Social Care Providers Research Articles

Person-centred care in Northern Ireland: learning from the experiences of adult social care users

PurposeThe move towards a “person-centred” or “personalised” system of adult social care has been at the heart of policy debates in Great Britain. However, policy developments in Northern Ireland are more limited than in other parts of the UK, and less attention has been paid to reforming adult social care. The purpose of this paper is to examine the views and experiences of adult social care users who receive care at home, to explore if and how a person-centred approach might work for older adults in Northern Ireland.Design/methodology/approachUsing a qualitative approach, semi-structured interviews were carried out with 12 people aged over 70 years who receive social care provision at home.FindingsThe empirical findings show that social care users experienced limited involvement in their care planning process, reflecting a predominantly service-led approach. The importance of care worker continuity and consistency was crucial for all participants, particularly for maintaining discreet routines and promoting personal dignity. However many experienced different care workers which presented challenges caused by the inconsistency of carers.Research limitations/implicationsThe majority of participants in the study were women, despite attempts to achieve greater gender diversity. It was also difficult to recruit a range of ethnic groups for the study. It would be important for future studies to include these groups and to ensure their voices are represented in further work in this area. Nonetheless, the findings offer valuable insight into the views of adult social care users and can form a useful basis for future studies.Originality/valueThe findings provide a more nuanced understanding of what people want and expect in social care to generate future policy debates and discussions in planning long-term adult social care provision in Northern Ireland. It also provides important and timely contribution to this area, where there is currently limited research and information available.

Comparing patients’ and other stakeholders’ preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries

ObjectivesTo measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries.DesignA discrete...

An ethnography exploring the limits of dedifferentiation in the lives of adults with intellectual disabilities

ABSTRACT Background: Dedifferentiation refers to the trend of positioning people with intellectual disabilities together with other disabled individuals for political purposes, to act as a counter to differentiated approaches. This article explores the influence of dedifferentiation in professional support settings through the lived experiences of people with intellectual disabilities and their staff. Methods: Ethnographic research, including participant observation and interviews, conducted with an intellectual disability social care provider and an independent community café, both based in an area of England. Results: Tensions exist between dedifferentiation aims and the lived experiences of people with intellectual disabilities, who often struggled to achieve in areas including independent community inclusion and paid employment. Conclusion: Dedifferentiation has disadvantages for people with intellectual disabilities. It can underestimate and mask needs that people experience in relation to their disabilities. Policy and professional support might be improved by (1) recognising these limits and (2) incorporating people’s real-world needs into support provision.

Interrogating the Administrative and Institutional framework of Social Security provisioning in Botswana Prospects and Challenges

This paper seeks to explore the administrative and institutional framework of social security provisioning in Botswana. It commences by locating social security within the socio political context. It then considers its cultural dimension. It then proceeds to consider the provision of indirect social services, health care, settlement and housing and then water and sanitation. Finally, it discusses the institutional framework upon which the above are based and prospects and challenges

How to address the mental health of migrant and refugee population in Europe? An integrated shift in health and social care services - MigHealthCare project

