Home for Christmas

UNITED KINGDOM—I love Christmas, and I’m not afraid to admit it. There is the underlying Christian message, which, along with a dwindling minority in the U.K., I actually believe. I also like the more Victorian aspects of Christmas: Christmas trees, Christmas cards (if my wife writes them), and Christmas Day. Aware that many spend Christmas alone and face hardship here and across the world, I am grateful that my family gathers together. At some point in the holiday season, all of our eight children and five grandchildren will visit, plus husbands, partners, friends, and a dog. I won’t answer email for a fortnight. Initially, I suffer withdrawal symptoms and then settle down, to emerge at the other end ready to face the next year. And next year is going to be one of my busiest.

Looking back on 2013

This year has been busy, too, but not exceptional. I have been lucky to visit 13 countries outside the U.K., and past blogs recount my visits to Hong Kong, Italy, Finland, Germany, Ireland, Australia, the United States, Taiwan, China, Singapore, Thailand, Saudi Arabia, and Bahrain. With the exception of Thailand, I have run in each of these places, which was one of my unstated goals for the year. My running miles on the ground this year amount to 700; my miles in the air 150,000. I am, I realise, very lucky to have the funding and freedom to do this.

Looking forward to 2014

A large part of my work next year will be taken up with the United Kingdom Research Excellence Framework (REF). A periodic exercise—recent ones, then called Research Assessment Exercises, took place in 2001 and 2008—it is the mechanism whereby the British government allocates core-research funding to British universities. I serve on the subpanel for dentistry, allied health professions, nursing, and pharmacy (subpanel 3 of main panel A), led by Hugh McKenna, CBE, FRCN, FAAN, pro-vice chancellor, research and innovation (equivalent to a university vice president) at the University of Ulster. 

McKenna a mental-health nurse, is one of the leading U.K. academic nurses. The REF is multifaceted, assessing research outputs (publications and patents), environment, and impact. However, at the heart of the exercise lies peer review, and the majority of the work is reading and rating publications for their international excellence. This will occupy almost all my waking hours between January and October 2014—in my office, on trains, and on planes.

I mentioned in a previous blog that I have been asked to lead a Lancet commission on U.K. nursing. This will take place over approximately the next two years, and I am in the process of assembling the commissioners this week. Once they are in place, the work of the commission can begin, and I will let you know who my colleagues are and keep you informed of progress. Each of the people I have contacted has received a statement from me, which is my assessment of the situation in the United Kingdom at present, and I have made this available on my own blog. Comments on this are welcome, as they will inform the commission.

Everyone’s an expert

Like last year, I thought I would make it to the end of the year without some public figure making an adverse pronouncement about nursing education, but I was wrong. This time it was Vince Cable, MP (member of Parliament), secretary of state for business, innovation, and skills in the British government. Cable claimed that degrees are superfluous to many jobs and, of course, he had to include nursing. I spotted this while I was in Singapore and, just as my blood pressure was rising, I saw that Ieuan Ellis, professor at Leeds Metropolitan University, had responded in the pages of THE (Times Higher Education).

I was especially gratified at his response, titled “Sterile debate,” because Ellis speaks with authority. He is chair of the U.K.’s Council of Deans of Health. Moreover, he is not a nurse; he is a physiotherapist and a pro-vice chancellor at Leeds Metropolitan University. In his response, Ellis said of Cable, “It is unfortunate that he is seemingly unaware of the benefits to patients of nurses being educated to degree level.” He cited a large body of work as follows: “The international RN4CAST study of nurses in more than 10 European countries (including England) shows that mortality is approximately 7 percent lower for every 10 percent increase in the proportion of nurses with degrees. This backs up work in the [United States] by University of Pennsylvania scholar Linda Aiken, who found that a 10 percent increase in the number of nurses with a bachelor’s degree was associated with a 5 percent reduction in the likelihood of patients dying within 30 days of admission.”

Season's greetings

I would like to thank the many people who have visited this blog; I hope that most of those who have read it will return in 2014. This is me, signing off for 2013 and wishing you all a very Merry Christmas and a Happy New Year!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Still in Southeast Asia

SINGAPORE—I’m still here. At this stage of any long visit, I realise that an enjoyable and productive time will end soon, but I also want to get back home and back to my desk at the University of Hull. Travel is always accompanied by mixed emotions.

The 2nd NUS-NUH International Nursing Conference, which ran parallel to the 18th Malaysia-Singapore Nursing Conference, was a great success. There were 300 delegates from 21 countries, including the United States. I gave my short paper on feeding difficulty in dementia. There is presently no cure for dementia, and, given the familial predisposition to the condition and that it is definitely associated with ageing, I told the audience that the only “cure” was to choose your parents wisely and die young. This very morbid piece of humour always raises a laugh. I was especially pleased to meet Theofanis (Theo) Fotis, PhD, RN, another Greek who works at Brighton University and co-edits the British Journal of Anaesthetic and Recovery Nursing. (It was here in Singapore that I met Alex Molasiotis, PhD, RN, for the first time.)

My birthday night was a great success, and the Indochine restaurant in Gardens by the Bay did not disappoint. The restaurant is themed Indochinese, the definition of which I just learned, and the rooftop bar has a stunning view of the gardens, the bay, and the elegant Marina Bay Sands Hotel. On the hotel’s three curved towers stands a huge overhanging boat-shaped platform, more than 50 storeys high. My wife let them know it was my birthday, and a “cake” duly arrived. Made of Thai crème brûlée with ice cream, with Happy Birthday written in chocolate sauce, it looked and tasted superb.

Happy Birthday to me from the Indochine restaurant.

