The Compounding Nature of Transitions in Dementia: Nursing Implications to Promote Dignity

Transitions in older age can be fraught with challenges for older adults and their families. In particular, a diagnosis of dementia – as a transition in and of itself – can lead to multiple transitions. Within this paper, we present a case study of a couple in which the wife is diagnosed with dementia, and the resultant transitions which follow for the wife, husband, and adult daughter. The case study provides a background of the tremendous difficulties that arise with a diagnosis of dementia, becoming a caregiver, and the precariousness of the caregiver role when health changes occur, resulting in a transition to a care facility. Psychosocial and existential responses in relation to a diagnosis of dementia, becoming a caregiver, and transitioning to a facility are discussed. Challenges in navigating the healthcare system are addressed that may diminish a sense of personhood for those with dementia, as well as nursing implications arepresented. In particular, we discuss nursing implications of discourses in dementia care, as well as ethical issues of balancing the wishes of caregivers and individuals with dementia

The Challenges Faced by Older, Incarcerated Adults: How Age Impacts the Prison Experience

The number of aging prisoners in North America has increased substantially in recent years. This group of inmates often experiences challenges that their younger counterparts do not, such as health issues, difficulty accessing health care, a lack of programming, navigating an environment that is not designed for aging individuals, and challenges related to post-release, such as securing adequate housing.  In this paper, we discuss the aforementioned challenges, as well as address implications from a health care perspective

Qualitative Description Research: An Examination of a Method for Novice Nursing Researchers

According to Bradshaw, Atkinson, and Doody (2017), a qualitative description (QD) design focuses primarily on describing and defining an often new phenomenon in order to provide basic information about the who, what, where, and why of the experience from the particular viewpoint from those involved. As a method, QD offers an accessible approach to qualitative research for many beginning nursing researchers but has been often overlooked or confused with other traditional descriptive methods such as case study, phenomenology, grounded theory, and ethnography. Given the value and applicability to the nursing profession, the two-fold purpose of this paper is: (a) to provide novice and student nursing researchers with a robust understanding of the QD approach to help guide their research activities and apply research findings within practice settings, and (b) to offer a comparative analysis of QD in relation to other qualitative approaches. Drawing from the literature, we present an in-depth overview of this QD approach by focusing on its purpose, guiding principles, and the steps of the research process.  &nbsp

A Critical Look at Participation of Persons with Mental Health Problems in Training Mental Health Professionals within University Education

Involvement of persons with mental health disorders, with or without addictions (persons with MHA), within mental health education is becoming more common in some parts of the western world, in particular, the United Kingdom. What does involving persons with MHA entail and what are the benefits and challenges in involving these individuals in education? In this paper, we take a critical look at involvement of persons with MHA within the literature and provide a case study of a Canadian inter-professional mental health and addictions course where persons with MHA were included in some aspects of teaching. We present the evaluation of the course, and offer implications for involvement of persons with MHA in university courses

Outcomes of a teacher-led reading intervention for elementary students at-risk for behavioral disorders

This is the publisher's version, also found here: http://cec.metapress.com/content/g8686u4nu0p8772l/?p=1258705a1fcb41948563bb666b6ae215&pi=2To date, reports of reading interventions for students at risk for emotional/behavioral disorders (E/BD) that have been published in refereed journals have involved sustained support by university or school-site personnel. This study examined the efficacy and feasibility of a reading intervention that 2 general education teachers implemented in inclusive settings to support 7 first-grade students at risk for E/BD and reading difficulties. Results of a multiple baseline design revealed lasting improvements in reading fluency for all students, accompanied by decreases in variability of academic engagement for 4 students. Although intervention goals, procedures, and outcomes exceeded teacher expectations, social validity ratings for some students declined between the onset and the conclusion of the intervention. This article presents limitations, future directions, and educational implications

Is learning being supported when information is provided to informal carers during inpatient stroke rehabilitation? A qualitative study

Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles. Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles. Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers’ understanding of information provided nor offer learning opportunities beyond written or verbal information. Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

A systematic review of sport and dance participation in healthy young people (15-24 years) to promote subjective wellbeing