Introduction Health and social care services across Europe are facing diverse challenges meeting the specific needs of migrants and refugees [1]. In this regard, vulnerable migrants fall outside mental healthcare services [2]. Based on this, Mig-Healthcare project, funded by the European Commission, explores the health needs of the migrant population in an effort to strengthen EU community-based services. Methods A total of 20 focus groups and 19 individual interviews were conducted between November 2017 and April 2018 with different stakeholders involved in the provision of health and social care to the migrant population in the 10 countries (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). Results First of all, the results highlight that the reception models in the host country such as closed camps were reported as a negative factor for health, especially mental health. Consequently, the restriction of movement, live in ex-barracks, in a status of uncertainty and social deprivation augments the mental vulnerability of immigrants and refugees. In this regard, the feeling of isolation was acted as an important factor influencing the prevalence of mental health problems, and these problems were related to an aggravation of the integration process. Finally, informants reported that the cultural conception of mental health determinates the help-seeking behaviour of migrants and refugees, being one of the main barriers accessing adequate mental health services. Discussion Mental health is regarded as a health priority by all the informants. However, health and social care services in Europe are ill-suited to delivery health care for migrants and refugees, in especially mental health care. As a result of this, most vulnerable migrants and refugees are excluded from these services. Conclusion Mig-Healthcare results highlight the need for tailored mental health care delivery for the migrant population with the aim of achieving increasing their accessibility to these services as well as their psychosocial well-being. Furthermore, policies should take into consideration the impact of the migration reception policies as part of the continuum of care. Lessons learned Migration and integration policies may impact on the mental health of the migrant population and a shift in care models to meet their specific needs may improve mental health outcomes and integration of migrant and refugee population in local European societies. Limitations Differences between national systems in the participant countries appeared. Another limitation is the lack of representability but the large scale of the study gives a big picture of different realities of the European reception of the migrant population, its impact on their mental health as well as their need for better access to mental health services. Bibliography [1] Puchner, K., Karamagioli, E., Pilouli, A., Tsiamis, C., Kalogeropoulos, A., Kakalou, E. et al. Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees. International Journal of Environ. Res. Public Health. 2018, 15(6):1100. [2] Lindert, J., Schouler-Ocak, M., Priebe, S. Mental Health, health care utilisation of migrants in Europe. European Psiquatry. 2008, 23(Suppl. 1): 14-20.

P52 A baseline review of the activity of the PICU pharmacists using electronically captured data

AimTo date there are no metrics for the clinical pharmacist service to PICU. It is accepted that use of a Clinical Information Management System (CIMS) has a role in medication safety,1 however there are few studies that review the information potential of a CIMS for collecting pharmacist activity.2MethodAdditional fields and custom reports were configured in the CIMS to enable PICU pharmacists to record their activity in the following areas:Medicines reconciliation within 72 hours of admission to PICUDischarge kardex reviewAnalgesia and sedation (A&S) reviewClinical pharmacy reviewOther interventions & medication error reporting continued as per normal practice. Data was analysed using Microsoft Excel®.ResultsComplete data was available from July 2017 to end of 2018.There were 1274 medicines reconciliations by a pharmacist within 72 hours of admission (78% admissions). 14% of discharge kardexes had been reviewed prior to discharge to the ward. There was an average of 190 pharmacy reviews per 100 bed days. A total of 780 Pharmacist A&S Plans were documented by the clinical pharmacists – an average of 2 per working day, and 48% of admissions.Comparisons between each six month period showed a significant increase in the number of pharmacists medicines reconciliations (p<0.001). No other differences were found.ConclusionThis study has shown that electronic tracking of pharmacist ward activity is possible. It has the potential to demonstrate compliance with external or internal standards and audits. This data continues to be collected, and therefore these results will be used as a baseline to compare future activity. The findings of this study may encourage other units to replicate, providing data that can be used for comparison. Further configuration of the CIMS to capture other metrics such as TDM, and document discrepancies in medicines reconciliation is planned.ReferencesForni A, Chu H, Fanikos J. Technology Utilization to Prevent Medication Errors. Current Drug Safety. 2010;5:13–18.Nelson S, Poikonen J, Reese T, El Halta D, Weir C. The pharmacist and the EHR. Journal of the American Medical Informatics Association. 2016;24:193–197.Health and Information Quality Authority. Guidance for health and social care providers; Principles of good practice in medication reconciliation. Dublin: HIQA; 2014

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Social work in the face of collapse

This article starts from the position that while generally unacknowledged in the mainstream academic literature, some degree of ecological and societal collapse is inevitable over the next few decades. Hence, social work has a responsibility to steward the future of our profession to support solidarity under what seems likely to be a situation of fracturing state capacity for social care provision in what will likely remain a neoliberally informed global hegemony. The argument is made that the activist ethos of community development will be essential to social work’s moral integrity in the future in resisting becoming an oppressive instrument of state control in a degrading environmental context.