In addition to the conference presentation I gave on this trip, I have delivered seminars on writing for publication to research students and on good practice in thesis supervision and marking to colleagues. I also delivered the “Trends in Research and Education of Nursing Development in Singapore” (TRENDS) seminar titled “From getting published to getting cited.” In doing so, I discussed the use of the World Wide Web and various kinds of online social media to increase circulation, readership, and citation of published work. A blatant self-publicist, I gave examples from my own use of social media, such as my Twitter page, our faculty Twitter page, the Journal of Advanced Nursing Twitter page, and several sites for tracking publications and citations, including Google Scholar, publicationslist.org, ResearcherID, and ORCID. (Did I leave any out?) I also showed a YouTube video from the excellent Social Media Revolution series on socialnomics, written by Erik Qualman.

Next week, I conclude my seminars with an update on Mokken scaling and some recent developments in this field. While here, I have written and submitted a manuscript with David Thompson, PhD, RN, FRCN, FAAN, of the School of Nursing, Midwifery and Paramedicine at Australian Catholic University in Melboure, Australia and Wenru Wang, PhD, RN, of the Alice Lee Centre for Nursing Studies at the National University of Singapore. The paper is about the phenomenon of Invariant Item Ordering in Mokken Scales, and we have submitted it to PAID (Personality and Individual Differences). The details of the study will be soporific to most readers of this blog, but I hope it excites the editors and reviewers of PAID. I also wrote the first draft of an article on quantitative research methods for Nursing Standard, to be included in a special feature edited by my fellow tweeter and good friend Leslie Gelling, PhD, RN, of Anglia Ruskin University (Cambridge), United Kingdom.

Wenru Wang, PhD, RN, Yours Truly, and Honggu He, PhD, RN, at the HUS-HUH conference.

Running continues, with difficulty. The National University of Singapore has excellent sports facilities on campus, including a full-size running track. This is well used by young students but not by many 58-year olds. I am sure that many of the students are surprised I can still walk. Given that it has been 86 degrees Fahrenheit and 91 percent humidity, I am also surprised. The effort is tremendous, even on the flat, and it’s almost impossible to compensate for the dehydration and salt loss. I convince myself that this is doing me some good, and I have managed to increase my distance to six miles by incorporating a run round the campus, nine laps of the track, and then the local park—all recorded for posterity on my Garmin Forerunner 110 GPS watch (other brands are available).

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Back in Southeast Asia

SINGAPORE—I am not sure if anyone has ever died of jet lag, but if there is a theory related to this, I am testing it to its limit. I have just made my third flight between the U.K. and Hong Kong in a month, and, since the end of September, I have made that journey four times with a round-the-world flight thrown in for fun. I am back in Singapore, the source of another post exactly one year ago, where I will spend four weeks teaching, consulting, and writing. The weather is doing its equatorial best to wear me down, but spending most days in short trousers and short-sleeved shirts is no hardship; I left the U.K. shivering autumnally and preparing for winter.

Bangkok weekend

My first week is over. I’m pleased that my wife has joined me for most of the first two weeks. We both have many friends in the region and none more so than Sally Wai-Chi Chan, PhD, MSc, BSc, RTN, RMN, FAAN, outgoing head of the Alice Lee Centre for Nursing Studies at the National University of Singapore, and her husband, Bing Shu Cheng, who has been working here in the Ministry of Health. We also have friends in Bangkok, and our first weekend was spent there with Alex Aziz and his family.

Mrs. Watson, Roger Watson, Sally Wai-Chi Chan, and Bing Shu Cheng.

Alex was one of my former students but not of nursing. I used to be a university warden at The University of Edinburgh. The system of wardens is one whereby academic and other staff live with their families in university premises alongside the students. Our role is mainly pastoral, and we are allocated one block or house of several hundred students. Alex, who lived and worked in our residence at Edinburgh in the early 1990s, works with the International Labour Organisation in Bangkok, an agency of the United Nations dedicated to improving the lives of workers across the globe. Alex actually featured in our faculty blog when he met out mutual colleague, Mark Hayter, PhD, RN, FAAN, on a visit to Bangkok.

Distinguished editors

In addition to me, there are two other distinguished editors on campus, and I went to hear them speak about global health at a lunchtime seminar today. They are Richard Horton, BSc, MB, FRCP, FMedSci, editor-in-chief of The Lancet, and Howard Bauchner, M.D., editor-in-chief of JAMA. These were interesting and inspiring talks; neither of these editors of two of the world’s leading medical journals displayed any kind of medical hegemony or superiority regarding their eminent journals.

Howard Bauchner makes a point.

I was interested to hear Bauchner say that JAMA received more than 5,000 submissions annually and publishes only 5 percent of them. He told us how his own interest in global health developed and also discussed difficulties in defining global health. Both editors reflected on the growing importance of noncommunicable diseases and the ethical aspects of global health. 

Richard Horton in action.

Horton explained his vision of global health and how evidence for successful health initiatives could be presented to world leaders. I was especially struck by his vision for The Lancet—that it should be “more than a journal” and how, under some circumstances, The Lancet has acted like an NGO (nongovernmental organisation) in trying to influence the global health agenda and related decision-makers.

In my next post, I’ll be reporting again from Singapore, on the forthcoming 2nd NUS-NUH International Nursing Conference, which runs parallel with the 18th Malaysia-Singapore Nursing Conference. I am giving a paper on research into feeding difficulty in dementia. My wife returns to the U.K. at the end of this week after celebrating my birthday. I’ve chosen the iconic IndoChine restaurant in Gardens by the Bay. As I say, no hardship!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Looking back on the American Academy

HULL, United Kingdom—Ten days and 11 flights after leaving the U.K., I returned, accompanied by a virus that floored me for four days. I hope I contracted it in the United States and not China, where airport posters warn of the dangers of some local strains of Avian flu.

