• Flexible working and work–life balance: midwives’ experiences and views

      Prowse, Julie M.; Prowse, Peter J. (2015-09-10)
      This article presents midwives’ views and experiences of flexible working and work-life balance. Both flexible working and work-life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work-life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work-life balance is marginalised and this is fuelling discontent and resentment among midwives and leading to divisions between full and part-time staff that reinforce flexibility stigma. Although flexible working and work-life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession. Keywords flexibility stigma, flexible working, full-time work, marginalisation, midwives, National Health Service,
    • Food choice motives, attitude towards and intention to adopt personalised nutrition

      Rankin, A.; Bunting, B.P.; Poinhos, R.; van der Lans, I.A.; Fischer, A.R.H.; Kuznesof, S.; Almeida, M.D.V.; Markovina, Jerko; Frewer, L.J.; Stewart-Knox, Barbara (2018-10)
      The present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns. Design/Setting: A survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition. Subjects: Nationally representative samples were recruited in nine EU countries (n 9381). Results: Structural equation modelling indicated that the food choice motives ‘weight control’, ‘mood’, ‘health’ and ‘ethical concern’ had a positive association and ‘price’ had a negative association with attitude towards, and intention to adopt, personalised nutrition. ‘Health’ was positively associated and ‘familiarity’ negatively associated with attitude towards personalised nutrition. The effects of ‘weight control’, ‘ethical concern’, ‘mood’ and ‘price’ on intention to adopt personalised nutrition were partially mediated by attitude. The effects of ‘health’ and ‘familiarity’ were fully mediated by attitude. ‘Sensory appeal’ was negatively and directly associated with intention to adopt personalised nutrition. Conclusions: Personalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.
    • Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort

      Power, M.; Uphoff, E.P.; Stewart-Knox, Barbara; Small, Neil A.; Doherty, B.; Pickett, K.E. (2017-03-28)
      The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population. Methods Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors. Results Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably). Conclusions The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.
    • Fools’ Gold - Lean management in the health sector

      McIntosh, Bryan; Sheppy, B.; Cohen, I.K. (2014)
      Purpose of paper: This paper provides a critical evaluation of the impact of lean practices in informing healthcare policy. Methodology: Review of primary and secondary literature Finding: There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to address rising healthcare spending and disappointing patient safety indicators. This encompasses a number of practices in Operations Management and Human Resource Management, including Just-in-Time (JIT), Total Quality Management (TQM), Total Productive Maintenance (TPM), employee empowerment, and extensive training. Used together there is great potential to improve overall firm competitiveness. However, despite widespread enthusiasm about the potential of lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. Contribution to knowledge: Our paper contributes to the organisational management literature in healthcare by showing that even though lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.
    • The forgotten people in British public health: a national neglect of the dying, bereaved and caregivers

      Karapliagou, Aliki; Kellehear, Allan (2016)
      The clinical and social epidemiology of living with a life-threatening or life-limiting illness, frail ageing, long-term caregiving, and grief and bereavement is well documented in the palliative care, psycho-oncology and psychiatric literature but this investigation asks what interest exists from the mainstream public health sector in these health and illness experiences. This paper reports a content analysis of 7 key British public health journals, 14 major public health textbooks and 3 public health websites employing key word and synonym searches to assess the size and quality of interest in populations related to ageing, dying, caregiving, and grief and bereavement. Compared with other public health issues, such as obesity and tobacco use, for examples, interest in the social experience and epidemiology of end-of-life experiences is extremely low. Reasons for this lack of interest are explored.
    • Frameworks and Models, Scaffolding or Straight Jackets? Problematising Reflective Practice

      Kelsey, Catherine; Hayes, S. (2015-11)
      This paper aims to open a debate about the impact of reflective practice questioning whether reflective frameworks and models argued to facilitate the education of highly skilled reflective practitioners can be oppressive rather than emancipatory in outcome. Contemporary education focuses on evidence based and effective practice with reflection at its core leading to empowerment and ultimately emancipation of the profession as independent and equal to medics and other health care professionals. Models and frameworks have therefore been developed to facilitate the education of highly skilled reflective practitioners; able to recognise the need to draw on evidence based practice in order to challenge out-dated methods and engage in new ways of working. This paper however questions the current focus on reflective practice suggesting that reflection in itself can be oppressive and support the commodification of nursing as a ‘workforce’, the profession at the beck and call of current governmental policy and control.
    • “A Friend in the Corner”: Supporting people at home in the last year of life via telephone and video consultation – an evaluation

