Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice.

BACKGROUND: Intellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided. AIM: To design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland. DESIGN: An accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis. SETTING: Intellectual disability services. PARTICIPANTS: 102 participants completed the programme and survey. METHODS: Pre-post survey and reported using the CROSS guidelines. RESULTS: Participants' expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects. CONCLUSIONS: Overall, the programme was positively evaluated and through engaging with the programme participants' perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership.

Exploring the experiences of women living with metastatic breast cancer [MBC]: A systematic review of qualitative evidence.

PURPOSE: Metastatic breast cancer [MBC] is the leading cause of cancer death in women globally with no cure. Women diagnosed with MBC endure a catastrophic upheaval to multiple aspects of their life and a radically transformed future landscape. Evidence suggests that the provision of care for women living with metastatic breast cancer is inadequate, socially isolating and stigmatising. To date, this topic has received little research attention. To increase understanding of the experiences of women living with MBC, a synthesis of current evidence is required. This paper presents a review of qualitative evidence on women's experiences of MBC. METHODS: A qualitative evidence synthesis [QES] was conducted to synthesise primary qualitative research on the experiences of women living with MBC. Searches were performed of electronic databases Medline, Medline Ovid, PsycINFO, Psych articles, PubMED, CINAHL Complete, Scopus and grey literature databases. The methodological quality of the included studies was appraised using a modified version of the Critical Appraisal Skills Programme [CASP]. Title, abstract, and full-text screening were undertaken. A 'best fit' framework approach using the ARC [Adversity, Restoration, Compatibility] framework was used to guide data extraction and synthesis. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation, Confidence in the Evidence from Reviews of Qualitative research [GRADE-CERQual]. RESULTS: 28 papers from 21 research studies containing 478 women's experiences of living with MBC were deemed suitable for inclusion in this qualitative evidence synthesis. Findings are presented in a new conceptual framework RAAW [adapted from ARC] for women living with MBC under themes: Reality, Adversity, Adjustment and Wellbeing. Findings revealed that a diagnosis of MBC impacted every aspect of women's lives; this is different to a diagnosis of early breast cancer. An overarching theme of lack of support extended across various facets of their lives. A lack of psychological, emotional, and psychosocial support was evident, with a critical finding that models of care were not fit for purpose. Deficits included a lack of information, knowledge, inclusion in shared decision-making and MDT support, specifically the need for palliative care/oncology support access. Some women living with MBC wanted to be identified as having a chronic illness not a life-limiting illness. Culture and socioeconomic standing influenced the availability of various types of support. The impact of treatment and symptoms had an adverse effect on women's quality of life and affected their ability to adjust. CONCLUSION: This review synthesised the qualitative literature on the experiences of women living with MBC. The ARC framework used in the synthesis was adapted to develop a revised conceptual framework titled RAAW to represent the evidence from this review on experiences for women living with MBC; Reality & Adversity: A diagnosis of MBC; Adjustment: Living with MBC; Wellbeing: Awareness, meaning, engagement [RAAW; MBC].

A scoping review on the psychosocial interventions used in day care service for people living with dementia.

BACKGROUND: Adult Day care centres provide an important aspect of care provision through all phases of the dementia illness from diagnosis to the end of life (Dabelko HI 2008) supporting the well-being of both older people living with dementia and their care partners. Services within adult day care settings are designed to provide biopsychosocial health benefits to participants as well as care partner respite. OBJECTIVE: To examine research studies, literature reviews and grey literature and identify and map the literature on psychosocial interventions used in day care services for older people living with dementia and chart their use, evaluation and outcomes. The research review question is "what are the psychosocial interventions used in day care service for older people living with dementia?" Psychosocial interventions are important non-pharmacological interventions which support people's wellbeing. METHODS: Inclusion/Exclusion criteria were identified and guided the search strategy. Participants were people aged 60 years and over living with dementia attending day care services. The use of psychosocial interventions for this cohort was the focus of the review. Databases were searched (Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, Open Grey, Lenus and WHO Global Index Medicus databases) using keywords/terms with Boolean operators from 2011 to 2023. Rayyan was used to extract and manage the data. RESULTS: The findings present a narrative and charting of the data from the 45 papers that met the review criteria, and this data is mapped onto the five objectives. Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions. CONCLUSIONS: This review has illustrated the wide variety in the types, range and facilitation of psychosocial interventions within adult day care services. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief intervention studies with little evidence of continuation after the study and further research is required given the complex and diverse range of interventions. Results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.

Knowledge, attitudes and practices in the provision of nutritional care.

The nutritional care of patients is one of the primary responsibilities of all registered nurses (Persenius et al, 2008). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual's quality of life (Field and Smith, 2008). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.

Aligning with the flow of control: A grounded theory study of choice and autonomy in decision-making practices of people with intellectual disabilities.

