Wednesday, 16 August 2017

Do nurses agree when patients say they are in pain?

Roger Watson, Editor-in-Chief

"I was in pain but the nurses did nothing; they didn't take me seriously." How often have we heard things like that from patients? A great deal of research effort and time in clinical practice has been spent by nurses and other researchers developing methods to assess pain to improve assessment and, presumably, patient comfort. But are we any good at it? This is the topic of a study from Belgium by Dequeker et al. (2017) titled: 'Hospitalized Patients’ vs. Nurses’ Assessments of Pain Intensity and Barriers to Pain Managementand published in JAN. The aim of the study was to: 'identify if nurses and patients equally assessed pain intensity and patient-related barriers to pain management in hospitalized patients' and over 500 patients were involved. Over 170 patients completed the same pain rating scale as the nurses responsible for their care. The results showed that nurses only moderately agreed with patients about their pain. As pain intensity reported by the patient increased, nurses were more likely to undersestimate it. Nurses consistently underestimated patients beliefs about pain; for example, patients' beliefs that they were reluctant to take opiod medication. Nurses saw this as less of a problem than patients.

In conclusion, the authors said: 'Nurses should be educated about these beliefs and should be encouraged to actively explore patient-related barriers to pain management with their individual patients. When the nurse knows which barriers are present in a patient, he/she could educate the patient to reduce the barriers of the patient. Routine pain assessments should also be encouraged, because a lot of patients do not always report pain, unless asked. Nurses could also instruct patients in how to use pain assessment scales and wards, or even hospitals, could choose one pain scale and instruct their nurses on its use.'

You can listen to this as a podcast


Dequeker, S., Van Lancker, A. and Van Hecke, A. (2017), Hospitalized Patients’ vs. Nurses’ Assessments of Pain Intensity and Barriers to Pain Management. J Adv Nurs.  doi:10.1111/jan.13395

Friday, 28 July 2017

Resilience as a Buffer of Stress in Nurses

Julie J. Lanz & Valentina Bruk-Lee

Lanz, J. J. and Bruk-Lee, V. (2017), Resilience as a Moderator of the Indirect Effects of Conflict and Workload on Job Outcomes among Nurses

Where have all the nurses gone? According to Lafer (2005), “the stress, danger, exhaustion, and frustration that have become built into the normal daily routine of hospital nurses constitute [the] single biggest factor driving nurses out of the industry” (p. 36). This is important because researchers have projected that there will be a significant shortage of 300,000 to 1 million registered nurses in the U.S. by 2020 (Juraschek et al, 2012). Indeed, the World Health Organization (WHO, 2016) reports that there is a global shortage of healthcare workers, and this shortage is reaching a crisis level in 57 countries.

Urban, rural, and student nurses all report similar stressors:
  • Caring for the dying 
  • Conflict with patients, families, and staff 
  • Workload 
  • Inadequate nursing staff 
  • Feeling unprepared to meet the emotional needs of patients 
  • Fear of failure 

These stressors are frequent – enough so that nurses are burnt out, getting injured, and even leaving the profession altogether. The two most frequently reported negative workplace events among a sample of Oregon nurses were interpersonal conflict at work and work role demands such as workload (Sinclair et al., 2009). One report estimated that U.S. employees spend 2.8 hours every week dealing with workplace conflict (Hayes, 2008). Thus, there is a critical need to investigate the effects of conflict and workload on job outcomes, as well as explore factors like resilience that may mitigate this stressful work environment.

A framework by which we can understand the stress process in nurses is the Emotion-Centered Model of Occupational Stress, which theorizes a causal flow from job conditions such as job-related stressors to job outcomes (i.e., strains, or reactions to a stressor; Spector & Goh, 2001). According to this model, a job stressor is a situation or condition that prompts a negative affective (i.e., emotional) response like frustration or anger. These negative emotions serve as a mechanism through which conflict and workload exert their influence on the experience of job outcomes (i.e., burnout, turnover intent, and injuries). Some variables, such as resilience, have previously been found to moderate the relationship between stressors and emotions (see Figure 1). In other words, highly resilient individuals under high levels of stress don’t experience as many negative emotions.

Figure 1. The Proposed Role of Resilience in the Emotion-Centered Model of Occupational Stress

The first objective of this study was to assess the relative effects of conflict and workload on burnout, turnover intentions, and injuries. Second, the mediating role of negative affect in the relationships between stressors and job outcomes was tested. Last, the study assessed resilience as a condition to the indirect effects of stressors on outcomes through the experience of negative emotional states. This study used a quantitative self-report two-wave design whereby 97 nurses were surveyed two weeks apart was used. Data from Time 1 and 2 were matched.

We found that conflict predicted turnover intentions and burnout; workload predicted injuries. Second, emotions were a mediating mechanism for most of the studied relationships consistent with Emotion-Centered Model of Occupational Stress, but not for workload and injuries, for which a direct relationship was found. Finally, resilience moderated the indirect effects of conflict on job outcomes via job-related negative affect. This effect was not found for the stressor workload, however.

