Challenges of using a Fitbit smart wearable among people with dementia.

OBJECTIVES: Limited research on using smart wearables such as Fitbit devices among people with dementia has shown favourable outcomes. The aim of this study was to explore the acceptability and feasibility of using a Fitbit Charge 3 among people with dementia, living in the community, who took part in the physical exercise component of the Comprehensive REsilience-building psychoSocial intervenTion pilot study. METHODS: A mixed methods study was conducted; Quantitative data relating to wear rates for the Fitbit were recorded and qualitative data were collected by group and individual interviews with the people with dementia and their caregiver about their experience of wearing/using the Fitbit in the study. RESULTS: Nine people with dementia and their caregiver completed the intervention. Only one participant wore the Fitbit consistently. Supporting set-up and use of the devices was time consuming and caregiver involvement was essential for day-to-day support: none of the people with dementia owned a smartphone. Few of them engaged with the Fitbit features, primarily only using it to check the time and only a minority wanted to keep the device beyond the intervention. DISCUSSION: When designing a study using smart wearables such as a Fitbit among people with dementia, consideration should be given to the following: the possible burden on caregivers supporting the use of the device; a lack of familiarity with this technology in the target population; dealing with missing data, and the involvement of the researcher in setting up and supporting use of the device.

LGBT + young people's perceptions of barriers to accessing mental health services in Ireland.

AIM: To explore the barriers to accessing mental health services in the Republic of Ireland from the perspectives of young LGBT + people aged 14-25. BACKGROUND: Significant mental health disparities exist between LGBT + young people and their cisgender and heterosexual peers, yet they do not have equitable access to mental health services. Limited research has explored barriers, which exist for LGBTI + young people in accessing services, particularly from their perspectives. METHOD: An anonymous online survey design, consisting of closed and open questions, was used. The study was advertised through local and national organisations and media. 1,064 LGBT + participants aged 14-25 opted to complete the survey. RESULTS: Most participants reported several barriers to them accessing mental health services that were interlinked across three levels: individual; sociocultural; and mental health system. CONCLUSION: Cultural competency training for practitioners, which address issues and concerns pertinent to LGBT + young people, is key to addressing many of the barriers identified. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use the findings to advocate for practice and organisational change within their services to ensure that care and support is responsive and sensitive to the particular needs of LGBT + young people.

Interventions for the management of obesity in people with bipolar disorder.

