'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.

Management of work stress and burnout among community nurses arising from the COVID-19 pandemic.

The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Life is for living: the contribution of the arts and gardens.

Quality of life and life enrichment are important throughout the lifespan and no less during ill-health or later life. The role of the arts and gardens and their potential benefits are not prominent within healthcare practice. This paper outlines the evidence reported in two literature reviews, one addressing the arts and the other focusing on gardens and gardening so that district nurses can understand what art-based and gardening opportunities they may offer their clients and their carers.

Falls and older people: preventative interventions.

Falls among older people are a major public health challenge, because the sequelae of falls can be severe, both in terms of mental and physical health repercussions. Building on an earlier article that discussed the reasons why older people fall, this article describes the interventions that may help reduce falls among older people. Four interventions which could be applied within UK community settings, namely, the Otago programme, the falls management exercise programme, tai chi and home assessment and modification are outlined here. District nurses are well placed to contribute to a reduction in falls among older people by identifying those susceptible to fall risks among their clients and putting in place the necessary interventions to minimise them.

Falls and older people: understanding why people fall.

Falls are common among older people and a major public health challenge. This article describes why falls are more common among older people, the potential causes of falls and what assessments should be undertaken to inform preventive interventions. District nurses are well placed to contribute to the understanding of why an older person has had a fall as part of a falls risk assessment.

Healthcare transition for adolescents and young adults with long-term conditions: Qualitative study of patients, parents and healthcare professionals' experiences.

AIM AND OBJECTIVES: To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND: Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN: Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS: Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS: Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS: The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE: Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.

The impact PICU nursing expertise has on a child's unplanned extubation.

BACKGROUND: Unplanned extubations in PICU are used as a measure of quality in clinical governance strategies. While many factors, such as sedation or unit activity, impact negatively on unplanned extubations, high nurse-patient ratios reduce adverse patient events and improve patient safety. However, optimal nurse-patient ratios and the impact of the level of nursing expertise on the quality of care are unknown. AIM: The study aimed to examine the impact of PICU nursing expertise on the unplanned extubations of children. DESIGN: Audit and analysis of existing adverse event patient and nurse workforce data. METHOD: This single-centre study examined unplanned extubations at a mixed general and cardiac tertiary PICU in the UK. Routinely collected data from nursing and adverse incident databases were examined. The dataset included over 74,477 nurse allocations between August 2006 and April 2011. Unplanned extubations were the adverse event of interest. RESULTS: A total of 78 unplanned extubations occurred between April 2006 and April 2011. The majority of unplanned extubations occurred when patients were looked after by junior nurses. The seniority of the nurse in-charge and the qualifications of the patient's nurse were not related to unplanned extubations. However, more unplanned extubations occurred at times of higher patient occupancy. CONCLUSIONS: Nursing expertise and nurse-patient ratios were not related to unplanned extubations in this study. Further research is needed to explore the non-workforce factors such as the securing of endotracheal tubes, sedation levels and unit activity and their relationship with adverse events. RELEVANCE TO CLINICAL PRACTICE: In paediatric intensive care units where nurse-patient ratios are high, further investigation is needed to establish what impact non-workforce factors have on unplanned extubations.

Nurses' attitudes towards older people and working with older patients: an explanatory model.

AIM: To establish an explanatory model of registered nurses' attitudes towards older people and working with older patients. BACKGROUND: Increasing demands for health-care from an ageing population will require a higher proportion of nurses who have positive attitudes towards older people and like working with older patients. METHOD: A convenience sample of registered nurses (n = 579; 79.3% response rate) attending continuing professional education courses within a large university in London was surveyed from October to December 2011. RESULTS: Registered nurses expressed positive attitudes towards older people and 89.7% reported positive attitudes towards working with older patients. The variables of self-ageing anxiety, attitudes towards health-care resource allocation, knowledge of ageing, ethnic group, job title, attitudes towards older patients and interaction between ethnic group and attitudes towards working with older patients explained 42.6% of the variance in attitudes towards older people. Factors, including attitudes towards older people, self-ageing anxiety, commitment to nursing, attitudes towards health-care resources allocation among older people and clinical specialty explained 16.7-34.3% of the variance in attitudes towards older patients. CONCLUSION: The models identified several related factors that may help in the selection and management of nurses for caring older people. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings highlight the importance of investing in continuing education related to gerontological nursing and the ageing process so that there is a growing pool of registered nurses who wish to care for older patients.

Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China.

