Monday, 13 February 2017

Fibromyalgia and sexuality in women

Roger Watson, Editor-in-Chief

Fybomyalgia is a chronic, painful disease which, in some people, has no identified cause. The physical effects are obvious and it also has severe psychological consequences such as depression. However, in the words of these authors from Spain: '(a)lthough concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms.'

The study is by Matarín Jiménez et al (2017), titled: 'Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study' and publshed in JAN. The aim of the study was: 'to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality.' The researchers interviewed 13 women and found that sexual activity could be painful. As one woman said: 'Sometimes you have to say, ‘Stop, stop, . . .you’re hurting me, I can’t do it’. Or he holds you and . . . ‘Ow, you’re hurting me!’' Anticipating such pain made contemplating sexual intercourse difficult and another woman said: 'I had a lot of discomfort doing it (coitus), some pain here (vulva) and I didn’t have one (an orgasm). I was very nervous, I couldn’t relax, I wasn’t enjoying it. How can you always explain that? It’s like...it’s a bit ridiculous.'

The authors pointed to one difficulty in conducting this kind of research which was: 'The implementation of Catholic morality in Spain makes sexuality a subject that is scarcely addressed in healthcare services.' In conclusion, they said: 'Guilt and fear have an impact on female sexuality, which becomes focused on pleasing the partner who, while desiring the woman, does not understand her.´and: '(i)n their battle to preserve their sexual health, women require support and understanding from their partner, their socio-family environment and from health professionals.'

You can listen to this as a podcast


Reference

MATARÍN JIMÉNEZ T.M., FERNÁNDEZ-SOLA C., HERNÁNDEZ- PADI L LA J .M., CORREA CASADO M., ANTEQUERA RAYNAL L.H. & GRANEROMOLINA J. (2017) Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study. Journal of Advanced Nursing doi: 10.1111/jan.13262

Successful strategies to stop smoking

Roger Watson, Editor-in-Chief

What works to help people stop smoking and to remain that way? Not surprisingly, having the desire and the self-efficacy to stop smoking are helpful and the desire to smoke makes it harder as this study from Japan by Taniguchi et al (2017) shows. The study titled: 'Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses’ counselling' is published in JAN.

The aim of the study was to: 'identify cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status after patients received smoking  intervention with nurses’ counselling.' Over 1000 participants responded to a questionnaire asking them about nicotine dependence and desire to stop smoking. The participants had all taken part in 'the Japanese smoking cessation therapy, which consists of smoking cessation intervention five times with nurses’ counselling over 12 weeks.'

The authors concluded: 'Our study indicated that having a high self-efficacy to quit smoking was associated with short-term success of quitting smoking in the smoking cessation intervention with nurses’ counselling. Continuing to have a strong desire to smoke at the end of the intervention was a significant predictor of relapse in the abstainers. Our finding suggested the necessity and importance of promotion of self-efficacy and control of postquit craving by appropriate behavioural counselling in the nurses’ intervention.'

You can listen to this as a podcast

Reference

TANIGUCHI C., TANAKA H., SAKA H., OZE I ., TACHIBANA K., NOZAKI Y.,  Y. & SAKAKIBARA H. (2017) Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses’ counselling. Journal of Advanced Nursing doi: 10.1111/jan.13258

Wednesday, 25 January 2017

Evaluating a service for abused women

Roger Watson, Editor-in-Chief

It is not easy for abused women to seek help. But what are their experiences when they do? That is the subject of a study from the UK by Bradbury-Jones et al. (2017) titled: Abused women’s experiences of a primary care identification and referral intervention: a case study analysis and published in JAN. The study aimed to: 'report the findings of a qualitative case study that investigated abused women’s experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care.' The acronym for the service is IRIS.

The study involved ten women, two of whom continued to live with the perpetrator of their abuse. The women were interviewed and the aim was to: 'elicit their experiences of the three aspects of the intervention: identification; referral; safety.' Women were 'overwhelmingly positive' about the intervention. One woman said: 'My doctor referred me. She was absolutely unbelievable. She took it very seriously. At this point I had been to every service and no-one cared. At this point I was really down and I was homeless with the kids. And I just thought ‘someone is going to help me now'.' Another woman said: 'got a lot of information that I needed because I was going through the services for the first time because I am not from Britain and so I got advice about the services so that I could use them in the future. So I know for the future and I was learning about what to do if it happened again. I just needed to know what to do in an emergency so I felt safer knowing there is help.'

In the words of the authors: 'All women in our study reported that they felt empowered by the process of being referred through IRIS. While not all chose to leave the abusive relationship, they nonetheless felt better equipped to deal with the future.'

You can listen to this as a podcast

Reference

BRADBURY-JONES C., CLARK M. & TAYLOR J. (2017) Abused women’s experiences of a primary care identification and referral intervention: a case study analysisJournal of Advanced Nursing doi: 10.1111/jan.13250

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

Reference

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.



References

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.

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.


References

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

Douglas, M. & Wildavsky, A. (1982) Risk and Culture. University of California Press, Berkeley, CA.

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