RSS 1.0Faculty of Health and Social Care
The Faculty of Health and Social Care is one of the major providers of Health and Social Care education in the North West and offers a wide range of programmes at both undergraduate and postgraduate levels. Programmes are delivered at four main locations: Riverside Campus (Chester), Leighton (Crewe), Warrington Campus and Wirral (Clatterbridge).
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A grounded theory exploration into situational adaptation strategies developed by Paramedics when dealing with mass casualty incidentsThe Manchester (U.K.) Arena bombing took place on the 22nd May 2017 at 22:31, when a suicide bomber detonated an improvised explosive device in the foyer of the Manchester Arena, as the crowd was leaving an event. The attack claimed the lives of 22 people, and a further 116 people required medical treatment, mostly for ballistic injuries. A key objective for Ambulance Service Commanders was to establish a casualty management system consisting of clinical triage, treatment, and transport of patients from a Casualty Collection Point into the hospital network. To achieve this, two Hazardous Area Response Teams were deployed alongside Consultant and Advanced Paramedics. The purpose of which was to provide point of injury care within the vicinity of the blast area. Whereas previous studies have identified how individuals react to the biopsychosocial response to traumatic incidents post the event, understanding how Ambulance Service personnel adapt to situations while deploying to, or during mass casualty incidents, remains an area that has received limited research in relation to defining empirical evidence. This study aimed to identify a process that either supported or inhibited Paramedics in achieving situational adaptability when dealing with a mass casualty situation. Constructivist Grounded Theory was used as the chosen methodology, with fifteen Paramedics volunteering to participate in the research. Analysis identified eleven theoretical categories, which were then divided into four theoretical themes. Combined, these formed the basis for four major theoretical propositions: ‘Training & Education’, appropriate application of ‘Incident Management Frameworks’, established ‘Peer Support Networks’, and individual reaction to ‘Stress stimuli’. This study makes a novel contribution to the phenomenon of situational adaptively. The significance of the resulting theory is that situational adaptability can be enabled through the application of effective decision making strategies, being able to draw on previous experiences, along with effective scene management. This along with communication strategies, support from peers, the incident commander, and multi-agency partners. Key identified inhibitors are presented as situational stressors, perceptions of threat, risk appetite, and environmental stimuli. Consequently, it is now possible to provide four recommendations for Paramedics preparing to respond to mass casualty incidents.
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A modified grounded theory study exploring the impact of military service in Northern Ireland on mental wellbeingMilitary service in Operation Banner during the Northern Ireland Troubles posed significant challenges for individual soldiers. The purpose of this study is to explore the impact of service in Operation Banner on the mental wellbeing of veterans who served in this conflict, and factors that have hindered or facilitated acquiring help in those who have experienced mental distress. This is a qualitative study that has utilised a modified grounded theory methodology and adopted a symbolic interactionism theoretical framework. Data were collected in semi-structured interviews with 16 veterans, recruited via advertising in newsletters distributed by veterans’ organisations to their members, advertising via posters and local radio and through snowballing. Data analysis was by open and focussed coding, supported by computer assisted qualitative data analysis software. The study confirms that for the majority, military service did not result in long-term mental distress and participants gained useful career and life skills. Yet, for some mental distress has persisted. Since leaving Operation Banner, the ability of veterans to cope with the past and meet present or future challenges has been through a combination of innate skills, resilience, individual initiative, outside support, and making use of opportunity. For some, though, coping has been hindered by internal barriers such as self-isolation, emotional suppression, legacies of military culture and veterans’ perceptions of indifference or even hostility by society and politicians. These barriers have led to some veterans to being predominantly oriented towards the past and unable or unwilling to seek help, a situation made worse by threats of prosecuting veterans, which have reinforced memories of the past. This study theorises, therefore, that there is no single way to help these veterans without understanding each veteran’s perception of themselves. When this self-identity is predominantly past-oriented, internal barriers negate the relevance of external help. When the veteran’s self tends towards future-orientation, external barriers to accessing help are more relevant. Understanding this individuality of self-perception may help to address factors that are maintaining past-orientation. Yet, for those who seek a resilient future, providing the right services, at the right time and in the right format is critical. This study helps to fill the relative gap in qualitative studies on UK veterans and those from Operation Banner in particular. Recommendations are made for the support of Operation Banner veterans and for future research.
