Reflection,the way to professional development?

Background. Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses’ reflections, what do they reflect about, and how do they deal with their reflections? Aims and objectives. The aim of this study was to describe the RNs’ experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs’ reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development? Design and method. The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study. Results. The qualitative differences regarding the RNs’ experiences of reflection were categorized as follows: to reflect (to think back – consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development. Conclusion. By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development. Relevance to clinical practice. The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge.     

The relationship between nurses’ job satisfaction and continuing professional development

Objective

To identify the correlation between nurse's perception of the continuing professional development (CPD) and the satisfaction of nursing career ladder system (NCLS) implementation.

Becoming and being an environmentally ‘woke’ nurse: A phenomenological study

BackgroundIncreasing numbers of nurses view environmental activism as part of their role. No studies have explored the reasons.AimThis study aimed to identify what awakened and shaped US and UK nurses’ environmental activism.DesignA Gadamerian hermaneutic phenomenological study.MethodsForty nurses were recruited in 2017 using purposive sampling (USA n = 23, UK n = 17). Four focus groups were followed by individual interviews. Iterative, fully immersive phenomenological analysis was conducted with corroboration of themes and a final “shared horizon.”FindingsParticipants described “lightbulb” events whereby they recognized environmental threats to people and the planet. Their nursing-centered values of social justice, generational fairness, and alleviating suffering underpinned a shared belief in their ability to help mitigate those threats. They believed it was their duty as nurses to take action on behalf of individuals, communities, and the planet.DiscussionThe nursing skill set of these nurses makes for effective leadership and environmental activism. Environmentally “woke” nurses have the skills to create solutions and systems approaches that increase sustainability, improve health and make a difference to people's lives, now and for future generations.     

‘Maybe what I do know is wrong…’: Reframing educator roles and professional development for teaching Indigenous health

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.     

‘… and in This Corner,the Patient’

Readers are invited to submit questions relating to problem cases. Inquiries will be answered by qualified consultants and replies forwarded by mail promptly. Selected problems and solutions are published every month in this section.     

Exploring the contribution and impact of master’s education for leadership development in adult general nursing: A scoping review

AimThe aim of this scoping review was to explore the evidence relating to master’s education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.BackgroundThe importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master’s education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.MethodsAn a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.ResultsEight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master’s education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master’s education for clinical leadership skills; and c) master’s education for professional and organisational outcomes.ConclusionsThe scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master’s education. Studies of the impact of master’s education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master’s education for adult/general nurses not in advanced roles and in examining the link between master’s education and improved patient, professional and organisational outcomes.     

Preschool children’s communication,motor and social development: Parents’ and educators’ concerns

Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing.

Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n?=?275), receptive vocabulary (n?=?131) and language (n?=?274).

Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.     

Technology is changing: is the continuing professional development also changing?

This paper considers the impact of the new information environment on the scientific communication. Reading behavior changes: today, we browse, scan, watch, receive an impression of something. The new reading habits are not simply determined by the new tools; they are rather influenced by the need to produce and share data and information, using personalized and mobile devices. Also the content formats change: researchers, clinicians, and nurses produce texts, figures, tables, photos, videos, tweets, blog posts and they share them to readers that have to collect, appraise, recombine and - most importantly - contextualize the information. This "continuous partial production" is consistent with a "continuous partial utilization" of data; this is a risk, but it is also an opportunity. On the one side, we risk a self-referential, individualized learning process; on the other side, we can enjoy the extraordinary chance to build a "shared learning environment", able to give a comprehensive solution to the challenges experienced by the health systems. Medical journals survive as valuable media to organize data and information; the new social web tools should support the traditional publishing patterns, to enhance the sharing of information, to help the appraisal of data, and to move forward new communities of learners.     

A literature review on the mutual impact of the spousal caregiver–cancer patients dyads: ‘Communication’, ‘reciprocal influence’, and ‘caregiver–patient congruence’

PurposeA diagnosis of cancer is the start of a journey of distress and adjustment for both the patient and his/her spouse. However, the dyadic phenomena are less conceptualised and related research is in the early stages. This review explores concepts of mutuality among spousal caregiver–cancer patient dyads and identifies directions for future research.MethodA systematic search, including trawling through six electronic databases, a manual search, and an author search, was conducted to identity articles that had been published in English and Chinese from January 2000 to March 2013, using key terms related to caregiver–patients dyads in cancer care. An inductive content analysis approach was adopted to analyse and synthesise the concepts of spousal caregiver–cancer patient dyads.ResultsThirty-one articles were identified. The findings are described according to Fletcher et al.'s proposals for conceptualising spousal caregiver–patient dyads. The proposed concepts of ‘communication’, ‘reciprocal influence’, and ‘caregiver–patient congruence’ have been found to be interrelated, and to contribute to the spousal caregiver–patient dyads' mutual appraisal of caregiving and role adjustment through the cancer trajectory.ConclusionsThe findings highlight the importance of a perspective that focuses on the nature of the relationship between couples coping with cancer and the quality of their communication with each other. It is recognised that communication may act as a fundamental element of the abovementioned three concepts. Better communication between couples would probably facilitate reciprocal influence and caregiver–patient congruence, which in turn would have a positive effect on intimacy between the couple and improve the caregiving outcomes.     

