Thursday, 4 January 2018

Commentary on Abuzour et al (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions


Julian Barratt

Abuzor, Lewis, and Tull (2018) have provided a much-needed comparative analysis of the different clinical reasoning processes used to support the prescribing decisions of pharmacists and nurses working in advanced clinical roles. Their main findings, namely that clinical reasoning is contextually dependent upon clinicians’ experiential and theoretical knowledge has resonance with a previous comparative study of the clinical decision-making processes of nurse practitioners and medical doctors I contributed to (Thompson, Morley, & Barratt, 2017). In that study, in contrast to the findings of Abuzor, Lewis, and Tull (2018), it was highlighted that both groups of professionals had similar approaches and cognitive models for decision-making processes, whereas Abuzor, Lewis, and Tull (2018) note that the pharmacists in their study focused on looking at medical notes and laboratory results.as the basis for their clinical reasoning, whilst the nurses prioritised examining and interacting with patients.

As Abuzor, Lewis, and Tull (2018) note pharmacists’ reluctance to examine patients is a limiting factor upon their clinical reasoning skills in comparison to other prescribing clinicians such as nurses and doctors. This limitation is important to highlight as the General Pharmaceutical Council’s indicative content of pharmacist independent prescriber programmes requires pharmacists to learn clinical examination skills relevant to the condition(s) for which the pharmacist intends to prescribe for, including recognition and responding to common signs and symptoms that are indicative of clinical problems, including the use of common diagnostic aids for assessment of a patient’s general health status, such as stethoscopes, sphygmomanometers, tendon hammers, and examination of the cranial nerves. As such clinical examination combined with focused history taking, ensures safe prescribing practice, and thus should provide the fundamental basis of clinical reasoning for all prescribing clinicians, including pharmacists; otherwise a potentially serious impediment to the quality of clinical reasoning skills could occur (Simmons, 2010).

I know from my own clinical academic work supporting experienced pharmacists to become advanced clinical practitioners, as part of the General Practice Forward View (NHS England 2016), that they are often initially reluctant to move their clinical focus away from medicines management towards engaging in clinical skills that require interacting with and touching patients, such as clinical examination. However with encouragement, guidance, and practising under supervision in the University skills lab, and with appropriate support from mentors out in practice, pharmacists can also begin to develop the same positive attitude towards the critical necessity for clinically examining patients to essentially inform their prescribing decisions that nurse practitioners and doctors typically have.

Julian Barratt
Head of Academic Business and Workforce Development
Institute of Health
University of Wolverhampton, UK
julian.barratt@wlv.ac.uk


References

Abuzour A.S.Lewis P.J.,Tully M.P. (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisionsJournal of Advanced Nursing, 74, 6574

General Pharmaceutical Council. Pharmacist independent prescribing programme - learning outcomes and indicative content [Online]. Retrieved from http://www.pharmacyregulation.org/sites/default/files/pharmacist_independent_prescribing_-_learning_outcomes_and_indicative_content.pdf [accessed 28 December 2017].

NHS England (2016). General Practice Forward View (GPFV) [Online]. Retrieved from https://www.england.nhs.uk/publication/general-practice-forward-view-gpfv/ [accessed 28 December 2017].

Simmons, B. (2010). Clinical reasoning: concept analysis. Journal of Advanced Nursing, 66, 1151–1158. doi: 10.1111/j.1365-2648.2010.05262.x

Thompson S.Moorley C., & Barratt J. (2017A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environmentJournal of Advanced Nursing, 7310971110. doi: 10.1111/jan.13206
 

Five myths about academic publishing (podcasts)

Roger Watson, Editor-in-Chief












Myth 1: you must learn to write in English

Myth 2: you can only submit a manuscript twice

Myth 3: myths surrounding publishing from MSc dissertations and PhD theses

Myth 4: journal do not like reviews

Myth 5: it is wrong to cite yourself

Tuesday, 2 January 2018

Personality and compassion fatigue

Roger Watson, Editor-in-Chief

We all have different personalities and these seem to suit us to different jobs and to influence the way we respond in certain situations. So, how does personality affect the way nurses react to their jobs and what can we learn from this?

This was the focus of an article from Taiwan by Chen et al. (2017) titled: 'The Influence of Personality Traits and Socio-Demographic Characteristics on Paediatric Nurses’ Compassion Satisfaction and Fatigue'. The article was based on a study which aimed to: 'explore the level of and the association between, compassion satisfaction and fatigue of paediatric nurses; to determine the association between personality traits and compassion satisfaction and fatigue; to identify the determinants of compassion satisfaction and fatigue'

Nearly 200 nurses completed questionnaires about themselves, their jobs and also their personality. All aspects of personality and also pursuing outdoor activities were associated with 'compassion satisfaction' (i.e. how satisfied someone is with their caregiving) but people who were conscientious, agreeable and emotionally stable were less likely to experience compassion fatigue - akin to burnout. Lower emotional stability and being single were associated with compassion fatigue. The authors concluded: 'workplace support schemes for paediatric nurses that focus on the personality trait of emotional stability and increasing social connection to realize and deal with their own experience of compassion fatigue, may help avoid the possible exacerbation of compassion fatigue at work.'

