A human rights-based framework for qualitative dementia research.

BACKGROUND AND OBJECTIVES: People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research and provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). DESIGN: This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. RESULTS: A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. CONCLUSIONS: The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia.

Older people's experience of COVID-19 restrictions on vaccine hesitancy: A longitudinal phenomenological study to support nurse-patient vaccination conversations.

AIMS: To explore how older people's experiences of COVID-19 restrictions influenced their decision to receive a vaccine and to support nurse-patient vaccination conversations. DESIGN: A longitudinal hermeneutic phenomenological study. The application of the COREQ checklist informed the reporting of this study. METHODS: Data were collected through semi-structured telephone interviews with older people (age ≥70) during two national restrictions implemented in England due to COVID-19. Phase one of interviews occurred between April and July 2020 (six interviews), and phase two of interviews between January and April 2021 (four interviews). Data analysis was performed through content analysis. RESULTS: Thirteen older people (mean age 78) worked through six stages about their thoughts and beliefs about receiving a vaccine, which encompassed four of the five elements of the 5C model of vaccine hesitancy, confidence, convenience, calculation, collective, but not complacency. Stages included 'our only hope is a vaccine'; 'understanding and acceptance of an effective vaccine'; 'social responsibility to protect others'; 'organized but left with unanswered questions'; 'need to feel secure' and finally 'vaccination alone is not enough'. CONCLUSION: The experience of COVID-19 restrictions by older people informed their approach of engaging with scientific information to inform their decisions to be vaccinated but also developed their sense of collective responsibility to younger generations and those at risk, which informed their adherence to restrictions and the vaccination programme. IMPACT: Nurses are optimally placed to support older people to implement and adhere to national government restrictions as appropriate and prevent obsessive routines, and support discussions and the provision of scientific information on COVID-19 vaccinations, whilst being inclusive of older peoples' sense of collective responsibility.

Taking Action in Student Harassment Situations: Application of the Behaviour Change Wheel to Bystander Intervention.

This study applied the Behaviour Change Wheel (BCW) to understand barriers and facilitators to bystander behaviors in UK students. The BCW includes detailed examination of the capabilities, opportunities, and motivations involved in behaviors. Two surveys (n = 515; n = 201) and a focus group study (n = 12) were undertaken. Capability to intervene may be influenced by confidence and beliefs about physical ability and safety. Students appeared to have the physical opportunity to intervene, but social opportunity might be influenced by cultural norms. Motivations might be influenced by beliefs as well as inherent stereotypes about perpetrators and victims. Behavior change techniques (BCTs) such as instruction on how to perform the behavior, reattribution and creating a valued self-identity should be applied to overcome these barriers. A logic model to theorize the change processes underlying bystander behaviors in this population offers a new perspective on what needs to be addressed in interventions.

Pressure injuries and skin tone diversity in undergraduate nurse education: Qualitative perspectives from a mixed methods study.

AIMS: To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones. DESIGN: Qualitative case study employing focus groups and semi-structured interviews. METHODS: Five higher education institutions in the United Kingdom were purposively chosen. At each of the five-case sites, one focus group with student nurses and one semi-structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants' narratives were transcribed verbatim and analysed via thematic analysis. RESULTS: Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching. CONCLUSION: Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance. IMPACT: Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care.

Older people's early experience of household isolation and social distancing during COVID-19.

AIM AND OBJECTIVE: To explore older people's initial experience of household isolation, social distancing and shielding, and the plans they constructed to support them through the COVID-19 pandemic. BACKGROUND: Public health guidance for those aged 70 or older was predominantly to undertake stringent social distancing within their household. Little is known about older people's experience of these measures. This paper explores changes experienced by those over the age of 70 during the first two weeks of household isolation, social distancing and shielding in the UK and the Republic of Ireland, and their early perceptions and plans to support them through the pandemic. METHODS: An inductive phenomenological study. University staff posted the study invitation flyer on social media, such as WhatsApp neighbourhood groups, the Nextdoor App and Twitter. Qualitative semi-structured interviews were undertaken with 19 participants and repeated at 2-week intervals for 10 weeks; further data collection is still in progress. This paper presents the findings from the baseline interviews, which showed older peoples' early responses. The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was adhered to in the reporting of this study. RESULTS: Three themes emerged from older people's early experiences of social distancing: protective measures; current and future plans; and acceptance of a good life, but still a life to live. CONCLUSION: People over 70 adapted to household isolation, social distancing and shielding, by using social media and neighbourhood resources. Nurses and other professionals can develop holistic care for older people by listening to their experiences of what works for them, helping them link to local and distant supports. Understanding the holistic life view of older people, including death anxiety, is an important element of care planning; to help older people access the protective resources, they need to reduce the serious risks associated with coronavirus. RELEVANCE TO CLINICAL PRACTICE: Older people engage with social media, and during the current pandemic and beyond nurses can engage with this medium to communicate with older people. The importance of nurses to understand some older people consider quality of life to be more important than longevity, which may impact on their adherence to health advice.

