bluuebunny/crossref_metadata_2025 huggingface dataset:
Privacy and dignity in a hospice environment—the development of a clinical audit
Authors: Gerry Edwina M
Published: May 2014

A clinical audit was developed and conducted at St Gemma's Hospice, Leeds, to provide evidence of the standard of privacy and dignity afforded to patients in the wards and Day Hospice. It involved setting standards from key documents and including patients, carers, and staff in developing questionnaires. The questionnaires were administered to 30 patients and 130 members of the multidisciplinary team. The response rates were 91% (patients) and 78% (staff). Evaluation of the questionnaires showed that 70% of patients rated their satisfaction with privacy and dignity as ‘excellent', with the remaining 30% rating it ‘very good'. For the most part, the ratings of staff and patients were in agreement and indicated achievement of the expected standard. However, some areas of concern were identified, including providing opportunity for hand washing prior to meals, closer monitoring of visitor numbers, avoiding interruption to staff, and maintaining privacy during conversations with staff. Disseminating the results of the audit resulted in some important discussions in the clinical teams and the formulation of an action plan to address the concerns.
Politics and palliative care: Vietnam
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Anger: a common form of psychological distress among patients at the end of life
Authors: O’Grady Eileen , Dempsey Laura , Fabby Carole
Published: May 2014

Psychological distress is common in palliative care patients and their families, and anger is a complex component of distress experienced by many patients at the end of life. Anger can be a form of tension release, as well as a coping mechanism for the patient and a way to disguise fear and anxiety. The interdisciplinary team are responsible for recognising psychological distress in patients, assessing their needs, and providing adequate psychological support. Although a certain level of psychological distress such as anger is expected in terminally ill patients owing to their situation, such responses may also be dysfunctional. This paper aims to highlight the challenges and complexities of adequately assessing and supporting palliative care patients who are presenting with psychological distress in the form of anger, in order to relieve their suffering and assist them in resolving their issues and improving their quality of life. Anger can be difficult to treat, and for some patients can be more distressing than some physical symptoms. Hence this paper also aims to offer anger management guidance to palliative care practitioners.
A multimodal, interdisciplinary programme for the management of cachexia and fatigue
Authors: Watkins Frances , Tulloch Sue , Bennett Cathy , Webster Brett , McCarthy Carmel
Published: May 2014

Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.
Interventional pain management in the palliative care patient
Authors: McHugh Marlene E , Miller-Saultz Debbie , Wuhrman Elsa , Kosharskyy Boleslav
Published: May 2014

For the majority of patients, cancer pain can be treated using the World Health Organization cancer pain guidelines; however, for 10–20% of patients with advanced cancer, adequate pain control cannot be achieved using these methods owing to disease pathophysiology preventing administration/absorption of pain medications or intolerance due to opioid toxicities. The need to expand analgesic treatment when oral, transdermal, and intravenous therapies fail requires exploration of interventional pain management techniques such as neuraxial (e.g. epidural and intrathecal) infusion therapies and neurolytic interventions. Nurses caring for patients with cancer pain should develop their knowledge of these multimodal approaches to cancer pain management.
Follow-up evaluation of a course to develop effective communication and relationship skills for palliative care
Authors: Andrew Jane , Taylor Cara
Published: May 2014

This paper reports on a longitudinal follow-up evaluation of an interprofessional experiential course to support the development of effective communication and interpersonal relationship skills in palliative care: ‘It's good to listen: advanced communication skills in end of life care’. The course was developed from evidence-based guidance produced by the West of Scotland Cancer Network and NHS Education for Scotland in 2009. The aim of the study was to explore the factors that support or hinder the sustainable integration of skills and learning from the course into clinical practice. Three focus groups were held across the NHS Board area. Following analysis of the transcripts the emergent themes were grouped under four headings; impact on practice, facilitating factors, hindering factors, and organisational issues. The findings suggest that organisations should consider the value they place on supporting interpersonal skills in end-of-life care and how they can enhance the facilitating factors and mitigate hindering factors to ensure sustainability and behavioural change.
Achieving effective control in cancer pain: a review of current guidelines
Authors: Fielding Flannery , Sanford Tanya M , Davis Mellar P
Published: May 2014

