Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

Purpose – One purpose is to update the core dataset of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to draw together the learning available from this dataset of reviews to propose a model of good practice that can be used as the basis for subsequent safeguarding adult reviews. Design/methodology/approach – Further published reviews are added to the core dataset from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been done from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further safeguarding adult reviews where self-neglect is in focus. Findings – Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where safeguarding adult reviews are commissioned.   Research limitations/implications – The national database of reviews commissioned by SABs is incomplete and does not contain many of the safeguarding adult reviews reported in this evolving dataset. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this dataset is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice. Practical implications – Answering the question “why” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on safeguarding adult reviews featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process. 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 proposes a new approach to safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.   Keywords: Safeguarding adult reviews, evidence, self-neglect, proportionality Paper type: Research pape

‘Real world’ effectiveness of the Falls Management Exercise (FaME) programme: an implementation study

BackgroundFalls incidence increases with age alongside declines in strength and balance. Clinical trials show that the Falls Management Exercise (FaME) programme improves strength and balance, which can reduce falls and improve physical functioning.ObjectiveTo determine if the clinical trial efficacy of FaME translates into effectiveness in non-research settings.Design and settingAn implementation study of FaME in 10 local authorities across the East Midlands region of England.SubjectsAdults aged 65 and over enrolled on a FaME programme.MethodAnonymised outcome data collected by the FaME providers were compared at baseline, end of programme and 6 months follow-up using univariate and multivariate analyses.ResultsFor 348 adults enrolled in programmes and analysed, the mean age was 76.8, 73% were female and 143 (41%) completed ≥75% of classes. Overall confidence in balance, fear of falling, functional reach and timed-up-and-go (all

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

Preliminary Characterisation of NP339, a Novel Polyarginine Peptide with Broad Antifungal Activity

FUNDING SOURCE The study was funded by NovaBiotics with support from The UK Governments’ Department of Health and Social Care, delivered by Innovate UK. Shane Smith and Carol Munro’s contribution to the project was funded by a Scottish Universities Life Sciences Alliance Bioskape grant award.Peer reviewedPublisher PD

Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England

The Independent Review into Gender Pay Gaps in Medicine in England was commissioned by the Department of Health and Social Care in 2017. It is the largest and most comprehensive review of its kind ever completed in the public sector. Chaired by Professor Dame Jane Dacre and led by Professor Carol Woodhams, the review takes a comprehensive approach to understanding the structural and cultural barriers affecting the female medical workforce

Surgical interventions for women with stress urinary incontinence : systematic review and network meta-analysis of randomised controlled trials

Funding: This project was funded by the NIHR HTA programme (project No 15/09/06). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care, UK. The funders were not actively involved in the research process at any stage. The study design; collection, analysis, and interpretation of data; writing of the manuscript; and decision to submit it for publication were performed independent of the funders.Peer reviewedPublisher PD

Enhancing deprescribing : a qualitative understanding of the complexities of pharmacist-led deprescribing in care homes

Funding statement This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme (project reference NIHR202053). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Acknowledgements Thank you to the pharmacists, GP practice and care home staff who took part in the interviews. We would also like to acknowledge the Norfolk and Waveney Clinical Commissioning Group as the study sponsor and our patient and public involvement colleagues Janet Gray and Christine Hanford who were supported by Jacqueline Romero, manager of PPIRes.Peer reviewedPublisher PD

Joining the dots: Day to day challenges for practitioners in delivering integrated dementia care

Despite the increasing policy focus on integrated dementia care in the UK, little is known about the opportunities and challenges encountered by practitioners charged with implementing these policies on the ground. We undertook an extensive, mixed‐methods analysis of how a contemporary multidisciplinary dementia pathway in the UK was experienced and negotiated by service providers. Our pragmatic mixed methods design incorporated three types of research interaction with practitioners: (a) Semi‐structured interviews (n = 31) and focus group discussions (n = 4), (b) Practitioner ‘shadowing’ observations (n = 19), and (c) Service attendance and performance metrics reviews (n = 8). Through an abductive analysis of practitioner narratives and practice observations, we evidenced how inter‐practitioner prejudices, restrictive and competitive commissioning frameworks, barriers to effective data sharing and other resource constraints, all challenged integrative dementia care and led to unintended consequences such as practice overlap and failure to identify and respond to people's needs. In order to more successfully realise integrated dementia pathways, we propose innovative commissioning frameworks which purposefully seek to diffuse power imbalances, encourage inter‐provider respect and understanding, and determine clear lines of responsibility

Implementing person-centred key performance indicators to strengthen leadership in community nursing: a feasibility study

From Crossref via Jisc Publications RouterBrendan McCormack - ORCID 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Replaced AM with VoR 2020-09-04Aims To explore the utility and feasibility of implementing eight person‐centred nursing key performance indicators in supporting community nurses to lead the development of person‐centred practice.Background Policy advocates person‐centred healthcare, but few quality indicators exist that explicitly focus on evaluating person‐centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive.Methods An evaluation approach derived from work of the Medical Research Council was used and the study was underpinned by the Person‐Centred Practice Framework. Participatory methods were used, consistent with person‐centred research.Results Data were thematically analysed, revealing five themes: giving voice to experience, talking the language of person‐centredness, leading for cultural change, proud to be a nurse and facilitating engagement.Conclusions The findings suggest that implementing the 8 person‐centred nursing KPIs and the measurement framework is feasible and offers a means of evidencing person‐centredness in community nursing.Implications for Nursing Management Person‐centred KPI data, used alongside existing quality indicators will enable nurse managers to evidence a high standard of care delivery and assist in the development of person‐centred practice.28pubpub