Monday, 27 February 2017

It's not easy for families to help adolescents avoid obesity

Roger Watson, Editor-in-Chief

If adolescents are going to avoid obesity, with its attendant health risks, then families need to support them. But this is not always easy as a Danish-Australian collaborative study by Eg et al. (2017) titled: 'How family interactions about lifestyle changes affect adolescents’ possibilities for maintaining weight loss after a weight-loss intervention: a longitudinal qualitative interview study' shows. The aim of the study was: 'to examine how family interactions related to lifestyle changes influence adolescents’ potential for maintaining weight loss after participating in a weight-loss treatment programme.'

Ten families with obese adolescents were followed over 5 years following a weight loss programme. Parents felt guilty at times when they knew they were not being helpful to their adolescent children, as one mother said: 'We just haven’t had the energy to go all-in and do the exercising and the slimming diet, because often we end up with these quick solutions, you know, when you come home and you’re kind of busy.' Another mother said: 'Often, I feel like an old schoolmarm, constantly scolding. Sometimes I get a bad conscience about telling him that he can’t have any more to eat. It makes you feel like some sort of watchdog.' Siblings not on a diet could make the situation more difficult: 'It can be difficult for him [the adolescent] to understand that he can’t necessarily eat the same things as [his brothers] can. Actually, I think that’s probably been the hardest thing for him to deal with.'

The authors concluded: 'It is fundamental that the entire family is supportive, regardless of family structure. Supporting the adolescent was far more difficult than families expected; more time-consuming and also a cause of family conflicts. In families with non-aligned expectations and effort levels it was difficult for the adolescent to maintain weight loss, especially when parents were divorced and not cooperating. Siblings not needing weight management seemed to play a major, but overlooked, role for the primary participant’s own weight management.'

You can listen to this as a podcast

Reference

EG M. , FREDERIKSEN K . , VAMOSI M. & LORENTZEN V. (2017) How family interactions about lifestyle changes affect adolescents’ possibilities for maintaining weight loss after a weight-loss intervention: a longitudinal qualitative interview study. Journal of Advanced Nursing doi: 10.1111/jan.13269




Nursing students' intention to work with older people

A Systematic Review of Psychometric Testing of Instruments that Measure Intention to Work with Older People

Che Chong Chin, Noran Naqiah Hairi, Chong Mei Chan


This systematic review summarizes the psychometric properties of instruments used to measure intention to work with older people among nursing students. This is done to identify the most suitable measurement instrument with good quality which then can be used to assess the student nurses’ intention during the nursing education.

The topic of this systematic review is crucial in anticipating the need for well-educated and motivated nursing workforce in order to face the ageing population. Preparation of future nurses to meet the health needs of older people is a critical concern for the nursing profession. However, caring for older people is complex and challenging in terms of the physical, psychological and social needs of patients. In addition the quality of healthcare services provided to the older population is strongly influenced by healthcare providers’ attitudes towards older people which has been shown to be the most significant predictor for intention to work with older people. On that account, it is very important to nurture student nurses with positive attitudes towards older people and further promote intention to work with the older population.

A psychometric systematic review was undertaken to retrieve published studies of instruments that measure intention to work with older people among student nurses. Eight database searches were conducted between 2006 and 2016. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist was used to assess the methodological quality of intention measurement instruments. The COSMIN checklist uses a 4-point scale to classify each assessment of a measurement property, where 3=excellent, 2=good, 1=fair and 0=poor, based on the scores of the items in the corresponding COSMIN box (Terwee et al. 2011).

The key findings of our paper were:
  • Seven different instruments were identified for psychometric evaluation. 
  • Measures of reliability were reported in eight papers and validity in five papers. 
  • Evidence for each measurement property was limited, with each instrument demonstrating a lack of information on measurement properties. 
  • Based on the COSMIN checklist, the overall quality of the psychometric properties was rated as poor to good. Only SINOPS (Koskinen et al. 2016) achieved a good score on the methodological quality of internal consistency and structural validity. 
  • We conclude that it is not possible to recommend the most suitable instrument for measuring intention to work with older people.

Gerontological nursing education plays an important role to improve the quality of older persons care. This is done through enhancing geriatric competencies encompassing knowledge, skills and attitudes of the student nurses. Ultimately, the goal will inspire student nurses to work with older people after they graduated. As postulated in the Theory of Planned Behavior (Ajzen 1991), intention to work with older people can be used as a proxy measurement of working with older people after they graduate. Nursing educators will then be able to evaluate the effectiveness of gerontological nursing teaching and learning process by assessing students’ intention to work with older people. With this in mind, it is very important to identify a psychometrically sound instrument to measure intention towards caring for our older people.