Pain is one of the most common and distressing elements of suffering related to cancer and cancer treatment. Progress in cancer treatment means people will live longer with the sequelae of cancer and disease-directed treatments, and both the short- and long-term effects of opioid use must be considered. Skilled practitioners caring for individuals with cancer help to alleviate cancer-related pain by using the World Health Organization (WHO) step-wise approach to pain management as well as recently updated national and international guidelines. Current guidelines go beyond the unidimensional WHO model by addressing comprehensive assessment, pharmacological management of opioids and adverse effects associated with opioid use, the role of adjuvants, and the application of non-pharmacological treatments. By following current guidelines promoting a multifaceted approach to the management of cancer-related pain and advocating for patient-centered care, nurses are uniquely positioned to champion effective cancer pain management.
Malignant pleural effusion in the palliative care setting
Authors: Arber Anne , Clackson Catherine , Dargan Susan
Published: May 2014

Malignant pleural effusion (MPE) is a distressing condition for the patient, causing many symptoms such as shortness of breath, dry cough, an uncomfortable feeling of heaviness in the chest, and pleuritic pain. MPE reduces quality of life and functional status. It indicates that the disease is now advanced and life expectancy is generally short, with a median prognosis of 3–12 months depending on the stage of the disease and the underlying malignancy. This paper discusses the palliative treatment options for MPE, which include thoracentesis, medical pleurodesis, and indwelling pleural catheter. It is important that decisions about treatment are made within the multidisciplinary team and alongside the patient and family. Treatment goals are concerned with the relief or elimination of dyspnoea, restoration of near-normal activity and function, and avoidance of inpatient care.
The development of the Grip on Challenging Behaviour dementia care programme
Authors: Zwijsen Sandra A , Gerritsen Debby L , Eefsting Jan A , Hertogh Cees MPM , Pot Anne Margriet , Smalbrugge Martin
Published: May 2014

Background:

Current guidelines and theories on the origin of challenging behaviour in dementia indicate that a structured multidisciplinary approach to its management is necessary. In the Grip on Challenging Behaviour study, a care programme was developed to improve the management of challenging behaviour.

Method:

In developing the care programme, the overlapping parts of dementia care guidelines were supplemented with discipline-specific parts. Three meetings with experts were arranged to further develop the structure of the care programme and to ensure a good fit with practice.

Results:

The care programme consists of four steps: detection, analysis, treatment, and evaluation. For each step, forms were developed to guide and structure the process and assign responsibilities for each discipline. As well as a description of the development and the content of the care programme, this paper presents two case studies in which the programme was used.

Conclusion:

The Grip on Challenging Behaviour care programme provides a way for dementia special care units to manage challenging behaviour in a structured way and with a multidisciplinary approach making use of their own resources.
Politics and palliative care: Ecuador
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Findings from a nursing scholarship study tour to inform a proposal for a day hospice model in South Australia
Authors: Swetenham Kate
Published: May 2014

South Australia releases national and international travel scholarships every year to the nursing and midwifery workforce to enable them to undertake observational site visits to inform the development of service models that can be introduced into care practices back in South Australia. Ten sites across New Zealand, Canada, and the UK agreed to host a site visit as part of a scholarship to look at day hospice (DH) programmes. The author undertook an observational study that included participation in DH programmes and discussions with staff and patients. There were many similarities across the three countries, in particular in the structure of the programmes, the staff makeup, and the support of the volunteer workforce. Two distinct models were observed: social and medical. Each has its value and both need to be incorporated to ensure services and participants have their needs met. Based on the site visits and other research, the author devised a proposal for South Australia to commence with a time-limited sessional group DH programme with a focus on maintenance of function for participants coupled with caregiver education and information provision.
Psychosocial functioning of Chinese older people with chronic physical illness
Authors: Tsang Hector WH , Cheang Callas TK , Tong Betsey YM , Tse Shirley SL
Published: May 2014

Using the Chinese Geriatric Depression Scale, The World Health Organization Quality of Life (WHOQoL) scale and the Self-concept Questionnaire, this article examined the relationship between depression and psychosocial functioning among 80 older people with chronic physical illness in Hong Kong. It aimed to test the hypothesis that people with chronic physical illness are prone to depression, which in turn leads to lower quality of life and negative self-esteem.

The group with chronic physical illness scored higher on the Geriatric Depression Scale than the control group. The control group had higher scores than the illness group in the physical health and psychological health domains of the WHO-QoL scale and had better functioning in activities of daily living and leisure. Despite some contradictory findings, the results of this study support the proposed hypothetical framework relating chronic physical illness to depression and support findings of previous research. Data from this study highlight the negative impact of chronic physical illness on the physical and psychological status of older people. Implications for rehabilitation services are discussed.
Encouraging the development of team working skills in physiotherapy students
Authors: Smith Sue
Published: May 2014

This research report provides an overview of the main findings from the student focus groups at the beginning and end of a module, undertaken on 50 first-year students on a BSc (Hons) Physiotherapy course. One of the module's learning outcomes was to ensure the development of team working skills. This module and this research project echoed the aims of the Department of Health's Meeting the Challenge, reflecting the government's commitment to modernizing education for allied health professionals. An understanding of the roles of other health workers and developing team working skills is integral to educational culture in terms of preparing physiotherapy students to be effective practitioners who can work well with others.