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‘How you keep going’: Voluntary sector practitioners’ story-lines as emotion workThe voluntary sector acts as the last line of defense for some of the most marginalized people in societies around the world, yet its capacities are significantly reduced by chronic resource shortages and dynamic political obstacles. Existing research has scarcely examined what it is like for voluntary sector practitioners working amidst these conditions. In this paper, we explore how penal voluntary sector practitioners across England and Scotland marshaled their personal and professional resources to “keep going” amidst significant challenges. Our analysis combines symbolic interactionism with the concept of story- lines. We illuminate the narratives that practitioners mobilized to understand and motivate their efforts amidst the significant barriers, chronic limitations, and difficult emotions brought forth by their work. We position practitioners' story- lines as a form of emotion work that mitigated their experiences of anger, frustration, overwhelm, sadness, and disappointment, enabling them to move forward and continue to support criminalized individuals. Our analysis details three story- lines— resignation, strategy, and refuge—and examines their consequences for practitioners and their capacities to intervene in wicked social problems.
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Welfare conditionality, ethics and social care for older people in the UK: From civic rights to abandonment?Welfare systems are becoming ever more conditional, with access to state support increasingly rationed via a legion of legally-defined and financially-driven restrictions and rules. Civic protection and economic rights for older citizens within Western policy systems are subsequently diminishing and continue to give way to neoliberal discursive practices which prioritise welfare activation, autonomy, participation, asset-based yet precarious self-care, the aversion of health-centred risks and much higher levels of eligibility for support. This article looks at welfare conditionality and its relationship to older people, ethics and governance within social care. By using three examples of welfare conditional reforms from the UK, it is highlighted that strains typically persist between the altruistic components of some ethical frameworks and the everyday experiences of many older people. The relative gatekeeping powers of welfare professionals and expectations placed on family members and carers have also increased, especially upon older people with higher needs and who may lack economic and cultural capital. This is despite rhetorical policy-led claims of increasing choice and control, and allowing support to be more asset-based and personalised.
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Invisible and at-risk: older adults during the COVID-19 pandemic.During the COVID-19 pandemic the risks to older adults of systemic abuse and neglect have become amplified, alongside increasing abuse and neglect in the community. Novel risks have also evolved involving cybercrime and the use of remote technologies in health and social care related to the pandemic. This commentary brings together lessons to be learned from these developments and initial ideas for actions to mitigate future risks.
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An analysis of the acceptability, feasibility, and utility of the Global Mental Health Assessment Tool for Primary Care (GMHAT/PC) in a UK primary healthcare setting: a practice-based mixed methods studyIntroduction: Published evidence shows that at least one in four people at any one time have mental health symptoms, most commonly of anxiety and depression. This is set against a background where the evidence demonstrates that primary care in general is poorly equipped to identify, diagnose and manage mental health disorders. The effect of these disorders affects the individual’s physical and social wellbeing and has an impact at all levels of Society. This study investigates the acceptability and feasibility of the Global Mental Health Assessment Tool for primary care (GMHAT/PC), and the impact of using it on the confidence and self-rated competence of healthcare workers. The Global Mental Health Assessment Tool for primary care (GMHAT/PC) is a computerised semi-structured interview tool to support a healthcare worker in the assessment of patients presenting with mental health symptoms. While single diagnosis tools are now more widely used in UK general practice, semi-structured mental health interview tools are not. GMHAT/PC was developed in the UK using resources from both community mental health services and primary care. Used in clinical practice, GMHAT/PC guides a healthcare worker through a comprehensive mental health assessment and its greater use has the potential to increase their diagnostic accuracy. With diagnostic accuracy comes more appropriate patient management. Method: The study deploys mixed methods research strategies in a UK general medical practice setting. Fifty-five healthcare workers were trained in the use of GMHAT/PC. They provided pre- and post-training self-ratings and participated in semi-structured interviews to provide views of the feasibility of the tool and its impact on their confidence and self-rated competence in mental health assessments. After training, the healthcare workers interviewed 198 patients with mental health symptoms using GMHAT/PC. The patients completed a questionnaire exploring their views of the time taken for the interview, whether it