We know that taking part in physical activity like sport and dance can bring wellbeing benefits, such as being more satisfied with life and happier, and feeling less anxious and depressed. Most of the evidence is however about adults. This review was carried out to investigate the relationships between subjective wellbeing (SWB) and taking part in sport and dance for healthy young people (15-24 years). Healthy people were defined as those without a condition diagnosed by a health professional. SWB describes wellbeing in terms of the good and bad feelings arising from what people do and how they think. The focus of this review was agreed through on-going collaborative engagement with UK-wide stakeholders representing policy, commissioning and managing, service delivery, and scholars from both academic and non-academic organisations. We examined studies from the past 10 years and found that there is limited good quality evidence, and very little conducted in the UK. The review includes published findings from 977 participants across six countries - China, Korea, India, Turkey, Sweden and the USA. In some studies, participants were predominantly female. A wide variety of wellbeing measures were used. The most common form of sport/dance related activity was based on meditative practices (yoga and Baduanjin Qigong). Other physical activities reported included body conditioning, aerobic exercise, dance training, hip hop dance and sports including volleyball, ice skating, Nintendo Wii Active Games. We included evidence from recent unpublished reports (grey literature) produced by or for sport and dance organisations since 2013. Participants in the evaluations were both male and female with a mean age between 13-24 years and were engaged in UK-based programmes of sport and dance. Findings illustrate that depending on activity type and delivery mode, taking part is associated with wellbeing improvements connected to social connectedness, pleasure, sense of purpose, confidence, interpersonal skills, happiness, relaxation, creative skills and expression, aspiration and ambition. Taking part was also associated with negative wellbeing connected to concerns about competency and capability. Overall, the evidence available in this review suggests that yoga-type activities have the potential to improve subjective wellbeing and that group-based and peer supported sport and dance programmes may promote wellbeing enhancement in youth groups. The evidence in this review provides limited promising findings upon which sport and dance programmes for wellbeing improvement could be developed. The lack of evidence identified in this review does not necessarily mean that wellbeing benefits are not accrued from taking part in sport and dance. There is scope to build evidence on wellbeing outcomes of sport and dance in healthy young people through well-designed, rigorous and appropriate research methods which are underpinned by relevant theory and use established methods of analysis

A systematic review of the subjective wellbeing outcomes of engaging with visual arts for adults (“working-age”, 15-64 years) with diagnosed mental health conditions

The importance of the visual arts in contributing to the wellbeing of adults with mental health conditions has been little documented beyond some insightful and influential interventions and exploratory studies. Initiatives such as Arts on Prescription projects have, in the UK provided examples of the positive effects that engagement in artistic and creative activity can have, and some of these have been documented in small-scale studies of interventions. Most of the evidence has been perceived as positive but of limited scale. In this context, this review was carried out to examine in a more focused way the ‘subjective wellbeing’ (SWB) outcomes of engagement with the visual arts for adults with a background history of mental health conditions. SWB embraces both the positive and negative feelings that arise in individuals based on their view of the world, how they think about themselves and others, and what they do in the interactions and practices of everyday life. Adult subjects in the studies included in this review were of ‘working-age’ (15-64 years). The focus of the review and the precise research question were agreed at inception sessions of the research team, and in collaborative engagement with stakeholders in the areas of policy, service-delivery, project and evaluation commissioning, and research and scholarship in the spheres of the visual arts and mental health. Published studies from the past 10 years were studied for the review, and their findings synthesised and integrated into an evaluation of the state of knowledge in the field, in terms of the specifics of the research questions. We found that there is limited high-quality evidence, though case studies from the UK have provided important and consistent findings, corroborated by grey literature that has reported on interventions and projects. The review includes published findings based on data on/from 163 participants across four countries – Australia, Sweden, the UK, and the USA. Overall, female respondents outnumbered male respondents. A wide variety of wellbeing measures were used in some quantitative, statistical studies. In-depth interviews dominated the qualitative studies, giving voice to the experiences of individual subjects. The visual arts practices that featured in the studies included forms of painting or drawing, art appreciation with selected art forms, artmaking culminating in an exhibition, and more general creative and craft activities that included visual artefacts such as ceramics or sculpture. Evidence we include from recent unpublished reports (grey literature) was produced by or for visual arts organisations since 2014. Participants in the evaluations were both male and female and were engaged in UK-based arts interventions, many via community arts or ‘Arts on Prescription’ types of intervention. Overall, the evidence available in this review has shown that engagement in the visual arts for adults with mental health conditions can reduce reported levels of depression and anxiety; increase self-respect, self-worth and self-esteem; encourage and stimulate re-engagement with the wider, everyday social world; and support in participants a potential renegotiation of identity through practice-based forms of making or doing. The most effective ‘working ways to wellbeing’ are also confirmed in processes of implementation that ensure provision of secure safe-space and havens for interventions; that recognise the value of non-stigmatising settings; and that support and sustain collaborative facilitation of programmes and sessions. 4 Some negative dimensions of engagement with the visual arts were also identified, including stress and pressure felt to complete activities or commit to artmaking, and the very real fear that the end of an intervention would mean the return to a world of anxiety, decreasing confidence and social isolation. The review shows that for adults starting visual arts activities or programmes, the subjective wellbeing outcomes are, for the majority of participants, positive. This applies to men and women alike across the studies. The most convincing evidence has emerged from focused qualitative research designs, and makes clear that the most effective work in the field continues to lack the necessary resources and infrastructure that would ensure sustainable practices and interventions. Overall, there is some evidence of benefit in a weak field that could be strengthened by fuller monitoring of cohorts to evaluate the long-term effects of participants’ engagement with the visual arts

Restoration of self-awareness of hypoglycemia in adults with long-standing type 1 diabetes: hyperinsulinemic-hypoglycemic clamp substudy results from the HypoCOMPaSS trial.

OBJECTIVE: Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. RESEARCH DESIGN AND METHODS: Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 2 × 2 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies. RESULTS: After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420-780] vs. 710 [460-1,260], P = 0.02; metanephrine, 2,412 [-3,026 to 7,279] vs. 5,180 [-771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. CONCLUSIONS: Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance