Monday, 5 February 2018

Living with lupus


Roger Watson, Editor-in-Chief

According to NHS Choices: 'Systemic lupus erythematosus (SLE) – lupus – is a long-term condition causing inflammation to the joints, skin and other organs. There's no cure, but symptoms can improve if treatment starts early. The aim of this study from Denmark was to: 'explore from the perspective of women the nature of basic existential conditions while living with systemic lupus erythematosus'. The study findings are reported in an article by Lisander et al. (2018) titled: 'The Existential Experience of everyday life with Systemic Lupus Erythematosus' and published in JAN.

Fifteen women diagnosed with lupus were interviewed and it was clear that this was an episodic condition which when  it 'was flaring, well-being was threatened and a laborious time to escape the feeling of a setback-in-life persisted long after the disease was medically under control'. One woman said: '(t)o live with it and
to avoid it dominates everything. Because it affects your everyday life...' while another described how good life could be without it but said : '...I know if I suddenly get something. Then everything is on at a standstill again and it takes time before I resurface'. Women reported losses, such as a career: 'It has to do with replacing the loss, if you can put it that mundanely. The loss was a working life. It took me many
years to accept that I would never be engaged within my profession again'. 

The authors concluded: 'Generally, the findings underscore the importance of policy makers and healthcare professionals being aware of and acting according to the influence of chronic illness on life, the changes that  occur in life and especially chronically ill patients’ unique needs for care and support from diagnosis and onwards',

You can listen to this as a podcast

Reference

Larsen, J. L., Hall, E. O. C., Jacobsen, S. and Birkelund, R. (2018), The Existential Experience of everyday life with Systemic Lupus Erythematosus. J Adv Nurs.  doi:10.1111/jan.13525

Wednesday, 17 January 2018

Sexual expression in people with dementia

Roger Watson, Editor-in-Chief

There are very few studies about sex in older people with dementia. In fact, there are not many studies about sex between older people, especially in long-term care facilities although one previous JAN interactive blog entry did look at sex between older people in care homes. However, a study from Spain by Villar et al. (2017) and published in JAN aimed to: 'explore staff responses, in terms of common practices, towards partnered sexual relationships in long-term care facilities where one or both people involved have dementia'. The article from the study is titled: 'Staff's reactions toward partnered sexual expressions involving people with dementia living in long-term care facilities'.

The authors surveyed over 2000 staff in over 150 nursing homes in Spain by presenting a vignette of situations with older people with dementia in sexual situations and asking 'What do you think most of your colleagues would do in this situation?' Unsurprisingly, such situations were viewed as problematic, especially if only one partner had dementia. Older and more experienced respondents were less supportive of such sexual activity. Likewise professional and senior staff were less supportive than care assistants.

The authors concluded: 'this study adds to the body of knowledge on long-term care facility staff practices regarding the management of sexual relationships involving persons with dementia, by highlighting the lack of a consistent and prevailing supportive response to this activity and also the high frequency of restrictive practices particularly when just one person with dementia is involved' and 'providing staff with clear guidelines regarding the management of specific sexual situations might be particularly useful.'

You can listen to this as a podcast

Reference

Villar, F., Celdrán, M., Serrat, R., Fabà, J. and Martínez, T. (2017), Staff's reactions toward partnered sexual expressions involving people with dementia living in long-term care facilities. J Adv Nurs. doi:10.1111/jan.13518

Thursday, 4 January 2018

Commentary on Abuzour et al (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions


Julian Barratt

Abuzor, Lewis, and Tull (2018) have provided a much-needed comparative analysis of the different clinical reasoning processes used to support the prescribing decisions of pharmacists and nurses working in advanced clinical roles. Their main findings, namely that clinical reasoning is contextually dependent upon clinicians’ experiential and theoretical knowledge has resonance with a previous comparative study of the clinical decision-making processes of nurse practitioners and medical doctors I contributed to (Thompson, Morley, & Barratt, 2017). In that study, in contrast to the findings of Abuzor, Lewis, and Tull (2018), it was highlighted that both groups of professionals had similar approaches and cognitive models for decision-making processes, whereas Abuzor, Lewis, and Tull (2018) note that the pharmacists in their study focused on looking at medical notes and laboratory results.as the basis for their clinical reasoning, whilst the nurses prioritised examining and interacting with patients.

As Abuzor, Lewis, and Tull (2018) note pharmacists’ reluctance to examine patients is a limiting factor upon their clinical reasoning skills in comparison to other prescribing clinicians such as nurses and doctors. This limitation is important to highlight as the General Pharmaceutical Council’s indicative content of pharmacist independent prescriber programmes requires pharmacists to learn clinical examination skills relevant to the condition(s) for which the pharmacist intends to prescribe for, including recognition and responding to common signs and symptoms that are indicative of clinical problems, including the use of common diagnostic aids for assessment of a patient’s general health status, such as stethoscopes, sphygmomanometers, tendon hammers, and examination of the cranial nerves. As such clinical examination combined with focused history taking, ensures safe prescribing practice, and thus should provide the fundamental basis of clinical reasoning for all prescribing clinicians, including pharmacists; otherwise a potentially serious impediment to the quality of clinical reasoning skills could occur (Simmons, 2010).

