bluuebunny/crossref_metadata_2025 huggingface dataset:
Spanish nurses’ preparedness to care for hospitalised terminally ill patients and their daily approach to caring
Authors: Arantzamendi Maria , Addington-Hall Julia , Saracibar Maribel , Richardson Alison
Published: May 2014

Objective: To describe Spanish nurses’ preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. Methods: An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives. Stage 2 was a regional survey (65% response rate) concerned with hospital nurses’ opinions of caring for terminally ill patients and their perceived competence. Results The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided with an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. Conclusion: There is a need for an integrative approach in Spain that combines an educational programme with a supportive environment, focusing on developing nurses’ competence to deliver emotional care and deal with their own feelings. Promoting a supportive environment might enable nurses to change their behaviour when caring for terminally ill patients and deal with patients’ emotional as well as physical needs.
‘I don't want to talk about it.’ Raising public awareness of end-of-life care planning in your locality
Authors: Hickey Deb , Quinn Sharon
Published: May 2014

The UK Department of Health's (2008) End of Life Care Strategy highlighted the need for greater public awareness around planning and the choices available as people approach the end of their life. Despite efforts to ‘normalise’ death and dying and recognise that they are an inevitable part of life, a taboo persists and open communication about these issues is often limited or restricted to periods of crisis. Translating national policy into meaningful local dialogue requires creative interventions that are adaptable to each community. This article explores these key themes and reports on the responses of the first 304 people to complete an end-of-life survey as part of local engagement with the general public in South West Essex regarding issues around death and dying.
Development of an end-of-life care pathway for patients with advanced heart failure in a community setting
Authors: Smith David
Published: May 2014

Chronic heart failure affects around 750 000 people per year in the UK. Despite the development of evidence-based treatments the 1-year survival rate is poorer than for many common cancers. Quality of life is poor, with breathlessness, peripheral oedema and fatigue being common symptoms. Through clinical audit a community heart failure nurse identified that the palliative care needs of patients with advanced heart failure were not being adequately addressed in his locality. A more cohesive way of managing these patients was required. Joint working between heart failure and palliative care clinicians as well as the development of an advanced heart failure shared care pathway and supporting tools resulted in patients with heart failure having improved access to palliative care, more of these patients dying in their preferred place of care, and the provision of a holistic heart failure service spanning referral to end of life. The impact of chronic heart failure on both individual patients and the NHS is considerable. With interdisciplinary and interorganisational collaboration, a new approach to managing patients with heart failure has been developed that has resulted in improved patient care.
Palliative and end-of-life care for patients with idiopathic pulmonary fibrosis: challenges and dilemmas
Authors: Lewis Debbie , Scullion Jane
Published: May 2014

Idiopathic pulmonary fibrosis (IPF) is a progressive, life-threatening interstitial lung disease of unknown aetiology and with limited proven treatment options. As it is predominately a disease of older age, a growing elderly population will increase its incidence. IPF has a poor prognosis, with a median survival of 3–5 years after diagnosis and a 5-year survival rate of 10–15%. Patients may suffer gradual decline but acute and unpredictable episodes of respiratory failure may result in death. Further research is needed to ascertain the worth of potential prognostic indicators such as age, respiratory hospitalisations, percentage of predicted forced vital capacity (FVC), and 24-week change in FVC. Integration of palliative care principles into IPF treatment is essential, including advance care planning, relief of physical and psychological burden, and patient and carer education. It is unknown whether pulmonary rehabilitation is of benefit but it may improve fatigue and functional capacity.
The search for a higher power among terminally ill people with no previous religion or belief
Authors: Collin Margery
Published: May 2014

In a palliative care setting, there is evidence from the practice of spiritual care delivery to suggest that some terminally ill patients may seek, with varying degrees of openness and articulation, to connect with a higher power, or God, despite having expressed no previous interest in religion or belief. Developing a better understanding of the thoughts and feelings of such patients requires insight into the initial triggers of their search. In this small qualitative study involving six patients, fear, hope, and a natural connection are posited as possible prompts. The results highlight the complexity of ambivalent feelings toward a transcendent being that can be the focus of anger and blame while simultaneously offering a source of comfort and hope for an afterlife. Moreover, the study revealed something of the extent to which health professionals may feel limited in facilitating necessary discussion by a need to protect patients and themselves from entering an unfamiliar and complex area.
Experiences implementing a 6-month pilot of a 7-day community CNS service in an urban hospice in Scotland
Authors: Milton Libby , Grady Anna , Cook Audra
Published: May 2014

