Anthony Paul O'Brien

The Impact of Group Music Therapy on Depression and Cognition in Elderly Persons With Dementia A Randomized Controlled Study

Objective: The aims of this study were to determine the effectiveness of group music therapy for improving depression and delaying the deterioration of cognitive functions in elderly persons with dementia. Method: The study had a prospective, parallel-group design with permuted-block randomization. Older persons with dementia (N = 104) were randomly assigned to the experimental or control group. The experimental group received 12 sessions of group music therapy (two 30-min sessions per week for 6 weeks), and the control group received usual care. Data were collected 4 times: (1) 1 week before the intervention, (2) the 6th session of the intervention, (3) the 12th session of the intervention, and (4) 1 month after the final session. Results: Group music therapy reduced depression in persons with dementia. Improvements in depression occurred immediately after music therapy and were apparent throughout the course of therapy. The cortisol level did not significantly decrease after the group music therapy. Cognitive function significantly improved slightly at the 6th session, the 12th session, and 1 month after the sessions ended; in particular, short-term recall function improved. The group music therapy intervention had the greatest impact in subjects with mild and moderate dementia. Conclusion: The group music intervention is a noninvasive and inexpensive therapy that appeared to reduce elders’ depression. It also delayed the deterioration of cognitive functions, particularly short-term recall function. Group music therapy may be an appropriate intervention among elderly persons with mild and moderate dementia.

The effect of shift rotation on employee cortisol profile, sleep quality, fatigue, and attention level: A systematic review

Background: Disrupted circadian rhythm, especially working night duty together with irregular sleep patterns, sleep deprivation, and fatigue, creates an occupational health risk associated with diminished vigilance and work performance. Purpose: This study reviewed the effect of shift rotations on employee cortisol profile, sleep quality, fatigue, and attention level. Methods: Researchers conducted a systematic review of relevant articles published between 1996 and 2008 that were listed on the following databases: SCOPUS, OVID, Blackwell Science, EBSCO Host, PsycINFO, Cochrane Controlled Trials Register, and CEPS. A total of 28 articles were included in the review. Results: Previous research into the effects of shift work on cortisol profiles, sleep quality, fatigue, and attention used data assessed at evidence Levels II to IV. Our systematic review confirmed a conflict between sleep-wake cycle and light-dark cycle in night work. Consequences of circadian rhythm disturbance include disruption of sleep, decreased vigilance, general feeling of malaise, and decreased mental efficiency. Shift workers who sleep during the day (day sleepers) experience cortisol secretion increases, which diminish the healing power of sleep and enjoy 1 to 4 hours less sleep on average than night sleepers. Sleep debt accumulation results in chronic fatigue. Prolonged fatigue and inadequate recovery result in decreased work performance and more incidents. Rotation from day shift to night shift and its effect on shift workers was a special focus of the articles retained for review. Conclusions: Disturbed circadian rhythm in humans has been associated with a variety of mental and physical disorders and may negatively impact on work safety, performance, and productivity.

Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia

AIM AND OBJECTIVES The objective of this study was to examine the efficacy of progressive muscle relaxation training on anxiety in patients with acute schizophrenia. BACKGROUND Many empirical studies have found progressive muscle relaxation training beneficial in reducing the psychological effects of anxiety. Progressive muscle relaxation training is also effective in reducing the distress symptoms associated with the symptomatology of schizophrenia. DESIGN An experimental randomised controlled trial using repeated measures. METHOD The study was designed to examine the effects of progressive muscle relaxation training on patients diagnosed with schizophrenia. Study participants were acute psychiatric inpatients in Taiwan. Eighteen patients were block randomised and then assigned to an experimental or control group. The experimental group received progressive muscle relaxation training and the control group received a placebo intervention. Results from the Beck anxiety inventory were compared between groups as a pretest before intervention, on day 11 of intervention and one week post-test after the intervention was completed. Changes in finger temperature were measured throughout the experiment. RESULTS The degree of anxiety improvement was significantly higher in the progressive muscle relaxation training group than in the control group after progressive muscle relaxation training intervention (p < 0.0001) and at follow-up (p = 0.0446; the mean BAI score fell from 16.4 pretest to -5.8 post-test. After adjusting for the change in patient finger temperature, the mean change in temperature was significantly different between the two patient groups. The average body temperature increased significantly after applying the progressive muscle relaxation training to patients with schizophrenia. CONCLUSION This study demonstrated that progressive muscle relaxation training can effectively alleviate anxiety in patients with schizophrenia. RELEVANCE TO CLINICAL PRACTICE Progressive muscle relaxation training is potentially an effective nursing intervention in the reduction of anxiety in patients diagnosed with schizophrenia, depending on the quality of their mental status at the time of intervention. Progressive muscle relaxation training is a useful intervention as it is proven to reduce anxiety levels across a spectrum of psychiatric disorders.

