Leah Macaden

Risk perception among older South Asian people in the UK with type 2 diabetes.

Aim.u2002 To report on a study which developed a knowledge of the experiences of South Asian people with diabetes in the UK in relation to socio-cultural and dietary practices, religion and ageing influences on the perception and understanding of risks. Background.u2002 South Asian people have enhanced vulnerability to poor health as a result of diabetes. Risk perception and management is culturally mediated, yet imperative to the behaviour adjustments required for diabetes management. Method.u2002 A grounded theory study with data collected by focus group with ethnic health development workers and individual interviews with 20 older people with diabetes. Where necessary, interpreters were involved in data collection. Findings.u2002 A number of issues influence the perception of risk among South Asian older people with diabetes: beliefs about its cause, perceived severity and its visibility, food and its social function, religion and beliefs about external control over their life span and diabetes management. People weighed up the risks in making decisions about issues such as dietary management and the emphasis placed on diabetes as a pathology. Conclusion.u2002 Good risk communication will maintain the current trend of improving patients choice and self-management in health care, and there is a need for this to be sensitive to the particular issues faced by South Asians with diabetes in the UK.

The influence of locus of control on risk perception in older South Asian people with Type 2 diabetes in the UK

macaden l & clarke cl (2010)xa0Journal of Nursing and Healthcare of Chronic Illness 2, 144–152 The influence of locus of control on risk perception in older South Asian people with Type 2 diabetes in the UK n n n nAim of the study.u2002 To analyse risk perception among older South Asian people with Type 2 Diabetes in the UK. n n n nBackground.u2002 South Asians living in the UK have an increased predisposition to developing Type 2 diabetes. It usually occurs later in life and has significant long-term risks that are preventable with life-style changes. Changes in life-style practices are likely to be influenced by an individual’s perception of control over his/her health yet perceptions of risk are influenced by sociocultural factors, religious beliefs and gender. n n n nMethod.u2002 In this Grounded Theory study, data collection involved: two focus group interviews with health development workers representing ethnic minorities; seven individual interviews with practitioners (three physicians, three nurse specialists and a dietitian); 20 interviews with UK-resident older South Asians (nine men and eleven women) with Type 2 diabetes together with analysis of their medical records. Data for the study were collected between March 2004–February 2005. n n n nFindings.u2002 Those participants who demonstrated an internal locus of control were proactive in managing their diabetes-related risks. Participants with an external locus of control in perceiving and managing their risks related to diabetes believed that their diabetes was due to fate, bad luck, divine planning or familial predisposition and were reactive in engaging with diabetes-related risks. n n n nRelevance to clinical practice.u2002 This study demonstrates the role of affect and external locus of control in risk engagement among older South Asians with Type 2 Diabetes. The appropriateness of the concordance and empowerment model of diabetes care for minority ethnic groups such as the South Asians who engage with diabetes-related risks reactively driven by external locus of control needs to be carefully assessed.

Delirium in older people in hospital: an education programme

AIMnThis study aimed to determine the effectiveness of an educational programme on the identification and management of delirium by nurses in the medical wards of a tertiary care hospital in South India.nnnMETHODnA non-equivalent controlled pre- and post-intervention research design was used. The sample size of nurses through convenient sampling was 15 in the experimental group and 17 in the comparison group. A questionnaire was used to assess the knowledge of nurses and an observation checklist was used to assess practice. The Confusion Assessment METHOD ( Inouye et al, 1990 ) was used to detect delirium among older people who were hospitalised. Data collection was carried out over a 6-week period.nnnRESULTSnThere was a significant improvement in the knowledge (p<0.001) and practice (p<0.003) of nurses in the experimental group following the educational programme.

Revealing student nurses' perceptions of human dignity through curriculum co-design

Dignity is a slippery concept to define - yet it has been at the heart of media and policy debates around the provision of health and social care in recent years; particularly in the United Kingdom following the Mid-Staffordshire scandal and subsequent Francis Inquiry. This paper considers the concept of dignity in care from the perspective of student nurses. Thus, it allows us to discuss how professional nurses-to-be conceptualise dignity and also how they consider it should/could be taught at undergraduate and postgraduate levels of training, and as part of their Continuing Professional Development. It is only through understanding how student nurses conceptualise and experience human dignity, and the giving and receiving of dignity in care, that it will be possible to support its facilitation in the preparation of practitioners. This paper reports on findings from a series of participatory research workshops held with undergraduate nursing students in Scotland in 2013-14 that were designed to engage the students in the development of educational resources to support the teaching of dignity in care within the nursing curriculum. The outputs from each workshop, along with analysis of transcripts of the workshop discussions, demonstrate the value of co-design as a methodology for involving students in the development of interdisciplinary resources. We observed a desire from students to actively enhance their understandings of dignity - to be able to recognise it; to see dignity in care being practiced; to experience providing such care and to have the appropriate tools to reflect on their own experience. Overall, the research revealed a rich understanding of the ways in which human dignity is conceptualised by nursing students as an embodied practice, associated with memory and personal to an individual. It was understood by the students as shifting, experiential and fragile.

