 'Never give up. I don’t think of death. I think of living and what I am going to do and what I am going to enjoy.'

In conclusion, the authors say: 'We have shown that 16 centenarians demonstrated resilience in their ability to positively frame very difficult life events by considering themselves ‘lucky’ or ‘fortunate’ thereby creating for themselves positive emotion. Their resilience was also evident in their ability to accept things they could not change (such as physical decline) with resignation and at the same time, a determination to move on. They knew how to manage anxiety and worry. Additionally, resilience was seen in their psychological flexibility, their positive attitude to and adaptation to change. We also found resilience in their quest to flourish, to be engaged in their passions, hobbies and interests and thus to find continuing meaning in their very long lives.'


Hutnik M, Smith P, Koch T (2016) Using a cognitive behavioural lens to understand psychological processes underlying resilience in the stories of 16 UK centenarians Nursing Open doi: 10.1002/nop2.44

Monday, 11 April 2016

Doumenting pressure ulcers

Roger Watson, Editor

The aim of this study was to describe the accuracy and quality of nursing documentation of the prevalence, risk factors and prevention of pressure ulcers, and compare retrospective audits of nursing documentation with patient examinations conducted in nursing homes.

Nursing homes were recruited through an email sent to nursing home managers in the municipalities connected to the Centre for Caring Research, southern Norway. Managers who wished to participate were invited to contact the project manager, one of the present authors (RLH), by phone or email. The inclusion criterion was all patients currently living in the nursing homes. Ethical considerations led to the exclusion of terminal patients and those considered by nursing staff to be too unwell. In total, 209
patients were invited to participate, and 155 (74%) patients or their proxies gave informed consent. Four of the five nursing homes had permanent-stay patients, including 2-4 patients in residential respite care or short-term stay.

The prevalence of pressure ulcers was 38 (26%) in the audit of the patient records and 33 (22%) in patient examinations. A total of 17 (45%) of the documented pressure ulcers were not graded. When comparing the patient examinations with the patient record contents, the patient records lacked information about pressure ulcers and preventive interventions.


Hansen R-L, Fossum M (2016) Nursing documentation of pressure ulcers in nursing homes: comparison of record content and patient examinations Nursing Open doi: 10.1002/nop2.47

Spanish translation of EdFED on the way

Roger Watson, Editor

The aim of this study is to obtain a Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale version, to assess its reliability for use by medical staff and caregivers at residential care homes, to evaluate by confirmatory methods its construct validity.A further aim was to determine the criterion validity with respect to biochemical markers of malnutrition such as serum albumin, transferrin, cholesterol and lymphocytes, the body mass index and the mini nutritional assessment.

The study will be conducted in residential care homes in the Costa del Sol healthcare district (Spain) in 2015. The study subjects will be aged over 65 years, institutionalized for at least 3 months and diagnosed with dementia. Exclusion criteria include terminal illness or other diseases that hinder feeding (stroke, Amyotrophic Lateral Sclerosis (ALS), motor neuron disease, maxillary fractures and paralysis.), the use of a gastrostomy tube, nasogastric tube, nasojejunal tube, enteral nutrition, refusal to participate in the study or the absence of consent by the legal guardians or reference relative/carers.


Saucedo Figueredo MC, Morilla Herrera JC, Ramos Gil R, Arjona Gómez MN, García Dillana F, Martínez Blanco J, Morlaes Ascencio JM (2016) Validation of the Spanish version of the Edinburgh feeding evaluation in dementia scale applied to institutionalized older persons with dementia: a study protocol Nursing Open doi: 10.1002/nop2.48

Who gets pressure ulcers?

Roger Watson, Editor

The study aimed to characterize demographic and clinical practice factors associated with community and hospital acquired pressure ulcers.

All patients admitted to the District General Hospital over 41 months between 2007–2010 were eligible for analysis. Throughout their hospital stay, data were collected by a single observer (GS) using a standardized reporting form to record their risk status and, where present, the location and category of any pressure ulcers.

The demographics of the 46,254 patients admitted to the general district hospital reflected the ageing population of the local community, with a mean age of 56 6 years. Of these patients, 6516 (14%) were considered to be at risk of developing a PU presenting with a maximum Waterlow score greater than 10 at some point during their hospital stay.