Developing clinical competency in crisis event management: an integrated simulation problem-based learning activity

This study aimed to evaluate the integration of a simulation based learning activity on nursing students’ clinical crisis management performance in a problem-based learning (PBL) curriculum. It was hypothesized that the clinical performance of first year nursing students who participated in a simulated learning activity during the PBL session would be superior to those who completed the conventional problem-based session. The students were allocated into either simulation with problem-based discussion (SPBD) or problem-based discussion (PBD) for scenarios on respiratory and cardiac distress. Following completion of each scenario, students from both groups were invited to sit an optional individual test involving a systematic assessment and immediate management of a simulated patient facing a crisis event. A total of thirty students participated in the first post test related to a respiratory scenario and thirty-three participated in the second post test related to a cardiac scenario. Their clinical performances were scored using a checklist. Mean test scores for students completing the SPBD were significantly higher than those who completing the PBD for both the first post test (SPBD 20.08, PBD 18.19) and second post test (SPBD 27.56, PBD 23.07). Incorporation of simulation learning activities into problem-based discussion appeared to be an effective educational strategy for teaching nursing students to assess and manage crisis events.

Culturally specific process measures to improve mental health clinical practice: indigenous focus

Objective: In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery. Method: This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients. Results: Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced ‘culturally appropriate’ practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries. Conclusions: Using evidence from a bicultural mental health nursing study that developed and validated generic and Mâori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups.

The Risk of Eating Disorders Among Female Undergraduates in Taiwan

The objective of this study was to investigate disordered eating among female college students. The study sought to establish a predictive model for the risk of eating disorders in young female university students in Taiwan. A group of 336 student participants were recruited with the results showing that more than one third (43.2%) of the college women surveyed were identified to be at risk for developing an eating disorder. The results of multiple logistic regression showed that bulimia score, elevated depression index, eating binges, the use of laxatives and medicine to control weight, and having lost 20 lb, or more, in the past 6 months were all considered to be risk factors for developing an eating disorder (the corresponding area under receiver operating characteristic curve = 0.905). The results demonstrate that unhealthy dietary behaviors are rapidly spreading among young Taiwanese female students. For the sample described in this article, 67.6% of the female college students had lost weight: 51% had dieted at least once to lose weight, 43% used exercise to lose weight, 24% used low-calorie diets to lose weight, 11% used healthy food to lose weight, 9.2% used rubber clothing and a diet patch to lose weight, 17.9% of the students used weight-loss drugs, and a few students sought medical assistance from weight-loss clinics or actually underwent liposuction (1.5%).

What is the meaning of palliative care in the Asia-Pacific region?

This paper describes the preliminary work required to understand cultural differences in palliative care in the United Kingdom and three countries in the Asia‐Pacific region, in preparation for a cross‐country study. The study is intended to address cultural understandings of palliative care, the role of the family in end of life care, what constitutes good care and the ethical issues in each country. Suggestions are then made to shape the scope of the study and to be considered as outcomes to improve care of the dying in these countries. It is anticipated that the method used to achieve consensus on cross‐country palliative care issues will be both qualitative and quantitative. Identifying key priorities in the delivery and quality measures of palliative care will involve participants in focus groups, a Delphi survey and in the development of clinical indicators towards creating standards of palliative care common to the Asian Pacific region.

Providing culturally congruent care for Saudi patients and their families

Abstract This article aims to increase an awareness of caring for Saudi families by non-Saudi nurses to improve their understanding of culturally competent care from a Saudi perspective. Healthcare providers have a duty of a care to deliver holistic and culturally specific health care to their patients. As a consequence of ‘duty of care’ obligations, healthcare providers must facilitate culturally congruent care for patients of diverse cultural backgrounds. For the Saudi family considerable cultural clashes may arise when Saudi patients are hospitalized and receive care from healthcare professionals who do not understand Islamic principles and Saudi cultural beliefs and values. The healthcare workforce in Saudi Arabia is a unique multicultural workforce that is mix of Saudi and significant other nationalities. Saudi nurses for example represent only 36.3% of the workforce in the different health sectors. Whilst the different ethnic and cultural background expatriate nurses represent 63.7% (Ministry of Health, 2010). This article also could increase the awareness of healthcare professionals caring for Arab and Muslims patients in another context in the world.

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

BACKGROUND Taiwan has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world with 55,499 ESRD patients on long-term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. AIM The study aim was to identify the factors affecting Taiwanese patients selection of PD in preference to HD for chronic kidney disease. METHODS A cross-sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patients choice of dialysis type. RESULTS Single-factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self-care ability, know-how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P < 0.05). Moreover, multinomial logistic regression after adjustment for interfering variables found that self-care ability and dialysis modality know-how were the two main factors affecting the persons selection of dialysis type. CONCLUSIONS Self-care ability and the persons knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.

The environment of inpatient healthcare delivery and its influence on the outcome of care

Aim: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care. Background: Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety. Conclusion: There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.