• ‘How you keep going’: Voluntary sector practitioners’ story-lines as emotion work

      Quinn, Kaitlyn; Tomczak, Philippa; Buck, Gillian; University of Toronto; University of Nottingham; University of Chester (Wiley, 2022-01-16)
      The 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.
    • Invisible and at-risk: older adults during the COVID-19 pandemic.

      Benbow, Susan M; Bhattacharyya, Sarmishtha; Kingston, Paul; Peisah, Carmelle (2021-12-16)
      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.
    • Welfare conditionality, ethics and social care for older people in the UK: From civic rights to abandonment?

      Carey, Malcolm; University of Chester (Oxford University Press, 2021-12-13)
      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.
    • The supervisor conundrum

      Knight, Kate; Leigh, Jacqueline; Whaley, Viki; Matthews, Marie; Doyle, Kate; Rabie, Gay; University of Chester; University of Salford; Manchester University NHS Foundation Trust (MA Healthcare, 2021-11-11)
      Commentry
    • The potential impact of extensive privatisation in the UK upon the ‘life chances’ of young people in care

      Carey, Malcolm; University of Chester (National Youth Agency, 2021-11-01)
      The article considers the potential impact of extensive privatisation in the UK upon the ‘life chances’ of young people in care
    • A modified grounded theory study exploring the impact of military service in Northern Ireland on mental wellbeing

      Kingston, Paul; Taylor, Lou; Finnegan, Alan; Frith, Anthony (University of Chester, 2021-11)
      Military 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.
    • This is how it feels: activating lived experience in the penal voluntary sector

      Buck, Gillian; Tomczak, Philippa; Quinn, Kaitlyn; University of Chester; University of Nottingham; University of Toronto (Oxford University Press, 2021-10-21)
      Increasing 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.
    • Assessment of sodium and iodine intake among university students in Casablanca, Morocco

      Jafri, Ali; Elarbaoui, Maria; Elkardi, Younes; Makhlouki, Houria; Ellahi, Basma; Derouiche, Abdelfettah; Université Mohammed VI des Sciences de la Sante; University of Chester; Université Hassan II de Casablanca (Elsevier, 2021-07-08)
      Introduction. – 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.
    • Development of the Compendium of Intellectual Disability Nursing Interventions

      Chapman, Hazel; Mafuba, Kay; Kiernan, Joann; Chester, Rebecca; Kudita, Chiedza; University of Chester (2021-07-06)
      This is a presentation that was delivered at the IASSIDD Europe Congress 6-8 July 2021, Amsterdam, Netherlands.
    • Universal credit, lone mothers and poverty: some ethical challenges for social work with children and families

      Carey, Malcolm; University of Chester (Taylor and Francis, 2021-06-22)
      This 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.
    • Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians

      Westwood, Clare; Lee, Tom; McSherry, Robert; Bettany-Saltikov, Josette; Catlow, Jamie; University Hospital North Tees and Hartlepool NHS Foundation Trust; North Tyneside General Hospital; University of Chester; Teesside University (Wiley, 2021-05-18)
      Aim: 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.
    • Employing with conviction: The experiences of employers who actively recruit criminalised people

      Atherton, Peter; Buck, Gillian; University of Chester (SAGE Publications, 2021-05-03)
      In 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.
    • Critical analysis of the Armed Forces Covenant Fund Trust Aged Veterans Fund

      Di Lemma, Lisa C G; orcid: 0000-0001-9161-1779; Finnegan, A; orcid: 0000-0002-2189-4926; Howe, S (BMJ Publishing Group, 2021-03-30)
      Background: 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.
    • The Teaching of Psychological Theory in the Undergraduate Pre-Registration Nurse Training Curriculum: Systematic, Integrative Literature Review

      Mitchell, Andrew E P; University of Chester (Nova Science Publishers, 2021-03-30)
      Aims and objectives. To establish how best to integrate psychology education into the pre-registration nurse training curriculum to enhance clinical practice. Background. Educational psychology focuses on applications of science to understand and improve how students learn and how they are taught. A key challenge for academics is integrating psychological theory within teaching sessions and clinical practice. Didactic teaching methods have had limited success as students do not see the direct relevance of psychological theory for clinical practice. Problem-based learning and simulation sessions may enhance the perceived importance for clinical practice. Design. Systematic, integrative literature review. Methods. A systematic search of the literature using multiple databases and search engines between the years 2010-2020 was undertaken using keywords and PICO algorithm. For this study, the following keywords were utilised; student nurse, pre-registration, education, problem-based learning, practice skills, simulation, psychology and learning theory. PICO identifiers were (Participants) pre-registration students, (Intervention) – psychology and psychological learning theory, (Comparison) – didactic taught sessions with problem-based and simulation, (Outcome) - improvement in theory or practice-based assessment. Results. Eleven studies were included. Evidence for traditional didactic teaching is limited. There is evidence that problem and simulation-based learning has shown success in demonstrating clinical practice implications. Conclusions. The findings reveal that psychology education is considered a central aspect of nurse training. Observational research is required to understand better the link between psychological knowledge and clinical practice. Relevance to clinical practice. There should be a strategic focus on the development and implementation of a coherent psychological theory in the pre-registration nurse training curriculum. Coherent and applied psychology curricula may have clear benefits for nurse education and clinical practice.
    • Evidence-based practice and evidence-informed practice competencies in undergraduate pre-registration nursing curricula: a document analysis at a University in England