Background: Patients and carers may face challenges in the out-of-hours period, with inadequate support and variations in service provision, including access to specialist palliative care. A pilot was undertaken to extend availability of the community clinical nurse specialist (CNS) team to include weekends and public holidays. Aim: To examine the need for a 7-day community CNS service. Method: Activity data was collected for 6 months and feedback was sought from service users and the CNS team. Results: There were 132 out-of-hours telephone contacts in the 6-month period, generating 35 home visits. Almost two thirds of these calls were proactive, ‘planned’ contacts. Most unplanned calls (68%) were from a carer for advice about symptom management and support as the patient's condition changed. Conclusion: The pilot demonstrated the need for a CNS service 7 days a week, and the service is now embedded in practice. Seven-day working benefits patients and families while being valued by the professional team.
Use of electronic data collection to assess pain in thalassaemia: a feasibility study
Authors: Trachtenberg Felicia L , Martin Marie , Green Sage , Oliveros Olivia , Carson Susan , Gerstenberger Eric , Allen Racquel , Eile Jennifer , Haines Dru
Published: May 2014

Aim

To assess the feasibility of collecting electronic pain data from thalassaemia patients, based on its acceptability and convenience to the participants and study team.

Methods

Participants in the Thalassemia Clinical Research Network Assessment of Pain Survey Study completed the Brief Pain Inventory (BPI) quarterly by paper or phone interview. Participants in a substudy completed the BPI Short Form daily over three non-consecutive transfusion cycles through an automated telephone system.

Results

The consent rate for the main study was 93%, with 93% retention. The substudy had 75% retention, with more than 75% of scheduled calls completed. Regular monitoring of enrolment, missed calls, data quality, and the performance of the subcontractor for the automated system was crucial to fulfillment of the study goals.

Conclusions

Use of electronic data collection for patient-reported outcomes was convenient for both patients and study personnel but required human interactions beyond the automated system to maximise data quantity and quality.
Nurses’ perceptions of caring for dying patients in an open critical care unit: a descriptive exploratory study
Authors: McCallum Amanda , McConigley Ruth
Published: May 2014

Background: Nurses in critical care areas play a vital part in providing end-of-life care and recognise that an ideal death should be peaceful, dignified, and comfortable. However, environmental restrictions in critical care units can make a peaceful death unachievable and can have a profoundly negative impact on end-of-life care. Purpose: To describe the provision of end-of-life care in an open high-dependency unit. Method: A descriptive exploratory approach was used involving semi-structured interviews with a purposive sample of five registered nurses working in the high-dependency area at a major teaching hospital. The interviews were audiotaped and transcribed. Thematic analysis was used to code the data and identify themes. Results: Three themes emerged from the data. The core theme was ‘the nurse as protector’. The two other themes were ‘conflict of care’ and ‘peace and quiet’. Within these themes, characteristics of an ideal death were identified and barriers to providing an ideal death were acknowledged. Conclusion: This study illustrates nurses’ perceptions of caring for dying patients in an open critical care unit. This environment influences the development of the nursing role as protector and presents barriers to achieving an ideal death.
Oral health perceptions of paediatric palliative care nursing staff
Authors: Couch Elizabeth , Mead Jean Marie , Walsh Margaret M
Published: May 2014

Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff’s perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.
Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis
Authors: D’Angelo Daniela , Vellone Ercole , Alvaro Rosaria , Chiara Mastroianni , Casale Giuseppe , Stefania Lucatelli , Latina Roberto , Matarese Maria , De Marinis Maria Grazia
Published: May 2014

This study was a retrospective analysis of prospectively collected data that aimed to map patients’ care transitions following admission to a specialist palliative care service in Italy called Antea Centre. Patients’ data was extracted from the Antea local database from 2007 to 2011. External transitions were defined as a change in the setting of care, with the patient no longer being cared for by Antea staff. Internal transitions were defined as a change in the setting of care, with the care still being provided by Antea staff. A total of 1123 patients out of 5313 admitted to the palliative service (21%) experienced transitions. Patients who experienced no transitions after their admission to the palliative care service were more likely to have a Karnofsky Performance Scale Index/30, to have been referred by a hospital physician, to have a shorter survival time, and to have home as their place of death (P<0.001). Although the patients with no transitions had worse clinical conditions, organisations should pay attention to reducing the possible negative effects of transitions, such as discontinuity of care and poor coordination.
Euthanasia: the perceptions of nurses in India
Authors: Poreddi Vijayalakshmi , Nagarajaiah  , Konduru Reddemma , Math Suresh Bada
Published: May 2014

