Dr Obrey Alexis

Purpose Prostate cancer is a leading cause of death in black men in the United Kingdom (UK). Evidence suggests that unmet supportive care needs are prevalent in contemporary healthcare, particularly for men with advanced prostate cancer, whilst less has been written specifically about the supportive care needs of black men. Therefore this study will examine black men’s experiences of support following prostate cancer treatment in England.

Method A qualitative research design was employed. Twenty black African and black Caribbean men were interviewed on a face-to-face basis to obtain insightful information about their experiences of prostate cancer. Interviews were recorded and transcribed. Data were analysed using thematic analysis which allowed for emergent themes.

Results In this study there were six emergent themes. These were: dealing with the treatment effect, support from loved ones, individuals and organisations, healthcare support, spirituality, and positivity. Black men used different coping strategies to deal with the side effects of treatment.

Conclusion Black men experienced a range of supportive care needs. Some men felt that their individual needs as black men were not met by healthcare professionals, although no specific reasons were forthcoming as to why they felt this way. Healthcare professionals should be aware of the support mechanisms that black men have used throughout the prostate cancer journey and to consider these approaches when treating and caring for black men.

This article documents the different forms of advocacy and highlights the importance of advocacy in the UK health- and social-care settings. It draws on a number of elements related to advocacy to demonstrate the challenges that nurses may encounter. Moreover, it identifies the skills and knowledge that nurses may use as being advocates for patients/clients and their families. The article makes a strong argument by highlighting that nurses are essential advocates and are duty-bound to adhere to their professional code of conduct. The Nursing and Midwifery Council (NMC) Code clearly states that nurses must ensure that patients/clients and their families are protected, respected, treated with dignity, and are given the highest standard of person-centered care. This article has considered these in relation to nurse advocacy.

Background: Psychological issues usually accompany the pregnancy of first-time mothers and psychoeducational interventions might be effective in addressing these concerns and preparing first-time mothers for childbirth and the postnatal period. This study aimed to identify, analyse and synthesise the components as well as determine the effectiveness of psychoeducational interventions that are used for managing psychological issues and enhancing birth preparedness among primigravid women or couples in LMICs.

Method: A systematic search of 12 databases (APA PsycINFO, Emcare, Embase, MEDLINE(R), Ovid Nursing, British Nursing Index, Health and Medical Collection, ProQuest, CINAHL, Cochrane, Hinari and PubMed) was conducted to identify relevant studies published between 1946 and October 2021. Quality of the included studies was appraised by the JBI critical appraisal tool and a narrative synthesis was conducted to analyse data extracted from included articles. The systematic review protocol is registered with PROSPERO (CRD42021237896).

Findings: The initial search yielded 8,658 articles. Sixteen articles including seven randomised controlled trials and nine non-randomised trials met the inclusion criteria and were selected and reviewed for quality. Thirty-nine outcomes were measured in the studies including psychological outcomes, birth preparedness outcomes and other outcomes. The design of the interventions included antenatal education that was delivered through lectures, role plays, trainings, and antenatal counselling. All the psychoeducational interventions had a significant effect (p d or Hedge’ g = 0.2 to 1.9) on certain psychological outcomes including childbirth attitude, fear of childbirth, depression, fear, and anxiety and birth preparedness outcomes.

Interpretation: Although first-time mothers experience a range of psychological issues during pregnancy, psychoeducational interventions were beneficial in addressing their psychological concerns. It would appear that these interventions are less expensive and could be easily implemented in LMICs. However, rigorous research like RCTs are hereby warranted to standardise the interventions and outcome assessment tools.

Purpose: To synthesise findings from published studies on barriers and facilitators to Black men accessing and utilising post-treatment psychosocial support after prostate cancer (CaP) treatment.

Methods: Searches of Medline, Embase, PsycInfo, Cochrane Database of Systematic Reviews and Central, CINAHL plus and Scopus were undertaken from inception to May 2021. English language studies involving Black men aged ³18 and reporting experiences of, or suggestions for, psychosocial support after CaP treatment were included. Low or moderate quality studies were excluded. Searches identified 4,453 articles and following deduplication, 2,325 were screened for eligibility. Two independent reviewers carried out screening, quality appraisal and data extraction. Data were analysed using thematic synthesis.

Results: Ten qualitative studies involving 139 Black men were included. Data analysis identified four analytical constructs. Experience of psychosocial support for dealing with treatment side-effects (including impact on self-esteem, fear of recurrence); barriers to use of psychosocial support (such as perceptions of masculinity, stigma around sexual dysfunction); facilitators to use of psychosocial support (including the influence of others and self-motivation); and practical solutions for designing and delivering post-treatment psychosocial support (the need for trusted healthcare and cultural channels).

