Obesity and overweight in intellectual and non-intellectually disabled children.

BACKGROUND: Few studies have compared overweight and obesity in intellectually disabled (ID) and non-intellectually disabled (N-ID) children. This research compared the prevalence of overweight and obesity between a sample of 218 ID and 229 N-ID school pupils in Northern Ireland (NI). Comparison of the physical activity and dietary behaviour of the two groups of school pupils were also undertaken. METHODS: Each pupil completed (assisted if required) a food intake and physical activity questionnaire. Following this body mass index (BMI) and waist circumference were measured and recorded. RESULTS: Significantly more ID pupils (72, 33%) were overweight/obese compared with 55 (24%) of the N-ID pupils in accordance with their BMI. ID pupils also had significantly higher waist circumferences. Over a quarter of foods consumed by the pupils were fatty and sugary foods and close to 30% of these foods were eaten by the ID children. Pupils spent most of their time engaging in low levels of activity such as reading, watching TV, on games consoles and listening to music. Pupils with an ID spent fewer hours on moderate and high levels of activities compared with those children with N-ID. CONCLUSIONS: Results of this study found higher levels of overweight and obesity in this sample than in international published research. Additionally significantly higher numbers of ID pupils were overweight and obese indicating the need for future research and public health to focus on this issue.

People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems.

This study describes the evaluation of an assessment and treatment unit for people with learning disabilities. Results showed the main reasons for admission for the 48 people admitted to the unit were because of challenging behaviours and mental health problems. Valid and reliable scales were used to measure the behaviours and mental health problems of those admitted across three-time periods: pre-admission, during admission and post-admission. The analysis found significant reductions in challenging behaviours and mental health problems following admission to the unit. The unit was staffed by a multidisciplinary team with nurses making up the largest group of staff. A number of issues of concern are discussed including access to mental health services for people with learning disabilities, the need for robust community services and areas that require further research. In conclusion, the study found evidence supporting the value of the unit and how it may lessen distress in learning disabled people who are behaviourally disturbed. It is suggested that nurses played a key role in the unit but they need to make the support and caring they provide more visible. Nurses need to harness and make explicit the caring they provide for people with learning disabilities.

Community psychiatric nursing: focus on effectiveness.

The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users.

Side rails as physical restraints in the care of older people: a management issue.

This article explores the use of side rails within the context of physical restraint in gerontological practice. It is debated that side rails can be considered as a form of physical restraint if the individual cannot voluntarily remove/lower the device if he/she wishes to do so. The value of side rails as a protective medium is debated with regard to their association with injuries sustained as a result. Side rails should be used with caution and within a risk management context. Frailty should not be an indicator for the use of side rails, an individualized approach to determine patient's suitability to side rails is advocated.

Side rails as physical restraints: the need for appropriate assessment.

Side rails are commonly used in the care of the older person. They can be classified as a physical restraint if they restrict the movement of an individual and also if the individual has an inability to have them removed/lowered at will. Advanced age should not be an indicator for side rail use and an individualized approach in patient assessment is advised.

Nurses' experiences of being present with a patient receiving a diagnosis of cancer.

Nurses' experiences of being present with a patient receiving a diagnosis of cancer This paper reports the findings of a study which describes the experiences of nurses who were present with a patient when they received a diagnosis of cancer, cancer recurrence or prognosis of terminal cancer. Semi-structured interviews were conducted with six nurses who had experience of caring for patients with cancer in an acute surgical setting. Data were analysed using a phenomenological descriptive approach. Participants' descriptions revealed the following seven core themes: 'What if it was me?'; divergent feelings; being there; becoming closer; method of disclosure; time as an influence and learning by reflection. Possible implications for nursing practice and education are discussed and recommendations are made for future research.

Multisensory environments: are they therapeutic? A single-subject evaluation of the clinical effectiveness of a multisensory environment.

This article reviews the current literature on multisensory therapy. Utilizing a single-subject quasi-experimental design, the therapeutic clinical effectiveness of multisensory therapy in promoting relaxation in a young man with learning disabilities is evaluated. Findings support the hypothesis that multisensory therapy can promote relaxation. It is concluded that multisensory environments are therapeutic, in that they can promote relaxation, and they may also have a place in the care of people with learning disabilities who display challenging behaviours.

Living with dementia: communicating with an older person and her family.

