Wednesday, 24 May 2017

Orthopaedic Nurse Practitioners shorten hospital stays and save money

Roger Watson, Editor-in-Chief

The case for advanced nursing roles has been well supported by evidence, much of it published in JAN, and a new study from Australia demonstrates the value of Nurse Practitioners in orthopaedics. The study by Coventry et al. (2017) aimed to: 'compare acute hospital length of stay and cost-savings for patients with hip fracture before and after commencement of the Orthopaedic Nurse Practitioner and identify variables that increase length of stay in hospital' and the article published in JAN is titled: 'Impact of the Orthopaedic Nurse Practitioner role on acute hospital length of stay and cost-savings for patients with hip fracture: A retrospective cohort study'.

The length of patient stay was related to co-morbidities such as dementia and cardiovascular disease but lengths of stay (LOS) were reduced using Orthopaedic Nurse Practitioners (ONP) and '(the) cost-savings to the hospital over one year was $354,483 and the net annual cost-savings per patient was $1,178.' The authors concluded: 'This study has shown that implementation of the role of the ONP significantly decreased acute hospital LOS without increasing mortality or complication rates. Further research is required into interventions that optimize time to surgery, manage anaemia and co-morbid conditions, reduce complications and lead to improved patient outcomes.'

You can listen to this as a podcast

Reference

Coventry, L. L., Pickles, S., Sin, M., Towell, A., Giles, M., Murray, K. and Twigg, D. (2017), Impact of the Orthopaedic Nurse Practitioner Role on Acute Hospital Length of Stay and Cost-savings for Patients with Hip Fracture: A Retrospective Cohort Study. J Adv Nurs. DOI: 10.1111/jan.13330

Tuesday, 16 May 2017

Women living with polycystic ovary syndrome

Roger Watson, Editor-in-Chief


According to the UK website NHS Choices polycystic ovary syndrome (PCOS) three main features are:


  • irregular periods – which means your ovaries don't regularly release eggs (ovulation)
  • excess androgen – high levels of "male hormones" in your body, which may cause physical signs such as excess facial or body hair
  • polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) which surround the eggs (it's important to note that, despite the name, if you have PCOS you don't actually have cysts).
The aim of this study from the UK by Tomlinson et al (2017) titled: 'The diagnosis and lived experience of polycystic ovary syndrome: A qualitative studyand publised in JAN was to: 'explore the impact of the diagnosis of polycystic ovary syndrome on health/ill health identity, how women experience this diagnosis and their health beliefs'. Thirty-two women were interviewed and a range of concerns were identified including: 'general lack of empathy by the medical profession'; 'difficulty in accessing specialist referral'; 'lack of information from professionals' amongst other things. 

The authors concluded: 'Women face a great deal of uncertainty as the diagnosis of PCOS is not straightforward and this leads to a view that the medical profession has little regard for the emotional and social consequences of their condition. However, from a medical perspective, the doctors also face uncertainty as there are many conditions that can mimic PCOS. These findings suggest that the experience of women with PCOS would be improved if their principal concerns were better addressed.'

You can listen to this as a podcast

Reference

Tomlinson JPinkney JAdams L, et al. The diagnosis and lived experience of polycystic ovary syndrome: A qualitative studyJ Adv Nurs. 2017;00:19https://doi.org/10.1111/jan.13300

Wednesday, 10 May 2017

Putting the ‘Physical’ Back into Nursing: Recognising Nursing as a Physically Demanding Occupation

Commentary on: Blake, H., Stanulewicz, N. & McGill, F. (2017) Predictors of physical activity and barriers to exercise in nursing and medical students. Journal of Advanced Nursing, 73(4), 917-929


Stephanie E. Chappel
Julie Considine
Brad Aisbett
Nicola D. Ridgers



In the April issue of JAN, Blake et al. (2017) investigated predictors of physical activity and barriers to exercise in nursing and medical students. Of specific interest are the findings related to nursing that showed close to 50% of nursing students were not meeting the national physical activity guidelines of 150 minutes of moderate-intensity physical activity a week (Department of Health 2014). Further, the most common barriers to nursing students’ engaging in physical activity were that physical activity was tiring, hard work, time-consuming, caused fatigue, and did not suit inconvenient work schedules (Blake et al. 2017). Blake and colleagues (2017) suggested that physical activity should be promoted to nursing students, and interventions should be tailored more broadly to accommodate the barriers of shift work.

However, these recommendations raise several questions. First, it is possible that physical activity, which is any movement requiring energy (Caspersen et al. 1985), was misinterpreted by the participants as exercise, which is planned physical activity (Caspersen et al. 1985), leading to an underestimation of actual activity levels. Second, physical activity occurs in a range of domains, including household duties, active transport, leisure-time and occupational activity (Hagströmer et al. 2006). The short version of the International Physical Activity Questionnaire (IPAQ) used in this work only captures a summary of all physical activity across a week and, does not separate physical activity into different domains (Hagströmer et al. 2006). The IPAQ also asks individuals to report the amount of walking completed in the last week, which can be misinterpreted as purposeful walking for exercise. Incidental walking that may occur at work (e.g., to and from a patients room; Hagströmer et al. 2006) may be under-reported. Finally, as with any subjective measure, there is potential for recall bias that can lead to an under- or over-estimation of actual physical activity levels; a limitation acknowledged by Blake et al. (2017). To avoid issues related to subjective reporting of physical activity, Blake et al. (2017) suggests future work should use objective monitoring, such as accelerometers, to more accurately capture physical activity. A particular advantage of using accelerometers would be the ability to quantify physical activity levels at work, given collected data are date- and time-stamped.