Conflict is a social stressor that leads to negative outcomes, and it is likely that resilient nurses use positive emotions to deflect the negative effects of conflict. Resilience interventions may be a promising avenue to ameliorate the negative effects of conflict on nurses' job attitudes and well-being. This pattern was not seen for workload, so using a human factors (i.e., ergonomic) approach to understanding the negative effects of workload might be more valuable (Holden et al., 2011). For organizations seeking to reduce costs associated with injuries, reducing nurse workload and increasing support for safe patient handling are critical factors.

Dr Julie Lanz
Department of Psychology
University of Nebraska at Kearney

Dr Valentina Bruk-Lee
Department of Psychology
Florida International University

Hayes, J. (2008). Workplace conflict and how businesses can harness it to thrive [WWW document]

Holden, R.J., Scanlon, M.C., Patel, N.R., Kaushal, R., Escoto, K.H., Brown, R.L. ... & Karsh, B.T. (2011). A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Quality & Safety, 20, 15–24. doi:10.1136/bmjqs.2008.028381

Juraschek, S.P., Zhang, X., Ranganathan, V., & Lin, V.W. (2012). United States registered nurse workforce report card and shortage forecast. American Journal of Medical Quality, 27, 241–249. doi:10.1177/1062860611416634

Lafer, G. (2005). Hospital speedups and the fiction of a nursing shortage. Labor Studies Journal, 30, 27–46. doi:10.1177/0160449X0503000103

Lanz, J. J. and Bruk-Lee, V. (2017), Resilience as a Moderator of the Indirect Effects of Conflict and Workload on Job Outcomes among Nurses. Journal of Advanced Nursing. doi:10.1111/jan.13383

Sinclair, R.R., Mohr, C.P., Davidson, S., Sears, L.E., Deese, M.N., Wright, R.R. … Cadiz, D. (2009). The Oregon Nurse Retention Project: Final Report to the Northwest Health Foundation [WWW document].

Spector, P. E., & Goh, A. (2001). The role of emotions in the occupational stress process. In P. L. Perrewé & D. C. Ganster (Eds.), Exploring theoretical mechanisms and perspectives (pp. 195–232). Bingley: Emerald Group Publishing Limited.

World Health Organization (2016). Health worker occupational health. Retrieved from


This study was funded by CDC/NIOSH through the Sunshine Education and Research Center (ERC) at USF (5T42OH008438-09). The opinions expressed are those of the authors and do not represent either NIOSH or USF.

Thursday, 27 July 2017

Prevention and management of patient and visitor aggression in general hospitals

Nurse managers: Determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study

Birgit Heckemann

Patient and visitor aggression (PVA) in general hospitals is internationally recognized as a problem that requires urgent attention. A large international body of research has to date investigated the perception and experiences of nursing staff with PVA (Lanctôt & Guay, 2014). However, little is known about how nurse managers experience and manage PVA, although the link between leadership, workplace safety, job satisfaction and quality of care has been recognised (Farrell, Touran, & Siew-Pang, 2014; Feather, Ebright, & Bakas, 2015).

This qualitative descriptive interview and focus group study explored nurse managers' behaviours, attitudes, perceived social norms, and behavioural control in the prevention and management of patient and visitor aggression in general hospitals. The study is part of a sequential mixed methods research project aimed at obtaining an international overview of PVA from a managers' perspective (Hahn et al., 2016).

Using the Reasoned Action Approach (Fishbein & Ajzen, 2010) as a theoretical underpinning for data collection and content analysis of 13 interviews and five focus groups, we identified three main themes: (1) Background factors: ‘Patient and visitor aggression is perceived through different lenses’; (2) Determinants and intention: ‘Good intentions competing with harsh organizational reality’; (3) Behaviours: ‘Preventing and managing aggressive behaviour, and relentlessly striving to create low-aggression work environments’.

Our key findings were:
  • Managers' behaviours depend on whether patient and visitor aggression is perceived from a situational and/or organizational perspective.
  • Existing communication channels between nursing staff and managers should be strengthened. Particularly formal incident reporting is underutilized as a tool to document and communicate aggressive incidents within the organization.
  • Nurse managers face substantial challenges in addressing patient and visitor aggression at an organizational level. This is due to a lack of financial resources and awareness within the organization.
Addressing patient and visitor aggression is challenging for nurse managers due to lack of coordination between the situational management of individual aggressive incidents and organizational feedback loops, protocols and procedures. Further challenges include a scarcity of financial resources and lack of interest in the topic across the organization. Being able to present patient and visitor aggression as a quality issue and business case might help to raise awareness and support within the organisation. Furthermore, clear communication about expectations, needs and available resources between staff and nurse managers could facilitate adequate support provision for

Birgit Heckemann
RN, MSc, PhD student
CAPHRI, Maastricht University


Farrell, G., Touran, S., & Siew-Pang, C. (2014). Patient and visitor assault on nurses and midwives: An exploratory study of employer ‘protective’ factors. International Journal of Mental Health Nursing, 23(1), 88–96. doi:10.1111/inm.12002

Feather, R., Ebright, P., & Bakas, T. (2015). Nurse manager behaviors that RNs perceive to affect their job satisfaction. Nurs Forum, 50(2), 125-136. doi:10.1111/nuf.12086.

