A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers.

AIMS: To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care. DESIGN: A qualitative, phenomenological design was used. METHODS: Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019. RESULTS: A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs. CONCLUSION: Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users. IMPACT: Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

A qualitative study exploring the support needs of newly qualified nurses and their experiences of an online peer support intervention.

BACKGROUND: In the transitional period following registration, newly qualified nurses may feel socially isolated and easily overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Such experiences place them at risk of burnout and leaving the profession. AIMS: To explore newly qualified nurses' support needs and their experiences of an online peer support intervention. METHOD: Eighteen newly qualified nurses participated in online peer support groups. After 3 months participants took part in interviews exploring their support needs and experiences of the groups. Eight one-to one interviews were conducted between October 2019 and January 2020. Qualitative thematic analysis was used. FINDINGS: Two themes identified were; "The Support needs of newly qualified nurses" with two subthemes, "The role of the newly qualified nurse" and "Unmet support needs"; "The online experience" with three subthemes, "Barriers to participation", "Anticipated benefits" and "Unmet expectations". CONCLUSION: Our findings suggested that there is insufficient support for newly qualified nurses. The newly qualified nurses wanted to use online support to help manage their stress. However, the organisation of online peer support needs careful consideration to ensure participation can be beneficial. IMPACT STATEMENT: Online support requires careful design and clear support from employing organisations to promote improved transition experiences. Further research should focus on evaluating adjusted online support interventions.

Exploring newly qualified nurses' experiences of support and perceptions of peer support online: A qualitative study.

AIMS AND OBJECTIVES: To explore newly qualified nurses' support needs and their perceptions of online peer support. BACKGROUND: The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well-being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses' emotional and social well-being. DESIGN: A qualitative exploratory study was designed, employing semi-structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist. METHODS: Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018-January 2019. FINDINGS: Two main themes arose. The first was Drowning, a lot of the time with two sub-themes: (i) Feelings and emotions about being a Newly Qualified Nurse: 'Absolutely terrified' and (ii) Support within the role: 'Somebody you can count on'. The second was Potential advantages and disadvantages of online modality: 'Somebody is going to get in that phone!' which included three sub-themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations. CONCLUSIONS: This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses' well-being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID-19 pandemic.

What is the nature of Mental Capacity Act training and how do health and social care practitioners change their practice post-training? A narrative review.

AIM AND OBJECTIVE: To identify training strategies and determine how registered health and social care practitioners change their practice after Mental Capacity Act training. DESIGN: Narrative literature review. DATA SOURCES: Seventeen databases were searched up to December 2019: CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, MEDLINE, Science Direct, Ovid, 0of Science, British Nursing Index, DH-Data and King's Fund Library Catalogue. REVIEW METHODS: Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed-methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified. CONCLUSION: To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario-based and relevant to trainees' practice. RELEVANCE TO CLINICAL PRACTICE: The Mental Capacity Act is widely misunderstood and implemented poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation. The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously.

Using technology to support the emotional and social well-being of nurses: A scoping review.

AIMS: (a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research. DESIGN: A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented. DATA SOURCES: Between 11-12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies. REVIEW METHODS: Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies. RESULTS: Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community. CONCLUSION: The review identified a dearth of research into how technology can support the well-being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed. IMPACT: Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face-to-face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology-mediated support for the emotional and social well-being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.

Living well in older age: what can we learn from the Japanese experience?

Japan has the most aged population in the world. Not only do people live longer in Japan, they also age better. While the ageing population reflects a success story driven by lifestyle factors and health promotion initiatives, it also results in challenges for policymakers, families and older people. Other countries with ageing population profiles, such as the UK, can learn from the Japanese experience. In this article, the authors focus on the potential of health promotion strategies, social connections and technology to enhance well-being in older age.

Experiences of peer support for newly qualified nurses in a dedicated online group: Study protocol.

AIM: To explore experiences of online peer support for newly qualified nurses. DESIGN: Qualitative study using semi-structured interviews and thematic analysis. METHOD: Phase one involves conducting focus groups with newly qualified nurses in the West Midlands area to refine the online peer support environment. Phase two involves 30-40 new nurses joining an online peer group for 3 months; participants will be able to access a general chat community alongside a more structured discussion board. Phase 3 will collect written interview data from all participants about their experiences of online peer support. Face-to-face interviews with 10-12 participants will also be undertaken. The study will run from May 2018-October 2019. FINDINGS: Data from focus groups, written and verbal interviews will be analysed using thematic analysis with the aid of NVivo software. Findings will be disseminated to participants and key stakeholders involved in the study and also via publication and networking events. CONCLUSION: If online peer support is found to be beneficial to new nurses, it may be adopted by local NHS trusts as part of an innovation scheme. IMPACT: It is important that the psychological well-being of nurses is addressed as more nurses are now leaving than joining the profession; this is an international concern. Online peer support may offer a sustainable and accessible means of promoting psychological well-being in the nursing workforce. In such a way, contributory factors to low retention rates such as burnout, stress and job dissatisfaction may also be reduced.

