Provision Of Care For People Research Articles

End of life care for people with a learning disability

To explore the experiences of learning disability and district nurses caring for people with a learning disability at the end of their lives. A small-scale semi-structured qualitative study involving interviews was carried out to explore the experiences of healthcare professionals from two specialist healthcare settings. Healthcare professionals felt that formal guidelines and support were needed in this complex area. The study also revealed that successful provision of palliative care for people with a learning disability requires a person-centred approach. Modifications to existing palliative care services, involving joint working, improved co-ordination and reasonable adjustments, is recommended. This aims to address any inequalities in care provision for people with a learning disability who are at the end of their lives.

Dentists’ attitude to provision of care for people with learning disabilities in Udaipur, India

This study determines and compares the attitudes of dentists to the provision of care for people with learning disabilities according to gender, qualification, previous experience of treating patients with learning disabilities and work experience of dentists. A cross-sectional study was conducted among 247 dentists (166 men and 81 women) using a pretested structured questionnaire. This questionnaire assessed the respondent's attitude towards learning-disabled patients in five categories: beliefs about treating them, their capabilities, discrimination against these patients, their social behaviour and quality of care to be received by these patients. The information on dentist's gender, qualification, work experience and previous experience of treating patients with learning disabilities was also collected through questionnaire. The Student's t-test and anova test were used for statistical analysis. The mean attitude score was found to be 71.13 ± 8.97. A statistically significant difference was found in the mean attitude scores of dentists with work experience (p = 0.000). Study subjects with postgraduate qualification and previous experience of treating patients with learning disabilities had significantly greater mean attitude score than their counterparts (p = 0.000). The overall attitude of dentists towards provision of care for people with learning disabilities was favourable, which increased with higher qualification and past experience.

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study

ObjectivesTo understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for...

Review article: People who present on multiple occasions to emergency departments

Research about people who present on multiple occasions to the ED began in the 1980s. Despite this, little is known of their journey as patients. Understanding ED use as a journey can help clinicians improve how they meet the needs of this patient group. Multiple terms were used to identify research on the use of the ED. Papers were included if they had a primary focus on multiple presentations by the general ED population. Integrative review methods were used to extract findings related to the patients' journeys. The findings confirm a sequence of events and processes that provide an outline of the journey through the experience of people who present on multiple occasions. The journey concerns people's decisions to present and re-present to the ED, their assessments on arrival, dilemmas of treatment, outcomes of care and long-term health outcomes. This patient group often have high and complex health needs, engage extensively with other health services and have poor long-term health outcomes. The issue of multiple presentations to the ED is complex and ongoing because of the morbidity of the people concerned, the preference of patients to attend, the purpose of the ED and preparation and role of the personnel and the difficulties with continuity of care. The provision of care for people who present on multiple occasions can be improved within the ED and health services generally through a better understanding of presentations.

Provision of care for people with long-term neurological disorders

Provision of care for people with long-term neurological disorders

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study

Objectives To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care...

Sociology and human rights: what have they got to say about care and dignity?

The focus of this contribution mainly falls on the relevant policy concerning care in the United Kingdom pertaining to older people, people with mental ill health and anyone else in receipt of health and/or social care services. It offers an attempt to consider the impact that sociology could have on improving the ethical practices of care. Attempts to assert rights in residential care have been challenged by a dominant culture that has eroded claims to citizenship. It is argued that this is due to a legal emphasis on regulation through care standards that has limited use because it avoids the realities of care. This contribution argues that a purely legal understanding of human rights is inadequate to address the social realities of inadequate care. The treatment of and provision of care for people living in long-stay institutions requires a human rights framework that operates socially rather than legally to recognise lived experiences in order to empower and emancipate.

J08 The oral health and dental treatment of adults with Huntington's disease

BackgroundThe Royal Hospital for Neuro-Disability (RHN) is the largest provider of care for people with advanced-stage HD in the UK. A dental department within the hospital provides oral health care...

Protocol for a national audit on self-reported confidence levels, training requirements and current practice among trainee doctors in the UK: The Trainees Own Perception of Delivery of Care in Diabetes (TOPDOC) Study

