Stress Management: Space, Movement, and the Pause

To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework. Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. A qualitative, multiple-case study. The cases were three acute wards in one hospital. Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care. This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised. Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards.

David Rando's meticulous and thought-provoking Modernist Fiction and News nevertheless begins with a somewhat misleading title. Rando is less concerned with specific news sources or the publication history of little magazines, and much more interested in “the news” broadly conceived in opposition, and apposition, to modernist literature. Rando's main interest is the important ways in which literary output in the early twentieth century—he concentrates on works appearing in the 1930s—reacted to and against the proliferation of newsprint in the space of the “media ecology,” building on Mark Wollaeger's 2006 Modernism, Media and Propaganda.Literature, according to Rando, both appropriates and questions the methods used in popular newspapers, using techniques like “nearness” and “delay” to open up an anecdotal space within the story itself. Rando draws heavily on Benjamin's writings about the modes of experience to lay out his argument; Benjamin also gets the very first lines of the book: “Every instant brings us news from across the globe, yet we are poor in noteworthy stories. The previous sentence is adapted from Walter Benjamin's statement in his 1936 essay, ‘The Storyteller’; I have substituted ‘instant’ for ‘morning’ and perhaps that is modification enough to make Benjamin's idea absolutely contemporary” (1).The idea of contemporaneity saturates this book, and Rando is at pains to stress the relevance of his comments about the relationality of literature and newsprint to current times: “Modernist novelists are … the first tentative denizens of the information age who responded creatively, and thus, for us, importantly, to a media environment and public orientation toward experience that has by now become quite naturalized” (23). Nearness, contiguity in time and space on multiple levels, is an important thematic concern: there is first the nearness of a page of newsprint, where each story bears little or no relation to the one contiguous to it except a random simultaneity; contrasted to this is the nearness engendered by Benjamin's idea of the anecdote, where authorial specificity “shocks” the reader into an immediate awareness of events in a way that the newspaper never can. In other words, the physical nearness of news stories on the printed page paradoxically results in a distancing and flattening of affect that, for Rando as for Benjamin, is a problem addressed through literature: “[M]odernists perceived a growing distance between news reporting and lived experience, and they developed and honed narrative techniques and an experimental resolve that made nearness and experience defining values. Improving on what the newspaper promised but failed to do, modernist novelists hoped not just to ‘make it new,’ but also to ‘make it near’” (18).To this end, Rando devotes his attention in this slim volume to a “limited” set of literary texts that includes Joyce's Finnegans Wake, Dos Passos's U.S.A., and Stein's three major autobiographical works, as well as the many references to Benjamin's writing, especially from The Arcades Project (20). He invokes Derrida's Archive Fever to theorize about the simultaneous acts of recording and repression involved in modernist literature's desire to be a better record of the times than newsprint could be. Rando's bibliography is both current and theoretically rigorous, and his revisiting of critical texts like Andreas Huyssen's After the Great Divide (1987) revitalizes older works that have already had an important impact on the field of modernist studies.The chapter titled “Nearness” begins Rando's exploration of literary space and Benjamin's understanding of experience. Beginning with the division between erfahrung and erlebnis, Rando explains that the move from the former toward the latter parallels the move from anecdotal, personal storytelling toward nuggets of information for immediate consumption, that is, the news. In this light, modernist fiction's use of the newspaper both as raw material for plot and also as props within stories, becomes a resistance to the assimilative, easy-to-consume nature of news media. Reading Woolf's “The Mark on the Wall,” Rando shows how the narrator's opening refusal to date the story “reclaim[s] an experience in time and an experience of time … [that] will form the antithesis to the newspaper's homogenous, empty time, which is held off until the very end of the story” (40). Narrative