Conclusions: Few intervention studies have focused on behaviours among Black CaP survivors, with existing research predominantly involving Caucasian men. There is a need for a collaborative approach to CaP care that recognises not only medical expertise, but also the autonomy of Black men as experts of their illness experience, and the influence of cultural and social networks.

Racially and ethnically minoritised healthcare staff groups disproportionately experience and witness workplace discrimination from patients, colleagues and managers. This is visible in their under-representation at senior levels and over-representation in disciplinary proceedings, and is associated with adversities such as greater depression, anxiety, somatic symptoms, low job satisfaction, and sickness absence. In the UK, little progress has been made despite the implementation of measures to tackle racialised inequities in the health services. So, what is it about the health service organisational context which shapes and maintains such inequities, and what role does discrimination, bullying and harassment play? Drawing on qualitative interviews with 48 healthcare staff in London (UK), we identify how micro-level bullying, prejudice, discrimination and harassment behaviours, independently and in combination, exploit and maintain meso-level racialised hierarchies. Within teams, the high diversity-low inclusion dynamic shaped and was perpetuated by in- and out-group inclusion and exclusion processes (including ‘insidious dismissal’) often employing bullying or microaggressions. These were linked to intersecting factors such as race, ethnicity, migration, language and religion, and could increase segregation. For racially and ethnically minoritised groups, ingroup maintenance, moving teams or leaving were also ways of coping with organisational inequities. We discuss implications for tackling racialised workplace inequities.

Postpartum Depression (PPD) is highly prevalent among women in low and middle income countries (LMICs). World Heath Organization has recognised interpersonal Psychotherapy (IPT) as the first line treatment for the postpartum depression. The primary aim of this review is to evaluate the effectiveness of IPT alone or in combination with pharmacotherapy or other psychosocial therapies for treating depressive symptoms in women with postpartum depression. The generated evidence from this review will help to inform policies in relation to the treatment of postpartum depression in LMICs.

Aim. Black African and black Caribbean men are two to three times more likely to be diagnosed with prostate cancer compared with white men, and some appear to have little knowledge of the disease. The aim of this study was to examine black African and black Caribbean men’s understanding and experience of prostate cancer post-treatment and to create a video to raise awareness in the African and Caribbean communities of the importance of testing.

Method. In total 20 black African and black Caribbean men were interviewed using a qualitative approach and the data were analysed thematically.

Findings. There was a lack of knowledge and understanding of prostate cancer among the study sample, who were also sometimes exposed to misinformation within the black community, including herbal remedies. Some participants believed their racial features were a barrier to the way in which limited information was shared with them by healthcare professionals.

Conclusion. There is a need to raise awareness about prostate cancer in black communities to educate men about the disease and its effects. Additionally, evidence-based information about the disease is required to educate black men and to reduce the effects of misinformation and herbal remedies on their well-being. In the health sector, unconscious bias should be recognised, addressed and avoided to ensure inclusive and person-centred care regardless of ethnicity.

Background: Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However,
many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management. Aim: To identify the barriers and enablers that influence nurses’ adherence to the principles of ANTT during wound care. Method: A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised. Findings: A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses’ behaviour. Conclusion: Nurses’ compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.

Purpose. To synthesize literature in order to elucidate the experiences of men who have survived testicular cancer and determine their quality of life following treatment. Methods. An integrated review sought appropriate literature by utilising a keyword search across seven databases. Retrieved studies were appraised for quality, with two qualitative, twelve quantitative, and two mixed method studies deemed appropriate for this review. The data were extracted and aggregated into categories by way of a thematic analysis. The themes were: personal challenges and impact on health, psychological and emotive challenges, perception of reproduction and sexual changes, and outlook and support. Results. Men experienced physical, emotional, and sexual difficulties. Some men believed they were infertile, despite evidence that fertility is not compromised in the long term. Psychological conditions can be exacerbated by cultural pressures to conceive and cultural expressions about male identity. Men who had undergone orchidectomy reported minimal impact on their mental health than the men who had chemotherapy or radiotherapy as part of their treatment modality.  Sexual dysfunction caused by chemotherapy-associated side effects was detrimental to men’s quality of life. In addition, men who had a partner, who were employed, and who had children were able to adjust better after treatment than those who did not. Provision of clear and honest information post-treatment helped testicular cancer survivors return to their normal lives. Conclusions.
The evidence from the review suggests that the burden of disease for testicular cancer survivors is overall low. Men who had surgical intervention and were treated for testicular cancer experienced minimal impact on their mental health status than the men who had chemotherapy or radiotherapy as part of their treatment modality. Implications for Cancer Survivors. There is a need to provide appropriate referrals to the relevant services, including psychosocial support, and the development of more adequate communication resources for men following treatment for testicular cancer.