Using technology to support the social and emotional well-being of nurses: A scoping review protocol.

AIMS: (a) To review the published literature on the use of technology to provide social or emotional support to nurses, (b) to evaluate and identify gaps in the research, (c) to assess whether a systematic review would be valuable, (d) to make recommendations for future developments. DESIGN: The protocol for the scoping review has been developed in accordance with recommendations from several methodological frameworks, as no standardized protocol currently exists for this purpose. METHODS: Our protocol incorporates information about the aims and objectives of the scoping review, inclusion criteria, search strategy, data extraction, quality appraisal, data synthesis, and plans for dissemination. Funding for this project was approved by Burdett Trust for Nursing in December 2016. DISCUSSION: Technology to support patient emotional and social well-being has seen a rapid growth in recent years and is offered in a variety of formats. However, similar support for nursing staff remains under-researched with no literature review undertaken on this topic to date. This is despite nurses working in emotionally demanding environments which can be socially isolating. The scoping review will map current evidence on the use of technology to support nursing staff and explore the range, extent, and nature of this activity. It will also give a basis for deciding if a full systematic review would be desirable. IMPACT: It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. This is an international concern. High staff turnover has an interpersonal cost and is associated with reduced quality of patient care. Financial implications are also important to consider as healthcare providers employ costly agency staff to address the workforce deficit. Online technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work.

Nursing students' experiences of delivering dementia friends sessions to peers.

BACKGROUND: Nursing students and registered nurses often feel underprepared for their roles in dementia care. Extracurricular activities offer nursing students additional opportunities for professional development. A student-academic partnership initiative was developed in which nursing students delivered dementia friends sessions to their peers before formal taught content. AIM: To explore dementia champion nursing students' experiences, identify factors that affect collaborative working and make recommendations for future student-academic partnership projects. METHOD: In individual and dual interviews, three students were asked about their experiences of participating in the initiative. Interviews were recorded, transcribed and analysed using a thematic analysis framework. FINDINGS: Four themes were identified: commitment to working with people who have dementia, difficulties in taking on extracurricular responsibilities, personal development, and relationships and collaboration. CONCLUSION: Students were motivated by the need to provide high-quality dementia care. They identified benefits of collaborative working including development of time management, team working, leadership, communication and presentation skills. Future projects should take into account student workloads and offer rewards that are congruent with nursing students' values.

Recognition of preclinical signs of dementia: A qualitative study exploring the experiences of family carers and professional care assistants.

AIMS AND OBJECTIVES: To identify preclinical signs of dementia by exploring the experiences of family caregivers and professional care assistants. BACKGROUND: Dementia results in disability, emotional strain and financial loss for people with dementia, family members and nations. Informal identification of social and behavioural risk signifiers could facilitate timely interventions with potential to delay onset of serious disability. DESIGN: A retrospective qualitative approach using a naturalistic interpretive design was used. Focus groups enabled in-depth understanding of the participants' experiences of life or work with people who subsequently developed dementia. METHODS: Purposive sampling was used to recruit family carers and professional carers who had cared for people who later developed dementia. The data from focus groups were fully transcribed and anonymised, and transcripts were analysed by two researchers. These researchers coded and analysed the transcripts independently; subsequently, overlapping and similar themes were identified and consensus reached on final themes. A third researcher was invited to review the analysis and ensure trustworthiness of the study findings. RESULTS: Findings revealed that preclinical signs of dementia were identifiable in retrospect Participants' accounts resulted in four themes, "Lowered Threshold of Frustration", "Insight and Coping Strategies," "Early signs of poor memory" and "Alarming Events." CONCLUSIONS: Earlier recognition of preclinical signs of dementia would allow affected individuals to follow health promotion advice and plan for the future. Identification of social exclusion prior to diagnosis has implications for antistigma campaigns and development of "dementia-friendly communities." RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could work with those at risk, facilitating lifestyle changes to postpone symptoms and advance planning for improved autonomy. Predementia should be viewed as a disability for which reasonable adjustments can be made at a community level, to enhance and extend emotional well-being and social inclusion.

A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes.