Euthanasia provokes controversies in various domains, such as the moral, ethical, legal, religious, scientific, and economic. India legalised passive euthanasia (withdrawal of life support) for patients with brain death or who are in a permanent vegetative state in 2011, but research on perceptions of euthanasia among people in India is limited. This study aimed to examine Nurses' perceptions of the practice of euthanasia as well as factors influencing those perceptions. A non-probability quantitative, cross-sectional design was adopted for a sample of 214 nurses working at a tertiary care centre. Data was collected through self-reported questionnaires at the Nurses' workplace. The findings revealed mixed opinions on euthanasia among the nurses. However, the majority of the participants did not agree with the practice of euthanasia. Nonetheless, further research is needed on this issue across the country among various health professionals in the context of current legislation.
Advance care planning for people with dementia: benefits and challenges
Authors: Dempsey Debbie
Published: May 2014

Advance care planning (ACP) is a process being championed within health and social care, particularly since the publication of the UK Department of Health's 2008 End of Life Care Strategy. However, its implementation in dementia care is yet to be fully realised and can pose significant ethical and legal dilemmas for the generic and specialist workforce, the patient themselves, and their family or loved ones. Challenges may be attributable to inadequate communication, capacity issues, missed opportunities, and the perception that dementia is not a life-limiting illness. The aim of this paper is to highlight the benefits of ACP for individuals with dementia while appraising the recognised barriers to assist in developing some realistic recommendations for future practice.
Death in nursing homes: a Danish qualitative study
Authors: Gorlén Tanja Fromberg , Gorlén Thomas , Neergaard Mette Asbjoern
Published: May 2014

Little is known about the quality of end-of-life care in Danish nursing homes (NHs). This qualitative descriptive study based on semi-structured group interviews with nursing staff members in three NHs in Copenhagen, Denmark, aimed to describe the participants' perceptions of end-of-life care in Danish NHs, with particular focus on medication administration and collaboration with GPs. Four main categories of problematic issues emerged: medication (problems with ‘as needed’ medication and lack of knowledge of subcutaneous administration), interpersonal relations (difficulties in cooperation and communication between relatives and GPs), decision making(problems concerning termination of life-prolonging treatment and the need for early planning of end-of-life care), and professional development (documentation and education). Considerable improvements may be achieved primarily by educating and training nursing staff and GPs. More research is warranted to optimise end-of-life care in Danish NHs.
Nurses' perspectives on the discharge of cancer patients with palliative care needs from a gastroenterology ward
Authors: Aamodt Ina Marie Thon , Lie Irene , Hellesø Ragnhild
Published: May 2014

Background: People with cancer usually like to spend as much time as possible at home rather than in the hospital. Nurses have a pivotal role when patients are discharged to a unit in hospital or from hospital to the community health-care system.

Aim: To explore how frontline surgical nurses assess patients with gastrointestinal cancer receiving palliative care and the implications of their assessment and competency for the patients' discharge destinations.

Methods: A descriptive exploratory approach was used involving focus group interviews with a purposive sample of ten nurses from an inpatient gastroenterology surgical ward at a university hospital in Norway. Transcriptions of the interviews were analysed using Kvale and Brinkman's thematic approach.

Results: Two overall themes emerged that had implications for the nurses' recommendations for optimal patient follow-up care after discharge: ‘the complexity of and fluctuations in the patients' health status' and ‘considering the competency of the nurses at the discharge destinations’.

Conclusions: This study illustrates surgical nurses' perspectives on the discharge destinations of cancer patients receiving palliative care. The findings have implications for initiatives aimed at providing more home-based palliative care.
Clinical nurse specialists’ perspectives on advance care planning conversations: a qualitative study
Authors: Boot Michelle , Wilson Catherine
Published: May 2014

Objective:

The aim of the study was to identify the challenges experienced by clinical nurse specialists (CNSs) when facilitating advance care planning (ACP) conversations with terminally ill patients. This paper focuses on the factors that influence CNSs when they are deciding whether to open an ACP discussion.

Methods:

Semi-structured interviews were used to collect data from eight purposively selected palliative care CNSs working in two different community teams. The interviews were recorded, transcribed, and analysed to identify themes.

Findings:

ACP required the CNSs to ‘walk a tightrope’, balancing potential harm with purported benefit. The nurses identified that their decision to introduce an ACP discussion was influenced by three key factors: an assessment of the patient's readiness to discuss the topic, their physical condition, and the nurse's relationship with the patient and family.

