bluuebunny/crossref_metadata_2025 huggingface dataset:
Are your shoelaces shortening?
Authors: Nyatanga Brian
Published: May 2014

Eighteen years’ experience of palliative care work suggests that this practice provides both immense satisfaction and profound stress for health professionals as they constantly care for patients with a life-threatening illness. The satisfaction comes from helping and supporting patients to enjoy an improved quality of life despite their illness and poor prognosis.
Developing spiritual and religious care competencies in practice: pilot of a Marie Curie blended learning event
Authors: Smith Tracy , Gordon Tom
Published: May 2014

The Marie Curie Cancer Care (2003) Spiritual and Religious Care Competencies for Specialist Palliative Care provide a common language for healthcare practitioners in the nebulous area of spiritual care. The development of a pilot blended learning event, as described in this paper, sought to integrate the competencies into practice by providing opportunities both online and in the classroom to explore this aspect of holistic care in depth. In the planning stages, multiprofessional focus groups determined the level of delivery, and emerging themes shaped the content. Self-awareness and reflection were key features and part of the overall process to improve competency. The features of the virtual learning environment (VLE) used were video, facilitated asynchronous discussion and direct links to key articles and documents, while interactive classroom activities built on prior learning. Evaluation covered all aspects of the course design from participant and facilitator perspectives. Participant comments were overwhelmingly positive in relation to the content and chosen delivery methods with concerns about online learning proving unfounded.
Recognizing the importance of palliative care skills for community matrons
Authors: Bowler Mandy , Mayne Gill , Gamlin Richard
Published: May 2014

Caring for people at the end of their lives is an important role for many health and social care professionals. One of the key aspects of this role is to discuss with individuals their preferences regarding the type of care and the location of that care. These discussions need to be handled with skill and sensitivity and the outcomes of such discussions then need to be documented, reviewed and communicated to other relevant people subject to the patient’s agreement. The community matron is well placed to handle this planning. Several audits have demonstrated that end-of-life planning and palliative care are crucial aspects of the community matron’s role. Training, development and support are therefore key to ensuring effective and efficient care planning to ensure positive outcomes for patients at the end of life.
Providing comfort to patients in their palliative care trajectory: experiences of female nurses working in an acute setting
Authors: Roche-Fahy Vivian , Dowling Maura
Published: May 2014

This study aims to explore the lived experience of nurses who provide comfort to palliative care patients in an acute setting in a small urban hospital in the west of Ireland. A qualitative approach using Gadamerian hermeneutic phenomenology was chosen for the study and data were collected using open interviewing. The main findings revealed four major themes (with sub-themes) that describe the lived experience of providing comfort to palliative care patients in an acute setting: time needed to provide comfort, emotional cost to the nurse in providing comfort, a holistic approach in the provision of comfort, and the role of education and the expert team in providing comfort. The study findings will contribute to a greater understanding of the difficulties and challenges that general non-specialized nurses in the acute setting have to understand and apply the philosophy of palliative care to patients in an acute care setting. The findings should also contribute to a broader appreciation between specialized and non-specialized nurses who are responsible for the delivery of holistic, individual person-centred care to patients requiring palliative care.
Sculpting the distress: easing or exacerbating the grief experience of same-sex couples
Authors: Higgins Agnes , Glacken Michelle
Published: May 2014

The grief experience of same-sex couples is under researched when considering the large body of literature that exists on bereavement within the heterosexual community. In a previous article, the background to a study - which sought to explore the grief experience of same-sex couples within an Irish context - was presented and some of the findings relating to one of the themes (‘tacit acknowledgement’) was presented (Glacken and Higgins, 2008). This article discusses other aspects of the findings under the theme titled ‘sculpting the distress’. This theme describes a number of critical incidents that sculpted the bereaved’s distress and were perceived by the bereaved person as either being helpful in their bereavement journey or exacerbating their distress. The critical incidents related to communication issues, staff attitudes and treating the couple as a unit of care. The differing philosophies of hospital and hospice care in relation to the care of the dying were clearly evident within this theme.
Understanding advance decisions, mental capacity and proxy decision-making in medical treatment
Authors: Dimond Bridgit
Published: May 2014

Mavis, a married woman of 45 years, was diagnosed with multiple sclerosis. She had witnessed a cousin suffer from the same illness and her immediate reaction was to take an overdose in an attempt to end her life. She then decided that she would like to draw up an advance decision refusing all treatment at a later time, should she become physically incapacitated and unable to care for herself. Her husband agreed to act as a witness for her and the statement was duly drawn up, signed and witnessed.
Book Reviews
Authors: Costello John
Published: May 2014