addressed their symptoms and whether they found it acceptable. Seventeen patients were also interviewed to further explore their opinions. Results: Ninety-nine per cent (99%) of the patient participants found the use of GMHAT/PC in their clinical assessment either “somewhat acceptable” or “very acceptable” (2 (1) = 6.636, N = 198, p = .010). Most healthcare workers identified time as a barrier to GMHAT/PC’s feasibility but viewed its use as feasible, provided that additional time was available for the assessment, such as extra appointment time, arranging an appointment at the end of a consulting session, or delegating the assessment to another healthcare worker with less time pressures. There was a statistically significant improvement in the self-rated competence (T = 253, z = 4.221, p < .001) and confidence (T = 378, z = 4.560, p < .001) of healthcare workers still in undergraduate training. For healthcare workers working under the supervision of a fully qualified general practitioner, statistically significant improvements were also seen in self-rated competence (T = 73, z = 2.801, p = .005) and confidence (T = 150, z = 3.491, p < .001). There was no statistically significant change in the confidence and self-rated competence of fully certified practitioners. Conclusion: The results show that the use of GMHAT/PC is highly acceptable to patients. Its use is feasible provided additional time is made available for the interview. There were improvements in the confidence and self-rated competence of undergraduate healthcare workers and those working under supervision. This research is important because it shows how the use of a tool such as GMHAT/PC could support healthcare workers in their practice, facilitating more accurate diagnoses and hopefully reducing the burden of mental health disorders for the individual and their societal settings. Future research should assess the value of semi-structured interview tools, such as GMHAT/PC, in developing trainee healthcare workers’ skills in mental health assessments, most particularly for common mental health disorders which cause significant disability for a large proportion of Society. Healthcare workers were concerned about the additional consultation time required for the GMHAT/PC interview. Future research could assess the impact of a semi-structured mental health interview on the patient’s subsequent consulting patterns.
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The supervisor conundrumCommentry
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The potential impact of extensive privatisation in the UK upon the ‘life chances’ of young people in careThe article considers the potential impact of extensive privatisation in the UK upon the ‘life chances’ of young people in care
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Assessment of sodium and iodine intake among university students in Casablanca, MoroccoIntroduction. – Iodine deficiency is still a matter of public health concern despite salt fortification andespecially with global recommendations to lower salt intake, this is mainly due to dietary habits. Uni-versity students have a diet based on street food high in sodium and low in other micronutrients (i.e.iodine and potassium). In this study, we aim to measure sodium and iodine levels in university studentsto assess their risk of developing complications later in life.Methodology. – A sample of 120 students aged between 18 and 25 years old was recruited and asked tocollect their 24-hours urine samples in special containers containing. Samples were stored then analyzedfor sodium, potassium, iodine and creatinine levels.Results. – The average urinary excretion of sodium was 3066.8 ± 1196.0 mg/day. Overall, 72.6% of par-ticipants consume more than 2 g/day of sodium. Average potassium intake is 1805.9 ± 559.4 mg/day,and all participants consume less than the adequate amount. Daily urinary excretion of iodine is135.6 ± 88.9 mg/day, and 69.2% of participants consume less than the recommended amount. Sodium,potassium and iodine intakes were higher in male participants (P-values = 0.008; 0.044 and 0.003, respec-tively). The lowest average iodine intake was observed in underweight participants (119.4 ± 31.4) with87.5% of underweight participants and 80% of female participants below the recommended intake.Conclusion. – Sodium intake is high while iodine intake is low in this studied population, especially inwomen.
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This is how it feels: activating lived experience in the penal voluntary sectorIncreasing calls for ‘nothing about us without us’ envision marginalised people as valuable and necessary contributors to policies and practices affecting them. In this paper, we examine what this type of inclusion feels like for criminalised people who share their lived experiences in penal voluntary sector organisations. Focus groups conducted in England and Scotland illustrated how this work was experienced as both safe, inclusionary and rewarding and exclusionary, shame-provoking and precarious. We highlight how these tensions of ‘user involvement’ impact criminalised individuals and compound wider inequalities within this sector. The individual, emotional and structural implications of activating lived experience therefore require careful consideration. We consider how the penal voluntary sector might more meaningfully and supportively engage criminalised individuals in service design and delivery. These considerations are significant for broader criminal justice and social service provision seeking to meaningfully involve those with lived experience.
