Conceptualising dementia crisis and preferences for resolution: A public perspective

Background: Crisis intervention services for people with dementia in the United Kingdom are poorly defined with no standardized model of working. This may be due to the lack of a clear conceptualization of dementia crisis, resulting in variation in national service delivery. Methods: This study employed a novel public engagement questionnaire data collection technique with 57 participants to gain an updated perspective on the concept of health-related crisis from the point of view of the public. Results: Analysis revealed crisis as a transformational moment that may arrive unexpectedly but could also be the culmination of a sequence of events. Crisis resolution requires external and expert help, and associated feelings of panic and despair can engender the task of resolution by oneself insurmountable. Conclusions: Participants had clear expectations of crisis intervention services, with initial practical and emotional support to reduce risks, and a person-centered approach with family involvement

Community Nursing Services in England

This open access book provides an historical account of the ways in which community nursing services in England have been shaped by policy changes, from the inception of the NHS in 1948 to the present day. Focusing on policies regarding the organisation and provision of community nursing services, it offers an important assessment of how community nursing has evolved under successive governments. The book also provides reflections on how historic policies have influenced the service of today, and how lessons learnt from the past can inform organisation and delivery of current and future community nursing services. It is an important resource for those researching community nursing and health services, as well as practitioners and policy makers

“Partnering to Understand Undergraduate Research and Writing Longitudinally”

In her longitudinal case study of a single undergraduate, College Writing and Beyond (2007), Anne Beaufort investigates several knowledge domains contributing to students’ development as writers. As a team of librarians and writing faculty in research and teaching partnership, we hope to build on Beaufort’s work by examining and elaborating the role of research with respect to writing development by sharing findings from our own longitudinal study of undergraduates’ development as writer-researchers. Specifically, we are interested in the ways in which undergraduates’ research interfaces with their writing practices as they advance through their general education coursework and various disciplines. How do students perceive and articulate their understanding of writing and research, respectively and/or in interaction with one another? Have students’ understandings of writing and research changed since their first year? How so? To what do students attribute their shaping influences? To what extent, for example, are students’ understanding of writing and research influenced by the faculty with whom they study? In this panel, we present findings associated with a set of student case studies based on collaboratively coded and analyzed student interviews, triangulated with student process and literacy narratives as well as faculty interviews. Findings to date concern the unexpected role of students’ work with primary data (e.g., interviews) as well as differences among students’ reading practices, understandings of source authority, and dispositions. These findings have implications for students’ research and writing as well as for how faculty and librarians might teach research, including in response to certain challenges posed by information literacy in the digital age

Not Profiting from Precarity: The Work of Nonprofit Service Delivery and the Creation of Precasiousness

This paper examines the impact of precarity on the nonprofit service providing sector (NPSS). Using in depth qualitative interviews, recent empirically-based surveys of the Ontario nonprofit sector and key academic and grey literature, we explore the deeper meaning of precarity in this sector. We contend that the NPSS is a unique, and in many respects, an ideal location in which to explore the workings and impact of precarity. Looking at the nonprofit sector reveals that precarity operates at various levels, the: 1) nonprofit labour force; 2) organization structure and operation of nonprofit agencies; and, 3) clients and communities serviced by these nonprofit organizations. By observing the workings of precarity in this sector, precarity is revealed to be far more than an employment based phenomenon but also a force that negatively impacts organizational structures as well as vulnerable communities

Community Nursing Services in England

This open access book provides an historical account of the ways in which community nursing services in England have been shaped by policy changes, from the inception of the NHS in 1948 to the present day. Focusing on policies regarding the organisation and provision of community nursing services, it offers an important assessment of how community nursing has evolved under successive governments. The book also provides reflections on how historic policies have influenced the service of today, and how lessons learnt from the past can inform organisation and delivery of current and future community nursing services. It is an important resource for those researching community nursing and health services, as well as practitioners and policy makers

Dyadic construction of dementia: meta-ethnography and behaviour-process synthesis

Objectives: Positive identity in people with dementia is maintained when there is good interaction with family caregivers. However, research on the experiences of dyadic interaction in dementia care is still limited. For this reason, we aimed to systematically review the dyadic experience of dementia caring. Method: Studies were identified through searching five databases: MedLine, EMBASE, PsycInfo, ASSIA, and CINAHL. Eligible studies employed qualitative or mixed method design, reported the experience of dyads of dementia with no comorbid organic or psychiatric disorders. No restrictions were made on language or year of publication, nor on sex or age of participants. The quality appraisal of studies was conducted by two researchers independently. We used meta-ethnography to synthesise data and developed a behavioural model to explain dyadic interaction. Results: A total of 17 studies were included in the review. The meta-ethnography generated two third-order constructs: Personal orientation and noises. When both people with dementia and their carers opt for dyadic oriented goals, their behavioural responses are likely to promote positive interaction. When only one partner opts for dyadic goals, the stress posed by the context may affect the interaction because of no perceived shared understanding of the situation. Conclusion: Our findings suggest that unequal power distribution within dementia dyads, can cause significant stress especially when coping strategies are impaired. Implications are found for family carers, people with dementia, and health professionals as the model we derived enhances the understanding of dyadic dynamics to care

