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1 – 10 of 28Henriikka Anne-Mari Seittu, Anneli Hujala and Minna Kaarakainen
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…
Abstract
Purpose
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).
Design/methodology/approach
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.
Findings
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.
Originality/value
This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.
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Sarah Mahon, Laura O'Neill and Rachel Boland
In 2014, the Health Service Executive (HSE) in Ireland published its Safeguarding National Policy and Procedures (HSE, 2014). Under this policy, all agencies providing services…
Abstract
Purpose
In 2014, the Health Service Executive (HSE) in Ireland published its Safeguarding National Policy and Procedures (HSE, 2014). Under this policy, all agencies providing services through the social care directorate must ensure a robust culture of safeguarding is in place. Concurrent to this has been a move in social policy, practice and research to include the voice of the service user, both in terms of planning and reviewing services. (e.g. HIQA, 2012; Flanagan, 2020) This article examines whether service users with intellectual disabilities want to be involved in safeguarding plans and, if so, how that can be supported. Using focus groups service users demonstrated their knowledge of safeguarding as a concept, how they felt about the issues raised, and, crucially what they felt they would like to see happen next in addressing a safeguarding incident or concern. The focus groups took place in a large organisation providing residential services, day services, independent living supports and clinical supports. Engaging service users in planning and responding to safeguarding concerns is a fundamental principle of human rights legislation, both nationally and internationally. This study aims to highlight that it is both possible and desirable to engage fully with service users using a range of simple communication tools. For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time, human resources and will need champions to get on board with the necessary culture shift.
Design/methodology/approach
Qualitative research examined peoples’ “lived experiences” and knowledge of safeguarding. Focus groups were used with thematic analysis highlighting common themes throughout, as guided by Braun and Clarke (2006). There were two objectives: Objective 1: measuring participant’s understanding of the safeguarding process. Objective 2: compare the potential differences between safeguarding plans devised by the participants in the focus groups, versus plans devised by trained designated officers responsible for safeguarding within the service.
Findings
Four principal themes emerged – 1. participants understanding of safeguarding; 2. restorative justice; 3. consent; and 4. high levels of emotional intelligence and compassion. Participants demonstrated that they could and did want to be involved in safeguarding planning and showed little variation in the plans compared to those completed by trained staff.
Research limitations/implications
The study was completed with a small sample size in a single service in one area. It may not represent the lived experiences and knowledge of safeguarding in other services and indeed other countries. The video may have led to some priming; for instance, the Gardai in the footage being called may have resulted in the participants stating that contacting Gardai should be part of the plan. After the video was shown, there was a heightened awareness of safeguarding. This may indicate that participants are aware of safeguarding but unsure of the terminology or how to discuss it out of context.
Practical implications
For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time and human resources and will need champions in the safeguarding arena to get on board with the shift in culture required.
Social implications
While there did not appear to be many barriers to listening to participants, to progress this as a standard practice a very real shift in culture will be needed. It is important for practitioners to ask: Is the vulnerable person aware that this concern has been raised? What is known of the vulnerable person’s wishes in relation to the concern? To truly engage with service users in safeguarding plans these questions need to be more than a “tick box” exercise. This process needs to be fully embedded into a culture that promotes a person-centred, rights-based, inclusive approach as a standard rather than a one-off project. Some structural changes will be needed regarding the time given to designated officers, and what resources they can access (such as speech and language therapy). However, the real difference will be made by services operating authentic leadership that champions engagement on this scale, to fully answer the question posed by the researchers at the beginning of this report, “Whose safeguarding is it anyway?”
Originality/value
There appears to be little evidence of service user engagement in terms of planning and processing safeguarding responses, either in research or anecdotally.
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Benjamin Thomas Gray and Matthew Sisto
The purpose of this study is to describe peer support work in a men’s mental health unit from a lived experience and service user’s perspective. The intertwining of process (a…
Abstract
Purpose
The purpose of this study is to describe peer support work in a men’s mental health unit from a lived experience and service user’s perspective. The intertwining of process (a lived experience perspective) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems.
Design/methodology/approach
This service user narrative draws on the extracts from a reflective journal of interactions and conversations with people with mental health problems as well as feedback from service users and staff about the value of peer support. These methods allow a first-person, service user’s, reflective and narrative account of peer support work.
Findings
Peer support work, particularly hearing voices sessions, are found to be highly therapeutic and worthwhile. They promote insight and create feelings of safety and hope in what can sometimes be a frightening and hostile ward environment. Peer support provides emotional and practical support. Sharing stories and experiences of mental illness with people leads to trust, feelings of being valued, heard and accepted as well as better experiences of care and being seen as a person first. Due to their shared experiences, peer support workers are able to befriend people with mental health problems on the ward. Peer support work bridges the gap and vacuum of care between people with mental health problems and staff. It compensates for understaffing to provide more holistic and person-centred care and support.