We recognise that this study was focused on students, although Blake et al. (2017) recommend that the healthcare workforce needs strategies to increase physical activity for shift workers. This conclusion raises several questions about whether nursing students are representative of a nursing workforce, and, whether data from nursing students were collected during clinical placement. Interestingly, in addition to nursing students, Registered Nurses (RNs) have also been identified as not meeting the national physical activity guidelines through their leisure-time physical activity (Naidoo and Coopoo 2007, Ahmad et al. 2015, Jung and Lee 2015), leading to a national focus on promoting nurses’ engagement in physical activity (National Insititue for Health and Care Excellence 2015). However, many of the claims that nurses do not meet physical activity guidelines and calls for increased physical activity among nurses are based on leisure-time activity alone. Given that a considerable proportion of waking hours are spent at work (Kikuchi et al. 2015), it is potentially misleading to conclude that strategies are required when occupational activity is not captured.

Although a lack of time and tiredness are consistently reported as the barriers to physical activity by both nursing students and RNs (Blake et al. 2017, Chin et al. 2016, Jung and Lee 2015), there is variability in the drivers of these barriers for physical activity. Nursing students are required to balance study, work and clinical placements that may or may not involve shift work (Blake et al. 2017). For RNs, lack of time is most likely the result of shift work as they spend majority of their waking hours at work (Kikuchi et al. 2015). Shift work also causes tiredness as sleep patterns are disrupted, yet this is further compounded by the physical demands of nursing work (Chin et al. 2016). Nursing involves several physically demanding tasks such as cardiopulmonary resuscitation, transferring patients, and pushing beds and wheelchairs. Studies have shown that in one shift nurses can lift up to 1800 kilograms (Babiolakis et al. 2015), maintain a high heart rate (51-64% maximal heart rate; Chen et al. 2011), and walk over 15,000 steps (Wakui 2000) or up to 8 kilometres (Chen et al. 2011). These physiological measures suggest that nurses are engaging in high amounts of physical activity through their daily duties and, are potentially meeting physical activity guidelines through their occupational physical activity. It is therefore too early to conclude that workplace physical activity interventions are required to increase nurses’ leisure time activity when little is known about nurses’ physical activity during a shift and the interaction between different domains of physical activity is poorly understood.

Nursing has been described as a physically demanding occupation. Yet despite the predominance of nurses in healthcare delivery, the ‘physical’ aspect of their work is poorly understood. A detailed understanding of nurses’ occupational physical activity using robust, valid measures is lacking. In order to ensure that nurses can provide the best care to their patients, there is an urgent need to understand the physical demands of nursing work.



Ms. Stephanie E. Chappel, BExSc (Hons)
PhD Candidate
Institute for Physical Activity and Nutrition (IPAN)
Deakin University, Geelong, Victoria
schappel@deakin.edu.au
Twitter: @Steph_Chappel

Professor Julie Considine, PhD
Professor of Nursing
School of Nursing and Midwifery and Centre for Quality and Patient Safety Research
Deakin University, Geelong, Victoria
and Centre for Quality and Patient Safety Research – Eastern Health Partnership
Box Hill, Victoria
julie.considine@deakin.edu.au
Twitter: @julie_considine

Associate Professor Brad Aisbett, PhD
Associate Head of School (Teaching & Learning, Exercise and Sports Science)
Institute for Physical Activity and Nutrition (IPAN)
Deakin University, Geelong, Victoria
brad.aisbett@deakin.edu.au
Twitter: @BradAisbett

Dr Nicola D. Ridgers, PhD
Senior Research Fellow
Institute for Physical Activity and Nutrition (IPAN)
Deakin University, Geelong, Victoria
nicky.ridgers@deakin.edu.au
Twitter: @NickyRidgers



References

Ahmad, W., Taggart, F., Shafique, M.S., Muzafar, Y., Abidi, S., Ghani, N., Malik, Z., Zahid, T., Waqas, A. & Ghaffar, N. (2015) Diet, exercise and mental-wellbeing of healthcare professionals (doctors, dentists and nurses) in Pakistan. PeerJ, 3, e1250.

Babiolakis, C.S., Kuk, J.L. & Drake, J.D.M. (2015) Differences in lumbopelvic control and occupational behaviours in female nurses with and without a recent history of low back pain due to back injury. Ergonomics, 58(2), 235-245.

Blake, H., Stanulewicz, N. & McGill, F. (2017) Predictors of physical activity and barriers to exercise in nursing and medical students. Journal of Advanced Nursing, 73(4), 917-929.

Caspersen, C.J., Powell, K.E. & Christenson, G.M. (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100(2), 126.

Chen, J., Davis, L.S., Davis, K.G., Pan, W. & Daraiseh, N.M. (2011) Physiological and behavioural response patterns at work among hospital nurses. Journal of Nursing Management, 19(1), 57-68.