twists are tied up with formalist experiments, so that we might identify in Woolf's stream of consciousness style “a sustained fantasy that explanations and facts can be indefinitely suspended, that one might dwell in illegitimate freedom, be released from the illusion that knowledge must be cobbled together from facts, and be exempted from the compulsion to live in the world clocked and charted by homogenous, empty time” (43).Rando suggests that if newsprint can be thought of as the “conscious,” linear, all-inclusive archive, then modernist literature becomes the “unconscious,” immediate, experiential one, working with and against its other, simultaneously imitating its methods even while it questions its claims to superiority and truth. Fiction becomes not simply contra facts but a more invidious version of them. It demands that readers substitute the idle act of empathy, which comes from reading news, for the shock caused by the “pathos of nearness” brought on by anecdotal literature.In the chapter entitled “Scandal,” Rando takes on Finnegans Wake and stresses its anecdotal nature as “a space where experience can emerge with a striking and unexpected intimacy not found in a newspaper, and where history that threatens to become abstract can concretize on a human scale not often found in traditional historiography” (53). Rando's comments on Joyce vis-à-vis Dante recalls some more recent work,1 but avoids convergences between Joyce criticism and genetic criticism.2 Benjamin's idea of the “pathos of nearness,” so central to Rando's own argument, comes from the former's “First Sketches,” for the The Arcades Project, and is itself therefore a tacit invitation to further consider literary revisions as an avenue for criticism. Although Rando does not develop this insight, his work perhaps provides fruitful avenues for further inquiry.In any case, Rando begins his chapter on Joyce and scandal with a discussion of HCE's “incident” in the park and draws on the work of other literary critics, Margot Norris and Wollaeger among them, to point out that the book “embarrasses the desire of news to extract reportable events from personal experience [and brings] scandal from the distant spheres of news into the intimate space of readers” (62). While this part of the chapter might sound familiar to those who have already spent time with the Wake, the second half uses the 1922 murder case against Frederick Bywaters and Edith Thompson and builds on the work of previous critics to demonstrate how Joyce's book of the night can be read as a series of “nested books” (72), the stories within stories loosely contained by the overarching text. The adulterous romance between Bywaters and Thompson nests inside the description of Paolo and Francesca, which is itself framed in the playacting between Glugg (Shem) and Issy, and the passage ends with one finger pointed outward, implicating the audience, with one word of sympathy: “Sowouyou.”3 Rando is best when he stops to dwell in close reading a single paragraph or even a line, and his claim that in each nested story “there exists a moment of pathos in which reports and events fall away and leave unframed experience in their stead, experiences that creep up and spring upon swooning observers” (71) is entirely convincing.Rando's obvious enjoyment in the complexities of Stein and Joyce that open his book poses some danger to the rest of the volume: subsequent texts seem to pale in comparison. He faces this problem in the third chapter, where the discussion of Dos Passos's trilogy is prefaced by the observation that the liquidation of character in the Wake is only one of the ways in which modernism tries to clear a space for itself in the media ecology. Dos Passos “writes characters right on the edge of the news” in a story that has been called “plotless, or propelled forward only by historical circumstances” (74–75). Thus, “[i]f Finnegans Wake denies all abstract contexts that would remove experience from its human scale, then Dos Passos's strategy is much the opposite … characters are seen from [a] great height, almost as mere side effects of news and history” (77). This examination of character leads Rando to deeper insights about language and nationhood that are closely tied to his opening injunction that we look to the modernists' “public orientation toward experience.” In a passage that can equally be read as literary criticism and political commentary, Rando notes, “For Dos Passos, the powerful continue to pervert the radically and distressingly malleable language of America for the purposes of domination, while the powerless seek to reinforce and rebuild the language of freedom upon which America was said to be founded” (86). Linking power, language, and the media ecology together, Rando concludes that “we see different strata of power productively engaged