Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a mixed methods pilot for a randomised controlled trial.

BACKGROUND: Urinary incontinence (UI) is a distressing condition affecting at least 5 million women in England and Wales. Traditionally, physiotherapy for UI comprises pelvic floor muscle training, but although evidence suggests this can be effective it is also recognised that benefits are often compromised by patient motivation and commitment. In addition, there is increasing recognition that physical symptoms alone are poor indicators of the impact of incontinence on individuals' lives. Consequently, more holistic approaches to the treatment of UI, such as Modified Pilates (MP) have been recommended. This study aimed to provide preliminary findings about the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for UI, and to test the feasibility of a randomised controlled trial (RCT) design. METHODS: The study design was a single centre pilot RCT, plus qualitative interviews. 73 women referred to Women's Health Physiotherapy Services for UI at Colchester Hospital University NHS Foundation Trust were randomly assigned to two groups: a 6-week course of MP classes in addition to standard physiotherapy care (intervention) or standard physiotherapy care only (control). Main outcome measures were self-reported UI, quality of life and self-esteem at baseline (T1), completion of treatment (T2), and 5 months after randomisation (T3). Qualitative interviews were conducted with a subgroup at T2 and T3. Due to the nature of the intervention blinding of participants, physiotherapists and researchers was not feasible. RESULTS: Post-intervention data revealed a range of benefits for women who attended MP classes and who had lower symptom severity at baseline: improved self-esteem (p = 0.032), decreased social embarrassment (p = 0.026) and lower impact on normal daily activities (p = 0.025). In contrast, women with higher symptom severity showed improvement in their personal relationships (p = 0.017). Qualitative analysis supported these findings and also indicated that MP classes could positively influence attitudes to exercise, diet and wellbeing. CONCLUSIONS: A definitive RCT is feasible but will require a large sample size to inform clinical practice. TRIAL REGISTRATION: ISRCTN74075972 Registered 12/12/12 (Retrospectively registered).

'Am I damaging my own family?': Relational changes between foster carers and their birth children.

Foster placements are more likely to break down where the foster carers already have birth children. Studies that explore the impact of fostering on foster carers and their birth children have suggested that relational changes occur, but these changes have not been examined in depth. This study aimed to explore the impact of fostering on parent-child relationships within foster families. Nine foster carers (including three couples) were interviewed separately, and the data were analysed using constructivist grounded theory methods. Analysis indicated that birth children may attribute particular importance to their position in the family (e.g. oldest child, youngest child) and that this is a key element of the way in which they relate to their parents. Emotional security and parent-child relationships can therefore be strained by a foster placement not taking this into account. Foster children also introduce significant competition for parental resources, putting a strain on relationships. Foster carers seem to prioritise, consciously or not, the preservation of relationships within the biological family. Reflecting on relationships and making changes to maximise potential improvements in relationships can lead to positive outcomes, and this can have an impact on whether families continue fostering or not.

Qualifying from the pre-registration nurse diploma course: the demand for career guidance.

A previous paper in Nurse Education Today [Marsland, L. (1996) Career guidance for student nurses: an unmet need, Vol. 16, No. 1, p. 10] presented research about career guidance received during nurse education by 1015 Registered General Nurses (RGNs) who qualified in 1990/1991. The findings revealed a substantial unmet need for guidance amongst this group, especially in relation to discussions about individual career planning. The paper argued that the greater variety of training experiences incorporated into the Project 2000 diploma course curriculum, plus the opportunity in some colleges to defer branch selection until after the common foundation programme, would increase rather than decrease the need for pre-registration guidance. The research presented in this subsequent paper investigates career guidance received by a cohort of adult branch nurses who qualified from the nurse diploma course in 1997/1998. Similarities and differences between the guidance experiences of the two cohorts are discussed, and deficits experienced by the diploma course nurses identified.

Planning a pathway in nursing: do course experiences influence job plans?

Little is known about the factors that influence career decisions within nursing. This study contributes to a limited body of knowledge about the affect of course experiences on job plans. The findings presented are from the first phase of a longitudinal questionnaire survey investigating nurses' careers. One thousand five hundred and ninety six adult branch nurses (87% response rate) from 37 universities returned a questionnaire at qualification which included questions about specialties experienced during the course, whether course experiences encouraged or discouraged them from working in the specialty, specialty(ies) of first job, and specialty(ies) planned for three years after qualification. Overall, course experiences were more likely to encourage than discourage diplomates from wanting to work in a particular specialty, although for three specialties (elderly care, outpatients and theatres) a significantly greater proportion felt discouraged than encouraged. Uniformity in the findings across the universities suggests that certain specialties may have intrinsic features that encourage or discourage many nurses from working in them, irrespective of the experience they gain. A stronger association existed between course influences and plans for three years after qualification, than between course experiences and first job. Findings are discussed in the context of other research in the area and their implications for recruitment.

Transposition of the great arteries.

The transposition of the great arteries is a life- threatening condition affecting infants. This article presents the surgical options for treatment, then describes the nursing care involved in the aftermath of the arterial switch procedure, the preferred intervention at Birmingham Children's Hospital. Research is currently being done to evaluate its success. Although long term follow-up is not yet possible, early results are promising.