Background Knee pain and related disability are important public health problems worldwide. In a systematic review, the prevalence of knee pain varied between 2.4% to 49.2% worldwide and disabilities were greater in those with knee pain compared to those without. The prevalence of knee pain may be higher in mountainous regions. The research student is from Nepal. He has a clinical interest in musculoskeletal disorders and had found at the time of the thesis that there had been no study undertaken across Nepal. Such a study would inform Nepalese health policy. Objectives To estimate the prevalence of knee pain and knee related disability, overall and in different ecological zones, of one region of Nepal. Methods A cross-sectional multistage cluster survey was undertaken using a questionnaire in Nepali delivered face to face to adults aged over 18 years in seven sites across the three ecological zones (plain, hilly and mountainous) of the Western Development Region of Nepal. Crude weighted and age standardised period and point prevalence rates of knee pain were estimated. The prevalence of disability was compared between those who had knee pain and those who did not have knee pain. Binary logistic regression was used to investigate potential independent risk factors for the prevalence of knee pain and knee pain related disability. Results In total 694 participants were recruited; 52.6% were women, the mean age was 41 years and 14.1% lived in the mountainous zone. The period prevalence of knee pain was 22.3% (95% CI 19.2% - 25.5%) and of chronic knee pain was 12.1% (95% CI 9.5 – 14.7%). The point prevalence was 7.6% (95% CI 5.7%-9.6%). Knee pain was higher in the mountainous zone compared to the plain zone. Overall 25.6% of the 694 participants had disability, as measured by the WHO DAS 2.0, and this was significantly higher in those with knee pain compared to those without (81.2% vs. 9.5%). Disability was highest among those with knee pain in the mountainous zone, with all having disability. Despite this only 54.8% of those with knee pain sought advice for their condition, those in the mountainous zone were less likely to seek advice, access hospital treatment or take oral medications. Conclusion Knee pain is highly prevalent in Nepal. Just under half who suffer do not access services for pain management, even though knee pain is associated with high levels of disability. Rates of knee pain are highest in the mountainous areas where access to services is lowest. This demonstration of unmet need, particularly in the poorest and most remote areas of the country, is of importance to policymakers who should focus on raising awareness and improving access to services.

This study adopted an ethnographic approach to examine the role of the Registered Nurse (RN) in the intellectual disability sector. The research setting (The Centre) is a residential facility for clients with intellectual disability in the northern suburbs of Adelaide that opened in 1971 and was similar to a hospital with the same hierarchy of nursing. Mental deficiency nurse training was conducted there until the 1990s but that qualification is no longer recognised. The Centre is under the umbrella of a large state disability organisation that is in the process of moving clients of the service from institutions (the Centre) to community living options such as group homes. The cessation of mental deficiency nurse training and the introduction of deinstitutionalisation were considered to impact on client health and in the late 1990s a 24 hour nursing service was commenced. There was strong anecdotal evidence the service should be evaluated. A review of the literature found some research had been conducted in overseas countries with a focus on deinstitutionalisation but with a paucity of interest in the role of the RN, particularly in Australia. Ethnography, first used in anthropology as a way of describing different cultures, was chosen as the research methodology because the researcher wanted to discover how the culture influenced the role of the RN. The researcher is an RN employed in the area. As an ethnographer and participant observer, the researcher became the data collection instrument. The entire culture is considered to be the sample in ethnography and data took the form of hundreds of hours of field note entries and interview transcripts. Following analysis, the findings were presented in themes answering the research question which was in two parts. The first ‘from the perspective of the nurse, client and other health care professionals, what constitutes intellectual disability nursing?’ and secondly ‘what are the every day rituals, norms and patterns within the disability culture that shape and influence disability nursing for the Registered Nurse?’. ‘Caring for the client who is institutionalised’, ‘The RN in the disability sector having certain qualities’, ‘Working within a different paradigm’, ‘Having to assume responsibility for large numbers of unregulated workers’, ‘Having to work alongside many professional groups’ and ‘Having different educational needs’ are themes which describe the role. Themes describe the diversity of the role and in describing the registered intellectual disability nurse as ‘different’ the role is compared with that of the nurse in other settings. The current research revealed there is a need for more health related education for unregulated workers and specific intellectual disability education for registered and enrolled nurses. Themes that answer the second part of the research question are ‘hierarchical structure’, ‘the Registered Nurse's position’ and ‘role confusion’. The non-nursing management at the top of the hierarchical ladder was found to significantly limit the role of the RN who was afforded no opportunity for leadership. Confusion over the RN's role and indeed individual workers' roles was observed at all levels. Findings suggest much stronger nursing leadership is required to provide advocacy and holistic care for the client and education for the carer. An outcome of the current research was the development of a model for intellectual disability nursing (see Table 8-1).

The study aimed to explore the lived experience of the careers of learning disability nurses in England. The methodology was informed by Hermeneutic Phenomenology, and the study design utilised narrative interviewing techniques based on an adapted model of the Biographic Narrative Interpretive Method (Wengraf 2001) in order to explore the career choices, experiences and beliefs, and values about learning disability nursing. Twenty in-depth qualitative interviews with learning disability nurses, who had been in practice in the 30-year period between 1979 and 2009, were undertaken in 2010 across nine counties in England. The data was interpreted using a narrative analysis approach. Key findings indicated that nurses, working in a diverse range of settings with varying degrees of experience, are motivated by working with people with learning disabilities and narrate their experiences of building relationships with people articulating the meaning of this for them as nurses. The initial reasons for choosing learning disability nursing as a career formed a key theme within the findings, with complex influences on their career choice. Additionally, all participants in this study created a narrative of change, focusing on the ways in which change in policy, practice and in societal views have impacted upon their working lives and their identity. The individual narratives have also been interpreted to form a collective narrative of learning disability nursing to specifically explore the identity of learning disability nurses and nursing in a changing context of health and social care provision.

No / Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. Objectives. To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. Design. Nonrandomized controlled trial. Setting. Service users¿ homes in East Yorkshire. Participants. Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. Procedure. One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. Analysis. Quantitative analysis of pre¿post differences between the groups, using t-test. Results. In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teaching and behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. Conclusion. Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.