The effectiveness of the Training and Support Program for parents of children with disabilities: a randomized controlled trial.

OBJECTIVE: The Training and Support Program (TSP) was designed to equip parents of children with disabilities with a simple massage skill for use with their children in the home environment. The effectiveness of the TSP was examined in a randomized controlled trial with a wait-list control group. METHODS: Parents were trained in massage by suitably qualified therapists in eight weekly sessions, each lasting 1 h. The sample comprised 188 parents who were randomized to an intervention group (n=95), who attended the TSP with their children immediately, or a control group (n=93), who were offered the TSP after 4 months of follow-up. Data were collected by self-administered questionnaires at baseline and at 4-month follow-up. RESULTS: The majority of participants were mothers (88%), with a partner (88%), and White European (82%); 40% worked full-time or part-time, and 34% had health problems (e.g., chronic fatigue, cancer, and arthritis). The TSP demonstrated statistically significant positive effects on parental self-efficacy (PSE) for managing children's psychosocial well-being and depressed mood (0.004 and 0.007). There were trends toward improvement on parental satisfaction with life (P=.053), global health (P=.065), and parental ratings of children's sleeping (P=.074) and mobility (P=.012). Effect sizes were small (0.11-0.23). Levels of anxiety, depression, and perceived stress were all higher than published norms. CONCLUSION: The TSP is an effective means of improving PSE and depressed mood. Additional means of supporting parents need to be investigated.

Psychosocial well-being of parents of children with ataxia who attended the Training and Support Programme: a 12-month follow-up.

The aim of this study was to investigate the impact of a Training and Support Programme (TSP) for parents of children with ataxia, 12 months after commencing the programme. The TSP provides instruction in basic massage to parents of children with disability and life limiting conditions. Questionnaires were mailed at 12-month follow-up to 27 parents who had completed a questionnaire at 4-month follow-up. Of the 14 parents who responded, the median age was 46 years (range 37-57 years), 11 were female and 6 were still massaging their children at 12-month follow-up. Eight children were male, median age 14 years (range 8.3-22.0 years). Results revealed trends towards improvements in parental satisfaction with life and improvements in children's sleeping and bowel movements for those who were still massaging their children at 12-month follow-up. Results suggest that it may be useful to offer parents support and encouragement in the year after attending the TSP, if they wish to continue to massage their children.

Comparison of sequential and simultaneous breathing and pulse check by healthcare professionals during simulated scenarios.

BACKGROUND: Basic life support guidelines for healthcare professionals recommend a sequential breathing and carotid pulse check allowing up to 10 s for each assessment. Life support providers are sometimes taught to do a simultaneous assessment of breathing and pulse check for up to 10 s. It is not clear whether this assessment improves diagnostic accuracy. METHODS: We recruited 119 healthcare professionals. The SIM-Man was used to develop 10 simulated cases scenarios. To assess performance, 89 participants did 10 simultaneous assessments followed by 10 sequential assessments, and 29 participants did the assessment techniques in reverse order. The primary outcome of the study was the number of correct diagnoses made with each assessment method. RESULTS: There were more correct diagnoses with a sequential assessment; 48.2% (569 out of 1180) compared to 33.5% (395 out of 1180) for the simultaneous method. Only 26.3% (n=31) had more than five accurate diagnoses with a simultaneous assessment, compared to 44.1% (n=52) for sequential assessments. Those performing sequential assessment achieved a median score of 5/10 correct diagnoses compared to a median score of 2.5/10 for the simultaneous method (Wilcoxon Z=-4.63, p<0.001). Sensitivity for the pulse check was 99% for both assessments; specificity was 48.9% for a simultaneous assessment and 61.9% for the sequential approach. For breathing check, specificity, sensitivity and accuracy were also higher with the latter method (sensitivity 99.6%, specificity 70.6% and accuracy 88%) CONCLUSION: A sequential assessment of breathing and pulse by healthcare professionals has greater diagnostic accuracy in simulated case scenarios.

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention.

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.

The influence of the training and support programme on the self-efficacy and psychological well-being of parents of children with disabilities: a controlled trial.

The purpose of the study was to examine the effectiveness of an intervention for parents of children with disabilities in a controlled study focusing on parents' self-efficacy, psychological well-being and perceptions of change in children's sleeping, eating and mobility. The Training and Support Programme (TSP) was designed to equip parents with a simple massage skill that they could use with their children in the home environment. Parents were trained in massage by therapeutic massage therapists in 8-weekly sessions, each lasting 1h. The sample comprised 95 parents (49 in the Intervention Group, 46 in the Waiting-list Control Group) who attended the TSP with their children. Data were collected by self-administered questionnaires at baseline (before commencing the TSP), and at 8-week follow-up. The TSP demonstrated statistically significant positive effects on parents' anxious mood, self-efficacy for managing children's psychosocial well-being, self-efficacy in giving massage therapy, and perceptions of children's sleeping and eating. Relatively high levels of psychological distress were found among parents, particularly mothers. Overall, findings suggest that wider implementation of the Programme is warranted, and greater attention needs to paid to the psychological well-being of parents caring for children with disabilities.

Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students.