Originality/value
Lived experience/ service user perspectives and narratives on peer support are rare, particularly in a hospital setting. This article provides a rich, perhaps overlooked and hidden narrative on the nature of peer support work. People with mental health problems, like Ben, are often excluded from society, health and social care, education, employment and research. This narrative opens up a pathway to understanding peer support from a service user perspective.
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In Germany, various approaches have been taken to tackle the current teacher shortage in technical and vocational education and training (TVET). One attempt to remedy the shortage…
Abstract
Purpose
In Germany, various approaches have been taken to tackle the current teacher shortage in technical and vocational education and training (TVET). One attempt to remedy the shortage in Bavaria has been the introduction of an engineering education study programme at universities of applied sciences. Ideal candidates for this programme should have an interest in both engineering and social interaction. For effective recruitment, therefore, it is necessary to know applicants’ characteristics such as their vocational interests. In this study, the vocational interest profiles of students in TVET teacher training programmes were identified and their interest profiles and further characteristics were compared with those of other VET students at universities and universities of applied sciences.
Design/methodology/approach
An online questionnaire based on Holland’s interest theory and adapted from the Allgemeiner-Interessen-Struktur-Test-3 (interest structure test) was administered to 85 students in TVET teacher training programmes at universities and universities of applied sciences in Bavaria. Items regarding reasons for choosing a particular study programme, university location and other personal details were added.
Findings
The vocational interest profiles of students at universities and universities of applied sciences can be described as similar but weakly differentiated. Insights are provided by the characteristics of students such as the majority being first-time academics in the family. The reasons for choosing the degree programme and university location highlight the fact that a large proportion of students in engineering education would not have chosen a teaching-related degree programme if it had not been offered at the respective university of applied sciences.
Research limitations/implications
Although the sample in this study was small and, therefore, limiting, it represented a high proportion of TVET teacher training students in Bavaria and a substantial proportion of first-year students in TVET teacher training programmes at universities and universities of applied sciences in Bavaria (section 2.2 and 3.1). Thus, the findings provide valuable insights into commonalities in interest profiles between engineering education students at universities of applied sciences and other TVET students at universities. With respect to the domain of the chosen vocational specialisation, differentiated profiles emerged that, for example, showed a stronger artistic orientation among students in construction technology/wood. For further analysis, the previous variable-centred orientation of the analysis can be supplemented by person-centred analyses (e.g. cluster analysis and latent variable mixture modelling, LVMM) (cf. Leon et al., 2021).
Practical implications
The findings in this study reveal the potential for attracting candidates to universities of applied sciences if they prefer to study in rather rural areas close to their hometowns. With the aim to educate prospective teachers for future work not only in metropolitan regions but in rural areas too, offering bachelor degree programmes in rural areas would seem promising. A regional option can boost the recruitment of new students and attract candidates that otherwise would be unable to pursue studies or a career as a teacher in vocational education. The results of this study and those of previous studies suggest that universities of applied sciences can cooperate with universities to help solve the teacher shortage problem.
Social implications
Overall, it is apparent that the students' interests reached comparatively high values in all interest orientations and thus are only weakly differentiated. If undifferentiated profiles indicate low levels of career readiness, this significantly affects the recruitment of young people for the teaching profession. Assessing career orientation and promoting vocational interests should be prioritised during secondary school education. Vocational orientation measures are essential and should provide insight into typical activities of daily work life in different professions and thus pique and foster interests.
Originality/value
This study provides insight into how to respond to the teacher shortage in VET by identifying important characteristics of engineering education students using vocational interest profiling.
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Susan Jain, Kathy Dempsey, Stephanie Wilcox, Patricia Bradd, Joanne Travaglia, Deborah Debono, Linda Justin and Su-yin Hor
This paper aims to describe the design and evaluation of a pilot leadership development programme for infection prevention and control (IPAC) professionals during the COVID-19…
Abstract
Purpose
This paper aims to describe the design and evaluation of a pilot leadership development programme for infection prevention and control (IPAC) professionals during the COVID-19 pandemic. The programme’s aim was to improve IPAC knowledge and capacity in the health-care system by developing the leadership skills and capacities of novice and advanced Infection Control Professionals (ICPs), to respond flexibly, and competently, in their expanding and ever-changing roles.
Design/methodology/approach
The leadership programme was piloted with seven nurses, who were part of a clinical nursing team in New South Wales, Australia, over a 12-month period between 2021 and 2022. The programme was designed using a leadership development framework underpinned by transformational leadership theory, practice development approaches and collaborative and experiential learning. These principles were applied during programme design, with components adapted to learners’ interests and regular opportunities provided for collaboration in active learning and critical reflection on workplace experiences.
