An Exploration of Health Behaviors in a Mind-Body Resilience Intervention for Parents of Children with Developmental Disabilities.

OBJECTIVE: Parents of children with special needs such as learning and attentional disabilities (LADs) and autism spectrum disorder (ASD) are at high risk for stress-related disorders. The demands of parenting may compete with time for self-care behaviors such as physical activity, healthy eating, and adequate sleep. The objective was to describe health behaviors among this understudied population and assess the changes after a resilience intervention. METHODS: This was a secondary data analysis of a randomized controlled pilot virtual mind-body resilience intervention (Stress Management and Resiliency Training: A Relaxation Response Resiliency Program) trial for parents of children with LADs (n = 52) and ASD (n = 47). Parents completed self-report questionnaires about their weekly physical activity, eating behaviors, sleep duration, and fatigue before and after the 8-week intervention. Descriptive statistics and pre-post intervention effect sizes (Cohen's d) were calculated. RESULTS: Both parent groups reported suboptimal levels of health behaviors at baseline, but ASD parents reported lower health behaviors than LAD parents. LAD parents improved more on physical activity, with a higher percentage meeting recommendations at postintervention follow-up (d = 0.71) than ASD parents (d = 0.01). Eating behaviors showed small effect size improvements for both groups. Although sleep duration improved only with small or medium effect sizes for both groups, ASD parents rated their fatigue lower after the intervention (d = 0.81). CONCLUSION: Parents of children with special needs who participated in a virtual resilience intervention demonstrated suboptimal health behaviors. There is a need for targeted interventions for health behaviors that can promote resilience in these high-stress populations.

Assessing the perioperative communication needs of a patient with learning disabilities: An holistic case study approach.

Patients should be at the heart of everything we do. The aim should always be to achieve healthcare outcomes by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone: 'no decision about me, without me' (DH 2012). This article details a plan of care for an 18 year old male patient with a moderate level of learning disability who was scheduled for a tonsillectomy at a local NHS trust hospital. It focuses on the management of the patient's anxiety, nausea and pain. In accordance with the Health and Care Professions Council's code of confidentiality (HCPC 2014) the location and individual names of places and people concerned will not be disclosed. The patient presented at the pre-assessment appointment as having a learning disability consistent with a diagnosis of being on the autistic spectrum. More specifically, he had cognitive impairment which affected his ability to understand complex information. This, combined with a reduced ability to cope independently, formed the rationale for the attendance of a carer throughout his perioperative journey. According to the National Autistic Society (NAS) there are approximately 700,000 people with autism spectrum disorder (ASD) in the UK ie more than 1 in 100. Autism is a part of daily life for 2.8 million people (NAS nd).

'Advocate for your patients and do your best'.

Why did you become a nurse? I am a learning disability nurse who has spent a large part of my career working with children who have a learning disability and their families in the community. My experiences in supporting children have enabled me to consider their holistic needs across all areas of service and community provision.

Using workload measurement tools in diverse care contexts: the experience of staff in mental health and learning disability inpatient settings.

ACCESSIBLE SUMMARY: What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited. What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans. What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services. INTRODUCTION: The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. AIM: It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. METHOD: Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. RESULTS: The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. DISCUSSION: This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. IMPLICATIONS FOR PRACTICE: With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Sex and rearing condition modify the effects of perinatal lead exposure on learning and memory.