BACKGROUND: The care home workforce (over half a million people in the UK) has a pivotal role in the quality of care provided to the residents. Much care in this setting is inadequate, lacks a person-centred focus and neglects the dignity of residents. A combination of factors leads to burnout in nurses working in nursing homes, contributing to poor quality care. Recent reports have indicated that cultures of care need to be addressed through training, improved workforce support and supervision and that improving the quality of care for people with dementia can be achieved by the development of leadership in nursing and clarifying professional values. Addressing burnout through an educational intervention should improve quality of care and nurses' experiences. OBJECTIVES: The study aimed to explore the training needs of nurses working with people with dementia in nursing homes with a view to developing an educational intervention to reduce nurses' burnout and improve person-centred care. DESIGN: Four focus groups were conducted with 11 qualified nurses working in nursing homes; data was analysed using thematic analysis. RESULTS: Four themes emerged through the analysis of the transcripts. Participants reported that their work responsibilities revolved mainly around directing others, day to day care, paper work and supporting family carers. Nurses identified the importance of person-centred ways of being, communication and clinical skills when working in nursing home setting. They expressed their frustrations associated with managing staff levels, responding to behaviour that challenges and lack of time. CONCLUSIONS: The barriers to learning, experience of previous training and gaps in knowledge identified could inform the design of future training and support programmes.

Preventing and diagnosing dementia.

While dementia is an umbrella term for a range of degenerative brain disorders, many share similar presentations. Nurses are ideally placed to identify those at risk and empower them to access treatment and plan and prepare for their future needs--as such, they need up-to-date knowledge of the signs and symptoms of the different types of dementia to identify risk factors and make an informed diagnosis. This article, the third in a four-part series on dementia, examines the risk factors, signs, symptoms and diagnosis of dementia, as well as outlining lifestyle factors such as diet and exercise that may help to prevent the development of the condition.

New approaches to understanding dementia.

Improving understanding of brain disorders is likely to be one of the core aims of physiological research in the 21st century. This article, the second in a four-part series, looks at the main types of dementia and explores emerging theories about how the condition develops. These theories are improving our understanding of the neurodegeneration that characterises the most common forms of dementia, and will help improve care for those living with dementia.

How dementia differs from normal ageing.

Dementia is a collective name for a set of symptoms that include memory loss, mood changes, confusion and increasing difficulty with everyday tasks. This four-part series provides an overview of dementia and its treatment, from its causes and pathophysiology to diagnosis and the nurse's role in its management. This first article reviews the main forms of dementia and how research is shedding new light on the differences between dementia and normal ageing.

Overcoming challenges of conducting research in nursing homes.

In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors' experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses' working lives.

Transcultural nursing strategies for carers of people with dementia.

Caring for a family member with dementia is stressful, and carers from all backgrounds often feel overwhelmed and under-supported. Professional and family carers' perceptions of the challenges and satisfactions of caring are influenced by culturally derived expectations. However, experiences of caring often differ from stereotypical norms. Experiences of carer stress and beliefs about the nature and extent of support that can be expected from social networks and statutory services may differ between cultural groups in the UK, but sensitive advice, information, and emotional and practical support are universally required. Transcultural comparisons reveal similarities between carers' needs and enable identification of values-based culturally congruent recommendations that nurses can use to promote black and Asian minority ethnic carers' confidence and wellbeing. This article, based on practice experience and a literature review, explores the effect of caring among different cultural groups and offers recommendations for culturally congruent interventions to support carers. It provides evidence-based guidance to enable nurses to meet their responsibilities for transcultural working, as laid out in the Care Act 2014. A scenario illustrates recommendations for practice.

The nurse's role in caring for people with dementia.

This final article in a four-part series on dementia focuses on the nurse's role in managing dementia and highlights the importance of communication skills in providing high-quality care. It also discusses treatment options, such as medication and ensuring the patient's nutritional needs are met, as well as the importance of dealing sensitively with behavioural problems that may mask pain or emotional difficulties. Finally, it explains how the care environment can make a huge difference to the lives of people with dementia, where aspects such as clear signage and assistive technology can contribute to dignity and quality of life. and skills needed for best practice, this has not always been reflected in the care provided on the ground. This series aims to provide an up-to-date guide to dementia and dementia care for nurses in any setting.

The experiences of staff in a specialist mental health service in relation to development of skills for the provision of person centred care for people with dementia.

It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over £50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

It is unfair for GPs to be paid £55 for every dementia diagnosis.

The government proposes to pay GPs £55 for every diagnosis of dementia they make. The aim is to motivate doctors to assess and diagnose dementia so that the number of people identified as living with dementia matches the expected prevalence of the condition.