bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of the nurse practitioner in providing palliative care in long-term care homes
Authors: Kaasalainen Sharon , Ploeg Jenny , McAiney Carrie , Martin Lori Schindel , Donald Faith , Martin-Misener Ruth , Brazil Kevin , Taniguchi Alan , Wickson-Griffiths Abigail , Carter Nancy , Sangster-Gormley Esther
Published: May 2014

Aim:

The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC.

Methods:

Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis.

Findings:

NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits.

Conclusions:

NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
Family members' perceptions and expectations of the use of syringe drivers: a South African study
Authors: Wilkinson Margaret , Vember Hilda
Published: May 2014

Aim:

This study aimed to explore and gain insight into the perceptions and expectations of family members of terminally ill patients pertaining to the use of syringe drivers.

Background:

There is a lack of research regarding the use of syringe drivers in Africa and, more specifically, South Africa. However, syringe drivers have been in use for around two decades in some South African settings. Some family members’ ambivalence about the use of syringe drivers and the lack of research prompted this study.

Method:

A qualitative exploratory research design was used. Data was collected using semi-structured interviews, diaries, observation, and documentation. Thematic analysis and coding were used to analyse the data.

Results:

Four main themes were identified: the rationale for the need for the syringe driver, positive perceptions pertaining to the use of the syringe driver, negative perceptions, and concerns/anxieties. The study also highlighted the challenges of drug addiction in some households when caring for terminally ill patients.

Conclusion:

The need for more continuous education and written information and support for immediate and extended family members was evident.
Advance care planning in care homes: the experience of staff, residents, and family members
Authors: Stone Louisa , Kinley Julie , Hockley Jo
Published: May 2014

Background: In the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end-of-life care for frail older people living and dying in care homes. Advance care planning (ACP) discussions are an integral part of this. This study explored experiences of initiating and completing these discussions in homes undertaking the GSFCH.

Methods: A qualitative descriptive study was carried out in three nursing care homes implementing the GSFCH programme. Following an ACP discussion, 28 semi-structured interviews were conducted with the resident, a family member, and the staff member who undertook the ACP. Content analysis was then conducted.

Findings: Three main categories of findings emerged: understanding ACP, undertaking ACP discussions, and impact of and reactions to ACP discussions. Staff understanding of ACP varied, affecting the depth of their discussions. Documentation was either a useful prompt or limited the discussion, blocking opportunistic cues and encouraging a ‘tick-box’ exercise. Residents were open to ACP, although the way it was introduced could affect the results. Families were comforted that the resident's future care had been considered. Education was identified as being important, and role modelling ACP enabled a member of staff to develop their skills and confidence in it.

Conclusions: Care home staff need to develop the knowledge, skills, and confidence to engage in discussions around end-of-life care. The assistance of a trained facilitator who role-models this process should be explored.
Care managers' views on death and caring for older cancer patients in Japan
Authors: Matsui Miho , Kanai Emi , Kitagawa Akiko , Hattori Keiko
Published: May 2014

Care managers (CMs) have an important role in coordinating care for cancer patients who are in the end-of-life stage; however, little is known about their views of death and their experiences while caring for older cancer patients. This study was conducted to examine CMs' views of death and caring for older cancer patients in a home care setting in Japan. Convenience sampling was undertaken, and 35 offices from 43 approached services agreed to participate. The final valid sample included responses from 136 CMs (90.7%). Most CMs, including nurses, care workers, home helpers, and social workers in home care settings, experienced difficulty in managing the care of cancer patients in the end-of-life stage. Respondents reported a wide array of experiences with end-of-life care, care management, and seminar attendance, and their ages and Frommelt Attitude Toward Care of the Dying (FATCOD) scores were associated factors. Moreover, multiple regression analysis indicated that better attitudes toward caring for the dying were positively associated with seminar attendance. These results suggest that CMs need education about palliative and end-of-life care in order to promote good home care for cancer patients.
Essential knowledge for family caregivers: a qualitative study
Authors: Angelo Jennifer K , Egan Richard , Reid Kate
Published: May 2014

Background: Family caregivers are the backbone of the social care delivery system. With cancer and other life-limiting diseases on the rise, the need for well-informed informal/family caregivers has never been greater.

Aim: To uncover the information that palliative care teams routinely provide to family caregivers.

Design: The methodology used was the nominal group technique, a type of focus group.

Participants: A total of 17 community palliative care health professionals participated in one of three focus groups.