in struggle and disputation of the same single language, in the same way that Dos Passos self-consciously sculpts his narrative out of the common language and media space he shares with the news” (94).Rando's final two chapters, “Identity” and “War,” concentrate on Stein's autobiographical works, The Autobiography of Alice B. Toklas certainly, but more so Everybody's Autobiography and Wars I Have Seen, to show how the anecdotal form is used masterfully to break conventions of autobiographical writing as well as news reporting, so that one is “transformed from the empathetic newspaper reader to one who experiences a pathos of nearness” (111). These two chapters function like mirrors to each other, the first explaining Stein's pains to find an autobiographical mode that has no ending, and the second contrasting war news stories to assert the central truth about war, that it is made up of “endings of all kinds—of stories, of lives, the war, and, finally, Wars I Have Seen itself” (120). It is chiefly and most fruitfully in this last chapter that Rando turns to Derrida's ideas about archive fever, the simultaneous recording and suppressing of experience with which a testament like Wars necessarily engages. Again, Rando brings up the thorny relationship between news media and works of fiction that are forced to share the same media ecology, and shows how War both uses and abuses the techniques of reportage (one of the ironies of a book focused on “being existing,” or lived experience, is that it was marketed as war reportage when first published in 1945, and Rando dwells on the deliciousness of this). If Everybody's Autobiography is a book that is concerned with showing the hollowness of an always-already completed authorial “I” engaging with its own past, War, to Rando, is primarily concerned with ending, a (to quote Benjamin) “Messianic cessation of happening.”4 Of course, in the clash between the “real” and created worlds, there can be no ultimate contest, and Rando considers that fact: “Practically nothing can finally distinguish modernist fiction from news. The privileged sphere of the ‘literary’ is now everywhere and nowhere. The purview of news is finally everything. Between Stein and [war reporter Ernie Pyle] … there is little besides the ability to end, arrest, or stand still that can distinguish them. But it may be that this is no small difference in the age of endless information” (137).Rando's very last chapter is a brief statement he calls “Coda: Make It Now” in which he argues emphatically for the need to presume that “modernism matters most right now, and always has” (143). He cites recent work by Keith Williams and Patrick Collier, as well as Wollaeger, to assert that one must read modernism's questions and comments as relevant to our current perceived crisis in the news media. One cannot resist the rightness of his assertions—I wonder how many modernists would deny that they, at least, find the issues brought up by modernist writers relevant to their own daily, lived experiences. But Rando desires to reach beyond the literary reader, to the socially conscious and politically active one, the reader of works like Tom Fenton's Junk News: The Failure of the Media in the 21st Century (2009), which title he quotes as an example of how relevant modernist anxiety about news media is to the present day. This desire to “make now” some of the most obtuse works of modernist fiction to the field of cultural studies best further commentary. Rando's call to “make it now” strikes most powerfully in an example that he includes in his introduction but never revisits: Toni Morrison's refashioning of the real-life tale of Margaret Garner in Beloved. This novel, as opposed to Finnegans Wake or Everybody's Autobiography, say, is an example of a book that can equally be found in a small lending library or book club as in a classroom or literary investigation. It thus best demonstrates the political angle that Rando is at pains to stress: that the techniques of struggle used by fiction writers against the influence of news media can fruitfully be adapted by contemporary writers as well. Morrison's book is the best example of how Rando's conclusions about Woolf's resistance to reported time, Joyce's flirtations with scandal and immediacy, Dos Passos's refusal of historical determinacy through characterization, and Stein's ambivalence about beginnings and endings might all usefully and accessibly be applied to break the chains of constant and never-ending RSS feeds.Ultimately, this book provides a small Benjaminian shock of warning: it does not do to be glib about the shortcomings of hard-nosed commercial news media. Its strength, however, is when it ignores this larger context and concentrates on the playful, erudite reworkings of ordinary life that make up so much of modernist literature.

