An @WeNurses Twitter Chat on NICE Guidelines and Evidence in Nursing

Are NICE Guidelines Enabling Our Caring Professionals to Meet NMC Standards of Evidence-Based Practice?

By Stephen Williams, Sian Jackson and Sarah O’Donnell (2013)

15042014wenursesThis is a proposed @WeNurses chat co-written by Steve Williams aka @MHNurseLecturer, Sian Jackson aka @firecracker1305 and Sarah O’Donnell aka @sarah_searz. This proposed twitter chat came about as a result of a pre-registration nursing @BradfordUni debate on evidence-based practice in healthcare. This represents a strand of ‘SoMe’ (Social Media) integration and dissemination of student-nursing practice as explored in Williams (2013).

The NMC (Nursing and Midwifery Council) (2008) code states we must: “deliver care based on the best available evidence” (p.6) and keep our “knowledge and skills up to date” (p.6). NICE (National Institute of Health and Care Excellence) guidelines have assisted practice since 2001. With a variety of treatment options/pathways it seeks to enable professionals to provide evidence-based advice and care. However is the evidence assessed by NICE sufficiently contextually relevant for our patients’ clinical needs?

Research evidence can become rapidly out dated and some academics and practitioners might argue it’s not always sufficiently well developed for practice. Nurses establish their practice in a variety of ways and their ability to critically evaluate research varies (Funk et al., 1991; Kirkevold, 2008). NICE guidelines take two years to be developed prior to publication. This suggests that upon publication they are already out of date and indeed may not be updated for a further three to four years.

An example of such issues with NICE guidance can be seen in the development of guidelines for self-harm (Pitman and Tyrer, 2008). Pitman and Tyrer (2008) point out that this was developed on research evidence with only one recommendation based on a RCT (randomised controlled trial) quality of evidence. Most of the research at the time was on the physical impact of self-harm and the guidelines received criticism for amalgamating self-poisoning and self-laceration as a single kind of problem (Barker and Buchanan-Barker, 2004). Is it pertinent to argue then that a culture of ‘following NICE guidelines’ perhaps disables nurses obligation to critically review nursing research and related evidence themselves?

NICE guidelines set out to reduce inequalities in treatment provision. Whilst this is a laudable ideal the reality of treatment provision is considerably murkier. Take the provision of IVF (in vitro fertilization): NICE guidelines in 2004 recommended three full cycles of treatment for those who met agreed clinical criteria. By mid-2005 PCTs (primary care trusts) were being asked to make at least one cycle available by the secretary of state. There was no mandate or mechanism for ensuring the recommendations were implemented (House of Commons Health Committee, 2008). A further critical point is that PCT’s in England were able to set the eligibility criteria for access to NHS funding above and beyond clinical criteria set out in the guideline (House of Commons Health Committee, 2008). This being the case – are they really addressing health inequalities and are we confident the advice they prompt us to give is sufficiently empirically robust?

A twitter chat in conjunction with @WeNurses is scheduled for Tuesday 15th April 2014 at 8pm online.

References

Barker, P. Buchanan-Barker, P., (2004), NICE and self-harm: Blinkered and exclusive,Mental Health Nursing, 24,6,pp. 46.

Funk, S.G., Thornquist, E.M., Wiese, R.A. and Champagne, M. T. (1991), Barriers to using research findings in practice: The clinicians perspective. Applied Nursing Research. 4, pp 90-95.

House of Commons Health Committee (2008), Health Inequalities: Written Evidence, Session 2007-08, Volume II, Her Majesty’s Stationery Office.

Kirkevold M. (1997), Integrative Nursing Research – An Important Strategy to Further The Development of Nursing Science and Nursing Practice, Journal of Advanced Nursing, 25, pp 977-984.

Nursing and Midwifery Council (2008), The Code: Standards of conduct, performance and ethics for nurses and midwives, NMC.

Pitman, A. and Tyrer, P. (2008), Implementing clinical guidelines for self-harm – highlighting key issues arising from the NICE guidelines for self-harm, Psychology and Psychotherapy: Theory, Research and Practice, 81, 4, pp. 377-397.

Williams, S. (2013), Embracing Digital Education for Nursing (An @WeNurses Web-blog Article), The Inside Skinny Latte Blog, September 9th 2013, Available from: http://mhnurselecturer.co.uk/?p=8, [accessed 19th November 2013].

An @WeNurses Twitter Chat On Resilience

personalresilienceasanurse

A Twitter Chat for @WeNurses on Resilience (Hosted 7th March 2013)

Originally Posted on April 8, 2013 by mhnurse

Following a recent twitter chat I  joined forces with Maxine Craig (@maxine_craig) and Andrew Moore (@steesimprove), two Organisational Development NHS professionals from South Tees, to co-host a twitter chat on the #WeNurses hashtag. We found that we shared a common interest in the idea of ‘resiliency’ and elected to collaborate and develop a twitter chat on this topic. You can find the archive of this twitter chat via WeNurses.co.uk. Here’s my covering blurb from that twitter chat, that I have subsequently edited a little.

