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.

Anybody NOT in Hong Kong?

Hong Kong SAR, China—My first 2014 visit to Hong Kong was busy, mainly because so many other UK nursing academics were here. The list included: Hugh McKenna, CBE, PhD, FRCN, FAAN, pro-vice-chancellor (research and innovation), University of Ulster, UK; Dame Jill Macleod Clark, DBE, PhD, FRCN, professor of nursing, University of Southampton, UK; and Dawn Freshwater, PhD, RN, pro-vice-chancellor, University of Leeds, UK (soon to become deputy vice-chancellor, University of Western Australia). McKenna chairs the Research Excellence Framework’s subpanel for dentistry, allied health professions, nursing, and pharmacy, on which Macleod Clark, Freshwater, and I sit, and McKenna and Macleod Clark will serve on The Lancet Commission on UK Nursing, which I will chair. It’s a very small world.

Laifuyu/iStock/Thinkstock

Of course, we had to have dinner, and we were joined at Felix, one of Hong Kong’s most exclusive “high-level” restaurants (located at the tower atop world-famous Peninsula Hotel), by Kay Jones, MBA, chief operating officer, School of Health Sciences, City University London, UK, and Philip Esterhuizen, PhD, RN, lecturer in adult nursing, University of Leeds. The view over the harbour to Hong Kong island is eye-watering, the food to die for (I don’t think I have ever used that expression before), and the service unobtrusive and immaculate. The washrooms are a triumph, with surprises for both genders (best Googled rather than explained).

Amidst all this luxury dining and fun, this impromptu type of meeting, which involves colleagues who are as busy or more busy than me, is crucial. We have to take these opportunities, as nobody else provides them. Held without agenda, aims, or objectives, they are the most productive. Untrammelled by organisational issues, hierarchy, or the need to list tangible, bean-counting outcomes, such as how does this benefit my university, these gatherings are the time to discuss the state of nursing, the future of nursing, and who we need to cultivate. Of course, the Chatham House Rule applies, and what is said by whom at these tables stays at these tables.

Once again, I was in Hong Kong with Mark Hayter, PhD, FRSA, FAAN, my colleague from Hull and fellow editor of Journal of Advanced Nursing. Although we were teaching and consulting at Hong Kong Polytechnic University, our time here allows us to set up lunches and dinners with key people in the SAR (Special Administrative Region) and to extend the influence of our own work with the Journal of Advanced Nursing and the University of Hull. We also took time while in Hong Kong to meet Linda Sim, manager of the Marco Polo Club, the frequent-flyer privileges club associated with Cathay Pacific Airways. We dined at Hutong, another high level Chinese restaurant overlooking Hong Kong harbour, and were joined by Graeme Smith, PhD, RN, professor of nursing at Edinburgh Napier University, UK, and editor of Journal of Clinical Nursing, based in Hong Kong.

Recognition at last

This month, Alzheimer’s Disease International published a report, Nutrition and Dementia, in which my work on the development of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale is cited. I was very pleased to see this, as it may increase the use of the EdFED and stimulate further research. It also reminded me how grateful I am for long-standing collaborations in the development and application of the EdFED, especially with Ian Deary, PhD, FRSE, FBA, professor, The University of Edinburgh, UK, and Li-Chan Lin, PhD, RN, professor, National Yang-Ming University, Taipei, Taiwan.

While in Hong Kong, I resided out in the New Territories, to the North of Hong Kong, where I found a running route along the reservoir in Sha Tin. It was cold this time of year and humid—not ideal for running, but still a great way to start the day and to register another 20 miles over five days in my wife-imposed half-marathon training program me.

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.

All publicity is just publicity

HULL, United Kingdom—The Lancet Commission on UK Nursing is going well, if you consider all publicity to be good publicity. Without meaning to ignore the many congratulations I have had on being asked to lead this and the offers of help, it is human nature that the stream of derision on Twitter and two letters in Nursing Standard verging on the abusive should have the greater impact.

So, what has upset people so much? Where do I start?

Why another commission on nursing? Why is a “medical” journal investigating nursing? The terms of reference are not yet published. Why is there no patient representation? Why all academics? Why no student voice? Why so many people from Hull? Why so few women? How have the commissioners been selected? (The undemocratic approach has been likened to South Africa before the yoke of apartheid was thrown off!) I think that is all, and I have no intention of retorting—as well I am able—as these detractors know I cannot.

