This could be Rotterdam ...

GENOA, Italy—The well-known British pop band The Beautiful South played a song titled “Rotterdam,” the chorus of which observes, “This could be Rotterdam or anywhere, Liverpool or Rome …” It felt like that for me these past two weeks because, following Slovenia, I have been in Rotterdam and Genoa. Telling you this also allows me to note that, while many readers of “Hanging smart” will know the song, they may not know that The Beautiful South comes from my home town of Hull and evolved from an equally famous band The Housemartins. So, after that trip down musical memory lane …

Rotterdam

I was in Rotterdam last week for the 5th European Nursing Congress. The theme of these meetings is always care of older people, and the congress, held over four days, provided a series of keynotes and parallel sessions on research and practice related to gerontological nursing. The opening ceremony was attended by Queen Máxima of the Netherlands. One of the keynote speakers was my good friend and colleague Li-Chan Lin, PhD, RN, of National Yang Ming University in Taipei, Taiwan. Lin has pioneered the use of the Montessori method and spaced retrieval to help older people with dementia eat. I had the privilege of co-authoring an article reporting the first randomised controlled trial using these methods. Lin also spent six months with me at the University of Sheffield as a Leverhulme Visiting Professor, and her invitation for me to visit her in Taiwan in 2004 led to an unbroken stream of annual visits to Taiwan.

My own contribution to the Rotterdam proceedings was a workshop titled “Four easy steps to publishing your manuscript,” which was well attended. The Journal of Advanced Nursing provided a special issue for the conference abstracts, and it was good to see each of the 1,000 delegates holding a copy of the journal. Six years ago, at the previous congress, the abstracts were published in a special issue of Journal of Clinical Nursing, which I then edited.

Genoa

After one day at home to remind the family of my existence, I went to Genoa, Italy for a week of activities as a visiting professor (docenti) at the University of Genoa. In Rotterdam, I had met Julita Sansoni, PhD, RN, associate professor at Sapienza University of Rome, and illustrating the cliché “It’s a small world,” she was here in Genoa this week, and we had dinner together.

Loredana Sasso

Excitement is growing in the nursing department here because, next week, Loredana Sasso, MSN, MedSc, RN, will be inducted as a fellow of the American Academy of Nursing in Washington, D.C. Sasso is the first Italian nurse to be inducted, and I am very proud to be her co-sponsor, along with my colleague Mark Hayter, PhD, RN, FAAN, (also a docenti in Genoa). I will be there with Mrs. Watson and a delegation of 14 Italians cheering on this great pioneer of Italian nursing. Pictures and news from the academy meeting will feature in my next entry.

Cheers! In Genoa with (l-r) Milko Zanini, Giuseppe Aleo,
and Mark Hayter.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Italy, Qatar, and back to the UK

EN ROUTE TO MANCHESTER—After a 4 a.m. start, I’m having breakfast in the luxurious Al Mourjan Business Lounge in Hamad International Airport in Doha, Qatar. I’m also reflecting on yet another month spent largely away from home as I watch my diary fill up with travel well beyond the middle of the year.

My flight to Doha was aboard the fabulous Boeing Dreamliner plane, and the picture shown below, which I took en route from Manchester, England to Doha, shows its unique wing shape against an extraordinarily blue sky. As I write this, I am about to return to Manchester from Doha, aboard Qatar Airways Flight QR46. 

Italy

Wing tip of the
Boeing Dreamliner

Earlier this month, I spent a week in Genoa, Italy at the University of Genoa, which I visit regularly. The weather in Italy was beginning to warm up, which was a change from a cold and dull UK. On this occasion, Mark Hayter, PhD, RN, FAAN, my Hull colleague, was there, making his second visit. Since we both edit the Journal of Advanced Nursing, we often share our experience of writing for publication with colleagues and students. It’s a good double act, as we complement each other methodologically across the quantitative-qualitative spectrum.