“Resilience” is a topic of particular interest to a growing variety of stakeholders in health and social care and beyond. This is evident in the relatively recent call for science to adopt a more positive mind-set (Luthar and Zelazo, 2003: cited in Mohaupt, 2009) and the rise of ‘positive psychology’. You can find resiliency research present in fields as diverse as ecology, physics, medicine, social psychology, and psychiatry as far back as the 1940’s (Mohaupt, 2009).

Coming from the Latin ‘resilio’ meaning ‘spring back’ (Oxford Dictionary, 2010) in a therapeutic context it describes how people can get through adversity by drawing upon their various strengths (Kyuken, Padesky and Dudley, 2009). Definitions and the usage of resilience have changed over time, but the bottom line is that resilience is currently conceptualised as “a dynamic concept referring to a person’s ability to maintain or regain health after exposure to adversity” (Herrman and Jane-LLopis, 2012, p.1).

Our question, and topic for our nursing twitter chat, is – how do we build personal resilience as nurses? The idea of nursing (and indeed we could argue any kind of person-focused work) as a kind of “emotional labour” with a concomitant risk of “burnout” is well established in the literature and across the fields of nursing (Henderson, 2001; Brotheridge and Grandey, 2002, Mann and Cowburn, 2005). It would seem to make sense then to join these things up and consider carefully how nurses can apply the developing expertise from well-being and positive-psychology research (e.g. Seligman and Csikszentmihalyi, 2000) to themselves, colleagues and those they care for.

Positive-psychology interventions (PPI) are not primarily about treating people with significant emotional and psychological health difficulties (SEPHD), although there is considerable interest and research into this (see Sin and Lyubomirsky, 2009). PPI strategies run the gamut of: writing thank-you letters, practicing optimistic thinking, re-living/rehearsing positive experiences, to practicing mindfulness skills. These interventions have been shown to increase well-being in people without SEPHD (e.g. Lyubomirsky et al. 2011). The need for national and local NHS strategies to develop staff health and well-being was recognised on the back of the Boorman report (Boorman, 2009) and led to the development of the Department of Health (DH) “Healthy Staff, Better Care for Patients” National guidance for the NHS (DH, 2011). Your NHS trust should have a health and well-being strategy and policy.

That’s the rhetoric – what of the reality? The national guidelines places staff at the top of the chain of responsibility in their illustrative diagram of how we should go about “embedding improvements to the health and well-being of staff in the NHS” (DH, 2011, p.6). There is, naturally, the predictable raft of guidelines for managers, the organisation, the wider health system and the community beyond that. So, in the light of all this how do we build personal resilience as nurses?

References:

Boorman, S. (2009), NHS Health and Well-being: Final Report, DoH.

Brotheridge C.M. and Grandey A.A. (2002), Emotional Labor and Burnout: compating Two Perspectives of “Perople Work”, Journal of Vocational Behaviour, 60: pp.17-39.

Department of Health (2011), Healthy Staff, Better Care for Patients: Realignment of Occupational Health Services to the NHS in England, DoH.

Henderson A. (2001), Emotional Labor and nursing: an under-appreciated aspect of caring work, Nursing Inquiry, 8(2); p130-8.

Herrman H. and Jane-Llopis E., (2012), The status of mental health promotion. Public Health Reviews, 34(2).

Kuyken W., Padesky C.A. & Dudley R., 2009, Collaborative Case Conceptualization: Working Effectively with Clients in Cognitive Behavioural Therapy, New York: Guildford Press.

Lyubormirsky, S.,  Dickerhoof, R.,  Boehm, J.K.,  and Sheldon, K.M. (2011). Becoming happier takes both a will and a proper way: an experimental longitudinal interventions to boost well-being. Emotion. 11(2): pp 391-402.

Mann S. and Cowburn J. (2005), Emotional labour and stress within mental health nursing, Journal of Psychiatric and Mental Health Nursing, 12 (2), pp154-162.

Mohaupt, S. (2009), Review Article: Resilience and Social Exclusion, Social Policy and Society, 8 (1), pp 63-71.

Oxford Dictionaries. (2010) Oxford Dictionaries Oxford University Press.http://oxforddictionaries.com/definition/english/resilience (accessed February 18, 2013).

Seligman, M.E.P. and Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55, p5-14.

Sin N.L. and Lyubomirsky S. (2009), Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis., Journal of Clinical Psychology, 65(5): pp.467-487.