The Relationship between Kitwood's Model of Needs and a Student's Music Therapy Practice in an Acute Assessment Unit for People Living with Dementia and Mental Health Issues

<p>This study focused on reviewing a student's music therapy practice at an acute assessment unit for people living with dementia and mental health issues, finding links between the placement philosophy, and new ideas about practice. Kitwood's (1997) book on personhood and the needs of people who are living with dementia and other mental health issues appeared to resonate with the student music therapists' practice. This was supported by the active use of his model of needs by nursing staff at the placement. Investigations looked specifically at Kitwood's model of needs; how music therapy links with his philosophy and how interventions during practice connected to those needs. The data was draw from descriptive clinical notes using secondary analysis. The rich qualitative data was analysed using deductive and inductive methods. Findings are presented under Kitwood's model of needs, forming the five categories for the study. The main themes within these categories were then summarised and explanations given under both Kitwood's model of needs and music therapy interventions used to meet them. Though the findings are qualitative, specific to this study and not necessarily generalisable, several links within music therapy practice, and nursing practice revealed the importance and need for more person-centred individualised care programmes for patients in mental health settings.</p>

Delivering mental healthcare to patients with a depressive disorder alongside a life-limiting illness

The concurrent assessment and treatment of mental health disorders and palliative illnesses is complex. Affective disorders are more prevalent in people who need palliative care. Identifying the most suitable place of care and multi-professional multidisciplinary teams to provide support can be challenging and bewildering for professionals and patients. Mental health clinicians may be left with a sense of therapeutic nihilism, while palliative care teams can feel limited by the mental health resources available for treating those living with significant physical and mental health needs. We discuss the fictional case of a gentleman with metastatic bowel cancer who has developed symptoms of depressive disorder and identify how taking a pragmatic patient-centred approach can offer a route through potential dilemmas when seeking to provide individualised care based on needs. We used lay person experience alongside our own experiences of novel mechanisms for cross-specialty working in order to direct psychiatric trainees’ approaches to such cases.

What Older Patients and their Relatives Say is Important During Acute Hospitalisation: A Qualitative Study

Background: Due to the growing elderly population across the world, providing safe and effective care to older people is an increasing concern. Hospitals need to adapt to ensure high-quality care for older patients. Several age-friendly frameworks and models aiming at reducing risks and complications have been promoted. However, care for the elderly must be based on the patients’ reported needs, and relatives are often an important part of the patients’ resources. The primary aim of this study was to explore elderly patients’ and their relatives’ experiences of acute hospitalisation and determine what is important for them to experience a good hospital stay. Methods: This study has a qualitative research design in which patients aged 75 years or older and their relatives were interviewed during their acute hospitalisation. The study was conducted at two medical bed wards at a large university hospital in Norway. All interviews were thematically analysed.Results: Four major themes were identified in patients’ and relatives’ descriptions of how they experienced the hospital stay and what was important for them during the hospital stay: being seen and valued as a person, individualised care, patient-adapted communication and information, and collaboration with relatives. The themes span both positive and negative experiences, reflecting great variability in the experiences described.Conclusions: The results underscore how small things matter in relation to how we meet and communicate with older patients and their relatives. How health personnel get to know the patient’s individual values, need for care, information and involvement of relatives affects their experiences of the hospital stay.

Considerations in Management for Trans and Gender Diverse Patients with Inherited Cancer Risk

Purpose of Review To best support all patients with inherited cancer risk, we must broaden our scope of practice to consider the needs of the transgender and gender diverse (trans) community. We considered best practice for supporting trans patients including tailored risk assessments and management recommendations. Recent Findings There is limited literature considering trans patient care in cancer genetics. Small case studies have highlighted how medical transition and cancer risk–reducing options intersect with the need for individualised care. Studies have also shown that cancer genetics professionals do not feel prepared to support trans patients. Summary Patient-centred care for trans patients relies on a multidisciplinary team (MDT) engaged in shared decision-making. National guidelines are needed to standardise access to appropriate discussions around risk-reducing options and screening. International collaborative research is required to provide empiric data on the impact of gender-affirming treatments on cancer risk, and more experiential data is needed from trans patients accessing cancer genetics services. Finally, education and training in this area should be formally embedded for all cancer genetics professionals.