Results: Three themes emerged as dominant priorities for the education of family caregivers: caring for oneself physically, emotionally, and spiritually; learning practical skills; and knowing what to expect and plan for as the family member's health declines.

Conclusions: The participants encourage caregivers to meet their own needs as well as care for family members. They help to empower family caregivers by encouraging them to take time for themselves, providing practical information for individual situations, and educating them on the signs and symptoms of approaching death. Successful terminal home care is possible through family caregiver support and empowerment.
Nurses' attitudes toward palliative care in south-east Iran
Authors: Razban Farideh , Iranmanesh Sedigheh , Rafei Hossein
Published: May 2014

Background: Nurses are the element of the palliative care team who spend the most time with patients. Nurses' attitudes toward palliative care affect their behaviour toward their patients.

Aim: This study sought to examine oncology and intensive care unit (ICU) nurses' attitudes toward palliative care in south-east Iran.

Methods: A self-administered questionnaire was used to assess the palliative care attitudes of 140 oncology and ICU nurses from three hospitals supervised by Kerman University of Medical Science.

Results: Participants had moderately negative to neutral attitudes toward palliative care (2.99±0.29 out of 5). Among all categories, the highest mean score came from the category of ‘patient's preferences' (mean=3.66) and the lowest from the category of ‘withholding and withdrawing treatment’ (mean=2.42). A significant correlation was found between nurses' attitudes toward palliative care and some demographic characteristics, including marital status, type of ward, palliative care education, personal study about palliative care, level of education, and experience of caring for a dying family member.

Conclusions: This study suggests that educational designers should include specific courses about death and palliative care in undergraduate and postgraduate nursing curricula. Educational programmes need to build on the specific experiences of death and dying among nurses and auxiliary nurses.
Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia
Authors: MacWilliams Judy , Bramwell Michael , Brown Sally , O'Connor Margaret
Published: May 2014

Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.
Changes in symptom severity in Taiwanese lung cancer patients after gefitinib treatment: a pilot study
Authors: Wang Shu-Yi , Tsai Chun-Ming , Lin Chia-Chin
Published: May 2014

Aim

The purpose of this study was to investigate symptom severity in advanced non-small cell lung cancer patients prior to gefitinib treatment and at 1-, 3- and 6-month intervals after starting treatment.

Methodology

Fifty seven patients completed the Taiwanese version of the M.D. Anderson Symptom Inventory. The data were analysed using descriptive statistics, the Friedman non-parametric test, and Pearson correlation coefficients.

Results

Symptoms of nausea, difficulty remembering, lack of appetite, sadness, and vomiting increased at 1 month after treatment started, pain and shortness of breath increased at 3 months, and disturbed sleep, drowsiness, and numbness increased after 6 months. Fatigue and dry mouth increased at 3 months after treatment started and then decreased. Only distress decreased throughout the course of treatment.

Conclusion

The findings may lead to the development of better clinical guidelines and improved information for patients on when to expect the greatest impact from their symptoms during the course of treatment.
Patients’ experiences of ongoing palliative chemotherapy for metastatic colorectal cancer: a qualitative study
Authors: Cameron Jenny , Waterworth Susan
Published: May 2014

Background

Colorectal cancer is the second most common cause of cancer death in New Zealand. With new chemotherapy regimens, patients with metastatic colorectal cancer are now living longer with the condition and its treatment.

Aim

This study aimed to explore patients’ experiences of extended palliative chemotherapy for metastatic colorectal cancer.

Methods

A convenience sample of 10 outpatients who had been receiving palliative chemotherapy for more than 12 months from a teaching hospital and regional cancer centre in New Zealand participated in face-to-face semi-structured interviews. The data was analysed using a general inductive approach.

Findings

Three key themes were identified: the importance of relationships, presenting a positive face, and life is for living. The importance of interpersonal relationships with health professionals and a sense of comradery with other chemotherapy patients positively affected the patients’ experiences of treatment. Positivity was a key coping strategy that also has negative implications as patients may not reveal their concerns and needs.

Conclusion

The key to improving the care of people with advanced cancer is understanding their experiences of care. Communication between the patient, family, and health-care team ensures assumptions that misinterpret attributes of positivity are not made.
Impact of the environment on role performance in older stroke survivors living at home
Authors: Reid Denise
Published: May 2014

This article examines the experiences of older stroke survivors living in Ontario, Canada, in adapting to their changing life roles. A qualitative study using in-depth, focused interviews was conducted with a sample of 18 men and women who had suffered stroke and who lived at home. It aimed to explore interactions among the home environment and disability.