Students discussed their experiences, challenges and coping strategies used while working together in a small group (n=5) on a group assessment of a case study. Qualitative data were supplemented by the Team Reflexivity Questionnaire and consideration of the principles underpinning Belbin's work on team roles. The main findings focussed on group members' poor assertiveness and listening skills. This in turn led to difficulties in planning, negotiating for a leader and delegating and organizing work. Discussion of the implications of these findings on educational practice is undertaken, looking particularly at the development of assertiveness skills early in the undergraduate course, observational monitoring of ‘early’ group interactions and allowing time for new groups to socialize before allocating the formal assessment task. Recommendations for tutor practice are made.
Circulatory response to hydrotherapy and dry heat in individuals with type 2 diabetes
Authors: Scott Petrofsky Jerrold , Besonis Chris , Rivera David
Published: May 2014

In total, 33 subjects aged 23–74 years were examined to observe the effect of exposure to warm water hydrotherapy (40ºC), local heating (40ºC) and global (whole body) dry heat at 30ºC and 40ºC on their circulation. Data from patients with type 2 diabetes (n=16, mean age=58.3±11.5 years, mean weight=88.1±16.4 kg) were compared to data from control subjects (n=17, mean age=52±14.2 years, mean weight=80.4±12.3 kg).

Vascular occlusion was used to assess endothelial damage. Subjects with type 2 diabetes had an impaired circulatory response to warm water immersion, dry heat and the application of local heat to increase skin temperature. Blood flow, in general, was diminished in diabetics by at least 50% when comparing resting blood flow in diabetics to that in control subjects. The response to heat under any condition studied here was also severely impaired in subjects with diabetes.

These findings suggest that the application of warmth to increase circulation in patients with diabetes may not be as beneficial as once thought. In addition, the diminished sensation seen in diabetic patients with sensory neuropathies may make prolonged heating of their limbs potentially dangerous. For these reasons, therapists should use heat with caution in patients with diabetes.
Influence of occupation and home environment on the wellbeing of European elders
Authors: Green Sharon , Sixsmith Judith , Dahlin Ivanoff Synneve , Sixsmith Andrew
Published: May 2014

ENABLE-AGE was a EU-funded project involving research teams in Germany, Hungary, Latvia, Sweden and the UK. A main aim was to study the relationship between home and healthy ageing for very old people living alone at home. In all, 1918 older people from the five EU countries were surveyed.

This article addresses results from a sub-set of in-depth interviews, conducted with 80 octogenarians in Sweden and the UK. The impact of the home environments and patterns of occupational engagement on individual wellbeing is presented. Findings indicate that occupational pursuits are diverse, and not dictated by chronological age. Social activities outside the immediate home environment are particularly valued, as is easy access to favourite local venues. Additionally, being able to leave the home to pursue chosen activities is enjoyed and nurtured. House-bound elders find their occupational satisfaction increasingly dependent upon both their own ingenuity and the accessibility of the interior home.
Usefulness of digital gait analysis for assessing patients with Guillain-Barré syndrome
Authors: Walton Timothy , Vincent Mary , Richards Jim , Davidson Ian
Published: May 2014

This study aimed to investigate the usefulness of laboratory-based digitized gait analysis as an outcome measure to identify improvement in a mildly affected patient with Guillain-Barré syndrome 10 and 20 months post-nadir. Data are presented in the form of a single case study.

Considerable improvements were found within ground reaction forces and lower limb kinematics, indicating a markedly improved functional gait pattern. This improvement was reinforced by positive subjective feedback.

Initially, this assessment intended to identify the extent to which sensitive measurements using digitized gait analysis could provide a means of examining patient improvement following Guillain-Barré syndrome. As a serendipitous finding, it was noted that it can also provide a focus to therapy sessions.
The appropriate use of equipment for moving and handling patients
Authors: Hampton Sylvie
Published: May 2014

A case study reported on BBC Radio 4 highlighted the lack of knowledge and understanding that is associated with lifting patients in and out of bed and onto chairs. A lady remained seated in her wheelchair for 22 months because the local authority did not allow her carers to lift her and never considered supplying appropriate equipment that would have allowed them to lift her in safety. The authority had a responsibility to care for this lady and, as there is a vast range of equipment available, to allow someone to develop a life-threatening pressure ulcer is both unnecessary and disgraceful.

