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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Layers of listening: qualitative analysis of the impact of early intervention services for first-episode psychosis on carers’ experiences(Cambridge University Press, 2015-08)Background: Early Intervention Services (EIS) comprise low-stigma youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims: By analysing carers’ accounts of their daily lives and affective challenges during a relative’s first-episode psychosis against the background of wider research into Early Intervention Services, this paper explores relationships between carers’ experiences and EIS. Methods: Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results: Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these service user-focused engagements also emerge; they risk leaving carers’ emotions unacknowledged and compounding an existing lack of helpseeking. Conclusions: By focusing on EIS’s engagements with carers, this paper draws attention to an urgent broader question; as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?
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Psychiatric morbidity in medically ill patients using Spanish version of GMHAT/PC(Taylor and Francis, 2016-12-14)The study aimed to assess psychiatric morbidity in medically ill patients and to examine the use of GMHAT/PC Spanish version in a general health setting. We recruited patients who were hospitalized at the services of Internal Medicine, Surgery and G/O during a period of 1 month for each service. The diagnosis of a medical illness was supported by specialists in each service. A trained GP conducted a psychiatric assessment of all the participants using GMHAT/PC. The interview was carried out at patients’ bedside. Of 455 medically ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. In this study the proportion of medically ill with mental disorders was less compared to other studies. The GMHAT/PC is more close to identifying clinical cases of mental illness and also patients who need help. The GMHAT is more a diagnostic instrument than a screening instrument. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC. A holistic approach of providing care to such patients may improve their overall outcome and quality of life.
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Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial(Elsevier, 2017-12-11)Background - Provision of early intervention services has increased the rate of social recovery in patients with first episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. Methods - We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16–35 years, had non-affective psychosis, had been clients of early intervention services for 12–30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Findings Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5–13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. Interpretation - Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so.
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Nutrition Knowledge, Dietary Patterns and Anthropometric Indices of Older Persons in Four Peri-urban Communities in Ga West Municipality, Ghana(African Health Sciences, 2018-09-30)ABSTRACT Background: Older adults are vulnerable to malnutrition due to sociologic, physiologic and anatomical effects of ageing. Objective: To investigate the influence of nutrition knowledge and dietary patterns on nutritional status of community-dwelling ambulatory older adults. Methods: This cross-sectional survey involved 120 elderly aged 60-70 years purposively selected from four peri-urban communities in Ga West municipality, Ghana. Nutrition knowledge was assessed using a structured questionnaire and dietary intakes obtained using a standardized food frequency questionnaire. BMI from weight/height measurements was proxy for nutritional status. Data was analyzed descriptively in SPSS. Associations were tested using correlation analyses (-1
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Enhancing practice teachers’ knowledge and skills using collaborative action learning sets(Community Practitioner, 2014-06-23)This research project was designed to enhance the critical thinking and problem-solving skills of practice teachers (PTs) and promote role modelling to specialist community public health nursing (SCPHN) students. This paper explores the impact of action learning sets (ALS) on the trainee PT role and associated students and stakeholders. Pre- and post-intervention surveys were completed by eight trainee PTs and three focus groups were held consisting of trainee PTs, practice education facilitators and students. Three focus groups for the trainee PTs, practice education facilitators and allocated students were held. Findings are presented in relation to three themes: knowledge, skills and role modelling in practice; dedicated practice teacher development; and ALS in practice. Data analysis demonstrated that the PTs valued the dedicated module and ALS enhanced their knowledge and skills. These skills were role modelled to students to guide reflection and knowledge acquisition. All participants intended to develop ALS as part of continued professional development. The paper concludes with recommendations to improve the educational development of both trainee and experienced PTs through the integration of ALS as part of PT development.
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CPTs’ perceptions of their role satisfaction and levels of professional burnout(Community Practitioner, 2011-05-19)This paper reports on a multi-method research project that explored perceived role satisfaction and professional burnout among community practice teachers (CPTs) while facilitating postregistration education and caseload management. A bespoke Satisfaction Questionnaire and the Maslach Burnout Inventory (Educators) were completed by 23 participants to elicit quantitative and qualitative data. Findings are presented in relation to three themes – aspects of the CPT role leading to satisfaction, aspects leading to dissatisfaction or burnout, and ways to enhance satisfaction and reduce burnout. The majority of CPTs were satisfied with their current role. A number of factors were elicited that affected participants’ perceived satisfaction. Respondents scored low levels of burnout overall, with high levels of personal accomplishment and low levels of depersonalisation. The relationship between participants’ satisfaction and their levels of burnout was not found to be statistically significant. However, mean scores on the emotional exhaustion subscale indicate moderate levels of emotional exhaustion. The paper concludes with recommendations to improve the support provided by employers and partner universities for CPTs.