This paper presents the initial findings from a longitudinal quantitative study of two cohorts of students who entered the 10 pre-qualifying programmes of the Faculty of Health and Social Care, University of the West of England (UWE), Bristol, UK. The overall aim of the study is to explore students' attitudes to collaborative learning and collaborative working, both before and after qualification. On entry to the faculty, 852 students from all 10 programmes completed the UWE Entry Level Interprofessional Questionnaire, which gathered baseline data concerning their self-assessment of communication and teamwork skills, and their attitudes towards interprofessional learning and interprofessional interaction. Comparative analysis of these data was undertaken in terms of demographic variables such as age (i.e. older or younger than 21 years), experience of higher education, prior work experience and choice of professional programme. The results indicate that most students rated their communication and teamwork skills positively, and were favourably inclined towards interprofessional learning, but held negative opinions about interprofessional interaction. Some student groups differed in their responses to some sections of the questionnaire. Mature students, and those with experience of higher education or of working in health or social care settings, displayed relatively negative opinions about interprofessional interaction; social work and occupational therapy students were particularly negative in their responses, even after adjustment for confounding demographic variables. The paper concludes by considering the implications of the findings for interprofessional educational initiatives and for professional practice.

A randomised controlled trial of lay-led self-management for people with multiple sclerosis.

OBJECTIVE: To determine the impact of the Chronic Disease Self-Management Course (CDSMC) on people with multiple sclerosis (MS). METHODS: 2-group, randomised, controlled trial with Intervention Group (IG) and Waiting-List Control Group (WLCG). Additional data were collected from a Comparison Group (CG) who chose not to attend the CDSMC. Participants completed baseline questionnaires; IG participants attended the CDSMC immediately; all participants were assessed at 4-months and 12-months. RESULTS: 216 baseline questionnaires were returned; 73% were female, mean age 51.1 years, mean disease duration 12.0 years. Results showed that the CDSMC had an impact on self-management self-efficacy (ES 0.30, p=0.009 for the IG) and MSIS physical status (ES 0.12 for the IG, p=0.005). There were no other statistically significant changes. However, trends towards improvement on depression (ES 0.21 for the IG, p=0.05) and MS self-efficacy (ES 0.16 for the IG, p=0.04) were noted. All improvements were maintained at 12-months. At baseline, CG participants were older, had longer disease duration (p<0.01) and less anxiety (p=0.009) compared to RCT participants. CONCLUSION: The CDSMC provides some small positive effects for people with MS. Motivation to attend may be linked to psychological distress and disease duration. PRACTICE IMPLICATIONS: The CDSMC may be of value for those with mild anxiety/depression who need extra support. Attendance early in the disease course is recommended.

A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial.

Physical activity (PA) helps to prevent osteoporosis, but older women are often sedentary. This study used a pre-post randomized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change (SoC) and processes of change from the transtheoretical change model (TTM) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40-65 years. The home-based exercise prescription consisted of strength and balance training that was progressive, individually tailored and included a walking program. Individuals in the training group (n=61) had a positive, significant progression in psychological SoC (P<0.001), whereas no progression in stages occurred in the control group (n=55). After the intervention, the training group demonstrated significant improvements in PA, lower body muscle strength, static and dynamic balance, with no significant changes in the control group. These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women.

Concerns about numeracy skills of nursing students.

Accurate mathematical calculation is a critical skill that nurses must demonstrate in order to administer medications safely. The ability of undergraduate nurses to calculate the correct dosage of medication consistently has been a concern of schools of nursing for a long time. This study explores the ability of a group of nursing students to calculate mathematical drug problems within an English University. A convenience sample of 37 second year nursing students volunteered to complete a 10-item drug calculation test, requiring understanding of simple division and multiplication, percentages, ratio and proportion, conversion of units and multiple-stage procedures. The students' median correct score was 6 out of 10 (range 0-9). No one achieved full marks. Only 3 were able to achieve 9 out of 10, indicating that, on average, students were unable to achieve 90% mastery. This finding supports past literature and is of concern. It is of concern that these student nurses did not have the ability to perform drug calculations at a 90% mastery level. It has been recommended that admission requirements be reviewed, and that students are tested throughout their programme and that skills are reinforced both in the classroom and practice setting. This could be achieved using a variety of methods, supporting a teaching and learning framework to integrate analytical and procedural competence underpinned by the creation of national standards. Also, both educators and practitioners must take responsibility for ensuring adequate support and guidance are available to student nurses.

Second year scepticism: pre-qualifying health and social care students' midpoint self-assessment, attitudes and perceptions concerning interprofessional learning and working.

A study in an English Faculty of Health and Social Care explores the effects of a pre-qualifying interprofessional curriculum incorporating interprofessional modules in each year of study. The study design involves collecting data on entry to the Faculty, after completion of the second interprofessional module, on qualification and after 9 months qualified practice. At each point, students complete questionnaires concerning communication and teamwork skills and interprofessional learning and working. This paper presents results from 723 students at the second data collection point. Although most students were positive about their communication and teamwork skills, they were less positive than on entry to the Faculty. Similarly there was a negative shift in students' attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own interprofessional relationships. Mature students' responses were more positive than those of younger students. The emergence of differences in responses based on a professional programme suggests that interprofessional education may not necessarily influence professional socialization. Demographic and professional variables affecting students' responses in their second year of study demonstrate the complexity of student learning. The planned follow-up of the students will show whether variables affecting interim data have a long-term effect on attitudes.

Cooling strategies for patients with severe cerebral insult in ICU (Part 2).

Critically ill patients who have sustained a severe cerebral insult will be actively cooled should they develop an elevated body core temperature. Patients who require therapeutic hypothermia for neuroprotection may require the same cooling strategies. A literature review suggested limited evidence to support cooling strategies currently used within one intensive care unit. An experimental approach was used to examine the effects of paracetamol and four external cooling strategies on patients with severe cerebral insult It is suggested that paracetamol is effective in reducing body core temperature and that fans may not. However, data obtained from the study of the four external cooling strategies were inconclusive.