BackgroundAs the incidence and prevalence of diabetes increases across the world, resource pressures require doctors without specialist training to provide care for people with diabetes. In the UK, national standards have been set to ensure quality diabetes care from diagnosis to the management of complications. In a multi-centre pilot study, we have demonstrated a lack of confidence among UK trainee doctors in managing diabetes. Suboptimal confidence was identified in a number of areas, including the management of diabetes emergencies. A national survey would clarify whether the results of our pilot study are representative and reproducible.Methods/DesignTarget cohort: All postgraduate trainee doctors in the UK.Domains Studied: The self reported online survey questionnaire has 5 domains: (1) confidence levels in the diagnosis and management of diabetes, (2) working with diabetes specialists, (3) perceived adequacy of training in diabetes (4) current practice in optimising glycaemic control and (5) perceived barriers to seeking euglycaemia.Assessment tools: Self-reported confidence is assessed using the 'Confidence Rating' (CR) scale for trainee doctors developed by the Royal College of Physicians. This scale has four points - ('not confident' (CR1), 'satisfactory but lacking confidence' (CR2), 'confident in some cases (CR3) and 'fully confident in most cases' (CR4).Frequency of aspects of day-to-day practice is assessed using a six-point scale. Respondents have a choice of 'always' (100%), 'almost always' (80-99%), 'often' (50-79%), 'not very often' (20-49%) and 'rarely' (5-19%) or never (less than 5%).DiscussionIt is anticipated that the results of this national study will clarify confidence levels and current practice among trainee doctors in the provision of care for people with diabetes. The responses will inform efforts to enhance postgraduate training in diabetes, potentially improving the quality of care for people with diabetes.

Awareness in people with severe dementia: Review and integration

Objective: Although awareness has been extensively researched in relation to people with dementia, studies have focussed mainly on people who have dementia of mild to moderate severity. Consequently, relatively little is known about awareness in people with severe dementia, and there is no clear conceptual framework to indicate how this should be understood or investigated. Method: This review presents a conceptual framework for considering awareness in people with moderate to severe dementia which distinguishes fundamental awareness of sensory and perceptual stimuli and three levels of awareness involving more complex cognitive operations, termed ‘on-line monitoring’, ‘evaluative judgement’ and ‘meta-representation’, and provides an integration of the available evidence regarding each level. Results: Findings indicate that sensory and perceptual awareness can be detected even in people with very severe or end-stage dementia, while some aspects of complex awareness may be retained into the severe stages. Conclusions: The environmental context and the nature of caregiving interactions influence the extent to which awareness is expressed. There may be scope for enhancing the expression of some aspects of awareness in people with moderate to severe dementia, but this should only be undertaken where it is likely to improve quality of life. Understanding more about awareness is an important element in the provision of high-quality care for people with moderate to severe dementia.

Sheltered housing and care for older people

Sheltered housing schemes for older people took a new turn in the UK with the community care policy of the early 1990s giving care provision for people living in such schemes. There is relatively little research on what sheltered housing schemes provide and what makes them work well. Data was gathered in relation to sheltered housing provision for older people in the north Antrim area of Northern Ireland through 10 focus groups with tenants and 16 questionnaires administered with managers of schemes. Tenants valued the independence and choice of sheltered housing in comparison with institutional care. They also highly valued the social interaction with other tenants, fostered by activities such as coffee mornings, regular lunches and social events. Tenants often helped each other with transport and when sick. Tenants of schemes in small towns were generally satisfied, because of access to shops, churches and other services. Transport was an issue for many, particularly in more rural areas and in relation to attending hospital appointments. Scheme managers were often available to tenants for long and anti‐social hours. The home care arrangements were generally regarded as satisfactory although there were criticisms of the limited hours for tasks and the skills of some care workers. Some scheme managers thought that the publicly‐funded homecare service would be more efficient if the staff were managed from the housing scheme. Appropriate social activities and effective care arrangements are an important aspect of supported housing, as well as the independence it offers. Consideration needs to be given to access to services in locating new schemes.

Debating issues around death and dying in general settings

Over the last few weeks there has been a stream of letters in UK national newspapers debating different aspects of care associated with people who are dying. In particular, there has been a critique of the Liverpool Care Pathway for the Dying Patient (LCP) documentation (Ellershaw and Wilkinson, 2003), hydration at the end of life and ‘do not attempt resuscitation’ orders. For many in health care, being faced with death and dying is frightening. In the generalist setting, death is not a daily occurrence and, unlike in specialist palliative care, many aspects of management do not appear straightforward. Perhaps what lies behind some of the letters is fear — fear of getting it wrong, fear of hastening death, and fear of taking responsibility for decisions in relation to dying. In the UK, a strong hospice movement exists. Hospices, however, were never meant to be the sole providers of care for people who are dying. The majority of the …

Assessors find checklist for care open to interpretation

IN JULY this year the Department of Health (DH) released an updated version of its 2007 framework for the provision of NHS-funded nursing care for people with continuing health needs (see panel).

