Sunday, 14 August 2016

Adjusting to being a nursing student - does alcohol help?

Roger Watson, Editor-in-Chief

Being any kind of student is not easy, especially at the start of your course.  Often you have moved away from home, you are entering an unfamiliar situation and all of this may be compounded by the difficulty of the programme and financial worries.  Self-doubt sets in.  Nursing students experience all of this and more as they have the added dimension of having to cope with clinical work and there has never been a nursing student who wondered if and how they were going to cope.

A study from Ireland by Horgan et al. (2016) titled:'Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students' and publised in JAN aimed to: 'to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students.'  Over 400 students were involved in completing a standard and validated set of instruments and the investigators looked at the relationship between what was measured.

All the key measures in the study were related: depressive symptoms, social adjustment, personal adjustment and peer support.  The quantity of alcohol the students consumed was related to depressive symptoms but not in the way that may be expected; those who consumed more alcohol appeared to be less depressed. However, the effect of this alcohol consumption had on academic performance was not studied and the authors were not advocating the use of alcohol.  Furthemore, other studies have shown contradictory results.

The authors concluded: 'Poor mental health of nursing and midwifery students may impact on both academic and clinical performance. As such, strategies need to be put in place to support healthcare students in striving toward positive mental health and well-being. These students are the future of the healthcare system and it is important that they are able to monitor their own mental health and seek treatment when needed.

You can listen to this as a podcast


HORGAN A., SWEENEY J., BEHAN L. & MCCARTHY G. (2016) Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students Journal of Advanced Nursing doi: 10.1111/jan.13074

Thursday, 4 August 2016

Integral Option for Mitigating Conflict in Healthcare

Response to: Almost J., Wolff A.C., Stewart-Pyne A., McCormick L.G., Strachan D. & D'Souza C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505

Wesley A. Harris  BSN, RN, CCRN
Baylor Scott & White Medical Center – White Rock
Texas, USA

I recently read the Almost et al. (2016) review regarding mitigating conflict in the healthcare arena, and I would like add an additional perspective. I was an ICU nurse for eight years, but have been a facility educator for the past two. I have dealt with serious conflict resolution several times in my career (with varying degrees of success), and I am always looking for new ways to manage conflict. Of course, conflict resolution is an important aspect of leadership because there will always be dissenting opinions and unpopular viewpoints that will need to be integrated into the team.

Yi (2016) recently completed a quasi-experimental investigation to measure the impact of team building exercises on young healthcare professionals. They emphasize the importance of formal training with regards to team building in order for healthcare professionals to improve communication and therefore mitigate conflict. My facility recently mandated biennial training from the Crisis Prevention Institute (CPI) and we are hopeful we will see similarly decreased conflict in our facility as well. It is my suggestion that your readers should also advocate for a formalized team building training program if they are serious about taking further action to mitigate these obstacles.


Almost, J., Wolff A.C., Stewart-Pyne, A., McCormick, L.G., Strachand, D. & D’Souza, C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505. doi: 10.1111/jan.12903

Yi, Y.J. (2016). Effects of team-building on communication and teamwork among nursing students. International Nursing Review, 63, 33-40.

i-Robot in the nursing home

Roger Watson, Editor-in-Chief

I was asked recently at a seminar I gave on feeding difficulty in older people with dementia about the use of robots with people with dementia.  I have to say that I stumbled over my words a bit as I was not very sure what to say; there is something a bit 'off' about the concept of unleashing robots on older people with dementia. They are already confused and robots are hardly likely to reinforce reality.  But can the use of robots - in this case 'PARO Therapeutic Robot' - have any benefits for older people with dementia?  This was the subject of an article from Norway by Jøranson et al. (2016) titled: 'Change in quality of life in older people with dementia participating in Paroactivity: a cluster-randomized controlled trial' and published in JAN.

As explained by the authors: 'The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia'.  The control group received treatment as usual while the intervention group had two 30 minute sessions of activities with Paro twice weekly for 12 weeks.  Quality of life and use of psychotropic medications were measured as outcomes.  The study was carried out in nursing homes (NH).

Quality of life was maintained in the intervention group while it deteriorated in the control group and less psychotropic medication was used by the control group.  In the words of the authors: 'Pleasant and engaging activities, such as group activity with Paro could improve QoL. We believe interaction with Paro in group sessions to be an accessible non-pharmacological activity in NH facilitated by nursing staff. Activity with Paro seems to be especially suitable for NH residents with severe dementia to maintain QoL and nursing staff should particularly focus on engaging this group, often challenged by apathy and withdrawal.

You can listen to this as podcast


JØRANSON N., PEDERSEN I., ROKSTAD A.M.M. & IHLEBÆK C. (2016) Change in quality of life in older people with dementia participating in Paroactivity: a cluster-randomized controlled trial. Journal of Advanced Nursing doi: 10.1111/jan.13076

Monday, 11 July 2016

The h-index: meritocracy or spurious reductionism?

Niall McCrae, King’s College London

A recent JAN editorial has put a few ‘noses out of joint’. Editor-in-chief Roger Watson, far from the metropolitan elites in the cool climes of Hull, has emulated the irreverent poet Philip Larkin, whose verbal bombs from that smoky port were as loud as those of the Luftwaffe’s blitz in the Second World War.

Surveying the publication activity of the nursing professoriate, Watson et al. (2016) found several cases of chairs of nursing departments whose output was no better than that of a novice research worker. According to the Scopus database, some had h-index scores of 1; this could amount to a single publication, cited once. Watson et al.’s exposé has drawn an angry response, but as the Lancaster bomb crews once said: the greater the flak, the closer you are to the target.

