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Approximately 10% of the world's population have a cognitive disability. Cognitive disabilities can have a profound impact on a person's social, cognitive or mental functioning, requiring high levels of costly health and social support. Therefore, it is imperative that interventions and services received are based upon a sound evidence-base. For many interventions for this population, this evidence-base does not yet exist and there is a need for more Randomised Controlled Trials (RCTs). The process of conducting RCTs with disabled populations is fraught with methodological challenges. We need a better understanding of these methodological barriers if the evidence-bases are to be developed. The purpose of this study was to explore the methodological and practical barriers to conducting trials with adults with cognitive disabilities. As a case example, the literature regarding RCTs for people with intellectual disabilities (ID) was used to highlight these pertinent issues. A systematic literature review was conducted of RCTs with adults with ID, published from 2000 to 2017. A total of 53 papers met the inclusion criteria and were reviewed. Some of the barriers reported were specific to the RCT methodology and others specific to people with disabilities. Notable barriers included; difficulties recruiting; obtaining consent; resistance to the use of control groups; engaging with carers, staff and stakeholders; the need to adapt interventions and resources to be disability-accessible; and staff turnover. Conducting RCTs with people with cognitive disabilities can be challenging, however with reasonable adjustments, many of these barriers can be overcome. Researchers are not maximising the sharing of their experience-base. As a result, the development of evidence-bases remains slow and the health inequities of people with disabilities will continue to grow. The importance of the MRC guidelines on process evaluations, together with implications for the dissemination of ‘evidence-base’ and ‘experience-base’ are discussed.

Many individuals approaching the end of life with advanced dementia will live in a care or residential home. A wide spectrum of care is required and physical and safety needs may be prioritised above all other requirements. The Namaste Care Programme is designed to provide a holistic approach to meeting the needs of those with advanced dementia. This paper will outline the process of introducing this programme into a care home and its impact upon those who were involved. With a small sample of residents (n=9) the programme ran for 4 weeks. Feedback was gathered at baseline and during the programme from family and staff. This service innovation offered useful insights and indicated that it has the potential to improve the experiences of those with dementia, their family members and staff. The learning gained will be valuable when developing this initiative at scale and for future robust evaluation.

The burden of chronic illness is increasing globally as a result of increased life expectancy, unhealthy lifestyles, and advances in medical interventions and treatments. Therefore, people living with chronic conditions, and their families, will have to assume greater responsibility in managing such conditions. However, to do so they require appropriate support from healthcare services. This article explores some of the tensions that hinder the self-management of chronic conditions. It emphasises the importance of individuals and their families having the desire, and being enabled, to assume an active and decisive role in the management of chronic conditions. Nurses have a role in enabling patients to optimise their self-management skills, but organisational constraints in healthcare services, as well as constraints in nurse training and nursing roles, may mean that nurses are unable to fulfil this role. This article considers some of the factors that may limit the development of patient and nursing roles in relation to self-management of chronic conditions.

ObjectivesTo assess the acceptability and use of a low-cost patient-held communication tool.DesignLongitudinal qualitative interviews at three time points over 18 months and document content analysis.SettingPrimary and community services.ParticipantsTwenty-eight dyads: People living with dementia in Northern Ireland and their informal carers.InterventionsA patient-held healthcare ‘passport’ for people living with dementia.Primary and secondary outcomesAcceptability and use of the passport—barriers and facilitators to successful engagement.ResultsThere was a qualified appreciation of the healthcare passport and a much more nuanced, individualistic or personalised approach to its desirability and use. How people perceive it and what they actually do with it are strongly determined by individual contexts, dementia stage and other health problems, social and family needs and capacities. We noted concerns about privacy and ambivalence about engaging with health professionals.ConclusionSuch tools may be of use but there is a need for demanding, thoughtful and nuanced programme delivery for future implementation in dementia care. The incentivisation and commitment of general practitioners is crucial. Altering the asymmetrical relationship between professionals and patients requires more extensive attention.

