Widening Access; Developing an eLearning Resource for Health and Social Care Professionals Caring for Children and Young People with Cancer.

Cancer is a key priority worldwide, and caring for children and young people with cancer requires a range of specific knowledge, skills and experience in order to deliver the complex care regimes both within the hospital or community environment. The aim of this paper is to disseminate work undertaken to design and develop pedagogical practice and innovation through an eLearning resource for health care professionals caring for children and young people with cancer across the globe. The work undertaken evaluated an existing cancer course (which has been withdrawn) that was developed and delivered through the Paediatric Oncology Nurses Forum, Royal College Nursing (Nurse Educators) and Warwick University. The evaluation consisted of 26 open and closed questions relating to the previous resource and was circulated to all health and social care professionals involved directly within specialist oncology services through the Children's Cancer and Leukaemia Group. Questionnaires were sent out to a convenience sample of 773 health care professionals and the response rate was 14%. The findings identified that the course was predominantly accessed by nurses, but other health care professionals also found it useful. Participants highlighted several areas where they believed content could be developed or was lacking. This included areas such as palliative and end of life care, nutrition, sepsis and teenagers and young people. This feedback was then used to develop a site dedicated to the care of children and young people with cancer.

Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography.

BACKGROUND: Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention. METHODS: Qualitative synthesis using meta-ethnography of primary studies reporting doctors' views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance. RESULTS: Fifteen papers (13 studies) conducted between 2007 and 2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions. CONCLUSIONS: This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing. TRIAL REGISTRATION: PROSPERO registration: CRD42017073740 .

Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries.

BACKGROUND: Screening children for autism has gained wider acceptance within clinical practice, and early intervention has improved outcomes. Increasingly, adapting an existing screening instrument is a common, fast method to create a usable screening tool, especially for countries with limited resources and/or expertise. However, concerns have been raised regarding adaptation adequacy and the feasibility of screening across cultural groups. This study systematically examined the levels of cultural adaptation and feasibility aspects considered when screening for autism in non-English speaking countries to build upon the sparse knowledge that exists on this topic in the literature. METHODS: Nineteen studies, obtained from five electronic databases, were examined. PRISMA guidance was used for this review. The Ecological Validity Framework model, and Bowen Recommendations for Feasibility were adopted to extract relevant data, which was synthesised narratively. RESULTS: Cultural adaptation within the included studies mostly involved language translation with little information offered to enable conclusions on how the processes were guided and maintained. Few cultural adjustments involved modifying screening methods; clarifying difficult concepts and changing instrument content were employed to address the core values, competence, beliefs, and norms of the adapted culture. However, less attention was given to adapt the screening goals within the context of cultural values, and customs or to consider interactional match between the clients and assessors. The review also highlighted an acceptable level of practicality to screen for autism but did not encourage integrating autism screening within routine practice or beyond the study context for different cultures. CONCLUSION: Concurring with previous literature, we agree that knowledge on cultural adaptation for autism screening instruments is limited and not sufficiently documented to establish adaptation levels (process and/or contents), and prove adequacy. However, this review provides an infrastructure to improve future adaptation processes. Integrating autism screening as routine medical practice is not encouraged and warrants further feasibility studies to minimize wasted resources and improve screening effectiveness in various health care systems.

Emotion Recognition in Children With Down Syndrome: Influence of Emotion Label and Expression Intensity.

Some children with Down syndrome may experience difficulties in recognizing facial emotions, particularly fear, but it is not clear why, nor how such skills can best be facilitated. Using a photo-matching task, emotion recognition was tested in children with Down syndrome, children with nonspecific intellectual disability and cognitively matched, typically developing children (all groups N = 21) under four conditions: veridical vs. exaggerated emotions and emotion-labelling vs. generic task instructions. In all groups, exaggerating emotions facilitated recognition accuracy and speed, with emotion labelling facilitating recognition accuracy. Overall accuracy and speed did not differ in the children with Down syndrome, although recognition of fear was poorer than in the typically developing children and unrelated to emotion label use. Implications for interventions are considered.

Emotion recognition by children with Down syndrome: investigation of specific impairments and error patterns.