Contemporary views on dementia as witchcraft in sub-Saharan Africa: A systematic literature review.

AIM: To explore the impact of cultural beliefs of dementia as witchcraft in sub-Saharan Africa. BACKGROUND: The population of sub-Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. METHOD: A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. RESULTS: The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health-seeking behaviours of and for people with dementia. CONCLUSION: There remains a need for dementia awareness and education across sub-Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best-placed healthcare professionals to support these initiatives and the development and implementation of low-resource nonpharmacological interventions to support people with dementia and their families living in the community. RELEVANCE TO CLINICAL PRACTICE: Nurses working in sub-Saharan Africa and those caring for patients from sub-Saharan Africa can only provide person-centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft.

Embedding skin tone diversity into undergraduate nurse education: Through the lens of pressure injury.

OBJECTIVE: To explore health disparity in on-campus undergraduate nurse education through the analysis of teaching and teaching material exploring pressure injuries. BACKGROUND: As a discipline, nursing espouses ideologies of inclusion, equity and valuing diversity. However, little is known about how these ideologies translate into clinical care. Pressure injury prevention is a routine aspect of nursing care; yet, there is evidence of inequity in relation to clinical care and patient assessment, as people with darker skin tones have a higher prevalence of severe pressure injuries before detection of damage occurs. Despite limited literature being available surrounding the topic of pressure injuries and skin tone diversity, it remains the responsibility of nurse educators to address contemporary issues and health disparity within the nursing curriculum. DESIGN: A multiple method collective case study. The STROBE checklist was followed in reporting this study. METHODS: Documentary and observational data of lectures regarding pressure injuries were collected during 2017 and 2018 from five Higher Education Institutes in England delivering approved nursing undergraduate programmes. RESULTS: Documentary analysis confirmed all Higher Education Institutes overwhelmingly directed teaching and learning activities about pressure injury towards people with Caucasian skin tones. Observation of teaching indicated all teaching sessions only contained brief, separate and superficial information on people with pressure injuries and darker skin tones. There was no discursive language or awareness of colour or colour blindness. CONCLUSION: Radical critique of all teaching and learning activities needs to occur, to help explore, improve and meaningfully and authentically include diversity and inclusivity in nurse education, and in particular, how people across the skin tone spectrum are included and represented in teaching and learning activities. RELEVANCE TO CLINICAL PRACTICE: Critical examination of current teaching practice is crucial to address disparity and ensure care for people with darker skin tones is optimised. Nurse educators have a responsibility to educate for the care needs of all, as the quality of nurse education has a direct impact on care delivery and health disparity. This paper highlights the importance of addressing skin tone diversity and offers the opportunity for reflective practice, not just in formal education, but in clinical settings by preceptors and senior staff.

Elements of a sustainable, competent, and empathetic workforce to support patients with dementia during an acute hospital stay: A comprehensive literature review.

Internationally, there has been a focus on the development of acute hospital workforces to support and care for people with dementia. Recommendations and initiatives to improve person-centred care in acute hospitals have included: education and training, dementia-specific roles, clinical leads, and environment changes. The aim of this literature review is to understand the elements of a sustainable, competent, and empathetic acute hospital workforce providing person-centred care for patients with dementia. The following databases were searched for literature published in English from January 1, 2006, to August 1, 2016: CINHAL, MEDLINE, PsychINFO, PubMed, and Science Direct. A thematic analysis was applied to develop a meta-synthesis of the data. A total of 12 papers with a range of methodological approaches from various countries were included. Emergent themes were as follows: understanding the current workforce, implementation and evaluation of training, and exploration of new and existing roles. An important element was the sustainability of acute hospital workforces competent in dementia care, as studies highlighted an ageing nursing population and a high turnover of staff. Dementia awareness training was sustainable, although there was a lack of consistency in the length, content, and delivery, which had a viable impact on the provision of empathetic and person-centred care. The lack of consistency of training and specialist dementia roles restricts recommendations from a robust evidence base.