It is important to learn about the available equipment and to understand how it can be applied in practice to offer quality of life to the patient and to prevent pressure damage occurring. This article describes the case study and offers some suggestions for the type of equipment that could have been provided in this case.
Suitable moving and handling equipment: A guide
Authors: Fernandes Tanya
Published: May 2014

The regular transfer and lifting of patients can place added stresses on carers. The high incidence of injury among care staff has resulted in an increase in the use of mechanical devices, designed to reduce musculoskeletal strain.

This article looks at the various mobility aids, options and hoists available to aid carers involved in the essential task of moving and handling people. Contact details for the manufacturers and suppliers of such mechanical aids will be provided.
Speaking up for speech in Parkinson's Disease
Authors: Miller Nicholas , Noble Emma , Jones Diana
Published: May 2014

People with PD almost inevitably experience changes to how they communicate and alterations to swallowing affecting eating and drinking. Most studies have focused at the level of impairment, while the social-psychological impact of communication and swallowing changes in PD has been almost completely neglected.
Exploring social and leisure participation among stroke survivors: Part one
Authors: Amarshi Farah , Artero Lisa , Reid Denise
Published: May 2014

Older adults who live in the community often report decreased levels of social and leisure participation following stroke. A qualitative study using open-ended, focused interviews was conducted with a sample of 12 older adult stroke survivors. This study aimed to explore how often older adult stroke survivors participate in social and leisure activities, the meaning(s) associated with this participation and the factors felt to hinder or contribute to this participation.

The first part of the article provides the background and methodology to the study. Part two, published in the following issue, details the findings from the interviews and provides discussion.
Promoting equality through the amended Disability Discrimination Act
Authors: Scullion Philip
Published: May 2014

Rehabilitation professionals may well see one of their central functions as the prevention or mitigation of disability. Some health professionals view disability as ‘failure’ in relation to outcomes of health systems or particular therapies. Many view ‘disability’ as synonymous with illness, dependence or deviation from socially or medically determined norms.
The School AMPS: A tool for assessing classroom activity and participation
Authors: Payne Sally
Published: May 2014

Paediatric occupational therapists have traditionally used a variety of standardized tests in their assessment of children with special needs. This is partly because of the number of tools available to us, and partly a response to the perceived need to provide ‘scientific’ evidence to justify our clinical practice.
An investigation into the use of a journal club for evidence-based practice
Authors: McQueen Jean , Nivison Catherine , Husband Vicki , Miller Claire
Published: May 2014

Literature linking journal clubs with evidence-based practice is plentiful but largely descriptive in nature. Existing research has tended to focus on how journal clubs are run with limited evidence presented to demonstrate that evidence found has been incorporated into practice. The purpose of this study was to explore the potential impact participation in a specific journal club had on knowledge of evidence for practice and actual clinical practice.

A small-scale exploratory study using pre- and post-questionnaires as a method of data collection was undertaken with seven occupational therapists involved in the journal club. Questionnaire results were analysed qualitatively through content analysis to identify key themes in the data generated.

Findings appear indicative of some changes in professional practice and staffs attitude following participation in the journal club with staff reporting an increased awareness of the evidence base for interventions. Specific ideas for future research have evolved from this exploratory study. This may act as a catalyst for much needed evaluation in this field.
Impairment of muscle performance before and following total hip replacement
Authors: McMeeken Joan M , Galea Mary P
Published: May 2014

The aim of this preliminary descriptive study was to investigate the presurgical condition and medium term postsurgical outcomes of pain, function and muscle performance in patients with total hip replacements who do not receive specific perioperative exercise.

The 17 participants in this within-subject study were acute tertiary hospital patients scheduled for total hip replacement. The main outcome measures were pain (visual analogue scale), function (timed up and go test and stair climbing), and muscle performance (isokinetic testing of quadriceps and hamstrings). These measures were collected by a physiotherapist blinded to the purpose of the study, at three time periods, twice before surgery to establish stability of measurement and at 8–12 weeks post surgery.