Background: Direct Payments (DP) is a service user-implemented scheme in which the individuals assessed as needing personal, social or health-related care services are given cash payments, allowing them to ‘buy in’ services they require. Previous research indicates DP offer the user greater control and flexibility over their care. However, the literature highlights problems with the system including user responsibilities, carer recruitment, provision of information and support. Aim: To examine the impact of DP on service users in a large Health and Social Care Trust, in Northern Ireland. Method: Thirty DP users from the Trust area were recruited to the study. The sample consisted of 2 respondents who were in direct receipt of DP, and 28 informal carers who implemented the budget on behalf of an eligible DP service user. Each respondent completed an interview with the study researcher, following an interview schedule devised by the research team. Results: Findings show service users are generally satisfied...

Aim The project aims to assess current specialist practice in relation to the new and ever-changing healthcare climate and explore some of the issues that specialist nurses encounter. Background The current financial recession is driving a range of economic policy changes and consequently service provision, in particular the work and impact of nurses working in a specialist role, being examined. This has resulted in many specialist nurses feeling very vulnerable. Method A cross sectional survey was completed by nurses working in specialist roles (n = 96) in a large health and social care setting in the United Kingdom. Findings A response rate of 62% was achieved: 44% provide nurse led clinics and 42% are nurse prescribers. The mean length of time qualified as a registered nurse was 27 years. Less than a third felt that the current computer system for activity recording reflected their current workload and 65% needed administrative support. Conclusion This study demonstrates the insufficient resources available to specialist nurses resulting in inappropriate but necessary, use of time and restricted opportunities for learning and development

Caring for families of critically ill patients is part of emergency nurses' role, but there is a difference of opinion about whether families should be present during resuscitation attempts. This article reports on an opinion survey conducted at two health and social care trusts in Northern Ireland, in which 160 emergency nurses were asked for their views on holistic family-centred care during and after resuscitation. Most participants said that, although they have a duty to provide such care, they are often prevented from doing so by lack of staff and time, and by inadequate education. In light of this finding, the article suggests that staff should take part in debriefing sessions and follow-up programmes should be made available for families after resuscitations have been attempted.

The sudden admission to an emergency department (ED) of a patient requiring resuscitation can be a traumatic experience for families, who often require a great deal of support from ED staff. The needs of such staff must be considered too, if the care of patients and families during resuscitation attempts is to be improved. This article discusses the findings of a systematic review of the literature on family-centred care during and after resuscitation attempts, and reveals that, although families appear to favour witnessed resuscitation, the practice remains controversial among healthcare professionals. Chaotic workloads, time restraints, lack of education and poor coping abilities all appear to affect wider implementation of the practice in EDs.

Aims To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. Background It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend. Methods A systematic search of the following databases was conducted for the period from 2005–2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected. Results A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated. Conclusion New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency.

This paper reports on the role of family members in everyday diabetes self-care and in diabetic crises. It is based on qualitative data drawn from 45 semi-structured interviews with a wide range of people with an established diagnosis of Type 1 or Type 2 diabetes, who were admitted to hospital for urgent or emergency treatment in connection with their diabetes. The interviews were carried out in two contrasting sites in the United Kingdom in 2009–2010, transcribed and analysed thematically with particular reference to framework analysis methods. We found that family involvement in self-care was common, and the role of family and friends was especially important when the person with diabetes needed urgent help. We comment on the diversity of family members who assisted regularly or dealt with crises, the importance of taking account of the complexities of family life, including reciprocal care, and the particular problems faced by people without family support. Finally, we make recommendations for further research and for improvements in existing services.

Background: People with multiple sclerosis (MS) often require full-time care, which may be provided by informal carers. Respite becomes a vital part of carers’ lives allowing temporary relief. Little attention in the literature is given to the people who experience respite care. Aim: The aim of this study was to assess the views of respite care by MS patients and their carers. Method: A cross sectional survey was conducted in Northern Ireland, one questionnaire for patients and another for carers. The lists of two long stay respite units provided the sample for the study, from these 96 patients and 96 carers were approached. A total of 70 patients (73%) and 28 carers (29%) responded. Results: Seventy-one percent of patients used respite care to give their carers a break; 64% of carers used respite to relieve stress. More than half, 64% of patients, enjoyed respite; 6% were angry about requiring respite; 57% of carers felt guilty about using respite. Overall, 81% of patients were satisfied with respite. Almost all carers (96%) stated that respite allowed them to continue caring. Conclusions: Both patients and carers felt respite was a positive and necessary form of care. The study did highlight that activities or outings for patients in respite would be welcomed.