This article is designed to explore and examine the key components of communication that emerged during the interactional analysis of a role play that took place in the classroom. The 'actors' were nurses who perceived the interaction to reflect an everyday encounter in a hospital ward. Permission to tape the interaction was sought and given by all persons involved. The principal 'players' in the scenario were: the patient, a 70-year-old-woman who had been admitted with dementia, her son and daughter, and the nurse in charge of the ward. The fundamental dynamics of the use of power and restriction, truth telling, family stress, interpersonal conflict, ageism, sexism, empathy and humanism surfaced during the analysis. The findings show that therapeutic communication should be the foundation on which nursing should stand. The article continues with an exploration of the theoretical frameworks that guided the analysis of interaction and concludes by suggesting tentatively some meaningful implications for nursing practice. It plans to furnish provocative new insights into the sometimes covert communication dynamics occurring within the nurse-patient relationship. Finally, it aims to generate discussion on this little-charted realm of human social interaction.

Nurses' attitudes to the extension and expansion of their clinical roles.

Nurses are increasingly being asked to extend or expand their traditional roles, often for reasons other than their own professional development. This study, across three specialties in one hospital, examines whether or not nurses view such change in a positive light.

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate-non-graduate status, a comparative study.

A review of the literature suggests people with learning disabilities are viewed negatively by others in society. Such negative views have also been found among many health care professionals, including nurses. This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n = 31) towards people with learning disabilities. The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire. Two comparisons between subjects in the study were undertaken-a comparison of the attitudes of graduate nurses and those who were non-graduates; a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities. From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified. Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession. The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses. Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities.

Interpreting problematic behaviour in people with learning disabilities: 2.

The main theme of the first part (Vol 5(8): 546-50) of this two-part article was a focus on understanding the causative factors of problematic behaviour in people with a learning disability. A logical sequence to the identification of causes of problematic behaviours is that interactions to lessen such behaviours are identified. In this article, a discussion on interventions to guide nursing practice is offered. A short list of some interventions which emanate from the identified causes is presented in Table 1 for guidance; these interventions are analogous with many nursing and related theories (Peplau, 1952; Johnson, 1980; Wolfensberger, 1983; Roper et al, 1985; Jenner, 1992; Burford, 1993; Quinn and Mathieson, 1993). It is suggested that there is need for a paradigm shift to take place in the interpretation and understanding of problematic behaviours, and it is further suggested that nursing theories should be utilized within such a paradigm.

Causation of problematic behaviour in people with learning disabilities: 1.

This article, the first of two parts, examines the need for learning disability nurses to explicate the specific behaviours which are often grouped under the umbrella term 'challenging/problematic behaviours'. The prevalence of such behaviours in people who have learning disabilities is discussed. In addition, a review of the main theories of causation of problematic behaviour is presented, with a particular emphasis on the issues of violence and aggression in clients. The second article will offer suggestions on interpreting challenging behaviours in people who have learning disabilities.

The implementation and evaluation of a quality improvement initiative at Oaklands.

Striving for high quality care is one of the cornerstones in the management of nursing practice and implementing quality improvement initiatives contributes to this goal. In this paper an account is given of how the implementation of a quality initiative, a redesigned needs and strengths nursing assessment, contributed to an improvement in quality of life for a group of children who have learning disabilities. It is also postulated that the initiative may improve staff morale and lessen the likelihood of burn-out-- a phenomenon which can adversely effect the quality of care provided by nurses. A small pilot evaluation study using questionnaires and observation was undertaken to evaluate the initiative. Findings suggest that nursing assessment is one of the factors which has contributed to an improvement in the quality of interpersonal aspects of nursing care for the children at Oaklands.

Student nurses' attitudes towards people with learning disabilities.

This article reports a study in which the attitudes towards people with learning disabilities held by three groups of student nurses (two Project 2000 groups and one traditional group) are measured and compared. Findings indicate significantly more positive attitudes towards people who have learning disabilities by the Project 2000 students who had placement experience with this client group.

A concept analysis of, and proposed new term for, challenging behaviour.

While the term 'challenging behaviour' is used frequently in literature with reference to people who have learning disabilities, the concept has not been defined comprehensively and empirical indicators for the presence of the phenomenon have not been defined from the perspective of nurses for people with learning disabilities. In this paper the concept 'challenging behaviour', as used in the area of nursing people who have learning disabilities, is analysed. It is suggested that it is an ambiguous term which is unsuitable for use in the field of learning disabilities. A new term is synthesized to replace that of 'challenging behaviour' and an attempt to develop concise indicators which will demonstrate the concept's presence in individuals who have a learning disability will be undertaken. It is suggested that the proposed term is less ambiguous than 'challenging behaviour' and, as such, is more user-friendly for both nurses and other carers of people who have learning disabilities. The paper concludes with the recommendation that further refinement is required in practice to expand and define the operational indicators of the proposed new term 'problematic behaviours'.