Participants’ perspectives on mindfulness-based cognitive therapy for inflammatory bowel disease: a qualitative study nested within a pilot randomised controlled trial

BackgroundMindfulness-based interventions have shown to improve depression and anxiety symptoms as well as quality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences of this group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives of patients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) about the intervention.MethodsIn a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapy for patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey were conducted. Data from both were analysed using thematic analysis. Data and investigator triangulation was performed to enhance confidence in the ensuing findings.Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from two Scottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group) also completed a postal survey and participated in two focus groups after completing post intervention assessments.ResultsThe major themes that emerged from the data were the following: perceived benefits of MBCT for IBD, barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educational and an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints.ConclusionsThis qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD. Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness. The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associated with IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentially influence the degree of therapeutic gain from MBCT for some participants.

Student nurses' perceptions of dignity in the care of older people

AIMnThe aim of this research was to investigate student nurses perceptions of the concept of dignity in the care of older people. Student nurses regularly move between the classroom and the clinical setting and are thus ideally placed to cast light on the barriers that exist to providing dignity in care and the way in which their theoretical understanding of dignity is shaped by exposure to the practice setting.nnnMETHODnAll student nurses on a three-year undergraduate nursing programme at one university were invited to participate in an online questionnaire survey and focus groups.nnnRESULTSnStudents equated the practice of upholding dignity with listening to individuals, involving them in decision making and maintaining their privacy. Participants were mostly confident about what dignity meant in practice, but were unsure about the more theoretical aspects. Four major barriers to the promotion of dignity were highlighted-these were organisational, environmental, professional and personal in nature.nnnCONCLUSIONnDignity education should occupy a more prominent position in pre-registration nursing programmes.

Co-Designing Inflammatory Bowel Disease (IBD) Services in Scotland: Findings from A Nationwide Survey

BackgroundThe Scottish Government’s ambition is to ensure that health services are co-designed with the communities they serve. Crohn’s and Colitis UK and the Scottish Government acknowledged the need to review and update the current IBD care model. An online survey was conducted asking IBD patients about their experiences of the NHS care they receive. This survey was the first step of co-designing and developing a national strategy for IBD service improvement in Scotland.Aim: To explore IBD patients’ experiences of current services and make recommendations for future service development.MethodsThis study was part of a wider cross-sectional on-line survey. Participants were patients with IBD across Scotland. 777 people with IBD took part in the survey. Thematic analysis of all data was conducted independently by two researchers.ResultsThree key themes emerged:Quality of life: Participants highlighted the impact the disease has on quality of life and the desperate need for IBD services to address this more holistically.IBD clinicians and access: Participants recognised the need for more IBD nurses and gastroenterologists along with better access to them. Those with a named IBD nurse reported to be more satisfied with their care.An explicit IBD care pathway: Patients with IBD identified the need of making the IBD care pathway more explicit to service users.ConclusionsParticipants expressed the need for a more holistic approach to their IBD care. This includes integrating psychological, counselling and dietetic services into IBD care with better access to IBD clinicians and a more explicit IBD care pathway.

Being Dementia Smart (BDS): A Dementia Nurse Education Journey in Scotland

Abstract There is a global demographic transition secondary to population ageing. The number of older people living with multimorbidities including dementia has been significantly rising both in developed and developing countries. It is estimated that there would be 74.7 million people living with dementia by 2030 that would escalate to 135.46 million by 2050. 62u2006% of people with dementia currently live in low and middle income countries that are very poorly resourced to cope with this epidemic. Dementia is now duly recognised as a national priority within the UK and a global priority at the 2013 G8 Summit. Management and care of an individual with dementia requires a multidisciplinary approach with expertise and a competent skill base. Nurses are central to the delivery of dementia care delivery in hospitals, community and residential care settings. It is against this background that this pre-registration integrated dementia curriculum was developed to build capacity and capability with dementia expertise among the future nursing workforce in Scotland in line with the National Dementia Strategy.

A scoping review of the pharmaceutical care needs of people with sensory impairment

This scoping review collated evidence of the pharmaceutical care needs of people with sensory loss (SL).

‘Has she seen me?’: a multiple methods study of the pharmaceutical care needs of older people with sensory impairment in Scotland

Objectives To explore the pharmaceutical care needs of, and service provision to, older people with sensory impairment (visual, hearing and dual impairment) on prescribed polypharmacy (≥4 medicines) in Scotland. Design Interviews were conducted with older people with sensory impairment and community pharmacy personnel, which informed the content of a subsequent national cross-sectional survey of community pharmacists. Setting Scotland, 2015–2016. Participants Older people with sensory impairment and community pharmacy personnel. Results Interviews were completed with 23 older people with sensory impairment (dual impairment n=13, visual or hearing impairment n=5 of each) and 30 community pharmacy personnel from eight of 14 Scottish Health Boards. A total of 171 survey responses were received. Older people reported that they did not always disclose their sensory impairment to pharmacy personnel. They also reported that medicines were difficult to identify particularly when their name, shape or colour changed. Pharmacy personnel relied on visible cues such as white canes or guide dogs to identify visual impairment and suggested that hearing loss was less visible and more difficult to identify. Many assistive aids in support of medicine management, such as dosette boxes, seemed inadequate for complex medication regimens. Few community pharmacy personnel reported receiving training in the care of people with sensory impairment. Conclusions This is the first comprehensive, multistakeholder, in-depth exploration of the pharmaceutical care needs of older people with sensory impairment. Strategies are needed to enable people with sensory impairment to disclose their impairment to pharmacy personnel (and other healthcare providers). Community pharmacy personnel require training to deliver person-centred pharmaceutical care for older people with sensory impairment particularly regarding communication with individuals in this vulnerable population.