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Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance(Wiley, 2017-08-31)Introduction Early Intervention Services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). Methods EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80 %, 81%-90 %, and 91-95 %. Patient-level resource use and outcomes were measured one year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained. Results At a threshold of £20,000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%). Conclusions The results from England suggest that striving to maximise fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.
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Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study(Oxford University Press, 2015-11-04)Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP.
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The Healthy Futures Project(Gay Rabie, Jean Evers, Veronica Olsen, K.Byrne, 2017)This article discusses the formation of the Healthy Futures Network which is an informal network of schools in the North West who began meeting over a period of several months seeking to address issues relating to the Health and Wellbeing of young people. The health focus was mainly on Obesity and Physical activity. There was however a recognition of the need to address underlying contribution factors relating to health and wellbeing. In 2014, this informal “Network” became the ‘Healthy Futures Network’, a cross-sector partnership between the University of Chester and 8 schools from the North West of England funded by Health Education England (North). The Project was designed to assess how a collaborative network of schools at a regional/sub-regional level could work together to promote health and wellbeing, and to improve emotional health and wellbeing of their pupils. This project was also part of an engagement strategy for raising aspiration and awareness of potential career education opportunities within the NHS.
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The impact of severe haemophilia and the presence of target joints on health-related quality-of-life(BioMed Central, 2018-05-02)Background: Joint damage remains a major complication associated with haemophilia and is widely accepted as one of the most debilitating symptoms for persons with severe haemophilia. The aim of this study is to describe how complications of haemophilia such as target joints influence health-related quality of life (HRQOL). Methods: Data on hemophilia patients without inhibitors were drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost-of-illness assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK). Physicians provided clinical and sociodemographic information for 1285 adult patients, 551 of whom completed corresponding questionnaires, including EQ-5D. A generalised linear model was developed to investigate the relationship between EQ-5D index score and target joint status (defined in the CHESS study as areas of chronic synovitis), adjusted for patient covariates including socio-demographic characteristics and comorbidities. Results: Five hundred and fifteen patients (42% of the sample) provided an EQ-5D response; a total of 692 target joints were recorded across the sample. Mean EQ-5D index score for patients with no target joints was 0.875 (standard deviation [SD] 0.179); for patients with one or more target joints, mean index score was 0.731 (SD 0.285). Compared to having no target joints, having one or more target joints was associated with lower index scores (average marginal effect (AME) -0.120; SD 0.0262; p < 0.000). Conclusions: This study found that the presence of chronic synovitis has a significant negative impact on HRQOL for adults with severe haemophilia. Prevention, early diagnosis and treatment of target joints should be an important consideration for clinicians and patients when managing haemophilia.
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Is living well with dementia a credible aspiration for spousal carers?(Taylor & Francis, 2018-05-21)In England there has been substantial policy development and an academic drive to promote the goal of ‘living well’ for people with dementia and their family members. This article critically evaluates the feasibility of this intention, with reference to the experience of those caring for people with the condition. Qualitative data are utilised from a study which explored how couples negotiate relationships and care. The focus of this paper is the perspectives of spousal carers and the challenges they encounter within their caring role. Views were obtained via semi-structured joint interviews where the carer participated alongside the person with dementia. The extent to which living well with dementia is a credible aspiration for carers is examined via three themes: identity subsumed under care responsibilities; the couple as an isolated family unit; and barriers to professional support. The findings highlight that experience of caring is highly complex and fraught with multiple practical, emotional and moral pressures. It is asserted that research into dementia and care relationships must avoid a zero sum situation, prompted by living well discourses, where attempts to bolster the position of people with dementia compound the marginalisation and stigmatisation of informal carers.
