Supporting the emotional needs of young people in care: a qualitative study of foster carer perspectives

Young people who have been removed from their family home and placed in care have often experienced maltreatment and there is well-developed evidence of poor psychological outcomes. Once in care, foster carers often become the adult who provides day-to-day support, yet we know little about how they provide this support or the challenges to and facilitators of promoting better quality carer-child relationships. The aim of this study was to understand how carers support the emotional needs of the young people in their care and their views on barriers and opportunities for support. Participants were 21 UK foster carers, recruited from a local authority in England. They were predominantly female (86%), aged 42-65 years old and ranged from those who were relatively new to the profession (<12 months' experience) to those with over 30 years of experience as a carer. We ran three qualitative focus groups to gather in-depth information about their views on supporting their foster children's emotional well-being. Participants also completed short questionnaires about their training experiences and sense of competence. Only half of the sample strongly endorsed feeling competent in managing the emotional needs of their foster children. While all had completed extensive training, especially on attachment, diagnosis-specific training for mental health problems (eg, trauma-related distress, depression) was less common. Thematic analysis showed consistent themes around the significant barriers carers faced navigating social care and mental health systems, and mixed views around the best way to support young people, particularly those with complex mental health needs and in relation to reminders of their early experiences. Findings have important implications for practice and policy around carer training and support, as well as for how services support the mental health needs of young people in care

Exploring facilitators and barriers to nurses’ uptake of postgraduate education in Australia

Background Nursing education is designed to prepare competent nurses to meet the current and future healthcare needs of society. Nurses require advanced education to increase their ability to influence patient care positively (Cotterill-Walker, 2012), deliver optimal care (Robert Wood Johnson Foundation, 2013) and improve patient outcomes (Girot & Albarran, 2012). Therefore, it is important to understand registered nurses’ attitudes towards postgraduate education. To advance the profession and provide excellent patient care, barriers that hinder nurses from undertaking advanced education should be identified and then properly addressed. Identifying the facilitators that influence nurses to advance their education will help healthcare organisations and healthcare educators to develop programs that will promote an environment that supports education advancement. Aim The primary aim of this research was to explore registered nurses’ attitudes towards postgraduate education in Australia. Methods This research followed a sequential mixed-methods approach design that included development of an instrument (questionnaire- Nurses Attitudes towards Postgraduate Education [NATPGE]), an online survey and telephone interviews. Phase One comprised a survey, the Nurses’ Attitudes Towards Postgraduate Education (NATPGE) instrument developed for this research, which was given to a sample of registered nurses in Australia to explore the barriers to and facilitators of postgraduate specialty education. Phase Two comprised an interpretative study, which took a translational research approach in which qualitative data were collected through telephone interviews with registered nurses to contextualise the Phase One survey findings. The planned and deliberate synthesis of the findings, through discussion, from these two phases has direct implication to postgraduate education for specialty practice in Australia. Results Phase One (survey) was the final stage of the instrument development that used data-reduction techniques and the results of the survey showing the nurses’ attitudes towards postgraduate education. Principal Component Analysis was performed on all 14 NATPGE items. Accounting for 52.5% of the variance of the scale, the analysis identified a three-factor solution for 14 items: ‘facilitators’; ‘barriers’; and ‘professional recognition’. Qualitative analysis of the data from Phase Two, the interpretative study, showed three broad conceptualisations of registered nurses’ attitudes towards postgraduate education: ‘facilitators’; ‘barriers’ and ‘professional recognition’. Conclusion Understanding the factors that affect registered nurses’ attitudes towards postgraduate education will help educators identify areas for change to attract registered nurses to pursue postgraduate education. The overall results from this research provide a composite understanding of the facilitators of and barriers to postgraduate education for Australian nurses

Using Remote Sensing Techniques to Investigate the detection of Sargassum Blooms in the Caribbean and Possible Causes for these Events

Sargassum was thought to originate from a single source, the Sargasso Sea in the central west Atlantic. This has been challenged over the past decade after excessive amounts of the macroalgae began washing up on Caribbean coastlines in June 2011, leading the scientific community to investigate causes of this phenomenon. These, now yearly, events are having detrimental environmental and socioeconomic impacts in areas of the Caribbean and central America, providing motivation for uncovering any regime shifts or severe changes in anthropogenic activity. Anthropogenic sources of nitrate from three rivers surrounding the CWA in addition to wind stress and chlorophyll-a levels within the study area are investigated to determine if any of these drivers are stand-out reasons and to what extent. The results show some extreme events of river nutrient discharge from all three sources backed up by MERIS imagery that align with reports of sargassum strandings. The report found no significant correlation between excess nutrients and chlorophyll-a concentrations implying there is no competition for nitrate with phytoplankton. There was also no significant difference in wind stress in the months prior to stranding events, leading to the assumption nitrate is the most probable contributing factor to these occurrences

Nephronophthisis: a genetically diverse ciliopathy.