Following total hip replacement pain decreased and function generally improved. Concentric and eccentric performance of the tested muscles on the operated side returned to the preoperative state, but remained significantly weaker than the unoperated side 8–12 weeks following surgery. Poor muscle performance was correlated with poor function indicating that appropriate and targeted strengthening exercises to the muscles controlling the knee and hip joints on the operated side may be required to achieve maximum functional outcome.
Developing clinical expertise through clinical placement at masters level
Authors: Rushton Alison , Lindsay Geoff
Published: May 2014

This paper reports further on a descriptive survey that explored the characteristics of existing masters courses that aimed to develop clinical expertise. The focus of the paper is the clinical placement component of masters courses. Quantitative and qualitative data were combined through use of a questionnaire to a total population sample (n=171) of course tutors of masters courses in healthcare.

A very good response rate (n=148, 86.5%) found 89% (n=132) of courses aiming to develop clinical expertise. As a means of developing expertise, emphasis was placed on clinical placement by 38.6% of participants (n=51).

The data illustrate the features of clinical placement and raise key issues, such as the emphasis placed on part-time models of placement. Distinct differences between physiotherapy and other courses were highlighted, including physiotherapy's preference for two placements, the 2:1 model, placement of students outside of their place of work, and the use of placements at the end of the theoretical course components. The study has good external validity and can therefore be used as the basis for future work.
Use of simulated patients in development of physiotherapy students' interpersonal skills
Authors: Lewis Mark , Bell Jamie , Asghar Amanda
Published: May 2014

Aims

Research into the effect of using simulated patients on the self-perceived interpersonal skills of physiotherapy students is limited. This study sought to address this by investigating if such an approach is beneficial.

Methods

A cohort of 2nd year physiotherapy students (n = 35) completed a validated questionnaire that measured interpersonal (communication) skills at baseline (3 weeks before simulated patient interaction), and at follow-up (1 week following interaction). Paired t-tests were used to identify statistically significant shifts in perceived interpersonal skills.

Findings

Mean (baseline) anxiety and confidence scores were 11.9 (SD) and 13.8 (SD) respectively. Following interaction with simulated patients there was a significant improvement in mean anxiety (11) and confidence scores (15) (P<0.05).

Conclusions

Interaction with simulated patients appears to reduce student anxiety and increase confidence in communicating with patients.
A simple guide to the interpretation of clinical trial results
Authors: Morrow Brenda M
Published: May 2014

Introduction

The understanding and appropriate interpretation of results of clinical trials are fundamental to critical analysis and clinical decision-making. Reports should differentiate between statistically and clinically signifi cant results.

Content

This article will provide a guide to interpreting clinical trial results; by exploring the importance of ‘P’ values, the size and precision of a treatment effect and the incorporation of confi dence intervals into the description of the treatment effect, for both dichotomous and continuous variables.

Discussion and Conclusions

The results of clinical trials should only be used clinically after applying a combination of critical analysis, clinical acumen and common sense. The decision on whether the treatment would be clinically worthwhile must be judged according to the size of the treatment effect, the potential for harm, fi nancial cost, and the patient's likely experience of the intervention.
Qualitative research: Part one – Philosophies
Authors: Nicholls David
Published: May 2014

Background

Qualitative research has made great strides in recent years and it now makes an important contribution to our understanding of health and illness. But there are still many practitioners, academics and researchers who are totally bemused by its principles and practices.

Content

In the first of a series of three articles exploring qualitative research philosophies, methodologies and methods, I attempt to unravel some of its complexities and peculiarities, in the hope that those readers new to qualitative research will study it further and consider using it in the future. This article deals with broad questions of philosophy; most especially the fundamental difference between a quantitative and qualitative worldview.

Conclusions

This article explores the difference between a belief in a single objective reality and multiple realities, and relates these to quantitative and qualitative research methods. It also considers the role of theory, focusing on the difference between inductive and deductive reasoning. These concepts are the basis for the second article in the series on qualitative methodologies, to appear in the next issue.
Patient satisfaction with botulinum toxin therapy in adult spasticity
Authors: Sakel Mohamed , Mackenzie Robin
Published: May 2014

Aims

Health-care authorities in the UK are legally required to consult patients and public on optimizing service delivery. Yet to the authors knowledge, only one audit of patient satisfaction with botulinum toxin (BTX) treatment of spasticity have been published, and no surveys have been conducted in this area. This survey aimed to gain insights into patient perceptions of performance of one service delivering BTX therapy for patients with spasticity in one UK setting, to improve service delivery.

Methods

A questionnaire to explore patient satisfaction was developed and piloted by the authors, and sent to a convenience sample of 100 patients seen by the service.

