• Underlying thinking pattern profiles predict parent-reported distress responses in autism spectrum disorder

      Tollerfield, Isobel; Chapman, Hazel M.; Lovell, Andrew; Cheshire and Wirral Partnership NHS Foundation Trust; University of Chester (Springer, 29-05-2021)
      Appreciating autistic neurodiversity is important when supporting autistic people who experience distress. Specifically, use of a profiling model can reveal less visible autistic differences, including strengths and abilities. Binary logistic regressions showed that the likelihood of extreme distress responses could be interpreted based on parent-reported autistic thinking pattern profiles for 140 young people. Perspective-taking (specifically empathy), extreme demand avoidance, and over-sensory sensitivity each contributed to the combined regression models. From the clinical perspective of autism as a multi-dimensional and inter-connected construct, there may be implications for planning support and building positive self-understanding. Individually tailored adjustments and support strategies may be identified more easily after delineating variables found across four core aspects: sensory coherence, flexible thinking, perspective-taking, and regulation. Keywords: Autism; Distress; Profile; Strengths; Thinking patterns.
    • 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 Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019

      Forde, Hannah; Penney, Tarra; White, Martin; Levy, Louis; Greaves, Felix; Adams, Jean (Maad Rayan Publishing Company, 2022-01-29)
      Background: The World Health Organization recommends that countries implement fiscal policies to reduce the health impacts of sugary drinks. Few studies have fully examined the responses of industry to these policies, and whether they support or undermine health benefits of sugary drinks taxes. We aimed to explore the changes that sugary drinks companies may make to their marketing, and underlying decision-making processes, in response to such a tax. Methods: Following introduction of the UK Soft Drinks Industry Levy (SDIL) in 2018, we undertook one-to-one semi-structured interviews with UK stakeholders with experience of the strategic decision-making or marketing of soft drink companies. We purposively recruited interviewees using seed and snowball sampling. We conducted telephone interviews with 6 representatives from each of industry, academia and civil society (total n=18), which were transcribed verbatim and thematically analysed. Four transcripts were double-coded, three were excluded from initial coding to allow comparison; and findings were checked by interviewees. Results: Themes were organised into a theoretical framework that reveals a cyclical, iterative and ongoing process of soft drink company marketing decision-making, which was accelerated by the SDIL. Decisions about marketing affect a product’s position, or niche, in the market and were primarily intended to maintain profits. A product’s position is enacted through various marketing activities including reformulation and price variation, and non-marketing activities like lobbying. A soft drink company’s selection of marketing activities appeared to be influenced by their internal context, such as brand strength, and external context, such as consumer trends and policy. For example, a company with low brand strength and an awareness of trends for reducing sugar consumption may be more likely to reformulate to lower-sugar alternatives. Conclusion: The theoretical framework suggests that marketing responses following the SDIL were coordinated and context-dependent, potentially explaining observed heterogeneity in responses across the industry.
    • 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 contribution of intellectual disability nurses: Scoping research - Volume 1 of 3: Scoping literature review report

      Mafuba, Kay; Forster, Marc; Chapman, Hazel M.; Kiernan, Joann; Kupara, Dorothy; Chester, Rebecca; Kudita, Chiedza; University of West London; University of Chester; Edge Hill University; Berkshire Healthcare NHS Foundation Trust
      Introduction This scoping review of literature is the first part of a 3-phase project. The RCN Foundation commissioned the University of West London and their collaborators to undertake scoping research on understanding the contribution of nurses to improving the health and well-being of children, adults and older people with intellectual disabilities, now and for the future. The overall aim of the research is to identify nursing-led and / or nursing centred interventions that are in place to address the challenging and changing needs of people with intellectual disabilities. The research sought to identify interventions, that can be implemented by nurses working in multi-disciplinary teams. The research identifies areas of good care delivery, any innovative practices, and possible gaps in the provision of care for individuals with intellectual disabilities. Objective The overall objective of this review is to summarise evidence on the contribution of intellectual disability nurses to improve the health and well-being of children, adults and older people with intellectual disabilities, now and for the future. Methods We searched the Joanna Briggs Institute (JBI) Reports, Medline, Embase, PsycINFO, CINAHL, Academic Search Elite, ProQuest Dissertations and Theses (Global) also known as Index to Theses, ETHOS, UK Government publications, and professional organisations’ publications. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (for Scoping Reviews) (PRISMA-ScR) process and Joanna Briggs Institute (JBI) guidance was used to select the literature for review and to present the literature review report (Tricco et al., 2018; Peters et al., 2017). A mixed methods approach to the review and synthesis was used due to the heterogeneous nature of the evidence. JBI tools were used to rate studies for quality. Thematic synthesis was used to generate analytical themes. Results We retrieved 121 publications. Of these we excluded 35 after initial appraisal. We appraised 86 publications and excluded 33 after appraisal and we included 53 publications in this review. We identified a wide range of interventions (154) performed by intellectual disability nurses in a variety of settings across the lifespan. We categorised the intellectual disability nursing interventions into three themes; effectuating nursing procedures, enhancing impact of services, and enhancing quality of life. The majority of publications reported cross-sectional studies (77%), 6% of publications were literature reviews, and 17% were opinion papers. Only two of the primary studies investigated the effectiveness of intellectual disability nurse interventions. The majority of the publications focused on interventions related to adults (31). Not all publications focussed on a particular age group. One publication referred to maternity, five focussed on interventions relevant to children, ten identified interventions relevant to all age groups, five focussed on older adults, five focussed on end of life interventions and one publication was not clear. Conclusions We identified 154 interventions performed by intellectual disability nurses in a variety of settings. We categorised the interventions into three themes; Effectuating nursing procedures (52 interventions), Enhancing impact of services (73 interventions), and Enhancing quality of life (41 interventions). Publications identifying the interventions performed by intellectual disability nurses in relation to maternity, children, older adults and end of life care were limited. Publications did not demonstrate the impact and effectiveness of interventions. This advocates for high quality research being essential in determining the impact and effectiveness of intellectual disability nursing interventions across the lifespan. We recommend that a searchable online compendium of intellectual disability nurse interventions be established and regularly reviewed.
    • Understanding the contribution of intellectual disability nurses: Scoping research Volume 2 of 3: Scoping survey research report

