The policy imperative to increase public participation in health and social care research, planning and service delivery raises significant questions about optimum approaches, methods and the extent to which this policy can influence change in practice. This paper highlights the key policy literature on user involvement and participatory research methods to establish the context for a partnership research project exploring perceptions of risk in relation to falls from the perspectives of older people, carers, and health and social care professionals. The paper reports the methods used in developing user involvement in the research at a number of levels, including project management, and a consumer panel working alongside the research team and influencing the dissemination in local falls prevention strategies. The authors draw out the issues related to the context and method of involvement, and discuss the impact on research quality and local service development in health and social care.
Objective This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in Ôgetting readyÕ for user involvement.Background Relatively few health or social care systematic reviews have actively involved service users. Evidence from other research contexts shows that user involvement can have benefits in terms of improved quality and outcomes, hence there is a need to test out different approaches in order to realize the benefits of user involvement and gain a greater understanding of any negative outcomes.
This is the accepted version of the following article:Drennan VM, Norrie C, Cole L, Donovan S. Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance. J Clin Nurs. 2013 Feb;22(3-4) ABSTRACT Aim and objectives:The aim of this study was to establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England.Background: Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. Findings: Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. Conclusion:Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers.Relevance for clinical practice: Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home, and their family carers.
The specialist knowledge and skills of health and social care practitioners working with older people are often unacknowledged. This paper examines an important aspect of specialist knowledge, the understandings of ageing and old age that underpin practice in a society where negative assumptions about old age and older people are widespread. These understandings were explored through analysis of data from 30 interviews with health and social care practitioners working with older people at risk of falling. The interviews centred on a case vignette and the analysis presented here focuses on respondents' perceptions of the scenario and of the reluctance of its subject, a 79-year-old woman, to seek help after a fall. The findings suggest that practitioners' understandings of older people are grounded in practice and personal experience, with little evidence of the use of theoretical or research-based knowledge of ageing and old age. This suggests that the potential for formal knowledge of ageing to support reflective and empowering practice with older people has yet to be fully exploited. The paper concludes with a discussion of the relevance to interprofessional practice of gerontological theory and research and suggestions for further research.
Background SURECAN (SUrvivors’ Rehabilitation Evaluation after CANcer) is a multi-phase study developing and evaluating an Acceptance and Commitment Therapy (ACT) intervention integrated with exercise and work when highly valued (thus we called the intervention ACT+), for people who have completed treatment for cancer but who have low quality of life. We developed a training programme for therapists working in different psychological services to be delivered over 2–3 days. Our aim was to evaluate the extent to which the training could improve therapists’ knowledge and confidence to deliver ACT+ to cancer patients in a trial setting. Methods Three interactive workshops were delivered to 29 therapists from three clinical settings in London and in Sheffield. A mixed-methods approach was used. Questionnaires were designed to assess knowledge and confidence in using ACT+ with people who have low quality of life after cancer treatment. They were self-administered immediately prior to and after each workshop. Open text-based questions were used to elicit feedback about the workshops alongside a satisfaction scale. Semi-structured interviews were conducted with a purposive sample of therapists (n = 12) to explore their views about the training more deeply, and how it might be optimised. Results Quantitative analysis showed that knowledge of ACT, as well as confidence in using the ACT+ intervention in this setting increased significantly after training (28.6 and 33.5% increase in the median score respectively). Qualitative analysis indicated that most therapists were satisfied with the content and structure of the programme, valued the rich resources provided and enjoyed the practice-based approach. Potential barriers/facilitators to participation in the trial and to the successful implementation of ACT+ were identified. For some therapists, delivering a manualised intervention, as well as supporting exercise- and work-related goals as non-specialists was seen as challenging. At the same time, therapists valued the opportunity to be involved in research, whilst training in a new therapy model. Conclusions Training can effectively improve the knowledge and confidence of therapists from different clinical backgrounds to deliver a modified ACT intervention to cancer patients in a trial setting.
Economic and political pressures have led state governments to shrink and close long-term psychiatric inpatient units in favor of community-based treatment. These pressures present inpatient clinicians with an opportunity to examine their clinical practices and question whether the focus of treatment addresses the behaviors most relevant to helping patients achieve discharge and maintain community tenure. The social learning approach of Gordon Paul is the empirically validated treatment of choice for long-term psychiatric inpatients. In this study, we compared changes in daily functioning of sixty-four chronic psychiatric inpatients treated in two rehabilitation programs based extensively on Gordon Paul's social learning approach. Half of the participants were successfully discharged from the hospital. Analysis found both similarities and differences in behavioral improvements between the groups. These results provide some clarity to the relationship between selfcare skills, participation in programs, maladaptive behaviors, and achieving hospital discharge for chronically hospitalized individuals.
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