This is a well argued and clever book which does exactly what the title infers. The first four chapters, however, add little to what is already known and are very brief on certain areas such as suffering – a key issue in relation to this debate. Chapter 5 on ethical issues will be of interest to those wishing to develop their knowledge of this important debate; however, some sections (e.g. on the slippery slope argument) use a number of examples, such as the Vietnam war, which seem inappropriate and do not further the debate about whether this is a valid argument against assisted dying.
Pre-morbid skin changes in patients with cancer: Using ‘Welam’s sign’ as a new prognostic marker?
Authors: McKeown Alistair , Davidson Jennifer , Adam James , Welsh John
Published: May 2014

Identification of the imminently dying patient can be a complex and difficult process, especially in a frail and elderly population with malignancy. The Liverpool Care Pathway utilizes a number of identification criteria for end-of-life care, but additional prognostic physical signs may be useful. This article describes specific skin changes not previously featured in the literature in four patients at end of life with malignancy, and discusses the potential use of this as a prognostic indicator.
Podcasts with a difference: online information and resources
Authors: Smyth Dion
Published: May 2014

The internet provides a wealth of online learning opportunities and resources. Using podcasts to facilitate learning is becoming an increasingly common application for many institutions and courses. This month’s Web Words examines some websites that provide a different approach or style to promoting and providing information about health matters.
Evaluating the use of the Cleo® 90 infusion set for patients on a palliative care unit
Authors: Schneider Michael , Hoffmann Martin , Lorenzl Stefan
Published: May 2014

Although the use of subcutaneous infusion is common in palliative care, problems can occur. Normally, butterfly needles are used; however, there are occasional issues with patients being able to walk around or with restless patients who suffer from delirium. In these cases, needles often dislocate; therefore, a small observational study was undertaken to evaluate the use of the Cleo® 90 infusion set. The use of this needle system has been well established in diabetic patients who require continuous subcutaneous infusion of insulin, but has never been tested in a wider range of patients with other medications. In this 6-month study, 45 patients were identified for subcutaneous infusion and a total of 112 needles were used for this study, since we initially changed each site after 2 days to control the local site for adverse reactions. We have not observed any complications with drug combinations delivered via the attached tube and the needle, and have used up to five different drugs mixed together in a single syringe. Needles could be used for a mean time of 5 ± 2 days (range 2-12 days). Local site reactions have been observed only with sodium chloride infusions, which were not delivered via a pump system. Reddening and induration of the skin occurred, but they were reversible after removing the needle. As this was a small study in only one unit, without standardization the results can only be observational. However, it has shown, for the first time, that the Cleo® 90 needle can be safe and comfortable.
Education in the spotlight
Authors: Becker Bob
Published: May 2014

News stories related to palliative care are increasingly common across the media in most Western countries, but it is rare that palliative care education is thrust into the limelight. In late May it was reported in the British media (Wilkes, 2009) that a nurse undertaking a course in palliative care was sacked from his job as a result of comments made during an experiential exercise. The course organizers deemed the comments inappropriate and told his employer who considered that he had breached the Nursing and Midwifery Council’s Code of Conduct (NMC, 2008) on grounds that have yet to be published, and terminated his employment.
Book Review
Authors: Kiyange Fatia
Published: May 2014

As its title suggests, this book is a typical guide to the language, visions and dreams of the dying. Although it is targeting nurses, the book is relevant to any palliative care practitioner, including physicians and social workers, as well as palliative care beneficiaries such as the family members of a patient receiving palliative care. In its current form, it is relevant for all levels of service delivery, from primary or basic level to specialist or tertiary level.
Living with cancer-related fatigue: developing an effective management programme
Authors: Saarik Julie , Hartley Judith
Published: May 2014

A fatigue management programme was developed for hospice day care patients. Following feedback, and using the survivorship agenda, the authors found that cancer-related fatigue was a major difficulty for many patients. Fatigue, which affects ‘normal’ functioning and quality of life, is often related to cancer treatments which continue even after the patient has completed active treatment. A palliative care occupational therapist and physiotherapist (the authors) created a 1-year charity-funded pilot project to develop, run and evaluate a programme for cancer patients at any stage of their illness. Patients were referred when fatigue was recognized by their clinical nurse specialists as still significantly affecting their lifestyle, even if other possible causative factors had been medically managed. Twenty-eight patients completed the 4-week courses and reported positive reductions in fatigue levels, and better functioning and ability to cope.
Working family carers in Portugal: between the duty and the burden of caring for old vulnerable people
Authors: Fonseca Antnió M , Gonçalves Daniela C , Pereira Sandra M
Published: May 2014