Conclusion:

ACP involves risk-taking on the part of those initiating it, owing to the potential for unforeseen or negative consequences. Further research is required to identify the factors that facilitate nurses involving patients in ACP.
Improving dementia care in nursing homes: experiences with a palliative care symptom-assessment tool (MIDOS)
Authors: Krumm Norbert , Larkin Philip , Connolly Michael , Rode Peter , Elsner Frank
Published: May 2014

Background

In the past decade, the palliative care approach has been used in the care of frail older people living with debilitating chronic conditions, including dementia.

Aim

To describe health professionals' experiences of assessing the symptoms of people with dementia using a cancer-patient-oriented symptom-assessment tool from a palliative care context.

Method

This was a qualitative study that used semi-structured interviews (n=13) with clinical staff in three nursing homes prior to and following the implementation of the Minimal Documentation system for Palliative care (MIDOS) tool for assessing symptoms over a period of 6 weeks.

Results

Baseline interviews showed specific concerns about symptom assessment, such as uncertainty about underlying symptoms in residents who appeared to be in distress. After the implementation of the MIDOS tool, participants reported that daily use of the tool was perceived as helpful in evaluating symptoms other than pain and improved internal communication between staff regarding clinical decision making.

Conclusion

The MIDOS tool was perceived as a helpful and valuable complement to existing tools. Participants expressed some concerns regarding the subjective nature of perceiving symptoms and clinical decision making. The use of tools such as the MIDOS tool has the potential to enhance the quality of palliative care in dementia care.
Impact of a legislative framework on quality of end-of-life care and dying in an acute hospital in Spain
Authors: Sánchez Juana María Sepúlveda , Sánchez José Carlos Canca , Trueba Enrique Pérez , Dominguez Antonio Rueda , Asencio José Miguel Morales , Gil Isabel María Morales
Published: May 2014

Background

In Andalusia, Spain, a legislative framework was put in place in 2010 to guarantee dignity in dying and quality of care in the last phase of life.

Aim

The aim of this study was to determine whether health professionals have incorporated the requirements of this legislation into their clinical practice and whether there have been improvements in decision-making procedures affecting the quality of dying in hospitals.

Methods

A cross-sectional analysis was carried out in an acute hospital in Andalusia, Spain. Clinical records of patients who died in the Costa del Sol Hospital were evaluated before and after the new legislative framework was introduced. Participants were all the patients aged over 18 years (n=398) who died in 2009 (n=216) or 2011 (n=182) of oncological disease or non-oncological chronic disease. Bivariate analyses evaluated differences between the two periods and associations among the patients’ characteristics and the context of care.

Results

Provision of information on measures to facilitate comfort and the relief of physical suffering increased from 15.7% to 22.0%, although this was not significant. There was a significant increase in the number of patients who received joint counselling in this regard from doctors and nurses, from 0% in 2009 to 7.1% in 2011.

Conclusions

The minimal changes found 1 year after the implementation of the framework confirm that culture change is a lengthy, difficult task that cannot be achieved through laws alone.
Psychoneuroimmunology: a theoretical basis for occupational therapy in oncology?
Authors: Mailoo Venthan J , Williams Catherine J
Published: May 2014

Psychoneuroimmunology is the scientific study of the physiological two-way link between the mind and the immune system. It is difficult to find published results of clinical controlled trials of the therapeutic effects of occupational therapy modalities in cancer care. The roots of occupational therapy have been neglected and perhaps forgotten in England's NHS, resulting in the loss of professional identity. The original occupational therapy ethos is, however, supported by psychoneuroimmunology research findings.

This article looks at the oncology-specific psychoneuroimmunology literature and its implications for cancer treatment. It highlights the point that further research based on psychoneuroimmunology could contribute to an evidence base for occupational therapy in oncology.
Predicting outcome for older people in a hospital setting: which scales are appropriate?
Authors: Slade Anita , Fear Jon , Tennant Alan
Published: May 2014

Discharge from hospital to a nursing home represents a major event in the life of an older person and should follow the most comprehensive functional and medical assessment. This article aimed to identify factors that influence placement and specifically test which widely used standardized instruments of health status may be useful in an assessment. A cohort study was undertaken of 549 patients admitted to three acute ‘medicine for the elderly’ wards in an NHS Trust in Northern England. Outcome measures were a variety of health status measures in current use.

