Effectiveness of a multicenter training programme to teach point-of-care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes.

BACKGROUND: The primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD-scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes. METHODS: Five podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1-day), supervised scanning (5-weeks), independent scanning (3-weeks) and a final evaluation of performance (1-day).Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD-scan assessment) were assessed for every supervised scan and again for the final evaluation of performance. RESULTS: A total of 90 PAD-scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9-25.5) vs 9.3 min (IQR 7.3-10.5);p = 0.028) and DUOSATS scores (17.5 (IQR 16.8-21) vs 25 (IQR 24-25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3-5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist. CONCLUSION: A structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD-scan.

Efficacy of a group-based parenting program on stress and self-efficacy among Japanese mothers: a quasi-experimental study.

Early child development and the impact of parenting on later life are of global concern. The rise in child abuse and maltreatment in Japan suggests that measures to increase self-efficacy and reduce stress would benefit Japanese parents. In this study, we explored if Japanese parents attending a 123Magic parenting program reported reduced stress and enhanced self-efficacy. Questionnaire data were collected from 49 mothers attending a parenting program conducted in public nursery schools in one prefecture in Japan. There were significant changes in parenting self-efficacy scores (P < 0.001) and parenting stress scores (P < 0.01). Focus groups with 16 parents also found that there were benefits to parents in terms of increased confidence and less stress. The findings provide support for the role of public health nurses in delivering group-based parenting support in Japan.

Evaluation of services for children with complex needs: mapping service provision in one NHS Trust.

AIM: The aim of this paper is to identify and descriptively map the key characteristics of the model of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. BACKGROUND: In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. METHODS: An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child's condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. CONCLUSIONS: Parents experienced both health and social service communication challenges when seeking care for their child. These challenges can be located within a general systems theory and hierarchy approaches to understand the complexity of service provision.

Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme.

AIM: To explore whether changes in parenting self-efficacy after attending a parenting programme are related to changes in parenting stress and child behaviour. BACKGROUND: Adverse parenting is a risk factor in the development of a range of health and behavioural problems in childhood and is predictive of poor adult outcomes. Strategies for supporting parents are recognised as an effective way to improve the health, well-being and development of children. Parenting is influenced by many factors including the behaviour and characteristics of the child, the health and psychological well-being of the parent and the contextual influences of stress and support. Parenting difficulties are a major source of stress for parents, and parenting self-efficacy has been shown to be an important buffer against parenting stress. METHODS: In all, 63 parents who had a child under the age of 10 years took part in the research. Of those, 58 returned completed measures of parenting self-efficacy, parenting stress and child behaviour at the start of a parenting programme and 37 at three-month follow-up. FINDINGS: Improvements in parenting self-efficacy and parenting stress were found at follow-up, but there was less evidence for improvements in child behaviour. The findings clearly suggest a relationship between parenting self-efficacy and parenting stress; parents who are feeling less efficacious experience higher levels of stress, whereas greater parenting self-efficacy is related to less stress. This study adds to the evidence that parent outcomes may be a more reliable measure of programme effectiveness than child outcomes at least in the short term.

Audit as evidence: the effectiveness of '123 magic' programmes.

This paper reports on an audit to determine the effectiveness of '123 Magic', a group-based parenting programme that encourages parents to explore, discuss and practice strategies to manage child behaviour. The audit's use at a local level to provide evidence of effectiveness and areas for quality improvement is described. Audit can also be useful to determine outcomes locally and to develop new hypotheses for testing through research. The effectiveness of '123 Magic' was evaluated by measuring whether parenting self-efficacy increased after attending a programme. A total of 74 parents took part from 16 '123 Magic' parenting programmes from October 2007 to June 2009. Parents completed the TOPSE evaluation tool as a pre- and post-course measure of parenting self-efficacy. Scores increased at the end of the parenting programmes for all scales, which suggests that'123 Magic' is effective in terms of improving parenting self-efficacy and also demonstrates the value and contribution of parenting programme facilitators to supporting parents and families in the community.

