bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative exploration of patients’ experiences of music therapy in an inpatient hospice in Singapore
Authors: Leow Qi He Mabel , Blair Drury Vicki , Poon Wing Hong
Published: May 2014

Aim: This article reports on a study of terminally ill patients’ experiences with music therapy in a Singapore inpatient hospice. The study aimed to explore the experiences, expectations, and perceptions of the patients toward music therapy. Background: Music therapy is often used as a complementary therapy in hospice settings to allow for a more holistic care. Despite clinical observations on the effectiveness of music therapy, there has been a lack of formal research in the Asian setting concerning the experience of patients using music in a palliative care setting. Methods: A qualitative approach using Burnard’s thematic analysis method was used. Five adult patients from an inpatient hospice who were able to speak either English or Mandarin, and who had undergone at least one music therapy session with a qualified music therapist participated in individual face-to-face interviews. Results: Four themes emerged from the study. ‘Mirror of the inner feelings’ described how music acts as a mirror to reflect positive feelings, and deflect negative feelings. ‘Bridge of connection’ explained how music therapy acts as a bridge to facilitate connection to the inner self. ‘Music as a therapeutic medium’ identified how music acted as a therapeutic medium during music therapy. Lastly, ‘barriers to music therapy’ represented the various barriers to using music therapy. Conclusion: Music therapy is able to provide for the physical, psychological, and social needs of the terminally ill patient. It may be beneficial to promote the use of music therapy in the hospice setting.
Medical error in the hospice setting: exploring the perspectives of management staff
Authors: Sirriyeh Reema , Lawton Rebecca , Gardner Peter , Armitage Gerry
Published: May 2014

This study explores the experiences of health professionals in managerial roles at various levels in child and adult hospice care in northern England, studying perspectives around managing medical error, the issues that arise, and the challenges faced. A multicentred, descriptive, exploratory design was adopted. The sample comprised 10 hospice managers (five deputy and five senior managers) from four hospices (two adult and two children's) in the north of England. Participants took part in individual semi-structured interviews, which lasted between 45–60 minutes each. Interviews were transcribed and analysed by a team of three researchers, including two health psychologists and one nurse using a qualitative analytic framework. Emerging themes appeared to be inter-related and were ultimately linked to two meta-concepts; underpinning and fundamental to the data, these issues were intrinsically tied to all emerging themes. Primary themes were defined by their explanatory power and regularity. Primary themes highlighted the impact of managing error on management teams at a professional and personal level, the challenges for error management in hospice settings, the use of error management tools, and the conceptualization of blame in these settings. The strong influence of the health-care setting in which an error takes place on the outcomes of an error event for the health professional, managers, health-care organizations, and ultimately patients was evident.
Living with suffering as voiced by Thai patients with terminal advanced cancer
Authors: Nilmanat Kittikorn , Chailungka Pachariya , Phungrassami Temsak , Promnoi Chantra , Tulathamkit Kandawasri , Noo-urai Prachuap , Phattaranavig Sasiwimon
Published: May 2014

Cancer is a leading cause of death in Thailand. Thai cancer patients often seek medical treatment while in advanced stages of the disease. This longitudinal qualitative study aimed to describe the suffering that patients with terminal advanced cancer experience in their everyday life. A series of interviews were conducted and patient observation performed with 15 patients with terminal advanced cancer. Thematic analysis was applied and the overriding theme of the end-of-life experiences was living with suffering. Five inter-related sub-themes regarding the experience of suffering were identified in the informants' accounts, including physical symptom distress, feeling of alienation, sense of worthlessness, sense of burden to others, and desire for hastened death. The findings of this study can be of value for health professionals in cancer care in Thailand. Comprehensive end-of-life care programmes are needed to alleviate suffering in this group of patients.
Expanding palliative care nursing education in California: the ELNEC Geriatric project
Authors: Kelly Kathe , Thrane Susan , Virani Rose , Ferrell Betty , Malloy Pam
Published: May 2014

In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a ‘good death’ through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric ‘train-the-trainer’ project was launched in 2007 to increase the knowledge and educational skills of nurses and unlicensed staff providing end-of-life care for older adults in nursing homes, skilled nursing facilities, long-term care, and hospices. From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum.
Palliative care clinical trials: how nurses are contributing to integrated, evidence-based care
Authors: Hosie A , Fazekas B , Shelby-James T , Mills E , Byfieldt N , Margitanovic V , Hunt J , Phillips J
Published: May 2014

