bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomy and physiology of pain and the management of breakthrough pain in palliative care
Authors: Bass Madeline
Published: May 2014

The aim of the study was to explore terminally ill patients’ and their families’ experiences of hospital end-of-life care. The study design was a qualitative approach using interpretive phenomenology, which was applied prospectively. Ten patients and their closest family members were recruited in one Swiss university hospital.

Data collection included repeated observations, conversations with patients, and interviews with family members. It was found that people led unique lives; when a terminal illness intruded and during hospital stays, they continued to live their particular life. The hospital was experienced differently, as prison, heaven, or necessary sojourn. A caring stance of the professionals was crucial to patients’ and families’ sense of being well cared for. When care providers lacked skills or did not recognize patients and family members as persons, they suffered. In contrast, adequate care interventions improved their quality of life. The experience of being in the hospital cannot be separated from patients’ and families’ life stories.
Music therapy in the context of palliative care in Tanzania
Authors: Hartwig Rebecca
Published: May 2014

There has been much written to support music therapy as an adjunct in managing pain and anxiety in palliative care patients in Western societies, but little written on its use in developing countries. In light of increasing numbers of terminally ill patients in Tanzania owing to HIV/AIDS and cancer, limited access to opioids, and a growing interest in palliative care support, this study looks at the application of music in this context. The study reviews the history and principles of therapeutic music and outlines its role in palliative care. A qualitative study was conducted by questionnaire of 17 professionals involved in home-based palliative care in Tanzania. Findings include beliefs about the power of music, how music is being used to bring comfort to the dying patient, and the most important aspects of helpful music to many Tanzanian palliative care patients. Music can powerfully affect body, mind and spirit. It is vocal music, which is an accepted therapeutic music tool used to bring comfort to the palliative care patient and their family members. Finally, music is an active and participatory activity in Tanzanian culture, even for the dying.
Factors affecting decisional conflict for parents with children enrolled in a paediatric palliative care programme
Authors: Knapp Caprice , Madden Vanessa , Wang Hua , Curtis Charlotte , Sloyer Phyllis , Shenkman Elizabeth
Published: May 2014

Palliative care programmes have the potential to affect several health outcomes for children and families, including reducing decisional conflict. Method: A telephone survey was conducted with 140 parents of children with life-limiting illnesses enrolled in Florida’s publicly funded paediatric palliative care programme (Partners in Care: Together for Kids). Results: Multivariate results suggest that parents with less than a high school education had decisional conflict scores (DCS) that were 13 points higher (p<0.05) than parents with some college education. In addition, parents who indicated that they had recently made a decision for their children had DCS scores that were 7 points higher (p<0.05) than parents who indicated they had not. Discussion: Our findings suggest that paediatric palliative care programmes should treat parents with lower educational levels as being particularly vulnerable and should consider allocating additional resources to them when a decision for their children is imminent.
The mourning before: can anticipatory grief theory inform family care in adult intensive care?
Authors: Coombs Maureen A
Published: May 2014

Although anticipatory grief is a much-debated and critiqued bereavement concept, it does offer a way of understanding and exploring expected loss that may be helpful in certain situations. In end-of-life care in adult intensive care units, families often act as proxy decision makers for patients in the transition from curative treatment efforts to planned treatment withdrawal. Despite there being a developed evidence base to inform care of families at this time, few of the clinical studies that provided this evidence were underpinned by bereavement theory. Focusing on end-of-life intensive care practices, this paper integrates work on anticipatory grief and family interventions to present a family-centred framework of care. Through this it is argued that the complex needs of families must be more comprehensively understood by doctors and nurses and that interventions must be more systematically planned to improve quality end-of-life care for families in this setting.
Nurses' and care workers' attitudes toward death and caring for dying older adults in Japan
Authors: Matsui Miho , Braun Kathryn
Published: May 2014

Registered nurses (RNs) and care workers (CWs) have important roles in providing end-of-life care to older adults, but little is known about the attitudes of RNs and CWs in Japan. In this study, 464 RNs and CWs working in facilities in Japan were asked to complete a self-administered questionnaire that included the Frommelt Attitude Toward Care of the Dying Scale, Form B, Japanese version (FATCOD-Form B-J) and the Death Attitude Profile (DAP), Japanese version. A total of 388 (83.6%) questionnaires were returned, and 367 (79.1%) were fully completed. The final sample included 190 RNs and 177 CWs. Multiple regression analysis showed that better attitudes toward caring for the dying were positively associated with seminar attendance and negatively associated with fear of death.
Palliative Care for Children and Families: An Interdisciplinary Approach
Authors: Popplestone-Helm Sarah
Published: May 2014

