Evaluating a brief intervention for mealtime difficulty on older adults with dementia.

AIMS AND OBJECTIVE: To test a spaced retrieval intervention using spaced retrieval to alleviate mealtime difficulties in older people with dementia. DESIGN: A single-case study design. SETTING: Nursing Homes in North Central England, United Kingdom. PARTICIPANTS: Older people with Alzheimer's disease. METHODS: A single-case study using an ABA design was used. Data were collected using the Edinburgh Feeding Evaluation in Dementia scale, Mini Nutritional Assessment, and Body Mass Index before intervention, postintervention and following 3 months of postintervention. Realist evaluation was used to identify for which participants the intervention was effective, and an economic evaluation was also carried out. FINDING: Of 15 participants who entered the study, eight completed all phases of the study. A mean 104.4 h were needed to deliver the intervention. The number of sessions required ranged from 90-222. The length of time each participant retained information (for all sessions) ranged from 13-28 min. Participants had most difficulty with: "putting food into mouth and chewing it"; "realizing it was mealtime"; and "eating a whole meal continuously." A reduction in the difficulty with mealtimes occurred between phase A1-A2 for most participants. Six participants maintained this in phase A3. Similar patterns were evident for nutritional scores. For most participants, the effect size of the intervention was moderate or large. CONCLUSIONS: Spaced retrieval is useful in reducing mealtime difficulties in older participants with dementia. While the results of this study are promising, further large and multicentre trials are needed to explore the effectiveness of the intervention in diverse populations.

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi.

BACKGROUND: Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi. METHODS: The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing. RESULTS: The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%). CONCLUSION: The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

A systematic literature review on nurses' and health care support workers' experiences of caring for people with dementia on orthopaedic wards.

AIMS AND OBJECTIVES: To review literature on nurses' and health care workers' experiences of caring for people with dementia on orthopaedic wards. BACKGROUND: Dementia is a condition that affects a large number of the older population worldwide. It is estimated that there are 47·5 million people worldwide living with dementia with 4·6 million new cases being diagnosed annually. This number is said to increase to 75·6 million by 2030 and triple by 2050. It is also acknowledged that older people are at a greater risk of falls that are a devastating problem causing a tremendous amount of morbidity, mortality and use of health care services (Rubestein, Age and Ageing, 35, 2006, 37). Falls usually result from identified risk factors such as weakness, unsteady gait, confusion and certain medication. Therefore, it is reasonable to assume that a large population of older people suffering from dementia may be admitted to orthopaedic wards with various injuries. Nurse and support health workers may experience a range of difficulties when caring for this population of patients. DESIGN: A systematic review. METHODS: An extensive literature search using; CINAHL, MEDLINE, Academic Search Complete, National Health Service Evidence, websites like Department of Health, Dementia and Alzheimer's Society. RESULTS: The search generated several articles on dementia in general, however, only 14 articles dealing with care of these people in an acute hospital setting were found. No studies dealing with the care of people with dementia on orthopaedic wards were found; therefore, this review has taken a generalist nature and applies the findings to orthopaedic wards. The main themes identified from the review were: challenging behaviour and unsuitable care environment; lack of education on dementia; strain from nursing patients with dementia; and ethical dilemmas arising from care of people with dementia. CONCLUSION: It would be an over-simplification to say that the care of people with dementia on medical wards is the same as the care of trauma patients with dementia. Therefore, there is a need for a study to explore nurses' and health care worker's experiences of caring for trauma patients with dementia on orthopaedic wards. RELEVANCE TO CLINICAL PRACTICE: The results of this study could provide guidance on the effective care of people with dementia on orthopaedic wards.

Experiences of African nurses and the perception of their managers in the NHS.

