Ian Norman

Physical activity in older people: a systematic review

BackgroundPhysical 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.MethodsA 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.ResultsFifty 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.ConclusionThe 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.

Factors influencing turnover and absence of nurses: a research review

This review of the nursing literature aims to identify the factors with the greatest influence on turnover and absence of qualified nurses, possible common factors influencing both, and the relationship between absence and turnover. A hypothetical model grounded in the literature which depicts the expected relationships between these variables is presented for testing in an empirical study. The review identifies intent to stay in current employment as the variable with the greatest influence on turnover. Intent to stay is in turn most strongly associated with job satisfaction. Other variables are identified by single studies as having an influence on intent to stay, but are not supported by the results of other studies; exceptions are pay, opportunity for alternative employment and kinship responsibility, which are supported by the results of two studies. The relationship between job satisfaction and absence is unclear and requires further investigation. However, job satisfaction is identified as possibly influencing both absence and intent to stay and kinship responsibility is identified as a common antecedent of absence and intent to stay. Similarly, absence is identified as an antecedent to turnover. Thus, it is expected that absence would be positively related to turnover and negatively related to intent to stay. Understanding such relationships should allow identification of management strategies to reduce both turnover and absence.

The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students.

This paper reports findings from a study funded by the National Board for Nursing, Midwifery and Health Visiting for Scotland to test selected nursing and midwifery clinical competence assessment tools for reliability and validity. The study, which took place over two years from July 1997, involved comparing items in the selected tools with statutory competencies for nurses and midwives, collecting assessment data from a sample of 257 nursing and 43 midwifery students in four educational institutions and administering additional assessment measures (the Nursing Competencies Questionnaire (NCQ) (Bartlett et al., An evaluation of pre-registration nursing education: a literature review and comparative study of graduate outcomes, Oxford Centre for Health Care Research & Development, Oxford Brookes University, Oxford, 1998) and the Key Areas Assessment Instrument-KAAI) to the total student sample (and to their lecturers and practice assessors) at two time points which were six months apart. Our focus was the programme-specific clinical competence assessment tools but by testing these tools we also provide evidence on the validity of other methods of competence assessment. Validity of the methods was assessed, primarily, by calculating multivariate and univariate correlation coefficients between them. The NCQ and KAAI were analysed for internal consistency. The NCQ and the versions of KAAI for lecturers and practice assessors were found to have good internal consistency. The version of the KAAI tool developed for students showed reasonable internal consistency for nursing students, but less consistency for midwifery students. Correlational analysis of data collected on students showed that there is little or no relationship between most of the clinical competence assessment methods in current use, or between these methods and those introduced by the research team. This finding supports previous research, particularly in medical education and confirms that the different methods address different abilities.A clear finding from this study is that no single method is appropriate for assessing clinical competence. A multi-method UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.

Assessing competence to practise in nursing: a review of the literature

Recent reforms of nursing education have led to calls for assessment of clinical performance to contribute to academic qualifications that incorporate professional awards. Questions then follow concerning the psychometric quality of methods available for assessing competence and performance and the ability of the methods to distinguish between different levels of practice. The purpose of this review of the literature is to analyse methods of assessing competence to practise in nursing and draw conclusions on their reliability and validity. The methods reviewed include questionnaire rating scales, ratings by observation, criterion-referenced rating scales, simulations including the objective structured clinical examination (OSCE), Benners model of skill acquisition, reflection in and on practice, self-assessment and multi-method approaches. Methodological challenges to competence assessment are raised. Findings of the review are as follows. Questionnaire rating scales used to assess competence in nursing have not been rigorously tested for reliability and validity. The methodological limitations of observation can be overcome with use of criterion-referenced scales or simulations such as the OSCE or its variations, as has been found in research on competence assessment in medicine. The Barts Nursing OSCE, designed for the end of the common foundation programme of the nursing diploma course, has promise because it provides a close simulation to real life and is grounded in an interpretive approach to skill acquisition. Reflection on practice using portfolios, learning contracts and self-assessment is valid if based on rigorous analysis of critical incidents rather than simple description. Reflective approaches have the advantage of being located in real-life settings and can integrate theory with practice but they need skilled collaboration between teachers, employers and practitioners. The conclusion is that a multimethod approach enhances validity and ensures comprehensive assessment of the complex repertoire of skills required of students in nursing.

Using Realistic Evaluation to Evaluate a Practice-level Intervention to Improve Primary Healthcare for Patients with Long-term Mental Illness

Mental Health Link - a facilitated programme - aimed to develop systems within primary care and links with specialists to improve care for patients with long-term mental illness. A process evaluation based on Pawson and Tilley’s Realistic Evaluation complemented a randomized controlled trial. This article describes the method developed for this ‘realistic evaluation’, the mechanisms behind the integration of linked specialist workers and discusses practical and theoretical issues arising from the use of the realistic evaluation framework as a way of explaining the results of trials and service development. Retrospective interviews identified the important outcomes and were used to construct ‘Context-Mechanism-Outcome’ configurations. The 12 case studies represented what had happened. A second-level analysis using analytic induction developed ‘middle range theories’ designed to be of value to those developing care elsewhere. The intervention was successful in stimulating productive joint working, through case discussions, but often failed to ensure a review of progress.