The aim of this paper is to describe the emerging role of the palliative care clinical trials nurse in an era of evidence-based practice and increasing clinical trial activity in palliative care settings across Australia. An overview of the current clinical trials work is provided, with a focus on three aspects of clinical trials nursing practice that have significant implications for patients: managing the consent process, integrating clinical trials into multidisciplinary care, and establishing and building the evidence base to inform practice in palliative care settings. Clinical trials roles provide palliative care nurses with an opportunity to contribute to clinical research, help expand palliative care's evidence base, and develop their own research capabilities.
An Exploration of the Concerns of Patients with Inoperable Lung Cancer
Authors: Dale Moira J , Johnston Bridget
Published: May 2014

Appraisal of the literature suggests that patients with lung cancer report more unmet supportive care needs and greater psychological distress than patients with other cancers. This study aimed to explore the concerns of patients with inoperable lung cancer and to interpret those concerns to inform specialist palliative care nursing practice. A descriptive qualitative study was undertaken using semi-structured interviews with six participants on a single site. Three main themes were identified: steadfastly living life, family support and separation, and trust in professionals. The latter is crucial for enabling patients to express their concerns, which in turn allows support to be directed appropriately and from a patient-centred perspective.
Palliative care nursing in rural and urban community settings: a comparative analysis
Authors: Kaasalainen Sharon , Brazil Kevin , Willison Kathleen , Marshall Denise , Taniguchi Alan , Williams Allison , Wilson Donna M
Published: May 2014

Nurses have key roles in the coordination and delivery of community-based palliative care. The purpose of this study was to examine the differences between rural and urban community nurses’ delivery of palliative care services. A survey was distributed to 277 nurses employed by a community agency in Ontario, Canada, and a 60% response rate was obtained. Nurses reported spending 27% of their time providing palliative care. Rural and urban nurses had similar roles in palliative care but rural nurses spent more time travelling and were more confident in their ability to provide palliative care. Both groups of nurses reported moderate job satisfaction and moderate satisfaction with the level of interdisciplinary collaboration in their practice. Several barriers to and facilitators of optimal palliative care provision were identified. The study results provide information about the needs of nurses that practise in these settings and may provide a basis for the development of strategies to address these needs.
Student nurses' Experience of their first Death in Clinical Practice
Authors: Parry Maria
Published: May 2014

Background: It is important to understand how student nurses might feel when confronted with a dying patient, so that appropriate support and education can be offered prior to their placement. This paper aimed to explore student nurses’ experiences of their first death in clinical practice to help identify educational, training, and support needs. Methodology: A qualitative phenomenological approach was adopted and data was collected using a focus group involving five student nurse participants. Findings: The data analysis revealed four themes: the emotional influence of death, skills required, the role of the mentor, and relationships. The students’ experiences of their first death in clinical practice caused them considerable anxiety, and they reported feeling inadequately prepared for the reality of the situation. Conclusions: Educationalists and clinicians alike should give much consideration to finding teaching and learning methods that are appropriate to this challenging subject and that more effectively prepare students for what they might encounter.
Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life
Authors: Johnston Bridget , Östlund Ulrika , Brown Hilary
Published: May 2014

Background:

People nearing the end of life fear loss of dignity, and a central tenet of palliative care is to help people die with dignity. The Dignity Care Pathway (DCP) is an intervention based on the Chochinov theoretical model of dignity care. It has four sections: a manual, a Patient Dignity Inventory, reflective questions, and care actions.

Method:

The feasibility and acceptability of the DCP were evaluated using a qualitative design with a purposive sample of community nurses. Data was collected from April to October 2010 using in-depth interviews, reflective diaries, and case studies and then analysed using framework analysis.

Results:

The DCP was acceptable to the community nurses, helped them identify when patients were at the end of life, identified patients' key concerns, and aided nurses in providing holistic end-of-life care. It requires the nurse to have excellent communication skills. Some of the nurses found it hard to initiate a conversation on dignity-conserving care.

Conclusion:

The DCP helps nurses to deliver individualised care and psychological care, which has previously been identified as a difficult area for community nurses. All of the nurses wished to continue to use the DCP and would recommend it to others.
Is work stress in palliative care nurses a cause for concern? A literature review
Authors: Peters Louise , Cant Robyn , Sellick Kenneth , O’Connor Margaret , Lee Susan , Burney Sue , Karimi Leila
Published: May 2014

Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines.

Aim:

The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses.

Results:

Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress.

