Search results

Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).

The data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.

Three central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.

This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.

This study aims to investigate the experiences of frontline managers supervising and developing staff to support autistic adults living in two types of residential housing in the community.

A qualitative approach used semi-structured interviews with 14 frontline managers. Audio-taped material was transcribed and analysed using thematic analysis.

Two main themes emerged. Theme 1 “autism in practice” illustrates commonalities observed to affect autistic adults with learning disabilities receiving staff support; whilst one sub-theme illustrated the diversity in how these commonalities may be experienced and expressed, another focused on participants’ experiences of staff concerns regarding behaviours described as challenging. Theme two, “what’s important in autism-informed support” reflected participants’ perceptions of the features of successful person-centred staff support for autistic service users.

The “rich” experiences of these managers may not be readily generalised.

Features of good staff support for autistic adults who may show behaviours of concern included attending to individuals’ specific communication and sensory needs and for predictability within their environments. Developing staff skills and confidence to implement skilled approaches in the context of often high risk behaviour of concern took time and frontline managers “on site” to observe, coach, mentor and demonstrate good practice. More intellectually (verbally) able service-users were perceived as more “difficult” to support.

Staff supporting autistic adults in ordinary housing need frontline managers to act as practice leaders rather than administrators.

This study is the first to report, to the best of the authors’ knowledge, on management for staff supporting autistic adults living in community housing.

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Drawing on interviews with two types of essential workers – wound clinicians and care workers – the chapter examines stigma management in dirty care work through the lens of emotion management. The study combines two dimensions of dirty work: physical taint in relation to bodywork and social taint linked to working in close proximity to socially stigmatized clients. Hence, stigma management extends to dealing with the physically and socially dirty features of essential care work. In addition, the authors’ assessment of social stigma includes how essential care workers also sought to alleviate the social stigma encountered by their clients. In so doing, the authors extend the literature on dirty work to identify how emotion management skills are central to the stigma management strategies of the essential care workers in this study. The authors demonstrate how both groups deal with their stigma by emphasizing the emotion management skills in ‘doing’ dirty work and in the ‘purpose’ of this work, which includes acknowledging how the authors attempt to address the social taint encountered by their clients. Additionally, by comparing two occupations with different contexts and conditions of work, the authors show how complex emotion management skills are gendered in care work to expand the understanding of gender and stigma management. Furthermore, these emotion management skills emanate from the deep relational work with clients rather than through occupational communities. The authors argue that by focussing on emotion management, the hidden skills of dirty work in gendered care work are illuminated and contribute to contemporary debates about whether stigma can be overcome.

Secondary professional teacher education (onwards – SPTE) in Russia has gone through many stages, from ups to downs. There have been periods when SPTE was in low demand and associated with poor student success. However, SPTE has been able to meet the socio-economic challenges of the time, take its place in the hierarchy of Russian education and become a competitive and effective system of practice-oriented teacher training.

The chapter is devoted to the subject description of the dynamic process of formation and development of modern SPTE as an educational system. The authors analyse scientific and pedagogical publications and methodological works of Russian scientists and summarise the results on the basis of their analysis. The proposed chapter ‘Secondary Professional Pedagogical Education in Russia’ will consider the development of the modern system of secondary professional teacher education in Russia. Particular emphasis is placed on the continuity of the theory and practice of teacher training, the peculiarities of a person-centred educational environment and the strong continuity of secondary professional and higher teacher education.

The purpose of this paper is to present the views of people living with dementia in extra care housing (ECH). This is a model of housing with care and support aiming to support older people, including those with dementia, to live independently. Previous research identifies benefits but is predominantly derived from third-party accounts, with the voices of those living with dementia in ECH significantly absent.

This study adopted a qualitative approach conducting 100 interviews across 8 ECH schemes in England. Over half of the interviews were conducted with people living with dementia and their families with the remainder involving staff and commissioners.

Findings suggest there are a range of benefits including owning your own home, having a safe, age friendly location with flexible support, social interaction and continuing to live as a couple. Challenges included availability of staff, flexible resourcing, loneliness and the advancing symptoms of dementia.

Despite efforts to create an inclusive, diverse sample, the participants were all White British. Participants involved were identified by gatekeepers, which may present some bias in the selection.

Whilst ECH offers benefits to people living with dementia, addressing the challenges is essential for effective dementia care. Improving staff training, promoting person-centred care and fostering an inclusive community are critical for enhancing residents’ well-being and quality of life.

This paper explored the lived experiences of residents and family members, providing new insight into the advantages and disadvantages of ECH for people living with dementia.

In the project “Working the way I want” (AWIEW), people with and without disabilities are co-creating a needs assessment tool (NAT) to support participation in the labour market. This tool will include a technological solution at its core and a set of tested new social practices for its successful application in Germany.

The AWIEW project combines several methods and a participatory approach from different disciplines in a transdisciplinary project design. At the micro level, the participatory design approach is used to jointly develop the digital tool with people with disabilities (PWD). At the meso level, semi-structured interviews are used to gather data from different stakeholders in the PWD’ social ecosystem to uncover factors facilitating or hindering the successful transition of PWD to the labour market.