AIM: This study aims to explore experiences of racism, discrimination and equality of opportunity among black African nurses and their managers' perspective on these issues. BACKGROUND: International nurse migration has brought increased diversity in the nursing workforce internationally. These nurses have reported negative experiences associated with their integration in host nations. The UK has a long history of international nurse recruitment, which has been associated with experiences of racism and discrimination towards these nurses despite various equality Acts. Experiences of black African nurses and perceptions of their managers are good indicators of how effective these equality Acts have been. METHOD: A qualitative approach was used to gain an insight into black nurses' experiences and those of their managers in the UK National Health Service. FINDINGS: Nurses and managers reported that black African nurses face racism, discrimination and lack of equal opportunities in the British National Health Service. CONCLUSION: Racism and discrimination towards black and ethnic minority nurses are present in the National Health Service despite equality Acts. Robust measures to combat racism and discrimination are urgently needed. IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to be aware that good policies can be misinterpreted and disadvantage minorities, and should therefore take steps to promote good practice.

Communicating with older ethnic minority patients.

In a time of increasing cultural diversity, it is essential that healthcare professionals respond by providing culturally competent care. Healthcare professionals must recognise the diverse needs of people from ethnic minority communities to ensure that they receive equal standards of care. This is particularly pertinent when providing care for older ethnic minority patients who may not be fluent in English. This article focuses on the need to communicate effectively with this group of patients to meet their health and social care needs, with the ultimate aim of improving patient outcomes.

The skills and brain drain what nurses say.

AIMS AND OBJECTIVES: To explore sub-Saharan African nurses' reasons for moving to the UK, their views on the skills and brain drain, and what can be done to stem the situation. BACKGROUND: The UK and other developed nations such as the USA, Canada and Australia have been recruiting internationally qualified nurses including those from sub-Saharan African, which has raised concerns of skills and brain drain from these countries that are known to suffer from nurse shortages. METHODS: A purposeful sample of 30 nurses from sub-Saharan African was drawn from four National Health Service trusts in the north-east of England. Using focus group discussions and personal interviews, the study explored and examined nurses' views on their motivation to move to the developed countries and what can be done to reduce nurse migration from sub-Saharan African and give those countries a chance to develop their health systems by retaining their health personnel. RESULTS: Five main themes emerged from data analysis: poor remuneration, lack of professional development in the home countries, poor health care and systems, language and education similarities and easy availability of jobs and visas. CONCLUSION: Data indicate that migration motives for nurses are complex and inherent in historical links and in global values. Nurses stressed that they would like to stay in their own countries and help develop healthcare there, but reasons for moving were often strong and apparently not within their control. RELEVANCE TO CLINICAL PRACTICE: Nurse migration from sub-Saharan African has often been cited as a limitation in providing effective healthcare in those countries. Delineating motivational factors for nurses could help to stem this migration.

Experiences of African nurses in the UK National Health Service: a literature review.

AIM: This review aims to highlight the experiences of black African nurses in the United Kingdom. BACKGROUND: There is an acute shortage of trained nurses in the United Kingdom, which has occurred because of several factors including ageing of the nurse population and increasing demand due to an ageing population as well as under investment in nurse education during the 1980s. Government initiatives have included recruiting nurses trained overseas to meet present and future demands. Among these internationally recruited nurses, a large number came from Africa, but little is known about the experience of nurses once they are in the United Kingdom. Although it is known that ethnic minority nurses suffer discrimination in the National Health Service, experiences of internationally recruited nurses and nurses from African countries, in particular, merit attention as their nursing practices and culture in general are different from those of developed countries. METHODS: A literature search was conducted using CINAHL, Medline and Cochrane databases by using the following terms in various combinations: Experiences, African nurses, international nurses, ethnic minorities, discrimination, equal opportunities, United Kingdom and NHS. CONCLUSIONS: There is very little research into the experiences of African nurses in the United Kingdom. Research has concentrated on the experience of internationally recruited nurses and ethnic minority nurses in general. There is agreement that most foreign nurses have a negative experience of working in the United Kingdom. Nurses face discrimination in pay and conditions of service and most are exploited by managers. There are also ethical questions surrounding the recruitment of nurses form developing countries and their treatment once they come to the United Kingdom. RELEVANCE TO CLINICAL PRACTICE: As the nursing workforce in the United Kingdom becomes increasingly diverse through international recruitment, it is important to have knowledge of experiences of different groups of nurses. This helps to devise adaptation programs for smooth transition tailored to particular groups and training that will help United Kingdom nurses to work in harmony with their foreign colleagues.