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Development of the Compendium of Intellectual Disability Nursing InterventionsThis is a presentation that was delivered at the IASSIDD Europe Congress 6-8 July 2021, Amsterdam, Netherlands.
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Universal credit, lone mothers and poverty: some ethical challenges for social work with children and familiesThis article critically evaluates and contests the flagship benefit delivery system Universal Credit for lone mothers by focusing on some of the ethical challenges it poses, as well as some key implications it holds for social work with lone mothers and their children. Universal Credit was first introduced in the United Kingdom (UK) in 2008, and echoes conditionality-based welfare policies adopted by neoliberal governments internationally on the assumption that paid employment offers a route out of poverty for citizens. However, research evidence suggests that the risks of conditionality polices for lone parents can often include increased poverty, a deterioration in mental health or even destitution posed by paternalistic sanctions or precarious low-paid employment, which can undermine parenting capacities and children’s well-being. The article also critically appraises and questions challenges posed by an increased reliance upon contractual ethics by governments, alongside the wider behaviour modifying policies of the workfare-orientated state. This includes that working-class lone mothers can erroneously be stigmatised as representing a morally challenged dependent burden through activation policies and risk-averse social work practices.
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Underlying thinking pattern profiles predict parent-reported distress responses in autism spectrum disorderAppreciating autistic neurodiversity is important when supporting autistic people who experience distress. Specifically, use of a profiling model can reveal less visible autistic differences, including strengths and abilities. Binary logistic regressions showed that the likelihood of extreme distress responses could be interpreted based on parent-reported autistic thinking pattern profiles for 140 young people. Perspective-taking (specifically empathy), extreme demand avoidance, and over-sensory sensitivity each contributed to the combined regression models. From the clinical perspective of autism as a multi-dimensional and inter-connected construct, there may be implications for planning support and building positive self-understanding. Individually tailored adjustments and support strategies may be identified more easily after delineating variables found across four core aspects: sensory coherence, flexible thinking, perspective-taking, and regulation. Keywords: Autism; Distress; Profile; Strengths; Thinking patterns.
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Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and cliniciansAim: A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to lack of good quality clinical evidence for either option. The aim of this study was to understand the decision-making experiences of both clinicians and patients when faced with such a diagnosis. Methods: Qualitative, semi-structured interviews were undertaken with ten clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital Trusts across the North of England. Interviews were audio recorded, transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis. Results: Analysis of the interview transcripts evidenced the difficulties faced by both groups when faced with treatment decisions following a diagnosis of colorectal polyp cancer. Some of these difficulties were specific to either the clinician or patient group. Themes which were common to both groups included: complexity of risk information; external influences, unexpected diagnosis; and time. In addition, hospital system factors were disclosed which also influenced clinician and patient experiences. Conclusion: This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being fully involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future have been highlighted. What does this paper add to the literature? This qualitative study is, to the authors knowledge, the first exploring clinician and patient experiences of treatment decision making following a colorectal polyp cancer diagnosis. Key factors influencing how treatment decisions are made have been identified. As a result, a framework is proposed highlighting critical factors for consideration to deliver patient centred care.
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Commentary on "Older carers of people with learning disabilities: Their experiences with local authority assessment processes and personnel"Purpose - The purpose of this paper is to provide a commentary on "Older carers of people with learning disabilities: their experiences with local authority assessment processes and personnel" written by Rachel Forrester-Jones. Design/methodology/approach - The commentary considers the experiences of older carers in the context of research, legislative and policy changes over the last 30+ years. Findings - The needs of older carers of adults with learning disabilities are well recognised within the (limited) literature. Less attention has been given to practical strategies to identify and support such carers or to their broader family context. Originality/value - This commentary highlights that assessors carrying out carers' needs assessments should consider whether adults with learning disabilities are providing care to their older relative. The recognition of possible mutual or reciprocal care needs to be acknowledged and appropriate support offered.