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Combat Stress Management and Resilience: Adapting Department of Defense Combat Lessons Learned to Civilian Healthcare during the COVID-19 Pandemic.

Supporting Family Caregivers

Reviewed by: Architecture and Modern Literature by David Spurr Rita Sakr (bio) Architecture and Modern Literature, by David Spurr. Ann Arbor: University of Michigan Press, 2012. xi + 285 pp. $85.00 cloth; $30.00 paper. David Spurr’s Architecture and Modern Literature is in many ways monumental. It opens with a statement of its aims and parameters as an exploration of “a series of instances in which architecture and modern literature come together in ways that appear to break down the barriers between the two art forms, or at least to construct bridges between them,” while investigating “the manner in which the relations between architecture and literature are symptomatic of modernity as a crisis of meaning” (3, 6). The project thus appears both conceptually broad and well defined while it achieves two specific intellectual feats. On the one hand, the study constructs bridges not merely between architecture and literature but rather more widely, if largely implicitly, across literature, architecture, urban studies, cultural geography, art history, philosophy, psychoanalysis, ethics, and modernist studies. Perhaps the author could have further clarified the different directions of this complex interdisciplinarity and made it a more explicit component of his work. Nevertheless, it could be argued that formulating these disciplinary intersections more elaborately would have made Spurr’s study too theoretically dense and less pleasurable to read than it is. Moreover, Architecture and Modern Literature displays not only a fascinating understanding of cultural forms and fields (ranging from Babel and The Odyssey to “junkspace” and “non-lieu” and passing through The Inferno and The Arcades Project1) but also an ability to weave together architectural theory, philosophical principles, psychoanalytical insights, seminal spatial/geographical thought, and close readings of literary works (novels, poetry, and some drama). On the other hand, this study ambitiously traces the vast cultural time-space of modernity and modern literature across two centuries, while projecting its own view of modern literature and architecture’s particular horizons and transformations. Seeking to explore an originary moment for modernity, Spurr argues that [a]mong the effects of an emerging modernity in this period [late eighteenth and early nineteenth centuries] are a variety of manifestations that call both literary and architectural meanings into question. These include the aesthetic of the fragment, the value placed on subjective interiority, the significance given to the human body, the development of new materials and techniques, and a conception of the past in terms of stock or reserve. (28) It is hard to agree or disagree with the specific periodization of the [End Page 701] modern in literature and architecture proposed here because of the complex aesthetic and historical questions at stake. More interestingly, the parameters of intersecting transformations and concerns, as outlined in the “variety of manifestations” above, are very well substantiated in the book’s eight chapters. Referencing Martin Heidegger, Walter Benjamin, and Le Corbusier among others, the first chapter shows that literature’s approaches to “dwelling” have gone through several stages: “nostalgia” in the nineteenth century gave way to a “narrative and rhetorical” release from that phase as “a new consciousness of urban space” emerges “finally to a renewed confrontation with the absence of dwelling, where modern writing strives to relieve the misery of homelessness by giving thought to it” (54, 54-55). This argument is developed through readings of Charles Dickens, Marcel Proust, James Joyce, Virginia Woolf, and Samuel Beckett. The comparisons among the modernists here are presented succinctly: “If architecture figures in Proust as a metaphor of inner desire, it figures in Joyce as the concrete embodiment of modernity itself. Ulysses is a work that gets its characters out of the house and into the street, where they are confronted not with dwelling in its domestic sense but with their existence in urban space, the very scene of modernity” (63). In this context, Spurr wisely advises us not to confuse literary modernism, by Joyce and Woolf especially, with the “utopian manifestos of modern architecture in particular” (66). These themes are linked in many ways to the seventh chapter in which Spurr presents a primarily Heideggerian reading of building, dwelling, ruins, and the void in Robert Frost and Wallace Stevens: prominent cultural-geographical topics that Spurr revisits with...

