Staff views about involving service users in team formulation.

OBJECTIVES: The aim of the study was to explore staff views about whether and how service users should be involved in the process of team formulation. DESIGN: This study used Q methodology to explore health care professionals' views about service user involvement in team formulation meetings. METHODS: Forty staff members with experience of attending team formulation meetings completed a Q Sort in which they ranked how much they agreed or disagreed with 58 statements about service user inclusion in team formulation. Factor analysis was used to identify viewpoints within the data set. RESULTS: A three-factor solution accounting for 60% of the variance was considered the best fit for the data. The factors were: 'A safe space for staff', 'Concerns about inclusion and collaboration' and 'Service users might find attendance harmful'. Consensus statements identified areas where all participants agreed. CONCLUSIONS: This is an important area for exploration, given the growing practice of team formulation and the professional and ethical issues raised by service user involvement. There are a range of ways to promote inclusion within the practice, and staff should always consider the individual needs of service users.

Management of Agitation in Behaviours That Challenge in Dementia Care: Multidisciplinary Perspectives on Non-Pharmacological Strategies.

Objective: NICE guidelines recommend non-pharmacological interventions as the first-line approach for the management of behaviours that challenge. Recent work, however, highlights dissatisfaction with the lack of detailed guidance in the national guidelines regarding non-drug interventions. This study examines the views of practitioners regarding non-pharmacological treatments. It further explores perspectives on non-pharmacological strategies used in the management of agitation occurring within episodes of behaviours that challenge. Methods: Forty-two experienced practitioners attended a workshop where behaviours that challenge were described as occurring in three phases of agitation, using a framework adapted from the Positive Behaviour Support framework (pre-agitation, triggering and escalating, high level). The participants were asked to populate a template derived from the adapted framework. The completed templates recorded the clinical strategies the participants found useful to (i) prevent the occurrence of agitation, (ii) de-escalate distress and (iii) deal with perceived high levels of agitation. Results: The Positive Behaviour Support conceptual framework was perceived by participants as helpful in organising their clinical work. A number of interventions were suggested as preventative strategies: music therapy, doll therapy, physical activity and generic person-centred communication skills to enhance wellbeing. In contrast, de-escalation strategies identified by the participants focused on reducing emotional distress. The approaches for dealing with continued high levels of agitation involved a number of "control and restraint" techniques as well as medication. Conclusion: The template allowed specialist multidisciplinary professionals to identify skills for the management of distress and agitated behaviour linked to the respective phase of arousal. The template has scope to guide practitioners to identify the detail needed for the management of behaviours that challenge. The findings have the potential to influence the contents of forthcoming guidelines on alternatives to psychotropics in dementia care.

Recognising eating disorders in older people.

Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them. The authors describe a framework that nurses can use when assessing older people to determine whether they may have an eating disorder.

A longitudinal study of gender-related cognition and behaviour.

Gender schema theory proposes that children's acquisition of gender labels and gender stereotypes informs gender-congruent behaviour. Most previous studies have been cross-sectional and do not address the temporal relationship between knowledge and behaviour. We report the results of a longitudinal study of gender knowledge and sex-typed behaviour across three domains in children tested at 24 and 36 months (N = 56). Although both knowledge and sex-typed behaviour increased significantly between 2 and 3 years, there was no systematic pattern of cross-lagged correlations between the two, although some concurrent relationships were present at 24 months. Future longitudinal work might profitably focus on younger children using reliable preverbal measures of gender knowledge and employing a shorter lag between measurement times.

Sex-typed preferences in three domains: do two-year-olds need cognitive variables?

Gender schema theory proposes that sex-typed behaviour flows from the child's ability to 'tag' incoming information in terms of gender categories leading to heightened attention, recall and performance of sex-congruent behaviour. We investigate three questions in relation to this proposal: (1) the order of emergence of the child's ability to apply gender labels in each of three domains (social behaviour, same-sex peer preference and sex-congruent toy preference) and its impact upon sex-typed behaviour, (2) the role of the child's knowledge of his or her own sex in sex-typed preferences, and (3) the generality versus specificity of sex-typed behaviour across three domains. Participants were 56 two-year old children. Correct labelling of gender was achieved by 67% of children for self, by 54% for other children, by 23% for toys and by 13% for activities. There was a significant preference for sex-congruent toys and boys engaged in significantly more negative social interaction behaviours than did girls, but same-sex peer preference was not found. There was no effect of domain-specific labelling ability on corresponding sex-typed behaviour nor did sex-of-self knowledge explain sex-typed preference. There was no evidence of domain generality in sex-typed behaviours. The findings suggest that the impact of cognitive variables may have been overestimated.