Conclusion:

Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.
Evaluation of an admission and discharge programme at a UK specialist palliative day hospice
Authors: Vries Kay de , Wells Joanne , Plaskota Marek
Published: May 2014

This paper reports on a system of managing admissions and discharges from a specialist palliative day hospice (SPDH) in the south of England. SPDH is a well established component of palliative care provision in the UK, but studies have rarely addressed issues around admission and discharge. Case study methodology was used to evaluate the programme. Interviews were conducted with five patients who had attended the day hospice, taken a break or been discharged and returned; their carer(s); the key worker from the day hospice; and any other health professional who was involved in the patient's care during the admission. Communication issues were found within the team regarding referral and discharge processes, documentation of care, decision making, and information giving. Family members did not feel involved in decision making in relation to the programme. The most significant finding was the emotional and psychological impact on the patients of taking the break. Discharge from SPDH is known to be a difficult and sensitive issue, especially when patients are living with life-limiting illnesses that can change quickly. The patients in this study all had some form of dependency on the service and four of the five would have chosen to continue attending if they could. They experienced deterioration in psychological and physical wellbeing during the period in which they did not attend.
Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing
Authors: Tunnah Karen , Jones Angela , Johnstone Rosalynde
Published: May 2014

The literature has evaluated studies of hospice nurses and stress but very few studies have focused on community hospice nurses. This study explored hospice at home nurses’ experiences of caring for palliative and dying patients. Hospice at home nurses working in the community across North West Wales were interviewed and a grounded theory approach was used to categorise the data into the following themes: job satisfaction, stressors, coping strategies, and support. Recommendations arising from the study include encouraging the use of clinical supervision, attendance at multidisciplinary meetings, and the provision of stress-awareness training, and raising awareness of the role of hospice at home nurses in primary care. Implementation of these recommendations might be beneficial for staff wellbeing. Further work would identify whether such recommendations can help to prevent sickness and promote staff retention.
Discussing preferred place of death with patients: staff experiences in a UK specialist palliative care setting
Authors: Fields Anna , Finucane Anne M , Oxenham David
Published: May 2014

Background: National end-of-life care policies propose that health professionals regularly discuss matters such as preferred place of death (PPD) with patients.

Aim: To explore clinician experiences of discussing PPD with palliative care patients.

Method: Six clinicians from a Scottish hospice each participated in a semi-structured interview. Interview data was analysed using interpretative phenomenological analysis.

Results: Four themes were integral to the participants’ accounts: the importance of discussing preferences at the end of life (staff recognise the value of discussing patients’ final wishes), identifying how and when to discuss PPD (discussions are tailored to the individual), reflecting on the emotional aspects of discussing PPD (discussing PPD is challenging but rewarding), and a journey from expectations to experience (discussing PPD becomes easier with time).

Conclusion: Although potentially difficult, the participants believed that advance care planning is important and beneficial. With time, they had developed communication strategies enabling them to discuss PPD in an effective, patient-centred way.
Nurses' experiences caring for patients and families dealing with malignant bowel obstruction
Authors: Daines Patricia , Stilos Kalli , Moura Shari , Fitch Margaret , McAndrew Alison , Gill Ashlinder , Wright Frances
Published: May 2014

Malignant bowel obstruction (MBO) is a well-recognised complication of advanced abdominal and pelvic cancers. Often surgical intervention is not feasible, resulting in complex symptoms and an unpredictable course. Although symptom management is a crucial part of nursing care, psychosocial and emotional issues frequently emerge for patients and families. This qualitative study explored the perspectives of nurses from a palliative care unit, in-patient acute care oncology units, ambulatory cancer setting, and the community on their experiences of caring for patients with MBO and their families. Six individual interviews and two focus groups were conducted. Eight overarching messages were identified related to nurses' experiences. Highlights include aspects of patients' and families' emotional distress, and the nurse–patient relationship in relieving suffering. Nurses have an important and privileged role that involves identifying MBO signs and symptoms, having knowledge of treatment and symptom management options, and helping patients transition from a curative to a palliative philosophy of care.
Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients
Authors: Strang Susann , Bergh Ingrid , Ek Kristina , Hammarlund Kina , Westin Lars , Prahl Charlotte , Österlind Jane , Henoch Ingela
Published: May 2014

Aim:

To describe nursing students' reasoning about emotionally demanding questions concerning the care of dying patients.

Methods:

The Frommelt Attitude Toward Care of the Dying (FATCOD) Scale was completed by students at the beginning of their education, and there was great variation in the responses to five items. At a follow-up measurement in the second year, an open-ended question, ‘How did you reason when completing this question?’, was added to each of the these five items. Qualitative content analysis was used to analyse the responses.

