A Systematic Review of the Patient- and Carer-Related Factors Affecting the Experience of Pain for Advanced Cancer Patients Cared for at Home.

CONTEXT: Effective pain management is a priority in the palliative care of advanced cancer patients. A body of research is emerging examining the factors that influence the management and experience of pain for such individuals. Identifying such factors should allow for the development of targeted interventions to improve pain management in the home while ultimately reducing unnecessary suffering for the patient. OBJECTIVES: The objective of this study was to identify relevant patient- and carer-related factors which have an effect on the pain experienced by advanced cancer patients cared for at home. METHOD: This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement guidelines. Studies were retrieved from the CINAHL, MEDLINE, and Web of Science and assessed independently by two reviewers with discrepancies assessed by a third before quality assessment and data extraction. A narrative synthesis was produced. RESULTS: Our search strategy produced 720 hits, of which 10 studies were retained for the final analysis. The factors identified included carer knowledge of cancer pain management, carer burden, carer and patient distress, pain rating disparity, patient well-being, patient depression, patient affective experience, patient body image, and satisfaction with palliative/medical care. All factors identified are supported by only some evidence with many having only been explored in single studies. CONCLUSIONS: There is a lack of quantitative research in the area of factors influencing the experience of pain for advanced cancer patients cared for at home. Such findings would be useful in developing theories of change that would underpin interventions aimed at improving pain outcomes for this population.

Learning environment and emotional well-being: A qualitative study of undergraduate nursing students.

BACKGROUND: Students can experience multiple stressors during their academic life which have an impact on their emotional health and academic progress. PURPOSE: This study sought to explore students' understanding of and factors affecting their emotional well-being in an undergraduate nursing programme at a private nursing institution in Karachi, Pakistan. METHOD: In this qualitative study, data were collected through individual semi-structured interviews using a self-designed guide from 16 participants in total, drawn from various years of the selected undergraduate programme. FINDINGS: Participants noted that the quality of the 'learning environment' was a key influence on their emotional well-being. They highlighted faculty role and teaching approaches, academic expectations and availability of learning resources as important factors that affected their emotional well-being as well as their academic performance. Institutional support was also deemed important. Factors associated with a 'hidden curriculum' were found to be a threat to students' emerging sense of professionalism. CONCLUSION: Suggestions are given as to how the learning environment in the nursing programme under study can be improved to take into account students' emotional well-being. Emphasis needs to be laid on developing supportive faculty role to provide conducive learning environment and professional development of students. Efforts to develop stress-free academic environment with supportive institutional policies need to be considered.

Evaluating healthy schools: perceptions of impact among school-based respondents.

Schools are important settings in which to promote children's and young people's physical and emotional health. An evaluation of the National Healthy School Standard in England showed that education and health professionals have implemented a range of projects and activities to improve pupils' health. Although these were generally well received by parents and pupils, they were not uncritical of them. Perceptions of the value of health-related work were influenced by the contextual characteristics of schools--whether primary or secondary, the quality of social relationships, the quality of teaching, and the extent of pupil and parental involvement in the life of the school. With local responsibilities for children's services in England being reorganized in response to the Green Paper, Every Child Matters: Next Steps, there are new opportunities to develop a coherent set of outcome measures that pay due regard to pupils' and parents' views, and which inform collaborative reviews of healthy school programmes, in particular, and local services, more generally.

Evaluating the impact of the National Healthy School Standard: using national datasets.

An evaluation of the National Healthy School Standard (NHSS) was undertaken by the authors on behalf of the Department of Health and the Department for Education and Skills. One part of the evaluation involved gaining access to a number of datasets derived from previous research and analysing the health-related outcomes of schools which had attained Level 3 of the NHSS, compared with those of other schools. The sources which provided the most interesting findings were the Health-Related Behaviour Questionnaire (HRBQ) survey and the Ofsted database of school inspection ratings. This paper describes the statistical methods used, and the results of the HRBQ and Ofsted analyses. Using HRBQ data, many pupil-level outcomes were explored, but relatively few indicated significant differences and even those tended to be quite small. The Ofsted school-level data yielded stronger evidence of NHSS impact. The paper concludes by suggesting possible reasons for these findings.

Context matters: the educational potential of gay bars revisited.

Gay bars have been frequently identified as suitable environments in which to conduct HIV prevention activities among homosexually active men. In theory, they provide easy access to a relatively diverse group of men. However, gay bars are environments in which the primary purpose is a social one. Gay men use them to take time out, to socialize, and, on occasions, to find new sexual partners. They are also settings in which social reputations often have to be managed. This study examined the HIV/AIDS educational potential of four gay bars in London, Britain. Semistructured observations and interviews took place in four contrasting bars with a focus on men's perceptions of HIV/AIDS-related health promotion activities including condom promotion, the use of posters and small media, and understandings of safer sex. Respondents were ambivalent about AIDS-related health education activities being undertaken. The implications of such responses for the development of HIV primary prevention activities in such settings are discussed.