• Taking Control: The Psychosocial Benefits of Reablement

      Chapman, Hazel M.; University of Chester (Palgrave Macmillan, 2018-03-30)
      This chapter discusses the psychosocial theories that underpin the philosophy and practice of reablement services. Prior to a long-term condition an older person will have fulfilled a role (indeed several) and will have taken an active part in community life (Coulter, Roberts and Dixon 2013). When a person is incapacitated by impairment, disability and pain the natural consequence is that they become a ‘user’ of health and/or social care services. This change is often dramatic and involves some distress, often associated with the level of importance an individual places on the activities they are no longer able to carry out. In addition, inpatient care can reduce mobility (Merreywether and Chapman 2013), as well as creating dependence on others for personal care and daily activities (see Chapter 4). Alternatively, and with reablement, a person can regain a sense of control over their lives, which includes psychological, social and physical recovery. There is a need for the person to be engaged in a meaningful process which genuinely advances independent living. However, loss of confidence, feelings of helplessness and an altered self-concept create barriers to regaining control. Societal expectations of recovery (including those of acute health services) can make long-term illness and disability discreditable experiences, inhibiting social engagement and increasing feelings of helplessness. Together with the person, the attitude of reablement workers (anyone who works with a service user in a reablement capacity) is thus a critical factor in social inclusion (In Control 2015) and reablement. Concordance, the respectful partnership between service user and service provider in planning and achieving essential aspects of the reablement process, is a fundamental requirement of reablement. It involves valuing the person and acknowledging the human relationship, promoting self-esteem, a sense of control and confidence to try, without worrying about failure. Immanuel Kant, the eighteenth-century philosopher, identified the importance of treating people as ends in themselves, rather than as means to an end (McCormack and McCance 2010), with important implications for the rights of human beings, irrespective of their earning potential, cognitive abilities, appearance, morality or other attributes of difference. Kant also identified the importance of autonomy, and behaving in ways that protected it, in order to promote respect for the self and for other human beings (Gregor 1997). His view of autonomy was that the individual should be free to make a moral choice, rather than come under the influence of more powerful others, and it is from this that the principle of informed consent in modern health and social care is derived (Lysaught 2004). So, in order to respect the service user, we need to support them to make fully informed choices about their reablement plan and then enable them to pursue those choices, even if we would make different ones. Respect for self and others is strongly echoed in the humanistic values of unconditional positive regard, congruence (or authenticity) and empathy, to promote personal growth or self-actualisation. Unconditional positive regard means valuing the person as an end in themselves, regardless of their status or personal characteristics. Congruence means that a person’s view of themselves as they are (self-image) and the way they would like to be (ideal self) are very similar, so the person feels happy with who they are. Empathy means understanding the world from the other person’s view in order to relate to their emotional feelings and needs. Self-actualisation, or personal growth, is the process of leading a life in which the person feels happy within themselves but looks forward to the next challenge or opportunity for self-development. These values are fundamental to the person-centred therapy of Carl Rogers (1961) and are used to promote the development of cognitive and emotional adjustment. Thus, the person sees themselves as worthy of respect and is able to plan a future that involves growth and development. Differing terms are used for the role of the service user in working with health professionals: adherence, compliance and concordance. Compliance suggests unwilling or unthinking obedience, but not taking medicines or following advice, which affects health outcomes and costs, can be a mechanism by which the service user is blamed for any failure to recover (Bissell, May and Noyce 2004), sometimes earning them the label of being ‘non-compliant’. Adherence means the active choice to follow the advice or prescription of a health professional, and is the term generally used in relation to pharmacological interventions, while concordance is agreement upon a plan of action or care management which incorporates the knowledge and views of the person and the professional (Horne et al. 2005). Outmoded emphasis on the importance of compliance with health and social care professionals, which creates a barrier to open communication, undermines the value of the individual and reinforces their view of themselves as helpless, leading to dependence and disability. These psychoemotional dimensions of disability that oppress people are described by Thomas (2004, p. 38) as ‘being made to feel of lesser value, worthless, unattractive, or disgusting’ and can affect both their self-concept and their understanding of their relationships with others. Consequently, it is essential for all health and social care professionals and support workers who work in reablement to understand these ideas and to value and respect the humanity of the service users with whom they interact. This chapter will provide an explanation and synthesis of key theoretical concepts that underpin a psychosocial understanding of the issues associated with disability, ageing and long-term conditions. Initially, it will explore the idea of the self, and how the psychology of the self influences human thoughts, feelings and behaviours within, and as a result of, the reablement interaction. This will be followed by a broad discussion of ageing theories such as disengagement, active ageing and gerotranscendence as well as elements of positive psychology. Understanding stigma will enable understanding of personal values in order to develop non-stigmatising attitudes and behaviour. Centrally, the need to facilitate the personal motivation and self-efficacy of service users, while enabling them to feel secure and confident, will illustrate the complexity of working with individuals within the context of reablement. Chapter objectives By the end of this chapter you should be able to: • Determine what self-concept is and how it affects the success of reablement and is in turn affected by it • Recognise learned helplessness and how it is reinforced by a loss of control • Outline the ways in which stigma acts as a barrier to reablement • Appraise psychosocial theories of ageing and their implications for reablement • Describe person-centred therapeutic relationships as the foundation of reablement practice
    • Talking about my experiences ... at times disturbing yet positive': Producing narratives with people living with dementia