This study has shown that patients admitted to a General District hospital with a pressure ulcer or acquire a pressure ulcer during their inpatient stay are older and have an extended length of stay than those at risk who do not develop a pressure ulcer.


Worsley PR, Smith G, Schoonhoven L, Bader D (2016) Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis Nursing Open doi: 10.1002/nop2.50

Sunday, 6 March 2016

Training mental health staff to work with people who self-harm

Roger Watson, Editor

People who self-harm are also prone to committing suicide and, as the authors of this study from Finland - (Tapola et al. 2016) - explain: 'Suicide and self-injurious behavior (SIB) are substantial health problems worldwide. It has been estimated that over 800 000 people die due to suicide every year and for each adult who died of suicide there may have been more than 20 others attempting suicide.'  The study is titled: 'Effects of training on attitudes of psychiatric personnel towards patients who self-injure' and published in Nursing Open.

It is known that mental health staff can have negative attitudes towards people who self-harm and, of course, if such people do not receive appropriate care then they may progress to attempting suicide.  Positive attitudes towards people who self-harm are essential.  A training package about self-harm and suicide was developed and implemented with 50 mental health staff and their attitudes measured before and after.  The outcome was positive.

In conclusion the authors say: 'Although the study shows change in attitudes following the training, it is not known if this can result in changes in behavior as a result of the training.


Tapoloa V, Walstrhöm J, Lappalinen R (2016) Effects of training on attitudes of psychiatric personnel towards patients who self-injure Nursing Open doi: 10.1002/nop2.45

Sunday, 14 February 2016

Workplace violence against nurses in Ghana

Roger Watson, Editor

Workplace violence against nurses seems to be, literally, a universal problem.  Violence does not always involve physical assault but also insults and harassment.  The aim of this article by Boafa et al. (2016) from Ghana titled 'Sources, incidence and effects of non-physical workplace violence against nurses in Ghana' is: 'to document the incidence, sources and effects of workplace verbal abuse and sexual harassment against Ghanaian nurses'.  The study involved nearly 600 nurses in Ghanaian public hospitals.

As the authors say: 'While healthcare workers are generally recognized as increasing targets of violence, nurses are particularly at risk. In the UK, for instance, nursing has been described as the most dangerous occupation because of workplace violence'.  The present study is the first to survey workplace violence in Ghana.  The definition of workplace violence was that used by the WHO: ‘incidents where staff are abused, threatened, or assaulted in circumstances related to their work. . . involving an explicit or implicit challenge to their safety, well-being or health’.

As describe by the authors: 'Seventy-two of the 592 participants (12 2%) reported that they have been sexually harassed in their workplace in the past 12 months before the study. Of the 72 participants who were sexually harassed in the workplace, 83% reported that they were harassed inside the hospital and over 50% indicated that a medical doctor sexually harassed them. The second most commonly cited perpetrators of sexual harassment were relatives of patients.'  In terms of verbal violence: 'The incidence of verbal abuse was higher than that of sexual harassment. Of the 592 nurses, 312 (52 7%) reported to have suffered verbal abuse in the 12 months preceding the study. Out of these, 259 (83 0) were female nurses and 53 (17 0%) were male nurses.'

In conclusion, the authors state: 'This paper constitutes the very first study to be conducted on the incidence of workplace verbal abuse and sexual harassment against nurses in Ghana. The findings in this paper show that workplace verbal abuse and sexual harassment are major problems for nurses. More than half of the sample (52 7%) were exposed to verbal abuse and 12 2% were sexually harassed at the workplace in the 12 months preceding the study. Gender was statistically significantly associated with verbal abuse and sexual harassment. Participants who worked at the Greater Accra region experienced higher rates of sexual harassment and verbal abuse. Both forms of violence had significant impacts on the psychological well-being of participants. Furthermore, verbal abuse was statistically significantly associated with intention to quit the nursing profession'.


Boafo IM, Hancock P, Gringart E (2016) Sources, incidence and effects of non-physical workplace violence against nurses in Ghana Nursing Open doi: 10.1002/nop2.43