Wednesday, 14 September 2016

Drinking and pregnancy

Roger Watson, Editor-in-Chief

It is generally accepted that drinking alcohol during pregnancy is unwise due to the possibility of adverse consequences for the unborn baby.  This study from Scotland by Symon et al. (2016) titled: 'Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary' and published in JAN aimed: 'to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption.'

Over 500 women participated and, in the light of prevailing health warnings about drinking alcohol in pregnancy, the results are worrying.  As the authors explain: 'Over half the participants admitted to drinking above recommended daily limits at least occasionally in the peri-conceptual period; over a fifth did so weekly' and 'Twenty-eight women said they had drunk more than the recommended two units a day since finding out they were pregnant.' Saturday night was the most common night for drinking and: '196 women drank varying amounts of wine and 177 drank spirits. Six women admitted to drinking on their own peri-conceptually; one also said she drank on her own during pregnancy. All others said they only drank with family and/or friends.'

The authors concluded: 'We found some evidence to confirm the link between pre-pregnancy and pregnancy drinking reported in the wider literature, particularly when infrequent but heavy' and 'Existing alcohol screening instruments do not capture well the complexity of drinking patterns. As we found, some women engage in heavy episodic drinking without exceeding recommended weekly pre-pregnancy limits.'

You can listen to this as a podcast

Reference

SYMON A., RANKIN J., SINCLAIR H., BUTCHER G., BARCLAY K., GORDON R., MACDONALD M. & SMITH L. (2016) Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. Journal of Advanced Nursing doi: 10.1111/jan.13112

Nurses better than doctors - again!

Roger Watson, Editor-in-Chief

In the pages of JAN we have published several studies comparing nurse and physician led care in a range of settings and nursing frequently comes out 'on top'. A study from the USA by Lutfiyya et al. (2016) titled: ' Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?' and published in JAN aimed to address the question: 'Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)?'

Medicare records from over 53 million patients were sampled to provide, sequentially, three criteria based 5% samples to provide over 200,000 records for analysis.  The data were analysed for patient outcomes and cost and the results were very favourable towards nursing care.  The authors stated that patients cared for by nurses: '...had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare utilization, patient health outcomes and healthcare costs.'  They conclude: 'Our results, suggest nurse practitioner engagement in chronic patient management is associated with lower cost and quality care' and: 'This research might also provide direction and influence conversations taking place in other developed countries such as the UK, Canada and the Netherlands.'

You can listen to this as a podcast

Reference

LUTFIYYA M.N., TOMAI L., FROGNER B., CERRA F., ZISMER D. & S. ( 2016) Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners? Journal Advanced Nursing doi: 1001111/jan.13108

Tuesday, 13 September 2016

Extreme thinness in adolescents

Roger Watson, Editor-in-Chief

Some boys and girls are not just slim or 'thin' but extermely thin. The aim of this study from Finland by Mason et al. (2016) titled: 'Family factors and health behaviour of thin adolescent boys and girls' and published in JAN was: 'to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls.'

A large national sample of over 70,000 boys and girls (12-17) was studied and they were classed as being within the normal weight range, thin or extremely thin.  Then lifestyle and family factors were studied in relation to thinness. The results showed that more girls than boys were extremely thin and there was a range of factors such as exercise and smoking associated with this as well as family factors. Education among mothers and being familiar with the social patterns of the adolescents was associated with thinness - if parents were unfamiliar and mothers had lower education, the children were likely to be thinner. Eating a proper family meal was associated with less thinness. Smokers were also likely to be thin as were those who did not actively exercise.

The authors conclude: 'The results show thinness in adolescent girls to be more common than in adolescent boys. The results also show associations between adolescent thinness and health behaviour and family factors. These results are partly supported by previous international studies. However, longitudinal studies are needed to explain the causes of adolescent thinness' and: '(f)indings of this study can be used by both nursing and other healthcare professionals when planning and evaluating adolescents’ health check-ups or interventions in weight management, health behaviour or exercise. Nurses should be aware of the results when meeting up with adolescents and their families and discussing issues in adolescent health in clinics or at schools. For the healthcare policy makers, it is important to know that thin adolescents co-exist among their normal weight and overweight peers and the prevalence of thinness is similar to the other developed countries.'