Jayne Price is Sandra Ryan Research Fellow and Senior Teaching Fellow at the School of Nursing and Midwifery, Queen’s University, Belfast. Patricia McNeilly is also a Teaching Fellow at the School of Nursing and Midwifery, Queen’s University, Belfast.
Establishing the validity of a spiritual distress scale for cancer patients hospitalized in southern Taiwan
Authors: Ku Ya-Lie , Kuo Shih-Ming , Yao Ching-Yi
Published: May 2014

The present study was conducted to establish the validity of the spritual distress scale (SDS), a scale developed as part of a qualitative study in which 20 cancer patients were interviewed about spritual needs in 2003-2004. The SDS has four domains: relationship with self, relationship with others, relationship with God, and attitude towards death A measurement study was conducted whereby 85 patients completed the SDS during their hospitalization in the oncology unit of a medical centre in southern Taiwan. The SDS, including four domains of sub-scales, was broader than other spiritual scales in the literature that only contained one or two domains and focused on the health area. The SDS has established the adequate content and construct validity. Further training of nurses for assessing spiritual distress of cancer patients using the SDS would be recommended for future study. The established content and construct validity of the SDS could be applied in oncology for nurses to assess spiritual distress of cancer patients.
‘As long as it helps somebody’: why vulnerable people participate in research
Authors: Alexander Susan Jane
Published: May 2014

In the past, ethics committees and researchers have avoided research among vulnerable groups because of prevailing perceptions that such research is unethical and difficult. Taking an opposite stand, this article will argue that it is in fact unethical not to research vulnerable populations because, by excluding potential participants from research endeavours, they are being deprived of the benefits to be gained from research. Albeit well meaning, people in vulnerable populations are also being subjected to the paternalistic attitudes of those who believe they know what is in the best interests of others. There is ample evidence in existing literature that, not only is research among vulnerable populations unlikely to result in harm, but there are often benefits to be gained by both participants and researchers. Apart from the generic benefits of increased knowledge and improved health interventions, specific benefits for participants might be: therapeutic, cathartic, educational, empowering, altruistic and social. In contrast, the risks associated with researching vulnerable populations appear to be minimal. Yet, there is still evidence that health care professionals and other gatekeepers continue to hinder research amongst vulnerable populations through unilateral decision-making. This article will review existing literature on the topic of research amongst vulnerable populations, as well as contribute to the argument from the author’s own study on a sensitive topic.
Providing palliative and end-of-life care in the community: the role of the home-care worker
Authors: Devlin Margaret , McIlfatrick Sonja
Published: May 2014

Home-care workers play a vital role in enabling patients to be cared for in their own homes; however, there is a lack of research on their role. The aim of this study was to explore the role of home-care workers in palliative and end-of-life care in the community. A mixed methods approach was used with two key phases. Phase one comprised a cross-sectional survey to home-care workers and phase two involved a focus group with community nurses. It was found that home-care workers considered palliative and end-of-life care as an important part of their role, and that while it was more stressful than routine work, it was nevertheless very rewarding. While the home-care workers demonstrated that their role incorporated a genuine caring dimension, they identified the need for additional support in the provision of end-of-life care, specifically during out-of-hours. Various restricting factors such as training deficits, need for support and supervision and communication issues were also identified.
Community nurses’ experiences of ethical dilemmas in palliative care: a Swedish study
Authors: Karlsson Margareta , Roxberg Asa , Barbosa da Silva António , Berggren Ingela
Published: May 2014

Aim: The aim of this study was to highlight community nurses’ experiences of ethical dilemmas in palliative care. Background: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence. Method: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis. Findings: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients’ end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals. Conclusion: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues’ experience and deal with such issues.
Creating life: ethical issues surrounding genetics experiments
Authors: Smyth Dion
Published: May 2014

The recent news that Craig Ventner, the biochemist researcher who helped decipher the human genome has, for the first time, ‘created life’ in the laboratory by the insertion of a computer-generated genome into a cell, which has lead to the formation of a living and replicating bacterium from synthetic components, has been met with varying degrees of concern, consternation and congratulation. The advocates of the experiments suggest that this could herald the development of potentially useful applications such as the creation of bacteria that can produce specific medicines, while the opponents of such research (and often the researcher himself) more emotively argue that man is playing God. Nonetheless, practitioners cannot doubt the possible utility for future health care, including a relevance to palliative care provision, and the corresponding need to stay abreast of such technologies.
Early palliative care for lung cancer: improving quality of life and increasing survival
Authors: Dahlin Constance , Kelley John M , Jackson Vicki A , Temel Jennifer S
Published: May 2014

