Management of faecal incontinence in the elderly: current policy and practice

Faecal incontinence in the elderly community-based population, is an important daily practice issue for community nurses, and poses particular sensitive intervention and care challenges. Prevalence estimates from various studies indicate that approximately 10% of the elderly suffer from chronic faecal incontinence, however this figure could rise to 25% in a nursing home population (Whitehead et al, 2009; NICE, 2014). Faecal incontinence is often a taboo subject and people who face this issue experience feelings of loss of dignity, embarrassment, social isolation, depression and loneliness (Stenzelius et al, 2007; Razjouyan et al, 2015). Elderly people suffering from this debilitating condition also increase the burden of care to their family, care-givers and health care services (Alavi et al, 2015). Care and intervention that is focused on individual needs is at the forefront of modern nursing practice, and when effective management of faecal incontinence is achieved, this can have a significant effect on the patient's quality of life, self-esteem, dignity and social inclusion (Ousey et al, 2010; Gillibrand, 2012)

Nurses’ contributions to the resolution of ethical dilemmas in practice

Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision making in healthcare. In order to meet these challenges effectively we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, eleven registered acute care nurses, working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from local the National Research Ethics Committee Findings: Four major themes emerged: ‘Best for the patient’, ‘Accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro and micro decision making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemma

The impact of pre-diabetes diagnosis on behaviour change: an integrative literature review

Type 2 diabetes is a growing global problem that not only affects individuals but also has an impact upon the economic health of countries. The number of people developing type 2 diabetes can be reduced by up to by 80%; this can be achieved by targeting those who are ‘at risk’. This reduction can be achieved by appropriate lifestyle changes to diet and physical activity. It is not known what the impact of being informed of a diagnosis of pre-diabetes has on an individual’s motivation to make appropriate lifestyle changes. The aim of this study was to assess whether having the diagnosis of pre-diabetes encourages or empowers people to make appropriate lifestyle changes to prevent progression to a diagnosis of type 2 diabetes. Employing a systematic approach, an integrative literature review was undertaken using a standard retrieval and appraisal method. The studies demonstrated that pre-diabetes was found to be a challenging concept by patients and nurses alike. Lack of knowledge and support, along with patients’ perceived barriers, had an impact upon the various motivation and self-efficacy behaviours towards lifestyle changes. The integrative review found that more education and support are required to motivate lifestyle change in the person with pre-diabetes. This, however, does not need to be medicine led; use of peer and community based programmes could be not only cheaper, but also have the ability to provide potentially long-term support for people, and would provide continued reduced risk. Intervention needs to ensure that it is provided at an appropriate level to account for cultural, social and gender needs. Innovative approaches need to be considered to reduce the number of people who are diagnosed with pre-diabetes from progressing to type 2 diabetes and its associated potential complications

Self-Management among the Ethnic Groups with Type 2 Diabetes Mellitus in Thailand

The prevalence of diabetes mellitus has been rising all over the world. Self-management is required for diabetes mellitus patients. The objective of this study is to explore the self-management among the ethnic groups with type 2 diabetes mellitus in Thailand, an upper middle-income country which is located in South East Asia. The ethnic groups in Thailand are a minority group which has limited education and a different culture, language, costume and lifestyle from Thai people. The qualitative exploratory study was used in this study. In-depth interviews with semi-structured open questions were conducted by 20 participants from purposive sampling. These participants were the ethnic groups who have type 2 diabetes mellitus, received the services from a region hospital, understood Thai and were willing to participate. Content analysis was adopted for the study. The results showed that all of the participants controlled their diet before the appointment day and never miss their appointment. Only 3 participants did their exercise while 2 participants stated that they occasionally forgot to take medicine. 10 participants use the herbs for reducing the sugar level. 12 participants drank a lot of water after a lapse in the diet because they believed that water could dilute the sugar. The findings identified 5 themes; ‘controlling diet before appointment day’; ‘drinking water after a lapse in diet’; ‘medication being a vital importance’; ‘exercise is unimportant’; and ‘taking herbs for sugar reduction’. The results of this study are important to the health professionals to understand the self-management of Ethnic groups and use the data to create the appropriate intervention for promoting health among the ethnic groups with type 2 diabetes mellitus in Thailand. The findings will lead to the revision of health policy and the procedure for promoting health in this special ethnic groups