      Middleton-Green, Laura; Gadoud, A.; Norris, Beverley; Sargeant, Anita R.; Nair, S.; Wilson, L.; Livingstone, H.; Small, Neil A. (2016)
      Objective: To evaluate a 24/7, nurse led telephone and video-consultation support service for patients thought to be in the last year of life in Bradford, Airedale, Wharfedale and Craven. Method: Activity and other data recorded at the time of calls were analysed. Interviews with 13 participants captured patients and carers perspectives. Results: Between April 1st 2014 and March 31st 2015, 4648 patients were registered on the Gold Line. 42% had a non-cancer diagnosis and 46% were not known to specialist palliative care services. The median time on the caseload was 49 days (range 1-504 days). 4533 telephone calls and 573 video consultations were received from 1813 individuals. 39% of the 5106 calls were resolved by Gold Line team without referral to other services. 69% of calls were made outside normal working hours. Interviews with patients and carers reported experiences of support and reassurance and the importance of practical advice. Conclusion: A nurse led, 24/7 telephone and video consultation service can provide valuable support for patients identified to be in the last year of life and their cares. The line enabled them to feel supported and remain in their place of residence, reducing avoidable hospital admissions and use of other services. Providing this service may encourage health care professionals to identify patients approaching the last year of life, widening support offered to this group of patients beyond those known to specialist palliative care services.
    • From embracing to managing risks

      Keen, J.; Nicklin, E.; Wickramasekera, N.; Long., A.; Randell, Rebecca; Ginn, C.; McGinnis, E.; Willis, S.; Whittle, J. (2018-11)
      Objective: To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. Setting: Four acute National Health Service hospitals in England. Participants: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. Results: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. Conclusions: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.
    • From Plastered Skulls to Palliative Care: What the Past Can Teach Us About Dealing with Death

      Büster, Lindsey S.; Croucher, Karina T.; Dayes, Jennifer E.; Green, Laura I.; Faull, C. (2018)
      Modern, advanced healthcare detects and monitors long-term and life-limiting illness more comprehensively than ever before. However, death is now often considered medical failure, and is a virtually taboo topic of conversation in daily life. At a time when the societal relevance of archaeology is under scrutiny more than ever before, the AHRC-funded Continuing Bonds Project – a collaboration between archaeology and palliative care – explores the potential of the past to promote discussion. Not only does archaeology illuminate the diversity of practice surrounding death, the past provides a safe, distanced platform for considering death, dying and bereavement today. Through archaeological and ethnographic case studies, health and social care professionals and students consider topics such as place, choice and identity, in both personal and professional life. This article examines participant responses to a variety of archaeological material and presents post-workshop reflections which demonstrate the success of archaeology in opening up conversations and increasing confidence in discussing this most enduring and problematic of life events.
    • From Room 21: Narratives of liminality, shared space, and collective memory in dementia care

      Clegg, D.; Capstick, Andrea (2013)
      Since 2001 the Trebus Project has been collecting first-person narrative biographies of people with dementia, the majority of whom were living in UK care homes. In 2012 David Clegg, the director of the Trebus Project, received funding from the Wellcome Trust's Arts Awards to carry out an interdisciplinary exploration of the narratives of three people with dementia who, by coincidence, had occupied the same care home room (Room 21) at different times. Analysis of the three narratives to date has discovered some uncanny echoes and resonances. The narrators make frequent reference to other rooms which are temporally or spatially connected with Room 21 in some way. There are worm-hole-like exits and entrances to past times and places, and intimations of other rooms within, behind, and underneath this present living space. At points, events in national and social history sheer dizzyingly away from the accounts of them we have inherited from official sources. Extracts from the narratives of Room 21's three inhabitants, Frances, Peter and Shirley, will be presented in a way that juxtaposes the experience of dementia and post-war postmodern consciousness: liminal, fragmentary, frequently surreal, and beyond the reach of universalising accounts of either the 'illness experience' or revisionist history. Plans to disseminate the findings of the project by means of film and dramatic reconstruction will be discussed.
    • From sanctuary in health to university of sanctuary