Aims and objectives. To establish adolescents’ beliefs regarding the need for structured diabetes education and their views on how such a programme should be organised and what topics need to be addressed. Background. Structured diabetes education programmes have become common place in diabetes care in recent years. Despite the use of these programmes in adult patients, to date, there exists no tried or tested programme for adolescents. Prior to the development of programmes for this age group, there is a need to establish their views on programme content, delivery mechanisms and how best to introduce structured education in this population. Design. An exploratory qualitative study. Methods. Five focus group interviews were undertaken across three acute Hospital Trusts in Northern Ireland. A total of 21 adolescents between 13–19 years were interviewed. Data were analysed by means of a thematic content analysis framework. Results. All participants expressed a need for a structured education programme specifically tailored to their needs. The complexity of existing diabetes regimens brought with it feelings of frustration and guilt for the majority of adolescents. Many felt isolated and alone. Dietary management and insulin adjustment were seen as very complex. Conclusion. Participants favoured a structured diabetes education programme that was short in duration, practical in nature, positive in outlook and relevant to daily life. Relevance to clinical practice. Programmes should address the specific needs of adolescents, be delivered in a practical manner and be realistic for everyday use.

Aims and objectives. The aim was to review available literature on research and service evaluation evidence of nurse-led case management services targeting older people with multiple chronic conditions in their own homes. This was anticipated to highlight important issues for nursing practice, healthcare policy, service provision and health service research. Background. Enhanced roles for nurses have developed in response to demands for increased efficiency in the provision of healthcare especially in the area of chronic disease management. It is apparent that the evidence to support nurses providing a case management approach for patients with multimorbid chronic conditions in their home environment is ambiguous. Design. A systematic review of the literature. Methods. The review was carried out across multiple sources including search and alert engines, electronic databases, relevant journal websites and grey literature. The inclusion criteria applied concentrated on articles in the English language, case management intervention involving nurses providing care in the patients’ own home and older people (aged over 65 years) with multiple chronic illnesses. Of a total of 568 papers identified, eight were of relevance and included in the review. Results. The qualitative data derived from this systematic review suggests that access to case management services had a positive impact on the patient, the carer and the healthcare staff particularly the General Practitioner. In contrast the more robust quantitative data does not demonstrate a significant impact on emergency admissions, bed days, nor costs. Conclusions. Further research is needed to understand how case management can most effectively improve service effectiveness for patients and their carers and reduce cost of care. Relevance to clinical practice. A new emphasis on comparative effectiveness research is required which has the potential to reshape the whole system of healthcare provision for patients with complex needs.

Aim. To review systematically the literature about barriers to diabetes self-care from both patients’ and healthcare providers’ perspectives. Background. Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self-care in order to promote successfully self-care behaviours. Methods. A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986–2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results. A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed-method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions. Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice. Understanding barriers to diabetes self-care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes.

Aim. This paper is a report of a study to describe nurses’ perceptions of decision-making and the evidence base for the initiation of insulin therapy. Background. Several theoretical perspectives and professional’s attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions. Method. A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37·7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent. Results. People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses’ identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated. Conclusion. Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy.

Aim To evaluate methods of performance assessment through an international literature review and a survey of current practice. Background Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. Methods A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Results Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. Conclusions No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.

Trauma is the leading cause of mortality in young adults in the United Kingdom. Many such deaths are preventable if patients are treated effectively. Delay in providing care by experienced, trained staff is seen as a major factor in unsatisfactory trauma management. In order to reduce the number of deaths, the Advanced Trauma Life Support (ATLS) system has been recommended for use in the management of patients with major injuries. However, there is little evidence to support the participation of nurses in the ATLS system. The aim of this study was to investigate the influence of ATLS training on the performance of nurses in Accident and Emergency, taking account of experience and intuition. Results suggest that the Trauma Nursing Core Course and the Advanced Trauma Nursing Course have a positive influence on nurses' performance. Experienced staff who had received full, participative ATLS training demonstrated an improved understanding of the trauma situation resulting in rapid and accurate decision-making. However, attending the ATLS course as an observer appears to have minimal effect on a nurse's performance and such non-participant training should no longer be considered as equivalent to participant training.

