Carol Haigh

Tell me a story — a conceptual exploration of storytelling in healthcare education

The importance of storytelling as the foundation of human experiences cannot be overestimated. The oral traditions focus upon educating and transmitting knowledge and skills and also evolved into one of the earliest methods of communicating scientific discoveries and developments. A wide ranging search of the storytelling, education and health-related literature encompassing the years 1975-2007 was performed. Evidence from disparate elements of education and healthcare were used to inform an exploration of storytelling. This conceptual paper explores the principles of storytelling, evaluates the use of storytelling techniques in education in general, acknowledges the role of storytelling in healthcare delivery, identifies some of the skills learned and benefits derived from storytelling, and speculates upon the use of storytelling strategies in nurse education. Such stories have, until recently been harvested from the experiences of students and of educators, however, there is a growing realization that patients and service users are a rich source of healthcare-related stories that can affect, change and benefit clinical practice. The use of technology such as the Internet discussion boards or digitally-facilitated storytelling has an evolving role in ensuring that patient-generated and experiential stories have a future within nurse education.

Wikipedia as an evidence source for nursing and healthcare students

Where students once were confined to the University library, they are now at liberty to wander through cyber-space at will. There is evidence to suggest that student have been very quick to exploit the opportunities that the Internet can offer them. Students frequently cited search engines such as Google and Web 2.0 information sharing sites such as Wikipedia as the first places they look when seeking information for an assignment. Although a number of disciplines have accepted that Wikipedia can be viewed as an accurate and legitimate evidence source nurse educators tend to view Wikipedia with a degree of suspicion. The purpose of this paper is to carry out an exploratory study of health and health related content on a sample of Wikipedia site with the overall intention of assessing the quality of their source and supporting information. A 10% sample of health related Wikipedia entries were evaluated, with a total of 2598 references assessed. In total 1473 (56%) of the references citied on the Wikipedia pages reviewed could be argued to come from clearly identifiable reputable sources. This translates to a mean number of reputable sources of M=29 per Wikipedia entry. The quality of the evidence taken obtained from the 2500 plus references from over 50 Wikipedia pages was of sufficiently sound quality to suggest that, for health related entries, Wikipedia is appropriate for use by nursing students.

The who and where of clinical skills teaching: a review from the UK perspective

Over the years, the debate on clinical skill acquisition in Nursing is one that has been subject to constant scrutiny within educational settings, locally and globally. Indeed, the Nursing and Midwifery Council (NMC) have endeavoured to provide some clarity with the publication of the Essential Skills Cluster statements [NMC, 2006. Advance Information Regarding Essential Skill Clusters for Preregistration Nursing Programmes (NMC Circular 35/2006). NMC, London] and the recently updated Standards to Support Learning and Assessment in Practice [NMC, 2008. Standards to Support Learning and Assessment in Practice: NMC Standards for Mentors, Practice Teachers and Teachers, second ed. NMC, London]. In this paper, we seek to provide a review of the evidence and debate produced thus far surrounding skills acquisition in general and the role of the nurse lecturer in particular from a UK perspective.

Assessment of Dyspnea in Asthma: Validation of the Dyspnea-12

Background. Dyspnea is a prominent symptom in asthma. The Dyspnea-12 (D-12), an instrument that quantifies breathlessness using 12 descriptors that tap the physical and affective aspects, has shown promise for the measurement of dyspnea in cardiorespiratory disease. Objective. We report the results of a study designed to test the validity and reliability of the D-12 in a population of patients with asthma. Methods. This cross-sectional study included 102 patients with asthma. Subjects completed the D-12, Hospital Anxiety and Depression scale, St. George’s Respiratory Questionnaire (SGRQ), and Medical Research Council scale. Confirmatory factor analysis confirmed the two-component structure of the D-12 (i.e., seven items that tap the physical aspects of breathlessness and five items that tap the affective aspects). Results. The D-12 subscales had excellent internal reliability (Cronbach’s alpha for the “physical” score was 0.94 and the affective score was 0.95). The D-12 physical component was more strongly correlated with SGRQ Symptoms (r = 0.648), SGRQ Activities (r = 0.635) and Medical Research Council grade (r = 0.636), while the affective component was more strongly correlated with SGRQ Impacts (r = 0.765) and Hospital Anxiety and Depression scale scores (anxiety r = 0.641 and depression r = 0.602). Conclusion. This study supports validity of the D-12 for use in the assessment of dyspnea of patients with asthma. It assesses one of the most pertinent symptoms of asthma from two viewpoints—physical and affective.