One of my tasks on this visit was to inaugurate a series of international lectures for final-year nursing students, and I was asked to talk about writing for publication. I am really not sure how relevant this is to all of them, but I emphasised the bad things we academics get up to by way of cheating with regard to publications: plagiarism, duplication, fabrication, falsification, creation of bogus webpages and publications, and subversion of the peer-review system. Frankly, they loved it.

Qatar

Spotted on Professor
Gray's noticeboard

My return to the UK today follows a few days of visiting the Hamad Medical Corporation (HMC) in Doha. This visit was built around several lectures, workshops, and tutorials on writing for publication, and I was there at the invitation of Richard Gray, PHD, RN. Gray is an editor of the Journal of Psychiatric and Mental Health Nursing, also from the Wiley stable. 

Hamad Medical Corporation is, primarily, a private company that provides medical care on an impressive scale to the population of Qatar. It is not an educational or research institution but has a very active education department led by Annie Topping, PhD, RN, one of my long-time friends in nursing. I may have mentioned this in a previous entry, but I was a student nurse on the ward that Topping managed at St. James Hospital in London when I did my ward management assessment. We go back a long way.

In addition to the work, which starts at 7 a.m. in Qatar, I visited The Pearl, a housing complex mainly occupied by expatriates. The HMC owns two blocks there for its employees. Over a barbecue and speaking with friends, I gained more insight into expatriate lifestyle in Qatar, which, I imagine, is similar across the Middle East.

In a country that is nomadic in origin but now extremely urbanised, the expatriates are the nomads. Few spend a long time here, but most have spent a long time away from their native countries in expatriate communities. Similar communities can be found in Hong Kong and Singapore. Although expatriate life offers great rewards, it also requires great sacrifices, and I am not sure if it is a life I would have liked to lead. On the final day, I gave a lecture titled “Tips on successful publishing,” which you can listen to in this podcast.

Next month, the Middle East beckons again. I note that my 50-page passport has only one page left. and it is only four years old. My priority on returning to the UK is to obtain a new passport, or I will not be going anywhere.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

St. Martin's summer in Genoa

GENOA, Italy—Following my return from Australia, October was spent mainly in the UK. Early November finds me back in Genoa, Italy for my final visit of 2015. My visits for next year are planned already. The weather is exceptionally good, and I’m assured this is St. Martin’s summer—a warm spell in early November during the feast of St. Martin before the weather turns cold. I made the best of it with several early-morning runs along the coast.

Mary Seacole Leadership Awards

Soon after returning from Australia, I was in London for the  Royal College of Nursing Mary Seacole Leadership Awards. The event was held at the Royal College of Obstetricians and Gynaecologists (RCOG) in London’s Regent’s Park, and it was a bit like revisiting the scene of an accident. The 2008 UK Research Assessment Exercise Nursing and Midwifery subpanel meetings oscillated between the Royal College of Surgeons and the RCOG, both in Regent’s Park, and while I enjoyed my time on that panel, the work was hard and prolonged.

Parveen Ali describes her project
at the Mary Seacole Leadership
Awards ceremony in London.

I was invited to the awards ceremony by my very good friend and colleague Parveen Ali, PhD, RN, senior lecturer, University of Sheffield, one of the recipients in 2014. In addition to receiving her award at this event, she also presented her excellent project on the use of multilingual nursing staff as translators in UK hospitals. Her interest in the subject arose when she was working for a telephone triage service—since discontinued—called NHS Direct. A native of Pakistan, she is a fluent Urdu speaker, but when an Urdu speaker called, she was required to transfer them to a translator. Listening to the translators, who were not nurses, she often heard them misunderstand callers. These services cost a great deal, and she wondered why the National Health Service did not utilize the services of bilingual nurses, both for telephone services and in clinical practice. For her project, she reviewed the policies of many NHS Trusts and found much the same policy—with some anomalies—across England. Her study raises some very interesting points.

