Another quick visit to Rome

I was in Rome again this week to attend a conference. I missed by one day the 4 million visitors who were here for the double papal canonisation (Pope John XXIII and Pope John Paul II) on 23 April in St. Peter's Square. To non-Catholics, these events are unfathomable, and the ordinary “Catholic in the street” would have difficulty explaining the criteria, the significance, and the effect, if any, on their lives. As one of them, I won’t try to enlighten you.

The weather in Rome was a pleasant change from the U.K., where we are still having subzero Centigrade nights and the garden (the “yard”) is still a place to be endured rather than enjoyed. The conference, held in the Italian Ministero della Saluta (Ministry of Health), was run under the auspices of IPASVI (Nursing Board of Rome) and showcased the work of the Centre of Excellence for the Development of Nursing Research.

The research theme focused on the importance of nurses in feeding patients and contributing to health, and Gennaro Rocco, president of IPASVI, outlined the work of the centre. Since 2010, they have produced an impressive 82 publications from 48 funded projects, a great many in top journals and most in collaboration with other disciplines. Italian colleagues bemoan the poor state of academic nursing in Italy. I know everything is not perfect, but something seems to be working, and this is largely due to President Rocco.

The location of my accommodation was not ideal for running, but I managed to piece together two 3-mile runs early in the morning. Following my first half-marathon (see previous entry), I realised I was not as fit as I thought I was. So, I’ve been studying Run Fast: How to Beat Your Best Time—Every Time, by Hal Higden, and learning the difference between repeats and intervals—not the same thing—and what “fartlek” training is. If you sniggered at fartlek, go to the back of the class. It’s a real word; Google it.

Another review of UK nursing

I tried, without success, to take some days off at Easter, but, at least, I was mainly able to work at home. Once again, just when I thought it safe to read the newspapers without risk of stroke or heart attack, I see another review of nursing education has been commissioned by the U.K. government. The review will be led by Lord Willis, who led a commission on behalf of the Royal College of Nursing a few years ago. That commission looked at preregistration nursing education and came to the conclusion that there is no evidence that being an educated nurse means you are an uncaring nurse. It seems that this new commission will review all aspects of nursing education with a view to recruiting into nursing older candidates with the “right attitude.”

This strays into the territory of the Lancet Commission I will be leading, which I do not mind, but this newly commissioned review begins with the premise that there is a problem—that nurses are not caring enough and that they have little regard for patient dignity. These things may be true, but I am determined that the Lancet Commission is distinguished by the fact that it is not out to solve problems. It does not start from the premise that there is a problem—we don't deny there may be one. Instead, we want to see—whatever the current state of nursing—how best we can prepare nurses from registration throughout their careers to meet the challenges of the next 20 to 30 years.

Bad news

I mentioned in a previous entry that I was revising a research grant application for the Alzheimer’s Society. The proposal was duly revised, resubmitted, and rejected. I have never expressed irritation to a grant-awarding body in the past, but I did this time on the basis that I considered they had wasted my time. Everyone feels angry and let down when a research proposal representing months of works and investment of time and hope is rejected, but the task I was given was huge and the space in which it could be accomplished a challenge, and I failed—apparently. Back to the proverbial drawing board.

On the bright side, I have had several papers published, the most recent being one where, along with my co-authors David R Thompson, PhD, FAAN, Wenru Wang, PhD, RN, and Rob R. Meijer, PhD, we looked at issues affecting measurement of a property called invariant item ordering in the Mental Health Inventory. It was published in Personality and Individual Differences. Reviewer comments were extensive and very helpful, and, in the process of revision, we were asked to consider something that was new to me—person-item fit (PIF).

I contacted my Mokken scaling colleague Rob Meijer in the Netherlands, who has written about this. It just happened that he was developing software to analyse the kind of data I was looking at. In fact, he ran it for me and joined in authorship of the paper. Since then, his colleague Jorge Tendeiro, PhD, provided me with a link to the software and the syntax to run it. 

