Electronically Assisting Communication for Health Professionals

New information and computing technologies offer cost efficient and effective learning opportunities for health care professionals. The Assisted Electronic Communication project is prototyping, administering and evaluating a digital discourse system for health care professionals within an acute Hospital. Health care staff participating in the study are able to access and contribute to threaded, asynchronous discussions and themed information in the context of critical work documents. Early indications are that the system is viewed very positively, and seen as a way of critically engaging with new material that is getting closer to an idealized learning in the workplace

Alternatives to the medical model of childbirth : a qualitative study of user-centred maternity care.

This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users

HBSC England National Report: Health Behaviour in School-aged Children (HBSC) : World Health Organization Collaborative Cross National Study

Findings from the 2014 HBSC study for Englan

The conceptualization of school and teacher connectedness in adolescent research: A scoping review of literature

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.The aim of this scoping review was to map and summarize research relating to school and teacher connectedness, in order to increase current understanding of the ways these terms have been conceptualized in adolescent research. Specifically, this scoping review focuses on the analysis of the actual definitions used and the ways in which school connectedness and teacher connectedness are operationalized in existing measures. Using the terms connectedness, teacher and school as keywords, we searched SCOPUS, Web of Science, ERIC, the Cochrane Library and the EPPI Centre Database of Education Research for relevant peer-review articles published in English from 1990 to 2016. 350 papers were selected for the review. Many studies failed to provide a definition of school or teacher connectedness and there were some differences in the way these constructs were operationalized in the main measures. Future research should be thorough in the definition of these constructs, and ensure consistency between the definition used and the operationalization of the connectedness construct in the selected measure. Unpacking the global concept of school connectedness and examining the role of its different components (global feelings towards school, teacher connectedness, relationships with classmates, etc.) separately may also contribute to building a more coherent body of evidence in this area. Reflecting on the place of school and teacher connectedness in the broader context of the literature on school climate and bridging distances between the research on school connectedness and that on related constructs is another necessary step to move this field forward.Peer reviewedFinal Published versio

In labor or in limbo? : The experiences of women undergoing induction of labor in hospital: findings of a qualitative study

This is the peer reviewed version of the following article: Annabel Jay, Hilary Thomas, and Fiona Brooks, ‘In labor or in limbo? The experiences of women undergoing induction in labor in hospital: Findings of a qualitative study’, Birth: Issues in Perinatal Care, September 2017. Under embargo. Embargo end date: 17 September 2018. This article has been published in final form at DOI: 10.1111/birt.12310. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Background: Induction of labor currently accounts for around 25% of all births in high-resource countries, yet despite much research into medical aspects, little is known about how women experience this process. This study aimed to explore in depth the induction experience of primiparous women. Methods: A qualitative study was undertaken, using a sample of 21 first-time mothers from a maternity unit in the south of England. Semi-structured interviews were conducted in women's homes between 3 and 6 weeks postnatally. Data were recorded, transcribed, and analyzed thematically. Results: Women awaiting induction on the prenatal ward appeared to occupy a liminal state between pregnancy and labor. Differences were noted between women's and midwives’ notions of what constituted “being in labor” and the ward lacked the flexibility to provide individualized care for women in early labor. Unexpected delays in the induction process were common and were a source of anxiety, as was separation from partners at night. Women were not always clear about their plan of care, which added to their anxiety. Conclusions: Conceptualizing induction as a liminal state may enhance understanding of women's feelings and promote a more woman-centered approach to care. Thorough preparation for induction, including an explanation of possible delays is fundamental to enabling women to form realistic expectations. Care providers need to consider whether women undergoing induction are receiving adequate support, analgesia, and comfort aids conducive to the promotion of physiological labor and the reduction of anxiety.Peer reviewedFinal Accepted Versio

