• Obtaining Informed Consent in an Egyptian Research Study

      Rashad, A.M.; MacVane Phipps, Fiona E.; Haith-Cooper, Melanie (2004)
      This article explores the concept of internationally acceptable codes of ethics within the context of an Egyptian nurse’s PhD studies. Theoretical work, including gaining ethical approval for the project, took place in the UK, while the data collection phase of the study was done in Egypt. This highlighted areas where the Arab Muslim interpretation of some ethical principles, especially around the issue of gaining informed consent, differed from that currently accepted in British research ethics. The authors argue that it may not be possible, or even desirable, to standardize codes of ethics globally in areas such as academic research. Ethical principles develop from a unique mix of culture and religion. It may be more important to develop cultural competence that includes the ability to understand and respect the way in which ethical principles are interpreted by various societies.
    • Occupational competence strategies in old age: a mixed-methods comparison between hispanic women with different levels of daily participation

      Orellano-Colon, E.M.; Mountain, Gail; Varas, N.; Labault, N. (2014-01)
      In this pilot study, we explored the difference in the use of occupational competence strategies for daily participation between more active and less active older Hispanic women. Twenty-nine women who were 70 and older and lived alone participated in this study. We used a mixed-methods design by which the principal investigator administered a tool to measure participation restrictions during the quantitative phase and conducted in-depth interviews with a subsample in the qualitative phase. More active women predominantly used transportation resources, emotional social support, and spirituality to support participation in life activities. Less active women used more practical social support, assistive technology, and environmental modifications. Personal facilitators seemed to directly modify these strategies. These results suggest that older women with different activity levels use distinct internal and external resources to maintain or enhance daily participation. Future studies should explore whether these resources remain consistent across gender, living status, and ethnicity.
    • Older Adults’ Uptake and Adherence to Exercise Classes: Instructors’ Perspectives.

      Hawley-Hague, H.; Horne, Maria; Skelton, D.A.; Todd, C. (2016)
      Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors’ experiences of delivering exercise classes to older adults. Semi-structured interviews, informed by the Theory of Planned Behaviour (TPB), were conducted with instructors (n=19) delivering multi-component exercise classes to establish their perspectives on older adults’ uptake and adherence to exercise classes. Analysis revealed ‘barriers’ related to identity, choice/control, cost, venue and ‘solutions’ including providing choice, relating exercise to identity, a personal touch and social support. ‘Barriers’ to adherence included unrealistic expectations and social influences and ‘solutions’ identified were encouraging commitment, creating social cohesion and an emphasis on achieving outcomes. Older adults’ attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults’ uptake and adherence to classes. Instructors’ perspectives help us to further understand how we can design successful exercise classes.
    • Older people's care experience in community and general hospitals: a comparative study

      Green, J.R.; Forster, A.; Young, J.; Small, Neil A.; Spink, Joanna (2008)
      Community hospitals are an important component of the post-acute care pathway for older people. The objective of this study was to describe and contrast patients' and carers' experiences of community and general hospitals. Interviews with patients and carers revealed similarities in the perceptions of care between the two settings. These included appreciation of staff sensitivity, a sense of security, encouragement of independence and lack of activity. The community hospital was appreciated for its location, atmosphere, accommodation, greater sense of freedom, quality of food and staff attitudes. UK health policy promotes the development of community hospitals. This should be progressed in a way that retains key strengths of the specific service they offer.
    • Older people's views of a good death in heart failure: implications for palliative care provision

      Gott, M.; Small, Neil A.; Barnes, S.; Payne, S.; Seamark, D. (2008)
      Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. That prevalent model is identified as the "revivalist" good death. Our findings indicate that older people's views of a 'good death' often conflict with the values upon which palliative care is predicated. For example, in line with previous research, many participants did not want an open awareness of death preceded by acknowledgement of the potential imminence of dying. Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.
    • Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery?

      Mountain, Gail; Gossage-Worrall, R.; Cattan, M.; Bowling, A. (2017)
      This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area.
    • Optimising diagnostics through imaging informatics: Costs and opportunities

      Culpan, Gary; McIntosh, Bryan (2017)
      Increasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging—encompassing a range of technologies including X-ray, CT, MRI, nuclear medicine and ultrasound—is a key diagnostic service and central to decision-making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3–5% of the annual NHS budget. As a result, it is imperative that we maximise service efficiency while optimising patient outcomes.
    • Optimising person-centred transitions in the dementia journey: A comparison of national dementia strategies.