The first sign I was ill showed up in Boston; I nearly fainted during a five-mile run along the Charles River. Previous runs in Washington, D.C., had gone well; this was a struggle. But for a welcome lamppost, I would have hit the ground. My flight home from Boston’s Logan Airport is a blur, and I hope that what I attributed at the time to jet lag and exhaustion has not infected too many other passengers. That was the low point of my recent round-the-world trip.

The high point was attending the 40th Annual Meeting of the American Academy of Nursing and seeing colleagues being inducted into the academy. The following pictures, all featuring Yours Truly, celebrate the event.

Joyce Pulcini, PhD, RN, FAAN, of George Washington University (left)
and Yours Truly with Sally Wai-Chi Chan, PhD, RN, director of Alice Lee Centre
for Nursing Studies in Singapore, who was recently inducted into the American
Academy of Nursing. Chan was sponsored for membership in the academy by Pulcini and Elaine Amella, PhD, RN, FAAN, of Medical University of South Carolina. Amella, one of my own sponsors in 2007, was unable to attend.

Chan (center) and Yours Truly (far right) with Courtney Lyder, ND, FAAN, dean, UCLA School of Nursing, Los Angeles (second from right); Rob Fast, director of operations at UCLA School of Nursing and Lyder's personal assistant (far left); and Mark Hayter, PhD, RN, also newly inducted into the American Academy of Nursing. Hayter is a colleague of mine at the University of Hull and one of the editor's of Journal of Advanced Nursing.

Rita Pickler, PhD, RN, PNP-BC, FAAN, also an editor of Journal of
Advanced Nursing, with Hayter and Yours Truly.

I always consider my fellowship in the American Academy of Nursing as one my greatest honours. I was among the first three non-U.S. citizens to be inducted in 2007, the first from the U.K. and Europe. While international fellows have been unable—until now—to sponsor our own fellows, I have been instrumental, most years, in successfully organising sponsors for colleagues, including David Thompson of the Australian Catholic University and Seamus Cowman of the Royal College of Surgeons in Ireland.

Recently, however, the academy has decided to make its growing band of international fellows full members, charging us appropriately, but also affording us the right to sponsor our own fellows. There was some resistance to our initial entry, thus the two-tier membership for the past five years. Likewise, there was some resistance to this latest move. While lamenting the full fee—I’m Scottish—I publicly welcomed the move to full membership. I think it will increase the number and importance of the academy’s non-U.S. fellows. My previous hope—and efforts—to establish a forum for international fellows in the American Academy of Nursing may now be realized.

I see that dates for next year’s academy meeting clash with an invitation to Australia I have already accepted. I love Washington, D.C., now the permanent home of the academy’s annual meetings, and I will miss my 2014 visit. Anyone who doubts what America has achieved since independence only need visit Washington. The view of the capitol building from the National Mall—and vice versa—is one of the most impressive in the free world. I usually take in the White House and nod to the occupants, walk round the National World War II Memorial with gratitude for our allegiance, hold back tears at the Vietnam Veterans Memorial, and “have a dream” as I ascend the steps to the Lincoln Memorial. I guess all this will still be there the year after next.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

UK to USA via China

JINAN CITY, Shandong Province, China—If anything exemplifies the Chinese character, it is their behaviour in elevators. Most Westerners walk to an elevator, select a floor, and wait for things to happen. Not the Chinese. They run into elevators, select their floor, and immediately press the “> <“ button to close the door. Beware; in China, these buttons actually work! In the UK, they are buttons with no obvious purpose; most of us suspect they are not connected.

So, entering an elevator with a Chinese person in it requires rapid reactions and split-second timing. If you are some distance from the elevator, do you run, or do you wait? Getting that wrong could mean bruised elbows as the doors slam shut (another feature of Chinese elevators) and little sympathy from the occupant. If you get close to the elevator before the door slams shut, you may have the opportunity to press the call button and retain the elevator, incurring the wrath of the occupant or occupants.

The Chinese seem very impatient in their daily lives; everything happens at breakneck speed: driving, walking, speaking, eating, and thinking. To some Westerners—this one included—it can be exhausting. Retiring to your hotel room at night is like heaven.

But I love the Chinese people. They fascinate and frustrate in equal measure, something I discuss regularly with my Chinese colleagues. As the old cliché puts it, China is a country of contradictions, and these contradictions are everywhere.

On the one hand, it’s a nonindividualist, collective culture where, on the other hand, people drive with little regard for other road users. On the one hand, it’s a health-obsessed culture where taking exercise is highly regarded and each food is considered healthy for one spurious reason or another, this juxtaposed, on the other hand, against astonishing levels of tobacco use and alcohol abuse (amongst men). At a more prosaic level, Chinese adherence to modesty in dress and sexual mores is puzzling. When using the washroom in the school, I stood at a male urinal while the students I had been teaching (predominantly female) stood next to me and washed their hands, as if a more-than-middle-aged gent did not have enough problems.

Since my last entry, I have been back to the United Kingdom to teach, supervise, and hold meetings. I am ultimately heading for the annual meeting of the American Academy of Nursing in Washington, D.C., but I took the opportunity to return to the Far East to make one of many visits to Shandong University School of Nursing. These visits are intended to promote the Journal of Advanced Nursing, but I was asked to do some teaching and delivered a session on statistics to Master of Nursing students.

Yours Truly, Florence, and friends.

