Using FaceReader to explore the potential for harnessing emotional reactions to motivate hand hygiene.

Background: Handwashing is a key strategy for reducing the spread of infection but hand hygiene practises are often poor. Pre-testing messages prior to a campaign is expensive and time consuming. Objective: This study investigates (1) emotional reactions to handwashing messages based on four different theoretical constructs (Knowledge of Risk, Comfort, Disgust and Social Norms), (2) how images may influence emotional reactions and (3) the influence of emotion, images and theoretical construct on handwashing motivation. Methods: A novel methodology was employed whereby FaceReader, software that automatically analyses emotions, was used to identify reactions to handwashing messages. Thirty-one participants from The University of Sheffield were recruited for this laboratory study. Results: Most participants did not react strongly to any message and emotional reactions were similar for messages from different theoretical constructs. Adding images to text messages intensified some emotional reactions, particularly Happy and Disgusted for the two messages from the Disgust theoretical perspective. Moreover, participants thought that messages that used images were 1.8 times more likely to encourage handwashing. Knowledge of Risk messages (most encouraging) were 2.9 times more likely to be selected as encouraging handwashing than Comfort messages (least encouraging). An increase in the Disgusted emotion was also associated with an increase in encouragement. Discussion: This study suggests that handwashing messages should be designed to exploit emotional reactions but more research is needed to understand how to design messages for these reactions. Whether disgust is as important post Covid-19 requires future investigation. FaceReader can be usefully and inexpensively employed to pre-test handwashing messages.

Evaluating children's handwashing in schools: an integrative review of indicative measures and measurement tools.

Children are a key target of handwashing interventions as washing hands reduces the spread of disease and reliance on antibiotics. While there is guidance for evaluating handwashing with adults in other settings, this is lacking for children in schools. An integrative review of 65 studies where handwashing was measured in schools was conducted to establish which indicative measures (what is measured to evaluate the processes and/or impacts of, handwashing) and measurement tools (data collection instruments) have been applied to evaluate handwashing in schools, and under what circumstances. Further analysis highlighted different challenges when seeking to apply such measures and tools in schools, as opposed to other settings. It was concluded that indicative measures, and measurement tools need to be appropriate to the organizational setting, the study participants, and research objectives. A summative analysis of relevant considerations is presented.

Effectiveness and Efficiency of Persuasive Space Graphics (PSG) in Motivating UK Primary School Children's Hand Hygiene.

Good hand hygiene is necessary to control and prevent infections, but many children do not adequately wash their hands. While there are classroom communications targeted at children, the toilet space, the location of many hand hygiene activities, is neglected. This paper describes an initial evaluation of "123" persuasive space graphics (images and messages integrated within an architectural environment that encourage specific actions). The effectiveness (whether hand hygiene improves) and efficiency (the ease with which a setting can adopt and implement an intervention) is evaluated in three UK schools and one museum. Five evaluations (participant demographic, handwashing frequency, handwashing quality, design persuasiveness, stakeholder views) were conducted. In the school settings, persuasive space graphics increased the quality and frequency of handwashing. In the museum setting, frequency of handwashing slightly increased. In all settings children found the graphics persuasive, and stakeholders also believed them to be effective. Stakeholders considered persuasive space graphics a low-cost and time-efficient way to communicate. It can be concluded that persuasive space graphics are effective in increasing hand hygiene, particularly in school settings where children have a longer exposure to the graphics. Persuasive space graphics are also an efficient low-cost means of communicating hand hygiene.

Fostering nursing innovation to prevent and control antimicrobial resistance using approaches from the arts and humanities.

BACKGROUND: Efforts to address the complex global problem of antimicrobial resistance (AMR) highlight the need for imagination and innovation. However, nursing has not yet leveraged its potential to innovate to prevent AMR advancing. AIMS: This paper focuses on the initial phase of an ongoing research and development study that seeks to foster nursing imagination and innovation by enhancing the meaningfulness of AMR for practising nurses and by facilitating their creative ideas. METHODS: This aim is addressed through application of arts and humanities approaches, in particular the use of visualisation, co-design and historical methods, underpinned by the Design Council Double Diamond process model. The first phase with 20 UK participants explored how hospital and community-based nurses understand and respond to the priorities and consequences of AMR within their everyday working lives. RESULTS: Nurses varied in their conceptualisations of AMR and in their depictions and explanations of its meaning and priority within everyday practices. Some saw infection prevention and control as bound up with AMR, whereas others differentiated in the context of specific work activities. Insights into related reasoning and practice tactics were also generated. CONCLUSIONS: The initial project phase provides a basis for fostering nursing innovation in this important field.

Communicating Handwashing to Children, as Told by Children.

