A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer.

This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.

Assistive technology and people: a position paper from the first global research, innovation and education on assistive technology (GREAT) summit.

Assistive technology (AT) is a powerful enabler of participation. The World Health Organization's Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a "state of the science" view of AT users, conceptualized as "People" within the set of GATE strategic "P"s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People's preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.

The Paralympic athlete: a systematic review of the psychosocial literature.

BACKGROUND: There is a lack of knowledge of the psychosocial wellbeing and attributes of Paralympic athletes. Such knowledge may reveal what contributes to exceptional performance. OBJECTIVES: To systematically review the literature on psychosocial wellbeing and attributes of the Paralympic athlete. STUDY DESIGN: Systematic literature review. METHODS: Five key databases that index psychosocial literature were searched: CINAHL, ISI Web of Science, MEDLINE, PsycINFO and SportsDiscus. RESULTS: Sixteen papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, sample characteristics, outcome assessment and outcomes examined. The emerging thematic areas are 1) participation, motivations and goals; 2) mental imagery; 3) stress and coping; 4) personality; 5) attitudes towards other disabled-bodied athlete groups; 6) knowledge and attitudes towards doping; and 7) transitions to retirement. CONCLUSIONS: Relative to the biomechanical aspects of the Paralympian, the psychosocial literature remains limited and diffuse. Nonetheless an understanding of the psychosocial profile of these athletes complements the extant physiological and technological knowledge in enabling a holistic view of what contributes to the successful Paralympic athlete and may facilitate the team working to optimize performance and wellbeing in these high-performing individuals.

Barriers, activities and participation: incorporating ICF into service planning datasets.

PURPOSE: Guided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities. METHOD: Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland. RESULTS: Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction. CONCLUSIONS: This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.

Psychosocial interventions for the prevention of disability following traumatic physical injury.

BACKGROUND: Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning. OBJECTIVES: To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury. SEARCH STRATEGY: The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008. SELECTION CRITERIA: Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI). DATA COLLECTION AND ANALYSIS: Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data. MAIN RESULTS: We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients. AUTHORS' CONCLUSIONS: This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.

Measuring quality of life in prosthetic practice: benefits and challenges.

There is an increasing awareness that the inclusion of quality of life as an outcome measure is important in ensuring a client-centred and holistic assessment. This review outlines the benefits of quality of life as an outcome measurement in the field of prosthetics. It introduces the key concepts and challenges in the definition and assessment of quality of life post-amputation, including the relative advantages and disadvantages of adopting generic, disease/condition specific, dimension specific and individualized measures of quality of life. In conclusion, the review delineates and recommends issues and guidelines for consideration when undertaking quality of life research and assessment. A co-ordinated approach by practitioners in the field of prosthetics is necessary to ensure the inclusion of quality of life as an outcome measure and to ensure its measurement in a standardized and rigorous manner.

An exploratory study of the conditions important in facilitating the empowerment of midwives.

OBJECTIVE: to explore the conditions important in facilitating the empowerment of midwives, as judged by practising midwives. DESIGN: a cross-sectional, descriptive, national survey of nurses and midwives practising in Ireland was undertaken in 2002. The questionnaire used in the survey included the 'Understanding of Empowerment Scale'. PARTICIPANTS: the data come from a larger national study of empowerment among nurses and midwives carried out by the authors in 2001/2 (Scott et al., 2003). A random sample of 4050 nurses and midwives in Ireland was obtained from the Live Register of An Bord Altranais (Irish Nursing Board). There was an overall response rate of 46% (n = 1781). Of these, 1340 people completed questionnaires, as 441 of those who replied were not in practice at the time. Of those who completed the questionnaire, 7% (n = 95) were practising midwives. Their findings are reported in this paper. MEASUREMENTS AND FINDINGS: factor analysis using the Principal Axis Factoring method of extraction and an oblique (Direct Oblimin) rotation was carried out on the Understanding of Empowerment Scale. This suggested four factors or conditions important for the empowerment of midwives: control, support, recognition and skills. KEY CONCLUSIONS: these findings relating to the conditions that facilitate empowerment in midwifery reflect the professional distinctiveness of midwifery and take into account the specific role and working environment of the midwife. IMPLICATIONS FOR PRACTICE: the identification of the important conditions to facilitate empowerment in midwifery provides a framework with which to explore ways of building on strengths and addressing weaknesses within the current situation for midwives in Ireland and elsewhere. These suggestive findings offer an opportunity to further develop a tool to measure levels of these conditions necessary to facilitate empowerment in midwifery.