Objective: To explore adjustment strategies adopted by Black African (BA) and Black Caribbean (BC) men in the UK as a response to the impact of PCa diagnosis and treatment effects.
Methods: Men were recruited through the UK-wide ‘Life After Prostate Cancer Diagnosis’ (LAPCD) survey. Telephone interviews were conducted with men (n=14) with BA and BC backgrounds between 18-42 months post-diagnosis. Data were analysed using a Framework approach.  
Results: Most men (n=12) were born outside the UK, were married (n=9) and employed (n=9). Median age was 66 years (range: 55-85). Six overarching themes emerged: a strong reliance upon faith beliefs; maintaining a ‘positive’ front; work as distraction; non-disclosure of diagnosis even amongst family members, influenced by stigma and masculinity concerns; active awareness-raising amongst a minority, and; support-seeking from close community. A few men emphasised a need to ‘pitch’ awareness-raising messages appropriately. Potential links existed between faith beliefs, presenting a positive front, community support-seeking and local awareness-raising.
Conclusion: The provision of patient-centred care requires cultural sensitivity. Interventions that challenge stigma and mens’ reluctance to disclose problems associated with PCa and treatment may encourage help-seeking for symptom support. Research is needed to determine how best awareness-raising messages should be conveyed to black men.  

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

Objective. The number of younger men being diagnosed with Prostate cancer (PCa), (aged ≤65) is increasing. It is recognised that PCa and treatment side effects can have a significant impact on quality of life. This study explores the challenges faced by younger couples affected by PCa with dependent children (under 18 years) or young adults (18-29 years) in their families. Methods. Twenty-three men with PCa and their partners were interviewed (separately) by telephone. Participants were recruited from respondents to the Life After Prostate Cancer Diagnosis (LAPCD) national survey. Men were three to five years post-diagnosis, and following a range of treatment pathways. Data were analysed using the Framework approach. Results. Younger couples affected by PCa felt challenged by issues relating to their parental role and the dynamics within the family. Five main themes emerged: difficult conversations about PCa diagnosis; parental perceptions of the impact of diagnosis on children; parental responses to the impact of PCa on the family; shielding, coping and normalising strategies; and levels of support. Conclusions. A diagnosis of PCa can cause significant disruption to the family unit and the quality of life of its members. Support programmes offering guidance to children/young adults affected by PCa in their family, and addressing the concerns of parents may help families to better adapt. Encouraging clinical professionals to initiate conversations with younger couples about their children may be a way forward in directing appropriate support. Further research is needed to elucidate appropriate, effective supportive interventions.

Purpose: To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa).
Methods: A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare’s meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations.
Results: Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/or each other from the impact of PCa. Being a partner and its challenges highlights the responsibilities partners assume and the impact of their supporting role. Yet, partners sometimes report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals. Couples often recognise the value of facing PCa together.
Conclusions: PCa affects both members of the dyad as individuals, as well as the couple’s relationship. How best to support couples and how to overcome difficulties in expressing their concerns to one another requires further consideration. Healthcare professionals should endeavour to employ a couple-focused approach where appropriate.

Prostate cancer is the most commonly diagnosed cancer in men in the UK, with 46 690 new cases in 2014. While there is sufficient research on this topic in the USA, there is no review in the UK regarding both black men and their significant others’ perspective on prostate cancer screening. Aim: To identify and explore factors that may influence black men and their significant others’ knowledge and awareness of prostate cancer screening. Method: A literature search revealed seven relevant articles. Results: Six of the seven articles were conducted in the USA. The results are described using four themes: perception of prostate cancer screening, fear,

anxiety and discomfort, misinformation about prostate cancer screening procedures and communication and decision-making. Conclusion: The evidence suggests that some black men and their significant others had knowledge and awareness of prostate cancer screening. However, their views were influenced by misperceptions, misinformation, fear and anxiety

around screening procedures and mortality. Communication and spousal support were important in decision making.

Objective: To report a meta-synthesis of qualitative studies exploring men’s sense of masculinity following treatment for prostate cancer.
 

Interventions/Methods: Six databases were searched to identify relevant studies conducted and published between Jan 1990 and Aug 2016. Titles and abstracts were reviewed by two reviewers. Studies that met the inclusion criteria were selected and reviewed for quality. The extracted data was then synthesised. 
 

