Service users' views of therapeutic care

The overall aim of the study was to evaluate the effectiveness of the Therapeutic Care service delivered by the Red Cross. Specific objectives were to explore service users’ experiences and perceptions of Therapeutic Care. The research adopted a qualitative approach with purposive sampling used to identify and recruit individuals from Central Scotland who had received the service in the last 12 months. In-depth unstructured interviews were conducted with 30 service users aged between 39 -100 years, who suffered from a range of health conditions including cancer, Parkinson’s disease, arthritis, chronic pain and mental ill health

Does therapeutic massage support mental well-being?

Massage was once a traditional medical practice of many ancient cultures. Today, the practice of modern therapeutic massage is embedded within the field of complementary or alternative medicine (CAM). The demand for evidence based medicine requires the integration of clinical expertise with the best available external evidence from systematic research. Thus in the last twenty years the therapeutic uses of massage have broadened and research has sought to investigate its physical, physiological and psychological effects. This paper reviews the literature in order to determine whether massage is an effective CAM modality that contributes positively to mental wellbeing. The evidence suggests that massage therapy is a relatively safe intervention with no significant adverse effects being reported

From dawn to dusk: a temporal model of caregiving: adult carers of frail parents

Caregiving is not a short term commitment. Of the estimated 6 million carers in the UK, almost a third of co-resident carers have been caring for at least 10 years (Rowland and Parker 1998). Yet our understanding of how caregiving evolves over time is limited. Many of the existing temporal models of care are based on studies of service users who suffer from dementia and their carers. These models have a tendency to map the experiences of carers in line with the progress of this degenerative condition. This focus means that existing models overlook the care provided for non-users of services such as older people without dementia, whose progress towards frailty and dependence is uncertain. The study on which this paper is based was a longitudinal, qualitative one which used a grounded theory methodology. Over a period of 28 months, it explored the experiences of unsupported carers of older people who were not known to service providers. This study provides a unique insight into the lives of ‘unsupported carers’ and reveals how caregiving evolves over time. The paper outlines a temporal model of care and argues that unsupported or hidden caring is simply one of many dynamic stages; that carers are more receptive to service intervention during particular stages of their caregiving trajectory; and that in order to be effective, service interventions need to be ‘stage specific’

Surviving the transition from active to post-caregiving: the experiences of former carers

This paper focuses on the experiences of former carers; individuals who were previously unpaid informal carers actively providing care for a relative, but for whom caregiving has now come to an end. The carer population in the UK is constantly changing. Current estimates put the number in the UK at 6.5 million, of which 30% to 40% unpaid carers take on a caring role each year, while for approximately 2 million their role comes to an end (Carers UK, 2015). These figures illustrate the dynamic nature of informal caregiving and suggest that the population of former carers is increasing in size. Yet, this is a group that is almost completely overlooked by policy and practice, which tends to focus on providing support to those who are currently providing care. Drawing on data from an online survey, this paper presents former carers’ perspectives on negotiating the transition from active caregiving to post-caregiving. Participants were drawn from across the UK, were self-selected and had been former carers for between one and ten years. Variables reflecting the characteristics of care recipients, duration of caregiving, carers’ wellbeing, employment status and sources of support were explored. Findings suggest that former carers find it difficult to negotiate the transition into the post-caring period. They struggle with the psychological and emotional aspects of transition. Adaptation to a non-caregiving life is shaped by age and the level of support that is received but can be an isolating experience underpinned by a legacy of poor health and wellbeing

Health and wellbeing in the post-caregiving period

This paper focuses on the experiences of former carers; individuals who were previously unpaid carers of older people but for whom caregiving has ceased. Caring has been conceptualised as a ‘career’ that is characterised by key events, one of which is the end of caregiving and the transition into the post-caregiving period. Few temporal models of care include the post-caregiving period, yet this stage is an integral part of former carers’ experiences. Current estimates put the number of carers in the UK at 6.5 million. This population is constantly changing with 30% to 40% unpaid carers starting to provide care each year and a similar proportion stopping. These figures suggest that the population of former carers is increasing in size. Yet, this is a group that is almost completely overlooked by policy, which tends to focus on providing support to those who are currently providing care. The literature suggests that caregiving has negative long term effects on people lives and is detrimental to their health and wellbeing; that when it ends, carers have no purpose to their lives and poor health means they are unlikely to re-enter the workplace. An alternative view is that far from leaving carers with no purpose, caregiving has enabled them to develop new skills and attributes which they can use in other contexts. In other words, the end of caregiving may offer former carers the opportunity to explore new horizons and opportunities. Drawing on data from a mixed methods study, the paper explores the transition made by former carers’ and their perspectives on personal wellbeing. Data analysis was guided by the principles of ground theory. The iterative approach of constantly comparing data enabled the emergence and identification of common themes and core categories. Findings suggest that former carers find it difficult to negotiate the transition into the post-caring period. They struggle with the psychological and emotional aspects of transition. Adaptation to a non-caregiving life is shaped by age and for older people in particular, can be a lengthy isolating experience underpinned by a legacy of poor health and wellbeing

