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  • Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing

    Finucane, Anne M; orcid: 0000-0002-3056-059X; email: a.finucane@ed.ac.uk; Hulbert-Williams, Nicholas J; Swash, Brooke; Spiller, Juliet A; Wright, Brigid; Milton, Libby; Gillanders, David (SAGE Publications, 2022-12-28)
    Background:: Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing. Aim:: To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff. Design:: A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up. Setting/participants:: Participants were recruited from Marie Curie hospice and nursing services in Scotland. Results:: Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen’s d = 0.7) and mental wellbeing (Cohen’s d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction. Conclusion:: Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.
  • Nutrition knowledge and influence on diet in the carer-client relationship in residential care settings for people with intellectual disabilities.

    Özdemir, Aslıhan; orcid: 0000-0003-3053-3089; Hall, Rebecca; lovell, Andrew; Ellahi, Basma; orcid: 0000-0001-6825-9770 (2023-01-17)
    People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in 'making everyday food choices' (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health. [Abstract copyright: © 2023 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.]
  • An ethnographic investigation into multidisciplinary team collaboration - the role of psychological safety in a high-secure forensic in-patient hospital in Germany

    Lovell, Andrew; Mitchell, Andrew; Chapman, Hazel; Theunissen-Schuiten, Lettie (University of Chester, 2022-06)
    Background: Multidisciplinary team (MDT) collaboration in high-secure forensic in-patient hospitals is, although essential to the work, hardly studied. The culture of MDT collaboration differs due to their composition and the environment. Psychological safety (PS), that is the interpersonal feeling that the environment is safe enough to engage in MDT collaboration, without fear for personal consequences, could support staff to construct and better accumulate knowledge about patients between the different professions. Aim: To explore factors of influence on the culture of MDT collaboration and PS in the constantly changing MDT in day-to-day life. To understand how interactions with the environment and people in the environment become meaningful and are enhanced or create barriers which prevent staff from engaging in MDT collaboration. To study the role of PS and which factors, if any, influence it and how they interact with each other. Methodology/methods: A symbolic interactionist ethnographic methodology was used, with an emic approach to data collection and an eclectic approach to data analysis. Ten observations of weekly treatment meetings and 13 interviews (with a psychiatrist, a psychotherapist, a social worker, a teacher, five nurses, two ward mangers, two occupational therapists) were conducted and analysed through thematic analysis (TA). Reflexivity was used to constantly feedback on the role and presence of the researcher in the study. Findings: Four central themes were discovered: a shared approach to care; support and informal relationships; leadership and power and hierarchy; and PS, influenced by all and influencing all. The themes are visualised in a model of the social construction of MDT collaboration and PS. They are distinct and interrelated and discovered on four levels of social interaction in the hospital. The absence of a shared model of care, the supportive relationships, leadership, and the personal interpretation of the interactions between staff exerted the most influence on MDT collaboration and on PS. The absence of a multidisciplinary shared model of care kept the features of the total institution (TI) and the totality of the medical model in place. The traditional inequality and power issues between the professions responsible for the treatment and their knowledge, and the supporting staff created barriers to effective MDT collaboration and PS. The locally constructed meeting chaired by the nursing staff, the relationships, support, sub-teams, and inclusive leadership and behaviour enhanced both MDT collaboration and PS as a team emergent state (TES). These factors promote a culture of equality, belonging and perceived value. However, without a shared model of care, the relationships and perceived equality and support in sub-teams promoted dependencies on the knowledge and the support of others and revealed detrimental effects of high PS in sub-teams on MDT collaboration. Implications: MDT collaboration is complex and requires an unequivocal, carefully designed setting informed by a shared model of care with meaningful roles for all professions, inclusive leadership, and supportive informal relationships. Findings include the need to: diminish the deeply embedded unequal culture of collaboration informed by the TI and the medical model; diminish the dependencies on knowledge and support of others; promote an innovative culture of safe MDT collaboration with no fear for personal consequences for its members. Further recommendations for practice, education, and further research have been made.
  • Lockdown Diaries: merging fact and fiction in auto/biographical research

    Bennett, Julia; University of Chester
    From January to March 2021 the UK experienced its third Covid lockdown. By this time, 10 months after the first UK lockdown started, the scenario of staying at home, working from home and home schooling had become familiar. Towards the end of, so far, the final full lockdown in England, and on the day of the budget announcements, people from across the UK were asked to complete one day diaries for this project. The diaries, along with media accounts and other publicly accessible data, have been used to create a series of short fictionalised narratives of one day during the pandemic. Based on the autobiographical accounts the participants produced, the stories explore how people from different backgrounds, life stages and geographical areas spent their time during lockdown, highlighting both shared and very different experiences across and between places and age groups. The stories draw attention to mundane everyday lives during this time. The relatively experimental method of creating composite characters taken from real life also provides material for exploring how the use of fiction (here biographical fiction) in research can work to help to bring social science research into the public realm.
  • Understanding Lived Experiences of Food Insecurity through a Paraliminality Lens

    Moraes, Caroline; McEachern, Morven G.; Gibbons, Andrea; Scullion, Lisa; University of Bristol; University of Chester; University of Salford; University of Salford (Sage Publications, 2021-04-30)
    This article examines lived experiences of food insecurity in the United Kingdom as a liminal phenomenon. Our research is set within the context of austerity measures, welfare reform and the precarity experienced by increasing numbers of individuals. Drawing on original qualitative data, we highlight diverse food insecurity experiences as transitional, oscillating between phases of everyday food access to requiring supplementary food, which are both empowering and reinforcing of food insecurity. We make three original contributions to existing research on food insecurity. First, we expand the scope of empirical research by conceptualising food insecurity as liminal. Second, we illuminate shared social processes and practices that intersect individual agency and structure, co-constructing people’s experiences of food insecurity. Third, we extend liminality theory by conceptualising paraliminality, a hybrid of liminal and liminoid phenomena that co-generates a persistent liminal state. Finally, we highlight policy implications that go beyond short-term emergency food access measures.

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