Posters encouraging handwashing would seem to offer a low-cost solution addressing barriers to handwashing in schools. However, what barriers can be successfully addressed and, how effective posters targeted at children may be is not known. In this study, using a co-design methodology, seventy-nine children (aged 6 to 11) from three English schools evaluated and generated handwashing messages in two workshops.The results were then compared with an evaluation (by the authors) of handwashing posters targeted at children. Messages that children considered most effective addressed barriers relating to reminders and encouragement, and education and information (particularly germ transmission, consequence, location and avoidance).Messages that addressed time and social norms were not considered as effective.Posters targeted at children also used reminders and encouragement, and education and information messages. However, the focus of these education and information messages was on instruction (how and when to wash hands), not on germs. Unlike the posters targeted at children, the majority of children's messages were persuasive in that they did more than simply instruct. This has implications for the design of posters and educational material in handwashing interventions.

The impact of spousal bereavement on hospitalisations: Evidence from the Scottish Longitudinal Study.

This paper estimates the impact of spousal bereavement on hospital inpatient use for the surviving bereaved by following the experience of 94,272 married Scottish individuals from 1991 until 2009 using a difference-in-difference model. We also consider the sample selection issues related to differences in survival between the bereaved and non-bereaved using a simple Cox Proportional-Hazard model. Before conducting these estimations, propensity score approaches are used to re-weight the non-bereaved to generate a more random-like comparison sample for the bereaved. We find that those bereaved who survive are both more likely to be admitted and to stay longer in hospital than a comparable non-bereaved cohort. Bereavement is estimated to induce on average an extra 0.24 (95% CI [0.15, 0.33]) hospital inpatient days per year. Similar to previous studies, we estimate the bereaved have a 19.2% (95% CI [12.5%, 26.3%]) higher mortality rate than the comparable non-bereaved cohort.

Effectiveness of interventions for preventing occupational irritant hand dermatitis: a quantitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this quantitative systematic review is to identify, appraise and synthesize the best available evidence on the effectiveness of moisturizers, barrier creams, protective gloves, skin protection education and complex interventions (a combination of two or more of the interventions listed) in preventing occupational irritant hand dermatitis (OIHD) in wet workers. These interventions will be compared to an alternative intervention or to usual care (workers regular skin care regime). The specific review question is: "What is the effectiveness of moisturizers, barrier creams, protective gloves, skin protection education and complex interventions in preventing OIHD in wet workers?"

An analysis of policy to practice initiatives in Scotland: what are the key lessons learned?

AIM: The study sought to identify and explain common issues and lessons arising from four national health policy initiatives related to nursing, midwifery and allied health professions (NMAHPs) in Scotland between 2005 and 2010. BACKGROUND: The Scottish government has been seeking effective practice developments in NMAHPs through enacting policy initiatives to improve patient care. Despite many of these initiatives being individually evaluated, no integrative systematic study has been undertaken to synthesise better understandings. DESIGN: Multiple case study design involving qualitative research was the main methodology. METHODS: The study used purposive and snowball sampling and in-depth interviews to elicit the views of 24 stakeholders. FINDINGS: This study enabled identification and explanation of key generic lessons such as internal policy alignment, good leadership and governance at all levels, effective communication, and sustainability linked to policy external alignment. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Findings highlight the importance of strategy for internal policy alignment involving top-down and cross-sectional cooperation and appraising external policy alignment when progressing a sustainable policy initiative. At all levels, leadership is important to provide clear guidance, manage different expectations and enable understanding of initiatives for enactment. Analysis of such initiatives would be useful in preparing nurse managers.

Decision precision or holistic heuristic?: Insights on on-site selection of student nurses and midwives.

Concerns about quality of care delivery in the UK have led to more scrutiny of criteria and methods for the selection of student nurses. However few substantive research studies of on-site selection processes exist. This study elicited and interpreted perspectives on interviewing processes and related decision making involved in on-site selection of student nurses and midwives. Individual and focus group interviews were undertaken with 36 lecturers, 5 clinical staff and 72 students from seven Scottish universities. Enquiry focused primarily on interviewing of candidates on-site. Qualitative content analysis was used as a primary strategy, followed by in-depth thematic analysis. Students had very mixed experiences of interview processes. Staff typically took into account a range of candidate attributes that they valued in order to achieve holistic assessments. These included: interpersonal skills, team working, confidence, problem-solving, aptitude for caring, motivations, and commitment. Staff had mixed views of the validity and reliability of interview processes. A holistic heuristic for overall decision making predominated over belief in the precision of, and evidence base for, particular attribute measurement processes. While the development of measurement tools for particular attributes continues apace, tension between holism and precision is likely to persist within on-site selection procedures.

The economic cost of bereavement in Scotland.

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.

A national study of selection processes for student nurses and midwives.