Fishbein, M., & Ajzen, I. (2010). Predicting and Changing Behavior: The Reasoned Action Approach. New York: Taylor & Francis.

Hahn, S., Heckemann, B., Gerdtz, M., Hamilton, B., Riahi, S., Thomson, G., . . . De Santo Iennaco, J. (2016). PERoPA – the nursing managers’ perspective. Retrieved from Research Project Information: PERoPA – the nursing managers’ perspective website:

Heckemann B, Peter KA, Halfens RJG, Schols JMGA, Kok G, Hahn S. Nurse managers: Determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study. J Adv Nurs. 2017;00:1–11.

Lanctôt, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggress Violent Beh., 19(5), 492-501. doi:

Friday, 21 July 2017

How do we evaluate nursing care?

Roger Watson, Editor-in-Chief

As long as I can remember we have been looking for ways to measure nursing care. These parallel discussions for definitions of  nursing and they come and go. Now they have definitely come back. Resources for medical and nursing care are limited worldwide, professional boundaries are becoming blurred and roles are beginning to change. Nurses nearly always work as parts of a multidisciplinary team and it is not always easy to decide what happens as a results of nursing. 

The issue of indicators is the subject of an article from Canada by Dubois et al. (2017) titled: 'Which priority indicators to use to evaluate nursing care performance? A discussion paper' and published in JAN. The aim of the article was: '(a) discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care'.

By reviewing previous work the authors arrived at a list of 12 indicators which I will not list here; refer to Table 3 of the article. Some of the 'usual suspects' such as pressure ulcers and falls are there but also team composition and length of continuous work. The key references are provided and the evidence is summarised.

You can listen to this as a podcast


Dubois, C.-A., D'Amour, D., Brault, I., Dallaire, C., Déry, J., Duhoux, A., Lavoie-Tremblay, M., Mathieu, L., Karemere, H. and Zufferey, A. (2017), Which priority indicators to use to evaluate nursing care performance? A discussion paper. J Adv Nurs. doi:10.1111/jan.13373

Pressure sores are painful

Roger Watson, Editor-in-Chief

I am well aware the we no longer refer to 'pressure sores' and even the term 'pressure ulcer' has been replaced by 'pressure injury' - and a good thing too because that is exactly what skin breakdown due to pressure is: a pressure injury. However, the original term 'sore' reminds us also that pressure injury is painful as explained in this article from UK and Australia by Jackson et al (2017) titled: 'Pain associated with pressure injury: a qualitative study of community based, home-dwelling individuals' and published in JAN.

The aim of the study was 'to provide deep insights into the pain associated with pressure injuries' and towards that end 12 people experiencing or who had experienced pressure injury were interviewed. One person said: 'You tend to think that pain is a question of mind over matter, but it isn’t. There’s nothing, apart from taking the pain killers. You are at its mercy. And pressure sores are relentless. . . . the pressure ulcer is there 24 hours. And it doesn’t matter where you sit, where you lie, where you turn, it’s there, there’s no getting away from it.' Another person was more specific: 'Like there’s glass in it, that’s what that feels like. All the time, like I’ve got glass in my foot. It just rubs all the time. It’s horrible. Stings as well as rubs and they just cover it up.' The unbearable nature of the pain was expressed by someone who said: 'The one thing that’s consuming me at the moment is the pressure sore. Everything else fades into insignificance, the fact that your heart might stop at any moment doesn’t worry me as much as the pressure sore. It’s consumed me in the last two to three weeks. . .'

The authors concluded: 'Our findings suggest that both the assessment of pain and the subsequent
management of the pain were not well managed in this patient group' and '(t)here is clearly a need for revised nursing policy and practices with better assessment and recognition of risk to reduce (pressuse injury) developing, strong patient advocacy and involvement to ensure optimal pain management strategies are in place and adhered to.

You can listen to this as a podcast


Jackson, D., Durrant, L., Bishop, E., Walthall, H., Betteridge, R., Gardner, S., Coulton, W., Hutchinson, M., Neville, S., Davidson, P. M. and Usher, K. (2017), Pain associated with pressure injury: a qualitative study of community based, home-dwelling individuals. J Adv Nurs. doi:10.1111/jan.13370

Friday, 30 June 2017

How Much More Evidence Do We Need about Nurses’ Work Environments?

Ann-Marie Urban

Over three decades of research, monies, attention and recommendations highlight how the working conditions influence nurse turnover, retention, cost and more recently as highlighted in the recent virtual issue on nurses’ health. Gallagher and Pickler note the importance of healthy diets and stress management as part of improving nurses’ health, however, it is important to recognize the problematic work environment that continues to influence nurses’ health and their work. The realities of many work environments do not allow nurses to practise in a safe and caring way much of the time. Unfortunately, it requires nurses to be productive, expedite discharge, manage increasing complex patients and practise within a traditional hierarchical structure. Sadly, this disconnect has created nurses who are increasingly sick, stressed, bullied, burned out and morally fatigued.

