'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships.

BACKGROUND: Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. DESIGN: A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. PARTICIPANTS: Participants were 35 healthcare recipients and 37 carers (n = 72 total). RESULTS: Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. CONCLUSION: The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships. PATIENT OR PUBLIC CONTRIBUTION: The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.

A qualitative systematic review of experiences of persons with dementia regarding transition to long-term care.

INTRODUCTION: The current qualitative systematic review identified and examined critically the literature on how persons with dementia experience transitions to long-term care. Results are intended to help develop guidelines for future care and research. METHOD: A search was conducted of OvidSP, SCOPUS, Web of Science, ProQuest, PsycINFO, CINAHL, AgeLine and Informit databases. In total, 4705 articles were reviewed (published 1954-2018). A textual narrative approach was used to synthesise the findings of the included articles. RESULTS: Seven articles met inclusion criteria (five using data collected from interviews with persons with dementia and two using reports from a proxy). Overall, the findings showed that transition to long-term care possesses varied meanings for persons with dementia, is often not the decision of the persons with dementia, and is a process throughout which social connections remain important. DISCUSSION: Accounts of the experiences of persons with dementia regarding transitions from community to long-term care show that they and their families should be supported: with respect to their individual contexts, to share the positives and negatives of the transition experiences, to make decisions together, and to maintain old and establish new social connections.

Introducing an interactional approach to exploring facilitation as an implementation intervention: examining the utility of Conversation Analysis.

BACKGROUND: The widely adopted integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework identifies facilitation as a 'core ingredient' for successful implementation. Indeed, most implementation scientists agree that a certain degree of facilitation is required to translate research into clinical practice; that is, there must be some intentional effort to assist the implementation of evidence-based approaches and practices into healthcare. Yet understandings of what constitutes facilitation and how to facilitate effectively remain largely theoretical and, therefore, provide scant practical guidance to ensure facilitator success. Implementation Science theories and frameworks often describe facilitation as an activity accomplished in, and through, formal and informal communication amongst facilitators and those involved in the implementation process (i.e. 'recipients'). However, the specific communication practices that constitute and enable effective facilitation are currently inadequately understood. AIM: In this debate article, we argue that without effective facilitation-a practice requiring significant interactional and interpersonal skills-many implementation projects encounter difficulties. Therefore, we explore whether and how the application of Conversation Analysis, a rigorous research methodology for researching patterns of interaction, could expand existing understandings of facilitation within the Implementation Science field. First, we illustrate how Conversation Analysis methods can be applied to identifying what facilitation looks like in interaction. Second, we draw from existing conversation analytic research into facilitation outside of Implementation Science to expand current understandings of how facilitation might be achieved within implementation. CONCLUSION: In this paper, we argue that conversation analytic methods show potential to understand and refine facilitation as a critical, and inherently interactional, component of implementation efforts. Conversation analytic investigations of facilitation as it occurs in real-time between participants could inform mechanisms to (1) improve understandings of how to achieve successful implementation through facilitation, (2) overcome difficulties and challenges in implementation related to interpersonal communication and interaction, (3) inform future facilitator training and (4) inform refinement of existing facilitation theories and frameworks (e.g. i-PARIHS) currently used in implementation interventions.

Expanding current understandings of epistemic injustice and dementia: Learning from stigma theory.

The current paper addresses the nature of epistemic injustice as it may be experienced by persons with dementia. We describe how theoretical models of stigma align with the current model of epistemic injustice through a consideration of the concepts of 'stereotype', 'prejudice' and 'discrimination', shared by the two models. We draw on current understandings of dementia-related stigma to expand understandings of the epistemic injustice faced by persons with dementia. We discuss how these insights may inform the development of mechanisms to uphold the basic human right to speak, to be heard, and to be believed for persons with dementia.

Familiar communication partners' facilitation of topic management in conversations with individuals with dementia.

BACKGROUND: Language and memory impairments affect everyday interactions between individuals with dementia and their communication partners. Impaired topic management, which compromises individuals' construction of relevant, meaningful discourse, is commonly reported amongst individuals with dementia. Currently, limited empirical evidence describes the sequential patterns of behaviour comprising topic-management practices in everyday conversation between individuals with dementia and their communication partners. AIMS: To describe the sequential patterns of behaviour relating to the manifestation of topic-management impairments and facilitative behaviours in everyday interactions between individuals with dementia and their familiar communication partners (FCPs). METHODS & PROCEDURES: Three 20-min conversations between individuals with moderate to severe dementia and their FCPs were recorded. Conversation Analysis was used to examine sequences in which topic-management appeared to be impaired. OUTCOMES & RESULTS: Conversational behaviours that reflected a difficulty in contributing on-topic talk were pervasive in the talk of the three individuals with dementia. FCPs responded to these conversational difficulties by using two categories of facilitative behaviours. The first involved responding to an individual with dementia's explicit repair-initiation by performing repair. In the second category, explicit repair-initiation was absent; instead, the distance of the conversational difficulty from the prior topic-shifting turn mediated the form and outcome of the FCPs' facilitative behaviours. Each category successfully facilitated the individual with dementia to contribute on-topic talk. CONCLUSIONS & IMPLICATIONS: The findings contribute to a growing understanding of topic-management abilities in everyday interactions involving individuals with dementia. Individuals with dementia took a proactive role in eliciting topic-management support. The FCPs responded with turns that facilitated the individuals with dementia to talk on-topic. Clinically, the results support and extend the current topic-management recommendations available in communication partner training programmes, and promote conversations which attend to the personhood of the individual with dementia.

