Acceptability and suitability of alcohol, smoking and substance involvement screening test for older people in the community.

Background: Alcohol use is a common phenomenon within Australian culture. While there has been significant focus on alcohol use among young Australians, there has been little on health promotion or early interventions focussing on older Australians.Methods: This paper presents the findings of an explorative study that used four interactive focus group workshops to ask the question: Is an existing World Health Organisation alcohol and drug screening tool called the Alcohol, Smoking and Substance Involvement Screening Test (originally developed for young people) acceptable and suitable for older people? The data were analysed based on the question using thematic coding.Results: Participants generally considered that they would be more comfortable talking with their health providers about their alcohol and drug use rather than filling out the Alcohol, Smoking and Substance Involvement Screening Test themselves. This suggests that the tool should be modified to accommodate the differences in health status that reflect life events of the different older age groups.Conclusion: Due to potential complex medical and diverse range of pharmacotherapies common among this age group, it is recommended that, if the tool is used, it be administered by health practitioners such as nurses.

"The Chicken or the Egg": Barriers and Facilitators to Collaborative Care for People With Comorbidity in a Metropolitan Region of South Australia.

Mental health disorder and alcohol and other drug comorbidity is prevalent in Australia. This qualitative study used semistructured interviews (N = 20) to elicit clinicians' and workers' knowledge, experiences, and opinions regarding issues pertaining to service needs of people with comorbidity in a metropolitan region of South Australia. The study revealed barriers to effective access and delivery of comorbidity care by MH and AOD services. Participants reported difficulties with identification, access, suitability, policy, funding, and collaboration between sectors and services responding to comorbidity. Results suggest that these models of practice were inadequate influencing the delivery, consistency, and reliability of comorbidity care.

Understanding the Essential Meaning of Measured Changes in Weight and Body Composition Among Women During and After Adjuvant Treatment for Breast Cancer: A Mixed-Methods Study.

BACKGROUND: Changes in weight and body composition among women during and after adjuvant antineoplastic treatment for breast cancer may influence long-term survival and quality of life. Research on factual weight changes is diverse and contrasting, and their influence on women's perception of body and self seems to be insufficiently explored. OBJECTIVE: The aim of this study was to expand the understanding of the association between changes in weight and body composition and the women's perception of body and selves. METHODS: A mixed-methods research design was used. Data consisted of weight and body composition measures from 95 women with breast cancer during 18 months past surgery. Twelve women from this cohort were interviewed individually at 12 months. Linear mixed model and logistic regression were used to estimate changes of repeated measures and odds ratio. Interviews were analyzed guided by existential phenomenology. RESULTS: Joint displays and integrative mixed-methods interpretation demonstrated that even small weight gains, extended waist, and weight loss were associated with fearing recurrence of breast cancer. Perceiving an ambiguous transforming body, the women moved between a unified body subject and the body as an object dissociated in "I" and "it" while fighting against or accepting the body changes. CONCLUSIONS: Integrating findings demonstrated that factual weight changes do not correspond with the perceived changes and may trigger existential threats. IMPLICATIONS FOR PRACTICE: Transition to a new habitual body demand health practitioners to enter a joint narrative work to reveal how the changes impact on the women's body and self-perception independent of how they are displayed quantitatively.

Changes in Weight and Body Composition Among Women With Breast Cancer During and After Adjuvant Treatment: A Prospective Follow-up Study.

BACKGROUND: Antineoplastic adjuvant treatment for breast cancer can cause changes in women's weight and body composition and influence their general health and survival. OBJECTIVE: The aim of this study is to investigate the extent and patterns of change in weight and body composition after current standard adjuvant antineoplastic treatment for breast cancer. METHODS: Data on weight and body composition from 95 women with breast cancer Stage I to III were obtained during 18 months on a bioelectric impedance analyzer. Changes and odds ratio (OR) were calculated by a linear mixed model and logistic regression. RESULTS: At 18 months, there was an increase in weight of 0.9 kg (95% confidence interval [CI], 0.3-1.5; P = .003) and an average positive association of 0.35 kg/cm increased waist circumference (95% CI, 0.29-0.42 kg; P < .0001). Relative weight changes ranged from -12.7% to 20.5%. Weight gains related to increased body fat were observed mainly in premenopausal women receiving chemotherapy (1.4 kg; 95% CI, 0.4-2.4; P = .007). For menopausal status, OR was 2.9 (95% CI, 1.14-7.1; P = .025), and for chemotherapy, OR was 2.6 (95% CI, 1.03-6.41; P = .043). The OR for weight loss in Stage III breast cancer was 12.5 (95% CI, 1.21-128.84; P = .034) and 4.3 (CI, 1.07-17.24; P = .40) for comorbidity. CONCLUSIONS: Results demonstrate that weight changes in a pooled sample are overestimated. However, premenopausal women receiving anthracycline-based chemotherapy show a tendency toward a body composition with increasing fat mass. IMPLICATIONS FOR PRACTICE: A scheduled assessment of changes in weight and body composition is relevant at 18 months after treatment. To compare future studies, common measuring and cutoff points are needed.

Effectiveness of primary nursing in the care and satisfaction of adult inpatients: a systematic review protocol.

REVIEW OBJECTIVE: The objective is to identify the best available evidence on the effectiveness of primary nursing in the care and satisfaction of adult inpatients.

"The ambiguous transforming body"--A phenomenological study of the meaning of weight changes among women treated for breast cancer.