Prostate cancer has become an important public health problem with considerable social and economic consequences. The mainstay of treatment for men with prostate cancer that has extended beyond the confines of the prostate gland is hormonal manipulation therapy (HMT). As this is a form of medical castration, it has the potential to challenge the stereotypical image of men. It is evident that cancer produces intense demands for information and assurance. However, although patient education has been increasingly recognised as an essential component of the professional nurse’s role, it has not as yet reached its’ full potential. The dearth of evidence-based educational packages available for men with prostate cancer on HMT was recognised. This study considered the key theoretical and contextual aspects that must be regarded when developing such material. The necessity to assess the individual information needs of specific client groups as a precursor to the planning of effective educational programmes, which are patient-centred was also emphasised. The result of this study was the development of an educational package, which consisted of an informational booklet as an adjunct to the verbal teaching of a urology specialist nurse. Objectives: To develop an evidence-based education package to address the knowledge deficits and informational needs of men with prostate cancer on hormonal manipulation therapy (HMT). Design: A review of the relevant theoretical and contextual issues regarding patient education issues was conducted. Results from a research study which investigated the knowledge and informational needs of a sample of men (n=90) with prostate cancer on HMT were also utilised. Setting: Three urology centres in Northern Ireland. Participants: Data from 90 men diagnosed with prostate cancer, commenced on HMT, who were aware of their diagnosis were used to inform the development of this education package. Results: The result of this study was a 15-page information booklet, based on sound theoretical and contextual issues and the informational needs of this client group, which would be used as an adjunct to the verbal teaching of the Urology Specialist Nurse. Conclusion: An evidence-based education package, with a strong theoretical foundation, suitable for addressing the expressed needs of men with prostate cancer on HMT was developed in this study. The implementation of this education package should become a routine and not merely an incidental aspect of the care of all men with prostate cancer who are to be commenced on HMT.

Summary • Diabetes Nurse Specialists (DNSs) are often the hub of the communications network for the entire diabetes multiprofessional health care team, patients and their families. Frequently they liaise between primary and secondary care and have a key role in the provision of a ‘seamless service’. To work effectively and efficiently they need a foolproof system of documentation and communication. • The aim of the study was to investigate the means by which DNSs document patient care in order to provide baseline information about ongoing record-keeping practices. • The study comprised a cross-sectional survey in which data were obtained by questionnaire. All DNSs in the UK registered with the British Diabetic Association were invited to participate in the study. A 70.3% response rate was achieved (n = 545). • The results indicated that manual profession-specific records were used by 65.3% of DNSs, 21.1% used shared/integrated records, 12.8% used computerized records and only 0.7% made use of patient-held records. Whilst almost all DNSs felt that a good record-keeping system was essential in providing ‘seamless care’ to patients, not all felt their system was efficient. Of those using a computerized system 65.7% rated it as efficient, compared with only 28.1% of those using a profession-specific system and 26.1% of those using a manual shared system. • A high percentage of DNSs (65.9%) felt that the provision of ‘seamless care’ was hindered by communication problems with members of other professional groups. • The findings from this study indicate that computers alone cannot bridge the gap between primary and secondary care, but ‘seamless care’ may become more of a reality with computerized record-keeping systems and participation by all members of the multidisciplinary team.

It is widely agreed that patient education is a vital aspect of diabetes care (Assal et al, 1983; Alberti et al, 1991; Day and Assal, 1997). The European Patients' Charter (Alberti et al, 1991) states that: 'continuing education for you and your family is a fundamental right for people with diabetes'. It is generally acknowledged that diabetes self-management is often inadequate to enable patients to achieve optimal health. Research suggests that lack of knowledge per se may not be the problem, rather that patients do not put their knowledge into practice. Therefore in this article general principles in the process of patient education which should facilitate self-management behaviour will be considered. In particular the importance of an individualised approach to care, patient assessment, the implications of the work of Strauss and Glaser (1975) on the self-management of chronic illness and Malcolm Knowles' (1990) work on facilitating adults to learn will be discussed in relation to diabetes education.

