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, on World Day for Safety and Health at Work (April 28) we will make available a virtual issue of select papers recently accepted for publication 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.



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

Tuesday, 10 January 2017

Men in nursing: joining and leaving

Roger Watson, Editor-in-Chief

Men have always been a minority in nursing globally; I know - I am one. There is only one country exception and that is Jordan where they have a problem recruiting women to nursing. Otherwise, the pattern is the same across the world. Given the gender imbalance in and the female gender stereotyping of nursing, what makes men become nurses and why do they leave? This is the focus of a study from Poland by Kluczyń ska (2016) titled: 'Motives for choosing and resigning from nursing by men and the definition of masculinity: a qualitative studyand published in JAN. The study aimed to: 'establish the main motives for choosing nursing by men in Poland and the results for leaving the profession.'

The author interviewed 17 men in nursing in Poland to try and find answers. Reasons for joining were varied but some saw it as a vocation. Others came in by accident or simply to get a job. Others still claimed it was due to an interest in medicine. This last group were the ones most conscious of their masculinity. Men left nursing almost exclusively due to low income.

The author concluded: 'The study indicated that men’s decision to choose nursing is polymotivational in nature. The specified groups of motives (vocation, medical interest, accident, pragmatic motives) were not mutually exclusive and frequently overlapped, but usually one of the motives was crucial for the choice of nursing' and '(t)he motives for the choice sometimes become the reasons for resignation. Employment stability is associated with a low income, which usually contributes to the resignation of men from the nursing profession, as most of them feel obliged to perform the role of breadwinners.'

You can listen to this as a podcast

Reference

KLUCZYŃSKA U. (2016) Motives for choosing and resigning from nursing by men and the definition of masculinity: a qualitative study. Journal of Advanced Nursing doi: 10.1111/jan.13240


Wednesday, 4 January 2017

Nurses leading Social innovation

Jeniffer Barr PhD RN
Central Queensland University


People grapple with ways to tackle “wicked problems”. The term “wicked problems” refers to global health issues resistant to traditional strategies. An example is poor lifestyle choices and chronic illness. The question is can nurses do more about these “wicked problems”?

With rising health care costs and decline in public spending there has been a call for innovative solutions. The growing awareness that many significant health issues are social problems, social innovation has been proposed rather than just innovative solutions (van der Have & Rubalcaba 2016). Social innovation refers to a novel solution focusing on a group rather than an individual (van der Have & Rubalcaba 2016). The solution can achieve being more efficient; more sustainable; or even more just. The solution, however must lead to social change.

Consensus for a definition of social innovation has been elusive. Clarity of what this term means is required (Bosworth et al. 2016, van der Have & Rubalcaba 2016). This creates a challenge for nurse researchers and managers who aspire to do things differently to solve these mammoth social and health issues through the application of social innovation.

Nurses will find familiarity in the sociological lens of social innovation where it is argued new ways of creating and implementing social change is through new social practices (Bosworth et al. 2016, van der Have & Rubalcaba 2016). The conceptual focus on ‘practice’ aligns well to the values of nursing. Practice for nurses is centred on the patient (end user), as is social innovation. It is the end user who will determine if the proposed novel solution is appropriate and worthy of implementing.

Social innovation researchers are calling for measurements which indicate that social innovation has occurred. Mobilising end users to be involved is one suggested metric. Bosworth et al. (2016) cautions that claiming to show that social innovation has occurred as one has mobilized the end users is a tautology as social innovation is not possible without involving the end users. What else could be used to confirm this is a social innovative project?

What researchers focus on could indicate social innovative work. Social innovation requires exploring the nature of the “problem”; considering what has already been attempted; and then determining a novel way to solve the problem. Applying a novel way could be a dilemma for nurse managers who are accountable to provide evidence based care and effective use of health funds. However, a novel way may lack evidence for applicability. Determining what is value for money and who makes this judgement is another important question to be considered (van der Have & Rubalcaba 2016).

Typically health measurements focus on outcomes of interventions, like economic savings; effectiveness; improved health status (efficacy) and risk aversion (patient safety). Whilst social innovation could still measure these concepts; it must also show social impact as one outcome measurement (van der Have & Rubalcaba 2016). The question will be how has this new solution created social change?

Social innovation tends to focus on local needs and local values (van der Have & Rubalcaba 2016). It is likely that during consultation social innovation will emerge from local strengths and opportunities available, rather than wide spread applicability (Bosworth et al. 2016). Therefore, nurse researchers will need to consider appropriate methodologies to maximise success of engaging social innovation so a local need is address. Yet, the translation of this research into practice for others beyond the local area will also be needed.

An analysis of the local context should include the views of many. Considering the local context and adapting the solution accordingly through consultation of both the end user and those who will implement the solution will be required for the success of social innovative interventions. This is necessary as the solution needs to be perceived as appropriate by the front-line staff who will implement the solution and the end-users who will receive the solution (van der Have & Rubacaba 2016).

Key principles for social innovation are:
  • New combinations of current ideas or hybrid approaches not just “new” ideas can be included;
  • A combination of disciplines moving beyond traditional disciplinary boundaries to solve problems is needed;
  • The lived experience and ideas of end users is an essential part of the process; 
  • Those at the coal face should be involved as this will enhance the acceptability and readiness to implement and receive a novel intervention; and finally
  • The intervention must have a social impact; the goal is for change.

The greatest benefit of applying social innovation is the shared contribution from both end users and researchers. Traditionally, researchers have had a paternalistic approach to “improving” things for end users, whereas social innovation is collaborative and discourages people working in silos. It is the sharing of knowledge and skills which evolves to novel approaches for resistant problems (Bosworth et al. 2016). Also, involving combinations of disciplines who may not typically work together is useful as it is more likely to create a novel way rather than another version of a traditional approach. Traditional approaches to date have been unsuccessful in addressing the “wicked problems”.

Sharing knowledge and skills with others is not a new thing for nurses who have embraced the need to work in teams. Examining complex health issues using a cross-disciplined approach to viewing and solving problems has become the mantra. Whilst the synergy of different ideas and knowledge aligns with social innovation; grappling with disciplinary turfs and gaining authentic trust so that information can be shared will be an additional challenge facing social innovative researchers working in health. However, nurses as the largest health group and the most commonly employed health care professional in all local communities are well positioned to lead the way to implementing social innovative solutions.



References

Bosworth G., Rizzo F., Marquardt D., Strijker D., Haartsen T. & Thuesen A.A. (2016) Identifying social innovation in European local rural development initiatives. The European Journal of Social Science Research, 29 (4), 442- 461.

Van der Have R.P. & Rubalcaba L. (2016) Social innovation research: An emerging area of innovation studies? Research Policy, 1923- 1935.


Dr Jennie Barr is Deputy Dean for Research in the School of Nursing and Midwifery and Central Queensland University, Australia. Of herself she says: 'My research focus is health and wellbeing of workforce and vulnerable populations. National health survey of Australian nurses resulted in over 6,000 respondents showing developing and poor health of the workforce (Ross and Barr). My theoretical framework of PND, delayed maternal adaptation and mechanical infant caring (2008) continues to be useful. In my role as Deputy Dean of Research I continually aim to improve research engagement. This led to the article in 2012 about researcher safety.'