This paper intends to reflect on some of the predominant traits of caring for older vulnerable people in Portugal, where the most common care model is a mix of informal home-based provision and support from the public and private sectors. We shall address some issues concerning the risks and limits of informal caretaking of older dependent people based on a case study of a woman who has to fulfil multiple roles, pushing her to the limit of her ability to cope. Evidence indicates that solutions to the challenges of caring for an ageing population, especially those in a vulnerable condition, require a consideration of material, social, cultural, and psychological measures. On the basis of the nature of the links between these areas, the quality of the care provided and the consequences for the working family carers, we can define standards of caring solutions for older people and hence derive policies for preventive and optimized interventions. Our final aim is to emphasize the importance of palliative care settings to improve the quality of life and minimize the suffering of both older people and their carers.
Assisted dying: time to join the debate
Authors: Lee Gay
Published: May 2014

Assisted dying is a social and political issue, but it also becomes a real-life, ethical, and practical matter for me as a palliative care nurse when a patient tells me they no longer want to go on living. The fundamental dilemma facing us as both health-care professionals and UK citizens is whether UK law should be changed to allow people to decide for themselves when their lives should end, even if this would require medical assistance. Three further questions follow:
Collaborative working in end-of-life care: developing a guide for health and social care professionals
Authors: Alsop Anne
Published: May 2014

This article describes a project to develop collaborative working between palliative care nurse specialists and community matrons for patients with a non-cancer diagnosis. Pathways to clarify decision-making in end-of-life care were created as part of the project and were subsequently developed into a guide for use by health or social care professionals caring for any patient, irrespective of diagnosis. The guide is designed to facilitate best practice in end-of-life care, by identifying the key questions which need to be addressed and the appropriate responses at different stages of the patient journey. The project was supported by the Help the Hospices’ Care Beyond Cancer programme, funded by the St James’s Place Foundation. The programme is designed to identify models of effective, replicable end-of-life care provision for patients with a non-cancer diagnosis, and to widen access to specialist palliative care.
Thinking about the effects of a natural disaster on existing palliative needs
Authors: Fowler-Kerry Susan , Cunningham Colette
Published: May 2014

We would like to pose the following question to readers: have you thought about palliative care in the wake of natural disasters? This is a question not frequently asked perhaps, or even considered, but one we believe needs global attention.
An investigation into the perceived stressors for staff working in the hospice service
Authors: Hackett Addy , Palmer Stephen
Published: May 2014

This article reports on the findings of phase two of a study into stress and coaching needs in two hospices in the United Kingdom. Phase one was a cross-sectional study to assess the levels of stress and the main stressors as experienced by members of staff working within these two hospices. Phase two of the study uses qualitative methodology with the purpose of obtaining a deeper understanding of the stressors as experienced by hospice staff. Two focus groups were held, one at each hospice, and the data were analysed using grounded theory as its theoretical framework. A further aim of the current study was to identify coaching needs among this staff group in order to develop a tailor-made coaching programme for this service.
Fostering employability through lifelong learning
Authors: Smyth Dion
Published: May 2014

The past few decades have seen staggering challenges and changes to the composition and structure of our societies. Technological, scientific, and medical modernization has meant that the evolving professional development of palliative care knowledge and experience and the ability to make more informed decisions about our lives and those of our patients, has moved the focus of learning from a discrete formal classroom-based activity, to an enduring process of formal and informal personal enquiry and erudition.
Experiences of nurses practising home-based palliative care in a rural South African setting
Authors: Campbell Laura Mary
Published: May 2014

Background:

Home-based care is necessary in rural South Africa owing to the impact of the HIV/AIDS epidemic, inaccessible health-care institutions, and overcrowding in hospitals. Palliative care has been introduced as part of home-based care and there is a call for research to inform practice, training, and support of caregivers. This exploratory paper reports on four nurses’ experiences of providing home-based palliative care (HBPC) in rural KwaZulu-Natal.

Methodology:

The study employed the qualitative method of photo-elicitation, which was used as a launching point for individual one-to-one interviews with the participants.

Findings:

HBPC increases access to care and provides a means of humanizing care and supporting patients in familiar community structures. It also enables nurses to practise independently and facilitates practise of traditional customs and use of traditional medicines. Challenges include patients’ understanding of palliative care and nurses being placed at risk.