Results showed that baseline assessment using generic self-completed measures of health status failed to predict future placement. However, four measures used routinely within a clinical setting – the Northwick Park Dependency Scale, the Abbreviated Mental Test Score, the Modified Barthel Index and the Caregiver Strain Index – did discriminate across outcomes.
Evidence-based community rehabilitation: Is it possible?
Authors: Enderby PM
Published: May 2014

All health professionals would probably agree that where there is evidence of benefit of an intervention, we should use it if resources allow, and where there is evidence that something is ineffective, weshould not do it. However, having neither positive nor negative evidence arouses different responses by different individuals. Some will do nothing, others will do what they think is best, others will conform to the routine practice by peers and a few will try and investigate the situation to gain some evidence to inform their practice.
Mental health recovery and occupational therapy in Australia and New Zealand
Authors: Lloyd Chris , Tse Samson , Bassett Hazel
Published: May 2014

Every individual with mental illness has the right to be safe and cared for. Most people will receive the love and care from their families and friends, but they will also expect mental-health professionals, occupational therapists and the community to work together to provide the necessary services to support their recovery from mental illness.

This article highlights the development of the recovery approach for people with mental illness in Australia and New Zealand. The implications of recovery concepts for occupational therapy, in the areas of individualized approach, participation of service users and carers, person-centred assessment and intervention, intersectoral links and mental-health promotion, are discussed. There are a number of key areas requiring further research and debate, notably the most effective means of implementing and evaluating recovery-focused interventions.
A review of the use of Lycra pressure orthoses for children with cerebral palsy
Authors: Attard Jes , Rithalia Shyam
Published: May 2014

Dynamic Lycra pressure orthoses (or garments) have been used in recent years as a treatment modality for children with motor impairment, namely cerebral palsy. Improving function is the ultimate goal of prescribing such garments, but there are other important beneficial effects, such as improving proximal stability to help posture and function.

This article attempts to explain, in view of current knowledge, how and why dynamic Lycra pressure garments are used and their benefits to children who wear them, providing an outline of current theories behind their function. Two case reports are detailed and some areas for further research are identified.
An extended role for support workers: the views of occupational therapists
Authors: Mackey Hazel
Published: May 2014

The health and social care environment in Britain is undergoing rapid change and reorganization, which requires occupational therapy practitioners to consider the service they provide, the skill mix needed to support service provision and the boundaries, roles and relationships between professionally qualified staff and support workers. A study, using a qualitative design, was conducted to discover what occupational therapy practitioners perceive to be the major factors that need to be addressed before an extended role for support workers can be implemented. Five focus group interviews were conducted with occupational therapy practitioners, both qualified and unqualified, from a large NHS community trust in the West Midlands.

Five key factors emerged: the need to increase role clarity; to lessen role threat; to review organizational effectiveness; to ensure clear delegation; and to design and implement responsive training programmes.
Purchasing electric profiling beds: Benefits and challenges
Authors: Rush Anita
Published: May 2014

Pressure ulcer prevention and treatment has relied on the provision of special beds and mattresses in the past. When patients spend most of their time in bed, it is essential to ensure that they are as comfortable as possible, can change position, are at a reduced risk of sustaining pressure damage and ultimately, are able to get in and out of bed with ease. The correct choice of bed is paramount as it will provide a safe working environment for carers and a better quality of care for the patient.

The aim of this article is to raise the awareness of organizations to the benefits of electric profiling beds and highlight the pitfalls of implementing a electric profiling bed replacement programme. The article concludes that purchasing an electric profiling bed is not as straightforward as it may appear: for organizations implementing a bed replacement programme, it requires systems in place that enable best value for money, are cost-effective and have cost improvements.
Perceptions of interprofessional roles within the spinal cord injury rehabilitation team
Authors: Pellatt Glynis Collis
Published: May 2014

A spinal cord injury requires input from a range of health-care professionals. Interprofessional teamwork has been seen as the cornerstone of rehabilitation. However, teamwork may be affected by misperceptions of role and function between professional groups.

This article presents some findings from a larger ethnographic research study. Its aim is to identify the perceptions of professionals of the roles and relationships within the rehabilitation team. Semistructured interviews were carried out with 27 health-care professionals in a spinal cord injuries unit.

The findings suggest a ‘knowing paradox’ in that nurses, occupational therapists and doctors felt that their colleagues misunderstood their role, yet all the professionals felt that they understood their colleagues’ contribution to rehabilitation. Misunderstandings may cause conflict that could impact on the patient's rehabilitation experience. Therefore, professionals need to develop supportive structures that enable greater communication and understanding of each other's roles and competencies.
Recently qualified physiotherapists' perceptions of work-related musculoskeletal disorders
Authors: Graham Lynsey , Gray Heather
Published: May 2014

The prevalence of work-related musculoskeletal disorders (WRMSDs) among physiotherapists may be as high as 91%, with recently qualified clinicians at greatest risk. Therefore, using a focus group design, this study explored how physiotherapists, within their first 5 years of practice, perceive WRMSDs.