      Fortinsky, R.H.; Downs, Murna G. (2014-04)
      The journey for people with Alzheimer’s disease or another dementia involves the need for increasing levels of support, with transitions across care settings. Although transitional care has received increasing attention in the health care arena, no widely accepted transitions typology exists for the dementia journey. At the same time, national dementia strategies are proliferating. We developed a typology containing six transitions that cover the dementia journey from symptom recognition to end-of-life care. We then critically evaluated whether and how the national dementia strategies of Australia, England, France, the Netherlands, Norway, Scotland, and the United States addressed each transition. Adopting a person-centered perspective, we found that most or all of the national strategies adequately address earlier transitions in the journey, but fewer strategies address the later transitions. We recommend that next-generation national dementia strategies focus on later transitions, specify how care coordination and workforce training should make transitions more person centered, and use person-centered outcomes in evaluating the success of the strategies’ implementation and dissemination.
    • Optimising productivity, quality and efficiency in community nursing.

      Holland, A.; McIntosh, Bryan (2012)
      By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.
    • Optimizing diagnostic imaging through skills mix: costs and opportunities

      McIntosh, Bryan; Hardy, Maryann (2017-06)
      Increasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging, encompassing a range of technologies including X-ray, Computer Tomography, Magnetic Resonance Imaging and ultrasound, is a key diagnostic service and central to decision making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3-5% of the annual NHS budget. As a result, it is imperative that we maximize service efficiency while optimizing patient outcomes.
    • Optimum positioning for anteroposterior pelvis radiography: A literature review

      Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018-09)
      Aim: Pelvic radiography is used for the identification of hip joint changes, including pathologies such as osteoarthritis. Several studies have recommended that the position for this radiological procedure should be standing, not supine, to reflect the functional appearances of the hip joint. The aim of this review was to evaluate pelvis radiography positioning with respect to the image appearances and information provided for clinical decision-making. Aside from this, potential recommendations to the radiographic technique for an erect pelvis projection will be considered. Method: A literature search was performed using databases/abstract systems (ScienceDirect, Web of Science, PubMed, and MEDLINE). Only articles written in English were included. Results: Twenty-five articles were identified. Findings from the review describe the effect of repositioning from supine to erect on a series of specific hip measurements. These include pelvic tilt, joint space width, and the acetabular component. Conclusion: Evidence within the literature illustrates that in several studies, there were differences when repositioning from supine to standing for a number of pelvic metrics. Standing positioning is promoted by some authors since this may facilitate the early diagnosis of hip joint pathology and assist in the planning of surgical interventions. Literature is very limited on how to optimally perform erect pelvis radiography, and this should be an area for future research.
    • Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed methods study.

      Horne, Maria; McCracken, G.; Walls, A.; Tyrrell, P.J.; Smith, C.J. (2015-03)
      Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.
    • Overcoming challenges of conducting research in nursing homes

      Jenkins, C.; Smythe, A.; Galant-Miecznikowska, M.; Bentham, P.; Oyebode, Jan R. (2016-05)
      In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors’ experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses’ working lives.
    • Overgeneral autobiographical memory in Parkinson's disease

      Smith, Sarah J.; Souchay, C.; Conway, M.A. (2010)
      Autobiographical memory (AM) concerns the ability to remember past events from one's own life and consists of autobiographical knowledge (personal facts) and autobiographical incidents (personal events). The novelty of this research was to assess both personal factual and personal event AM in Parkinson's disease (PD) for specified lifetime periods. An autobiographical fluency task was used in which participants were asked to recall personal events and personal facts from five separate lifetime periods. Previous findings as well the brain regions affected in PD lead to the hypothesis that Parkinson's patients would recall less autobiographical memories especially for the most recent lifetime periods. Sixteen non-demented and non-depressed Parkinson's patients and sixteen age-education-matched controls participated. The results showed a temporal gradient for the recall of personal events in Parkinson's patients as they recalled fewer events for recent time periods. The PD group also had more difficulties in recalling autobiographical events rather than an autobiographical knowledge. The difficulty in recalling autobiographical events was characterized by overgenerality, with PD patients failing to generate specific episodic memories.
    • Pain and delirium in people with dementia in the acute general hospital setting

      Feast, A.R.; White, N.; Lord, Kathryn; Kupeli, N.; Vickerstaff, V.; Sampson, E.L. (2018-11-01)
      Background: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.
    • Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards

      Sampson, E.L.; White, N.; Lord, Kathryn; Leurent, B.; Vickerstaff, V.; Scott, S.; Jones, L. (2015-04)
      Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (b 5 0.20, 95% confidence interval [CI] 5 0.07- 0.32, P 5 0.002) and at rest (b 5 0.41, 95% CI 5 0.14-0.69, P 5 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.