Building Meaningful Community Advocacy for Ethnic‐based Health Equity: The RoAd4Health Experience

The pervasive failure of policies aimed at overcoming health inequities suffered by European Roma reflects the oppressive and impoverished living conditions of many ethnic minorities in the Western world. The multiple social inequities that Roma experience and the cumulative effect on their health prove that the failure of health policies that impact Roma must be attributed to their ameliorative nature. These policies legitimize the mechanisms of oppression that sustain inequities, fueling fatalistic attitudes toward minorities, while these minorities internalize the stigma and attempt to survive on the margins of society. This paper presents the RoAd4Health project, a community initiative in which academic researchers partnered with Roma communities to overcome health inequities. We present the multiple methods utilized for building meaningful advocacy, such as photovoice and asset mapping led by Roma agents of change. These methods provided the capacity to develop a local narrative of disparities, build alliances to gain capacity to respond to injustices, and take actions to promote social change. The results of effectively involving all significant stakeholders (i.e., community agents of change, residents, health and social care providers, Roma community grassroots organizations, and institutional actors) are discussed along with lessons learned.

Editorial

[ ]with “bed blocking” a permanent factor contributing to tight hospital capacity, hospital managers took to the phone and urged social care providers to take patients who should have been discharged from hospital but had not yet due to lack of social care provision in the community Progress made over decades between the sectors proved brittle and collapsed under the weight of a perceived imminent need to increase hospital bed capacity [ ]after spending more than £330 mio on 50 VANGUARD projects in three years, NHS England still have not actually told us whether they consider it a success or not

COVID‐19: Moving beyond the pandemic

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is the cause of COVID-19. As of April 11th, 2020, there were almost 2 million cases of COVID-19 internationally and over 100,000 deaths (John Hopkins University, 2020). There has been significant effort to increase hospital and healthcare capacity to reduce the number of fatalities associated with this global pandemic (Choi & Logsdon 2020).

Addressing embodied inequities in health: how do we enable improvement in women's diet in pregnancy?

To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. All local, comprising twenty-two lower SEP PPP and forty-three HSCP. Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

Changes in the balance between formal and informal care supply in England between 2001 and 2011: evidence from census data.

Informal care plays a crucial role in the social care system in England and is increasingly recognised as a cornerstone of future sustainability of the long-term care (LTC) system. This paper explores the variation in informal care provision over time, and in particular, whether the considerable reduction in publicly-funded formal LTC after 2008 had an impact on the provision of informal care. We used small area data from the 2001 and 2011 English censuses to measure the prevalence and intensity (i.e. the number of hours of informal care provided) of informal care in the population. We controlled for changes in age structure, health, deprivation, income, employment and education. The effects of the change in formal social care provision on informal care were analysed through instrumental variable models to account for the well-known endogeneity. We found that informal care provision had increased over the period, particularly among high-intensity carers (20+ hours per week). We also found that the reduction in publicly-funded formal care provision was associated with significant increases in high-intensity (20+ hours per week) informal care provision, suggesting a substitutive relationship between formal and informal care of that intensity in the English system.

Exploring the role of volunteers in social care for older adults

PurposeThis paper aims to report the findings of a study that explores the contribution volunteers make to social care for older adults, identifying lessons for the social care sector and policymakers.Design/methodology/approachAn exploratory multiple case study design was used to capture the perspectives and experiences of managers of services, volunteer co-ordinators, volunteers, paid care staff and older people. Seven diverse social care organisations took part in the study drawn from three locations in the South West of England.FindingsThis study identified three distinct models of volunteer contribution to social care services for older people. Although the contributions made by volunteers to services are valued, the study drew attention to some of the challenges related to their involvement.Research limitations/implicationsThe organisations taking part in this small-scale study were all based in the South West of England, and the findings are therefore not generalisable but contribute to the growing evidence base related to this important field.Practical implicationsThis study demonstrates the importance of the volunteer co-ordinator role and suggests that it is properly funded and resourced. It also confirms the importance of volunteers receiving appropriate training and support.Originality/valueGiven the increasing involvement of volunteers in the provision of social care, this paper provides lessons to ensure the role of volunteers in social care enhances rather than diminishes the quality of care provided.

