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


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.


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.'

Monday, 26 December 2016

Inciting Dialogue and Disruption in Dementia – The Making of the Film ‘Michael’s Map’

Professor Charlotte L Clarke
University of Edinburgh

People with a diagnosis of dementia experience many changes to their social networks - and the dynamics of these changes and their effects were explored in a participatory secondary data analysis project funded by the Economic and Social Research Council held by Professor Charlotte Clarke and Heather Wilkinson (University of Edinburgh, UK) and in partnership with the Mental Health Foundation and Alzheimer Scotland (ES/L01470X/1 - Inciting dialogue and disruption –developing participatory analysis of the experience of living with dementia and dementia care). More information about the research is available at Talking Dementia.

Still from Michael's Map
The research re-analysed a qualitative dataset of 156 interviews with people diagnosed with dementia and their family carers which had been collected as part of the Department of Health funded study into peer support and dementia advisor roles within the National Dementia Strategy for England (see Clarke et al 2013, 2014, 2016; Keyes et al 2014). We worked with a further 35 people living with dementia to co-analyse the data, using the format of a series of four workshops with each of four groups to achieve this. An analytical framework was based on:
·         The cultural theory of risk (seeking to understand how the social organisation of communities influence the ways in which members of that community perceive and respond to risk), using Douglas’ classic group-grid analysis (Douglas & Wildavsky 1982). The ‘grid’ refers to regulation and the extent to which members of that community are expected to adopt the rules for personal and professional conduct that the community espouse. The ‘group’ refers to cohesiveness and is the extent to which individuals within a given community are bounded together and see themselves as a coherent community. 
·         An ethic of care framework, based on definitions of the five elements developed specifically for the application of an ethic of care to dementia care settings by Brannelly (2006). Our analysis began by taking the instances identified through the group-grid analysis of the data set and identifying where each of the five elements of the framework occur (attentiveness, responsibility, competence, responsiveness and trust). We then explored and mapped links between the occurrences of the five elements identified, thus tracing examples in the data set of interpersonal interaction that promote an ethic of care framework.

The key findings of the analysis were that:
·         Dementia and the effect it has on adhering to presumed but unspoken social expectations can lead to a gradual process of withdrawal of friends and withdrawing of oneself which culminates in social exclusion.
·         Peer support, which is underpinned by a different set of social expectations, can restore a sense of social inclusion and is beneficial for some people, but not everyone.
·         More attention to the collective nature of care which includes peer support, families, communities and professionals, with people with dementia recognised as playing an active role within this network, could better support social inclusion.
·         New social expectations based on co-operative listening, co-operative action, and co-operative caring could lead to solidarity with people with dementia and a society where people with dementia can be included in community, social and public life.
In this research process, the analysis moved between individual voices and composite pleural voices – firstly, having heard the ‘individual’ narratives of people living with dementia in the 156 interviews of the original dataset, and secondly worked with a further 35 people living with dementia during the secondary data analysis, the research process thirdly joins the identified research themes together in the development of a created and performed single narrative (Michael’s Map) – leaving the final voice of interpretation with yourself as audience rather than in the academic telling.   

The film, Michael's Map has been produced in a partnership between the University of Edinburgh and Skimstone Arts and is freely available at on Vimeo.

We would very much appreciate hearing about how you use the film and to what effect – so please do email me.


Brannelly, T. (2006) Negotiating ethics in dementia care. An analysis of an ethic of care in practice. Dementia 5:2;197-212.

Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Reynolds, J., McClelland, S., Hodgson, P., Corner, L. and Cattan, M. (2013)  HEALTHBRIDGE: The NationalEvaluation of Peer Support Networks and Dementia Advisers in implementation ofthe National Dementia Strategy for England. Published by the Department of Health and accessed 11/10/13

Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Corner, L. & Cattan, M. (2014) Organisational Space for Partnership and Sustainability: Lessons from the Implementation of the National Dementia Strategy for England. Health & Social Care in the Community. Published online: 22 SEP 2014 | DOI: 10.1111/hsc.12134
Clarke, C.L., Keyes, S.E., Wilkinson, H., Alexjuk, J., Wilcockson, J., Robinson, L., Reynolds J., McClelland S., Hodgson P., Corner, L. & Cattan, M. (2016) ‘I just want to get on with my life’ – A mixed methods study of active management of quality of life in living with dementia. Ageing & Society. DOI: https://doi.org/10.1017/S0144686X16001069

Keyes S.E., Clarke C.L., Wilkinson H. et al. (2014) ‘We’re all thrown in the same boat…’ A qualitative analysis of peer support in dementia care. Dementia Published online 17/4/14 DOI: 10.1177/1471301214529575

Tuesday, 20 December 2016

How do we select potential nurses?

