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AbstractIntroductionThe mental well-being of internationally deployed disaster-relief workers has become an issue of concern. The psychological consequences for the relief worker being exposed to trauma and threats have been well documented; however, the role of pre-deployment preparation in supporting mental well-being has not received due attention, despite research indicating the need for it.Hypothesis/ProblemThis case series examines the experiences of deployed volunteers of one emergency-relief organization. The aim of this research was to identify the participants’ interpretations of the appropriateness of the pre-deployment preparation they had received in light of supporting their mental well-being during and after deployment.The main research questions were: How appropriate was pre-deployment preparation in supporting mental well-being? What elements were lacking, and what else would be useful?MethodsUsing a hermeneutic phenomenological approach, thematic, semi-structured interviews were conducted with six deployed volunteers of an international emergency-relief organization. Data were analyzed using content analysis.ResultsThe participants in this study regarded the pre-deployment preparation they had received, on the whole, as appropriate in supporting their mental well-being. The seven main themes identified as important and supportive of mental well-being were: (1) realistic expectations, (2) team building and support, (3) self-awareness and self-care, (4) post-deployment support, (5) practical skills and creative solutions, (6) shared values and beliefs, and (7) safety and security. Specific areas identified as lacking within these themes included communication, self-care, post-deployment support, and safety and security.ConclusionThemes identified as important for supporting mental well-being in this research largely were consistent with those in previous research. The generally positive experiences of the support received do not reflect results from existing research, where significant shortcomings in worker support have been expressed. However, important elements were also identified as lacking in this specific pre-deployment preparation.MäkinenTH, MiettinenSM, KernohanWG. Mental well-being considerations in preparation for disaster health care: learning from deployment. Prehosp Disaster Med. 2015;30(4):110.

Background/Aims:Midwives who volunteer as aid workers overseas need to be equipped with knowledge of the local culture and customs prior to their deployment. However, this information is not always easily accessible. The aim of this study was to address the need for knowledge prior to departure by interviewing expatriate workers about their experiences of living and working in Liberia, to develop a framework to guide the structure of future guideline development.Methods:In this qualitative study, eight expatriate nurses and midwives working with humanitarian organisations were interviewed; transcripts were subject to thematic content analysis. It was possible to confirm the findings through personal experiences of a 7-week placement as a midwife.Results/Conclusions:The findings suggest that information is required to support intrinsic, extrinsic and practical aspects of working as a midwife in humanitarian response situations. This tripartite structure can be used to inform preparation more effectively.

Background:The palliative care clinical nurse specialist (PC-CNS) is a core member of the specialist palliative care team. According to professional policy, the role has four specific components: clinical practice, education, research, and leadership and management. Little is known about how to support staff in this role.Aim:The aim of this study was to explore what learning, development, and support PC-CNSs in one hospice need to enable them to fulfil all components of their role.Design:Using a descriptive exploratory approach, semi-structured interviews were undertaken with a purposive sample of community PC-CNSs from a hospice in Northern Ireland. Interviews were audio-recorded, transcribed verbatim, and thematically analysed.Findings:Seventeen interviews were analysed and three themes identified: influence of organisational culture, influence of the individual, and learning and development solutions.Conclusions:Participants reported that the PC-CNS role was stressful. They identified that the organisational culture and indeed individuals themselves influenced the learning and development support available to help them fulfil the four components of the role. Working relationships and stability within teams affected how supported individuals felt and had implications for managers in meeting the needs of staff while balancing the needs of the service.

Aim:The aim of this paper is to report on a study that compared ambulance clinicians’ views of two different types of patient coverings, focusing on core caring concepts such as comfort, dignity, and safety.Design:Ambulance clinicians’ views were gathered in respect of two types of patient coverings, and 128 ambulance patients were randomly distributed into a control or experimental group receiving respectively either the traditional cotton blanket or a multi-layered TelesPro rescue covering. Views were gathered using a short questionnaire developed by the authors.Findings:Ambulance clinicians, in their own view, maintained the core caring concepts no matter which type of covering was used. Findings suggest strongly that the rescue covering provided for a superior patient experience in respect of all core concepts and one functional aspect.Conclusions:Ambulance clinicians undertake caring that encompasses the core caring concepts of comfort, safety, and dignity, while remaining vigilant to threats to these constituents of caring.

Aim:To explore district nurses' beliefs regarding referral of a patient receiving palliative care for physiotherapy.Method:Three focus groups, guided by the Theory of Planned Behaviour, were undertaken with a purposive sample of 16 district nurses. All were audio-recorded, transcribed, and subject to content analysis.Results:Nine beliefs were identified as influencing referral decisions, the majority of which were negative, such as the belief that physiotherapists lack palliative care skills and could foster false hope. Additional barriers to referral included a lack of contact and communication with physiotherapists, poor knowledge or experience of physiotherapy, unsuitable referral systems, and poor availability of services.Conclusion:These findings help to explain why so few patients receiving palliative care access rehabilitation services. To ensure that patients have appropriate access to palliative rehabilitation, there needs to be consideration of how the identified barriers can be overcome.