Purpose: Choice and autonomy are recognized as values facilitating genuine self-determination. Subsequently greater understanding of these concepts in decision-making practices of adults with intellectual disabilities is required. Aims: The twofold aim of this research study was to ascertain the core concern (most important issue) for adults with intellectual disabilities as they make choices and exercise autonomy and to develop a theory explaining how these adults attempt to resolve their core concern. Methods: This research study undertaken in a single organization in the Republic of Ireland applied classic-grounded theory methods. Participants included twelve adults who were attending day services and accessing a variety of other organizational services. Interviews were undertaken, between January 2012 and September 2013, in different contexts on up to 4 occasions (46 interviews). Data analysis utilized concurrent processes of constant comparative analysis. Results: The main issue of concern for these participants was 'control' in environments that were controlling of them and they responded by 'aligning with the flow of control' explained by how they framed control, emotionally connected and adjusted in compliance situations. Conclusions: This theory offers a conceptual delineation of the way adults with intellectual disabilities manage the daily tensions and harmonies in decision-making.

Dwarf mistletoe affects whole-tree water relations of Douglas fir and western larch primarily through changes in leaf to sapwood ratios.

Dwarf mistletoes induce abnormal growth patterns and extreme changes in the biomass allocation of their hosts as well as directly parasitizing them for resources. Because biomass allocation can affect the resource use and efficiency of conifers, we studied the influences of dwarf mistletoe infection on above-ground biomass allocation of Douglas fir and western larch, and the consequences of such changes on whole-tree water use and water relations. Sap flow, tree water potentials, leaf:sapwood area ratios (A L:A S), leaf carbon isotope ratios, and nitrogen content were measured on Douglas fir and western larch trees with various degrees of mistletoe infection during the summer of 1996 in western Montana. Heavy dwarf mistletoe infection on Douglas fir and western larch was related to significant increases in A L:A S. Correspondingly, water transport dynamics were altered in infected trees, but responses were different for the two species. Higher A L:A S ratios in heavily infected Douglas firs were offset by increases in sapwood area-based sap flux densities (Q SW) such that leaf area-based sap flux densities (Q L) and predawn leaf water potentials at the end of the summer did not change significantly with mistletoe infection. Small (but statistically insignificant) decreases of Q L for heavily infected Douglas firs were enough to offset increases in leaf area such that whole-tree water use was similar for uninfected and heavily infected trees. Increased A L:A S ratios of heavily infected western larch were not offset by increases of Q SW. Consequently, Q L was reduced, which corresponded with significant decreases of water potential at the end of the summer. Furthermore, mistletoe-infection-related changes in A L:A S as a function of tree size resulted in greater whole-tree water use for large infected larches than for large uninfected trees. Such changes may result in further depletion of limited soil water resources in mature infected stands late in the growing season. Foliage from infected trees of both species had lower water use efficiencies than non-infected trees. Our results demonstrate substantial changes of whole-tree processes related to mistletoe infection, and stress the importance of integrating whole-tree physiological and structural processes to fully understand the mechanisms by which pathogens suppress forest productivity.

Stem respiration of ponderosa pines grown in contrasting climates: implications for global climate change.

We examined the effects of climate and allocation patterns on stem respiration in ponderosa pine (Pinus ponderosa) growing on identical substrate in the cool, moist Sierra Nevada mountains and the warm, dry, Great Basin Desert. These environments are representative of current climatic conditions and those predicted to accompany a doubling of atmospheric CO2, respectively, throughout the range of many western north American conifers. A previous study found that trees growing in the desert allocate proportionally more biomass to sapwood and less to leaf area than montane trees. We tested the hypothesis that respiration rates of sapwood are lower in desert trees than in montane trees due to reduced stem maintenance respiration (physiological acclimation) or reduced construction cost of stem tissue (structural acclimation). Maintenance respiration per unit sapwood volume at 15°C did not differ between populations (desert: 6.39 ± 1.14 SE µmol m-3 s-1, montane: 6.54 ± 1.13 SE µmol m-3 s-1, P = 0.71) and declined with increasing stem diameter (P = 0.001). The temperature coefficient of respiration (Q 10) varied seasonally within both environments (P = 0.05). Construction cost of stem sapwood was the same in both environments (desert: 1.46 ± 0.009 SE g glucose g-1 sapwood, montane: 1.48 ± 0.009 SE glucose g-1 sapwood, P = 0.14). Annual construction respiration calculated from construction cost, percent carbon and relative growth rate was greater in montane populations due to higher growth rates. These data provide no evidence of respiratory acclimation by desert trees. Estimated yearly stem maintenance respiration was greater in large desert trees than in large montane trees because of higher temperatures in the desert and because of increased allocation of biomass to sapwood. By analogy, these data suggest that under predicted increases in temperature and aridity, potential increases in aboveground carbon gain due to enhanced photosynthetic rates may be partially offset by increases in maintenance respiration in large trees growing in CO2-enriched atmospheres.

Determining the efficacy of auricular acupuncture for reducing anxiety in patients withdrawing from psychoactive drugs.

