• Some ethical limitations of privatisation within social work and social care in England for children and young people

      Carey, Malcolm; University of Chester (Routledge, 2019-04-01)
      The article considers some of the ethical impications of the ongoing privatisation of social care and social work services.
    • The emergence of accelerated resolution therapy for treatment of post-traumatic stress disorder: A review and new subgroup analyses

      Kip, Kevin E.; orcid: 0000-0002-6401-0051; Berumen, Jessica; Zeidan, Amina R.; Hernandez, Diego F.; Finnegan, Alan P. (Wiley, 2019-01-25)
    • Issues of Ageing, Social Class, and Poverty

      Carey, Malcolm (Routledge, 2019-01-18)
      This chapter examines some ethical and political challenges generated by the increasingly complex needs of an ageing society upon social work. It concentrates on the UK as a case study and critically evaluates related age-graded policies and practices relating to social work and care. The chapter includes a discussion of the on-going ethical tensions between social diversity within an ageing society and the shrinking of formal care provision.
    • Sleep hygiene education and children with developmental disabilities:findings from a co-design study

      Sutton, Julie E; Huws, Jaci C; Burton, Christopher R; University of Chester; Bangor University (SAGE publications, 2019-01-17)
      This qualitative study develops a programme theory demonstrating the complexity embedded in sleep hygiene education (SHE) as an intervention to improve sleep problems in children with developmental disabilities. In co-design workshops, eight parents and six sleep practitioners deliberated themes developed from findings of an earlier exploratory study of stakeholder perceptions of SHE. A SHE tool underpinned by programme theory was developed evidenced by midrange theories of change. Analytical themes were developed to explain the programme theory and the complexities of a successful SHE intervention: the need to legitimize children’s sleep problems and consider the nature of customization, knowledge sharing, health expectation and impact of sleep service rationing and gaming strategies on implementation success. Policy and practice implications include a need to raise the public profile of children’s sleep problems and promote parental involvement in intervention implementation. Further research is needed to test out this theory-driven framework for evaluating SHE.
    • Academic induction: Perceptions of newly appointed university lecturers in nurse education: An interpretive phenomenological inquiry

      Ashford, Ruth; Mansfield, Madeleine; Carr, Helen (University of Chester, 2019-01-11)
      Aims: Empirical evidence demonstrates successful expert nurses appointed as nurse lecturers in higher education find themselves as ‘newcomers’ to the role and organisation. New nurse lecturers often find their transition to higher education confusing and challenging. Using the conceptual framework of communities of practice, this study aims to provide original research into what induction means for new nurse lecturers, and gain an in-depth understanding of their perceptions and experiences of their induction into working in a multi-sited university. Method: A qualitative research methodology was employed, using the theoretical approach of Interpretive Phenomenological Analysis (IPA) developed by Smith, Flowers, and Larkin (2009). Eight lecturers, with between one to three years’ experience as nurse lecturers, were recruited from one university in the North West of England. Purposive sampling was utilised and data was obtained through one-toone semi-structured interviews. Verbatim transcripts were analysed following the principles of IPA. Findings: Three super-ordinate themes emerged (partial transition, dual communities of practice, introduction), along with six sub-ordinate themes (expectations of the nurse educator role, career change, contextual influences, location and culture of sites, tick box exercise, and the limited role of the mentor). New nurse lecturers found transition stressful: key aspects included the culture shock and the career change of adopting their new academic identity. Changing identity from a nurse to an educator, working across the boundaries of both practice and academia, was a struggle, particularly in participants with visiting lecturer experience who had mistakenly perceived this would prepare them for the role. Early role preparation was essential to understanding the different cultures and processes within the university. Formal mentoring supported development of self-confidence, but its value was undermined due to the mentors’ workload and lack of understanding of their role, which affected relationship building. Supportive heads of department, and informal mentoring and peer support, were essential in developing new academic identities. Conclusion: This study contributes to practice through the development of an induction framework for new nurse educators. This framework acknowledges the relevance of maintaining a dual community of practice for new nurse educators, in supporting their new identity and their dual continuing professional development. Practical outcomes include: development of an informational resource for new lecturers (including visiting lecturers); development of a community of learning with facilitated workshops and online information resources; development of mentor training and resources for mentors; and mentors being thoughtfully designated by heads of department, with hours attached to their workload for mentoring. A long term online community of practice is needed for new staff to keep in touch and share information. Heads of department need to take ownership of inductions to ensure that their staff feel welcomed and supported in their new environment, with regular evaluation taking place.
    • Social Work Through Collaborative Autoethnography