Conclusion:

The study uncovered several benefits to HBPC for patients and nurses, but also highlighted various challenges in its implementation. Further research is needed before any recommendations for practice, training, and support can be made.
Developing competencies for end-of-life care in care homes
Authors: Lansdell John , Mahoney Mary
Published: May 2014

The English Department of Health's End of Life Care Strategy suggests that suboptimal end-of-life care in care homes results from inadequate training of staff at all levels. This article reports on one hospice's pilot project that addressed the question, ‘Does a competency development package provide a way in which the hospice can support improved end-of-life care in care homes in a sustainable way through education?’ The project followed the Medical Research Council framework for the development and evaluation of complex interventions. Competency domains were identified and statements written with participating care homes. A five-day education course was delivered to support the competencies and an assessment workshop explored how the framework could be integrated into existing appraisal systems. At the end of the project, the care homes identified aspects of education and support that would ensure the competencies became fully embedded. From the conclusions drawn, a collaborative model of competency development, education, and assessment is proposed to enable a measurable and sustainable improvement in end-of-life care in the care home setting.
Nurses' experiences assessing the spirituality of terminally ill patients in acute clinical practice
Authors: Smyth Therese , Allen Sonia
Published: May 2014

Aim: To explore and describe how nurses define spirituality and incorporate spiritual care into their clinical practice. Method: A two-phase, mixed-methods, explanatory descriptive design was adopted. Sixteen nurses working in an acute medical ward completed a purpose-designed questionnaire. This was followed by unstructured focus group interviews. The data generated was analysed using a thematic coding process. Findings: Four themes were identified: understanding spirituality, assessment of spirituality, difficulties in meeting spiritual needs, and education. The exploration of the nurses’ experiences showed that they did not clearly define or recognize the concept of spirituality, but they did recognize an aspect of patient care that required a transition away from a technical to a humane response. Conclusion: Despite the lack of a clear definition of spirituality and application of an established spiritual assessment tool, nurses do assess spirituality and incorporate spiritual care into their clinical practice, even in acute care settings.
Symptom experience and management among people with acute myeloid leukaemia in Thailand
Authors: Temtap Suthisa , Nilmanat Kittikorn
Published: May 2014

In Thailand, haematological malignancy is one of the most common types of cancer. This cross-sectional study, conducted in Southern Thailand, aimed to describe the symptom experiences of and symptom management strategies among patients with acute myeloid leukaemia (AML). Sixty hospitalized patients with AML were recruited. The Symptom Experience Scale and two open-ended questions regarding symptom-management strategies were used to collect data via face-to-face interviews 2 weeks after the induction phase of the AML protocol. The data was analysed using descriptive statistics and content analysis. High fever, weakness, nausea, and anorexia were the four most prevalent symptoms reported. Other prevalent symptoms included weight loss, bleeding, nausea and vomiting, dysphagia, and a cluster of psycho-emotional symptoms: worrying, fear, feeling discouraged, and feeling bored. Patients used various approaches and strategies to alleviate their symptoms, which could be categorized into five groups: preventive, direct, distraction, complementary, and restorative approaches. This study has provided important information for the development of symptom-management nursing programmes for patients with AML, particularly in Thailand.
Provision of information about malignant spinal cord compression: perceptions of patients and staff
Authors: Hutchison Cathy , Morrison Audrey , Rice Ann Marie , Tait Gemma , Harden Sharon
Published: May 2014

Background: Various guidelines have highlighted the importance of patients being given information on malignant spinal cord compression (MSCC), both when diagnosed with the condition and as a tool to aid early detection. Aim: To determine patient and staff views on the provision of MSCC information to patients with a diagnosis of or considered to be at high risk of developing MSCC. Methods: Patients with MSCC admitted to a large regional cancer centre in Scotland over a 6-month period were interviewed. Staff were also surveyed using similar questions. Results: Fifty-six patients and fifty staff were recruited. Only 4% of staff reported giving any written information about MSCC to patients with a confirmed diagnosis, although 20% of patients said they received it and 77% wanted it. A total of 54% of staff reported giving prophylactic information about MSCC to patients, although the majority of the patients (86%) said they would have wanted this information. Patients generally did not access additional information about MSCC and were dependent on the limited amount provided by the health care team. Conclusion: Health professionals need to ensure that patients get the information they want, which will allow them to recognize MSCC symptoms early for improved treatment outcomes or to better adapt to a diagnosis.
A pilot study to evaluate an outpatient service for people with advanced lung cancer
Authors: Roulston Audrey , Bickerstaff David , Haynes Tommy , Rutherford Lesley , Jones Louise
Published: May 2014