PURPOSE: There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements. However, little is known about the quality of life (QoL) of older people living alone in Mainland China. This study aimed to investigate QoL and its related factors among Chinese older people who live alone. METHODS: A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured questionnaire through face-to-face interviews. QoL was measured using the Older People's Quality of Life Questionnaire. Other data collected included self-rated health, physical health, cognitive function, depression, functional ability, loneliness, social support, physical activity, health services satisfaction, satisfaction with overall dwelling conditions and socio-demographic variables. RESULTS: Older people living alone in Mainland China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, previous occupation and health services satisfaction were independently related to QoL, accounting for 68.8% of the variance. Depression and previous occupation had an interaction effect upon QoL. CONCLUSIONS: This study identified nine factors influencing the QoL of older people living alone in Mainland China. Interventions to increase satisfaction with dwelling conditions, improve economic level, social support and functional ability, decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their QoL.

Nurses' misperceptions of weight status associated with their body weight, demographics and health status.

OBJECTIVE: To assess the agreement between self-perceived weight status and BMI status, calculated from self-reported height and weight, in nurses and to evaluate the relationship between weight status misperceptions and personal body weight, demographics and health status. DESIGN: Cross-sectional questionnaire survey. SETTING: A large university in London, UK. SUBJECTS: Four hundred and fifty-six student nurses and 588 qualified nurses attending university were surveyed; 355 student nurses and 409 qualified nurses completed questionnaires representing a response rate of 78 % and 70 %, respectively. RESULTS: The respondents were mainly female (90·0 %), 66·5 % were white and their mean age was 31 years. Sixty-eight per cent of qualified nurses and 77 % of student nurses correctly perceived their weight status. In logistic regression, (mixed) black ethnicity (OR = 2·53, 95 % CI 1·01, 6·32), overweight by BMI (OR = 3·10, 95 % CI 1·31, 7·33) and ≥3 family histories of obesity co-morbidities (OR = 2·51, 95 % CI 1·04, 6·08) were significantly associated with misperceptions in the sample of student nurses, whereas overweight by BMI (OR = 5·32, 95 % CI 2·66, 10·67) was the only significant variable in the sample of qualified nurses. CONCLUSIONS: A substantial proportion of nurses misclassified their weight status. Nurses' misperception of weight status was related to their own BMI status, ethnic background and obesity-related family histories. Being aware of this may help nurses not only promote their own healthy weight, but also fulfil their public health role to practise weight management successfully with both patients and the public. While limitations of the sample mean that the study findings cannot be generalized, they do provide grounds for future larger-scale research.

Nurses' attitudes towards medical devices in healthcare delivery: a systematic review.

AIMS AND OBJECTIVES: To describe nurses' attitudes towards medical devices and the factors influencing these attitudes. BACKGROUND: Nurses work in an increasingly technological environment with many medical devices supporting healthcare delivery. Understanding nurses' attitudes towards medical devices is important for their successful use. There has been no published systematic review which has examined nurses' attitudes towards the use of medical devices within nursing practice. DESIGN: A systematic review including all study designs. METHODS: A search of six databases was undertaken for publications written in English dating from 1985-June 2013. The search yielded 30 studies. RESULTS: Nurses reported a multidimensional perception of medical devices. While some nurses recognised the potential contribution of medical devices to better outcomes for patients and themselves, the use of medical devices was also associated with increased personal stress, decreased autonomy and increased administrative time. The design of devices, knowledge and training relating to device management and use were identified as key factors influencing nurses' attitudes. CONCLUSION: To ensure adequate knowledge and skill, the provision of training on device management and use, together with good device designs, is essential to foster positive attitudes. Further studies focusing on developing improved understanding of nurses' attitudes are needed. RELEVANCE TO CLINICAL PRACTICE: Healthcare delivery increasingly incorporates the use of medical devices so that understanding nurses' attitudes towards medical devices is essential for their safe implementation.

Development of a competency tool for adult trained nurses caring for people with intellectual disabilities.

AIM: To develop and test a competency assessment tool for adult trained nurses caring for people with intellectual disabilities in hospital. BACKGROUND: The report 'Death by indifference' in 2007 highlighted inadequate care given to people with intellectual disabilities in hospital. This study sought to develop and test a competency assessment tool for adult trained nurses in the care of this patient group. METHODS: A review of the literature informed the topic guide for focus groups (n = 4) with experienced adult trained nurses, learning disability nurses and people with intellectual disabilities (n = 25). Expert interviews (n = 29) were conducted to identify emergent themes. A draft competency assessment tool was reviewed by an expert panel (n = 5) and tested within a convenience sample (n = 34; response rate 28%) at a local district general hospital across several clinical specialities. RESULTS: The participants considered themselves to be either 'novice' or 'competent' across most items. The tool was then redrafted and minor amendments made. 'Little or no knowledge' or 'novice' was reported in areas such as consent, diagnostic overshadowing and management of self harm. CONCLUSION: Use of the competency assessment tool will support assessment of current levels of knowledge and skills and inform educational provision of the workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Use of the competency assessment tool will inform nursing management of skill levels and educational need.