The provision of clinically based education for nursing students is an essential part of their learning needs. In this article, the opportunity to enhance clinically based learning by means of preceptors is discussed and investigated. A case study was conducted of one college of nursing after the introduction of the Preregistration Diploma of Higher Education in Nursing (Project 2000) course. The study involved preceptors (62), nursing students (15), ward managers (4), senior nurse managers (2) and nurse teachers (8). The investigation involved quantitative and qualitative approaches, data being gathered through questionnaires and interviews. The results indicate that preceptors included functions such as being a role model and supervision of learners' skills but not assessment as part of their role. These views were supported by students, teachers and managers. Knowledge of the clinical area and experience were reported to be preceptors' greatest assets for the role but lack of time to work with students was cited as the greatest barrier. Extra resources required were reported to be protected time for the student and preceptor to work together and further in-service education. The implications of these results for clinically based learning opportunities in the future are discussed.

Purpose of the research The need for continuity of care in the management of women diagnosed with breast cancer is important yet challenging. The aim was twofold; to explore 1) the concept of continuity of care from the perspectives of women diagnosed with breast cancer, their carers and their health care professionals (HCPs), 2) actual experiences amongst these three groups relating to continuity of care. Methods and sample A three-phase cross-sectional survey was conducted involving eight focus group interviews with women who had been diagnosed with breast cancer ( n = 47) and structured questionnaires to both carers ( n = 33) and HCPs ( n = 44). Data were analysed according to three categories of continuity of care; relational, informational and managerial. Key results According to the patients: ‘Continuity of Care' is the continuous care over time; it involves the relationship between the HCP and the patient. It is not just a follow-up review. The relationship is built on trust, loyalty and constancy. The perception is that the providers of care know you, know your case history and your future care is agreed on.' Across all phases of the study the three categories of continuity of care were identified but there were differences as to the weight different groups placed on them. Continuity of care was reported to be achieved for the majority of the respondents across all three samples however deficiencies in the service were identified. Conclusion The results provide an opportunity to improve service; recommendations have been made and steps to implementation taken.

The role of multi-professional learning in diabetes care has been controversial due largely to the severe practical problems that need to be overcome to allow comparisons with the standard uni-disciplinary approach. We describe the operation and analysis of a unique university-based but community-orientated multi-professional diabetes care course over a four-year period. The analysis is based both on objective assessment of students by the teaching team and by the assessment of the course and the teaching methodology by the students following completion. The results show significant improvements in knowledge, very good perception of quality and usefulness, with a large impact on the students' clinical confidence and perceived clinical practice following completion. Analysis in nine areas of diabetic care is presented with the vast majority of responding students confirming a better community standard of care as a result. We are of the opinion that these results support the application of multi-professional learning to encourage improved community care of diabetes.

Driving towards an improved research and development culture Background This study examined the research and development culture and capacity within one NHS Trust in Northern Ireland. Strengths and challenges were identified and opportunities for further research and development expansion were sought. Methods This is a two-stage project incorporating a baseline survey (n = 379) followed by consultation with key stakeholders across the Trust (n = 11). Findings In the survey, over half of the respondents (n = 194) stated they had participated in a research project and a significant number (n = 313) read health care journals. Identification of barriers to research resulted in findings similar to other published work. Staff responded positively about using research in practice (n = 328) and that practice should be influenced by research (n = 312). Nurse Managers indicated support for research and development activity. Conclusion The study provides a starting point from which to develop a positive research and development culture within this Trust. Implications for nursing management After establishing a baseline of research and development activity across a large acute Trust, the strengths and weaknesses of such activity were identified with a view to informing a strategy to develop this aspect of professional activity. A change in an organizational culture cannot be made without full support of both the clinicians and their managers.

This paper is borne of the increasing interest and relevance of computers in nursing. It describes the method, and results obtained from a postal questionnaire survey distributed across the United Kingdom to gain information about the developments in computing in nursing education. The results indicate that considerable developments have been made, but that they are more piecemeal than co-ordinated. A selection of the results are presented and discussed, and one or two points concerning future proceedings are raised.