Genoa

Links between my own University of Hull and the University of Genoa are strengthening. Our previous dean made a visit with me last year, and colleagues from Hull are working, albeit at a distance, with Genovese colleagues on translation and validation of a questionnaire designed to help in health promotion related to melanoma. Mark Hayter, PhD, FAAN, my colleague of many sojourns to the Far East and a Journal of Advanced Nursing editor, visited two weeks before me and, like me, has a programme of visits planned for 2016 and has also established collaborative projects.

My week here has been spent working with colleagues on a range of research and writing projects and teaching research students about writing for publication. The next visit, which will bring Hayter and me here at the same time, is in February 2016.

Pain

My running continues, but climbing of all sorts and gym work have ceased, because of a deltoid muscle-rotator cuff injury. I can’t pour water out of a kettle, shake hands, use a mouse and keyboard, turn over in bed, or scratch my head without extreme pain. Although I am having physiotherapy and taking some very powerful antiinflammatory medication, I’m still in pain.

Next week, I will be Aberdeen, on the north coast of Scotland, the city of my birth, to take part in a review of the nursing and midwifery education provision at Robert Gordon University. I’m hoping that will be the final flight of 2016, but it looks like I may need to go to Saudi Arabia in late November or early December. Next week, I also celebrate my 60th birthday with family and friends at home in Hull, and then I look forward to a long break at Christmas before traveling to Oman the first week of January.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

En route to London from Italy

BRITISH AIRWAYS FLIGHT 2869—I ran out of two things these past two weeks: energy and enthusiasm. As I write this, I am on the journey home from Genoa in northern Italy to London’s Gatwick Airport in the United Kingdom, having spent a week in Italy teaching and consulting with colleagues at the University of Genoa. After posting my previous blog entry about my time in Taiwan, I spent a week in Hong Kong, two nights at Heathrow Airport, and then this week in Genoa.

My energy has been at low ebb for most of this three-week journey. It took most of my two weeks in the Far East to overcome jet lag and then, after returning to Europe, I underwent another bout, from which I am only now recovering. I am not looking for sympathy—most of my international work is self-imposed—but I am a lot older now than when I started these years of intensive international work.

I completed the week in Hong Kong with colleague Mark Hayter, PhD, RN, FAAN, and, after fitting in a variety of dinners and breakfasts with old friends and colleagues, Mark and I flew home. Formal links with Hong Kong Polytechnic University are now concluded, but I return to Hong Kong in June to work with the University Grants Committee, and I will continue to advise the university’s Research Assessment Exercise.

Regaining inspiration

As usual, I ran the Corsa Italia several times in Genoa, mostly in darkness, as the days were quite short. The PhD students here are an inspiration to work with. For my past two visits, they have been working on a rapid review, applying the principles of rapid evidence assessment. They work as a group, with my support, and they are in the process of producing for publication a very good review on the influence of the clinical learning environment on nursing students’ competence with regard to patient safety.

Members of my PhD class at the University of Genoa
working hard on a rapid evidence assessment review.

Next week, the RN4CAST@IT will be launched at the University of Genoa, and Walter Sermeus, PhD, is coming from the University of Leuven in Belgium to help with the launch. RN4CAST, which was inspired by and involves the work of Linda Aiken, PhD, RN, FRCN, FAAN, has been very effective across Europe in providing evidence for the effectiveness of nursing care and the value of graduate nurses. I played a small part in the project by putting my Genovese colleagues in contact with Sermeus and Aiken.

Summing up, after 17 podcasts, 10 lectures, keynotes and plenaries, and a rejection of a major paper on the effect of sampling on Mokken scaling (to be continued), in addition to keeping up with all my work as acting associate dean for research at Hull, I am returning to my family with the prospect of five weeks at home, which will be a joy. My travel responsibilities during those weeks will be limited to obtaining visas for forthcoming visits to China and Saudi Arabia and preparing lectures for those visits. Life is busy and never dull.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

A good week for nursing

HULL, United Kingdom—I have just returned from a week in Genoa (Genova to the locals) in the Ligurian region of Italy, on the country’s northwest coast. Once again, I taught research students at the University of Genova and liaised with collaborators about various research and writing projects. My colleagues there have translated the Edinburgh Feeding Evaluation in Dementia scale into Italian, and I was helping them test its psychometric properties. This provides me with another database on which to run my own beloved method of Mokken scaling. The sample size is small, but the results are promising and point, as does most psychometric work, to the need for a larger sample. We should get a preliminary publication out of this work.