A clinical update on hypermobile Ehlers-Danlos syndrome during pregnancy, birth and beyond

New estimates suggest that cases of hypermobile Ehlers-Danlos syndrome (hEDS) along with the related hypermobility spectrum disorders (HSD) affect approximately 1 in 20 pregnancies globally per year. As such, cases in maternity services should no longer be considered rare, only rarely diagnosed. These conditions can impact upon childbearing in different ways, yet healthcare professionals are often perceived to be lacking in awareness. This article updates and builds upon a previous international review of maternity care considerations for those childbearing with hEDS/HSD. Findings point to a need for individualised care planning in partnership with parents as part of a multidisciplinary approach. As our knowledge of these conditions has developed significantly in recent years, new research insights could usefully be embedded in staff and student education. As a first step, www.hEDSTogether.com has been launched hosting a freely downloadable EDS Maternity tool for use in practice, along with an i-learn module hosted by the Royal College of Midwives.

Systemic Safety Inequities for People with Learning Disabilities: A Qualitative Integrative Analysis of The Experiences of English Health and Social Care for People with Learning Disabilities, Their Families and Carers.

Background Failures in care for people with learning disabilities have been repeatedly highlighted and remain an international issue, exemplified by a disparity in premature death due to poor quality and unsafe care. This needs urgent attention. Therefore, the aim of the study was to understand the care experiences of people with learning disabilities, and explore the potential patient safety issues they, their carers and families raised. Methods Two data sources exploring the lived experience of care for people with learning disabilities were synthesised using an integrative approach, and explored using reflexive thematic analysis. This comprised two focus groups with a total of 13 people with learning disabilities and supportive staff, and 377 narratives posted publicly via the feedback platform Care Opinion. Results The qualitative exploration highlighted three key themes. Firstly, health and social care systems operated with varying levels of rigidity. This contributed to an inability to effectively cater to; complex and individualised care needs, written and verbal communication needs and needs for adequate time and space. Secondly, there were various gaps and traps within systems for this population. This highlighted the importance of care continuity, interoperability and attending to the variation in support provision from professionals. Finally, essential ‘dependency work’ was reliant upon social capital and fulfilled by paid and unpaid caring roles to divergent extents, however, advocacy provided an additional supportive safety net. Conclusions A series of safety inequities have been identified for people with learning disabilities, alongside potential protective buffers. These include; access to social support and advocacy, a malleable system able to accommodate for individualised care and communication needs, adequate staffing levels, sufficient learning disabilities expertise within and between care settings, and the interoperability of safety initiatives. In order to attend to the safety inequities for this population, these factors need to be considered at a policy and organisational level, spanning across health and social care systems. Findings have wide ranging implications for those with learning disabilities, their carers and families and health and social care providers, with the potential for international learning more widely.

End of life care in a secure hospital setting

AimsTo measure the standard of care provided to patients who had a natural and expected death whilst in secure care at Roseberry Park Hospital, Middlesbrough.Mallard ward is a low secure psychiatric ward for older aged men suffering from cognitive difficulties and significant physical comorbidity in addition to a severe and enduring mental illness. The patient population is such that it will remain the most appropriate placement for some patients until their death. It is vital that staff members on Mallard ward and indeed all parts of the Trust are aware of the priorities for care of the dying person and ensure that care is provided in accordance with these priorities.The Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 national organisations, published One Chance to get it Right – Improving people's experience of care in the last few days and hours of life in June 2014. This document laid out five priorities for care of the dying person focussing on sensitive communication, involvement of the person and relevant others in decisions and compassionately delivering an individualised care plan.MethodThe data collection tool was adapted from End of Life Care Audit: Dying in Hospital, a national clinical audit commissioned by Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians. Data were collected from both electronic and paper records. There were three natural and expected deaths in the last two years.ResultFor all three patients, there was documented evidence that they were likely to die in the coming hours or days.End of life care discussion was held with the nominated persons and not with the patients due to their lack of mental capacity.The needs of the patients and their nominated persons were explored in all three cases.All patients had an individualised care plan which was followed.The palliative care team supported the staff with the care of these patients.The care provided was largely consistent with the priorities listed.ConclusionThe national audit compares performance of only acute NHS Trusts with no data to reflect the performance of mental health hospitals. It is imperative that mental health services work in collaboration with physical health and palliative care services so they are able to continue providing a high level of care to this patient group. Clinicians and staff involved in the care of dying patients also need to be adequately trained.