Chin, D.L., Nam, S. & Lee, S.J. (2016) Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study. International Journal of Nursing Studies, 57, 60-69.

Department of Health (2014) Australia's Physical Activity and Sedentary Behaviour Guidelines. Vol. 2016. Commonwealth of Australia, Canberra.

Hagströmer, M., Oja, P. & Sjöström, M. (2006) The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutrition 9(06), 755-762.

Jung, H.-S. & Lee, B. (2015) Contributors to shift work tolerance in South Korean nurses working rotating shift. Appl Nurs Res, 28(2), 150-155.

Kikuchi, H., Inoue, S., Odagiri, Y., Inoue, M., Sawada, N. & Tsugane, S. (2015) Occupational sitting time and risk of all-cause mortality among Japanese workers. Scand J Work Env Hea, 41(6), 519-528.

Naidoo, R. & Coopoo, Y. (2007) The health and fitness profiles of nurses in KwaZulu-Natal. Curationis, 30(2), 66-73.

National Insititue for Health and Care Excellence (2015) Physical activity: for NHS staff, patients and carers.



Tuesday, 9 May 2017

Balancing Quality, Cost and the Nursing Workforce

Balancing Quality, Cost and the Nursing Workforce

Claire Su-Yeon Park, MSN, RN
CEO, Center for Econometric Optimization in the Nursing Workforce, Seoul


How can we achieve value-based nursing care resulting from improved quality yet reduced cost? We long for the best point of leverage balancing quality and cost; however, most studies seem to still present fragmented “snap shots” of the phenomenon of interest. We should be mindful of this because an unclear picture may lead to muddled policy-making. In this regard, I proposed a theory entitled “Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory” which explains “the inter-relationship in the continuum of changes between quality of care and cost, in particular, as they relate to nurse staffing.” The study “Optimizing staffing, quality and cost in home healthcare nursing: Theory synthesis” (Park 2017) is published in JAN.

I took note of inconsistent and non-conclusive evidence on both quality and cost in home healthcare, gaining insight into the limited theoretical basis on the dynamics between quality and cost that such evidence must be built upon.

To address this discrepancy, we created “Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory” through the theory synthesis process, which helps determine a practical and applicable optimum level of nursing staffing where nurses, patients and healthcare organizations (or stakeholders) can all be satisfied. The specific approach pinpoints “the theory-driven Optimum Nurse Staffing Zone as well as the Optimized Nurse Staffing (Sweet Spot), which can be navigated by Mathematical Programming (Optimization) based on the Duality Theorem in Mathematical Economics (Diewert 1982, p. 556)” (Park 2017). The “Optimized Nurse Staffing (Sweet Spot)” signifies a single best point of leverage “to achieve the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way” (Park 2017).

Non-linear optimization illustration produced by MATLAB

My theory could significantly impact nursing workforce policy-making to ensure optimal patient care relative to cost. “Not only does it address a timely issue – i.e., the balance between quality and cost – in the healthcare delivery system, but it is also applicable, durable and valuable due to the fact that Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory can be used to determine the sweet spot among quality, nurse staffing and cost in any healthcare/research setting” (Park 2017). Innovation in the healthcare delivery system as well as advancing nursing practice in real-world situations would be ultimately achievable.


Claire Su-Yeon Park, MSN, RN
CEO, Center for Econometric Optimization in the Nursing Workforce
Seoul, Republic of Korea
clairesuyeonpark@gmail.com

References

DIEWERT W.E. (1982) Duality approaches to microeconomic theory. In Handbook of Mathematical Economics: Volume II (Arrow K.J. & Intiriligator M.D., eds.), North-Holland Publishing Company, Amsterdam, Netherlands, pp. 535-599.

PARK C.S. (2017) Optimizing staffing, quality and cost in home healthcare nursing: Theory synthesis. Journal of Advanced Nursing. doi: 10.1111/jan.13284.



Note: This article is published under an exclusive license agreement with John Wiley & Sons, Limited; Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory: Copyright ⓒ 2016 Park, Claire Su-Yeon. All Rights Reserved. The copyright has been registered in Korea [C-2016-031091] and is pending in the U.S.A. [1-4218094011] with an effective copyright date of 02 Dec 2016; patent-pending in Korea (Park’s User-friendly Cloud-based Intersectional Optimized Nurse Staffing (Sweet Spot) Decision-making Support System [10-2017-0052130] with an effective patent-pending date of 24 Apr 2017); the Patent Cooperation Treaty (PCT) patent claiming priority of the Korean patent application pending [in progress]. Use of the contents, illustrations, and even ideas in Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory, even in part, requires written permission from the copyright/patent holder.



Tuesday, 2 May 2017

Disaster leads to disaster

Roger Watson, Editor-in-Chief

Disaster leads to disaster - at least, that's the case for adolescent girls after a natural disaster, according to a study from the USA by Sloan et al (2017 and published in JAN. The article is titled: 'Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster' and was based on a study following the 2010 earthquake in Haiti.