I know from my own clinical academic work supporting experienced pharmacists to become advanced clinical practitioners, as part of the General Practice Forward View (NHS England 2016), that they are often initially reluctant to move their clinical focus away from medicines management towards engaging in clinical skills that require interacting with and touching patients, such as clinical examination. However with encouragement, guidance, and practising under supervision in the University skills lab, and with appropriate support from mentors out in practice, pharmacists can also begin to develop the same positive attitude towards the critical necessity for clinically examining patients to essentially inform their prescribing decisions that nurse practitioners and doctors typically have.

Julian Barratt
Head of Academic Business and Workforce Development
Institute of Health
University of Wolverhampton, UK
julian.barratt@wlv.ac.uk


References

Abuzour A.S.Lewis P.J.,Tully M.P. (2018) A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisionsJournal of Advanced Nursing, 74, 6574

General Pharmaceutical Council. Pharmacist independent prescribing programme - learning outcomes and indicative content [Online]. Retrieved from http://www.pharmacyregulation.org/sites/default/files/pharmacist_independent_prescribing_-_learning_outcomes_and_indicative_content.pdf [accessed 28 December 2017].

NHS England (2016). General Practice Forward View (GPFV) [Online]. Retrieved from https://www.england.nhs.uk/publication/general-practice-forward-view-gpfv/ [accessed 28 December 2017].

Simmons, B. (2010). Clinical reasoning: concept analysis. Journal of Advanced Nursing, 66, 1151–1158. doi: 10.1111/j.1365-2648.2010.05262.x

Thompson S.Moorley C., & Barratt J. (2017A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environmentJournal of Advanced Nursing, 7310971110. doi: 10.1111/jan.13206
 

Five myths about academic publishing (podcasts)

Roger Watson, Editor-in-Chief












Myth 1: you must learn to write in English

Myth 2: you can only submit a manuscript twice

Myth 3: myths surrounding publishing from MSc dissertations and PhD theses

Myth 4: journal do not like reviews

Myth 5: it is wrong to cite yourself

Tuesday, 2 January 2018

Personality and compassion fatigue

Roger Watson, Editor-in-Chief

We all have different personalities and these seem to suit us to different jobs and to influence the way we respond in certain situations. So, how does personality affect the way nurses react to their jobs and what can we learn from this?

This was the focus of an article from Taiwan by Chen et al. (2017) titled: 'The Influence of Personality Traits and Socio-Demographic Characteristics on Paediatric Nurses’ Compassion Satisfaction and Fatigue'. The article was based on a study which aimed to: 'explore the level of and the association between, compassion satisfaction and fatigue of paediatric nurses; to determine the association between personality traits and compassion satisfaction and fatigue; to identify the determinants of compassion satisfaction and fatigue'

Nearly 200 nurses completed questionnaires about themselves, their jobs and also their personality. All aspects of personality and also pursuing outdoor activities were associated with 'compassion satisfaction' (i.e. how satisfied someone is with their caregiving) but people who were conscientious, agreeable and emotionally stable were less likely to experience compassion fatigue - akin to burnout. Lower emotional stability and being single were associated with compassion fatigue. The authors concluded: 'workplace support schemes for paediatric nurses that focus on the personality trait of emotional stability and increasing social connection to realize and deal with their own experience of compassion fatigue, may help avoid the possible exacerbation of compassion fatigue at work.'

You can listen to this as a podcast

Reference

Chen, Y.-P., Tsai, J.-M., Lu, M.-H., LIN, L.-M., Lu, C.-H. and Wang, K.-W. K. (2017) The Influence of Personality Traits and Socio-Demographic Characteristics on Paediatric Nurses’ Compassion Satisfaction and Fatigue. J Adv Nurs. doi:10.1111/jan.13516

Wednesday, 20 December 2017

Why do people with oral cancer continue to smoke?

Roger Watson, Editor-in-Chief

Some might think that after a diagnosis of cancer - especially oral cancer - someone who smoked would simply quit. But that is not the case. This is the subject of an article from Taiwan by Chang et al. (2017) titled: 'Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time-matched study' and published in JAN. The study aims were: 'to compare the social support, depression, nicotine dependence, physical function and social–emotional function of those who continued smoking with those who quit smoking, by matching age and survival time and to identify the predictors of continued smoking during the survival period.'

The study 'compared 92 people with oral cavity cancer who continued smoking with 92 people who quit smoking'. The results of the study showed that those who quit: 'had significantly more social support, less depression and greater social–emotional function than the continued smoking group. People who were unmarried, received surgery without reconstruction, had poor social support and had poor social–emotional function were more likely to continue smoking. In conclusion, the authors say: 'healthcare professionals who care for people with oral cavity cancer should pay more attention to social support, psychological status and nicotine dependence-related symptoms of their participants during the survival period. In particular, healthcare professionals may be able to help people with coping and emotional regulation and especially with smoking cessation. Future research is needed to develop plans for the survival period that include assessment of nicotine dependence and instructions for smoking cessation, alleviation of nicotine dependence and enhancement of self-efficacy in coping with continued smoking.

You can listen to this as a podcast

Reference

Chang S-LLo C-HPeng H-LChen C-RWu S-CChen S-C. (2017) Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time-matched studyJ Adv Nurs2017;  https://doi.org/10.1111/jan.13506