The codesign of implementation strategies for children's growth assessment guidelines in the dental setting.

BACKGROUND: Considering the interdisciplinary role dental staff can play in addressing overweight and obesity in childhood, this study aimed to codesign guideline implementation strategies for children's growth assessment and dietary advice guidelines in the dental setting. METHODS: This qualitative study utilised principles of codesign and appreciative inquiry through a series of four, two-hour focus groups with dental staff and parents. Focus groups were analysed using content analysis. RESULTS: Discussion fell into two main themes, engaging patients throughout their care journey and supporting staff to engage with the guidelines. Six strategies were developed within these themes: (1) providing growth assessment information to patients and families before appointments, (2) providing refresher training to staff, (3) involving dental assistants in the growth assessment, (4) keeping dental staff updated regarding referral outcomes, (5) culturally appropriate information resources for patients and families, and (6) enabling longitudinal growth tracking in patient information systems. CONCLUSIONS: This study successfully designed six implementation strategies for children's growth assessment guidelines in the dental setting. Further research is required to determine their impact on guideline adherence.

Being above a healthy weight in childhood is a major public health issue. In parts of Australia, dental staff need to screen for and promote healthy weight among children. As this is not a normal part of dental care, it could be hard for this change to come about. So, this study aimed to create strategies to help dental staff to screen for and promote healthy weight among children. As we wanted those impacted by the strategies to have a say, we worked with public dental staff and parents. When health staff and the community come together to design ways to improve health care, this is known as codesign. In groups, these people codesigned a series of strategies. Strategies for parents included: (1) informing parents about what to expect in their child's appointment; and (2) creating resources for parents from other cultures. Strategies for dental staff included (1) ensuring staff were trained; (2) involving the whole dental team to save time; (3) ensuring dental staff heard back from services they sent children to for healthy weight support; and (4) creating a way to record children's growth over time. Bringing in both parents and dental staff gave them a voice to codesign strategies to help dental staff screen and promote healthy weight among children. This produced a suite of strategies that were appropriate for all involved.

Debriefing as a form of reflection and catharsis for researchers.

Background The collection of sensitive data can arouse emotional reactions and researchers may have difficulty distancing themselves from personal stories. Debriefing can address the emotional effect of an experience on researchers. Aim To explore the debrief responses of three research assistants who were involved in the review of retrospective charts and medical notes in a study that examined the risk factors for readmission in young people with anorexia nervosa. Discussion Based on a review of the responses, the principal research team reflected on the value and effectiveness of a debrief tool for research assistants entering sensitive quantitative data. The paper highlights these reflections. Conclusion The use of an electronic debrief tool, while not without its challenges, provides an opportunity for individual reflection and a platform for emotional release for researchers engaged in sustained and intensive collection of sensitive data. This type of tool may serve as a guide for research teams and assist them in monitoring the well-being of those collecting sensitive data. We also advocate that a debriefing tool may contribute to closure for research assistants who become emotionally invested and affected by meticulous quantitative data entry. Implications for practice This paper provides recommendations for future use of an electronic debrief tool for researchers collecting sensitive data.

Participatory action research for women with anorexia nervosa.

AIM: To discuss the application of the principles of participatory action research (PAR) in a project that developed and evaluated a mentor-mentee support programme for women with anorexia nervosa. BACKGROUND: A programme was developed and implemented in which mentors and mentees participated in workshops, social activities and focus groups that sought to support and develop resilience for those experiencing anorexia nervosa. DISCUSSION: PAR principles were mirrored in the programme, paying respect to the views and needs of each participant, an open trajectory to possible conclusions and a continuous feedback cycle. Mentees had a sense of empowerment, ownership of the programme and hope that recovery was possible. It allowed their voices to be heard and provided them with belief they could begin new relationships and friendships. CONCLUSION: The principles of PAR suited a project aimed at developing self-determination and resilience in women with anorexia nervosa. IMPLICATIONS FOR RESEARCH/PRACTICE: PAR would be readily transferable to a number of mental health settings where empowerment is of paramount concern.

End-of-life decisions in the Intensive Care Unit (ICU) - Exploring the experiences of ICU nurses and doctors - A critical literature review.

BACKGROUND: End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment. OBJECTIVES: The purpose of this paper is to critically review the literature related to end-of-life decision making among ICU doctors and nurses and focuses on three areas: (1) Who is involved in end-of-life decisions in the ICU?; (2) What challenges are encountered by ICU doctors and nurses when making decisions?; and (3) Are these decisions a source of moral distress for ICU doctors and nurses? REVIEW METHOD: This review considered both qualitative and quantitative research conducted from January 2006 to March 2014 that report on the experiences of ICU doctors and nurses in end-of-life decision making. Studies with a focus on paediatrics, family/relatives perspectives, advance care directives and euthanasia were excluded. A total of 12 papers were identified for review. RESULTS: There were differences reported in the decision making process and collaboration between doctors and nurses (which depended on physician preference or seniority of nurses), with overall accountability assigned to the physician. Role ambiguity, communication issues, indecision on futility of treatment, and the initiation of end-of-life discussions were some of the greatest challenges. The impact of these decisions included decreased job satisfaction, emotional and psychological 'burnout'. CONCLUSIONS: Further research is warranted to address the need for a more comprehensive, standardised approach to support clinicians (medical and nursing) in end-of-life decision making in the ICU.

Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa.

Anorexia nervosa is a potentially life-threatening eating disorder where people intentionally refuse to eat sufficient amounts to maintain a healthy body-weight for fear of becoming fat. The intense preoccupation with restriction of food and control of body weight makes this one of the most complex and confusing conditions for practitioners to treat. While no single treatment has been found to be superior to another in the treatment of anorexia nervosa, general practice guidelines are available to guide mainstream treatment, however there are no guidelines for practitioners of complementary therapies. Complementary therapies such as acupuncture show promise as an adjunctive therapy in improving co-morbidities such as depression and anxiety levels among people with anorexia nervosa, by strengthening mind, body and overall well-being. The aim of this guideline is to assist and support acupuncture practitioners to deliver effective and safe adjunctive acupuncture treatments to people with anorexia nervosa, by providing a practice guideline that is underpinned by an ethical and evidence-based framework. The use of complementary therapies and specifically acupuncture in the treatment of anorexia nervosa may provide important adjunctive care to allow a comprehensive treatment approach that potentially improves quality of life, reduces anxiety and instils hope for recovery. It is hoped that acupuncture practitioners treating patients with anorexia nervosa will refer to these guidelines and apply the guidance (as deemed appropriate).

Original research: an inpatient program for adolescents with anorexia experienced as a metaphoric prison.

OBJECTIVE: The purpose of this study was to explore the experiences of adolescents within an inpatient behavioral program for the treatment of anorexia nervosa, as well as those of the nurses who cared for them. In particular, the study focused on the effects of the program's behavior modification principles on the relationship between patient and nurse. METHODS: Using a qualitative, naturalistic design, the investigator (LMR) conducted in-depth, face-to-face, semistructured interviews with adolescent patients being treated for anorexia in an acute care setting and the pediatric nurses working there. She invited all patients and nurses involved in the program to participate in the study, and then conducted interviews up until the point of saturation (when responses ceased to reveal any new information or themes). She interviewed 10 adolescent patients and 10 pediatric nurses in total. RESULTS: Study findings illuminated the challenges nurses and patients face in forming therapeutic relationships within an environment the patient often experiences as a de facto prison, with nurses taking on the role of prison warden. In interviews, both patients and nurses frequently used language suggestive of incarceration, and from their accounts of life within the program, three major themes emerged: "entering the system," "'doing time' within the system," and "on parole or release." CONCLUSION: Thematic analysis revealed that an oppressive prison metaphor colored the experiences of both patients and nurses within this program and negatively affected the development of therapeutic relationships between them. Findings suggest that policy changes regarding length of stay, nurse training, visitation, initiation of psychological therapy, and mealtime may improve therapeutic relationships within such programs.

Nurses and the 'therapeutic relationship': Caring for adolescents with anorexia nervosa.

BACKGROUND: Research studies suggest that hospital programmes for young people diagnosed with anorexia nervosa have high readmission rates and limited effectiveness. Nurses caring for these adolescents face a particular set of problems in seeking to establish therapeutic relationships. AIM: This paper reports a study with the original aim of providing rich data on the development of therapeutic relationships between adolescents diagnosed with anorexia and paediatric nurses. However, it was discovered that paediatric nurses were struggling to develop therapeutic alliances with these adolescents. The study was then modified to explore the difficulties and obstacles hindering the formation of therapeutic relationships in this context. METHOD: The study used naturalistic inquiry. The 10 participants were Registered Nurses from the acute wards of an Australian children's hospital with at least 2 years' experience of caring for adolescents with anorexia nervosa. The data were collected using semi-structured interviews that were recorded on audiotape and then thematically analysed both manually and with the aid of the NUD*IST computer package. FINDINGS: Participants described how they struggled to develop therapeutic relationships in this clinical environment. Three themes emerged: (1) 'Struggling for understanding' explores the difficulties nurses experienced in coming to terms with the complexities of a diagnosis of anorexia nervosa and its recovery processes. (2) 'Struggling for control' examines the power struggle between nurses and patients and the mutual distrust that often developed between them as a consequence of this struggle. (3) 'Struggling to develop therapeutic relationships' describes the difficulties some nurses had in establishing therapeutic alliances with these adolescents. CONCLUSION: Recommendations are made for improving the nursing component of hospital treatment programmes for adolescents with anorexia nervosa in the direction of more genuinely therapeutic relationships.