Can you imagine losing your home and possibly your whole family as an adolesecent girl in the wake of a devastating earthquake and ending up homeless, hungry and alone? Could anything be worse? Well, in the case of adolescent girls in Haiti, it could and it did. The study set out to: 'describe the physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake.' Computer assisted self-interviews were used to collect information between 2011-2013. The majority of the 78 girls who responded reported some kind of abuse - including sexual - at the hands, often, of boyfriends or other family members. It should be noted that such abuse was reported prior to the earthquake and, due to the low response rate to questions about abuse prior to the earthqaake, it was not entirely clear if there had been an increase.

In conclusion, the authors say: 'The findings from this study are important because they increase our understanding of violence against adolescent girls who were displaced from their homes and separated from their immediate families following a catastrophic natural disaster' and '(T)he results from this study suggest that there are many areas that organizations, foundations and governments can address in the future. Interventions and policy initiatives for adolescent girls should include education that increases their awareness of their vulnerability for gender-based violence as well as strategies for self-protection.'

Listen to this as a podcast

Reference

Sloand, E., Killion, C., Yarandi, H., Sharps, P., Lewis-O'connor, A., Hassan, M., Gary, F., Muller, C. N. and Campbell, D. (2017), Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster. J Adv Nurs. doi:10.1111/jan.13316

Sunday, 23 April 2017

Caring for a dying child at home

Roger Watson, Editor-in-Chief

There can be few things that have more impact on a family than the death of a child. But the period leading up to death is also hard. Where parents may receive post-bereavement counselling, support is also needed when death is approaching as this study from Switzerland by Eskola et al (2017) titled: 'Maintaining family life balance while facing a child’s imminent death—A mixed methods study' and published in JAN explores.

The aim of the study was to: 'understand parents’ experiences and needs during a child’s end-of-life care at home and to identify systemic factors that influence its provision.' From a nationwide study in Switzrland between 2012-2015, 47 families were studied between 2011-2102 who had a dying child at home. Information from questionnaires and interviews was used.

The physical and emotional toll on some parents is captured in this quote from one father: 'I drove home in the evening, parked in front of the garage. . . Do you think I was able to get out of the car?! I remained seated three quarters of an hour, just sat there and slept. In fact, I was at home, but couldn’t manage to get out of the car. No energy, empty batteries.' Practical help was really appreciated as explained by one mother: 'This daily household crap—getting groceries, cooking, cleaning, paying the bills (. . .) It would have been so nice, if there had been somebody to take over all these tasks and we could have spent the time with our child.' The authors concluded: 'Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents needs could be better met.'

You can listen to this as a podcast

Reference

Eskola K, Bergstraesser E, Zimmerman K, Cignacco E (2017) Maintaining family life balance while facing a child’s imminent death—A mixed methods study Journal of Advanced Nursing DOI: 10.1111/jan.13304


Friday, 21 April 2017

Commentary on: Leading change: a concept analysis

Commentary on Nelson-Brantley H.V., and Ford D.J. (2017) Leading change: a concept analysis. Journal of Advanced Nursing 73(4), 834-846.


Dr Mark Hughes
University of Brighton, UK


As a management and organization studies academic with a strong interest in leading change, I read Nelson-Brantley and Ford’s (2017) recent paper with interest and I will certainly be referring to this informative paper in my future work. I share their desire for greater conceptual clarity around change leadership. Ford and Ford (2012) raised similar concerns, although not nursing specific, in their review of the leadership of organizational change literature published in peer-reviewed journals between 1990 and 2010.

As the authors rightly remind us, the focus of their concept analysis potentially has life or death consequences, so I do hope that their paper provokes much-needed debate, as the debate often appears to myself and others to be trapped in the past (see By et al, 2016). I want to fuel this debate through raising four challenges which could be directed at the paper and more generally at leading change theories and their implications for nursing practices.

1. Do aggregate success/failure rates inform or misinform nursing change practices?

A shift away from management towards leadership was prefaced by claims of change failure. In essence, change management failed, with an implication that change leadership was going to succeed. However, the evidence base for these highly publicized aggregate failure rates was non-existent (Hughes, 2011). Intuitively we appreciate that a success/failure rate for transforming a hospital will differ from the rate for improving nursing education given that they are completely different activities and that there will be considerable contextual variations even within nursing.

2. Are the prescriptions of Kotter really applicable to nursing change practices?

Professor John Kotter’s 1996 book features very prominently in the paper, potentially reflecting his contribution to leadership studies. Even assuming that Kotter’s business cases are applicable to healthcare settings, I have generic concerns about this model of leading change (Hughes, 2016). Over the past two decades, we have witnessed academic advances in understanding ethics, power and politics, processes, agency and discourses in relation to organizational change, which appear to be missing from Kotter’s account of leading change. It was disappointing that the conceptual analysis did not reveal ethics as one of the attributes for leading change or make any reference to ethics.

