Preparing young people with complex needs and their families for transition to adult services

© RCN Publishing Company Limited 2018Improving survival rates for children and young people with complex health needs requires a robust system for transition to adult services. Effective planning is essential to ensure a smooth transition process that is in the best interests of the young person and their family. This article discusses the needs and requirements for planned and purposeful transition processes to support young people with complex healthcare needs and their families. It considers the preparation of adult services, the team, the young person and their parents in line with an integrated approach and the nurse’s role. Recommendations for practice include the necessity for an integrated approach to ensure optimum outcomes and ascertaining the potential value of a nurse-led service in delivering the transition process. A carefully tailored planning strategy should be developed to prepare and support young people with complex health needs through transition

Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

Abstract   Purpose – One purpose is to update the core data set of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice.   Design/methodology/approach – Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from SAR findings and recommendations is presented.   Findings – Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence-base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change.   Research limitations/implications – There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice.   Practical implications – Answering the question “how to create sustainable change” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.   Originality/value – The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to embed change in policy and practice.     Keywords: Safeguarding adult reviews, change, self-neglect, action plans   Paper type: Research pape

Informal mental health patients: what are they told of their legal rights?

Purpose – This study sought to determine what written information is given to informally admitted patients in England and Wales regarding their legal rights in relation to freedom of movement and treatment. Design/methodology/approach - Information leaflets were obtained by a search of all National Health Service mental health trust websites in England and health boards in Wales and via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings - Of the 61 organisations providing inpatient care, 27 provided written information in the form of a leaflet. Six provided public access to the information leaflets via their website prior to admission. Although the majority of leaflets were accurate the breadth and depth of the information varied considerably. Despite a common legal background there was confusion and inconsistency in the use of the terms informal and voluntary as well as inconsistency regarding freedom of movement, the right to refuse treatment and discharge against medical advice. Research implications - The research has demonstrated: the value of Freedom of Information Act 2000 requests in obtaining data. Further research should explore the effectiveness of informing patients of their rights from their perspective. Practical implications - Work should be undertaken to establish a consensus of good practice in this area. Information should be consistent, accurate and understandable. Originality - This is the only research reporting on the availability and content of written information given to informal patients about their legal rights. Keywords: Informal inpatient, legal rights, Mental Health Act Code of Practice, voluntary patients, written information. Paper type: Researc

Out-of-school lives of physically disabled children and young people in the United Kingdom: A qualitative literature review

Currently there appears to be few opportunities and little evidence of physically disabled children and young people (C&YP) participating in mainstream social activities. A qualitative review was undertaken to examine the factors affecting physically disabled C&YP (8–15 years) in the United Kingdom participating in out-of-school activities. Views and experiences were explored from the perspective of the service users and providers to assess current provision and to determine the need for future research into factors that may affect participation. Searches were conducted across eight databases, the references of the included studies were checked and the websites were searched. Studies that used a qualitative design that examined the views relating to out-of-school activities were included. Nine papers were identified, which included three peer-reviewed papers and six pieces of grey literature and pertinent government documents to include views and experiences of out-of-school activity provision. The main themes emerging from the review were the need for social inclusion, out-of-school activities run by volunteers and accessibility, with threads throughout, which require further research including parental influence, provision, training and attitudes. This review highlights the absence of the service user’s voice and sheds light on the limited provision and barriers affecting participation in out-of-school activities

The chimera of choice in UK food policy 1976-2018

Purpose This paper presents a critical discourse analysis of “choice” as it appears in UK policy documents relating to food and public health. A dominant policy approach to improving public health has been health promotion and health education with the intention to change behaviour and encourage healthier eating. Given the emphasis on evidence-based policy making within the UK, the continued abstraction of choice without definition or explanation provoked us to conduct this analysis, which focuses on 1976 to the present. Design/methodology/approach The technique of discourse analysis was used to analyse selected food policy documents and to trace any shifts in the discourses of choice across policy periods and their implications in terms of governance and the individualisation of responsibility. Findings We identified five dominant repertoires of choice in UK food policy over this period: as personal responsibility, as an instrument of change, as an editing tool, as a problem and freedom of choice. Underpinning these is a continued reliance on the rational actor model, which is consonant with neoliberal governance and its constructions of populations as body of self-governing individuals. The self-regulating, self-governing individual is obliged to choose as a condition of citizenship. Research limitations/implications This analysis highlights the need for a more sophisticated approach to understanding “choice” in the context of public health and food policy in order to improve diet outcomes in the UK and perhaps elsewhere

Business Pandemic Infuenza Planning Checklist

credit is requested.businessChecklist.pdf: 206 downloads, before Oct. 1, 2020

Service user involvement in an undergraduate nursing programme

This article highlights the impacts that service user involvement can have on the education of UK undergraduate student mental health nurses both personally and professionally. It reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach. It reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach embracing two focus groups. The findings from the two focus groups highlight that the service user input (‘expert by experience’) offered a positive learning experience for the students, enabled them to appreciate the meaning of recovery and hope, facilitated the identification as to the importance of their role in terms of connecting meaningfully with those they are supporting plus reconsidering key priorities for practice. They suggest also that there is theory/practice gap reduction as students were able to connect the service user narratives to the evidence base for deeper understanding and application. Although only a brief evaluation of a short theory module within a wider mental health programme including a limited number of students, the findings echo the wider literature and offer further rationale to support direct service user involvement in mental health education across other professions, perhaps interesting at this time as increasingly, learning/teaching programmes implement blended learning with significant online teaching and less face to face facilitation of learning. This article highlights the positive impact not only of service user input into healthcare education but also the benevolent influence skilled narratives can have as a pedagogical approach for learning. Although there is much in the literature as to the benefits for student learning in involving service users within HEI education, there is limited information as to ‘how’ and ‘why’ this is the case, this article seeks to bridge that ga

Every Child Matters outcomes: What Do They Mean for Disabled Children and Young People?

To date, little attention has been paid to the appropriateness of the Every Child Matters (ECM) outcomes framework to disabled children. This article reports findings from a research project which sought the views of disabled children and their parents about their desired outcomes. Twenty-nine children and 90 parents were interviewed. The findings indicate that ECM outcomes are appropriate to disabled children but can have different meanings. In addition, the need to recognise the importance of maintaining outcomes, as well as progress, is highlighted

‘I wouldn't push that further because I don't want to lose her’: a multiperspective qualitative study of behaviour change for long-term conditions in primary care

Background: Health outcomes for long-term conditions (LTCs) can be improved by lifestyle, dietary and condition management-related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective: To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design: Multiperspective, longitudinal qualitative research involving six primary health-care practices in England. Consultations between patients with LTCs and health-care practitioners were audio-recorded. Semi-structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re-interviewed 3 months later. Framework analysis was applied to all data. Participants: Thirty-two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results: Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion: Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health-care organizations

What next for Shared Lives? Family-based support as a potential option for older people

With an ageing population and limited resources the challenge for policy makers and practitioners is how best to provide for the care and support needs of older people. This article draws on findings from two studies, a scoping study of the personalisation of care services and another which aimed to generate evidence about the potential use of family-based support schemes (Shared Lives, SL) for certain groups of older people. Forty-three schemes participated in a survey to gather information about services provided and the extent to which this included older people and their carers, and six staffs were interviewed across two schemes about issues for expanding provision for older people in their local areas. It was evident that SL schemes were already supporting a number of older people and there was support for expansion from both schemes and local authorities. Adequate resources, awareness raising, management commitment, and a pool of suitable carers would be needed to support any expansion effort. There is also still a need for SL to be more widely known and understood by care managers if it is to be considered part of mainstream provision for older people