Reviewed by: Travel and Modernist Literature: Sacred and Ethical Journeys David Farley Travel and Modernist Literature: Sacred and Ethical Journeys. Alexandra Peat. New York: Routledge, 2010. Pp. xi + 197. $125.00 (cloth). Traveling the roads of Southern France in the summer of 1912 and feeling both mentally and physically exhausted by the time he reached Chalus, Ezra Pound gleaned an important truth about the spiritual lives of the troubadours. He felt that the difficult material conditions of travel during the middle ages were enough to cause them to envision the landscape of the afterworld, salvation for oneself and hell for one's enemies.1 That spirituality during this earlier religious age had real, lived conditions as its source was significant for Pound, for whom travel was such an important part of his subsequent poetic development. [End Page 216] The connections between movement, modernism, and spirituality are likewise at the center of Amanda Peat's fine new book, Travel and Modernist Literature. By attending to the real conditions of the modern world evinced through travel, she suggests, we can trace the contours of a spirituality that has been eclipsed by the secularism of modernity. Peat focuses in particular on the trope of the pilgrimage as it appears in various modernist novels. Whether these pilgrimages are real or imagined, whether this spiritual stance is sincere, nostalgic, or ironic, Peat provides us with a fresh vocabulary, taken from travel studies, that helps us read these works anew and think again about the ways in which lived conditions and representation inform one another. Peat's analysis of the pilgrimage motif derives from E. Alan Morinis's taxonomy of the pilgrimage from his 1992 collection Sacred Journeys: The Anthropology of Pilgrimage.2 She starts off by putting Virginia Woolf's The Voyage Out, E. M. Forster's A Room with a View, and Rose Macaulay's The Towers of Trebizond into conversation in the context of the "initiatory pilgrimage," showing how by focusing on female travelers these authors rewrite and critique the gendered nature of the traditional pilgrim narrative. This revision and critique ultimately resists the conventional teleology of the pilgrimage. Such resistance is evidenced again in the second chapter, in which Peat looks at Forster again, this time A Passage to India, and Henry James's The American and The Ambassadors, seeing these works as evidence of the "acquisitive pilgrimage." In Morini's terminology, "acquisitive" connotes a modern consumerism that emerges in the context of the rise of the tourist industry, and Peat argues convincingly how these authors substitute for the act of acquisition the holier act of renunciation. In the third chapter, Peat examines Ernest Hemingway's The Sun Also Rises, F. Scott Fitzgerald's Tender is the Night, and Claude MacKay's Banjo, focusing on the concept of the expatriate through the lens of the "wandering pilgrimage." She shows how this "mobile expatriatism" illuminates questions of nationality, individual identity, and community, arguing that the expatriate experience doesn't simply replicate a Eurocentric cultural hegemony overseas but acts as a site where cultures collide in ultimately redemptive ways. Finally, Peat looks at Jean Rhys's Voyage in the Dark, Evelyn Waugh's A Handful of Dust, and Joyce Cary's To Be a Pilgrim, as well as Woolf's The Years as "imaginary pilgrimages," where the concept of "home" in the context of empire is interrogated and ultimately transformed in "the postcolonial moment" (132). Although Peat builds her book on a borrowed terminology, this allows her to engage issues and critical approaches that are germane to both modernist and travel studies. Central to her argument about the initiatory pilgrimage, for instance, is a discussion of the role and concerns of women travelers in the traditionally gendered genres of travel writing and the bildungsroman, and in her section on the acquisitive pilgrimages she draws on critical work on the rise of the tourist industry and the figure of the tourist. If this study seems more about spirituality than about actual travel and the lived conditions of modern travel, for Peat the former cannot be rightly understood without reference to the latter. In stating her goals, Peat urges us to see travel fiction as a...