What will the conditions be like in another decade? While nurses know that they work in the adverse conditions of acute care, they may not understand how they contribute to and are organized to meet institutional demands. Increasing patient acuity, budget constraints, a chronic shortage of staff, and overcrowding are routine in hospitals, yet no one discusses how this influences nurses’ work except when discussing nurses as stressed, fatigued or comprising patient care. Nurses are placed in situations where they lack the time, the resources and, in some cases, even the knowledge to care for patients. Because of these problems every year nurses suffer mental and physical injuries which are largely preventable. And sadly but not widely acknowledged, because the majority of nurses are women, this work is expected. Patriarchal underpinning and gendered assumptions situate nurses and their work in a quagmire of persistent problems with strategies focusing on nurses rather than on the system. While the nurse and nurses’ work have been widely studied, a focus on gender related to nurses’ physical and mental health is lacking. Understanding the realities and acknowledging the actualities of nurses’ work in hospitals are key to change. However, before a new reality will be realized, embedded assumptions about nurses and their work must be acknowledged by government, hospital managers and nurses. Similarly, nurses’ work must be understood within the context of the moving political and economic agendas. Further attention must be directed to the nurse’s work environment and how this influences patient care and the health of nurses.

Although efforts to improve the conditions in hospitals have been attempted, few strategies effectively support nurses’ health in their efforts towards patient care in the context of today’s hospitals. What has to change for hospital administrators, governments, professional associations, unions and researchers to notice and make changes? Is it not enough that nurses’ illness and injuries continue to be a problem, and that patient care is compromised? The existing traditional structure must be challenged to embark on another way. Supporting nurses’ health is vitally important for their overall well being for the care of patients.

A new structure would recognize nurses’ work by shifting their participation to a collaborative decision-making team. Different models of care delivery would move nurses to autonomous roles such as patient education, admission and discharge coordinators and patient advocates or to a model that incorporates an expanded role for nurses. Nurses and their work must also be understood within a broader sociopolitical context. Creating a collective awareness about the influencing powers could provide the space for discussion and possibilities for change. The gendered aspect of nursing must also be acknowledged as well as how nurses actively participate in maintaining their place in the hospital. Nurses, too, must realize other possibilities; they must realize that they do not have to become injured, stressed or leave the profession because of the patriarchal and political ruling. Untangling power will take time; however, if we begin to recognize and name it, nurses’ work has the potential to change.

Ann-Marie Urban, RN, RPN
Associate Professor
Faculty of Nursing, University of Regina,

Wednesday, 28 June 2017

Should residents in care homes have sex?

Roger Watson, Editor-in-Chief

My answer to the question that heads this entry is 'why not?' However, this entry covers an article from New Zealand by Cook et al. (2017) titled: 'Ethics, intimacy and sexuality in aged care' and published in JAN. The study on which the article is based aimed to: 'analyse the accounts of staff, family and residents to advance ethical insights into intimacy and sexuality in residential care.' Four  people, including a resident, were involved and interviewed.

With regard to the possibility of intimacy, the resident said: 'No. Couldn’t do anything here because if the door opened and somebody like [manager] walked in I’d be mortified. There are no locks on the door, as you notice. . .So there really is no privacy here at all . . .. I don’t feel like I’m home.' A care assistant expressed uncertainty about what to do with regard to sexuality: 'It [sexuality-related issues] does happen, I’ve seen it happen and nobody talks about it and, we’ve got to make a judgement call, which I have done on a few occasions. . ..and you just don’t know which is the right way . . ..'  The Registered Nurse was aware that some older people may be exploited but said: 'As long as they’re not being taken advantage of and I think for some it can open up new relationships, new caring. Again, when we talk about this everybody thinks of [penetrative] sex. . .but sometimes just to sit, cuddle, kiss, stroke, whatever, that’s more than enough for a lot of them.'

In conclusion, the authors said: 'The topic is complex: too often ageism shapes assumptions about older people’s entitlement to be intimate; where there is cognitive impairment, the debate about upholding the preferences of the “then” self or the well-being of the “now” self may result in conflict among decision-makers; proxy decision-makers may have limited knowledge of the resident’s lifetime of sexual preferences. Education and policies upholding rights may increase staff awareness beyond their own moral code. However, rigid policies may work against residents’ wellbeing. Instead, flexible responses that focus on person-centred wellbeing rather than a risk management approach are desirable.'

You can listen to this as a podcast


Cook, C., Schouten, V., Henrickson, M. and Mcdonald, S. (2017), Ethics, intimacy and sexuality in aged care. J Adv Nurs. doi:10.1111/jan.13361

Fatigue leads to nursing absence

Roger Watson, Editor-in-Chief

Fatigue and the work involved in nursing are closely related, but does fatigue lead to adverse outcomes for nurses? An article from the USA by Sagherian et al. (2017) titled: 'Acute fatigue predicts sickness absence in the workplace: A 1-year retrospective cohort study in pediatric nurses' and published in JAN came from a study that aimed to: 'examine the relationship between fatigue and sickness absence in nurses from a paediatric hospital over 12 months of follow-up. A secondary aim was to identify other work and personal factors that predict sickness absence.'