You can listen to this as a podcast

Reference

Chen, Y.-P., Tsai, J.-M., Lu, M.-H., LIN, L.-M., Lu, C.-H. and Wang, K.-W. K. (2017) The Influence of Personality Traits and Socio-Demographic Characteristics on Paediatric Nurses’ Compassion Satisfaction and Fatigue. J Adv Nurs. doi:10.1111/jan.13516

Wednesday, 20 December 2017

Why do people with oral cancer continue to smoke?

Roger Watson, Editor-in-Chief

Some might think that after a diagnosis of cancer - especially oral cancer - someone who smoked would simply quit. But that is not the case. This is the subject of an article from Taiwan by Chang et al. (2017) titled: 'Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time-matched study' and published in JAN. The study aims were: 'to compare the social support, depression, nicotine dependence, physical function and social–emotional function of those who continued smoking with those who quit smoking, by matching age and survival time and to identify the predictors of continued smoking during the survival period.'

The study 'compared 92 people with oral cavity cancer who continued smoking with 92 people who quit smoking'. The results of the study showed that those who quit: 'had significantly more social support, less depression and greater social–emotional function than the continued smoking group. People who were unmarried, received surgery without reconstruction, had poor social support and had poor social–emotional function were more likely to continue smoking. In conclusion, the authors say: 'healthcare professionals who care for people with oral cavity cancer should pay more attention to social support, psychological status and nicotine dependence-related symptoms of their participants during the survival period. In particular, healthcare professionals may be able to help people with coping and emotional regulation and especially with smoking cessation. Future research is needed to develop plans for the survival period that include assessment of nicotine dependence and instructions for smoking cessation, alleviation of nicotine dependence and enhancement of self-efficacy in coping with continued smoking.

You can listen to this as a podcast

Reference

Chang S-LLo C-HPeng H-LChen C-RWu S-CChen S-C. (2017) Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time-matched studyJ Adv Nurs2017;  https://doi.org/10.1111/jan.13506

What keeps older nurses working?

Roger Watson, Editor-in-Chief

Keeping older nurses at work is important. Older nurses have experience that should not be lost and in these days of nursing shortages, health services need to keep as many nurses as possible. So, how do older nurses make decisions about retirement? This was the subject of an article from the USA by Wargo-Sugleris et al. (2017) titled: 'Job satisfaction, work environment, and successful aging: determinants of delaying retirement among acute care nurses' and published in JAN. The study aimed to: 'determine the relationships between job satisfaction, work environment and successful ageing and how these factors relate to Registered Nurses’ intent to retire.'

Using an online survey, nearly 3000 nurses responded. The results showed that: '(a)ge accounted for most of the variance in years to retirement.' In nurses who were primary financial providers this was associated with more years to retirement and successful ageing was associated with more anticipated years to retirement. Contrary to expectations: 'neither work environment nor job satisfaction was significantly associated with years to retirement.'

In conclusion the authors said: 'As the average age of nurses continues to increase and a need for well-educated, experienced nurses is observed, it is vital to understand and explain factors influencing retention and delaying retirement' and '(d)elaying retirement in older nurses is important because as the average age of Registered Nurses continues to increase, the need to engage and retain them by delaying retirement is vital to caring for the influx of Baby Boomers predicted to require medical care. Combined with the reduction of new workforce entrants predicted and the strain that a large influx of retirees would have on government entitlements creates a need for continued research in delaying retirement in Registered Nurses'.

You can listen to this as a podcast

Reference

Wargo-Sugleris, M., Robbins, W., Lane, C. J. and Phillips, Linda. R. (2017), Job satisfaction, work environment, and successful aging: determinants of delaying retirement among acute care nurses. J Adv Nurs.  doi:10.1111/jan.13504

Tuesday, 12 December 2017

MOOC ‘Understanding Violence against Women – Myths and Realities’

As acronyms go MOOC doesn’t roll easily off the tongue. Massive Open Online Courses harness the reach of the worldwide web to the immediacy of social media and magically turn teaching and learning into something entirely new for educators and learners alike. Developing a new MOOC ‘Understanding Violence against Women – Myths and Realities’ with my colleague Roisin McGoldrick took us into uncharted technological and pedagogical waters. With no students in front of you and no entry requirements, these free courses, covering every subject under the sun, attract learners from across the globe who might be studying at all hours of the Scottish day and night. Designing a course on VAW, a complex and at times controversial topic, for an invisible audience, was a challenge to two experienced educators used to the cut and thrust of lectures, PowerPoint, handouts and groupwork. Converting what we knew into audio-visual learning steps to capture and retain learners’ interest over a six-week period meant that most of how we did things went out the window. Knowing you are only ever one click away from internet oblivion at the best of times, teaching such a complex and highly controversial a subject required us each to find a friendly yet authoritative ‘voice’, somewhere between a pal and a mentor. I won’t even go into the whole teaching to camera business...

