No second chance: junior neonatal nurses' experiences of caring for babies at the end-of-life and their families

Death of an infant is acutely stressful for parents and professionals. Little is known about junior nurses' experiences providing end-of-life care in Neonatal units (NNU). This study aimed to better understand junior nurses' experiences providing end-of-life care in NNU. Neonatal nurses (n = 12) with less than 3 years experience participated in a focus group. Nominal Group Technique (NGT) was used to build consensus around the challenges faced, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision-making whilst secondary analysis involved thematic analysis. All issues, whether environmental, professional or social appeared driven by an awareness on the part of nurses, that there was no ‘second chance’ which created a huge pressure to ‘get if right’ for the infants and families. Regarding future care 2 areas of improvement identified were ‘Education and Training’ and Support. This paper unpacks these findings making recommendations for practice.

“There’s a Catch-22”. The complexities of pain management for people with advanced dementia nearing the end of life: a qualitative exploration of physicians’ perspectives

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

No second chance: the experiences of junior neonatal nurses in providing end-of-life care for babies and families in the NNU

Background

An infant’s death is acutely stressful for parents and professionals. Little is known about junior nurses’ experiences providing end-of-life care in Neonatal Units (NNU).

Objectives

To better understand junior nurses’ experiences providing end-of-life care in NNU, the study explored the challenges and opportunities inherent in their practice relating to providing such care to babies and their families.

Methods

Neonatal nurses (n=12) with less than 3 years’ experience who were undergoing a neonatal education programme participated. Two focus groups were convened each with 6 nurses. The Ethics Committee at the relevant University approved the study. Nominal Group Technique (NGT) was used in the focus groups to build consensus around the challenges faced by junior nurses, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision making whilst secondary analysis involved thematic analysis.

Results

The study identified the pressures these nurses felt in having only one chance to ‘get it right’ for the infants and their families. They perceived the need for further ‘education and training’ highlighting that improved education provision would include both additional courses and internal training sessions. Greater ‘support’ from mentors themselves more experienced in this aspect of care within the NNU was identified as important in addressing issues around confidence building and skill development.

Conclusions

The results highlight junior nurses’ need for specific education and mentorship around end-of-life care for babies. This presentation will outline the implications for practice, education and further research.

Proposta di traduzione di “The End of the End of Everything” di Dale Bailey

L’obiettivo della tesi è quello di proporre ed analizzare una traduzione del racconto "The End of the End of Everything"" di Dale Bailey dall'inglese verso l’italiano. In primo luogo, l’elaborato introduce il tema della corretta strategia traduttiva da adottare in relazione al tema, al genere e alla collocazione editoriale del racconto. Dopodiché, seguono l' introduzione dell'autore, la contestualizzazione del racconto e la sua traduzione in italiano. Infine, la tesi si conclude con l'analisi, che prenderà in esame le principali difficoltà da me affrontate e risolte durante il processo di traduzione.

Faith on the Home Front: Aspects of Church Life and Popular Religion in Birmingham, 1939-1945

The nature of religion on the domestic front in Britain during the Second World War has, hitherto, been relatively unexplored. This study focuses on Birmingham and describes wartime popular religion, primarily as recounted in oral testimony. The difference the War made to people’s faith, and the consolation wrought by prayer and a religious outlook are explored, as are the religious language and concepts utilised by the wartime popular media of cinema and wireless. Clerical rhetoric about the War and concerns to spiritualise the war effort are dealt with by an analysis of locally published sources, especially parish magazines and other religious ephemera, which set the War on the spiritual as much as the military plane. A final section of the study is devoted to measuring the extent of the influence of the churches in the creation of a vision for post-war Britain and Birmingham.

Millennial-scale fluctuations of the European Ice Sheet at the end of the last glacial, and their potential impact on global climate