Forty children's nurses were involved and adminstered a measure of fatigue. Then they were followed up to check on their work patterns. The study showed that the extent of fatigue at the start of the study could predict sickness absence from work; nurses who were more fatigued were more likely to experience sickness absence. In conclusion, the authors say: 'Nursing management can monitor nurse fatigue and unit workloads to decrease this unfavourable outcome and consequently maintain safe practice environments.'

You can listen to this as a podcast


Sagherian, K., Unick, G. J., Zhu, S., Derickson, D., Hinds, P. S. and Geiger-Brown, J. (2017), Acute fatigue predicts sickness absence in the workplace: A 1-year retrospective cohort study in pediatric nurses. J Adv Nurs. doi:10.1111/jan.13357

Tuesday, 27 June 2017

Are nursing students angry people?

Roger Watson, Editor-in-Chief

The answer to the question is that they are more angry than other university students according to this article from Korea by Jun et al. (2017) titled: 'Comparing Anger, Anger Expression, Life Stress, and Social Support Between Korean Female Nursing and General University Students' and published in JAN which aimed to: 'compare anger, anger expression, life stress and social support among female students at a nursing university and a general university and to examine factors affecting anger in each group.'

Nearly 300 female university students, approximately divided into two equal groups of nursing students and other university students participated in the study which required them to complete a questionnaire on anger and sources of anger. The results showed that: '(n)ursing students’ anger scores were slightly higher than the scale’s median value but significantly higher than general students’ scores. Additionally, nursing students’ anger scores in this study were higher than those recorded by homeless people (who commonly reported alcohol problems and difficulty maintaining peer and familial relationships) using the same scale...' The reasons for the higher levels of anger in the nursing students was not clear but it may be the nature of their programme, as the authors explain: 'South Korean nursing students must complete large amounts of homework in each major course to satisfy nursing program certification standards set by the Korean Accreditation Board of Nursing Education.'

In conclusion the authors say: 'High levels of anger in health care providers may lead to poor mental health and reduced care quality. It is therefore particularly important to manage anger among nursing students' and '(a)nger expression and same-sex peer relationships affected nursing students’ anger...(t)herefore, nursing training programs should aim to reduce their students’ same-sex peer relationship stress and provide beneficial anger expression techniques.'

You can listen to this as a podcast


Jun, W. H. and Lee, G. (2017), Comparing Anger, Anger Expression, Life Stress, and Social Support Between Korean Female Nursing and General University Students. J Adv Nurs. doi:10.1111/jan.13354

Monday, 26 June 2017

Stress in newly qualified nurses

Roger Watson, Editor-in-Chief

Nurses are know to suffer stress and the period after qualification and entering clinical practice is an especially stressful period. This UK study by Halpin et al (2017) and published in JAN aimed to: 'investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months postqualifying.' The study was titled: 'A longitudinal, mixed methods investigation of newly qualified nurses’ workplace stressors and stress experiences during transition.'

Nearly 300 nurses completed a stress questoinnaire and were interviewed when they qualified and were followed up at 6 (over 100 nurses) and 12 months (over 80 nurses) after qualifying. While stress did not change significantly over the study, at each phase of the study 'workload' was the highest source of stress. Nurses reported being 'terrified' at the start; as one nurse said: 'When you first start obviously you are terrified because you are suddenly feeling responsible for everybody, all your patients. Just the overall feeling of the weight of responsibility, that stresses me.' They also did not like appearing not to know everything and one nurse said: 'It’s quite hard to say to some people, ‘sorry, I’m newly qualified’ because they just want answers then and there, so that’s added stress as well for me.'

In the words of the authors: 'Many of the stressors experienced by the participants had the potential to inhibit a successful transition. The results showed that the participants experienced a broad range of stressors throughout their first 12 months postqualifying resonating with the outcome of previous international studies...' In conclusion, the authors said: 'Planned, regular, constructive feedback from the (newly qualified nurse)’s manager would assist with personal development and the early identification of work-related stressors. Organization based training to improve effective and civil team-working together with a clear strategy to report and address incivility would also be beneficial. Healthcare experience prior to commencing nurse education appears to be a personal asset and is worthy of further research as it implies a change to pre-registration recruitment strategies should be considered.'

You can listen to this as a podcast


Halpin, Y., Terry, L. M. and Curzio, J. (2017), A longitudinal, mixed methods investigation of newly qualified nurses’ workplace stressors and stress experiences during transition. J Adv Nurs doi:10.1111/jan.13344

Friday, 16 June 2017

Addressing the needs of first-time fathers

Roger Watson, Editor-in-Chief

Childbirth is time when attention is, rightly, focused on the woman and the baby. But what about the father and, esepecially, first-time fathers? What are their needs and how can they be addressed? This is  the topic of an article from Singapore by Shorey et al. (2017) titled: 'First-time fathers’ postnatal experiences and support needs: A descriptive qualitative study' and published in JAN.