Participants perceived physiotherapy as a high-risk profession; however, they felt that their training would prevent them developing ‘serious’ injuries. Injury preventative strategies were often neglected owing to high caseloads, time constraints, a desire to appear able to cope and moral obligations towards patients. The physiotherapists tended to respond to WRMSDs by self-treating, becoming more aware of their personal risk and taking future precautions as a result.

This study highlights that there is a significant need to increase physiotherapists' awareness of their risk of WRMSDs, as well as shifting the culture within the health services to one that facilitates the use of preventative strategies.
Reliability of the Australian Therapy Outcome Measures for quantifying disability and health
Authors: Morris M , Taylor N , Dodd K , Perry A , Skeat J , Unsworth C , Duncombe D , Duckett S
Published: May 2014

The Australian Therapy Outcome Measures (AusTOMs) quantify client outcomes for physiotherapy, speech pathology and occupational therapy across four domains: impairment (of body structure and function); limitation in functional activity; restriction of participation in societal roles; and distress/wellbeing (level of concern). Data reporting the preliminary reliability of the AusTOMs tools are presented. Participants were 150 clinicians from hospital and rehabilitation centres in Melbourne, Australia. Written case vignettes were used to obtain percentage agreement scores between raters for each of the four domains of the AusTOMs. Test–retest reliability was also determined.

Satisfactory preliminary inter-rater scores were obtained, with most scales in each profession showing high levels of agreement, although some scales had at least one domain with less than 80% agreement. Across all three professions, test–retest reliability was satisfactory. Overall, specific domains showed less agreement than others, and the implications of these findings and indications for further research are discussed.
Use of video self-modelling and implementation intentions following facial nerve paralysis
Authors: Coulson Susan E , Adams Roger D , O'Dwyer Nichols J , Croxson Glen R
Published: May 2014

This research aimed to address smile deficits after long-term facial nerve paralysis (FNP) by implementing two treatments not previously used for FNP: video self-modelling and implementation intentions. Two FNP subjects were studied, who were both experiencing difficulty producing symmetrical smiles, particularly in social situations. Smile types measured were a symmetrical (adapted) smile and an asymmetric (everyday) smile. Treatment involved each subject observing only his or her best adapted smiles on videotape, three times a day for 2 weeks. Time from onset to smile completion was recorded and to assess quality, 20 observers rated randomly ordered smiles.

For adapted smiles, there was both a significant post-treatment decrease in time from initiation to completion and a rated improvement on the dimensions of overall smile quality, movement control and symmetry. Therefore, with increased speed, the more symmetrical adapted smile could be used spontaneously during designated social interactions. These case studies suggest that smile symmetry and control can still be improved some years after FNP, and that video self-modelling and implementation intentions warrant further research.
Influences on long-term exercise adherence in older patients with cardiac disease
Authors: Little Anne , Lewis Kiara
Published: May 2014

Using a qualitative approach, this study explored attitudes, social support and barriers influencing long-term exercise adherence among five older patients with cardiac disease.

Results found that patients understood and valued the benefits of health-related exercise, thereby demonstrating positive exercise attitudes. Some patients, however, were unsure of the recommended guidelines for producing exercise benefits. Introducing into exercise rehabilitation programmes strategies to assess knowledge of exercise guidelines may prove useful in confirming patients' understanding of these guidelines. Future research into the effectiveness of such strategies is recommended.

Support from family, friends, and health professionals was found to be important in long-term exercise adherence. Some patients, however, were unhappy with the nature of support provided. While doctors encouraged patients to exercise, not all prescribed exercise because they knew little about the referral schemes available. This suggests the need to evaluate service provision to ensure that doctors are informed and active in prescribing exercise.

Barriers, such as poor health and lower body limitations, did not prevent exercise per se, however, they did prevent patients exercising at levels recommended to protect against disease progression.
An interprofessional role-emerging placement in HIV rehabilitation
Authors: Solomon Patricia , Jung Bonny
Published: May 2014

People with human immunodeficiency virus (HIV) are living for longer with a variety of impairments and disabilities that are amenable to rehabilitation interventions. This article presents an interprofessional model of clinical education in which an occupational therapy student and a physiotherapy student worked together to develop an emerging role for their professions in the management of HIV in a community health centre.