Findings

Questionnaire findings suggest that centralized vs peripatetic services, patient and treatment team characteristics, patients expectations and the treatment setting are influential factors in patient satisfaction. The majority of patients felt that the service met their expectations. Patient dissatisfaction centred on lengthy waiting times.

Conclusions

Patient satisfaction is an essential part of the evidence base necessary to evaluate or change a clinical service. This survey revealed dissatisfaction with waiting times for BTX therapy; finding a new therapeutic role for physiotherapists as physio-injectorsrather than BTX injections being provided solely by consultantsis suggested as a potential solution to this. Advantages and disadvantages of potential implications of this are assessed. There is a need for a validated questionnaire and carefully refined multidisciplinary research to build on these service evaluation findings.
An exploration of clients' goals during inpatient and outpatient stroke rehabilitation
Authors: Gustafsson Louise , McLaughlin Kate
Published: May 2014

Aims

The purpose of this pilot study was to explore the goal setting of clients with stroke during inpatient and outpatient rehabilitation.

Methods

Sixteen participants were recruited from an inpatient (n=6) and outpatient (n=10) stroke rehabilitation programme. A semi-structured interview was conducted to determine participant's goals for rehabilitation and the goals of therapy sessions. Responses were coded according to the International Classification of Functioning, Disability and Health and thematic analysis undertaken to further summarize the responses.

Findings

Thematic analysis identified a difference in the types of goals identified by the two participant groups. Goals for the inpatient group were focused on activities and participation (n=18, 78%), whereas a more even distribution between activities and participation (n=23, 56%) or body functions and structures (n=18, 44%) was observed with the outpatient group. When asked to identify the perceived goals of therapy session, participants from both groups stated goals primarily related to body functions and structures (74–86%).

Conclusions

This study has highlighted an apparent shift in clients' goals during the inpatient and outpatient phases of stroke rehabilitation. In addition, a clear discrepancy between the clients' goals and their perceived goals of therapy sessions during both phases of rehabilitation was evident. These findings suggest a need for an improved process of collaborative goal setting during stroke rehabilitation.
Using qualitative observational methods in rehabilitation research: Part two
Authors: Clarke David J
Published: May 2014

Background

Qualitative observational methods are an effective means of detailing social processes and phenomena that constitute the day-to-day reality of practice in rehabilitation units. Of vital importance in this approach is the need to record and analyse fieldnotes in sufficient detail, to ensure the researchers' explanations of particular processes or events are an accurate and credible representation of those phenomena.

Content

In this second article, the process of participant observation is discussed, and the approaches to recording fieldnotes and working with qualitative observational data are described with illustrative examples. These examples also serve to highlight three principles that researchers should pay attention to when developing fieldnote records.

Conclusions

Participant observation allows the researcher to gain access to and develop understanding of what the social and occupational world feels and looks like to those who work in rehabilitation. For observational data to be comprehensive and address the research questions posed, the context and organization of social settings as well as phenomena of particular interest should be captured as fully as possible. A considered and rigorous approach to recording and analysing fieldnotes will ensure this is achieved.
An analysis of the East Kent Outcome System for use in intermediate care
Authors: Murphy Annette , Logan Philippa
Published: May 2014

Aims

Intermediate care is a multiprofessional rehabilitation service aimed at helping people to remain in their own homes and to avoid hospital admission. Historically, however, each profession of the rehabilitation team has set their own goals with the client. This study aimed to identify and test the feasibility of using a goal attainment outcome measure that the whole intermediate care team could adopt; if successful, this would enable combined goals and thus a more efficient service.

Methods

A literature review was carried out to identify a suitable and appropriate goal attainment outcome measure. The East Kent Outcome System (EKOS) was chosen and adopted by four intermediate care teams in Nottingham City Primary Care Trust, UK. An audit of EKOS record forms was then conducted in 2008, which looked at EKOS goal summary records completed by all members of the multidisciplinary team.

Findings

EKOS goal summary records were completed for 334 service users who were receiving rehabilitation either at home or in a residential care setting over this 1-year period. The total number of goals set for this population was 1061, with an average of three goals per service user. Of these goals, 79% were fully achieved and 13% were not achieved. Of the goals not achieved, the most common reason was that people's health had deteriorated.

Conclusions

The EKOS can be used with success by intermediate care services to quantify the goal setting process and provide a consistent, systematic method of writing and recording goals.
Is circuit class physiotherapy possible during inpatient spinal cord injury rehabilitation? A feasibility trial
Authors: Lynch Elizabeth A , Watson Sarah C
Published: May 2014

Elizabeth A Lynch, Sarah C Watson

Aims: This article describes a feasibility study to determine whether circuit classes could be successfully provided to patients with recently acquired spinal cord injury (SCI) undergoing inpatient rehabilitation.