I am always surprised to see the large bust of Florence Nightingale in the foyer to the school; another contradiction. What place this Western epitome of class, privilege, and Christian values has in atheist, communist China is hard to fathom. And nobody here can explain. China remains a communist country; students of all subjects at the university have to study Marxism. Official dinners, such as my welcoming banquet, are attended by the director of the School of Nursing, who is a Communist Party official. Every school has one. On the other hand, China has a free-enterprise economy, one of the strongest in the world, although its success is viewed here as an outcome of communism. Outside my hotel, I saw an old man rummaging through a garbage bin. Chinese communism/capitalism—whatever it’s called—has been successful, for some people.

The pollution here is very bad. Even my host admitted that Jinan is one of the most polluted cities in China. I arrived on a warm day with the usual blue haze in the sky. After a three-mile run near my hotel, the taste in my mouth was terrible, my eyes were stinging, and my throat hurt. The following morning, the rain came, and the clouds concentrated the pollution at a very low level. The fumes literally choked me, and I got an idea of what some of the industrial cities of England must have been like before the Clean Air Act. We have largely lost our heavy industry, as European manufacturing has moved on a large scale to China, the rest of the Far East, and Southeast Asia—and they are paying the price. The rain did, however, clear the pollution for a day, and I faced a beautiful clear morning on my third day. It felt like winter—perfect for running—but the effect in my respiratory system was the same. 

Before the rain.

After the rain.

While working out a round running route through my part of the city, I had the added pleasure of finding that, for motorcycle users—going at, yes, breakneck speed—the distinction between the road and the pavement intended for motorcycles is flexible. This uncertainty was compounded by pavements suddenly giving way to unguarded storm drains and then ending at busy junctions, with no obvious sign of a safe crossing. Next time, I may eschew running altogether but, at least, I got mainland China on my Garmin GPS webpage, and I intend to get the USA on the same page with runs in Washington. D.C. and Boston over the weekend.

Great news to end this entry! I just received an email from Rob Fast, the PA to my good friend Dean Courtney Lyder of UCLA School of Nursing, inviting me to dinner at 701 Pennsylvania Avenue on Friday night. Last year, this topped the best restaurants Washington. I feel like an A-list celebrity.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Heat, humidity, and innovation

HONG KONG—The ability of Hong Kong residents to fall asleep instantly on a train and awaken at their station amazes me. This week, I am living in Sha Tin, in the New Territories of Hong Kong, and commuting to Hung Hom to work at The Hong Kong Polytechnic University (HKPU). The 20-minute train journey, which begins at Lo Wu, on the border with mainland China, is packed in the mornings. Those who get a seat simply close their eyes and sleep. Most of those standing stare at the screen of their mobile phone. I simply cannot imagine the Far East and Southeast Asia before the mobile phone. It is the same wherever I go in this part of the world. Whether in Japan, Singapore, Hong Kong or Taiwan, the people’s dedication to mobile technology puts even my own technology-addicted children to shame.

Hong Kong Polytechnic University is a lively place. Recruitment days, graduations, celebrations—there is always something happening in its concourses. In a decade of visiting this campus, I cannot recall a time when there was not a new building being erected. To the present, these have always been in neat red brick. However, the most recent addition is Innovation Tower, which is drawing attention in the design world.

Innovation is a key word here, and it is also demonstrated in the exclusive Hotel ICON, built by HKPU to train students of hotel management in the environment of a five-star luxury hotel. The basement Asian buffet is great for lunch and, over dinner, the views from the high-level Above & Beyond are fabulous. HKPU has recently entered the Twittersphere and has been tweeting about our visit and our seminars.

The schedule at HKPU is heavy. I am here with my University of Hull colleague Mark Hayter, PhD, RN, to teach in a preregistration master’s nursing programme. But teaching here is not the same as back home. In the Far East and Southeast Asia, it is rare for students to ask questions in class; they would never dream of interrupting you. Instead, they queue up after the lecture and ask questions, individually. Generating audience participation is virtually impossible, and the most direct question is usually met with silence. This difference in culture is one adjustment you have to make to your teaching here; everything is very formal.

Alex Molasiotis

Students enrolled in the programme are all graduates and employees of the prestigious Hong Kong Sanatorium & Hospital. Luckily, the hospital has requested that some of the teaching be provided by international scholars, so, for several years, we have visited twice annually. The students are bright and challenging, with varied academic backgrounds. They are a pleasure to teach and have no difficulty asking questions, but always after the lecture. I was pleased to hear from Alex Molasiotis, PhD, RN, head of the school of nursing, that the contract has been renewed for a few years.

Mark Hayter focuses on qualitative methods and I on quantitative methods. Therefore, my sessions cover the concepts of measurement, study designs, and statistics. I also give a presentation to new intakes of master’s and undergraduate students on a systematic approach to studying anatomy and physiology. This is something I want to work up into a more concise presentation and then publish something to accompany it.

I have published several books on anatomy and physiology, but I have a passion to convey the logic of anatomy and the relationship between structure, function, and control. As I write for my “Four things about ...” blog, which is about a simple approach to anatomy and physiology, I am encouraged by the number of hits (87,335). There was a public holiday during our visit, and I used the time to revise one of my online lectures on homeostasis, which is linked to the blog. We were both invited to give seminars; Mark delivers one on sexual health, and mine is on activities of daily living.

