An mHealth Walking Intervention for Pregnant Women with Obesity

Introduction: Adverse maternal and infant health outcomes are associated with a rise in obesity and excessive gestational weight gain, which may be modified with physical activity in pregnancy. Using mobile health technology has the potential to reach widely at a low cost, to deliver physical activity interventions founded upon behaviour change theory to support women with gestational weight gain management. Aim: To establish the feasibility, practicality and acceptability of a walking-based intervention for women who are pregnant and obese. Specific objectives were to; conduct a systematic literature review; develop and test the feasibility, of a walking intervention for women who are pregnant and obese using mobile health technology; qualitatively evaluate participants' and health professionals' views on the intervention design; design a protocol for a definitive RCT intervention. Methods: A systematic review was conducted investigating the components and effectiveness of walking interventions for women who are pregnant and obese. Following this, feasibility randomised controlled trial, of a physical activity intervention to women who are pregnant and obese, delivered via Facebook, was implemented. It was developed using the Capability, Opportunity, Motivation- Behaviour model as per National Institute of Health and Care Excellence guidelines, to deliver self-monitoring, goal-setting and 'information about health consequences' behaviour change techniques. Semi-structured interviews with participants and health professionals assessed the acceptability of the intervention. Primary outcome measures were feasibility of recruitment, attrition, and trial procedures. Secondary outcomes were: engagement in Facebook group, physical activity, gestational weight gain, maternal and infant outcomes. Results: The systematic review identified two eligible studies, both underpowered but showing a trend in improved maternal outcomes. For the feasibility trial, 40 women were recruited. Retention rate was 85% in the intervention and 75% in the control group. Participants were compliant to wearing Fitbit (intervention arm 32/35 days and the control 28/35 days). In the intervention arm, 20/20 participants joined the Facebook group. The level of engagement varied, with some active and some 'lurking' participants. The interviews revealed that participants found it practical and convenient to access health information via a closed Facebook group. Conclusion: Recruitment and adherence rates and Facebook participation, suggest that the study is feasible and acceptable. Findings from the feasibility study informed the final protocol of a large size randomised controlled trial, to test the effectiveness of a mobile health-based walking intervention

The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence.

There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control

The association between care left undone and temporary Nursing staff ratios in acute settings: a cross- sectional survey of registered nurses

Background The shortage of health workers is a global phenomenon. To meet increasing patient demands on UK health services, providers are increasingly relying on temporary staff to fill permanent posts. This study examines the occurrence of ‘care left undone’, understaffing and temporary staffing across acute sector settings. Methods “Secondary data analysis from an RCN administered online survey covering nurses from hospitals and trusts across all four UK countries. Staffing and ‘care left undone’ measures were derived from the responses of 8841 registered nurses across the UK. A locally smoothed scatterplot smoothing regression analysis (Loess) was used to model the relationship between any ‘care left undone’ events and full complement, modest and severely understaffed shifts, and proportions of temporary staff. Results Occurrence of ‘care left undone’ was highest in Emergency Departments (48.4%) and lowest in Theatre settings (21%). The odds of ‘care left undone’ increase with increasing proportion of temporary staff. This trend is the same in all understaffing categories. On shifts with a full quota of nursing staff, an increase in the proportion of temporary staff from 0 to 10% increases the odds of care left undone by 6% (OR = 1.06, 95% CI, 1.04–1.09). Within the full quota staffing category, the difference becomes statistically significant (p < 0.05) on shifts with a proportion of temporary nursing staff of 40% or more. On shifts with a full quota of nursing staff the odds of a ‘care left undone’ event is 10% more with the proportion of temporary nursing staff at 50%, compared to shifts with modest understaffing of 25% or less with no temporary nursing staff (OR = 1.1, 95%CI, 0.96–1.25). Conclusion The odds of a ‘care left undone’ event are similar for fully staffed shifts with a high temporary nursing staff ratio compared to severely understaffed shifts with no temporary nursing staff. Increasing the proportion of temporary nurse staff is associated with higher rates of self-reported care left undone by nursing staff. This has significant implications for nurse managers and policy makers

Analysis of a nursing survey: Reasons for compromised quality of care in inpatient mental health wards

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: ‘Understaffing’, ‘Professional Code Expectations and Moral Distress’ and ‘Management’. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality

Determinants of nurse job dissatisfaction - findings from a cross-sectional survey analysis in the UK