Prostate cancer has become a public health problem worldwide with considerable social and economic consequences. Many men have extraprostatic spread at diagnosis, and treatment usually involves hormonal manipulation therapy, which can challenge the stereotypical male image. It is often assumed that merely the provision of educational material for patients in an accessible form is sufficient to address informational needs. However, with the increasing emphasis on evidence-based practice, an essential element of the patient education process is evaluation of the impact of educational interventions. In this study, a randomised controlled trial was used to evaluate the effect of an evidence-based education package on the knowledge of disease and treatment, quality of life, coping and satisfaction of a sample (n=55) of men with prostate cancer on hormonal manipulation therapy in the UK. The men were randomly assigned to experimental (n=28) and control group (n=27). Established instruments with satisfactory reliability and validity were used to measure the dependent variables. The independent variable, namely the education package, had been developed following the results of a previous study, which assessed the informational needs of this client group. This package consisted of an information booklet supplemented by the verbal teaching of a urology nurse. Results demonstrated that delivery of the education package had a significant effect on knowledge, quality of life and satisfaction with care, but not on coping. This study has contributed to the evidence-base for practice in urological nursing. This education package should become a routine, and not merely incidental aspect of care for this client group.

This article concerns the evolution of the concept of health, as reported in selected nursing journals, over the last 10 years. It builds on an analysis reported by Reynolds [Reynolds CL. The measurement of health in nursing research. Adv Nurs Sci 1988;10(4):23–31.] who initially investigated the concept of health and the means by which it was measured during the period 1977–1987. Using the same journals as Reynolds, the methodology of systematic review is used to analyse the way in which health is defined, the frequency with which it is investigated and the means by which it is measured, and these data are compared with Reynolds findings. The results indicate that; three times as many studies have been conducted in the last 10 years, a more holistic concept of health has emerged, and the instruments used are becoming more sophisticated. These findings are discussed and the implications for patient education and health care professionals considered.

This article concerns the early stages of a research study which attempted to improve the assessment of student nurses' clinical competence by means of profiling. During the course of the paper the reasons for undertaking assessment will be considered, the existing assessment approach will be briefly reviewed, the use of action research as the method of inquiry will be addressed, and the initial findings from the study described.

BACKGROUND: The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world. One such national education programme in the United Kingdom is the DESMOND Programme, which has been shown to be robust and effective for patients in general. However, these programmes are not generally targeted to people with intellectual disabilities (ID), and robust evidence on their effects for this population is lacking. We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID. This protocol is for a pilot trial to determine whether a large-scale randomised trial is feasible, to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes, in particular as a means to reduce glycated haemoglobin (Hb1Ac), improve psychological wellbeing and quality of life and promote a healthier lifestyle. This protocol describes the rationale, methods, proposed analysis plan and organisational and administrative details.METHODS/DESIGN: This trial is a two arm, individually randomised, pilot trial for adults with ID and type 2 diabetes, and their family and/or paid carers. It compares the DESMOND-ID programme with usual care. Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom. Family and/or paid carers may also participate in the study. Participants will be randomly assigned to one of two conditions using a secure computerised system with robust allocation concealment. A range of data will be collected from the adults with ID (biomedical, psychosocial and self-management strategies) and from their carers. Focus groups with all the participants will assess the acceptability of the intervention and the trial.DISCUSSION: The lack of appropriate structured education programmes and educational materials for this population leads to secondary health conditions and may lead to premature deaths. There are significant benefits to be gained globally, if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments.TRIAL REGISTRATION: Registered with International Standard Randomised Controlled Trial (identifier: ISRCTN93185560 ) on 10 November 2014.

Background There is an urgent need for the development of simple communication tools that convey the strengths, assets, and healthcare needs of people living with dementia. A Healthcare Passport may improve communication with range of health and social support services, enhancing quality and continuity of care, and to permit a consideration of the challenges and how these might be managed effectively and compassionately. This study aims to evaluate the acceptability and use of this type of intervention for people living with dementia and their carers. Methods/Design This is a qualitative longitudinal study informed by a critical realist review. The participants will be individuals identified as having mild-moderate dementia and informal carers. The in-depth interviews will occur at three points over the course of 18 months as they use the passport. This will be supplemented by analysis of the content of the passports and information from health and social care providers on the daily practicalities of using the passport in a range of healthcare settings. Discussion By using a critical realist review and a qualitative, longitudinal approach, the study allows for the assessment of a complex intervention in a manner which goes beyond evaluating the basic efficacy of the passport, but looking more deeply at how it worked, for whom, and in what context. It has the potential to develop new data on how interventions improve communication across a range of service providers, while encouraging health and social care professionals to respect and encourage the development of self-management and retention of personhood throughout the progression of life-limiting illnesses.