Many patients with lung cancer are symptomatic from diagnosis, and quality of life (QoL) may be maximised through the use of specialist palliative care in parallel with other treatments. This study explored anxiety, depression, and QoL in five patients, predominantly male (n=4) and with mean age 74 years, using a ‘Breathing Space’ clinic over a 4-week period. Breathing Space is a nurse-led multidisciplinary outpatient clinic using integrative care with lung cancer patients. The patients received weekly interventions to improve their wellbeing. Qualitative data were collected to explore their expectations and experiences of the clinic, and quantitative data were captured using the Eastern Cooperative Oncology Group Performance Status Rating (ECOG-PSR), the Hospital Anxiety and Depression Scale (HADS), the EQ-VAS, and the EQ-5D. These data were analysed using thematic content analysis and SPSS respectively. It was found that preconceived ideas about clinic attendance were replaced with positive impressions. Anxiety and EQ-VAS scores improved for all patients, and depression scores improved for four of the five patients, although no tests of significance were made. The qualitative data indicated that there were psychosocial benefits to attending the clinic.
IMhPaCT: an education strategy for cross-training palliative care and mental health clinicians
Authors: Taylor Janet , Swetenham Kate , Myhill Karin , Glaetzer Karen , Picot Sharon , van Loon Antonia
Published: May 2014

The Australian Integrated Mental Health and Palliative Care Task (IMhPaCT) project aimed to improve the quality of palliative care for people with a severe and persistent mental illness and those who develop mental health issues as a response to their diagnosis of a life-limiting illness. These patients and families are generally cases of high complexity and require strong collaboration and cooperation across various service sectors. Education across both palliative care and mental health services was identified as a key objective in improving palliative care service delivery in this patient population. This article specifically addresses one aspect of the project—the education strategy. The processes of development, implementation, and evaluation of outcomes are discussed.
Educating prison staff in the principles of end-of-life care
Authors: Howe Jill Banks , Scott Gill
Published: May 2014

End-of-life (EoL) care is a priority in health care and aims to provide services for all those who are dying, irrespective of their location. Providing this care to those in prison services is challenging. This paper reports a project that aimed to provide an education programme to both prison nurses and officers to support their understanding of EoL care and how it may be provided within the confines of the prison environment. On offer was a mixed-methodology education programme incorporating a pre-existing university module not specifically tailored to the prison setting. The mentorship of a clinical nurse specialist already known to the prison staff proved crucial to its successful implementation. Following the educational programme, both the nurses and the prison officers reported having a deeper understanding of the issues and more confidence in providing EoL care to prisoners who are patients. Further delivery of the programme to a wider group is planned, and similar initiatives nationally may provide a flexible, affordable approach to EoL care for those ending their days in prison.
Home visiting nurses' attitudes toward caring for dying patients, and related workplace factors
Authors: Sakai Mahiro , Naruse Takashi , Nagata Satoko
Published: May 2014

Aim

To identify workplace factors related to home visiting nurses' (HVNs) positive attitudes toward caring for dying patients.

Methods

In this cross-sectional study, 343 HVNs working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012.

Results

304 questionnaires (88.6%) were returned, and the data of 206 HVNs (60.1%) in 54 different agencies was analysed. Multiple regression analysis showed that attendance at terminal care seminars, agency support of schedule organisation enabling attendance at terminal care seminars, and positive feedback from patients and families were significantly positively associated with HVNs' attitudes toward terminal care.

Conclusion

These results may give useful interventional methods for nursing managers to enhance HVNs' terminal care practices.
Living and dying with heart failure in long-term care: experiences of residents and their family members
Authors: Kaasalainen Sharon , Strachan Patricia H , Heckman George A , D'Elia Teresa , McKelvie Robert S , McAiney Carrie , Stolee Paul , van der Horst Mary Lou , Kelley Mary Lou , Demers Catherine
Published: May 2014

The purpose of this study was to explore the experiences of long-term care (LTC) residents living and dying with heart failure (HF) and their family members. An exploratory descriptive design was used to collect data from seven LTC residents and seven family members. The data was analysed using thematic content analysis. The main themes that emerged from the data were: limited understanding of the HF diagnosis, living with restrictions and other comorbidities, making decisions about transitioning to end-of-life care, and learning and negotiating the lines of communication. Residents and family members communicated with many health-care providers about managing the HF symptoms but most often worked through the nurse when problems arose or decisions about care needed to be made. The findings from this study contribute to our understanding of residents' and family members' experiences in managing residents' HF in LTC.
Experiences and perceptions of nurses caring for dying patients and families in the acute medical admission setting
Authors: Mak Yim Wah , Lim Chiang Vico Chung , Chui Wai To
Published: May 2014

Aim:

This study aimed to explore the experiences and perceptions of nurses caring for dying patients and their families in the acute medical admission setting.

Methods:

A qualitative interpretive descriptive methodology was used to explore the experiences and perceptions of 15 nurses recruited via purposive sampling from three acute medical wards of a hospital in Hong Kong.

Results:

The nurses perceived insufficiency and experienced great mental and physiological strain regarding their caring roles in this setting. Four themes were derived from the findings: lack of preparedness for patients’ deaths, reflecting on their own nursing roles for dying patients, reflecting on the meaning of death and their personal experiences of the death of their own family members, and coping with caring for dying patients.