      Mitchell, W.L.; Haith-Cooper, Melanie (2017)
      The shocking pictures of a drowned Syrian boy in September 2015 spurred European governments and organisations into taking action to address the growing refugee crisis. The University of Bradford was no different and the senior management team began to look at ways of responding. Consultation was carried out with local organisations at a Bradford City of Sanctuary event and with other UK universities. This suggested that the university should: Recognise how the concept of sanctuary fits with its traditional values and the strategic plan (which includes inclusivity, diversity, internationalisation and sustainability); See this as a long-term issue. ‘Responses need to be long-term. The refugee crisis will be here for years to come.’; Recognise this as an issue that is wider than Syrian refugees. There are substantial numbers of asylum seekers and refugees escaping conflict in other countries such as Eritrea, Afghanistan and Iraq; Align with the civic and community response. The city of Bradford has a proud history of welcoming and including newcomers from all corners of the world and has responded positively to the current crisis. The City of Sanctuary initiative plays a major role in this response. The university response would follow three main principles: To build on and scale up the excellent work previously carried out at faculty level in being awarded Sanctuary in Health to then apply for a University of Sanctuary award; To develop a holistic response across the university, involving faculties, professional services and students. This should be inclusive to generate commitment, ownership and awareness across the whole university; To take a broad, inclusive definition of sanctuary, embracing academics at risk as well as student refugees and asylum seekers.
    • Future of an ageing population evidence review; Developing medical fitness and wellbeing environments to maintain health and wellbeing over the lifecourse

      Mountain, Gail; Gomersall, T.; Taylor, J. (2015-07-20)
      Background and methods This report is derived from a review of the research evidence on physical activity interventions and initiatives, interventions to support self-management/ self-care of long-term conditions and digitally enabled care services and technologies. The aim was to use existing evidence to envision future services and associated infrastructure. The Evidence Review involved scoping the literature for topics researched and to determine the nature of that research. Rapid-scoping review methods were applied to trusted sources, and searches for specific key texts were conducted. A separate search was conducted to identify literature relevant to each domain. A narrative was then produced from the review findings. Review findings The evidence base for physical activity interventions is growing. There has been significant recent investment in the development and evaluation of interventions to promote activity and reduce sedentary behaviour at the individual, community and population levels. The evidence to link higher levels of physical activity to positive health outcomes and disease prevention is convincing, both in ‘well’ populations and in those with long-term health conditions. Self-management interventions are heterogeneous in nature but common elements exist across the majority of them. The consensus in the literature is that self-management will become increasingly important due to unsustainable demands upon services. Evaluation of selfmanagement interventions reveals a small but varying effect across a wide range of outcomes. However, little is known about the mechanisms by which these interventions work and how these might vary across differing conditions and populations. Technology is being increasingly used to support service delivery in a wide range of contexts, and for the delivery of a variety of interventions including fitness and self-management. There is strong evidence supporting the use of technology for remote monitoring of people with longterm conditions, but further research is required. Implications Digital applications are already altering established patterns of service delivery. The findings presented here reveal varying results of efficacy which do not accord with the optimistic future described in various envisaging reports. Research has yet to consider unwanted and unforeseen effects of moving towards technology-enabled services. It is also important to consider how to effectively harness new health data emerging from the use of eHealth systems, technology-enabled services and health-tracking devices. There is an ongoing requirement to evaluate new technologies and technology-enabled services in ways that provide both timely and robust answers, particularly as technology development is a continually moving target. These considerations are discussed in this report.
    • The gait initiation process in unilateral lower-limb amputees when stepping up and stepping down to a new level