Findings
The authors’ evaluation suggests that the programme was feasible, acceptable and considered to be effective by this cohort. Moreover, participants valued the opportunities to engage in active and experience-based learning with peers, and with the support of senior and experienced ICPs. The action learning sets were well-received and allowed participants to critically reflect on and learn from one another’s experiences. The mentoring programme allowed them to apply their developing leadership skills to real workplace challenges that they face.
Research limitations/implications
Despite a small sample size, the authors’ results provide empirical evidence about the effectiveness of using a practice development approach for strengthening ICP leadership capacity. The success of this pilot study has paved the way for a bigger second cohort of participants in the programme, for which further evaluation will be conducted.
Practical implications
The success of this leadership programme reflects both the need for leadership development in the IPAC professions and the applicability of this approach, with appropriate facilitation, for other professions and organizations.
Originality/value
ICP leadership programmes have not been previously reported in the literature. This pilot study builds on the growing interest in IPAC leadership to foster health system responsiveness and change.
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This paper aims to illustrate, by means of a content analysis of 278 weekly School Meeting minutes, the ways in which student voice is actualized in one democratic free school in…
Abstract
Purpose
This paper aims to illustrate, by means of a content analysis of 278 weekly School Meeting minutes, the ways in which student voice is actualized in one democratic free school in Germany.
Design/methodology/approach
This paper uses a qualitative content analysis methodology of 278 weekly School Meetings minutes.
Findings
This paper uses Fielding’s (2012) patterns of partnership typology to illustrate what counts as student voice and participation in a democratic free school.
Research limitations/implications
Limitations included being reliant on translations of German texts, some missing minutes from the entire set, the lack of a single author for the minutes (and thus degree of detail differs) and the fact that the School Meeting minutes make reference to other meetings for various sub-committees for which no minutes exist, and thus, findings on the degree of student voice may be limited. And because this is a study of one school, generalizability may be difficult. Future research into these sub-committee meetings would prove helpful as well as content analyses of other democratic free schools’ meeting minutes.
Originality/value
This study can help people more deeply understand what goes on in democratic free schools and what student voice and participation can mean within this context.
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Claire Bates and Rose Matthews
The purpose of this study is to explore the support needs surrounding intimate relationships and sexuality of autistic adults accessing funded social care in England.
Abstract
Purpose
The purpose of this study is to explore the support needs surrounding intimate relationships and sexuality of autistic adults accessing funded social care in England.
Design/methodology/approach
Semi-structured interviews with 15 autistic adults who were accessing funded social care examined their support needs surrounding intimate relationships and sexuality, with subsequent data analysis using reflexive thematic analysis.
Findings
Four themes were generated: Help at hand, but not too close for comfort, No “cookie-cutter rules”: personalised, inclusive approaches, Playing it safe, not leaving it too late, and Autism-informed education and support.
Practical implications
The authors produced an online learning module for social care staff in England on best practice in supporting autistic adults without learning disabilities with relationships and sexuality.
Originality/value
To the best of the authors' knowledge, there has been no other UK-based research published to date on the social care support needs of autistic adults without learning disabilities surrounding relationships, gender and sexuality.
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The purpose of this paper is to provide an example of patient-led co-production.
Abstract
Purpose
The purpose of this paper is to provide an example of patient-led co-production.
Design/methodology/approach
The New Economics Foundation’s six principles of co-production (nef, 2013) have been used to frame the activities undertaken during the author’s relationship with a community mental health nurse.
Findings
This paper describes a co-produced project between a patient and a community mental health nurse to create a range of resources and to deliver training, resulting in mutual benefit for both parties.
Practical implications
This paper invites policy makers to consider the unique role that community mental health nurses can play in supporting patients with long-term challenges that have developed because of an imbalance and an abuse of power within earlier relationships; by adopting a co-production approach, centred on the patient’s interests and skills, a working partnership can be achieved wherein both parties feel that they matter.
Originality/value
Co-production is usually used with groups of stakeholders working together in an equitable way to design or deliver a new service; this paper, however, seeks to demonstrate how the process can be effectively used when the project is patient-led within the context of a therapeutic relationship.
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Inger James, Annica Kihlgren, Margaretha Norell Pejner and Sofia Tavemark
The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the…
Abstract
Purpose
The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.
Design/methodology/approach
In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.
Findings
The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.
Originality/value
The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.
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Lorna de Witt, Kathryn A. Pfaff, Roger Reka and Noeman Ahmad Mirza
Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review…
Abstract
Purpose
Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices?
Design/methodology/approach
The authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological Abstracts and Abstracts in Social Gerontology that yielded 17 papers eligible for review.
Findings
“There’s always something positive and something negative” is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults’ health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources.
Originality/value
The authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities.
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