Conclusions:

There are similarities between these experiences and those of nurses in similar settings in different cultures. There is a need for further research into and educational preparation of nurses in bereavement care and means of coping with somatic, cognitive, behavioural, and emotional responses in an environment where the emphasis is on curing people who are dying rather than caring for them.
Managing urinary incontinence at the end of life: an examination of the evidence that informs practice
Authors: Farrington Naomi , Fader Mandy , Richardson Alison
Published: May 2014

To achieve a ‘good’ death, management of urinary incontinence at the end of life arguably should be as much a priority for nursing attention as managing symptoms such as pain and nausea. To understand how contemporary best practice is described and the nature of interventions prescribed for managing this issue, this article reviews the content of 16 seminal palliative care textbooks and 10 journal articles (retrieved through systematic search techniques) that discuss the management of urinary incontinence for patients at the end of life. The findings depict an area of nursing that has been governed by ‘common sense’ and precedent rather than evidence-based research, particularly regarding the use of indwelling urinary catheters. There is very little robust research evidence on this topic. Further research is required to ascertain the current state of practice in settings where patients who are approaching the end of life are cared for and the needs and preferences of patients and families.
Politics and palliative care: Venezuela
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Nurses’ perceptions of proactive palliative care: a Dutch focus group study
Authors: Verschuur Els ML , Groot Marieke M , Sande Rob van der
Published: May 2014

Background

Early identification of pain and other problems is an important aspect of palliative care. Although nurses have an important role in palliative care, little is known about nurses’ perceptions of proactive palliative care.

Objectives

This study aimed to explore nurses’ perceptions and experiences of proactive identification of problems and requirements among patients with palliative care needs.

Methods

This was a qualitative study in which 16 nurses working in palliative care took part in two focus groups.

Results

All of the nurses underlined the importance of their early involvement in palliative care. Anticipation of possible future problems, advice and information about end-of-life care and palliative care facilities, and assessment of patients’ wishes regarding care and preferred place of death were mentioned as important aspects of the early identification of problems and needs. Four themes were identified: the start of proactive palliative care; communication, support, and guidance; advocating for patients; and cooperation with health professionals.

Conclusions

Nurses’ involvement in proactive palliative care is important in supporting patients’ palliative care management. Ongoing education, focused on multidisciplinary communication and cooperation, professional development, and empowerment of nurses, remains of utmost importance.
Buteyko: A useful tool in the management of asthma?
Authors: Thomas Sandy
Published: May 2014

Medical management of asthma focuses on drugs which, although effective, are costly and produce side-effects. Recent evidence suggests a role for breathing interventions that reduce total ventilation, such as the Buteyko method, which has strong similarities to techniques already used by therapists to manage hyperventilation. Both approaches should be made readily available to patients with asthma. Asthma nurses and therapists should consider these techniques to enable patients to ‘step down’ drug treatments in accordance with medical guidelines. This may involve a re-thinking of their role, from one where the main emphasis is on supporting the established medical model towards one that also offers a non-pharmacological alternative.

This article explains the aims of Buteyko and discusses the increasing evidence base for methods that reduce ventilation and may benefit many patients with asthma, not just those with established chronic hyperventilation.
Does the introduction of a simple wedge to school seating reduce adolescent back pain?
Authors: Candy Elizabeth , Watts Richard , Shepstone Lee
Published: May 2014

Back pain in adolescence is an increasingly common problem. The objective of this study was to assess the effects of a change in seating position for students suffering from back pain. Volunteer students between the ages of 16 and 18 years were recruited from two schools. Students completed pain diaries on a twice daily basis. After the first week, the intervention school students were given a high density foam wedge to use on normal school chairs.

In total, 48 students took part in the study: 26 in the control and 22 in the intervention school. Use of the wedge was associated with a significant reduction in both intensity and frequency of back pain recorded in the intervention school (P <0.001). The results of this study demonstrate that a change in seating position appears to reduce back pain in school students. A randomized cluster study is planned to investigate this further.
Work activities of occupational therapists in Australian mental health services
Authors: Lloyd Chris , King Robert
Published: May 2014

The aim of this study was to obtain a profile of occupational therapists' work activities in contemporary Australian mental health services so as to better understand the specific contribution of this profession. The study also aimed to determine whether or not actual work activity was congruent with the preferred roles of occupational therapists.

A cross-sectional survey of 196 occupational therapists working in mental health was conducted. For the purposes of the study, a new instrument was developed that evaluated both actual and preferred work roles in four broad categories: administrative, general clinical skills, specialist clinical skills and community development. Respondents were engaged in a greater proportion of generic than discipline-specific work activities. They reported a preference for higher levels of activity in each of the work categories.