A major barrier to broader public acceptance of palliative care for life-threatening illnesses has been the reasonable presumption that forgoing aggressive treatment in favour of palliative care would necessarily result in a shortened lifespan. Patients and treatment providers alike felt that they were confronting a stark choice between improving quality of life at the expense of quantity of life, or extending quantity of life, but at the expense of quality of life. In contrast, many hospice and palliative care providers believed that patients might live longer if symptoms were managed and every effort was made to maintain quality of life. In this commentary, we focus on our recent high-profile publication that directly addresses these issues (Temel et al, 2010).
Where do nurses go for help? A qualitative study of coping with death and dying
Authors: Peterson Jennifer L , Johnson Malynnda A , Halvorsen Bonnie , Apmann Lisa , Chang Pi-Ching , Kershek Stephanie , Scherr Courtney , Ogi Matthew , Pincon Deborah
Published: May 2014

As end-of-life care becomes a more prominent issue in health care, it is important to address the experience from the caregivers’ perspective. In order to cope with the stressful experience of caring for a dying patient, nurses need programmes that both help them develop coping strategies and prepare them for caring for dying patients as well as resources to help them cope with the experience once it has happened. Because little is known about the coping habits of nurses facing the death of a patient, research is needed that examines their coping responses to develop more effective resources. This research examines the resources that nurses use when coping with the death of a patient. The results of this research indicate that communication with patients and their families, as well as coworkers, is an integral part of that process.
Enhancing end-of-life care with dignity: characterizing hospice nursing in Romania
Authors: Vosit-Steller Julie , White Patricia , Barron Anne-Marie , Gerzevitz Diane , Morse Allison
Published: May 2014

Aims: The purpose of this research was to characterize the nursing actions practiced by Romanian nurses affiliated with Hospices of Hope that promote dignified dying and explore needs to promote a more dignified death. Methods: A survey method used the International Classification for Nursing Practice dignified dying survey. A convenience sample of 43 hospice nurses responded. Descriptive statistics, t-tests and content analysis were used to analyze the data. Results: Characteristics that promoted dignified dying included the use of a formal, iterative process of assessment, interventions that supported pain and symptom management, and spiritual comfort at the end of life. Participants described family-centered hospice care that integrated Christian orthodox tradition that transformed patients as death approached. Conclusion: Dignity for terminally ill Romanians will be enhanced as the nurses implement these interventions. Awareness of cultural and spiritual differences concerning end of life will facilitate dialogue among nurse scientists.
Accessing vulnerable research populations: an experience with gatekeepers of ethical approval
Authors: Walker Susan , Read Sue
Published: May 2014

Accessing vulnerable populations for research purposes can be difficult, as participants must be sheltered from research that might be insensitive, intrusive, and potentially distressing. People diagnosed with a life-limiting condition may be vulnerable, and involving such people in research samples may be fraught with difficulties. Nevertheless, it is important that these vulnerable populations participate in health and social-care research so that their requirements and opinions can be learnt. This paper describes an experience of proceeding through an ethical approval process for a proposed qualitative research study into the preferred place of death of a group of potentially vulnerable hospice patients. Research of this nature had never been undertaken at the hospice before, and the researchers expected to encounter a degree and variety of gatekeeping when seeking access to this sensitive population.
Caring for children and families in the community: experiences of Irish palliative care clinical nurse specialists
Authors: Quinn Claire , Bailey Maria E
Published: May 2014

An increasing number of children require care at home owing to life-limiting illness. In addition, there is growing recognition of the specific care needs of such children and their families, and it is anticipated that recent developments in children's palliative care will result in more people accessing these services. In the Republic of Ireland (ROI), community palliative care clinical nurse specialists (CNSs), who are not registered children's nurses, contribute significantly to the support of these children and families. This study aimed to obtain a picture of the current nursing service that would help to determine whether the needs of these patients are being met. Seven community palliative care CNSs from across one health region in the ROI participated in a focus group. Four key themes emerged: gaining access to the child and family, role complexities, pressures of caring, and support strategies. Provision of community children's palliative care by the CNS is complex. The participants demonstrated their commitment to consult, coordinate, negotiate, and ultimately deliver the care required by children and families, but against a background of issues relating to accessing the patient and family, the complexity of the CNS role, and the pressures that such work incurs.
Supporting care home residents at the end of life
Authors: Addicott Rachael
Published: May 2014