References

Ajzen I. (1991) The theory of planned behavior. Organizational Behavior and Human Decision Processes 50(2), 179-211.

Koskinen S., Salminen L., Puukka P. & Leino-Kilpi H. (2016) Learning with older people--Outcomes of a quasi-experimental study. Nurse Education Today 37, 114-122. doi: 10.1016/j.nedt.2015.11.018

Terwee C. B., Mokkink L. B., Knol D. L., Ostelo R. W., Bouter L. M. & de Vet H. C. (2011) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research 21(4), 651-657. doi: 10.1007/s11136-011-9960-1.



Outcomes reported in a cluster-randomized controlled trial with the socially assistive robot Paro

Jose M. Moran, PhD
Metabolic Bone Diseases Research Group. Nursing Department,
University of Extremadura, Spain


Commentary on Jøranson N., Pedersen I., Rokstad A.M.M. & Ihlebæk C. (2016) Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial. Journal of Advanced Nursing 72(12), 3020–3033


We read with interest the recent paper from Jøranson and colleagues (Joranson et al. 2016) about the changes in quality of life in older people with dementia participating in Paro-activity. As indicated by the authors the trial was in adherence with the CONSORT statement and was registered at ClinicalTrials.gov with the record NCT02008630. We would like to highlight that authors report outcomes and experimental design are both different to those initially registered (Clinicaltrials.gov, 2013)

The overall objective of the trial NCT02008630 was to investigate changes in measures related to the risk of falls among elderly with dementia participating in animal-assisted interventions. The prespecified intervention consisted of 30 minutes sessions with animal-assisted activity or animal-assisted therapy two times a week for 12 weeks in groups of 4-6 participants. The prespecified primary (Changes in Norwegian version of Berg balance test) was not reported and was changed to the Brief Agitation Rating Scale (BARS). Prespecified secondary outcomes changes in Norwegian version of Quality of Life in Late-Stage Dementia (QUALID)) and changes in optional and ordinary medication were reported. Other two prespecified outcomes were not reported (changes in physical activity measured by Actigraphy and video recordings of two group sessions at each location). Additionally prespecified design included three arms (not two) with animal-assisted (dog) activity/therapy and no intervention. No interventions with the Paro assistive robot were prespecified. Some prespecified outcomes were published by the authors in Geriatric Nursing (Olsen et al. 2016), a manuscript that reported data from the effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia, and was also linked to the trial NCT02008630 but reports data from a sample that differs from the recently reported in Journal of Advanced Nursing.

The Journal of Advanced Nursing endorses the CONSORT (Consolidated Standards of Reporting Trials) guidelines on best practice in clinical trials reporting (Moher et al. 2010). Any changes to trial outcomes after the trial commenced should be declared (with reasons) in the methods section to avoid selective outcome reporting (Williamson and Gamble 2005) that may produce an overestimation of benefit. As the adherence to the CONSORT statement is mandatory by the authors that published in the Journal of Advanced Nursing such discrepancies should be noticed in the peer review process. We understand that the concerns expressed here might not affect to the overall conclusions presented by Jøranson and colleagues but certainly those results are not in adherence with the CONSORT statement as the authors declared in their manuscript.


Jose M. Moran, PhD
Metabolic Bone Diseases Research Group. Nursing Department, University of Extremadura. Avd. Universidad S/N, Cáceres, Spain.
e-mail: jmmorang@unex.es


References

ClinicalTrials.gov: NCT02008630. 2013. Animal-assisted Interventions in Health Promotion for Elderly With Dementia. Accessed at https://clinicaltrials.gov/show/NCT02008630 on 22 January 2017.

Joranson N., Pedersen I., Rokstad A.M. & Ihlebaek C. (2016). Change in quality oflife in older people with dementia participating in Paro-activity: acluster-randomized controlled trial. Journal of Advanced Nursing 72(12), 3020-3033. doi: 10.1111/jan.13076

Moher D., Hopewell S., Schulz K.F., Montori V., Gotzsche P.C., Devereaux P.J., Elbourne D., Egger M., & Altman D.G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. British Medical Journal 340, c869. doi: 10.1136/bmj.c869.

Olsen C., Pedersen I., Bergland A., Enders-Slegers M.J., & Ihlebaek C. (2016). Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia. Geriatric Nursing 37(4), 284-291. doi: 10.1016/j.gerinurse.2016.04.002.

Williamson P.R. & Gamble C. (2005). Identification and impact of outcome selection bias in meta-analysis. Statistics in Medicine 24(10), 1547-1561. doi: 10.1002/sim.2025.


Monday, 13 February 2017

Fibromyalgia and sexuality in women

Roger Watson, Editor-in-Chief

Fybomyalgia is a chronic, painful disease which, in some people, has no identified cause. The physical effects are obvious and it also has severe psychological consequences such as depression. However, in the words of these authors from Spain: '(a)lthough concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms.'