This paper discusses how transdisciplinary results can be incorporated into the development of a tool that supports PWD in navigating their occupational orientation processes. Some preliminary findings are: (a) Vocational orientation for PWD often starts with difficulties in imagining a future job; participative designs need to start from this premise. (b) PWD’ knowledge about the labour market depends on information provided by their social ecosystem; thus, research and design must take this ecosystem into account. (c) Welfare organisations instil a feeling of security and competence within their structures that has to be considered in needs assessment – both as a hindering and an empowering factor.

This paper highlights the importance of combining a digital solution and new practices for a promising approach towards enhancing the participation of PWD in the labour market.

The purpose of this paper is to outline what early support should be offered to children and young people with neurodevelopmental conditions including those who are autistic or have intellectual disability. A review of all child and adolescent mental health services (CAMHS) services in the Northwest completed by NHS England and Improvement (Doyle and Ryan, 2021) found that there was no clear Tier 2 offer (for mild to moderate mental health issues) for autistic children and young people or for those with intellectual disability. Following this review, a project group that had developed a model for mental health services for autistic children and young people and for those with intellectual disability (Wee et al., 2021) was tasked with articulating the “Getting Help” offer for children and young people with neurodevelopmental conditions, including intellectual disability.

A working group was created consisting of professionals from mental health, education and local authority and lived experience representatives of coproduction partners. A brief review of the background literature was also conducted. Six meetings were held to create a framework for the “Getting Help” offer and to discuss what the offer should be based on professional expertise and lived experience.

Recommendations for the Getting Help multi-agency offer included pre- and post-assessment support as part of a single attention deficit hyperactivity disorder/autism/neurodevelopmental pathway, community support for children with intellectual disability, access to adapted mental health support and the need for early recognition and support for avoidant and restrictive food intake disorder. Key themes from working group discussions included the reduction in the quality of services experienced by children and families due to silo working, which increased the risk of falling between multi-agency services and led to early signs of neurodevelopmental needs, or mental health issues being missed. Another theme was aiming for equity of access and outcomes.

This work is a response to a coproduced review of CAMHS in the Northwest and incorporates the lived experience of young people and families. It also adopts a holistic multi-agency neurodevelopmental approach rather than focusing on a single diagnosis or service.

Psychosocial problems, including social isolation and loneliness, are prevalent in rural communities and can impact the use of health services and health outcomes. Current approaches to managing patients with predominantly psychosocial issues may not be the most appropriate. Social prescribing (SP) is a relatively new way of linking patients with sources of non-medical support within the community. Emerging literature suggests that community-based, non-medical activities are an effective and preferred approach to managing psychosocial problems. However, there is little evidence describing the attitudes of general practitioners (GPs) towards formal SP pathways.

This research will occur in a general practice in a rural area of Tasmania, Australia. The project will deliver an education module to rural GPs to highlight the benefits of SP and provide a streamlined pathway for referring patients to community support hubs. Existing community organisations will act as “link workers” to connect patients with suitable community activities. GPs will complete a baseline and follow-up survey to measure their perception of SP and the acceptability, feasibility and appropriateness of such an intervention.

The acceptability, feasibility and appropriateness of the pathway will be assessed using published measures. Free-text responses to open-ended questions will be used to complement the quantitative data. A hybrid effectiveness-implementation method will be used to gather information about the rate of uptake and quality of the SP referral process and identify barriers and facilitators of the process in a real-world setting.

While qualitative data for SP programmes is predominantly positive, quantitative data is lacking. Although the planned project is relatively short, it will provide a basis for future SP programme implementation and guide the approach to data collection and implementation assessment.

The barriers to and facilitators of introducing a SP programme in a rural general practice setting may be used to guide the development and implementation of future large-scale SP interventions. This research is both timely and relevant as the problem of social isolation and loneliness, especially in rural areas of Australia, is becoming more well-recognised as a driver of poor health and unnecessary health service usage.

Using SP to address psychosocial risks may reduce healthcare burden and costs. Few SP programmes have been delivered and formally assessed in Australia, and the best way to implement SP locally remains unclear. By delivering a SP intervention in a rural setting and assessing GPs’ responses, future SP projects will be better able to design and integrate social and medical care services.

This study aims to explore the experiences of non-offending partners (NOPs) of men who perpetrated contact and non-contact sexual offences.

In-depth semi-structured interviews were carried out with eight women and analysed using interpretative phenomenological analysis.

Findings yielded two superordinate themes, eight subordinate themes and an overarching theme. The first superordinate theme “Paying for their Husband’s Transgressions” captured many ways in which the women’s lives were impacted by their husbands offending. The second superordinate theme “Navigating the Darkness” encompassed the women’s experiences of trying to adapt to their new lives. The overarching theme “A Contaminated Life” pertained to the shared experiences of the women who all described encountering instant and profound consequences. This research highlighted the need for immediate signposting to support services for NOPs. The value of a humanistic counselling approach paired with forensic expertise was also identified. Future research with cross-cultural samples and same sex-couples would enrich the current understanding of this experience.

This research highlighted the need for immediate signposting to support services for NOPs. The value of a humanistic counselling approach paired with forensic expertise was also identified.

Qualitative research on the experiences of NOPs of men who perpetrated sexual offences is sparse. Furthermore, existing research focuses on the experiences of women who’s own children were abused, with the partners of men who have perpetrated extra-familial or non-contact offenses remaining largely neglected.