      Kumah, E; Bettany-Saltikov, J; van Schaik, P; McSherry, R; Teesside University; University of Chester (Elsevier, 2021-03-13)
      Evidence-based practice and evidence-informed practice competencies in undergraduate pre-registration nursing curricula: a document analysis at a University in England Abstract Background In response to the heightened emphasis on incorporating the best available evidence into healthcare decision-making, healthcare training institutions have been actively incorporating Evidence-Based Practice (EBP), and/or Evidence-Informed Practice (EIP) competencies into undergraduate healthcare curricula. However, there is a gap in the scientific knowledge about the actual contents, as well as the extent of integration of EBP and EIP in undergraduate pre-registration nursing programmes. Method A document analysis utilising Rohwer et al.’s (2014) framework was conducted to review and analyse the content of EBP and EIP competencies in the 2018/2019 curriculum of the undergraduate pre-registration nursing programme of a University located in England, United Kingdom. Results Competencies relevant to EBP were included in four nursing modules. However, EIP competencies were not included in the curriculum. Conclusion There is an urgent need for a more structured and holistic way of teaching and assessing EBP competencies through the integration of the principles of EIP, in order to enhance the effective application of evidence into clinical nursing practice.
    • A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

      Benbow, Susan Mary; Eost-Telling, Charlotte; Kingston, Paul; University of Chester; Older Mind Matters (Cambridge University Press, 2021-02-24)
      We carried out a narrative review and thematic analysis of literature on the physical healthcare, mental healthcare and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States. Five themes were identified: experience of discrimination/ prejudice and disrespect; health inequalities; socioeconomic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/ prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a life course perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users.
    • 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 study

      Mason-Whitehead, Elizabeth; Sharma, Vimal; Quinn, Bennett N. E. (University of Chester, 2021-02)
      Introduction: 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.
    • The use of photo elicitation to explore the impact of social work student’s perceptions of placements on social work tutors and consider their role in practice learning

      Caffrey, Bridget; Fruin, Helen; Bailey-McHale, Julie; Ridgeway, Victoria; Bailey-McHale, Bex; University of Chester (Taylor & Francis, 2020-12-22)
      The importance of learning in practice is acknowledged across health and social care professions. Social work students’ experiences in practice settings has attracted some attention in academic literature, and the role and impact of the Practice Educator (PE) on student learning is increasingly recognised. However, there is a paucity of research examining the role of the social work tutor generally and particularly within practice learning settings. This paper presents a small-scale qualitative study exploring the impact of visual images produced by social work students reflecting their practice experiences on six social work tutors. Photo elicitation prompted discussion in a focus group setting which was subsequently thematically analysed, with four themes emerging. These were dichotomous relationships, difference and diversity, tutor brokerage skills, and student support. The images encouraged tutors to reflect upon the complexity of their relationship with social work students and question whether they were professionally equipped to support students in complex placement situations. In addition, the effectiveness of the curriculum in preparing social work students for practice was considered, particularly space afforded to students to reflect on practice learning in a safe environment. Opportunities to support SW tutors in their role and SW students in practice are deliberated.
    • Population Health Screening after Environmental Pollution

      Stewart, Alex G.; orcid: 0000-0002-4931-5340; email: dragonsteeth@doctors.org.uk; Wilkinson, Ewan; orcid: 0000-0002-2167-8756; email: ewilkinson@chester.ac.uk (MDPI, 2020-11-24)
      Following environmental pollution exposure, calls to screen the population for disease or disease markers are often made. Population screening is a cross-sectional review of a population to find latent cases or biomarkers of disease that indicate the possibility of disease development; it differs from environmental screening or an epidemiological survey. Recognized standard approaches have been developed over 60 years to ensure quality and effectiveness in complex programs. We surveyed the literature for papers on health screening following environmental exposures and checked them for reference to accepted criteria such as those of Wilson and Jungner. We applied these criteria to three situations covering source/hazard (arsenic contaminated land), pathway/exposure (radiation release), and receptor/disease (lead poisoning). We identified 36 relevant papers. Although across the papers the whole range of criteria were addressed, no paper or program utilized recognized criteria. Issues and gaps identified included limited strategic approaches, lack of treatment, environmental prevention being seen as the screening outcome instead of treatment of identified individuals, and programs which did not fit the World Health Organization screening description. Robust discussion in the literature is needed to consider the organization and role of health screening following environmental exposures.