These findings suggest that, contrary to some previous reports, not only are occupational therapists in Australia engaged in a broad spectrum of non-specialist mental health work activities, but these activities are mostly congruent with their expectations and wishes.
The use of acupuncture in the management of rheumatoid arthritis: a case study
Authors: Cai Lang , Bowen Catherine Jane
Published: May 2014

Rheumatoid arthritis is a systemic inflammatory disease of unexplained cause, with no known cure. Medications used for disease control are far from innocuous and being aware of toxicities becomes an integral part of life for the person with this disorder. Acupuncture, as a part of traditional Chinese medicine, offers a different view to health and illness from that of Western medicine and has been used in the treatment and prevention of disease for thousands of years.

In this case study, a patient with an 8-year history of rheumatoid arthritis achieved a satisfactory result after being treated with acupuncture. This indicates that acupuncture could be useful in the management of this disease. However, more studies are needed to evaluate the active role of acupuncture in this field.
Building good practice: lessons from a multimethod study of speech and language therapy
Authors: Roulstone Sue , Glogowska Margaret , Peters Tim J , Enderby Pam
Published: May 2014

This article examines data from a multimethod study of speech and language therapy for pre-school children. The study compares the impact of intervention offered immediately following assessment with a control condition of monitoring over a 12-month period. A randomized controlled trial, a survey and in-depth interviews with parents are used.

Data from the component studies were reviewed in order to draw out implications for good practice. These cluster into four areas: caseload selection, eclecticism, targeting and acceptability of therapy. Therapists were found to individualize therapy for their heterogenous caseloads. Parents generally valued therapy but wanted more specific activities.

The article concludes that the heterogeneity of therapists’ caseloads creates challenges for evidence-based practice. In order to increase therapists’ understanding of factors that are critical to success, therapy should be systematically varied within a well-documented hypothesis testing approach.
Factors influencing the effectiveness of manual handling education
Authors: Gray Heather , White Jade
Published: May 2014

Annually, over one half of reported occupational injuries are associated with the manual handling of loads. Employers are legally required to provide training and education in safer handling practices, to prevent the occurrence of such injuries. However, the effectiveness of this education is not conclusive.

In total, 45 back care advisers, employed in nine out of the 15 Scottish health board regions, participated in seven focus groups to explore their perceptions of the effectiveness of manual handling education. A model was developed that summarized the five key factors they perceived to be major influences, which were: training; culture and the organization; the back care advisers; resources; and evidence-based practice. This model could be used to examine potential inefficiencies in current manual handling education provision.
Evaluation of the role of the rehabilitation assistant
Authors: Knight Katherine , Larner Stuart , Waters Karen
Published: May 2014

The aim of this study was to evaluate the role of the rehabilitation assistant: a junior multidisciplinary grade combining key elements from nursing, occupational therapy, physiotherapy and speech and language therapy. The authors analysed daily activities, sophistication of clinical thinking and functioning of the role using timesheets, the think-aloud technique and semi-structured interviews. Rehabilitation assistants were found to facilitate rehabilitation and extend therapists' roles.

Mobility, washing and dressing and activities of daily living were found to constitute most of a rehabilitation assistant's average day, with nursing skills and speech and language therapy appearing only in specific teams. All of the rehabilitation assistants displayed the ability to be able to think about the reasons behind the tasks they carried out, as opposed to merely following instruction from senior staff. The organization of the role of the rehabilitation assistant differed according to the team focus, structure and process within which the team operated. However, the specific role and boundaries of rehabilitation assistants' responsibilities need to be clearly defined for the role to function optimally.
An investigation of occupational therapy and physiotherapy roles in a community setting
Authors: Smith Susan , Roberts Pennie
Published: May 2014

This qualitative study investigated current occupational therapy and physiotherapy practice in a community rehabilitation setting to elicit areas of role difference, skill sharing and commonality within the two professions. The study was carried out with service users (n=4), occupational therapy and physiotherapy clinicians (n=11) and therapy service managers (n=9) to try and explore as many different opinions and experiences as possible. Focus groups were used to gather the data.