      Mafuba, Kay; Chapman, Hazel M.; Kiernan, Joann; Kupara, Dorothy; Chester, Rebecca; Kudita, Chiedza; University of West London; University of Chester; Edge Hill University; Berkshire Healthcare NHS Foundation Trust
      Introduction This scoping research identifies nursing-led and or nursing centred interventions that are in place to address the changing needs of people with intellectual disabilities (ID). Aims The aim of the research is to identify nursing-led and / or nursing centred interventions that are in place to address the challenging and changing needs of people with ID. The research identifies interventions, that can be implemented by nurses working in multi-disciplinary teams. The research also identifies areas of good care delivery, innovative practices, and possible gaps in the provision of care for individuals with intellectual disabilities. Methods We undertook an online survey to collect quantitative and qualitative data. We used voluntary response sampling to collect data from 230 participants from 7 countries. Participants were primarily registered intellectual disabilities nurses working with people with ID. We used thematic, and content analyses to analyse qualitative data. We undertook descriptive and inferential statistical analyses of quantitative data, specifically we undertook Pearson correlations and Pearson Chi-square analyses. Results We identified 878 interventions from 7 countries. These interventions were undertaken in a wide range of settings and across the lifespan (maternity (4), children (156), adults (384), older adults (129), all age groups (393) and end of life (19). We categorised the interventions into five themes; effectuating nursing procedures, enhancing impact of ID services, enhancing impact of mainstream services, enhancing quality of life, and enhancing ID nursing practice. We identified several case studies that demonstrate the positive impact of ID nursing interventions. Conclusions ID nurses implement a wide range of emerging interventions working in multi-disciplinary teams. They practice in a wide range of settings in the UK and other countries. More work is needed in order to better understand the reasons for the limited involvement of ID nurses with pregnant women with IDs and in end-of-life care. The variation in understanding the interventions undertaken by ID nurses between countries need to be further investigated.
    • Understanding the contribution of intellectual disability nurses: Scoping research. Volume 3 of 3 – Compendium of intellectual disability nursing interventions.

      Mafuba, Kay; Chapman, Hazel M.; Kiernan, Joann; Kupara, Dorothy; Chester, Rebecca; Kudita, Chiedza; City University, London; University of Chester; Edge Hill University; Berkshire Healthcare NHS Foundation Trust
      Introduction The RCN Foundation commissioned the University of West London and their collaborators to undertake scoping research on understanding the contribution of nurses to improve the health and well-being of children, adults and older people with intellectual disabilities (ID), now and for the future. The overall aim of the research was to identify nursing led and or nursing centred interventions that address the challenging and changing needs of people with ID. This, the ‘Compendium of ID nursing interventions’ provides a catalogue of these interventions. The research project report is in three volumes; Volume 1/3: Scoping literature review report; Volume 2/3: Scoping survey research report; and Volume 3/3: Compendium of intellectual disabilities nursing interventions (this volume). Methods In phase 1 of the project, we undertook a scoping literature review using the Joanna Briggs Institute’s (JBI) scoping review protocols. We used the PRISMA-ScR process and JBI guidance to select the literature for review and to present the literature review report (Trico, et al., 2018; Peters, et al., 2017). A mixed methods approach to the review and synthesis was used due to the heterogeneous nature of the evidence. JBI tools were used to pool findings and rate them for quality. Thematic synthesis was used to generate analytical themes. Empirical (quantitative, qualitative, mixed methods) studies, synthesised evidence (literature reviews) and opinion papers, (n = 52) were included in the review (see volume 1 of the report). In phase 2 of the project, we undertook an online survey to collect quantitative and qualitative data. There were 230 participants from 7 countries. We used thematic, and content analyses to analyse qualitative data. We undertook descriptive and inferential analyses of quantitative data (see volume 2 of the report) Emerging ID nursing interventions In total we identified 925 interventions. In phase 1 we identified 154 ID nursing interventions, and in phase 2 we identified 878 interventions. The discrepancy in the total numbers is that interventions which appeared in both phases are only recorded once. In phase 2, these interventions were undertaken in a wide range of settings and across the lifespan. We categorised the interventions into five themes; effectuating nursing procedures, enhancing impact of ID services, enhancing impact of mainstream services, enhancing quality of life, and enhancing ID nursing practice. We have merged the interventions we identified in the literature review and from the table below. We have removed duplicates and merged the evidence sources where appropriate.
    • 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 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; Bell, Sophie; University of Chester (Policy Press, 2020-08-10)
      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.
    • 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.
    • 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.