A Scoping Review of the Factors That Influence Families' Ability or Capacity to Provide Young People With Emotional Support Over the Transition to Adulthood.

The transition to adulthood is typically marked by changes in relationships with family members, peers, and romantic partners. Despite this, the family often maintains a prominent role in young adults' lives. A scoping review was conducted to identify the factors that influence families' ability or capacity to provide young people with emotional support during the transition to adulthood, and to understand the gaps in this research area. Title and abstract searches were conducted from January 2007 to February 2021 in multiple databases, including PsycINFO, MEDLINE, and Sociological Abstracts. Fifteen semi-structured interviews were also conducted with stakeholders (professionals from relevant sectors/working within this field). In total, 277 articles were eligible for inclusion in the review. Following data extraction, 19 factors were identified. Factors with the most research (more than 20 articles) included: family proximity or co-residence; mental health; sex or gender differences; and family communication. Factors with less research included: societal context; young person's sexual orientation or gender identity; social networks; and adverse life events. Gaps in the research area were also identified, including methodological issues (e.g., lack of mixed methods and longitudinal study designs), a disproportionate focus on the parent-child relationship, and a lack of contextually situated research. Our findings indicate that future research in this area could benefit from taking an intersectional, multi-method approach, with a focus on the whole family and diverse samples.

A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol.

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service. Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People's Secure Estate (CYPSE) in England: study protocol.

INTRODUCTION: Young people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People's Secure Estate: a 'whole systems' approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme. METHODS AND ANALYSIS: A mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences. ETHICS AND DISSEMINATION: Ethical approval was granted by the Health Research Authority, Her Majesty's Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness.

This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches.

Parenteral opioids for maternal pain relief in labour.

BACKGROUND: Parenteral opioids are used for pain relief in labour in many countries throughout the world. OBJECTIVES: To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010) and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with placebo or another opioid. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed study eligibility, collected data and assessed risk of bias. MAIN RESULTS: We included 54 studies involving more than 7000 women that compared an opioid with placebo or another opioid administered intramuscularly or intravenously. The 54 studies reported on 27 different comparisons, and for many outcomes only one study contributed data. Overall the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. AUTHORS' CONCLUSIONS: Parenteral opioids provide some relief from pain in labour but are associated with adverse effects. Maternal satisfaction with opioid analgesia was largely unreported but appeared moderate at best. We did not examine the effectiveness and safety of parenteral opioids compared with other methods of pain relief in labour and this review needs to be examined alongside related Cochrane reviews. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse events for mothers and their newborns.

The role of specialist and general nurses working with people with multiple sclerosis.

AIM: To describe the perceived role of nurses and other carers of people with multiple sclerosis from the perspective of different stakeholders (people with multiple sclerosis, non-specialist nurses, specialist nurses and other health care professionals). BACKGROUND: Multiple sclerosis is one of the commonest causes of disability in young adults. People with multiple sclerosis require supportive care during the disease trajectory. The role of different health and social care providers has not been reported previously. DESIGN: Survey. METHOD: Questionnaire data collected in 2002 during the first phase of scale development (health professionals n = 459; people with multiple sclerosis n = 65; total response rate 59.4%). The data were reanalysed to compare responses across sample groups. RESULTS: There was consensus that neurologists and specialist nurses were the most appropriate professionals in the provision of specialist care with specialist nurses also being identified as key providers of emotional support. However, there were also significant differences in nominations reflecting the different perspectives of the stakeholder groups and a self-report bias. Each stakeholder group frequently emphasised their own perceived contribution to care. The different perspective of people with multiple sclerosis was also noteworthy with their greater emphasis on social care and lay support. CONCLUSIONS: The findings indicate a dissonance in the views of different stakeholders within the care system. The division of labour associated with nursing care requires further exploration. The contrasting paradigms of health care professionals and people with multiple sclerosis regarding models of disability were highlighted. RELEVANCE TO CLINICAL PRACTICE: Multiple sclerosis, like other chronic illnesses, requires substantial nursing care. There is a growing number of specialist nurses in the workforce, however, little is known how their role interfaces with other nurses.

The contribution of nurses to child health and child health services: findings of a scoping exercise.

Historically, nurses have made a significant contribution to the health of children. To date, few attempts have been made to conceptualize the nature of that contribution. This article describes a scoping exercise undertaken to provide a conceptual basis for examining the contribution of nurses to child health and child health services. Three approaches were utilized: strategic topic-focused literature reviews (asthma, cancer, disadvantaged families, minor ailments, school health, sick neonates, teenage pregnancy, children with complex needs, children in need of protection or looked-after, troubled schoolchildren), stakeholder conferences and an expert panel. The contribution of nurses to child health and child health services was found to be broad-ranging and diffuse. The contribution is expressed in four integrated dimensions: assessment, health promotion, clinical care and health care organization. The conceptual models detailed in the scoping exercise provide a platform for future inquiry.

Development and validation of a learning needs assessment scale: a continuing professional education tool for multiple sclerosis specialist nurses.

AIM: To develop and validate a learning needs assessment scale. BACKGROUND: Learning needs analysis is a central component of continuing professional development but there is a lack of psychometrically developed learning needs assessment tools. Self-assessment questionnaires are emerging as a key method. The development of a learning needs analysis scale for multiple sclerosis specialist nurses is described. DESIGN: A psychometric approach comprising the three phases of the development and testing of the scale are outlined. METHOD: Phase 1: Item identification using a literature review; postal survey of stakeholders (n = 320), 20 nurse interviews; four nurse focus groups; five telephone interviews with people with MS. Phase 2: Refinement of draft scale and establishing face and content validity testing using an expert panel. Phase 3: Testing of draft scale using data from a postal survey (n = 47 MS specialist nurses) to assess the feasibility and effectiveness of scale, internal consistency and construct validity. Test-retest reliability was assessed using data from 17 MS specialist nurse respondents to calculate intra-class correlation coefficients. RESULTS: The data from the different study phases informed scale refinement. The validity and reliability of the scale was confirmed through testing. CONCLUSION: The study provides an example of how a robust learning needs assessment scale may be developed for a specialist area of nursing practice to be used in conjunction with more subjective approaches. RELEVANCE TO CLINICAL PRACTICE: High quality nursing care depends upon a competent nursing workforce that engages in continuing professional development. This study provides an example of a psychometrically developed learning needs assessment scale to inform continuing professional development needs of nurses working in a specialist area of practice.

Learning needs analysis: the development of a tool to support the on-going professional development of multiple sclerosis specialist nurses.

Continuous professional development (CPD) is essential in modern day nursing. Learning needs analysis (LNA) is an important element of CPD. This paper describes the development of a LNA tool for multiple sclerosis specialist nurses. The tool contains an empirically developed LNA schedule and uses a blend of both subjective and objective exercises to help the nurse formulate a comprehensive learning plan. The tool is organised into four phases: phase 1, focuses on the knowledge and skills necessary to the fulfillment of work-based objectives; phase 2, involves a more in-depth assessment of particular areas of professional knowledge; phase 3, examines learning strategies; and phase 4, involves the development of a learning plan. The tool has been implemented throughout the UK via local trainers. While the tool was developed for a specialist nurse population the principles upon which it is based are likely to be transferable to other nursing contexts.