Results:

Of 140 students who completed the FATCOD, 111 provided free-text responses. The analysis of these responses revealed three themes: death perceptions, the students' understanding of their current situation, and the nurse's responsibility.

Conclusion:

This study provides useful information on students' reasoning about emotionally demanding questions relating to the care of dying patients. Such knowledge is valuable in helping students to overcome their fear and fulfil their expectations concerning their future proficiency.
Effect of training on health and functional status in older adults with intellectual disability
Authors: Carmeli Eli , Merrick Joav , Berner Yitshal N
Published: May 2014

Policy makers and the welfare system need to respond to the unique needs and expectations of ageing people with a lifelong intellectual disability (ID). Lack of physical activity, along with functional decline, may result in falls – yet little attention has been paid to the balance capability of older adults with ID.

A total of 27 participants, chosen from a sample of foster home residents in Haifa, Israel, were assigned to two groups for this study: group A underwent a 6-month balance training programme and group B underwent a 6-month muscle strengthening programme. The evaluation procedures included the short-form health survey questionnaire, a physical performance test and a functional reach test. The results showed improvements in function between baseline tests and post-training programme tests in both groups, yet group A demonstrated a more significant improvement in balance capability and general health.
Screening long-stay psychiatric patients for risk factors for coronary heart disease
Authors: Haw Camilla , Merriman Sheila , Kirk Judy , Stubbs Jean
Published: May 2014

The aim of this study was to screen long-stay psychiatric patients for risk factors for coronary heart disease. Participants were interviewed individually and had anthropometric and physiological measurements and blood samples taken.

Of the 64 participants, 21 (33%) were overweight and a further 25 (39%) obese. Of those interviewed (n=47), 34 (72%) were current smokers. In total, 44% of those sampled (n=57) had a raised screening blood pressure, 9% of those sampled (n=34) had an elevated serum cholesterol and in 17% of those sampled (n=53), electrocardiogram abnormalities consistent with coronary heart disease or hypertension were present. Risk factors for coronary heart disease were more common in this population of chronically and severely mentally ill inpatients than in the general population. These patients need careful ongoing monitoring and measures aimed at coronary heart disease risk reduction.
Using a complexity model of human behaviour to help interprofessional clinical reasoning
Authors: Stephenson Richard C
Published: May 2014

Within health settings, there is increasing recognition that interprofessional education and practice are essential components of effective therapy and rehabilitation. Interprofessional clinical reasoning, using cognitive mapping, has previously been promoted as a means of exploring theory and practice. However, this may be confounded by adherence to traditional professional models that conceptualize behaviour in mutually exclusive ways.

This article offers complexity theory as an appropriate model for understanding client behaviour and for solving a problem. Behaviour is the result of weighted influences, where the weighting is variable depending on experience and the success of previous behaviours. No assumed priority is given to any aspect of behaviour and interprofessional reasoning is explored as each profession makes explicit the knowledge and practice base used to understand the weighting of each influence. All evidence can be considered, embracing different research models and professional reasoning, promoting reasoning based on the strength of evidence without an assumed hierarchy of information.
Transcultural health care: what a rehabilitation practitioner needs to know
Authors: Qureshi Bashir
Published: May 2014

In Britain, the government’s population census 2001 has confirmed the legal classification of all British citizens. Ethnically, they are grouped as: White; Mixed; Asian or Asian British; Black or Black British; Chinese or Chinese British; or Other. The different religious and secular categories include Christian, Buddhist, Hindu, Jew, Muslim and Sikh. Moreover, the UK’s four countries – England, Scotland, Wales and Northern Ireland – each have autonomy for internal affairs.
Bathing and showering equipment for children: A guide
Authors: Hong Chia Swee , Wheble Jane , Jarvis Sue
Published: May 2014

Bathing is a pleasant experience for most children. Supportive equipment is needed for some children with disabilities to enable them to be more independent with bathing. Careful assessment is essential to ensure the provision of the most appropriate bathing and showering equipment. There is a range of bathing and showering equipment available to meet the needs of most children with disabilities.

