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AnteayerEvidence-Based Nursing

Nociceptor-stimulating devices can help reduce pain, anxiety and fear in children requiring regular injections

Por: Waite · M. · Iness · E. J.

Commentary on: Canbulat Sahiner N, Turkmen AS, Acikgoz A, et al. Effectiveness of two different methods for pain reduction during insulin injection in children with Type 1 Diabetes: Buzzy and ShotBlocker. Worldviews Evid Based Nurs [EPub ahead of print 11 Oct 2018].

Implications for practice and research

  • Use of ShotBlocker or Buzzy during insulin administration was effective in reducing self-reported, parental and observer assessments of pain in comparison with no intervention.

  • ShotBlocker or Buzzy was effective in lowering self-reported, parental and observer assessments of fear and anxiety prior to and during insulin administration in comparison with no intervention.

  • Further research is needed to examine the effectiveness of the devices over a longer time period for children who need regular injections.

  • Context

    The negative impact of needle-related procedures has been widely reported with evidence of distress, anxiety and non-compliant behaviours.1 This is...

    Exploratory analysis of single 15 min videotaped structured play session of children aged 1 year reveals no differences between fathers parenting behaviours whether infants are born prematurely or at term

    Por: Lee · A. J.

    Commentary on: McMahon GE, Spencer-Smith MM, Pace CC, et al. Influence of fathers’ early parenting and development of children born very preterm and full term. Journal of Pediatrics 2019:205; 195–201.

    Implications for practice and research

  • Fathers’ parenting behaviours are important to subsequent child development.

  • Further research is needed to review parental interactions and child development for infants born prematurely.

  • Context

    Parenting behaviours impact on child development.1 Children are influenced by a range of factors, including social, cultural, psychological, financial and intellectual standing. Child factors also influence parenting behaviours (such as prematurity, neurodevelopmental disability and gender). Fathers’ parenting styles differ to mothers’, and this can also impact on child behaviour.2

    There are many ways to measure behaviours associated with ‘positive and negative’ parenting.1 There are also a number of ways to measure social, emotional and developmental status of children.

    Long time coming for children and young people in the long-term plan

    Por: Barker · R.

    Buried on page 50 of the NHS Long Term Plan, at the end of a paragraph where other totally generic statements are ‘bolded’, is a sentence I want to see written on banners, spray painted across the front of Whitehall and on the front page of every politician’s ‘vote for me’ handouts between now and 2030. ‘Over the coming decade the goal [of the NHS] is to ensure that 100% of children and young people who need specialist [mental health] care can access it’ (

    If this is surprising to readers, that our country currently is not even trying to meet the health needs of children with mental health conditions, it should not be. Until the publication of the NHS Long Term Plan, the stated goal was to increase funding and staffing to services to meet the needs of one in three children and young people in...

    Lack of perceived competence is linked to perceived workplace bullying among Jordanian registered nurses

    Por: Hallett · N.

    Commentary on: Obeidat RF, Qan’ir Y, Turaani H. The relationship between perceived competence and perceived workplace bullying among registered nurses: a cross sectional survey. Int J Nurs Stud 2018; 88:71–78.

    Implications for practice and research

  • Workplace bullying is a significant issue and should be addressed at all levels.

  • Future research should explore the link between workplace bullying and actual competence toidentify whether workplace bullying leads to a lack of perceived competence or that less competent nurses attract higher levels of bullying.

  • Context

    Bullying in nursing has received much attention over the years, from the idea that nurses ‘eat their young’1 to recent UK media reports that National Health Service directors will have a legal duty to act on bullying.2 Bullying in nursing appears to be a universal phenomenon, identified in studies across the globe at rates between 5% and 87%.

    EBN Perspectives, Mental Health

    Por: Green · L. · Barrett · D.

    EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes

    The challenges of being a student nurse and the advice proffered by peers

    Por: Swift · A. · Twycross · A.

    EBN engages through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

    Dementia is strongly linked to Down syndrome and contributes to early death in people with Down syndrome

    Por: Parsons · G. S.