Nephronophthisis (NPHP) is an autosomal recessive cystic kidney disease and a leading genetic cause of established renal failure (ERF) in children and young adults. Early presenting symptoms in children with NPHP include polyuria, nocturia, or secondary enuresis, pointing to a urinary concentrating defect. Renal ultrasound typically shows normal kidney size with increased echogenicity and corticomedullary cysts. Importantly, NPHP is associated with extra renal manifestations in 10-15% of patients. The most frequent extrarenal association is retinal degeneration, leading to blindness. Increasingly, molecular genetic testing is being utilised to diagnose NPHP and avoid the need for a renal biopsy. In this paper, we discuss the latest understanding in the molecular and cellular pathogenesis of NPHP. We suggest an appropriate clinical management plan and screening programme for individuals with NPHP and their families

Polymorphisms in the circadian expressed genes PER3 and ARNTL2 are associated with diurnal preference and GNβ3 with sleep measures

Sleep and circadian rhythms are intrinsically linked, with several sleep traits, including sleep timing and duration, influenced by both sleep homeostasis and the circadian phase. Genetic variation in several circadian genes has been associated with diurnal preference (preference in timing of sleep), although there has been limited research on whether they are associated with other sleep measurements. We investigated whether these genetic variations were associated with diurnal preference (Morningness-Eveningness Questionnaire) and various sleep measures, including: the global Pittsburgh Sleep Quality index score; sleep duration; and sleep latency and sleep quality. We genotyped 10 polymorphisms in genes with circadian expression in participants from the G1219 sample (n = 966), a British longitudinal population sample of young adults. We conducted linear regressions using dominant, additive and recessive models of inheritance to test for associations between these polymorphisms and the sleep measures. We found a significant association between diurnal preference and a polymorphism in period homologue 3 (PER3) (P < 0.005, recessive model) and a novel nominally significant association between diurnal preference and a polymorphism in aryl hydrocarbon receptor nuclear translocator-like 2 (ARNTL2) (P < 0.05, additive model). We found that a polymorphism in guanine nucleotide binding protein beta 3 (GNβ3) was associated significantly with global sleep quality (P < 0.005, recessive model), and that a rare polymorphism in period homologue 2 (PER2) was associated significantly with both sleep duration and quality (P < 0.0005, recessive model). These findings suggest that genes with circadian expression may play a role in regulating both the circadian clock and sleep homeostasis, and highlight the importance of further studies aimed at dissecting the specific roles that circadian genes play in these two interrelated but unique behaviours

Interprofessional Learning during an International Fieldwork Placement

The need for competent interprofessional health care professionals is well recognised. Various educational activities have been developed to facilitate the development of interprofessional competence. In this paper we describe an interprofessional, fieldwork experience conducted in a developing country, and the learning gained by the first cohort of students who completed the five week immersion. Eight final year students from Medicine, Occupational Therapy, Physiotherapy and Speech Pathology were interviewed pre- and post-placement by an independent researcher. The transcribed interviews were analysed thematically. Findings indicated that over the placement students gained an appreciation of the skills of the other disciplines and were able to move beyond a textbook definition of what a certain profession did to acquire a real understanding of interprofessional practice. However, students reported that this understanding was predicated on their first clarifying the extent to which they were working in a transdisciplinary or interdisciplinary team, and becoming more confident in their own disciplinary contribution without reliance on formal documentation or standardised assessments. Using daily team discussions, self-reflections and discussions with clinical educators, the students learned to prioritise their busy caseload, share resources and skills, and facilitate team members to achieve therapeutic goals. The interprofessional learning took place in an intercultural context where the students learned to work with children with severe disabilities, with staff with different classroom approaches, and with interpreters, while adjusting emotionally to the level of unmet need of many of the children. Based on the students' experiences, immersion in an intercultural fieldwork experience is a useful way to facilitate interprofessional learning

Accommodation needs for carers of and adults with intellectual disability in regional Australia: Their hopes for and perceptions of the future

Introduction: This article provides an in-depth investigation of the accommodation circumstances of a population of aging adults with intellectual disability living at home with parents or in supported accommodation in an Australian regional centre. Given the ageing of both the carer and adult population with intellectual disability our research explored the accommodation needs and perceptions of future lifestyle issues from the perspective of both the carers and the adults with intellectual disability. This study aimed to describe these accommodation circumstances related to a regional/rural location and did not make direct comparisons with urban/metropolitan situations. Methods: A mixed methods approach, specifically an explanatory design, participant selection model was utilised for the overall study. This article reports on the qualitative study consisting of data from both free response open-ended survey questions and semi-structured interviews with selected adults with intellectual disability and their carers. This study explored and described participants’ experiences and perceptions regarding their accommodation needs and future lifestyle issues. A purposive sampling technique was used to identify a representative sample of participants for interviews. The interview questions were guided by the results of the quantitative first study phase. Data were analysed by content analysis for major themes emerging from the interview and free response survey data. Results: A total of 146 carers (mean age 61.5 years; range 40–91 years) and 156 adults with intellectual disability (mean age 37.2 years; range 18–79 years) participated in the study. Data saturation was reached after 10 interviews were undertaken with carers (mean age 60 years) and 10 with adults with intellectual disability (no age criteria applied). Six major themes were identified: ageing, family issues, living at home, living away from home, government support and funding, and future needs. The perceptions and views of both adults with intellectual disability and their carers around these major themes are reported and discussed. Conclusions: This study indicates that there is a lack of suitable, available, supported accommodation for people aged 18 years and older with intellectual disability in this Australian regional centre. Consequently, aging parents caring at home have little choice but to continue in their caring role. For those caring away from home, existing services are decreasingly seen as fitting the ideal life they want for the person with intellectual disability for whom they care. The told experiences, perceptions and views of older carers of and adults with intellectual disability have highlighted their increasing vulnerability to the ‘disability system’. The findings suggest that government and disability services must acknowledge the changing needs of people with intellectual disability in connection with their advancing age and the urgency of increasing care needs due to the advancing age of their carer/s. The overwhelming feeling is that the carer’s voice will only be heard when the situation reaches crisis point. For many carers and their families this has already occurred