Four major themes were uncovered in the data: role adjustment – occupational losses and gains; personal, physical and economical challenges; ‘life is worth living’; and resources and supports. Findings from this study show that stroke survivors lost occupations, modified old ones and regained new ones. There were challenges with which some individuals dealt through modifying the environment and through the use of assistive devices, personal assistance and family support. In other instances, the stroke survivor lived in a world that posed accessibility issues and financial restraints.

The study points to the importance of recognizing that stroke survivors use many strategies to regain control over aspects of their home and community environments to enable greater autonomy and participation. This study has implications for health professionals, who can assist stroke survivors on their return to community living.
Physiotherapy management of fibromyalgia syndrome: a survey of practice in Northern Ireland
Authors: Mcveigh Joseph G , Baxter GD , Archer Susan , Hurley Deirdre , Basford Jeffrey R
Published: May 2014

The aim of this study was to identify the physiotherapeutic management of patients with fibromyalgia syndrome (FMS) in Northern Ireland. A postal questionnaire was distributed to physiotherapists working in outpatient settings in this region (n = 106). A response rate of 71% (n = 75) was achieved. Patients with FMS featured in the caseloads of all respondents. The most important reported goal of treatment was to ‘increase daily function’ (n = 24; 32%). Exercise (n = 44; 58.7%) and hydrotherapy (n = 12; 16.0%) were the most common treatment approaches. A total of 45.3% (n = 34) of respondents stated that they did not believe they could adequately assess patients with FMS and 41.3% (n = 31) reported that they had no training in the management of FMS. Private practitioners were significantly (P = 0.05) more likely to believe that physiotherapy was beneficial for patients with FMS than their NHS counterparts.

In conclusion, physiotherapy treatments for patients with FMS in Northern Ireland are consistent with current evidence. However, practice varies and physiotherapists are uncomfortable with their level of training in FMS.
Assessing clients for the correct hoist or sling: a practical guide
Authors: Rush Anita
Published: May 2014

The high incidence of injury among those who regularly transfer and lift patients and the growing emphasis placed on health and safety in the workplace has led to an increase in the use of mechanical devices.

This article highlights the importance of training rehabilitation nurses and carers in the correct use of hoists and slings, respecting the client’s comfort and safety and minimizing their own risk of musculoskeletal injury. It offers some common examples of different types of hoists and slings, describing their advantages and limitations, and gives some practical advice on risk assessment.
Qigong as alternative therapy for depression and anxiety disorders
Authors: Tsang Hector WH
Published: May 2014

Owing to rapid social changes and urbanization, people in major cities around the world are known to suffer from tremendous psychosocial stress. This explains why the prevalence of people suffering from anxiety and depression has substantially increased in recent years.
Burnout and self-efficacy in Norwegian physiotherapists
Authors: Mandy Anne , Saeter Marthe , Lucas Kevin
Published: May 2014

Professional and occupational burnout is a recognized syndrome among health-care professionals. Research within the physiotherapy profession, predominantly involving UK and Australian populations, has identified that burnout has a detrimental effect on both the practitioner and the employer. However, there is limited research concerning the effect of burnout in Scandinavia. The concept of self-efficacy has also not been investigated in relation to burnout in physiotherapists.

The aim of this study was to investigate the relationship between burnout and self-efficacy in Norwegian physiotherapists. In total, 127 qualified physiotherapists were surveyed using the Bergen Burnout Inventory and the General Self-Efficacy Scale. Significantly low levels of burnout were demonstrated (t=5.9; P <0.01). Burnout scores were positively correlated to length of time since qualification (rs=0.9). Self-efficacy scores were in the upper quartile, but no relationship between selfefficacy and burnout scores was shown.
Evaluating current practice in the provision of written information to stroke patients and their carers
Authors: Hoffmann Tammy , Mckenna Kryss , Worrall Linda , Read Stephen J
Published: May 2014

This study aimed to determine current practice in the provision of written information to 57 stroke patients and their carers. It also explored their informational needs while in hospital and 6months later and examined the suitability of the written materials received, comparing readability levels to participants' general reading ability.

While in hospital, 22.8% of patients and 41.7% of carers received written information, yet 91.2% of patients and 100% of carers wanted information. More than half of the participants wanted information on preventing strokes, causes and risk factors of stroke, recovery, what a stroke is, stroke-related medications and sources of further information. At 6months after stroke, 75.5% of patients and all carers wanted further information. The mean SMOG readability level of the written materials received was equivalent to a grade 11 level of education, compared to the patients' mean reading ability, which was equivalent to a 7th–8th grade reading level.