      Gant, Valerie; Cheatham, Lisa; DiVito, Hannah; Offei, Ebenezer; Williams, Gemma; Yatosenge, Nathalie; University of Chester (Taylor & Francis, 2019)
      This paper discusses a research project involving 5 MA Social Work Students and 1 member of Social Work Academic Staff. Using narrative and taking a collaborative autoethnographical approach, this project highlights some of the feelings that students articulated following a 70 day placement experience. Findings include anxiety, powerlessness and frustration, together with growing confidence, recognition of their skills and a deeper understanding of the role of ‘self’ in social work. Raising issues of preparedness for practice placement, this paper has implications for both social work practice and social work education. Autoethnography (AE) is both a method of carrying out research and a methodology, specifically a qualitative methodology linked to ethnography and narrative inquiry. AE results in highly personalised narrative accounts of the researcher’s engagement with specific sociocultural contexts in the pursuit of knowing more about a phenomenon. Applying such a methodology to explore collaboratively issues of student lived experience of placement is a new and innovative use of this method.
    • Politicisation or Professionalisation? Exploring divergent aims within UK voluntary sector peer mentoring

      Buck, Gillian; University of Chester (Wiley, 2019)
      Meaningful ‘user involvement’ is an established aim of social work practice, and increasingly, an aspiration of criminal justice, yet there are unique challenges to participatory work within punitive contexts. Drawing upon a study of peer mentoring in the voluntary sector, this article unveils some core tensions related to (ex)service user involvement in criminal justice. Interviews with mentors, mentees, and key stakeholders, along with direct observations of practice, reveal that respondents often see their work as personal-political, emphasising the value of lived expertise and of collective action to address limiting social conditions. Simultaneously, however, mentoring is framed nationally and shaped locally by more established aims to correct, improve, and manage, individual ‘offenders’. There is, therefore, a fundamental tension between processes of politicisation, or coming together to assert a user voice and affect social change; and professionalisation, wherein mentors are co-opted into forms of practice they often critique.
    • Beating the blues with pleasurable activity

      Mitchell, Andrew E. P.; University of Chester (Philip Allan, 2019)
      In this article Chartered Psychologist, Andrew Mitchell explains how behavioural activation (BA) can be used to treat depression
    • Registered nurses’ experiences of communicating respect to patients: influences and challenges

      Clucas, Claudine; Chapman, Hazel Margaret; Lovell, Andrew; University of Chester (SAGE Publications, 2019)
      Background: Respectful care is central to ethical codes of practice and optimal patient care, but little is known on influences on and challenges in communicating respect. Research question: What are the intra- and inter-personal influences on nurses’ communication of respect? Research design and participants: Semi-structured interviews with 12 hospital-based United Kingdom registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. Ethical considerations: The study was approved by the Institutional ethics board and National Health Service Trust. Findings: Three interconnected superordinate themes were identified: ‘private self: personal attitudes’, ‘outward self: showing respect’ and ‘reputational self: being perceived as respectful’. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses’ reputational self as respectful, with negative implications for patient care. Discussion: The study offers an in-depth understanding of intra- and interpersonal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care.
    • Midwifery and psychological care

      Jones, Alun Charles (Mark Allen Group, 2018-12-02)
    • Diversity in ageing, reductive welfare and potential new ways of utilising ethics in social work with Older People

      Carey, Malcolm; University of Chester (Routledge, 2018-11-30)
      This chapter examines some ethical and political challenges generated by the increasingly complex needs of an ageing society upon social work. It concentrates on the UK as a case study and critically evaluates related age-graded policies and practices relating to social work and care. The chapter includes a discussion of the on-going tensions between social diversity within an ageing society and the shrinking of formal care provision, alongside the impact of professional codes of ethics.
    • The tyranny of ethics? Political challenges and tensions when applying ethical governance to qualitative social work research