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Finding the Forgotten: Motivating Military Veterans to Register with a Primary Healthcare Practice(Oxford University Press, 2018-05-09)Introduction: In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient's medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff's understanding of veterans' health and social care issues. Materials and Methods: Data were provided by four primary healthcare centers' containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester's Research Ethics Committee. Results: The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff's interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. Conclusion: The primary healthcare staff took ownership and responsibility for this initiative. They were creative in introducing new ways of engaging with the local armed forces community. Many veterans' and staff were unaware of veterans' entitlement to priority medical services, or the wider provisions available to them. It is probable that veterans declaring their military status within primary healthcare, or registering with a general practitioner for the first time is likely to increase. Another review will be undertaken after 12 mo, which will provide a better indication of success. There remains however an ongoing need to reach out to those veterans who never access a primary healthcare practice. This paper adds to the limited international empirical evidence undertaken to explore help-seeking behavior in an armed forces community. The positive outcomes of increased awareness and staff commitment provide a template for improvement across the UK, and will potentially stimulate similar initiatives with international colleagues.
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Nurse Education and the Military Veteran(Australian Nursing & Midwifery Federation, 2018-04-23)No occupation is more dangerous than serving in a nation’s armed forces, where service-personnel may face atrocious conditions and events. Some experience mental health problems including Post Traumatic Stress Disorder, depression and anxiety. The spouse and children are exposed to frequent moves, and endure long periods separated from a partner or parent. Nurses are well placed to make a substantial difference in the care of veterans and their families, although many Veterans believe healthcare professionals “cannot understand” their experiences (Finnegan et al, 2017). To change this narrative, the UK has introduced a new under-graduate educational initiative. An initial single site pilot study was undertaken at the University of Chester, England in 2017. The aim was to produce educational sessions that provided student nurses with an insight into the Armed Forces Community (AFC) of serving personnel, veterans and their families, and construct an understanding of the biopsychosocial needs aligned to their care, health and wellbeing. The intent was to stimulate critical thinking to focus on the individual and family needs by encouraging a problem solving approach.
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Lyme’s Disease: Recognition and Management for Emergency Nurses(RCN Publishing, 2018)Over the last 10 years there has been a significant rise in the numbers of patients who present to the Emergency Department (ED) with a diagnosis of Lyme disease. Although some patients may remain asymptomatic a significant number of patients present with a rash focused around a previous tick bite. Others may present with a wide range of debilitating symptoms that can be very problematic, if left untreated. Due to the growing prevalence of Lyme disease within the United Kingdom (UK) and the US, this article offers an overview of the vector borne nature of this illness and provides the Emergency Nurse with information on the pathophysiology, prevention, presenting symptoms, and management of Lyme disease.
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Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factors(BioMed Central, 2018-04-30)Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. Methods: The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. Results: There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P = 4 × 10− 4 and P = 0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54 ± 0.97 mmol/L) than those with the E3 (5.98 ± 1.05 mmol/L) (P = 0.001) and E4 (6.09 ± 1.06 mmol/L) (P = 2 × 10− 4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P = 2 × 10− 6 and P = 3 × 10− 4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P = 4 × 10− 4 and P = 0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction on lipid outcomes. Conclusion: In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
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Mental Health and Primary Care(Insight Medical Publishing Group, 2017-07-21)Mental ill-health is a leading cause of disability and most people with mental health problems approach their primary care doctors for help. One in four consultations in primary care is mainly due to mental health related issues. Yet mental health hasn’t received due attention so far in primary care setting. The main challenges in taking mental health services at primary care level include limited mental health specialists, low priority given to mental health, Inadequate training and skills of primary care workforce, Inadequate specialists’ support to primary care workers as well as negative attitude and stigma towards metal illness. Investing in work force’s training and education in identifying and managing mental disorders at primary care is the only way forward to address the huge treatment gap exists for mental illness. The use of technology and computers may assist this process further. An example is use of a pragmatic computer assisted diagnostic and treatment tool such as GMHAT/PC. Psychiatrists and other mental health professionals need to change their mind-set to work differently by supporting primary care workers, spending more time in training front line workers and taking some leadership in keeping the mental health agenda high up in policy makers’ list.
