• Understanding and working with challenging behaviour

      Ingram, Charles; Lovell, Andy; University of Chester (RCN Publishers, 2011-03)
      This article examines the theoretical approaches to understanding and managing individuals with a learning disability who display behaviours that challenge. The authors explain how drawing on these approaches can help professionals from different disciplines to provide effective, patient-centred care.
    • Understanding and working with people with learning disabilities who self-injure

      Heslop, Pauline; Lovell, Andy; University of Bristol ; University of Chester (Jessica Kingsley, 2012-11-15)
      Adopting a predominantly psychological approach, this book provides carers with up-to-date information and resources to provide appropriately individualised care to people with learning disabilities who self-injure. Understanding and Working with People with Learning Disabilities who Self-Injure synthesises traditional (behavioural) and newer (psychological) approaches to understanding self-injury, drawing on psychoanalytic and social theory to provide practical guidelines for more sustained and effective support. It suggests that motivations for self-injury may be similar for people with and without learning disabilities, and draws on case work examples to suggest person-centred techniques that encourage communication particularly important with people who do not use verbal communication - and recovery. The book covers a range of specific needs, including people with autism who self-injure, and emphasises the views of people with learning disabilities themselves and their families about what has worked best, and why. At the end of each chapter, a variety of practical implications for the provision of support are given. This book is for those supporting people with learning disabilities who self-injure and will be a useful resource for social workers, psychologists, counsellors, learning support workers, nurses and social and health care students.
    • Understanding Blogging Motivations in Palliative Care Using Maslow’s Hierarchy of Needs.

      Ngwenya, Nothando; Kingston, Paul; Mills, Stella; Africa Health Research Institute, KwaZulu Natal, South Africa; University of Chester; Staffordshire University (Inderscience, 2018-09-24)
      The pervasive use and potential of weblogs has increased the field of social health informatics and is becoming increasingly difficult to ignore. The prevalence of these technologies for narrative use brings about the fusion of diverse schools of thought on motivation. One proven model is that of Maslow, whose theory of needs has an intuitive appeal in understanding bloggers’ needs and motivations. This paper considers theoretical and practical blogging experiences for palliative care users through the embracement of Maslow’s hierarchy of needs. Palliative care patients, carers and clinicians were interviewed about their weblogs and data qualitatively analysed. The results indicate that the experience of maintaining a weblog is therapeutic for individuals and fulfils needs hierarchically from the lowest to the highest as outlined in Maslow’s theory.
    • Understanding depression

      Khan, Nahim; University of Chester (Chemist and Druggist, 2016-07-11)
      Quiz on use of the NICE guidelines on depression
    • Understanding minimum and ideal factor levels for participation in physical activities by people with haemophilia: An expert elicitation exercise.

      Martin, Antony P; orcid: 0000-0003-4383-6038; Burke, Tom; Asghar, Sohaib; Noone, Declan; Pedra, Gabriel; orcid: 0000-0002-2023-5224; O'Hara, Jamie (2020-04-08)
      The benefits of physical activity (PA) for people with haemophilia (PWH) may include improvements in joint, bone and muscle health. However, the factor VIII activity level required to avoid a bleeding episode associated with PA is unknown. To elicit the opinion of clinical experts on the minimum level and ideal factor VIII activity ('level') required to avoid a bleeding episode during participation in different types of PA for PWH. Based on the 2017 National Hemophilia Foundation PA descriptions, clinical experts estimated a minimally acceptable and an ideal factor level at which a bleed could be avoided. The uncertainty around estimates was quantified using an approach to construct a probability distribution to represent expert opinion. Minimum and ideal factor level increased with higher risk PA, whether or not joint morbidity was present, as did the experts' uncertainty in their estimates (ie the range between lowest and highest estimates for minimum and ideal levels). Mean minimum levels ranged from 4% to 48% for low to high risk for people without joint morbidity, and from 7% to 47% for those with joint morbidity. For ideal factor levels, corresponding figures were 9%-52% and 12%-64%, respectively. To support a patient-centric outcome, expert opinion indicates that the clinical norm of 0.01 IU/mL (1%) trough level is insufficient. It is anticipated that introducing a more targeted approach to meet the needs of patients who are increasingly physically active will benefit patients further in addition to recent treatment advances. [Abstract copyright: © 2020 John Wiley & Sons Ltd.]
    • Understanding of the Care Act 2014 among carers of adults with learning disabilities