A scoping review of crisis teams managing dementia in older people

Background: Research on crisis teams for older adults with dementia is limited. This scoping review aimed to 1) conduct a systematic literature review reporting on the effectiveness of crisis interventions for older people with dementia and 2) conduct a scoping survey with dementia crisis teams mapping services across England to understand operational procedures and identify what is currently occurring in practice. Methods: For the systematic literature review, included studies were graded using the Critical Appraisal Skills Programme checklist. For the scoping survey, Trusts across England were contacted and relevant services were identified that work with people with dementia experiencing a mental health crisis. Results: The systematic literature review demonstrated limited evidence in support of crisis teams reducing the rate of hospital admissions, and despite the increase in number of studies, methodological limitations remain. For the scoping review, only half (51.8%) of the teams had a care pathway to manage crises and the primary need for referral was behavioral or psychological factors. Conclusion: Evidence in the literature for the effectiveness of crisis teams for older adults with dementia remains limited. Being mainly cohort designs can make it difficult to evaluate the effectiveness of the intervention. In practice, it appears that the pathway for care managing crisis for people with dementia varies widely across services in England. There was a wide range of names given to the provision of teams managing crisis for people with dementia, which may reflect the differences in the setup and procedures of the service. To provide evidence on crisis intervention teams, a comprehensive protocol is required to deliver a standardized care pathway and measurable intervention as part of a large-scale evaluation of effectiveness

You’ve just cursed us : precarity, austerity and worker participation in the nonprofit social services

The article utilizes qualitative data from two Canadian case studies to address this issue. The two cases reveal that market-embracing austerity is driving the erosion of workplace participation, both in terms of the level of control workers exercise over their day-to-day task and representative security. The article is divided into four sections. The first provides a literature that begins with outlining the impact of austerity in the NPSS sector, followed by prospects for employee participation among the Canadian/Ontario NPSS organisations in this context, and research questions. The next section outlines the study’s method, followed by the findings, discussion and concluding sections

Improvements in Bilateral Differences in Lean Mass and Strength in Persons with Parkinson’s Disease Presenting Unilateral Motor Symptoms

In persons with Parkinson’s disease (PD), individuals present altered motor symptoms such as rigidity, tremors and bradykinesia. These motor symptoms typically present in the early stages of PD unilaterally. Resistance training with instability (RTI) and cadence walking (CW) are effective in improving markers of fragility and motor function. The benefit of combining RTI and CW and its effects on lean mass and strength hav not been studied. PURPOSE: to examine the effects of RTI, CW and RTI+CW on lean mass in affected and unaffected sides and strength in persons with PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. DXA scans and strength assessments were performed at pre- and post-assessments. RESULTS: A significant difference was present between affected and unaffected sides of lean mass in the upper and lower body of PD participants, with the unaffected side averaging more lean mass for all groups. The average lean mass at pre-assessments in the unaffected arm was 2.92 + 1.05 kg versus the affected arm at 2.80 + 0.99 kg, p=0.043. The difference in the unaffected and affected arms’ lean mass decreased and was no longer significant at post-assessments (unaffected 2.9 + 1.01 kg and affected 2.88 + 1.00 kg, p=0.165), indicating a significant time effect. There was not a significant difference in lean mass for the affected and unaffected legs. A significant group x time effect was observed for RTI and RTI+CW in comparison to CW alone for lean mass differences in affected and unaffected arms at post-assessments (p=0.048 and p=0.44). A significant difference was noted between RTI and RTI+CW in comparison to CW alone in chest press improvements at post-assessments (RTI 30.00 + 16.43 lbs, CW 7.50 + 11.29 lbs, p=0.033 and RTI+CW 18.33 + 7.53 lbs, p=0.47). Interestingly, no group differences in leg press were noted. CONCLUSION: Bilateral differences exist in lean mass DXA results in the affected and unaffected arms of persons with PD who present motor symptoms unilaterally. The bilateral differences in lean mass are improved in RTI and RTI+CW but not in CW alone

AQUEDUCT intervention for crisis team quality and effectiveness in dementia: protocol for a feasibility study

Background: Specialist community teams often support people with dementia who experience crisis. These teams may vary in composition and models of practice, which presents challenges when evaluating their effectiveness. A best practice model for dementia crisis services could be used by teams to improve the quality and effectiveness of the care they deliver. Objective: The aim of this study is to examine the feasibility of conducting a large-scale randomized controlled trial comparing the AQUEDUCT (Achieving Quality and Effectiveness in Dementia Using Crisis Teams) Resource Kit intervention to treatment as usual. Methods: This is a multisite feasibility study in preparation for a future randomized controlled trial. Up to 54 people with dementia (and their carers) and 40 practitioners will be recruited from 4 geographically widespread teams managing crisis in dementia. Quantitative outcomes will be recorded at baseline and at discharge. This study will also involve a nested health economic substudy and qualitative research to examine participant experiences of the intervention and acceptability of research procedures. Results: Ethical approval for this study was granted in July 2019. Participant recruitment began in September 2019, and as of September 2020, all data collection has been completed. Results of this study will establish the acceptability of the intervention, recruitment rates, and will assess the feasibility and appropriateness of the outcome measures in preparation for a large-scale randomized controlled trial. Conclusions: There is a need to evaluate the effectiveness of crisis intervention teams for older people with dementia. This is the first study to test the feasibility of an evidence-based best practice model for teams managing crisis in dementia. The results of this study will assist in the planning and delivery of a large-scale randomized controlled trial. International Registered Report Identifier (IRRID): DERR1-10.2196/1897