Reconstructing Northern Hemisphere ice-sheet oscillations and meltwater routing to the ocean is important to better understand the mechanisms behind abrupt climate changes. To date, research efforts have mainly focused on the North American (Laurentide) ice-sheets (LIS), leaving the potential role of the European Ice Sheet (EIS), and of the Scandinavian ice-sheet (SIS) in particular, largely unexplored. Using neodymium isotopes in detrital sediments deposited off the Channel River, we provide a continuous and well-dated record for the evolution of the EIS southern margin through the end of the last glacial period and during the deglaciation. Our results reveal that the evolution of EIS margins was accompanied with substantial ice recession (especially of the SIS) and simultaneous release of meltwater to the North Atlantic. These events occurred both in the course of the EIS to its LGM position (i.e., during Heinrich Stadial –HS– 3 and HS2; ∼31–29 ka and ∼26–23 ka, respectively) and during the deglaciation (i.e., at ∼22 ka, ∼20–19 ka and from 18.2 ± 0.2 to 16.7 ± 0.2 ka that corresponds to the first part of HS1). The deglaciation was discontinuous in character, and similar in timing to that of the southern LIS margin, with moderate ice-sheet retreat (from 22.5 ± 0.2 ka in the Baltic lowlands) as soon as the northern summer insolation increase (from ∼23 ka) and an acceleration of the margin retreat thereafter (from ∼20 ka). Importantly, our results show that EIS retreat events and release of meltwater to the North Atlantic during the deglaciation coincide with AMOC destabilisation and interhemispheric climate changes. They thus suggest that the EIS, together with the LIS, could have played a critical role in the climatic reorganization that accompanied the last deglaciation. Finally, our data suggest that meltwater discharges to the North Atlantic produced by large-scale recession of continental parts of Northern Hemisphere ice sheets during HS, could have been a possible source for the oceanic perturbations (i.e., AMOC shutdown) responsible for the marine-based ice stream purge cycle, or so-called HE's, that punctuate the last glacial period.

'Expanding Horizons': investigating the Glasgow 2014 legacy for young people in the East End of Glasgow

The recent staging of Glasgow 2014 drew universal praise as the ‘Best Games Ever’. Yet the substantial undertaking of hosting the Commonwealth Games (CWG) was sold to the nation as more than just eleven days of sporting spectacle and cultural entertainment. Indeed, the primary strategic justification offered by policymakers and city leaders was the delivery of a bundle of positive and enduring benefits, so-called ‘legacy’. This ubiquitous and amorphous concept has evolved over time to become the central focus of contemporary hosting bids, reflecting a general public policy shift towards using major sporting mega events as a catalyst to generate benefits across economic, environmental and social dimensions, on a scale intended to be truly transformative. At the same time, the academy has drawn attention to the absence of evidence in support of the prevailing legacy rhetoric and raised a number of sociological concerns, not least the socially unequitable distribution of purported benefits. This study investigated how young people living in the core hosting zone related to, and were impacted upon, by the CWG and its associated developments and activities with reference to their socio-spatial horizons, the primary outcome of interest. An ‘ideal world’ Logic Model hypothesised that four mechanisms, identified from official legacy documents and social theories, would alter young people’s subjective readings of the world by virtue of broadening their social networks, extending their spatial boundaries and altering their mind sets. A qualitative methodology facilitated the gathering of situated and contextualised accounts of young people’s attitudes, perceptions, beliefs and behaviours relating to Glasgow 2014. In-depth interviews and focus groups were conducted before and after the Games with 26 young people, aged 14-16 years, at two schools in the East End. This approach was instrumental in privileging the interests of people ‘on the ground’ over those of city-wide and national stakeholders. The findings showed that young people perceived the dominant legacy benefit to be an improved reputation and image for Glasgow and the East End. Primary beneficiaries were identified by them as those with vested business interests e.g. retailers, restaurateurs, and hoteliers, as well as national and local government, with low expectations of personal dividends or ‘trickle down’ benefits. Support for Glasgow 2014 did not necessarily translate into individual engagement with the various cultural and sporting activities leading up to the CWG, including the event itself. The study found that young people who engaged most were those who had the ability to ‘read’ the opportunities available to them and who had the social, cultural and economic capital necessary to grasp them, with the corollary that those who might have gained most were the least likely to have engaged with the CWG. Doubts articulated by research participants about the social sustainability of Glasgow 2014 underscored inherent tensions between the short-lived thrill of the spectacle and the anticipated longevity of its impacts. The headline message is that hosting sporting mega events might not be an effective means of delivering social change. Aspirant host cities should consider more socially equitable alternatives to sporting mega events prior to bidding; and future host cities should endeavour to engage more purposefully with more young people over longer time frames.

CIL 10.5782 – End of a dedication for Gaius Marius

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Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Use of GLP-1 mimetic in type 2 diabetes mellitus: is it the end of fragility fractures?

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