The study aimed to: 'explore first-time fathers’ postnatal experiences and support needs in the early postpartum period'. Fifteen first time fathers were interviewed  and, hardly unexpectedly, the researchers found: '1) No sense of reality to sense of responsibility, (2) Unprepared and challenged, (3) Support: needs, sources, experience and attitude and (4) Future help for fathers'. For example, one father said: 'One thing that we want to do (as a father) is to get more involved. But, another thing, maybe, from the hospital or from institutes, is telling us what we have to do. So, to be more aware, involve us more so that we will feel more important (laugh)'. The authors concluded: 'This study provides empirical evidence on the experiences and support needs of first-time multiracial fathers in Singapore. The fathers in this study underwent a series of emotional and personal challenges during their transition to fatherhood in the early postnatal period. They shared their support needs and the desire to be considered as an integral part of their family by Singapore healthcare professionals, especially nurses and midwives'.

You can listen to this as a podcast.


Shorey, S., Dennis, C.-L., Bridge, S., Chong, Y. S., Holroyd, E. and He, H.-G. (2017), First-time fathers’ postnatal experiences and support needs: A descriptive qualitative study. J Adv Nurs doi:10.1111/jan.13349

Wednesday, 7 June 2017

Are nurses fit to work?

Roger Watson, Editor-in-Chief

How fit are nurses compared with those they look after - the general population, and what happens to nurses' fitness when they work as nurses? That was the focus of a study from Australia by Perry et al. (2017) which aimed to: 'examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave'. The outcome of this study is an article published in JAN titled: 'Health, workforce characteristics, quality of life and intention to leave: The ‘Fit for the Future’ survey of Australian nurses and midwives'.

Physical and mental health in over 4,500 nurses was studied over two years in New South Wales and compared with the general public and the characterstics of the nurses related to their fitness was examined. The results showed that nurses were more physically fit than the general public but less fit in terms of mental health. Nurses became less physically fit as they aged but reported better mental health. Nurses with poor mental health were more likely to want to leave their job.

The authors concuded: 'The study provides evidence for nursing/midwifery managers, researchers, decision-makers and policy-makers, and advocates for the development and implementation of targeted interventions for the nursing and midwifery workforce. Findings indicate potential benefit in terms of staff quality of life and workforce retention, for interventions focused not only on mental health, well-being, coping and resilience particularly but also on better sleep, pain reduction, smoking cessation and general health screening/health promotion.

You can listen to this as a podcast


Perry, L., Xu, X., Duffield, C., Gallagher, R., Nicholls, R. and Sibbritt, D. (2017), Health, workforce characteristics, quality of life and intention to leave: The ‘Fit for the Future’ survey of Australian nurses and midwives. J Adv Nurs. doi:10.1111/jan.13347

Tuesday, 6 June 2017

Can a nurse who smokes promote health?

Roger Watson, Editor-in-Chief

Does it matter if a nurse smokes? Will they be effective at health promotion? This was the subject of an article from Spain which was based on a study aiming to: 'explore the views of current and ex-smoker nurses on their role in supporting patients to stop smoking.' The article by Mijika et al (2017) was titled: 'Health professionals’ personal behaviours hindering health promotion: A study of nurses who smoke'.

The study used interviews with nurses who had or who still smoked in one hospital in Spain. The views of the nurses varied; one nurse who thought it made no difference said: 'I think that in terms of patients it (being a nurse who smokes) doesn’t have an impact (on the care provided to the patient), I mean . . . the patient knows, when you are at work you are a nurse...'. But another disagreed, saying: 'I think it does have an impact. I think it does. [. . .] For example, if a patient is trying to quit and has a lung cancer and a smoker nurse who smells of tobacco approaches him advocating for something that she’s doing wrong. . ., that has to provoke some kind of reaction in the patient.' Even in the face of patients ill from a smoking related disease, nurses were able to justify smoking: 'I have experienced situations like when you are taking care of a patient who is very ill, grasping for breath, with a lung cancer, the family very uptight, with...very bad...and I have got out and said “I’m going to smoke.” I mean situations that overwhelm you, that you can’t control with medication, that you can’t control...that affects your human nature, you know?'

The authors concluded: 'Nurses with an unhealthy behaviour such as smoking experience
internal processes that might have a negative impact when engaging in health promotion practice. Smoking nurses may be inhibited as health promoters without noticing it, and they may need help to
address the conflict that they experience between their professional responsibility and their smoking behaviour. If health promotion practices are to be enhanced, interventions that help these health professionals are necessary.'

You can listen to this as a podcast


Mujika, A., Arantzamendi, M., Lopez-Dicastillo, O. and Forbes, A. (2017), Health professionals’ personal behaviours hindering health promotion: A study of nurses who smoke. J Adv Nurs.  doi:10.1111/jan.13343

Monday, 5 June 2017

Response to commentary on Blake, Stanulewicz & McGill (2017) Predictors of physical activity and barriers to exercise in nursing and medical students

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

Holly Blake
Natalia Stanulewicz
Francesca McGill

On the May 10th 2017, JAN interactive published a commentary on Blake, Stanulewicz and McGill (2017) by Chappel et al. (2017). The authors of the commentary raised two main concerns regarding the study:(1) a possible misinterpretation of physical activity (PA) as solely “formal exercise” by the participants, and (2) a questionable extrapolation of the proposal for the need for PA interventions from student to staff nurse populations.

