Carers Create: Carer perspectives of a creative programme for people with dementia and their carers on the relationship within the (carer and cared-for) dyad.

INTRODUCTION: Relationships between people with dementia and their carers can prove challenging over the trajectory of the disease. Interventions with a potential to address this include arts and music-based activities. This research project aimed to evaluate a community engagement programme (Carers Create) where both people with dementia and their carers participate together in singing and other activities. A specific focus was on the impact of the sessions on the dyadic relationship. METHODS: A grounded theory approach involved conducting three focus group interviews with carers of people with dementia (n = 16) facilitated by members of a local U3A (University of the Third Age) who were trained and supported by university researchers. Recorded conversations were transcribed and analysed using a three-stage coding and thematic development technique. RESULTS: Four overarching themes were identified from the discourse: remembering the positive qualities of the cared-for, the physical and emotional demands of caring, Carers Create as a shared, beneficial activity and the enduring value of Carers Create. CONCLUSION: Carers found the sessions to positively influence the relationship with the person they cared for through offering some relief from the day-to-day pressures of caring and, in some cases, restoring elements of a previously strong relationship. Crucial to the experience was the fact that the sessions included both carer and cared-for, offering activities to do together, and that they took place within a group, thereby offering a degree of mutual support. In addition, some carers were able to build on learning which had taken place and use certain techniques, such as singing, to help manage care, thus extending the improved relationship.

Using music interventions in the care of people with dementia.

The therapeutic properties of music have been recognised since antiquity. In recent years, there has been a growing evidence base to support claims about the benefits of music for individuals with various health conditions, including dementia. It has been reported that music interventions can lead to improvements in cognition, behaviour and psychosocial well-being in people with dementia, as well as improving the experience of carers. Therefore, it is suggested that nurses should consider harnessing music's potential by incorporating it into the care they provide. This article explores the evidence base for the use of music in dementia care and outlines its potential benefits. It also details the range of music interventions, modes of delivery, and considerations for practice and research.

Challenges of implementing and embedding a programme to improve care for older people with dementia on hospital wards.

The authors took part in a national research project that evaluated an intervention to enhance person-centred care for people with dementia in hospital. The Person, Interactions, Environment (PIE) programme involves staff observing care on a ward, focusing on these three areas. Findings from observations form the basis for introducing changes to ward practices. Implementing PIE led to improvements in practice but proved challenging in the context of the NHS. Sustaining the programme after the research required important features to be in place, in particular the presence of a 'driver' to maintain momentum, the support of the ward manager to encourage ward staff to take part and a degree of flexibility and persistence in the implementation of the programme. Staff expressed satisfaction from taking part in PIE, which continues to be used to improve care in this area of practice.

Effects of singing groups on staff well-being: a feasibility study.

AIMS: To determine the feasibility of recruiting and retaining staff 'singing for well-being' groups over three months and the acceptability of the proposed intervention and data collection methods, and to explore the potential effects of singing groups on staff well-being. METHOD: This was a feasibility study that used a two-group wait-list crossover design. Standardised measures of well-being, engagement, burnout and organisational commitment were used, alongside participant feedback. Questionnaires were given to participants at baseline, three months and six months, with the mean group scores for the measures used calculated at each point. FINDINGS: Participant recruitment did not meet the target set, and only half of the participants returned pre-intervention and post-intervention questionnaires. Acceptability of the programme was high and, despite limited data, positive effects emerged in relation to emotional and work-related well-being. Participant comments about the singing programme and facilitator were universally favourable. CONCLUSION: This feasibility study suggests there may be several benefits of staff singing groups, in terms of improving the well-being of participants. However, proceeding to a full research trial would require additional time and resources to maximise recruitment.

Community singing groups for people with chronic obstructive pulmonary disease: participant perspectives.

AIM: Chronic obstructive pulmonary disease (COPD) is a major public health issue which is irreversible and progressive, but previous research suggests that singing may have beneficial effects. The aim of this study was to establish the views of participants with COPD taking part in a singing for better breathing programme. METHODS: This was a descriptive qualitative study nested within a single-cohort feasibility study which included measures of lung function and wellbeing. Participants ( n = 37) were interviewed following a community singing programme that ran over 10 months in South East England. RESULTS: Findings support those from previous studies regarding the impact of singing on respiratory wellbeing. These included the teaching on breath control, relaxation and the breathing exercises, singing as a means to deflect attention away from breathing problems, leading to increased activity levels and the mutual support for respiratory problems. Beyond the impact on breathing, the singing was also seen as fun, and provided friendship and a 'feel-good' factor which led to motivation to participate in further activities. For some, it was the highlight of the week, and singing together in a group was felt to be central to the benefits experienced. Findings are compared with the quantitative measures within the same study. CONCLUSION: The majority of participants reported improvements in respiratory symptoms as well as mental and social wellbeing following the programme. The study contributes to the evidence base in supporting and highlighting the consistently positive experiences of a large sample of participants, despite variable outcomes in clinical measures.

The Contribution of Community Singing Groups to the Well-Being of Older People: Participant Perspectives From the United Kingdom.