3. Do we need nurses to lead or manage change or both?

The call for nurses to lead change has been echoed in the UK. But as a patient of the UK National Health Service, rather than a practitioner, I fear we may underestimate management in delivering high-quality healthcare. As a patient more mundane aspects such as hospital cleanliness, available appointments, maintaining effective medical records and effective hospital communications with myself really do matter. My fear is that organizations have become seduced by notions of leading change at the expense of other crucial activities. The paper rightly touches upon dualities and paradox, but potentially misses an opportunity to encourage a dualities aware approach.
Effective change leadership means appreciating how dualistic forces can shape and enable change. By adopting a dualities aware perspective, leaders can come to terms with the intuitive desire to resolve contradiction by instead managing the complementarities within contradictory forces. (Sutherland and Smith, 2013: 220)
The implication is that rather than nurses leading or managing and dealing with change or continuity, they will typically be involved in managing and leading changes and continuities. In any effectively run hospital continuities may prove to be as important as changes and we may find managing those continuities is as important as leading changes.

4. Does associating leading with changing really inform nursing change practices?

The authors rightly tend to make associations between leading and changing, rather than asserting that leaders influence organizational change. Whilst institutional rhetoric of nurses leading change may be strong, I have reservations about the empirical reality of leaders influencing organizational change. Parry (2011:57) is cited in the concept analysis, but what I took away from his short review of leadership and organizational change was that ‘there are many more books and articles on practitioner or conceptual scholarship than on theoretical or empirical scholarship. Much of the practitioner work is case study-based, and anecdotal and not rigorous in its conduct.’ This concern could be levelled at some citations in the content analysis. I personally found Ford and Ford’s (2012:22) review of the leadership of organizational change literature persuasive:
There is simply too little empirical research that specifically addresses the leadership of change to warrant a prescription for what works…we find, the available research equivocal and incomplete regarding both what constitutes effective leadership and the impact of change leaders approaches, behaviors, and activities on change outcomes of any type.

I welcome the publication of this concept analysis in clarifying the concept of leading change and situating this analysis in the context of nursing and healthcare. I am personally still not convinced that we have the empirical evidence to satiate the institutional desires for leading change in healthcare or any other sector.


Dr Mark Hughes
Reader in Organizational Change
University of Brighton
Brighton Business School
Brighton, UK
m.a.hughes@brighton.ac.uk



References

By R.T., Hughes M & Ford, J. (2016) Change leadership: Oxymoron and myths. Journal of Change Management 16 (1), 8-17.

Ford, J.D. & Ford L.W. (2012) The leadership of change: A view from recent empirical evidence. In Research in Organization Change and Development (Pasmore W., Woodman, R and Shani, A. eds) 20: (1-36).

Hughes, M. (2011) Do 70 per cent of all organizational change initiatives really fail? Journal of Change Management 11(4), 451-464.

Hughes, M., (2016) Leading changes: Why transformation explanations fail. Leadership 12(4), 449-469.

Nelson-Brantley H.V. & Ford D.J. (2017) Leading change: a concept analysis. Journal of Advanced Nursing 73(4), 834–846. doi: 10.1111/jan.13223

Parry K.W. (2011) Leadership and Organization Theory. In The SAGE Handbook of Leadership (Bryman A., Collinson D., Grint K., Jackson, B. & Uhl-Bien, M. eds), SAGE Publications Ltd., London EC1Y 1SP, pp. 53.70.

Sutherland, F. & Smith, A.C.T. (2013) Leadership for the age of sustainability: A dualities approach to organizational change”. In Organizational Change, Leadership and Ethics: Leading Organizations Towards Sustainability (By R.T. & Burnes B. eds), Routledge, London, pp. 216-239.



Sunday, 16 April 2017

Improving outcomes in gastroesophageal cancer

Roger Watson, Editor-in-Chief*

What influences the time between developing gastroesophageal cancer and a doctor realising a patient has it? This was the subject of the a study titled: 'Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review' by Lee et al (2017) and published in JAN. The aim of the study was to: 'identify the most crucial interval to encourage earlier diagnosis in with gastroesophageal cancer and to identify potential factors effecting this interval' and the study used a systematic review method. Twelve articles published between 2000-2016 were analysed.

Three main themes were used to present the data: total delay; patient interval (ie time between symptoms and seeing a doctor); and treatment interval. In the words of the authors: 'This literature review identifies the patient interval as the most crucial factor for engaging in preventive measures to encourage earlier diagnosis. Most patients present at too late a stage for curation of GOC.' This supports UK government and cancer research charity calls for campaigns to increase earlier diagnosis by increasing awareness of symptoms in the general population. This should encouage people who have symptoms to see their doctor as early as possible, to receive trearment and survive longer. In conlusion, the authors say: 'The incidence of GOC is increasing across the globe, yet survival remains poor. However, there is a significant lack of focus on this cancer in the literature' and 'Potential sufferers of this cancer need to be encouraged to seek medical attention as the patient interval is the most crucial to survival. For this, community level interventions are required to raise awareness of the signs and symptoms of this cancer.'

*Declaration of interests: Roger Watson is a co-author of this article

Listen to this as a podcast

References

Lee A, Khulusi S, Watson R (2007) Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review Nursing Open DOI: 10.1111/jan.13308

Wednesday, 5 April 2017

What tells us that an older person is going to be malnourished in a nursing home?

Roger Watson, Editor-in-Chief

What indicates that an older person in a nursing home will develop malnutrition? That is the subject of a study by Bauer et al (2017) titled: 'Changes in nutritional status in nursing home residents and associated factors in nutritional status decline: a secondary data analysis' and published in JAN which aimed to: 'describe changes in the nutritional status of nursing home residents over a period of 1 year and identify factors associated with a decline in nutritional status'.