Nurses are the key to improving mental health services in low‐ and middle‐income countries

Mental health nursing is a critical issue for most countries. Nurses in low- and middle-income countries are often the primary providers of care for people with mental disorders. Some are highly qualified professionals who train other providers to identify and treat mental disorders. However, in other instances, particularly in low-income countries, nurses have had very little or no mental health training and receive no support from mental health professionals. The lack of sufficient mental health professionals in these countries creates an environment where nurses without training are often the only providers available to care for people with mental disorders. In September 2007 the World Health Organization and the International Council of Nurses produced a report summarizing the responses to some of the questions on a survey of nursing mental health practices in 177 countries and territories. The summary of the open-ended questions (e.g. what are the key issues for nurses providing mental health care in your country?) is reported for the first time in this article. Subsequent to the release of the Nurses in Mental Health Atlas, an online forum was held. There were 615 subscribers to this forum from over 80 countries. This article summarizes the rich insights and recommendations from both the survey's open-ended comments and the online forum. The issues discussed include: the varied and complex roles for nurses in mental health care; nursing education; prescribing practices; nurse recruitment and retention; human rights; research; and technical expertise.

Learning disability and health

Primary care is the main provider of medical care for people with learning disability, write Dr Afia Ali and Dr Ian Hall.

Defying all odds: coping with the challenges of volunteer caregiving for patients with AIDS in South Africa

This paper is a report of a study to explore the challenges experienced by volunteer caregivers of people living with HIV/AIDS and the strategies employed in coping with these challenges. Informal caregiving is associated with stresses that often results in poor health outcomes for caregivers. In South Africa, volunteers play a major role in the provision of care for people living with HIV/AIDS and have been shown to experience burdens as a result of caring. However, little is known about stress and coping among volunteer caregivers. An ethnographic study was conducted, using observation and in-depth interviews, to collect data with 20 volunteers and other stakeholders in two semi-rural communities in South Africa over a 19-month period in 2002/2003. 'Defying all odds' emerged as the central theme that encompassed the various ways in which volunteer caregivers dealt with the many practical challenges confronting them. These challenges initially posed a threat to volunteering work but were gradually appraised by volunteers as challenges that could be dealt with using various strategies in order to continue providing care. Eight themes highlighting these challenges and the coping strategies employed by volunteers were identified. A clear understanding of how volunteers deal with challenges of caring for people living with HIV/AIDS can give insight into their weaknesses and strengths and can inform the design of interventions aimed at providing support. Studies are needed to facilitate better understanding of the processes of appraisal of challenges by volunteers and the effectiveness of coping strategies, and to track coping strategies over time.

Linking the world with training and research for improving haemophilia care

Linking the world with training and research for improving haemophilia care

Multidisciplinary community mental health team staff's experience of a ‘skills level’ training course in cognitive analytic therapy

This study sought to explore community mental health teams' (CMHTs) experiences of receiving an innovative introductory level training in cognitive analytic therapy (CAT). CMHTs are important providers of care for people with mental health problems. Although CMHTs have many strengths, they have been widely criticized for failing to have a shared model underlying practice. Inter-professional training which develops shared therapeutic models from which to plan care delivery is, therefore, essential. We have been developing such a training based on the psychotherapeutic principles of CAT. Twelve community mental health staff (six mental health social workers and six community psychiatric nurses) were interviewed by an independent interviewer following the completion of the training programme. The interviews were analysed using a qualitative thematic analysis. The analysis revealed that the programme increased the participants' self-assessed therapeutic confidence and skill and fostered the development of a shared model within the team, although the training was also perceived as adding to workload. The results of this study suggest that whole-team CAT training may facilitate cohesion and also suggest that having some shared common language is important in enabling and supporting work with 'difficult' and 'complex' clients, for example, those with personality disorders. Further development of such training accompanied by rigorous evaluation should be undertaken.

Dementia is the new cancer

January has seen the announcement of a review of care provision across local authorities in England. When interviewed on BBC breakfast news, Ivan Lewis MP, Parliamentary Under-Secretary of State for the Department of Health, conceded that care provision for people with dementia was essentially a postcode lottery. There have been numerous cases reported recently where care services have been withdrawn from vulnerable, elderly people following a raft of reassessments of their care needs. Mr Lewis highlighted the need for a national framework, and foreshadowed a new strategy for carers which will be launched in the spring, in partnership with the Alzheimer′s Society.

Elderly people with cognitive impairment: costing possible changes in the balance of care

The objective of this paper is to investigate the service needs and support costs of elderly people with cognitive impairment on hospital and community health services, primary health care, social services, and informal carers in England. It examines the resource consequences of major changes in the provision of care, exploring the implications for both cost and effectiveness. The study was designed to provide a secondary analysis of the OPCS disability surveys in order to estimate the balance of care, and current provision of services. It also estimates of costs of present provision and potential policy options. Results show large scale improvements in the provision of care for people living in private households and local authority homes require significant increases in funding, but reductions in the provision of long-stay hospital beds can significantly reduce the cost burden to the public purse. Given the increasing demand pressure on health and social care expenditure, it seems unlikely that large scale improvements in the care supplied to elderly people with cognitive impairment can be achieved without some change in the balance of care. The cost of implementing improvements in care for the 200000 people living in private households and the 45000 people in local authority homes could be offset by reducing the provision of costly long stay hospital provision with alternative institutional care such as NHS nursing homes.