BACKGROUND: Bipolar disorder is one of the most common serious mental illnesses, affecting approximately 60 million people worldwide. Characterised by extreme alterations in mood, cognition, and behaviour, bipolar disorder can have a significant negative impact on the functioning and quality of life of the affected individual. Compared with the general population, the prevalence of comorbid obesity is significantly higher in bipolar disorder. Approximately 68% of treatment seeking bipolar patients are overweight or obese. Clinicians are aware that obesity has the potential to contribute to other physical health conditions in people with bipolar disorder, including diabetes, hypertension, metabolic syndrome, cardiovascular disease, and coronary heart disease. Cardiovascular disease is the leading cause of premature death in bipolar disorder, happening a decade or more earlier than in the general population. Contributing factors include illness-related factors (mood-related factors, i.e. mania or depression), treatment-related factors (weight implications and other side effects of medications), and lifestyle factors (physical inactivity, poor diet, smoking, substance abuse). Approaches to the management of obesity in individuals with bipolar disorder are diverse and include non-pharmacological interventions (i.e. dietary, exercise, behavioural, or multi-component), pharmacological interventions (i.e. weight loss drugs or medication switching), and bariatric surgery. OBJECTIVES: To assess the effectiveness of interventions for the management of obesity in people with bipolar disorder. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and the Cochrane Central Register for Controlled Trials (CENTRAL) to February 2019. We ran additional searches via Ovid databases including MEDLINE, Embase, and PsycInfo to May 2020. We searched the World Health Organization (WHO) trials portal (International Clinical Trials Registry Platform (ICTRP)) and ClinicalTrials.gov. We also checked the reference lists of all papers brought to full-text stage and all relevant systematic reviews. SELECTION CRITERIA: Randomised controlled trials (RCTs), randomised at the level of the individual or cluster, and cross-over designs of interventions for management of obesity, in which at least 80% of study participants had a clinical diagnosis of bipolar disorder and comorbid obesity (body mass index (BMI) ≥ 30 kg/m²), were eligible for inclusion. No exclusions were based on type of bipolar disorder, stage of illness, age, or gender. We included non-pharmacological interventions comprising dietary, exercise, behavioural, and multi-component interventions; pharmacological interventions consisting of weight loss medications and medication switching interventions; and surgical interventions such as gastric bypass, gastric bands, biliopancreatic diversion, and vertical banded gastroplasty. Comparators included the following approaches: dietary intervention versus inactive comparator; exercise intervention versus inactive comparator; behavioural intervention versus inactive comparator; multi-component lifestyle intervention versus inactive comparator; medication switching intervention versus inactive comparator; weight loss medication intervention versus inactive comparator; and surgical intervention versus inactive comparator. Primary outcomes of interest were changes in body mass, patient-reported adverse events, and quality of life. DATA COLLECTION AND ANALYSIS: Four review authors were involved in the process of selecting studies. Two review authors independently screened the titles and abstracts of studies identified in the search. Studies brought to the full-text stage were then screened by another two review authors working independently. However, none of the full-text studies met the inclusion criteria. Had we included studies, we would have assessed their methodological quality by using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. We intended to combine dichotomous data using risk ratios (RRs), and continuous data using mean differences (MDs). For each outcome, we intended to calculate overall effect size with 95% confidence intervals (CIs). MAIN RESULTS: None of the studies that were screened met the inclusion criteria. AUTHORS' CONCLUSIONS: None of the studies that were assessed met the inclusion criteria of this review. Therefore we were unable to determine the effectiveness of interventions for the management of obesity in individuals with bipolar disorder. Given the extent and impact of the problem and the absence of evidence, this review highlights the need for research in this area. We suggest the need for RCTs that will focus only on populations with bipolar disorder and comorbid obesity. We identified several ongoing studies that may be included in the update of this review.

Effects of a Mindfulness Activity on Nursing Service Staff Perceptions of Caring Behaviors in the Workplace.

Research on caring in nurse-to-nurse relationships is not extensive, but studies have shown that health care workers can experience incivility in the workplace and unhealthy relationships can increase stress and influence nurse retention. The current study examined nurse perceptions of caring in the workplace and the effect of a mindfulness activity. A mixed method design was used, and data were collected on 164 nursing staff members after a 1-minute mindfulness activity. Pre- and post-survey growth in caring behavior indicated a statistically significant positive effect for the treatment group. Qualitative reports showed that after completing a mindfulness activity, staff members were more focused, and willing to set a good example, off er help to others, and encourage a positive overall work environment. Mindfulness activities can improve nurse-to-nurse caring and reduce incivility in the workplace. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 28-36.].

Selection, collection and analysis as sources of evidence in case study research.

Background Case study research is a valuable way to explore and describe nursing phenomena in their natural contexts. Multiple sources of evidence are critical in this approach. It is imperative that the strategies for selection, collection and analysis of cases are considered and articulated in the early stages of planning, to avoid having large datasets which cannot be harmonised. Aim To critically examine what is meant by 'multiple sources of evidence' and how they can be used in case study research. Two examples of case study research are used to illustrate the decisions the authors made during the selection, collection and analysis stages of the research. Discussion These decisions included what sources would be used, rationales for their use, and how the data would be collected and analysed. In addition, multiple sources of evidence can result in large amounts of data so the use of NVivo to manage the data is described. Conclusion Each source of evidence selected must have a clear purpose and relate to the study's objectives. Clarification of this during the early planning of any research is imperative. Implications for practice The authors hope that the examples provided to illustrate how multiple sources of evidence are used will guide researchers conducting case study research.

'Seeing me through my memories': a grounded theory study on using reminiscence with people with dementia living in long-term care.