Using data from 157 older residents, several factors were related to the development of malnutrition. In the words of the authors: 'care dependency, length of stay, changes in body mass index and malnutrition risk at baseline were significantly associated with a decline in nutritional status.' However, risk of malnutrition at admission to a nursing home is 'the most important risk factor indicating a decline in nutritional status.' The authors conclude: 'Our findings indicate that it is critical for the topic of malnutrition to be emphasized in basic and advanced nursing educational programmes, to train nursing professionals to identify nursing home residents at risk effectively and early on. The identification of residents at risk should be performed during their admission to nursing homes and at regular time intervals using validated nutritional screening tools.'

You can listen to this as a podcast.

Reference

BAUER S., HALFENS R.J.G. & LOHRMANN C. (2017) Changes in nutritional status in nursing home residents and associated factors in nutritional status decline: a secondary data analysis. Journal of Advanced Nursing doi: 10.1111/jan.13297

How effective are physician substitutes?

Roger Watson, Editor-in-Chief

You may not be aware that in the NHS there are people with roles that are like doctors and nurses, but they are neither. Depending on your view these people can be either ‘super nurses’ or ‘sub-doctors’. But do they work?

A recent review of research compared these ‘substitute doctors’ roles with doctors in long-term care of older people. The results show they are better than doctors at improving health of patients, preventing secondary complications and completing care processes. They are equally as good as doctors at preventing deaths, providing medications and completing mandatory physical examinations. They are also cheaper. This is important as more older people spend their final years in long-term care, which is expensive and health service resources are scarce. 

There are two main substitute doctors roles are Nurse Practitioners and Physician Associates. They are different but have very similar roles in assisting or even substituting for doctors. Nurse Practitioners are Registered Nurses with advanced training in diagnosis and treatment. Physician Associates are science graduates with similar advanced training.

Like most of these advanced roles, Nurse Practitioners and Physician Assistants started in the USA. Nurse Practitioners began in the USA in the 1940s and they were trained in areas like midwifery and anaesthetics where they could work independently. Physician Associates started in the USA in the 1960s and their role was designed to assist doctors directly with examining patients and prescribing drugs. The two roles have spread across the world and Nurse Practitioners now exist in over fifty countries and Physician Associates exist in over ten countries.

Nurse Practitioners can perform many of the tasks of doctors and are generally well accepted in advanced roles by doctors. But less is known about the new Physician Associate roles and some doctors are worried. The role is recognised as one that can assist doctors but replacing doctors is another matter. The lack of professional registration, which helps to define a role, is one worry. It leads to a ‘fluid’ role which could be used to undermine the role of the doctor and take away training opportunities for junior doctors. Other than that, Physician Associates lack many of the skills required to work independently or unsupervised.

Nurse Practitioners – who have several titles – have existed for over twenty years in the UK and since this is not a ‘registerable’ profession, the exact numbers are not know but there are many hundreds working in the UK. Physician Associates have only existed here for about ten years and the government wants to increase their numbers. This is also not a registerable qualification and exact numbers are not known. But in 2014 there were around 200 in the UK with plans to increase that and more than double the number of training places from 100 to 225. The recent research showing that they can be successfully used to replace doctors is good news for the UK government and for UK universities.

The future for substitute doctors in the UK looks very good. Funding issues in the NHS probably make them a necessity. The evidence that they are effective in at least one important role and often better and cheaper that doctors will surely encourage more growth in training places and numbers in the NHS.

One issue remains for both Nurse Practitioners and Physician Associates and that is regulation. Being a Nurse Practitioner is what is known as a ‘recordable qualification’ and Nurse Practitioners can choose to do this with the Nursing and Midwifery Council. Of course, all Nurse Practitioners are Registered Nurses and must keep that status to work as Nurse Practitioners. For Physician Associates, there is the Faculty of Physician Associates at the Royal College of Physicians of London. Registering with them is only encouraged but not compulsory.

Proper registration and regulation of substitute physician roles will increase confidence in them and lead to wider acceptance. It is doubtful if people will turn up at doctors’ surgeries and say, ‘can I see the substitute physician?’. But soon it is more likely that this is who they will see.


You can listen to this as a podcast

Reference

Lovink MH, Persoon A, Koopmans RTCM, Van Vught AJAH, Schoonhoven L, Laurant MGH (2017) Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the aging population: a systematic literature review Journal of Advanced Nursing doi: 10.1111/jan.13299



Tuesday, 4 April 2017

Commentary on: Models of partnership within family-centred care in the acute paediatric setting

Commentary on Dennis, C., Baxter, P., Ploeg, J. & Blatz, S. 2017. Models of partnership within family-centred care in the acute paediatric setting: a discussion paper. Journal of Advanced Nursing, 73, 361-374.


Denise A. Sackinger, MN, RN, CPNP-PC, CPN
University of Washington


In the discussion paper “Models of Partnership Within Family-Centred Care in the Acute Pediatric Setting,” Dennis et al. (2017) present a cogent discussion of partnership models within the acute pediatric setting. The authors used a self-developed appraisal tool to evaluate eight partnership models originating from Western and developed countries. The tool evaluated each of the models on defining characteristics or dimensions, major conceptual propositions or relationships and context or role of environment. The category of defining characteristics evaluated the extent to which the major concepts were clearly defined in the model (semantic clarity).