The English Department of Health's 2008 End of Life Care Strategy reported that 17% of deaths in England occur in care homes, with the majority of these in the 85 years and over age group. Given this, the ageing population, and the projected increase in the number of people dying, it is evident that the number of deaths in care homes is likely to increase. The research presented here seeks to consider the factors that support residents to remain in care homes towards the end of life. This study is based on four case studies of care homes in England and on interviews with external health and social care professionals who interact with these care homes. The findings indicate that three core features are fundamental to the delivery of high-quality end-of-life care in care homes: advance care planning, multidisciplinary communication and working, and provision of dignified and compassionate care. Previous research has uncovered some of these issues; this study suggests that it is the combination of these factors that makes them fundamental to meeting residents' care preferences and ensuring high-quality care.
Development and evaluation of the Pain Assessment in the Communicatively Impaired (PACI) tool: part II
Authors: Kaasalainen S , Stewart Norma , Middleton Joan , Knezacek S , Hartley Terry , Ife Christie , Robinson Lara
Published: May 2014

Pain is a common symptom for long-term care residents, particularly those in need of palliative care. However, pain assessment in residents who have communication limitations is challenging. A study was conducted with the aim of developing a pain assessment tool that could feasibly be used by direct care providers in long-term care with minimal training yet demonstrating strong psychometric properties. The study used both qualitative and quantitative methods to develop and test the Pain Assessment in the Communicatively Impaired (PACI) tool. Part I of this paper reported on the development phase; this second part reports on the test results. The validity and reliability results of the PACI tool were acceptable, and the convergent validity was moderately strong. A moderate level of interobserver agreement was evident, with kappas ranging from 0.46 to 0.63 for the individual items and a kappa score of 0.59 for the total tool score. The overall results of this study support the psychometric properties and feasibility of the PACI tool, offering preliminary support for its use in clinical practice.
Discussing life story, forgiveness, heritage, and legacy with patients with life-limiting illnesses
Authors: Keall Robyn M , Butow Phyllis N , Steinhauser Karen E , Clayton Josephine M
Published: May 2014

Aim: To explore the perceptions that individuals with life-limiting illnesses have about their lives, both positive and negative, and their messages to future generations. Methods: A preparation and life completion intervention (Outlook) was assessed for acceptability and feasibility in an Australian palliative care setting. This paper reports a qualitative analysis of the participants’ responses to the intervention. The intervention sessions were audiotaped, transcribed, and analysed using interpretative phenomenological analysis. Results: Eleven participants were recruited from inpatient and outpatient hospital and hospice settings. Three overarching themes were identified: life review, current situation, and legacy/principles. Conclusions: The intervention provided insights into individual palliative care patients’ sense of self, views of their current situation, hopes, and how they would like to be remembered.
Transition to an in-patient palliative care unit: carers share their experiences
Authors: Harrington Ann , Mitchell Patricia , Jones Jacqueline , Swetenham Kate , Currow David
Published: May 2014

Background:

For a carer, transitioning the care of a person who is dying to others may be a challenging experience. At this time, more than any other, carers’ experiences need to be understood. The emotional impact of care transitions may have clinical significance for both carers and those they care for.

Aim:

To explore carers’ experiences of the transition of the person they were caring for to in-patient care.

Method:

Carers reflected on their experiences through an explorative/descriptive research methodology.

Results:

Feelings of guilt and relief figured prominently in the participants’ discourses.

Conclusions:

Prominent feelings of guilt and relief overshadowed the participants’ experiences of transitioning care. This finding needs to be considered by care providers.
Knowledge and perceived competence among nurses caring for the dying in long-term care homes
Authors: Brazil Kevin , Kaasalainen Sharon , McAiney Carrie , Brink Peter , Kelly Mary Lou
Published: May 2014

Background: The quality of care provided to dying long-term care (LTC) residents is often inadequate, which may be due to the lack of formal training that LTC staff receive in palliative care (PC). This cross-sectional study assessed PC knowledge and self-efficacy in ability to provide PC in a sample of registered nurses working in LTC homes. Method: A survey was conducted in four LTC homes in October 2009 to June 2010. Nursing staff knowledge of PC was evaluated using the Palliative Care Quiz for Nurses (PCQN). The Self-Efficacy in End-of-Life Care Survey (S-EOLC) was used to measure nursing staff confidence in their ability to provide PC. Findings: Close to 60% of the nursing staff participated (69 of 119). The participants did not score highly on the PCQN: the average correct score ranged from 52.50% to 63.41% across the homes. There were no significant differences between the homes for the mean number of correct responses on the PCQN (P=0.329) or mean scores for the three S-EOLC subscales. Rank ordering of the percentage of correct PCQN answers by item and LTC home demonstrated that similar misconceptions were held across homes. Conclusion: Despite their confidence in PC practice, the participants’ PC knowledge gap reveals a need for PC training for staff working in LTC homes. The PC education and training provided should both include a gerontological perspective and address the expertise and knowledge already held by staff.
Respite support for children with a life-limiting condition and their parents: a literature review
Authors: Ling Julie
Published: May 2014