AIMS AND OBJECTIVES: To understand people with dementia, staff and relatives perspectives on reminiscence, its impact on their lives and experience of care and care giving. BACKGROUND: The quality of life of people with dementia living in long-term care is an important question for providers and policymakers. Reminiscence is thought to have potential for increasing resident-staff interaction, thereby contributing to enhanced personhood for people with dementia. Relatively little is known about the effects of reminiscence on people with dementia or staff. DESIGN: This is a grounded theory study. This design was chosen because of its focus on understanding people's behaviour, interaction and response to events. METHODS: In-depth interviews were conducted with residents with dementia (n = 11), relatives (n = 5), healthcare assistants (n = 10), nurses (n = 9) and nurse managers (n = 3). RESULTS: Reminiscence enabled staff to see and know the person beneath the dementia. It acted as … a key revealing the person to staff, enabling them to engage with the person with dementia in a different way. Knowing the person enabled staff to understand (through the lens of the person's past) and sometimes to accommodate the person's current behaviour. CONCLUSION: The theory of 'seeing me (through my memories)' was generated from the data. This theory explains that through reminiscing and engaging with the person with dementia, staff begin to see the person (their personhood) through the mirror of their memories. RELEVANCE TO CLINICAL PRACTICE: This study found that reminiscence enhanced the experience of living in long-term care for residents with dementia and working in long-term care settings for staff.

Creating a simulated Mental Health Ward: lessons learned.

The future of psychiatric-mental health nursing depends on the preparation of nurses who will meet the mental health care needs of society. The current article discusses the development of the "Mental Health Ward," a simulated mental health experience that was offered for the first time to undergraduate baccalaureate nursing students at a Midwestern university in the United States. The Mental Health Ward is an innovative simulated hospital environment that includes the use of standardized patients and role play scenarios, resulting in a full mission simulation whereby students learn various psychiatric diagnoses and practice various pertinent skills, including nursing assessments, admission and discharge processes, medication administration, and therapeutic communication. Lessons learned by faculty and students in formulating the Mental Health Ward are presented.

Nurses' and midwives' experiences of clinical supervision in practice: a scoping review protocol.

OBJECTIVE: To outline and examine what evidence exists related to nurses' and midwives' experiences of participating in clinical supervision. INTRODUCTION: The practice of clinical supervision is increasingly prevalent in nursing and midwifery, yet disparity remains in relation to professionals' understanding and experience of this clinical support and how it is implemented in practice. This scoping review will identify the available evidence and gaps in knowledge that exist in relation to nurses' and midwives' experience of this practice and examine how the various forms are defined in the literature. METHODS AND ANALYSIS: Comprehensive searches of CINAHL Complete, MEDLINE (EBSCO), PsycINFO (EBSCO), Embase, Scopus and the Cochrane Library will be carried out. Grey literature will also be searched and all results will be screened independently by two reviewers using identified inclusion and exclusion criteria. All empirical data that identify and report nurses' and midwives' experiences of clinical supervision will be included in the review. Studies that include other health and social care professionals will be excluded where the nursing and midwifery cohort is not reported independently. Data from all relevant studies will be extracted using a validated adapted data extraction form. Our review will be guided by the Joanne Briggs Institute Methodology and findings will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Extension for Scoping Reviews statement. ETHICS AND DISSEMINATION: This review does not require ethical approval. Our dissemination strategy includes peer-reviewed publication, presentation and conferences and sharing through stakeholder networks.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review.

OBJECTIVES: To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion. METHODS: A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized. RESULTS: In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care. CONCLUSIONS: A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Developing a structured education reminiscence-based programme for staff in long-stay care facilities in Ireland.

AIMS AND OBJECTIVES: This paper describes the steps used in developing and piloting a structured education programme - the Structured Education Reminiscence-based Programme for Staff (SERPS). The programme aimed to prepare nurses and care assistants to use reminiscence when caring for people with dementia living in long-term care. Reminiscence involves facilitating people to talk or think about their past. BACKGROUND: Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes. DESIGN: The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model (Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation. METHODS: Grounded theory was used (1) to generate data to shape the 'building blocks' for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence. RESULTS: Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia. CONCLUSIONS: This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation. RELEVANCE TO CLINICAL PRACTICE: The incorporation of client and professional experience in the design phase is a key strength of this approach to programme design.

