• Silence of a scream: application of the Silences Framework to provision of nurse-led interventions for ex-offenders

      Eshareturi, Cyril; Serrant-Green, L.; Galbraith, V.E.; Glynn, M. (2015-05-01)
      The Silences Framework and its underpinning concept of ‘Screaming Silences’ was originally presented with the invitation for further peer review and utilisation in other contexts in order to test its usefulness and enable critique by a wider audience. This paper reports the use of the framework in a study researching nurse-led interventions for released ex-offenders. Screaming Silences were situated in how an issue, as experienced by ex-offenders, screams out to them in relation to their health and its impact on their reality while remaining silent in the consciousness of society and the application of practice. In addressing these Screaming Silences, we associated the Silences Framework within marginal discourses as they are less prioritised by policy and frequently positioned as far removed from what society considers as normal. Screaming Silences were situated in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which these experiences occurred. We affirmed that the framework is ideally suited for researching issues which are under-researched, silent from policy discourse and excluded from practice, as it is oriented towards exploring individual experiences by valuing individual interpretations of events.
    • The Silences Framework: a tool for exploring marginalised perspectives

      Eshareturi, Cyril (2017-03-31)
      The Silences Framework as a tool for exploring marginalised perspectives The Silences Framework was devised for use as a vehicle for exposing additional viewpoints in studies revolving around sensitive subjects and marginalised perspectives. Cyril’s presentation conveys the use of The Silences Framework in the provision of a nurse-led intervention for custodial community based ex-offenders. ‘Screaming Silences’ as exposed were located in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which their experiences occurred. Crucially, The Silences Framework as used sought to acknowledge and redress the balance of power relating to ‘what and whose’ experience count in a research study. Epistemologically, the generation of knowledge using the framework necessitated an anti-essentialist perspective which was interpretive in nature. Thus, the intent was to arrive at what constitutes as truth from the lived experiences of the individuals researched. It is hoped that this presentation will facilitate understanding by unravelling the process of using The Silences Framework to underpin applied research and concurrently contribute to the wider use of the framework in research with other marginalised groups.
    • A simple framework for analysing the impact of economic growth on non-communicable diseases

      Cohen, I.K.; Ferretti, F.; McIntosh, Bryan (2015-05-13)
      Non-communicable diseases (NCDs) are currently the leading cause of death worldwide. In this paper, we examine the channels through which economic growth affects NCDs’ epidemiology. Following a production function approach, we develop a basic technique to break up the impact of economic growth on NCDs into three fundamental components: (1) a resource effect; (2) a behaviour effect; and (3) a knowledge effect. We demonstrate that each of these effects can be measured as the product of two elasticities, the output and income elasticity of the three leading factors influencing the frequency of NCDs in any population: health care, healthrelated behaviours and lifestyle, and medical knowledge.
    • A single-centre experience of implementing a rapid CXR reporting and CT access pathway for suspected lung cancer: Initial outcomes

      Hunter, R.; Wilkinson, Elaine; Snaith, Beverly (2022-05)
      Lung cancer remains a major cause of preventable death and early diagnosis is critical to improving survival chances. The chest X-ray (CXR) remains the most common initial investigation, but clinical pathways need to support timely diagnosis through, where necessary, escalation of abnormal findings to ensure priority reporting and early CT scan. This single-centre study included a retrospective evaluation of a rapid lung cancer CXR pathway in its first year of operation (May 2018-April 2019). The pathway was initially designed for primary care referrals but could also be used for any CXR demonstrating abnormal findings. A parallel cross-sectional survey of radiographers explored their understanding, adherence and concerns regarding their role in the pathway operation. Primary care referrals on the rapid diagnostic pathway were low (n = 51/21,980; 0.2%), with 11 (21.6%) requiring a CT scan. A further 333 primary care CXR were escalated by the examining radiographer, with 100 (30.0%) undergoing a CT scan. Overall, 64 of the CT scans (57.7%) were abnormal or demonstrated suspicious findings warranting further investigation. There were 39 confirmed primary lung carcinomas, most with advanced disease. Survey responses showed that most radiographers were familiar with the pathway but some expressed concerns regarding their responsibilities and limited knowledge of CXR pathologies. This baseline evaluation of the rapid lung cancer pathway demonstrated poor referral rates from primary care and identified the need for improved engagement. Radiographer escalation of abnormal findings is an effective adjunct but underlines the need for appropriate awareness, training, and ongoing support. Engagement of the multiprofessional team is critical in new pathway implementation. Rapid diagnostic pathways can enable early diagnosis and the radiographer has a key role to play in their success.
    • Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery

      Al-Janabi, H.; McLoughlin, C.; Oyebode, Jan R.; Efstathiou, N.; Calvert, M. (2019-08)
      Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic ‘IMPACT’. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
    • Skill maximisation: the future of healthcare

      McIntosh, Bryan; Sheppy, B. (2013)
      The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.
    • Skill mix - HCAs and their role in quality healthcare

      McIntosh, Bryan; Smith, S. (2012)
      The NHS must increase productivity by 6% every year if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. We know staff costs make up 60% of the NHS budget, so it is likely that both the number and composition of the 1.7 million-strong workforces will need to change in order to meet these targets. We argue that while substituting registered nurses with healthcare assistants (HCAs) is desirable in terms of financial benefits, there is not enough research evidence to identify the impact of changes or maximisation in skill mix upon efficiency (represented by the number of NHS cases treated) and the quality of care experienced by service users.
    • The SMART personalised self-management system for congestive heart failure: results of a realist evaluation

      Bartlett, Y.K.; Haywood, A.; Bentley, C.L.; Parker, J.; Hawley, M.S.; Mountain, Gail; Mawson, S. (2014-11-25)
      Background Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF. Methods The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation. Results The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes. Conclusions Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.
    • Snakes and ladders: human resources in nursing

      McIntosh, Bryan; Watt, S. (2012)
      � McIntosh and Watt focus on a recent research that many female registered nurses who return from a career break at a lower grade relative to their experience and training. They note that the reintegration of the most highly trained and experience registered nurses will not only reduce the need and cost of training but will critically enhance the quality of delivery. The NHS must make greater use of these highly skilled and experienced registered nurses, not just for sound economic reasons but for improved health outcomes as well. Patients and clients all deserve the most skilled, experienced and able registered nurses, regardless of their life circumstances.; Many female registered nurses return from a career break at a lower grade relative to their experience and training, which has a detrimental implication for the National Health Service in terms of operational efficiency. It is imperative that human resources are used to the maximum benefit of the nursing service. Adapted from the source document.
    • Social Networking for Learning in Higher Education: Capitalising on Social Capital

      Hartley, Alison S.; Kassam, A.A. (2015)
      This study explores the evolution of student-led social networking groups initiated and sustained by a cohort of undergraduate students over a 3-year time frame. The study contributes to this growing area of research by exploring the impact of peer-led, peer-supported informal learning through social media networks. Social capital is a useful lens through which to understand the findings, and particularly in interpreting descriptions of the evolution of the group over time. The findings suggest that students build bridging social capital to support the transition into higher education, form relationships and learn collaboratively through a large cohort-based Facebook group. Over time, this form of social capital and the use of the Facebook group declines due to a lack of perceived reciprocity and an increased perception of competitiveness amongst peers. However, there is accompanied by a subsequent rise in the building of bonding social capital between closer peer relationships facilitated through the use of various WhatsApp groups. The findings have implications for considering how social networking might support the student journey towards more nuanced, more personalised collaborative learning and a move towards more self-directed learning.
    • Social policy for people with dementia in England: promoting human rights?

      Boyle, Geraldine (2010)
      This paper discusses whether current UK social policy promotes the human rights of people with dementia living in England. The author focuses on the role of recent legal reforms and key developments in social care policy--notably the Mental Capacity Act 2005 and the 2009 National Dementia Strategy--in facilitating their human rights to liberty and self-determination, particularly a right to choose to live at home. The extent to which the National Dementia Strategy provides access to services and support which provide an alternative to institutional care is critiqued. Whilst recent legislative change has endorsed the rights of people with dementia to liberty and self-determination, it is suggested there is a lack of commitment in government policy more generally to providing access to social care to enable people with dementia to exercise these human rights.
    • Sources of emotional challenge for practitioners delivering family centred care after the death of child: an inductive thematic analysis