Moving on. Since the initial announcement, we have added more commissioners, and we are working on the terms of reference, which will be agreed upon soon and duly published. Without attempting to answer my critics, I am honoured personally to have been asked by The Lancet to lead the commission and, given that reports from The Lancet are referred to almost daily on BBC (British Broadcasting Commission) Radio, the journal’s reach and influence is indisputable. The organization has a well-oiled publicity machine, and their podcasts are well worth listening to. If you have an iPad (access via other tablets is also available), you can subscribe (free) and download them automatically.

Nursing Open

The first teleconference of Nursing Open’s editorial team took place this week. We have four associate editors, based in Australia (Allison Williams, PhD, MN), Bahrain (Seamus Cowman, PhD, FAAN, FFNMRCSI), Canada (Alex Clark, PhD, RN), and Finland (Riitta Suhonen, PhD, RN). With such an international team, these teleconferences have to take place at a time antisocial for someone—usually me. I have another teleconference this evening with the equally geographically disparate team of Journal of Advanced Nursing editors. Life is sometimes stressful and inconvenient, but never dull.

My children have great difficulty explaining to their friends what I do, and most attempts end with a question to me: “Dad, what exactly is it that you do?” For the second time in this entry, where do I start?

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

Strange time of year

HULL, United Kingdom—I find January a strange time of year. The previous year ends in a frenzy of finishing things off, yet the New Year starts with just as much work to do as ever—and with the added stress that you’re now behind by at least two weeks.

My editor-in-chief inbox at the Journal of Advanced Nursing (JAN) was full of new manuscripts to review. Clearly, the editors had been making the most of the break and processing their allocation of manuscripts, so my “outbox”—the one that fills up with manuscripts ready for editing and production—is still not empty. I’m not complaining. If there were no manuscripts, there would be no JAN. Incidentally, if you want to know more about the editorial team of JAN, visit our blog and scroll down to the series of pieces called “Ten things about,” and you’ll find out about us there.

The Lancet Commission

The Lancet Commission is taking shape. The commissioners are appointed, and the press has picked up the story—must have been something to do with my well-crafted press release. I’ve been in the local newspaper, on local radio, and in Nursing Standard. I understand the need to get information out to the press, but I get irritated speaking to journalists. Is it just me, or do they not understand the purpose of a press release? I feel like saying “That’s the story; you’ve got it,”' but they insist on probing, and they always make me feel I’m trying to hide something. I’m not afraid to say, “I don’t know,” to a journalist, but I hate the subsequent efforts to help me find an answer. It must be a technique they learn in journalism school. I have put up a list of the commissioners on my new “Lancet Commission on UK Nursing” blog.

Feeding difficulty in dementia

The other major distraction from doing what I want—making travel arrangements and running statistical analyses on large datasets—has been revising a grant application to the Alzheimer's Society. The application is for a three-year PhD studentship, and the proposed project is to take forward a line of work on interventions for feeding difficulty in older people with dementia. This is my second application, the first having been rejected.

Feeding difficulty in older people with dementia has been a major interest since my days in clinical practice. My development of the Edinburgh Feeding Difficulty in Dementia (EdFED) scale, along with Ian Deary, PhD, FBA, at The University of Edinburgh, opened many doors for me, none more important than that of Li-Chan Lin, PhD, of National Yang-Ming University, Taipei, Taiwan. I had the privilege of hosting Professor Lin as a Leverhulme Visiting Professor while I was at The University of Sheffield. She gave an excellent lecture that was chaired by Vice-Chancellor Sir Keith Burnett, CBE, FRS, and reported in Research Endeavours And Dissemination (READ), the nursing research bulletin. Lin and I translated the instrument into Chinese, and it has been used as an outcome measure in her seminal work on interventions to help older people with dementia who have feeding difficulty.

The interventions are based on Montessori methods and spaced retrieval, and all evidence to date suggests that they work. My intention is to transfer the work to the UK and develop a brief intervention. We have proof of concept, but the intervention is time-consuming and labour-intensive. If I have attended to the revisions to the satisfaction of the Alzheimer’s Society, I may be awarded the grant, and you will be among the first to know.

Nursing Open

Finally, as if I did not have enough to do, I have agreed to be the founding editor for a new Wiley journal called Nursing Open. The journal will be online, open access, and pay to publish, a very different venture from JAN. The website should be populated before my next entry, so I hope you will look forward to learning more about Nursing Open and its team of associate editors.

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

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.