The intersection of culture in the provision of dementia care: A systematic review.

AIMS AND OBJECTIVES: To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia. BACKGROUND: Due to the nature of global immigration and recruitment strategies, health care is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently, there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care. METHOD: A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1st January 2006 to 31st July 2016. RESULTS: A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people; impact of cultural perceptions on service use; acculturation of the workforce; and cross-cultural communication. CONCLUSION: Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care. RELEVANCE TO CLINICAL PRACTICE: Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person-centred dementia care.

An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting.

AIMS AND OBJECTIVES: To review patients' and healthcare professionals' perceptions of patient involvement in promoting hand hygiene compliance in the hospital setting. BACKGROUND: Initiatives continue to emphasise the importance of involving patients in their safety at the point of care. A patient-centred care approach aimed to empower patients to become active members of the healthcare team. However, understanding the perceptions of patients and healthcare professionals of patient involvement in promoting hand hygiene compliance among healthcare professionals has yet to be fully explored. DESIGN: Integrative literature review. METHODS: A five-stage review process informed by Whittemore and Knafl's methodology was conducted. MEDLINE and CINAHL were searched for papers published between January 2009-July 2017. Data were extracted manually, organised using NVivo 11 and analysed using thematic analysis. RESULTS: From an identified 240 papers, 19 papers were included in this review. Thematic analysis revealed two main themes with three related subthemes. Patients were willing to remind healthcare professionals (especially nurses) to wash their hands, healthcare professionals perception towards patients' involvement varied from one study to another. However, an overall positive attitude towards patient involvement was related to how patients asked and how healthcare professionals responded to being asked. CONCLUSION: There is limited evidence regarding patients' actual intention to ask healthcare professionals to wash their hands, and some evidence that patients are reluctant to do so. Further research is required to understand this area thoroughly, including which situations patients would feel more empowered to speak up. RELEVANCE TO CLINICAL PRACTICE: Simple messages promoting patient involvement may lead to complex reactions in both patients and healthcare professionals. It is unclear, yet how patients and staff react to such messages in clinical practice. There is a need for a deeper understanding of how they can work together to support harm free care.

Pressure injuries in people with darker skin tones: A literature review.

AIMS AND OBJECTIVES: In this article, we aimed to explore the literature to ascertain what research evidence exists in relation to the identification of pressure injuries in people with dark skin tones. BACKGROUND: Pressure injuries development has been widely researched and documented; however, much of this work does not address ethnicity or race and assumes Caucasian-ness. Thus, the perceptions of people with dark skin tones and the influence of skin pigmentation on identification and management of pressure injuries is under examined. DESIGN: Literature review. METHODS: A comprehensive electronic database search was undertaken of PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane and British Nursing Index (BNI) between 1990-July 2016. Alongside the electronic data, journals, books, papers from conferences, relevant national and international organisations and reference lists were also used to help source key studies. RESULTS: A search of the literature revealed 11 relevant articles. The foci of studies included the following: risk of sustaining a pressure injuries based on skin tones, identification of pressure injuries amongst people with dark skin tones, pressure injuries and place of care and socio-economic impact on pressure injuries development. Overall, findings indicate that people with darker skin tones are more likely to develop higher stage pressure injuries. Reasons for this are not fully elucidated; however, it may be associated with current skin assessment protocols being less effective for people who have darker skin tones resulting in early damage arising from pressure not being recognised. CONCLUSION: From the literature reviewed, it can be seen that there is a lack of guidance and evidence, and people with darker skin tones are more likely in comparison with people presenting as Caucasian to develop higher stage pressure injuries. RELEVANCE TO CLINICAL PRACTICE: The current literature suggests a need for researchers and clinicians to consider skin tone variances rather than ethnicity when exploring comprehensive skin assessment.

Caring for a patient with delirium in an acute hospital: The lived experience of cardiology, elderly care, renal, and respiratory nurses.