The weather is unusually warm for this time of year, and the humidity is high. Local colleagues assure us that it is getting cooler, but running for several miles means you end up drenched in sweat and severely dehydrated, with a core temperature above the physiological norm. Even after a cold shower, it takes an hour to cool down. If you arrive at a social event within that hour, you look as if you have been swimming—fully clothed.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Sunshine and sea

GENOA, Italy—The vagaries of air travel mean I arrive here on Monday, 16 September, at 10 p.m. instead of 2 p.m. After an unexpected night in the Radisson at Manchester Airport and an unplanned visit to Rome, I miss my first meeting. I meet my good friend and translator, Guiseppe Aleo, professor at the University of Genoa (Università degli Studi di Genova), in the lobby of the hotel to catch up on what I have missed and to plan the week ahead. I am an honorary docenti (teacher) at the university.

Genova—for some reason we call it Genoa—is on the Ligurian coast of Italy, where the food and wine are superb. This was the home of Christopher Columbus—remind me again, what country did he discover?— and Marco Polo. I have been coming here for several years to work with colleagues in nursing at the university, in particular Loredana Sasso and Annamaria Bagnasco. I teach postgraduate nursing students and advise colleagues on research and publishing in English-language academic nursing journals.

Tuesday, 17 September

My first full day here is spent with colleagues at the university, reviewing several research projects underway. The range of what is being studied here is impressive and clinically oriented. Academic nursing is relatively young in Italy, but there are some active centres where research into nursing issues is making great progress. Today’s meetings progress slowly, however, as I have to work through my translator.

The weather is superb. One of the main local news items is the righting of the liner “Costa Concordia,” which sank nearby last year. Over dinner, a colleague with vast knowledge of the safety systems on these ships explains how difficult it is to sink one of these vessels.

Dinner is in a formaggio (cheese) restaurant outside Genova. The Ligurian coast has a backdrop of mountains, and most of the towns here seem, in a clichéd but literal way, to “hang” off the mountains. Most remarkable is the network of high bridges and tunnels that run parallel to the coast. Moving along the coast, you either are looking down—vertiginously—from one of these bridges on the regular series of roads with hairpin bends that run below to the coastal towns, or up from those same roads. Italian driving means that the transition between the bridges and the roads is seamless.

Wednesday, 18 September

I spend the day with University of Genoa postgraduate research students. I meet these students twice a year. In the past, they have listened to me lecture, from morning until night, on a range of topics. Apart from the fact that I am on the verge of repeating myself—some of these students have been in the group since I started visiting here—I feel it is time to catch up with their projects, to give me the opportunity to question them and for them to question each other.

I work without my translator, because the rules state that the projects are to be presented in English. They all do very well, helping each other—and me—with the language. The projects range from educational to clinical work. I have always been impressed by the students’ ability to think clearly, apply best research practice to their projects, and deal with hard questions. I am especially heartened that they interrogate each other. Using this format, the students are able to learn and understand what the others are doing. I would like to see this approach adopted with my own research students and others at the University of Hull. Several of the students are on Twitter. Gianluca Catania and Milko Zanini are two who are worth following.

At dinner this evening, we discuss the Francis Report (blog passim), and it becomes evident that criticism of nursing in the U.K. has a negative effect in countries such as Italy, where our system of nursing education is held up as a good example of what can happen if you educate nurses at university level. Politicians and policymakers in other countries, opposed to raising educational standards in nursing, are quick to cite problems in U.K. nursing.

This evening, I am taken on an unexpected tour of the historical heart of Genoa. Superlatives are hard to find, but this is one of the biggest surprises of my life. Rows of palaces with relatively modest and mysterious exteriors hide courtyards, architecture, and elaborately painted ceilings, glimpsed only through doorways and gaps in curtains. All of these buildings are now businesses, mainly banks. The tour ends in the historical port where the galleon “Neptune” from Polanski’s 1986 film “Pirates” is berthed. Many people do not recognise it and assume it to be an historical ship, to the amusement of the Genoese.

The "Neptune," built to full scale for filming of Roman Polanski's
"Pirates," is a popular tourist attraction in Genoa's harbor.

Thursday, 19 September

This is my final morning with the research students, and I hear about two new projects. The remainder of the day is spent looking at research projects with colleagues and advising on the analysis. I am one of the few people who regularly use Mokken scaling, a form of item response theory. Some of the datasets being established here are suitable for analysis. I am especially pleased that a large dataset of older people with dementia is being gathered, including the Edinburgh Feeding Evaluation in Dementia (EdFED) scale—translated into Italian—which will soon be ready for analysis, at which point I will have my first co-authored paper with Italian colleagues.

Friday, 20 September

My final day is spent with colleagues, reviewing projects and planning potential publications. Already, I have several short visits planned for next year, which should give me a view of Genoa in all seasons. Combined with a planned visit to Rome, I feel that Italy has become a firm fixture in my professional life.

I have run here every day, building up from three to six miles over the course of three evenings. The Corso Italiana, a tiled promenade approximately two miles long, is ideal for this. There are many runners, walkers, and others taking various forms of exercise, and the view of the Ligurian Sea, especially as the sun goes down, is worth the effort. It is a great segue between the end of a working day and the start of an excellent Italian dinner. According to my Garmin webpage—where my runs are recorded from my GPS watch—I have burned 2,500 kilocalories in the past three days, a drop in the ocean compared to my calorie intake over the same period.

Saturday, 21 September

On this last morning, a last run, coffee by the coast, and a midmorning beer in the sweltering heat before going to the airport. I reflect on the title of this blog—a climbing term—and think how little outdoor climbing I have done this year. Back home, the season is almost over, but I still enjoy indoor climbing two or three times weekly with my children. As a form of exercise and mental rest, it is unbeatable. I have a fairly busy week ahead at my own university, then back to the airport on Saturday for a visit to Hong Kong. 