      Gant, Valerie; University of Chester (RCN Publishing, 2017-05-26)
      The Care Act (2014) gave new rights to carers for assessment and aimed to provide a structure for a more personalised approach to care and support (DoH, 2014). The UK population is an aging one and research indicates that people with learning disabilities are part of this longevity (Emerson and Hatton, 2008; Foster and Boxall, 2015; Walker and Ward, 2013) with the majority of people with learning disabilities remaining in family care for many years (Cairns, et al. 2013; Gant, 2010). Thus carers are frequently providers of care for their relative with a learning disability and take on many levels of responsibility, often lasting for decades. This paper describes a research study involving 9 carers of adults with learning disabilities to establish their views on this piece of legislation, its likely significance to them and their relatives, and provides a forum for discussion and debate in terms of possible implications for practice.
    • Understanding perineal pain: Women's descriptions

      Steen, Mary; Royal College of Midwives/University of Central Lancashire (Mark Allen Publishing, 2008-06-01)
      Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is, therefore, impossible for another person to know exactly what someone else’s pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person’s experience of pain. Therefore during a PhD Study which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen & Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analysed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered. (Melzack & Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women’s descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.
    • Understanding the association between teenage pregnancy and inter-generational factors: A comparative and analytical study

      Whitehead, Elizabeth; University of Chester (Elsevier, 2007-06-27)
      This article aims to identify the number of teenage pregnant women who also have mothers who became pregnant when they were in their teenage years and to explore the importance of this intergenerational experience on the teenagers themselves, their significant family, friends and society as a whole.
    • Understanding the Determinants of homelessness through examining the life stories of homeless people and those who work with them: a qualitative research protocol

      Mabhala, Mzwandile A.; Ellahi, Basma; Massey, Alan; Kingston, Paul; University of Chester (Insight Medical Publishing Group, 2016-07-04)
      There has been a sharp increase in homelessness following recent UK welfare and other social policy reforms; these reforms included public expenditure reductions, compounded by benefit cuts which lowered/capped housing benefits and weakened welfare protection and the housing safety net. The increase occurred despite efforts by the government and charitable organisations to mitigate it, which raises questions about their strategies’ effectiveness and about policymakers’ understanding of homelessness. This study aims to gain insight into the determinants of homelessness through examining the life stories of homeless people and those who work with them. Constructivist grounded theory (CGT) is used to develop a theoretical explanation of the determinants of homelessness. Qualitative in-depth semi-structured interviews are being conducted in several centres for homeless people in the north west of England, UK. Initial analysis of the stories of homeless people reveals four determinants of homelessness: home and childhood environments; experiences during school life; type of social lifestyle; and opportunities for access to social goods. Participants see their homelessness as a manifestation of fundamental determinants of social inequalities such as education; income inequality; unemployment and welfare; barriers to housing and other services; crime and living environment.
    • Understanding the diffusion of the idea of contact with nature to enhance health: An Eliasian case study

      Thurston, Miranda; Greening, Kim (University of Chester, 2015-12)
      In public health working in a less medical and more preventative way by focussing on the wider determinants of health, inter-sectoral collaboration, and evidence based practice have been advocated as ways to raise the health status of the population. In recent years, the idea of contact with nature to enhance health has come to the fore as one way to tackle current public health challenges: for example, diabetes, overweight and obesity, chronic liver disease, hypertension and mental health problems. Yet little is known about how this idea has diffused through the interdependent figurations of researchers, policy makers and into use through the actions of people in local organisations. The processes connecting these interdependent figurations are complex and, in the case of contact with nature, are not well understood. This is the research problem this thesis seeks to address, that is to say, the evidence into action process of an idea. The theoretical perspective of Norbert Elias is used throughout the thesis to analyse the diffusion process of the idea. Elias’s work is concerned with long term processes in human history; in adherence with his approach to sociological inquiry a historical context going back more than three generations provides the backdrop for the empirical work. An examination of the context illuminated the significance of the decade of the 1970s onwards to the present use of the idea of contact with nature in public health; notably the shift in discourse about hazards, risk and threats from nature to one of health enhancement. Norbert Elias’s own thinking and discourse about contact with nature to enhance health is used as a touchstone for the analysis. The empirical data in the thesis is generated through mixed methods, principally bibliometrics and content analysis, to reveal the diffusion and development of the idea over time and to show the way that the idea is framed when used by researchers, policy makers and by people within organisations. An Eliasian approach to case study methodology is utilised. Sub-study 1 revealed that empirical research literature about the idea emerged in the 1970s and that the number of publications per annum increased year on year until 2005. The empirical research was generated by researchers located across several continents and from different disciplines. Early researchers into the idea investigated the psychological benefits whilst latterly epidemiological studies have come to the fore. Sub-study 2 showed that the idea was taken up widely by policy makers in four government departments in England from 2000, with a peak in 2011. There were more references to the idea in the policy documents of the Department for Environment, Food and Rural Affairs than other government departments; the references of this department took an ecosystem services stance. Sub-study 3 showed that during July to October 2013 and within Greater Manchester, 36 organisations were providing and/or promoting activities which involved the idea of contact with nature on their websites. Of these 36 organisations, 16 (44%) were conservation/wildlife based agencies whose use of the idea included the pursuit of their own agendas and purposes. ix An analysis of the results, using the theoretical perspective of Norbert Elias, shows the involvement of many figurations of interdependent individuals, and the long term, largely unplanned, and non-linear character of the diffusion process. The empirical findings reflect the transdisciplinary nature of the research, inter-sectoral collaboration across government departments within policy, and the adoption of the idea outside of the traditional health service. People and thinking from the environment sector have greatly influenced the diffusion and development of the idea, and their involvement has widened the scope and form of public health action.
    • Understanding the Processes Involved in Implementing an Improving Access to Psychological Therapies Service: An Exploratory Study that Investigates Practitioner and Client Experience Regarding its Effect on Patient Pathways, Service Design and Overall Outcomes

