Epidemiology of adolescent substance use in Norfolk schools.

BACKGROUND: The pattern of alcohol and substance use is changing, with the introduction of novel psychoactive substances, the internet as a means of acquisition and variations in drug purity and price. Alcohol and substance use among adolescents is associated with behavioural, mental health, health and social difficulties; arising at a vulnerable period in their development. Little is known about adolescent substance use in the UK, especially in rural areas. AIM: To investigate the prevalence of substance use amongst young people, aged 16-21 years, in Norfolk schools. DESIGN: Cross sectional questionnaire survey. METHOD: Pupils from two, sixth form colleges in Norfolk answered a self-report questionnaire designed to measure prevalence, age of onset and frequency of use for alcohol, tobacco, illicit substances including new psychoactive substances as well as demographic data. RESULTS: A total of 482 students completed the survey (68% participation rate). Life-time use of alcohol was reported by 442 (91.7%) students and over half the pupils had tried tobacco (52.5%, n=253). About 40.7% reported cannabis use and nearly one-fifth (18.9%, n=91) reported using 3,4-methylenedioxymethamphetamine (MDMA); 41.1% (n=198) students reported using 'any drug' and 23.2% (n=112) 'using an illicit drug other than cannabis' and 8.7% (n=42) reported the use of a novel psychoactive substance. CONCLUSION: The most widely used substances were alcohol, tobaccos and cannabis; in keeping with European trends. Over the past decade a decline in alcohol and drug use by adolescents has been seen in the UK. However, since 2010 this decline has slowed with an increase in substance use noted in the past 2 years. This study provides evidence to support this trend. The findings demonstrate differences between the use of substances by pupils in this Norfolk sample compared to national surveys and more urbanized areas. These regional differences can be used to assist the development of local interventions targeting substance use among adolescents.

Epidemiology of adolescent substance use in London schools.

BACKGROUND: Alcohol and substance use in adolescence can be associated with a range of health, emotional, social, behavioural and legal problems. There has been a change in the recreational drugs available to users in recent years; however, little is known about how this impacts the youngest and most vulnerable population of substance users. AIM: To investigate the prevalence of substance use among children aged 15-18 years in London schools. DESIGN: Questionnaire survey. METHOD: Students aged 15-18 years in three London schools self-completed the questionnaire which collected demographic data (age, gender and ethnicity) and data on frequency of use of alcohol, tobacco and classical recreational drugs and novel psychoactive substances. RESULTS: Completed surveys were available from 533 students (47.8% of those invited to participate). One hundred thirteen (20.4%) students reported lifetime use of at least one recreational drug, cannabis (96, 18.7%) was commonly reported and only 6 (1.1%) reported use of a novel psychoactive substance. A total of 250 (47.8%) reported using alcohol at least once; those from White and Mixed ethnic groups were more likely to report using alcohol than those in other ethnic groups. A total of 382 (74.2%) students reported using tobacco at least once, and students from ethnic minorities were more likely to smoke than their White counterparts. CONCLUSION: This study supports previous findings that alcohol and drug use are declining in adolescents in UK. There are different patterns of substance use amongst different ethnic groups; this is important to schools and policymakers planning interventions related to substance use in school-aged children.

Weight management care practices of English and Chinese nurses.

BACKGROUND: Obesity is a growing global public health problem which requires all healthcare professionals to deliver weight management care within their roles. AIM: To describe nurses' perceived barriers, skills and practices regarding weight-related care and explore differences between English and Chinese nurses. METHODS: A cross-sectional, self-administered questionnaire survey was distributed to 588 English nurses employed in a range of clinical settings and healthcare organizations and attending a large university in London (October-November 2010), and 519 Chinese nurses working in one of the largest hospitals in Shanghai, China (February-April 2011). Perceived barriers, skills and practices regarding weight-related care were measured. Data analysis was undertaken using responses from 399 English and 466 Chinese nurses. RESULTS: English and Chinese nurses reported similar barriers to undertaking weight-related care practices which included two relatively new barriers, namely complex patients and the absence of clear practice guidelines. Both English and Chinese nurses reported being moderately skilled to perform weight-related care practices with the most mean skill scores at the moderate level. Up to 11-54% of the English nurses and 10-25% of the Chinese nurses reported providing recommended weight-related interventions for most of their patients. Generally, the English nurses reported more barriers, high-level skills and practices regarding weight-related care than the Chinese nurses. LIMITATIONS: The convenience samples and self-report data may have been sources of bias. CONCLUSIONS: A variety of barriers and limited skills may help explain the suboptimal weight-related practices among the nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Skill development of pre-registration and qualified nurses is indicated as well as the development of the nurse role to include weight management care of obese patients. Evidence-based guidelines should be readily accessible to support the nurse role in weight-related care.