Current evidence suggests that participatory arts activities, and particularly group singing, may contribute to the well-being of older people. However, there is currently a paucity of prospective research from the participant perspective. This qualitative study nested within a randomized controlled trial aimed to assess participants' perspectives of the acceptability and effect on health and well-being of a community singing program for older people. Volunteers recruited to the intervention arm (n = 131) were invited to write comments on their experiences over three data collection points of a 14-week singing program. A subsample (n = 19) participated in a retrospective semi-structured interview. Data were subjected to content and thematic analysis. Comments and interviews from 128 individuals suggested that the singing groups led to specific, incremental benefits to physical, psychological, social, and community well-being. Benefits tended to tail off after the program ended. Suggestions were made for the future running of such groups.

Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial.

BACKGROUND: As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people. AIMS: To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England. METHOD: A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more. RESULTS: A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06-4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53-7.01), anxiety (mean difference = -1.78; -2.5 to -1.06) and depression (mean difference = -1.52; -2.13 to -0.92). CONCLUSIONS: Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people.

Experiences of being a control group: lessons from a UK-based randomized controlled trial of group singing as a health promotion initiative for older people.

Existing randomized controlled trials within the health field suggest that the concept of randomization is not always well understood and that feelings of disappointment may occur when participants are not placed in their preferred arm. This may affect a study's rigour and ethical integrity if not addressed. We aimed to test whether these issues apply to a healthy volunteer sample within a health promotion trial of singing for older people. Written comments from control group participants at two points during the trial were analysed, together with individual semi-structured interviews with a small sample (n = 11) of this group. We found that motivation to participate in the trial was largely due to the appeal of singing and disappointment resulted from allocation to the control group. Understanding of randomization was generally good and feelings of disappointment lessened over time and with a post-research opportunity to sing. Findings suggest that measures should be put in place to minimize the potential negative impacts of randomized controlled trials in health promotion research.

Drawing breath: promoting meaning and self-management in COPD.

The prevalence of chronic obstructive pulmonary disease (COPD) is rising and its associated cost to the NHS is not sustainable. Health policy supports the promotion of self-management programmes for long-term conditions, which build on a person's strengths, interests and preferences. This article presents an account of how one individual with COPD was able to harness her artistic skills and health interests, both to manage her own condition and also to contribute more broadly to health promotion and COPD prevention.

The effectiveness and cost-effectiveness of a participative community singing programme as a health promotion initiative for older people: protocol for a randomised controlled trial.

BACKGROUND: The growth in numbers of older people represents a considerable cost to health and social care services in the United Kingdom. There is an acknowledged need to address issues of social exclusion and both the physical and mental health of this age group. In recent years there has been much interest in the potential contribution of the arts to the health of communities and individuals. There is some evidence that participative singing may be of benefit to older people, however studies to date are limited in number and have lacked rigour. There is therefore a need to build on this knowledge base to provide more quantifiable evidence of both effectiveness and cost effectiveness of singing as a health intervention for this population group. METHODS: The proposed study is a pragmatic randomised controlled trial with two parallel arms. The primary hypothesis is that singing groups for older people improve both physical and mental aspects of quality of life when compared to usual activities. Potential participants will be volunteers over 60 years living in the community and recruited through publicity. Eligible and consenting participants will be randomized to either a singing group or a control group. Singing groups will take part in a twelve week planned programme of singing and control groups will continue with usual activities. The primary outcome measure will be the York SF-12, a health related quality of life measure which will be administered at baseline, three and six months after baseline. The study will evaluate both effectiveness and cost-effectiveness. DISCUSSION: This study proposes to add to the existing body of evidence on the value of singing for older people by using a rigorous methodological design, which includes a power calculation, a standardised intervention and assessment of cost-effectiveness. It should be regarded as a stage in a progressive programme of studies in this area. If group singing is found to be effective and cost-effective it may offer an alternative means to maintaining the health of people in later life. TRIAL REGISTRATION: ISRCTN62404401.

The Silver Song Club Project: singing to promote the health of older people.

Attention has recently been drawn to the contribution of the arts, and of singing in particular, to health and wellbeing. This article describes a qualitative research project which aimed to gain participants' views of taking part in Silver Song Clubs--community-based singing groups for older people. Seventeen individuals aged 60-plus from six clubs were interviewed and a number of benefits were identified. These included: enjoyment; better mental health and wellbeing; increased social interaction; improvements in physical health; cognitive stimulation and learning; and improved memory and recall. It is suggested that such benefits sit well within a model of health relevant to older people themselves. Community nurses working with this age group might consider including an assessment for interest in musical and related activities, and also should be aware of any local initiatives into which individuals can be referred.

Supporting practice teachers to identify failing students.

The subject of identifying and supporting failing students in community nursing education programmes has been largely overlooked in the literature, yet is of great concern to practice teachers. This article discusses the views on the topic of a group of practice teachers in the light of existing, related research and proposes a number of indicators for good practice. It is suggested that of central importance is the need for higher education institutions and practice teachers to work together in identifying students causing concern at an early stage in their studies, based on both objective and subjective observations, and to have in place documented procedures to be followed when such situations arise.