      Benbow, Susan M.; Kingston, Paul; University of Chester (SAGE, 2014-09-22)
      Background: This research investigated narrative production and use with families living with dementia. We hypothesised that the process of narrative production would be beneficial to people with dementia and carers, and would elicit important learning for health and social care professionals. Method: Through third sector partners, we recruited community-dwelling people with dementia and carers who consented to develop written, audiotaped or videotaped narratives. Audio-taped narratives were transcribed verbatim and handwritten narratives word-processed. After checking by participants, completed narratives were analysed thematically using qualitative data analysis computer software. A summary of the analysis was circulated to participants, inviting feedback: the analysis was then reviewed. A feedback questionnaire was subsequently circulated to participants, and responses were analysed thematically. Results: Twenty-one carers and 20 people with dementia participated in the project. Four themes of support were identified: ‘relationships’, ‘services’, ‘prior experience of coping’ and having an ‘explanation for the dementia’. Three themes were identified as possible additional stresses: ‘emotions’, ‘physical health’ and ‘identity’. We suggest a model incorporating all these themes, which appeared to contribute to three further themes; ‘experience of dementia’, ‘approaches to coping’ and ‘looking to the future’. In participant feedback, the main themes identified were ‘emotions’, ‘putting things in perspective’, ‘sharing or not sharing the narrative’ and ‘actions resulting’. Conclusions: Producing a narrative is a valuable and engaging experience for people with dementia and carers, and is likely to contribute to the quality of dementia care.Further research is needed to establish how narrative production could be incorporated into routine practice.
    • 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.
    • Teaching strategies

      Woodhouse, Jan; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses the range of teaching strategies and how they can change depending on whether the setting is classroom or practice. Use of the appropriate teaching strtaegy can move the elarner from being dependent to self-directed learning.
    • Teaching styles

      Gidman, Janice; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses teaching styles and how they need to be appropriate for the content of the session and the nature of the group of students.
    • Teamwork

      Gee, Alan; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses the role of the team in the healthcare profession.
    • The Care Act 2014: a new legal framework for safeguarding adults in civil society

      Penhale, Bridget; Brammer, Alison; Morgan, Pete; Kingston, Paul; Preston-Shoot, Michael (Emerald, 2017-08-14)
    • The cat is out of the bag – point-of-care testing (POCT) is here to stay

      Phin, Nick; Poutanen, Susan M (European Centre for Disease Control and Prevention (ECDC), 2020-11-05)
    • The clusters and frequencies of adverse social conditions amongst the homeless people

      Mabhala, Mzwandile A. (Oxford University Press (OUP), 2019-11-13)
      Abstract Background A growing body of evidence identifies interconnected social indicators that can lead to homelessness. Several studies identify a catalogue of social disadvantages that starts from childhood and persist throughout the life course that leads to homelessness. Qualitative evidence indicates that their adverse childhood experiences(ACEs) and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults. However, very little research seeks to objectively investigate these issues. This study aims to use the cross-sectional study to document the cluster and frequency of adverse social conditions amongst the homeless people in North West England in 2019. Methods The study design was cross-sectional. We used IBM SPSS 21, with a significance level set at p < 0.05, CI 95% to analyse the data. Results The mean age was 39.12, range 21-64, 90.5% male. 52%(χ2= 33.4, df = 1, p = 0.001) described their health as poor, 90% (χ2= 61.85, df = 2, p = 0.001) smoked cigarette daily, 83.3% (χ2= 76.4, df = 3, p = 0.001) used drugs daily, 78.6% (χ2= 13.7, df = 1, p = 0.001) saw a doctor in preceding 6 months, 63.4% (χ2= 73.8, df = 3, p = 0.001) left school before age 16; 26.2% (χ2= 37.7, df = 3, p = 0.001) left school at 16, 11.9% (χ2= 33.1, df = 10, p = 0.001) encounterd criminal justice system at the age of 11, 28.6% (χ2= 60.8, df = 8, p = 0.001) had reprimand/caution or conviction at 17. ACES: 57% (χ2= 34.7, df = 3, p = 0.001) experienced humiliation by adults in their household; 54% (χ2= 30.7, df = 3, p = 0.001) threatening behaviour, 50% (χ2= 26.0, df = 3, p = 0.001) physical violence in their household. Conclusions These early stage preliminary results indicate that adverse social circumstances that occur in childhood are disproportionately represented in homeless population. Key messages Homelessness is more complex than the absence of accomodation. Adverse social circumstances that occur in childhood are disproportionately represented in homeless population.
    • The Cost of Von Willebrand Disease in Europe: The CVESS Study