Students developed a consultation model that focused on self-management of HIV-related disability. Students were able to provide mutual support to each other as they designed a joint assessment process and educational materials for people living with HIV. This model of clinical education successfully integrated three innovative educational elements: a role-emerging placement, interprofessional education and HIV care. Careful planning and selection of students for this type of placement is essential for its success.
A review of paediatric occupational therapy university curricula in South Africa: Part one
Authors: Brown G Ted , Brown Anita , Roever Carsten
Published: May 2014

The paediatric content of the eight undergraduate and entry-level postgraduate occupational therapy programmes in South Africa was examined through a survey of the faculties. In the first of a two-part article documenting the study, current best practices in paediatric occupational therapy are reviewed by means of a literature review. Part two will identify and discuss the current status of the paediatric content of occupational therapy education programmes in South Africa, including theoretical frameworks, assessments and intervention strategies.

The literature suggests that there is a degree of commonality in paediatric occupational therapy practice between Canada, the US, the UK and Australia in terms of theoretical frameworks, assessment tools and intervention strategies used. Teaching staff must not only include current best practices based on sound research evidence in paediatrics in curricula, but teach in the context of the diverse client diagnostic groups that students will encounter upon graduation.
Sources of stress in undergraduate podiatry students in the UK and Australia
Authors: Mandy A , Tucker B , Tinley P
Published: May 2014

High sources of stress have been reported in health-care students, including physiotherapy students. However, there are no studies investigating stress in podiatry students. This study was undertaken to examine the sources of stress in undergraduate podiatry students in universities in both the UK and Australia. The Undergraduate Sources of Stress (USOS) questionnaire, comprising 18 items in three subscales (academic demands, financial issues, personal issues), was administered to students in all years of the bachelor programmes in the UK (n=54/97, response rate=56%) and Australia (n=56/94, response rate=60%).

Academic concerns were rated highest for all students, particularly the amount to learn, time demands and intellectual demands of the course. UK levels of academic stress are greatest when students are in their first year, when academic demands are combined with clinical education placements. The university fees were significantly higher for Australian students (P=0.001). In total, 64% of podiatry students in Australia worked in paid employment while studying, compared with 41% of the UK podiatry students. Mean hours of paid employment were 5.3hours for UK students and 7.0hours for Australian students. However, there was no correlation between any of the stress subscales on number of hours worked. High levels of academic stress reported by podiatry students are consistent with other student health-care professions.
Vocational rehabilitation in the UK: Opportunities for health-care professionals
Authors: Frank Andrew O , Thurgood Judy
Published: May 2014

Many therapists have had little training in vocational rehabilitation, which is increasingly seen to be important because of demographic change and the need for people to work longer, including those with ill health or disabilities. This article reviews the interface between those with physical disabilities or chronic ill health, health professionals, employers and various government schemes in the UK. Although concentrating on physical ill health, many of the themes will also be applicable to people with mental health problems. All health professionals concerned with the care of people of working age will increasingly need to advise on the implications of ill health on employment and rehabilitation professionals will be expected to provide a lead.

This article covers definitions of vocational rehabilitation and its importance for the current delivery of health care in the context of recent government legislation. It introduces readers to schemes that support and encourage individuals back into work and their interrelationships with the benefits system. It includes innate factors that may influence return to work (job retention), or finding new employment. A further section covers the responsibility of employers to their employees, including a section on work-related ill health.
Encouraging the use of reflexivity in the writing up of qualitative research
Authors: Smith Susan
Published: May 2014

There is no set formula to guide researchers in writing up qualitative research projects. Much writing up of any research tends to eliminate the self-analysis of the researcher. This article analyses the author's position in relation to the qualitative research process.

Reflexive research is defined as a method that fully embraces and exploits the subjectivity of the researcher. Increasing reflexivity of research can increase the credibility and trustworthiness of qualitative data. In this article, examples from a qualitative study are used to illustrate how much of the reflexive self-analysis undertaken as part of the original design was lost in the study's formal scientific write-up.