Most children with a life-limiting condition are cared for in the family home by their parents, who require professional support to provide this care. Owing to advances in medicine and medical technology these children are living longer and, given the often relentless and all-encompassing nature of caring for children with life-limiting conditions, respite (facilitation of short breaks) is considered central to quality palliative care provision for children and their families. However, there is still ambiguity in exactly what is meant by the term ‘respite’, what constitutes respite care, whether the services currently provided meet the needs of the child and family, and how respite is best provided. This paper reviews the literature relating to respite as a component of children's palliative care. Themes from the literature are identified and discussed. Challenges for the providers of respite care are identified and suggestions made regarding the future development of responsive and family-focused respite care.
Forgotten grievers: an exploration of the grief experiences of bereaved grandparents (part 2)
Authors: Gilrane-McGarry Ursula , O'Grady Tom
Published: May 2014

The death of a child is a traumatic family life event. Although parental bereavement has received substantial attention, little research has focused on the grief experiences of bereaved grandparents. The aims of this Irish national study were to identify and describe the bereavement experiences of grandparents following the death of their grandchild and to explore their needs and supports throughout. A previous paper provided background to the study, covered the methods used in depth, and presented one of the three key findings: ‘cumulative pain’. The present paper discusses the remaining two findings: factors that facilitate and factors that inhibit the resolution of the cumulative pain. Several factors were perceived by the bereaved grandparents as being either helpful or unhelpful in easing the pain of their grief. Among these were acknowledgment of the deceased grandchild and the grandparents themselves, the relationship with the bereaved son or daughter, family dynamics, and support mechanisms.
Nonsmoking policy in Danish hospices
Authors: Ishøy Torben
Published: May 2014

The Danish Smoke-free Environments Act 2007 aimed to prevent the harmful health effects of secondhand smoking. It requires employers to take practicable steps to ensure smoke-free environments for all, i.e. employees as well as members of the public (visitors, clients, customers, etc). Palliative care aims for a holistic approach that takes into account all aspects of patients' psychological, physical, and social needs. This may be challenged by a smoke-free policy in an end-of-life care setting. This paper looks at the concept of smoke-free standards in Danish end-of-life care settings.
A comparison of the nurse work environment between perinatal and non-perinatal hospice providers
Authors: Lindley Lisa C , Fornehed Mary Lou , Mixer Sandra J
Published: May 2014

Background: Hospice nurses have a unique role in providing perinatal care, yet little is known about the work environment in which nurses provide care for families and infants at the end of life.

Objective: To compare the nurse work environment between perinatal and non-perinatal hospices.

Methods: Data from the 2007 US National Home and Hospice Care Survey was used. The sample included 526 US hospice agencies. Comparisons were calculated using the Pearson chi-square and Wald tests.

Results: A majority of hospices provided perinatal care (60%). Compared with non-perinatal hospices, the perinatal nurse work environment had a significantly higher proportion of registered nurses (mean 0.87 vs mean 0.79), along with clinical nurse specialists and nurse practitioners to support them (95.6% vs 84.9%). Nurses within perinatal care providers worked in a climate of significantly greater safety (95.6% vs 84.9%) and technology (63.7% vs 47.1%).

Conclusions: Understanding the unique perinatal hospice nurse work environment may be essential for advancing knowledge and compassion for mothers and babies at the end of life.
Educating families about end-of-life care in advanced dementia: acceptability of a Canadian family booklet to nurses from Canada, France, and Japan
Authors: Arcand Marcel , Brazil Kevin , Nakanishi Miharu , Nakashima Taeko , Alix Michel , Desson Jean-François , Morello Rémy , Belzile Louise , Beaulieu Marie , MPM Hertogh Cees , T van der Steen Jenny , Toscani Franco
Published: May 2014

Background: The families of people with late-stage dementia need to be informed about the course of the dementia and the comfort/palliative care option. A booklet was written for that purpose and can be provided to family members by physicians and nurses. Methods: The acceptability of the booklet for nurses was tested in Canada (French and English version), France (French Canadian version) and Japan (translated and adapted version). Results: Overall, 188 nurses completed a survey questionnaire. The booklet was accepted best in Canada and less so in France and Japan. Despite regional variation, the majority of the nurses perceived the booklet as useful for families. The French and Japanese nurses also reported a greater need for palliative care education in advanced dementia. Conclusion: The booklet may help nurses educate families about end-of-life issues in dementia palliative care, but local adaptation of the booklet content and physician engagement are necessary.
New Zealand hospice nurses' self-rated comfort in conducting spiritual assessment
Authors: Taylor Elizabeth Johnston
Published: May 2014

Aim

To measure how comfortable hospice nurses in New Zealand are in conducting spiritual assessment and explore potentially associated factors.

