Khim Horton

A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions

ABSTRACT The prevention of falls is currently high on the health policy agenda in the United Kingdom, which has led to the establishment of many falls-prevention services. If these are to be effective, however, the acceptability of services to older people needs to be considered. This paper reports a systematic review of studies of older peoples perceptions of these interventions. The papers for review were identified by searching electronic databases, checking reference lists, and contacting experts. Two authors independently screened the studies and extracted data on the factors relating to participation in, or adherence to, falls-prevention strategies. Twenty-four studies were identified, of which 12 were qualitative. Only one study specifically examined interventions that promote participation in falls-prevention programmes; the others explored older peoples attitudes and views. The factors that facilitated participation included social support, low intensity exercise, greater education, involvement in decision-making, and a perception of the programmes as relevant and life-enhancing. Barriers to participation included fatalism, denial and under-estimation of the risk of falling, poor self-efficacy, no previous history of exercise, fear of falling, poor health and functional ability, low health expectations and the stigma associated with programmes that targeted older people.

Student nurse socialisation in compassionate practice: A Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

The role of health professionals in promoting the uptake of fall prevention interventions: a qualitative study of older people's views

BACKGROUND uptake of and adherence to fall prevention interventions is often poor and we know little about older peoples perceptions of and beliefs about fall prevention interventions and how these affect uptake. OBJECTIVE to explore older peoples perceptions of the facilitators and barriers to participation in fall prevention interventions in the UK. METHODS we undertook a qualitative study with older people who had taken part in or declined to participate in fall prevention interventions using semi-structured interviews (n = 65), and 17 focus groups (n = 122) with older people (including 32 Asian and 30 Chinese older people). This took place in community settings in four geographical areas of the South of England. The mean age of participants was 75 years (range 60-95). Data analysis used a constant comparative method. RESULTS older people reported that health professionals and their response to reported falls played a major role in referral to and uptake of interventions, both facilitating and hindering uptake. Health professionals frequently failed to refer people to fall prevention interventions following reports of falls and fall-related injuries. CONCLUSIONS consideration should be given to inclusion of opportunistic and routine questioning of older people about recent falls by practitioners in primary care settings. Referrals should be made to appropriate services and interventions for those who have experienced a fall to prevent further injuries or fracture.

Gender and the negotiation between older people and their carers in the prevention of falls

Little is known about how negotiation between older people and their carers varies according to gender. This paper reports a study of older men and women who have had multiple falls and the actions of their key family members to prevent multiple falls. In-depth interviews were conducted with 35 older people who had had recurrent falls, and separately with the identified key family member. The actions taken by the relatives to prevent future falls were classified as protective, coercive, negotiating, engaging and ‘reflective of mutual respect’. It was found that sons caring for older mothers took only ‘protective’ and ‘coercive’ actions, resulting in mothers having passive and submissive roles. In contrast, the daughters who were caring for their fathers undertook most often ‘engaging’ and some ‘negotiating’ actions, which empowered the fathers in their decision making. Daughters had a ‘peer-like’ relationship with the mothers that they supported and cared for, and undertook primarily ‘negotiating’ as well as ‘engaging’ actions. The two men who cared for older men took no specific actions but maintained mutual respect for each other. The findings demonstrate several ways in which the gender of the dyad members influences the nature of the negotiation between close relatives, and throws light on the factors that influence the autonomy and dependence of older people.

The Devaluation of Nursing: a Position Statement

How nursing as a profession is valued may be changing and needs to be explored and understood in a global context. We draw on data from two empirical studies to illustrate our argument. The first study explored the value of nursing globally, the second investigated the experiences of overseas trained nurses recruited to work in a migrant capacity in the UK health care workforce. The indications are that nurses perceive themselves as devalued socially, and that other health care professionals do not give nursing the same status as other, socially more prestigious professions, such as medicine. Organizational and management structures within the NHS and the independent care home sector devalue overseas nurses and the contribution they make to health care. Our conclusions lead us to question the accepted sociocultural value of the global nursing workforce and its perceived contribution to global health care, and to consider two ethical frameworks from which these issues could be discussed further.

An analysis of delegation styles among newly qualified nurses

Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybodys friend and avoids assuming authority; the role model, who hopes that others will copy their best practice but has no way of ensuring how; and the inspector, who is acutely aware of their accountability and constantly checks the work of others. Conclusion Newly qualified nurses require educational and organisational support to develop safe and effective delegation skills, because suboptimal or no delegation can have negative effects on patient safety and care.