Bone and the ‘Comforts of Life’

Coffee drinking, smoking and especially alcohol abuse are considered to be risk factors for fractures and osteoporosis. Caffeine causes acute increase in urinary calcium excretion, but epidemiological evidence for the effects of coffee consumption on the risk of fractures is contradictory. Many, (but not all) studies point to decreased bone mass or increased fracture risk in smokers. Alcohol abuse is associated with deleterious changes in bone structure detected by histomorphometry, and with a decrease in bone mineral density (BMD). These changes may also be produced by factors commonly associated with alcohol abuse, e.g. nutritional deficiencies, liver damage and hypogonadism. Alcohol, however, has clear-cut direct effects on bone and mineral metabolism. Acute alcohol intoxication causes transitory hypoparathyroidism with resultant hypocalcaemia and hypercalciuria. As assessed by serum osteocalcin levels, prolonged moderate drinking decreases the function of osteoblasts, the bone-forming cells. In addition, chronic alcoholics are characterized by low serum levels of vitamin D metabolites. Thus, alcohol seems to have a direct toxic effect on bone and mineral metabolism. In contrast, it has recently been reported that moderate alcohol consumption by postmenopausal women may have a beneficial effect on bone.     

Comparing patients’ and physiotherapists’ views of professionalism and professional standing: an Australian perspective

Background: Professionalism in health care comprises adherence to professional values and ethical codes, discipline-specific standards of practice and competencies, and specific expectations about appearance and social standing. Specialisation in a particular area of practice further increases expectations of professionalism and competency-based standards.

Objective: To investigate, in an Australian setting, patients’ and physiotherapists’ perceptions of the features and value of professionalism in specific physiotherapy practice contexts.

Major Findings: The professional standing of physiotherapists was similar to that of chiropractors, with judges, general practitioners and solicitors more highly regarded by both patients and physiotherapists. Participants had similar views about the importance of several elements of professionalism. In response to questions about professional appearance, both patients and physiotherapists preferred business attire for male physiotherapists, whereas opinions varied for female physiotherapists. Patient/therapist views diverged regarding the link between specialisation and professionalism. Patient participants presented with a list of physiotherapists with differing nomenclature/titles to treat their back pain indicated they were more likely to select a physiotherapist with a special interest in back pain and factors such as location of the physiotherapy service and recommendations from a friend influenced their choice of physiotherapist. In contrast, physiotherapist participants responded that postgraduate qualifications, years of experience and facilities were more important in the choice of a physiotherapist.

Conclusions: Patients and physiotherapists share some views on professional behaviours and values, professional appearance and standing within the community. They differ with regard to perceptions of specialisation and how extra qualifications add to their perception of trust and professionalism.     

Crowd physiology: the ‘penguin effect’

The effects of heat retention on an individual in a crowd situation (the ‘penguin effect’) is introduced and described, with implications for the emergency services and the potential casualties themselves discussed. Management of anyone who collapses in the core of a crowd should involve much more than first-aid treatment for fainting. Some people may die from the effect.     

Does ‘Strong Analgesic’ Equal ‘Strong Opioid’? Tapentadol and the Concept of ‘µ-Load’

Introduction

The distinct properties of the centrally-acting analgesic tapentadol derive from the combined contributions of an opioid component and a nonopioid component. However, the opioid component’s relative contribution to analgesic and adverse effects has not previously been elucidated. Tapentadol’s analgesic effect derives from the combined contribution of an opioid mechanism and a nonopioid mechanism, the extent of which can vary for different pains. Likewise, the interaction can vary for various adverse effects. Hence, the contribution of each mechanism to adverse effects can be different from the contribution to analgesia. We here estimate the percent contribution of each component of the mechanism of action to analgesia and to adverse effects.

Areas Covered

Several approaches to in vitro and in vivo data to estimate the contribution of tapentadol’s opioid component to analgesia and to the two important opioid adverse effects, respiratory depression and constipation. The results are then compared with clinical data.

Expert Opinion

Traditional opioids, such as morphine, oxycodone, and others, produce their analgesic effects primarily through a single mechanism—the activation of µ-opioid receptors (MOR). Therefore, the contribution of the opioid component to adverse effects is 100%. In contrast, the newer strong analgesic tapentadol produces its analgesic effect via two separate and complementary analgesic mechanisms, only one of which is µ-opioid. We applied standard drug–receptor theory and novel techniques to in vitro and in vivo data to estimate by several different ways the μ-load of tapentadol (the % contribution of the opioid component to the adverse effect magnitude relative to a pure/classical µ-opioid at equianalgesia) in respiratory depression and constipation, and we compared the results to clinical evidence. The estimate is remarkably consistent over the various approaches and indicates that the μ-load of tapentadol is?≤?40% (relative to pure MOR agonists, which have, by definition, a µ-load of 100%).

Funding

Grünenthal GmbH.