Background A lower recruitment and high turnover rate of registered nurses have resulted in a global shortage of nurses. In the UK, prior to the COVID-19 epidemic, nurses’ intention to leave rates were between 30 and 50% suggesting a high level of job dissatisfaction. Methods In this study, we analysed data from a cross-sectional mixed-methods survey developed by the Royal College of Nursing and administered to the nursing workforce across all four UK nations, to explore the levels of dissatisfaction and demoralisation- one of the predictors of nurses’ intention to leave. We carried out logistic regression analysis on available data in order to determine what impacts job dissatisfaction. Results In total, 1742 nurses responded to questions about working conditions on their last shift. We found that nearly two-thirds of respondents were demoralised. Nurses were five times more likely (OR 5.08, 95% CI: 3.82–6.60) to feel demoralised if they reported missed care. A perceived lack of support had nearly the same impact on the level of demoralisation (OR 4.8, 95% CI: 3.67–6.38). These findings were reflected in the qualitative findings where RNs reported how staffing issues and failures in leadership, left them feeling disempowered and demoralised. Conclusion A large proportion of nurses reported feeling dissatisfied and demoralised. In order to reduce the negative impact of dissatisfaction and improve retention, more research needs to investigate the relationship dynamics within healthcare teams and how the burden experienced by RNs when unsupported by managers impacts on their ability to provide safe, good-quality care. These findings predate the current Covid-19 pandemic outbreak which may have had a further detrimental effect on job satisfaction in the UK and other nation’s nursing workforce

Advanced practice nurses' experiences and well-being: baseline demographics from a cohort study

Aims: Create a cohort of Advanced Practice Nurses from across the UK. Report the initial questionnaire including demographics, work experiences, and well-being. Background: In the UK, advanced nursing practice is not regulated. This has led to the concern that advanced nurses are working in very different ways with different levels of autonomy and support. Methods: Participants were recruited via university and Royal College of Nursing mailing lists, and social media adverts. They completed the initial questionnaire about their background and workplace, work experiences, credentialing, and well-being. Results: 143 nurses were recruited to the cohort and 86 completed the survey. Over 40 job titles were reported, across five pay bands. Job title was not correlated with pay band (p=0.988). Participant wellbeing was not significantly different from the UK general population, but they reported high rates of work-related stress (44.2%) compared to the NHS national average (37.9%). Conclusion: There is wide disparity in pay which is not reflected in title or setting. The high levels of work-related stress require further exploration. Implications for nursing management: The range of experiences reported here should encourage managers to evaluate whether title, pay, and support mechanisms for APNs in their organisations align with suggested national standards set by Royal Colleges and government departments

Malignant pleural mesothelioma patients' experience by gender : findings from a cross-sectional UK-national questionnaire

Objectives: Malignant mesothelioma is an aggressive malignancy of mesothelial surfaces, most commonly those of the pleura. The aim of this study was to understand, using a national questionnaire, the gendered care experiences of patients with malignant pleural mesothelioma (MPM). Patients were asked about their experience of the diagnostic process, about information clarity, health care professionals’ knowledge, general practitioner support and overall satisfaction with care received. Setting: Recruitment of patients was carried out in three UK countries (England, Wales and Scotland) via mesothelioma clinical nurse specialists. Participants: In total, 503 patients completed the questionnaire. 460 had MPM, the remainder had other types of mesothelioma. In accord with the study protocol, only the MPM patients were included in this study. Primary and secondary measures were: (1) time from symptom to diagnosis, (2) satisfaction with the diagnosis and treatment, and (3) quality of life and well-being. Results: There were gender differences in time from symptom to diagnosis. The time from symptom to diagnosis was significantly longer for women than men (median=152 days vs men=92 days, p=0.01). Lack of a verified source of exposure to asbestos was a hindrance to private treatment access for women (95% of those that access private treatment are men). Patients were five times more likely to be satisfied if they thought that the doctors knew enough about their condition (OR=4.4, p=0.001) and nearly three times more likely to be satisfied if information was presented in a sensitive way (OR=2.8,p=0.01). Conclusions: This study has several implications for clinical practice. Our findings suggest that the diagnostic time in women might be reduced by reviewing diagnostic processes including occupational history taking, and by revising the occupational risk of mesothelioma categorisation

Should I stay or should I go? Why nurses are leaving community nursing in the UK

Worsening working conditions for nursing workforce has seen a massive exodus of staff, particularly in community nursing in the UK. Aim: The study aim was to map working conditions as well as identify differentiating characteristics of community nurses that intend to leave their profession. Design: Eligibility criteria were community nurses working in all 4 UK countries. All data was collected by means of a cross-sectional survey via the largest closed, private community nursing online-forum. Logistic regression was carried out to ascertain the effects of the variables on the intention to leave. Results: The total number of respondents was 533. Findings showed that one in two of all community nurses (≈46%) are reporting job dissatisfaction. Length of unpaid overtime per shift (odds increase by 30% for each hour of overtime), manager support, proportion of permanent staff, team size, shift length, travel mileage, worsened conditions in the last year and overall self-rated working conditions were differentiating factors between those that intended to leave the job. The proportion of permanent staff on the team and perceived lack of support from management best predicted the likelihood of leave rates. Our findings imply that low nurse retention will fuel an even higher exodus because job dissatisfaction is highest on teams with lowest permanent staff ratios. Poor management that is inept at supporting frontline staff means that the fundamental retention issues are exacerbated and will not stop the unprecedented crisis that is predicted to lead to a collapse of care provision in community settings. Nurses play a central role and are ‘key’ to delivering the much- desired patient-centred care’ therefore their well-being and job satisfaction should become a priority for policymakers