The authors conclude that stroke patients and their carers want substantially more information than they are receiving, both while in hospital and 6months later. The majority of written information that is distributed to these people is unsuitable in terms of readability levels and other factors.
Development and design of equipment over the last 15 years
Authors: Collins Fiona
Published: May 2014

There has been an enormous development in the design, function and appearance of equipment during the last 15 years. An increasing older population, clinical guidelines and demanding consumers have led to manufacturers providing more sophisticated equipment, enabling people to maintain their independence. Further, such design has reduced the risks associated with manual handling and pressure ulcer development.

This article will consider a range of equipment currently in use, such as manual handling equipment, stairlifts, pressure-relieving devices and armchairs. New trends in equipment provision will be discussed, in addition to highlighting those items no longer recommended for use, and why.
Reliability and repeatability of the shuttle walk test in patients with chronic low back pain
Authors: Armstrong M , McDonough S , Baxter D
Published: May 2014

The aim of this study was to assess the test–retest reliability and repeatability of the shuttle walk test in patients with chronic low back pain. This was assessed by comparing performance on two consecutive walk tests performed on ten patients with chronic low back pain.

There were no significant differences in the visual analogue scale for pain, resting heart rate, resting oxygen saturation (SaO2) or resting Borg perceived rate of exertion scale between the two study days. There was a significant and strong correlation between trials for the distance completed and peak heart rate. There was a significant but moderate correlation for peak SaO2 and peak Borg rating of perceived exertion. The coefficients of repeatability for the repeated shuttle walk test were 2.5 shuttles for change in distance completed, 8 beats per minute for change in peak heart rate, 2% for change in peak SaO2 and 2.2 for change in Borg rating of perceived exertion.

This study demonstrates that the shuttle walk test is a reliable and repeatable measure in patients with chronic low back pain and may be of value in establishing the impact of treatments on the functional disability associated with chronic low back pain.
Validation of a new measure for post-acute rehabilitation
Authors: Powell Theresa , Kalmus Ellis , Wright Liz , Plumb Jonathan , Atkins Rachel , Pantke Renata
Published: May 2014

This study aimed to develop and validate a brain injury outcome measure with sufficient discriminatory power for use in a post-acute rehabilitation setting. A 56-item questionnaire – the Postacute Rehabilitation Measure (PARM) – covering disability and participation restriction was validated against the Functional Independence Measure and Functional Assessment Measure (FIM+FAM) using both carers and the rehabilitation team as respondents. Participants were 67 patients with acquired brain injury from 12 post-acute rehabilitation facilities.

PARM showed a lower mean score than FIM+FAM on all sections except emotions. Correlations between sections of PARM and FIM+FAM ranged 0.63–0.89. Test–retest reliability ranged 0.84–0.97. Inter-rater reliability (carer vs team) was more variable. PARM is therefore a reliable and valid measure for post-acute outpatient rehabilitation that has the advantage of being completed by either the carer or the team. It shows fewer ceiling effects than FIM+FAM in this population.
Use of specialized equipment to mobilize bariatric patients
Authors: Rush Anita
Published: May 2014

Obesity is increasing and the number of patients with a body mass index of more than 40 and weight of more than 191 kg (30 stone) has almost doubled within the last decade. Following surgery, bariatric patients are encouraged to self-mobilize. Professionals need to have a mobilization programme that enables therapeutic goals for the very dependent bariatric patient. Step-by-step handling guidelines for professionals and carers undertaking the rehabilitation will minimize the inherent risks associated with handling bariatric patients. This article looks at the rehabilitation equipment available to health-care professionals working with this client group.
Participating in a community theatre production: A dramatherapeutic perspective
Authors: Pyman Tina , Rugg Sue
Published: May 2014

This phenomenological study was conducted with eight members of a community theatre group who recreated an old time music hall performance in January 2004. The study explored participants' experiences of taking part in this chosen leisure activity, focusing on any personal enrichment that might ensue. While personal enrichment is a term often used in dramatherapy, and in community theatre, few studies have investigated a potential link.

Data were collected from semi-structured interviews conducted with a purposive sample of members of both the cast and the production team. Respondents' perceptions of their community theatre experience proved to be multi-faceted, relating to personal development and/or learning, challenge, compromise and co-operation, individual and/or collective validation, increased awareness of community identity, developing creativity and a sense of empowerment and/or escape. Participants also reported a range of tangible individual benefits from their experiences. These included friendship, improved confidence, a feeling of being valued, increased self-esteem, enjoyment, the opportunity to be ‘someone else’ and encouragement to learn new skills. Participants' experiences fostered their personal and collective creativity in many ways.

