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Aims and objective: To test a spaced retrieval intervention using spaced retrieval to alleviate mealtime difficulties in older people with dementia. Design: A single-case study design. Setting: Nursing Homes in North Central England, United Kingdom. Participants: Older people with Alzheimer's disease. Methods: A single-case study using an ABA design was used. Data were collected using the Edinburgh Feeding Evaluation in Dementia scale, Mini Nutritional Assessment, and Body Mass Index before intervention, postintervention and following 3 months of postintervention. Realist evaluation was used to identify for which participants the intervention was effective, and an economic evaluation was also carried out. Finding: Of 15 participants who entered the study, eight completed all phases of the study. A mean 104.4 h were needed to deliver the intervention. The number of sessions required ranged from 90-222. The length of time each participant retained information (for all sessions) ranged from 13-28 min. Participants had most difficulty with: "putting food into mouth and chewing it"; "realizing it was mealtime"; and "eating a whole meal continuously." A reduction in the difficulty with mealtimes occurred between phase A1-A2 for most participants. Six participants maintained this in phase A3. Similar patterns were evident for nutritional scores. For most participants, the effect size of the intervention was moderate or large. Conclusions: Spaced retrieval is useful in reducing mealtime difficulties in older participants with dementia. While the results of this study are promising, further large and multicentre trials are needed to explore the effectiveness of the intervention in diverse populations. K E Y W O R D S dementia, mealtimes, nutrition, older people, single-case study, spaced retrieval

Although teenage pregnancy and childbearing has declined throughout sub-Saharan Africa, the recent increase in teenage pregnancy in countries such as Malawi has prompted interest from social researchers. Using Malawi Demographic and Health Survey (MDHS) data from 2004 to 2015, this study employs multilevel logistic regression to examine the magnitude of change over time in risk and protective factors for teenage childbearing. During this period, teenage childbearing declined from 36.1% (C.I.: 31.5–36.7) in 2004 to 25.6% (C.I.: 24.0–27.3) in 2010 before increasing to 29.0% (C.I.: 27.4–30.7) in 2015. Age and being married (compared to never married) were consistently significantly associated with increased odds of teenage childbearing. However, delaying sexual debut, attaining secondary education, belonging to the richest quintile and rural residence offered protective effects against early motherhood, while Muslim affiliation (compared to Christian denominations) was associated with increased likelihood of teenage childbearing among adolescents. Teenage childbearing remains high in the country, largely influenced by adolescents’ early sexual debut and child marriage—risk factors that have hardly changed over time. While individual socioeconomic predictors are useful in explaining the apparent high risk of adolescent fertility among specific subgroups in Malawi, sustained declines in teenage childbearing were not evident at district level.

Purpose There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants. Design/methodology/approach A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs. Findings Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters. Research limitations/implications Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented. Practical implications The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs. Originality/value Training of health care staff in culturally appropriate communication requires effective practice.

Aims and objectives To review literature on nurses’ and health care workers’ experiences of caring for people with dementia on orthopaedic wards. Background Dementia is a condition that affects a large number of the older population worldwide. It is estimated that there are 47·5 million people worldwide living with dementia with 4·6 million new cases being diagnosed annually. This number is said to increase to 75·6 million by 2030 and triple by 2050. It is also acknowledged that older people are at a greater risk of falls that are a devastating problem causing a tremendous amount of morbidity, mortality and use of health care services (Rubestein, Age and Ageing, 35, 2006, 37). Falls usually result from identified risk factors such as weakness, unsteady gait, confusion and certain medication. Therefore, it is reasonable to assume that a large population of older people suffering from dementia may be admitted to orthopaedic wards with various injuries. Nurse and support health workers may experience a range of difficulties when caring for this population of patients. Design A systematic review. Methods An extensive literature search using; CINAHL, MEDLINE, Academic Search Complete, National Health Service Evidence, websites like Department of Health, Dementia and Alzheimer's Society. Results The search generated several articles on dementia in general, however, only 14 articles dealing with care of these people in an acute hospital setting were found. No studies dealing with the care of people with dementia on orthopaedic wards were found; therefore, this review has taken a generalist nature and applies the findings to orthopaedic wards. The main themes identified from the review were: challenging behaviour and unsuitable care environment; lack of education on dementia; strain from nursing patients with dementia; and ethical dilemmas arising from care of people with dementia. Conclusion It would be an over-simplification to say that the care of people with dementia on medical wards is the same as the care of trauma patients with dementia. Therefore, there is a need for a study to explore nurses’ and health care worker's experiences of caring for trauma patients with dementia on orthopaedic wards. Relevance to clinical practice The results of this study could provide guidance on the effective care of people with dementia on orthopaedic wards.

BackgroundTeenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.MethodsThe study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.ResultsThe teenage pregnancy and childbearing rate averaged 29% (pConclusionThe findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

As the workforce in the British National Health Service (NHS) has become more diverse, several researchers have reported that experiences of overseas’ nurses have been largely negative. This paper explores black African nurses’ experiences of equal opportunities, racism, and discrimination in four NHS trusts in the North East of England. Thirty nurses from sub-Saharan countries working in four NHS trusts were interviewed between 2006 and 2008 using semi-structured interviews and focus group discussions to gain an insight into their experiences in the NHS. This study suggests that black African nurses experienced discrimination and racism emanating from white colleagues and other overseas nurses, managers, patients, and their relatives, as well as lack of opportunities in their workplaces. Managers seemed to be treating British and other overseas nurses more favorably than black African nurses. Although much progress has been made in valuing and embracing diversity in the NHS, this paper highlights areas in which more work is required.