The reasons why writers are reluctant to write about the ‘self’ in published journals are explored. Two different approaches to qualitative writing up are discussed: the ‘realist’ and the ‘confessional’ approaches. The confessional approaches that were lost in the design and process of this study are described, taking power relationships as a theme for the examples cited. The need for both confessional and realist tales in the writing up of qualitative research is considered in relation to participant visibility and service user empowerment.
Learning about occupation: An innovative educational method
Authors: Hunt Eithne , Ryan Susan
Published: May 2014

Participation in everyday occupations is vital for all humans and has a positive influence on health. This focus is endorsed in the World Health Organisation's International Classif ication of Functioning, Disability and Health (2001) and is enshrined in the World Federation of Occupational Therapists (WFOT) revised Definition of Occupational Therapy (2004). Enabling and enhancing participation in daily occupations is occupational therapy's unique contribution to society (Law, 2002).
Cauda equina syndrome: The development of a citywide physiotherapy pathway of care
Authors: Ferguson Fraser
Published: May 2014

Cauda Equina Syndrome (CES) is a very rare condition in patients with low back pain (LBP), however, the discovery of CES is seen as a surgical emergency. With the rapid rolling out of patient self-referral to outpatient physiotherapy, there is an increased likelihood of physiotherapists being exposed to this condition. However, the literature to date has focused on CES from a medical perspective and clear physiotherapy guidelines have not been reviewed.

To improve and standardize the citywide management of such patients a pathway of care was developed. Clinical specialist physiotherapists oversaw the development guided by orthopaedic and neurosurgery consultants. The results of a three-cycle audit suggest this evidence-based pathway of care is an effective tool in identifying patients with CES.
Interdisciplinary circuit class therapy: Increasing therapy time on an acute stroke unit
Authors: Zanker Kate , English Coralie , Prideaux Nicole , Luker Julie
Published: May 2014

The purpose of this study was to evaluate whether the implementation of interdisciplinary circuit class therapy is a feasible and sustainable means of increasing activity-based therapy time for patients in an acute stroke unit.

Thirty participants (15 with stroke as a primary diagnosis) participated in twice weekly circuit class therapy for 3 weeks. Measures included therapy time, attendance rate and patient levels.

Circuit class therapy signifi cantly increased the time spent engaged in activity-based therapy (circuit class therapy days: 86 ± 28; non-circuit class therapy days: 32 ± 26, P < 0.001). Circuit class therapy was feasible; operating within existing staffi ng levels with an attendance rate of 78%. It was sustainable over a 12-month period and it was also associated with high patient satisfaction.

Circuit class therapy is a feasible and sustainable way of increasing activity-based therapy time for patients in an acute care setting. Further research should examine the impact of circuit class therapy provided in an acute care setting on recovery of functional abilities and length of hospital stay.
Peer observation: A tool for continuing professional development
Authors: Davys Deborah , Jones Vivienne
Published: May 2014

Peer observation has been advocated as a means of monitoring and improving the quality of teaching in higher education, while peer support and review have been used to provide feedback and monitoring in the clinical context. The process of peer observation of practice in educational, managerial and clinical settings could facilitate improvements in all aspects of practice, have relevance as a tool for continuing professional development and help improve the quality of care for service users.

This article presents a background to peer observation and highlights its relevance to health-care professionals. A practical process to assist in the implementation of peer observation is outlined, with consideration to relevant contextual issues.
Supervising assistant practitioners: Evaluating a reflective diary approach
Authors: Mackey Hazel , Whitfield Louisa
Published: May 2014

This study examined the use of a reflective diary approach to the supervision of assistant practitioners, a new breed of higher level support workers who complement the work of professionally registered practitioners. A qualitative methodology was used to understand the experiences and insight of assistant practitioners and their supervising therapists. The evaluation took place in a single healthcare trust and involved focus groups with two groups of stake holders: assistant practitioners and their supervising therapists.

This study demonstrated that the reflective diary has the potential to be a valuable tool in the supervision of assistant practitioners who are attempting to learn new skills, and balance expectations and performance as they define and clarify new working practices. Findings indicate that a reflective diary approach to supervision is useful to assistant practitioners in developing clinical decision-making skills and confidence. It is also a useful tool for supervising therapists to use, explore and reflect on competence and delegation issues. However, for the reflective diary to be used effectively in supervision, a clear and explicit rationale for the purpose of the reflective diary must be given to assistant practitioners and their supervisors to increase motivation and engagement with using reflective diaries.
Getting help from each other
Authors: Akhurst Jacqui
Published: May 2014

Over the past decade, increasing numbers of journal articles have illustrated the value of working across traditional disciplinary boundaries. In this journal, it has become common for one or two articles a month to refer to work in health teams, for example, Fayed et al (2007) refer to models of collaboration and Magee and Andrews (2007) report on referrals from multidisciplinary teams. In ‘real life’ therapeutic contexts, health professionals work in multi-disciplinary teams, and the resultant combination of approaches has the potential to enhance rehabilitation processes for patients.