AIMS: To explore the lived experience of caring for a patient during an acute episode of delirium by nurses working in cardiology, elderly care, renal, or respiratory specialities. BACKGROUND: A missed or delayed diagnosis of delirium in an acute hospital setting adversely impacts on patient outcomes. Nurses are the best placed health care professionals to identify a change in patient's cognitive status but struggle to do so. DESIGN: Inductive interpretative phenomenology. METHODS: Semi-structured interviews with nurses working in an acute hospital in England between November 2016 and March 2017 (n = 23). Interviews were transcribed verbatim and analysed using thematic analysis. FINDINGS: Three themes were identified: (i) "sometimes delirium is confusing", difficultly in differentiating between delirium and dementia; (ii) "everyone in the ward was looking after him", a need for collaborative working to provide harm free care; and (iii) "he was aggressive with us, but after treatment he was a gentleman", acceptance and tolerance of aggression. CONCLUSION: The need for education across specialities, with a combination of classroom and simulation teaching. Alongside, the development of structures to support the development of nursing teamwork and reporting of near miss incidents that occur with patients during an episode of delirium.

Differentiation of delirium, dementia and delirium superimposed on dementia in the older person.

Delirium is an acute clinical emergency that requires prompt clinical intervention. A predisposing factor for delirium is dementia, and delirium may highlight the vulnerability of a patient to developing dementia. However, delirium also occurs during an acute illness in patients diagnosed with dementia; this is classified as delirium superimposed on dementia. This complex interplay of both dementia syndromes and the condition of delirium has been extensively studied. However, delirium continues to be under-recognised in the acute setting, which impacts negatively on patient outcomes. Nurses are the health professionals best placed to recognise a change in a patient's cognitive symptoms, but nurses caring for the older person have suggested the identification of and differentiation between delirium, dementia and delirium superimposed on dementia remains very confusing. A need for further education with supportive guidelines and protocols is required to empower nurses caring for an older person to verbalise changes in patients' cognitive status in a reliable, robust and systematic manner.

Implementation of evidence-based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence-based practice: A qualitative study.

The aim of the study was to explore how community nurses apply the best available evidence to their practice, and how they mentor student nurses to conceptualize and implement evidence-based practice in community settings. In the UK, the expansion of health-care provision in the community has supported the development of highly skilled community nurses. However, there is limited literature regarding the strategies used by community nurses to implement evidence-based practice and mentor student nurses to conceptualize evidence-based practice in community placements. An exploratory qualitative approach applying inductive reasoning to focus group data was used. As a result, nurses working for a community NHS Foundation Trust in South England with a mentor qualification were invited to participate in one of the seven focus groups, 33 nurses participated. Data were analyzed with thematic analysis. The themes discussed in this paper are: 'our practice is evidence-based' as guidelines and policies provided structure, but occasionally stifled autonomous clinical decision-making, and 'time' as a barrier and facilitator to mentoring student nurses in community settings. In conclusion, nurses need to develop the ability to incorporate patients' needs and wishes within evidence-based care. Time was a facilitator for some community mentors, but protected time is required to complete the necessary practice documentation of student nurses.

Community- and hospital-based nurses' implementation of evidence-based practice: are there any differences?

The aim of this paper is to discuss the effect of nurses' beliefs, knowledge, and skills on the implementation of evidence-based practice (EBP) in hospital and community settings. EBP refers to the implementation of the most up-to-date robust research into clinical practice. Barriers have been well documented and traditionally include the negative beliefs of nurses as well as a lack of time, knowledge, and skills. However, with degree entry nursing and a focus on community health care provision, what has changed? A comprehensive search of contemporary literature (2010-2015) was completed. The findings of this review show that the traditionally acknowledged barriers of a lack of time, knowledge, and skills remained; however, nurses' beliefs toward EBP were more positive, but positive beliefs did not affect the intentions to implement EBP or the knowledge and skills of EBP. Nurses in hospital and community settings reported similar barriers and facilitators.

Development of an activities care crew to support patients.

Improving care for people with dementia in acute hospitals is a priority in the UK. The Royal Berkshire Hospital in Reading has implemented a range of initiatives, including environmental changes to older people's care wards, development of workforce skills and knowledge, engagement with third sector providers, use of volunteers, and the development of an activities care crew. This article focuses on the work of the activities care crew. The care crew formation, using monies from vacant posts, has supported the provision of one-to-one nursing and engagement of patients in meaningful activities. Overall, the initiatives have reduced the number of falls with serious harm, improved the experience of people with dementia and their families, and supported partnership working with patients, families and multidisciplinary teams.