Many of these findings have implications for drama used for therapeutic purposes. In conclusion, this study explored participants' experience and music hall experience. The results showed that, far from being a simple staging of old songs in a recreated historical setting, those who took part saw their experience as one of myriad opportunities, developing their knowledge, skills and attitudes, and enriching their lives.
Effectiveness of an adjustment group for brain injury patients: A pilot evaluation
Authors: Forman Alexandra CM , Lincoln Nadina B , Vesey Patrick A
Published: May 2014

Mood disturbances are a common problem after brain injury (BI) and can affect rehabilitation. The aim was to evaluate a psychological support group to improve mood and to determine the effect on adjustment.

A single case experimental design was used. Participants were assessed in baseline and intervention phases on the Hospital Anxiety and Depression scale and Mental Adjustment to Brain Injury questionnaire. In the intervention phases, participants attended a group once a week for 16 weeks, aimed at helping adjustment and mood.

Ten participants with BI (mean age 45.6 years) were recruited. Comparison of initial and final assessments showed a significant improvement on anxiety and depression scores. Visual inspection showed that participants improved with intervention and worsened with no intervention. Therefore, participants with BI attending the group showed an improvement in mood in response to intervention but there was no significant effect on adjustment.
Speech and language therapy provision for people with Parkinson's disease
Authors: Noble Emma , Jones Diana , Miller Nick , Burn David
Published: May 2014

Few details are known about the experience of people with Parkinson's disease (PD) and their carers in relation to their need for and access to speech and language therapy (SLT). This study investigated the perceptions of need in relation to maintaining communication and the nature and experience of SLT. Questionnaires were sent to 141people with PD and 78carers living in the community, of whom 123 and 68 respectively responded. Twenty-five people with PD (20%) had had contact with SLT, of whom 71% felt referral was at the right time and 80% felt SLT had helped. Eighty-three percent of all respondents with PD felt that referral should occur before changes posed a problem. Easier and increased access to SLT was needed, focusing on overall management of communication rather than specific impairments. This study contributes to the PD National Institute of Health and Clinical Excellence Guideline (2006) recommendation to articulate best practice in SLT.
Potential screening measures for depression and anxiety after stroke
Authors: Bennett Hazel E , Lincoln Nadina B
Published: May 2014

Depression and anxiety are common problems after stroke. The National Clinical Guidelines for stroke (Royal College Physicians, 2004) recommend that all patients are screened for low mood. The aim of the review was to identify measures which could be used for this purpose and to review the evidence for their sensitivity and specificity with stroke patients.

A literature search was conducted using electronic databases, including Medline, Embase, PsycInfo and CINAHL, to identify articles published in peer reviewed journals on mood assessment after stroke.

Questionnaire measures were identified which were appropriate only for those able to communicate verbally. In addition visual analogue and observer rating scales were identified which were considered appropriate for all stroke patients. The hospital anxiety and depression scale (HADS) and general health questionnaire (GHQ) had most evidence to support their use as screening measures for people without communication problems. The stroke aphasic depression questionnaire–hospital version (SADQ-H) had best support for use as a screening measure for those with communication problems. No measures were identified that had been validated as screening measures for anxiety after stroke.

The HADS, GHQ12 and SADQ-H10 were recommended as short screening measures suitable for detecting depression after stroke. However the cut-offs giving good sensitivity and specificity were not well established for stroke patients and measures need to be developed for detecting anxiety.
Choosing support equipment in children's therapy
Authors: Bakewell Joanna
Published: May 2014

During normal development, children learn how to position themselves so they can mobilize, participate in play and perform activities of daily living. Disabled children may have problems in the development process, which make achieving these positions difficult. Therapy can help these children develop the skills and muscle strength to position themselves as a precursor for learning activities such as sitting, crawling and standing.

Equipment is necessary when children need more support in therapy or when they require continual positioning to prevent muscle contractures for example. Equipment such as wedges and standing frames also enable children to interact more easily with people and their environment, and provide important benefits to body systems.