Testing a parenting programme evaluation tool as a pre- and post-course measure of parenting self-efficacy.

AIM: This paper is a report of a study to measure changes in parenting self-efficacy after attending a parenting programme and to determine if these changes are maintained over time. BACKGROUND: A need for the evaluation of parenting programmes from the perspective of parents who take part has led to the development of a Tool to Measure Parenting Self-Efficacy. Self-efficacy, a self-perception of one's ability to perform competently and effectively in a particular task or setting, provided the framework for the development of the tool. METHODS: A total of 356 parents took part in the study over 53 parenting programmes in the UK in 2004-2005. Parents completed the evaluation tool as a pre- and post-course measure of parenting self-efficacy and at 4-month follow-up. FINDINGS: Parenting self-efficacy increased at the end of the parenting programmes for all scales. The increase from baseline to end of course was maintained for all scales at four month follow-up and there was a further increase for two scales. Increases in self-efficacy were found across a range of parenting programmes. CONCLUSION: The tool can be used to assess the impact of different types of parenting programmes on parenting self-efficacy and in research into this topic.

Developing and validating a tool to measure parenting self-efficacy.

AIMS: This paper reports the development of a tool to measure parenting self-efficacy as an aid to evaluating parenting programmes. BACKGROUND: Whilst there has been increasing interest in parenting programmes from parents, government and professionals, there is a lack of rigorous evaluation studies of their effectiveness, particularly their longer-term outcomes. Equally, there is little research evidence of the views and experiences of parents themselves. It is important to develop robust outcome measures which draw on well-developed theoretical constructs to measure parents' perceived abilities to manage their children based on their own views and experiences. Self-efficacy, a self-perception of one's ability to perform competently and effectively in a particular task or setting, may provide such a framework. METHODS: Data from 12 focus groups conducted with parents and parenting programme facilitators informed the development of the tool. A thematic analysis of the focus group transcripts identified key items to be included in the self-efficacy instrument, and these were developed into 82 Likert-format statements. A multi-method approach was used to test the instrument for validity and reliability. FINDINGS: Nine domain specific sub-scales of parenting were identified from the analysis of the focus group data. Internal reliability coefficients for the subscales ranged from 0.80 to 0.89, and the overall scale reliability was 0.94. External reliability coefficients ranged from rs = 0.58 (n = 19, P < 0.01) to rs = 0.88 (n = 19, P < 0.01). CONCLUSION: A valid and reliable tool to measure parenting self-efficacy has been developed, which will aid evaluation of parenting programmes.

A qualitative study exploring the experiences and views of mothers, health visitors and family support centre workers on the challenges and difficulties of parenting.

Successive policy documents have referred to the need to support parents as an approach to reducing social exclusion, behaviour problems among young people and crime rates. Much of the rhetoric focuses on professional intervention, and there is less attention paid to the views and experiences of parents themselves. The present study explores the experiences and views of mothers, health visitors and family support centre workers who work with parents on the challenges and difficulties of parenting children under the age of 6 years. It provides an appreciation of their views on effective parenting and how parents can be helped to feel more effective in the parenting role. Focus groups, which were exploratory and interactive in form, were conducted across three primary care trusts in Hertfordshire, UK. Three samples were purposively selected in order to examine the range and diversity of experiences and views about parenting, and included the parents of children up to the age of 6 years, health visitors and family support centre workers. The mothers were those waiting to attend a parenting programme, and included first-time mothers and those with more than one child. The health visitors and family support workers had a range of experience in working with parents and children, and included those who were facilitating parenting programmes and those who were not. A number of themes emerged surrounding the challenges and difficulties of parenting and effective parenting, including expectations of others, establishing routines, play, behavioural issues and discipline, empathy, and communication. Similar themes emerged from all groups; however, there were qualitative differences between parents and professionals in the way in which these issues were expressed. Key statements from the parent focus groups have been developed into self-efficacy statements, which will be used as input to the development of a tool to measure the effectiveness of parenting programmes.