Infant Feeding Practices in The Klang Valley, Malaysia

Breastfeeding has always been the most optimum nutrition to babies. Despite its numerous benefits to the baby, mother and the society, the breastfeeding rate and duration is still low in most developing countries including Malaysia. The latest survey by the Malaysian’s Ministry of Health in 2006 showed that the breastfeeding rate at 4 months was only 32 % and even lower at 6 months (19.4%) (1) . The aim of this study is to show the current breastfeeding rate in the Klang Valley, Malaysia and looking at the factors involved in the early breastfeeding cessation. Mothers who delivered their babies were invited to answer a 55-point questionnaire based from the United State’s Infant Feeding Practices Study II (IFPS II) (2) via face to face or telephone call. Some of the questions include the type of infant feeding method, influence from husband, family and the media regarding the decision of infant feeding method, problems in breastfeeding, reasons of breastfeeding cessation and social and health supports received by the mother. The study showed that 93 % of the mothers (n = 259) initiated breastfeeding in the hospital. However only 33 % of them were exclusively breastfeeding their babies at 4 months and 21 % of the mothers were exclusively breastfeeding their babies at 6 months old. Forty two percent of the mothers said that husbands played an important role in the decision making of the infant feeding type, while 34 % agreed that grandmothers had a strong influence in the same decision making. Fifty four percent of the mothers said that having a low milk supply as the main reason to stop breastfeeding, while 35 % of them had to stop breastfeeding because they were returning to work. The remaining 11 % had other reasons such as baby refused to breastfeed, discouraged by family members and mother or baby had a health problem. Majority of the mothers had some health support to breastfeed from the medical staff and about 45 % did not received any support from the family members. Even though the Malaysian Government has been actively promoting breastfeeding to all its hospital, the breastfeeding pick up rate is still unsatisfactory. The role of family members and the society in supporting mothers to breastfeed has been undermined and could be one of the main reasons for the low and short breastfeeding rate and duration. Less mothers in the Klang Valley Malaysia were successful in breastfeeding their babies due to a variety of reasons including failure to get enough support from family members and society. This showed that mother’s knowledge alone is insufficient to ensure breastfeeding success. Effort must be made to help mothers to successfully breastfeed their babies such as educating the immediate family members (husband, grandparents, siblings), providing sufficient facilities for breastfeeding at the work place and the formation of more breastfeeding support group.

Putting knowledge to work in clinical practice : understanding experiences of preceptorship as outcomes of interconnected domains of learning

AIMS AND OBJECTIVES To explore how preceptor support can assist newly qualified nurses to put knowledge to work across interconnected forms of knowledge when delegating to healthcare assistants. BACKGROUND Current literature on preceptorship in nursing has failed to explore how competence is underpinned by knowledge frameworks in clinical practice. DESIGN An ethnographic case study in three hospital sites in England (2011-2014). METHODS Data collection included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis. A tool to assist newly qualified nurses to delegate and supervise newly qualified nurses during the preceptorship period was developed and piloted with thirteen newly qualified nurses in the same sites. A process evaluation was undertaken. FINDINGS Focusing on a key task for newly qualified nurses, delegation to healthcare assistants, we argue that preceptorship can support newly qualified nurses as they put knowledge to work in the transition from qualifying student to newly qualified nurses. In supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles (interconnected domains of learning) are key to understanding effective preceptorship. CONCLUSIONS We suggest that putting knowledge to work early in their careers with preceptorship support may assist newly qualified nurses to develop confidence and competence in delegation and supervision of healthcare assistants. RELEVANCE TO CLINICAL PRACTICE Our findings suggest that newly qualified nurses need to be supported by effective preceptorship in their learning as they transition from undergraduate to post graduate. Preceptorship programmes at ward and organisational level need to recognise the intensity of the learning required during this transition phase.

Associations between vitamin D status and radial bone geometry in older South Asian and Caucasian women

A. L. Darling, O. A. Hakim, K. Horton, M. A. Gibbs, L. Cui, J. L. Berry, S. A. Lanham-New and K. H. Hart Department of Nutrition and Metabolism, Faculty of Health and Medical Sciences, University of Surrey, Guildford, School of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford and University of Manchester, Manchester, UK