Experiences and needs of bereaved carers during palliative and end-of-life care for people with chronic obstructive pulmonary disease

This study explored the experiences of palliative care that bereaved carers had while providing care to a dying loved one with chronic obstructive pulmonary disease (COPD).

Method: Semi-structured interviews were undertaken with nine carers whohad lost a loved one in the preceding 6 to 24 months.These interviews explored levels of satisfaction with disease management, symptom management, and end-of-life care. With permission, interviews were tape recorded, transcribed, and subjected to content analysis.

Findings: Three themes emerged from the data: the impact of the caring experience, the lack of support services, and end-of-life and bereavement support. Carers experienced carer burden, lack of access to support services, a need for palliative care, and bereavement support.

Conclusion: The findings provide a first insight into the experiences of carers of patients with advanced COPD. Bereaved carers of patients who had suffered advanced COPD reported that they had received inadequate support and had a range of unmet palliative care needs. Special attention should be paid to educating and supporting carers during their caring and bereavement periods to ensure that their quality of life is maintained or enhanced

Inclusion & the Special Educational Needs (SEN) Resource Base In Mainstream Schools: Physical Factors to Maximise Effectiveness.

As a society, we have a responsibility to provide an inclusive built environment. As part of the need to promote inclusion, there is now a growing trend to place pupils with Special Educational Needs (SEN) into a mainstream school setting. This is often facilitated by providing a specialist SEN resource base located within the mainstream school. If so, the following paper outlines why the whole school should be considered when locating and implementing a SEN resource base. It also highlights the wider opportunities for enhancing inclusion for SEN pupils if giving holistic thought to the wider context of the resource base. It then indicates a four-stage approach, using the ASD pupil as an illustrative example, to help evaluate the optimum SEN resource base location within a mainstream school setting. Finally it highlights in conclusion, some benefits and challenges for an enriched school environment for all pupils, if considering genuine inclusion.

Meeting the supportive needs of family caregivers in palliative care:challenges for health professionals

Caring for a dying relative is demanding, and family caregivers have acknowledged many unmet needs associated with their caregiver role. Consistently, caregivers of dying patients with cancer have reported that they need more support and information from health care professionals. Moreover, a number of palliative care clinicians and researchers have called for interventions to enhance the support offered to family caregivers. However, before researchers can develop and test palliative care interventions directed to families, it is important to identify barriers that may confront health care professionals with regard to the provision of supportive family care. For new interventions to be feasible they must be applicable within the constraints of current palliative care service delivery environments. This paper provides an account of issues that may impinge on optimal transference of supportive strategies from health care professionals to family caregivers of patients receiving palliative care. By acknowledging these barriers to supportive care, researchers and health care professionals can begin to design and implement interventions that are clinically relevant and more likely to be effective.

Non-medical prescribers and pharmacovigilance:participation, competence and future needs

To determine UK non-medical prescribers' (NMPs) (supplementary or independent) current participation and self-reported competence in pharmacovigilance, and their perceptions of training and future needs.

‘Preparing Social Workers for Practice: Re-evaluating Student Learning Needs’

Among the key developmental priorities that have been identified in the current process of reform taking place in social work in the UK is the need to improve social work students' preparedness to meet the challenges they will encounter in practice. This paper contributes to the current debate about this issue by reporting a research study that focused on final year undergraduates' experience of academic and practice learning and considered the impact of demographic factors, including age, gender, disability, previous experience and qualifications, on their perceptions of preparedness. The results indicate that students were satisfied with most aspects of preparatory teaching and learning. However, the findings also highlight areas in which students' preparation could be further enhanced, including their skills in dealing with conflict and managing risk. The results suggest that social work programmes should not overly depend on practice learning to prepare students to address the challenges presented by increasingly complex working environments and that educators need to work closely in collaboration with employing partners to ensure that the curriculum keeps up to date with the changing learning needs of practitioners.

The health status and health service needs of primary caregivers of cancer survivors: a mixed methods approach

This study aimed to measure the health status and care needs of people who provide informal care to cancer survivors in the UK. Semi-structured interviews were conducted with a purposive sample of 24 cancer professionals to identify the care needs of caregivers. In addition, we conducted a postal survey measuring the health and wellbeing (SF-36) and health service utilisation of 98 primary caregivers of a random sample of cancer survivors, 2-20 years post-treatment. Interviews indicated that caregivers’ needs were largely unmet. In particular, there appeared to be a need in relation to statutory health care provision, information, psychological support and involvement in decision making. There were no significant differences between survivors and caregivers in terms of mental health scores; and caregivers performed better on physical health domains compared to cancer survivors. Compared to UK norms and norms for caregivers of other chronic conditions, cancer caregivers had substantially lower scores on each SF-36 health domain. Cancer may impact negatively on an informal caregiver’s health long after treatment has ended. Providing appropriate and cancer specific information may alleviate difficulties and improve health and wellbeing. Specific concentration should be given to the development and delivery of information support for caregivers of post-treatment cancer survivors.

Counselling for sight loss: Using systematic case study research to build a client informed practice model

There is compelling evidence to suggest that acquired sight loss negatively impacts on emotional well-being. Despite increasing recognition of the need to provide emotional support for people with sight loss, we still do not fully understand what counselling interventions help and why they help. The aim of this study was to examine the process and outcome of counselling for a 70-year-old client who had experienced complete, irreversible, post-operative sight loss in order to gain a deeper understanding of client-defined helpful aspects of therapy. A Hermeneutic Single-Case Efficacy Design study was undertaken having received ethical approval from the University's Research Ethics Committee. The client received six sessions of counselling from a vision-impaired counsellor working within a pluralistic framework. Measures were completed by the client at every session, as well as at pre-and post-counselling. All sessions were recorded and transcribed. The client also participated in pre-and post-counselling interviews. Data formed a rich case record that was analysed by a quasi-judicial enquiry team. Results suggested that this was a successful outcome case. Client-defined helpful aspects of therapy were (1) feeling understood; (2) being able to express emotions around the loss of sight; (3) finding a new identity; (4) finding ways to cope with fear, loss, dependency, and other people's perceptions; (5) exploring the possibility of a positive future without sight; (6) making sense of things; and (7) finding ways to become more socially connected. Relevant therapeutic tasks are proposed, and four key aspects of therapy are identified, which may have implications for the development of a practice model.