      Tatterton, Michael J.; Honour, A.; Lyon, J.; Kirkby, L.; Newbegin, M.; Webster, J. (2021)
      Care after the death of a child and support of their bereaved family is an important element of the services offered by children’s hospices in the United Kingdom. The study aims to explore the emotional challenges of those delivering care to families of children in hospice cool rooms. An internet-based questionnaire was sent to all practitioners to explore their perspectives of providing care to bereaved families whilst the child’s body was in the hospice, as well as caring for a child’s body after death. In total, 94.9% (n=56) of staff responded. Two key themes were identified that represent the emotional challenges perceived by staff: the impact of deterioration of a child’s body; and witnessing the acute grief of families. Practitioners seek to provide care that recognises the importance of family and demonstrates family-centred care, as well as supporting families to deal with the changes that occur after death. Organisations can support practitioners to deliver care in cool rooms by providing training and education on anticipating and managing the pathophysiological changes that occur after death as well as training in grief and loss, and how to support a bereaved family.
    • South Asians and epilepsy: Exploring health experiences, needs and beliefs of communities in the north of England.

      Ismail, Hanif; Wright, J.; Rhodes, P.J.; Small, Neil A.; Jacoby, A. (2005)
      Purpose: To examine the beliefs and experiences of South Asians with epilepsy and the extent of provision of appropriate information and accessible services for them by health professionals. Methods: Qualitative interviews with 30 South Asians with epilepsy, 16 carers and 10 health professionals. In addition, two focus groups were held with 16 South Asians without epilepsy recruited from community centers. The interview sample was divided by religious groupings (Hindus, Sikhs and Muslims). Fieldwork was conducted in Bradford and Leeds (England Results: Beliefs that epilepsy is caused by spirit possession (Muslims) or attributable to sins committed in a past life (Sikhs and Hindus) were reported as being widely held among South Asians living both in the UK and the Indian subcontinent, although few informants themselves subscribed to such views. Compliance with conventional medication was high; however, those who experienced seizures most often were most likely to turn to traditional South Asian therapies. Most informants used both treatments simultaneously. The main issues regarding the provision of services were: lack of appropriate information and advice; language and communication barriers; problems in interaction with health professionals. Also discussed were the potential merits of attending support groups. Greatest dissatisfaction was expressed in relation to primary care, whereas the highest praise was reserved for specialist epilepsy nurses. Conclusions: Our findings show both similarities and differences between participants¿ experiences, where gender, age or other aspects of personal biography can be as important as religion, culture or country of origin. Furthermore, the impact of being diagnosed with epilepsy can be exacerbated by structural impediments to accessing information and appropriate services.
    • Spatial Distribution of Sulfate Concentration in Groundwater of South-Punjab, Pakistan

      Mubarak, N.; Hussain, I.; Faisal, Muhammad; Hussain, T.; Shad, M.Y.; AbdEl-Salam, N.M.; Shabbir, J. (2015)
      Sulfate causes various health issues for human if on average daily intake of sulfate is more than 500 mg from drinking-water, air, and food. Moreover, the presence of sulfate in rainwater causes acid rains which has harmful effects on animals and plants. Food is the major source of sulfate intake; however, in areas of South-Punjab, Pakistan, the drinking-water containing high levels of sulfate may constitute the principal source of intake. The spatial behavior of sulfate in groundwater is recorded for South-Punjab province, Pakistan. The spatial dependence of the response variable (sulfate) is modeled by using various variograms models that are estimated by maximum likelihood method, restricted maximum likelihood method, ordinary least squares, and weighted least squares. The parameters of estimated variogram models are utilized in ordinary kriging, universal kriging, Bayesian kriging with constant trend, and varying trend and the above methods are used for interpolation of sulfate concentration. The K-fold cross validation is used to measure the performances of variogram models and interpolation methods. Bayesian kriging with a constant trend produces minimum root mean square prediction error than other interpolation methods. Concentration of sulfate in drinking water within the study area is increasing to the Northern part, and health risks are really high due to poor quality of water.
    • Special Edition: Reframing Diversity Interventions in Austere Times.

      Archibong, Uduak E. (2013)
      Affirmative action policies in South Africa and other countries have been designed to address inequity and discrimination, and to manage a wide range of diversity in all spheres of life, particularly after the end of apartheid in 1994. Years after implementing affirmative action in South Africa, perceptions of its impact or even benefit seem to vary from person to person. This article presents the findings from a study utilizing different data sources including document review, interviews, and a consensus workshop on the perceptions of the impact of affirmative action in South Africa. It is part of a larger European Commission–funded comparative study of positive action measures across countries in North America, the European Union, and South Africa. Participants were drawn from different public and private organizational sectors, racial groups, genders, age groups, and people with disabilities. The analyzed data provided insight into how society might be perceiving and reacting to the operation of affirmative action in South Africa.