Design

Cross-sectional, mixed-methods, descriptive study.

Sample and setting

Sixty hospice nurses from three New Zealand hospices.

Methods

An investigator-designed questionnaire measured respondents' comfort with asking patients spiritual assessment questions proposed for use in the health-care literature. Other items assessed personal and work-related factors. Open questions generated data about how these nurses assess spirituality. The data was analysed using measures of central tendency, binomial non-parametric tests, and content analysis.

Findings

These nurses were generally comfortable with proposed spiritual assessment questions and perceived spiritual assessment to be important. Personal factors including age, years in nursing, religiosity, and spirituality were not related to this comfort; however, training was associated with comfort.

Conclusion

These findings underscore the importance of training and show how nurses can be comfortable with and capable of assessing patient spirituality.
Evaluating a self-directed palliative care learning package for rural aged care workers: a pilot study
Authors: Pitman Steven
Published: May 2014

Aim: To evaluate the effectiveness of a self-directed learning package in increasing palliative care knowledge and confidence for aged care workers in Rural New South Wales, Australia. Method: Participants piloted a palliative care self-directed learning package and completed pre- and post-package knowledge and confidence questionnaires with a 6-month follow-up. The data was then analysed via paired two-tailed T-tests. Results: There was a statistically significant mean increase in knowledge and confidence after completion of the self-directed learning package. Knowledge but not confidence increases were retained after 6 months. Conclusion: Self-directed learning packages can play a part in increasing knowledge and confidence in palliative care for rural aged care workers. Questions remain regarding the role of ongoing support, education, and mentoring.
Online learning: a new approach to continuing professional development
Authors: Finucane Caroline
Published: May 2014

Government initiatives such as The NHS Plan (Department of Health, 2000) have finally acknowledged the need to provide a more flexible education for the health-care workforce. In the November issue of IJTR, Priestley and Selfe (2003) described the development of a foundation degree in health and social care which meets the needs of the Modernization Agenda and of rehabilitation students by enabling work-based learning.
Effects of patient-focused care on seclusion in a psychiatric intensive care unit
Authors: Sullivan Dan , Wallis Marianne , Lloyd Chris
Published: May 2014

The objective of the study was to evaluate whether the introduction of patient-focused nursing care affected the number of seclusions and the length of time patients spent in seclusion, in an acute psychiatric unit. The study used a pre-intervention–post-intervention design and was conducted in an eight-bed locked unit within a large regional general hospital in Queensland, Australia. The medical records of all people who were secluded as part of their management while in hospital, during two 6-month periods, were retrospectively reviewed. Changes to the ways in which nurses conducted their daily activities were implemented during the time between the data collection periods.

There were no differences between the groups with respect to the number of times a patient was secluded. However, following implementation of patient-focused care, there was a reduction in the length of time for which patients were secluded. The only change in medication administration was that post-implementation, Haloperidol was used in fewer seclusion episodes. The findings indicate that changes to nursing practice may result in closer monitoring of patients and a reduction in the time patients spend secluded in acute inpatient psychiatric settings.
Buggy-to-wheelchair progression for children with cerebral palsy: Parents’ and therapists’ opinions
Authors: Shahid Mohammad
Published: May 2014

Some children with cerebral palsy (CP) are transported in buggies until they master the skills of ambulation. Many never learn to walk and progress from a buggy to a wheelchair as a means of maximizing their independence and improving their motor and functional skills. Therapists and parents often hold conflicting views as to why a child may not be progressed to a wheelchair from a buggy.

A study was undertaken to explore the opinions of health professionals and parents concerning this problem. A questionnaire for each cohort (therapists n=17; parents n=28) was constructed containing 10 identical but general questions. Results obtained were analysed individually for each cohort and then compared to see if there was any concordance between them. Both groups believed the main factors preventing change were: transport problems making wheelchair travel difficult; inadequate housing; poorer manoeuvrability of the wheelchair compared with the buggy; and a lack of information about progressing to a wheelchair. Statistical analysis showed no correlation between how parents and therapists responded. A multilingual handbook for therapists and parents needs to be produced detailing the pros and cons of buggy-to-wheelchair progression.
A review of two workshops for occupational therapists to share clinical opinions in neuro-oncology
Authors: Tempest Stephanie , Macdonald Andrea , Holmes Claire
Published: May 2014

This article describes how a group of senior occupational therapists identified a gap in evidence-based practice within neuro-oncology and how they sought to address this by organizing two workshops, to seek opinions from like-minded peers. It also includes a summary of the process involved in organizing the workshops and the resulting opinions from 95 occupational therapists on the personal, clinical and environmental factors affecting their work with neuro-oncology patients. The process of gathering the information and the issues discussed are relevant to all disciplines working in all specialist areas where there is limited evidence or service frameworks.