The study is by Matarín Jiménez et al (2017), titled: 'Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study' and publshed in JAN. The aim of the study was: 'to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality.' The researchers interviewed 13 women and found that sexual activity could be painful. As one woman said: 'Sometimes you have to say, ‘Stop, stop, . . .you’re hurting me, I can’t do it’. Or he holds you and . . . ‘Ow, you’re hurting me!’' Anticipating such pain made contemplating sexual intercourse difficult and another woman said: 'I had a lot of discomfort doing it (coitus), some pain here (vulva) and I didn’t have one (an orgasm). I was very nervous, I couldn’t relax, I wasn’t enjoying it. How can you always explain that? It’s like...it’s a bit ridiculous.'

The authors pointed to one difficulty in conducting this kind of research which was: 'The implementation of Catholic morality in Spain makes sexuality a subject that is scarcely addressed in healthcare services.' In conclusion, they said: 'Guilt and fear have an impact on female sexuality, which becomes focused on pleasing the partner who, while desiring the woman, does not understand her.´and: '(i)n their battle to preserve their sexual health, women require support and understanding from their partner, their socio-family environment and from health professionals.'

You can listen to this as a podcast


Reference

MATARÍN JIMÉNEZ T.M., FERNÁNDEZ-SOLA C., HERNÁNDEZ- PADI L LA J .M., CORREA CASADO M., ANTEQUERA RAYNAL L.H. & GRANEROMOLINA J. (2017) Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study. Journal of Advanced Nursing doi: 10.1111/jan.13262

Successful strategies to stop smoking

Roger Watson, Editor-in-Chief

What works to help people stop smoking and to remain that way? Not surprisingly, having the desire and the self-efficacy to stop smoking are helpful and the desire to smoke makes it harder as this study from Japan by Taniguchi et al (2017) shows. The study titled: 'Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses’ counselling' is published in JAN.

The aim of the study was to: 'identify cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status after patients received smoking  intervention with nurses’ counselling.' Over 1000 participants responded to a questionnaire asking them about nicotine dependence and desire to stop smoking. The participants had all taken part in 'the Japanese smoking cessation therapy, which consists of smoking cessation intervention five times with nurses’ counselling over 12 weeks.'

The authors concluded: 'Our study indicated that having a high self-efficacy to quit smoking was associated with short-term success of quitting smoking in the smoking cessation intervention with nurses’ counselling. Continuing to have a strong desire to smoke at the end of the intervention was a significant predictor of relapse in the abstainers. Our finding suggested the necessity and importance of promotion of self-efficacy and control of postquit craving by appropriate behavioural counselling in the nurses’ intervention.'

You can listen to this as a podcast

Reference

TANIGUCHI C., TANAKA H., SAKA H., OZE I ., TACHIBANA K., NOZAKI Y.,  Y. & SAKAKIBARA H. (2017) Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses’ counselling. Journal of Advanced Nursing doi: 10.1111/jan.13258

Wednesday, 25 January 2017

Evaluating a service for abused women

Roger Watson, Editor-in-Chief

It is not easy for abused women to seek help. But what are their experiences when they do? That is the subject of a study from the UK by Bradbury-Jones et al. (2017) titled: Abused women’s experiences of a primary care identification and referral intervention: a case study analysis and published in JAN. The study aimed to: 'report the findings of a qualitative case study that investigated abused women’s experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care.' The acronym for the service is IRIS.

The study involved ten women, two of whom continued to live with the perpetrator of their abuse. The women were interviewed and the aim was to: 'elicit their experiences of the three aspects of the intervention: identification; referral; safety.' Women were 'overwhelmingly positive' about the intervention. One woman said: 'My doctor referred me. She was absolutely unbelievable. She took it very seriously. At this point I had been to every service and no-one cared. At this point I was really down and I was homeless with the kids. And I just thought ‘someone is going to help me now'.' Another woman said: 'got a lot of information that I needed because I was going through the services for the first time because I am not from Britain and so I got advice about the services so that I could use them in the future. So I know for the future and I was learning about what to do if it happened again. I just needed to know what to do in an emergency so I felt safer knowing there is help.'

In the words of the authors: 'All women in our study reported that they felt empowered by the process of being referred through IRIS. While not all chose to leave the abusive relationship, they nonetheless felt better equipped to deal with the future.'

You can listen to this as a podcast

Reference

BRADBURY-JONES C., CLARK M. & TAYLOR J. (2017) Abused women’s experiences of a primary care identification and referral intervention: a case study analysisJournal of Advanced Nursing doi: 10.1111/jan.13250