This article will explore the support equipment available for use in therapy sessions.
Virtual reality: A healthy perspective
Authors: Powell Wendy , Simmonds Maureen
Published: May 2014

Slowed movements are a common consequence or correlate of illness, injury and ageing. Slow movements, including slow walking, are inefficient and add to the physiological burden (Ada et al, 2003). Unfortunately slow movements can frequently persist and contribute to long-term disability. However, research has demonstrated that exercise, including treadmill training, can improve long-term outcomes (Ada et al, 2003; Luft et al, 2008), although motivation and adherence to exercise remains problematic.
Self-care for health professionals: Addressing mind, body and spirit
Authors: Tse Samson
Published: May 2014

While I write this editorial, I am continuously troubled by the updates on the aftermath of a violent 8.0 magnitude earthquake in the Sichuan Province of China, and of the cyclone in Myanmar where people are not only suffering from natural disaster but also from human stupidity.
Let's talk about sexuality: Whose responsibility is it?
Authors: Sengupta Subhajit , Davis Sally , Stubbs Brendon
Published: May 2014

Human sexuality is biopsychosocial in nature. It is discussed in the literature as a dynamic process and the right of all individuals (Sakellariou and Algado, 2006). Irwin (1997) compared sexual health to culture, and discussed how changes in sexuality parallel changes in culture over time. Sexuality is not just about ‘having sex’ but includes making relationships, self-esteem, tactile expressions and the need for intimacy and closeness. These issues are important in the lives of the general population, and also therefore, of the clients seen by health-care professionals (Wells, 2002; Barnes and Ward, 2005).
How much physical activity do people recovering from stroke do during physiotherapy sessions?
Authors: Elson Tony , English Coralie , Hillier Susan
Published: May 2014

Aims

This study investigated the amount of time people recovering from stroke spend engaged in physical activity during physiotherapy sessions, and the types of activities included in physiotherapy sessions.

Design

An observational study was conducted with 15 people receiving inpatient stroke rehabilitation. Participants were video-taped in one circuit class therapy session and one individual physiotherapy session. The proportion of session time participants spent engaged in physical activity within circuit class therapy and individual physiotherapy sessions and the proportion of session time participants spent engaged in specific activities during therapy sessions was measured.

Findings

There was little difference in the percentage of the total session time that participants spent engaged in physical activity (mean difference=1.7 (standard deviation 13.9%; 95% confidence interval −6.0 to 9.4) between the two modes of therapy delivery. The most prevalent activity engaged in during individual therapy sessions was walking (44%). The most prevalent activity engaged in during circuit class therapy sessions was activities in standing (25%). A large percentage of therapy session time was spent resting in sitting in both circuit class therapy (30%) and individual physiotherapy sessions (21%).

Conclusions

Participants spent a similar percentage of the total therapy time in circuit class therapy and individual therapy sessions engaged in physical activity. As circuit class therapy sessions ran for longer each day, and involved a lower staff to patient ratio they may be a more resource efficient means of providing therapy. This requires further investigation. In both types of physiotherapy sessions, participants spent a large amount of time inactive. Physiotherapists should consider strategies to maximize the time patients spend engaged in physical activity, regardless of the form of therapy delivery.
The lived experience of mental health service users in a UK community rehabilitation scheme
Authors: Kowlessar Omar A , Corbett Kevin P
Published: May 2014

Aims

There is a paucity of research on the lived experience of mental health service users in community rehabilitation services. This exploratory study researched this phenomenon within one UK community rehabilitation scheme.

Methods

A non-experimental phenomenological design and analysis of semi-structured interviews enabled an exploratory description of the phenomenon. Use of this design was based on policy recommendations and gaps in the literature on the lived experience of users.

Findings

Interpretative phenomenological analysis of data yielded five overarching themes not previously reported: belief about mental illness; the value of independence; community rehabilitation scheme accommodation/peer relationships; adjusting to a community setting; and feeling involved in care; all of which emerged from 64 sub-themes related to the phenomenon.

Conclusions

The study revealed shared and unique experiences and highlighted how being cared for within a community mental health rehabilitation service involved users carefully/logically weighing up gains/disadvantages; such as being provided with accommodation/financial benefits together with feeling ‘labelled’/coping with a potentially stigmatising diagnosis. The study yielded rich and varied data as individual experiences are posited as differing according to users' own perceptions, experiences and social context. Implications are discussed for professionals working in community mental health rehabilitation settings.
Electronic mentoring: An innovative approach to providing clinical support
Authors: Stewart Susan , Carpenter Christine
Published: May 2014

Aims

Professional isolation is a contributing factor to poor recruitment and retention of physical therapists in rural positions. This article describes the implementation and evaluation of a pilot electronic mentoring, or e-mentoring, programme to address the need for support of physical therapists working in rural positions, in British Colombia, Canada.