    Commentary on: Hithersay R, Startin CM, Hamburg S, et al. Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years. JAMA Neurol 2018. doi: 10.1001/jamaneurol.2018.3616. [Epub ahead of print 19 Nov 2018]. doi:10.1001/jamaneurol.2018.3616

    Implications for practice and research

  • Care for older adults with Down syndrome should be organised with the exceptional risk of developing dementia in mind as this will improve their medical outcomes.

  • There is an urgent need for research into effective treatments for dementia in adults with Down syndrome to prevent or delay the onset of dementia.

  • Context

    Advances in care for people with Down syndrome have greatly increased their lifespan.1 However, with this comes the devastating risk of developing dementia, which contributes to early mortality when compared with the general population.2Common health problems associated with Down syndrome are intellectual disability and congenital heart defects, but in older people, Down...

    Supplementing standard batterer intervention programmes with individual motivational plans may increase empathic capacity in perpetrators of intimate partner violence

    Por: Walter · R.

    Commentary on: Romero-Martínez Á, Lila M, Gracia E, et al. Improving empathy with motivational strategies in batterer intervention programmes: Results of a randomized controlled trial. Br J Clin Psychol 2018, doi:10.1111/bjc.12204.

    Implications for practice and research

  • Adding individualised motivational plans (IMP) to standard batterer intervention programmes (SBIP) may enhance specific cognitive processes associated with empathy to increase behavioural control in perpetrators of intimate partner violence (IPV).

  • IMP uses several intervention strategies (ie, motivational interviewing, therapists and group goal reinforcement, and retention techniques) concomitantly. Future research is needed to identify the contribution of each intervention strategy and their combined effects on the treatment outcome(s).

  • Context

    There is a growing body of literature that supports motivational intervention treatments that increase an individual’s capacity for empathy as effective strategies in decreasing IPV among perpetrators.1 2 The study by Romero-Martinez and colleagues investigated the effect of...

    Womens experiences of breast cancer reveal the need for a holistic person-centred approach to breast cancer care

    Por: Kerin · U.

    Commentary on: Smit A, Coetzee BJ, Roomaney R, et al. Women’s stories of living with breast cancer: a systematic review and meta-synthesis of qualitative evidence. Soc Sci Med 2019; 222:231–45. doi: 10.1016/j.socscimed.2019.01.020

    Implications for practice and research

  • Findings illustrate the physical, psychosocial and emotional impact of breast cancer on women.

  • A holistic, person-centred approach to breast cancer care is required before, during and after active cancer treatment has been terminated.

  • The proposed trajectory of breast cancer framework will enable future researchers to consider breast cancer experiences relative to particular breast cancer time-points.

  • Context

    Breast cancer is reported to be the most common type of cancer in women.1 There are distinct histological subtypes; luminal A, luminal B, basal-like and human epidermal growth factor receptor 2 (HER2) enriched.2 Improved molecular understanding has facilitated the development of targeted treatments. Disease stage and...

    Acceptance-focused processes and self-compassion protect pregnant women from developing postpartum depressive and anxiety symptoms and improve relationships with health caregivers

    Por: Saleh · A. S. E. M.

    Commentary on: Monteiro F, Fonseca A, Pereira M, et al. What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion. J Affect Disord 2019;246:522–9. doi: 10.1016/j.jad.2018.12.124.

    Implications for practice and research

  • Pregnant women are more susceptible to postpartum depression (PPD); self-compassion will enable them to cope with life challenges, and support interpersonal relationships with caregivers.

  • This study emphasises promotion of acceptance-based processes as preventive measures for at-risk women, which may protect them from developing psychological symptoms.

  • Context

    Women in the postpartum stage are susceptible to increased risk for mood disturbances.1 The most common psychological postpartum problem is depression, which affects approximately 10%–15% of women and represents a considerable psychological health consequence, presenting as emotional, behavioural, cognitive and interpersonal troubles. As such, early diagnosis and treatment are important.2 Evidence-based studies identify postpartum affective...

    Over-confidence in cardiac devices can create a barrier in engaging patients in advance care planning and discussions around device deactivation

    Por: Elliott · K.

    Commentary on: Hadler RA, Goldstein NE, Bekelman DB, et al. "Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2019;34:275–82. doi: 10.1097/JCN.0000000000000565.