BACKGROUND: Changes in weight and body-shape are well known side effects among women treated for breast cancer. Caring for these women requires knowledge of how they perceive these bodily changes. However, knowledge on weight changes and how such changes influence the women's perception of their bodies and selves is limited. OBJECTIVE: To describe the essential meaning of the phenomenon of changes in weight and body-shape in women treated for breast cancer and how these changes influence the women's perception of body and self. DESIGN: The study design is guided by existential phenomenology as a unifying framework and descriptive life-world research as the methodological approach. Data consisted of 12 individual interviews. SETTING: The study was conducted at a department of oncology at a Danish university hospital in 2014. PARTICIPANTS: Women with changes in weight and body-shape were invited to participate in the study for purposeful selection. Inclusion procedure took place when the women attended the outpatient clinic at one year follow-up. RESULTS: The essential meaning "The ambiguous transforming body--between a luxury problem and fear of recurrence"' was formed by three interrelated constituents: (1) the body--a demanding stranger; (2) fighting to be the master in one's own life, and (3) accepting the bodily changes. CONCLUSION: Weight changes may induce a feeling of being in transition between a former well-known body and a current strange demanding body. Interpreting the bodily changes in the light of being alive, the weight changes appeared as a luxury problem. However, knowing that excess fat can cause breast cancer, the women are caught in a dilemma because the medication is supposed to contribute to long-term survival and at the same time is a possible contributor to weight gain. Being alive but unable to avoid bodily changes, the changes influenced the women's self-perception as autonomous agents and provoked self-blame, shame and feelings of ungratefulness. Thus, relieving the burden of changes in weight and body shape is not only a question of appearance, but encompasses the desire for life and anxiety of death.

Parenting experiences of living with a child with attention deficit hyperactivity disorder: a systematic review of qualitative evidence.

BACKGROUND: Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide. Parenting a child with attention deficit hyperactivity disorder is challenging and parents find it difficult to raise the child and struggle to get professional support. Research has shown how living with a child with Attention Deficit Hyperactivity Disorder influences the families' daily life. This includes how the parents manage to maintain a bearable family life, supportive or not supportive factors as well as parents' experiences of collaboration with professionals in diverse settings. OBJECTIVE: The objective of this systematic review was to identify and synthesize the best available evidence on parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services. INCLUSION CRITERIA: This review considered research articles with qualitative data examining the experiences of parents of children with attention deficit hyperactivity disorder. The phenomena of interest were parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services, and collaboration with professionals. SEARCH STRATEGY: Retrospective and prospective searches were conducted in MedNar, ProQuest Dissertations and Theses, PubMed, Embase, PsycINFO and CINAHL. The reference lists of the included research articles were searched for additional studies, and a search for cited citations in Web of Science was conducted. METHODOLOGICAL QUALITY: Two independent reviewers assessed articles selected for retrieval for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument. DATA EXTRACTION: Data were extracted from research articles included in the review using the standardized data extraction tool from the Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved aggregation and synthesis of findings. RESULTS: A total of 21 research articles were included in the review. The review process resulted in 129 study findings that were aggregated into 15 categories. The categories generated six synthesized findings: 1) An emotional roller coaster between hope and hopelessness, 2) Mothers as advocates in a battlefield within the system and family, 3) Parental experiences in a crossfire of blame, self-blame and stigmatization, 4) Shuttling between supportive and non-supportive services and professionals, 5) Routines, structures and strategies within everyday life, and 6) Despite multiple challenges, it is not all bad. CONCLUSIONS: The findings illustrate the complexity of parental experiences that are influenced by guilt, hope, blame, stigmatization, exhaustion, reconciliation and professional collaboration. The findings address the impact attention deficit hyperactivity disorder has on the everyday family, and how parents seem to adapt to their life situation in the process of accepting their child's disorder. IMPLICATIONS FOR PRACTICE: Health care systems and other professionals need to provide support and understanding to families of children with ADHD. IMPLICATIONS FOR RESEARCH: Further research is needed to examine how professionals in health care settings can address the individual needs of the families and how future interventions may support the families and improve competences of health professionals.

Better medication management for Aboriginal people with mental health disorders: a survey of providers.

OBJECTIVE: To explore the experiences and training needs of service providers in relation to medication management for Aboriginal people with mental health disorders. DESIGN: Survey. SETTING: Aboriginal and mainstream health and human service organisations in metropolitan, rural and remote South Australia. SUBJECTS: Aboriginal health workers, nurses, mental health workers, substance misuse workers, managers, liaison officers, social workers, police, pharmacists, general practitioners, community workers, counsellors, paramedics, educators, family support workers and others. RESULTS: The major health service issues for Aboriginal people with mental health disorders and their carers are related to access to, and availability and appropriateness of services. Quality use of medications by Aboriginal clients is influenced by drug and alcohol misuse, cost, compliance, feelings about the value of medicines, sharing of medications and unwanted side-effects. Many workers providing services to Aboriginal people with mental health disorders lack adequate training and/or resources on mental health and safe medication management; yet, are required to provide advice or assistance on these matters. CONCLUSIONS: The survey provides new, reliable evidence relevant to mental health services and medication management for South Australian Aboriginal people. It highlights the major issues impacting on quality of care and service provision, demonstrates the wide range of health and allied workers providing medication advice and assistance to Aboriginal people, and reveals workforce development needs.

Critical ethnographic methodology in nursing research: issues and solutions.

Five methodological issues were encountered in a study using critical ethnography to investigate nurses' attitudes, knowledge and practices towards patients with alcohol and drug related problems in a general hospital. These issues related to the recording of field notes, over-identification with participants, the role of being a researcher, the effect of the researcher's presence - the Hawthorne effect, and cultural differences. The latter issue was viewed from the personal perspective as an international student from Denmark conducting the research in an Australian setting. This paper discusses the issues in turn and concludes with recommendations on how they might be effectivley addressed by other researchers considering to use critical ethnography.