This article explores the basic process in assessing a child for appropriate equipment and provides an overview of some of the available bathing and showering equipment.
The Ibis XP tilt-in-space powered wheelchair: A review
Authors: Collins Fiona
Published: May 2014

Trying to find the most appropriate wheelchair to meet the individual needs of a large and often diverse client group can be a challenge for therapists. This is particularly so in the case of wheelchair users whose functional ability and sitting stability deteriorates over a period of time. Continuing to meet a changing need can be time consuming and expensive. As a result, the client may have to wait some time before his or her needs are met, particularly if funding is limited or if therapists are scarce on the ground. Consequently, a ‘catch up’ becomes the order of the day: the client's condition changes, the therapist visits, modifications are agreed, but by the time they are implemented they are no longer appropriate for the client, whose needs have further deteriorated. Fundamentally, many clients therefore never have their needs met adequately.

A number of factors need to be considered when prescribing suitable wheelchairs, such as the diagnosis or disability of the user, his/her projected long-term needs, functional ability, size and sitting ability. The Ibis XP from Movingpeople.net is a compact powered tilt-in-space wheelchair that is multi-adjustable – an endless range of combinations, all from one frame size. In addition to the single frame design, a range of accessories can be purchased either at the time of the prescription or subsequently, in order to customize the chair to the needs of the user as and when these change.
A UK national framework for support worker education and development
Authors: Everett Tina , O'Siochru Mairead , McPherson Karen
Published: May 2014

The role of the support worker is developing rapidly in the current political climate and support workers' boundaries of clinical practice are expanding. Many are now working across the therapy professions, in the public, private and voluntary sectors, and a number of support workers in the NHS are obtaining ‘assistant practitioner’ status (Standing Conference of English WDC Chief Executives, 2003).
Do patients' expectations of physiotherapy affect treatment outcome? Part 2: Survey results
Authors: Metcalfe Caroline J , Klaber Moffett Jennifer A
Published: May 2014

The literature suggests that patients' expectations of benefit can affect the outcome of health, although little research of this subject in physiotherapy has been carried out. Previous research has found that there are many pre-treatment variables that may confound the effect that expectations have on the outcome of treatment. This article examines the relationship between patients' expectations of benefit and the outcome of physiotherapy.

Before-and-after postal questionnaire surveys were completed by 285 patients referred for musculoskeletal outpatient physiotherapy for a peripheral joint problem. The results showed that higher expectations of benefit were related to greater change in functional disability and health status, and more perceived improvement. Other variables of importance were age and baseline functional disability.

This research suggests that the strength of patients' expectations of benefit is related to the outcome of physiotherapy. Physiotherapists may be able enhance treatment outcome by raising expectations. However, further research is needed to determine whether, and by what means, patients' expectations can be altered to improve the outcome of physiotherapy.
Horsemastership part 2: Physical, psychological, educational and social benefits
Authors: Young Rhona Lee , Bracher Maggie
Published: May 2014

The therapeutic benefits of the horse to humans have existed for years. Although early findings on the benefits of the horse as a therapeutic medium exist, the first scientific inquiry into the therapeutic usefulness of the horse did not take place until the mid-19th century. Even today, the literature existing on the benefits of horsemastership is lacking.

In a previous article, the components of horsemastership were discussed from a therapeutic perspective and the skills and knowledge of the occupational therapist were applied to highlight the potential the occupational therapy profession has to offer this developing field. In this article, the benefits of horsemastership as a therapeutic medium will be discussed and related to the practice of the Fortune Centre of Riding Therapy. The contraindications and precautions of horsemastership are also highlighted and discussed.
Living with Parkinson's disease: The carer's perspective
Authors: Mott Sarah , Kenrick Marita , Dixon Miriam , Bird Graham
Published: May 2014

The objective of this study was to explore the experience of caring for a person with Parkinson's disease. The study looked at health and psychosocial outcomes of caring and access to and perceived understanding of health professionals and support services.

A 34-item survey was administered to a convenience sample of carers of people with Parkinson's disease obtained through Parkinson's New South Wales Inc., an Australian state-based non-profit community organization. In total, 303 responses were received from primary caregivers. Female carers reported higher levels of psychosocial sequelae as a result of caring for a person with Parkinson's disease than male respondents. Despite a range of support services available, carers did not widely avail themselves of these.

In conclusion, caring for a person with Parkinson's disease is a complex undertaking. While the person with Parkinson's disease requires ongoing support, the needs of the carer must not be underestimated or ignored.
Development of a patient handling assessment tool
Authors: Hignett Sue , Crumpton Emma
Published: May 2014

This article describes the development and validation of the Patient Handling Organizational Question Set (PHOQS). A safety culture framework for patient handling was recommended by the Royal College of Nursing after a consultation process with a wide range of stakeholders. The recommendations are provided as three levels of competency for back care advisors, manual handling supervisors (such as ward managers) and individual nurses.