Seasonal influenza vaccination knowledge, risk perception, health beliefs and vaccination behaviours of nurses.

The relationship between knowledge, risk perceptions, health belief towards seasonal influenza and vaccination and the vaccination behaviours of nurses was explored. Qualified nurses attending continuing professional education courses at a large London university between 18 April and 18 October 2010 were surveyed (522/672; response rate 77·7%). Of these, 82·6% worked in hospitals; 37·0% reported receiving seasonal influenza vaccination in the previous season and 44·9% reported never being vaccinated during the last 5 years. All respondents were categorized using two-step cluster analyses into never, occasionally, and continuously vaccinated groups. Nurses vaccinated the season before had higher scores of knowledge and risk perception compared to the unvaccinated (P<0·001). Nurses never vaccinated had the lowest scores of knowledge and risk perception compared to other groups (P<0·001). Nurses' seasonal influenza vaccination behaviours are complex. Knowledge and risk perception predict uptake of vaccination in nurses.

The relationship between doctors' and nurses' own weight status and their weight management practices: a systematic review.

It has been established that health professionals' smoking and physical activity influence their related health-promoting behaviours, but it is unclear whether health professionals' weight status also influences their related professional practices. A systematic review was conducted to understand the relationship between personal weight status and weight management practices. Nine eligible studies were identified from a search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases. All included studies were cross-sectional surveys employing self-reported questionnaires. Weight management practice variables studied were classified under six practice indicators, developed from weight management guidelines. Syntheses of the findings from the selected studies suggest that: normal weight doctors and nurses were more likely than those who were overweight to use strategies to prevent obesity in-patients, and, also, provide overweight or obese patients with general advice to achieve weight loss. Doctors' and nurses' own weight status was not found to be significantly related to their referral and assessment of overweight or obese patients, and associations with their relevant knowledge/skills and specific treatment behaviours were inconsistent. Additionally, in female, primary care providers, relevant knowledge and training, self-efficacy and a clear professional identity emerged as positive predictors of weight management practices. This review's findings will need to be confirmed by prospective theoretically driven studies, which employ objective measures of weight status and weight management practices and involve multivariate analyses to identify the relative contribution of weight status to weight management.

The relationship between health professionals' weight status and attitudes towards weight management: a systematic review.

This systematic review aims to address the question of whether health professionals' weight status is associated with attitudes towards weight management. Twelve eligible studies were identified from a search of the Cochrane Library, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and three Chinese databases, which included 14 independent samples comprising a total of 10 043 respondents. Attitudes towards weight management were classified under eight attitude indicators. Quantitative synthesis of the findings of included studies showed that health professionals of normal weight were more likely to be more confident in their weight management practice, perceive fewer barriers to weight management and have more positive outcome expectations, have stronger role identity and more negative attitudes towards obese individuals than health professionals who were overweight or obese. However, there was no difference between overweight and non-overweight health professionals in their perceptions of the causes and outcomes of obesity. In addition, being female and having relevant knowledge and clinical experience of weight management appeared to predict positive attitudes towards obesity/obese patients and high self-efficacy in weight management, respectively. Future research should focus on prospectively theory-driven studies, and employ appropriately validated instruments and multivariate analyses to identify the relative contribution of weight status to attitudes towards weight management.

Environments for nursing scholarship and journal impact factor in five countries.