Methods: Eleven patients with SCI participated in a physiotherapy circuit class run in addition to regular inpatient rehabilitation, over a two month period. All patients chose to attend the circuit classes for the duration of their availability. On completion of the trial, a purpose-designed questionnaire was administered to investigate patient satisfaction. Feedback was also collected from staff regarding their experience of the circuit class.

Findings: No adverse events occurred during any circuit classes. Patients reported high levels of satisfaction with the class, reporting that classes were challenging, motivating, confidence building and a source of peer-support. Staff reported that circuit classes helped build clinical skills and confidence, and allowed the provision of effective therapy to SCI patients. All patients and staff recommended that circuit classes continue.

Conclusions: This small feasibility study demonstrated that it is both possible and desirable to implement circuit class physiotherapy to a cohort of people with recently acquired SCI undergoing inpatient rehabilitation.
Psychoneuroimmunology of infection: implications for occupational therapy
Authors: Mailoo Venthan J , Chow Gary , Wilkins Amy J , Kennish Sophie
Published: May 2014

Background: Psychoneuroimmunology is the study of the interactive relationships between the mind and immune system. This article looks at psychological factors influencing infection susceptibility. A thorough review of the research evidence on this topic is beyond the scope of this article. Recent infection-specific psychoneuroimmunology literature is therefore highlighted and possible underlying mechanisms are summarized.

Content: Current evidence shows that susceptibility to infections and allergies can be increased by chronic stress through suppression of the T-helper 1 immune response in favour of a T-helper 2 immune response.

Conclusions: Holistic interventions such as stress management, lifestyle changes, and career management could be considered to reduce susceptibility to infection. Further research however is required in this area to contribute to an evidence base underpinning psychosocial interventions for preventative health care.
Influences on women's completion of a cardiac rehabilitation programme
Authors: Sherwood Sarah A , Povey Rachel C
Published: May 2014

Aims:

This article describes a study investigating patient and programme factors influencing women's completion of a cardiac rehabilitation (CR) programme.

Methods:

A qualitative cross-sectional design was adopted. Semi-structured interviews were conducted with five women who had completed and five women who did not complete the CR programme. An interpretative phenomenological analysis was conducted on the reviews; both individually and within the two groups (‘completers’ and ‘non-completers’). This entire process was also undertaken by a second researcher, and led to the emergence of a list of both individual themes and master themes for each group.

Findings:

Positive influences on completion included a correct medical understanding, successful behavioural changes in terms of lifestyle control, approach-focused coping, addressing support needs and positive recognition for the role of CR. Negative influences on completion included incorrect medical understanding, limited lifestyle changes, emotion focused coping, high degree of concern on the impact of significant others and lack of perceived consistent value of CR.

Conclusions:

In order to improve completion rates for CR programmes among women with heart disease, it is important to clarify their initial medical understanding and beliefs, and to continually reassess their perceptions during programme delivery. Incorporating individual support, flexibility, and bespoke programmes for different age groups may enhance attendance at cardiac rehabilitation programmes.
Visual methods in practice and research: a review of empirical support
Authors: Pain Helen
Published: May 2014

Aims:

Many therapists and health researchers use visual objects or activities in the course of their work, but may make assumptions regarding the perception and understanding of them. The purpose of this article is to examine some of the assumptions made in the literature when visual methods are used, and to draw together evidence that supports or challenges their use.

Methods:

The literature was searched across a number of academic disciplines, and 285 papers and books were reviewed for empirical support of visual methods, including the development of perceptual skills and how images are understood. These were compiled into a narrative summary.

Findings:

Empirical and theoretical support was found for the development of perception and conceptual understanding of visual images. Many authors have reported fruitful use of visual and verbal communication together. Use of visual methods when verbal communication is impaired or absent, and whether they facilitate the expression of emotion, are discussed.

Conclusions:

Using visual methods, whether in interventions or research, require an informed choice of medium, method and interpretation, but also offer a sound basis for enriched understanding when applied in a sensitive and reflective manner.
Neuropsychological sequelae in motor neurone disease: outcomes of a peer support programme
Authors: Ng Louisa , Talman Paul , Khan Fary
Published: May 2014

Aims: Motor neurone disease (MND) is an incurable, progressive and fatal neurodegenerative disease. The focus of management is on achieving the best quality of life for patients and their families. Peer support has been proposed as an effective means of coping with a stressful life experience although data on efficacy are mixed.