    Implications for practice and research

  • Stage II-IV heart failure patients with cardiac devices may overestimate their device’s ability to prevent further deterioration and death. This may become a barrier to engaging in advance care planning.

  • Further research is required to evaluate best methods of engaging these patients in discussions around advance care planning and device deactivation.

  • Context

    Guidelines for managing patients with heart failure indicate that discussions about the condition, treatment options and advance care planning should be discussed at an early stage of the disease.1 Prior to implanting a cardiac device, clinicians should be discussing when device deactivation might become appropriate.2–4...

    Preventing postpartum depression: fatigue management is a place to start

    Por: Dennis · C.-L. · Vigod · S.

    Commentary on: Wilson N, Lee JJ, Bei B. Postpartum fatigue and depression: a systematic review and meta-analysis. J Affect Disord 2019;246:224–33.

    Implications for practice and research

  • Fatigue is an under examined and seldom treated condition many women experience postnatally that is highly correlated to depression.

  • Efforts to accurately and consistently measure fatigue are needed for effective detection and management.

  • Fatigue management may be an important strategy to help prevent postpartum depression among vulnerable women.

  • Context

    A positive fatigue–depression correlation among postpartum women suggests a need to develop evidence-based interventions targeting fatigue. These interventions may be less stigmatising than depression treatment and could help prevent postpartum depression.


    The purpose of the study1 was to synthesise the relationship between postpartum fatigue and depression among parents in the first 2 years following childbirth. A meta-analysis was conducted on the correlation between fatigue...

    Health checks have a limited effect on reducing morbidity and mortality in asymptomatic populations

    Por: Frazer · K.

    Commentary on: Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2019;1:CD009009. DOI: 10.1002/14651858.CD009009.pub3.

    Implications for practice and research

  • Current evidence does not support continuing trials of health checks in general population and could lead to unnecessary tests and treatments.

  • Future research should examine effects of structural public health interventions including effects of higher tax on cigarettes and alcohol on reducing disease.

  • Context

    General health check programmes screen asymptomatic groups with the aim of detecting disease or risk factors at an earlier stage to prevent future illness and improve health outcomes.1 2 General health screening, while providing benefits, is associated with disadvantages including false reassurance or over treatment.3 Criteria for establishing screening and evaluation of programmes are essential.3


    This was an update...

    Tele-health-monitoring may decrease emergency room visits and hospitalisation in patients with COPD

    Por: OConnor · S.

    Commentary on: Hong Y and Lee SH. Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. Int J Nurs Stud 2019;92:1–15.

    Implications for practice and research

  • Monitoring patients’ health remotely at home using technology has been gaining in popularity for a number of years.

  • Evidence suggests that tele-monitoring may have the potential to reduce emergency room visits and hospitalisation for patients with chronic obstructive pulmonary disease (COPD), particularly those with high disease severity.

  • More rigorously conducted trials of tele-monitoring in patients with  COPD are required to determine clinical and cost-effectiveness.

  • Context

    COPD is a long-term, debilitating, respiratory condition that impacts the lives of millions of people worldwide. Poor management of COPD can lead to hospital admissions, increased healthcare costs and poorer outcomes for patients and their families.1 A range of interventions are...

    Portable nursing stations reduce the rate of inpatient falls in UK hospitals

    Por: Haghgoshayie · E. · Hasanpoor · E.

    Commentary on: Ali UM, Judge A, Foster C, et al. Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis. Age Ageing 2018;47:818–24.

    Implications for practice and research

  • Portable nursing stations (PNSs) are one of the most important prevention programmes for reducing the rate of inpatient falls.

  • The PNSs provide a useful schema in reducing the direct and indirect costs.

  • Due to the new nature of PNSs and understanding the facilitators and barriers to implementation of this innovation, more interventions, qualitative research and randomised controlled trials are needed to be developed.

  • Context

    Inpatient falls are serious adverse events that can increase patient morbidity as well as hospital costs. Almost every year, 3.4 million people over 65 years fall in the UK.1 One of the most common type of inpatient accident are falls, reporting for up to...

    What are sensitivity and specificity?

    Por: Swift · A. · Heale · R. · Twycross · A.