A significant piece of news is that The Lancet, one of the leading medical journals in the world, has invited me to lead a commission into U.K. nursing. I have accepted the invitation and am in the process of appointing commissioners. Although the commission will focus on U.K. nursing, it will not be completely composed of U.K. nurses. That’s all I can say for the moment, but I will keep you up to date on progress over the next two years.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Gender problems

MUNICH, Bavaria, Germany—“Don’t you have a gender problem?” I was asked as I sat down to dinner in a Munich restaurant last night. I thanked the questioner—a distinguished Austrian physician—for his concern, prodded myself in all the appropriate places, and assured him that all was well in the gender department. The Germans and Austrians do have a sense of humour!

What my colleague was referring to was nursing. In German, there is no word to denote a man in nursing. The German word for nurse—“krankenschwester”— is a feminine noun. Spain and Italy simply had to change “enfermería” and “infermiera,” respectively, to “-o” endings to indicate masculinity, but this is not an option in German. Gendered nouns mostly fell into disuse in English centuries ago so, while we tend to associate nursing with women, the word itself is neutral.

Bernd Reuschenbach

I was in Munich to address the 47th Kongress für Allgemeinmedizin (general practice) und Familienmedizin (family medicine) this morning. The theme of the conference was “Komplexität in der Allgemeinmedizin-Herausforderungen und Chancen,” essentially “complexity in care.” I am here at the invitation of Bernd Reuschenbach, a lecturer in psychology at Katholische Stiftungsfachhochschule München (the Catholic Foundation University of Munich) and Antonius Schneider, chair of general practice at Technische Universität München. Reuschenbach is engaged here in nursing education, and Schneider was one of the main conference organisers.

Antonius Schneider

The title of my presentation was “Nurses and doctors can and should work together.” Addressing the issues of complexity and interprofessionalism, I tried to illustrate the advanced and specialist roles that nurses play in some parts of Europe and the United States. Such developments are only starting in Germany, and the question-and-answer session was challenging, to say the least. I learned that I should stop referring to “the UK and Europe.” as if the UK is not part of Europe. I was asked, if nursing took over a range of advanced roles, what would be left for doctors to do, and could nurses replace general practitioners (family doctors).

“Of course not,” I replied. In answer to what was left for doctors to do, I answered, “Diagnosis, that’s what you’re trained for.”

I thought I had gotten away with it, but someone approached me afterward to say she was “astonished” (not in a good way) about the things happening around interprofessional learning in the UK that I had seemingly ignored. It was maybe a lesson to be more thorough in the future, but I also warned her that what many people say they are doing is not, necessarily, what they are actually doing.

On a lighter note, I was linked up to a mobile tie-clip microphone. When I visited the washroom, the microphone was still turned on, and you can guess the rest. Further demonstration that the Germans have a sense of humour.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Up in the air

SOMEWHERE over Australia—Cathay Pacific Flight CX100 left Sydney, New South Wales (NSW), Australia at 2 p.m. After dinner, a film, and a sleep, we are still over Australia, nearly six hours later. This is a vast land with miles and miles of nothing below us most of the time. I have a great fondness for most of the countries I visit regularly. Australia, however, has a special place in my heart.

My family has been associated with this country for more 50 years following the emigration of some of my family, including my grandmother, after the Second World War. Three of my children have been here. It is hard not to like the place. As the early morning flight to Sydney from Brisbane circled the lagoon, clear blue water reflecting a perfect sky made me want to stay a while.

The Sydney skyline.

Meanwhile, back in the real world, I am on the way to Hong Kong. After that, it’s on to the U.K. and home to family and work. I have visited four countries in three weeks and have reported on my visits to Ireland and Taiwan. My annual visits to Australia are due to my part-time professorship at the University of Western Sydney, an eponymous university that lies to the west of Sydney. It is spread over several campuses —some of it is a long way from Sydney—and I feel lucky to be based on the Campbelltown, NSW campus, which is relatively rural but within a short train journey of the centre of Sydney.

June to August is the winter season in Australia, and the early mornings were ideal for running. There was frost on the ground and, as the sun rose revealing a cloudless sky, I was able to explore some new parts of town. My academic activities included teaching senior honours undergraduate students about turning their assignments into published articles. I also presented to colleagues on other campuses about increasing their online profile—this blog was referred to—and about ethical issues in academic publishing.

I especially enjoyed giving a lecture to clinical nurse consultants and other clinical colleagues at the Nepean Hospital in Penrith, NSW, on presenting a conference paper. Online lectures are used a lot here, on several campuses, to teach nurses and midwives, and I make a contribution to this by providing links to my online lectures at my own University of Hull. I used my nights alone in the hotel to make one, especially for students here, on writing for quantitative research. You can listen to it and hear what I sound like; don’t be too harsh.

I mentioned my family earlier. My final weekend in Australia was spent in Brisbane, Queensland, where most of my cousins live. This is definitely the best time of year to visit Brisbane, as it is only hot at the moment, as opposed to unbearable. I paid a visit to a Royal Australian Air Force (RAAF) base near Brisbane and had some fun in the cockpit of an RAAF Airbus refuelling plane. It was still on the ground, I emphasise. I then watched the All Blacks (New Zealand) destroy the Wallabies (Australia) at rugby union on television. For North American readers, rugby is American football without the helmets.

Second Officer Watson pretends he knows what he's doing.

Soon, I will be home to spend the rest of October in the U.K. In September, I have several European trips planned. Otherwise, if the weather holds, I will be climbing rocks.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

From one heat wave to another

TAIPEI, Taiwan—Wherever I go, weather records are broken. This week, the weather in Taiwan has been the hottest on record for 100 years. Depending on what you read or to whom you speak, the temperature in Taipei yesterday was either 37.5 or 39 C (99.5 or 102.2 F). Either way, the air temperature exceeds body temperature and, according to this morning’s Taipei Times, the government is considering calling public holidays if these temperatures return. There are hotter places but, as one who visits here regularly, I’m finding the crushing humidity exhausting. When there’s no precipitation which, when it comes, is in the form of torrential rain, the relative humidity has varied between 70 and 90 percent.