Attitudes and values of nurse educators: an international survey.

Within the last two decades the holistic care of patients has become increasingly important to nurse practitioners and educators. This has led to a move from a wholly biological approach to care to one that requires greater moral reasoning and value judgments by practitioners. There is a significant body of literature suggesting that values developed by students throughout their education can be affected to varying degrees by the nurse educators to whom the student is exposed. Yet, there is a dearth of research into what the values held by such nurse educators may be. A questionnaire was distributed to nurse educators from nineteen different countries at an international conference. Overall, educators reported high regard for the values of honesty and intellectualism, whilst maintaining a more cautious, although still positive, attitude toward altruism in health care.

Editorial: Nurses and publications – the impact of the impact factor

Over the past decades, the sheer volume of written work produced on nursing and by nurses has grown exponentially. In the almost 150 years since Notes on Nursing (Nightingale 1860), nursing has produced voluminous tracts of literature. There are now literally thousands of publications devoted to the practice and scholarship of nursing. As contributors to the body of literature, we observe that it was not all that long ago that nurses began to be urged to publish. For a (seemingly) brief period, it did not matter where you published, as long as you published. Then there was the pressure to target double-blind peer reviewed journals. The goal posts have moved again and currently, for most of us, the pressure is to target our publications efforts toward the higher impact journals, or journals with an impact factor (IF). The IF is a means of ranking journals based on citations, and so is considered to be a measure of the standing and influence of a particular journal. Though there are other measures, IF is the longest standing measure of journal quality and is a figure derived from the ratio of citations of a journal in one year to papers published by that journal over the previous two years (http:// www.thomsonreuters.com/business_units/ scientific/free/essays/impactfactor/; retrieved 14 April 2009). For example, the impact factor for a journal reported in 2008 refers to the number of citations in 2007 to papers published in 2005– 2006. It should be noted – and often is by its detractors – that the IF is quite meaningless in terms of the impact of the contents of a journal on practice and, of course, it only refers to the journal as a whole and tells us nothing about the quality of any single piece that is published in a journal. Impact Factor is not the only measure; there are rivals including the Eigenfactor (http://www.eigenfactor.org; retrieved 24 April 2009) and the Scimago journal rank indicator (http://www.scimagojr.com). What the IF may lack in meaning, it makes up for in simplicity. Any effort to explain in simple terms – as done above for the IF – the means by which Eigenfactors and Scimago rank indexes are calculated requires considerable leaps in imagination, if not of faith, and some more complex mathematics than are required to calculate an IF. For these reasons, the IF remains the ‘gold standard’ and most cited measure in this area. A cursory glance at websites providing a range of indicators demonstrates that, in terms of ranking journals, they all provide more or less the same ranking measures. This includes the H-index which is a popular way for academics to rank themselves relative to their peers – in addition to total citations. The H (or Hirsch) index for journals means the same thing as an individual’s H-index (http://www.stuenpuntoos.be/WG_Papers/ Scientist_19_22_8.pdf; retrieved 24 April 2009). An H-Index indicates the number of papers that have been cited a certain number of times, for example, an H-index of 10 means that a journal has 10 papers that have been cited in a given period – often five years. The H-index, which does not really rank journals any differently from other indicators, has the beauty of relative simplicity and also meaning – within the confines of the citation paradigm – in that it is insensitive to very highly cited papers and does not penalise for low or uncited papers. However, it should be noted that for all of the above the ‘bottom line’ is citations, and the more the better. The above measures are all internationally recognised. There are also some local ranking measures in place in some countries. Australia for example, has the recently developed ERA (Excellence in Research Australia) journal ranking lists, which provides discipline specific tiered rankings of journals (http:// www.arc.gov.au/era/indicators.htm; retrieved 24th April 2009). There may or may not be concordance between the ranking scores of the international and local ranking measures. Thus, the IF (and to a lesser extent, the other measures described above) are of obvious interest to publishers, librarians, academics and those engaged in related activities. However, as a judge of academic quality, these measures have been subject to criticism for several reasons. The IF has been around longest, and so, as expected, has been subject to the most critique. Criticisms have been widespread, and include the ease with which it can be manipulated and misused (Amin & Made 2000, The PLoS Medicine Editors 2006). Furthermore, though the primary purpose of the IF is as a means of ranking journals, the uses to which the IF are applied are broader and, the literature suggests that in many contexts, they are used as a means of judging academic performance and considered in relation to individuals, and decisions around employment, tenure and promotion (Kovner & Brewer 2006). Thus, there is the pressure for academics to target high IF journals. The IF focuses on the peer reviewed journals, therefore it effectively privileges particular forms of writing, and particular types of literature, and thereby, has the potential to influence the nature of writing we do. Johnstone (2007: 35) comments that the focus on IF is such that nurses everywhere are