The PHOQS was developed in consultation with health and safety executive inspectors as an audit tool. In total, 16 health-care organizations participated in the validation process by providing documentary evidence and observational and interview data. The findings from the project suggest that competency-based training does influence the safety culture (physical and cognitive) behaviour of nurses in patient handling tasks.
Using mastery learning to develop patient handling skills in occupational therapy students
Authors: Wise Marina , Iris Vardi
Published: May 2014

Allied health educators have a responsibility to produce graduates who possess the knowledge, skills and confidence necessary to perform core clinical skills. The patient handling skills of occupational therapy students have been questioned by some occupational therapy practitioners and in response, a teaching method based on mastery learning was trialed and evaluated, with the aim of improving this set of core clinical skills.

Using the mastery learning approach, students were required to work in groups under the guidance of their tutor to develop skills in 20 selected patient handling tasks. Students were examined against set criteria for each patient handling task assessed. Upon completion of the study, students participated in a focus group and provided feedback about their learning experience to an educational consultant via a questionnaire. The results showed that the mastery learning approach, as practised in this unit of study, was successful in facilitating the students' achievement of the educational outcomes related to patient handling.
Pulsed electromagnetic field therapy and osteoarthritis of the knee: Synthesis of the literature
Authors: Marks R , van Nguyen J
Published: May 2014

Knee joint osteoarthritis is a painful disorder, often resulting in progressive functional impairment and disability. One modality used in the treatment of knee osteoarthritis is pulsed electromagnetic field therapy. This article examines the evidence base that details the rationale for and the outcomes of applying pulsed electromagnetic fields to the osteoarthritic knee joint.

The related English language literature was reviewed to examine whether pulsed electromagnetic fields applied to an osteoarthritic knee joint are likely to be efficacious, and if so why. Although limitations to the published literature on this topic exist, the available basic and seven randomized clinical research studies in this field support the value of continuing to explore the potential of applying pulsed electromagnetic fields to ameliorate pain and dysfunction associated with the osteoarthritic knee joint.

Further clinical research to validate the use of pulsed electromagnetic fields in lessening osteoarthritic knee joint pain and facilitating function and joint repair is indicated.
Evaluation of a moulded handle walking aid for older people with non-arthritic hands
Authors: Marston Adrian , Brookes Elaine
Published: May 2014

This study aims to assesses whether the use of an ergonomic moulded handle stick can have a holistic effect on the health and lifestyle of an older person with non-arthritic hands. Moulded handles are ergonomically designed for comfort and allow the pressure to be spread evenly across the palm of the hand. The authors also aim to provide evidence for issuing or not issuing a moulded handle stick, rather than a conventional stick, for those therapists who wish to take a patient-centred approach and move away from the traditional practice of prescribing a walking aid solely based on the patient's physical ondition.

A convenience sample of six volunteers was used, all conventional stick users of more than 3 months (mean age 81 years). Participants were individually taught how to use their new moulded handle stick. The evaluation period was approximately 2 weeks, after which recorded face-to-face individual semi-structured interviews took place.

Analysis from the interview transcripts revealed a core variable of self-efficacy, with significant improvement in confidence and a reduced fear of falling during ambulation. This study provides evidence to suggest there are holistic health benefits, associated with increased self-efficacy during mobility, in issuing moulded handle sticks to older patients with non-arthritic hands. Further research of a quantitative nature is needed to infer statistical significance.
Changing practice speciality in occupational therapy: Exploring the experience. Part one
Authors: Richardson Jennifer , Rugg Sue
Published: May 2014

Official sources report an ongoing shortage of occupational therapists in the UK. Despite this, the career behaviours of senior occupational therapists have gone largely un-researched to date. This twopart article explores one aspect of this field; namely such therapists' experience of changing practice specialities. Having used this process as a retention strategy earlier in her career, the first author questioned whether other occupational therapists were acting in the same way.

In this, the first part of this article, the authors outline the background to this area, exploring research on practice speciality choice, career transition, retention and attrition in a variety of healthcare disciplines, including occupational therapy. This material shows that, while individuals' experience of changing practice speciality necessarily varies, the reasons given are broadly personal, professional and/or organizational in nature.