      Carey, Malcolm; University of Chester (Taylor & Francis, 2018-11-29)
      This paper examines problems which current ethical governance processes generate for qualitative researchers within social work. It draws upon case studies and critical theory to detail the unpredictable and diverse nature of much social work qualitative research. It argues that too often this research is pitted against a narrow institutional focus placed on positivist-orientated empirical research and income generation. Overtly instrumental interpretations of ethics - often determined by realist and bioethical paradigms - can quickly inhibit the methodological dynamism required to meaningfully capture the complex and non-binary issues which social workers accommodate in their work and subsequent research. Arguments that policy-led, institutional and professional cultures have generated a conservative culture of risk-aversion within the neo-liberal university are also considered.
    • Being homeless in an unequal society: A qualitative analysis of stories of homeless people

      Mabhala, Mzwandile A. (Oxford University Press (OUP), 2018-11-21)
    • Exploring Preceptorship Programmes: Implications for Future Design

      Taylor, Louise M; Eost-Telling, Charlotte L; Ellerton, Annie; University of Chester (John Wiley & Sons Ltd, 2018-11-15)
      • Aims and objectives: To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes. • Background: Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations. • Design: A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation. • Methods: Forty-one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study utilised the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. • Results: The response rate for the questionnaire was 56.1% (n=23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint. • Conclusions: There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, i.e., trust policy, and its delivery, i.e. preceptorship offering. There was no one framework that would universally meet the needs of all trusts, yet there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context. Relevance to clinical practice: The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations.
    • Inhibitor clinical burden of disease: a comparative analysis of the CHESS data.

      Oladapo, Abiola O; email: Abiola.Oladapo@shire.com; Lu, Mei; Walsh, Shaun; O'Hara, Jamie; Kauf, Teresa L (2018-11-09)
      BACKGROUND:Patients with hemophilia and inhibitors generally face greater disease burden compared to patients without inhibitors. While raising awareness of relative burden may improve the standard of care for patients with inhibitors, comparative data are sparse. Analyzing data drawn from the Cost of Haemophilia across Europe - a Socioeconomic Survey (CHESS) study, the aim of this study was to compare the clinical burden of disease in patients with severe hemophilia with and without inhibitors. Hemophilia specialists (N = 139) across five European countries completed an online survey between January-April 2015, providing demographic, clinical and 12-month ambulatory/secondary care activity data for 1285 patients. Patients with hemophilia who currently presented with inhibitors and those who never had inhibitors were matched on baseline characteristics via propensity score matching. Outcomes were compared between the two cohorts using a paired t-test or Wilcoxon signed-rank or McNemar's test. RESULTS:The proportion of patients who currently presented with inhibitors was 4.5% (58/1285). Compared to PS-matched patients without inhibitors, patients with inhibitors experienced more than twice the mean annual number of bleeds (mean ± standard deviation, 8.29 ± 9.18 vs 3.72 ± 3.95; p < .0001) and joint bleeds (2.17 ± 1.90 vs 0.98 ± 1.15; p < .0001), and required more hemophilia-related (mean ± standard deviation, 1.79 ± 1.83 vs 0.64 ± 1.13) and bleed-related hospitalizations (1.86 ± 1.88 vs 0.81 ± 1.26), hemophilia-related consultations (9.30 ± 4.99 vs 6.77 ± 4.47), and outpatient visits (22.09 ± 17.77 vs 11.48 ± 16.00) (all, p < .001). More than one-half (53.5%) experienced moderate/severe pain necessitating medication compared to one-third (32.8%) of patients without inhibitors (p = .01). CONCLUSIONS:Patients with hemophilia and inhibitors exhibited greater clinical burden and higher resource utilization compared to their peers without inhibitors. Strategies for improving the standard of care may alleviate burden in this population.
    • Art therapy with refugee children: a qualitative study explored through the lens of art therapists and their experiences