Methods: The first (preliminary) study on the effectiveness of six-week face-to-face peer support program (n = 7) in MND was studied through a pre-post design.

Findings: Results showed that despite high participant satisfaction and a trend towards reduced psychological distress (depression, anxiety and stress) six-weeks post programme, psychological distress had worsened again at 12 months, while quality of life, coping strategies and caregiver burden remained unchanged.

Conclusions: Although participant numbers were too small to be conclusive, it is suggested that group face-to-face peer support is a feasible form of support in MND and should be considered even in patients who are severely disabled and/or have severe verbal communication (dysarthria).
Supporting practice-based learning with video-mediated technologies: an overview
Authors: Taylor Teri , Nichol David
Published: May 2014

Aims: The primary aim of this article is to present a an overview of the use of technologies and in particular, video-mediated technologies, in the one-to-one support of students.

Contents: Historically, limited research into the use of video communications to support practice-placed learning, highlighted a number of difficulties but suggested the potential for more widespread use in the future. However, despite dramatic improvements in hardware, software and infrastructure, video-mediated communications remain limited in their practice-based application. This article explores in brief, the historical issues associated with the technology and potential reasons for a lack of more comprehensive use in current education. Raising questions relating to consumer demands, the article explores how the development of infrastructure has failed to keep pace with technologies, thus, potentially contributing to a slower uptake within education than envisaged a decade ago.

Conclusions: With reference to new, emerging technologies and the development of national and global infrastructures, suggestions are made as to how future, health-related higher education may alter from traditional models of learning.
Handwriting in healthy adults aged 20-24 years: informing handwriting rehabilitation
Authors: Gozzard Megan , McCluskey Annie , Lannin Natasha , Drempt Nadege van
Published: May 2014

Aims: To describe the handwriting of healthy young adults by exploring the types of handwriting activities performed and characteristics of handwriting such as speed, style, and legibility. Findings will help to inform the practice of rehabilitation therapists who assess and treat adults with impaired handwriting.

Methods: Descriptive cross-sectional study. Sixteen healthy Australian adults aged 20-24 years were recruited using quota sampling methods. Both observational and survey methods were used. Participants used a digital pen and kept a log of handwriting occasions over three consecutive days.

Findings: The mean age of participants was 21.6 years (SD=1.3). Participants wrote on few occasions each day (mean=2.4, SD=1.9), with a large variation in the number of words written per day (median=52.8, IQR=129.5). Notes, messages, and lists were most commonly written. Most occasions (78%) involved self-generated text. Many participants (31% when self-generating text) wrote at least a few illegible words, but the overall meaning of text could be understood.

Conclusions: The quantity of text written per occasion/per day by these young adults was small, but similar to that collected from older adults in an earlier study. Findings may help rehabilitation therapists to determine when handwriting is ‘impaired’, and whether their assessments are relevant for today's young adults.
Rehabilitation for Patients After Stroke in a Tertiary Hospital: is it early and Intensive Enough?
Authors: Mohd Nordin Nor Azlin , Aziz Noor Azah , Alkaff Sharifa Ezat , Sulong Saperi , Aljunid Syed
Published: May 2014

Background: This study aimed to evaluate the provision of rehabilitation to and the functional recovery of stroke survivors receiving acute care in a tertiary hospital.

Methods: Analyses of medical records of stroke patients who were admitted to a main teaching hospital between the years 2006-2009. Variables studied were the demographics, clinical profiles, rehabilitation profiles and the patients' functional recovery at discharge, as measured on a modified Rankin Scale (mRS).

Findings: Records of 557 patients; mean age 64 years, 53.7% females were analysed. Mean length of stay was 6.8 days SD=5.8 during which, 62.7% received daily rehabilitation. Mean time from stroke diagnosis to rehabilitation was 3.0 days SD=2.0; 51.0% of cases were seen after 48 hours of hospital admission. Rehabilitation was provided mainly by physiotherapy services to 71.6%, 64.7% and 52.5% of severe, moderate and mild cases, respectively. Mean mRS was 3.5, SD=0.9 and 53.0% had not regained any level of walking ability prior to discharge. Age and severity level significantly predicted mRS at discharge (F6,536=12.26, P<0.001).

Conclusions: Provision of rehabilitation to acute stroke survivors in a tertiary hospital was sub-optimal. Establishment of dedicated stroke rehabilitation services is recommended to enable better functional gain in post-stroke survivors.