It is discouraging that in six of the eight models reviewed, the concept of “partnership” was not explicitly defined. Family Centered Care is the core of pediatric nursing. Partnership is a foundational concept of Family Centered Care (Institute for Patient- and Family-Centered Care). Practice models are symbolic representations of knowledge (Chinn and Kramer, 2015). For models to be translated into practice, the concepts must be clearly defined (Meleis, 2012). As such, a partnership model which does not plainly explicate the primary concept upon which it is focused lacks semantic clarity. Lack of semantic clarity, thus concept clarity, leaves the model open to individual interpretation rather than being a unifying model of nursing care delivery. As nursing scientists, we must be clear and consistent in our conceptual definitions to provide the building blocks for model development to allow for model testing across various contexts. My hope is that we are training and developing a generation of nursing scholars who strive to understand and clarify the abstract concepts we accept as a normal part of our profession. As abstract concepts are clarified, practice models can be hypothesized and tested in an effort to provide the best care to patients and families.

I commend Dennis et al. (2017) for providing us with a framework to evaluate models of care. This framework is helpful for critically analyzing conceptual models of care. This framework can help us to identify critical aspects of conceptual models that need refinement.



Denise A. Sackinger, MN, RN, CPNP-PC, CPN
Doctoral Student, School of Nursing
University of Washington
Seattle, Washington
esacki@uw.edu


References

CHINN, P. L. & KRAMER, M. K. 2015. Knowledge Development in Nursing:  Theory and Process (9th Ed), St. Louis, MO, Elsevier.
DENNIS, C., BAXTER, P., PLOEG, J. & BLATZ, S. 2017. Models of partnership within family-centred care in the acutepaediatric setting: a discussion paper. Journal of Advanced Nursing, 73, 361-374.
INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE. Patient- and Family-Centered Care [Online]. Available: http://www.ipfcc.org/about/pfcc.html [Accessed].

MELEIS, A. I. 2012. Theroretical Nursing:  Development & Progress (5th ed), Philadelphia, PA, Lippincott Williams & Wilkins.


Wednesday, 29 March 2017

Measuring 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.

Che C.C., Hairi N.N. & Chong M.C. (2017) A systematic review of psychometric testing of instruments that measure intention to work with older people. Journal of Advanced Nursing. doi: 10.1111/jan.13265

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.


Monday, 20 March 2017

What is the impact of shift work on the psychological functioning and resilience of nurses?

Roger Watson, Editor-in-Chief

Everyone who has worked as a nurse has worked shifts, including night shifts. There seems to be no way out of shifts and nothing is perfect. Either you do very long exhausting stints or many short ones, some very early, some very late...and then those nights. Some people love them, some people hate them. I hated them - yet I did them permanently for a while.

So what does this do to nurses? That was the focus of a study from Australia by Tahghighi et al. (2017) titled: 'What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review' and published in JAN which aimed to: 'synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts.' This was a systematic review and 37 articles were reviewed.

The outcome was inconclusive and much more work is needed with better designed studies. The authors concluded: 'The majority of studies were correlational comparing different patterns of shift work schedules and utilized inconsistent outcome measures. Based on the current evidence, we cannot definitively conclude that nurses who work shifts have poorer psychological functioning than those who do not. Instead, the current evidence suggests that for some nurses, shift work is associated with negative psychological outcomes and these outcomes appear highly dependent on contextual and individual factors.

You can listen tom this as a podcast

Reference

TAHGHIGHI M., REES C.S., BROWN J.A., BREEN L.J. & HEGNEY D. (2017) What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review. Journal of Advanced Nursing doi: 10.1111/jan.13283

Monday, 13 March 2017

Existential aspects of protected mealtimes

Roger Watson, Editor-in-Chief

Are protected mealtimes worth the effort? My only involvement in a study in one of our local hospitals suggested they made no difference to nutrition. However, meals are more that just nutrition; they fulfil important social and, as this article discusses, existential functions.

The study is Danish by Beck et al. (2017) titled: 'Supporting existential care with protected mealtimes: patients’ experiences of a mealtime intervention in a neurological ward' and published in JAN. The aim of the study was: 'to explore the experiences of patients who were admitted to the neurological ward during an intervention – inspired by Protected Mealtime – that changed the traditional mealtime practice.' Protected mealtimes are times when any unnecessary interruptions by staff such as doctors or therapists is prevented during mealtimes to allow patients to eat peacefully and undisturbed. Interviews were held with 13 patients to find out what their experiences of protected mealtimes was.

Patients were positive about the experience of protected mealtimes and one said: 'They introduced what they call Quiet Please. Well, with that. . . you feel the vacuum of mealtime. That is where it all slows down. You get a break and get a refresher on what [the doctors] had been saying to us.' Another patient said: 'Before the project started, I think there was much more turmoil. I did not think about it, but when they started the project, you could feel the present. The turmoil was really uncomfortable, especially after you had tried the other thing. The authors concluded: 'Patients felt that mealtimes were meaningful and nourishing events that provided a calming and pleasant environment that made them feel embraced and recognized as humans.'