Results: A total of 14 studies met the inclusion criteria and passed the quality assessment. The meta-synthesis found that men’s sense of masculinity diminished following treatment for prostate cancer. Impotence, incontinence, the loss of control and physical changes caused psychological stress. Underpinning these factors were cultural influences and dominant ideals of what it means to be a man. 
 

Conclusions: Men had entrenched ideas about what manhood entailed. The review found that men’s sense of masculinity was diminished post treatment for prostate cancer. They felt that they could not exercise their manliness because of the side effects associated with prostate cancer treatment.
 

Implications for Practice: More support and communication throughout the process is required to better inform patients of the outcomes of treatment. Additionally, it would be beneficial to have open forums through which to encourage men to talk frankly about their masculine identities.

Over the past few years, there has been an impetus to recruit internationally registered nurses to work in the National Health Service (NHS) to avert the labor shortage inherent in the United Kingdom.

Purpose

To determine internationally registered nurses' perception of discrimination, support, and their adjustment to a new environment in the NHS in England.

Methods

A descriptive survey was used. Data were collected from 188 internationally recruited nurses using a questionnaire approach from 15 National Health Service hospitals in England. Data were analyzed using chi-square, Fisher exact, or Kruskal-Wallis tests.

Results

The study had a 21% response rate. There were 81.9% females and 18.1% males who participated in the survey. A mean score of 7.55 and standard deviation of 6.82 were calculated for the number of years of experience of working in the NHS. The findings revealed many statistical differences between the different ethnic groups used in the study. Generally, internationally recruited nurses from Africa, in particular, perceived discrimination to be evident in the workplace, the support they received was limited, and their adjustment to a new environment was the weakest in comparison with the other internationally recruited nurses from the different data sets.

Conclusion

Although the needs of all internationally recruited nurses should be considered, it would appear that the needs of African nurses are the greatest because the study found that they experienced challenges in the working environment in the NHS.

Health care or nursing assistants are valuable members of health care teams who undertake a wide range of tasks, contribute to meeting the increasingly complex healthcare needs of patients and have various levels of training. However, they are not subject to regulation in many countries. If training and regulation are pre-requisites for ensuring the standards of care delivered by registered nurses, then this must also apply to nursing assistants. Regulation ensures the need for on-going education and development which is critical to maintaining and refreshing the values underpinning compassionate care for both nursing assistants and registered nurses.

Aim: To explore the perceptions and work experiences of internationally recruited neonatal nurses. Background: Neonatal nursing and health care are global issues facing developing and developed countries. In the UK, the recruitment of international nurses to address the labour shortage is not a new phenomenon. Methods: A purposeful sample was drawn from internationally recruited neonatal nurses, working at two teaching hospitals in London. Husserl" s phenomenological approach underpins this study. Thirteen nurses, (all female) participated in the study and semi-structured face-to-face interviews were conducted to capture the unique perceptions and experiences of neonatal nurses at two hospital sites. A qualitative approach was adopted and this study used Colaizzi" s analytical framework to analyse the data. Results: The analysis of the data resulted in four themes namely the support mechanisms, unfamiliarity with family centred care, feelings of being treated like a child and coping strategies. Conclusion: It can be concluded that in recruiting internationally recruited neonatal nurses to work in the NHS, there is a need to support them, encourage them to become familiar with family centred care and they should be treated as qualified nurses. Therefore, there is a need to consider these findings in any recruitment process involving neonatal nurses. Relevance to clinical practice: Internationally recruited neonatal nurses play an important role in caring for neonates in the NHS in the UK however meeting their needs have not always been addressed in the health care setting.

This paper presents an analysis based on the recently recruited overseas nurses in the NHS in the United Kingdom [UK].

Objectives

The aims of the study were to determine how overseas nurses perceive equal opportunity as well as the opportunities for skill development and training to be in the National Health Service [NHS] in the UK.

Methods

A survey approach was adopted to investigate the aims of the study. There were 900 questionnaires distributed of which 188 were suitable for the study, thus giving rise to 21% success rate.

Results

The findings revealed many statistical differences between the different ethnic groups used in the study. Overall, overseas nurses from Africa perceived equal opportunity and their prospect for skills development and training to be different to that of their overseas counterparts. In addition the results showed that African nurses were less likely to view their experiences positively particularly if they were not working in any of the NHS trust hospitals in London.

Conclusion

It is important to say that equal opportunity as well as opportunities for skills development and training should be universal within the NHS as this could improve the inequitable treatment that is apparent throughout the UK. There is a need for NHS trust hospitals in the UK to review their equal opportunity and skills development and training policies in the light of these findings.