The authors used the material reviewed as the basis for an interview-based qualitative study of 10 senior I/II occupational therapists who had changed practice specialities within the previous decade. The methods used to explore this area, the findings from the study conducted and the implications of these results for occupational therapy practice, are detailed in part two of this article.
Changing practice speciality in occupational therapy: Exploring the experience. Part two
Authors: Richardson Jennifer , Rugg Sue
Published: May 2014

Despite an ongoing shortage of occupational therapists in the UK, the career behaviours of senior occupational therapists are under-researched. This article explores Senior occupational therapists' experience of changing practice specialities as a potential retention strategy. The background to this area was considered in part one of this article.

In the second part of this article, the authors detail an interview-based qualitative study conducted with 10 Senior I/II occupational therapists who had changed practice specialities within the previous decade. Thematic analysis of the study data led to the emergence of five inter-related study categories. These reflected participants' reasons for changing practice speciality, the practical steps taken, the elements that made changing easier or more difficult and the resulting effects. A model of the process of changing practice speciality was derived from these data. This saw participants as influenced by a range of personal, professional and organizational elements. These, in turn, influenced the practical steps taken to effect change.

Reported outcomes included increased job satisfaction and retention within the profession. These findings suggest that changing practice speciality can improve recruitment and retention among Senior occupational therapists, to the benefit of all concerned.
Research governance, not research ‘smotherance’
Authors: Corr Susan , Beaulieu Karen , Griffiths Sue
Published: May 2014

The UK Department of Health guidelines introduced in March 2001 aimed to improve research quality and safeguard the public by enhancing the ethical and scientific quality of research. It also aimed to promote good practice, reducing adverse incidents, ensuring that lessons would be learnt and preventing poor performance and misconduct. This framework applies to all within health and social care who participate in research and those who host, fund, manage and undertake research.
A review of paediatric occupational therapy university curricula in South Africa: Part two
Authors: Brown G Ted , Brown Anita , Roever Carsten
Published: May 2014

This is the second article of a study of the paediatric content of undergraduate and entry-level postgraduate occupational therapy university programmes in South Africa. Current best practices in paediatric occupational therapy were examined through a literature review, which is presented in part one. This second article reports the results of the survey that examined the paediatric theoretical models, assessment tools and interventions taught by the eight universities in South Africa that offer occupational therapy programmes. Six faculties responded to the electronic survey, yielding a response rate of 75%.

On average, paediatrics constituted 21.5% of the total South African occupational therapy curricula. The most commonly taught theoretical models were Erikson's Eight Stages of Psychosocial Development, neurodevelopmental therapy and the Model of Human Occupation. There was a deficit in curricular programming with regard to perceptual motor theory. The Developmental Test of Visual-Motor Integration, Goodenough-Harris Drawing Test and the Test of Visual Perceptual Skills (non-motor) were among the most widely taught assessments. All six university programmes incorporated health promotion and disease prevention into their syllabuses. Therefore, occupational therapy students in South Africa receive a broad and varied education with regard to paediatrics.
Long-term effects of static positional stretches of the patient's stroke-affected shoulder
Authors: Gustafsson Louise , McKenna Kryss
Published: May 2014

The purpose of this randomized controlled trial was to investigate the 6-month follow-up effects of an inpatient management programme for the stroke-affected shoulder. The programme included twice daily 30-min static positional stretches of the stroke-affected shoulder and positioning of the stroke-affected upper limb using an armrest support at all other times. In total, 32 participants (17 treatment group and 15 comparison group) were recruited from an inpatient stroke rehabilitation unit. Dependent variables, including pain-free range of motion into external rotation, hemiplegic shoulder pain, motor recovery and functional independence, were measured at admission to rehabilitation, discharge from rehabilitation and at 6 months after discharge. Analysis of data was completed using linear mixed models.

There were no statistically significant differences between the two groups from discharge to follow-up. Clinically important differences were identified in favour of the comparison group with respect to all dependent variables. The results of this study question the effectiveness of the inpatient management programme and highlight adverse long-term effects. Further research is required to investigate how soft tissue length of the stroke-affected shoulder can be maintained and to investigate possible explanations for the results.
Occupational balance: The relationship between daily occupations and wellbeing
Authors: Douglas Fiona M
Published: May 2014

Working in a university, as part of the occupational therapy programme team, it seems that occupational therapy students, in common with other students, live at a hectic pace. Studying, part-time work, being a partner or parenting all compete for the same amount of time and energy.
Ankle joint dorsiflexion: Assessment of true values necessary for normal gait
Authors: Weir John , Chockalingam Nachiappan
Published: May 2014

Motion of a reduced quantity has been referred to as 'equinus' and the widely accepted theory is that when equinus is present, an abnormal foot function occurs. For normal foot function and human ambulation the amount of ankle joint dorsiflexion required is claimed to be 10 degrees. The main purpose of this study was to determine and investigate this arbitrary figure of 10 degrees.