Regarding the first concern, the IPAQ-SF has been established as a reliable measure (e.g., Craig et al., 2003), that has been employed extensively across populations, cultural groups and demographics, and is extensively utilised worldwide. It was the preferred measure for use in this study due to its short format and ease of use, and has been described as ‘the most appropriate outcome measure for clinical and research use, as it has excellent reliability and moderate correlation with accelerometry’ (Silsbury et al, 2015).

We cannot report on exactly how participants interpreted the individual IPAQ-SF items in this online survey, although the measure includes items relating to walking, and vigorous or moderate intensity activities, and examples of activities were provided. Importantly, our participants were healthcare students, who receive education and training around health behaviours as part of their studies. At the institution where the data were collected, this includes both the distinction between types and levels of PA, and the relevance of work-related PA (including incidental activities) and their contribution to overall daily activity. Therefore, recognising there will be individual variation in the retention of learning, the overall potential for misinterpretation of PA and what it entails is likely to be low, or certainly lower in this sample than for other populations. For nurses, health promotion is a core aspect of their future professional role and as such is emphasised early in the first year of training.

We accept that PA may be either under, or over-reported using self-report measures, and that objective data is required to accurately measure PA levels. We do not dispute the potential for under-reporting of PA, although a systematic review of the validity of the IPAQ-SF including 23 studies, found that in almost all of the included studies, PA was actually overestimated using the IPAQ-SF by 36-173% (Lee et al, 2011).

Chappel and colleagues were concerned about extrapolating from student nurse to nurse populations, given the likelihood of higher PA in nurses within clinical settings. However, we remain convinced that our recommendations, based on our student sample and taken in context alongside the published literature, remain highly relevant to nurses as well as students of nursing.

First, workplace PA interventions can generate benefits in a range of occupational groups (see review by Anderson et al, 2009) including occupations incurring highly physical demands, such as home care workers (Pohjonen & Ranta, 2001). Physically demanding work does not necessarily have positive effects on physical fitness and so worksite PA intervention may offer additional benefits beyond work-related activities Further, we make no claim in our article that nurses and healthcare students are one and the same, although it is of clear relevance that all of the nursing students who completed our survey were registered on courses involving integrated clinical placements, and were regularly working alongside registered nurses in diverse clinical areas; therefore it follows that they may be exposed to similar work-related physical activities, and they were asked to report their activities with relation to clinical placements as well as university time.

Second, if high levels of work-related PA are observed in nurses (note: we do not know how this compares with students PA whilst on shifts), or if registered nurses self-report higher levels of PA than student nurses, we feel it would be unwise to focus only on the differences between the two populations in debating where to target PA intervention. The published evidence suggests that barriers to exercise reported by both groups can be similar, and that many nurses and students [a] do not meet government recommendations for daily PA, [b] are overweight or obese, and [c] report that their own health habits can impede their willingness to promote PA to patients. This sits clearly in line with the national call for health improvement of the health and medical force made in the 2010 Prime Minister’s Commission on the Future of Nursing and Midwifery in England, and the current government investment in health and well-being through the NHS Five Year Forward Plan.

With efforts to increase retention of nursing graduates, there is an increasing drive to instil healthy lifestyle behaviours in student nurses to ensure a healthy public health workforce for the future. This may help to establish patterns of healthy behaviours early on that will continue into the nursing career, and be promoted to patients and their families. Patterns of health behaviours that are established early on are likely to continue beyond registration and through the nursing career. Orr et al (2014) propose that PA positively correlates with motivation, well-being, coping and positive attitude, and that these attributes in turn impact on employability, retention and absence; they advocate that poor health and well-being of nurses may present risks around fitness to practice and may even breach the Nursing and Midwifery Council (NMC) Code of Conduct. These are all relevant factors for students and nurses, and for the transition between the two roles; and so it would be challenging to claim that these populations were unrelated.

Thus, we propose that health behaviours should be advocated and supported from student through to registered nurse rather than focusing solely on [i] either group, or [ii] the potential differences in PA between groups becoming determinants of whether it is timely to offer services, to which group, and to the exclusion of the other. Because of this we strongly disagree that it is premature to advocate PA intervention for nurses in the NHS workplace informed by findings from our sample, which sits alongside a wealth of published research evidence and national government-funded workplace intervention programmes.

Both nurses and nursing students consistently report low levels of PA, high levels of overweight and obesity, and barriers to healthy lifestyles influenced by common variables such as time pressure and shift work. We now need to move forwards in supporting healthcare professionals (of the current and next generation) to make healthy lifestyle choices. In workplace health practice, service commissioners do not necessarily distinguish between nurses and trainees who are not yet registered when it comes to promoting health – they all contribute to NHS healthcare through the profession of nursing, and can all access the same workplace physical activity interventions (see Nottingham University Hospitals NHS Trust as an exemplar of NHS well-being: Blake et al, 2013) and a ‘flagship’ trust in the UK Department of Health Five Year Forward Plan.

The ultimate goal of promoting PA to nurses or student nurses is broadly the same: to protect the physical and mental health of individuals, to reduce unnecessary burden to the NHS, and to support high quality patient care.