Auricular acupuncture (AA) is a widely accepted treatment option for substance abuse that is used in more than 700 treatment centers worldwide. Despite claims of perceived clinical benefits by patients and treatment staff, research efforts have failed to substantiate purported benefits, and the mechanism(s) by which AA serves in the treatment of addiction remain inconclusive. Numerous studies have shown AA to be an effective treatment for perioperative anxiety. In this study, we hypothesize that AA reduces the anxiety associated with withdrawal from psychoactive drugs. The study used a randomized, controlled design and included a sample of 101 patients recruited from an addiction treatment service. Subjects were assigned to one of three treatment groups (National Acupuncture Detoxification Association [NADA] AA, AA at sham points, or treatment setting control) and were instructed to attend treatment sessions for 3 days. The primary outcome measure state anxiety was assessed using a pretest-posttest treatment design. The study hypothesis was not confirmed. The NADA protocol was not more effective than sham or treatment setting control in reducing anxiety. The widespread acceptance of AA in the treatment of addiction remains controversial.

Chair massage for treating anxiety in patients withdrawing from psychoactive drugs.

CONTEXT: Therapeutic massage has been proven to be an effective, nonpharmacologic, alternative for managing state and trait anxiety in a variety of clinical situations. However, no controlled study has investigated this effect in an addiction treatment setting. AIM: The aim of this study was to investigate the effectiveness of chair massage for reducing anxiety in persons participating in an inpatient withdrawal management program for psychoactive drugs. DESIGN: The design was a randomized, controlled clinical trial conducted from June 2008 to January 2009. SUBJECTS: Eighty-two (82) adult patients received inpatient treatment for psychoactive drug withdrawal (alcohol, cocaine, and opiates). SETTING: This study was conducted at the Withdrawal Management Services at the Capital District Health Authority, Halifax, Nova Scotia. INTERVENTIONS: Subjects were randomly assigned to receive chair massage (n = 40) or a relaxation control condition (n = 42). Treatments were offered for 3 consecutive days. Standard counseling and pharmacologic management were also offered concurrently to patients in all conditions. MEASUREMENTS: The primary outcome measure was anxiety assessed using the Spielberger State-Trait Anxiety Inventory (STAI). State and trait anxiety scores were determined immediately prior to and following each treatment intervention. RESULTS: Analysis of STAI scores showed a significant reduction in state and trait anxiety for both interventions (p < 0.001). The magnitude in the reduction in state (p = 0.001) and trait (p = 0.045) anxiety was significantly greater in the chair massage group where the effect on state anxiety was sustained, at least in part, for 24 hours. CONCLUSIONS: Within the clinical context of this study, chair massage was more effective that relaxation control in reducing anxiety. Further investigation of chair massage as a potential nonpharmacologic adjunct in the management of withdrawal related anxiety is warranted.

Pharmacogenomics: personalizing drug therapy.

Pharmacogenomics is a rapidly growing field of research into the ways in which genetic variation affects drug response. Its objective is to develop precisely targeted, optimal drug therapy. One area of pharmacogenomics focuses on identifying genetic markers for differences in the way people metabolize drugs; another concentrates on developing genetic tests that predict how specific patients will respond to agents such as statins or cancer therapies. Nurses are now called upon to interpret such information or services in order to provide appropriate patient teaching regarding drug selection.

Stem maintenance and construction respiration in Pinus ponderosa grown in different concentrations of atmospheric CO(2).

To determine whether long-term growth in enriched CO(2) atmospheres changes the woody tissue respiration component of aboveground carbon budgets, we measured woody tissue respiration of stems of 3-year-old ponderosa pine (Pinus ponderosa Laws.) grown in ambient (350 ppm) or twice ambient (700 ppm) atmospheric CO(2) concentrations in open-top field chambers located in Placerville, CA. Total respiration rate was measured by gas exchange, and construction respiration was calculated from the construction cost, percent carbon of stem samples and relative growth rate. Maintenance respiration was determined as the difference between total and construction respiration. The Q(10) of respiration was greater in stems grown in elevated CO(2) than in stems grown in ambient CO(2) (2.20 versus 1.67). As a result, mean daily respiration per unit volume of wood modeled for the month of September was greater in trees growing in elevated CO(2) than in ambient CO(2) (46.75 versus 40.45 mol m(-3) day(-1)). These effects of atmospheric CO(2) concentration were not the result of differences in relative growth rate. Calorimetric analyses of woody tissue construction cost indicated no difference between treatments; however, trees in the elevated CO(2) treatment showed a 1% lower carbon concentration than trees in the ambient CO(2) treatment. Estimates of construction respiration did not differ between treatments, confirming that the treatment differences in mean daily respiration rate were attributable to the maintenance component. Under future predicted atmospheric conditions, changes in the maintenance respiration of woody tissue may lead to an increase in the respiration component of whole-plant carbon budgets of ponderosa pine. Our results suggest that potential increases in the maintenance component of stem respiration should be considered when modeling the response of forest stand growth to enriched CO(2) atmospheres.