Perceptions and experiences of nursing students communicating with people living with dementia: The validation, emotion, reassure, activity (VERA) communication skills framework.

BACKGROUND: There is an increased risk with advancing age that degenerative conditions such as dementia will affect a person's capacity to communicate. Thus, there is increased possibility that nursing students will be caring for this client group and will need to have the skills to communicate effectively. The Validation, Emotion, Reassure, Activity (VERA) framework is a communication tool developed for this purpose. OBJECTIVES: This pilot study explored nursing students' perceptions and experiences of communicating with people with dementia incorporating the VERA communication skills framework. METHODS: Using a descriptive qualitative approach, second year undergraduate general nursing students were eligible for inclusion if they were assigned to complete their 4-week clinical placement in the designated research site and were willing to participate. Students allocated to the designated research site (n = 6) in semester 1 received standard communication skills as part of the undergraduate programme and students allocated (n = 10) in semester 2 received 2.5 h of additional communication skills based on the VERA framework. Data were analysed using framework analysis as described by Ritchie & Spencer. RESULTS: The findings showed that students in both groups had initial reservations about communicating with people living with dementia. They employed several strategies including nonverbal techniques, distraction, reminiscence and life story work. However, students who received the VERA communication training felt more prepared to engage in these strategies because of the VERA training. CONCLUSION: With increasing numbers of people with dementia accessing health care, it is crucial that future nursing staff are equipped to meet the specific care needs of this population; which includes effective communication. The VERA framework can be useful to structure communication for nursing students. IMPLICATION FOR PRACTICE: The VERA training may be considered a useful framework for increasing undergraduate nursing students' knowledge and confidence in advance of clinical placements in older person's services. Nursing staff should continue to support students on clinical placements which involve caring for people with dementia and be cognisant of the trepidation students may have when first meeting this client group.

An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory.

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.

The experiences and perceptions of young people and older people living with dementia of participating in intergenerational programmes: A qualitative evidence synthesis.

BACKGROUND: Intergenerational programmes are formal activities bringing different generations together and have been identified as a way to help people living with dementia to stay socially connected. While there is some evidence from individual studies as to their benefits, there is no overall coherent account as to the perceptions and experiences of participants who engage in such programmes. This review synthesises qualitative evidence of the experiences and perceptions of young people and older people living with dementia of participating in such programmes. METHODS: We searched EBSCO CINAHL, OVID Medline, Embase, Ovid PsycINFO, the Web of Science, Epistemonikos and grey literature sources. We used thematic synthesis to analyse and synthesise the evidence in to four themes, with 11 key findings. We assessed our confidence in each of these findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. FINDINGS: Our review highlights the potential enjoyment for young people and older people living with dementia when participating in Intergenerational programmes, despite some initial trepidation. These programmes provide an opportunity to establish and develop relationships and for young people to learn about dementia, ageing and how to interact with older people living with dementia. However, it is important to have staff facilitators present to provide reassurance to both groups. It is also important to take the personal preferences of participants into account and to be considerate of noise levels and other aspects of programme delivery that may inhibit engagement. CONCLUSION: This is the first qualitative evidence synthesis specifically exploring Intergenerational programmes aimed at older people living with dementia. We provide insights into the perspectives of those who have participated in Intergenerational programmes. It is important to consider these views, together with other evidence of effectiveness, when planning Intergenerational programmes. While our review is limited by a small number of studies from only a few countries, we have moderate to high confidence in our findings. Further research into the development of Intergenerational programmes specifically tailored for people living with dementia is needed. The findings also provide guidance for people planning to deliver or design future Intergenerational programmes.

A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight.

BACKGROUND: Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. AIMS: The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. METHODS: Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. RESULTS: Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. CONCLUSION: Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.

"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings.

WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.

Telling a 'good or white lie': The views of people living with dementia and their carers.

