Wednesday, 29 March 2017

Measuring intention to work with older people

A systematic review of psychometric testing of instruments that measure intention to work with older people

Che Chong Chin, Noran Naqiah Hairi, Chong Mei Chan


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

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

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

The key findings of our paper were:
  • Seven different instruments were identified for psychometric evaluation. 
  • Measures of reliability were reported in eight papers and validity in five papers. 
  • Evidence for each measurement property was limited, with each instrument demonstrating a lack of information on measurement properties. 
  • Based on the COSMIN checklist, the overall quality of the psychometric properties was rated as poor to good. Only SINOPS (Koskinen et al. 2016) achieved a good score on the methodological quality of internal consistency and structural validity. 
  • We conclude that it is not possible to recommend the most suitable instrument for measuring intention to work with older people.
Gerontological nursing education plays an important role to improve the quality of older persons care. This is done through enhancing geriatric competencies encompassing knowledge, skills and attitudes of the student nurses. Ultimately, the goal will inspire student nurses to work with older people after they graduated. As postulated in the Theory of Planned Behavior (Ajzen 1991), intention to work with older people can be used as a proxy measurement of working with older people after they graduate. Nursing educators will then be able to evaluate the effectiveness of gerontological nursing teaching and learning process by assessing students’ intention to work with older people. With this in mind, it is very important to identify a psychometrically sound instrument to measure intention towards caring for our older people.



References

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

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

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

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


Monday, 20 March 2017

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

Roger Watson, Editor-in-Chief

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

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

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

You can listen tom this as a podcast

Reference

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

Monday, 13 March 2017

Existential aspects of protected mealtimes

Roger Watson, Editor-in-Chief

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

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

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

You can listen to this as a podcast

Reference

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

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

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



Response to: Commentary on: Jøranson N., Pedersen I., Rokstad A.M.M. & Ihlebæk C. (2016) Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial


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

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

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

We are very sorry to have committed such an error.

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


Reference

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


Friday, 3 March 2017

Get Healthy!

Rita Pickler, JAN Editor

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

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

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

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

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