      Morgan, George; Brighton, Sarah; orcid: 0000-0003-3489-368X; email: sarah.brighton@hcdeconomics.com; Laffan, Mike; Goudemand, Jenny; Franks, Bethany; Finnegan, Alan (SAGE Publications, 2022-08-17)
      Background: Von Willebrand disease (VWD) is one of the most common inherited bleeding disorders, imposing a substantial health impact and financial burden. The Cost of von Willebrand disease in Europe: A Socioeconomic Study (CVESS) characterises the socio-economic cost of VWD across Germany, Spain, Italy, France, and the UK. Methods: A retrospective, cross-sectional design captured 12 months of patient disease management, collected from August-December 2018, for 974 patients. This enabled estimation of direct medical, direct non-medical and indirect costs, utilising prevalence estimates to extrapolate to population level. Results: Total annual direct medical cost (including/excluding von Willebrand factor [VWF]) across all countries was the highest cost (€2 845 510 345/€444 446 023), followed by indirect costs (€367 330 271) and direct non-medical costs (€60 223 234). Differences were seen between countries: the UK had the highest direct medical costs excluding VWF (€159 791 064), Italy the highest direct-non medical (€26 564 496), and Germany the highest indirect cost burden (€197 036 052). Total direct medical costs per adult patient increased across VWD types with Type 1 having the lowest cost (€23 287) and Type 3 having the highest cost (€133 518). Conclusion: A substantial financial burden arises from the prevalence of VWD for the European healthcare systems considered.
    • The emergence of accelerated resolution therapy for treatment of post-traumatic stress disorder: A review and new subgroup analyses

      Kip, Kevin; Berumen, Jessica; Zeidan, Amina R.; Hernandez, Diego; Finnegan, Alan (Wiley, 2019-01-25)

      Bailey, Jan; Kingston, Paul; Taylor, Louise; Eost-Telling, Charlotte (Oxford University Press (OUP), 2019-11-08)
      Abstract This presentation will offer new and alternate insights into ‘scams’ and the health effects of fraud on older people. It reports data captured from a Mass Observation Project “Directive” focusing on scams and their impact on individuals. Eighty “Observers’” aged 50 and over responded to the “Directive”. Responses indicate that falling victim to a scam may have negative impacts on individuals’ mental wellbeing, self-esteem and relationships with others. Data analysis also identified that fear of victimisation can also affect individuals, resulting in worry, anxiety and maladaptive coping strategies. Offering a sociology of health perspective, we will focus is on these health impacts of scams and the legitimisation of the issue as a socio-political problem. We will also highlight additional important areas for consideration, such as the absence of a common understanding of the concept and nomenclature of ‘scam’, and the ‘vagaries of scams’ by presenting a typology of scams.
    • The impact of factor infusion frequency on health-related quality of life in people with haemophilia

      Pedra, Gabriel; Christoffersen, Pia; Khair, Kate; Lee, Xin Ying; O’Hara, Sonia; O’Hara, Jamie; Pasi, John (Haemnet, 2020-08-15)
      Background. Some studies suggest that people with haemophilia (PwH) who use prophylaxis value low frequency of clotting factor administration more than a lower risk of bleeding. However, more frequent infusions offer the potential of reducing joint disease and pain, which in turn may improve functioning and quality of life.AimsTo explore the impact on health-related quality of life (HRQoL) aspects of haemophilia associated with adherence and annual infusion rate in the context of factors influencing treatment that are important to patients, including prophylaxis, chronic pain, concomitant conditions and hospital admission.Materials and methodsHRQoL was assessed in participants with severe haemophilia in the ‘Cost of Haemophilia in Europe: a Socioeconomic Survey’ (CHESS) study who were using prophylaxis. Patients using on-demand treatment were excluded. This multivariate analysis examined the interaction between factors potentially influencing treatment and HRQoL, and minor and major bleeds.ResultsFrom the total CHESS population (n=1,285), 338 (26%) participants provided responses for major and minor bleeds and target joints, and 145 (11%) provided EQ-5D-3L responses. Major and minor bleeds were associated with pain. Patients with severe chronic pain reported a substantial negative impact on HRQoL; but this was significantly improved by increases in the annual infusion rate. This was not apparent in participants with mild or moderate pain.ConclusionIncreasing the frequency of prophylaxis infusions is associated with improved quality of life in PwH who have severe chronic pain. However, increasing the number of infusions per week in those with mild or moderate chronic pain with the intention of improving prophylactic effect may not have the same effect.