Reviewed by: Moonlighting: Beethoven and Literary Modernism by Nathan Waddell Alexander Carpenter Moonlighting: Beethoven and Literary Modernism. By Nathan Waddell. Oxford: Oxford University Press, 2019. [xiii, 248 p. ISBN 9780198816706 (hardcover), $85; also available as an e-book, price varies.] Bibliography, index. Approaching Nathan Waddell's Moonlighting: Beethoven and Literary Modernism, a reader might reasonably wonder, Is this a work of literary criticism or a musicological study? Happily, it is both. The book offers an account of Beethoven's influence on early modernist writers that integrates close readings of literature with the Anglo-German musicology and music criticism of the nineteenth century, in working toward an understanding of how the "Beethovenian" shaped the development of literary modernism. Moonlighting develops its argument through five substantial case studies, each focusing on different musical pieces and aspects of Beethoven's legacy as they appear in the writings of a cadre of important early modernist writers, including E. M. Forster, Virginia Woolf, Aldous Huxley, Wynham Lewis, Dorothy Richardson, and Rebecca West. Waddell argues that, while most "musico-literary" studies that focus on Beethoven and modern literature seek to explore the resemblances—the "structural analogies" (p. 1)—between musical works by Beethoven and literary texts, Moonlighting instead focuses on how the Beethoven legend, and the conventions of representation it engendered, fed the imaginations of early modernist writers. These writers, Waddell insists, "knew Beethovenian legend when they saw it . . . and were eager to use it" (p. 1). Waddell prefaces his case studies with a massive introductory chapter: at 46 pages and 148 footnotes, it is by far the longest and densest section of the book. In this introduction, Waddell not [End Page 604] only lays out the argument of Moonlighting but also takes on modernism as a whole, challenging notions of "anti-traditionalism" as central to modernism. He also deconstructs the long-standing musicological convention of dividing Beethoven's oeuvre into three periods—"tradition, to individualism, to transcendence" (p. 5)—and suggests that this taxonomy gives rise to the decisive interpretation of Beethoven's music as embodying a heroic struggle (the topic of the subsequent chapter). Waddell compares and contrasts the influence of Wagner and Beethoven on late nineteenth and early twentieth-century culture and then concludes his introduction with a turn to Beethoven reception in fin de siècle Vienna, discussing Max Klinger's 1902 Beethoven statue and Gustav Klimt's Beethoven Frieze as exemplars of "versions" of Beethoven inherited from the nineteenth century and focusing on the establishment of what he calls a Beethovenian "routine" or "habit." Modernist writers, Waddell asserts, were able to "avail themselves of Beethovenian routine to establish intimacy between writer and reader," since readers also knew and understood the "norms and customs" of the "Beethovenian habit" (p. 36). Waddell centers his first chapter, "The Idea of the Heroic," on Howard's End by E. M. Forster and on the book's double-fictionalization of the Beethoven myth—that is, on how Forster's characters themselves filter Beethoven's music through the conventions of the heroic narrative. Waddell's study of Howard's End identifies a fundamental tension within the novel "between two kinds of convention: on the one hand, the claim that certain Beethoven compositions depict or encode heroic experiences . . . and on the other, the assumption that a heroic explanation of this music represents an unmediated way to explain its value" (p. 52). This tension, as Waddell demonstrates, is complicated and intensified by the fact that Forster imposes another layer of mediation—a not wholly reliable narrator—on this whole process. The chapter concludes with Waddell's claim that Howard's End is a "musicological document" by dint of its tacit criticism of and "intervention into the very terms of the nineteenth-century musicology which authorized" the idea that Beethoven's music is heroic, that it is "'about' struggle, defeat, endurance, overcoming" (p. 72). In chapter 2, "Eloquent Citations," Waddell stays with E. M. Forster, shifting to address "A View without a Room" (the 1958 postscript to his 1908 novel A Room with a View) alongside Wyndham Lewis's novel Tarr and Virginia Woolf's Jacob's Room. In this chapter, he turns to Beethoven's "Moonlight" Sonata. As one...

There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.

Managing disruptive behaviors in the health care setting: focus on obstetrics services

Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review.

Seventy-five patients who had a clinically diagnosed disabling disease and who usually had difficulty with one or more activities of selfcare were identified in a 10-month survey of the acute wards of a large teaching hospital. Their dependence on assistance for specific activities at home and in the acute wards was recorded by a research nurse in interviews carried out in the patient's home within two weeks of hospital discharge. The study showed that although most of the disabled patients were able to continue with their daily selfcare activities, their increased dependence on assistance in hospital in comparison with their home was often due to limitations in the provision and use of ward facilities. The effects of these limitations on the selfcare of disabled patients are illustrated. It is concluded that disabled patients would enjoy greater independence in selfcare activities in acute wards and could be less dependent on nursing staff if there was improvement in ward design and the provision of aids and equipment whilst the abilities of disabled patients for selfcare were recognised by ward staff.