A qualitative study exploring junior paediatricians', midwives', GPs' and mothers' experiences and views of the examination of the newborn baby.

OBJECTIVE: to explore the experiences and attitudes of midwives, junior paediatricians (SHOs), GPs, and mothers to the examination of the newborn baby. To provide an appreciation of their views on several issues, in particular the purpose and value of the examination, who is thought to be appropriate to carry it out and when and where it should take place. DESIGN: qualitative using semi-structured interviews, which were exploratory and interactive, in order to examine the range and diversity of experiences and attitudes to the neonatal examination. SETTING: South-east England. PARTICIPANTS: four samples were purposefully selected to include ten each of midwives, SHOs, GPs and recently delivered mothers. SHOs were currently working in paediatric departments of a district general hospital or teaching hospital and their experience of conducting examinations of the newborn baby ranged from several months to several years. Midwives included both those trained in the examination and currently conducting examinations, and those not so trained and not carrying out the examination. Most of the midwives had been qualified for over ten years and had a wide range of clinical experience in hospital and community settings. The GPs were from ten practices in two Health Authorities and all had some experience of conducting neonatal examinations. Of the mothers, a few had had their babies examined at home by midwives, others in hospital by an SHO. Mothers included those with a family history of problems relevant to the examination, those with previous pregnancy complications and others with no problems or complications. Some were first-time mothers. FINDINGS: all groups perceived the examination to be a useful screening tool providing reassurance to parents. They considered both midwives and SHOs to be appropriate professionals to carry out the examination, if adequately trained. Most thought that midwives have a better rapport with mothers, are able to provide continuity of care and more often discuss health-care issues than do SHOs. Few SHOs reported receiving any formal training in the examination of the newborn baby. IMPLICATIONS FOR PRACTICE: the extension of the practice of midwives examining the newborn baby following relevant training would be acceptable to all stakeholders. The implications of increased demands on the midwives' workload may need to be considered.

A qualitative study exploring midwives' perceptions and views of extending their role to the examination of the newborn baby.

OBJECTIVES: to explore midwives' attitudes and perceptions about extending their role to the examination of the newborn baby, as well as their general perceptions and attitudes to new role developments. DESIGN: qualitative, data collected using semi-structured interviews, which were exploratory and interactive in form. SETTING: six maternity hospitals in South-east England. PARTICIPANTS: ten midwives were purposefully selected, including five trained in the examination of the newborn baby and currently conducting examinations and five who had not. Most of the midwives had been qualified for over ten years and had a wide range of clinical experience in hospital and community settings. FINDINGS: midwives identified many benefits to themselves, to their profession and to the mothers as a result of developing their role into the examination of the newborn baby. The major benefit cited was improved job satisfaction, which was directly related to their ability to give continuity and total care to mothers and babies. Midwives also perceived that undertaking the examination strengthened their position as autonomous practitioners, by enabling them to provide total care to mothers and babies who fitted their criteria of normality. Moreover, midwives thought that improvements in the overall quality of care to mothers would result from them performing the examination, including improved communication, greater continuity of care and a more holistic examination. Although midwives were concerned about possible increase in workloads and pressure to take on new roles, the examination was generally perceived as being easily incorporated into their current practice without compromising overall standards in midwifery care. Midwives expressed concern about 'extending' practice into areas that did not fit their perceptions of normality and about being 'pressurised' into taking on new roles. IMPLICATIONS FOR PRACTICE: it would appear from this study that an important consideration for midwives in their acceptance of new roles, is the relationship of that role to their position as experts in normality. Midwives in this study viewed the examination of the newborn baby as 'fitting in' with their perceptions of the core values of midwifery.

Boiling point.

I am writing in response to Yvonne Salisbury's letter 'Practice Nurse Alarm' (Nursing Standard week ending May 14, 1988).