BACKGROUND: Universities worldwide are seeking objective measures for the assessment of their faculties' research products to evaluate them and to attain prestige. Despite concerns, the impact factors (IF) of journals where faculties publish have been adopted. RESEARCH OBJECTIVE: The study aims to explore conditions created within five countries as a result of policies requiring or not requiring faculty to publish in high IF journals, and the extent to which these facilitated or hindered the development of nursing science. DESIGN: The design was a multiple case study of Brazil, Taiwan, Thailand (with IF policies, Group A), United Kingdom and the United States (no IF policies, Group B). Key informants from each country were identified to assist in subject recruitment. METHODS: A questionnaire was developed for data collection. The study was approved by a human subject review committee. Five faculty members of senior rank from each country participated. All communication occurred electronically. FINDINGS: Groups A and B countries differed on who used the policy and the purposes for which it was used. There were both similarities and differences across the five countries with respect to hurdles, scholar behaviour, publishing locally vs. internationally, views of their science, steps taken to internationalize their journals. CONCLUSIONS: In group A countries, Taiwan seemed most successful in developing its scholarship. Group B countries have continued their scientific progress without such policies. IF policies were not necessary motivators of scholarship; factors such as qualified nurse scientists, the resource base in the country, may be critical factors in supporting science development.

Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students.

BACKGROUND: Exposure therapy is effective for phobic anxiety disorders (specific phobias, agoraphobia, social phobia) and panic disorder. Despite their high prevalence in the community, sufferers often get no treatment or if they do, it is usually after a long delay. This is largely due to the scarcity of healthcare professionals trained in exposure therapy, which is due, in part, to the high cost of training. Traditional teaching methods employed are labour intensive, being based mainly on role-play in small groups with feedback and coaching from experienced trainers. In an attempt to increase knowledge and skills in exposure therapy, there is now some interest in providing relevant teaching as part of pre-registration nurse education. Computers have been developed to teach terminology and simulate clinical scenarios for health professionals, and offer a potentially cost effective alternative to traditional teaching methods. OBJECTIVE: To test whether student nurses would learn about exposure therapy for phobia/panic as well by computer-aided self-instruction as by face-to-face teaching, and to compare the individual and combined effects of two educational methods, traditional face-to-face teaching comprising a presentation with discussion and questions/answers by a specialist cognitive behaviour nurse therapist, and a computer-aided self-instructional programme based on a self-help programme for patients with phobia/panic called FearFighter, on students' knowledge, skills and satisfaction. DESIGN: Randomised controlled trial, with a crossover, completed in 2 consecutive days over a period of 4h per day. PARTICIPANTS: Ninety-two mental health pre-registration nursing students, of mixed gender, age and ethnic origin, with no previous training in cognitive behaviour therapy studying at one UK university. RESULTS: The two teaching methods led to similar improvements in knowledge and skills, and to similar satisfaction, when used alone. Using them in tandem conferred no added benefit. Computer-aided self-instruction was more efficient as it saved teacher preparation and delivery time, and needed no specialist tutor. CONCLUSION: Computer-aided self-instruction saved almost all preparation time and delivery effort for the expert teacher. When added to past results in medical students, the present results in nurses justify the use of computer-aided self-instruction for learning about exposure therapy and phobia/panic and of research into its value for other areas of health education.

An investigation of job satisfaction, organizational commitment and role conflict and ambiguity in a sample of Chinese undergraduate nursing students.

This study aimed to explore the relationships between job satisfaction and organizational commitment, role conflict and ambiguity, and demographic variables associated with retention of nurses within the Chinese healthcare workforce. A hypothetical model derived from a review of research studies investigating relationships between these variables was tested in a cross-sectional questionnaire survey of all the final year nursing students in a medical university in China. Seventy-one out of the total sample of 75 final year nursing students completed the questionnaire, producing a response rate of 95%. Descriptive and inferential statistical analysis of the data revealed a positive relationship between job satisfaction and organizational commitment, and a negative relationship between job satisfaction and role conflict and ambiguity. These results largely support the hypothesised associations between variables found in research studies derived mainly from samples of Western qualified nurses. However, contrary to previous studies, the findings suggest that aspirations to work in a clinical post are associated with high job satisfaction, and degree level student nurses have relatively high job satisfaction. The main implications for nursing education and practice are that educators and clinical mentors should work collaboratively to reduce the gap between theory and practice, specifically to improve the quality of student nurses' clinical experience in China and elsewhere. Positive clinical placement experience is related to high job satisfaction, and so, potentially, to improved retention. Future studies are needed which investigate changes in job satisfaction and other related variables over time, which have student nurse samples that are sufficient to enable the predictive value of these variables on retention in the healthcare workforce to be investigated.

Putting portfolios in their place.

