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Working together: findings from the Optimal Study

Nursing and Residential CareVol. 20, No. 2 EditorialWorking together: findings from the Optimal StudyAdam GordonAdam GordonSearch for more papers by this authorAdam GordonPublished Online:15 Jan 2018https://doi.org/10.12968/nrec.2018.20.2.74AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alzheimer's Society. Low expectations: attitudes on choice, care and community for people with dementia in care homes. 2013. http://bit.ly/2BT91SN (accessed 11 December 2017) Google ScholarBritish Medical Association. Government needs to address problems facing care home services, warns GP leaders. 2016. http://bit.ly/2yZE94x (accessed 11 December 2017) Google ScholarFisher M, Ridley S. Uncertainty in end-of-life care and shared decision making. Crit Care Resusc. 2012; 14(1):81–87 Google ScholarGordon AL, Goodman C, Dening T et al.. The Optimal Study: describing the key components of optimal health care delivery to UK care home residents: a research protocol. J Am Med Dir Assoc. 2014; 15(9):681–686 Crossref, Google ScholarIliffe S, Davies SL, Gordon AL et al.. Provision of NHS generalist and specialist services to care homes in England: review of surveys. Prim Health Care Res Dev. 2016; 17(2):122–137. https://doi.org/https://doi.org/10.1017/s1463423615000250 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 February 2018Volume 20Issue 2ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 15 January 2018 Published in print 2 February 2018 Information© MA Healthcare LimitedPDF download

Della Cruscanism and Newspaper Poetics: Reading the Letters of Simkin and Simon in the World

Della Cruscanism and Newspaper Poetics: Reading the Letters of Simkin and Simon in the World Claire Knowles (bio) One of the givens in recent critical work on the della cruscans is that there is a straightforward distinction between what is a Della Cruscan poem, and what is not. This approach makes sense in the case of what has become known as the “first wave” of Della Cruscanism because it was always a relatively well-delineated phenomenon. Della Cruscanism began when a group of English and Italian friends living in Florence published privately a collection of poetry (written both in English and Italian) called The Florence Miscellany (1785). There is, then, only one first wave Della Cruscan text and only two key vehicles responsible for its dissemination back home in England: the privately printed Miscellany and the respectable monthlies such as the European Magazine and the London Chronicle who took it upon themselves to reprint poems from the Miscellany in their pages. In this context, deciding what constitutes a Della Cruscan poem is fairly straightforward—a Della Cruscan poem is, quite simply, a poem that first appeared in the Florence Miscellany. Things become more complicated, however, when Della Cruscanism enters what I have described elsewhere as its “second wave.”1 Two years after the publication of The Florence Miscellany, one of its key contributors, Robert Merry, published a poem in a similar vein to those appearing in the book under the pseudonym of “Del Crusca” in Edward Topham’s fashionable paper, the World.2 His poem inspired a reply from a poet calling herself [End Page 581] “Anna Matilda” (the playwright, Hannah Cowley). Della Crusca responded in verse to his new fan, she wrote back, and the flirtatious and theatrical dialogue that became one of the hallmarks of the second wave of Della Cruscan poetry was born. The popularity of Anna Matilda and Della Crusca’s playful exchange in the pages of the World began a fad for pseudonymous poetry in the daily newspapers that continued well into the 1790s. Poetry had, of course, been a feature of the daily newspapers long before the runaway success of the Della Cruscans. But by 1789 consciously “poetical” pseudonyms similar to those of Della Crusca and Anna Matilda (“Glanville,” “Philander,” “Laura,” “Maria”) came to be favored by contributors to the World. Such was the public appetite for Della Cruscan poetry during the late 1780s and early 1790s that the paper’s printer John Bell went on to publish two collections of Della Cruscan poetry—The Poetry of the World (1788) and The British Album (1790)—as well as numerous volumes by individual Della Cruscan poets.3 The success of the World, a success grounded in the paper’s ability to attract and retain audiences through a clever engagement with London’s vibrant literary and theatrical scenes, had a significant impact on the media landscape of the latter part of the eighteenth century. Newspaper historian Stanley Morison writes, for example, “by 1800 all the daily papers in London had altered their make-up and headings into accordance with that of the World. The writing and reporting style, frivolous, up-to-date, and very personal, was also widely copied.”4 Similarly, Della Cruscan poetry, or poetry modelled in certain key respects on Della Cruscan poetry, was to become a common feature of all of the most widely read newspapers of the late eighteenth century, including the Morning Post, the Morning Star and the Oracle. What precisely might make a particular poem or poet “Della Cruscan” becomes more difficult to pinpoint in the wake of the success of the second-wave of Della Cruscan poets. The proliferation of vehicles for the publication of poetry over the course of the 1780s and 1790s, combined with the enormous popularity of the particular type of verse written by Merry and his associates, meant that second-wave Della Cruscanism expanded in the latter part of the 1780s to become a phenomenon with very loose boundaries indeed. Jerome McGann, for example, has famously suggested [End Page 582] that the Della Cruscan movement came into cultural dominance in the final decades of the eighteenth century precisely “because the writing explicitly encouraged further...

