Background This paper details the experiences of nine people with mild ⁄ moderate intellectual disability who self injure; looking beyond the clinical presentations in an attempt to capture the perceptions these people have of their care in a medium secure unit. Methods A phenomenological approach was used, and during in-depth interviews, the participants gave rich descriptions of their experiences of self-injury. Results The analysis of the interviews revealed four main themes; coping strategies, staff and the organizational response -therapeutic communication, close observation and looking to the future. As a coping strategy, self-injury was seen as an effective means of reducing distress -there were unique and common reasons for this distress. Common themes relating to the actions and reactions of health professionals and the organizational response were evident within all accounts. Conclusions The theoretical and clinical implications for service users are discussed.

This study provides feedback from research with staff and clients of a medium secure learning disability service in north-west England. Participants were asked about incidents which required the use of physical intervention, using unstructured interviews within a participatory research framework. The article explores clients' and staff accounts of aggressive incidents and the consequences of physical intervention. Clients cited other clients and the ward atmosphere as the main reasons for aggressive behaviour. Some clients said that the use of physical intervention made them more frustrated and brought back memories of frightening experiences. Staff reported that incidents of aggression and the use of physical intervention were upsetting and traumatic, causing feelings of guilt and self-reproach. Staff said that they always used physical intervention as a last resort, although clients often reported otherwise. Time out and post-incident discussions were valued by both groups, as were strong staff/client relationships.

Accessible summary We gave a questionnaire to self‐advocates who were attending a conference. The questionnaire asked them how they felt about the information they get with their medicine. Fifty‐eight people completed the questionnaire. Many of them said they did not get enough information about their medicine. Most people wanted easy‐read leaflets and pictures. There are many different places to find easy‐read information on the internet. We think they should be collected and checked. We also think that doctors and chemists need to spend more time with people to explain about medicines. Abstract BackgroundPrevious research has found that people with learning disabilities are not given prescription information that is tailored to their needs. We wanted to find out people’s information requirements. Materials and MethodsA questionnaire was co‐produced by the authors and consultants with learning disabilities. It asked what information people received from their GP and pharmacist about medications. The questionnaire was circulated at a self‐advocacy conference in the North of England. Fifty‐eight self‐advocates completed the questionnaire. ResultsInformation from GPs and pharmacists was mainly instructional, referring to when and how to take the medicine and dosage. Most respondents struggled to read the leaflets and remember verbal information. Many wanted the information in easy‐read format, and some wanted pictures or diagrams as well. A key theme was that health professionals often talked only to carers or support workers rather than involving the patient directly, and some respondents disclosed that they were not informed about side effects or alternative medications. ConclusionsHealth professionals should take time to discuss health issues and medication with the individual rather than only with carers. This could be facilitated by providing information in an accessible format.

This paper provides feedback from research with staff who work with people who self-harm in a medium secure learning disability service in the north-west of England. It outlines some of the experiences described by staff, as well as personal and organizational responses to incidents of self-harm; explanations that staff use to understand the behaviour; and recommendations for change to treatment models and the staff support system. The information was gained using in-depth interviews, within a participatory research framework. Staff reported experiencing powerful emotional responses to incidents of self-harm, ranging from feelings of anger to feelings of inadequacy and guilt. A number of explanatory models were used by participants to understand the behaviour, and these were generally carefully considered and related to the client's individual situation. The staff/client relationship was often reported as being very rewarding but sometimes staff felt the client was manipulating them. This raised issues about the balance between client autonomy and risk, which was a concern for all staff. When discussing support needs, participants commented that there should be more training that they are able to use in practice, and that more support is needed in the form of discussion groups with colleagues. The findings from this study may be relevant to similar residential facilities.

Accessible summary• Clients and staff at a service called Calderstones talked to the authors about self injury. • Clients said that staff do not understand why they self-injure. Some clients feel punished when staff stop them self-injuring. All clients like talking to staff and said that telling their problems to staff helps them. Clients said that they should be allowed self-injure without staff being blamed. • Staff said they feel upset and worried when a client self-injures. They told the authors they would like more training about self-injury. Some staff would like clients to be allowed to self-injure, but don't want to be blamed for a client's injuries. SummaryThis paper is the synthesis of two pre-existing studies. It details the experiences of nine people with mild/moderate learning disabilities who self injure, and those who work with them. At the time of this study the participants were living and working in a medium secure unit at Calderstones NHS Trust in Lancashire. A phenomenological approach was used, and during in-depth interviews, the participants gave rich descriptions of their experiences of self injury. The descriptions that emerged from the interviews detailed four main themes: understanding, communication, control and blame.

Background: The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.

This article describes an exploration of the subjective experiences of self-injurious behaviour from the perspective of a woman with mild intellectual disabilities, Catherine (pseudonym). At the time of the study, Catherine was detained in a medium secure unit for adults with intellectual and associated disabilities, and had lived there for approximately  years.The study draws together her views and explores her understanding and experiences of her self-injurious behaviour using a qualitative, phenomenographic method. Catherine agreed to participate in in-depth discussions with the researcher, a nurse who had previously worked closely with her.The results offer sections of transcripts to illustrate the direction and focus of the discussions, which emphasize service issues and functions of Catherine's self-injury.

Physical restraint is used in inpatient services for people with intellectual disabilities as a way of holding a person to avoid injury. This article uses data from an ethnographic study in a locked unit in the north of England to explore women's experiences of physical restraint using a feminist disability studies analysis. Data consists of field notes as well as interviews with 16 of the women who had experienced restraint, and 10 staff who worked with them. The women gave insights into the gendered phenomenon of restraint in light of their past experiences of violence. The authors argue that restraint is used with women to encourage passivity at times when more relational and therapeutic methods could be used. The article offers recommendations for alternative strategies that services can encourage.