Filmed v. live social contact interventions to reduce stigma: randomised controlled trial

BACKGROUND Direct social contact interventions are known to reduce mental health stigma. Filmed social contact may be equally effective and have practical and cost advantages. AIMS To compare the effectiveness of a DVD, a live intervention and a lecture control, in reducing stigma, testing the hypotheses that: (a) DVD and live interventions will be equally effective; and (b) the interventions with social contact (DVD/live) will be more effective than the lecture. Cost-effectiveness, process and acceptability are also assessed. METHOD Student nurses were randomised to: (a) watch a DVD of service users/informal carers talking about their experiences, (b) watch a similar live presentation, or (c) attend a lecture. Primary outcomes were changes in attitudes (using the Mental Illness: Clinicians Attitudes Scale, MICA), emotional reactions (using the Emotional Reactions to Mental Illness Scale, ERMIS), intended proximity (using the Reported and Intended Behaviour Scale, RIBS), and knowledge (using the Social Contact Intended Learning Outcomes, SCILO), immediately after the intervention and at 4-month follow-up. RESULTS For the 216 participants, there were no differences between the DVD and live groups on MICA, ERMIS or RIBS scores. The DVD group had higher SCILO (knowledge) scores. The combined social contact group (DVD/live) had better MICA and RIBS scores than the lecture group, the latter difference maintained at 4 months. The DVD was the most cost-effective of the interventions, and the live session the most popular. CONCLUSIONS Our hypotheses were confirmed. This study supports the wider use of filmed social contact interventions to reduce stigma about mental illness.

Care work and quality of care for older people: A review of the research literature

There is considerable research on work satisfaction and stress of care staff on the one hand and on quality of care and well-being of older people on the other. However, very little research in continuing-care settings for older people (nursing homes, residential homes and long-stay wards) links perceptions of workers (work satisfaction and stress) with the process of care (quality of care) and outcomes for residents/patients (well-being). This is a notable omission, given the emphasis of government policy on improving quality of health and social care services for vulnerable elderly people in the UK. The White Papers, The New NHS and Modernising Social Services and the National Priority Guidance for Health and Social Services for 2000–2003, all emphasize the importance of services that are responsive to local needs and which maintain and promote independence. The Centre for Policy on Ageing has been commissioned by the Department of Health to develop national standards for nursing and residential home care services for older people. This work will build upon recommendations of the Burgner Report and Achieving a Better Home Life, which identified areas for benchmarking. The national standards proposed under the forthcoming National Service Framework for Older People will underpin new legislation to regulate care services.

Evaluation of a Peer-Led Mutual Support Group for Chinese Families of People with Schizophrenia

Family interventions in schizophrenia have shown positive effects on patients but little attention has been paid to their effects on family members, particularly those in non-Western countries. This randomized controlled trial evaluated the effectiveness of a bi-weekly, 12-session, family-led mutual support group for Chinese caregivers of schizophrenia sufferers over 6 months compared with standard psychiatric care. It was conducted with 76 families of outpatients with schizophrenia in Hong Kong of whom 38 were assigned randomly to either a mutual support group or standard care. Families’ psychosocial health status and patients’ symptom severity and length of re-hospitalizations at recruitment, one-week and 12-month post-intervention were compared between groups. Results of repeated-measures mixed model indicated that the mutual support group experienced significantly greater improvements in families’ burden, functioning and number of support persons and length of patients’ re-hospitalizations at two post-tests. The findings provide evidence that mutual support groups can be an effective family-initiated, community-based intervention for Chinese schizophrenia sufferers.

The relationship between physicians’ and nurses’ personal physical activity habits and their health-promotion practice: A systematic review

Background: Sedentary lifestyles are rising in many countries which has implications for global health. Health professionals are well placed to promote increased physical activity levels to their patients. Objective: To examine the relationship between physicians’ and nurses’ personal physical activity and their physical activity promotion practices. Methods: Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHL, PsychInfo, British Nursing Index and four Chinese databases were searched to March 2011. Extracted data were verified by a second researcher. Results: Thirteen studies met the inclusion criteria and were cross-sectional surveys employing a variety of self-report questionnaires. The majority of studies found that a higher personal physical activity level was associated with higher physical activity-promoting practices, and that health professionals with positive attitudes towards physical activity were more likely to promote physical activity to their clients. Conclusion: The findings of this review need to be confirmed by well-designed large studies which employ validated measures of physical activity and physical activity-promoting practices and involve multivariate analyses to identify the relative contribution of personal physical activity levels to physical activity-promoting practices.

Testing a model of absence and intent to stay in employment : a study of registered nurses in Malta

This study used a cross-sectional, correlational design to test a model of absence and turnover of registered nurses developed from a review of the research literature (Gauci Borda and Norman, 1997). Testing the model involved comparing the relationship between job satisfaction, kinship responsibility, pay, employment opportunity, intent to stay in employment and absence for male and female registered nurses. All registered nurses (n = 254) working in clinical areas on a full-time shift basis, in one large general hospital in Malta were surveyed by questionnaire and their absence data were obtained from the hospital personnel records. A response rate of 67% (n = 171) was achieved. The results showed that nurses were satisfied with their job and intended to stay in their present employment for the next 12 months. Relationships between variables differed between male and female nurses, with job satisfaction being associated with intent to stay for male nurses but not for females and kinship responsibility and intent to stay being associated with absence in female but not male nurses. In contrast to many previous studies of nurses, an association was found between job satisfaction and absence. Several variables, including fear of change, which may influence intent to stay of Maltese nurses, were identified. The proposed model of absence and turnover stood up reasonably well to testing, but the results for the whole sample, and the sub-samples of male and female nurses supported different parts of the model. The main implication for future research is that male and female nurses should be studied separately due to differences found between the two groups.