Perinatal/neonatal palliative care: Effecting improved knowledge and multi-professional practice of midwifery and children's nursing students through an inter-professional education initiative.

This paper presents a study that examines the potential value of a new and innovative inter-professional education (IPE) experience for final year midwifery and children's nursing students focused on improving awareness of end-of-life care for infants in conjunction with the support of their families. The study uses an action research approach to examine midwifery and children's nursing student experiences of an IPE initiative in developing knowledge regarding perinatal/neonatal palliative care. The setting is a Higher Education Institute in the South of England that included final year midwifery students (n = 39) and children's nursing students (n = 34) taking part in the study. Qualitative and quantitative data indicated that the IPE intervention had proven worth in developing knowledge and confidence in the students as both student groupings felt they lacked knowledge and confidence about perinatal/neonatal palliative care before attending the study day. Students felt that learning with, from and about the other profession represented was important in generating their knowledge. Educators should explore innovative ways to enable the further development of the fledgling speciality of perinatal/neonatal palliative care through education on an interprofessional platform.

Spotlight on equality of employment opportunities: A qualitative study of job seeking experiences of graduating nurses and physiotherapists from black and minority ethnic backgrounds.

BACKGROUND: There is growing attention in the UK and internationally to the representation of black and minority ethnic groups in healthcare education and the workplace. Although the NHS workforce is very diverse, ethnic minorities are unevenly spread across occupations, and considerably underrepresented in senior positions. Previous research has highlighted that this inequality also exists at junior levels with newly qualified nurses from non-White/British ethnic groups being less likely to get a job at graduation than their White/British colleagues. Although there is better national data on the scale of inequalities in the healthcare workforce, there is a gap in our understanding about the experience of job seeking, and the factors that influence disadvantage in nursing and other professions such as physiotherapy. AIM: This qualitative study seeks to fill that gap and explores the experience of student nurses (n=12) and physiotherapists (n=6) throughout their education and during the first 6-months post qualification to identify key experiences and milestones relating to successful employment particularly focusing on the perspectives from different ethnic groups. PARTICIPANTS: Participants were purposively sampled from one university to ensure diversity in ethnic group, age and gender. METHODS: Using a phenomenological approach, in-depth semi-structured interviews were conducted at course completion and 6 months later. RESULTS: Two main themes were identified. The 'proactive self' ('It's up to me') theme included perceptions of employment success being due to student proactivity and resilience; qualities valued by employers. The second theme described the need to 'fit in' with organisational culture. Graduates described accommodating strategies where they modified aspects of their identity (clothing, cultural markers) to fit in. At one extreme, rather than fitting in, participants from minority ethnic backgrounds avoided applying to certain hospitals due to perceptions of discriminatory cultures, 'I wouldn't apply there 'cos you know, it's not really an ethnic hospital'. In contrast, some participants recognised that other graduates (usually white) did not need to change and aspects of their identity brought unsolicited rewards 'if your face fits then the barriers are reduced'. CONCLUSIONS: The findings indicate that success in getting work is perceived as determined by individual factors, and fitting in is enabled by strategies adopted by the individual rather than the workplace. Demands for change are more acute for graduates from black and minority ethnic backgrounds. This is an issue for healthcare organisations seeking to be inclusive and challenges employers and educators to acknowledge inequalities and take action to address them.

The Experience of Myeloma Caregivers During Home-Based Oral Chemotherapy Treatment: A Qualitative Study.

OBJECTIVE: The primary aim of this qualitative study was to explore myeloma carers/caregivers experience during outpatient-based oral treatment for patients with multiple myeloma (MM). DATA SOURCES: Literature review. In-depth, open-ended interviews of seven purposively selected caregivers of MM patients in the United Kingdom. CONCLUSION: Findings showed that carers were involved in practical and emotional caregiving activities, assisting the patient with managing complex oral combination treatments, and monitoring side effects. Care-giving activities continued after treatment, and experiences were described within the context of the MM journey and fear and uncertainty about the future. Caregivers also experienced a range of emotions, which they often kept hidden from the MM patients and other family members. Difficulties balancing caring responsibilities, particularly for those with jobs, were expressed. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to understand the importance of considering carers' involvement when assessing patients, and the need to address caregivers' continuing support and information needs. Problems navigating health and social care processes should be anticipated, and nurses can direct the carers to appropriate resources to meet their needs.

Prostate cancer among Jamaican men: exploring the evidence for higher risk.

BACKGROUND: Historically, black men of African descent have been disproportionately affected by prostate cancer compared with Caucasian men. African-Caribbean men are generally at higher risk of prostate cancer, with Jamaican men noted to have the highest incidence in the world. No robust evidence exists for the increased incidence among Jamaican men, or indeed, a clear explanation for the reasons these men are at a greater risk of developing the disease in comparison with other African-Caribbean men. METHODS AND FINDINGS: A literature review was undertaken. The findings indicated that black men of African descent, specifically Jamaican men, are at greater risk of prostate cancer and this finding applies to Africa, the Caribbean, the UK and USA. CONCLUSIONS: Current evidence for the higher incidence of prostate cancer among Jamaican men remains inconclusive and does not provide a clear explanation for its prevalence. More comparative studies are required to identify any predisposing factors responsible for this anomaly, worldwide. The involvement of health professionals in these research undertakings is important to obtaining insight into prostate cancer and in devising strategies to improve management and health outcomes.

Co-constructing sexual recovery after prostate cancer: a qualitative study with couples.