The ability of children with Down syndrome to recognize expressions of emotion was compared to performance in typically developing and nonspecific intellectual disability groups matched on either MA or a performance-related measure. Our goal was to (a) resolve whether specific emotions present recognition difficulties; (b) investigate patterns of errors; and (c) explore the relationships among emotion-recognition ability and cognitive, linguistic, and adaptive behavior levels. Emotion-recognition ability in the Down syndrome group was significantly poorer than in the typically developing group overall, particularly for fearful expressions. Error patterns and relationships between task performance and assessment measures also differed across groups. Findings are consistent with a neurological explanation of specific deficits in sociocognitive functioning in children with Down syndrome.

Working with the disabled patient: exploring student nurses views for curriculum development using a SWOT analysis.

BACKGROUND: Increased longevity will mean an increase in people presenting with cognitive and physical disabilities, such as sight loss or dementia. The Patient Rights (Scotland) Act 2011 states that health care should be patient-focussed, taking into account patient needs. This will necessitate nursing curricula to reflect the needs of people who have disabilities and equip the future workforce with knowledge and skills to provide appropriate care. This study explores student nurses' strengths and weakness when working with people with disabilities and identifies opportunities and threats to developing their knowledge and skills to meet the needs of this population. METHODS: As part of a study day, students from the year one Nursing programme were asked to take part in a SWOT analysis and post comments under the categories: strengths, weakness, opportunity and threats on a central wall about working with people with disabilities. RESULTS: Students acknowledged some of the challenges of being disabled especially in a health setting but also believed they were developing their skills to provide holistic care that ensured autonomy. Communication was viewed as both a strength and weakness and was identified as an essential skill to working effectively with people who had a disability. Students acknowledged that clinical staff were not always experts in working with people who were disabled and welcomed the opportunity to work with experts and clients as well as being directed to resources to increase their knowledge. CONCLUSIONS: Integration of disability into the nursing curriculum is needed to ensure students have awareness of and the confidence to work effectively with people who have a range of cognitive and physical disabilities alongside other medical problems.

Reflective writing: the student nurse's perspective on reflective writing and poetry writing.

BACKGROUND: Reflective writing is a mandatory part of nurse education but how students develop their skills and use reflection as part of their experiential learning remains relatively unknown. Understanding reflective writing in all forms from the perspective of a student nurse is therefore important. OBJECTIVES: To explore the use of reflective writing and the use of poetry in pre-registered nursing students. DESIGN: A qualitative design was employed to explore reflective writing in pre-registered nursing students. SETTING: A small university in Scotland. PARTICIPANTS: BSc (Hons) Adult and Mental Health Pre-registration Student Nurses. METHODS: Two focus groups were conducted with 10 student nurses during March 2012. Data was analysed thematically using the framework of McCarthy (1999). RESULTS: Students found the process of reflective writing daunting but valued it over time. Current educational methods, such as assessing reflective accounts, often lead to the 'narrative' being watered down and the student feeling judged. Despite this, reflection made students feel responsible for their own learning and research on the topic. Some students felt the use of models of reflection constricting, whilst poetry freed up their expression allowing them to demonstrate the compassion for their patient under their care. CONCLUSIONS: Poetry writing gives students the opportunity for freedom of expression, personal satisfaction and a closer connection with their patients, which the more formal approach to reflective writing did not offer. There is a need for students to have a safe and supportive forum in which to express and have their experiences acknowledged without the fear of being judged.

A decade on: what have we learnt about supporting women with intellectual disabilities through the menopause?

Carr and Hollins highlighted the paucity of research on the menopause in women with intellectual disabilities and, 10 years on, this area still remains poorly researched. Work exploring the age of onset of the menopause has suggested that the menopause is earlier in this group of women, but studies exploring what women with intellectual disabilities understand and experience during the menopause are limited. In this study 15 women with mild to moderate intellectual disabilities were interviewed using a semi-structured interview on a one-to-one basis about their knowledge and understanding of the menopause. Findings revealed limited accessible information about the menopause and a paucity in the women's knowledge and understanding about the menopause. This suggests a need for more accessible information, in order to increase understanding and awareness of the menopause in these women.