A few years ago, colleagues and I were caught in Typhoon Morakot, a low-grade typhoon against which it was almost impossible to walk. (Our hotel shook.) I would not like to see a typhoon that registers at the top end of the scale. Last year, at dinner in Chaiyi City, the room suddenly moved a few inches in one direction and then, after a few wobbles, settled back to its original position. Earthquakes, some literally tearing large parts of Taiwan apart, are a regular feature here. I have been here for a week, at Tzu Chi Buddhist College of Technology (TCCN), which is in Hualien, on the Pacific coast of Taiwan. (I’m hoping my university insurance company agents are not reading this entry.)

With me are my colleagues from the Wiley stable, Mark Hayter, PhD, RN, FRSA, and Graeme Smith, PhD, RN, editors, respectively, of Journal of Advanced Nursing and Journal of Clinical Nursing. We have been providing writing-for-publication seminars, workshops and consultancy sessions to colleagues in the nursing school at TCCN. Our link with the college spans eight years, over which time the school has significantly increased its publication output, and not only in our journals. All three of us have also held research grants with colleagues here and have co-authored articles with them.

At TCCN, Yours Truly seated at center, flanked on my
right by Mark Hayter and on my left my Graeme Smith.

We prefer the long train journey between Taipei and Hualien to the short plane journey. It is demonstrably safer (Google “Hualien airport crash”) and takes in a large section of the beautiful and lush Pacific coast. A free day on these journeys is rare, but today is relatively free, and we will re-visit our “old friend” the 101, previously the tallest building in the world. This Gothic-art deco tower never ceases to inspire awe in terms of its symmetry and elegance. The view from the top, accessible via an ear-popping elevator, the fastest in the world, is truly leg wobbling, even for a rock climber.

From Taiwan, I head to Hong Kong for one night before flying on to Sydney. In my last entry, I stated that no visit to Taiwan is without incident and that I would be surprised if none occurred on this trip. My problem? Which one to tell you about. 

We have a favourite restaurant where we requested to eat. On the way from our hotel, we screamed directions to our driver, who willfully ignored our instructions and drove us to one of the best local hotels. It was a soulless place with a large deserted dining room and mediocre food. Our host, completely aware of our request to eat elsewhere, thought it better for us to eat here. The Taiwanese are a polite, caring, and attentive people, but cultural differences run deep, and what you receive is rarely what you ask for.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Inane matters

CORK, Ireland—A short break from this blog has given me time to do the first full entry on the brand-new Journal of Advanced Nursing blog, which has had more than 400 views since June. I also publish our newsletter for the Faculty of Health and Social Care at Hull as a blog, and my own blogs have been updated. I was pleased to see that my “Four things about ... (a simple approach to anatomy and physiology)” has had more than 84,000 views. Forgive the blatant plug!

Since my last entry, I have been: 1) enjoying some extreme weather in the United Kingdom (30 degrees Celsius, or 86 degrees Fahrenheit, is considered extreme in the U.K.), 2) working hard on a research-grant proposal, 3) rock climbing, and 4) running—poorly—in a set of league races. My work as editor-in-chief continues, and it has brought me to Cork, Ireland for the annual meeting of the International Academy of Nursing Editors, a group that suffers from the acronym INANE.

This is my first time at INANE, and I was asked to chair an early morning “Town Hall” meeting on hot topics in editing. We covered several topics, including open-access publishing, succession planning for editorial positions, and the training that those new to editing might require. INANE is a truly international organisation, and this meeting, hosted by the Department of Nursing and Midwifery at University College Cork, attracted more than 100 people—mostly, but not exclusively, editors from 16 countries.

This is the first of three weeks of travel. After returning to the U.K. from Ireland, I will spend a week in Taiwan and the following week in Australia, which is where my first contribution to Reflections on Nursing Leadership magazine, the progenitor to my “Hanging smart” blog, was written. Naturally, I intend to send my reflections on these visits.

I rarely visit Taiwan without some hilarious incident, usually at my expense. For example, a few years ago I sent some clothes to the local laundry, which phoned my Taiwanese colleague, whose cell phone is always on speaker, to enquire if I wanted my underpants (“shorts” in the United States) pressed. The secretaries in the open-plan office were unable, despite considerable effort, to suppress their laughter. When the exchange was translated to me, I laughed, too—eventually. I will be surprised if there is nothing to report next week.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

A week in the life of an editor-in-chief

HULL, UK, Sunday, 16 June—I leave my family celebrating Father’s Day—my Father’s Day (third Sunday in June)—at lunchtime to travel to Oxford for a few days. You may have gathered I like to travel, but I don’t like travelling on a Sunday. In the United Kingdom, Sunday means slow and indirect trains with several changes, reduced service on the train (no free wine in first-class, for example), and when you have left your family sitting outside in a sunny garden, it feels so much worse.

The purpose of my visit is the annual two-day management-team meeting for the Journal of Advanced Nursing (JAN). Therefore, my mood lifts as I reach Oxford—location of the Wiley-Blackwell offices—and check in to my hotel. The most interesting and enjoyable part of my work, amongst many interesting things I do, is my role as editor-in-chief of JAN. I get the opportunity to work with some superb people at Wiley-Blackwell. Some have been my colleagues here for years, and I have a top team of editors to work with. A pint of Guinness with fish and chips at the Head of the River pub on the Thames also helps lift my spirits.

