Beverley Burrell

People with advanced cancer often experience significant emotional turmoil that accompanies their diagnosis and cancer-related treatments. Therefore, psychological interventions become relevant to address these impacts; however, there is a lack of research into the psychological support needs of those with advanced cancer (those not yet in palliative or end-of-life stages). In this context, we developed a mindfulness-based intervention, Coping with Cancer Mindfully (CCM), to provide psychological and emotional support to adults with advanced cancer. This article reports on qualitative interviews from a mixed method study of the CCM intervention exploring its utility and the extent it provides psychological support to this population in a pre-post-intervention design.

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.

Aim: The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older.Background: The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self‐management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease‐specific.Design: Quantitative systematic review.Review methods: Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods (EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for assessing the weight of evidence.Data sources: Medline, CINAHL, PubMed and PsycINFO 1999–2014.Results: Twelve studies were included in the review (n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization.Conclusion: While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low.

BURRELL B and TRIP H. Nursing Inquiry 2011; 18: 174–183Reform and community care: has de‐institutionalisation delivered for people with intellectual disability? In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing ‘Prisons of protection’ and moral treatment. Secondly the paper traces reforms commencing in the 1960s where changes from institutional care to community care were informed by humanistic ideals, a key driver being the concept of normalisation. Theorists offered competing discourses that formed the bases of arguments for the status quo whilst resistant voices advocated change. Covering such significant changes leads us to assess the state of de‐institutionalisation’ as it stands today and how it may be perceived in the future. We assert that Foucault’s genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de‐institutionalisation we question whether a form of re‐institutionalisation may be occurring.

The aim of this study was to examine women's reports of negotiation and decision-making regarding use of menopausal hormone therapy after hysterectomy. Women who have experienced surgical menopause have more intense menopausal symptoms than women who have natural menopause and are often prescribed menopausal hormone therapy. Over the past decade acceptance of use of menopausal hormone therapy has been challenged by publications indicating its associated risks. Foucauldian discourse analysis was used to examine the discourses influencing women's experiences of early menopause precipitated by surgery and their decision-making regarding the use of menopausal hormone therapy. The project investigated via semi-structured interviews the perceptions and experiences of 30 New Zealand women aged 45–65 years who had undergone surgical menopause. The predominant discourses within which the participants' descriptions of their experience were embedded were: (a) new public health, (b) medical, and (c) lay moral judgment. Their health keeping/management practices were influenced by moral imperatives for quality of life, managing risk, and taking care of oneself. The use of menopausal hormone therapy for surgical menopause provides an example of the infiltration of public health discourse into lay judgments and influenced people to identify potential lifestyle problems and direct them to medicine and pharmacology as moral imperatives; and how women resist these discourses in various/particular ways.

A Foucauldian discourse analysis is employed to identify how our current understandings of menopause are culturally and historically determined by medical discourse. The polarity of the normal and the abnormal (pathological) became the crux of medical deliberation, where deviation from norms becomes the reason for intervention. Through manifold relations of power and the 'struggle of knowledges' medicine derives social authority, influencing social orthodoxies thus normalising menopausal women via discursive constructs. The course of nature in ageing women has been re-categorised as unnatural. In using the case of hormone therapy (HT) and the emergence of bio-identical or natural hormones, while deconstructing the premises used in marketing both types of hormone therapy, the tenuousness of scientific claims about these hormones is revealed. Discourses on bio-identical hormones (BHT) display a reliance on seemingly opposing naturalist and scientific arguments. Menopause, having been constructed as a deficiency disease, required initially chemical hormone replacement and now bio-identical hormones replacing the mainstream medical solution. The idea of the postmenopausal state as diseased is perpetuated as the basis to suggest therapies to women. This paper suggests that although therapeutic in a few cases, hormone preparations are in fact potentially dangerous lifestyle drugs.