      Pietroni, Patrick; Thomas, Mike; Steen, Scott (University of Chester, 2015-12-31)
      The English Improving Access to Psychological Therapies (IAPT) programme is a government-funded initiative that aims to provide timely and equitable access to evidence-based psychotherapeutic interventions, within a primary care setting. Despite the many achievements of the programme, there are several issues regarding research to clinical gaps, as well as a high rate of variation between sites concerning outcomes and attrition. This thesis explores the implementation process of the IAPT delivery model to understand which factors are influential in the successful uptake and integration of evidence-based psychotherapeutic interventions. The aims of this thesis are:  To explore, identify and analyse the implementation process involved in establishing and delivering an IAPT service.  To uncover the factors that either facilitate or impede its development to provide a more in-depth and detailed account of the implementation and operation of services.  To develop an understanding regarding the applicability of evidence-based practice and the IAPT delivery model in a clinical setting, for the provision of psychological therapies. I conducted a series of semi-structured interviews with practitioners delivering and implementing services, across seven sites, and clients, across three sites. The design and analysis followed an Interpretative Phenomenological Analysis, focusing on personal meaning and sense-making processes. The objective of the interview was to understand the implementation process regarding the IAPT delivery model, exploring how this influences personal experiences and client engagement. Additionally, participant narrative was set in context using open-access data collected and published by the programme. The analysis generated three master themes for practitioners delivering and implementing services including: ‘A Call to Action’ describing how participants regarded this process as a genuine opportunity to make a real impact in mental healthcare; ‘Contextual Influences on Service Operation’ which explores the activities in becoming a locally determined, adaptable and relevant service; and a ‘Focus on Relationships’ outlining the relational and collaborative work involved during implementation. For the client group, three master themes were generated including: ‘A Personal Journey: From Discovery to Advocacy’ illustrating the changing experiences involved during service access and engagement; ‘Perception of Self’ which portrays how individuals made sense of their engagement by judging what it meant to them; 5 and ‘Outside Factors’ which explores the role of others and the physical journey made in getting to services. The analysis suggested that both groups made sense of their experiences in complex and varied ways. Heavily influencing the implementation of the IAPT delivery model is the over-arching need to boost throughput and quantity, possibly at a cost of quality. Additionally, it is argued that the use of routine outcome monitoring in services is useful for reflecting on the implementation process and engaging clients. The key to successful implementation appears to be about achieving integration, requiring a whole-systems based approach that considers the mediating pathways into and out of services. In light of the findings and literature, the thesis proposes several recommendations for future practice and further research.
    • Understanding violence when the perpetrator has an intellectual disability: The perceptions of professionals

      Lovell, Andy; Skellern, Joanne; University of Chester (SAGE, 2017-12-18)
      Aim: The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. Background: The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. Design: A qualitative study investigating the views and perceptions of professionals working directly with people with an intellectual disability in different settings. Methods: 22 semi-structured interviews were undertaken with professionals from a variety of backgrounds and four themes were generated through data analysis. Findings: Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. Conclusion: Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.
    • Universal credit, Lone mothers and poverty: Some context and challenges for social work with children and families

      Carey, Malcolm; University of Chester
      Universal Credit is a streamlined benefits delivery system initially introduced in the United Kingdom (UK) in 2008. Conditionality-based welfare policies are increasingly international in scale, and are now widely adopted by neoliberal governments on the basis that paid employment offers the most efficacious route out of poverty for citizen-subjects. Numerous studies suggest otherwise, and highlight their negative impact upon the social rights, lived experiences, and attempts to alleviate poverty for service users. This article analyses the reformed benefit system and wider workfare policies effect upon lone mothers, including as a consequence of engagement with an ever more stigmatizing benefit system, and associated risks posed by sanctions or precarious low-paid employment. It highlights some of the consequences for social work with children and families of Universal Credit: including ongoing tensions and challenges created for the profession by the punitive policies of the workfare-orientated centaur state.
    • University-Trust collaboration: A secure learning disability service in transition