Fish and chips lift my spirits.

Monday

The first day of the meeting is concerned with reviewing the year: what has worked and what needs to change. We consider the journal impact factor (JIF). Despite its manifest imperfections, and a recent call for it to be ignored, many authors decide where to send manuscripts by JIF, and we simply do not have the luxury of ignoring it. Our consideration of the impact factor is given added poignancy by the fact that announcement of the 2012 rankings is imminent. Let me introduce the team:

The publishers

At Wiley-Blackwell, my immediate contact and journal manager is Rosie Hutchinson, who has been with Wiley-Blackwell since 2009. My longest-standing contact and contemporary is Associate Director Griselda Campbell, whom I have known for more than 20 years, since she visited me as an early-career academic at the University of Edinburgh, when she worked for another publishing company. Then, there is what I refer to as the “engine house” of the Journal of Advanced Nursing: Senior Editorial Assistant Gareth Watkins and Managing Editor Di Sinclair. Nothing seems to be too much trouble for Gareth and Di, and the extent of their knowledge of the online system we use to manage submissions and reviewing is immense.

The editors

I don’t hesitate to say that I work with the best possible team of editors. They are all experienced and capable, and a cursory glance at their profiles reveals the calibre of person who edits JAN. New to the team, but joining us from the Journal of Clinical Nursing (which I used to edit) is Mark Hayter, PhD, RN, FRSA. He was featured in my previous blog, due to his forthcoming induction as a fellow of the American Academy of Nursing. Jane Noyes, DPhil, MSc, RN, works in Wales. She, along with Lin Perry, PhD, MSc, RN, and Brenda Roe, PhD, RN, FRSH—another colleague of more than 20 years standing—preceded my appointment. They are an incredible repository of knowledge about the Journal of Advanced Nursing and also bring very specific expertise to their roles as editors. The newest member of the team is Rita Pickler, PhD, RN, FAAN, who joins us from the United States.

Dinner is in Oxford at Malmaison; excellent food, wine, and good company. I learn about the Travel John from Di, whose annual visit to the Glastonbury Festival is imminent. The Rolling Stones are headlining.

Tuesday

Sleepless night—no JIF announcement yet! In a previous blog, I explained that my success as editor-in-chief is partly judged on the basis of JIF.

Our second day at the management-team meeting always focuses on planning, and this is where the real discussion and debate take place. Many ideas—mostly mine—are “shot down in flames,” and we often end up back where we started with some change proposed to the way we do things. Our main concerns are maintaining a reputation for quality, good service to authors, and good management of copy flow. We realise that we often make adjustments to the systems at our peril and need to be absolutely sure that what is decided is both necessary and likely to work.

The team disperses at the end of the day; back to their own countries, day jobs, and professional duties. I remain in Oxford for a final night on my own, with time to catch up on Skype calls, FaceTime, emails, and editing.

Wednesday

After my third early-morning run of the week along the River Thames, I “hot-desk” at the Wiley offices to catch up with work: write a European Community-funded research proposal with a colleague from the United States; lunch with the publishing team to discuss the use of Journal of Advanced Nursing Linkedin pages, and prepare my first entry for our new blog.

I travel from Oxford to the south coast of England to address the inaugural conference of Phi Mu Chapter of the Honor Society of Nursing, Sigma Theta Tau International (STTI), launched in 2011 at the U.S. Embassy in London. Dinner is with Dame Betty Kershaw, DBE, OStJ, FRCN, Elizabeth Rosser, DPhil, MN, DipRM, Dip NEd, RN, RM, and Eileen Richardson, MA Ed, RGN, SCM, Cert Nursing Studies (Education). Kershaw was the driving force behind establishing this all-England chapter of STTI, which is hosted by Bournemouth University. Rosser has now taken over as president, and Richardson has supported this work throughout. I stay in Hotel Miramar, where a plaque on the wall indicates that J.R.R. Tolkien, author of The Lord of the Rings, was a frequent visitor.

J.R.R. Tolkien stayed here!

No announcement of JIF yet, but an SMS message from Ian Norman, PhD, RN, CQSW, editor-in-chief of International Journal of Nursing Studies, informs me that we have both slipped down the rankings (unsmiley face).

Thursday

Excellent news! The JIF of Journal of Advanced Nursing has improved, despite slippage in rankings. Congratulations to Nursing Outlook, in the top five; commiserations to Nursing Science Quarterly, which, along with another 65 journals, has still not reappeared on the Thomson Reuters list. My email to the team is more upbeat than the one I had been planning overnight.

It is a great honour to present the opening keynote at the Honour Society. My theme is “Putting nursing back at the heart of people care,” and the session is attended by the vice-chancellor (equivalent to president) of Bournemouth University. Dinner is like a reunion of old friends and colleagues and is attended by a trio of nursing dames: Dame Kershaw, referred to above; Dame June Clark, DBE, PhD, RN, FRCN, FAAN, recently inducted as a fellow of the American Academy of Nursing, an avid reader of this blog, and the person responsible for bringing the Honour Society to the United Kingdom for the first time in Wales; and Dame Yvonne Moores, DBE, FRSH, CIMgt, former chief nurse of England, following her roles as chief nurse in Wales and Scotland. For an explanation of the title “Dame,” you need to understand the U.K. Honours system, and few of us actually do!

Friday

Six hours and three trains later, I am back in Hull with my family. Tomorrow starts with a 5-kilometre Park Run. On Sunday, I fly to Dublin for one night. No more travelling until the end of July, and no more entries to the blog until then, either.

Gotta run! Photo from Park Run, different time of year.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.