Exploring care home providers’ public commitments to human rights in light of the United Nations Guiding Principles on Business and Human Rights

Purpose The purpose of this paper is to explore care home providers’ public communications covering their commitments to respecting residents’ the human rights. The discussion considers the United Nations guiding principles on business and human rights United Nations Guiding Principles on Business and Human Rights (UNGPs) and a domestic legal and regulatory human rights framework. Design/methodology/approach Qualitative content analysis undertaken in 2017 of 70 websites of England’s largest commercial care home providers. Findings There are strong value-based public commitments in the websites of many English care home providers, which may or may not be interpreted as expressing their commitments to human rights. Research limitations/implications Research was limited to websites, which are public facing and marketing tools of care home providers. This does not provide inferences regarding the practical implementation of value-based statements or human-rights-based procedures or policies. This paper does not make any value judgements regarding either the public communications of care home providers or normative claims regarding human rights and care home service provision. Practical implications There is a need for clarification and debate about the potential role and added value of the corporate responsibility to respect human rights and the UNGPs’ operating principles within the English residential care sector. Further exploration of the relationship between personalisation/person-centred care and human rights might be useful. Originality/value This paper introduces the UNGPs and corporate responsibility to respect human rights to the debate on human rights, personalised/person-centred care, safeguarding and care homes in England. It adds a new perspective to discussions of the human rights obligations of care home providers.

Proof of concept that requiring energy labels for dwellings can induce retrofitting

How to induce households to install energy efficient technology remains a puzzle. Could an energy labeling requirement for residential real estate help? We propose that the salient color-letter grades on the English Energy Performance Certificate (EPC) served as targets, motivating vendors to invest in energy efficiency. To test our hypothesis we look to a random sample of over 16,000 homes in England. In the post-EPC data we find a cluster of homes with energy efficiency scores just above the D-grade threshold. This cluster was not present prior to the requirement, replicates in an independently-drawn random sample and is significantly larger amongst properties that can be identified as treated by the EPC requirement. We conclude that the EPC requirement induced investment, and hence that energy efficiency labels have potential to green the housing stock. We infer from our analysis how the design of the EPC could be altered to motivate greater investment in energy efficiency.

The Honeymoon, A Novel

The Honeymoon, A Novel

A Second Ode to William Shakespeare

The first poem that was published by our Editor-in-Chief in the SpringerNature journal SILICON was entitled On Editing (From A Hospital Bed). It was published in 2014 and it was written in a year that President Barack Obama and Prime Minister David Cameron ruled-the-roost in the USA and in the UK, respectively. Since that year we have celebrated the 400th anniversary of the death of William Shakespeare (2016). Herein is presented a second poem written for SILICON by our Editor-in-Chief. It is entitled A Second Ode To WS. This poem is intended to be an acknowledgement of the positive influence of the writings of William Shakespeare on the life of author. Indeed the study of the “Sweet Swan of Avon” dates back to Professor Clarson’s days as a pupil at a Yorkshire Grammar School back home in merry England.

Streamlining or watering down? Assessing the 'smartness' of policy and standards for the promotion of low and zero carbon homes in England 2010–15

The knowledge and enforcement problems faced by governments in defining traditional ‘command and control’ regulation are well known. Significant legal scholarship offers alternative models of ‘smart,’ ‘responsive’ environmental regulation, emphasising the need for policy instrument mixes, including the vital role of voluntary, industry-led sustainability standards. Yet, as is being increasingly recognised, these contributions leave open the need for detailed, qualitative evaluation of instrument mixes as a complement to primarily quantitative cost-benefit analyses that predominate in regulatory impact assessments by governments. Addressing this need, this paper evaluates policy and standards for low and zero carbon homes in England during the Coalition government (2010–2015) when the ecological modernisation discourse of the previous New Labour government became subsumed by a deregulation agenda. Our study, incorporating 70 stakeholder interviews, suggests that, in supplier-driven markets such as housing in England, a ‘smart’ mix of mandatory and voluntary standards requires a strong, central role for government in setting national, mandatory standards and supporting their delivery. There is an important potential supplementary role for voluntary tools and local authority discretion, though our study highlights problems that can arise when such different instruments promote diverging roadmaps towards a policy goal.