      Kingston, Paul; Taylor, Louise; Bailey, Jan; Eost-Telling, Charlotte (Oxford University Press (OUP), 2019-11-08)
      Abstract The Mass Observation Project, established in 1937, documents the lives of ordinary people living in the UK, and explores a wide range of social issues. The Project distributes a set of written questions (“Directives”) to a panel of 500 members of the British public (“Observers”) three times each year; “Observers” respond in writing. From the initial commissioning of a “Directive” to data becoming available for analysis takes between four to six months. This approach offers researchers an opportunity to capture in-depth qualitative data from individuals with a range of demographic backgrounds who live across the UK. As there are no word limits on “Observers’” responses and they remain anonymous, a “Directive” often yields rich, high-quality data. Additionally, compared with alternative methods of collecting large volumes of qualitative data from a heterogeneous population, commissioning a “Directive” is cost-effective in terms of time and resource.
    • The Therapeutic Lie: A reflective account illustrating the potential benefits when nursing an elderly confused patient

      Moncur, Thomas; Lovell, Andy; University of Chester (Australian Nursing & Midwifery Federation, 2018-02-31)
      This article explores, through case study examples from practice, the circumstances when it might be considered appropriate, even beneficial, to lie to patients.
    • Thinking nursing

      Mason, Tom; Whitehead, Elizabeth; University of Chester (Open University Press, 2003)
      This major textbook provides a unique one-stop resource that introduces nursing students to the disciplines that underpin nursing practice. The broad range of subjects covered includes sociology, psychology, anthropology, public health, philosophy, economics, politics and science.
    • 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.
    • Tolerating violence: A follow up study to a survey identifying the extent of, and reasons for, the non-reporting of incidents of aggression in one NHS Trust

      Lovell, Andy; Skellern, Joanne; University of Chester (Kavanah, 2009-10)
      This paper reports on a study of people in NHS Trusts working with people with learning difficulties where aggression and violence is a concern.
    • ‘Tolerating violence’: A qualitative study into the experience of professionals working in one UK learning disability service

      Lovell, Andy; Skellern, Joanne; University of Chester (Wiley-Blackwell, 2013-05-06)
      This article reports on a qualitative follow-up study to a whole-population survey investigating the underreporting of violence within one learning disability service. The survey had identified a pronounced level of under-reporting but suggested an unexpected degree of complexity around the issue, which warranted further study. Design. A qualitative research design was employed. Semi-structured interviews were conducted with 22 professionals working in learning disability services; data were subsequently transcribed verbatim and subject to stringent thematic analysis. The findings confirmed that the decision to report an incident or not was complicated by professional interpretation of violence. Three themes were produced by the analysis: the reality of violence, change over time and (zero) tolerance. Conclusion. The study indicates that both experience of violence and ways of understanding it in relation to learning disability are shared across professional groups, although nurses are both more inured and generally more accepting of it. The study suggests that the relationship between learning disability nurses and service users with a propensity for violence is complicated by issues of professional background and concerns about the pertinence of zero tolerance. The availability of effective protocols and procedures is important, but services need also to acknowledge the more ambiguous aspects of the therapeutic relationship to fully understand under-reporting of service user violence in the context of learning disability.
    • A tool for assessing perineal trauma

      Steen, Mary; Cooper, Keith; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Macmillan Magazines, 1997-10-02)
      The initial aim of this study was to develop a reliable visual tool to assist in the assessment of the severity of oedema and bruising in perineal trauma, using a categorical scale of `none', `mild', `moderate' and `severe'. A standardised set of photographs was selected by 10 clinically experienced midwives to represent these categories. The tool was tested in a clinical trial involving 77 women, recording and monitoring changes in the level of oedema and bruising during the first 48 hours following suturing of an episiotomy. The results demonstrated a statistically significant change for both oedema and bruising. However, the less experienced assessors reported some uncertainties in assessing a small proportion of women. A combined method, using this tool with a categorical scoring scale, was used to minimise difficulties in the assessment. Two pairs of midwives, one pair very experienced in assessing perineal trauma and the other less experienced, evaluated the combined method. The results showed a high level of agreement. The standard set of photographs and categorical scoring scale together resulted in a reliable and sensitive assessment tool to evaluate severity of perineal trauma.