      Akthar, Zahra; Lovell, Andrew; University of Chester (Taylor and Francis, 2018-11-09)
      This article sets out to explore the use of art therapy with refugee children, from the perspective of art therapists and their experiences. Three semi-structured interviews were conducted to gain insights by capturing experiences and stories. Using thematic analysis, five themes were identified: (1) giving voice; (2) rebuilding trust, opening wounds; (3) sharing stories, healing pain; (4) exploring identity, discovering new-self; and (5) understanding art therapy. Upon reflection, two key aspects of art therapy were established, these were identified as: (1) providing refugee children with a safe space to heal and discover new-self, and (2) giving refugee children a voice to express and share stories. Despite the last of the five themes (understanding art therapy) being established as a factor that limits the use of art therapy, this has created an avenue for further research. From the findings, it was concluded that art therapy can be a useful form of psychotherapy for refugee children. Art therapy can provide these children with a safe space to heal, and give them a voice to be heard.
    • Knowledge translation and the power of the nursing academic conference

      Finnegan, Alan; McGhee, Stephen; Roxburgh, Michelle; Kent, Bridie; University of Chester; University of South Florida; University of Highlands and Islands; University of Plymouth (Elsevier, 2018-11-08)
      The national and international conference experiences present a unique learning opportunity. There are differing events that reflect the full nursing employment spectrum from clinical delivery, organizational and policy development and academia in education and research. Many conferences provide a platform for academics with differing levels of experience to come together and welcome contributions from students and all grades of post-registration nurses, educationalists, administrators, and researchers. In selecting the programme, the conference organisers will often circulate a calling notice and potential presenters will submit their abstracts to be blind peer reviewed. Therefore, conferences showcase the best of the best and provide the current perspective of areas of growth within the nursing sector. Conferences have a plethora of delivery routes ranging from posters, oral presentations (both short and long), panel discussions, key notes, seminars, exhibitions and workshops. These present an exceptional chance to listen, present, network and discuss nursing innovation and academic research.
    • A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

      Kamugisha, S Robert; Dobson, Andrew E; Stewart, Alex G; Haven, Nahabwe; Mutahunga, Birungi; Wilkinson, Ewan (2018-10-12)
      Introduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources.
    • Community-Based Health Insurance Increased Health Care Utilization and Reduced Mortality in Children Under-5, Around Bwindi Community Hospital, Uganda Between 2015 and 2017.

      Haven, Nahabwe; Dobson, Andrew E; Yusuf, Kuule; Kellermann, Scott; Mutahunga, Birungi; Stewart, Alex G; Wilkinson, Ewan (2018-10-09)
      Introduction: Out-of-pocket fees to pay for health care prevent poor people from accessing health care and drives millions into poverty every year. This obstructs progress toward the World Health Organization goal of universal health care. Community-based health insurance (CBHI) improves access to health care primarily by reducing the financial risk. The association of CBHI with reduced under-5 mortality was apparent in some voluntary schemes. This study evaluated the impact of eQuality Health Bwindi CBHI scheme on health care utilization and under-5 mortality in rural south-western Uganda. Methods: This was a retrospective cross-sectional study using routine electronic data on health insurance status, health care utilization, place of birth, and deaths for children aged under-5 in the catchment area of Bwindi Community Hospital, Uganda between January 2015 and June 2017. Data was extracted from four electronic databases and cross matched. To assess the association with health insurance, we measured the difference between those with and without insurance; in terms of being born in a health facility, outpatient attendance, inpatient admissions, length of stay and mortality. Associations were assessed by Chi-Square tests with p-values < 0.05 and 95% confidence intervals. For variables found to be significant at this level, multivariable logistic regression was done to control for possible confounders. Results: Of the 16,464 children aged under-5 evaluated between January 2015 and June 2017, 10% were insured all of the time 19% were insured for part of the period, and 71% were never insured. Ever having had health insurance reduced the risk of death by 36% [aOR; 0.64, p = 0.009]. While children were insured, they visited outpatients ten times more, and were four times more likely to be admitted. If admitted, they had a significantly shorter length of stay. If mother was uninsured, children were less likely to be born in a health facility [adjusted odds ratio (aOR) 2.82, p < 0.001]. Conclusion: This study demonstrated that voluntary CBHI increased health care utilization and reduced mortality for children under-5. But the scheme required appreciable outside subsidy, which limits its wider application and replicability. While CBHIs can contribute to progress toward Universal Health Care they cannot always be afforded.