Challenges of improving oral health for adults in care homes.

In 2016 the National Institute for Health and Care Excellence (NICE) published a guideline on oral health for adults in care homes in England. The author was a co-opted member of the NICE oral health for adults in care homes public health advisory committee. This article reviews the NICE guideline as it applies to care homes, and relates it to the results of a survey of oral care practice undertaken in a large care home organisation and the available research literature from the past 20 years. The literature and survey results suggest that, if translated into practice, the NICE guideline could do much to improve oral health for adults in care homes. The survey highlighted that 85% of residents required support from carers to undertake mouth care. It also found that care homes experienced significant difficulties in accessing dental services for residents. The author concludes that providers need to equip staff with the necessary knowledge and skills to undertake mouth care and to give this area of personal care greater priority. Finally, the author suggests that the Care Quality Commission could ensure that the NICE guideline is translated into practice in care homes.

Parents, local house prices, and leaving home in Britain

AbstractLeaving the parental home is a significant step in young adults' housing careers and pathways to independence. Although a large literature examines how life course trajectories influence leaving home, much less is known about how the “linked lives” of parents and the local cost of housing shape young people's departures from the family residence. By enriching the U.K. Household Longitudinal Study with house price data, this study investigates how parental attributes and the geography of local housing costs influence home leaving in contemporary Britain. The results show that higher local house prices are associated with delayed departure from the parental home, although the relative magnitude of this effect is modest. By contrast, the effects of parental factors are more nuanced. Parental characteristics have little impact on the odds of leaving home to form partnerships, whereas the likelihood of departing to live alone or in shared accommodation is reduced by parental homeownership or living with both biological parents. Taken together, these findings suggest that young adults' residential pathways are shaped by the complex patterns of choice and constraint that are generated by disparities in family circumstances and local opportunity structures.

Maternal and Perinatal Outcomes in Women Planning Vaginal Birth After Cesarean (VBAC) at Home in England: Secondary Analysis of the Birthplace National Prospective Cohort Study

(BJOG. 2016;123:1123–1132) Some women in England who have undergone a cesarean section (CS) in an earlier pregnancy prefer a planned vaginal birth after cesarean (VBAC) in a midwifery-led setting, such as at home, in a freestanding midwifery unit, or in an alongside midwifery unit which resides in the same facility as a hospital obstetric unit (OU). However, present national guidelines suggest that women with a previous CS plan subsequent births in an OU to avoid maternal and fetal complications. This study aimed to compare vaginal birth rates in women planning VBAC at home to those planning VBAC in an OU, and to determine transfer rates for those planning VBAC at home. In addition, analysis of maternal and perinatal outcomes for these groups was undertaken.

Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

BackgroundAgeing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits. ObjectiveThis study explored facilitators and barriers to the implementation of monitoring technologies in care homes. DesignEmbedded multiple-case study with qualitative methods. SettingThree dementia-specialist care homes in North-West England. ParticipantsPurposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents. Methods36 semi-structured interviews with staff, relatives and residents; 175h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis. ResultsFindings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice. ConclusionImplementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.

Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework

BackgroundUnderstanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes...

Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings.

Developing, implementing and evaluating an end of life care intervention.

Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

British teachers’ transnational work within and beyond the British Empire after the Second World War

Focusing on British graduates from Gipsy Hill Training College (GHTC) in London, this article illustrates transnational history’s concerns with the reciprocal flows of people and ideas within and beyond the British Empire. GHTC’s progressive curriculum and culture positioned women teachers as agents of change, and the article highlights the lives and work of married and single graduates overseas after the Second World War. Some migrated to the dominions of Australia, Canada and New Zealand, while South Africa and Southern Rhodesia (Zimbabwe) were popular destinations for short-term teaching contracts. A few graduates went to the colonies as missionaries and colonial servants, and a handful taught in extra-imperial sites. Wherever they were located, these British women promulgated the college’s progressive ideals and shared their experiences with people at home in Britain, thereby shaping understandings of the Empire and constructing a world that was differentiated by class, gender, race and nation.