OBJECTIVE: A common symptom of cognitive decline in people living with dementia, or people with memory problems, the cause of which has not yet been diagnosed, is the person repeatedly asking for loved ones who are deceased or making statements that are incorrect. Carers are then faced with a dilemma, do they avoid and distract or 'correct' the person and tell the 'truth', or tell a lie. This paper explores the concept of lying from the perspective of people living with dementia in the community and their informal/unpaid carers. METHODS: A descriptive qualitative study utilising focus groups to collect the data was conducted. Three focus group's with a purposive sample of people with memory problems (n = 14) and three focus group's with informal/unpaid carers (n = 18) were undertaken. Qualitative content analysis was used to analyse the data. RESULTS: All participants considered that blatant lying with the intention to deceive and do harm is not acceptable. However, telling a 'good lie' or 'white lie' to alleviate distress was in certain circumstances considered acceptable. The intention behind the 'lie' in their view had to be to do good, and the informal/unpaid carer telling the lie had to really 'know the person' and be cognisant of family preferences. Some informal/unpaid carers acknowledged that it may be acceptable for health care professionals to tell a 'good lie' or 'small lie' in certain circumstances. However, health professionals need to 'know the person' and need to consider informal/family caregivers' wishes. CONCLUSION: Lying was only considered acceptable in the context of knowing the person and when done with the intention not to harm or deceive, undertaken with empathy, and only for the purpose of mitigating the person living with dementia's distress.

The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study.

BACKGROUND: A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community. METHODS: This is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery. CONCLUSION: This feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility. TRIAL REGISTRATION: ISRCTN25294519 Retrospectively registered 07.10.2019.

Sexual transmission of Hepatitis C Virus infection in a heterosexual population: A systematic review.

Background: Hepatitis C virus (HCV) infection is an important cause of liver disease worldwide. Identification of risk factors can guide screening and prevention. Sexual transmission in monogamous heterosexual relationships is rare but it is uncertain which sexual behaviours are linked to HCV transmission. This review aimed to determine risk factors for sexual HCV transmission in heterosexuals in low HCV prevalence countries (PROSPERO registration CRD42016051099). Methods: We searched Medline, Embase, Science Citation Index-Expanded, Social Sciences Citation index, Conference proceedings (Web of Science), CINAHL, Scopus, LILACS, PubMed, and grey literature (04/11/2016). We included studies published in/after the year 2000 that examined sexual risk factors for HCV infection, other than interspousal transmission, in heterosexual adults (≥18 years). We excluded prisoners, people who inject drugs (PWIDs), people co-infected with HIV or from high prevalence countries. Two reviewers completed study selection, data extraction, risk of bias and quality of evidence assessment (GRADE) independently. Meta-analysis could not be conducted. Results: Eight studies were included, examining seven factors (multiple sex partners, receiving/providing sex commercially, PWID partner, and unprotected vaginal, oral, anal sex). None were significant, except the evidence for the factor having a PWID partner was conflicting. Conclusions: We are uncertain about the results due to the very low quality of evidence (GRADE). A more liberal approach to review inclusion criteria might be useful in further identifying factors associated with an increased risk of sexual transmission of HCV infection in a heterosexual population. However, caution should be applied to avoid the impact of confounders on the findings.

Revisiting task orientated care: Oral histories of former student nurses in Ireland (1960-2001).

The apprenticeship model of nurse training was in place in Ireland up to the end of the twentieth century. Task orientated care was a feature of this model. It is important to examine task allocation from the student's perspective, in light of current and on-going debates regarding student nurses' supernumerary status. Both approaches influence the status of the student; as a worker with task allocation and as a learner with supernumerary status. Oral history interviews were undertaken with twelve former student nurses (1960-2001) to explore their experiences of clinical learning and task allocation. Task allocation consisted of household tasks and tasks involving patient care. Students' experiences were influenced more by issues surrounding the task, particularly the 'task-person', than the task itself. Therefore, a learning environment that is inclusive, supportive and understanding of students' learning is recommended, regardless of the model of nurse training or education that might be in place. These findings can inform current debate on supernumerary status and task allocation for the student nurse within their clinical learning environment, but also on the history of nurse education in Ireland in the twentieth century.