Simulation in mental health interprofessional education

Purpose: Mental health care involves multiple professionals from diverse backgrounds providing interdependent and complex services. Accordingly, care needs to be planned skillfully in partnership with health and social care providers and mental health service users. Working from an interprofessional lens enables professionals to work collaboratively to affect care that is safe and improves health outcomes. Yet, in practice there is often a disconnect between mental health care professionals that hinders collaborative practice and impacts the quality of care. Furthermore, stigmatization of mental illness continues to pervade health care professionals’ attitudes which serves to further compromise health outcomes. Interprofessional education (IPE) using simulation is proposed as an effective teaching and learning method to improve collaborative practice and decrease stigma amongst mental health care professionals in undergraduate education. Approach: Undergraduate nursing and pharmacy students from two universities participated in a one-day IPE event. During the event, students collaboratively interviewed standardized patients portraying mental health service users and developed an interprofessional plan of care. Faculty perspectives of the event were gathered to identify challenges and recommendations for ongoing implementation. Findings: Current literature and faculty facilitator feedback supports IPE using simulation as an effective teaching and learning strategy to develop therapeutic communication skills, address stigma amongst students prior to practice, clarify professional roles, and improve interprofessional collaboration. Faculty facilitator recommendations to improve the implementation of IPE with healthcare professionals during undergraduate education include early introduction of IPE, adequate preparation for students, realistic case scenarios, facilitator and standardized patient training, and funding to support events. Conclusion: The use of standardized patients in the context of interprofessional mental health education is a strategy with the potential to improve collaborative practice and address mental illness stigma amongst health care professionals. Further research with students is needed to evaluate the effectiveness of simulation in mental health IPE.

MEDICAL-SOCIAL AND ECONOMIC ISSUES IN TREATMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME

Introduction. Аt the present stage of treatment of patients with diabetic foot syndrome can not yet be considered satisfactory, which requires further study of this problem in order to improve the provision of medical and social care to the above patients. Aim. Тo study medical, social and economic issues of providing medical care to patients with diabetic foot syndrome based on the analysis of their treatment in the Ternopil region. Matherials and Methods. The study is based on a retrospective analysis of the treatment of 1963 patients with diabetes mellitus complicated by diabetic foot syndrome during 2000–2017. Neuropathic-infected form of foot lesion was diagnosed in 692 (35.2 %) patients, ischemic-gangrenous - in 604 (30.8 %), mixed – in 667 (34 %) patients. According to the degree of lesion (according to Megitt - Wagner), the distribution of patients was as follows: II – 247 (12.6 %) patients, III – 995 (50.7 %), IV – 584 (29.7 %), V – 137 7 %) of patients. Patients with acute purulent-necrotic lesions and chronic wound defects of the lower extremities underwent surgery of various volumes: surgical debridement, small or high amputation. Results. The analysis of the obtained results allowed to note a number of social, medical and economic problems, the solution of which will significantly improve the results of treatment and in particular reduce the number of amputations in patients with diabetic foot syndrome. As the analysis shows, typical mistakes in the treatment of patients can be divided into three main groups: organizational, diagnostic and tactical. Organizational mistake lies in the fact that today in Ukraine there is no single system providing skilled care to patients with diabetic foot syndrome. The most common diagnostic mistakes include incorrect and insufficiently qualified diagnostics of clinical forms of diabetic foot syndrome and the depths of the spread of purulent-necrotic lesions of the tissues of the foot. The above mistakes significantly affected the timing and results of treatment, worsening the results of the latter. Conclusions. Based on the analysis of treatment of 1963 patients with various pathogenetic forms of the diabetic foot syndrome, a number of medical, economic and social issues have been identified that require their solution. The most typical mistakes and shortcomings in the treatment of these patients were analyzed. A program was proposed to improve the quality of specialized medical care for patients with diabetic foot syndrome.

