Raising concerns in healthcare services : the experience of staff and families

This portfolio thesis has three parts. Part one is a systematic literature review in which the existing research literature on the psychological and systemic factors that influence healthcare staff’s decision to whistleblow on poor care is examined and its quality evaluated. Part two is an empirical paper which uses Interpretative Phenomenological Analysis (IPA; Smith, 1996) to explore the experiences of families of people with intellectual disabilities when noticing and reporting concerns in healthcare services. Part three comprises the Appendices, containing supporting information relating to parts one and two and epistemological and reflective statements.Abstract - Systematic literature review:Purpose This systematic literature review aimed to investigate the psychological and systemic variables influencing whistleblowing decisions in healthcare settings. Design/methodology/approach A search of academic databases was undertaken and reference lists of the resulting articles were searched. In total 17 studies using a range of methodologies were analysed using Narrative Synthesis. Methodological quality was assessed. Findings Psychological variables were grouped into beliefs about advocacy and professional roles, fear and diverse responses to wrongdoing. Systemic variables were grouped into relationships with peers, the culture of the organisation and feedback, however there was a complex interplay of factors. Research Implications Further research is needed to examine the efficacy of these interventions and to represent the views of a wider range of healthcare professionals. Originality/value This was a timely review given recent reports on the treatment of whistleblowers in healthcare, indicating interventions to facilitate whistleblowing such as increasing the ease of reporting systems, providing feedback and creating a more compassionate organisational culture.Abstract : empirical paperBackground: This study aimed to increase understanding of the lived experiences of families of people with intellectual disabilities when noticing and raising concerns in services. A qualitative design was employed. Methods: Seven participants were recruited through local and national voluntary agencies; five were mothers of people with intellectual disabilities, one was the aunt and one the sister. Participants took part in semi structured interviews centred on their experiences of noticing and raising concerns, these were recorded and transcribed. The data was analysed using Interpretative Phenomenological Analysis (IPA; Smith, 1996). Results: The data was grouped into three overarching themes: relationships between staff, family and service user, the nature and importance of concerns and the process of raising concerns. Conclusions: This research highlights important implications for services such as the need to simplify the process of raising concerns, attend to the relationship with families and ensure advocacy services are available for those without family

The concept of a “safe harbour” and mandatory human rights due diligence

publishersversionpublishe

Refereeing as a Post-Athletic Career Option

Athletes may be especially primed to become referees, yet we do not know what former athletes think about this career choice. To address the worldwide referee shortage, it is important to better understand athletes’ perceptions of refereeing. From a Career Contingency Model framework, it is evident athletes’ perception would influence their decision to consider refereeing. This study’s aim was to examine athletes’ perceptions of the refereeing environment (RQ1) and identify referee recruitment barriers (RQ2). Utilizing a descriptive phenomenological approach, 23 current and former athletes took part in semi-structured interviews based on their lived experience as an athlete. The participants identified the officiating environment as a High Stress Environment with Financial Instability, while Time and Lack of Knowledge and Support were identified as recruitment barriers. The results contributed to the burgeoning line of research attempting to address the global referee shortage and provide both theoretical and practical implications for sport managers

From ‘due diligence’ to ‘adequate redress’. Towards compulsory human rights and environmental insurance for companies?

This article considers the case for compulsory corporate human rights and environmental insurance. From the perspective of corporate law, changes have taken place within a legal framework that has certain features that have hindered the availability of remedies for victims of associated human rights and environmental harm. This article problematises the issue of redress for corporate human rights violations and environmental degradation within the context of international developments in this field. It considers whether there is a prima facie case for the establishment of a comprehensive compulsory human rights and environmental insurance regime for companies that would require them to operate to a high standard of care in their operations, and which would ultimately provide a more straightforward system of redress for victims

“Physical well-being is our top priority”: Healthcare professionals' challenges in supporting psychosocial well-being in stroke services

Background Following stroke, a sense of well-being is critical for quality of life. However, people living with stroke, and health professionals, suggest well-being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well-being, and to examine how the practice context influences care practice. Methods Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using Applied Tensions Analysis. Results Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well-being, this could be deprioritised amidst the time-oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible. Conclusion Stroke care is shaped by biomedical and organisational imperatives which privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well-being within their work. This has implications for the well-being of people with stroke, and the well-being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well-being work remains other to the ‘core’ work of stroke, and what needs to be considered if stroke services are to better support people’s well-being. Patient or public contributions People with stroke, family members, and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research

HAE international home therapy consensus document

Hereditary angioedema (C1 inhibitor deficiency, HAE) is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility for parenteral treatment results in delays. Home therapy offers the possibility of earlier treatment and better symptom control, enabling patients to live more healthy, productive lives. This paper examines the evidence for patient-controlled home treatment of acute attacks ('self or assisted administration') and suggests a framework for patients and physicians interested in participating in home or self-administration programmes. It represents the opinion of the authors who have a wide range of expert experience in the management of HAE

Internal validation of STRmix™ – A multi laboratory response to PCAST

We report a large compilation of the internal validations of the probabilistic genotyping software STRmix™. Thirty one laboratories contributed data resulting in 2825 mixtures comprising three to six donors and a wide range of multiplex, equipment, mixture proportions and templates. Previously reported trends in the LR were confirmed including less discriminatory LRs occurring both for donors and non-donors at low template (for the donor in question) and at high contributor number. We were unable to isolate an effect of allelic sharing. Any apparent effect appears to be largely confounded with increased contributor number

User Experiences of Development of Dependence on the Synthetic Cannabinoids, 5f-AKB48 and 5F-PB-22, and Subsequent Withdrawal Syndromes

Emergence of synthetic cannabinoids (SCBs) in herbal smoking mixtures is a public health concern. New SCB’s such as 5f-AKB48 and 5F-PB-22 have been detected in French seizures and in sudden death post mortems in the US. The aim was to describe development of dependence on herbal smoking mixtures containing the SCB’s, 5f-AKB48 and 5F-PB-22 and subsequent withdrawal syndromes. Dependent users of herbal smoking mixtures known to contain the SCB’s 5f-AKB48 and 5F-PB-22 with an average Severity of Dependence Score (SDS) of 13 were interviewed using a structured guide (three males/three females). Narratives were analysed using the Empirical Phenomenological Psychological (EPP) five step method. Six themes with 68 categories emerged from the analysis. Themes are illustrated as 1) Networks and Product Availability; 2) Drivers and Motives for Use; 3) Effect and Pathways toward Dependence; 4) Poly Substance Use and Comparisons to Natural Cannabis; 5) Dependence and Withdrawal and 6) Self-detoxification Attempts. Two higher levels of abstraction above these theme-levels emerged from the data, with sole use of herbal smoking mixtures containing 5f-AKB48 and 5F-PB-22 centering on the interplay between intense cravings, compulsive all-consuming seeking, use and re-dose behaviours, and fear of the psychiatric and self-harms caused when in withdrawal. This is the first study describing dependence and withdrawal experiences in users dependent on 5f-AKB48 and 5F-PB-22. Given the potential for adverse psychiatric and physical consequences of dependent use, further development of specific clinical responses and clinical research around toxicity and withdrawal severity are warranted