A conversation analytic study of patterns of overlapping talk in conversations between individuals with dementia and their frequent communication partners.

BACKGROUND: Difficulty participating in conversation is commonly experienced by individuals with dementia, secondary to cognitive and language deficits. Frequent communication partners (FCPs), however, report being largely unaware of how to support their conversation partners with dementia during conversation. In particular, taking a turn appropriately may be difficult for either partner due to trouble predicting a partner's behaviour and, hence, difficulty with timing conversational turns appropriately, potentially resulting in overlapping talk. AIMS: To investigate the patterns of overlapping talk in the interaction between individuals with dementia and their FCPs. METHODS & PROCEDURES: Three participants with moderate-severe dementia participated in conversation with an FCP. Ten minutes of 'casual' and 'task-oriented' conversation were audio- and video-recorded. Patterns of overlapping talk were investigated using conversation analytic methods. OUTCOMES & RESULTS: Overlapping talk was a consistent feature of all three dyadic interactions during both social and task-oriented talk. All participants exhibited competitive and non-competitive forms of overlapping talk. The data reveal that FCPs commonly yielded their own turns when overlapped by a partner in order to create opportunities for their partners with dementia to communicate. Participants with dementia demonstrated some retained pragmatic abilities, both using continuers and yielding the floor to their partner when competitively overlapped in order to encourage a speaker to continue. CONCLUSIONS & IMPLICATIONS: These findings contribute to the understanding of the impact of dementia on the maintenance of sensitivity to the sequential aspects of everyday talk. From a clinical perspective, these findings can inform the training of FCPs about retained abilities and evidence-based support strategies, equipping them with knowledge and skills to structure and maintain fluent conversation.

Transcranial non-invasive brain stimulation in swallowing rehabilitation following stroke--a review of the literature.

BACKGROUND: This descriptive review of the literature outlines the current evidence-base underpinning the potential of transcranial brain stimulation techniques to modulate swallowing function in healthy individuals and in treating post-stroke dysphagia. METHODS: Published research was identified by review of scientific databases (Scopus, Medline Ovid, Science Direct, AMED and Google Scholar) using relevant keywords. In addition, the reference lists of identified articles were scrutinized to identify further potentially relevant papers. Studies employing variants of transcranial magnetic or direct current stimulation for the purpose of modulating swallowing motor cortical excitability in healthy participants or dysphagia following stroke were included. Due to a significant heterogeneity in stimulation paradigms, all included studies were summarised and descriptively analysed in relation to the participants tested, cortical representations targeted by brain stimulation and outcome measures used. RESULTS: Seventeen studies met inclusion criteria (seven evaluating healthy participants, 10 evaluating participants presenting with post-stroke dysphagia). Cortical stimulation most commonly targeted pharyngeal motor representations (13/17 studies). In the 10 clinical studies, stimulation was applied contralesionally (5/10 studies), ipsilesionally (3/10 studies) or bilaterally (2/10 studies). A range of behavioural and neurophysiological outcome measures demonstrated positive effects on swallowing function across studies. CONCLUSION: There is promising proof of concept that non-invasive brain stimulation may provide a useful adjunct to post-stroke swallowing rehabilitation practice. Eventual transition of optimal paradigms into routine clinical practice will be accompanied by practical considerations in relation to local and national frameworks, e.g. the prescription and provision of treatment.

Formation of ammonia from an iron nitrido complex.

Radical ideas: Reaction of the iron(IV) nitrido complex [PhB(MesIm)(3)Fe[triple chemical bond]N] (see picture, Mes=2,4,6-Me(3)C(6)H(2)) with TEMPO-H (1-hydroxy-2,2,6,6-tetramethylpiperidine) results in high yields of ammonia and quantitative formation of [PhB(MesIm)(3)Fe(tempo)]. The mechanism likely involves hydrogen-atom transfer from TEMPO-H to the nitrido complex. Similar reaction with the triphenylmethyl radical yields [PhB(MesIm)(3)Fe[triple chemical bond]N--CPh(3)].