Futures planning, parental expectations and sibling concern for people who have a learning disability

A questionnaire was e-mailed to 200 siblings on the Sibs database to explore future plans, parental expectations and sibling concerns regarding people who have a learning disability; 21 questionnaires were returned. A full discussion regarding sibling support was reported by 12 (57%) of respondents; 7 (33%) stated this discussion had not taken place, and 2 (9%) were unsure. Twelve (57%) of participants reported no clear future plan; where a plan did exist, seven (33%) of respondents claimed it was fully agreeable to both them and their parents. Eleven (52%) of respondents reported no difference between their wishes regarding their future role and parental wishes. Key themes generated were: satisfaction with services, parental influence, sibling concern about the future, futures planning, the impact of the disabled person upon sibling lives, and siblings needs. Further qualitative exploration into issues for siblings of adults who have a learning disability is required.

First Steps Toward Understanding the Variability in Acute Pain Service Provision and the Quality of Pain Relief in Everyday Practice Across the United Kingdom

BACKGROUND Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity. OBJECTIVES The objectives of this article are (1) to describe current pain service provision and activity (2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice. METHODS Phase 1: Surveys were conducted in two phases during 2010-2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011. RESULTS Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%). CONCLUSIONS Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities.

Reconstructing nursing altruism using a biological evolutionary framework

AIM This paper presents a discussion of the role of altruism in development of the discipline of nursing and an exploration of how nursing altruism compares with current thinking in biological evolutionary theory. There is an assumption that the role of the nurse has its foundations in altruistic behaviours; however, the source of this altruism is never analysed or debated. DATA SOURCES A search of the biological altruism, altruism and health-related literature encompassing the years 1975-2007 was performed using Google Scholar. DISCUSSION The first element of the study is a brief overview of nursing altruism as a way of establishing the conceptual boundaries. Additionally, the major tenets of biological evolution are explored to clarify the theoretical underpinnings of the hypotheses presented. A key premise of this study is that nursing altruism is not solely a manifestation of disinterested sacrifice for the benefit of others, but is more concerned with ensuring the survival of a clearly defined social group. IMPLICATIONS FOR NURSING A re-evaluation of altruism as a motivating factor in nursing and as an element of the therapeutic relationship is long overdue. It is time that the nursing profession examined professional driving forces using more than traditional philosophical frameworks. CONCLUSION Nursing altruism is programmed to ensure the survival of the meme rather than to act in the best interest of patients. Certainly patients reap the benefits of this selfish altruism, but that can be argued to be a side effect rather than a result.

Editorial: Embracing the theory/practice gap

Like any discipline worth its salt, nursing has had its share of heretics and purveyors of sacrilege. To provide some examples; who would have thought, before the early 1970s, that giving patients information about what was going to happen to them would alleviate their stress? Who could have believed that allowing parents to be with their children in hospital was a good thing? What about the notion that pain is what the patient says it is and occurs when the patient says it does? Honestly, who saw that one coming? All of these, now the foundations of essential care, were seen as radical or even dangerous in their day. Therefore, in the proud knowledge that I am about to join the hallowed ranks of nursing blasphemers such as Boore (1978), Hawthorn (1974) and McCaffery (1998), I have a thought to share and it is this: