How do patients spend their time in stroke rehabilitation units in England? The REVIHR study.

AIM: To examine how patients spend their time in stroke rehabilitation units in England. METHODS: We recruited 144 patients within a month after stroke from four stroke rehabilitation units and observed their activity type, interactions and location. Each participant was observed for 1 min every 10-minutes, for a total of 20 h, over three consecutive days. Multilevel modelling was performed to assess differences across sites. RESULTS: Across the four sites a total of 12,248 observations were performed. Patients spent on average 37% of the observed time inactive and 60% alone. A health care professional was present for 18% of the observations and patients' most frequent contact was with family members (19%). Patients were mainly physically active in the presence of therapists, but they practiced self-care activities of daily living most frequently in the presence of nursing staff. There were limited opportunities for activity away from the bedside. Significant differences were found between the units, including patients' level of contact with rehabilitation assistants and nursing staff, but not in their time with occupational therapists and physiotherapists. CONCLUSIONS: Stroke patients in England spend a large proportion of their day inactive and alone. Opportunities to promote a rehabilitation focused environment may include: a) enhancing the role of rehabilitation assistants, b) supporting nursing staff in maximising opportunities for the practice of activities of daily living and c) involving family members in the rehabilitation process.IMPLICATIONS FOR REHABILITATIONClinicians need to consider stroke patients' activity levels and rehabilitation experience outside formal therapy.The role of rehabilitation assistants and nursing staff can be key in promoting patient activity and practice of self-care ADL tasks.Pragmatic strategies to encourage family involvement in the rehabilitation process need to be developed.

Dementia and hearing loss: A narrative review.

Dementia and hearing loss are both common among older people. The co-occurrence of the two conditions increases complexities in all aspects of an individual's care and management plan. There has been increasing research interest in the relationship between dementia and hearing loss in recent years. In this review we discuss the relationship between hearing loss and dementia, including hearing loss as a risk factor for dementia; the effects of dementia with hearing loss on affected persons' quality of life and the care they receive; screening and available interventions; and opportunities for prevention. We also discuss dementia and hearing loss in the care home setting, as the majority of residents have either, or indeed both, dementia and/or hearing loss. Several mechanisms have been suggested for how hearing loss and dementia may be related but the evidence for how these may operate together is still unclear. Similarly, although it is to be hoped that the active identification and management of hearing problems may help to reduce the future development of cognitive impairment, evidence for this is still lacking.

Giving permission to care for people with dementia in residential homes: learning from a realist synthesis of hearing-related communication.

BACKGROUND: Managing hearing communication for residents living with hearing loss and dementia in long-term care settings is challenging. This paper explores how care can be effective in optimising hearing communication for residents living with dementia. We argue that the underlying notion of permission or authorisation allows care staff to do what they know will be effective in providing person-centred care that enhances hearing communication. The paper also indicates that this notion of permission can usefully be applied to other areas of care home practice. METHODS: To address hearing-related communication in care homes, we conducted a realist synthesis (RS). As a theory-driven approach to reviewing literature, it also uses expert opinion to understand complex health situations. Using RS, we developed a theory surrounding the management of hearing-related communication in care homes. Applying formal processes to the literature search and data extraction, the analysis uncovered relevant mechanisms and contexts to help confirm, refute or refine our understanding of how hearing communication could be improved. RESULTS: Forty-three papers were selected for the realist synthesis. The documents were analysed to construct five context-mechanism-outcome configurations (CMOCs). The CMOCs represent possible care interventions to optimise hearing-related communication in care homes for person living with dementia and hearing loss (PLWDHL). They include leadership promoting positive regard and empathy through person-centred care, communication training for staff, 'knowing the person' and relationship building for responsive awareness of residents' hearing needs, maintaining and monitoring hearing communication through care planning, and managing noise in the care home environment. CONCLUSIONS: Leadership that provides appropriate training and resources is likely to enhance knowledge and skills, leading to staff feeling able and equipped to respond to the hearing-related communication needs of PLWDHL. Collaboration with local hearing services is likely to raise awareness of hearing loss among care home staff. Importantly, care staff require a sense of permission from leadership, to work with knowledge and autonomy in the interest of residents living with dementia and hearing loss.

Displacement of death in public space by lay people using the automated external defibrillator.

This paper reports on a study where a technology, the Automated External Defibrillator (AED), enables a socially troubling death in public space to be moved to a more acceptable location. This was a qualitative study, using semi-structured interviews with lay (non-medical) people, in a variety of locations, who had been trained to use an AED. The AED, and its use by lay people, means that the time and place of death from heart attack can be changed from a location like a railway station or shopping centre to the ambulance or hospital. Thus the lay people involved can act as what Timmermans (1999) terms 'death brokers'.

Desperately seeking sociology: nursing student perceptions of sociology on nursing courses.

This paper will present the findings of a qualitative study exploring the perceptions of students confronted by a requirement to learn sociology within a nursing curriculum. Those teaching sociology have a variety of explanations (more or less desperate), seeking to justify its place on the nursing curriculum. While there may be no resolution to the debate, the dispute thus far, has largely been between sociology and nursing academics. Absent from this debate are the voices of students 'required' to learn both nursing and sociology. What do students make of this contested territory? When students are trying to learn their trade, and know how to practice safely and efficaciously what do they make of the sociological imagination? How realistic is it to expect students to grasp both the concrete and practical with the imaginative and critical? Findings from this qualitative, focus group study suggest that students do indeed find learning sociology within a nursing curriculum "unsettling". It would seem that students cope in a number of ways. They fragment and compartmentalise knowledge(s); they privilege the interception of experiential learning on the path between theory and practice; and yet they appear to employ sociological understanding to account for nursing's gendered and developing professional status.