You can listen to this as a podcast

Reference

BECK M., BIRKELUND R., POULSEN I. & MARTINSEN B. (2017) Supporting existential care with protected mealtimes: patients’ experiences of a mealtime intervention in a neurological ward. Journal of Advanced Nursing doi: 10.1111/jan.13278

Response to commentary on Jøranson N. et al. (2016) Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial

Nina Jøranson PhD RN
Ingeborg Pedersen PhD
Anne Marie Mork Rokstad PhD RN
Camilla Ihlebæk PhD



Response to: 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


We would like to thank Dr. Jose M. Moran for noticing the unfortunate mistake of inserting an incorrect ClinicalTrials.gov Identifier in our published paper. We are pleased to be given the opportunity to clarify this mistake.

The ClinicalTrials.gov Identifier in the published paper, NCT 02008630 is connected to the project "Animal-assisted Interventions in Health Promotion for Elderly With Dementia", which refers to one of two completed studies in a large Norwegian intervention study by Norwegian University of Life Science. This particular study conducted animal-assisted interventions in day-care centres. This study investigated another sample, which was home-dwelling older people with dementia. Hence, other outcome measures were used, such as Berg balance test, as primary outcome.

However, the discussed study referred unfortunately to an incorrect ClinicalTrials.gov Identifier, an error producing confusion when checking ClinicalTrials.gov to investigate if studies are in adherence with the CONSORT guidelines. The discussed study has the correct ClinicalTrials.gov Identifier: NCT01998490 "Animal-assisted or Robot-assisted Interventions in Health Promotion for Elderly With Dementia" and refers to the study on robot-assisted interventions conducted in several nursing homes. This study should, and did, use BARS as primary outcome measure. We conducted the RCT on robot-assisted interventions in adherence with the CONSORT guidelines.

We are very sorry to have committed such an error.

On behalf of the authors:
Dr Nina Jøranson
Associate Professor, PhD
VID Specialized University, Faculty of Health Studies
Oslo, Norway


Reference

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. doi: 10.1111/jan.13076


Friday, 3 March 2017

Get Healthy!

Rita Pickler, JAN Editor

The American Nurses’ Association (ANA) has declared 2017 “Year of the Healthy Nurse.”

A healthy nurse is one who focuses on “creating and maintaining balance and synergy in physical, intellectual, emotional, social spiritual, personal, and professional well-being” (ANA). That’s a tall order with a lot of creating and balancing. Leaders at ANA have argued, however, that healthy nurses are necessary not only their own well-being, but also in the best interests of those for whom they provide care. Healthier nurses are certainly likely to be better role models for their patients and the public. Healthier nurses, who may feel better and feel better about themselves, can also contribute to healthier work environments.

To help nurses become healthier, the ANA has provided a toolkit on its website with smoking cessation, limiting alcohol use, and improved nutrition, sleep, and exercise leading the agenda. Their Healthy Nurse/Healthy Nation Grand Challenge kicks off March 9, 2017 at the ANA Annual Conference in Tampa, Florida. There is certain to be a good deal of excitement about this among the over 3.5 million US nurses and perhaps worldwide. We also hope that health care systems and nurses’ employers are excited about this movement and find ways for nurses to get and stay healthy.

JAN is going to do its part as well. Next month, we will make available a virtual issue of select papers that focus on some of the challenges nurses confront to getting and staying healthy as well as some strategies that may work to improve nurses health. We hope you check this space next month for a link to the virtual issue; the selected papers will be available at no cost for one month from the JAN website. In the spirit of Year of the Healthy Nurse, for the remaining months of 2017, JAN will highlight in this space one or two recently published papers on specific healthy nurse related topics.

For now, check out the ANA website. Then take a walk, relax with your loved ones, enjoy a healthy meal, and get some sleep!


Tuesday, 28 February 2017

Helping older people thrive in nursing homes

Roger Watson, Editor-in-Chief

What happens to older people once they enter nursing and residential homes is of increasing concern, as more older people are admitted to nursing homes and spend longer times in them. Essentially, do they thrive there or not? This study from Sweden by Björk et al. (2017) titled: ‘Residents’ engagement in everyday activities and its association with thrivingin nursing homes’ and published in JAN aimed to: ‘To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving.’

This was a large study involving over 170 nursing homes and over 4000 residents. Standard questionnaires were sent to homes for completion by staff to find out what residents did and if they were thriving. One of the questionnaires was the Thriving in Older People Assessment Scale. The results of the study show which activities were most common for residents such as physical touch and hugs from staff and talking to relatives. The extent to which residents thrived was related to things like being involved in an activity and being nicely dressed.

The authors concluded: ‘This study found that resident engagement in activities was significantly associated with thriving. Engagement in everyday activities can be interpreted to support resident personhood by being connected to one’s life history, significant others, activities and interest.’

You can listen to this as a podcast

Reference

BJÖRK S., LINDKVIST M., WIMO A., JUTHBERG C., BERGLAND Å. & EDVARDSSON D. (2017) Residents’ engagement ineveryday activities and its association with thriving in nursing homes. Journal of Advanced Nursing doi: 10.1111/jan.13275

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.