This article (a follow on from an article concentrating on Northern Ireland) examines the relationship between percentage bed occupancy (PO), turnover interval (TI) and methicillin-resistant Staphylococcus aureus (MRSA) rates in the acute beds of specialist English hospital trusts and describes the TI and levels of bed occupancy. The data were collected from publicly available data: MRSA rates of blood-borne infection per 1000bed days from the Department of Health; average length of stay from Hospital Episode Statistics; and percentage occupancy from the Department of Health Hospital Activity statistics were used. Pearson's Correlation coefficients were used as basis for inferential analysis. The mean TI for all trusts was as 0.94days, median 0.95days. Twenty percent of trusts had TIs, on average, of less than 0.58days (13.9hours) and 10%had a TI less than 0.32days (7.6hours). The mean PO was 84.98%and the median was 84.76%. Seventy percent of the trusts exceeded the recommended 82%bed occupancy. The inference from this study is that there is a relationship between TI and PO and rate of MRSA infection in specialist English hospitals and that PO rates are at a level which may interfere with good infection control procedures.

The data describe bed turnover intervals (TI), bed percentage occupancy (PO) and methicillin-resistant Staphylococcus aureus (MRSA) rates per 1000 bed days of patient episodes. It was collected from annual hospital statistics in Northern Ireland (NI) and from the Communicable Diseases Surveillance Centre (CDSC) NI. The descriptive data show 6 of the general 11 surgical Trusts, out of a total of 12 Trusts examined, had PO greater than 85%; and all 11 medical facilities in these Trusts had occupancy rates greater than 85%. A significant correlation was established between turnover interval and MRSA per 1000 bed days of patient episodes in acute services beds. The correlation of PO with MRSA rates was 0.49 (ns). The conclusions drawn from the study are that in many Trusts the rates of bed occupancy for general surgery and general medicine is in excess of national guidelines and rapid turnover of patients is related to rates of MRSA infection. The implications for nurses and managers are discussed.

A diagnosis of head and neck cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients with head and neck cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of head and neck cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life. Although a phenomenon well recognized, little is known about many factors that influence or impact psychosocial dysfunction in individuals with head and neck cancer. Even less is known about the effective management of psychosocial dysfunction. To date, there is evidence to suggest that psychosocial interventions generally provide an overall positive effect. Moreover, some intervention studies, such as education alone, have failed to achieve the desired results. In addition, some studies suggest an advantage of cognitive- behavioral therapy over other forms of psychological treatment. With the growing impetus to investigate factors associated with psychosocial dysfunction, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients.

Children diagnosed with Developmental Dysplasia of the Hip (0.2% of live births) are often treated by splintage to hold the head of the femur in the acetabulum during early joint development. Whilst clinically effective, this can create difficulties for the parents in handling the child and affects the mobility of the family, which subsequently creates emotional and social difficulty resulting from the disruption of the family routine. To identify these problems and their order of priority, a survey of 113 recently affected families was carried out in England and Northern Ireland. Parents identified mobility, emotional and social problems. Splintage size and shape was the fundamental problem from which the other difficulties arose. Solutions to the basic difficulties of transporting and seating a child in splintage would largely alleviate the feelings of frustration felt by the families and enable more normal activities of daily living.

Throughout the ages, physicians have listened to sounds and felt vibrations from human joints in their attempts to diagnose pathology. They have used a wide vocabulary to describe these phenomena, but technology has been slow to provide recording and analytic equipment. Lately, accelerometers have been used with considerable success in a new noninvasive method now known as vibration arthrometry (formerly "arthrography"). The technique has been used in early detection of congenital dislocation of the hip and also in diagnosis of meniscal pathology. More recently, patellar vibration has been used to assess the mechanical properties of articular cartilage. Vibration arthrometry has also yielded new information on a possible damage mechanism associated with shock vibration that arises during cavitation of synovial fluid. Joint vibrations are therefore useful aids to diagnosis and may even be etiologic in orthopedic disease.

The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. An online survey was created to gather demographic details and chaplains’ opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and Provision of a specialized skill or service. Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalize professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public. However, a minority felt disconnected from the professionalization agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned.

The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. An online survey was created to gather demographic details and chaplains’ opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and Provision of a specialized skill or service. Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalize professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public. However, a minority felt disconnected from the professionalization agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned.

BackgroundDementia is a leading cause of death worldwide. Often, people with moderate to advanced dementia are admitted to nursing homes for specialist care. When a person with dementia no longer has the capacity to make decisions about their care, nursing home staff, in combination with family members, may have to make decisions based on a person’s best interests. Family carers often report feeling unprepared to participate in these decisions. Advance Care Planning (ACP) can support family carers in best interest decision-making on goals of care at the end of life. However, given its relative importance, the prevalence of ACP in dementia care is poor. This study set out to examine the effectiveness of an intervention designed to facilitate ACP with family carers.MethodsA paired cluster randomised controlled trial was employed. The intervention comprised: a trained facilitator; family education; family meetings; documentation of ACP decisions; and intervention orientation for GPs and nursing home staff. Twenty-four nursing homes with a dementia nursing category located in Northern Ireland, UK participated. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in ACP discussions were invited to take part. Participants completed postal questionnaires prior to receiving the intervention or usual care and again, six weeks later.Results12 nursing homes were allocated to each group, 11 from intervention and 12 from usual care were analysed. The primary outcome was family carer uncertainty in decision-making about the care of the resident as measured by the Decisional Conflict Scale (DCS). There was evidence of a reduction in total DCS score in the intervention group compared with the usual care group (−10.5, 95% confidence interval −16.4 to −4.7; p<0.001).ConclusionsThe ACP was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Implications for clinicians and policy makers include the need to recognise the importance of family carer education and improving communication between family carers and formal care providers.