An eloquent riposte by Gary Rolfe (2016) in the Journal of Clinical Nursing showed Watson et al.’s findings to be flawed, partly due to reliance on a database of dubious comprehensiveness. Scopus misses some nursing journals, authors’ details are frequently incorrect, and a more fundamental problem in the blunt collation of data is in the loss to female scholars whose names changed on marriage.

Accepting some of the criticisms, Watson would prefer Web of Science for a future survey, and the ORCiD number should be used to prevent disadvantage to women. Perhaps someone could take this on, but the results will not be any more impressive across the board. My h-index in Scopus lingers at a modest 8; in Web of Science it is a paltry 6. These numbers are frustratingly low for a writer with two books, numerous book chapters and over 50 published papers. By contrast, Google Scholar would give me a reassuring score of 12, being more inclusive in journal coverage and in types of citation.

No metric will satisfy all, but the h-index is an objective measurement not merely of the number of publications but the author’s impact. A paper in The Lancet will contribute much more to the score than one published in the East Yorkshire Archives of Health & Postmodern Poetry (impact factor unavailable).

A nursing professoriate emerged later in the UK than in the USA, and it seems that confidence in the academic prowess of the discipline is not as well developed here as in other countries. Deans of nursing faculties or chairs of nursing departments have a vital role in contributing to the science and knowledge of healthcare, and publication is the vehicle for changing and improving practice. Rolfe suggested that professors be rated by a mystical p-index, for which no criteria were offered. The h-index may seem crude, but at least it is objective, whereas a nebulous notion of ‘influence’ would be highly subjective – and could perpetuate an 'old boys club'.

Indeed, Rolfe’s argument, while persuasive on many points, has a degree of the reactionary tone of the establishment. Professors of nursing are not suited to an ivory towers mentality, and they should be able to face criticism from the likes of Watson et al., who will keep us on our toes. Let’s not shoot the messenger.


Rolfe G (2016) Professorial Leadership and the h-index: the rights and wrongs of academic nursing Journal of Clinical Nursing DOI: 10.1111/jocn.13428

Watson R, McDonagh R, Thompson DR (2016) h-indices: an update on the performance of professors in nursing in the UK Journal of Advanced Nursing DOI: 10.1111/jan.12924

Tuesday, 5 July 2016

Graduate nurses save more lives

Roger Watson, Editor-in-Chief

The value of graduates in nursing is already well known from previous studies, for example, the RN4CAST study (Sasso et al. 2015).  However, these studies measured the extent to which graduate nurses were present in hospitals and the extent to which patients survive.  There was no direct link between the nurses providing care for specific patients.  Now a study from Qatar by Gkantaras et al. (2016) titled: 'The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study)' has made that link and it supports the view that the higher the proportion of graduates who care for a patient, the more likely the patient is to survive their stay in hospital.

The NuGaT study used patient electronic records where the nurses who cared for patients identifed themselves by a uniqure personal code each time nursing care was provided.  From this code it was possible to identify the nurses and find out whether or not they were a graduates.

You can listen to this as a podcast


Gkantaras I, Hafhoud ZR, Foreman B, Thompson DR, Cannaby AM, Deshpanda DH, Watson R, Topping A, Gray R (2016) The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study) Journal of Advanced Nursing doi: 10.111/jan.13059

Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, Spandorano F, Icardi G, Watson R, Sermeus W (2015) RN4CAST@IT: why is it important for Italy to take part in the RN4CATS project? Journal of Advanced Nursing doi: 10.1111/jan.12709

Wednesday, 29 June 2016

Nursing in the year AD 2000*

Roger Watson, Editor-in-Chief

When I was very young - and even in 1975 when the lecture by Peggy Nuttall on which the paper is based was delivered - the year AD 2000 was one when we would have solved most of the problems of humanity; cars would fly and we would be able to communicate by speaking to our wristwatch. The 'crisis' in the UK National Health Service (NHS) referred to by Nuttall would no longer be an issue as economic and social progress would be such that we could look back over 25 years and laugh at our ignorance.  Well, how wrong was that assessment?  In fact, of the three things mentoined above only one has been achieved: we can speak to people via our wristwatches!  But the NHS remains in crisis and cars seem to be as dependent on tarmacadam roads as they were then.  I learned a great deal from Look and Learn magazine but I think it raised my hopes too much.

I urge you to read this excellent and prescient piece and tick off the issues which Nuttall identifies will be relevant in AD 2000: chronic ill-health; immigration; primary healthcare; retention of nurses in the workforce; the effect of night-shift working on nurses.  All of these are issues now and, while she did not refer to non-communicable diseases or global health, you feel that she could see how these would be issues in the next century.  She also points to the internal strife in nursing, that was evident then and it is evident now.

I think that this JAN classic paper from the first volume indicates the quality of some of our nursing leaders at this time, to whom we probably owe the survival of and the progress made by our profession.  It also demonstrates the vision of Founding Editor Dr James P Smith who ensured that JAN was reflecting the very best thinking about the situation of and the future of nursing; in this case 25 years on.

You can listen to this as a podcast


Nuttal P (1976) Nursing in the year AD 2000 Journal of Advanced Nursing 1, 101-110

* Peggy Nuttall was Vice Chairman, Royal College of Nursing, London and this was an address, the First Battersea Memorial Lecture, on 7 November 1975 to the Association of Integrated and Degree Courses in Nursing