Working in partnership, both across social care and health and with service users, has been a persistent theme of the health and social care modernisation agenda in the United Kingdom. Despite a relatively underdeveloped evidence base, the development of health and social care partnerships has continued to feature in recent policy and legislative initiatives in the United Kingdom. At the same time there has been a major shift in focus towards the outcomes that support services deliver. A central question remaining is whether the policy initiatives driving the development of health and social care partnerships are delivering improved outcomes, particularly the outcomes valued by people who use services. This article outlines research designed to explore this issue across 15 health and social care partnerships in England and Scotland, building from previous research by the Social Policy Research Unit based at the University of York. It sought to assess the extent to which health and social care partnerships deliver the outcomes that people who use services value, and to determine the features of partnership working associated with the delivery of these outcomes. A robust outcomes framework was defined, which provided the basis for interviews with those receiving support from partnerships. Working with three user‐researcher organisations, interviews were completed with 230 individuals in 2006. On the basis of this, some service users were able to identify features of partnership that particularly contributed to improved outcomes. These included continuity of staff and sufficient staff and a range of resources, including the availability of long‐term and preventative services. Given the definitional and methodological complexity surrounding partnership working, and the challenges of attribution, the study faced some limitations in its ability to make wider inferences about partnership and outcomes. A theory of change should be employed in future studies of this type.
( 2 0 1 0 ) Journal of Nursing and Healthcare of Chronic Illness 2, 102-112 Dementia and risk: contested territories of everyday life Aims. The project aimed to understand the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. Background. This paper addresses a gap in the literature by embedding constructions of risk within everyday events and social contexts, and communicates such constructions through the voices of people with dementia, carers and practitioners. Method. This symbolic interactionalist study involved data collection by interview with 55 people with dementia (sometimes twice), and their nominated carer and practitioner. The sample was drawn from three regions of the United Kingdom. Data were collected during 2004. Conclusions. Five 'contested territories' of everyday living with dementia are outlined in this paper: friendships, smoking, going out, domestic arrangements, and occupation and activity. These contested territories are purposeful and allow for 102Ó 2010 Blackwell Publishing Ltd sense making, maintenance of self, claiming and relinquishing decision making, and creating purpose(lessness) in people's lives. Relevance to clinical practice. Assessing and managing risk in a way that respects the dynamics and purposes of contested territories will support care that is person centred, and moreover respectful of the relationships that contribute to maintaining the individual's sense of self and purpose.Key words: carer, contested territories, dementia, everyday life, risk, symbolic interactionism IntroductionThe paper addresses the complex area of risk management in dementia care. It described a qualitative study in which 55 people with dementia were interviewed, together with their nominated family member and carer. The findings demonstrate the everyday ways in which people with dementia experience risk and its impact on their sense-making, and their identity, purpose and control over their lives. As such, the paper contributes to a growing awareness of the critical importance of the ways in which the micro-dynamics of people's lives are affected by others and it offers a way of intervening to support the identity of the person with dementia.
There has been growing discussion in the literature about the merits and demerits of disclosing a diagnosis to a person with dementia. There is growing empirical evidence that general practitioners (GPs) are reluctant to share the diagnosis with people with dementia. To date little research has examined what GPs tell their patients and their families. The purpose of the reported study was to examine what GPs tell people with dementia and their families about the condition. The study relied on data gathered from an opportunistic sample of 114 GPs who were attending a training course in care of people with dementia. Findings reveal a disparity between what GPs tell the family and the person. People with dementia tend to be given information about the symptoms and the cause is described predominantly as part of ageing. Family members are given information about symptoms, cause, prognosis and available supports. Best practice regarding diagnosis disclosure to people with dementia needs to be established. This includes what people with dementia are told, how they are told and what supports are made available to those who have been told.
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