Rural community development - New challenges and enduring dilemmas

Rural community vitality depends on communities maintaining adequate infrastructure, having access to services, enhancing business and economic opportunities and establishing policy settings to foster outcomes. Vitality also relies on communities “rethinking” assets, developing networks, building local cooperation and acting on local passion and motivation. In addressing both these aspects, current approaches to rural and regional development represent a partial approach. Efforts largely focus on service provision, discrete initiatives, information dissemination and provision of resources to meet perceived needs. While these are crucial elements of rural development, a more comprehensive approach is needed. A more comprehensive agenda involves engagement that helps people act on existing motivation, includes greater recognition of frustration and anger in regional areas, and helps people gain better access to information and services. A broader approach would also reexamine agency assumptions, better foster community confidence, provide more coordinated frameworks for discrete initiatives, and establish community relationships beyond those of service delivery. In implementing this expanded approach community developers face five challenges – a greater recognition of community values, new forms of participation, coping with perceptions, fostering community confidence and changes to the role of government. Addressing these challenges raises fundamental dilemmas such as focused action vs. community unity, participative democracy vs. representative democracy, and volunteerism vs. professionalism

Work and informal caregiving: challenges and opportunities

Working in an employed role has become increasingly influential in structuring the lives of informal caregivers with this having a significant impact on their socio-economic wellbeing. Over the life course most caregivers move through periods of both commodified work (being employed in the labour market) and non-commodified work (caring and family work). Many carers are unable to sustain paid employment in light of increasing demands of caregiving, choosing to focus on their caregiving responsibilities. However, at the point when these responsibilities end, they are left financially worse off and face difficulties accessing paid work again with many unable to return to their previous roles. Paid work and caregiving are perceived as different spheres - but for caregivers each creates conflicting demands. Uncommodified activities are less valued yet the informal sector carries the burden of social care with the monetary value placed on informal caregiving in the UK at £119 billion per year (1). Drawing on findings from a recent mixed methods study, this paper will discuss ways in which informal caregivers negotiate their employment status including how their ‘employability’ can be enhanced through skills and knowledge gained from caregiving. Reference (1) Buckner and Yeandle (2011) Valuing Carers 2011: Calculating the Value of Carers’ Support, Carers UK, The Centre for International Research on Care, Labour and Equalities and the University of Leeds, London, UK

An integrated literature review of death education in pre-registration nursing curricula: key themes

Recent policy has raised the profile of end-of-life care internationally, with the aim of increasing access to quality care for everyone experiencing life-limiting illness. This reflects an international shift in the provision of palliative care to encompass chronic conditions other than cancer. Nurses have an important role in delivering this care and need to be equipped with particular knowledge and skills. However, pre-registration nursing curricula have traditionally had a limited emphasis on death and dying and nurses report feeling unprepared to care for dying patients. This has led to claims that death education in pre-registration curricula is inadequate. This integrated review explores published literature that reports on death education within pre-registration nurse education. Presenting an international overview, the aim of the review is to contribute to knowledge about the nature and extent of death education in pre-registration curricula. In the context of this paper, death education encompasses both palliative and end-of-life care. Electronic searches of major bibliographic databases found inconsistencies across educational provision with variations in quantity, content and approach. Despite an increasing amount of death education in pre-registration curricula, there remains a deficit in key areas such as knowledge, skills, organisation of care and teamwork

Nitrated cross-linked b-cyclodextrin binders exhibiting low glass transition tempratures

Polymeric binders such as β‐cyclodextrins (βCDs) are used to bind with other constituents of energetic formulations and to prevent accidental ignition. One of the advantages of βCDs is the ability to tune their properties by chemical modification. Here, we synthesised nitrated cross‐linked βCDs (βNCXCDs) to produce new binders for energetic formulations. The cross‐linking of βCD with non‐toxic triethylene glycol diglycidyl ether (TEGDGE, X=T) and poly(ethylene glycol) diglycidyl ethers (PEGDGE, X=P) yielded soft, water soluble oligomeric compounds (βCXCDs) which can improve the processability of energetic formulations and contribute to their desensitisation. When the PEGDGE cross‐linker was used, lower glass transition temperatures were achieved, which extended the operative range of the βCPCD binder to −20 °C. The analogous nitrated systems (βNCXCDs) were therefore synthesised using a 1 : 1 (v/v) ratio of 98 % sulfuric acid/100 % nitric acid or 100 % fuming nitric acid, increasing their solubility in acetone and tetrahydrofuran. The nitrated derivatives were characterised by decomposition temperatures (200 °C) and energies (up to 1750 J g−1) comparable to nitrocellulose. Moreover, the glass transition of the inert βCXCDs at low temperatures (<0 °C) was conserved in the corresponding nitrated βNCXCDs, ensuring the desensitisation of energetic compositions even at low temperatures. This is the first time that nitrated derivatives of βCD with glass transition temperatures below 0 °C have been reported, suggesting such derivatives could make suitable replacements for nitrocellulose and other binders in energetic formulations