BACKGROUND: This paper presents the main findings from a project that aimed to evaluate selection processes for the recruitment of student nurses and midwives. OBJECTIVES: The main objectives were to: Design The evaluation was designed principally to achieve explanation, with multiple case study methodology adopted as the main approach. Within this ambit mixed methods of data collection involving questionnaires and interviews were used. Participants Seven of the Scotland-based Higher Education Institutions participated in the research, with participation from Admissions Tutors, clinical interviewers, academic interviewers, and students. METHODS: The methods included: a scoping questionnaire with follow-on questionnaire to elicit views on the strengths and limitations of chosen selection processes; interviews and focus groups to build on these findings. Analytical approaches were congruent with the chosen data collection approaches. Findings HEIs typically have rationales for their various chosen approaches to selection. However, our findings indicate that there is a lack of evidence for most selection approaches particularly in relation to interviewing. There is a growing evidence-base for the use of multiple mini interviews, and emotional intelligence testing. CONCLUSIONS: There is a need to work collectively cross-UK to bring together the evidence-base around selection so that processes and decision-making are as valid, reliable, effective and transparent as possible.

Development of a family nursing model for prevention of cancer and other noncommunicable diseases through an appreciative inquiry.

BACKGROUND: Cancer and non-communicable diseases are a major issue not only for the developed but also developing countries. Public health and primary care nursing offer great potential for primary and secondary prevention of these diseases through community and family-based approaches. Within Thailand there are related established educational curricula but less is known about how graduate practitioners enact ideas in practice and how these can influence policy at local levels. AIM: The aim of this inquiry was to develop family nursing practice in primary care settings in the Isaan region or Northeastern Thailand and to distill what worked well into a nursing model to guide practice. MATERIALS AND METHODS: An appreciative inquiry approach involving analysis of written reports, focus group discussions and individual interviews was used to synthesize what worked well for fourteen family nurses involved in primary care delivery and to build the related model. RESULTS: Three main strategies were seen to offer a basis for optimal care delivery, namely: enacting a participatory action approach mobilizing families' social capital; using family nursing process; and implementing action strategies within communities. These were distilled into a new conceptual model. CONCLUSIONS: The model has some features in common with related community partnership models and the World Health Organization Europe Family Health Nurse model, but highlights practical strategies for family nursing enactment. The model offers a basis not only for planning and implementing family care to help prevent cancer and other diseases but also for education of nurses and health care providers working in communities. This articulation of what works in this culture also offers possible transference to different contexts internationally, with related potential to inform health and social care policies, and international development of care models.

Bereavement and bereavement care in health and social care: provision and practice in Scotland.

The interview study described here aimed to explore current views of and practice in bereavement care and identify priorities for service development in Scotland. Fifty-nine participants who worked with the bereaved in some way, or whose interest was in bereavement or bereavement care, were interviewed. They represented National Health Service organizations, chaplaincy departments, educational institutions, academic departments, voluntary groups, and other related bodies, such as funeral directors. Transcripts were read repeatedly and initial emerging themes were identified, coded and shared between research team members to reach a consensus for key themes. Priority areas for development were related to raising public awareness, coordination of services, guidance, and professional education.

An evaluation of the process and initial impact of disseminating a nursing e-thesis.

AIM: This paper is a report of a study conducted to evaluate product, process and outcome aspects of the dissemination of a nursing PhD thesis via an open-access electronic institutional repository. BACKGROUND: Despite the growth of university institutional repositories which make theses easily accessible via the world wide web, nursing has been very slow to evaluate related processes and outcomes. METHOD: Drawing on Stake's evaluation research methods, a case study design was adopted. The case is described using a four-phase structure within which key aspects of process and impact are reflexively analysed. FINDINGS: In the conceptualization/re-conceptualization phase, fundamental questions about the purpose, format and imagined readership for a published nursing PhD were considered. In the preparation phase, seven key practical processes were identified that are likely to be relevant to most e-theses. In the dissemination phase email invitations were primarily used to invite engagement. The evaluation phase involved quantitative indicators of initial impact, such as page viewing and download statistics and qualitative feedback on processes and product. CONCLUSION: Analysis of process and impact elements of e-thesis dissemination is likely to have more than intrinsic value. The advent of e-theses housed in web-based institutional repositories has the potential to transform thesis access and use. It also offers potential to transform the nature and scope of thesis production and dissemination. Nursing scholars can exploit and evaluate such opportunities.

Windows and mirrors: reflections of a module team teaching the arts in nurse education.

The five-year experience of a group of nursing lecturers teaching the expressive arts within a Scottish degree programme is outlined and discussed. The place of the arts is contextualised within curriculum developments and module content, sequencing, thematic development, mode of delivery, assessment, student evaluation and pedagogical approaches are all addressed. Relationship to practice is discussed in terms of the art of nursing, reflection, ethics and spirituality. Future developments are discussed in terms of drawing upon the wider resources of the humanities, rather than merely expressivist sources of art. The paper concludes by encouraging the teaching of the arts in nurse education to remain responsive to practice issues and to consideration of students' learning needs.