The findings from this study were broad ranging. Service users were frequently unable to identify the difference between occupational therapists and physiotherapists. Skill sharing and the blurring of professional boundaries between occupational therapists and physiotherapists occured on a daily basis. Interdisciplinary team working was regarded as essential for an effective needs-led service by all the participants of the study. However, despite this, it appeared that professional tribalism existed between the two professional groups, which hampered effective team working at times. There was a general feeling that increasing interprofessional education at as early a stage in undergraduate training as possible was vital and would help increase awareness of other professional roles and prepare therapists for the reality of working life.
Moving and handling education: Educating the experienced practitioner
Authors: Hall Nick , Bryer Melanie
Published: May 2014

This article focuses on an occupational therapist's experience of teaching moving and handling skills as part of his role of ‘key trainer’ in a primary care NHS trust. Time constraints on the staff involved require effective teaching and communication methods to be used in order to ensure the best possible outcomes in terms of patient and staff safety. Potential obstacles to effective moving and handling education are investigated and existing learning techniques used are reflected upon. Educational theory is then evaluated and integrated into future teaching sessions, resulting in a proposed framework for moving and handling education. The term ‘moving and handling educator’ (as opposed to trainer) is therefore suggested as more accurately reflecting the nature of this role.

This article may therefore be of particular value to moving and handling ‘key trainers’ workingwithin primary and intermediate care, with the aim of increasing the ability of all groups of clinicians to effectively use these manual handling skills in practice.
Making audit a part of practice in multidisciplinary teams
Authors: Finucane Lucy
Published: May 2014

Recently, there has been an increased research focus on ways of working and roles within multidisciplinary teams, especially mental health teams (Onyett, 2003; Harrison, 2005a,b). Less has been written about the specific tasks that various professions undertake and the distinctive skills they bring to the team environment.
Evidence-based postural assessment for use in therapy and rehabilitation
Authors: Warren JG , Bettany-Saltikov J , van Schaik P , Papastefanou S
Published: May 2014

Clinical assessment of spinal dysfunction involves the evaluation of back shape or symmetry. Variations in symmetry, shape or balance are generally believed (in conjunction with other symptoms) to be indicators or possible causes of dysfunction. With the onset of clinical governance, evidence-based practice has become paramount in all aspects of health. Numerous non-invasive objective methods varying in sophistication, cost and portability have been developed to measure and document back shape and posture.

The purpose of this current study was to assess the reliability of a new low-cost system on healthy young subjects. Intrarater reliability, using Pearson's correlation and intraclass correlation coefficients of landmark points on 50 ‘normal’ subjects using a portable digital system, is reported. The results indicate that the system is reliable (P<0.001) and provides data suitable for evidence-based practice in clinical rehabilitation.
Is the pharmaceutical industry exerting undue influence?
Authors: Scullion Philip
Published: May 2014

There is a growing awareness among clinicians that patient histories must include a comprehensive list of drugs, whether prescribed ‘over the counter’ or obtained illegally. Herbal remedies may also have significant, although often unrecognized, physiological effects (Abraham, 2004). Collectively, this information is vital as it may influence patient safety. The pharmaceutical industry's declared goal is to ‘bring patients life-enhancing medicines’ – yet there is growing evidence that this is not always achieved.
Spanish social workers' views of mental health services
Authors: Gamita Marta Trias , Atwal Anita
Published: May 2014

There has been limited research in Spain examining the specialist roles carried out by social workers since the introduction of mental health reforms. The aim of this research was to identify specific work activities of community mental health social workers in Spain (Catalonia) and to ascertain their perceptions of their role. A postal survey of 140 (response rate 31%) social workers working in the Centres de Salut Mental was used.

The findings from the survey suggest that social workers in Spain have a strong role in supporting families. While interprofessional working was considered to be important, social workers did not collaborate closely with occupational therapists, GPs and psychiatrists. It is suggested that social workers in Spain may wish to explore shared learning as a means of promoting interprofessional collaboration.
Measuring changes in activity limitation and participation restriction in people with COPD
Authors: O' Shea Simone D , Taylor Nicholas F , Paratz Jennifer D
Published: May 2014

Given the identified need to measure outcomes in terms of activity limitation and participation restriction, the authors evaluated the test-retest reliability of the Patient-Specific Functional Scale and the London Handicap Scale for people with chronic obstructive pulmonary disease (COPD). Twelve people with moderately severe COPD were measured on two occasions separated by a 2-week interval. Severity of COPD was determined using British Thoracic Society guidelines on lung function measures.

Reliability coefficients for the Patient-Specific Functional Scale and London Handicap Scale were 0.55 and 0.71 respectively. To be 95% confident that real change had occurred, groups would need activity scores to increase by 1 out of 10 and handicap scores to increase by 6 out of 100. For individuals, changes in activity scores of 2 out of 10 and handicap scores of 17 out of 100 would be required.

These results indicate that both scales could be suitable for testing hypotheses in groups of people with COPD. However, only the Patient-Specific Functional Scale is likely to be able to detect and monitor changes in individuals.
The therapeutic nature of the human–animal bond
Authors: Benda William
Published: May 2014

Rehabilitative medicine, despite its reliance upon technological advances, owes much of its success to the therapeutic nature of the human–human bond. Healing, however, is not necessarily species-specific.