The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, a particular contribution to the management of chronic diseases. In the context of this study, there is a particular focus on the origins of each CDM model examined, the processes by which nursing care is developed, sustained and mainstreamed, and the outcomes of each case study as experienced by service users and carers. Aims To explore, identify and characterise the origins, processes and outcomes of effective CDM models and the nursing contribution to such models using a whole systems approach Methods The study was divided into three phases: Phase 1: Systematic mapping of published and web-based literature. Phase 2: A consensus conference of nurses working within CDM. Sampling criteria were derived from the conference and selected nurses attended a follow up workshop where case study sites were identified. Phase 3: Multiple case study evaluation Sample: 7 case studies representing 4 CDM models. These were: i) public health nursing model; ii) primary care nursing model; iii) condition specific nurse specialist model; iv) community matron model. Methods: Evaluative case study design with the unit of analysis the CDM model (Yin, 2003): • semi-structured interviews with practitioners, patients, their carers, managers and commissioners • documentary analysis • psycho-social and clinical outcome data from specific conditions • children and young people: focus groups, age-specific survey tools. Benchmarking outcomes: Adults benchmarked against the Health Outcomes Data Repository (HODaR) dataset (Currie et al, 2005). Young people were benchmarked against the Health Behaviour of School aged Children Survey (Currie et al, 2008). Cost analysis: Due to limitations in the available data, a simple costing exercise was undertaken to ascertain the per patient cost of the nurse contribution to CDM in each of the models, and to explore patterns of health and social care utilisation. Analysis: A whole system methodology was used to establish the principles of CDM. i) The causal system is a “network of causal relationships” and focuses on long term trends and processes. ii) The data system recognises that for many important areas there is very little data. Where a particular explanatory factor is important but precise data are lacking, a range of methods should be employed to illuminate each factor as much as possible. iii) The organisational whole system emphasises how various parts of the health and social care system function together as a single system rather than as parallel systems. iv) The patient experience recognises that the whole system comes together and is embodied in the experience of each patient. Key findings While all the models strove to be patient centred in their implementation, all were linked at a causal level to disease centric principles of care which dominated the patient experience. Public Health Model • The users (both parents and children) experienced a well organised and coordinated service that is crossing health and education sectors. • The lead school nurse has provided a vision for asthma management in school-aged children. This has led to the implementation of the school asthma strategy, and the ensuing impacts including growing awareness, prevention of hospital admissions, confidence in schools about asthma management and healthier children. Primary Care Model • GP practices are providing planned and routine management of chronic disease, tending to focus on single diseases treated in isolation. Care is geared to the needs of the uncomplicated stable patient. • More complex cases tend to be escalated to secondary care where they may remain even after the patient has stabilised. • Patients with multiple diagnoses continue to experience difficulty in accessing services or practice that is designed to provide a coherent response to the idiosyncratic range of diseases with which they present. This is as true for secondary care as for primary care. • While the QOF system has clearly been instrumental in developing and sustaining a primary care nursing model of CDM, it has also limited the scope of the model to single diseases recordable on a register, rather than focus on patient centred care needs. Nurse Specialist Model • The model works under a disease focused system underpinned by evidence based medicine exemplified by NICE guidelines and NSF’s. • The model follows a template drawn from medicine and sustainability is significantly dependent on the championship and protectionism offered by senior medical clinicians. • A focus on self-management in LTCs gives particular impetus to nurse-led enablement of self-management. • The shift of LTC services from secondary care to primary care has often not been accompanied by a shift in expertise. Community Matron Model • The community matron model was distinctive in that it had been implemented as a top down initiative. • The model has been championed by the community matrons themselves, and the pressure to deliver observable results such as hospital admission reductions has been significant. • This model was the only one that consistently resulted in open access (albeit not 24 hours) and first point of contact for patients for the management of their ongoing condition. Survey Findings Compared to patients from our case studies those within HODaR visited the GP, practice nurse or NHS walk-in centres more, but had less home visits from nurses or social services within the six weeks prior to survey. HODaR patients also took significantly more time off work and away from normal activities, and needed more care from friends/ relatives than patients from our study within the last six weeks. The differences between the HODaR and case study patients in service use cannot easily be explained but it could be speculated when referring to the qualitative data that the case study patients are benefiting from nurse-led care. Cost analysis – The nurse costs per patient are at least ten times higher for community matrons conducting CDM than for nurses working in other CDM models. The pattern of service utilisation is consistent with the focus of the community matron role to provide intensive input to vulnerable patients. Conclusions Nurses are spearheading the kind of approaches at the heart of current health policies (Department of Health, 2008a). However, tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of CDM models and limiting the contribution nurses are able to make to CDM. These include: ? data systems that were incompatible and recorded patients as a disease entity ? QOF reinforced a disease centric approach ? practice based commissioning was resulting in increasing difficulties in cross health sector working in some sites ? the value of the public health model may not be captured in evaluation tools which focus on the individual patient experience. Recommendations Commissioners and providers 1. Disseminate new roles and innovations and articulate how the role or service fits and enhances existing provision. 2. Promote the role of the nurses in LTC management to patients and the wider community. 3. Actively engage with service users in shaping LTC services to meet patients’ needs. 4. Improve the support and supervision for nurses working within new roles. 5. Develop training and skills of nurses working in the community to enable them to take a more central role in LTC management. 6. Develop organisations that are enabling of innovation and actively seek funding for initiatives that provide an environment where nurses can reach their potential in improving LTC services. 7. Work towards data systems that are compatible between sectors and groups of professionals. Explore ways of enabling patients to access data and information systems for test results and latest information. 8. Promote horizontal as well as vertical integration of LTC services. Practitioners 1. Increase awareness of patient identified needs through active engagement with the service user. 2. Work to develop appropriate measures of nursing outcomes in LTC management including not only bureaucratic and physiological outcomes, but patient-identified outcomes. Implications of research findings 1. Investment should be made into changing patient perceptions about the traditional division of labour, the nurses’ role and skills, and the expertise available in primary care for CDM. 2. Development and evaluation of patient accessible websites where patients can access a range of information, their latest test results and ways of interpreting these. 3. Long-term funding of prospective evaluations to enable identification of CDM outcomes. 4. Mapping of patient experience and patient satisfaction so that the conceptual differences between these two related ideas can be demonstrated. 5. Development of appropriate measures of patient experience that can be used as part of the quality outcome measures. 6. Cost evaluation/effectiveness studies carried out over time that includes national quality outcome indicators and valid measures of patient experience. 7. The importance of whole system working needs to be identified in the planning of services. 8. Research into the role of the health visitor in chronic disease management within a public health model

Written evidence submitted by HBSC England study team, Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire (BYC033)

The 2017 Youth Select Committee conducted an inquiry into body image, inviting submissions from individuals and organisations. The HBSC England study team from the Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire submitted evidence based on analysis of data from the HBSC study.Final Published versio