Methods

An action research approach was used to examine whether an e-mentoring programme could effectively support physical therapists in paediatric clinical practice. The pilot programme involved an experienced physical therapist who mentored two sole charge physical therapists with no paediatric experience from a distance using their laptop computers. Programme evaluation data was obtained through questionnaires, field notes and a final group meeting using videoconferencing.

Findings

The key to the success of the e-mentoring programme was the collaborative interaction between the mentor and the mentee. Other factors that supported this interaction and beneficial outcomes of the programme were identified.

Conclusions

This pilot study has shown that technology combined with skilled communication can break down the barriers of distance and be an effective tool for clinical support. Further research is needed to establish the optimal organization of this type of programme and to rigorously evaluate the long-term benefits and effectiveness of e-mentoring.
How to read and critically appraise a reliability article
Authors: Bialocerkowski Andrea , Klupp Nerida , Bragge Peter
Published: May 2014

Background

This article is a guide to critically appraising reliability studies based upon fundamental reliability concepts. It focuses on reliability studies of physical measurement instruments used in the allied health professions.

Content

Eight critical appraisal questions specific to reliability studies are outlined, and their theoretical basis and importance described. The questions encompass key aspects of reliability theory; selection of clinically stable participants appropriate to the instrument and condition of interest; minimization of random error; appropriate periods of time between measurements; the interpretation of frequently used reliability statistics; and the generalizability of results. The importance of interpreting reliability studies in specific clinical contexts and settings is emphasized.

Conclusions

These questions will guide clinicians and researchers to make informed decisions regarding whether reliability evidence can be applied to their specific context.
Participatory research. Part 1: key features and underlying philosophy
Authors: Northway Ruth
Published: May 2014

Background

The use of participatory research approaches is growing within the context of health and social care services, as researchers seek to include service users in research into services provided.

Content

Participatory research is characterized by working with a community, changing the balance of power, involving a different role for the researcher and active participation of the community at all stages of the research process. This results in the production of ‘useful’ knowledge and a commitment to action on the part of the researcher and the community.

Conclusions

The areas involved in participatory research are explored to provide readers with an understanding of its key features and underlying philosophy. This provides the foundation for a subsequent article in the next issue, which considers the practical implications of using this as a research approach.
Workforce planning in the context of service redesign, workforce migration and changing demographics
Authors: Harden B , Fraher E
Published: May 2014

Introduction

Healthcare is facing unprecedented challenges in which economic, demographic and policy changes will impact upon all aspects of workforce and service delivery both within the UK and internationally. How the rehabilitation workforce responds to the challenges will be a fundamental marker of the success of future service delivery.

Content

These changing imperatives require a reinterpretation of existing workforce planning. A more collaborative and patient-centred approach is now advocated within which productivity becomes a major player, with quality remaining at the heart of the agenda alongside an increasing emphasis upon prevention. This article describes how the workforce needs to realign itself with this directional change.

Conclusions

This article provides an overview of the current policy context shaping the health workforce agenda and suggests future strategies to assist planners in achieving an effective planning cycle within the rapidly changing and dynamic health care delivery system.
Proposing a new sexual health model of practice for disability teams: the Recognition Model
Authors: Couldrick Lorna , Sadlo Gaynor , Cross Vinette
Published: May 2014

Background

Health and social care professionals working with disabled people are increasingly recognising the importance of holistic practice that encompasses the sexual health needs of service users. For some this is a new and unfamiliar area of practice. A new sexual health model, the Recognition Model, developed to assist good practice, is proposed.

Content

The Recognition Model builds on evidence from an extensive research project into the practice of community physical disability teams (occupational therapists, nurses, physiotherapists, speech and language therapists and psychologists). At its core is the recognition of disabled people as having sexual desires and needs like anyone else. This research indicated potential limitations of the PLISSIT sexual health model.

Conclusions

The Recognition Model takes a team approach to protect and support the sexual health of service users. It draws on existing skills within the team, and depends on every team member, regardless of role, positively responding to direct or indirect questions asked by the service user, thereby affirming the relevance and priority he or she may attach to sexual expression.
Supporting the transition from student to practitioner: a scheme to support the development of newly qualified practitioners
Authors: Upton Dominic , Solowiej Kazia , Upton Penney
Published: May 2014

Background

The Allied Health Professions Support and Development Scheme was a pilot project administered by NHS Education for Scotland (NES) and the Scottish Government. The scheme was put in place to aid in the recruitment, retention and career development of newly qualified practitioners (NQPs) in NHSScotland. During the scheme, NQPs were provided with mentor support, an online learning facility and financial incentives.

