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Yes / and objectives: People with dementia occupy around one quarter of general hospital beds, with concerns consistently raised about care quality. Improving workforce knowledge, skills and attitudes is a mechanism for addressing this. However little is known about effective ways of training healthcare staff about dementia. This study aimed to understand models of dementia training most likely to lead to improved practice and better care experiences for people with dementia, and to understand barriers and facilitators to implementation. Method: A collective case study was conducted in three National Health Service Acute Hospital Trusts in England. Multiple data sources were used including interviews with training leads/facilitators, ward managers and staff who had attended training; satisfaction surveys with patients with dementia and/or carers; and observations of care using Dementia Care Mapping. Results: Interactive face-to-face training designed for general hospital staff was valued. Simulation and experiential learning methods were felt to be beneficial by some staff and stressful and distressing by others. Skilled delivery by an experienced and enthusiastic facilitator was identified as important. Staff identified learning and practice changes made following their training. However, observations revealed not all staff had the knowledge, attitudes and skills needed to deliver good care. Patient and carer satisfaction with care was mixed. A major barrier to training implementation was lack of resources. Supportive managers, organisational culture and strong leadership were key facilitators. Conclusion: Dementia training can lead to improved care practices. There are a range of key barriers and facilitators to implementation that must be considered. / National Institute for Health Research Policy Research Programme (NIHR PRP) under Grant [PR-R10-0514-120006].

Yes / This article investigates the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings. The study involved an in-depth knowledge review and analysis of literature on the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings from 2008 to 2017, as well as semi-structured interviews with 15 key stakeholders. Participants were stakeholders from both primary and secondary care and included equality and diversity leads, human resource professionals, NHS service managers, representatives of trade unions and health professional regulatory council representatives. The knowledge review indicates that to date, black, Asian and minority ethnic staff are disproportionately represented in NHS disciplinary proceedings. Evidence gathered demonstrates the continuation of inappropriate individual disciplinary action and failure to address organisational shortcomings against black, Asian and minority ethnic members of staff. Overall, six factors were identified as underpinning the disproportionate representation of black minority ethnic staff in disciplinaries: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support; and disciplinary policy misapplication.

The goal of this research project was to determine if introducing intergenerational interactions would supplement or detract from the use of horticulture as a therapeutic tool when working with elderly adults and preschool children. The program was set up to compare independent group activities with intergenerational activities. A group of elderly adults in the University Adult Day Service and a group of preschool children in the University Child Development Laboratory School took part in both separate age group and intergenerational activities. There were three sessions each week: one for the children's group, a second one for the elderly adults' group, and a third one that combined both groups. The same activity was done during all three sessions each week, with modifications to make the activity appropriate for each age group and to make it more interactive for the intergenerational group. These activities took place in the campus building where the day care centers are located. Four volunteers assisted with the activities. Two worked with the children's group both during separate and intergenerational activities, and two volunteers similarly assisted with the elderly adult group. Video cameras were used to record each session. These videos were viewed and evaluated after the 10-week horticulture therapy program was completed to score attendance and participation during separate age group activities, and attendance, participation, and interaction between the two groups during intergenerational activities. This data was used to determine if introducing intergenerational interactions affected the individual's attendance or participation, and to determine if the interactions between the two groups showed any change over time. Several variables were shown to affect the outcome of research. The first variable discussed is the effect of the staff, volunteers, or administration on the participants and the activities. Staff and volunteers can greatly affect intergenerational interactions by: 1) failing to encourage participation from participants of all ages, 2) lacking experience or having discomfort in working with special populations, 3) failure to establish adequate communication with the researcher or with each other, or 4) demonstrating a negative attitude towards the project. The second variable in research is the limitation introduced by data analysis using video. While video recording is useful in evaluating data, it can cause problems due to a limited viewing area, limited viewing angles, blocked screens, or unfamiliarity with recording equipment. Videos were used to assess participation and interaction. Participation scores include three categories: "no participation" for present but inactive participation, and "working with direct assistance" or "independent participation" for active participation. Participation was affected by the horticulture activities' set up, difficulty level, and availability of assistance from volunteers. Children's participation during separate group activities was affected mainly by the difficulty level and set up of activities. Elderly adult's participation during separate age group activities was affected mainly by each individual's abilities and availability of assistance. Children's intergenerational participation scores show an increase in the category of "working with direct assistance", while elderly adults' intergenerational scores show an increase in the categories of "no participation" and "independent participation". In part, the change in intergenerational participation was due to a decrease in the assistance available from volunteers for each individual. Lastly, the percentage of total interaction time between the generations during activities increased over time. However, the introduction of intergenerational interactions detracted from the use of horticulture as a therapeutic tool for elderly adults and preschool children. It is recommended that intergenerational programming may not be useful to fulfill specific horticulture therapy goals for these groups. At the same time, the intergenerational activities involving horticulture plant-based activities were more successful at increasing interactions than the craft-type activities. Therefore horticulture may be a useful activity for intergenerational programs with a goal of increased interaction and relationship development. / Master of Science

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