      Twigg, Peter C.; Buckley, John G.; Jones, S.F.; Scally, Andy J. (2005)
      Unilateral lower-limb amputees lead with their intact limb when stepping up and with their prosthesis when stepping down; the gait initiation process for the different stepping directions has not previously been investigated. Ten unilateral amputees (5 transfemoral and 5 transtibial) and 8 able-bodied controls performed single steps up and single steps down to a new level (73 and 219 mm). Duration, a-p and m-l centre of mass and centre of pressure peak displacements and centre of mass peak velocity of the anticipatory postural adjustment and step execution phase were evaluated for each stepping direction by analysing data collected using a Vicon 3D motion analysis system. There were significant differences (in the phase duration, peak a-p and m-l centre of pressure displacement and peak a-p and m-l centre of mass velocity at heel-off and at foot-contact) between both amputee sub-groups and controls (P<0.05), but not between amputee sub-groups. These group differences were mainly a result of amputees adopting a different gait initiation strategy for each stepping direction. Findings indicate the gait initiation process utilised by lower-limb amputees was dependent on the direction of stepping and more particularly by which limb the amputee led with; this suggests that the balance and postural control of gait initiation is not governed by a fixed motor program, and thus that becoming an amputee will require time and training to develop alternative neuromuscular control and coordination strategies. These findings should be considered when developing training/rehabilitation programs.
    • Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system

      Abdulhasan, Zahraa M.; Scally, Andy J.; Buckley, John G. (2018-08)
      Background: Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.
    • Gendered migrations and precarity in the post-Brexit-vote UK: the case of Polish women as workers and carers

      Duda-Mikulin, Eva A. (2020)
      Polish migration to the UK post European Union enlargement has been studied extensively but limited attention has been paid to women and their gendered mobility. In this paper, I argue that it is key to turn attention to women migrants as those who are often responsible for reproductive labour and who raise future generations of workers and citizens. This is pivotal to consider in light of ageing European societies and the need for workers and Brexit. Arguably, precarity is characteristic of contemporary life. This applies to the post-Brexit-vote UK and the uncertainty linked to the future after 2019. Precarity is inevitably characteristic of many migrants’ lives often punctuated by a lack of job security which is linked to limited material and psychological well-being. For women migrants, this state of affairs is further compounded by their attachment to the private sphere which often constitutes a barrier to their engagement in the paid labour market on the same footing as men. This paper draws on qualitative primary data gathered from 32 Polish women migrants who were initially interviewed in 2012/2013 and subsequently some of them were re-interviewed in 2016/2017.
    • General concepts of goals and goal-setting in health: A narrative analysis

      Ogbeiwi, Osahon (2021-03)
      Goal-setting is fundamental to organisational management, yet not every manager knows how do it well. A narrative literature review was done to explore current knowledge of definitions and classifications of goals, and principles of goal-setting in the health sector. Online databases generated 65 relevant articles. Additional literature sources were snowballed from referenced articles, and textbooks. Most academic authors define ‘goal’ synonymously as ‘aim’ or ‘objective’, but with evidence of hermeneutical confusion in general literature. Goal classifications are diverse, differing according to their contextual, structural, functional and temporal characteristics. Many authors agree that goal-setting is problem-based, change-oriented and can effectively motivate attainment, if the goal statement is formulated with a specific and challenging or SMART framework. However, recent authors report varying defining attributes for SMART, and evidence of past studies that have empirically examined the nature and efficacy of frameworks currently used for formulating goal statements for health programmes is lacking.
    • General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia.

      Downs, Murna G.; Iliffe, S.; Turner, S.; Wilcock, J.; Bryans, M.; Keady, J.; O'Carroll, R.; Levin, E. (2004)
      Objective: to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.
    • General Practitioners’ perceptions of the stigma of dementia and the role of reciprocity

      Gove, Dianne M.; Small, Neil A.; Downs, Murna G.; Vernooij-Dassen, M. (2017)
      A qualitative exploration of the stigma of dementia reported that GPs described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this paper, we explore whether GPs perceive people with dementia as lacking reciprocity and, so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. GPs’ perceptions of societal views of people with dementia included a perception of a lack of reciprocity. Specifically, an absence of reciprocity was linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden to, society. GPs reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia and lack of opportunities for people with dementia to reciprocate. GPs occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasise the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.
    • General Radiography

      Clough, Gillian R.; Beck, Jamie J.W. (2008)