They also provided me with a draft article (“Practical Guide to Check the Consistency of Item Response Patterns in Clinical Research through Person-Fit Statistics: Examples and a Computer Program”) they wrote for people like me who may not, unlike them, have the programming and statistical knowledge to do these things without a lot of help. In fact, the paper quoted what I said to Meijer when I read one of his papers on PIF: “I have read the 2001 paper; frankly, most of this is beyond me and Google is not much help.” My ignorance has spurred a paper, and I was glad to be of service.

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

Another expert on nursing!

HULL, United Kingdom—My next entry was to be from Basel—a report on fresh Swiss mountain air and a Who’s Who? of global nursing personalities. And then something annoyed me.

My wife got to the Sunday Telegraph (14 March 2014) the weekend before I did, taking great interest in an interview with Angela Rippon. Rippon is one of our national treasures: the first female newsreader on U.K. television and a former dancer who took the nation by surprise with a famous routine in a 1976 Christmas comedy special of the duo Morecambe and Wise. Now she fronts the occasional television special and co-chairs the dementia friendly communities champion group, something she became interested in after her mother died with dementia. Although my wife gave me some snippets from the interview, she failed—on the basis that she did not want Sunday spoiled—to read out the following quote (page 23): “Nurses themselves say that everything changed when nurses were learning in a university lecture hall, and not in the ward with hands-on practice. Because they trained on wards, they had contact with patients all the time.”

I had to take some time to catch my breath after typing the above; I nearly stopped breathing on Sunday. I am astonished by how ignorant some people are about nursing education and how ready they are to blame the ills on university education. Everything is not perfect; in fact, much is wrong. But pointing the finger at something that took place at a time when things, allegedly, got worse is simply irresponsible.

Since the halcyon days of nursing care by good-hearted angels of mercy called to the profession by God, or because they were not clever enough for medical school, so many things have changed—in the U.K. National Health Service, in the profile of patients in hospital and at home, and in our society. Of course, public figures often live in an evidence-free zone where they use their opinions to first convince themselves and, then, by taking every opportunity to air those opinions, to convince others, with each utterance making them more sure they are correct.

Linda Aiken et al.’s recent Lancet paper demonstrates the worth of graduate education for nurses. I doubt that Angela Rippon has read it, would read it, or would change her mind if she did read it. However, the most obvious error in the argument against university-educated nurses is that they do all their learning in a lecture hall. Note how “lecture hall”—as opposed to “classroom”—is often used pejoratively in these arguments, as lecture halls represent the epitome of a university education. The argument is wrong, because nursing students have always, demonstrably, spent 50 percent of their time in clinical practice. This was emphasised recently by the U.K. Nursing and Midwifery Council in response to the Francis Report on appalling standards of care in one U.K. National Health Service Trust.

OK, relax!

Good things continue to happen. Despite my present workload, my first loves—data analysis and writing—have not been neglected.

I, together with my good colleagues, David R. Thompson, PhD, FRCN, FAAN, of Australian Catholic University in Melbourne, and Wenru Wang, PhD, RN, of National University of Singapore, submitted a manuscript to Personality and Individual Differences (PAID) on the scale properties of the Mental Health Inventory. It contained a warning about the phenomenon of invariant item ordering, a desirable property of scales whereby the way in which the scale orders people is the same as the order in which they respond to the questions. Still with me?

The initial response from reviewers was longer than the submitted manuscript. However, we received some expert help on person-item fit statistics from Rob R. Meijer, PhD, professor of psychometric and statistical techniques at the University of Groningen in the Netherlands, and it has just been accepted for publication. The next paper, using the quality-of-life SF-36 scale will address some problems associated with local stochastic independence of items in questionnaires. It’s all fascinating stuff about which I love to talk, but I wonder why people avoid me in the coffee room?

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.