This paper discusses the use of portfolios in nursing education and sets this in an international context. It argues that the assessment of clinical competence in the practice setting is inherently problematic, as recognized in certain recent policy documents, and evaluates the role that portfolios can play. A number of theoretical approaches to the definition and use of portfolios are discussed, and particular attention is paid to their reliability and validity as assessment tools. The paper concludes by arguing that there is a need for further research into the credibility, reliability and validity of this approach to the assessment of nurses' competence.

Priorities for mental health and learning disability nurse education in the UK: a case study.

The closure of psychiatric and mental handicap hospitals, the emphasis on community rather than hospital care and the distinction between health and social care for people in the community, with its funding implications, have demanded that mental health and learning disability nurses face the challenges of developing new skills and new ways of working. In this paper the findings of a study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB) are reported. This study explored the impact of these reforms on nurses and their practice, and identified the educational needs of mental health and learning disability nurses that have changed as a result. The study took a multiple-case study approach and involved interviews with 22 'key informants' and 88 mental health and 59 learning disability stakeholders in six sites, three in each nursing specialty. Inductive analysis of the interview data revealed 20 categories which summarize the major issues facing the two nursing specialties. These categories are discussed under seven themes and issues for nurse education are raised.

Managed mental health care: problems and possibilities.

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as 'managed care' has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.

The changing emphasis of mental health and learning disability nurse education in the UK and ideal models of its future development.

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.

Clinical leadership in nursing development units.

There is an expectation for Nursing Development Units (NDUs) to explore and develop the clinical leadership role. This paper describes how 28 Department of Health funded NDUs in England sought to meet this objective. We describe the personal and professional characteristics of NDU clinical leaders (CLs) and their perceived responsibilities. We identify 10 elements which appear to be central to the CL role and together form a core role set of the leader which is applicable, to some extent, across clinical specialties and settings. The position of the CL in the organizational hierarchy emerges as crucial to his/her ability to act on these responsibilities and fulfil a leadership role.

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.

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 of two quality assessment instruments: Monitor and Senior Monitor.

This paper is concerned with validity of Monitor and Senior Monitor. The study carried out, which was funded by the Department of Health, attempted to establish the validity of the instruments through a multiple triangulation research design. Monitor and Senior Monitor were compared to another instrument, Qualpacs, and also to other methods that focused on quality of nursing care--observation of patients' activities and interactions with nurses, and interviews with patients and nurses on their perceptions of quality. The results did not reveal a clear picture. Convergent validity was relatively strong for Senior Monitor and the Monitor DG3 schedule, but not the DG1, DG2 and DG4 schedules, when compared to Qualpacs. The comparison with observation of nurse-patient activities and interactions supported Monitor rather more than Senior Monitor, particularly with respect to frequency of omitted activities. Both instruments showed considerable construct validity in that congruence emerged between their items and the views of patients and nurses on what constitutes quality.

Clinical audit, related cycles and types of health care quality: a preliminary model.

This paper is drawn from a study carried out in England, funded by the Department of Health. The aims of the study were to explore clinical audit in the four health professions of clinical psychology, occupational therapy, physiotherapy and speech and language therapy and to develop a model of clinical audit and guidelines for use by practitioners and managers. The focus in this paper is the model development. Included are examples of audits relevant to different types of health care quality that illustrate the process of clinical audit using the model. The modelling process involved interrogating the clinical audit cycle and related cycles against the data and identifying their inter-connecting links. The model was refined and reformulated to include guidelines for the professions on what is needed to make clinical audit work. The position of the professional service manager is crucial. A mandate that includes creating machinery at provider unit level, mobilizing the principal working groups and promoting internalization of audit by practitioners, is essential for audit to be effective.

A model of clinical supervision for nurses undertaking short placements in mental health care settings.

This paper presents a model of supervision developed from the experience of supervising undergraduate general nursing students undertaking clinical experience in psychiatric wards. Supervision structures and methods are presented and the theoretical under-pinnings of the supervision model are discussed. Our experience of using the model over the past 5 years suggests that it has the potential to allow students to gain a good understanding of individual patients within a short time span and to engage with them as active collaborators in care. The supervision model can also assist students to develop the knowledge and insights needed to gain the respect of senior colleagues, and the confidence to challenge the professional conservatism that often characterizes psychiatric wards.