Care Homes are usually seen as the last refuge for older people but residents are sometimes required to move between homes for administrative purposes. There is concern that such moves threaten their well-being and survival. Relocations have been contested repeatedly in court. A recent ruling and its review of case-law and literature provides guidance for practitioners who may be consulted for advice in this demanding situation.
Objectives-To work with specialist community teams to assess the practicality and acceptability of identified outcome measures for routine use in dementia services. Setting-Seven specialist dementia services: four multidisciplinary teams, a specialist service for carers, a community psychiatric nurse team, and a day hospital. Outcomes need to reflect the aims of the service and the needs and expectations of service users. The key objectives for dementia services were identified by questionnaires completed by general practitioners, district nurses, and specialist service professionals and by interviews with carers and excarers.4 Candidate measures from the literature review were then assessed against these objectives. The final shortlist included nine measures which met the literature criteria and service objectives.Outcome measures will only be incorporated into practice if clinicians see their value and want to use them, and they will only be used properly if they understand the basics of methodology, have been trained to use them properly, and have the time to do so.5 Evaluations of outcome measures have not always been related to clinical experience and day to day practicalities and it is these factors which are likely to effect the probability of whether measures are accepted and used by service providers. This paper describes a practical approach to overcoming this by examining the shortlisted measures from our review which have already been proved to be valid and reliable, and testing them for practicality and acceptability in routine practice. Staff views of the perceived value of the measures is also considered, as is the effect of using outcome measures with carers. We hope that the details of the
Summary
The adequacy of postgraduate trainees is assessed rather more frequently than that of the teaching process. A survey was therefore undertaken of the views of sixty‐two junior psychiatrists regarding the clinical units they had worked on during their 3‐year rotational training programme at the Maudsley Hospital. The quality of the training experience was felt to be related to work load (not too light), to the number of trainees attached to each consultant, and to the attention given by the consultant to instruction on practical management. The factors felt to need most attention were feedback from consultants on the trainee's performance, and the standards of academic instruction and of interdisciplinary team‐work.
This retrospective study looks at the outcome of 71 consecutive liaison referrals. Placement was noted at three-month follow-up and further use of medical, psychiatric and social services, compliance with clinical management and recommendations was also measured. Nearly half the patients had dementia and about half had a functional disorder. In 90% of referrals the recommendations were followed. At three-month follow-up 17% had died, 26% had further medical hospital admission, 39% had moved into a continuing care facility (residential/nursing home), and over half had further contact with the old age psychiatry services.
more important to service users than their psychiatrists, this does not tell us what happens in practice. The real question which we should be asking is to service users themselves and how they feel religion has been accounted for in treatment. I worry that the answers might be even more demoralising. Taking a spiritual history is both an easy and important task to be undertaken by any professional. It can substantially help a service user feel understood and hence engaged in treatment. The Spirituality Special Interest Group provides several tools which should surely become routine practice for all mental health professionals, at the very least in screening (www.rcpsych.ac.uk/PDF/ DrSEaggeGuide.pdf). The suggestion of prayer with service users is a troubling one with the potential to lead to transgression of boundaries through sharing such an intimate act. It leads to duplicity of the psychiatrist's role, erosion of the purpose of treatment and in my mind is best avoided.
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