Fourteen normal adult subjects with a normal range of motion at the ankle joint and no known gait abnormalities took part in the study. Predetermined suitable anatomical landmarks were marked by reflective skin markers. Data was collected at a frequency of 120Hz using a three-dimensional opto electronic motion analysis system and the three-dimensional co-ordinates were smoothed using a Butterworth filter (Fc = 7Hz) and analysed. All foot angles were expressed relative to the sub talar neutral position and were expressed as joint co-ordinate system (JCS) angles.

Results indicated a ankle joint dorsiflexion value of between 12 and 22 degrees with a wide variation between subjects (Coefficient of Multiple correlation (CMC) values 0.723–0.992).

The results appear to show ankle joint dorsiflexion in normal subjects is greater than the value traditionally espoused by clinicians for walking. This is as a result of the anatomical basis on which measurements are currently made. Although, this may have clinical implications in terms of orthotic prescriptions, more research is needed to determine the effect of terrain, footwear and muscle length on the measurements.
Intermediate care: An occupational therapy perspective
Authors: Grant Mary , Ward Gill , Dring Paula , Booth Julie , Jacob-Lloyd Hilary , Steed Anita , Hibberd Jane
Published: May 2014

This study aimed to examine the involvement of occupational therapists in the development of intermediate care services in England. A non-experimental survey design was employed and a postal questionnaire was sent to 414 members of the specialist section of the College of Occupational Therapists: Older People. Quantitative and qualitative data from the 159 respondents was analysed using descriptive statistics and content analysis respectively.

Results indicate that the occupational therapists in this study were heavily involved in the development of intermediate care services. This included the creation and monitoring of integrated equipment stores and in the extension of their role to include intermediate care coordination. Intermediate care provision for older people with mental health problems was seen to be an area requiring further development. The National Service Framework for older people continues to provide opportunities for occupational therapists working to further develop and shape services for this growing sector of society.
Neuroplasticity and learning lead a new era in stroke rehabiliation
Authors: Carey Leeanne
Published: May 2014

Novel insights into how the brain adapts with recovery and experience, together with advances in learning theory, provide a strong foundation for the development of rehabilitation approaches that aim to restore lost capacity and improve clinical outcome following stroke. The value of rehabilitation and need to adopt rehabilitation methods based on clinical and basic science has intensified over the past decade (Selzer et al, 2006). As therapists we need to contribute to this knowledge and adopt more restorative, learning-based approaches to intervention.
Assessment of dependence on assistive ambulatory devices among older adults: A new tool
Authors: Liu Hao , Zabel Reta , Prati Victor
Published: May 2014

The use of an assistive ambulatory device (AAD) such as a cane or walker may potentially be linked to a greater risk of falling. This study examined the test and re-test reliability of an instrument developed by the authors: the Ambulatory Device Dependence Efficacy Scale (ADDES), which assesses older institutionalized adults’ level of dependence on an AAD, with the aim of determining the relationship (if any) between AAD dependence and falling.

Thirty-five AAD users from two assistive living facilities qualified to participate in this study. The validity of the ADDES was evaluated by three experienced physical therapists working in geriatric settings. The test reliability of the ADDES and how it related to history of falling were also assessed and analysed. This study found the ADDES scale to be highly reliable in testing how dependent an AAD user is on his/her AAD during walking. Findings showed that dependence on an AAD is positively correlated with the length of time it has been used. ADDES scores may indicate the level of falls risk, although a follow-up study is suggested to explore this relationship further.
Introduction to the use of Rasch analysis to assess patient performance
Authors: McAllister Sue
Published: May 2014

Background: Rasch analysis is a statistical model used to develop assessment tools to effectively measure change in human attributes. It has a number of advantages compared to other statistical approaches; the most important of these is that it enables the development of assessments that more accurately quantify patient performance.

Content: This article will discuss issues of measurement in rehabilitation, describe the advantages of Rasch analysis and illustrate these with examples from the rehabilitation literature.

Discussion and conclusions: An understanding of Rasch analysis will assist clinicians to make informed decisions about selection of assessment tools that will provide the most accurate measurement of their patient’s performance and better support decision making regarding patient eligibility, progress and discharge. This information will also assist clinicians in critically analysing research evidence where assessment tools are used to generate data for comparative analysis.