      Lovell, Andy; University of Chester (RCN Publishers, 2011-06)
      This article describes how a research project, looking at the management of change within a learning disability service in transition from medium to low security, confirms the importance of staff involvement in the process.
    • The use of a mobile app in health visiting to support school readiness

      Lee, Fiona; Wright, Paula; University of Chester; Bridgewater Foundation Trust (Mark Allen Group, 2016-08-24)
      Starting school is a major milestone in family life, and there is increasing awareness that a child who is ‘ready for school’ when they begin full-time education is more likely to reach their full potential. This is not only in terms of academic achievement, but also social and behavioural skills, which have an impact later in adulthood (UNICEF, 2012). Health visitors’ responsibilities include supporting parents to maximise their child’s health and development from birth onwards—a complex and challenging remit for which they need to be continually developing engaging strategies and tools (Department of Health, 2009). This article reviews the collaborative development of a school readiness mobile app for Bridgewater Community Foundation NHS Trust. The project won the prestigious 2016 Journal of Health Visiting Award for School Readiness, and the University of Chester was recognised as a key collaborator in this innovative development. The article seeks to inspire health visiting colleagues to search for collaborative partners to address school readiness in an engaging way with parents.
    • The Use of Language in Hospice Care and the Impact on Patients and Families

      Gant, Valerie; University of Chester (Sage, 2017-07-01)
      Whilst there is an expanding literature and a growing knowledge-base relating to patient and family experiences in hospice settings (1,2,3), there is a much more limited corpus reflecting the first-person perspective of patients and their families. These accounts can be helpful in highlighting perceived gaps between current practice and family needs (4). This narrative account reflects upon the perspective of a hospice patient’s family during her last week of life and notes how the actions and language of staff members and volunteers had a major impact on the overall experience and subsequent grieving processes of family members.
    • 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
      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.
    • Use of storytelling and audio podcasts in qualitative research

      Sutton, Julie E.; University of Chester (RCNI, 2019-08-01)
      The author discusses the use of service user story telling through the medium of audio podcasts, in service evaluation. The author argues this is an effective way to promote service user participation in service improvement projects and highlights how audio podcasts can stimulate emotional connections in service evaluators leading to informed identification of priorities for change
    • User involvement

      Dulson, Julie; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses user involvement policy, the user involvement continuum, and barriers to user involvement and their solutions.
    • Using a feminist standpoint to explore women’s disclosure of domestic violence and their interaction with statutory agencies

      Mason, Tom; Keeling, June J. (University of ChesterUniversity of Chester, 2011-11)
      This thesis explores women’s disclosure of domestic violence, and is based on the findings of two research studies. The first study explored prevalence rates of domestic violence reported by women following childbirth. The subsequent narrative study explored women’s experiences of disclosure and their interactions with statutory agencies. The research was influenced by a feminist epistemology, recognizing the marginalisation of the women’s experiences from a subjugated relationship, addressing the power relationship between the researcher and participants and because of the significant disparity between gendered lives. The study was conducted in two parts. A survey of five hundred women in the immediate postnatal period within a large NHS Hospital participated in the first part of the study. The second study involved narrative interviews with fifteen women living within their own community who talked about their experiences of domestic violence and issues surrounding disclosure. Women’s stories about disclosure including the responses they received were influenced by cultural narratives. The theories of social power have been utilized as an explanatory framework and provide the theoretical basis of the analysis. The study found low levels of disclosure at two specific points along the pregnancy/childbirth continuum; during booking in clinic and in the immediate postnatal period. Furthermore, the findings revealed three specific tactics used by perpetrators to engage women in the early relational stage with the intentionality of exerting control and subjugation. These have been termed feeling special, feeling vulnerable and commitment. Whilst women talked of coercion and subjugation by their partners, they also talked of how their interactions with statutory agencies limited their agency. The significance of this study is that the thesis was able to challenge contemporary policies developed by statutory agencies in the provision of support to women who experience domestic violence. The thesis develops some understanding of the nature and role of cultural narratives and patterns of disclosure before suggesting new directions to further advance the findings presented. Finally, the thesis proposes recommendations to improve training for statutory agencies in providing a response to women disclosing domestic violence, suggesting a new direction in thinking about the facilitation of this training.