The results from this study are used to raise awareness of the needs of this specialist client group and of the occupational therapists working in this clinical area. They demonstrate an effective way to reflect on practice and lay the foundations for the continued development of evidence-based practice.
A new form of electroanalgesia in the management of chronic pain
Authors: Royle John
Published: May 2014

For many years now, pain management has had a cancer pain focus. However, non-cancer-related pain, such as that arising from joint and skeletal problems and phantom limb syndrome, affects many people on a day-to-day basis.
The use of mime therapy as a rehabilitation method for patients with facial nerve paresis
Authors: Beurskens Carien HG , Devriese Pieter P , Van Heiningen Ide , Oostendorp Rob AB
Published: May 2014

Since 1980, patients with sequelae of peripheral facial nerve paresis have been treated with mime therapy at the physiotherapy department of the University Medical Centre in Nijmegen, which aims to rehabilitate facial expression. Mime therapy was developed by Jan Bronk (a mime actor) and Pieter Devriese (an otolaryngologist) in the 1970s, using the principles of mime for patients suffering from either lack of facial movement or uncontrolled movements. Both therapists and patients reported benefits of mime therapy; most importantly, an improved symmetry of the face.

There is a belief within the profession that evidence-based treatment is required to scientifically substantiate physiotherapy. A detailed description of the mime therapy treatment is essential for performing a randomized controlled trial, which is currently underway.

This article aims to comprehensively describe the historical development and clinical characteristics of mime therapy and to give insight into its usefulness as a tool in the treatment of patients with facial nerve paresis.
Efficacy of botulinum toxin for spasticity management in neurorehabilitation
Authors: Kulkarni Jai
Published: May 2014

This article aimed to assess the effect of botulinum toxin type A (BTX-A), when used in conjunction with physiotherapy, in spasticity management. Patients were assessed before and after BTX-A injection using the following outcome measures: the Medical Research Council (MRC) scale for motor testing; the Modified Ashworth Scale (MAS) for spasticity; the Global Pain Scale (GPS); the modified Barthel score for activities of daily living; spasm frequency; and adductor tone rating.

In total, 72 patients (aged 13–81 years; 43% male) received BTX-A treatment. MAS scores were reduced by a median of 1 point (P <0.001) and 56% of patients had a 30% or greater reduction in GPS scores after injection. Mean spasm frequency (per hour) was reduced by 3.1 (P <0.001) and improvements were detected in adductor tone and activities of daily living scores (P <0.001 and P=0.046 respectively) after injection, while MRC scale scores showed statistically significant improvements, particularly in severely impacted categories (P=0.007). Reported improvements in affected joints were made by patients and carers, with benefits lasting an average of 6 months. BTX-A injections were well tolerated. These findings suggest that BTX-A injections have a key role to play in spasticity management.
Evaluating the Community Dependency Index in a social services context
Authors: Stubbs Rachel , Atwal Anita , Mckay Elizabeth
Published: May 2014

In the UK, current health-care policy has outlined the importance of evidence-based practice. Within social services, the need for evidence of efficacy of occupational therapists’ practice in social services is often raised. This article discusses the use of the Community Dependency Index (CDI), reporting an initial evaluation undertaken by occupational therapists in an inner London social services department. This was undertaken in order to enhance practice.

The results of this pilot study suggest that the measure is not sensitive enough to reflect the complexity of the client’s presenting problems. However, it can be a useful measure to determine whether a client could benefit from rehabilitation. In using this measure, careful consideration should be given to the criteria for its use within practice. The CDI, unfortunately, did not fully meet the expectations of the social services, but its usefulness may be enhanced by the use of a quality-of-life measure.
Wheelchair postural support for young people with progressive neuromuscular disorders
Authors: Clark Janice , Morrow Marina , Michael Shona
Published: May 2014

This study aimed to measure the effects of postural support within the wheelchair on posture, respiration and upper limb function for young people with progressive neuromuscular disorders. A prospective two-period randomized crossover study was used. Participants were 19 people (aged 6–21years) with a diagnosis of Duchenne muscular dystrophy or Friedreich's ataxia, who required the use of a wheelchair. Participants were assessed for wheelchair seating with a standardized in-depth protocol. The new wheelchair seating was then fitted. Sitting posture, respiration and upper limb function when sitting in a standard wheelchair and also when sitting in the adaptive seating were measured.

In the adaptive seating there was a significant improvement in many of the postural measures. No such improvement was found in respiratory function. Participants were able to complete one of the six upper limb function tests more quickly in the adaptive seating.