Contents

This article describes the independent evaluation of the scheme, one which aims to assess the scheme's impact on recruitment, retention and career development of NQPs in NHSScotland. It was found that involvement in the scheme made NQPs feel valued as practitioners and increased their awareness of the wider allied health profession agenda. Financial support provided as part of the scheme was used to help with a range of costs including accommodation, training courses, continuing professional development (CPD) and student loan repayments.

Conclusions

Overall the majority of NQPs (86%) regarded the scheme as a positive experience and indicated that they would recommend it to their colleagues. Similar schemes may be successfully put in place elsewhere around the world to support NQPs. A later article will consider the impact of this scheme on recruitment and retention of allied health professionals in rural areas of NHS Scotland.
Practice development efforts impact on mental health rehabilitation: results-based health care implications
Authors: Lee Sun Wook , Forsyth Kirsty , Melton Jane , Kielhofner Gary , Taylor Renee R.
Published: May 2014

Aim: The central aim of this study was to measure the extent of utilization of the Model of Human Occupation (MOHO) according to an existing conceptual framework ( Melton et al, 2010 ) and to examine whether professional development efforts aimed to support the use of this model were associated with a higher degree of incorporation of this model into everyday practice. 4secondary aim was to determine whether certain pre-identified contextual and personal variables influenced the use of MOHO in everyday mental health practice.

Methods: The authors solicited participation from 429 occupational therapy practitioners from six NHS mental health trusts in England using an online survey method and 262 (61.1%) responded.

Findings: A vast majority (92.1%) of the respondents indicated that they used MOHO as a primary treatment approach. Moreover, therapist participation in professional development efforts aimed to increase MOHO use were associated with higher levels of MOHO use, and the extent of MOHO use was associated with positive client (r=0.33, P<0.01), and professional outcomes (r=0.31, P<0.01 and r=0.33, P<0.01). Characteristics of the immediate team context and personal characteristics were linked to the extent of MOHO use among practitioners (r=0.30, P<0.01). Similarly, causal mechanisms that involve MOHO use in building confidence, finding flow, constructing know-how, accumulating reward, conferring with others, and channeling time were also linked with the extent of MOHO use among practitioners (r=0.55, P<0.01).

Conclusion: Findings suggest that there may be a significant payoff for professional development efforts that aim to support client-centered, occupation-focused approaches to mental health rehabilitation practice.
Explanatory case study design: application in paediatric burns health services research
Authors: Simons Megan , Ziviani Jenny , Copley Jodie
Published: May 2014

Background:

Explanatory case study design offers a way to address complex research issues; however its application in health arenas has been limited.

Contents:

This article describes the application of explanatory case study design when investigating complex, multifactorial phenomena in a clinical setting. To provide an example, this article shows a case where it was applied to the investigation of functional outcome following burn injury in children, within the real-life contexts of hospital, home, and school.

Conclusions:

Strategies implemented to maintain quality and rigour of the research design, whilst responding to the inherent difficulties of working in a clinical setting, are outlined. A summary model of the implementation of explanatory case design is presented to provide a benchmark against which this methodology, as applied in health research, can be appraised.
Associated movement reduction training for children with developmental coordination disorder: a pilot trial
Authors: Miyahara Motohide , Schreiber Natalie Ginther , Green Clare
Published: May 2014

Aims:

Associated movements (AMs) are an indicator of poor movement quality, and are prevalent in children with motor impairment. The ability of children to inhibit AMs has been demonstrated in the hands, but the possibility of reducing AMs that involve both the upper and lower limbs has not been investigated. The aims of this study were to explore the possibility of reducing the AMs and to examine if the reduction of the AMs impacts on locomotion.

Methods:

An AM reduction intervention under stress gait conditions was piloted in nine children with developmental coordination disorder. A single-case alternating treatment design was used to evaluate the intervention effects of AM reduction training (experimental treatment) and strength training (control treatment) on the AMs under stress gait and running form, over a period of six months.

Findings:

Visual inspection of individual time-series plots from four children with intact data revealed a reduction of AMs, but the effect was temporary in two cases. The reduction of AMs did not coincide with the improvement of running form.

Conclusions:

This study highlighted the possibility of reducing AMs under stress gait, and indicated that the reduction of AMs did not improve the movement quality of running form.