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The psychological distress in healthcare workers: Current perspectives and challengesAims and objectives. The review presents evidenced-based literature on psychological distress amongst health care professionals; the work is not a systematic review but covers a wide selection of contemporary literature and covers the COVID-19 pandemic. The review discusses several reasons why psychological distress within health care professionals requires separate consideration and strategies to support resilience and access to support. Background. Health care workers report high workplace stress levels, burnout, psychological distress, and an increased risk of mental health problems. This is when the World Health Organisation recommends supporting health care professionals’ mental health and social aspects. It is also accepted that the physical and mental ill-health in health care workers can impact operational effectiveness and delivery of patient outcomes. Literature review. The integrative review utilized keywords to undertake a search of the literature. The following key terms ‘healthcare worker,’ ‘health professional,’ ‘mental health,’ ‘resilience,’ ‘support,’ ‘social risk factors,’ ‘physical risk factors’ and ‘Intervention.’ The PsycINFO, CINAHL and Embase and the Cochrane library were searched to find contemporary research articles. Conclusions. The review has collated the available evidence and recommendations for supporting healthcare workers. It is recognized that stressors can increase the prevalence of psychological distress and lead to recruitment and retention issues. Stressors for psychological distress in health care professionals are the impact of patient-specific situations, interprofessional working relationships and perceived workload burden.
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Does integrated health and care in the community deliver its vision? A workforce perspectivePurpose –The purpose of this paper is to explore and capture workforce perceptions, experiences and insights of the phenomena of integrated care (IC) in a community health and care NHS trust in England; including whether there are any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care. Design/methodology/approach – A qualitative design based on an interpretivist research paradigm was used with a purposive sampling technique. Five in-depth semi-structured interviews were conducted with community nursing, social workers and allied health professionals. Colaizzi’s (1978) descriptive phenomenological seven-step method was applied to analyse data, with the emergence of 170 significant statements, 170 formulated meanings and 8 thematic clustering of themes to reveal 4 emergent themes and 1 fundamental structure capturing the essential aspects of the structure of the phenomenon IC. Findings – This study revealed four interdependent emergent themes: (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes. (2) Awareness of culture and professionalism: embracing inter-professional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes. (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services. (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient. Shared positivity of IC, embracing new ways of working. Originality/value – This study proposes considerations for future practice, policy and research from a local, national and global platform, highlighting the need for any IC strategy or policy to incorporate the uniqueness of the “voice of the workforce” as a key enabler to integration developments, only then can IC be a fully collaborative approach.
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Critical analysis of the Armed Forces Covenant Fund Trust Aged Veterans FundBackground: Relatively little research is available regarding the specific needs of older military veterans and the services introduced to support them. In 2016, the Armed Forces Covenant Fund Trust launched the Aged Veterans Fund (AVF), to understand the impact that military service may have on ageing, and to support initiatives targeting their health and well-being. This fund was financed for 5 years and included 19 UK portfolio projects. Method: The paper presents a retrospective evaluation on the processes and impact of the AVF, with the intent of informing policy, educational services, service providers and stakeholders of the lessons learnt. The inclusion criteria was veterans and their families aged 65 years of age or over. In 2019, data were drawn from documentary evidence related to the programmes. Qualitative analysis were performed on 78 eligible sources and 10 themes were identified. Results: Programmes were rolled out via collaborative partnerships referrals, focusing on person-centred or skill-exchange approaches. Challenges were encountered, such as capacity and timelines issues. A limited amount of associated cost-savings was observed, even if examples of sustainability and high satisfaction were reported. Evidence was found of programmes boosting health and well-being outcomes, in raising awareness, and in positively impacting on clinical practice, such as re-admission rates. Conclusion: The AVF programmes were successful in their intent to provide support to older veterans and their families. The findings provide indicators of the next steps required for the support of ageing veterans. Further investigation of the cost-effectiveness of age-friendly veterans’ services is needed.
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Employing with conviction: The experiences of employers who actively recruit criminalised peopleIn England and Wales, criminal reoffending costs £18 billion annually. Securing employment can support desistance from crime, but only 17% of ex-prisoners are employed a year after release. Understanding the motivations of employers who do recruit criminalised people therefore represents an important area of inquiry. This article draws upon qualitative interviews with twelve business leaders in England who proactively employ criminalised people. Findings reveal that inclusive recruitment can be (indirectly) encouraged by planning policies aimed to improve social and environmental well-being and that employers often work creatively to meet employees’ additional needs, resulting in commercial benefits and (re)settlement opportunities.