    Whenever we create a test to screen for a disease, to detect an abnormality or to measure a physiological parameter such as blood pressure (BP), we must determine how valid that test is—does it measure what it sets out to measure accurately? There are lots of factors that combine to describe how valid a test is: sensitivity and specificity are two such factors. We often think of sensitivity and specificity as being ways to indicate the accuracy of the test or measure.

    In the clinical setting, screening is used to decide which patients are more likely to have a condition. There is often a ‘gold-standard’ screening test—one that is considered the best to use because it is the most accurate. The gold standard test, when compared with other options, is most likely to correctly identify people with the disease (it is specific), and correctly identify those who do not...

    Supporting family in their search for meaning and purpose during unexpected ICU admission improves coping, resilience and psychological outcomes

    Commentary on: Wong, P, Liamputtong P, Koch S, et al. Searching for meaning: a grounded theory of family resilience in adult ICU. J Clin Nurs 2018;28:781–91. Doi: 10.111/jocn.14673

    Implications for practice and research

  • To be resilient, families of intensive care unit (ICU) patients must be supported to seek and understand information, advocate for their loved one and find personal meaning and purpose in the admission.

  • Future research is needed to understand the best psychosocial interventions for family during ICU admission.

  • Context

    Intensive care units (ICUs) are evolving to function with increased family involvement. However, unchecked family involvement in the ICU can place a family at risk for psychological problems including anxiety, depression and if severe enough, postintensive care syndrome family (PICS-F). These risk factors may be lessened if a patient and family-centred care (PFCC) model is used. The foundation for PFCC involves dignity and respect, collaboration, information sharing...

    Poor communication hinders the role of the school nurse as a key professional in protecting children and young people from maltreatment

    Por: Wilkinson · Y.

    Commentary on: Harding L, Davison-Fischer J, Bekaert S, Appleton JV. The role of the school nurse in protecting children and young people from maltreatment: An integrative review of the literature. Int J Nurs Stud. 2019 Jan 2;92:60–72.

    Implications for practice and research

  • Interagency communication can be problematic; adopting an interagency approach to education and training in this area may be beneficial.

  • There is a need for research exploring the impact of school nurse interventions in relation to child maltreatment from the perspective of children and young people.

  • Context

    Child maltreatment is a global public health issue with one in four adults experiencing physical violence in their childhood.1 Effects are far reaching and long standing for children and young people; these include behavioural, physical and mental health consequences. Internationally, in a global overview of school health services, it was found that at least 102...

    Resources page

    Por: Heale · R.
    Health improvement Scotland Scottish Intercollegiate Guidelines Network (SIGN)British Guideline on the Management of Asthma

    The guideline covers diagnosis and management of asthma in adults and children, and sections of the guideline are updated biennially. The 2019 update includes a complete revision of the section on monitoring asthma, including new information on predicting future risk of asthma attacks, and updates to the sections on pharmacological management of asthma, supported self-management, non-pharmacological management of asthma, and management of acute asthma in adults and children. It also includes a new checklist of information for patients and carers.

    Risk reduction and management of delirium

    This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow-up of adults with delirium, as well as reducing the risk of delirium. The guideline applies to all settings: home, long-term care,...

    Making visible the invisible: the brilliance study

    Por: Russell · S.

    Commentary on: Collier A, Hodgins M, Crawford G, et al. What does it take to deliver brilliant home-based palliative care? Using positiveorganisational scholarship and video reflexive ethnography to explore the complexities of palliative care at home. Palliat Med 2018:269216318807835. doi: 10.1177/0269216318807835.

    Implications for practice and research

  • Presents credible arguments that good practice is reinforced and encouraged through making everyday interactions visible.

  • Explains and demonstrates the research methodology of  Positive Organisational Scholarship in Healthcare (POSH, study of that which is positive, flourishing and life-giving in organisations) and video-reflexive ethnography (VRE) to support generalisability of these methods for research.

  • Context

    Despite the increasing number of people worldwide requiring palliative care at home, there is limited evidence on how such care is best practised. Care can improve symptom management, quality of life and prevent hospitalisation at the end of life. There is significant variation in how it is delivered....