The most important nursing paper in Europe

Linda Aiken

I said it was a good week for nursing, and I was referring to the publication last week of a paper by Aiken et al. titled “Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.” (Linda H. Aiken, PhD, RN, FAAN, FRCN, Claire M. Fagin Leadership Professor in Nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania, USA, is on the Lancet Commission on UK Nursing, which I will chair, as is another co-author of the paper, Anne Marie Rafferty, PhD, CBE, PhD, FRCN, chair of nursing policy, King’s College London, UK.) The paper, published in The Lancet, is one outcome of the RN4CAST study and, in addition to showing the effect of inadequate staffing levels on failure to rescue patients, shows—clearly—the benefit of degree-level education for nurses.

Alvisa Palese, MNS, BMS, RN, associate professor, Udine University, Italy, and I were among referees of the Aiken et al. paper, and we published a comment in The Lancet alongside it. I am pleased to have played a small part in such a seminal paper, a document many of us hope will have a profound influence on European nursing education and practice. Watch for further correspondence in the pages of The Lancet. My Italian colleagues have already submitted a letter and some “heavyweights” in Canadian, U.K., and Australian nursing are “limbering up.” (They emailed me the morning before I left Genoa.)

It has also been a good week for nursing in Italy. I’m a bit late with this news, but the first six nursing academics have just been given licences for employment as full professors. (I was able to confirm the numbers just this week.) Until now, nursing academics have been promoted only to the level of associate professor. It especially pleases me that Alvisa Palese, my good friend, colleague, and—ironically—research student, is one of the six.

The Italian process for appointing senior academics is national and very rigorous. A committee—the Abilitazione Scientifica Nazionale (ASN)—makes annual judgments on the basis of individual applications. Although I am one of an international panel of assessors for the ASN, I was not involved in this last round. The primary “unit of currency” for promotion is publications, and these must be in refereed journals with an international reputation. Those with impact factors are at the top of the hierarchy.

There is worrying news that the ASN is going to make future recommendations on the basis of an individual’s h-index, and there is a rumour that an h-index of 23 will be the requirement. I have been consulted by Italian nursing academics and organisations about this, because the h-index is something about which I have written. My view on the use of h-indices per se is that caution should be exercised. Moreover, I think an h-index requirement of 23 is ludicrous. Few academics attain that level, and it is especially the case that few nurses have attained it, or will. I’m glad to say I have, but only after a 16-year professorial career.

Next ports of call

Next week, I will be in Belfast to sit on the validation panel of a nursing programme at the University of Ulster, and I have dinner booked with Hugh McKenna, CBE, PhD, FRCN, FAAN, pro vice-chancellor, University of Ulster, UK. Later this month, I go to Basel for a long weekend to discuss issues that face nursing globally with Hester Klopper, PhD, MBA, RN, RM, FANSA, president of the Honor Society of Nursing, Sigma Theta Tau International, and a select group of colleagues. We’ll be meeting under the umbrella of GAPFON (Global Advisory Panel on the Future of Nursing).

I put more than 20 Genovese miles on my Garmin GPS watch, and I plan to add Northern Ireland and Switzerland for the first time this year. My 19-year-old son just broke 20 minutes for the first time in our local 5-kilometre parkrun race. Pressure to perform in my family is terrific, but what I like most is that none of my children—most of whom are runners and climbers—expect me to do any worse than they do. For your information, my fastest 5 kilometres is 21 minutes 38 seconds, and that was last year when I was a young man of 57. I am now 58 and have not broken 22 minutes this year, but I’m working on it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

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.