Adaptive seating within the wheelchair can instantaneously improve sitting posture for this client group. There is, however, potential for the person's position to be over-corrected with inappropriately configured seating. There are no immediate differences in respiratory function and only small differences in upper limb function between the two chairs with the protocol of this study.
Psychological impact of the SARS outbreak on a Singaporean rehabilitation department
Authors: Sin Sim So , Huak Chan Yiong
Published: May 2014

Severe acute respiratory syndrome (SARS) developed in Singapore in March 2003. It started from three index cases and rapidly multiplied in the hospitals. The total number of probable SARS cases was 238, of which 42% was health-care workers. This article describes the psychological impact of the SARS outbreak on the staff of a rehabilitative services department in a general hospital in Singapore 2 months after the outbreak.

In total, 55 rehabilitation staff were asked to participate in this voluntary survey, consisting of self-reported measures on demographics, the General Health Questionnaire (GHQ) and the Impact of Events Scale (IES). A questionnaire measuring changes in life priorities as a result of SARS and ways that people coped with SARS was also administered. A total of 23.4% of subjects had GHQ scores higher than 5, indicating presence of psychiatric symptoms, while 12.8% of them scored more than 30 for IES, indicating presence of post-traumatic stress symptoms. Support from colleagues, taking precautionary measures and getting clear directives and disease information had helped participants to cope with the psychological impact of the epidemic.

Health-care facilities need to look into infection control, good information dissemination and emotional support structures for staff to help their employees cope with the psychological impact of epidemic outbreaks.
Impact of the introduction of a multidisciplinary weaning team on a general intensive care unit
Authors: Bruton A , McPherson K
Published: May 2014

The majority of patients needing mechanical ventilation are weaned rapidly and easily, but a significant minority (20–30%) require more gradual withdrawal. Evidence suggests that a structured approach to this process, involving a multidisciplinary team, is likely to be the most successful. This article describes the process of setting up a multidisciplinary weaning team on a general intensive care unit in a regional hospital.

A team drawn from nursing, physiotherapy and anaesthetic staff was created and a decision was made to introduce protocol-directed weaning. Change management theory and published evidence-based guidelines were used to make this introduction. Pre- and post-protocol introduction data were collected on staff perceptions and weaning outcomes. The team overcame a number of barriers to change and protocoldirected weaning was successfully embedded into routine practice. Protocol-directed weaning reduced the reintubation rate from 16% to 3.4% (P=0.015). The process of introducing the changes necessary to use protocols for weaning also altered the attitudes and perceptions of unit staff and improved interdisciplinary working relationships.

Introducing changes to weaning practice required concerted efforts over a lengthy period of time, during which it was essential to support all the staff involved. However, the process has been an important step for the service, allowing the authors to develop new ways of working that are directed at improving patient care.
A guide to choosing children's daily living equipment
Authors: Hong Chia Swee , Wheble Jane
Published: May 2014

Children with disabilities may need supportive equipment to enhance their ability to manage with activities of daily living. Assessments form an essential component in the provision of equipment.

This article will consider some of the fundamental issues surrounding the assessment and the provision of equipment for seating, drinking, eating and sleeping. Some useful products are recommended.
Lobbying for occupational therapy: Launch of the COT's manifesto
Authors: Richards Sheelagh
Published: May 2014

As the trade union and professional body for occupational therapists in the UK, the British Association and College of Occupational Therapists (COT) lobbies government in the interests of its members, and often in the interests of patients and service users. The COT is regularly consulted on key policy initiatives, including by the devolved administrations in Scotland, Wales and Northern Ireland.
Reliability of marker placements and optoelectronic systems for analysing spinal movement
Authors: Chockalingam Nachiappan , Cochrane Tom , Dangerfield Peter
Published: May 2014

While highlighting various investigations into anatomical landmarks that could be used in spinal and back surface measurement, this study indicates the usefulness of optoelectronic systems and marker placements for spine and back movement analysis. Earlier research has demonstrated the use of optoelectronic gait analysis systems to measure dynamic back movements and the potential to produce repeatable patterns of such back movements. These consistent patterns of movement suggest a relationship between spinal and back surface motion. However, these studies, mainly measuring the range of movement (ROM) of the spine, have not examined the effects of marker placements.

This investigation examined the spine ROM and the movement of markers on the back using a three-dimensional optoelectronic system developed for gait and movement studies. Interobserver variability was assessed using three subjects and three investigators. While indicating the changes in various segmental lengths during right and left lateral flexion in different planes, this investigation reports the technical error of measurement (0.00–0.02 cm for differences in linear distances and 0.31–0.83° for angles) and the coefficient of reliability (83–98%) on marker placements. The results suggest the feasibility of application of this technique to investigate dynamic trunk and spinal movement.