This study uncovers issues participants consider when making decisions regarding adherence and highlights the importance of the nurse's role in eliciting patients' concerns and the providing appropriate information to allay fears and misconceptions.

There is insufficient evidence to determine whether self-management interventions benefit people with bronchiectasis. In the absence of high-quality evidence it is advisable that practitioners adhere to current international guidelines that advocate self-management for people with bronchiectasis.Future studies should aim to clearly define and justify the specific nature of self-management, measure clinically important outcomes and include children as well as adults.

Background: Despite emerging evidence and guidelines, poor prescribing and

This study uses a qualitative approach to explore the experiences of 22 UK foster carers when a child is 'moved on' from a placement, focusing specifically on their experiences of loss. In most cases participants report loving the child as their own and describe their surprise at the profundity of their feelings of loss and grief when living through the child's departure. These emotions can be fruitfully perceived as 'disenfranchised grief' in that its severity was unexpected and was not recognised as legitimate by the carers' social group or professionals working with them. As a result, their loss was neither perceived as legitimate nor given a vehicle for expression. In some cases, participants report that the experience changed their approach to caring for children and even resulted in them ceasing to foster. The implications for practice include preparing foster carers to expect a grief response when their children move on, to recognise that this might be disenfranchised and to enhance peer and professional support during that process.

BackgroundBronchiectasis is a chronic respiratory condition that impacts significantly on individuals and healthcare services. Self-management is recommended in clinical guidelines for bronchiectasis as an intervention to enable patients to manage their condition, yet there is little evidence to support it.MethodsThree face to face focus groups (17 adults with bronchiectasis) were conducted at three National Health Service (NHS) sites in North West England. Additionally, semi-structured telephone interviews were undertaken with 11 healthcare professionals (HCPs), including doctors, nurses and physiotherapists. Thematic analysis identified common themes and occurrences verified by independent audit.FindingsFour common overarching themes were identified: the meaning of self-management; benefits; barriers and influencers to self-management; subthemes varied. Both groups recognised component interventions. Patients highlighted that self-management enabled them to learn what works and moderate behaviour. Aspects of delivery and structure were important to HCPs but a ‘make do’ culture was evident. Benefits for both groups included empowering patients. Common barriers for patients were time, mood and lack of access to support which could mitigate engagement with self-management. HCPs identified barriers including patient characteristics and lack of resources. Influencers for patients were peer, carer and psychosocial support, for HCPs influencers were individual patient attributes, including ability and motivation, and HCP characteristics such as knowledge and understanding about bronchiectasis.SummaryThis is the first study to explore patients’ and HCPs’ views of self-management for bronchiectasis. The need for an individual, flexible and responsive self-management programme specific to bronchiectasis was evident. Personal characteristics of patients and HCPs could affect the uptake and engagement with self-management and HCPs knowledge of the disease is a recognised precursor to effective self-management. The study identified key aspects for consideration during development, delivery and sustainability of self-management programmes and findings suggest that patients’ psychosocial and socioeconomic circumstances may affect adoption and activation of self-management behaviours.

A small number of studies in adults have generated high-quality evidence that is insufficient to inform robust conclusions, and studies in children have provided no evidence. We identified only one dual-therapy combination of oral and inhaled antibiotics. Results from this single trial of 53 adults that we were able to include in the quantitative synthesis showed no evidence of treatment benefit with oral plus inhaled dual therapy in terms of successful treatment of exacerbations, serious adverse events, sputum volume, lung function, and antibiotic resistance. Further high-quality research is required to determine the efficacy and safety of other combinations of dual antibiotics for both adults and children with bronchiectasis, particularly in terms of antibiotic resistance.

Nebulisation is an important and common method of administering medication to patients with respiratory disease. Although the routine use of nebulisers is contentious, they are helpful when the patient is unable to use other devices, perhaps because of illness or poor dexterity, and are recommended in certain clinical situations, such as acute, life-threatening asthma. This article aims to inform nurses of current evidence regarding the advantages and limitations of nebuliser therapy. Patient experiences of receiving nebulisers are discussed, as well as the importance of cleaning and maintaining the equipment.

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