You can listen to this as a podcast

Reference

MASON A., RANTANEN A., KIVIMӒKI H., KOIVISTO A.-M. & JORONEN K. (2016) Family factors and health behaviour of thin adolescent boys and girls. Journal of Advanced Nursing doi: 10.1111/jan.13096













Friday, 9 September 2016

How best to place a nasogastric tube

Roger Watson, Editor-in-Chief

The debate about placing nasogastric tubes continues. It was a procedure I hated carrying out and when I was a student some of my classmates volunteered to have one passed - not me!  I sincerely hope that students are no longer asked to volunteer; the procedure is not without its risks. The options for verifying placement when I was in practice were aspiration of contents (hopefully from the stomach) and testing for acidity with litmus paper followed by lisening to the stomach with a stethoscope while some air was introduced into the tube with a syringe.  If all was well you'd hear a bubbling sound; if not, the patient would cough violently and develop pneumonia.  I sincerely hope the latter practice has ceased;  x-ray was an option but I don't recall its use.

The aim of a study by McFarland (2016) titled: 'A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients' and publshed in JAN was: 'to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.'  McFarland obtained six studies using a systematic review method.  A cost utility analysis was performed and also a sensitivity analysis. The methods are described in full in the article.

The results showed that: 'the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.'

You can listen to this as a podcast

Reference

MCFARLAND A. (2016) A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients. Journal of Advanced Nursing doi: 10.1111/jan.13103

Sunday, 14 August 2016

Adjusting to being a nursing student - does alcohol help?

Roger Watson, Editor-in-Chief

Being any kind of student is not easy, especially at the start of your course. Often you have moved away from home, you are entering an unfamiliar situation and all of this may be compounded by the difficulty of the programme and financial worries. Self-doubt sets in. Nursing students experience all of this and more as they have the added dimension of having to cope with clinical work and there has never been a nursing student who wondered if and how they were going to cope.

A study from Ireland by Horgan et al. (2016) titled:'Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students' and publised in JAN aimed to: 'to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students.'  Over 400 students were involved in completing a standard and validated set of instruments and the investigators looked at the relationship between what was measured.

All the key measures in the study were related: depressive symptoms, social adjustment, personal adjustment and peer support.  The quantity of alcohol the students consumed was related to depressive symptoms but not in the way that may be expected; those who consumed more alcohol appeared to be less depressed. However, the effect of this alcohol consumption had on academic performance was not studied and the authors were not advocating the use of alcohol.  Furthemore, other studies have shown contradictory results.

The authors concluded: 'Poor mental health of nursing and midwifery students may impact on both academic and clinical performance. As such, strategies need to be put in place to support healthcare students in striving toward positive mental health and well-being. These students are the future of the healthcare system and it is important that they are able to monitor their own mental health and seek treatment when needed.

You can listen to this as a podcast

Reference

HORGAN A., SWEENEY J., BEHAN L. & MCCARTHY G. (2016) Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students Journal of Advanced Nursing doi: 10.1111/jan.13074

Thursday, 4 August 2016

Integral Option for Mitigating Conflict in Healthcare

Response to: Almost J., Wolff A.C., Stewart-Pyne A., McCormick L.G., Strachan D. & D'Souza C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505


Wesley A. Harris  BSN, RN, CCRN
Baylor Scott & White Medical Center – White Rock
Texas, USA


I recently read the Almost et al. (2016) review regarding mitigating conflict in the healthcare arena, and I would like add an additional perspective. I was an ICU nurse for eight years, but have been a facility educator for the past two. I have dealt with serious conflict resolution several times in my career (with varying degrees of success), and I am always looking for new ways to manage conflict. Of course, conflict resolution is an important aspect of leadership because there will always be dissenting opinions and unpopular viewpoints that will need to be integrated into the team.

Yi (2016) recently completed a quasi-experimental investigation to measure the impact of team building exercises on young healthcare professionals. They emphasize the importance of formal training with regards to team building in order for healthcare professionals to improve communication and therefore mitigate conflict. My facility recently mandated biennial training from the Crisis Prevention Institute (CPI) and we are hopeful we will see similarly decreased conflict in our facility as well. It is my suggestion that your readers should also advocate for a formalized team building training program if they are serious about taking further action to mitigate these obstacles.



References

Almost, J., Wolff A.C., Stewart-Pyne, A., McCormick, L.G., Strachand, D. & D’Souza, C. (2016) Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing 72(7), 1490–1505. doi: 10.1111/jan.12903

Yi, Y.J. (2016). Effects of team-building on communication and teamwork among nursing students. International Nursing Review, 63, 33-40.