Developmental lead (Pb) exposure is associated with cognitive impairments in humans and rodents alike. In particular, impaired spatial learning and memory, as assessed using the Morris water maze (MWM), has been noted in developmentally Pb-exposed rats. Although sex and rearing environment can influence MWM performance in normal animals, the interactions of sex and rearing environment on the impact of developmental Pb exposure on hippocampal-dependent processes has not been well characterized. The present study examined the effects of perinatal exposure (i.e., gestation through weaning) to different levels of Pb (250, 750 and 1500 ppm Pb acetate in food) in males and females raised in a non-enriched environment (standard cage with 3 animals and no toys) or an enriched environment (large cage containing a variety of toys that were changed twice weekly). Testing in the MWM began at postnatal day 55. Behavioral outcomes were influenced by sex and rearing environment, with complex interactions with Pb exposure. In non-Pb exposed control animals, beneficial effects of environmental enrichment on spatial learning and memory were observed in males and females, with greater effects in females. Pb exposure in females mitigated at least some of the benefits of enrichment on learning, particularly at the lowest and highest exposure levels. In males, enrichment conferred a modest learning advantage and for the most part, Pb exposure did not affect this. However, in males with the highest Pb exposure, enrichment did help to overcome detrimental effects of Pb on learning. In females, any potential benefit to reference memory contributed by enrichment was muted by exposure to Pb and for the most part, this was not reproduced in males. Thus, there are complex interactions between sex, environment, and Pb exposure on spatial learning and memory. Environmental manipulation is a potential risk modifier of developmental Pb exposure and interacts with other factors including sex and amount of Pb exposure to affect the functional influences of Pb on the brain.

Effect of music on mealtime disruptions.

BACKGROUND: People with learning disabilities can disrupt mealtimes with non-cooperative, aggressive and self-injurious behaviours that challenge other people to tolerate and manage them. These behaviours appear to arise because the proximity of other people, and the heightened activity and noise of a dining room, causes anxiety and agitation. AIM: To examine how delivering calming background music via headphones affected anxiety-driven behaviours that disrupted mealtimes. METHOD: A sample of 30 adults with mild, moderate or severe learning disabilities were videotaped during mealtimes on two consecutive days. On the first day, half the group ate without any calming music while the other half sat opposite them wearing earphones and listening to calming music. On the second day, the non-music and music groups swapped around. RESULTS: Of the participants who tolerated the earphones, only three showed disruptive behaviour; all three had been sitting at the table waiting for their food. With so few examples, meaningful inferential analysis was not possible. However, there were signs that calming music had a positive effect on disruptive mealtime behaviours. It eliminated physical harm, complaining and verbal repetition in one person, and stopped another from shouting/swearing. It also reduced the incidence of shouting/swearing, restlessness and vocalising. CONCLUSION: Calming music and reduced waiting at tables for food may reduce disruptive behaviours.

Depression in school-aged children: assessment & early intervention.

A careful assessment of all of these factors will help nurse therapists who are also primary care providers develop a more holistic approach to treatment and, thus, increase treatment effectiveness. The three-pronged assessment approach discussed above is cost effective, safe, and indicated as a frontline measure to assess the risk for depression in children and their parents (particularly mothers), which can begin the process of "true" early intervention. I say "true" early intervention because in my role as an early intervention specialist, my first meeting with families usually occurs after a crucial incident requiring hospitalization of the child or the parent, or school failure, or both. My programs of intervention are hardly "early," although treatment is started relatively early in the life of the child. In the past few years, I have noticed that psychiatric-mental health advanced practice nurses, including myself, are increasingly working in some capacity in primary health centers, such as school-based clinics, churches, collaborative practices, and community health centers. It would be wonderful if we used these settings to identify risk for depression in children and begin preventive treatment (starting with teaching good sleep hygiene, a treatment in itself) to truly make early intervention a reality.

Spirituality and learning disabilities: a qualitative study.

This article describes a unique empirical study where critical incidents were obtained from learning disability nurses to understand how they attempt to meet the spiritual needs of the people for whom they care. Following analysis, the nurses' approaches to meeting spiritual needs were categorized as 'personal' and 'procedural', and each of these is described in turn. There then follows a discussion on the effects of these nurses' interventions on both clients and their families, and nurses themselves. The findings of the study illuminate how these learning disability nurses attempted to meet the spiritual needs of people with learning disabilities in their care. The findings may help nurses ensure that spiritual needs are identified in the construction of the personal care plans of people with learning disabilities.