Developing a Culture of Publication: a joint enterprise writing retreat

Purpose: Many students irrespective of level of study produce excellent course work which, if given support and encouragement could clearly be of a publishable standard. Academic staff are expected to produce quality publications meeting peer review standards although they may be relatively novice authors. All are engaged in some aspects of academic writing practices but not as frequently involved in co-production of publications emanating from student work. This activity is still at the margins of much of the student experience. Design/methodology: Mindful of these issues, we designed and offered a writing programme including a writing retreat. This brought together undergraduate and postgraduate students from a range of applied disciplines (health and art, design and architecture) and their supervisors with the aim of co-producing publications and participating in a community of scholarly practice. The project was delivered over nine months. It involved four days ‘compulsory’ attendance and included a preparatory workshop, a two day off campus writing retreat and a dissemination event. Student and supervisors applied to participate as a team. Kirkpatrick’s (2006) four-stage classic model: reaction, learning, changes in behaviour and real world results was used as a framework for the educational evaluation. Key findings organised thematically were: Supervisor-supervisee relationships; space and time; building confidence enabling successful writing and publication. Originality/Value: This paper will provide an overview of the design, content and approaches used for successful delivery of this innovative project. It will draw on examples that illustrate the different types of joint enterprise that emerged, illuminate experiences of co-production and co-authorship along with recommendations for future ventures

Young people with diabetes and their peers

Type 1 Diabetes (T1D) is amongst the most common form of chronic illness affecting young people in the UK. Self- management is crucial, but managing their T1D is often difficult for young people

Changing Operating Lists on the Day of Surgery - a Service Evaluation

This study aims to explore how often the operating list is changed on the day of surgery, and the reasons why this may occur. The purpose being to analyse the wider potential impact of changing the list on the day of surgery has on patient safety, patient satisfaction and theatre efficiency. Survey data was collected across a multi-specialty elective operating department. The findings demonstrated a significant (P <0.001) change in operating lists occurred in 37.3% of sessions with a variety of potentially avoidable reasons. We concluded that improved organisation and communication before the planned session could reduce the occurrence of changes, increasing patient safety, theatre efficiency and potentially reducing incidents

Exploring how young people think about and respond to diabetes in their peers

Adolescence is a difficult time for people with diabetes and it is often accompanied by a deterioration in blood glucose control. This article looks at the effect the attitudes of peers can have on adolescents with diabetes. Three focus groups of 12–14-year-olds were asked about their knowledge of diabetes and were then presented with realistic vignettes about the condition, which they discussed. They then took part in a mythbusting session to help address misconceptions. The research team identified themes that emerged from the focus groups. Their findings suggest that a supportive peer network may be a valuable resource in good management of diabetes in young people. The research team suggest that more education about the condition is needed in schools and should be designed in collaboration with young people with diabetes

A prospective study of mental health status in morbidly obese patients.

Aim: To determine if co-morbidities have an effect on mood in a cohort of morbidly obese patients

Survey of people with type 2 diabetes shows the majority prefer diabetes education to be given during regular diabetes check-ups; other education preferences and opinions on self-care vary depending on patient characteristics

Type 2 diabetes is classified globally as a pandemic affecting all populations, to such an extent, that nearly every human being will have some kind of reference to it. This paper contributes to a widening knowledge base, in a very important aspect of diabetes, related to patient education and its concomitant impact on the ability by a person with diabetes to self-manage their condition. It has been explored, investigated and recognised that high standard, individually tailored, psychosocially orientated patient education will have beneficial, clinical and cost-effective results on disease and quality of life (QoL) outcomes.1 Patient preferences as to type and mode of delivery of education have not been explored to any great depth in diabetes and indeed in other conditions. There is also a paucity of information regarding which aspects of self-management or self-care patients prefer, or do not prefer, to carry out in order to maintain optimal biophysical and psychosocial outcomes