• 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.
    • 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 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 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, Louise (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.

      Eost-Telling, Charlotte L; Kingston, Paul; Taylor, Louise; Bailey, Jan (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.
    • 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.
    • Translating the power of Coverdell fellows to address global nursing challenges

      McGhee, Stephen; Visovsky, Constance; Clochesy, John; Finnegan, Alan; University of South Florida; University of Chester (Elsevier, 2018-03-10)
      Academic opportunities to enter undergraduate nursing should include access for mature, experienced professionals who are prepared to care for an ever more diverse patient population and who can provide nursing expertise in the global arena. The Coverdell Fellowships in nursing are designed to actively support Returned Peace Corps Volunteers (RPCV) in developing nursing skills in such a way that supports the local community. Coverdell Fellows already have the skills and abilities enabling them to communicate with sensitivity and to develop therapeutic relationships with diverse global populations. Many Colleges of Nursing are currently faced with the challenge of providing students with opportunities which will allow them to become more globally aware and culturally competent. Thus, working with the Peace Corps, a highly respected organization with longstanding international experience, is an obvious step not only to bolster the nursing workforce, but also to develop a more globally sensitive and competent nursing workforce in the U.S. and abroad.
    • Trapped in discourse? Obstacles to meaningful social work education, research and practice within the neoliberal university

      Carey, Malcolm; University of Chester
      This article appraises the role of the neoliberal university in regulating social work education, research and practice. The dominance of governments and employers in determining social work education is highlighted, alongside the ascendancy of skills-based and vocational training. Moreover, it is proposed that research, associated learning, and practice are now more often moulded around essentialist science-based, behavioural or functionalist paradigms, which fit conveniently with free market, politically conservative and authoritarian agendas. The neoliberal university is increasingly able to rationally prepare social workers to fulfil narrow ideological objectives, which includes priority given to attempts to empower, pathologise, and scientifically manage structurally disadvantaged populations from minority groups. Reductive paradigms, nevertheless, can struggle to cope with social fragmentation and diversity, with social work students often ill prepared for many of the complex challenges which they later face as qualified practitioners. Analysis for the article draws from critical theory, and it is concluded that market-based discourses and related professional paradigms - and the symbolically constituted and hyperreal fantasies which they help to maintain - can prove difficult to escape. Social work continues to face a precarious future within university settings in which free market narratives, associated norms, targets, and labour insecurity prevail.
    • The trident: A three-pronged method for evaluating clinical, social and educational innovations

      Ellis, Roger; Hogard, Elaine; University of Chester (SAGE, 2006-07-01)
      This article describes a distinctive approach to programme evalution used in over forty funded evaluations in the Social and Health Evaluation Unit at the University of Chester. It categories the questions asked by evaluators into three main groups: those concerned with outcomes and impact; those concerned with process; and those representing the views of the stakeholders involved in the programme.
    • The trident: a three-pronged method for evaluating programmes and initiatives

      Ellis, Roger; Hogard, Elaine; University of Chester (Chester Academic Press, 2008)
      This book chapter discusses an approach to the evaluation of community safety initiatives.
    • Type 1 diabetes in young people: the impact of social environments on self-management issues from young people’s and parents’ perspectives.

      Spencer, Joy; Cooper, Helen; Milton, Beth; University of Chester; Liverpool University (SB Communications Group, 2014-02-08)
      In the UK, young people with type 1 diabetes generally have poor glycaemic control. Managing type 1 diabetes in young people is complex, and is underpinned by relationships with significant others in the social environments they inhabit. This qualitative study explores the social environments of young people with type 1 diabetes and their potential influence on glycaemic control. Twenty young people with type 1 diabetes and their parents (n=27) were interviewed about their experiences in the environments of the home, with friends (social), at school and in the diabetes clinic. It was found that the diabetes clinic was vital to the medical management of type 1 diabetes, and the family provided stable support for most young people with type 1 diabetes. However, there were barriers to self-management in school and social environments. It was concluded that each family had a unique story about the social factors in the environments they encountered that affected self-management of type 1 diabetes.