Strengthening the role of the ward manager: a review of the literature.

BACKGROUND: The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. AIM: To identify initiatives that have strengthened the ward manager role. METHODS: A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. FINDINGS: Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. CONCLUSION: The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. IMPLICATIONS FOR NURSING MANAGEMENT: The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

Older people and alcohol use.

The proportion of older people drinking alcohol above the recommended levels has been increasing in the UK. Alcohol dependency and misuse can lead to various physical and psychological problems for older people. A range of factors can influence alcohol dependency and misuse among older adults, which need careful consideration when interventions are being developed to reduce consumption. Interventions to reduce alcohol consumption among older people can include: home visits, telephone support, mentoring, one-to-one and group programmes, family and community engagement programmes, outreach programmes, and targeted support groups focused on education and social activities. There is a need for the training of community nurses focused on improving the detection (screening and assessment), treatment and service provision for older people.

Maximising influenza vaccination uptake among older people.

Older adults aged 65 years and over are particularly vulnerable to seasonal influenza as their immune system is weaker than that of younger adults. The influenza vaccination helps to reduce influenza severity and the incidence of complications, but a range of factors can affect uptake among older people. These factors can be categorised as follows: the system of vaccination; influenza vaccination mistrust and fear of side-effects; health beliefs and behaviours; and other factors. Various interventions to maximise influenza vaccination uptake among older people in the community have been identified, including: interventions to increase community demand, enhance access and improve influenza vaccination among community nurses, as well as provider or system-based interventions and societal interventions. Community nurses have been found to have a positive influence on influenza vaccination uptake and should continue to promote the benefits of influenza vaccination to their patients who are 'persistent decliners'.

Does the use of antipyretics in children who have acute infections prolong febrile illness? A systematic review and meta-analysis.

OBJECTIVE: To review the literature and test the hypothesis that the use of antipyretic drugs in children with acute infections slows recovery. STUDY DESIGN: A systematic review and meta-analysis of the literature was undertaken to investigate the effect of antipyretic drugs upon recovery from infectious diseases in children. A search of Medline (1946 until November 2012) and EMBASE (1980 until November 1, 2012) was undertaken to identify studies in which the authors compared the use of antipyretic medications with nonpharmacologic treatments for fever. RESULTS: Six papers were identified, 5 of which were included in the meta-analysis. Three studies focused on children with malaria and the other 3 considered general viral and respiratory infections and varicella. The pooled mean difference in time to fever clearance was 4.16 hours and was faster in those receiving antipyretics compared with those not (95% CI -6.35 to -1.96 hours; P = .0002). There was little evidence of statistical heterogeneity (χ(2) 4.84; 4 df; P = .3; I(2) 17%). CONCLUSION: There is no evidence from these studies that the use of antipyretics slows the resolution of fever in children.

Nurses' self-efficacy and practices relating to weight management of adult patients: a path analysis.

BACKGROUND: Health professionals play a key role in the prevention and treatment of excess weight and obesity, but many have expressed a lack of confidence in their ability to manage obese patients with their delivery of weight-management care remaining limited. The specific mechanism underlying inadequate practices in professional weight management remains unclear. The primary purpose of this study was to examine a self-efficacy theory-based model in understanding Registered Nurses' (RNs) professional performance relating to weight management. METHODS: A self-report questionnaire was developed based upon the hypothesized model and administered to a convenience sample of 588 RNs. Data were collected regarding socio-demographic variables, psychosocial variables (attitudes towards obese people, professional role identity, teamwork beliefs, perceived skills, perceived barriers and self-efficacy) and professional weight management practices. Structural equation modeling was conducted to identify correlations between the above variables and to test the goodness of fit of the proposed model. RESULTS: The survey response rate was 71.4% (n = 420). The respondents reported a moderate level of weight management practices. Self-efficacy directly and positively predicted the weight management practices of the RNs (ß = 0.36, p < 0.01), and fully or partially mediated the relationships between perceived skills, perceived barriers, professional role identity and teamwork beliefs and weight management practices. The final model constructed in this study demonstrated a good fit to the data [χ2 (14) =13.90, p = 0.46; GFI = 0.99; AGFI = 0.98; NNFI = 1.00; CFI = 1.00; RMSEA = 0.00; AIC = 57.90], accounting for 38.4% and 43.2% of the variance in weight management practices and self-efficacy, respectively. CONCLUSIONS: Self-efficacy theory appears to be useful in understanding the weight management practices of RNs. Interventions targeting the enhancement of self-efficacy may be effective in promoting RNs' professional performance in managing overweight and obese patients.