Aims and objectives. To explore sub-Saharan African nurses' reasons for moving to the UK, their views on the skills and brain drain, and what can be done to stem the situation. Background. The UK and other developed nations such as the USA, Canada and Australia have been recruiting internationally qualified nurses including those from sub-Saharan African, which has raised concerns of skills and brain drain from these countries that are known to suffer from nurse shortages. Methods. A purposeful sample of 30 nurses from sub-Saharan African was drawn from four National Health Service trusts in the north-east of England. Using focus group discussions and personal interviews, the study explored and examined nurses' views on their motivation to move to the developed countries and what can be done to reduce nurse migration from sub-Saharan African and give those countries a chance to develop their health systems by retaining their health personnel. Results. Five main themes emerged from data analysis: poor remuneration, lack of professional development in the home countries, poor health care and systems, language and education similarities and easy availability of jobs and visas. Conclusion. Data indicate that migration motives for nurses are complex and inherent in historical links and in global values. Nurses stressed that they would like to stay in their own countries and help develop healthcare there, but reasons for moving were often strong and apparently not within their control. Relevance to clinical practice. Nurse migration from sub-Saharan African has often been cited as a limitation in providing effective healthcare in those countries. Delineating motivational factors for nurses could help to stem this migration. © 2013 Blackwell Publishing Ltd.

Aim: To evaluate the evidence published in systematic reviews on the effectiveness of interventions aimed at alleviating mealtime difficulties in older people with dementia. Background: Older people with dementia gradually lose their self-care abilities as the condition of dementia progresses and this includes the ability to eat independently. There is a large body of research into this phenomenon, including into the effectiveness of interventions to alleviate the problems which arise. Recently there have also been several systematic reviews with different conclusions about the effectiveness of these interventions.

In a time of increasing cultural diversity, it is essential that healthcare professionals respond by providing culturally competent care. Healthcare professionals must recognise the diverse needs of people from ethnic minority communities to ensure that they receive equal standards of care. This is particularly pertinent when providing care for older ethnic minority patients who may not be fluent in English. This article focuses on the need to communicate effectively with this group of patients to meet their health and social care needs, with the ultimate aim of improving patient outcomes.

An exploratory qualitative study design was adopted for this study and underpinned by Rex’s migrant workers framework (Rex, 1999). Semi-structured interviews were conducted with ten ward managers from four NHS trusts in the north-east of England to gain an insight into their experiences of working with black African nurses with regard to equal opportunities in accessing professional development and promotion. Managers reported that black African nurses experienced racism from patients, racism from colleagues, discrimination and lack of equal opportunities. A unique finding of the study was that managers stereotyped black African nurses as lacking motivation for professional development and promotion.The authors recommend that NHS ward managers receive training in implementing anti discrimination policies and valuing equalityand diversity.

© 2013 John Wiley & Sons Ltd. Aim: This study aims to explore experiences of racism, discrimination and equality of opportunity among black African nurses and their managers' perspective on these issues. Background: International nurse migration has brought increased diversity in the nursing workforce internationally. These nurses have reported negative experiences associated with their integration in host nations. The UK has a long history of international nurse recruitment, which has been associated with experiences of racism and discrimination towards these nurses despite various equality Acts. Experiences of black African nurses and perceptions of their managers are good indicators of how effective these equality Acts have been. Method: A qualitative approach was used to gain an insight into black nurses' experiences and those of their managers in the UK National Health Service. Findings: Nurses and managers reported that black African nurses face racism, discrimination and lack of equal opportunities in the British National Health Service. Conclusion: Racism and discrimination towards black and ethnic minority nurses are present in the National Health Service despite equality Acts. Robust measures to combat racism and discrimination are urgently needed. Implications for nursing management: Managers need to be aware that good policies can be misinterpreted and disadvantage minorities, and should therefore take steps to promote good practice.

Aim. This review aims to highlight the experiences of black African nurses in the United Kingdom. Background. There is an acute shortage of trained nurses in the United Kingdom, which has occurred because of several factors including ageing of the nurse population and increasing demand due to an ageing population as well as under investment in nurse education during the 1980s. Government initiatives have included recruiting nurses trained overseas to meet present and future demands. Among these internationally recruited nurses, a large number came from Africa, but little is known about the experience of nurses once they are in the United Kingdom. Although it is known that ethnic minority nurses suffer discrimination in the National Health Service, experiences of internationally recruited nurses and nurses from African countries, in particular, merit attention as their nursing practices and culture in general are different from those of developed countries. Methods. A literature search was conducted using CINAHL, Medline and Cochrane databases by using the following terms in various combinations: Experiences, African nurses, international nurses, ethnic minorities, discrimination, equal opportunities, United Kingdom and NHS. Conclusions. There is very little research into the experiences of African nurses in the United Kingdom. Research has concentrated on the experience of internationally recruited nurses and ethnic minority nurses in general. There is agreement that most foreign nurses have a negative experience of working in the United Kingdom. Nurses face discrimination in pay and conditions of service and most are exploited by managers. There are also ethical questions surrounding the recruitment of nurses form developing countries and their treatment once they come to the United Kingdom. Relevance to clinical practice. As the nursing workforce in the United Kingdom becomes increasingly diverse through international recruitment, it is important to have knowledge of experiences of different groups of nurses. This helps to devise adaptation programs for smooth transition tailored to particular groups and training that will help United Kingdom nurses to work in harmony with their foreign colleagues.