My long experience of teaching about violence against women has shown me that it is one of the few academic subjects where students’ personal opinions can sometimes trump all the research evidence you can throw at them. Violence against women (VAW) is so deeply interwoven in the warp and weft of world history and modern life that finding a way to unpack its complexities was our first task. We wanted to stimulate thinking and ideas around violence against women and girls and offer perspectives for people to consider. We were firmly feminist in our approach and were clear that our aim was not necessarily that everyone agreed but that we provided them with a strong foundation from which to build their learning and their own analyses. To do that we needed to introduce some serious sociological concepts such as gender, power and violence. We hoped this would help them make personal connections with underpinning theories, theoretical frameworks and the lived realities for women living with violence the world over.

Before we started on the content however we were clear we needed a clear ethical learning framework for learning. Given its high international prevalence and gendered nature, it was very likely that many of our participants would have either direct or indirect experience of violence against women and girls in private, social or public settings. We recognised that for some, this may well have influenced their decision to study the course and how they might interpret our materials. We would be covering topics which people would likely find distressing and because we were not around to have a private chat after class, we created a ‘Health Warning’ with regular reminders about the need for self-care and regular breaks to allow processing and learning. We established clear ground rules stressing the importance of being mindful of themselves and respectful of others in group discussions and in responding to other people’s posts in the online space, their sole and virtual classroom. WE stressed that personal experience is wholly that – unique and personal - and should not be used as evidence of more general points that people might wish to make. The chances of disclosures were likely to be high and we asked people only to share information about themselves that they were comfortable making available in the course’s public online platform. This request was well adhered to and might be a useful reminder for use in other public social media platforms,

“Please be sensitive to the potential for causing distress to yourself and to others in what you say and post during your time studying on this course.

We observed this in action many times. Participants contravening the ground rules were dealt with very effectively and graciously by the others in ways which were a model of pro-social, measured and well-argued rebuttals.

Each learning step of the six-week course contained short lectures, reading materials, hyperlinks, video extracts and opportunities for online discussion. There were quizzes and ‘live streams’ where people could tune into a YouTube channel and post question for us to answer live on air. We eventually got used to teaching direct to camera, to breaking learning down to small baby steps and getting to the point and sharpish! We dashed off compact articles, wandered down the vast storehouses of Shutterstock images, interviewed experts over Skype and chipped into online discussions being carried out across continents. We learned about media schedules, subtitling, editing and were fortunate in having tremendous contributions from a range of well-kent Scottish and internationally renowned experts in the VAW field and the support of a team of learning technologists and film and audio-visual specialists.

Our community of learners included survivors, a range of professionals, VAW specialists, students and people who were simply interested in exploring a new subject. Some were regular contributors to the discussion and many were not – content to learn in their own way. There is absolutely no requirement to chip in our ‘tuppenceworth’. We witnessed extraordinary moments of enlightenment as people began to make sense of their own or others’ experiences. We read with interest as people spoke of their growing confidence in their own knowledge to open up conversations about VAW with family, friends and colleagues for the first time. In an extraordinary piece of sychronicity, the Weinstein story and the #MeToo campaign broke when we were dealing with ‘Media Representations of VAW’. The chat was mighty and the analysis of the press coverage was a joy to behold in its confidence, knowledge and outrage! The pleasure of taking part in discussions with participants from every corner of the globe, of hearing their perspectives and of reaching so many people was a new one to me. The feedback since the first course ended in mid-November 2017 has been extremely positive. People connected to the issue in new ways, realised that they could play a part in preventing violence against women and many resolved at the end to take action in their own communities. The course page invites learners to join the global movement to prevent VAW. By taking part in a course like ours I believe they made a start. We explored VAW Prevention at the end of the course and when people read about the first Zero Tolerance Campaign in Scotland, the 16 Days of International Activism against VAW, One Billion Rising and White Ribbon for instance many were inspired into taking action in their own communities. Learning about VAW is an intervention and a key part of primary prevention. Knowledge is indeed power, we busted some myths and shared some realities and just maybe we have helped bring about some changes of mind. People are already signing up for the next run starting on 5 February 2018. Click here to join us.

Anni Donaldson
I am a Knowledge Exchange Fellow and Project Lead at the Equally Safe in Higher Education (ESHE) Project at the University of Strathclyde. Based in the School of Social Work and Social Policy, the ESHE Team are creating a national Gender-based Violence Prevention toolkit for use in Scottish universities. I have been working in the field of domestic abuse and violence against women research, teaching and practice development for nearly thirty years. I am a historian and am currently completing my doctoral thesis ‘An oral history of domestic abuse in Scotland 1979-1992’. I am also a blogger and journalist.

anni.donaldson@strath.ac.uk

@AnniDonaldson

Blog: www.glasgowanni.com

@equallysafeHE

#16daysStrath

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