Katie Booth

Chronic disease patient education: lessons from meta-analyses

Twelve meta-analyses were identified concerning education for people with chronic diseases where behaviour modification is a part of the treatment regime. By combining the results of these meta-analyses a second stage descriptive meta-analysis was conducted. The aim of the exercise was to explore the effects of patient education and implications for educational treatment. The results provided evidence of the gaps that exist in current research practice. These gaps include the need to utilise rigorous research designs to explore the quantitative effects of patient education, and the need to qualitatively explore the processes by which these effects have transpired. Where randomised controlled trials had been conducted the effects of patient education were usually small and were only known for 6 months of follow-up. In addition, the educational interventions tested were generally poorly described, and failed to adhere to theoretical models. The results of this review have highlighted the need for practitioners to use theoretically based teaching strategies which include behaviour change tactics that affect feelings and attitudes. In alignment with these conclusions, the review has provided guidelines for future research practice.

Patients' perceptions of what makes genetic counselling effective: an interpretative phenomenological analysis.

Little is known about what makes for effective genetic counselling. Helping counselees adjust to their genetic situation is highlighted as a goal in most definitions of genetic counselling, but the processes involved in this are less clear. The current investigation focused on counselees’ perceptions of their genetic consultation as a possible influence on adjustment. Participants were all attending a Regional Genetics Clinic in the UK for the first time and were being seen for a variety of reasons. Transcripts of the interviews were analysed using interpretative phenomenological analysis. Being seen by an ‘expert’ was seen as a positive aspect of attending the genetics clinic and one that was associated with receiving full information. The perception that either they, or the doctor, were able actively to do something about their situation, helped to relieve feelings of vulnerability. The implications of these findings are discussed in relation to the way genetic counselling is conducted.

Reflexology and progressive muscle relaxation training for people with multiple sclerosis: A crossover trial

PURPOSE To compare the effects of reflexology and progressive muscle relaxation training for people with multiple sclerosis, provided by nurse therapists, on psychological and physical outcomes. METHODS A crossover design was chosen with a 4-week break between treatment phases. The Short Form 36 and General Health Questionnaire 28 were completed by patients (n=50) pre and post each of the 6-week treatment phases. Salivary cortisol levels, State Anxiety Inventory, systolic and diastolic blood pressure and heart rate data were collected pre and post the weekly sessions. RESULTS All of the chosen measures except for three SF-36 scales recorded significant changes, however, despite the 4-week break (washout period), most outcome measures did not return to their pre-treatment baseline levels. This meant that the analysis of the data was complicated by significant effects involving ordering of treatment occurring for eight of the variables (one from SF-36, two from the GHQ, SAI, Salivary Cortisol, Systolic BP and HR). However, there was a difference in the State Anxiety Inventory values between the treatments of the order of 1.092 units (95%CI 0.211-1.976) (p=0.016, Wilks lambda=0.885, df=1, 48) in favour of reflexology. Changes in salivary cortisol comparing levels pre 1st to post 6th session favoured reflexology (95%CI 0.098-2.644) (p=0.037, Wilks lambda=0.912, df=1, 48). A significant difference was found in the way the treatments affected change in systolic blood pressure following sessions; this favoured progressive muscle relaxation training (p=0.002, Wilks lambda=0.812, df=1, 48). CONCLUSION Positive effects of both treatments following sessions and over the 6 weeks of treatment are reported, with limited evidence of difference between the two treatments, complicated by ordering effects.

Links between nurses and cigarette smoking

Abstract The thoughts and feelings of nurses in training about cigarette smoking were studied by means of a survey of nurses in four schools of nursing in the north-west of England. Questionnaire data, together with material from in-depth interviews with a 10% sample from those nurses who were current smokers was the basis of an exploration of various issues concerned with nurses and smoking cessation. Analysis of the data suggested that the prevalence of cigarette smoking amongst nurses in training was similar to that amongst comparable members of the general population, and that nurses did not attribute increased cigarette consumption to specifically nursing situations. In comparison with their colleagues, nurses who were current smokers appeared to believe that cigarettes are less dangerous to health, and demonstrated some differences in their responses to a situation which had potential for health education. A considerable proportion of the current smokers both wanted to stop smoking and were prepared to give up time in order to do so; many others had made a previous attempt at smoking cessation. Interview data suggested that many felt guilty about their smoking, and considered their smoking to be linked with social activities, the management of difficult situations and (for female nurses) weight control. Encouragement, especially from other smokers trying to stop smoking, help with cessation techniques, regular opportunities to monitor progress and receive support were all features identified by current smokers and ex-smokers as being useful in the design of a support system which might help those nurses who wished to stop smoking.

What do people talk about during reflexology? Analysis of worries and concerns expressed during sessions for patients with multiple sclerosis

BACKGROUND Our previous study evaluated the use of reflexology compared to progressive muscular relaxation in improving the psychological and physical profile associated with multiple sclerosis. In this paper audiotapes from the reflexology sessions have been analysed to give a picture of the nature of interaction between patients and therapists during treatment. METHODS A crossover design with two groups was chosen. Each participant received six sessions of both interventions. All reflexology sessions were recorded and the tapes transcribed and analysed. RESULTS Analysis of the available audiotapes (n=245) revealed that reflexology provided opportunities for 48 out of the 50 participants to share worries and concerns. Recurring disclosure themes related to physical symptoms and treatment, psychological concerns, home/family worries, and work/leisure issues. Explorative analysis revealed some differences in the amount of disclosure over the weeks, between for example the participants type of MS and time living with the diagnosis. CONCLUSIONS Reflexology appears to have created a space for patients to talk about their worries and concerns, and to receive advice and support from the nurse therapists. This work contributes to the debate about the role of the therapeutic relationship within reflexology practice.

Problems encountered in setting up support groups in nursing

Abstract There has been much discussion on the value of support groups as a means of enabling nurses to deal with the emotional costs of their daily work. This paper describes a range of problems encountered while setting up support groups. Some of the groups were specifically to help nurses give up smoking while others were planned to help with a wide range of problems. From the findings, suggestions are made which may be of value to nurses in all specialties.