Roger Watson, Editor-in-Chief

In the UK recently a great deal of attention has been paid to the preparation of nurses, including the initial selection process. Interviewing - despite a complete lack of evidence - appears to be the backbone of UK government policy, and this study from the UK by Traynor et al (2016) studies the use of interviews in nursing student selection. The study titled: 'Identifying applicants suitable to a career in nursing: a value-based approach to undergraduate selection' is published in JAN and aimed to: 'complement existing evidence on the suitability of Multiple Mini Interviews as a potential tool for the selection of nursing candidates on to a BSc (Hons) nursing programme.'

Over 300 undergraduate nursing students took part with over 30 assessors and used the Multiple Mini Interview which is: 'modelled on the Objective Structured Clinical Examination and consists of several stations each with a different examiner.' The results were promising in that the method appeared to be reliable between assessors. However, there was no correlation with original interview scores or with academic performance. The authors conclude: 'We have shown that implementing an (Multiple Mini Interview) based on the assessment of  values is a feasible approach to selection in undergraduate nursing' but that there is a 'need for further improvement.'

You can listen to this as a podcast


TRAYNOR M., GALANOULI D., ROBERTS M., LEONARD L. & GALE T. (2016) Identifying applicants suitable to a career in nursing: a value-based approach to undergraduate selection. Journal of Advanced Nursing doi: 10.1111/jan.13227

What do nursing support workers do?

Roger Watson, Editor-in-Chief

What do nursing support workers do that is the same or different form Registered Nurses? Nursing support workers is a general term coined by Christine Duffield - a co-author in this study from Australia - which describes nursing co-workers such as nursing assistants, care assistants and auxiliary nurses. The study by by Roche et al. (2016) and published in JAN titled: 'A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study' aimed to: 'determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not.' As explained by the authors: 'Data were collected from 10 sampled units: six in one large teaching hospital and four in two small non-teaching  hospitals. Nurses on the units were observed in randomly assigned 2 hour blocks occurring Monday through Friday between the hours of 7 am-7 pm over 2 weeks.'

The results showed that: 'Nursing support staff spent the majority of their time engaged in direct care tasks, e.g. admission and assessment, hygiene and mobility. Although licensed/regulated nurses were less likely to undertake direct care tasks compared with support workers, those who worked on units with support workers undertook more direct care compared with those who worked on units without support workers.'  The authors conclude: 'Using objective work sampling data, it was determined that direct patient care tasks were most frequently undertaken by (assistants in nursing) in a sample of medical and surgical units in (Western Australia). Evidence was also found that nursing teams supplemented with (assistants in nursing) tended to be observed providing more direct care overall compared with nursing teams without (assistants in nursing) and that both (assistants in nursing)and regulated nursing staff (RNs and ENs) contributed to this difference.'

You can listen to this as a podcast


ROCHE M. A., FRIEDMAN S., DUFFIELD C., TWIGG D. E. & COOK R. (2016) . Journal of Advanced Nursing doi: 10.1111/jan.13224

Cancer screening by nurses and midwives

Roger Watson, Editor-in-Chief

Do nurses and midwives practice what they preach about cancer screening? These professions may be at higher occupational risk of various cancers and are part of an ageing workforce so the risk of cancer is possibly higher than in other workforces. This study titled: 'The personal cancer screening behaviours of nurses and midwives' from Australia by Nicholls et al. (2016) and published in JAN aimed: 'to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake.'

Over 5000 nurses and midwives were surveyed and the data analysed to see what factors were related to cancer screening behaviours. Generally, nurses and midwives underwent cancer screening more frequently than the general population but part-time workers were more likely to do this than full-time workers and those working shifts were less likely to undergo screening than those in office-based jobs.  There were differences for the different types of cancer: breast; bowel; skin; and prostate, which are explained in the article.

The authors concluded: 'Higher participation rates in nurses, compared with the general public, are good news for the health of nurses and midwives and the community that relies on their care. Study findings suggest this ageing workforce is making protective choices which will impact their future risk of illness and premature departure from the workforce. However, findings also indicate avenues to further improve participation rates, particularly for skin and bowel cancer screening, and to ensure those thinking of undergoing screening fully understand its relative risks and benefits.'

You can listen to this as a podcast


NICHOLLS R., PERRY L., GALLAGHER R., DUFFIELD C., SIBBRITT D. & XU X. (2016) The personal cancer screening behaviours of nurses and midwives. Journal of Advanced Nursing  doi: 10.1111/jan.13221