Recordkeeping and the life‐long memory and identity needs of care‐experienced children and young people

AbstractIn family settings stories, photographs and memory objects support narratives of identity and belonging. Such resources are often missing for people who were in care as children. As a result, they may be unable to fill gaps in their memories or answer simple questions about their early lives. In these circumstances, they turn to the records created about them by social workers and care providers to reconstruct personal histories. Research suggests that thousands of requests to view records for this purpose are made each year in England under the subject access provisions of data protection legislation. This article reports the findings of MIRRA, a participatory research project on the memory and identity dimensions of social care recordkeeping. Drawing on data collected during interviews and focus groups with adult care leavers, the study explores the motives and experiences of care‐experienced people who access their records in England. Findings show the practical and cultural challenges they face when doing so and the resulting impacts on well‐being. The study suggests that the development of person‐centred approaches to recordkeeping in social work, which focus on the perspectives and experiences of the individual, could better support the lifelong memory and identity needs of care‐experienced people.

Comment] The challenges of planetary mental health in the COVID-19 era.

As the focus of the COVID-19 crisis is gradually taken away from emergency healthcare needs, increased attention is warranted on the psychological impact of the pandemic on a global level. Existing guidance on managing the COVID-19 related distress needs to be better informed by upcoming larger-scale research. Applying e-Health can be useful in dealing with the immediate psychological needs, while developing strategies to identify vulnerable populations and shifting the provision of mental health and social care to community services need to be prioritised when looking at the future. Focusing on global mental health during this universal crisis is an opportunity for promoting a more compassionate and less discriminating society.

Care navigators decision-making in prescribing Telecare for older people.

This aim of this study was to explore the decision-making process of Care Navigators in prescribing Telecare for older people living at home. The study took place in the South of England. A structured model of decision-making was used as the theoretical framework and a qualitative approach was employed. Care Navigators (n=7), acting on behalf of the Local Authority as 'external trusted assessors' were interviewed according to a semi-structured interview schedule. Documentary evidence of decision-making (Telecare Reasoning Forms) (n=10), were also analysed and added to the interview data. The main themes identified were the process of decision-making, training needs, and the support of Care Navigators and partnership working. Care Navigators adopted a complex decision-making process involving information gathering, information synthesis, consideration of alternatives to Telecare and implementation. Decision-making has a strong ethical dimension, especially around funding. Training focused on the functioning and technical aspects of equipment. However, other training needs were identified in order to support decision-making, for example, assessing mental capacity. Peer support networks were valuable to Care Navigators and they developed good relationships with social care and Telecare provider staff. However, professionals making referrals to the Care Navigators for Telecare often did not understand their role or funding eligibility. In conclusion, Care Navigators are well-placed to prescribe Telecare in terms of knowledge and decision-making skills. Comprehensive training is necessary in order to support decision-making. Peer support and education of professionals referring for Telecare is also advocated.

Greenspace interventions for mental health in clinical and non-clinical populations: What works, for whom, and in what circumstances?

With growing strain on mental health services, greenspace interventions could be a promising addition to current health and social care provisions as they have the potential to be widely accessible for people within their own communities and used alongside a variety of treatment plans. Despite promising progress in greenspace research, the underlying mechanisms and processes of greenspace interventions are still unclear. Without knowing these it is impossible to understand why programmes work and how best to replicate them. To address this gap this review uses realist methodology to synthesise the international evidence for greenspace interventions for mental health in both clinical and non-clinical populations. Forty-nine full text articles are included in the review and the underlying contexts, mechanisms, and outcomes of the interventions identified and refined into an original overriding theory under three themes of Nature, Individual Self, and Social Self. The interaction of these three factors represents a new conceptual framework for greenspace interventions for mental health and shows what works, for whom, and in what circumstances. The findings of this review are not only theoretically novel but they also have practical relevance for those designing such interventions including the provision of recommendations on how to optimise, tailor and implement existing interventions.