Metropolitan Scurvy in the Shadow of the Cook Voyages

ABSTRACTRecent scholarship on scurvy in 18th-century Britain has focused on the disease in the context of voyages of exploration, especially those bound for the Pacific Ocean. Using materials from quack physicians, print culture and popular song, this essay contends that the problem of scurvy was just as acute in metropolitan London and elsewhere in Britain. By studying representations of the disease and its markets at home in Britain, it aims to shed new light on the treatment and perception of the disease at sea, particularly during the voyages of James Cook (1768‒79).

Serving on the Eugenic Homefront: Virginia Woolf, Race, and Disability

If eugenics was a “war against the weak,” as Edwin Black characterizes it, then interwar Britain was a homefront in the crusade against contagion from all sides: disabled, sexually perverse, working class, and nonwhite enemies at home in England and abroad in the colonies. I contend that modernists like Virginia Woolf enlisted dysgenic subjects to serve on the battlefield in order to lay the foundations for new, seemingly more inclusive, versions of eugenics and also to provide the raw material for the intellectual and bodily fragmentation of modernist aesthetics. I read this phenomenon in Woolf’s own blackface, cross-dressing performance in the 1910 Dreadnought Hoax and in her 1927 novel To the Lighthouse. These examples demonstrate how the nation was beginning to recruit unfit subjects and put them on the frontlines of the war on degeneracy, rather than eliminate them. By demonstrating how such service members were nonetheless stripped of their worth and even sacrificed in battle, my reading of Woolf excavates the modernist roots of liberal biopolitics—or what I call the afterlife of eugenics.

What we know about designing an effective improvement intervention (but too often fail to put into practice)

It is temptingly easy to treat improvement interventions as if they are drugs—technical, stable and uninfluenced by the environment in which they work. Doing so makes life so much easier...

Negotiating and valuing spaces: The discourse of space and ‘home’ in care homes

This paper examines how space in care homes is experienced and negotiated by people who live and work in them. The analysis of qualitative data of five in-depth case studies of care homes in England revealed three key ways in which space is negotiated: a) the way in which values affect interactions inside versus outside the care home environment, b) the negotiation of boundaries and domains within the homes, and c) the sense of being at ‘home’. The paper illuminates how the design of the buildings and organisational factors can reinforce or bridge dichotomies between inside and outside spaces. Residents’ abilities to re-negotiate boundaries, domains and communal spaces within homes are shown to be affected by organisational factors such as priorities of staff members. Despite ‘home’ being a common discourse, the spaces within care homes were often organised, ordered and experienced as two distinct, co-present worlds: the dwelling place of residents and the workplace of staff.

Realising dignity in care home practice: an action research project.

More than 400,000 older people reside in over 18,000 care homes in England. A recent social care survey found up to 50% of older people in care homes felt their dignity was undermined. Upholding the dignity of older people in care homes has implications for residents' experiences and the role of Registered Nurses. The study aimed to explore how best to translate the concept of dignity into care home practice, and how to support this translation process by enabling Registered Nurses to provide ethical leadership within the care home setting. Action research with groups of staff (Registered Nurses and non-registered caregivers) and groups of residents and relatives in four care homes in the south of England to contribute to the development of the dignity toolkit. Action research groups were facilitated by 4 researchers (2 in each care home) to discuss dignity principles and experiences within care homes. These groups reviewed and developed a dignity toolkit over six cycles of activity (once a month for 6months). The Registered Nurses were individually interviewed before and after the activity. Hard copy and online versions of a dignity toolkit, with tailored versions for participating care homes, were developed. Registered Nurses and caregivers identified positive impact of making time for discussion about dignity-related issues. Registered Nurses identified ongoing opportunities for using their toolkit to support all staff. Nurses and caregivers expressed feelings of empowerment by the process of action research. The collaborative development of a dignity toolkit within each care home has the potential to enable ethical leadership by Registered Nurses that would support and sustain dignity in care homes. Action research methods empower staff to maintain dignity for older people within the care home setting through the development of practically useful toolkits to support everyday care practice. Providing opportunities for caregivers to be involved in such initiatives may promote their dignity and sense of being valued. The potential of bottom-up collaborative approaches to promote dignity in care therefore requires further research.