BACKGROUND: Men are likely to experience deterioration in sexual functioning as a consequence of treatment for prostate cancer. Indeed, sexual difficulties are common across all treatment modalities. OBJECTIVE: To determine the impact of treatment for prostate cancer on intimacy and sexual expression/relationships from the perspective of couples. METHODS: An observational study was conducted including in-depth interviews with 18 people affected by prostate cancer; comprising eight couples and two individual men. RESULTS: Four categories were identified that illustrated the impact of prostate cancer on intimacy and sexual recovery. These related to social influences and language used to describe the loss or recovery of sexual activities; difficulties in discussing sexual activity with clinicians; the clash of individual impact of prostate cancer recovery versus the impact on the couple, and the re-integration of sexual activities into the relationship. CONCLUSIONS: Though only one person in a partnership experiences cancer, these data indicated the extent to which prostate cancer treatment also impacts on partners. The study indicates that adjustment to erectile dysfunction (ED) takes time, but is a highly significant event in couples' lives and its importance should not be under-estimated. Consequently, we suggest that relational models of care should be considered, whereby side-effects are recognised as impacting on both members of the partnership (for example ED, or lack or ejaculate). Supportive care in this context, therefore, may best be based on a relational approach using language and interventions that are appropriate to the patient and their situation.

African and Afro-Caribbean men's experiences of prostate cancer.

UNLABELLED: It is well documented that prostate cancer presents a significant health problem for middle-aged and elderly men in the UK, with further evidence suggesting that the disease is more prevalent in men of African and Afro-Caribbean (AAC) ethnicity. There is also evidence that these men are diagnosed much later and that the disease is more aggressive than in Caucasian men. AIM: To explore AAC men's experiences of prostate cancer and their understanding of its associated risks. The purpose was to gain an insight from these men's perspectives and ascertain whether a more focused health promotion strategy, and specific UK-based research, was needed in this area. METHOD: A purposive sample of seven AAC men was recruited from a hospital trust's patient list after gaining approval from a research ethics committee. In-depth face-to-face interviews were carried out and the transcripts analysed thematically. FINDINGS: The four main themes that emerged were: disease-prompted awareness, checking up as a necessary evil, defining and constructing factors influencing prostate cancer screening uptake, and appraising perceived myths about prostate cancer through personal beliefs. CONCLUSIONS: Among this group of AAC men, socioeconomic status, such as education and professional background, were factors that influenced their level of awareness of prostate cancer and prompted their decisions to seek help. However, it is evident from these men's perspectives that a more specific health education strategy that promotes early detection and management, targeting AAC men, would help in demystifying prostate cancer and encourage them to seek help earlier. Further research studies and health education in prominent social outlets are recommended in increasing AAC men's awareness of prostate cancer and its associated risks.

Equality of employment opportunities for nurses at the point of qualification: an exploratory study.

BACKGROUND: Securing employment after qualification is of utmost importance to newly qualified nurses to consolidate knowledge and skills. The factors that influence success in gaining this first post are not known. OBJECTIVES: The study aimed to describe the first post gained after qualification in terms of setting, nature of employment contract and geographical distribution and explore the relationship between a range of factors (including ethnicity) and employment at the point of qualification. DESIGN: An exploratory study using structured questionnaires and secondary analysis of data routinely collected by the universities about students and their progress during their course. SETTINGS: The study was conducted in eight universities within a large, multicultural city in the UK as part of the 'Readiness for Work' research programme. PARTICIPANTS: Eight hundred and four newly qualified nurses who had successfully completed a diploma or degree from one of the universities; a response rate of 77% representing 49% of all graduating students in the study population. METHODS: Data were collected by self-completed semi-structured questionnaires administered to students at the time of qualification and at three months post-qualification. Routinely collected data from the universities were also collected. RESULTS: Fifty two percent of participants had been offered a job at the point of qualification (85% of those who had applied and been interviewed). Of these, 99% had been offered a nursing post, 88% in the city studied, 67% in the healthcare setting where they had completed a course placement. 44% felt "confident" and 32% "very confident" about their employment prospects. Predictors of employment success included ethnicity, specialty of nursing and university attended. Predictors of confidence and preparedness for job seeking included ethnicity, nursing specialty, gender and grade of degree. Newly qualified nurses from non-White/British ethnic groups were less likely to get a job and feel confident about and prepared for job seeking. CONCLUSIONS: This study has demonstrated that ethnicity does lead to employment disadvantage for newly qualified nurses. This is an important contribution towards recognizing and describing the evidence so that appropriate responses and interventions can be developed. It is important that universities and healthcare institutions work closely together to support students at this important time in their nursing career.

Discussing the sexual consequences of treatment in radiotherapy and urology consultations with couples affected by prostate cancer.

OBJECTIVE: To explore the ways in which prostate cancer treatment-induced sexual changes are presented as viable topics for discussion in urology and radiotherapy clinics. PATIENTS AND METHODS: Ethnographic observations were made of 60 consultations between clinicians, patients and partners in clinical oncology and prostate cancer urology clinics. RESULTS: Sexual functioning was discussed infrequently in both clinic settings. Despite the presence of partners in nearly half of consultations, involvement of the partner tended to be minimal. Overall, discussions of wider psychosexual concerns were marginalised in consultations, and there were limited opportunities for couples to discuss the specific impact of prostate cancer and its treatments on sexual functioning. CONCLUSION: Given the potential burden of symptoms and side-effects, there is a need to include discussions of sexual recovery and rehabilitation in consultations, and to provide opportunities to discuss the sexual consequences of treatment with men and their partners.