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Beating the blues with pleasurable activity(Philip Allan, 2018)In this article Chartered Psychologist, Andrew Mitchell explains how behavioural activation (BA) can be used to treat depression
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Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol(Public Library of Science, 2017-11-28)Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n=821) and participants with type 2 diabetes (T2D) (n=861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P=0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction=0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P=0.008) and those in the highest tertile (P=0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P=0.024) and those in the highest PUFA tertile had lower HDL-C (P=0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
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Using visual methodology: Social work student's perceptions of practice and the impact on practice educators.(Taylor & Francis, 2018)Practice learning within social work education plays a significant part in students’ educational journey. Little is understood about the emotional climate of placements. This paper presents a small scale qualitative study of 13 social work students’ perceptions of their relationship with a practice educator (PE) and 6 PE’s perceptions of these emotional experiences. Visual methodology was employed over a two-phased research project, first social work students were asked to draw an image of what they thought practice education looked like, phase two used photo eliciation, PEs were then asked to explore the meaning of these images. Results demonstrated that social work students focused on their own professional discourse, the identity of PEs, power relationship and dynamics between themselves and PEs, the disjointed journey and practice education in its entirity. Whilst the PEs shared their personal views of practice education and reflected on this, both groups had a shared understanding of practice education including its values and frustrations. Keywords: social work placements, visual methodology, practice educators
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Maintaining a safe environment(Elsevier, 2018)INTRODUCTION Managing our own safety is thought to be a basic survival skill, which all individuals possess. We are not aware of managing our physiological homeostasis (for example, ensuring that our body cells are supplied with sufficient oxygen to produce the energy they need to function), and spend years learning to calculate and avoid risk from the external environment, The ability to control safety, including physiological homeostasis, and using physical ability and intellectual ability to manage risk, depends on a person’s stage in their lifespan development, their physical and mental wellbeing, their cognitive ability and the ability to control environmental factors such as housing, traffic, pollutants and even conflict. Throughout the world there are many differences in the types of hazards and risks that people are exposed to and just as many differences in the way that people manage their own safety. The inclusion of this AL in the Roper et al (1996, 2000) model is to draw your attention to the importance of being able to recognise the threats that exist to human survival and wellbeing and identify the impact that this may have upon any individual at any given time in their lives. In order to develop the knowledge that you need to apply it to your nursing practice, you will also need to read about the underlying physiology (how the body functions), pathophysiology (the disease process), psychology (thoughts, feelings and behaviours) and nursing practice in more depth. Several health psychology and psychology for nursing texts are referred to throughout this chapter, but physiology, pathophysiology and nursing practice are underpinned by core texts (Brooker & Nicol, 2011; Waugh & Grant, 2014). By understanding the processes involved in maintaining a safe internal and external environment for the person, you will learn to assess risk and plan care to maintain the safety of your patients. The model helps us to develop our understanding by focusing upon three key areas: • the human body's ability to protect itself and the biological mechanisms that it employs to carry this out • the ability that individuals have to make choices and take action to keep safe and free from danger • the identification and understanding of the dangers and hazards that exist in the surrounding environment (including the health care environment) and how they pose a threat to individual safety and wellbeing. These three areas will be discussed throughout this chapter within the framework of the model and will help to develop an understanding of the AL and enable nursing interventions to be as individualised and effective as possible. Often concern for our own health and safety only becomes heightened when we become ill, have an accident or hear about a tragedy or event that has had terrible human consequences. However, patient safety is essential for high quality health care, and a requirement in the United Kingdom Code for Nurses, Midwives and Health Visitors (Nursing and Midwifery Council, 2015) is to make the care and safety of people our main concern. Therefore, in nursing, we need to be able to assess and prevent risk, whether it arises from the person’s own health needs, or from the care we give and the way in which we give it. By using the framework of the Roper et al (1996, 2000) model in the following way we can begin to examine and identify how complex and varied health and safety issues really are and also identify the interrelatedness that exists between the other ALs. This chapter will therefore focus on the following: 1 The model of living • maintaining a safe environment in health and illness across the lifespan • dependence and independence in the activity of maintaining a safe environment • factors influencing the activity of maintaining a safe environment. 2 The model for nursing • the nursing care of individuals with health problems that affect their ability to undertake the activity of maintaining a safe environment • understanding of the hazards in the health care setting and how to promote patient safety effectively