Dr Holly Blake
School of Health Sciences
University of Nottingham, UK

Natalia Stanulewicz
Department of Psychology
Durham University, UK

Francesca McGill, RN
Alder Hey Children’s Hospital
Liverpool, UK


Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, Johnson DB, Buchanan LR. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. Am J of Prev Med. 2009 Oct;37(4):340-57. doi: 10.1016/j.amepre.2009.07.003.
Blake H, Zhou D, Batt ME. Five-year workplace wellness intervention in the NHS. Perspect Public Health. 2013 Sep;133(5):262-71. doi: 10.1177/1757913913489611.
Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB.
Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International PA Questionnaire Short Form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act. 2011 Oct 21;8:115. doi: 10.1186/1479-5868-8-115.
Orr J, McGrouther S, McCaig M. Physical fitness in pre-registration nursing students. Nurse Educ Pract. 2014 Mar;14(2):99-101. doi: 10.1016/j.nepr.2013.10.002.

Pohjonen T, Ranta R. Effects of worksite physical exercise intervention on physical fitness, perceived health status, and work ability among home care workers: five-year follow-up. Prev Med. 2001 Jun;32(6):465-75.

Silsbury Z, Goldsmith R, Rushton A. Systematic review of the measurement properties of self-report PA questionnaires in healthy adult populations. BMJ Open 2015;5:e008430. doi:10.1136/bmjopen-2015- 00843

Wednesday, 31 May 2017

Nurses' Health Virtual Issue

The American Nurses Association has declared 2017 the Year of the Healthy Nurse. In recognition of this, JAN has put together a special Virtual Issue, comprised of previously published papers addressing key areas of nurses’ health, including the connection between health, workplace participation and strategies nurses use to self-manage their health and well-being.

All the JAN articles in the Virtual Issue will be free to access until 12 November 2017:

Breastfeeding in the face of domestic violence

Roger Watson, Editor-in-Chief

Can mothers continue to breastfeed if they are experiencing domestic violence? If so, what effects does it have on them? This was the topic of  an article from from Sweden by Finnbogadóttir and Thies-Lagergren (2017) titled: 'Breastfeeding in the context of domestic violence – a cross sectional study' and published in JAN aimed to: 'determine the differences in breastfeeding among women who did and did not experience domestic violence during pregnancy and postpartum in a Swedish context. In addition, to identify possible differences regarding breastfeeding between groups with or without a history of violence. Further, determine the relationship between exclusive breastfeeding and symptoms of depression'. Over 700 women resopnded to a questionnaire.

In fact, the majority of women experiencing domestic violence continued to breastfeed and this was no different from women not experiencing it. However, women who were depressed breastfed significantly less. This, of course, does not mean that women exeperiencing domestic violence did not experience difficulties with breastfeeding - but this was not part of the present study. It is still important to screen for domestic violence and also for depression. In conclusion the authors said: 'Not only is it desirable to recognize women who are exposed to violence but also crucial to identify and screen for depression in early pregnancy to give suitable treatment and support to those with symptoms of depression as the health of newborns depends on their mother’s mental well-being.

Yiou can listen to this as a podcast


Finnbogadóttir, H. and Thies-Lagergren, L. (2017), Breastfeeding in the context of domestic violence – a cross sectional study. J Adv NursDO10.1111/jan.13339

Tuesday, 30 May 2017

Using social media to recruit nurses

Roger Watson, Editor-in-Chief

Nursing organisations and hospitals were slow to adopt social media and some hospitals even had Twitter accounts and Facebook pages while prohibiting their employees from making any mention of their work in their own social media pages. However, while employees are expected to behave responsibly, there is much greater recognition of the use of social media in nursing and healthcare. But can hospitals use social media to make themselves more attractive to potential employees? 

An article from Belgium by Carpentier et al (2017) titled: 'Recruiting nurses through social media: Effects on employer brand and attractiveness' and published in JAN addresses this issue. The study on which the article is based aimed to: 'investigate whether and how nurses’ exposure to a hospital’s profile on social media affects their perceptions of the hospital’s brand and attractiveness as an employer'. Specifically, the study looked at one hospital's use of Facebook and LinkedIn to promote themselves and sent out questionnaires to nursing students and qualified nurses to look at how attractive the hospital was as an employer.

The results show that: '(n)urses’ exposure to the hospital’s Facebook or LinkedIn page had a significant effect on a majority of the employer brand dimensions' which included aspects such as image and attractiveness. Also, 'nurses who visited the Facebook page felt more attracted to working at the hospital. Most of these effects were mediated by social presence.'  In conclusion, the authors say: 'This study indicates that hospitals’ investments in social media can be justifiable because they can have a positive effect on potential applicants’ organizational attractiveness and employer brand perceptions.'

You can listen to this as a podcast


Carpentier, M., Van Hoye, G., Stockman, S., Schollaert, E., Van Theemsche, B. and Jacobs, G. (), Recruiting nurses through social media: Effects on employer brand and attractiveness. J Adv Nurs. Accepted Author Manuscript. doi:10.1111/jan.13336

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


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


Tomlinson JPinkney JAdams L, et al. The diagnosis and lived experience of polycystic ovary syndrome: A qualitative studyJ Adv Nurs. 2017;00:19

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
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
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
Twitter: @BradAisbett

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


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.