The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis.

OBJECTIVE: To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression. DESIGN: Systematic review with meta-analysis PARTICIPANTS, INTERVENTIONS: Pregnant women over the age of 18 years who receive massage interventions. MEASUREMENTS AND FINDINGS: Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I2 = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I2 = 75%) when compared with usual care. However, none of the trials had a low risk of bias. KEY CONCLUSIONS: Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term. IMPLICATIONS FOR PRACTICE: Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.

How death anxiety impacts nurses' caring for patients at the end of life: a review of literature.

Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. This paper explores the literature on death anxiety and nurses' attitudes to determine whether fear of death impacts on nurses' caring for dying patients. Fifteen quantitative studies published between 1990 and 2012 exploring nurses' own attitudes towards death were critically reviewed. Three key themes identified were: i). nurses' level of death anxiety; ii). death anxiety and attitudes towards caring for the dying, and iii). death education was necessary for such emotional work. Based on quantitative surveys using valid instruments, results suggested that the level of death anxiety of nurses working in hospitals in general, oncology, renal, hospice care or in community services was not high. Some studies showed an inverse association between nurses' attitude towards death and their attitude towards caring for dying patients. Younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. Studies from several countries showed that a worksite death education program could reduce death anxiety. This offers potential for improving nurses' caring for patients at the end of their life.

Communication competence within dietetics: dietitians' and clients' views about the unspoken dialogue--the impact of personal presentation.

BACKGROUND: Although client communications are affected by clients' assumptions about professionals' characteristics drawn from dress attire, little is known about how this dialogue operates in dietetics. The present study aimed to describe how dietitians and their clients interpret this dialogue and to explore the implications for practice. METHODS: A purposive quota sample of dietitians (n = 46) from 21 health services in one state of Australia and a quota of their adult patients (n = 34) were interviewed about dietitians' nutrition education roles. Semi-structured interviews were transcribed and identified themes developed into a questionnaire to survey Australian dietitians. Analysis used frequencies and nonparametric statistics (P <0.05). Triangulation of the results obtained from the studies revealed a strong agreement between data sources. RESULTS: Dietitians' dress attire was perceived as a key source of nonverbal communications by dietetics clients. This was recognised by 75% of the 256 dietitians who were surveyed nationally. Dietitians favoured a professional style (i.e. skirt or slacks, with top). Many clients rejected formal dress (i.e. suit, high heels) as being a potential communication barrier. Some clients viewed dietitians' bodily size/shape as a role model. Implications of dietitians' presentation (i.e. how you look) were important to both clients and dietitians. CONCLUSION: Dress style is implicated in nonverbal communication dialogues between the dietitian and client. As a matter of competence and to maintain congruency in communication, dietitians should be aware of their clients' preferences for formality of dress, and conduct their attire accordingly.

Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals.

BACKGROUND: Nutrition screening using evidence-based clinical practice is important for identifying patients whose nutritional status may be compromised, so that they receive appropriate treatment. Introduction of the Malnutrition Universal Screening Tool ('MUST') in two wards in two Melbourne hospitals resulted in low screening completion rates by nursing staff. Nurses' screening practices were explored to understand personal and workplace barriers to compliance. METHODS: Surveys of patients' medical records and focus groups with nurses were used to gather data. Audio-recorded group narratives were transcribed verbatim, and then coded thematically to develop understandings of response patterns. RESULTS: A survey of admitted patients (n = 46) showed low screening rates by ward (17% and 62%). Eighteen nurses in two wards participated in three focus groups. The five main themes that emerged were: 'screening role', 'task priorities', 'recognition of evidence-based practice', 'uncertainty of protocols' and 'degree of competence'. Screening completion was limited by workloads, uncertainty about screening policy and also individuals' skill in use of the tool. CONCLUSIONS: Application of 'MUST' can be facilitated by increasing nurses' competence through training and by the provision of ongoing support. When implementing nutrition risk screening, dietitians' roles should include continually working with nurses to identify and reduce the barriers that prevent the adoption of universal screening. Enhancement of collaboration is essential to ensure that optimal nutrition care occurs.

Exploring dietitians' verbal and nonverbal communication skills for effective dietitian-patient communication.

BACKGROUND: Little is known about how dietitians conduct their communication with individual patients in the process of nutrition education. To study this issue, both practitioners' and patients' perceptions of dietitians' skills were examined in the first phase of a two-phase study. The resulting narratives were used to develop a questionnaire to survey Australian dietitians involved in clinical practice. METHODS: A purposive sample of dietitians in one state (n = 46; 12%), working in hospital, community or private practice, and a quota of their adult patients (n = 34), were interviewed. In the second stage, Australian dietitians (n = 258; 16%) responded to a national survey in 2006, which asked about educational strategies, communication skills, and professional attributes. Descriptive statistics were used to compare response distributions, and nonparametric statistics were used to examine between-group relationships. Criterion for item acceptance was established as >or=70% agreement. Triangulation of results revealed strong agreement between data sources. RESULTS: Four main communication competencies were established: interpersonal communication skill, nonverbal communication, professional values, and counselling skill. There was no significant difference in practice by work category or experience. The communication competencies, together with 26 accompanying skills, are described. CONCLUSION: An understanding of this guide to communication practice might help enhance dietitian-patient relations.

Effects of diet and exercise on plasma vitamin D (25(OH)D) levels in Vietnamese immigrant elderly in Sydney, Australia.

Vitamin D deficiency may be associated with osteoporosis and fractures in the elderly. In Australia where there is a sizeable Vietnamese population, research has not yet clarified the roles of diet, exercise and sun exposure in determining vitamin D status. Plasma samples for 25-hydroxy-vitamin D (25(OH)D); dietary intake of vitamin D and calcium; muscle strength and sun exposure were measured and weekly dairy intake, exercise levels and smoking habits were surveyed in free-living elderly of Vietnamese and Australian/British origin. There was marginal vitamin D deficiency (<37 nmol/L 25(OH)D) in 63% of Vietnamese but only in 37% of Australian/British born. Low dairy intake and no vigorous exercise were best predictors of vitamin D deficiency in Vietnamese, taking into account age, gender, dietary intake and sun exposure. Since these migrant elderly may not get adequate sun exposure due to either clothing customs or cultural norms that encourage fair (untanned) skin, it is important to encourage increased exercise and dairy intake.

An analysis of managerial skills for the current and future health care environment.

A survey questioned 503 experienced practitioners about managerial tasks and responsibilities of senior professionals in four allied health fields: physiotherapy, speech-language pathology, occupational therapy, and medical radiation science. Participants worked in a range of settings, including the private and public sectors, small and large departments/units, and community and hospital-based work sites. Factor analysis identified eight managerial areas of functioning: department running, staff relations management, legislative knowledge, career path management, implementation and change, quality assurance, management of future planning, and prioritizing work. The professional field of the practitioner influenced the importances attached to these areas, while work setting and gender of practitioner had minimal impact. Level of involvement in managerial tasks had no bearing on the importance attached to competency areas. Open-ended comments added depth to the results of the factor analysis. The findings are discussed with respect to the changing requirements being placed upon health service personnel.

Rehabilitation following a stroke: a participant perspective.

Following a stroke in January 1996 the author, a college lecturer, kept notes of his feelings, perceived treatment, and other people's responses to him. This paper reports these especially as they relate to the experience of illness, disability and rehabilitation. Areas covered include the experience of the stroke itself, perceptions of the process, reactions to disability and therapies, and the experience of trying to return to a 'normal' life. No claim is made for the uniqueness or significance of this account. It is simply offered as a contribution towards a better understanding of the patient's perspective on disability and rehabilitation.