<p>This phenomenological study describes what it is like for people over 74 years to experience nursing care in acute medical and surgical wards, and relates their insights to implications for nursing practice. The six people who took part responded to newspaper stories inviting older people who had been in hospital recently to speak with a nurse researcher about the times they spent with nurses. They included eight episodes of hospitalisation in seven acute care public hospital wards. All chose to be interviewed in their own homes. The approach followed van Manen's (1990) method for researching lived experience. Their stories are contained in this thesis as individual chapters. The analysis moved from description largely in the respondents' own words, to the researcher's portrayal of the "free act of seeing" resulting in explication of salient features or structures of each story, and then to hermeneutic reflection using the four existentials of lived body, lived space, lived time and lived relation to others. Aggregation of the concerns revealed in each story illuminates the commonalities and differences of each and uncovers aspects of lived care for these people. Notions of care may be experienced negatively, as when care is absent or deficient in meeting patient need and expectation, or positively as when care is fully realised in the nurse-patient encounter. Nursing which includes negotiating the systems, mediating interpersonal issues, and practical help was excellent care for these patients. Value was given to the ability to quickly evaluate a patient's life ways of being and acknowledge these as of equal importance to the expected health outcomes from the particular medical diagnosis and intervention. The description of older people's experience of nursing care is useful for the potential to increase understanding of the needs and expectations of older people in acute wards. Through the phenomenological practice of reflecting and re-writing new perspectives on nursing are developed. These are expressed through myth and metaphor as one means of enhancing the caring work of nursing toward older people. The study offers some implications for nursing education, practice and the organisation of health (illness) care.</p>

<p>This phenomenological study describes what it is like for people over 74 years to experience nursing care in acute medical and surgical wards, and relates their insights to implications for nursing practice. The six people who took part responded to newspaper stories inviting older people who had been in hospital recently to speak with a nurse researcher about the times they spent with nurses. They included eight episodes of hospitalisation in seven acute care public hospital wards. All chose to be interviewed in their own homes. The approach followed van Manen's (1990) method for researching lived experience. Their stories are contained in this thesis as individual chapters. The analysis moved from description largely in the respondents' own words, to the researcher's portrayal of the "free act of seeing" resulting in explication of salient features or structures of each story, and then to hermeneutic reflection using the four existentials of lived body, lived space, lived time and lived relation to others. Aggregation of the concerns revealed in each story illuminates the commonalities and differences of each and uncovers aspects of lived care for these people. Notions of care may be experienced negatively, as when care is absent or deficient in meeting patient need and expectation, or positively as when care is fully realised in the nurse-patient encounter. Nursing which includes negotiating the systems, mediating interpersonal issues, and practical help was excellent care for these patients. Value was given to the ability to quickly evaluate a patient's life ways of being and acknowledge these as of equal importance to the expected health outcomes from the particular medical diagnosis and intervention. The description of older people's experience of nursing care is useful for the potential to increase understanding of the needs and expectations of older people in acute wards. Through the phenomenological practice of reflecting and re-writing new perspectives on nursing are developed. These are expressed through myth and metaphor as one means of enhancing the caring work of nursing toward older people. The study offers some implications for nursing education, practice and the organisation of health (illness) care.</p>

Jeong S, Inoue Y, Kondo K, Matsumoto D, Shiraishi N. Formula for predicting FIM for stroke patients at discharge from an acute ward or convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2014; 5: 19-25. Objective: To develop formulas for predicting Functional Independence Measure (FIM) at the time of discharge from an acute or convalescent hospital ward using multicenter data. Methods: Data from 4,311 acute patients (22 hospitals) and 1,941 convalescent patients (24 hospitals) were divided into two groups (calculation group and verification group). Multiple regression analysis was performed to develop formulas for predicting discharge FIM and test their validity with data from the verification group. Results: The formula derived for predicting discharge FIM for acute patients was 85.04 + (-0.53 × age) + (12.06 × subarachnoid hemorrhage) + (-7.90 × complication present) + (-0.70 × number of days from onset of stroke until admission) + (1.24 × admission GCS) + (-1.08 × admission NIHSS) + (-4.15 × modified Rankin Scale score before stroke) + (0.30 × admission motor FIM) + (1.03 × admission cognitive FIM), with R2 = 0.78. The formula derived for predicting discharge FIM for convalescent patients was 33.04 + (-0.34 × age) + (-3.88 × complication present) + (-0.11 × number of days from onset of stroke until admission) + (2.44 × admission GCS) + (-1.68 × modified Rankin Scale score before stroke) + (0.53 × admission motor FIM) + (1.25 × admission cognitive FIM) (R2 = 0.66). Conclusion: Using a large multicenter database, we developed separate formulas for predicting FIM at discharge from an acute ward and from a convalescent ward with proven external validity.