Physical activity in older people: a systematic review.

BACKGROUND: Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Little is known about the physical activity of the older adults or their compliance with current physical activity guidelines. METHODS: A systematic literature search of the published literature was conducted. Included were published reports of original research that independently reported: the PA level of non-institutional older adults (aged 60 years and over); and the proportion of older adults in the different samples who met PA recommendations or guidelines. The review was restricted to studies published since 2000 to provide a current picture of older adults' PA levels. RESULTS: Fifty three papers were included in the review. The percentage of older adults meeting recommended physical activity ranged from 2.4 - 83.0% across the studies. Definitions of "recommended" physical activity in older adults varied across the studies as did approaches to measurement which posed methodological challenges to data analysis. Older age groups were less likely than the reference group to be regularly active, and women were less likely than men to achieve regular physical activity, especially leisure time physical activity, when measured by both subjective and objective criteria. CONCLUSION: The review highlights the need for studies which recruit representative random samples of community based older people and employ validated measurement methods consistently to enable comparison of PA levels over time and between countries.

Developing complex interventions for nursing: a critical review of key guidelines.

AIMS AND OBJECTIVES: To identify the most comprehensive approach to developing complex interventions for nursing research and practice. BACKGROUND: The majority of research in nursing is descriptive and exploratory in nature. There is an increasing professional and political demand for nurses to develop and provide evidence to support their practices. Nurses need to explore current practice and develop and test interventions to provide the evidence required for safe practice. DESIGN: A literature review using a systematic approach. METHODS: The review was carried out using four databases: CINAHL, PubMed, PsycINFO and BNI (2000-2011), and the search was limited to 'brief interventions' and complex intervention development (January 2000-September 2011). Included papers reported on guidelines for intervention development or 'how' an intervention was developed. RESULTS: Six papers reported on guidelines for developing interventions. There are many similarities between the guidelines with a similar pattern of guideline development in Europe and the USA. The only guideline reported to have been used in the development of interventions is the Medical Research Council framework (MRC) (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000), with 9 of 14 papers that describe the development of an intervention reporting the use of this guideline. The other five papers did not mention the use of any guideline or framework. CONCLUSIONS: The MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework appears to be the most widely used guideline reported for developing complex interventions. Although the updated MRC (Developing and Evaluating Complex Interventions, 2008) framework adds considerably to the original MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework, other guidelines contribute additional guidance which can inform the development of nursing interventions. These additional guidelines are presented in a model for developing complex interventions for nursing. RELEVANCE TO CLINICAL PRACTICE: The model will help nurses planning to develop nursing interventions as it provides additional and nursing-specific guidance to the MRC (Developing and Evaluating Complex Interventions, 2008) framework for the development of complex interventions for nursing practice.

Development and testing of an instrument to assess nurses' knowledge, risk perception, health beliefs and behaviours related to influenza vaccination.

AIMS AND OBJECTIVES: To develop an instrument to measure nurses' knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours and evaluate its construct validity and internal consistency reliability. BACKGROUND: Although instruments to assess predictors of nurses' vaccination behaviours have been developed, their validity and reliability have not been reported. DESIGN: Instrument development and initial validity and reliability testing. METHODS: The instrument was developed drawing on a literature review and expert consultation and was refined through pilot work. A cross-sectional survey using a revised version of the instrument was conducted among a convenience sample of 520 registered nurses (response rate 77.4%). Cronbach's alpha coefficient was calculated to determine internal consistency of the sub-scale in the instrument. Principal components analysis with varimax rotation was carried out to evaluate the instrument's construct validity and examine its internal structure. RESULTS: Cronbach's alpha coefficients for the three newly developed scales ranged from 0.70-0.76. Principal components analysis produced a good fit and confirmed the internal design of the instrument. In the seasonal influenza knowledge sub-scale four factors explained 44.8% of the total variance; in the H1N1 knowledge sub-scale two factors explained 44.7% of the total variance. Three factors in the risk perception scale contributed 50.5% of the total variance and two factors in the vaccination behaviours scale contributed 62.1% of the total variance. CONCLUSIONS: An instrument has been developed to assess nurses' knowledge, risk perception and health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The instrument was valid and reliable for the setting where it was used. RELEVANCE TO CLINICAL PRACTICE: This instrument could be used to assess nurses' knowledge, risk perception, health beliefs towards influenza and influenza vaccination and their vaccination behaviours. The three newly developed scales could also be used independently to measure variables influencing nurses' vaccination practices.